Comparative study of antibacterial and antifungal effects of rigid gas permeable contact lens disinfecting solutions.

The aim of this study was to compare antimicrobial efficacy of rigid contact lens disinfecting solutions. We tested five commercially available solutions: Unique pH (Alcon Laboratories), Boston Advance (Polymer Technology Corp.), Nitilens Conditioner GP (Avizor), Total Care (AMO), Boston Simplus (Bausch&Lomb). Their efficacy to disinfect saline solution experimentally contaminated with American Type Culture Collection (ATCC): Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Candida albicans (ATCC 90028) and Staphylococcus epidermidis (isolated from our laboratory) was tested. All tested solutions reduced concentrations of bacteria and fungi below 1000 CFU/mL (Colony forming unit; reduction by 3 log and 1 log, respectively) after the 8 hours period. Overall, all contact lens care solutions showed good disinfecting activity against tested bacteria and fungi, with more variation in their antifungal than in antibacterial efficacy. Results of our study might be valuable when selecting appropriate solutions for non-compliant contact lens wearers.

Testing of the retinal visual acuity in high myopia with cataracts.

In the presence of the media opacities and extreme ametropia, especially in high myopia, often arises a question of expected visual acuity, e.g. after cataract extraction because of the possible degenerative changes of the choroid and retina. In the measurements were enrolled 15 patients between 45 and 60 years of age, 9 female and 6 male. We have tested preoperative retinal visual acuity by the interferometer. One month postoperatively visual acuity was measured by Snellen international charts at a distance of 6 m. Both measurements are calculated using log MAR scale. Measurements were paired and the differences are calculated and analyzed for the significance. No significance was found (p > 0.05). It was concluded that measured differences were incidental and interferometer measurements are reliable in predicting post cataract visual acuity in high myopia

Lens replacement habits in soft contact lens wearers.

The aim of this paper was to assess soft contact lens replacement habits of patients of Contact Lens Clinic, Zagreb University Hospital Department of Ophthalmology, Zagreb, Croatia. During spring of 2010, a survey was conducted in Contact Lens Laboratory, Zagreb University Hospital Department of Ophthalmology, Zagreb, Croatia. 47 completed surveys were collected and analyzed. The results of the survey have shown that the majority of soft contact lens wearers wear them longer than recommended by the manufacturer. It also showed that they eventually replace the lenses in regular intervals, indicating that they base their lens replacement on constant criteria. The main reasons for the eventual lens replacement were increased blur or discomfort while wearing lenses. Since it is obviously impossible to convince all lens wearers to replace their lenses as recommended by the manufacturer, it is up to the contact lens practitioners to find the way to reduce the risks of lens overwear. It may be achieved by introducing a method that will enable each soft contact lens wearer to choose an optimal lens replacement regimen without risking their eye health.

Comparison between refractometer and retinoscopy in determining refractive errors in children--false doubt.

Early detection of a refractive error and its correction are extremely important for the prevention of amblyopia (poor vision). The golden standard in the detection of refractive errors is retinoscopy--a method where the pupils are dilated in order to exclude accomodation. This results in a more accurate measurement of a refractive error. Automatic computer refractometer is also in use. The study included 30 patients, 15 boys, 15 girls aged 4-16. The first examination was conducted with refractometer on narrow pupils. Retinoscopy, followed by another examination with refractometer was performed on pupils dilated with mydriatic drops administered 3 times. The results obtained with three methods were compared. They indicate that in narrow pupils the autorefractometer revealed an increased diopter value in nearsightedness (myopia), the minus overcorrection, whereas findings obtained with retinoscopy and autorefractometer in mydriasis cycloplegia, were much more accurate. The results were statistically processed, which confirmed the differences between obtained measurements. These findings are consistent with the results of studies conducted by other authors. Automatic refractometry on narrow pupils has proven to be a method for detection of refractive errors in children. However, the exact value of the refractive error is obtained only in mydriasis--with retinoscopy or an automatic refractometer on dilated pupils.

[Comparison of local acetylcysteine and artificial tears in the management of dry eye syndrome]. / Usporedba djelovanja lokalno apliciranog acetilcisteina i umjetnih suza u lijecenju suhog oka.

Dry eye syndrome is a common clinical entity causing difficulties to many people, especially the elderly. Standard substitution therapy with artificial tears may frequently prove inadequate, thus any new treatment modality is highly welcome. The syndrome implies lacrimal hyperosmolality, which in turn results in mucus accumulation in the conjunctival sac causing additional irritation. Locally applied acetylcysteine, a mucolytic, regulates mucus secretion and reduces mucus accumulation. The aim of the study was to compare the efficacy of artificial tear therapy and therapy with local acetylcysteine. The study included 32 patients with the symptoms and signs of dry eye attending our department between March 20 and May 9, 2003. All study patients were on long-term substitution therapy with artificial tears. Upon evaluation of subjective discomforts and objective signs, the patients were switched from artificial tear therapy (Isopto-Tears, Alcon, with polyvinyl alcohol as active ingredient) to therapy with locally applied acetylcysteine (Brunac, Bruschettini). All parameters were re-evaluated at 2-week control visit. Thirty of 32 patients (94%) completed the study with control visit. Of these, 18 (60%) patients reported reduction of subjective discomforts, ten (33%) patients observed no change, and two (7%) patients experienced more discomforts with acetylcysteine than with artificial tear therapy. On objective sign evaluation, 12 (40%) patients showed less discomforts, unchanged condition was recorded in 13 (43%) patients, and five (17%) patients had more discomforts as compared with artificial tear therapy. A statistically significant difference (p=0.05) between artificial tear therapy and acetylcysteine therapy was found for the subjective symptom score but not for the objective sign score. Therapy with acetylcysteine proved more efficient than artificial tears in reducing subjective symptoms but had no effect on the objective signs of dry eye syndrome. The advantages of acetylcysteine include more convenient instillation timing (4 times daily) and reduced nocturnal discomfort, whereas shortcomings are the sense of burning on instillation, bad odor, and as yet relatively high price on the Croatian market.

Internal quality audit and quality standards as a method of quality improvement at the Department of Ophthalmology, University Hospital.

Quality assessment of clinical health care with the programme of quality standard is a method of health management, through which better efficiency and safety of health outcomes can be achieved. In the period from 2002 to 2004, a pilot program of quality has been carried out on the Department of Ophthalmology, University Hospital Center in Zagreb. Seven internal audit teams of hospital commission and teams of hospital departments were evaluating introducing practice for quality standards every three months. In the period of two years improvement in all standards of quality has been noticed (expressed in percent of progress towards the ideal result of 100%): personnel 20%, patient rights 15%, medical equipment 40%, quality of emergency service 60%, implementation of clinical guidelines and criteria for elective admission 55%, quality of risk prevention 70%, quality of medical records 60%. The two-years-improvement dynamics of about 46%, first year 24%.

Target intraocular pressure in the management of glaucoma.

Achievement of target intraocular pressure is the goal of every efficient antiglaucoma therapy. Target intraocular pressure is the level of intraocular pressure which is associated with minimal likelihood of visual field or optic nerve lesion, or an existing lesion progression due to elevated intraocular pressure. Results of large clinical studies which have offered some new concepts on target intraocular pressure in the management of glaucoma are reviewed. An association between the curve of intraocular pressure decrease and glaucoma progression was demonstrated in these studies. Generally, a lower value of target intraocular pressure implies better protection from the loss of vision and visual field impairment in glaucoma patients. In advanced glaucoma, the greatest possible reduction from the initial intraocular pressure should be attempted. A 20% reduction from the initial intraocular pressure or decrease to < 18 mmHg in advanced glaucoma has been recognized as a favorable strategy to reach target intraocular pressure. In normal tension glaucoma, a lower value of target intraocular pressure is associated with a slower disease progression. In patients with initial glaucoma, 25% reduction from the initial intraocular pressure will slow down the disease progression by 45%. The value of target intraocular pressure depends on the pretreatment level of intraocular pressure, optic nerve condition, glaucoma disease state, rate of glaucoma progression, patient's age, and other risk factors for the development of glaucoma.

[Intraocular pressure values following vitrectomy with silicone oil tamponade]. / Razina ocnog tlaka nakon vitrektomije sa silikonskom tamponadom.

Secondary glaucoma is a relatively common complication after pars plana vitrectomy and silicone oil injection for repair of complex retinal detachment. The aim of this study was to evaluate the influence of silicone oil tamponade on intraocular pressure elevation and to identify the mechanism of this elevation. The study included 45 eyes of 45 patients who had undergone pars plana vitrectomy and silicone oil tamponade for repair of complex retinal detachment. Ophthalmic examination was performed before vitrectomy, and one and six months after vitrectomy. The increase in intraocular pressure was measured one month postoperatively in 37.77% of patients. The mechanism of intraocular pressure increase was silicone oil emulsification in 52.98%, closure of Ando's iridectomy in 23.54%, and idiopathic angle closure glaucoma in 23.54% of patients with elevated intraocular pressure. After silicone oil removal, elevated intraocular pressure persisted in 7 (15.55%) patients; in 5 patients it was controlled medically, while two patients underwent glaucoma surgery. Six months postoperatively 3 patients developed secondary neovascular glaucoma due to the prolipherative ischemic disease. Elevation of intraocular pressure following vitrectomy with silicone oil tamponade had a temporary effect, as it did not lead to permament intraocular pressure elevation but regressed after silicone oil removal from the eye.

A contribution to the surgery of the trachomatous entropion and trichiasis.

Although the WHO document WHO/PBL/93.29 recommends the bilamellar tarsal rotation operation for trachomatous entropion, we will describe another operation that has proved to be very reliable. It is a combined method, consisting of the modified tarsal wedge resection and the eversion splinting-grey line incision. A possible additional correction of the grey line incision on the first postoperative day improves the results. A total of 708 eyes with moderate trachomatous entropion and major trichiasis underwent this surgery, but only 508 of these were followed up during a 6-month period. The rate of failed operations, which consisted of incomplete closure of the lids or more than two inverted lashes remaining, was 6.9%.

Advanced glycation endproducts in human diabetic and non-diabetic cataractous lenses.

BACKGROUND: Advanced glycation endproduct (AGE) formation is thought to contribute to aging and cataract formation in the lens. In this study, we evaluated AGE immunoreactivity in human diabetic (n=14) and nondiabetic (n=31) cataractous lenses in relation to high-molecular-weight (HMW) protein content, which is believed to contribute to the onset of cataract. METHODS: AGE immunoreactivity was detected in alkali-soluble individual lens samples. Competitive ELISA with polyclonal anti-AGE antibody was performed to estimate AGEs. SDS-PAGE was used to detect changes in lens protein composition on the basis of molecular size. RESULTS: Regression analysis of data from nondiabetic lenses showed a significant correlation between lens AGE content and patient age (r=0.665, P<0.001). The curve exhibited exponential regression ( y=0.272.e(0.025x)). The level of nonspecified AGEs measured in diabetic lenses showed an overall increase compared with nondiabetic lenses (4.03+/-1.85 vs 1.78+/-0.71 AU/mg protein, P<0.0078). SDS-PAGE showed the occurrence of HMW proteins in both diabetic and nondiabetic lens samples. However, in diabetic patients, who had a higher level of AGEs, a significantly higher proportion of HMW proteins was also observed. The levels of AGE and percent of HMW aggregates showed a very significant correlation ( r=0.68, P<0.007) in the diabetic group, whereas in nondiabetics the correlation, although positive, did not reach statistical significance. CONCLUSION: The AGE distribution, with a higher proportion in the samples of lenses rich in HMW aggregates, corroborates the hypothesis that the advanced glycation process might have a role in degenerative changes in eye lens, which in diabetic patients occur vigorously and much earlier than in those without diabetes.