Promjene intraokularnog tlaka nakon nekomplicirane fakoemulzifikacije u ranom poslijeoperacijskom razdoblju u zdravim očima

The aim was to determine early changes in intraocular pressure (IOP) following uneventful phacoemulsifi-cation and intraocular lens (IOL) implantation in healthy eyes. This prospective interventional case series study was conducted at Ophthalmology Department, Kragujevac Clinical Centre, Kragujevac, Serbia. The study included 123 eyes of 123 cataract patients, 66 women and 57 men, age range 50-88 (mean 70.73±7.94) years having undergone phacoemulsification and in-the-bag implantation of a foldable IOL. The patients were treated at Kragujevac Clinical Centre between June 2015 and May 2016. IOP was measured by Goldmann applanation tonometry preoperatively, then 4-6 hours, 18-24 hours and 7 days postoperatively by the same examiner. The mean IOP preoperatively was 15.10±2.68 mm Hg. In three patients, maximum measured IOP was 22 mm Hg. At 4-6 hours postoperatively, the mean IOP was 24.29±7.56 mm Hg (p<0.001), at 18-24 hours it was 18.37±4.80 mm Hg (p<0.001), and 7 days after the surgery the mean IOP was 16.24±2.90 mm Hg (p<0.05). The measured IOP values were statistically signif-icant in all measured times. However, at 4-6 hours and 18-24 hours, the mean IOP value was highly statis-tically significant (p<0.001). Although 7 days after the surgery IOP normalized, the mean IOP value was statistically significant (p<0.05). In conclusion, our research showed that even eyes with normal preopera-tive values and uncomplicated phacoemulsification course can show very high IOP values postoperative-ly, which can cause pain, blurred vision and, rarely, compromise visual function.Cilj rada je bio utvrditi rane promjene intraokularnog tlaka (IOT) nakon fakoemulzifikacije i implantacije intraoku-larne leće (IOL) u zdrave oči. Ova prospektivna interventna studija slučaja provedena je na Oftalmološkom odjelu Kliničkog centra Kragujevac u Kragujevcu, Srbija. Studija je obuhvatila 123 oka bolesnika s kataraktom, 66 žena i 57 muškaraca, u dobi od 50-88 (srednja dob 70,73±7,94) godina, koji su bili podvrgnuti fakoemulzifikaciji i implan-taciji IOL u kapsularnu vrećicu. Bolesnici su liječeni u Kliničkom centru Kragujevac između lipnja 2015. i svibnja 2016. godine. IOT je mjeren Goldmannovim aplanacijskim tonometrom prijeoperacijski, a zatim 4-6 sati, 18-24 sata i 7 dana poslijeperacijski, a mjerenja je obavio isti ispitivač. Srednja vrijednost IOT prijeoperacijski je iznosila 15,10±2,68 mm Hg. Kod tri bolesnika najviši izmjereni IOT bio je 22 mm Hg. Kod mjerenja provedenog 4-6 sati poslijeoperacijski srednja vrijednost IOT bila je 24,29±7,56 mm Hg (p<0,001), zatim u 18-24 sata bila je 18,37±4,80 mm Hg (p<0,001), a 7 dana nakon operacije srednja vrijednost IOT bila je 16,24±2,90 mm Hg (p<0,05). Izmjerene vrijednosti IOTbile su statistički značajne u svim vremenima mjerenja. Međutim, u 4-6 sati i 18-24 sata srednja vrijednost IOT bila je visoko statistički značajna (p<0,001). Iako se 7 dana nakon operacije vrijednost IOT normali-zirala, srednja vrijednost je bila statistički značajna (p<0,05). U zaključku, naše istraživanje je pokazalo da čak i oči s normalnim prijeoperacijskim vrijednostima i nekompliciranim tijekom fakoemulzifikacije mogu pokazivati vrlo visoke vrijednosti IOT, što može uzrokovati bol, zamagljen vid i, rijetko, ugroziti vidnu oštrinu

Je li smanjena koncentracija dušikova monoksida nakon intravitrealne injekcije triamcinolon acetonida jedan od razloga porasta očnog tlaka?

Diabetic macular edema is the most common cause of vision loss in patients affected by diabetes mellitus. For eyes with persistent retinal thickening despite anti-VEGF therapy, treatment with intravitreal triamcinolone may be considered, especially in pseudophakic eyes. The aim of this study was to examine aqueous humor nitric oxide concentration changes in pseudophakic eyes with persistent diffuse diabetic macular edema after intravitreal injection of triamcinolone acetonide, as well as the potential impact of these changes on the intraocular pressure values. In 10 pseudophakic eyes with persistent diffuse diabetic macular edema, paracentesis of anterior chamber with aspiration of aqueous humor and nitric oxide concentration measurements were done on the day of the intravitreal application of 20 mg triamcinolone acetonide, and after 1, 3, 6 and 9 months. Also, we were recording intraocular pressure values before the intravitreal triamcinolone acetonide injection and during the next 9 months. One month after the intravitreal triamcinolone acetonide injection, we noticed a decrease of nitric oxide concentration (45.37±5.55 μmol/L) by 31.79% compared to the initial values (66.52±7.66 μmol/L). After that, nitric oxide concentrations began to rise slightly, and at the end of the ninth month the mean nitric oxide concentration was similar to that recorded at the beginning of the study. Intraocular pressure values had increasing trend one month after the intravitreal triamcinolone acetonide injection (23.70±4.08 mm Hg) compared to the initial values (16.21±1.55 mm Hg), but after nine months these values returned to normal levels. Decreased concentration of nitric oxide could be one of the reasons for increased intraocular pressure after intravitreal application of triamcinolone acetonide in the treatment of diffuse diabetic macular edema.Dijabetični edem makule najčešći je uzrok gubitka vida kod bolesnika s dijabetesom melitusom. Za oči s trajnim zadebljanjem mrežnice unatoč anti-VEGF terapiji liječenje intravitrealnim triamcinolonom može se razmotriti, osobito kod pseudofakičnih očiju. Cilj ovog istraživanja bio je ispitati promjene koncentracije dušikova monoksida u očnoj vodici u pseudofakičnim očima s trajnim difuznim dijabetičnim edemom makule nakon intravitrealnog ubrizgavanja triamcinolon acetonida, kao i potencijalni utjecaj tih promjena na vrijednosti očnog tlaka. U 10 pseudofakičnih očiju s ustrajnim difuznim dijabetičnim edemom makule paracenteza prednje očne sobice s aspiracijom očne vodice i mjerenjem koncentracije dušikova monoksida obavljena je na dan intravitrealne primjene 20 mg triamcinolon acetonida te nakon 1, 3, 6 i 9 mjeseci. Također smo bilježili vrijednosti očnog tlaka prije intravitrealnog ubrizgavanja triamcinolon acetonida i tijekom sljedećih 9 mjeseci. Mjesec dana nakon intravitrealnog ubrizgavanja triamcinolon acetonida primijetili smo smanjenje koncentracije dušikova monoksida (45,37±5,55 μmol/L) za 31,79% u odnosu na početne vrijednosti (66,52±7,66 μmol/L). Nakon toga koncentracije dušikova monoksida počele su lagano rasti, a na kraju devetog mjeseca srednja koncentracija dušikova monoksida bila je slična kao i na početku studije. Vrijednosti očnog tlaka imale su trend porasta mjesec dana nakon ubrizgavanja intravitrealnog triamcinolon acetonida (23,70±4,08 mm Hg) u usporedbi s početnim vrijednostima (16,21±1,55 mm Hg), ali nakon devet mjeseci te su se vrijednosti vratile na normalnu razinu. Smanjena koncentracija dušikova monoksida mogla bi biti jedan od razloga povišenog očnog tlaka nakon intravitrealne primjene triamcinolon acetonida u liječenju difuznog dijabetičnog edema makule

Prikaz slučaja bolesnice sa laringealnim granulomom

The aim of this case report is to present the laryngeal granuloma in 23 year old female patient. Case outline: Te 23 year old female was admitted for examination, because of long lasting, progressive hoarseness. In anamnesis, we found that she has undergone general anesthesia for 8 times, in the early childhood. We performing direct laryngoscopy with complete otorhinolaryngologic examination, rigid endovideostroboscopy and the large granuloma of the larynx was found. Conclusions: Laryngeal granuloma of vocal cords affected mainly men, except for cases associated with laryngeal intubation. We should keep in mind that postintubation laryngeal granuloma might develop after tracheal intubation, so care must be taken to avoid the potential complication.Cilj ovog rada je da prikažemo slučaj granuloma larinksa kod bolesnice ženskog pola. Prikaz bolesnika: Bolesnica starosti 23 godine, javila se zbog dugotrajne, promuklosti. U anamnezi ove bolesnice dobijamo podatak da je kod nje, tokom ranog detinjstva 8 puta bila primenjena endotrahealna intubacija. Tokom dijagnostičke evaluacije primenjena je direktna laringoskopija, kompletan otorinolaringološki pregled i rigidnu endovideolaringostroboskopija i uočen je laringealni granulom. Zaključak: Laringealni granulom je benigni izraštaj koji je češći kod osoba muškog pola, osim u slučajevima kod kojih je primenjivana endotrahealna intubacija. Trebalo bi imati u vidu da bi laringealni granulom mogao da se razvije posle primene endotrahealne intubacije, pa treba preduzeti sve mere da bi se izbegla ova potencijalna komplikacija

Congenital upper eyelid coloboma with ipsilateral eyebrow hypoplasia

Introduction. Coloboma is a Greek word, which describes the defect of all layers of the organ, and it can be congenital or as the result of an injury, operation, or some disease. Congenital upper eyelid coloboma is a rare anomaly, with the unknown incidence. The size of the defect is different, but it always involves all layers of the eyelid. This malformation is more frequent at the upper eyelid, and unilaterally, at the junction of the medial two thirds. Sometimes, it can also involve the eye, and may be a component of many syndromes (Goldenhar, Fraser, Manitoba, CHARGE, Cat eye). Case report. We are describing the case of the upper eyelid coloboma with the rare eyebrow anomaly at the three-month old girl, and the result of reconstruction. The baby was treated conservatively with lubricants and overnight patching. Pentagonal excision of the defect was performed in general anesthesia. Three layers of the eyelid were prepared: the skin, muscle and tarsoconjunctival layer. Because of orbicularis muscle malposition, reinsertion and reposition of the muscle fibres were performed. Then, lateral canthotomy was made and the suture of three layers of the eyelid. Catgut suture 7-0 was used for the conjunctiva and muscle. Nylon 6-0 was used for skin suture. Z-plasty was done on the upper part of the pentagonal excision in order to reduce skin tension at the suture line. The operation lasted about 60 minutes and the hospitalization three days. The occlusive dressing was applied for two days. The stitches were removed after seven days. The postoperative swelling of the upper and lower eyelid disappeared in five days. There were no complications in the postoperative period. Conclusion. The main principle of the treatment of eyelid coloboma is surgical reconstruction of all layers of the eyelid, in optimal period, using different surgical methods, which depends on the size of the defect. An early diagnosis is of the greatest importance, as well as the treatment of associated anomalies. Complications of the upper eyelid coloboma depend on the size of the defect, presence of the eye anomalies and the method of reconstruction

Procena težine simptoma alergijskog rinitisa vizuelnom analognom skalom

Objective. To examine the characteristics of patients with allergic rhinitis and assess the severity of symptoms by using a visual analog scale. Methods. A prospective study was carried out among allergic rhinitis patients, who were referred by the primary care physician to the ENT Department of Health Centre Kragujevac. The assessment of severity of symptoms was performed using visual analog scale (overall influence of all nasal or nasal and ocular symptoms, VAS score of 0 'nasal or nasal and ocular symptoms do not bother' to 10 'nasal or nasal and ocular symptoms are extremely bothered') during the first examination. Data was statistically analysed with descriptive statistical methods, t-test, x2 test and logistic regression using by standard statistical software package (SPSS for Windows, version 19.0). Results. Among our respondents there were 34.3% (37/108) males and 65.7% (71/108) females. Average age of all patients was 29 ± 15,1. Average duration of disease in the sample studied was 7,2 ± 16,2 years. The majority of our participants were classified as having moderate to severe persistent allergic rhinitis. Severity of disease has a greater impact on the VAS score of disease duration. Average VAS score of all participants were 6,9±4,2. It was found that the severity of the disease and the presence of ocular symptoms in patients with allergic rhinitis have an impact on the VAS score (p lt 0,0001) while the use of therapy and sensitization to inhalant allergens did not have such impact. Conclusion. Visual analog scale is a simple quantitative method to assess the severity of allergic rhinitis.Cilj. Proceniti težinu simptoma metodom vizuelne analogne skale kod obolelih od alergijskog rinitisa. Metode: Sprovedena je prospektivna studija u kojoj su analizirani oboleli od alergijskog rinitisa, koje su izabrani lekari upućivali na ORL odeljenje specijalističko-konsultativne službe Doma zdravlja 'Kragujevac'. Težina simptoma procenjena je vizuelnom analognom skalom (ukupan uticaj svih nazalnih ili nazalnih i okularnih simptoma, VAS skor od nula - 'nazalni ili nazalni i okularni simptomi uopšte ne smetaju', do 10 - 'nazalni ili nazalni i okularni simptomi izuzetno smetaju') prilikom prvog pregleda. Statistički značajnim smatrane su vrednosti za p lt 0,05. Podaci su statistički obrađeni primenom deskriptivnog metoda, t-testa, X2-testa i logističke regresije standardnim statističkim paketom (SPSS za Windows, verzija 19.0). Rezultati. Među našim ispitanicima bilo je 34,3% (37/108) osoba muškog pola, dok je osoba ženskog pola bilo 65,7% (71/108). Starost svih ispitanika bila je 29 ± 15,1. Prosečna dužina trajanja bolesti u ispitivanom uzorku bila je 7,2 ± 16,2 godine. Najviše ispitanika imalo je umereno do težak perzistentan oblik bolesti. Prosečna vrednost VAS skora za sve ispitanike bila je 6,9 ± 4,2. Primenom logističke regresije ustanovljeno je da težina bolesti ima veći uticaj na VAS skor od trajanja bolesti. Utvrđeno je da težina bolesti i prisustvo okularnih simptoma kod obolelih od alergijskog rinitisa ima veći uticaj na VAS skor (p lt 0,0001), dok primena terapije i senzibilizacija na inhalatorne alergene nema. Zaključak. Vizuelna analogna skala je jednostavan kvantitativan metod za procenu težine alergijskog rinitisa

Proinflammatory and regulatory cytokines in pseudoexfoliation syndroma

Pseudoeksfolijacije (PEH od eng. Pseudoexfoliation) predstavljaju čestu okularnu manifestaciju sistemskog oboljenja i jedan su od vodećih uzrokaa nastanka glaukoma. Pseudoeksfolijativni sindrom je poremećaj organizma koji karakteriše izmenjen sastav ekstracelularnog matriksa sa patološkim nakupljanjem fibrilarnog materijala u intra- i ekstra- ćelijskom tkiva organizma (pluća, jetra, srce, bubreg, žučna kesa, krvni sudovi, moždanice, oko, ekstraokularni mišići). U oku u kome su nastali hemodinamski poremećaji usled nakupljanja pseudoeksfolijacija i poremećaja protoka krvi u krvnim sudovima retine razvija se pseudoeksfolijativni glaukom.Pseudoexfoliation (PEX) is ocular manifestation of the systemic disease and one of themost common cause of glaucoma. PEX syndrome is disorder, characterized with extracellular tissue disorder with abnormal accumulation of fibrilar material in intra and extracellualr tissue of the body (lung, heart, kidney blood vessel , eye, extraocular muscles). PEX can produce hemodinamyc disorder in the eye, as also as in retinal blood vessel, so PEH glaucoma can be developed. Using known contents of the PEX fiber and reachable date of the fibrous tissue production, we explore the production process of the PEX. We measured ascorbic acid and nitric oxide concentrations in the humour aqueousus and sera of thepatients to prove oxidative stress conditions. For explanation of the PEX process production we measured evels of the proinfalmmatory and regulatory cytokines. Aqueous humour level of proinflammatory cytokines TNF-α and IL-17 are increased in patients with early and late stage of PEX syndrome and PEX glaucoma, while IL-6 levels are increased in early stage of PEX syndrome and PEX glaucoma. Serum level of proinflammatory cytokine IL-6 is increased in patients with early and late stage of PEX syndrome. Aqueous humour level of regulatory cytokine TGF-β is increased in early stage of PEX syndrome. Early and late stage of PEX syndrome show increased level of PDGF. PEX glaucomatous patients have increased level of EGF, IL-8, and ITAC; but IGF levels were detected only in PEX glaucoma. Increased TGF-β level activates fibrous tissue production in early stage of PEX syndrome with later activities of PDGF, EGF and IL-8 in late stage of PEX syndrome. Fibrous tissue production is furthermore controlled with IGF, IL-8 and ITAC in PEX glaucoma stage. We used our results to make sheme for potential PEX production process. In the future, it will be interesting to investigate what the locus minoris of this process is, and where it can be interrupted

OCULAR HYPERTENSION - RISK FACTORS AND THERAPY?

Introduction/Aim: The goal of our study was to analyze the epidemiological`s characteristics of ocular hypertension, as well as the influence of chronic risk factors on glaucoma development (conversion in glaucoma). We tried to make some entries for solving this complex ophthalmological problem. Material /Methods: From 2009 to 2015, a retrospective control study was performed on 121 patient with diagnoses of bilateral ocular hypertension and without disease progression/conversion of glaucoma (by standard protocols of diagnosis and basic procedures) on tertiary level at Clinic of Ophthalmology, Clinical Centre of Kragujevac, Serbia.. The authors analyzed epidemiological characteristics: sex, age groups, positive/negative family history and personal history with chronic risk factors (one and/or two) of ocular hypertension. The data obtained from this study were statistically analyzed in SPSS program, version 20.00. Results: As for the patients, 69 of them (57.02%) were male and 52 female (42.98%). Dominant age group was between 40-49 (42.15%) and then group between 50-59 (40.50%) years of age. Anamnesis data indicated the absence of family anamnesis 71 (58.68%). Risk factors for ocular hypertension were presented in 103 (85.13%) patients, 18 of them (14.87%) did not respond. One risk factor - cardiovascular disease was noted in 83 (68.59%), with two risk factors - cardiovascular diseases and diabetes mellitus in 20 patients (16.53%) and with PEX syndroma at other respondents. Conclusion: Ocular hypertension is not a common disease, but with risk factors, such as older age, positive family history, and chronic risk factors syndicated, represents a serious clinical and social problem, so the question remains for ophthalmologists - pro or against therapy? Those in favor of therapy would state the safety and protection from conversion/progression of glaucoma; but those  against therapy would only mention adequate monitoring of patients

Parasitic eye infection by Ascaris lumbricoides: Case report

The parasitic infection is an affection of the body as well as the eye with parasites, protozoa's, worms and ectoparasites, with world incidence of 30%. These diseases are chronic, systemic diseases because of weak innate immunity and ability of parasites to evade immune answer of the host or increasing the resistance to the adaptive immunity of the host. Parasites can evade immunity of the host by: antigens variations, forming cysts, changing the hosts and by synthesis of some cytokines, which decrease immunity of the host. Ascaris lumbricoides is the largest intestinal nematode parasitizing man. The worm is known to cause subconjunctival mass, granulomatous iridocyclitis, choroiditis, recurrent vitreous hemorrhage, chronic dacryocystitis and invasion into the subretinal space. The goal of this case was to analyze the affection of the eye, caused by the Ascaris lumbricoides as very rare ocular pathology

The relationship between perifoveal capillary ring alterations and visual acuity in diabetic retinopathy

Background/Aim. The relationship between the foveal avascular zone (FAV) and visual acuity (VA) in retinal dis-eases remains a matter of discussion. The aim of this study was to determine the impact of diabetic macular ischemia (DMI) on VA through the analysis of the perifoveal capillary network in various stages of diabetic retinopathy - DR (non-proliferative diabetic retinopathy – NPDR and proliferative diabetic retinopathy – PDR). Methods. Qualitative and quantitative analysis of 143 angiograms of patients with different stages of DR was performed. The degree of macular ischemia was assessed by the analysis of 2 parameters: perifoveal capillary ring, ie, the FAZ outline irregularity, and capillary loss. Finally, a comparison was made between the degree of macular ischemia with the best-corrected VA, depending on macular thickness. Results. In the eyes with mild and moderate NPDR, without significant macular thickening, no statistically significant decrease in VA caused by macular ischemia was noticed (p = 0.81). Opposite, in a subgroup with severe NPDR and PDR, without significant macular thickening, a statistically significant difference was presented among eyes with moderate and severe macular ischemia compared to eyes with lower grades of macular ischemia (p = 0.021 and p = 0.018, respectively). In the eyes with moderate NPDR and mild macular ischemia, the increase in macular thickness resulted in a statistically insignificant decrease in VA compared to eyes with a normal macular thickness (p = 0.088). However, in the eyes with severe NPDR, every pathological increase in macular thickness caused a statistically significant decrease in VA, regardless of the degree of macular ischemia (p = 0.018–0.040). A similar relationship was also found in the eyes with PDR (p = 0.017–0.042). In the eyes with a statistically significant decrease in VA, most of the examined eyes (98%) had the FAZ outline irregularity in the nasal perifoveal subfield. Conclusion. In the absence of significant macular thickening, the destruction of one-half of the perifoveal capillary network, or greater, is associated with reduced VA. The location of macular ischemic changes in the nasal parts of the perifoveal capillary ring plays a crucial role in its effects on visual function

Učinak primarne argon laserske trabekuloplastike na sniženje intraokularnog tlaka i kvalitetu života u bolesnika s pseudoeksfolijacijskim glaukomom

The aim of the study was to assess the impact of primary argon laser trabeculoplasty (ALT) on intraocular pressure (IOP) lowering and quality of life improvement in patients with pseudoexfoliative glaucoma. Sixty patients with newly diagnosed pseudoexfoliative glaucoma who underwent primary ALT (group 2) or medication therapy (group 1) were followed-up. The effect of ALT on IOP reduction, dry eye development and number of antiglaucoma drugs used was examined. Patients were examined at the beginning of the study and then after 6, 12, and 18 months. A statistically significant difference between IOP values was observed throughout the 18-month follow-up, with the highest significance recorded 6 months after ALT (p=0.009). Twelve months after the start of the study, the TBUT value was 6.0±0.8 s in group 1 and 8.4±0.7 s in group 2. In group 2, the value of Schirmer test was constantly above 10 millimeters. The number of antiglaucoma medications used in group 1 was statistically significantly higher as compared to group 2 throughout the 18-month study period. ALT was found to be better choice for temporary regulation of IOP in patients with pseudoexfoliative glaucoma.Cilj studije bio je utvrditi utjecaj primarne argon laserske trabekuloplastike (ALT) na snižavanje intraokularnog tlaka (IOP) i poboljšanje kvalitete života bolesnika s pseudoeksfolijacijskim glaukomom. Praćeno je šezdeset bolesnika s novodijagnosticiranim pseudoeksfolijacijskim glaukomom koji su bili podvrgnuti primarnom ALT-u ili antiglaukomskim lijekovima. Ispitan je utjecaj ALT-a na sniženje IOP-a, razvoj suhog oka i broj korištenih antiglaukomskih lijekova. Bolesnici su pregledani na početku ispitivanja, a zatim nakon 6, 12 i 18 mjeseci. Statistički značajna razlika između vrijednosti IOP-a uočena je tijekom svih 18 mjeseci praćenja, a najveća značajnost 6 mjeseci nakon ALT-a (p=0,009). Dvanaest mjeseci nakon početka ispitivanja vrijednost TBUT bila je 6,0±0,8 s u 1. skupini i 8,4±0,7 s u 2. skupini. Vrijednost Schirmerova testa u 2. skupini bila je stalno iznad 10 milimetara. Broj antiglaukomskih lijekova korištenih u 1. skupini bio je statistički značajno veći u usporedbi s 2. skupinom tijekom svih 18 mjeseci. ALT je bio bolji izbor u privremenoj regulaciji IOP-a u bolesnika s pseudoeksfolijacijskim glaukomom