Background/Objectives: Accurate biometric measurements are critical for achieving optimal refractive outcomes in cataract surgery. This study evaluated the agreement of biometric measurements between a swept-source optical coherence tomography (SS–OCT) biometer (Argos®, Movu Inc.) and an optical low-coherence interferometry (OLCI) biometer (Aladdin®, Topcon Corp.). Parameters analyzed included axial length (AL), anterior chamber depth (ACD), lens thickness (LT), keratometry (K1, K2), and white-to-white corneal diameter (WTW). Methods: A total of 170 eyes were examined, and agreement was assessed using Bland–Altman analysis, intraclass correlation coefficients (ICCs), and Pearson correlation coefficients. Results: Excellent agreement was observed for AL (ICC = 0.975), ACD (ICC = 0.960), LT (ICC = 0.951), K1 (ICC = 0.921), and K2 (ICC = 0.927). Moderate agreement was found for astigmatism axis (ICC = 0.655) and cylinder power (ICC = 0.891). Poor agreement was noted for astigmatism-related Jackson cross-cylinder vectors J0 (ICC = 0.334) and J45 (ICC = −0.311), as well as for WTW (ICC = 0.338). Bland–Altman plots demonstrated narrow limits of agreement for most parameters, with mean differences of 0.009 mm for AL and 0.06 mm for ACD. Conclusions: Both devices demonstrated high degrees of agreement for core biometric parameters, supporting their clinical interchangeability. However, the variability in WTW and astigmatism-related measurements highlights the need for caution when precise corrections are required.

Obesity is a disorder with an increasing prevalence, associated with cardiovascular and metabolic pathologies. The amount and the distribution pattern of adipose tissue must be considered when managing this disease. Abdominal obesity carries a higher risk of developing obesity-related comorbidities. Body composition methods allow an objective diagnosis and follow-up in obese patients. Although bioelectrical impedance (BIA) is a practical, affordable, and widespread technique to assess body fat percentage (%BF), its accuracy has often been questioned. Therefore, the present study aimed to determine BIA’s accuracy in subjects with abdominal obesity compared to air-displacement plethysmography (AP) as the reference method. Measurements with both body composition techniques were performed on 80 subjects (41 men and 39 women) with a large range of body mass indexes (BMIs). Abdominal obesity, diagnosed as a waist-to-height ratio (WHtR) above 0.5, was present in 28 of them. Agreement between methods was analyzed using t-tests, correlation, and Bland–Altman plots. Compared to AP, BIA underestimated %BF by 3.07 ± 5.81% (CCC = 0.82) in the entire study group. The agreement was comparable in subjects with and without central obesity (2.97 ± 6.21% and 3.26 ± 5.1%, respectively). The changes in body shape geometry due to different adipose tissue distribution patterns only marginally affected BIA’s determinations.

Background/Objectives: This study aims to evaluate the efficacy, safety, and predictability of Transepithelial Photorefractive Keratectomy (TPRK) using the SmartPulse® technology excimer laser for the correction of myopia and myopic astigmatism, assessing visual and refractive outcomes over a one-year follow-up period. Methods: This retrospective cohort study analyzed data from patients who underwent TPRK at the Ophthalmology Department—“Victor Babes” University of Medicine and Pharmacy in Timisoara (Romania), between January 2019 and June 2023. The procedure was performed using the SmartPulse® Technology of the SmartSurfACE AMARIS 750S excimer laser (SCHWIND eye-tech-solutions, Kleinostheim, Germany). Preoperative assessments included visual acuity, refraction, and corneal measurements, with postoperative evaluations conducted for up to 12 months. Results: This study included 92 eyes from 46 patients (mean age 29.02 years, 63% male). At 12 months post-op, 100% achieved UDVA 20/25 or better, with an efficacy index of 1.01. Refractive accuracy was 96% within ±0.50 D of the target and astigmatism ≤ 0.50 D in 99% of eyes. The safety index was 1.01. Corneal haze occurred in 8.70% of eyes and was effectively managed with dexamethasone drops. Conclusions: TPRK with the SmartPulse® technology excimer laser demonstrated high efficacy and safety in correcting myopia and myopic astigmatism, achieving stable visual outcomes over one year. The procedure also showed excellent predictability with a low incidence of complications, supporting its use as a reliable refractive surgery option.

Background: Single-step transepithelial photorefractive keratectomy (TPRK) is a modern refractive surgery technique that offers a no-touch approach for correcting myopia and astigmatism. This study aims to evaluate the short-term visual and refractive outcomes of TPRK in patients with myopia and astigmatism over a 6-month follow-up period. Methods: This retrospective cohort study included patients who underwent single-step TPRK using the Amaris 750S laser platform with SmartSurfACE and SmartPulse® technologies, targeting a plano refraction. Procedures were performed with aspheric, non-wavefront-guided profiles, and outcomes were assessed postoperatively. Results: 96% of eyes achieved 20/20 or better uncorrected distance visual acuity (UDVA), with 98% reaching 20/25 or better, and 100% achieving 20/32 or better. UDVA was the same or better than preoperative corrected distance visual acuity (CDVA) in 96% of eyes, and no eyes lost two or more Snellen lines. Refractive outcomes showed strong precision, with 93% of eyes within ±1.00 D of the target. Astigmatism correction was accurate, with 100% of eyes having ≤1.00 D of astigmatism, and 80% achieving a precise astigmatism angle of error between −5° and 5°. Conclusion: Single-step TPRK with SmartSurfACE and SmartPulse® technologies provides highly effective and predictable visual and refractive outcomes for myopia and astigmatism. The procedure consistently delivers precise corrections with minimal complications, making it a reliable option for refractive surgery.

Mitomycin C is an antimetabolite with an important anti-mitotic effect on cellular proliferation, also used as adjunctive therapy for haze prophylaxis after corneal surface ablation techniques. In this study, 60 eyes undergoing refractive surgery (Streamlight TransPRK) were allocated randomly into two groups of 30 eyes each: Group I: without the use of Mitomycin C 0.02% (MMC) and Group II: with intraoperative MMC 0.02% use for 20 seconds. Refractive results, efficacy, safety and endothelial layer function and morphology were evaluated during the three-month follow-up. The main outcome measures were endothelial cell density (ECD), coefficient of variation (CV), central corneal thickness (CCT), hexagonal cell percentage (HEX), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and mean refractive spherical equivalent (MRSE). The assessments were compared between groups. After three months, the mean ECD decreased in both groups, the morphology and distribution of endothelial cells suffered modifications in both groups, with statistically insignificant differences between groups. In conclusion, intraoperative topical application of 0.1 mL of a 0.02% solution of mitomycin C on patients with low to moderate myopia with or without astigmatism undergoing Streamlight TransPRK does not have a negative impact on endothelial cell layer function or morphology.

Objectives: COVID-19 has varied clinical manifestations, from asymptomatic to severe cases, and conjunctivitis is one of them, but sometimes a lone initial symptom is found to be present. The aim of this study was to identify the prevalence of conjunctivitis as the first symptom in COVID-19 patients in a primary healthcare unit. Methodology: A retrospective study was conducted, analyzing the presenting complains/symptoms and results of COVID-19-confirmatory tests. Results: Out of the 672 cases that were sent for RT-PCR testing, only 121 (18%) were found to be positive. Among these, 2.67% patients had both conjunctivitis and COVID-19, 77.77% patients had unilateral eye affected, while 22.22% had bilateral conjunctivitis of varying degrees. Fifteen patients diagnosed to have both acute conjunctivitis and COVID-19 presented other symptoms associated with COVID-19 infection. Three patients had only acute conjunctivitis during their entire course of COVID-19. Conclusions: Conjunctivitis is a symptom of COVID-19 and may be the first sign of the infection, until the onset of the classical manifestations; such patients may continue to be a viral reservoir. Physicians should not miss unilateral conjunctivitis as it can be the only presenting complaint of COVID-19 during the initial phase, which might worsen if undetected and can aid in the spread of the contagion.

Objectives: Streptococcus pneumoniae is the leading bacterial etiologic agent in acute otitis media (AOM), and it produces a more severe inflammatory response than other otopathogens. Additionally, the presence of multidrug-resistant (MDR) S. pneumoniae is an important issue in the management of AOM. The present pilot study aimed to ascertain whether MDR S. pneumoniae is associated with a higher inflammatory response and/or a more severe disease. Methods: This was a prospective, single-center study on nonpneumococcal conjugate vaccine-immunized pediatric patients with severe AOM. Demographic and clinical characteristics were recorded. Middle ear fluid was obtained and cultured for each patient; antibiotic-resistance profiling was tested for S. pneumoniae isolates. The C-reactive protein (CRP) level and complete blood count were determined. Patients with positive middle ear fluid culture for S. pneumoniae were divided into 2 groups according to antibiotic resistance profile: MDR and non-MDR. Results: MDR S. pneumoniae was identified in 15 (35.7%) of the 42 eligible patients. Children in this group had significantly higher CRP levels (72.23 ± 62.92 vs. 14.96 ± 15.57 mg/L, p < 0.001), higher absolute neutrophil count (8.46 ± 3.97 vs. 5.22 ± 4.5 × 103/mm3, p = 0.004), higher percentage of neutrophils (52.85 ± 13.49% vs. 38.34 ± 16.16%, p = 0.004), and were more prone to develop acute mastoiditis (p = 0.01). Receiver operating characteristic analysis identified CRP as the best biomarker to discriminate between the 2 groups of patients (AUC = 0.891). Conclusion: MDR S. pneumoniae was associated with a more severe inflammatory response and a higher incidence of mastoiditis.

Ovarian cancer (OC) represents the most common and lethal gynecologic malignancy, due to its increased incidence and mortality rate. It is usually diagnosed in advanced stages and, even though surgery and platinum-based treatments are initially efficient, recurrences emerge in over 70% of cases. Although there are multiple options of chemotherapy drugs from which to choose, little is known regarding the best strategy for prolonged survival. Thus, this study aimed to assess the effect that most frequently used chemotherapeutic regimens have upon time-to-treatment-failure (TTF) from the first line and beyond, considering clinical and biological factors which influence the treatment outcome of platinum-resistant recurrent OC. We retrospectively analyzed data from 78 patients diagnosed with platinum-resistant OC, who underwent chemotherapy-based treatment with or without anti-angiogenic therapy at OncoHelp Oncology Center, Romania (January 2016–February 2021). Our study identified positive predictive factors for TTF related to histology (serous carcinoma subtype), anthropometry (age over 60 for patients treated with topotecan with or without bevacizumab), renal function (creatinine levels between 0.65 and 1 mg/dL for patients treated with regimens containing bevacizumab and pegylated liposomal doxorubicin) and treatment choice (bevacizumab in combination with pegylated liposomal doxorubicin or topotecan used from the first line and beyond).

OBJECTIVE: The embolization of thrombi formed within the atria can occur in any form of atrial fibrillation (AF), i.e., paroxysmal, persistent, or permanent. Although ischemic stroke is the most frequent embolic event associated with AF, embolization to other sites in the pulmonary and systemic circulations may occasionally occur. To avert the risk of embolization, long-term oral anticoagulation therapy is recommended for all AF patients if the CHA2DS2-VASC score is at least 1 for men and at least 2 for women. Since anticoagulant therapy is associated with an increased risk of bleeding, the choice of oral anticoagulant agent should be made by careful consideration of the benefit- to-risk ratio. The use of a newer class of direct oral anticoagulants (DOACs) as an alternative to the anti-vitamin K (AVK) anticoagulants (warfarin, acenocumarol, etc.) can help mitigate the need for periodic monitoring of International Normalized Ratio (INR) and adverse bleeding events that are commonly associated with the use of AVK anticoagulants. Though the use of DOACs (dabigatran, rivaroxaban, edoxaban, apixaban, etc.) is gaining ground due to their relative safety profile and the low overall cost, quite a few clinicians remain skeptical about their use. PATIENTS AND METHODS: Our objective was to evaluate the risk of thromboembolism, stroke, neuropsychiatric illness, depression, and dementia, in patients with non-valvular atrial fibrillation who have been treated with either acenocumarol or apixaban, as well as to see the inflammatory status (ESR) and levels of fibrinogen. Our team at Municipal Emergency University Hospital, Timisoara, Romania, conducted a retrospective study using the medical records of AF patients who were treated with either apixaban or acenocumarol between 2016-2019. We divided the patients into two groups and compared the groups for the aforementioned outcomes. RESULTS: AF patients who were prescribed apixaban had a lower rate of stroke and psychiatric illness compared to those on acenocumarol. No significant correlation was found in terms of risk of developing depression or dementia between the groups. CONCLUSIONS: Non-valvular AF patients on apixaban had lower rates of thromboembolic events than the patients on acenocumarol. This article will serve as a reminder of the positive health and financial outcomes of apixaban use, especially to those healthcare systems that are still oblivious to the decrease in economic burden and gain in quality-adjusted life years (QALY) by the long-term use of NOACS/ DOACS instead of the AVK anticoagulants.

Background: Poorly informed college students tend to adopt the habit of cigarette smoking. This habit often continues into their adulthoods, adversely affecting the population’s health and increasing the burden on healthcare systems. Aim: We aimed at exploring the predictors of the avoidable habit of smoking. We performed an analysis of the correlation between the potential predictors (marijuana use among peers and truancy) and the tobacco smoking statuses of the students. Material and method: Our study sample included 2976 students from colleges in Timis County, Romania, during the 2018–2019 period. The gender distribution of the participants was 62.5% girls and 37.5% boys, between the ages 18 and 25 years. A logistic regression test was performed to determine the impact of some personal and environmental factors, which are responsible for heavy smoking in this population. Results: Our findings suggest that the degree of marijuana smoking among friends and the frequency of college truancy are meaningful predictors of heavy smoking among young adults. The students with higher cigarette smoking rates had significantly more marijuana-smoking friends when compared to the students with average smoking rates. The truancy was higher among the students with higher cigarette smoking rates, compared to the students with average smoking rates.

Incidence and clinical results of intraoperative flap and interface-related complications were investigated after Femtosecond-LASIK surgery, where flap creation was performed with VisuMax® femtosecond laser. A retrospective 10-year cohort study was conducted including all eyes treated for all refractive errors by Femtosecond-LASIK technique. All the flaps were made by the same refractive surgeon with the VisuMax® (Carl Zeiss Meditec) femtosecond laser. We report the intraoperative flap and interface-related complications in these eyes, also describing their management. The study included 4,032 eyes. Flap and interface-related complications were: opaque bubble layer (OBL) 21.18%, suction loss 1.29%, difficult docking 0.69%, difficult dissection of the flap 0.59%, bleeding from limbal blood vessels 0.35%, de-epithelialization of the flap 0.12%, and interface debris 0.025%. These situations were appropriately addressed, with favorable outcomes. Flap creation is an important step in LASIK surgery. The predictability and safety have improved since the flap incision is assisted by a femtosecond laser, but complications of the flap and interface can still occur during the flap creation. Refractive surgeons should be aware and properly manage any unusual situation.

Background and objective: Amblyopia is the leading cause of visual impairment in children and adults and is very common during childhood. The aim of this study was to identify the prevalence and the risk factors of amblyopia in a pediatric population with refractive errors from an Eastern European country. Materials and methods: A total of 1231 children aged 5–16 years, who had refractive errors and were examined from January to August 2017, were enrolled in a cross-sectional population-based study. Every child underwent a complete ophthalmological exam. Amblyopia was defined as a visual acuity (VA) of less than 0.63. The study respected the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) criteria for defining amblyopia (MEPEDS, 2008). Parents participated in a face-to-face interview. The questionnaire contained details about their family history of amblyopia; the child’s maternal nutritional status in the preconception period; their history of maternal smoking or work in a toxic environment; the child’s birth, and the child’s history of congenital naso-lacrimal duct obstruction (CNLDO). Results: Amblyopia was identified in 2.8% of the participants. The ocular conditions hyperopia (p = 0.0079), astigmatism (p = 0.046), anisometropia (p < 0.001), esotropia (p < 0.001), exotropia (p = 0.0195), and CNLDO (p < 0.001), as well as a family history of amblyopia (p < 0.001), were associated with amblyopia. The non-ocular risk factors for amblyopia that were found in the study included low birth weight (p < 0.0009), prematurity (p < 0.001), an Apgar score under 7 (p = 0.0008), maternal age, maternal smoking history or work in toxic environment (p < 0.001), and maternal body mass index in the preconception period (p < 0.003). Conclusions: Some of the risk factors we identified for amblyopia are modifiable factors. This is an important observation as an adequate health education program can provide the relevant information for future mothers that will allow for a better management of the condition. We also wanted to highlight the need for amblyopia screening starting from the age of 3 years in case of significant parental refractive errors, strabismus, prematurity, and maternal risk factors.

Abstract Background and aims: Our aim was to evaluate the association between the potential risk factors and the different stages of age-related macular degeneration (AMD) in a population aged 52-85 years. Material and methods: One hundred and ten patients with different stages of AMD were evaluated by direct interview for identifying possible present factors risk and were subjected to a detailed ophthalmological examination, including measurement of the macular area by the Spectral Domain-Optical Coherence Tomograph Heidelberg Engineering (SD-OCT). For the grading of AMD we used the International Classification and Grading System for Age-Related Maculopathy. Results: In our study, diabetes, arterial hypertension, dyslipidemia and smoking were risk factors for AMD. A longer history of diabetes or smoking status was associated with stage 3 or 4 of AMD. We found no statistical significant association between pseudophakia and AMD. Conclusions: Further investigation is needed to identify and to clarify the association between these possible risk factors and AMD.

AbstractBackground and aims: C-reactive protein (CRP) is an inflammatory biomarker that may be associated with diabetic retinopathy (DR). The body mass index (BMI) is an important element, frequently evaluated in patients with diabetes mellitus. The purpose of this study was to determine the relationship between CRP, BMI and existing DR in type 2 diabetes (T2DM) subjects. Material and method: Thirty T2DM patients aged 35-50 were subjected to a general, ophthalmologic and fundus examination. Results: 9 of the 30 patients (30%) didn’t presented changes in the fundus examination. 15 (50%) presented minor retinal changes while 6 (20%) were diagnosed with DR: one case of nonproliferative diabetic retinopathy, 2 cases of preproliferative DR and 3 cases of proliferative DR. In patients with normal fundus examination and minor retinal changes, CRP was positive in the majority of the cases (95.8%). CRP was positive in only one patient in the group with diagnosed DR. BMI was increased in 85.71% of the patients with retinal changes: angiosclerosis or DR and in only 22.22% of the patients without retinal changes. Conclusions: Lower CRP and higher BMI were associated with higher prevalence of DR.