Specific characteristics of ocular biometric factors in glaucomatous patients with pseudoexfoliative syndrome as measured by optical low-coherence reflectometry

Cilj istraživanja: Primjenom optičke niskokoherentne reflektometrije utvrditi razliku biometrijskih čimbenika oka između promatranih skupina (skupine sa pseudoeksfolijativnim sindromom i kataraktom, skupine sa pseudoeksfolijativnim glaukomom i kataraktom, skupine s primarnim glaukomom otvorenog kuta i kataraktom i skupine s kataraktom ) i odrediti biometrijske čimbenike oka specifične za skupinu glaukomskih bolesnika sa pseudoeksfolijativnim sindromom. Nacrt studije: Retrospektivna, opažajna studija. Ispitanici i metode: U studiju je bilo uključeno 136 ispitanika starijih od 40 godina, neovisno o spolu. predviđenih za operaciju katarakte u Klinici za očne bolesti Kliničke bolnice „Sv Duh „ u Zagrebu. Uzorak je činilo 205 očiju podijeljenih u četiri grupe prema dijagnozi; 44 oka s PEX sindromom i kataraktom, 62 oka s POAG i kataraktom, 45 očiju s PEX glaukomom i kataraktom i 54 oka s kataraktom Detaljnom analizom medicinske dokumentacije ispitanika prikupljeni su i analizirani podaci biometrijskih mjerenja (CCT, PD, ACD, LT, AL, RT, K1,K2, AST, WTW) izmjereni primjenom optičke niskokoherentne reflektometrije na uređaju Lenstar LS 900® (Haag Streit International, Kӧniz, Switzerland). Rezultati: Skupina očiju PEX/GLA/KAT imala je statistički značajno tanju centralnu debljinu rožnice (CCT) od skupine očiju PEXSY/KAT prosječne vrijednosti 530,05±39,16µm naspram 560,84±42,52 µm ( Tukey post hoc test p=0,001). Skupina PEX/GLA/KAT imala je značajno manji promjer zjeničnog otvora (PD) od skupine PEXSY/KAT. (χ²=11,516 df=3 p=0,0092). Skupina PEX/GLA/KAT pokazuje značajno niže vrijednosti zakrivljenosti rožnice K1 u odnosu na kontrolnu KAT skupinu (Test razlike medijana parova p=3,052). U skupinama PEX SY/KAT i PEX/GLA/KAT otkrivamo značajno više vrijednosti WTW u odnosu na kontrolnu KAT skupinu, pri čemu skupina PEX/GLA/KAT ima značajno manje vrijednosti WTW od skupine PEXSY/KAT (Mann Whitney U test p>0,05, egzaktni p=0,023). Testiranjem razlika prema AST čimbeniku otkrivamo da skupina očiju s PEX promjenama s i bez glaukoma ima statistički značajno veći astigmatizam (AST) od kontrolne skupine KAT. (χ²= 10,931 df = 3 p =0,0121). Zaključak: Primjenom optičke niskokoherentne reflektometrije uočili smo razlike biometrijskih čimbenika među promatranim skupinama i definirali neka odstupanja biometrijskih čimbenika u očima s pseudoeksfolijativnim glaukomom. U skupini PEX/GLA/KAT ustanovili smo značajno tanju CCT u odnosu na skupinu PEXSY/KAT. Nadalje, ustanovili smo manju zakrivljenost rožnice po manje strmom meridijanu K1 u skupinama PEX s i bez glaukoma u odnosu na kontrolnu skupinu KAT. U rezultatima našeg istraživanja uočili smo statistički značajno veći WTW i veći AST u skupinama PEX s i bez glaukoma u odnosu na kontrolnu skupinu KAT. Usporedbom svih ispitivanih skupina utvrđene razlike za AL, AD, LT, K2, LP i RLP nisu postigle statističku značajnost. Rezultati našeg istraživanja ukazuju da optička niskokoherentna reflektometrija može imati ulogu u dijagnostici pseudoeksfolijativnog glaukoma i doprinose poticanju znanstvenih ideja o novim metodama dijagnostike specifičnosti biometrijskih čimbenika oka u glaukomskih bolesnika sa pseudoeksfolijativnim sindromom.The aim of the study: The aim of the study was to assess biometric factor aberrations and differences among groups of eyes with pseudoexfoliative syndrome and cataract, pseudoexfoliative glaucoma and cataract, primary open-angle glaucoma and cataract, and with cataract and as well as determine biometric factors of the eye specific for the group of glaucomatous patients with pseudoexfoliative syndrome by use of optical low- coherence reflectometry. Study design: Retrospective, observational study. Subjects and methods: This study included 136 patients , older than 40 years, regardless of sex . The study included 205 eyes divided into the following four groups according to diagnosis: 44 eyes with pseudoexfoliative syndrome and cataract; 62 eyes with POAG and cataract; 45 eyes with pseudoexfoliative glaucoma and cataract and 54 eyes with cataract. Data on biometric measurements (AL, ACD, K1, K2, AST, LT, CCT, RT, PD and WTW).) obtained by use of optical low-coherence reflectometry on a Lenstar LS 900® (Haag-Streit International, Kӧniz,Switzerland). Data were collected and analyzed by thorough survey of medical documentation of patients scheduled for cataract surgery at Clinical Department of Ophthalmology, “Sveti Duh” , University Hospital in Zagreb, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia. Results: The PEX/GLA/KAT eye group had statistically significantly thinner CCT than PEXSY/KAT eye group 530.05 ± 39.16μm vs 560.84 ± 42.52 μm, (Tukey post hoc test p = 0.001). Eye groups with PEXSY/KAT and PEX/GLA/KAT showed statistically significantly lower values of the corneal curvature of the less steep meridian (K1) than the control KAT group (p = 2.826 and p = 3.052). From the results we can see differences in PD between the groups PEXSY/KAT and PEX/GLA/KAT, where the PEX/GLA/KAT group had a significantly smaller pupillary diameter (PD) than the PEXSY/KAT group ((χ² = 11,516 df = 3 p = 0.0092). PEX SY/KAT and PEX/GLA/KAT groups had significantly higher values of WTW than the control KAT group. PEX/GLA/KAT group has significantly lower values of WTW than the PEXSY/KAT group. (Mann Whitney U test; p> 0.05, exact p = 0.023). By testing the difference to the AST factor, we find that PEX/GLA/KAT I PEXSY/KAT groups had statistically significantly higher astigmatism (AST) than the control KAT group (χ² = 10,931 df = 3 p = 0.0121). Conclusion: Using Optical low-coherence reflectometry, we proved some deviations of biometric factors in the eyes with pseudoexfoliative glaucoma. In the PEX/GLA/KAT group we found a significantly thinner CCT relative to the PEXSY/KAT group. Furthermore, we found a smaller corneal curvature at a less steep meridian K1 in PEX with and without glaucoma compared to the KAT control group. In the results of our study, we observed statistically significant higher WTW and higher AST in PEX with and without glaucoma compared to KAT control group.. By comparison of all the investigated groups found differences for AL, AD, LT, K2, LP and RLP did not achieve statistical significance. The results of our research indicate that optical low-coherence reflectometry can play an role in the diagnosis of pseudoexfoliative glaucoma and contributes to the stimulation of scientific ideas on new diagnostic methods of specific biometric factors in glaucoma patients with pseudoexfoliative glaucoma

Giant Aneurysm of Basilar Artery

In the article we showed the patient, a woman with unruptured giant aneurysm of basilar artery, we showed the done examinations, and therapy dilemmas about what to do in the given case. We found in literature a number of examples which suggest operation treatment, but of embolisation too, some suggest conservative treatment

Head Trauma and Posttraumatic Epilepsy in Slavonski Brod, East Croatia, 1988-2008

Posttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients after head trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma different severity in period from 1989. to 2008., which we werified radiological, electroenfephalographic, and psychical changes were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3 in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptic therapy (AETh), 30 patients were seizure free, 10 patients had 1-2 epileptic seizure monthly (EPA/CPA), 10 patients got prophylactic AETh in period 6-12 months. 14 patients developed psychical changes which were verified by psychiatrist. The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remission is more difficult in case psychiatric comorbidity

Head Trauma and Posttraumatic Epilepsy in Slavonski Brod, East Croatia, 1988-2008

Posttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients after head trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma different severity in period from 1989. to 2008., which we werified radiological, electroenfephalographic, and psychical changes were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3 in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptic therapy (AETh), 30 patients were seizure free, 10 patients had 1-2 epileptic seizure monthly (EPA/CPA), 10 patients got prophylactic AETh in period 6-12 months. 14 patients developed psychical changes which were verified by psychiatrist. The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remission is more difficult in case psychiatric comorbidity

Specifičnosti biometrijskih čimbenika oka u glaukomskih bolesnika s pseudoeksfolijativnim sindromom mjerenih optičkom niskokoherentnom reflektometrijom

The aim of the study was to assess biometric factor aberrations and differences among groups of eyes with cataract and pseudoexfoliative syndrome, cataract and pseudoexfoliative glaucoma, and cataract and primary open-angle glaucoma (POAG), and to determine biometric factors of the eye specific for the group of glaucomatous patients with pseudoexfoliative syndrome by use of optical low-coherence reflectometry. This retrospective study included 72 patients, and the study sample of 102 eyes was divided into the following three groups according to diagnosis: 29 eyes with pseudoexfoliative syndrome and cataract; 36 eyes with POAG and cataract; and 37 eyes with pseudoexfoliative glaucoma and cataract. Data on biometric measurements (central corneal thickness, pupillary diameter, anterior chamber depth, lens thickness, axial length, retinal thickness, astigmatism and white-to-white) obtained by use of optical low-coherence reflectometry on a Lenstar LS 900® (Haag-Streit International) were collected and analyzed by thorough survey of medical documentation of patients scheduled for cataract surgery at Department of Ophthalmology, Sveti Duh University Hospital in Zagreb, Croatia. Comparative analysis of the groups yielded statistically significant differences in central corneal thickness (F2/99=7.066; p=0.001) and lens thickness (F2/96=5.133; p=0.008). The group of eyes diagnosed with pseudoexfoliative glaucoma and cataract had a significantly thinner cornea as compared with the other two groups and a significantly thicker lens as compared with the group of eyes with POAG and cataract. In conclusion, optical low-coherence reflectometry revealed differences in biometric factors among the three groups of eyes, with a statistically significantly thinner cornea and thicker lens in the group of glaucomatous patients with pseudoexfoliative syndrome.Cilj je bio optičkom niskokoherentnom reflektometrijom utvrditi odstupanja i razlike biometrijskih čimbenika između skupina ispitivanih uzoraka očiju s kataraktom i pseudoeksfolijativnim sindromom, kataraktom i pseudoeksfolijativnim glaukomom i kataraktom i primarnim glaukomom otvorenog kuta te odrediti biometrijske čimbenike oka specifične za skupinu glaukomskih bolesnika s pseudoeksfolijativnim sindromom. U retrospektivnu studiju bilo je uključeno 72 ispitanika, a uzorak su činila 102 oka podijeljena u tri skupine prema dijagnozi: 29 očiju s pseudoeksfolijativnim sindromom i kataraktom, 36 očiju s primarnim glaukomom otvorenog kuta i kataraktom, 37 očiju s pseudoeksfolijativnim glaukomom i kataraktom. Detaljnom analizom medicinske dokumentacije ispitanika predviđenih za operaciju katarakte u Klinici za očne bolesti Kliničke bolnice Sveti Duh u Zagrebu prikupljeni su i analizirani podaci biometrijskih mjerenja (centralna debljina rožnice, promjer zjenice, dubina prednje sobice, debljina leće, aksijalna duljina, debljina rožnice, astigmatizam i horizontalni promjer rožnice izmjereni primjenom optičke niskokoherentne reflektometrije na uređaju Lenstar LS 900®, Haag Streit International). Usporednom analizom skupina zabilježene su statistički značajne razlike za centralnu debljinu rožnice (F2/99=7,066; p=0,001) i debljinu leće (F2/96=5,133; p=0,008). Skupina očiju s dijagnozom pseudoeksfolijativnog glaukoma i katarakte imala je značajno tanju rožnicu u odnosu na ostale dvije skupine očiju i značajno deblju leću od skupine s primarnim glaukomom otvorenog kuta i kataraktom. U zaključku, primjenom optičke niskokoherentne reflektometrije utvrđene su razlike u biometrijskim čimbenicima promatranih skupina i statistički značajno tanja rožnica te zadebljana leća u skupini glaukomskih bolesnika s pseudoeksfolijativnim sindromom

THE FIRST CASE OF OCULAR THELAZIASIS IN CROATIA

Prikazujemo slučaj okularne infekcije uzrokovane telazijom u 82-godišnjeg bolesnika. Infekcija pripada skupini zoonoza, a uzrokovana je parazitom (nematodom) iz porodice Thelaziide. Opisane su dvije vrste telazija koje uzrokuju infekciju u ljudi: Thelazia callipaeda i Thelazija californiensis. Prenosi se sa životinja, najčešće psa, na čovjeka putem muha iz porodice Drosophilidae. Bolesnik se javlja u hitnu oftalmološku ambulantu zbog bolova i svrbeža u lijevom oku koji traju već nekoliko dana. Prigodom prvog pregleda ustanovljeno je jako crvenilo konjunktive i cilijarnog područja, te veliki kornealni apsces pozitivan na fl uorescenski test bez vidljivih struktura u pozadini. Pregledom vanjskog konjunktivalnog kuta, pod vjeđom, uoči se pokretna, crvolika forma. Tijekom pregleda, uz lokalnu anesteziju tetrakainom, ukupno je odstranjeno sedam sitnih, mliječno bijelih crva različitih veličina i faze razvoja. Nakon kirurške ekstirpacije parazita, učini se mikrobiološka identifi kacija i utvrdi dijagnoza telazioze.The fi rst case of ocular thelaziasis in a human male patient in Croatia is presented. Thelaziasis is a zoonosis caused by nematodes of the genus Thelazia, parasites of the conjunctival bags or tear ducts of mammals and birds. Two types of the genus Thelazia (T.) have been described as causes of infection in humans, T. callipaeda and T. californiensis. To date, less than 300 thelaziasis cases in humans have been reported. This zoonosis is very rare in humans in European countries, with a high incidence in Asian countries, especially in China, Thailand and Japan. Because of the high prevalence of the parasites in the Far East, T. callipaeda is called ‘Oriental eye worm’. The fi rst case of thelaziasis in Europe was described in 2008 in Italy and France, where cases in animals had already been reported. Seasonal occurrence of thelaziasis in Europe depends on the presence of the vector, fruit fl ies of Drosophilidae family, Phortica variegate as the most common type. Adult worm is milky white, females grow to 20 mm and males up to 12 mm. Dogs and cats are the most common sources of infection for humans, which occurs as unilateral ocular infection. The clinical picture of infection is similar to bacterial and allergic conjunctivitis with tearing and foreign body sensation. After removal of worms, clinical signs quickly disappear and there is no need for anthelmintic treatment. In the treatment of secondary infections, local antibiotics and corticosteroids can be applied. The 82-year-old male patient presented to outpatient ophthalmology clinic for occasional sensation of pain, itching, redness and tearing in his left eye during the last few days. His left eye was blind due to previous retinal detachment and had severe conjunctival and ciliary infection with large corneal abscess. Worm-like movement in the lateral canthus was observed. After topical anesthesia, seven worms were removed. Upon surgical extirpation of the parasite, the diagnosis of thelaziasis was verifi ed by microbiological identifi cation. Only two cases of Thelazia in dogs were reported in Croatia, in December 2013 and January 2014. It is important to bear in mind this cause of eye infections, especially when caused by larval stages that are diffi cult to identify. Untimely diagnosis and inadequate treatment lead to extended illness and complications. The appearance of this parasite in Croatian patients suggests the need for inclusion of the pathogen in the differential diagnosis of bacterial or allergic conjunctivitis

Specific characteristics of ocular biometric factors in glaucomatous patients with pseudoexfoliative syndrome as measured by optical low-coherence reflectometry

Cilj istraživanja: Primjenom optičke niskokoherentne reflektometrije utvrditi razliku biometrijskih čimbenika oka između promatranih skupina (skupine sa pseudoeksfolijativnim sindromom i kataraktom, skupine sa pseudoeksfolijativnim glaukomom i kataraktom, skupine s primarnim glaukomom otvorenog kuta i kataraktom i skupine s kataraktom ) i odrediti biometrijske čimbenike oka specifične za skupinu glaukomskih bolesnika sa pseudoeksfolijativnim sindromom. Nacrt studije: Retrospektivna, opažajna studija. Ispitanici i metode: U studiju je bilo uključeno 136 ispitanika starijih od 40 godina, neovisno o spolu. predviđenih za operaciju katarakte u Klinici za očne bolesti Kliničke bolnice „Sv Duh „ u Zagrebu. Uzorak je činilo 205 očiju podijeljenih u četiri grupe prema dijagnozi; 44 oka s PEX sindromom i kataraktom, 62 oka s POAG i kataraktom, 45 očiju s PEX glaukomom i kataraktom i 54 oka s kataraktom Detaljnom analizom medicinske dokumentacije ispitanika prikupljeni su i analizirani podaci biometrijskih mjerenja (CCT, PD, ACD, LT, AL, RT, K1,K2, AST, WTW) izmjereni primjenom optičke niskokoherentne reflektometrije na uređaju Lenstar LS 900® (Haag Streit International, Kӧniz, Switzerland). Rezultati: Skupina očiju PEX/GLA/KAT imala je statistički značajno tanju centralnu debljinu rožnice (CCT) od skupine očiju PEXSY/KAT prosječne vrijednosti 530,05±39,16µm naspram 560,84±42,52 µm ( Tukey post hoc test p=0,001). Skupina PEX/GLA/KAT imala je značajno manji promjer zjeničnog otvora (PD) od skupine PEXSY/KAT. (χ²=11,516 df=3 p=0,0092). Skupina PEX/GLA/KAT pokazuje značajno niže vrijednosti zakrivljenosti rožnice K1 u odnosu na kontrolnu KAT skupinu (Test razlike medijana parova p=3,052). U skupinama PEX SY/KAT i PEX/GLA/KAT otkrivamo značajno više vrijednosti WTW u odnosu na kontrolnu KAT skupinu, pri čemu skupina PEX/GLA/KAT ima značajno manje vrijednosti WTW od skupine PEXSY/KAT (Mann Whitney U test p>0,05, egzaktni p=0,023). Testiranjem razlika prema AST čimbeniku otkrivamo da skupina očiju s PEX promjenama s i bez glaukoma ima statistički značajno veći astigmatizam (AST) od kontrolne skupine KAT. (χ²= 10,931 df = 3 p =0,0121). Zaključak: Primjenom optičke niskokoherentne reflektometrije uočili smo razlike biometrijskih čimbenika među promatranim skupinama i definirali neka odstupanja biometrijskih čimbenika u očima s pseudoeksfolijativnim glaukomom. U skupini PEX/GLA/KAT ustanovili smo značajno tanju CCT u odnosu na skupinu PEXSY/KAT. Nadalje, ustanovili smo manju zakrivljenost rožnice po manje strmom meridijanu K1 u skupinama PEX s i bez glaukoma u odnosu na kontrolnu skupinu KAT. U rezultatima našeg istraživanja uočili smo statistički značajno veći WTW i veći AST u skupinama PEX s i bez glaukoma u odnosu na kontrolnu skupinu KAT. Usporedbom svih ispitivanih skupina utvrđene razlike za AL, AD, LT, K2, LP i RLP nisu postigle statističku značajnost. Rezultati našeg istraživanja ukazuju da optička niskokoherentna reflektometrija može imati ulogu u dijagnostici pseudoeksfolijativnog glaukoma i doprinose poticanju znanstvenih ideja o novim metodama dijagnostike specifičnosti biometrijskih čimbenika oka u glaukomskih bolesnika sa pseudoeksfolijativnim sindromom.The aim of the study: The aim of the study was to assess biometric factor aberrations and differences among groups of eyes with pseudoexfoliative syndrome and cataract, pseudoexfoliative glaucoma and cataract, primary open-angle glaucoma and cataract, and with cataract and as well as determine biometric factors of the eye specific for the group of glaucomatous patients with pseudoexfoliative syndrome by use of optical low- coherence reflectometry. Study design: Retrospective, observational study. Subjects and methods: This study included 136 patients , older than 40 years, regardless of sex . The study included 205 eyes divided into the following four groups according to diagnosis: 44 eyes with pseudoexfoliative syndrome and cataract; 62 eyes with POAG and cataract; 45 eyes with pseudoexfoliative glaucoma and cataract and 54 eyes with cataract. Data on biometric measurements (AL, ACD, K1, K2, AST, LT, CCT, RT, PD and WTW).) obtained by use of optical low-coherence reflectometry on a Lenstar LS 900® (Haag-Streit International, Kӧniz,Switzerland). Data were collected and analyzed by thorough survey of medical documentation of patients scheduled for cataract surgery at Clinical Department of Ophthalmology, “Sveti Duh” , University Hospital in Zagreb, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia. Results: The PEX/GLA/KAT eye group had statistically significantly thinner CCT than PEXSY/KAT eye group 530.05 ± 39.16μm vs 560.84 ± 42.52 μm, (Tukey post hoc test p = 0.001). Eye groups with PEXSY/KAT and PEX/GLA/KAT showed statistically significantly lower values of the corneal curvature of the less steep meridian (K1) than the control KAT group (p = 2.826 and p = 3.052). From the results we can see differences in PD between the groups PEXSY/KAT and PEX/GLA/KAT, where the PEX/GLA/KAT group had a significantly smaller pupillary diameter (PD) than the PEXSY/KAT group ((χ² = 11,516 df = 3 p = 0.0092). PEX SY/KAT and PEX/GLA/KAT groups had significantly higher values of WTW than the control KAT group. PEX/GLA/KAT group has significantly lower values of WTW than the PEXSY/KAT group. (Mann Whitney U test; p> 0.05, exact p = 0.023). By testing the difference to the AST factor, we find that PEX/GLA/KAT I PEXSY/KAT groups had statistically significantly higher astigmatism (AST) than the control KAT group (χ² = 10,931 df = 3 p = 0.0121). Conclusion: Using Optical low-coherence reflectometry, we proved some deviations of biometric factors in the eyes with pseudoexfoliative glaucoma. In the PEX/GLA/KAT group we found a significantly thinner CCT relative to the PEXSY/KAT group. Furthermore, we found a smaller corneal curvature at a less steep meridian K1 in PEX with and without glaucoma compared to the KAT control group. In the results of our study, we observed statistically significant higher WTW and higher AST in PEX with and without glaucoma compared to KAT control group.. By comparison of all the investigated groups found differences for AL, AD, LT, K2, LP and RLP did not achieve statistical significance. The results of our research indicate that optical low-coherence reflectometry can play an role in the diagnosis of pseudoexfoliative glaucoma and contributes to the stimulation of scientific ideas on new diagnostic methods of specific biometric factors in glaucoma patients with pseudoexfoliative glaucoma