Refractive errors in children: analysis among preschool and school children in Tuzla city, Bosnia and Herzegovina.

Aim To establish the prevalence of refractive errors in preschool and school children between 4 and 15 years of age, living in Tuzla, Bosnia and Herzegovina. Methods Children from all elementary schools in the city of Tuzla and as well from eight day-care centres were screened for refractive errors in the period 2015-2019. Any child, who failed to pass the screening examination, was referred to an ophthalmologist for complete ophthalmological evaluation. The obtained data were analysed using non-parametric statistics. Results The highest number of children who were tested after the screening process was during 2015. A total of 7415 children (3790 males and 3625 females), in the age range of 4-15 were screened. In the total sample of children who were completely evaluated (n=145; 290 eyes) the most common refractive error was astigmatism, in 152 (52.4%) eyes. In the preschool children (n=18; 36 eyes), the most common refractive error was astigmatism, in 19 (52.8%) eyes, followed by hyperopia, in 9 (25%) eyes. In the school children (n=127) (254 eyes), the most common refractive error was astigmatism, in 133 (52.4%) eyes, followed by myopia, in 92 (36.2%) eyes. The overall prevalence of refractive errors was 1.95% (145 with refractive error out of 7415 screened). Conclusion Prevalence of refractive errors is high enough to justify a school eye screening programme.

Simultaneous Penetrating Keratoplasty, Cataract Removal and Intraocular Lens Implantation in Tuzla, Bosnia and Herzegovina.

INTRODUCTION: It is known that simultaneous penetrating keratoplasty, cataract removal and intraocular lens implantation are always a big challenge to a surgeon, especially in developing countries such as Bosnia and Herzegovina. In these cases there is always a higher rate of different kind of intraoperative complications. Phacoemulsification after penetrating keratoplasty especially in older people may cause significant endothelial injury and also could affect long term graft survival. AIM: The aim of this report is to describe one of these challenging cases and the possible ways to manage them in developing countries. CASE REPORT: In this paper we report a case of a 46 year-old female patient, with a cataract on her right eye with a central corneal leukoma. She reported that when she was 6 years old, she had an eye injury with corn leaf. At the age of 10 year she reported that she had another injury of the same eye with a glass. She reported that she wasn't seeing quite good after that. Three years ago she had a transplantation of amniotic membrane due ulcer on the same eye. She reported also that even after this procedure she wasn't seeing quite good. Now she was admitted to hospital for a triple surgical procedure. At that moment patient has been ophthalmological examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found central corneal leukoma, occlusion of pupil and complicated cataract. Before surgery her Uncorrected distance visual acuity (UDVA) on her left eye was light perception. A combined procedure of penetrating keratoplasty (PKP), open-sky cataract extraction, and intraocular lens (IOL) implantation was planned. Thirty days after surgery her visual acuity was 0,5 without correction. It is concluded that cataract surgery in patients after keratoplasty is more complicated. CONCLUSION: Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.

Congenital Bilateral Anophthalmia: a Case Report and Review of Literature.

INTRODUCTION: Anophthalmia is congenital absence of the eyes; it may be unilateral or bilateral. Though rare, it occurs worldwide. It usually occurs in association with other systemic malformations. CASE REPORT: Therefore, the case of a female child delivered in University Clinic Center Tuzla is presented here with bilateral anophthalmia. The diagnosis was confirmed with an ocular computer tomography (CT) scan that showed under development of both globes within the orbit with a conclusion of bilateral anophthalmia. No other anomalies were found. CONCLUSION: This is unique case in the territory of Bosnia and Herzegovina, as according to the literature this is the first case of anophthalmia presented in this region. Currently two years ago she is followed both in ophthalmic and pediatric clinic at University Clinical Center in Tuzla.

Amblyopia in Children: Analysis Among Preschool and School Children in the City of Tuzla, Bosnia and Herzegovina.

AIM: This study measured the prevalence of amblyopia in preschool and school children between 4 and 15 years of age in Tuzla, Bosnia and Herzegovina and as well and to examine its relations with anisometropia and strabismus. METHODS: Children from eight daycare centers and twenty four elementary schools were screened for amblyopia by volunteer personnel (medical students), any child who failed to pass the screening examination, was referred to the ophthalmologist for complete examination at University Clinic Center Tuzla. The examination included VA, stereopsis, cover testing, refractive retinoscopy, and examination of the red reflex and posterior pole. RESULTS: Total of 7415 children, which included 3790 males and 3625 females, in the age range of 3 to 15 years from 24 schools and 8 preschool were screened. Fifty night children (1.9%) were diagnosed with amblyopia, unilateral in 28 and bilateral in 31. CONCLUSION: Prevalence of significant refractive errors is high enough to justify a school eye screening program solely for this purpose. preschool and school screening program in children in critical period of development of amblyopia must be conducted to find out the ametropias and amblyopia in time; and treat them earlier.

Phacoemulsification After Penetrating Keratoplasty Due War Injury at Young Adult.

INTRODUCTION: It is known that phacoemulsification of cataracts after penetrating keratoplasty there are always some difficulties and of course a higher rate of different intraoperative complications. Phacoemulsification after PK may cause significant endothelial injury and affect long term graft survival. AIM: The aim of this report is to describe one of these cases and the possible ways to manage them. CASE REPORT: We report a case o of a 31-year-old female patient, with a cataract on her left eye. She reported that when she was 10 years old, she was admitted to regional hospital in Bosnia and Herzegovina due perforative corneal war injury. At the age of 11 years at Germany on her left eye corneal transplantation was performed. She reported that she wasn't ever seeing quite good, due high myopia. Twenty years after war injury she was admitted to hospital. At that moment patient has been ophthalmologicaly examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found occlusion of pupil and complicated cataract. Her only wish was to get operated due cosmetic reasons. Before surgery her visual acuity on her left eye was light perception. Thirty days after surgery her visual acuity was 0,1 without correction. CONCLUSION: It is concluded that cataract surgery in patients after keratoplasty is more complicated. Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.

EPIDEMIOLOGICAL ANALYSIS OF OCULAR MELANOMA IN UNIVERSITY CLINIC CENTER IN TUZLA, BOSNIA AND HERZEGOVINA.

AIM: Melanoma represents a malignant tumour arising from melanocytes. Uveal melanoma is the most common primary ocular malignancy among the adult population. The aim of the study was to examine epidemiological characteristics of ocular melanoma in University Clinic Centre in Tuzla, Bosnia and Herzegovina from January 2001 till November 2015. METHODS AND MATERIALS: In this retrospective study we used all available medical documentation to investigate the clinical findings which included age, gender, tumour size, histopathological features and the precise anatomic origin of the ocular melanoma. RESULTS: Over the 14 year period of this study, there were 32 patients with microscopically confirmed ocular melanoma at the Department of Pathology. All malignant melanoma were uveal origin. DISCUSSION AND CONCLUSION: For early detection of the disease, regular checkups are necessary, especially in older population. As there is a limited number of reports on the epidemiology of malignant tumors of eye and ocular adnex in our region, this is very important study. We conclude that this is a first study in Bosnia and Herzegovina that document the number of uveal melanomas.

Is Prevention of Glaucoma Possible in Bosnia and Herzegovina?

INTRODUCTION: Glaucoma is the second leading cause of blindness in the world and represents a significant social and health problem. Early detection of glaucoma enables early initiation of treatment and may delay disease progression. The aim of this work is to determine whether it is possible to detect glaucoma in early stages. METHODS: A public awareness campaign was carried out in University Clinic Center (UCC) in Tuzla, Bosnia and Herzegovina (B&H) during 2012, 2013, 2014 and 2015 Glaucoma Week, with one-day, free of charge screening of individuals. This screening program was composed of getting brief medical history, slit-lamp examination including intraocular pressure and anterior chamber dept evaluation and non-mydriatic fundus exam with evaluation of the cup/disk ration. RESULTS: A total of 682 individuals were screened, 277 were male and 405 were female. The youngest individual was 8 years old and the oldest individual was 84 years old. The mean age was 57.6 years. Intraocular pressure higher then 21,9 mmHg was found in 83 patients. CONCLUSION: Glaucoma is a disease that affects visual acuity and gradually leads to blindness. It occurs in all age groups in both sexes and in all races. Early detection of disease and proper treatment can prevent permanent loss of vision. Detection and early treatment of glaucoma must become one of the leading public health programs in B&H.

Treatment of congenital aniridia associated with subluxated infantile cataract.

A 5 year old boy was presented at Eye clinic University clinical center Tuzla with congenital aniridia in both eyes. Clinical examination revealed visual acuity of 0.08 without correction in right and 0.7 with -5.0 Dsph and -1.0 Dcyl Axx 109 degrees in left eye. Opthalmologic examination showed bilateral aniridia associated with moderate cataract in the right and incipient cataract in the left eye. In the right eye, zonular weakness with incipient capsular displacement and esotropia of delta6 degrees, were noted. The patient underwent phacoemulsification, implantation of capsular tension ring and Artificial Iris implant in the capsular bag. Phacoemulsification went uneventful and early postoperative recovery was successful with no signs of aniridia-associated keratopathy development and normal values of intra ocular pressure. Patient was not motivated for operation of the left eye and it was corrected with soft contact lens. Six month after the operation visual acuity in the right eye improved to 0.9 with +1.25 Dsph and maintained stable in left eye, with complete elimination of esotropia and signs of binocular vision restoration. Small incision cataract extraction with IOL and Artificial Iris implantation in one procedure can be used to correct congenital aniridia and cataract with significant visual function improvement.

The safety and efficacy of day care cataract surgery.

PURPOSE: To evaluate safety and efficacy of day care cataract surgery in developing country. PATIENTS AND METHODS: This prospective study included 200 patients planned for cataract surgery during October and November 2012 divided in to two groups, day care cataract surgery (DCCS) and inpatient cataract surgery (ICS), with same number of male and female patients right and left eyes. All patients had same operative conditions and postoperative follow up. RESULTS: The average age of patients in this study was 68.4 +/- 7.47 years. Visual acuity before cataract extraction was 0.1754 where 44.5% of patients had severe visual impairment and another 23% had complicated cataract. Posterior capsule rupture was noted in 4.5% of cases. The main risk factors in both groups were: higher age, female gender, left side, complicated cataract, higher dioptric power of IOL and ECCE. Regular control opthalmologic examinations 30, 90 and 180 days after the cataract extraction did not reveal signs bullous keratopathy, wound dehiscence, cystoid macular edema and endophtalmitis in any of patients. Postoperative visual acuity 180 days after the operation in DCCS was 0.920 +/- 0.154 and 0.928 +/- 0.144 in ICS. Visual acuity less than 0.5 was noted in 4.5% due to posterior eye segment changes. Patients in DCCS group had 30 control examinations more and 95 days of hospitalization less than ICS with 16.5% cost reduction. CONCLUSION: The concept of day care cataract surgery is equally safe and more cost effective than inpatient cataract surgery.

Use of the toric intraocular lens for keratoconus treatment.

A 50 year old man presented to Eye clinic University clinical centre Tuzla with bilateral visual impairment. Clinical examination revealed low visual acuity and keratoconus in both eyes, white cataract in right eye and diabetic retinopathy in left eye. Ultrasonography examination was normal. The patient underwent Trypan blue capsule staining, phacoemulsification and implantation of intraocular lens Alcon AcrySof SN60T9 16 D spherical and 6.0 D cylinder power. Phacoemulsification went uneventful and early postoperative recovery was successful. Visual acuity improved to 0,8 and fundus examination revealed background diabetic retinopathy. Postoperative follow up two years after surgery showed no signs of keratoconus progression and visual acuity maintained the same.

Pediatric cataract in Tuzla Canton, Bosnia and Herzegovina.

AIM: To estimate incidence and to present descriptive epidemiological data on pediatric cataract in Tuzla Canton, Bosnia and Herzegovina. METHODS: Medical records of all patients hospitalized at the Eye Clinic of the University Clinical Center Tuzla over the 8-year period were retrospectively examined. Prevalence, morphology and type of cataract, its possible etiology and existence of other associated ocular and systemic diseases were analyzed. RESULTS: The study included 87 eyes of 58 children. Average age at presentation was 11.12 (SD ± 9.03) years. A total of 34 (58.62%) patients were males and twenty-four (41.38%) females. Twentynine (50%) cataracts were unilateral. Thirty-seven (63.79%) patients had isolated cataracts and 24 (29.31%) patients had other ocular anomalies associated with pediatric cataract. High refractive anomalies, nystagmus and microphthalmus were most commonly associated ocular findings. Strabismus was present in 14 (24.13%) cases. Posterior cortical cataract was present in 29 (32.58%) and nuclear cataract in 28 (31.46%) cases. Estimated incidence of congenital cataract was 2.62 per 10.000 births and incidence of pediatric cataract was 8.6 per 10.000 births. CONCLUSION: Prevalence of pediatric cataract in Tuzla Canton is within the worldwide range. Late presentation of children with cataract remains the problem that needs to be addressed. Improved patient education and public awareness are needed in order to change the course of avoidable childhood visual impairment.

Treatment of congenital aniridia associated with subluxated infantile cataract.

A 5 year old boy was presented at Eye clinic University clinical center Tuzla with congenital aniridia in both eyes. Clinical examination revealed visual acuity of 0,08 without correction in right and 0.7 with -5.0 Dsph and -1.0 Dcyl Axx 109° in left eye. Opthalmologic examination showed bilateral aniridia associated with moderate cataract in the right and incipient cataract in the left eye. In the right eye, zonular weakness with incipient capsular displacement and esotropia of Δ6º, were noted. The patient underwent phacoemulsification, implantation of capsular tension ring and Artificial Iris implant in the capsular bag. Phacoemulsification went uneventful and early postoperative recovery was successful with no signs of aniridia-associated keratopathy development and normal values of intra ocular pressure. Patient was not motivated for operation of the left eye and it was corrected with soft contact lens. Six month after the operation visual acuity in the right eye improved to 0.9 with +1.25Dsph and maintained stable in left eye, with complete elimination of esotropia and signs of binocular vision restoration. Small incision cataract extraction with IOL and Artificial Iris implantation in one procedure can be used to correct congenital aniridia and cataract with significant visual function improvement.

Phacoemulsification of irradiation cataract after brachytherapy.

A 24-year old man presented to the Policlinic with severe visual impairment in his left eye. The patient had been treated earlier with Iodine-125 brachytherapy due to iris melanoma. Clinical examination revealed low visual acuity, filtration device, iris atrophy, posterior synachiae and completely white cataract. Ultrasonography revealed scleral thinning with no signs of retinal detachment. The patient underwent synechiolysis, trypan blue capsule staining, phacoemulsification and implantation of 23D intraocular lens Alcon AcrySof (MA60BM). Phacoemulsification went uneventful and early postoperative recovery was successful. Visual acuity improved to 0,2 and fundus examination revealed radiation retinopathy with diffuse retinal scaring.

Significance of ultrasonography in evaluation of vitreo-retinal pathologies.

PURPOSE: To assess the diagnostic value of ultrasonography in the detection of vitreo-retinal pathologies. MATERIAL AND METHODS: This prospective study included all patients from retina department in Eye Clinic University Clinical Center Tuzla first time referred and examined by a single experienced vitreo-retinal surgeon in period from January 2011 to January 2012. Complete ophthalmic examination and ultrasonography-standardized echography were performed to all patients for detection and confirmation of vitreo-retinal pathology. RESULTS: Study included 146 eyes from 122 patients. 58 (39.7%) eyes had poor posterior segment visualization, 21 (14.4%) eyes due to dense cataracts and 37 (25.3%) eyes due to different vitreous opacities. 88 (60.3%) eyes had good or partial posterior eye segment visualization, where 67 (45.9%) eyes had proliferative vitreo-retinopathy and 55 (37.7%) eyes had tractional retinal detachment. Most common causes for referral to vitreo-retinal surgeon were ocular complications of diabetes mellitus 94 (64.4%), ocular trauma 18 (12.3%), rhegmatogenous retinal detachment 16 (10.9%) and intraocular inflammation 9 (6.2%). Ultrasonography confirmed suspected diagnosis and operative management plan in 120 (82.2%) eyes, sublassified previously established diagnosis in 19 (13%) eyes and helped further operative planning and established completely new diagnosis and changed initial management plan in 7 (4.8%) eyes. The final clinical diagnosis confirmed the ultrasonography findings in 142 from 146 (97.3%) eyes. CONCLUSION: Ultrasonography is useful part of ophthalmic examination for detection, evaluation and follow up of different vitreo-retinal pathologies.

Risk factors and diabetic retinopathy.

The aim of the study was to determine the correlation between risk factors and diabetic retinopathy, which is the leading cause of blindness in developed countries for patients aged 20 to 65. We compared risk factors between patients without retinopathy, with non-proliferate and with proliferate retinopathy (p<0.05). Duration of diabetes is most important for the development of retinopathy. Hyperglycaemia and high blood pressure are important for progression. Better control of blood sugar and elevated blood pressure can reduce progression of retinopathy and risk of vision loss.

Corneal astigmatism after micro-incision cataract operation.

GOALS: To evaluate the effect of micro-incision (2.2 mm) and small-incision (3.0 mm) coaxial phaco-emulsification on surgically induced astigmatism (SIA). METHODS: Cataract patients (n = 60, 60 eyes) were randomized into two groups: 30 eyes in the 2.2-mm incision group, 30 eyes in the 3,0-mm group. Phaco-emulsification was followed by intraocular lens implantation via the Monarch II injector with the C cartridge (Alcon Laboratories Inc., Fort Worth, TX, USA). Uncorrected distance visual acuity, corneal keratometry and corneal astigmatism and SIA were assessed 1, 7 and 30 days after cataract surgery. RESULTS: At 1, 7 and 30 days postoperative, SIA of the 3.0-mm group was greater than SIA of the 2.2-mm (p < or = 0.05) only at first postoperative day, but SIA was similar between the 2.2-mm group and the 3,0-mm group at other follow-ups. Time wise, mean SIA at 30 days was greater than SIA at 90 days in the 3.0-mm group (p = 0.04), while SIA did less change with time for the 2.2-mm group. Postoperative uncorrected distance visual acuity tended to be better with the smaller incisions, but this trend did not reach statistical significance (p > or = 0.07) especially at letter follow-ups. CONCLUSION: Incision size contributed to postoperative corneal astigmatism especially at earlier postoperative period. When incision size was reduced from 3.0 mm to 2.2 mm, SIA was reduced and refractive stabilization was faster. In longer period of time difference between 3,0 mm and 2,2 mm incision size groups decreases.

Terson's syndrome successfully treated with combined therapy.

PURPOSE: To present a case of Terson's syndrome consequent to ruptured intracranial aneurism treated successfully with a combined therapeutic approach. METHODS: Case report. A 37 year old man was urgently referred to the UCC Tuzla with sudden headache, vomiting and unconsciousness. CT scan showed ruptured aneurism of anterior communicant artery with signs of retinal thickening. Later ocular examination showed the massive bilateral vitreous haemorrhage. RESULTS: Patient was treated with medicamentous therapy for 7 months with no significant improvement. 7 months after aneurism rupture patient agreed to a surgical treatment. Right eye was treated surgically and left eye continued with conservative therapy. Visual acuity after vitrectomy improved in right eye to 1.0 and 0.5 in left eye. CONCLUSIONS: Terson's syndrome is relatively common complication of subarchnoid haemorrhage. Vitrectomy is safe and efficient approach to treat patients with Terson's syndrome.