Marija Jelić Vuković

Background and Objectives: Pseudophakic dysphotopsia is a common cause of dissatisfaction after uncomplicated cataract surgery. We compared its course with two intraocular lenses (IOLs). Materials and Methods: In this prospective, non-randomized study, 348 of 488 enrolled patients completed two years of follow-up after implantation of the Akreos Adapt AO (n = 176) or AcrySof IQ (n = 172) IOL through a superior or temporal corneal incision. Positive and negative dysphotopsia were assessed with a modified Radford questionnaire at one week, eight weeks, one year, and two years. Repeated measurements were analyzed with exact McNemar tests and generalized estimating equations adjusted for incision site, age, and sex. Results: At one week, dysphotopsia was reported by 45.9% of patients with the AcrySof IQ and 21.0% with the Akreos Adapt AO (adjusted odds ratio 3.27, 95% CI 2.02–5.29); negative dysphotopsia occurred only with the AcrySof IQ (8.7%). Later differences in any dysphotopsia were small and non-significant (0.9–2.2 percentage points). Dysphotopsia decreased significantly in both groups from 33.3% to 14.7% overall. Incision site was not associated with dysphotopsia. Conclusions: Early dysphotopsia was more frequent with the AcrySof IQ, although this represents an association rather than proof of causality; with both IOLs, symptoms became less frequent over time, and annoying symptoms became rare.

Background/Objectives: To describe the presentation, diagnostic evaluation, management, and clinical outcome of unilateral corneal ulcer in an otherwise healthy infant without identifiable predisposing factors. Methods: We report a case of a 2-month-old infant who presented with a visible white corneal lesion. Initial examination revealed a 2 × 1 mm fluorescein-positive corneal ulcer with a surrounding stromal infiltrate. There was mild conjunctival injection without ocular discharge. The anterior chamber was deep, without cells or flare. Corneal scraping was deferred because specimen collection would have required sedation or general anesthesia. Consequently, the microbial etiology remained unconfirmed, and empirical antimicrobial treatment was initiated. Results: The patient was treated with topical azithromycin, tobramycin, moxifloxacin, and aciclovir, as well as liposomal ozonized oil eye drops. During empirical treatment and close clinical monitoring, the corneal epithelial defect resolved within seven days, and the surrounding stromal infiltrate progressively decreased in size and opacity. At the one-month follow-up, a small residual stromal scar remained outside the visual axis. Conclusions: This case illustrates the diagnostic and therapeutic challenges of managing corneal ulcer in early infancy when microbiological confirmation is unavailable. The favorable clinical course observed during empirical treatment and close monitoring does not establish an infectious etiology or demonstrate a causal effect of antimicrobial therapy.

Background and Objectives: Iris-based biometric identification is among the most accurate personal recognition technologies in routine use today. Cataract remains the leading cause of blindness worldwide, and surgical removal of the opacified lens is the most frequently performed ophthalmic operation globally, inevitably involving mechanical and thermal manipulation of the anterior segment, where the iris resides. The aims of this study were: (1) to compare the effect of ultrasound phacoemulsification (PHACO) and conventional extracapsular cataract extraction (ECCE) on iris-based identification; (2) to determine whether the vital dye trypan blue, used during phacoemulsification of mature cataracts, independently impairs biometric accuracy; and (3) to quantify associations between key intraoperative parameters and post-operative recognition performance. Materials and Methods: This prospective, non-randomised comparative cohort study enrolled 120 participants assigned to four parallel cohorts (n = 30 each) (clinically allocated by surgical indication rather than randomised; group comparability with respect to age, cataract severity and case complexity was not guaranteed, and findings should therefore be interpreted as observational associations rather than causal effects) according to clinical indication: PHACO (uncomplicated phacoemulsification), PHACO-DYE (phacoemulsification with trypan blue 0.6 mg/mL for mature cataracts), ECCE (conventional extracapsular extraction for complex cataracts), and a healthy Control group. Standardised iris photographs were acquired on the day before the surgery and one month after surgery using a semi-professional digital camera under controlled lighting. Images were processed by a custom Java-based iris recognition platform that performed boundary detection, polar normalisation into 65 discrete iris sectors, and sector-by-sector comparison using a dual-threshold matching rule: sectors with 100% identity, or with a residual difference below 2%, were scored as direct matches; all others were scored as indirect, non-matching elements. The primary outcome was the percentage of correspondence (match %) between pre- and post-operative templates. Intraoperative parameters, cumulative dissipated energy (CDE), phaco time, and estimated fluid used, were recorded for all phacoemulsification cases. Results: All three surgical groups showed significantly lower match percentages than controls (median 91.0%, IQR 86–96; Mann–Whitney U test, all p < 0.001). Median match % was 85.0% (IQR 71–89) for PHACO, 78.5% (68–85) for PHACO-DYE, and 44.0% (29–61) for ECCE. ECCE differed significantly from both phacoemulsification groups (Mann–Whitney U test, p < 0.001 each); no significant difference was found between PHACO and PHACO-DYE (Mann–Whitney U test, p = 0.210, not statistically significant). Only CDE differed significantly between PHACO and PHACO-DYE (Mann–Whitney U test, p = 0.026, statistically significant). All three intraoperative parameters showed significant negative correlations with match % (Pearson correlation coefficient), with estimated fluid used showing the strongest association (PHACO: r = −0.88; PHACO-DYE: r = −0.71; both p < 0.001). Conclusions: In this non-randomised cohort, surgical group was associated with postoperative match reduction, with ECCE showing markedly greater reduction than phacoemulsification; however, residual confounding by cataract severity, case complexity and baseline age differences limits causal interpretation. No significant unadjusted difference in match % was found between PHACO and PHACO-DYE, indicating that this study could not demonstrate an independent effect of trypan blue, though it also cannot exclude one, since dye use was itself linked to more complex, mature cataracts. Estimated intraoperative fluid use showed the strongest unadjusted negative correlation with match %; whether it is an independent predictor requires multivariable analysis that this study, as designed, was not powered to perform. These preliminary, hypothesis-generating findings support considering postoperative biometric re-enrolment after cataract surgery and further, adequately powered and adjusted studies before firm clinical or algorithmic recommendations can be made.

Background/Objectives: Chronic topical antiglaucoma therapy may affect the ocular surface. We assessed documented dry eye disease (DED) and its associations with active-ingredient burden, treatment duration, and preservative exposure. Methods: This retrospective cross-sectional study included 357 adults receiving topical antiglaucoma therapy at a tertiary center who had complete treatment and ocular-surface data. Ocular-surface testing was prompted by symptoms or clinical judgment. The first eligible visit identified during chronological record review was analyzed for each patient. DED was based on the treating ophthalmologist’s documented diagnosis. Logistic regression evaluated treatment-related factors. Results: DED was documented in 171/357 patients within this selected sample (47.9%; 95% CI 42.8–53.1%). Prevalence was higher with at least two versus one active IOP-lowering ingredient (60.6% vs. 23.1%; p < 0.001). Each additional ingredient was associated with higher DED odds after adjustment for age, sex, and glaucoma subtype (adjusted odds ratio [aOR] 2.65, 95% confidence interval [CI] 1.88–3.74). Longer treatment duration was also associated with higher odds (aOR 1.12 per 12 months, 95% CI 1.05–1.20). In the linear extended model, active-ingredient count was not associated with documented DED (aOR 1.02, 95% CI 0.69–1.51), whereas an exclusively preservative-free regimen was associated with lower odds (aOR 0.011, 95% CI 0.001–0.084) and fixed-combination therapy with higher odds (aOR 3.23, 95% CI 1.74–5.98). However, categorical modeling of ingredient count significantly improved extended-model fit (likelihood-ratio p < 0.001), indicating sensitivity to functional form. Documented DED occurred in 1/91 (1.1%) exclusively preservative-free patients versus 170/266 (63.9%) preserved-exposure patients, with sparse PF events limiting interpretation. Conclusions: Documented DED was common in this selected cohort undergoing ocular-surface assessment. Active-ingredient count was associated with DED in the primary adjusted model, but its interpretation in the extended model depended on the functional form used. The marked inverse association with an exclusively preservative-free regimen requires prospective confirmation because sparse data, limited overlap between treatment groups, treatment selection, and residual confounding preclude causal inference.

Background: Retinal microvascular assessment has emerged as a promising non-invasive approach for evaluating vascular health. Recent advances in retinal imaging technologies have enabled detailed characterization of retinal vascular structure and function, raising interest in their potential role as biomarkers of exercise-related vascular adaptation. This systematic review with narrative synthesis aimed to summarize current evidence regarding the relationship between exercise, physical fitness, and retinal microvascular biomarkers. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for studies published from January 2021 to June 2026, followed by a supplementary update search to identify eligible publications available through 31 July 2026. Search terms combined retinal microvascular assessment techniques with terms related to exercise, physical activity, physical fitness, and exercise training. Following screening and eligibility assessment, 42 publications were included in the final qualitative synthesis, comprising 20 publications identified through the initial search and 22 additional publications identified through the supplementary update search. Several publications represented complementary analyses of the same or overlapping study cohorts and were therefore not considered independent replications. Results: The included studies comprised observational studies and exercise intervention trials involving healthy individuals and clinical populations. Retinal biomarkers assessed included vessel diameters, arteriovenous ratio (AVR), vessel density, perfusion density, foveal avascular zone (FAZ), retinal oxygen extraction, wall-to-lumen ratio (WLR), and choriocapillaris perfusion parameters. Several studies reported measurable acute and chronic retinal vascular responses to exercise, although the direction, magnitude, and clinical meaning of these changes varied according to population, exercise modality, imaging technique, and biomarker. Observational studies generally reported associations between higher physical activity or cardiorespiratory fitness and a more favorable retinal vascular profile, but causal interpretation remains limited. Conclusions: Retinal microvascular biomarkers appear sensitive to acute physiological stress and may reflect selected adaptations associated with longer-term exercise exposure. However, retinal responses are heterogeneous and biomarker-specific, and their biological and clinical significance remains incompletely established. Methodological heterogeneity, overlapping study cohorts, and the limited number of adequately powered randomized and longitudinal studies constrain causal interpretation and generalizability. Retinal vascular measures should therefore currently be regarded as candidate biomarkers and research tools rather than validated surrogate outcomes or routine clinical measures.

Objective: To report a rare case of bilateral iris metastasis from small cell lung carcinoma (SCLC) and systematically review the literature on SCLC-associated iris metastases, with emphasis on clinical presentation, management, and outcomes. Materials and Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, ScienceDirect, Scopus, and Web of Science were comprehensively searched on 10 July 2025. Eligible studies included English-language reports of iris metastasis originating from SCLC in human subjects. Case report: A 58-year-old woman with previously treated SCLC developed bilateral iris metastases one year after complete remission of the primary tumor. Ophthalmic examination revealed whitish-gray, vascularized iris masses with iridocorneal angle involvement, associated with secondary angle-closure glaucoma and markedly elevated intraocular pressure (48 mm Hg) in the left eye. Cyclocryotherapy, preceded by systemic and topical antiglaucoma therapy, resulted in pain relief and a reduction in intraocular pressure; the patient died four months later due to pneumonia. Results (Systematic Review): Seventeen studies comprising 17 patients were included; the median age was 60 years, and 64.7% were male. The median interval from SCLC diagnosis to ocular presentation was 4 months, although iris metastasis was occasionally the initial or concurrent manifestation of disease. The most common presenting features were visual impairment (58.8%), ocular pain (41.2%), and elevated intraocular pressure (41.2%), while iris neovascularization (35.3%) and synechiae (29.4%) were also frequent. Bilateral involvement was reported in only one previous case. Treatment approaches were heterogeneous and included antiglaucoma therapy, systemic chemotherapy, local radiotherapy, anti-VEGF therapy, and enucleation. Among patients with available follow-up (n = 12), 58.3% died within a median follow-up of 7.5 months. Conclusions: Bilateral iris metastasis from SCLC is rare and may occur as a manifestation of recurrent disease after remission. It is an aggressive condition characterized by nonspecific ocular symptoms, variable management, and poor survival, underscoring the importance of early recognition and the need for evidence-based diagnostic and therapeutic strategies.

Background: Depression and anxiety are highly prevalent among medical students and may adversely affect academic functioning and professional development. Early identification of these symptoms and their associated factors is therefore essential. Religiosity has been suggested as a potential modifier of mental health outcomes, although existing evidence remains inconsistent. This study aimed to assess symptoms of depression and anxiety, levels of religiosity, and their associations among medical students. Methods: This cross-sectional study was conducted among medical students at the University of Osijek, Croatia, from 29 September to 5 October 2025. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and religiosity using the Duke University Religion Index (DUREL). Results: A total of 260 students (197 females, 63 males) completed the survey. At least mild depressive and anxiety symptoms were reported by 54.2% and 58.1%, respectively; 9.2% had moderately severe or severe depression, and 25% reported moderate to severe anxiety. Suicidal or self-harm ideation in the past two weeks occurred in 12.8%. Female students had higher median depression (p = 0.01) and anxiety scores (p = 0.005) than male students; however, these differences did not remain statistically significant after Bonferroni correction. Religiosity was not associated with PHQ-9 or GAD-7 scores after correction; however, categorical analyses indicated that students with moderate to high religiosity more frequently reported moderate to severe depressive symptoms (p = 0.037). Conclusions: The high prevalence of depression, anxiety, and suicidal ideation underscores the need for continuous mental health screening, early identification of risk factors, and implementation of preventive programs among the student population, particularly medical students as future healthcare professionals.

Background and Objectives: Corneal ulcers in patients with lagophthalmos due to facial nerve palsy pose a significant therapeutic challenge. Topical insulin has emerged as a promising adjuvant therapy for enhancing corneal re-epithelialization. The aim of this study is to evaluate the efficacy of insulin drops compared with lipid-based artificial tears, and to compare the corneal healing rate in achieving complete epithelialization within 30 days in diabetic patients. Materials and Methods: This retrospective case–control study included 32 patients with facial nerve palsy and lagophthalmos who developed an exposed corneal ulcer, of whom 20 received topical insulin and 12 received lipid-based artificial tears. The primary outcome was complete epithelialization at day 30. Additional variables included age, sex, and baseline defect characteristics. Results: By day 30, complete epithelialization was achieved in 18 of 20 patients (90%) in the insulin group compared with 5 of 12 (41.7%) in the control group. Binary logistic regression analysis confirmed significantly higher odds of healing with insulin treatment (OR = 10.8; 95% CI 1.8–63.9). No systemic adverse events or signs of hypoglycemia were observed. Conclusions: Topical insulin significantly accelerates corneal epithelialization in patients with facial nerve palsy and exposed ulcers, offering safe and effective adjuvant therapy for a high-risk population. Despite promising results, the study’s limitations—including small sample size, single-center design, and retrospective nature—highlight the need for larger, multicenter prospective studies to confirm efficacy, optimize dosing, and further evaluate long-term safety.

Rationale: Herpes simplex virus 1 establishes a latent infection in trigeminal ganglia. Reactivation causes cold sores, as well as viral keratitis. The purpose of this study was to report potential benefits of using active vitamin D receptor ligands (VDR-agonists) as adjunctive therapies for the treatment of infectious corneal perforations, and prevention of HSV recurrence. Patient concerns: A 57-year-old female with a past history of episodic, poorly-healing, corneal erosions, recurring orolabial herpetic lesions, as well as PCR-confirmed recurrences of herpes simplex keratitis presented with a burning sensation and slight pain in the right eye. Examination indicated HSV keratitis. Topical antibiotic and oral antiviral treatments were prescribed. Despite these standard-of-care treatments, a perforated corneal ulcer ensued. Diagnoses: Corneal perforation associated with HSV-1 keratitis recurrence, later confirmed by PCR analysis of corneal scrapings. Interventions: Corneal perforation was treated with a human fibrin glue, fortified with multilayered amniotic membrane transplant, as well as a therapeutical contact lens. Following surgery, calcifediol and paricalcitol were started as oral adjunctive therapies in an attempt to boost tissue regeneration and innate-immunity within the slow-healing cornea. Anterior segment optical-coherence tomography was used to measure corneal thickness. Frequent follow-ups with various specialists allowed for comprehensive patient evaluation, and meticulous screening for any signs indicating potential HSV-1 recurrence. Outcomes: Following calcifediol-paricalcitol therapy corneal thickening, and re-epithelization ensued. During combined calcifediol-paricalcitol therapy, the patient has had no recurrence of herpes simplex keratitis, or orolabial herpes lesions. Lessons: Corneal stabilization avoided a high-risk, full-thickness corneal transplantation, facilitating future cataract surgery, and allowing for some degree of visual recovery in this eye. Export

Objectives: Lutein is a carotenoid and one of the primary pigments with antioxidative effects found in the macula lutea of an eye. The present study aimed to determine the effects of lutein consumption in the form of functional food (hen eggs enriched with n-3 PUFAs, selenium, vitamin D and lutein) on macula lutea morphology by using an optical coherence tomography (OCT) in young healthy subjects. Participants and Methods: Randomized, double-blind, placebo-controlled pilot study included eleven healthy young subjects of both sexes (average age 18 to 28 years), assigned to a Nutri4 group and a control group. The Nutri4 group consumed nutritionally enriched hen eggs, while the control group consumed regular ones during the three-week protocol. At the beginning and end of the protocol, the subjects underwent ophthalmological examinations of the posterior eye segment by OCT. Venous blood was sampled to determine biochemical blood parameters (serum concentration of nutrients, liver enzymes, serum lipid profile, inflammatory markers). Results: Consumption of Nutri4 eggs led to a significant increase in n-3 PUFAs, lutein and vitamin E concentrations in serum. The average macular thickness (lower outer layer of the macula) was increased in the Nutri4 group, while no significant change was found in the retinal thickness of the control group after the dietary protocol. Urea was raised, and gamma-glutamyl aminotransferase significantly decreased in the Nutri4 group, while aspartate aminotransferase was increased in the control group after the corresponding dietary protocol. Conclusions: The consumption of enriched hen eggs has a beneficial effect on the thickness and volume of the retina.