Rozaliya Hristova

Sofia University "St. Kliment Ohridski"

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Yani Zdravkov

Sofia University "St. Kliment Ohridski"

Alexander Oscar

Medical University of Sofia

Ivan Tanev

Doshisha University

Iva Petkova

Medical University of Sofia

Davide Borroni

Riga Stradiņš University

G I Markov

Sofia University "St. Kliment Ohridski"

Carlos Rocha‐de‐Lossada

Universidad de Sevilla

José‐María Sánchez‐González

Universidad de Sevilla

M. Hristova

Beth Israel Deaconess Medical Center

H. Blagoeva

Cooperative Institutions

Medical University of Sofia

Alexandrovska Hospital

Sofia University "St. Kliment Ohridski"

Royal Liverpool University Hospital

University of Liverpool

Ophthalmology Clinic

Veneto Eye Bank Foundation

Medical University of Varna

Hospital Regional Universitario de Málaga

Riga Stradiņš University

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Imaging of proximal lacrimal system with spectral-domain anterior segment optical coherence tomography

Bulgarian Review of Ophthalmology (2023)

E. Yankova Rozaliya Hristova

Introduction: Lacrimal punctum is the entry point for tears to the nasolacrimal duct. In the literature there are few studies on the punctum, due to the lack of consensus regarding the imaging modalities for the proximal lacrimal system. There are currently no routinely used imaging modalities for the proximal lacrimal system. Aim : The aim of this article is to assess the proximal lacrimal system using a novel non-contact method with the use of anterior segment optical coherence tomography. Materials and Methods: This study included 25 right eyes of 25 healthy volunteers. Optical coherence tomography images of the right lower lacrimal puncta were obtained by two operators using SD OCT 3D OCT-2000 FA Plus (Topcon Corporation, Japan) and software version 8.11. The measurements were repeated after 7 days. The inner diameters of the canaliculus and tear meniscus height were measured. IBM SPSS v23 was used for statistical analysis. Results: The mean age of subjects was 24 ± 2.4 years. The study included 10 males and 15 females. The mean punctal diameters at Visit 1 and Visit 2 were 179.08 ± 76.97 µ and 179.64 ± 76.37 µ for investigator 1 (experienced), and 204.72 ± 106.98 µ and 192.32 ± 91.52 µ for the second investigator (inexperienced), respectively. In 20 patients the tear meniscus height in the punctum was measured. The Wilcoxon signed-rank test showed no statistically significant difference between the values of the two investigators (p = 0.106). Linear regression analysis demonstrated excellent correlation between the investigators (p = .000, r = 0.834). Levene’s test of homogeneity showed similar measurement variance between observers (p = 0.424, F = 0.643). Conclusion: Anterior segment optical coherence tomography can be successfully used to visualize the structures of the proximal lacrimal system and provide accurate measurement of the inner diameter of the canaliculus and tear meniscus height in healthy subjects. The method demonstrates excellent repeatability, which does not depend on investigator experience. It could be implemented successfully in future diagnostics of different lacrimal pathologies for objective assessment by imaging technology.

10.14748/bro.v67i2.9171

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Effect of autologous serum after amniotic membrane transplantation for persistent corneal ulcers

International Journal of Ophthalmology (2024)

Rozaliya Hristova Petya Yankova G I Markov Alexander Oscar Yani Zdravkov

To investigate the effect of adding autologous serum eye drops to the postoperative regime after amniotic membrane transplantation for severe persistent corneal ulcers.

10.18240/ijo.2024.09.10

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Vitamin D status in children with myopia

Bulgarian Review of Ophthalmology (2020)

Nevyana Veleva G. Dimtrova Alexander Oscar P. Kemilev O. Mladenov

Introduction. A dramatic increase of myopia worldwide has been observed in recent years. New risk factors for the development of myopia have been the target of numerous investigations. The basis of our research is the correlation between serum levels of vitamin D [25(OH)D] and myopia itself. Purpose: To find out the relationship between serum levels of 25(OH) D and myopia. Patients and methods: The study included 222 children with different refraction status. Full ophthalmologic examination, cycloplegic refraction, echobiometry were performed. The serum levels of 25(OH)D were measured by liquid chromatographic mass spectrometry (level of insufficiency < 80 nmol/L). Results: The average patients’ age (51% boys and 48,2% girls) was 11,7 y (SD ± 3,03). They were subdivided into two groups – children with myopia (84,7%) and those without myopia (15,3%). The mean serum 25(OH)D level of all tested was 61,48 nmol/L (16-140 nmol/L; SD ± 20,15); of myopia – 59,67 nmol/L (16-140 nmol/L; SD ± 19,30) and of the non-myopia group – 71,91 nmol/L (33-111 nmol/L; SD ± 21,79). There was a statistically significant difference in serum levels between the two groups (Р = 0,001). The risk of myopia was higher with the decrease of 25(OH)D values (OR = 1,028 ; 95% CI 1,008-1,048). Conclusion. In our investigation group we established low serum levels of 25(OH)D which indicated the need for conducting a population study of its status among Bulgarian children. The correlation between the higher risk of myopia and the vitamin D scarcity has to be further studied, also considering the factor of outdoor/sun-exposure time.

10.14748/bro.v64i1.6668

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Herpetic Uveitis: An Experience from a Tertiary Referral Center in Bulgaria

Sriwijaya Journal of Ophthalmology (2022)

Gueorgui Markov Rozaliya Hristova Nikolina Andonova Iva Petkova Yani Zdravkov

Introduction: The human Herpesviridae have been described as a leading cause of infectious uveitis. The most common manifestations are keratouveitis and iridocyclitis. The diagnosis is usually made on clinical grounds. The present therapy is based upon the inhibition of viral replication and the use of anti-inflammatory medications. Methods: A descriptive study was conducted on the records of 206 patients with uveitis from the Clinic of Ophthalmology at University Hospital Alexandrovska, Sofia, Bulgaria. The study period was from January 2012 until August 2019. The diagnosis was based on the clinical exam and, when necessary, on specialized testing – PCR on aqueous humor or vitreous material. We used descriptive statistical methods. Results: Out of 206 patients with intraocular inflammation, 46 (22.3%) were diagnosed with herpetic uveitis. Of them, 35 (76.1%) had anterior uveitis, 7 patients (15.2%) had panuveitis, and 4 patients (8.7%) had posterior uveitis. The mean age was 45.3 years. The leading complications were ocular hypertension, corneal leucoma, retinal detachment, and cataract. Antiviral therapy with acyclovir or valaciclovir, alone or with corticosteroids, was used in all groups. Conclusion: The herpesviruses are important causative agents of infectious uveitis. In our study, non-granulomatous, hypertensive anterior uveitis was the most common clinical entity. There were also a few patients with posterior and panuveitis. VZV was the most common etiologic agent. The panuveitis cohort had the worse prognosis for visual acuity, mostly as a result of retinal detachment. The posterior uveitis presented most frequently as focal retinochoroiditis with a good prognosis.

Intermediate uveitis

10.37275/sjo.v6i1.82

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Finegoldia magna and Mucorales molds co-infection in a severe case of SARS-CoV-2 disease

The Journal of Infection in Developing Countries (2023)

Rozaliya Hristova A. Vlahova Maria Christova Konstantin Stamatov Pavel Stanimirov

Rhino-orbito-cerebral mucormycosis has been reported as a sequela after coronavirus disease in immunocompromised patients with poorly controlled diabetes mellitus. Most cases have been identified in India, with only 19 reported elsewhere.We herein report the results of clinical, imaging, microbiological, and histopathological studies in an immunocompetent 67-year-old male with rhino-orbital infection by Finegoldia magna and Mucorales molds following severe SARS-CoV-2 disease associated with new-onset decompensated diabetes mellitus.Microbiological and histological studies confirmed the presence of both Mucorales molds and Finegoldia magna, which was successfully treated with antibiotics and a specific anti-fungal agent (Posaconazole).Careful multidisciplinary follow-up of patients treated for severe SARS-CoV-2 disease is necessary for the timely diagnosis of complications such as uncontrolled diabetes mellitus and opportunistic infections.

Mucorales

Hyporeflexia

Posaconazole

10.3855/jidc.17647

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Valsalva retinopathy - a case presentation.

Meditsinski Pregled / Medical Review (2012)

H. Blagoeva Rozaliya Hristova

Presentation (obstetrics)

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Clinical application of lasers in ophthalmology.

Meditsinski Pregled / Medical Review (2009)

H. Blagoeva Danail Petrov Rozaliya Hristova

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Dynamic correlation between corneal sensitivity and subjective symptoms in patients with Chronic corneal ulcers

Trakia Journal of Sciences (2021)

Rozaliya Hristova Alexander Oscar Stanislava Kostova Iva Petkova Yani Zdravkov

Purpose: This study assessed the correlation between corneal sensitivity and subjective symptoms in patients with chronic corneal ulcers before and after treatment. Methods: Corneal sensitivity was measured with Cochet-Bonnet aesthesiometry in twenty patients with mean age of53 years SD±20.65. Impression cytology was used to assess conjunctivalization, inflammation and keratinization. The epithelial integrity and stromal reaction were determined by anterior segment OCT. Treatment included either conservative measures or surgical ocular surface reconstruction. A questionnaire on subjective symptoms was implemented in order to obtain comparable data about their severity and effect on everyday life. Results: Mean corneal aesthesiometry was 143.03±81.68 mm/grms before treatment and 72.48±72.80 mm/grms on follow-up (p=0.001). An inverse correlation between age and corneal sensitivity was observed before treatment (p=0.002), but not after (p=0.102). Anterior segment OCT on follow-up demonstrated epithelialized corneal surface, reduced stromal reaction and scar tissue preventing further melting. All tested subjective symptoms demonstrated significant change after treatment except driving. Spearman’s analysis demonstrated a correlation between corneal sensitivity and pain (p=0.033), hyperemia (p=0.009) and driving (p=0.043). The change in corneal sensitivity correlated with tearing reduction (p=0.046) and prolonged tolerance to phone use (p=0.044). Conclusions: Cochet-Bonnet aesthesiometry is a useful diagnostic tool for evaluating corneal nerve function and monitoring the effect of treatment.

Corneal ulceration

10.15547/tjs.2021.01.012

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Influence of Corneal Visualization Scheimpflug Technology Tonometry on Intraocular Pressure

Ophthalmology Science (2021)

Davide Borroni Kunal A. Gadhvi Rozaliya Hristova Keri McLean Carlos Rocha‐de‐Lossada

To investigate the effect of Corneal Visualization Scheimpflug Technology tonometry (CST) on intraocular pressure (IOP).Cohort study.Patients with and without primary open-angle glaucoma (POAG) were included.Intraocular pressure was measured using the Icare rebound tonometer (ICRT; Icare Finland Oy) and the biomechanically corrected IOP (bIOP) using the CST. Intraocular pressure was measured at baseline with ICRT, followed by a CST measurement in one eye with the fellow eye acting as a control. Icare measurements were repeated at 10 seconds and 1, 2, 4, 8, 15, 30, and 60 minutes in both eyes. The ratio of test eye IOP to fellow eye IOP was used to control for intrasubject variation.Intraocular pressure change following Corneal Visualization Scheimflug Technology tonometry.Forty participants (mean age, 54.09 ± 20.08 years) were included comprising 20 patients with POAG and 20 patients with no ocular abnormalities other than cataract. Mean central corneal thickness was similar in those without POAG (547.4 ± 55.05 μm) and with POAG (520.22 ± 37.59 μm; P = 0.14). No significant change was found in IOP measured with the ICRT in the fellow eye versus the 1-hour period in either the healthy (P = 0.87) or POAG (P = 0.92) group. Significant changes were found in IOP after CST measurement for both healthy (P < 0.01) and glaucomatous (P < 0.01) eyes. After the CST measurement, the IOP reduced continuously from a mean of 13.75 mmHg to 10.84 mmHg at 4 minutes for healthy eyes and from 13.28 mmHg to 11.11 mmHg at 8 minutes for glaucomatous eyes before approaching (83% for healthy eyes and 92% POAG eyes) the pre-CST measurement at 1 hour.Corneal Visualization Scheimpflug Technology tonometry causes a significant reduction in IOP in both glaucomatous and healthy eyes that lasts for at least 1 hour afterward.

Scheimpflug principle

Corneal pachymetry

10.1016/j.xops.2021.100003

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Transplantation of ex vivo expanded limbal stem cells in neurotrophic keratopathy – a case report

Bulgarian Review of Ophthalmology (2016)

Rozaliya Hristova Yani Zdravkov M. Hristova Ivan Tanev

Представяме клиничен случай на невротрофична кератопатия, асоциирана с унилатерална лимбална стволовоклетъчна инсуфициенция. Извършена бе трансплантация на автоложни ех vivo размножени лимбални стволови клетки. Използваните диагностични методи включват биомикроскопия, микробиологично изследване на секрет от конюнктива и роговична лезия, полимеразно верижна реакция на преднокамерна течност за херпес вирусна ДНК, оптична кохерентна томография на преден очен сегмент. Поради липсата на подобрение след консервативно лечение се проведе минимално инвазивиа лимбална биопсия и трансплантация на амниотична мембрана. Получените автоложни стволови клетки бяха размножени ех vivo по иновативен протокол без ксенобиотични продукти с преносител нативна амниотична мембрана. След получаване на достатъчно епителни слоеве ех vivo, се направи биологично покритие с готовия трансплантат. Постоперативно роговичната повърхност бе напълно епителизирана и зрителната острота се подобри значително. Наблюдава се регрес на неоваскуларните съдове и всички симптоми на хронично възпаление се облекчиха. Трансплантацията на автоложни ех vivo размножени лимбални стволови клетки с преностител амниотична мембрана може да бъде ефективен метод за лечение на невротрофична кератопатия, асоциирана с лимбална стволовоклетъчна инсуфициенция.

Ex vivo

10.14748/bro.v0i4.4557

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