OCT-Angiography Findings in Children with Anisometropic Amblyopia.

PURPOSE: The purpose of this prospective study is to show findings of OCT angiography in children with anisometropic amblyopia with a statistically significant difference, regardless of the type of refractive disorder, between the amblyopic and the fellow eye. This research aimed to establish whether there is a difference in vascular density [VD] and size of the foveal avascular zone [FAZ] in the superficial capillary plexus [SCP]. METHODS: All children between 9 and 18 years of age who were treated at the Outpatient Clinic for Orthoptics and Pleoptics of the Department of Ophthalmology, University Medical Centre Maribor from January 2020 to December 2022 due to unilateral anisometric amblyopia were enrolled in our study. Fourteen children met the criteria. Cirrus 5000 high-resolution OCT with AngioPlex OCT angiography was used to analyze the size of the FAZ and VD in the SCP and TCS. The paired t-test or Wilcox signed-rank test [p < 0.05] was used for statistical analysis of each parameter between the amblyopic and fellow eye. RESULTS: Mean child age was 13 years ± 2.9 and ranged from 9 to 18 years. Most of the children [85.7%] were boys. The VD of the SCP did not show statistically significant differences between the visually impaired and control eyes [p = 0.328]. The comparison of the FAZ area between the two eyes was also not statistically significant [p < 0.808]. There was also no statistically significant difference in central macular thickness [TCS] [p < 0.291]. CONCLUSIONS: Our research results show no statistically significant differences in the VD and the FAZ of the SCP, and in the TCS between the amblyopic and fellow eye in children with unilateral anisometropic amblyopia. Our research did not confirm the results of certain previous studies in which a lower density of the capillary network was present in the visually impaired eye. Further studies with more children are necessary to confirm our results.

Comparison of the Ocular Trauma Score and Pediatric Ocular Trauma Score as Two Prognostic Models in Pediatric Open Globe Injuries. / Vergleich des Ocular Trauma Score mit dem Pediatric Ocular Trauma Score als 2 prognostische Modelle zur Behandlung von offenen Augenverletzungen bei Kindern.

AIM: To compare the ocular trauma score (OTS) and the pediatric ocular trauma score (POTS) as prognostic models of visual outcome after open globe injury in children during a period of 19 years. PATIENTS AND METHODS: A retrospective study of 36 open globe injuries in 36 patients younger than 18 years was conducted from January 2000 to January 2019. For each case, OTS and POTS points were calculated. RESULTS: Significant differences were observed in our patients using the two models regarding categories 1 to 4. One third of the cases were in categories 1 and 2 using the OTS model, and nearly 60% using the POTS model. Nearly 60% of our patients were in categories 3 and 4 using the OTS model and 30.6% using the POTS model. In category 5, no difference was observed between the two models. The comparison of distribution of the percentage of final visual acuity between OTS and POTS model in each category revealed a significant difference in category 1 in final visual acuity 20/40 or more (25 vs. 50%) as well as in final visual acuity 20/20 (0 vs. 30%). In category 2, final visual acuity was not significantly different in 20/40 or more between the two models; however, there was a significant difference in final visual acuity 20/20 - 12.5% in the OTS model and 45.5% in the POTS model. In category 3, significant differences were revealed between the two models. Using the OTS model, final visual acuity 20/40 or more was observed in more than 60% and using POTS model in 100%; final visual acuity 20/20 was observed in 36.3% using OTS model and in 50% using POTS model. In category 4 and 5, no differences were observed between OTS and POTS models. CONCLUSION: Our study did not confirm the benefit of POTS. The distribution of our cases among OTS categories demonstrated a significant difference between the two models with more cases distributed in lower categories in POTS group. In the POTS group, the prognosis for final visual acuity was significantly better in the first three categories than in the OTS group, probably as a result of a lower calculation for POTS points. In our opinion, the OTS model is easier to use, has a higher prognostic accuracy, and should be further used in counselling of paediatric cases.

[Cataract Surgery in Very Old Patients]. / Kataraktoperation bei Menschen im hohen Alter.

BACKGROUND: In recent years, there has been an increase in the number of very old patients requiring a cataract operation. However, there is little information on the intraoperative complications and safety in these patients. For various reasons, operations on patients from age 85 may be demanding: dense nuclear cataract, narrow pupils, low count of endothelial cells, loose zonula, and other ocular or systemic diseases. The aim of this retrospective study was to compare very old to younger cataract patients with respect to intraoperative complications and the maturity of the cataract. PATIENTS AND METHODS: This was a retrospective study on 4065 cataract patients treated in our department with IOL implantation with the corneal small incision technique between January 2015 and January 2018. The patients were split by age (from 85 and under 85). RESULTS: Of the 4065 cataract operations, 10.6% (431/4065) were performed on patients aged at least 85, 1.7% (69/4065) on patients aged at least 90 and 0.1% (4/4065) on patients of at least 95 years. There were statistically significant differences between the younger and older patients with respect to pupil dilatation (4.6 vs. 6.0%), use of the capsule tension ring (0.4 vs. 0%) and in capsule staining (5.5 vs. 7.0%). There were no intraoperative complications (e.g. anterior capsule laceration) in patients aged at least 85 and in 0.71% of patients aged under 85; loss of vitreous fluid was recorded in none of the patients in the older group and in 0.41% of patients in the younger group. CONCLUSION: Our study confirms that advanced age alone is not a contraindication for a cataract operation and is not associated with a greater rate of intraoperative complications. Cataract operations on very old patients are generally successful, but should be undertaken early - particularly on multimorbid patients or those with dementia - in order to support the psychological status. The age of the patient is irrelevant.

[Spectral Domain Optical Coherence Tomographic Findings in Systemic Lupus erythematosus in Patients Treated with Chloroquine]. / Ergebnisse spektraler optischer Kohärenztomografie bei den mit Chloroquin behandelten Patienten mit systemischem Lupus erythematodes.

PURPOSE: To recognise possible retinal changes in patients with SLE treated with chloroquine phosphate, as depending on the duration of treatment. METHODS: The study included 41 patients (82 eyes) who received treatment for SLE with chloroquine or hydroxychloroquine phosphate and had not previously been diagnosed with retinal pathology. Participants were divided into two groups according to the duration of treatment. The first group included 18 patients (36 eyes) treated for up to five years and the second group consisted of 23 patients (46 eyes) treated from five to twenty years. We performed a thorough eye exam, including best-corrected visual acuity, colour vision, visual field examination, dilated fundus examination, autofluorescence imaging, color fundus photography and spectral domain optical coherence tomography. RESULTS: Mean duration of treatment in the first group was 2.79 ± 1.37 years, and in the second group 8.67 ± 2.26 years. The difference in central retinal thickness between the two groups was not statistically significant (p > 0.05). Comparison of parafoveal thickness between the two groups was statistically non-significant in all quadrants (p > 0.05). Visual field examination, autofluorescence images and colour fundus photographs were without noteworthy pathology. CONCLUSION: Our results indicate that there were no significant changes in retinal structure between groups that depended on the duration of treatment. Hence, we can conclude that a yearly follow-up of these patients is sufficient to discover possible preclinical maculopathy.

[Development of Non-Arteritic Anterior Ischaemic Optic Neuropathy in the Initially Unaffected Fellow Eye in Patients Treated with Systemic Corticosteroids]. / Entwicklung einer nicht arteriitischen anterioren ischämischen Optikusneuropathie am ursprünglich gesunden Partnerauge bei den mit systemischen Kortikoidenbehandelten Patienten.

Background The objective of this prospective pilot study was to evaluate the results of systemic corticosteroid therapy in patient with non-arteritic anterior ischaemic neuropathy of the optical nerve (NAION) for an observation period of one year and to measure the NAION incidence in the initially healthy contralateral eye of these patients. Patients and Methods All patients diagnosed with acute NAION who were admitted to our ward during 2014 and who fulfilled all inclusion criteria for systemic corticosteroid therapy were included in the study. The inclusion criteria were corrected visual acuity of 0.3 or less and duration of illness of less than 2 weeks. All patients were examined by a rheumatologist and given a complete ophthalmological examination, including fluorescein angiography and examination of the visual field. Only 3 of the 23 patients fulfilled our inclusion criteria for corticoid treatment and were then treated. 10 patients served as controls. The treatment plan started with an initial dose of 80 mg prednisolone during the first two weeks. The dose was then tapered over 3 to 4 months. Results The mean best corrected visual acuity on admission was 0.12 and 0.35 after one year. The mean duration of treatment was 3.3 months. Treatment was discontinued after 5 to 6 months or 8 to 9 months after the initial examination. All patients then developed NAION on the contralateral eye. The mean visual acuity on the contralateral eye was 0.73. After 4 month follow-up, the visual acuity in two patients had decreased to 1.0 and in one patient was reduced from 0.8 to 0.4. No steroid treatment was initiated for the contralateral eye. No NAION was found in the contralateral eye in the control group. Conclusion Corticosteroid treatment improved vision in all patients with NAION in comparison with the untreated contralateral eye. In a single patient, visual acuity decreased in the contralateral eye. Our study confirmed that corticosteroid treatment may be a predisposing factor for the development of NAION am in the contralateral eye. Additional studies with more patients are needed to confirm our results.

Psychometric testing of the Slovenian Person-centred Climate Questionnaire - staff version.

AIM: To test the psychometric properties of the Slovenian version of the Person-centred Climate Questionnaire - staff version. BACKGROUND: Person-centredness can be a quality care indicator, but there are no valid and reliable instruments in the Slovene language aimed at exploring the person-centred care climate from a nursing staff perspective. METHODS: Content validity based on expert agreement was evaluated by calculating content validity indices. A cross-sectional survey design using a convenience sample of 790 nurses and nursing assistants from medical and surgical wards in 11 hospitals was used to test the construct validity and internal consistency reliability. RESULTS: The average content validity index for the scale was 0.97, all items had content validity indices higher than 0.78, showing satisfactory content validity. Three components, climate of safety, community and everydayness explained 71.22% of the variance in the data and thus confirmed scale dimensionality. Cronbach's α was acceptable for whole scale (0.90) and for subscales (0.89, 0.89 and 0.86). CONCLUSION: The Slovene version of the Person-centred Climate Questionnaire - staff version is valid and reliable and can be further used in surgical and medical wards in hospital settings. IMPLICATION FOR NURSING MANAGEMENT: The instrument enables further exploration of the relationships between perceived person-centredness and organisational outcomes.

Content validity, face validity and internal consistency of the Slovene version of Caring Factor Survey for care providers, caring for co-workers and caring of managers.

BACKGROUND: Caring relationships are important for developing a caring culture. It is important that care provider's relationships with patients, co-workers and managers are caring relationships. However, in the Slovene language, there is a lack of psychometrically sound instruments to measure these caring relationships. AIM: To explore the psychometric properties of the Slovenian version of the Caring Factor Survey (CFS) for care providers, the care given by co-workers and managers as judged by the providers, by evaluating its content validity, face validity and internal consistency. METHODS: In the process of our instrument, we used translation and back translation and validation based on experts' agreement. Content validity was quantified by the content validity index (CVI) and a modified Cohen's kappa index. Face validity was evaluated by ten nurses who reviewed the instruments. In the process of psychometric testing based on survey data, we used a cross-sectional research design with a convenience sample of 91 caregivers working in internal or surgical wards in two health care institutions. Cronbach's alpha and corrected item-total correlations were used to test internal consistency. RESULTS: All items in all three versions of the CFS had a CVI score higher than 0.78 and excellent modified Cohen's kappa index, showing excellent content validity. The average content validity indices were 0.990, 0.975 and 0.963. The face validity was good with no major remarks given. Cronbach's alpha was 0.941, 0.962 and 0.970. The item-total correlations reached a criterion of 0.2 < r < 0.3 for all items. CONCLUSION: All three versions of the CFS showed an acceptable content validity, face validity and internal consistency; however, due to some methodological shortcomings, results should be interpreted with caution. Further psychometric testing is needed.

Single-cell analysis reveals IGF-1 potentiation of inhibition of the TGF-ß/Smad pathway of fibrosis in human keratocytes in vitro.

Corneal wound healing is often affected by TGF-ß-mediated fibrosis and scar formation. Guided fibrosis with IGF-1 and antifibrotic substances might maintain corneal transparency. Primary human corneal keratocytes under serum-free conditions were used as a model of corneal stromal wounding, with markers of corneal fibrosis and opacity studied under TGF-ß2 stimulation. Single-cell imaging flow cytometry was used to determine nuclearization of Smad3, and intracellular fluorescence intensity of Smad7 and the corneal crystallin aldehyde dehydrogenase 3A1. Extracellular matrix proteoglycans keratocan and biglycan were quantified using ELISAs. On the TGF-ß2 background, the keratocytes were treated with IGF-1, and suberoylanilidehydroxamic acid (SAHA) or halofuginone ± IGF-1. IGF-1 alone decreased Smad3 nuclearization and increased aldehyde dehydrogenase 3A1 expression, with favorable extracellular matrix proteoglycan composition. SAHA induced higher Smad7 levels and inhibited translocation of Smad3 to the nucleus, also when combined with IGF-1. Immunofluorescence showed that myofibroblast transdifferentiation is attenuated and appearance of fibroblasts is favored by IGF-1 alone and in combination with the antifibrotic substances. The TGF-ß/Smad pathway of fibrosis and opacity was inhibited by IGF-1, and further with SAHA in particular, and with halofuginone. IGF-1 is thus a valid aid to antifibrotic treatment, with potential for effective and transparent corneal wound healing.

Prognostic factors of choroidal melanoma in Slovenia, 1986-2008.

INTRODUCTION: Choroidal melanoma is the most common primary malignancy of the eye, which frequently metastasizes. The Cancer Registry of Slovenia reported the incidence of choroid melanoma from 1983 to 2009 as stable, at 7.8 cases/million for men and 7.4/million for women. The aim of the retrospective study was to determinate the prognostic factors of survival for choroidal melanoma patients in Slovenia. PATIENTS AND METHODS: From January 1986 to December 2008 we treated 288 patients with malignant choroidal melanoma; 127 patients were treated by brachytherapy with beta rays emitting ruthenium-106 applicators; 161 patients were treated by enucleation. RESULTS: Patients with tumours thickness < 7.2 mm and base diameter < 16 mm were treated by brachytherapy and had 5- and 10-year overall mortality 13% and 32%, respectively. In enucleated patients, 5- and 10-year mortality was higher, 46% and 69%, respectively, because their tumours were larger. Thirty patients treated by brachytherapy developed local recurrence. Twenty five of 127 patients treated by brachytherapy and 86 of 161 enucleated patients developed distant metastases. Patients of age ≥ 60 years had significantly lower survival in both treatment modalities. For patients treated by brachytherapy the diameter of the tumour base and treatment time were independent prognostic factors for overall survival, for patients treated by enucleation age and histological type of tumour were independent prognosticators. In first few years after either of treatments, the melanoma specific annual mortality rate increased, especially in older patients, and then slowly decreased. CONCLUSIONS: It seems that particularly younger patients with early tumours can be cured, whereby preference should be given to eyesight preserving brachytherapy over enucleation.

Influence of cataract surgery on macular thickness: a 6-month follow-up.

PURPOSE: To determine long-term changes in macular thickness after cataract surgery. METHODS: Research work included 27 patients (27 eyes) who underwent uneventful cataract surgery with phacoemulsification and IOL implantation on one eye. Optical coherence tomography was used to obtain data of macular thickness before surgery and for patients who attended scheduled control measurement 1 month (22 patients), 3 months (23 patients), and 6 months (20 patients) after the surgery. RESULTS: The greatest increase in average macular thickness was seen 1 month after cataract surgery, statistically significant in all areas except in fovea and superior quarter of macula. Statistically significant decrease in macular thickness was noticed 3 and 6 months after the surgery. Comparison of macular thickness 6 months after cataract surgery and values before surgery showed no statistically significant difference. CONCLUSION: Findings confirmed the reversibility of macular thickness changes 6 months after cataract surgery and its return to preoperative values.

Corneal thickness in patients with age-related macular degeneration.

This observational study was designed to compare corneal thickness in patients with age-related macular degeneration (AMD) with the thickness in healthy control subjects to determine if there is a correlation between corneal thickness and the development of AMD. A total of 69 patients (119 eyes) with AMD and 31 healthy subjects (56 eyes) were evaluated. Corneal thickness was measured with a Galilei Dual Scheimpflug Analyser and retinal thickness was measured using optical coherence tomography. There was no significant difference in mean corneal thickness or mean retinal thickness between the AMD and control groups and no correlation between corneal and retinal thickness in either group. The results confirmed that corneal thickness is not associated with the development of AMD and cannot be used during diagnosis.

Phacoemulsification in isolated endogenous Candida albicans anterior uveitis with lens abscess in an intravenous methadone user.

We report the clinical course of a 31-year-old former intravenous drug user on methadone substitution therapy who injected methadone mixed with orange juice. She developed isolated metastatic Candida albicans anterior uveitis, which was treated with adequate systemic and local antifungal therapy. The uveitis regressed, but despite adequate local and systemic treatment, a lens abscess developed. Phacoemulsification and endocapsular intraocular lens implantation were performed, and the patient recovered 20/20 visual acuity in the affected eye. In patients with a history of injection drug use, persisting intravenous drug or substitution therapy abuse must be considered. Quick diagnosis and adequate treatment can prevent the development of widespread C albicans endophthalmitis, which has a poor visual prognosis. Early administration of antifungal and surgical therapy is crucial for achieving good functional results.

[Posterior capsule opacification after phacoemulsification in patients with rheumatoid arthritis]. / Posteriore Kapselopazifikation nach Phakoemulsifikation bei Patienten mit rheumatoider Arthritis.

PURPOSE: To assess the posterior capsule opacification (PCO) rate after phacoemulsification with polyacrylic intraocular lens (IOL) implantation in patients with rheumatoid arthritis (RA) compared with the controls, and to assess whether preoperative activity of RA is associated with a higher incidence of PCO. METHODS: 24 eyes of 20 RA patients operated in a period of 4 years were included in our study. A control group of 20 eyes from 20 health subjects were also included in our study. All procedures were performed by a single surgeon with the same surgical technique and postoperative medication. RESULTS: One year postoperatively in two eyes (8.3%) of RA-patients lens epithelial cells (LEC) migration of grade 1 was observed, in controls also in two eyes (10%). No correlation was observed between age, duration of RA or preoperative activity of RA and the PCO rate. CONCLUSION: Following acrylic IOL implantation, the PCO rate one year after surgery was 8.3% in RA patients and 10% in controls. RA patients present no higher risk for PCO development than controls.

Bilateral optic neuritis in a child following Epstein-Barr virus infection.

A rare case of bilateral optic neuritis is presented in a child with no light perception. Ophthalmic examination revealed dilated pupils without reaction to the light, swollen optic discs with small peripapillary hemorrhages in both eyes. Serology revealed evidence of recent Epstein-Barr virus infection. After treatment with high dose of corticosteroid visual acuity gradually improved. After four months visual acuity was normal despite complete pallor of the optic disc. Ebstein-Barr virus infection should be considered in the differential diagnosis of bilateral optic neuritis in a child with severe bilateral visual loss.

Intraocular pressure after phacoemulsification with posterior chamber lens implantation in open-angle glaucoma.

BACKGROUND: To evaluate changes in intraocular pressure (IOP) after phacoemulsification (Phaco) with posterior chamber lens (PC IOL) implantation in eyes with primary open-angle glaucoma (POAG) at least 2 years after surgery. PATIENTS AND METHODS: 19 eyes of 13 POAG patients who underwent uneventful clear cornea Phaco with PC IOL implantation and with follow-up of at least 2 years after surgery were included in this retrospective study. None of them had previous intraocular surgery or argon laser trabeculoplasty. RESULTS: The average preoperative IOP was 16.9 +/- 2.02 mm Hg. The average follow-up of was 36 +/- 11.8 months. 1 week after surgery a significant decrease in average IOP was observed (13.8 +/- 3.0 mm Hg; P = 0.000). 1 and 4 months after surgery IOP was still significantly lower than preoperatively. 8 months after surgery IOP significantly increased to 15.9 mm Hg (+/- 2.9 mm Hg; P = 0.022) with respect to 1 week postoperatively, but then again significantly decreased to 15.5 mm Hg (+/- 2.6 mm Hg; P = 0.020) 1 year after surgery and stayed approximately the same at 2 and 3 years after surgery. After 4 years the average IOP was 15.0 mm Hg (+/- 3.1 mm Hg; P = 0.216), that was statistically insignificant because of the small number of patients. In 79% (15 eyes) of our cases medical antiglaucoma treatment was unchanged, in 21% (4 eyes) the therapy was reduced. CONCLUSIONS: Uneventful Phaco with PC IOL implantation in good medically controlled POAG eyes was associated with a statistically significant long-term decrease in IOP, allowing the reduction of postoperative antiglaucoma medications in more than 20% of the eyes.

[Efficacy of selective laser trabeculoplasty in the treatment of primary open-angle glaucoma]. / Wirksamkeit der selektiven Lasertrabekuloplastik bei der Behandlung von primärem Offenwinkelglaukom.

BACKGROUND: Our aim was to investigate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study. PATIENTS AND METHODS: In 36 eyes of 36 patients suffering from uncontrolled POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and one day, one week, one month and 3, 6, 12, 18, 24, 30, 36, 42 and 48 months after. A failure was defined as an IOP reduction of less than 20% from pretreatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged. RESULTS: The mean follow-up time was 34 months (SD 12.9). The mean pretreatment IOP was 22.9 mm Hg (SD 2.1). At one month of follow-up, the mean IOP reduction was 5.3 mm Hg (SD 2.1) or 23.1% and at 6 months 5.6 mm Hg (SD 2.6) or 24.5%. At 12 months of follow-up, the mean IOP reduction was 5.6 mm Hg (SD 2.3) or 24.5% and at 24 months 6.2 mm Hg (SD 2.5) or 27%. At 36 months of follow-up, the mean IOP reduction was 6.4 mm Hg (SD 2.1) or 27.4% and at the end of 48 months of follow-up, the mean IOP reduction was 5.9 mm Hg (SD 2.0) or 25.4%. The success rate after 12 months determined from the Kaplan-Meier survival analysis was 97%, after 24 months 88%, after 36 months 76% and after 48 months 71%. CONCLUSION: SLT is an effective procedure for the treatment of POAG.

[Reduction of retinal light sensitivity in diabetic patients]. / Reduktion der Lichtunterschiedsempfindlichkeit der Netzhaut bei Diabetikern.

BACKGROUND: Visual field loss in diabetic patients has received comparatively little attention. The aim of the present study was firstly to assess the influence of type 2 diabetes mellitus on retinal light sensitivity in diabetic patients without signs of diabetic retinopathy (DR) and secondly to assess the association between visual field loss and the severity of nonproliferative DR. PATIENTS AND METHODS: 151 eyes of 151 diabetic patients with type 2 diabetes mellitus and 30 eyes of 30 healthy volunteers were included in our study. Visual acuity was 0.7 or better with correction. DR staging was based on a modified Airlie-House classification. The eyes were divided into four groups: no DR, mild NPDR, moderate NPDR and severe NPDR. Ophthalmic examination was normal in all diabetic patients, except for DR. All participants underwent visual field testing with the C 30-2 program of the Humphrey field analyser. RESULTS: Retinal light sensitivity was significantly reduced before clinically detectable DR with MD (mean deviation) p values less than 10% in 14.3% (8 of 56 eyes). Patients with mild NPDR had a significant reduction of retinal sensitivity in 21.1% (8 of 38 eyes), with moderate NPDR in 45.8% (11 of 24 eyes) and with severe NPDR in 63.6% (21 of 33 eyes). PSD (pattern standard deviation) p values less than 10% were observed in 7.1% (4 of 56 eyes) in patients without DR, with mild DR in 31.6% (12 of 38 eyes), with moderate in 50% (12 of 24 eyes) and in patients with severe DR in 60.1% (20 of 33 eyes). Using the analytical STATPAC program of the Humphrey Field Analyzer, the reduction of retinal sensitivity was significant between controls and diabetic patients without DR and between individual groups of diabetic patients. CONCLUSIONS: The severity of visual field loss was greater in advanced stages of DR. In diabetic patients with severe DR, a significant reduction of retinal light sensitivity was observed in more than 60%. In diabetic patients without DR, despite no evident capillary closure on fluorescein angiography--similar as in the control group, where retinal sensitivity was normal in all cases--a significant reduction of retinal sensitivity was found in more than 14.3%.