Suvremeni pristup u liječenju recidivirajuće erozije rožnice

Recurrent corneal erosions, independently of the origin, seem to show a similar tendency to abnormal adhesion between corneal epithelium and stroma. Although, for general ophthalmologist, it may at first seem to be one of the less difficult entities to diagnose and therefore to treat, for a patient suffering from this disorder it may be very frustrating, and sometimes even frightening. The majority of patients will respond to simple measures such as padding and antibiotic ointment, but there are a percentage of patients that require a more complex approach. The common goal of each conservative or surgical treatment is fast healing and encouraging proper formation of adhesion complexes between the epithelium and the stroma, without any infections or recurrences. The objective of this review is to assess the indications and outcomes of current treatment options for recurrent corneal erosion, based on literature survey. Briefly, in spite of the many different treatment options, there is still room for further research in the area. Phototherapeutic keratectomy opens a new line of possibilities and it should be considered as very effective therapy for refractive cases. Also, in spite of our recommendations, each patient should be treated individually.Recidivirajuće erozije rožnice, neovisno o uzroku, pokazuju sličnu tendenciju abnormalnoj adheziji između rožničnog epitela i strome. Iako za općeg oftalmologa dijagnosticiranje ovoga poremećaja, a time i liječenje predstavlja jedno od lakših entiteta, bolesniku ovo stanje može biti vrlo frustrirajuće, a ponekad i zastrašujuće. Većina bolesnika pozitivno reagira na jednostavne mjere kao što su zatvaranje oka zavojem i antibiotske masti, no postoji i dio bolesnika koji zahtijevaju složeniji pristup. Zajednički cilj svakog konzervativnog ili kirurškog liječenja je brzo cijeljenje i poticanje pravilnog formiranja adhezijskih kompleksa između epitela i strome bez infekcije ili recidiva. U ovom osvrtu je cilj predstaviti indikacije i rezultate današnjih opcija liječenja vezanih uz recidivirajuće erozije rožnice zasnovanih na istraženoj literaturi. U zaključku, možemo reći kako usprkos mnogim različitim opcijama liječenja još uvijek ima mjesta za daljnja istraživanja na ovom području. Fototerapijska keratektomija otvara nove mogućnosti i trebala bi se uzeti u obzir kao vrlo uspješna terapija refraktornih sučajeva. Također, usprkos našim preporukama, svakog bi se bolesnika trebalo liječiti individualnim pristupom

Amnijska membrana u liječenju neuroparalitične keratopatije

The aim of the study was to determine whether amniotic membrane could be used to treat neuroparalytic keratopathy. Amniotic membrane transplantation was performed in 19 patients with neuroparalytic ulcer. All patients were younger than 61 and all developed corneal problems due to interruption of the sensory afferent fiber innervating the cornea. In all patients, the follow up period was longer than 18 months. Postoperatively, all patients underwent fluorescein test and biomicroscope examination as well as subjective pain evaluation. Postoperatively, the pain was reduced in study patients. In one patient, retransplantation for disease recurrence was performed two months after the first operation. After the second operation, the pain was minimized for more than 18 months. Amniotic membrane transplantation appears to be a good method for pain reduction and better epithelial healing in patients with neuroparalytic keratopathy.Cilj rada bio je utvrditi može li se amnijska membrana rabiti u liječenju neuroparalitične keratopatije. Transplantacija amnijske membrane je učinjena kod 19 bolesnika s neuroparalitičnim ulkusom. Svi bolesnici bili su mlađi od 61 godine i kod svih su se problemi s rožnicom razvili kao rezultat prekida senzornih aferentnih vlakana koja inerviraju rožnicu. Razdoblje praćenja je kod svih bolesnika bio duži od 18 mjeseci. Poslijeoperacijski je kod svih bolesnika učinjen fluoresceinski test i biomikroskopski pregled, kao i subjektivna procjena boli. Nakon operacije bol je bila smanjena kod svih bolesnika. Kod jednog bolesnika učinjena je druga transplantacija, dva mjeseca nakon prve, zbog recidiva. Nakon druge operacije bol je bila smanjena više od 18 mjeseci. Transplantacija amnijske membrane čini se kao dobra metoda smanjenja boli i postizanja boljeg epitelijalnog cijeljenja kod bolesnika s neuroparalitičnom keratopatijom

Obostrani neuritis očnoga živca kao početna pojavnost neurosifilisa kod bolesnika pozitivnog na HIV

Syphilis, a disease which used to be terminal up to the 1950s, has become curable with the discovery of penicillin. In the last few years, an increase in its incidence has been recorded in the world as well as in Croatia, primarily with the human immunodeficiency virus (HIV) co-infection. We present a 40-year-old male patient who complained of a sudden decrease of visual acuity on both eyes, accompanied by dizziness. Clinical examination revealed low visual acuity and blurred edges of the optical nerve head without prominence. Pulse corticosteroid therapy failed to produce any recovery of visual acuity. Additional tests were done including Treponema pallidum hemagglutination assay (TPHA), which confirmed the infection with Treponema pallidum. The patient was administered Extencillin therapy. As a reaction to therapy administered, the patient.s visual acuity gradually fully recovered. In the medical literature available, there is no report of optical neuritis as the first and only manifestation of HIV and syphilis co-infection.Sifilis, bolest koja je do pedesetih godina prošloga stoljeća bila smrtonosna, otkrićem penicilina postala je izlječivom. U posljednjih nekoliko godina bilježi se porast incidencije kako u svijetu tako i kod nas, osobito uz suinfekciju virusom humane imunodeficijencije (HIV). Prikazujemo slučaj 40-godišnjeg muškarca koji se javio zbog naglog pada vidne oštrine na oba oka praćenog vrtoglavicom. Pri kliničkom pregledu utvrđena je niska vidna oštrina te glava vidnog živca nejasnih brisanih granica bez prominencije. Propisana pulsna kortikosteroidna terapija nije dovela do očekivanog oporavka vidne oštrine, pa su učinjene dodatne pretrage, među kojima i test hemaglutinacijske reaktivnosti Treponema pallidum (TPHA), kojim se dokazala infekcija bakterijom Treponema pallidum. Bolesniku je propisana terapija Extencillinom. Ova terapija je dovela do potpunog oporavka vidne oštrine. U dostupnoj medicinskoj literaturi, prema našim saznanjima, dosad nije opisan slučaj optičkog neuritisa kao prve i jedine manifestacije suinfekcije HIV i sifilisa

Neuroretinitis in cat scratch disease: a case report

Opisujemo dvadesetjednogodišnju, prethodno zdravu ženu s naglo nastalim gubitkom vida dva dana prije prijema u bolnicu. Gubitku vida prethodio je febrilitet u trajanju od dva tjedna. Kod prijema bolesnica je urednog kliničkog statusa osim oslabljenog vida na desno oko. Oftalmološkim pregledom, na oba oka, uočena je nejasna papila vidnog živca koja prominira, a drugog dana boravka razvoj obostranog edema makule s formiranjem zvjezdastih lipidnih eksudata parafovealno, što je govorilo u prilog neuroretinitisa. Konzultiran je infektolog, učinjena je serološka obrada i ordinirana antimikrobna terapija uz kortikosteroide i gastroprotektive. Početkom boravka bolesnica je imala slabljenje vida na oba oka, a potom postupni oporavak vida. Serološkom obradom potvrđena je Bartonella henselae kao uzrok tegoba. Provedeno je liječenje doksiciklinom i rifampicinom kroz šest tjedana. U ambulantnim kontrolama potpuno se oporavio vid na lijevo oko, no zaostalo je oštećenje vida na desno oko.A 21-year-old, previously healthy woman presented to our hospital with a sudden loss of vision to the right eye two days before admission. A two-week febrile period preceeded the vision loss. At the time of the admission the patient had decreased visual acuity in the right eye with otherwise normal general health status. Ophtalmological exam discovered unilateral blurred optic disc margins with disc swelling. On the second day it progressed and became billateral optic disc oedema with the development of the macular star formation which is tipical in the diagnosis of neuroretinitis. An infectologist was consulted, extensive laboratory workup was performed that also included serological tests. The patient was treated with antimicrobial therapy, corticosteroids and gastroprotectants. At the begining, the patient experienced a decrease in visual acuity, but later in the course of disease, her vision gradually recovered. Serological testing confirmed Bartonella henselae as the main etiological factor. Over the next six weeks she was treated with doxycycline and rifampicin. During the ambulatory follow up, visual acuity of the left eye completely restored, but visual acuity of the right eye, which was first affected, even after complete resolution of the optic disc oedema, hasn`t recovered fully to the level before the begining of the disease

Deciphering the Structural Basis of High Thermostability of Dehalogenase from Psychrophilic Bacterium Marinobacter sp. ELB17

Haloalkane dehalogenases are enzymes with a broad application potential in biocatalysis, bioremediation, biosensing and cell imaging. The new haloalkane dehalogenase DmxA originating from the psychrophilic bacterium Marinobacter sp. ELB17 surprisingly possesses the highest thermal stability (apparent melting temperature Tm,app = 65.9 °C) of all biochemically characterized wild type haloalkane dehalogenases belonging to subfamily II. The enzyme was successfully expressed and its crystal structure was solved at 1.45 Å resolution. DmxA structure contains several features distinct from known members of haloalkane dehalogenase family: (i) a unique composition of catalytic residues; (ii) a dimeric state mediated by a disulfide bridge; and (iii) narrow tunnels connecting the enzyme active site with the surrounding solvent. The importance of narrow tunnels in such paradoxically high stability of DmxA enzyme was confirmed by computational protein design and mutagenesis experiments