The global pandemic of severe acute respiratory syndrome, COVID-19 affects the world's economics, social and health systems and has a great impact on every person's life. In an attempt to control the spread of the disease, regular usage of face masks became an ordinary routine. A large proportion of the population is reporting ocular symptoms through the period of maskwearing that are still underestimated. Thus the eyes are not only widely exposed to a potential viral invasion but are also under the influence of an additional irritant factor, the face mask usage. The results of our pilot study indicate that the presence and severity of the ocular complaints are dependent on the type of mask and the duration of usage. Now, in the COVID-19 outbreak, the protection of the anterior ocular surface is necessary more than ever to contribute to personal eye health. Based on the concept for the protective role of the tear film and specifically, its lipid layer against the SARS-CoV-2 invasion, all substances sustaining tear film balance and lipid layer thickness could be beneficial in ensuring the local defense mechanisms. Some medications approved for the treatment of dry eye symptoms may have a defensive effect against the viral invasion, which should be additionally evaluated. The topical ophthalmic application of Cyclosporine A, Chloroquine, Azithromycin, Povidone Iodine, Hypertonic saline drops might contribute to local protection and ensure high local dose in minimum systemic effects.

Aim: To determine the diagnostic capabilities of Rarebit perimetry for detection of early functional changes in primary open-angle glaucoma. Methods: A total of 47 eyes divided into two groups: 23 eyes with preperimetric glaucoma (PPG) and a control group of 24 eyes were examined with Rarebit perimetry (RBP) and standard automated perimetry (SAP). To evaluate the differences between the groups were used Kruskal Wallis Test, Mann-Whitney Test and Fisher's Exact Test. The sensitivity and speci city of the RBP for detection of early glaucomatous changes were evaluated by ROC analysis using different algorithms. Results: Average MHR for control and PPG group were respectively: 94.71% (SD 2.58); 87.61% (SD 4.80). Differences in MHR between the groups were statistically signi cant (Mann-Whitney Test, p <0.001). The highest value of AROC (0.849) was achieved when as abnormal was accepted Rarebit test with MHR <90% when comparing healthy eyes to those with PPG. Conclusion: RBP is sensitive method for visual eld defects in preperimetric glaucoma. The test is quick and easy to perform.

Cataract is a multifactorial disease with increasing prevalence with age. Adult diabetics develop cataract earlier. Lens epithelial cells (LECs) exposed to oxidative stress (ROS), increased calcium deposit and membrane damage, undergo apoptosis, which results in lens opacification. Remaining LECs post-surgery leads to posterior capsular opacification (PCO). This study's aim was to investigate the physiological characteristics of LECs from cataractous diabetic and nondiabetic lenses. Leader cells migration from age-related cataracts started on day 5-7 and from type-2 diabetics on day 8-10. Differences were found in the collective migratory activity and colony formation. On day 22, the colonies formed by LECs from age-related cataracts were three times more, than those formed by diabetic LECs. DNA synthesis and FOXM1 expression occurred in 55.76% of age-related cataract LECs, but only in 33.45% of diabetic LECs. The highest level of reactive oxygen species (ROS) was found in diabetic LECs. Extracellular matrix calcification followed the same pattern as ROS. Among the main reasons for the development of age-related and diabetic cataracts is lens damage due to ROS release and elevated calcium levels. Diabetic LECs experience significantly lower in vitro migration and proliferative activities, compared to LECs from age-related cataracts. This is the first study of its kind in Bulgaria, contributing to the elucidation of the mechanisms of primary and secondary cataractogenesis in diabetic and nondiabetic adults.

The hallmark of keratoconus is central or paracentral stromal thinning, accompanied by apical protrusion and irregular astigmatism. Patients typically experience variable reductions in visual acuity, image distortion, and increased sensitivity to glare and light. The latter becomes of major interest when patients with keratoconus present with a cataract which contributes to a further visual decline. PURPOSE: To present a case report of a patient who underwent cataract surgery, with implantation of an intraocular implant called pinhole and correction of an irregular corneal astigmatism as a result of keratoconus. METHODS: A report of a rare case, the first implantation of XtraFocus implant in Bulgaria for the correction of keratoconus combined with cataract. RESULTS: All necessary measurements were performed using an iTrace aberrometer and IOL Master 700. The cataract removal was performed by standard phacoemulsification followed by implantation of a pinhole implant in the capsular bag. No complications related to the position of the implant were observed in the postoperative period. Optimal correction of the distance vision and near vision was achieved, and the results were monitored within six months after surgery. CONCLUSION: The pinhole implant was securely positioned in the capsular bag. Well tolerated by the patient, the implant played a key role in effectively overcoming the irregular corneal astigmatism. There is a significant improvement in visual acuity with results satisfying the patient's high expectations.