Dušica Pahor

Die Vorhersagefaktoren einer erfolgreichen selektiven Lasertrabekuloplastik bei Offenwinkelglaukom

BACKGROUND The aim of this study was to determine factors that predict successful selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG). PATIENTS AND METHODS In 122 eyes suffering from OAG, 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 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66, 72, 78 and 84 months thereafter. Success was defined as an IOP reduction exceeding 20 % of the pretreatment IOP. Correlations between successful SLT and baseline IOP, age, sex, hypertension, diabetes mellitus, family history of glaucoma, previous anterior segment surgery, the grade of trabecular meshwork pigmentation, laser energy used, and local antiglaucoma therapy were determined. RESULTS The mean follow-up time was 43.4 months (SD: 25.6). The mean pretreatment IOP was 22.5 mmHg (SD: 2.8). The success rate after 12 months determined from the Kaplan-Meier survival analysis was 88 %, after 24 months 79 %, after 36 months 67 %, after 48 months 58 %, after 60 months 49 % and after 84 months 48 %. We found statistically significant negative correlation betweens successful SLT and the grade of trabecular meshwork pigmentation (r = -0.234; p = 0.01), diabetes mellitus (r = -0.223; p = 0.014). We found no statistically significant correlations between successful SLT and baseline IOP, age, sex, hypertension, family history of glaucoma, previous anterior segment surgery, laser energy used, local antiglaucoma therapy. CONCLUSION SLT success in OAG with a mean follow-up time of 43.4 months was significantly predicted by the lower grade of trabecular meshwork pigmentation and the absence of diabetes mellitus.

Optical coherence tomography findings in hemodialysis patients

BACKGROUND The aim of the present prospective study was to compare retinal thickness between normal healthy subjects and chronic renal failure patients treated with maintenance hemodialysis (HD) as well as to determine whether there was any correlation between age and duration of HD treatment. PATIENTS AND METHODS A total of 24 eyes of 12 HD patients and 32 eyes of 16 controls underwent optical coherence tomographic scanning (OCT) in the central disc of 6000 mum in diameter. RESULTS The mean retinal thickness was measured in the inner temporal, superior, nasal and inferior quadrants. There was a highly significant difference in the inner quadrants between controls and HD patients (p < 0.005). The mean retinal thickness was also measured in all outer quadrants. The differences between HD patients and controls were highly significant (p < 0.005). The average reduction in retinal thickness in HD patients compared to the controls in the inner quadrants was 7.9% or 22 microm (279.0 in controls, 257.0 in HD patients) and 7.3% or 17.7 microm in the outer quadrants (244.5 in controls, 226.8 in HD patients). The average reduction in all quadrants was 7.7% or 20.1 microm (262 in controls, 241.9 in HD patients). The differences between HD patients and controls were highly significant in all quadrants (p < 0.001). No differences in foveal thickness between controls and HD patients were found. The reduction of retinal thickness was correlated with the age of HD patients, but not with the duration of HD treatment. CONCLUSION OCT revealed a significant reduction of retinal thickness in HD patients. The reduction was significant in all quadrants and was correlated to the age of HD patients. No differences in foveal retinal thickness were found.

Augensymptome als Initialzeichen von Wegener-Granulomatose

OBJECTIVE Wegeners granulomatosis (WG) is a systemic, necrotising, granulomatous vasculitis of unknown aetiology. Ocular involvement is present in up to 60 %. The aim of our study was firstly to evaluate the presence of ophthalmic manifestations as the first sign of WG in patients without obvious systemic manifestations of WG, and secondly to evaluate the clinical manifestation of ocular symptoms as the initial signs of WG. METHODS The medical records of all patients with a diagnosis of WG examined at the Department of Rheumatology and Immunology during the 5-year period from January 2003 to January 2008 were reviewed. Initial manifestation of WG, initial ocular presentation, biopsy results, laboratory testing results, treatment and the final outcome were determined. Only patients in whom WG was not diagnosed at the time of the ocular symptoms were included in the study. RESULTS Fifteen patients diagnosed with WG were identified. Six patients (40 %) developed no ocular symptoms before and after WG was diagnosed. Two patients (13.3 %) had a systemic disease first and subsequently developed ocular symptoms. Seven patients (46.7 %) had ocular symptoms as the first signs of WG (necrotising sclerokeratitis in two patients, peripheral ulcerative keratitis in two patients, non-granulomatous uveitis in one patient, anterior necrotising sclerokeratitis and nodular posterior scleritis with serous retinal detachment in one patient, severe retinal and chorioidal vascular occlusions with ischaemic optic disc neuropathy and complete visual loss in one patient). CONCLUSIONS In nearly 50 % of patients with WG, ocular symptoms were observed as the initial signs before WG was diagnosed. The initial symptoms may be obscure and may vary from one patient to another. Knowledge of the ocular initial symptoms of WG is very important and can contribute to a better prognosis and prevention of visual loss.

Postoperative inflammation after cataract surgery in patients with rheumatoid arthritis.

The purpose of the present study was to assess the influence of preoperative activity of rheumatoid arthritis (RA) on early postoperative anterior chamber inflammation after phacoemulsification and intraocular lens implantation. Twenty-three eyes in 18 patients were included in our study. On the first postoperative day, anterior chamber inflammation was observed in 11 eyes (47.8%). Five days after surgery, we found postoperative inflammation only in 1 eye (4.3%). Keratic precipitates were observed in 1 eye (4.3%) on the second postoperative day. We found no correlation between the extent of anterior chamber inflammation and the preoperative activity of RA. Postoperative anterior chamber inflammation was also not associated with the medical management of RA.

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.

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

SummaryPurposeTo determine long-term changes in macular thickness after cataract surgery.MethodsResearch 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.ResultsThe 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.ConclusionFindings confirmed the reversibility of macular thickness changes 6 months after cataract surgery and its return to preoperative values.

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. Cronbachs 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.

Gesichtsfelddefekte bei der Erstuntersuchung von Patienten mit nichtarteriitischer anterioren ischämischen Optikusneuropathie

Das Ziel dieser Studie war es, Gesichtsfelddefekte bei der Erstuntersuchung von Patienten mit nichtarteriitischer anterioren ischämischen Optikusneuropathie (NA-AION) mittels automatischer statischen Perimetrie zu analysieren. Retrospektiv wurden medizinische Befunde aller Patienten mit der ersten akuten NA-AION, die zwischen 2004 und 2014 in unsere Abteilung aufgenommen wurden, überprüft. Von 140 NA-AION-Patienten entsprachen 85 Patienten unseren Ein- und Ausschlusskriterien für die Studie. Bei allen Patienten wurde eine automatische statische Perimetrie durchgeführt. Gesichtsfelddefekte wurden erst in zwölf Kategorien und später in fünf Kategorien eingeteilt. Das Durchschnittsalter unserer Patienten war 64,8 Jahre, in einer Bandbreite von 36 bis 94 Jahre. Der Großteil der Patienten waren Männer: 49 von 85 (57,6 %). Bis auf das Krankheitsbild mit AION waren andere ophthalmologische Befunde normal. Ein typischer altitudinaler inferiorer Defekt mit einem scharfen Rand entlang des horizontalen Meridians wurde bei 30 von 85 Patienten bemerkt (35,3 %). Ungeachtet des Umfanges des Gesichtsfelddefektes wurde die inferiore bei 54 von 85 Patienten (63,5 %) und die superiore Zone bei 20 von 85 Patienten (23,5 %) beeinträchtigt. Konzentrische Verengung des Gesichtsfelddefektes kam bei 14 von 85 Patienten (16,5 %) vor. Bei drei Patienten (3,5 %) wurde ein parazentrales Skotom und bei zwei Patienten (2,4 %) wurden temporale Defekte entdeckt. Unsere Studie bestätigte, dass der relative Defekt in der Zone altitudinal inferior in Kombination mit dem absoluten Defekt in der Zone inferior nasal die häufigste Form des Gesichtsfelddefektes bei der mit einer automatischen statischen Perimetrie durchgeführten Erstuntersuchung von NA-AION-Patienten darstellt. The aim of our study was to analyze visual field defects in patients with non-arteritic anterior ischemic optic neuropathy (NA-AION) at initial examination using automated static perimetry. Medical records of all patients with first attack of acute NA-AION who were admitted to our department during the period of 11 years (2004–2014) were retrospectively reviewed. At the end, from 140 NA-AION patients, 85 patients who fulfilled our inclusion and exclusion criteria remained in the study. In all patients automated static perimetry was performed. Visual field defects were classified into 12 categories and condensed into 5 categories. The average age of our patients was 64.8 years, ranging from 36 to 94. The majority were men, 49 of 85 (57.6 %). Except for clinical picture of AION other ophthalmological findings were normal. Typical inferior altitudinal defect with sharp border along the horizontal meridian was observed in 30 of 85 patients (35.3 %). Regardless the extent of the visual field defects, inferior part was affected in 54 of 85 patients (63.5 %) and superior in 20 of 85 (23.5 %). Concentric narrowing of the visual field occurred in 14 of 85 patients (16.5 %). In three patients (3.5 %) paracentral scotoma and in two patients (2.4 %) temporal defects were observed. Our study confirmed that a combination of relative inferior altitudinal defect with absolute inferior nasal defect is the most common pattern of visual field defects at initial examination in NA-AION patients also using automated static perimetry.

Klinische Befunde bei Patienten mit nicht arteriitischer anteriorer ischämischer Optikusneuropathie (NAION) unter 50 Jahren

BACKGROUND The aim of our study was to determine the prevalence of NA-AION patients younger than 50 years among all our NA-AION patients and to compare clinical findings between young and elderly NA-AION patients. METHODS This was a retrospective review of complete ophthalmic examinations, including fluorescein angiography and visual field testing, performed on all patients with the first attack of acute NA-AION admitted to our department during the period of ten years (2004 to 2013). Of 120 NA-AION patients, 10 (8.3 %) were under 50 years of age. RESULTS The majority of these were men: 8 of 10 (80 %). The average best corrected visual acuity on admission was 0.34 (fingers counted up to 1.0) and on discharge 0.53 (fingers counted up to 1.0). Of 10 eyes, 6 were emmetropic and 4 hyperopic, from + 0.50 D to + 2.0 D. Aside from the clinical picture of AION, other ophthalmological findings were normal. In fluorescein angiography, typical changes for ischaemic optic neuropathy were observed in all patients. In a majority of patients, an inferior altitudinal visual field defect was found. As regards systemic risk factors, hyperlipidaemia was observed in 7, arterial hypertension in 3, diabetes mellitus without diabetic retinopathy in 3, and ischaemic heart disease in 1 of 10 patients. One patient was treated for rheumatoid arthritis without signs of vasculitis. In 3 patients, more than one systemic risk factor was observed. Two of our patients had no systemic risk factors except moderate hyperopia. Bilateral manifestation was observed only in one patient 8 months after the first attack. None of the patients experienced recurrent attacks. CONCLUSION The prevalence of younger patients in our study was lower than in previous studies. The reason could be the better medical prevention in our region. Our study confirmed that even in young NA-AION patients, moderate hyperopia could be a predisposing factor. Our study did not confirm the differences between young and elderly NA-AION patients as observed in previous studies. During a period of 10 years, we did not observe recurrences, high risk of other eye involvement or severe vision loss in our young patients compared to the elderly.

Influence of Cataract Surgery on Macular Thickness — A 3-Month Follow-Up

This prospective follow-up study evaluated the longer term changes to macular thickness and volume following cataract surgery. The study included 23 patients (23 eyes) who underwent ambulatory cataract surgery with phacoemulsification and intraocular lens implantation, followed by a scheduled optical coherence tomography measurement of macular thickness and volume after 3 months. Results were compared with preoperative data and measurements taken at 1 month after surgery, which were recorded in a previous study. A comparison of preoperative macular thickness values with those at 3 months after surgery demonstrated that the latter values remained greater in all macular regions except the superior outer macula, and that the differences were significant in the fovea, nasal inner macula and inferior outer macula. When macular thickness at 3 months after surgery was compared with that measured at 1 month, decreases were observed in all perifoveal areas, suggesting the reversible nature of cataract surgery-related macular thickness changes.