Nesteroidni protuupalni lijekovi u liječenju 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 značajna dodatna terapija u rutinskim i kompliciranim intraokularnim operacijama. Topički NSAID-i sprječavaju intraoperativnu miozu, smanjuju bol, postoperativnu upalu i učestalost cistoidnog makularnog edema (CME). Iako nema uspostavljenog protokola za profilaksu pseudofakičnog CME-a, zbog veze između proupalnih prostaglandina i CME-a primjena topičkih kortikosteroida i topičkih NSAID-a može spriječiti CME. NSAID-i imaju sinergistički protuupalni učinak sa steroidima, ali se mogu upotrijebiti i sami kada bi kortikosteroidna terapija mogla biti rizična. Zbog njihovog snažnog utjecaja na prevenciju perioperativnih komplikacija potrebna su prospektivna klinička istraživanja za definiranje protokola terapijske primjene topičkih NSAID-a

Progression of macular oedema following cataract surgery in a diabetic patient

Operacija katarakte najizvođenija je operacija u medicini. Šećerna bolest, kao jedno od najčešćih kroničnih oboljenja, povezana je s češćim i ranijim nastankom katarakte u odnosu na zdravu populaciju. Budući da je riječ o mikroangiopatskoj bolesti, u većini slučajeva imamo prisutan određeni stupanj oštećenja hematookularne barijere radi čega su pacijenti skloniji postoperativom padu vidne oštrine. Uzroci pada vidne oštrine postoperativno kod pacijenta sa šećernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojećeg dijabetičkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspješno liječiti.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 značajna dodatna terapija u rutinskim i kompliciranim intraokularnim operacijama. Topički NSAID-i sprječavaju intraoperativnu miozu, smanjuju bol, postoperativnu upalu i učestalost cistoidnog makularnog edema (CME). Iako nema uspostavljenog protokola za profilaksu pseudofakičnog CME-a, zbog veze između proupalnih prostaglandina i CME-a primjena topičkih kortikosteroida i topičkih NSAID-a može spriječiti CME. NSAID-i imaju sinergistički protuupalni učinak sa steroidima, ali se mogu upotrijebiti i sami kada bi kortikosteroidna terapija mogla biti rizična. Zbog njihovog snažnog utjecaja na prevenciju perioperativnih komplikacija potrebna su prospektivna klinička istraživanja za definiranje protokola terapijske primjene topičkih 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

Nonsteroidal antiinflammatory drugs and treatment of cystoid macular edema

Nesteroidni protuupalni lijekovi (NSAID, engl. nonsteroidal antiinflammatory drugs) postali su značajna dodatna terapija u rutinskim i kompliciranim intraokularnim operacijama. Topički NSAID-i sprječavaju intraoperativnu miozu, smanjuju bol, postoperativnu upalu i učestalost cistoidnog makularnog edema (CME). Iako nema uspostavljenog protokola za profilaksu pseudofakičnog CME-a, zbog veze između proupalnih prostaglandina i CME-a primjena topičkih kortikosteroida i topičkih NSAID-a može spriječiti CME. NSAID-i imaju sinergistički protuupalni učinak sa steroidima, ali se mogu upotrijebiti i sami kada bi kortikosteroidna terapija mogla biti rizična. Zbog njihovog snažnog utjecaja na prevenciju perioperativnih komplikacija potrebna su prospektivna klinička istraživanja za definiranje protokola terapijske primjene topičkih 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 najizvođenija je operacija u medicini. Šećerna bolest, kao jedno od najčešćih kroničnih oboljenja, povezana je s češćim i ranijim nastankom katarakte u odnosu na zdravu populaciju. Budući da je riječ o mikroangiopatskoj bolesti, u većini slučajeva imamo prisutan određeni stupanj oštećenja hematookularne barijere radi čega su pacijenti skloniji postoperativom padu vidne oštrine. Uzroci pada vidne oštrine postoperativno kod pacijenta sa šećernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojećeg dijabetičkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspješno liječiti.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

Progression of macular oedema following cataract surgery in a diabetic patient

Operacija katarakte najizvođenija je operacija u medicini. Šećerna bolest, kao jedno od najčešćih kroničnih oboljenja, povezana je s češćim i ranijim nastankom katarakte u odnosu na zdravu populaciju. Budući da je riječ o mikroangiopatskoj bolesti, u većini slučajeva imamo prisutan određeni stupanj oštećenja hematookularne barijere radi čega su pacijenti skloniji postoperativom padu vidne oštrine. Uzroci pada vidne oštrine postoperativno kod pacijenta sa šećernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojećeg dijabetičkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspješno liječiti.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

Cystoid macular edema after cataract surgery

Cistoidni makularni edem komplikacija je nakon operacije katarakte i najčešći je uzrok loše vidne oštrine nakon operacije katarakte. Različiti su patofiziološki mehanizmi nastanka makularnog edema, ali najčešće se dovodi u vezu s postoperativnom upalom pri kojoj se oslobađaju medijatori upale i dovode do nakupljanja tekućine u području makule. Protuupalni lijekovi, uključujući steroide i nesteroidne antireumatike, imaju veliku ulogu u profilaksi i terapiji cistoidnog makularnog edema. U ovom preglednom članku prikazani su najnoviji stavovi o patogenetskom mehanizmu nastanka edema, rizičnim faktorima, profilaksi i terapiji, proizišli iz istraživanja i kliničke prakse.Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery and is one of the possible causes of low visual acuity after cataract surgery. Various factors are implicated in its development but the core mechanism is likely surgically induced anterior segment inflammation that results in the release of endogenous inflammatory mediators. Anti-inflammatory medicines, including steroid and nonsteroid anti-inflammatory drugs, are postulated as having a role in both the prophylaxis and treatment of PCME. This article presents an updated review on the pathogenesis, risk factors, prophylaxis and treatment in PCME that reflect current research and practice

The role of computerized tomography in the diagnosis of acute abdomen

Cilj: Cilj ovog retrospekti vnog istraživanja bio je ispitati dijagnosti čku vrijednost kompjutorizirane tomografi je (CT) kod neoperiranih pacijenata koji su se prezenti rali kliničkom slikom akutnog abdomena u procjeni potrebe kirurškog liječenja te u detekciji uzroka nastanka kliničke slike. Ispitanici i metode: Retrospekti vno istraživanje obuhvati lo je neoperirane pacijente starije od 18 godina koji su upućeni na CT pretragu s kliničkom slikom i uputnom dijagnozom akutnog abdomena u razdoblju od 31. 10. 2014. do 31. 10. 2015. godine. Isključeni su pacijenti s laparotomijom ili laparoskopijom učinjenom unutar 30 dana prije CT pretrage te pacijenti koji su preminuli ti jekom hospitalizacije bez učinjenog kirurškog zahvata. Osim operacijskog nalaza, referentna metoda je bila kliničko praćenje ti jekom 30 dana nakon CT-a u neoperiranih pacijenata. CT nalaze neovisno su analizirala dva radiologa s više od 5 godina iskustva s abdominalnim CT pretragama, a nesuglasja su rješavana konsenzusom. Rezultati : Od ukupno 81 pacijenta (dobni raspon od 19 do 91 god., medijan 69 godina, omjer muškaraca i žena 45/36), 51 pacijent podvrgnut je hitnom kirurškom liječenju. Perforacija duodenalnog/želučanog ulkusa, diverti kuliti s i apendiciti s s komplikacijama, perforacija crijeva i komplikacija akutne upale žučnog mjehura bile su najčešće indikacije za operaciju. Osjetljivost i specifi čnost CT pretrage u ispiti vanoj skupini iznosila je 94,6 % i 84,0 %, dok su poziti vna i negati vna predikti vna vrijednost bile 93,0 % i 87,5 %. U stvarno poziti vnih nalaza CT-om smo uspješno procijenili uzrok nastanka kliničke slike u 83 % pacijenata. Zaključak: CT pretraga abdomena i zdjelice u pacijenata s kliničkom slikom akutnog abdomena pouzdana je dijagnosti čka metoda u procjeni indikacije za kirurško liječenje i detekciji uzroka nastanka kliničke slike.Aim: The aim of this retrospecti ve study was to determine the diagnosti c value of computerized tomography (CT) in pati ents without prior surgery who presented with clinical signs and symptoms of acute abdomen with the goal of assessment of the need for surgery and the detecti on of causes of acute abdomen. Pati ents and methods: This retrospecti ve study included all adult pati ents without prior surgery who were referred to perform abdominal CT scan with the diagnosis of acute abdomen in the period from October 31st 2014 ti ll October 31st 2015. Pati ents who had laparotomy of laparoscopy performed within 30 days prior to CT examinati on and those who died during hospitalizati on aft er the CT examinati on and without surgery were excluded. Reference standards in this study were surgery report and hospital observati on during 30 days aft er CT exam in pati ents who had no surgery. CT exams were independently analysed by two radiology specialists with more than 5 years of experience in abdominal CT imaging and all disagreements were sett led with consensus. Results: Out of 81 pati ents (age 19-91, median 69 years, male/female rati o 45/36) 51 had emergency surgery. Duodenal/gastric ulcer perforati on, diverti culiti s and appendiciti s with complicati ons, bowel perforati on and complicati ons of acute cholecysti ti s were the most common causes for surgery. Sensiti vity and specifi city of abdominal CT were 94.6% and 84.6%, while positi ve and negati ve predicti ve values were 93.0% and 87.5%, respecti vely. In pati ents with true positi ve results, CT successfully assessed the localizati on of the cause of acute abdomen in 83% of pati ents. Conclusion: Abdominal CT examinati on in pati ents with signs and symptoms of acute abdomen is a reliable diagnosti c method in the assessment of indicati on for surgery and the detecti on of causes of acute abdomen

Cystoid macular edema after cataract surgery

Cistoidni makularni edem komplikacija je nakon operacije katarakte i najčešći je uzrok loše vidne oštrine nakon operacije katarakte. Različiti su patofiziološki mehanizmi nastanka makularnog edema, ali najčešće se dovodi u vezu s postoperativnom upalom pri kojoj se oslobađaju medijatori upale i dovode do nakupljanja tekućine u području makule. Protuupalni lijekovi, uključujući steroide i nesteroidne antireumatike, imaju veliku ulogu u profilaksi i terapiji cistoidnog makularnog edema. U ovom preglednom članku prikazani su najnoviji stavovi o patogenetskom mehanizmu nastanka edema, rizičnim faktorima, profilaksi i terapiji, proizišli iz istraživanja i kliničke prakse.Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery and is one of the possible causes of low visual acuity after cataract surgery. Various factors are implicated in its development but the core mechanism is likely surgically induced anterior segment inflammation that results in the release of endogenous inflammatory mediators. Anti-inflammatory medicines, including steroid and nonsteroid anti-inflammatory drugs, are postulated as having a role in both the prophylaxis and treatment of PCME. This article presents an updated review on the pathogenesis, risk factors, prophylaxis and treatment in PCME that reflect current research and practice

Cistoidni makularni edem nakon operacije katarakte

Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery and is one of the possible causes of low visual acuity after cataract surgery. Various factors are implicated in its development but the core mechanism is likely surgically induced anterior segment inflammation that results in the release of endogenous inflammatory mediators. Anti-inflammatory medicines, including steroid and nonsteroid anti-inflammatory drugs, are postulated as having a role in both the prophylaxis and treatment of PCME. This article presents an updated review on the pathogenesis, risk factors, prophylaxis and treatment in PCME that reflect current research and practice.Cistoidni makularni edem komplikacija je nakon operacije katarakte i najčešći je uzrok loše vidne oštrine nakon operacije katarakte. Različiti su patofiziološki mehanizmi nastanka makularnog edema, ali najčešće se dovodi u vezu s postoperativnom upalom pri kojoj se oslobađaju medijatori upale i dovode do nakupljanja tekućine u području makule. Protuupalni lijekovi, uključujući steroide i nesteroidne antireumatike, imaju veliku ulogu u profilaksi i terapiji cistoidnog makularnog edema. U ovom preglednom članku prikazani su najnoviji stavovi o patogenetskom mehanizmu nastanka edema, rizičnim faktorima, profilaksi i terapiji, proizišli iz istraživanja i kliničke prakse