Jelena Mirkovic

Reported tetracaine allergy, particularly in the absence of supporting medical documentation or a confirmed allergy diagnosis, represents a common challenge during the preoperative assessment of patients undergoing cataract surgery. In such cases, clinical decisions often rely primarily on patient history, which may be incomplete, inaccurate, or unreliable, resulting in considerable diagnostic uncertainty. A narrative review of the literature was conducted to examine the clinical relevance of reported tetracaine allergy in perioperative management of cataract surgery. Based on critical appraisal and synthesis of the available evidence, a phenotype-based framework comprising three clinical presentation phenotypes was developed, accompanied by a structured algorithm to support preoperative decision-making. The proposed framework classifies patients into three clinically relevant phenotypes: the irritative phenotype, the suspected hypersensitivity phenotype, and the clinical uncertainty phenotype. This classification provides a structured approach to interpreting reported tetracaine allergy and forms the basis of a practical algorithm for phenotype-guided preoperative management. The phenotype-based framework is intended to support, rather than replace, clinical judgment in the preoperative evaluation of patients with reported tetracaine allergy. By providing a structured approach to decision-making when diagnostic information is limited or uncertain, the framework may improve the consistency and transparency of perioperative management. Although conceptual, the proposed framework highlights the importance of obtaining reliable clinical information in patients reporting tetracaine allergy. Further methodological studies, including prospective validation, are required before the framework can be recommended for routine clinical practice.

Introduction/Objective. Rhegmatogenous retinal detachment is an ophthalmic emergency which can result in vision loss. The aim of our study was to evaluate the demographic, epidemiological, clinical characteristics and treatment method of rhegmatogenous retinal detachment. Methods. This retrospective study was conducted at the Department of Vitreoretinal Surgery and Eye Trauma in the period between January 1, 2024 and December 31, 2025. The data included sex, age, season, onset of symptoms, presence of myopia, previous cataract surgery, as well as the method of treatment. Results. Out of 275 patients, there were 177 males (64.36%) and 98 females (35.64%). The majority of the study population was between 61 and 80 years old (n = 140, 50.91%). The most commonly selected surgical procedure was PPV (n = 226, 81.88%). Silicon oil was the preferred tamponade (n = 191, 75.2%). Best corrected visual acuity on admission was worse than 0.1 in the majority of the affected eyes (n = 177, 64.13%), while one month after surgery nearly half (n = 130, 47.1%) achieved visual acuity between 0.1 and 0.5. Recurrent detachment had 29 patients (10.32%). Conclusion. In conclusion, our study emphasizes that rhegmatogenous retinal detachment primarily affects males and individuals over 60 years of age within our region. Consequently, there is an urgent need to implement targeted public health initiatives to educate high-risk individuals on early symptoms, optimize primary ophthalmic triage, and establish efficient referral pathways to ensure timely surgical intervention and preserve functional vision.

Introduction. Valsalva retinopathy is an uncommon disorder that usually presents with acute onset of unilateral, or less frequently, bilateral visual impairment varying from subtle scotoma to total vision loss. It occurs as a result of Valsalva’s maneuver. In the vast majority of cases, hemorrhage is preretinal although subretinal, intraretinal and vitreous hemorrhage can be found. Valsalva retinopathy often develops due to numerous triggering activities such as vomiting, coughing, heavy weight lifting, intense aerobic exercise, labor and general anesthesia. Management options are either clinical observation or invasive techniques. We report a case of premacular hemorrhage due to Valsalva retinopathy induced by gym training. Case Outline. A 34 year-old woman was referred to the Eye Clinic, University Clinical Center of Serbia, complaining of sudden and painless unilateral decrease in vision occurred during intense physical activity. Best corrected visual acuity was measured as counting fingers at five meters distance. Dilated fundoscopy demonstrated a large, well demarcated premacular subhyaloid hemorrhage with visible rupture of the retinal vein branch. The patient was treated conservatively. Three months after the onset of symptoms, hemorrhage absorbed and best corrected visual acuity was 20/20. Conclusion. Valsalva retinopathy, although a rare condition, should not be omitted as a differential diagnosis of retinal and vitreous hemorrhages. Standard, observational treatment is generally sufficient for complete recovery of vision, however literature suggests that an individualized approach to each patient is required.

Introduction: Diabetic retinopathy is one of the major complications of diabetes mellitus. It is a progressive disease that includes following stages: no apparent DR, non-proliferative DR and proliferative DR. Contrast sensitivity is defined as the ability to distinguish details at low contrast levels. Numerous studies have shown that in patients with DR, in stages when visual acuity is normal or only mildly reduced, CS function is significantly affected. Aim: The aim of our study was to examine whether CS is reduced in patients with diabetes, and whether is it significantly lower in diabetic patients compared to healthy subjects. Material and methods: 20 patients with diabetes treated at Hospital for Eye Diseases, Clinical Center of Serbia and 20 healthy subjects from general population participated in the study. We have conducted case-control study. We used low-contrast ETDRS chart to measure CS. Results: CS in diabetic patients was compared with CS in healthy subjects. We also examined CS in diabetics with and without retinopathy. A statistically significant difference was ob served between the patients and the control group, both at monocular and binocular vision and the diseased persons had significantly impaired CS function. Regarding the stage of retinopathy, statistical significance existed only in monocular vision, in terms of decreased CS in patients with non-proliferative DR. Our study shows that there was no statistically significant difference in CS in diabetics with hemoglobin A1c lower than 7 and in those with hemoglobin A1c equal or higher than 7. Conclusion: Our research found that CS in diabetic patients can be greatly impaired, even in early stages of disease, while there were still no retinal abnormalities. In view of the fact that in all of our respondents visual acuity was normal, we conclude that measuring CS, could be good indicator of early vision disorders in diabetic patients.