Uloga vitamina u liječenju s dobi povezane degeneracije makule

The role of vitamins in the treatment of age related macular degeneration was reviewed. The following studies were selected for review: Eye Disease Case Control Study (EDCCS), Beaver Dam Eye Study, Blue Mountains Eye Study, Pathologies Oculaires Liees a l\u27Age Study (studija POLA) and Age Related Eye Disease Study (AREDS). These studies showed that antioxidant intake could be recommended in patients with certain forms of age related macular degeneration. A definite answer concerning the role of antioxidants is expected to be provided by additional studies.Pregledno je prikazana uloga vitamina u liječenju s dobi povezane degeneracije makule. Za pregled su izabrane slijedeće studije: Eye Disease Case Control Study (EDCCS), Beaver Dam Eye Study, Blue Mountains Eye Study, Pathologies Oculaires Liees a l.Age Study (studija POLA) i Age Related Eye Disease Study (AREDS). Ove su studije pokazale kako se unos antioksidansa može preporučiti u bolesnika s određenim oblicima s dobi povezane degeneracije makule. Od budućih se studija očekuje konačan odgovor u svezi s ulogom antioksidansa

Rezultati vitrektomije - lensektomije nakon komplikacija fakoemulzifikacije

In this study we presented visual results and complications in patients treated by vitrectomy and lensectomy for posterior dislocation of lens fragments during phacoemulsification. This retrospective study was carried out between 1998-2000. Eighteen patients had a vitrectomy and lensectomy done for posterior dislocation of lens fragments. The median age of the patients was 71. The median timing of the surgery was 13 days. One patient had a vitrectomy performed at the time of cataract surgery (day 0). Uveitis was present in 14 (78%) patients, corneal edema in 9 (50%) and ocular hypertension in 10 (55,5%) patients. After vitrectomy visual acuity was 0,5 or better in 9 patients (50%), 4 patients (22%) had intraocular hypertension, 2 patients (11%) had corneal edema, and 4 patients (22%) had uveitis. Visual acuity improved in most (17) our patients after vitrectomy. There was no statistically significant difference in final visual outcome considering timing of the vitrectomy-lensectomy. Vitrectomy significantly reduces ocular hypertension, uveitis and corneal edema.U ovoj studiji prikazani su rezultati vidne oštrine i komplikacije kod pacijenata za koje je rađena vitrektomija i lensektomija nakon dislokacije lećnih fragmenata za vrijeme fakoemulzifikacije. Studija je rađena od listopada 1998. godine do siječnja 2001. godine. Kod 18 pacijenata urađena je vitrektomija i lensektomija lećnih fragmenta nakon dislokacije u stražnji dio oka. Srednja dob pacijenata je bila 71 godinu. Srednje vrijeme od operacije pri kojoj se dogodila komplikacija do vitrektomije bilo je 13 dana. Kod jednog bolesnika rađena je vitrektomija odmah po komplikaciji (dan 0). Uveitis je bio prisutan u 14 (78%) bolesnika, kornealni edem u 9 (50%) i povišen intraokularni tlak u 10 (55,5%) bolesnika. Nakon vitrektomije vidnu oštrinu 0,5 ili bolju imalo je 9 bolesnika (50%), 4 bolesnika (22%) imalo je povišen intraokularni tlak, 2 bolesnika (11%) su imali kornealni edem i 4 bolesnika (22%) imali su uveitis. Poboljšanje vidne oštrine postignuto je kod većine bolesnika (17) nakon vitrektomije. Nije bilo statistički značajne razlike u konačnom ishodu operacija obzirom na vrijeme izvođenja vitrektomije- lensektomije. Vitrektomija značajno reducira intraokularni tlak, uveitis i kornealni edem

Analiza programa specijalističke izobrazbe iz oftalmologije

The aim of the study was to perform qualitative and quantitative analysis of residency curriculum in ophthalmology. A structured anonymous questionnaire was distributed to 73 medical doctors who were at least on the second year of their residency training in ophthalmology or young ophthalmologists with maximum 4 years of experience. The questionnaire consisted of 52 questions covering every segment of education from the current Protocol for Residency Education of Health Care Professionals in Ophthalmology. Forty-two (58%) doctors answered the questionnaire. Qualitative analysis showed that most of the procedures were mastered by residents. Diagnostic and/or examination procedures were mastered better than surgical and/or interventional procedures. Quantitative analysis showed that the majority of residents failed to reach the prescribed number of surgical procedures. Thirty-three (79%) participants were not satisfied with the current residency curriculum. Although residents mastered most of the prescribed procedures, current residency curriculum is far from being perfect and needs improvements. We think that objective assessment tools for monitoring the progress and competencies of residents during their residency training need to be developed.Cilj rada bio je provesti kvalitativnu i kvantitativnu analizu programa specijalističkog usavršavanja iz oftalmologije metodom anonimne ankete. O anonimnoj anketi obaviještena su ukupno 73 doktora medicine koji su bili najmanje na drugoj godini specijalizacije iz oftalmologije, odnosno oftalmolozi s maksimalno 4 godine specijalističkog staža. Anketa se sastojala od 52 pitanja vezana uza sve dijelove izobrazbe iz aktualnog Pravilnika o specijalističkom usavršavanju zdravstvenih djelatnika iz oftalmologije. Anketu su ispunila 42 (58%) doktora. Kvalitativna analiza pokazala je kako je većina predviđenih zahvata uspješno svladana za vrijeme specijalizacije. Dijagnostički zahvati i/ili razne metode pregleda svladani su bolje nego kirurški i/ili interventni postupci. Prema kvantitativnoj analizi većina specijalizanata nije ispunila predviđeni broj kirurških zahvata. Trideset troje (78%) sudionika nije zadovoljno trenutnim programom specijalističkog usavršavanja. Dakle, premda su specijalizanti ovladali većinom predviđenih zahvata, sadašnji program specijalističkog usavršavanja daleko je od savršenog i potrebna su poboljšanja. Smatramo da je potrebno razviti kvalitetne metode za objektivnu procjenu napretka i kompetentnosti specijalizanata za vrijeme specijalizacije

Obiteljsko pojavljivanje primarnog glaukoma otvorenog kuta

The aim of the study was to point out the role of inheritage of primary open angle glaucoma (POAG) and frequency of POAG among other glaucoma diseases. The study included 52 relatives from 12 families with family history of POAG through 3 generations. The examination consisted of complete ophthalmologic status, automated perimetry and optic nerve photography. A detailed anamnesis and family trees were taken. Individuals were diagnosed with POAG if they fulfilled two or three of the criteria for making a diagnosis: the level of intraocular pressure visual field loss or characteristic disc appearance. Subjects were considered "suspected POAG" if they fulfilled only one of the preceding three criteria. All three parameters had to be normal for an individual to be considered unaffected. Seven relatives (l2%) were diagnosed with POAG; fifteen (29%) relatives were classified as glaucoma suspects. Siblings of POAG patients had the highest risk of POAG developing compared with children or other blood relatives. The study presented results of investigation the frequency of POAG among other glaucoma diseases and 16% patients had a family history of POAG at least in 3 generations. Detailed anamnesis confirms familial appearance of POAG and examination of all available members enables the discovery of new cases (12%).Cilj istraživanja bio je naglasiti ulogu nasljeđa kod primarnog glaukoma otvorenog kuta te ukazati na njegovu učestalost među drugim glaukomskim oboljenjima. Ukupno je 52 elana iz 12 obitelji kod kojih se primarni glaukom otvorenog kuta pojavljuje kroz najmanje 3 generacije, obuhvaćeno je ispitivanjem. Pored detaljne obiteljske anamneze i izrade obiteljskog stabla, kliničko ispitivanje obuhvaćalo je: sveukupni oftalmološki pregled, automatiziranu perimetriju i fotografiju glave vidnog živca. Ispitanici su utvrđeni kao glaukomski bolesnici ako su ispunjavali 2 ili 3 uvjeta koji čine dijagnozu: visina intraokularnog tlaka, ispadi u vidnom polju te karakterističan izgled glave vidnog živca. Granični slučajevi ispunjavali su samo jedan postavljeni uvjet, a zdravi ispitanici su imali sve parametre u granici normale. Sedam rođaka (12%) dijagnosticirano je kao primarni glaukom otvorenog kuta a 15 (29%) kao granični slučajevi. Braća i sestre pacijenata s primarnim glaukomom otvorenog kuta imaju veći rizik pojave oboljenja u usporedbi s djecom ili ostalim rođacima. Studija pokazuje da je među glaukomskim pacijentima 16% onih s pozitivnom obiteljskom anamnezom za primarni glaukom otvorenog kuta kroz najmanje 3 generacije. Detaljna obiteljska anamneza potvrđuje obiteljsku pojavu primarnog glaukoma otvorenog kuta, a ispitivanje svih dostupnih članova omogućuje otkrivanje novih, dotad neregistriranih slučajeva - l2%

Postoperative Outcomes after Implantation of Intraocular Lenses in Eyes with Cataract and Uveitis

Despite advances in surgical technique and implant materials, cataract surgery in patients with uveitis is still a challenging procedure. We retrospectively evaluated postoperative outcomes of cataract surgery in 35 eyes of 29 patients with uveitis. Phacoemulsification with posterior chamber intraocular lens implantation was performed in all eyes. Postoperative evaluations were performed at day 2, and then at 7 days, 1, 3, and 6 months respectively. There were 16 males, and 13 females, aged 31 to 68 years. Follow-up ranged from 4 to 35 months. At final follow-up 33 eyes (94%) had an improvement in visual acuity compared with preoperative levels (p< 0,05). Giant cells were observed in the intraocular lens optic in 7 eyes (20%). Posterior capsule opacification occurred in 10 eyes (29%). Clinical cystoid macular edema was observed in 4 eyes, and 2 eyes required trabeculectomy with mitomycin C due to secondary glaucoma. Cataract surgery in patients with uveitis leads to successful visual results after correct surgical timing, and adequate anti-inflammatory therapy. There were no significant differences in the degree of inflammation after implantation of various types of intraocular lenses

Croatian Children’s Views towards Importance of Health Care Information

The aim of research was to investigate: the need for health care information of Croatian adolescents aged from 13 to 18 years; the difference in evaluation of the frequency of receiving information between hospitalized and healthy children; if the hospitalized children expectations about the frequency of receiving health care information differed significantly from information they have actually received; whose information was most comprehensible to the hospitalized children (doctors, parents, other health care givers). The children were either hospitalized in the pediatrics departments or were high schools pupils (healthy children). The hospitalized children »Completely agreed« (92.7%) with the statement »When I am sick, I should receive information about my health« in comparison to the healthy children (85.1%). In comparison to healthy children, the hospitalized children assessed that doctors, other health care givers and parents should give them information more frequently. The experience of hospitalized children indicate that they received less information then they have actually excepted. The information received from doctors was mostly in correlation with the understanding of this information. We concluded that the children want to be informed about their health, especially hospitalized children. Health care professionals should offer understandable health care information according to the children’s expectation

Croatian Children’s Views towards Importance of Health Care Information

The aim of research was to investigate: the need for health care information of Croatian adolescents aged from 13 to 18 years; the difference in evaluation of the frequency of receiving information between hospitalized and healthy children; if the hospitalized children expectations about the frequency of receiving health care information differed significantly from information they have actually received; whose information was most comprehensible to the hospitalized children (doctors, parents, other health care givers). The children were either hospitalized in the pediatrics departments or were high schools pupils (healthy children). The hospitalized children »Completely agreed« (92.7%) with the statement »When I am sick, I should receive information about my health« in comparison to the healthy children (85.1%). In comparison to healthy children, the hospitalized children assessed that doctors, other health care givers and parents should give them information more frequently. The experience of hospitalized children indicate that they received less information then they have actually excepted. The information received from doctors was mostly in correlation with the understanding of this information. We concluded that the children want to be informed about their health, especially hospitalized children. Health care professionals should offer understandable health care information according to the children’s expectation

Results of the antireflux ureterocystoneostomyat the urinary bladder vertex in a 28-year-period (1978-2005)

U radu se prikazuje retrospektivna studija rezultata antirefluksne ureterocistoneostomije na verteksu mokraćnoga mjehura (AUCN) prema Bradić-Pasiniju u posljednjih 28 godina. U suradnji s pedijatrima iz Varaždina, Čakovca i Koprivnice ovom se metodom operira veliki broj djece s primarnim vezikoureteralnim refluksom 3. - 5. stupnja. U navedenom se razdoblju operiralo 316 djece, od toga 67 dječaka i 249 djevojćica. Refluks 3. - 5. stupnja bio je prisutan na obje strane u 7 djece, tako da su obavljene ukupno 323 ureterocistoneostomije. Prilikom obrade učinjen je pregled urina, urinokultura, kreatinin, urografija, MCUG i cistoskopija. Klasifikacija je obavljena na temelju MCUG prema International Reflux Study. Svi su bolesnici poslijeoperacijski hospitalizirani 6 i 24 mjeseca nakon operacije te se učinila obrada kao i prije operacije. Od 323 AUCN kod 13 bolesnika (4,02%) dokazan je recidiv refluksa, kod (1,55%) poslijeoperacijska opstrukcija. U 305 bolesnika (94,43%) operacija je bila uspješna. Uspješnom plastikom smatrali smo onu u koje se nakon dvije kliničke kontrole nije mogao dokazati refluks ili opstrukcija, a urin je bio sterilan. Od 13 recidiva, 5 je operirano kod nas sa 100% uspjehom, ostali su liječeni u drugim ustanovama.In this paper we are presenting retrospective study results of the Bradić-Pasini antireflux ureterocystoneostomy (AUCN) procedure at the bladder vertex in children in the past 28 years. In collaboration with pediatricians from Varaždin, Èakovec and Koprivnica we subjected 316 children (67 boys and 249 girls) with severe primary vesicoureteral reflux (VUR) grades 3-5 to this surgical procedure. Bilateral reflux was present in 7 children, so total of 323 AUCN was performed. A complete evaluation, including urine analysis, urine culture, serum creatinine measurement, urography, voiding cystourethrography (VCUG) and cystoscopy was done before the surgical intervention. We used VCUG classification according to International Reflux Study. After 6 and 24 months we did post surgical evaluation, including the same types of analyses mentioned before, to reveal the late postoperative complications. We established reappearance of VUR in 13 cases (4,02%) and ureterovesical junction obstruction in 5 cases (1,55%). In 305 (94,43%) out of total 323 cases the AUCN was successful. The criteria for long-term successfulness were the absence of VUR or obstruction and negative urine culture. Out of total 13 reappearances of VUR, we treated 5 patients with the same technique, all of them with long-term success. The rest of them were treated elsewhere

Koroidna neovaskularizacija kod makularne degeneracije povezane s dobi liječene fotodinamskom terapijom i intravitrealnim triamcinolon acetonidom

The aim of the study was to show the effect of combined photodynamic therapy and intravitreal injection of triamcinolone acetonide in the treatment of choroidal neovascularization due to age-related macular degeneration. This retrospective, nonrandomized study included 20 patients with predominantly classic choroidal neovascularization due to age-related macular degeneration with no prior treatment. At baseline, all patients underwent ophthalmologic examination. Fluorescein angiography and optical coherent tomography were performed and analyzed. Triamcinolone acetonide, 4 mg, was intravitreally applied at 24-48 hours after standard photodynamic therapy. Follow up was scheduled at 3, 6 and 9 months. After 9 months, visual acuity improved in four, remained unchanged in 14 and decreased in two patients. In all patients, complete closure of choroidal neovascularization occurred after 9 months. At that time, a decrease in the central foveal thickness was also recorded in all patients. Combined photodynamic therapy and intravitreal injection of triamcinolone acetonide is a safe method in the treatment of choroidal neovascularization due to age-related macular degeneration, and leads to complete closure of choroidal neovascularization. To prove these promising results, a carefully designed, randomized, controlled study in a larger group of patients is needed.Prikazuju se rezultati kombinirane intravitrealne primjene triamcinolona i fotodinamske terapije kod razvoja koroidnih neovaskularizacija koje su nastale kao posljedica senilne makularne degeneracije. U retrospektivnu nerandomiziranu studiju bilo je uključeno 20 bolesnika s pretežito klasičnom koroidnom neovaskularizacijom, koji do tada nisu bili liječeni. Kod svih bolesnika učinjen je standardni oftalmološki pregled, fluoresceinska angiografija i optička koherentna tomografija. Triamcinolon acetonid, 4 mg, apliciran je intravitrealno 24-48 sati nakon fotodinamske terapije. Praćenje bolesnika je provedeno nakon 3, 6 i 9 mjeseci. Nakon 9 mjeseci kod 4 bolesnika došlo je do poboljšanja vidne oštrine, kod 14 bolesnika vidna oštrina je ostalna stabilna, dok je kod 2 bolesnika zabilježen pad vidne oštrine. Potpun nestanak koroidne neovaskularizacije kod svih je bolesnika zabilježen nakon 9 mjeseci. Kombinirana primjena triamcinolona i fotodinamske terapije sigurna je metoda u liječenju pretežito klasičnih koroidnih neovaskularizacija, koja dovodi do njihovog potpunog zatvaranja i nestajanja, no za potvrdu ovih rezultata potrebna je randomizirana analiza na većem broju bolesnika