15 research outputs found
LijeÄenje skvamozne neoplazije povrÅ”ine oka: prikaz sluÄaja
Aim: Ocular surface squamous neoplasia (OSSN) is a term that encompasses a wide and varied spectrum of very rare dysplastic disease of cornea and conjunctiva, ranging from conjunctival intraepithelial neoplasia (CIN), carcinoma in situ (CIS) to invasive squamous cell carcinoma (SCC) of conjunctiva and/or cornea. Case report: In our case report, we present squamous cell carcinoma of the conjunctiva and cornea in a 78-year old man. Our diagnostic algorithm included: slit lamp and fundus examination, gonioscopy, impression cytology (IC) andmagnetic resonance imaging (MRI). The patient underwentsurgical excisional biopsy of the lesion and intraoperativecryotherapy of the cut conjunctival edges and sclera-conjuctiva base region. Following surgical therapy, we started topical 0.02 % (0.2 mg/ml) Mitomycin C (MMC) application daily for 14 days. Control excisional biopsy of conjunctival edge and abrasion of involved cornea were performed following the last day of topical chemotherapy. Our controlexcisional biopsyrevealed tumor positive corneal tissue and the second cycle of topical 0.04 % (0.4 mg/ml) MMCchemotherapy wasstarted for next 3 weeks. The patient has been followed-up for 20 months through monthlyĆ¢ā¬ābased visits, with no recurrence of the disease. Conclusions: OSSN is a surgical challenge requiring a specialized Ć¢ā¬no-touchĆ¢ā¬ā¢ (NT) technique. In our case, the combination of surgical excision with intraoperative cryotherapy and topical chemotherapy with 0.02 % MMC application for 14 days, completed with second cycle of topical 0.04 % MMC drops for the next 21 days given the positive control biopsy, proved to be a good choice for eradication of OSSN with accurate further monitoring of the patient.Cilj: Skvamozna neoplazija povrÅ”ine oka (OSSN) vrlo je rijetka displastiÄna bolest rožnice i spojnice oka, sa slikom u rasponu od konjunktivalne intraepitelne neoplazije (CIN), karcinoma in situ (CIS) do invazivnog skvamocelularnog konjunktive i/ili rožnice (SCC). Prikaz sluÄaja: Opisali smo sluÄaj invazivnog skvamocelularnog karcinoma konjunktive i rožnice kod 78-godiÅ”njeg pacijenta. DijagnostiÄki plan ukljuÄio je kompletan oftalmoloÅ”ki pregled, gonioskopiju, impresijsku citologiju i magnetsku rezonanciju (MR), te je potvrÄena dijagnoza karcinoma ploÄastih stanica bez Å”irenja u orbitu i ostala intraokularna tkiva. Pacijent je podvrgnut kirurÅ”koj ekscizijskoj biopsiji lezije, uz krioterapiju konjunktivalnih rubova i skleralne baze lezije. Nakon kirurÅ”ke terapije, proveli smo topiÄku terapiju 0,02 % (0,2 mg/ml) Mitomycinom C (MMC) tijekom 14 dana. Kontrolna ekscizijska biopsija ruba spojnice i strugotine zahvaÄene rožnice provedena je posljednjeg dana topiÄke kemoterapije. Zbog pozitivnog nalaza tumorskih stanica u rožniÄnom tkivu nastavljena je topiÄka kemoterapija 0,04 % (0,4 mg/ml) MMC-om tijekom sljedeÄa 3 tjedna. Pacijent je redovito praÄen tijekom posljednjih 20 mjeseci bez recidiva bolesti. ZakljuÄci: OSSN je kirurÅ”ki izazov jer zahtijeva specijaliziranu no-touch operativnu tehniku. U naÅ”em sluÄaju, kombinacija kirurÅ”kog zahvata s intraoperativnom krioterapijom, te nakon toga topiÄka kemoterapija 0,02 % kapima Mitomycin tijekom 14 dana, uz nastavljen drugi ciklus topiÄke kemoterapije 0,04 % kapima Mitomycin tijekom sljedeÄeg razdoblja od 21 dana zbog pozitivne kontrolne biopsije dobar je izbor za lijeÄenje OSSN-a uz pažljivo daljnje praÄenje pacijenta
Bevacizumab and corneal pathology
Cilj rada je dati pregled postojeÄe literature o terapiji bevacizumabom u lijeÄenju neovaskularnih poremeÄaja rožnice. Rožnica je jedinstveno tkivo zbog svoje prirodne avaskularnosti. Imunoprivilegirano je vezivno tkivo koje služi kao mehaniÄka prepreka i prednja refraktivna povrÅ”ina oka. Krvnu opskrbu prima perilimbalnim cilijarnim arterijama. Neovaskularizacija (NV) rožnice je stanje koje obilježava patoloÅ”ko urastanje perilimbalnih krvnih žila u rožnicu, zbog kroniÄnog nedostatka kisika. PatoloÅ”ka stanja koja uzrokuju neoangiogenezu rožnice su kemijske ozljede, ishemija, infekcije, degeneracije, trauma i imunoloÅ”ki procesi. Abnormalne krvne žile uzrokuju stvaranje ožiljaka rožnice i kompromitiraju vidnu oÅ”trinu. Neovaskularizacija rožnice nastaje kada je ravnoteža izmeÄu pro-angiogenih i anti-angiogenih faktora naruÅ”ena u korist pro-angiogenih molekula. DosadaÅ”nji uobiÄajeni tretmani za lijeÄenje NV-a rožnice imaju ograniÄenu kliniÄku djelotvornost jer ne ciljaju molekularne posrednike angiogeneze. VEGF-A (engl. Vascular Endothelial Growth Factor-A) je glavni regulator hemangiogeneze. Bevacizumab prepoznaje sve VEGF izoforme. Neovaskularna stanja rožnice koja se mogu lijeÄiti bevacizumabom su: inflamatorna stanja, infekcije i traumatski/jatrogeni uzroci. Studije su pokazale djelomiÄno smanjenje neovaskularizacija rožnice kroz topiÄku, subkonjunktivalnu i intrastromalnu primjenu bevacizumaba. Anti-VEGF terapija stvorila je ogromnu nadu za lijeÄenje neovaskularizacije rožnice, no ona ima svoje granice u lijeÄenju, a uspjeÅ”nost lijeÄenja ovisi o veliÄini ožiljka, trajanju bolesti i opsegu neovaskularizacija. Anti-VEGF terapija je posebno uÄinkovita ako se primijeni u ranoj fazi (prva 2 tjedna neoangiogeneze). Kontrolirane prospektivne studije potrebne su za uspostavu dugoroÄne sigurnosti i odreÄivanje minimalne efektivne i maksimalne sigurnosne koncentracija bevacizumaba za lijeÄenje NV-a prednjeg segmenta oka.The purpose of this paper is to present a review of the current literature on anti-vascular endothelial growth factor (anti-VEGF) bevacizumab therapy for corneal neovascular disorders. Cornea is unique avascular, immunoprivileged connective tissue that acts as transparent mechanical barrier and the anterior eye refractive surface. Corneal neovascularizations (NV) are caused by chronic corneal ischemia with pathological ingrowth of perylimbal blood vessels into the cornea. Abnormal blood vessels cause scarring of the cornea and compromise visual acuity. Pathological conditions that cause corneal neoangiogenesis are: chemical burns, ischemia, infections, degeneration, trauma and immune processes. Corneal neovascularization occurs because of corneal pro-angiogenic and anti-angiogenic factors disequilibrium. The former treatment of corneal NV does not target the molecular mediators of angiogenesis. VEGF-A is the main regulator of angiogenesis. Bevacizumab recognizes all VEGF isoforms. Studies have demonstrated partial reduction of neovascularization through topical, subconjunctival and intrastromal bevacizumab application. Bevacizumab can be used in corneal inflammatory diseases, infections and traumatic/iatrogenic causes. Anti-VEGF agents have created enormous hope for the treatment of corneal neovascularization. Treatment of corneal NV with anti-VEGF antibody has limits and depends on the size of the scar, durability and range of neovascularization. Anti-VEGF agents are especially effective when administered early (less then 2 weeks in neoangiogenesis). Controlled prospective studies are needed to establish long-term safety, efficacy and minimum effective and maximum security concentration of the drug to treat neovascularisation of anterior eye segment
Nesteroidni protuupalni lijekovi u lijeÄenju cistoidnog makularnog edema
Nonsteroidal antiinflammatory drugs (NSAIDs) have become a significant therapeutic adjunctive tool in the routine and complicated intraocular surgery. Topical NSAIDs prevent intraoperative miosis, reduce pain, postoperative inflammation and incidence of cystoid macular edema (CME). Although there is no established protocol for prophylaxis of pseudophakic CME, due to the relationship between proinflammatory prostaglandins and CME, using corticosteroids and NSAIDs could prevent CME. NSAIDs have a synergistic antiinflammatory effect with steroids, but can also be used alone when corticosteroid therapy could be harmful. Prospective clinical trials need to define treatment protocol for topical NSAIDs use, due to their powerful influence to prevent perioperative complications.Nesteroidni protuupalni lijekovi (NSAID, engl. nonsteroidal antiinflammatory drugs) postali su znaÄajna dodatna terapija u rutinskim i kompliciranim intraokularnim operacijama. TopiÄki NSAID-i sprjeÄavaju intraoperativnu miozu, smanjuju bol, postoperativnu upalu i uÄestalost cistoidnog makularnog edema (CME). Iako nema uspostavljenog protokola za profilaksu pseudofakiÄnog CME-a, zbog veze izmeÄu proupalnih prostaglandina i CME-a primjena topiÄkih kortikosteroida i topiÄkih NSAID-a može sprijeÄiti CME. NSAID-i imaju sinergistiÄki protuupalni uÄinak sa steroidima, ali se mogu upotrijebiti i sami kada bi kortikosteroidna terapija mogla biti riziÄna. Zbog njihovog snažnog utjecaja na prevenciju perioperativnih komplikacija potrebna su prospektivna kliniÄka istraživanja za definiranje protokola terapijske primjene topiÄkih NSAID-a
Conjunctival Amelanotic Melanoma ā A Case Report
Conjunctival melanoma is a relatively rare malignancy. It is presented as pigmented nodule in any area of conjunctiva,
amelanotic tumors are pink with smooth apperance. The authors describe an amelanotic melanoma of the conjunctiva
in an 82-year-old female patient. Cytological, histopathological and immunohistochemical studies revealed an invasive
amelanotic melanoma exhibiting S-100 and MART-1 positivity. The patient undervent surgical and chemotherapy
treatement and three years after the initial treatment is in the terminal stage of metastatic disease. Absence of pigmentation
delayed early clinical detection and treatement. Awareness of this nonpigmented melanoma is crucial for early recognition
and appropriate management
Nonsteroidal antiinflammatory drugs and treatment of cystoid macular edema
Nesteroidni protuupalni lijekovi (NSAID, engl. nonsteroidal antiinflammatory drugs) postali su znaÄajna dodatna terapija u rutinskim i kompliciranim intraokularnim operacijama. TopiÄki NSAID-i sprjeÄavaju intraoperativnu miozu, smanjuju bol, postoperativnu upalu i uÄestalost cistoidnog makularnog edema (CME). Iako nema uspostavljenog protokola za profilaksu pseudofakiÄnog CME-a, zbog veze izmeÄu proupalnih prostaglandina i CME-a primjena topiÄkih kortikosteroida i topiÄkih NSAID-a može sprijeÄiti CME. NSAID-i imaju sinergistiÄki protuupalni uÄinak sa steroidima, ali se mogu upotrijebiti i sami kada bi kortikosteroidna terapija mogla biti riziÄna. Zbog njihovog snažnog utjecaja na prevenciju perioperativnih komplikacija potrebna su prospektivna kliniÄka istraživanja za definiranje protokola terapijske primjene topiÄkih NSAID-a.Nonsteroidal antiinflammatory drugs (NSAIDs) have become a significant therapeutic adjunctive tool in the routine and complicated intraocular surgery. Topical NSAIDs prevent intraoperative miosis, reduce pain, postoperative inflammation and incidence of cystoid macular edema (CME). Although there is no established protocol for prophylaxis of pseudophakic CME, due to the relationship between proinflammatory prostaglandins and CME, using corticosteroids and NSAIDs could prevent CME. NSAIDs have a synergistic antiinflammatory effect with steroids, but can also be used alone when corticosteroid therapy could be harmful. Prospective clinical trials need to define treatment protocol for topical NSAIDs use, due to their powerful influence to prevent perioperative complications
Progression of macular oedema following cataract surgery in a diabetic patient
Operacija katarakte najizvoÄenija je operacija u medicini. Å eÄerna bolest, kao jedno od najÄeÅ”Äih kroniÄnih oboljenja, povezana je s ÄeÅ”Äim i ranijim nastankom katarakte u odnosu na zdravu populaciju. BuduÄi da je rijeÄ o mikroangiopatskoj bolesti, u veÄini sluÄajeva imamo prisutan odreÄeni stupanj oÅ”teÄenja hematookularne barijere radi Äega su pacijenti skloniji postoperativom padu vidne oÅ”trine. Uzroci pada vidne oÅ”trine postoperativno kod pacijenta sa Å”eÄernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojeÄeg dijabetiÄkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspjeÅ”no lijeÄiti.Cataract surgery is the most performed surgery in modern medicine. Furthermore, diabetes mellitus is related to higher incidence and the earlier onset of cataract compared to a healthy population. As it is a microangiopathic disease, commonly there is a degree of hematoocular barrier damage which makes the patients susceptible to the postoperative drop in eye acuity. The causes of postoperative eye acuity reduction in diabetic patients following uncomplicated cataract surgery are related to the either onset of postoperative cystoid macular oedema or progression of existing diabetic macular oedema.Making the correct diagnosis and ensuring correct and timely therapy, postoperative complications can be succesfully treated
Nonsteroidal antiinflammatory drugs and treatment of cystoid macular edema
Nesteroidni protuupalni lijekovi (NSAID, engl. nonsteroidal antiinflammatory drugs) postali su znaÄajna dodatna terapija u rutinskim i kompliciranim intraokularnim operacijama. TopiÄki NSAID-i sprjeÄavaju intraoperativnu miozu, smanjuju bol, postoperativnu upalu i uÄestalost cistoidnog makularnog edema (CME). Iako nema uspostavljenog protokola za profilaksu pseudofakiÄnog CME-a, zbog veze izmeÄu proupalnih prostaglandina i CME-a primjena topiÄkih kortikosteroida i topiÄkih NSAID-a može sprijeÄiti CME. NSAID-i imaju sinergistiÄki protuupalni uÄinak sa steroidima, ali se mogu upotrijebiti i sami kada bi kortikosteroidna terapija mogla biti riziÄna. Zbog njihovog snažnog utjecaja na prevenciju perioperativnih komplikacija potrebna su prospektivna kliniÄka istraživanja za definiranje protokola terapijske primjene topiÄkih NSAID-a.Nonsteroidal antiinflammatory drugs (NSAIDs) have become a significant therapeutic adjunctive tool in the routine and complicated intraocular surgery. Topical NSAIDs prevent intraoperative miosis, reduce pain, postoperative inflammation and incidence of cystoid macular edema (CME). Although there is no established protocol for prophylaxis of pseudophakic CME, due to the relationship between proinflammatory prostaglandins and CME, using corticosteroids and NSAIDs could prevent CME. NSAIDs have a synergistic antiinflammatory effect with steroids, but can also be used alone when corticosteroid therapy could be harmful. Prospective clinical trials need to define treatment protocol for topical NSAIDs use, due to their powerful influence to prevent perioperative complications
Progression of macular oedema following cataract surgery in a diabetic patient
Operacija katarakte najizvoÄenija je operacija u medicini. Å eÄerna bolest, kao jedno od najÄeÅ”Äih kroniÄnih oboljenja, povezana je s ÄeÅ”Äim i ranijim nastankom katarakte u odnosu na zdravu populaciju. BuduÄi da je rijeÄ o mikroangiopatskoj bolesti, u veÄini sluÄajeva imamo prisutan odreÄeni stupanj oÅ”teÄenja hematookularne barijere radi Äega su pacijenti skloniji postoperativom padu vidne oÅ”trine. Uzroci pada vidne oÅ”trine postoperativno kod pacijenta sa Å”eÄernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojeÄeg dijabetiÄkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspjeÅ”no lijeÄiti.Cataract surgery is the most performed surgery in modern medicine. Furthermore, diabetes mellitus is related to higher incidence and the earlier onset of cataract compared to a healthy population. As it is a microangiopathic disease, commonly there is a degree of hematoocular barrier damage which makes the patients susceptible to the postoperative drop in eye acuity. The causes of postoperative eye acuity reduction in diabetic patients following uncomplicated cataract surgery are related to the either onset of postoperative cystoid macular oedema or progression of existing diabetic macular oedema.Making the correct diagnosis and ensuring correct and timely therapy, postoperative complications can be succesfully treated