Domagoj Ivastinovic

Repeated mobility testing for later artificial visual function evaluation

The study investigates the utility of a newly designed mobility test for repeated testing of visual function in patients with severe visual impairment and future application in evaluating functional progress in patients with artificial vision. Ten subjects divided into three groups based on visual acuity (VA) ranging from light perception to 20/200 and reduced visual field (VF) were included in the study. The mobility test consisted of using a set of four different but structurally similar and relatively short mazes having a constant number of obstacles of various sizes. The subjects, divided into three groups by acuity, passed through each course several times. In general, the patients with better VA had a larger extent of VF. Average speed and number of contacts were recorded as measures of performance. The average passing times of the groups through the courses were significantly different (p = 0.03), which was influenced by VA and VF. There was no significant difference in average number of contacts between the groups (p = 0.15). The mobility test proved to be appropriate for gaining statistically relevant results in repeated individual testing of patients with severe vision impairment. Results show promise for use this mobility test as a tool for assessing visual function of patients undergoing implantation of a visual prosthesis for artificial vision.

Evolution of early changes at the vitreoretinal interface after cataract surgery determined by optical coherence tomography and ultrasonography.

PURPOSEnTo evaluate the onset of posterior vitreous detachment (PVD) including early changes at the vitreoretinal interface after uneventful phacoemulsification in nonmyopic eyes using optical coherence tomography (OCT) and ultrasound.nnnDESIGNnProspective consecutive study.nnnMETHODSnPatients undergoing cataract surgery at our unit between January and October 2010 were recruited and examined with OCT and ultrasound preoperatively. Inclusion criteria were complete vitreoretinal attachment, no ocular pathology other than cataract, and no previous ocular surgery. All patients underwent phacoemulsification with intraocular lens implantation. Postoperatively, OCT and ultrasound were performed 1 month and 3 months after surgery. Exclusion criteria were axial length≥25 mm, lattice degeneration, intraoperative complications, and incomplete follow-up.nnnRESULTSnForty-nine eyes of 49 patients could be enrolled in the study. Some degree of PVD was noted in 29 eyes (59.2%) 1 month after surgery and in 35 eyes (71.4%) 3 months after surgery. Moreover, a significant decrease in prevalence of initial PVD and a corresponding increase of more advanced PVD stages throughout the duration of the study was observed. In patients older than 70 years some degree of PVD was diagnosed in 92.3% compared to 47.8% in patients younger than 70 years (P=.002).nnnCONCLUSIONnOCT facilitates the detection of early vitreoretinal separation that indicates initial PVD. After phacoemulsification the prevalence of some degree of PVD is consequently more frequent when supplementary OCT is used. Furthermore, OCT discloses a significant progression of PVD in the postoperative course. Patients older than 70 years are more likely to develop pseudophakic PVD.

Encircling band, laser retinopexy and lens removal as standard procedure in complicated retinal detachment shows a good clinical outcome

Purpose:u2002 To evaluate vitrectomy in conjunction with the use of perfluorocarbon, cerclage, laser retinopexy, lens removal and silicone oil as surgical treatment of proliferative vitreoretinopathy associated with retinal detachment.

The configuration of the vitreomacular interface determines the pattern of pseudophakic cystoid macular oedema

monly the source of information was an ophthalmologist (54%). There were significant genderrelated differences in the results: 89% of the women and 71% of the men had had their IOP measured sometime, women attended regular IOP measurements twice as often as men (60% versus 30% respectively), 22% of the men visited an ophthalmologist regularly and the same proportion were aware of therapy recommendation, whereas the corresponding percentages among women were 51% and 42%. The lesser likelihood of men to visit a physician may be a general trend, i.e. according to a report from the Finnish National Institute for Health and Welfare, 18% of men and 13% of women among the age group of 55–64 years had not visited a physician during the previous year (Helld an & Helakorpi 2015). The percentage of those who had had their IOP measured did not differ significantly between the two lower and the two higher level education sub-categories or between age groups. However, there were regional differences concerning IOP measurements: those from the Southwest Finland had had their IOP measured significantly more often than those from Northern Savo (86% versus 77% respectively), and those from a town with a university hospital more often than citizens of smaller outlying municipalities (86% versus 78% respectively). The availability of health services and information on glaucoma risks and care in local media might account for these kinds of differences. Even if an individual is suffering from glaucoma, the value of IOP is frequently in normal range and therefore tonometry as the only method is not sufficient for glaucoma screening. A campaign should be launched to encourage better awareness of the need and importance of regular eye inspections, especially among elderly men. All patients with glaucoma should be encouraged to inform their relatives of their increased risk for glaucoma and thus of the importance of having regular eye check-ups.

Prevalence of posterior vitreous detachment in glaucoma patients and controls.

To evaluate the impact of oxidative stress – present in glaucoma – on the vitreous. We therefore compare the presence of early and late stages of posterior vitreous detachment (PVD) between patients with glaucoma and controls.

Endogenous endophthalmitis after carotid endarterectomy due to exudative macular degeneration.

SummaryA 78-year-old male patient with unilateral exudative macular degeneration developed endogenous endophthalmitis 11 days after carotid endarterectomy. The endophthalmitis could not be treated by intravitreal application of antibiotics. The patient underwent vitrectomy and systemic application of vancomycin. Six days later, the eye was quiet and the patient was discharged with a visual acuity of 0.9xa0logMAR.Patients with exudative macular degeneration have a higher risk for developing endogenous endophthalmitis after vascular surgery of the carotid arteries and prolonged postoperative application of systemic antibiotics might be considered in these patients.ZusammenfassungEin 78 jähriger Patient mit einseitiger feuchter Makuladegeneration bekam eine endogene Endophthalmitis 11 Tage nach einer Karotisendarterektomie. Nachdem die intravitreale antibiotische Injektion zu keiner Beruhigung der Endophthalmitis geführt hat, wurde eine systemische Vancomycintherapie eingeleitet und eine pars plana Vitrektomie durchgeführt.Sechs Tage nach der Vitrektomie konnte der Patient mit einem Visus von 0.9 logMAR entlassen warden.Patienten mit feuchter Makuladegeneration haben eine erhöhtes Risiko für eine endogene Endophthalmitis nach gefäßchirurgischen Eingriffen der Arteria Carotis, und eine verlängerte postoperative antibiotische Prophylaxe sollte bei diesen Patienten in Betracht gezogen werden.

Vitreous hyper-reflective dots in pseudophakic cystoid macular edema assessed with optical coherence tomography

Purpose This study compares the presence of vitreous hyper-reflective dots (VHDs) detected with optical coherence tomography (OCT) between eyes with pseudophakic cystoid macular edema (CME) and those with no CME after cataract surgery. In addition, we evaluated the impact of VHDs on the responsiveness of pseudophakic CME to cortisone treatment. Setting Department of Ophthalmology, Medical University of Graz, Austria. Design Retrospective, monocenter case-controlled study. Methods Inclusion criteria for the study group and the control group were CME and no CME within 12 weeks following uneventful phacoemulsification in otherwise healthy eyes, respectively. VHDs (number and size) and the macular thickness were assessed with OCT. Furthermore, the number of peribulbar or intravitreal steroid injections was assessed. Results A total of 284 eyes from 267 patients were analyzed, among which 119 met the inclusion criteria for the study (n = 63) and the control group (n = 56). VHDs were observed in 54 (85.7%) study eyes and 21 (37.5%, p = 0.013) control eyes. The number of VHDs was 3.9±3.4 in the study group and 0.7±1 in the control group (p<0.001). The size of the VHDs was 33.5±9.1 μm and 36.6±17.9 μm in the study and control groups, respectively (p = 0.978). Overall, the number of VHDs correlated with central subfield thickness (r = 0.584, p<0.001), cube volume (r = 0.525, p<0.001), and postoperative best-corrected visual acuity (BCVA) (r = -0.563, p<0.001). The number of VHDs did not correlate with the frequency of peribulbar or intravitreal steroid injections. Conclusion VHDs occurred more often in eyes with CME than in eyes without CME following cataract surgery. In addition, the number of VHDs had an impact on the extent of macular thickening and subsequently postoperative BCVA. No correlation was found between the number of VHDs and the frequency of required peribulbar or intravitreal steroid injections.

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes

Purpose:u2002 To compare limbal and pars plana silicone oil removal (SOR) in aphakic eyes and to evaluate the acute effect of silicone oil flow to the corneal endothelium.