ASSOCIATION OF SERUM VITAMIN D CONCENTRATION AND GLAUCOMATOUS OPTIC NEUROPATHY IN WOMEN

Cilj istraživanja: Ovim istraživanjem smo ispitivali je li kod ispitanica oboljelih od glaukoma i okularne hipertenzije snižena serumska koncentracija vitamina D uslijed povišene koncentracije nitrita. Uspoređivali smo povezanost kliničkih parametara sa serumskom razinom vitamina D, kako bismo zaključili o povezanosti vitamina D i glaukomske optičke neuropatije. Hipovitaminoza D dovodi do manje inibicije NOS-a, tj. povećane aktivnosti sintetaze dušikovog oksida (NOS), veće produkcije NO i veće peroksinitritne toksičnosti. Dušikov oksid uzrokuje porast oslobađanja glutamata i neuronalnu toksičnost, što je jedan od uzroka nastanka glaukomske optičke neuropatije. Na ovoj patofiziološkoj povezanosti temelji se i naša hipoteza. Prisutnost vitamin D receptora je dokazana u mnogim strukturama ljudskog oka. Ukoliko postoji suficijentna koncentracija vitamina D, moguće je njegovo imunomodulatorno djelovanje. Nacrt studije: Opažajno presječno istraživanje s kontrolnom skupinom. Ispitanici i metode: U istraživanje je uključeno 90 ispitanica oboljelih od glaukoma u dobi od 45 do 55 godine starosti. U kontrolnu skupinu je uključeno 50 ispitanica iste dobne skupine. Ispitanicama smo uzeli oftalmološki status, izmjerili serumsku koncentraciju vitamina D i nitrita. Rezultati: Intraokularni tlak lijevoga oka je statistički značajno viši u oboljelih u odnosu na kontrolne ispitanice (t-test= -2,617, p=0,01). Prosječan c/d omjer kod oboljelih ispitanica je bio statistički značajan u odnosu na kontrolnu skupinu (t-test=-9,257; p<0,001). Postojala je statistički značajna razlika između oboljelih i kontrolnih ispitanica u vrijednosti MD indeksa lijevoga (t-test=2,693, p=0,008) i desnoga oka (t-test=3,006; p=0,003). Ispitanice oboljele od glaukoma imale su prosječnu koncentraciju vitamina D 40,6 nmol/L, a ispitanice u kontrolnoj skupini 50,43 nmol/L. Ova razlika bila je statistički značajna (t-test= 2,188; p= 0,031), odnosno ispitanice koje nisu imale glaukom su imale u prosjeku višu razinu vitamina D. Deficit vitamina D približno je izražen u obje ispitivane skupine. Normalna koncentracija vitamina D prisutna u 40% kontrolnih nasuprot 27,8% oboljelih ispitanica. Raspodjela ispitanica u skupinama prema koncentraciji vitamina D nije se statistički značajno razlikovala kod oboljelih i kontrolne skupine (Hi-kvadrat test= 2,210, p=0,331). U skupini oboljelih ispitanica serumska koncentracija vitamina D nije ovisna o dobi, nego je podjednaka 58 u obje dobne skupine (40,99:40,43 nmol/L). U mlađoj dobnoj skupini kontrolnih ispitanica prosječna koncentracija vitamina D bila 61.44 nmol/L što je bilo statistički značajno (t- test=3,832, p<0,001). Uočava se da je prosječna vrijednost vitamina D te dobne skupine viša od prosječne vrijednosti za cijelu skupinu (50,43nmol/L). Izmjerena vrijednost nitrata/nitrita ((NO3-/NO2-) je 15,48 pmol/L u skupini oboljelih i 12,93 pmol/L u kontrolnoj skupini. Nismo dobili statistički značajnu razliku između skupina, ali ovaj rezultat opravdava postavljenu hipotezu. Nitriti nisu bili statistički značajno povezani s vitaminom D niti kod jedne skupine ispitanica. Nismo našli povezanost serumske koncentracije vitamina D prema uznapredovalosti bolesti (MD indeks). Zaključak: Naši rezultati sugeriraju da serumska razina vitamina D može biti biljeg udružen s prisutnošću glaukoma, ali ne i sa težinom bolesti. Međutim još nije jasno je li povezanost između snižene serumske koncentracije vitamina D i glaukoma uzročna ili ne. Budući da nitriti nisu povišeni kod ispitanica sa glaukomom, možemo zaključiti da NO nije uključen u zaštitni učinak vitamin D na glaukom. Vitamin D insuficijencija je povezana s neurodegenerativnim bolestima uključujući glaukomsku optičku neuropatiju.Aim of the study: The aim was to investigate whether serum vitamin D concentration is decreased due to the increased nitrite concentration in female patients suffering from glaucoma and ocular hypertension. Correlation of clinical parameters with serum vitamin D level was compared to determine vitamin D association with glaucomatous optic neuropathy. Vitamin D hypovitaminosis leads to lower nitric oxide synthase (NOS) inhibition, i.e. to increased NOS, greater nitric oxide production and higher peroxynitrite toxicity. Nitric oxide induces release of glutamate and neuronal toxicity, which is one of the causes of glaucomatous optic neuropathy development. Our hypothesis was based on this pathophysiological association. The presence of vitamin D receptors has been demonstrated in many structures of the human eye. Thus, vitamin D immunomodulatory action may be postulated in the presence of a sufficient vitamin D concentration. Study design: Observational cross-sectional study with control group. Subjects and methods: The study included 90 women aged 45-55 suffering from glaucoma (patient group) and 50 age-matched women free from glaucoma (control group). All study subjects underwent ophthalmologic examination and determination of vitamin D and nitrite serum concentrations. Results: The left eye intraocular pressure was significantly higher in glaucoma patients as compared with control subjects (t-test=-2.617; p=0.01). The mean c/d ratio showed a statistically significant between-group difference (t-test=9.257; p<0.001). There was a statistically significant between-group difference in MD index on both left and right eyes (t- test=2.693; p=0.008 and t-test=3.006; p=0.003, respectively). The mean serum vitamin D concentration was 40.6 nmol/L in patient group and 50.43 nmol/L in control group, yielding a statistically significant difference (t-test=2.188; p=0.031). Accordingly, the mean serum vitamin D concentration was higher in the control group of women free from glaucoma. Vitamin D deficiency was recorded in a comparable proportion of subjects from both groups. Normal serum vitamin D concentration was found in 40% of control subjects versus 27.8% of glaucoma patients. Distribution of subjects according to vitamin D concentration did no differ significantly between the patient group and control group (%2-test=2.210; p=0.331). In the group of glaucoma patients, serum vitamin D concentration was not age dependent but was comparable in both age groups (40,99 vs. 40,43 nmol/L). In younger age group, the mean serum vitamin D concentration was 61.44 nmol/L, yielding a statistically significant difference (i-test=3.832; p<0.001). It should be noted that the mean serum vitamin D concentration measured in this age group exceeded the mean vitamin D concentration recorded in this group as a whole (50.43 nmol/L). The mean serum nitrate/nitrite (NO3-/NO2-) concentration was 15.48 ^mol/L and 12.93 pmol/L in the patient group and control group, respectively, yielding no statistically significant between-group difference but justifying the study hypothesis. Nitrites were not statistically significantly associated with vitamin D in either group of subjects. There was no association of serum vitamin D concentration with the disease severity (MD index) either. Conclusion: Our results suggest that serum level of vitamin D could serve as a marker associated with the presence of glaucoma but not with the disease severity. However, it remains obscure whether the association of lower serum vitamin D concentration and glaucoma is causal or not. Since, in female patients with glaucoma the increased amount of nitrites is not found, it can be concluded that NO is not involved in the protective effect of vitamin D on glaucoma. Vitamin D insufficiency is associated with neurodegenerative disorders including glaucomatous optic neuropathy

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

Kvaliteta života osoba oboljelih od šećerne bolesti tip 2

SAŽETAK Cilj istraživanja: Istražiti u kojoj mjeri šećerna bolest tip 2 narušava kvalitetu života oboljelih. Nacrt studije: Prosječno istraživanje provedeno je u Službi za internističku djelatnost OB „Dr. Josip Benčević“ u Slavonskom Brodu. Ispitanici i metode: Bolesnici Službe za internističku djelatnost OB „Dr. Josip Benčević“ u Slavonskom Brodu. U studiju je bilo uključeno 100 bolesnika oboljelih od šećerne bolesti tip 2. Podatci su se prikupljali putem upitnika s pitanjima. Korištena je metoda osobnog ispitivanja. Prikupljeni su podaci o dobi, razini obrazovanja, bračnom statusu, mjestu stanovanja te vrsti terapije koju ispitanici uzimaju. Upitnikom se ispituju tjelesne, duševne ili društvene posljedice nastale zbog ograničenog zdravlja. Rezultati: Analizom rezultata dobivenih istraživanjem dolazimo do zaključka da šećerna bolest tip 2 ima veći utjecaj na fizičko nego na emocionalno zdravlje oboljelih. Oboljeli se osjećaju u manjoj mjeri ograničeni u obavljanju fizičkih aktivnosti. Ispitanici koji svoje zdravlje procjenjuju pozitivnije, imaju bolju razinu fizičkog funkcioniranja, manje ih fizički ili emocionalni problemi ometaju u društvenim aktivnostima te obavljaju željeni broj aktivnosti. Zaključak: Kvaliteta života osoba oboljelih od šećerne bolesti tip 2 od velike je važnosti. O načinu na koji će bolesnik održati dobro opće stanje, ovisit će i njegova kvaliteta života. Šećerna bolest tip 2 ima utjecaja na kvalitetu života, ali pozitivan i odgovoran stav prema bolesti može omogućiti bolju kvalitetu života oboljelih.

Povezanost serumske koncentracije vitamina d i glaukoma kod žena

The aim of the study was to determine whether serum vitamin D level is lower in female patients with glaucoma as compared with control group. The mechanism by which vitamin D reduces intraocular pressure is not fully clarified. Almost all tissues possess vitamin D receptor (VDR). The mice lacking VDR (VDR knockout mice) have greatly contributed to the understanding of the general vitamin D physiologic function. VDR has been found in some ganglion layer cells, external and internal nuclear layers of retina, and in retinal pigment epithelium, while VDR epitopes have also been found in the ciliary body epithelium, pointing to the role of this protein in eye physiology. The 1,25(OH)2D3 modulates expression of the genes involved in the regulation of intraocular pressure in non-human primates. Extracellular matrix can be remodeled by 1,25(OH)2D3 treatment. Actin disruption can lead to cell morphology alteration, trabecular meshwork relaxation and intraocular pressure reduction. This observational cross-sectional study included 90 female glaucoma subjects aged 45-55 and 50 glaucoma free female subjects as control group. Results of a pilot study conducted in 20 glaucoma subjects and 20 control subjects are presented below. All study subjects underwent history taking, complete ophthalmologic examination and serum vitamin D determination. The mean serum vitamin D level was 32.31 nmol/L in glaucoma patients and 64.17 nmol/L in control subjects. Serum vitamin D level was statistically significantly lower in glaucoma patients as compared with control group (p<0.05).Cilj istraživanja bio je utvrditi je li kod ispitanica oboljelih od glaukoma snižena serumska koncentracija vitamina D u odnosu na kontrolnu skupinu. Mehanizam kojim vitamin D snižava očni tlak nije jasno poznat. Gotovo sva tkiva posjeduju receptor za vitamin D (VDR). Velik doprinos razumijevanju globalne fiziološke funkcije vitamina D dobiven je od miša kojemu nedostaje VDR (engl. knockout mice for VDR). VDR je pronađen u nekim stanicama ganglijskog sloja, u vanjskom i unutarnjem nuklearnom sloju mrežnice i u retinalnom pigmentnom epitelu. Epitopi za VDR su pronađeni i u epitelu cilijarnog tijela. To sve govori o važnosti tog proteina u fiziologiji oka. 1,25 (OH)2D3 modulira ekspresiju gena koji su uključeni u regulaciju očnog tlaka u nehumanih primata. Nakon liječenja pomoću 1,25(OH)2D3 može se remodelirati ekstracelularni matriks. Disrupcija aktina može dovesti do promjene stanične morfologije, relaksacije trabekularne mreže i sniženja očnog tlaka. Provedeno je opažajno presječno istraživanje s kontrolnom skupinom. U istraživanje je bilo uključeno 90 ispitanica oboljelih od glaukoma u dobi od 45-55 godina i 50 ispitanica u kontrolnoj skupini. Prikazuju se rezultati probnog ispitivanja u 20 ispitanica oboljelih od glaukoma i isto toliko u kontrolnoj skupini. Ispitanicama je uzeta anamneza i kompletan oftalmološki status te je određen vitamin D u serumu. Koncentracija vitamina D u serumu ispitanica s glaukomom bila je 32,31 nmol/L u odnosu na kontrolnu skupinu gdje je bila 64,17 nmol/L. U zaključku, kod ispitanica oboljelih od glaukoma bila je snižena serumska koncentracija vitamina D u odnosu na kontrolnu skupinu na statistički značajnoj razini od p<0,05

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

ASSOCIATION OF SERUM VITAMIN D CONCENTRATION AND GLAUCOMATOUS OPTIC NEUROPATHY IN WOMEN

Cilj istraživanja: Ovim istraživanjem smo ispitivali je li kod ispitanica oboljelih od glaukoma i okularne hipertenzije snižena serumska koncentracija vitamina D uslijed povišene koncentracije nitrita. Uspoređivali smo povezanost kliničkih parametara sa serumskom razinom vitamina D, kako bismo zaključili o povezanosti vitamina D i glaukomske optičke neuropatije. Hipovitaminoza D dovodi do manje inibicije NOS-a, tj. povećane aktivnosti sintetaze dušikovog oksida (NOS), veće produkcije NO i veće peroksinitritne toksičnosti. Dušikov oksid uzrokuje porast oslobađanja glutamata i neuronalnu toksičnost, što je jedan od uzroka nastanka glaukomske optičke neuropatije. Na ovoj patofiziološkoj povezanosti temelji se i naša hipoteza. Prisutnost vitamin D receptora je dokazana u mnogim strukturama ljudskog oka. Ukoliko postoji suficijentna koncentracija vitamina D, moguće je njegovo imunomodulatorno djelovanje. Nacrt studije: Opažajno presječno istraživanje s kontrolnom skupinom. Ispitanici i metode: U istraživanje je uključeno 90 ispitanica oboljelih od glaukoma u dobi od 45 do 55 godine starosti. U kontrolnu skupinu je uključeno 50 ispitanica iste dobne skupine. Ispitanicama smo uzeli oftalmološki status, izmjerili serumsku koncentraciju vitamina D i nitrita. Rezultati: Intraokularni tlak lijevoga oka je statistički značajno viši u oboljelih u odnosu na kontrolne ispitanice (t-test= -2,617, p=0,01). Prosječan c/d omjer kod oboljelih ispitanica je bio statistički značajan u odnosu na kontrolnu skupinu (t-test=-9,257; p<0,001). Postojala je statistički značajna razlika između oboljelih i kontrolnih ispitanica u vrijednosti MD indeksa lijevoga (t-test=2,693, p=0,008) i desnoga oka (t-test=3,006; p=0,003). Ispitanice oboljele od glaukoma imale su prosječnu koncentraciju vitamina D 40,6 nmol/L, a ispitanice u kontrolnoj skupini 50,43 nmol/L. Ova razlika bila je statistički značajna (t-test= 2,188; p= 0,031), odnosno ispitanice koje nisu imale glaukom su imale u prosjeku višu razinu vitamina D. Deficit vitamina D približno je izražen u obje ispitivane skupine. Normalna koncentracija vitamina D prisutna u 40% kontrolnih nasuprot 27,8% oboljelih ispitanica. Raspodjela ispitanica u skupinama prema koncentraciji vitamina D nije se statistički značajno razlikovala kod oboljelih i kontrolne skupine (Hi-kvadrat test= 2,210, p=0,331). U skupini oboljelih ispitanica serumska koncentracija vitamina D nije ovisna o dobi, nego je podjednaka 58 u obje dobne skupine (40,99:40,43 nmol/L). U mlađoj dobnoj skupini kontrolnih ispitanica prosječna koncentracija vitamina D bila 61.44 nmol/L što je bilo statistički značajno (t- test=3,832, p<0,001). Uočava se da je prosječna vrijednost vitamina D te dobne skupine viša od prosječne vrijednosti za cijelu skupinu (50,43nmol/L). Izmjerena vrijednost nitrata/nitrita ((NO3-/NO2-) je 15,48 pmol/L u skupini oboljelih i 12,93 pmol/L u kontrolnoj skupini. Nismo dobili statistički značajnu razliku između skupina, ali ovaj rezultat opravdava postavljenu hipotezu. Nitriti nisu bili statistički značajno povezani s vitaminom D niti kod jedne skupine ispitanica. Nismo našli povezanost serumske koncentracije vitamina D prema uznapredovalosti bolesti (MD indeks). Zaključak: Naši rezultati sugeriraju da serumska razina vitamina D može biti biljeg udružen s prisutnošću glaukoma, ali ne i sa težinom bolesti. Međutim još nije jasno je li povezanost između snižene serumske koncentracije vitamina D i glaukoma uzročna ili ne. Budući da nitriti nisu povišeni kod ispitanica sa glaukomom, možemo zaključiti da NO nije uključen u zaštitni učinak vitamin D na glaukom. Vitamin D insuficijencija je povezana s neurodegenerativnim bolestima uključujući glaukomsku optičku neuropatiju.Aim of the study: The aim was to investigate whether serum vitamin D concentration is decreased due to the increased nitrite concentration in female patients suffering from glaucoma and ocular hypertension. Correlation of clinical parameters with serum vitamin D level was compared to determine vitamin D association with glaucomatous optic neuropathy. Vitamin D hypovitaminosis leads to lower nitric oxide synthase (NOS) inhibition, i.e. to increased NOS, greater nitric oxide production and higher peroxynitrite toxicity. Nitric oxide induces release of glutamate and neuronal toxicity, which is one of the causes of glaucomatous optic neuropathy development. Our hypothesis was based on this pathophysiological association. The presence of vitamin D receptors has been demonstrated in many structures of the human eye. Thus, vitamin D immunomodulatory action may be postulated in the presence of a sufficient vitamin D concentration. Study design: Observational cross-sectional study with control group. Subjects and methods: The study included 90 women aged 45-55 suffering from glaucoma (patient group) and 50 age-matched women free from glaucoma (control group). All study subjects underwent ophthalmologic examination and determination of vitamin D and nitrite serum concentrations. Results: The left eye intraocular pressure was significantly higher in glaucoma patients as compared with control subjects (t-test=-2.617; p=0.01). The mean c/d ratio showed a statistically significant between-group difference (t-test=9.257; p<0.001). There was a statistically significant between-group difference in MD index on both left and right eyes (t- test=2.693; p=0.008 and t-test=3.006; p=0.003, respectively). The mean serum vitamin D concentration was 40.6 nmol/L in patient group and 50.43 nmol/L in control group, yielding a statistically significant difference (t-test=2.188; p=0.031). Accordingly, the mean serum vitamin D concentration was higher in the control group of women free from glaucoma. Vitamin D deficiency was recorded in a comparable proportion of subjects from both groups. Normal serum vitamin D concentration was found in 40% of control subjects versus 27.8% of glaucoma patients. Distribution of subjects according to vitamin D concentration did no differ significantly between the patient group and control group (%2-test=2.210; p=0.331). In the group of glaucoma patients, serum vitamin D concentration was not age dependent but was comparable in both age groups (40,99 vs. 40,43 nmol/L). In younger age group, the mean serum vitamin D concentration was 61.44 nmol/L, yielding a statistically significant difference (i-test=3.832; p<0.001). It should be noted that the mean serum vitamin D concentration measured in this age group exceeded the mean vitamin D concentration recorded in this group as a whole (50.43 nmol/L). The mean serum nitrate/nitrite (NO3-/NO2-) concentration was 15.48 ^mol/L and 12.93 pmol/L in the patient group and control group, respectively, yielding no statistically significant between-group difference but justifying the study hypothesis. Nitrites were not statistically significantly associated with vitamin D in either group of subjects. There was no association of serum vitamin D concentration with the disease severity (MD index) either. Conclusion: Our results suggest that serum level of vitamin D could serve as a marker associated with the presence of glaucoma but not with the disease severity. However, it remains obscure whether the association of lower serum vitamin D concentration and glaucoma is causal or not. Since, in female patients with glaucoma the increased amount of nitrites is not found, it can be concluded that NO is not involved in the protective effect of vitamin D on glaucoma. Vitamin D insufficiency is associated with neurodegenerative disorders including glaucomatous optic neuropathy

Association between serum vitamin d level and glaucoma in women

The aim of the study was to determine whether serum vitamin D level is lower in female patients with glaucoma as compared with control group. The mechanism by which vitamin D reduces intraocular pressure is not fully clarified. Almost all tissues possess vitamin D receptor (VDR). The mice lacking VDR (VDR knockout mice) have greatly contributed to the understanding of the general vitamin D physiologic function. VDR has been found in some ganglion layer cells, external and internal nuclear layers of retina, and in retinal pigment epithelium, while VDR epitopes have also been found in the ciliary body epithelium, pointing to the role of this protein in eye physiology. The 1,25(OH)2D3 modulates expression of the genes involved in the regulation of intraocular pressure in non-human primates. Extracellular matrix can be remodeled by 1,25(OH)2D3 treatment. Actin disruption can lead to cell morphology alteration, trabecular meshwork relaxation and intraocular pressure reduction. This observational cross-sectional study included 90 female glaucoma subjects aged 45-55 and 50 glaucoma free female subjects as control group. Results of a pilot study conducted in 20 glaucoma subjects and 20 control subjects are presented below. All study subjects underwent history taking, complete ophthalmologic examination and serum vitamin D determination. The mean serum vitamin D level was 32.31 nmol/L in glaucoma patients and 64.17 nmol/L in control subjects. Serum vitamin D level was statistically significantly lower in glaucoma patients as compared with control group (p<0.05)