Progression of Age Related Maculopathy in Phakic Versus Pseudophakic Eyes

Age-related maculopathy (ARM) is one of the leading causes of central visual acuity loss in older western population. Many factors are responsible for the fast development of ARM. One of this is significant increases of optical radiations through artificial lens after removal of the catarctous lens. The aim of this study was to compare progression of ARM in phakic and pseudophakic patients and to calculate the possibility of pseudophakia as a risk factor for faster progression of ARM. Medical records of 76 patients, older than 60 years (32 male and 44 female) with early forms of ARM were randomly evaluated. They had undergone cataract removal by phacoemulsification with intraocular lens implantation from January 2002 to December 2006 at the Department of Ophthalmology, Rijeka University Hospital, Croatia. Patients were examined two weeks after the surgery and followed up for two years. The control group consisted of 48 patients (21 males and 27 females) with also early forms of ARM, older than 60 years, examined at the Policlinic Department from January 2006 to December 2006 and followed up at least for two years without any cataract surgery. Comparing progression of ARM in these two groups, a total of 19 patients (25%) in pseudophakic group showed progression to late forms of ARM, but only 6 patients (12.5 %) in the control group developed these aggressive ARM forms. More aggressive forms of ARM in pseudophakic group indicate that pseudophakia should be considered as a risk factor for development of ARM

Subklinički optički neuritis

Acute optic neuritis is often associated with multiple sclerosis. It is considered to be the most common ocular symptom of multiple sclerosis. In addition to acute optic neuritis, in patients with multiple sclerosis, subclinical optic neuritis is also described. It is characterized by slow progression and bilateral involvement, thus being unnoticed by the patient. The purpose of the present study was to assess vision impairment in multiple sclerosis patients without a history of acute optic neuritis, using a number of functional tests including visual field testing by Octopus 101 perimetry N1 program, contrast sensitivity testing by Pelli Robson chart, and color vision by Ishihara pseudoisochromatic plates. The study included 35 multiple sclerosis patients aged 18-50 years, without subjective signs of vision impairment and visual acuity 1.0 according to Snellen. Visual field defects were found in 28 patients. The most common defects of visual fields were retinal sensitivity depression in peripheral zone and nerve fiber bundle defect. Reduced contrast sensitivity was found in 30 (86%) patients. Study results indicated multiple sclerosis patients free from signs of optic neuritis to suffer vision function impairment, as demonstrated by Octopus perimetry and contrast sensitivity testing with Pelli Robson charts.Akutni optički neuritis je često povezan s multiplom sklerozom. Smatra se najčešćom oftalmološkom manifestacijom te bolesti. Uz akutni optički neuritis opisani su i bolesnici sa supkliničkim oblikom. Svrha ovog istraživanja bila je procijeniti oštećenje vida kod bolesnika s multiplom sklerozom bez povijesti akutnog optičkog neuritisa primjenom brojnih funkcionalnih testova uključujući testiranje vidnog polja pomoću programa perimetrije Octopus 101 N1, testiranje kontrastne osjetljivosti Pelli Robsonovim tablicama i ispitivanje kolornog vida pseudoizokromnim tablicama prema Ishihari. Ispitivanje je uključilo 35 bolesnika s multiplom sklerozom u dobi od 18-50 godina bez subjektivnih znakova oštećenja vida i oštrine vida 1,0 prema Snellenu. Oštećenje vidnog polja pronađeno je u 28 bolesnika. Najčešća oštećenja su depresija osjetljivosti mrežnice u perifernoj zoni i defekt snopa živčanih vlakana. Smanjena kontrastna osjetljivost pronađena je u 30 (86%) bolesnika. Rezultati ispitivanja pokazali su da se u bolesnika s multiplom sklerozom bez subjektivnih znakova oštećenja vida mogu naći supklinička oštećenja pomoću perimetrije Octopus i Pelli Robsonovim tablicama za ispitivanje kontrastne osjetljivosti

IMPORTANCE OF MACULAR OPTICAL COHERENCE TOMOGRAPHY IN EUROOPHTHALMOLOGY

Cilj: Sloj vlakana vidnog živca (RNFL, engl. retinal nerve fi berlayer) čine aksoni retinskih ganglijskih stanica. Optička koherentna tomografi ja (OCT, engl. optical coherence tomography) važan je alat u dijagnostici optičkih neuropatija. Za procjenu osjetljivosti pretrage izolirano se snimao samo RNFL i posebno se uključila analiza sloja ganglijskih stanica (GCL, engl. ganglion cell layer) u makuli. Metode: Ovo je retrospektivna analiza snimki OCT-a u 348 pacijenata koji su pod sumnjom na optičku neuropatiju upućeni u neurooftalmološki kabinet, u razdoblju od godine dana. OCT snimke dobivene su uređajem SOCT Copernicus REVO (Optopol TechnologySp. z.o.o.; softver verzija 7.0.0). Rezultati: Osjetljivost mjerenja RNFL-a je 37,6 % (62/165) (uz 95 %-tni interval pouzdanosti (CI) 30,2 % - 45,4 %), a dijagnostička točnost testa je 58,6 % (165/292) (CI 95 %: 52,7 % - 64,3 %). Ako se uzme u analizu i GCL čak su 103 pacijenta (35.2 % - 103/292) analizirajući samo RNFL bila lažno negativna, odnosno bez GCL ne bi se otkrila optička neuropatija. Zaključak: OCT je postalo važno pomagalo u neurooftalmološkoj praksi. Omogućava vizualizirati aksonalni/ neuronalni integritet vidnog puta. Upotreba OCT-a makule uz analizu GCL dovela je do dodatnog proširenja primjenljivost OCT-a u neurooftalmologiji.Aim: The retinal nerve fi ber layer (RNFL) is made up of retinal ganglion cell axons. We evaluated sensitivity of optical coherence tomography (OCT) when measuring only RNFL or when a ganglion cell layer (GCL) analysis is added to the evaluation of optic neuropathy. Methods: This was a retrospective analysis of OCT in 348 patients examined at the neuro-ophthalmology department for suspicion of optic neuropathy during one year. OCT scans were taken with SOCT Copernicus REVO (Optopol Technology Sp. z.o.o.; software version 7.0.0). Results: Sensitivity of measuring RNFL alone was 37.6% (62/165) (with 95% confi dence interval (CI) 30.2%-45.5%) with 58.6% accuracy (165/292) (CI 95%: 52.7%-64.3%). When taking GCL in analysis, 103 patients (35.2%; 103/292) would be classifi ed as normal, false-negative if just RNFL measurements would be the only criterion for diagnosing optic neuropathy. Conclusions: OCT has become one of the most important tools in neuroophthalmic practice. It allows us to visualize axonal/neuronal integrity in the afferent visual pathway. Use of macular OCT with GCL analysis has contributed to the extended applicability of OCT in neuro-ophthalmology

Novel possibilities in treatment of dry age-related macular degeneration

Senilna makularna degeneracija (engl. age-related macular degeneration; AMD) jedan je od najvažnijih uzroka gubitka centralnog vida kod starije populacije. Dijelimo je na „vlažnu” i „suhu” formu, ovisno o prisutnosti koroidne neovaskularizacije (engl. choroidal neovascularization; CNV). Do sada nijedna terapija nije potvrđena i odobrena za liječenje geografske atrofije (engl. geographic atrophy; GA), najtežeg oblika „suhog” AMD-a, jer nije bilo moguće popraviti oštećenja retinalnog pigmentnog epitela (engl. retinal pigment epithelium; RPE) i fotoreceptora. Liječenje se svodilo na pokušaje zaustavljanja progresije oboljenja i širenja geografske atrofije. Namjera ovog članka je prikazati podatke novijih dovršenih i tekućih kliničkih ispitivanja s naglaskom na mjesto djelovanja potencijalnih lijekova. Danas su nam dostupne brojne nove dijagnostičke metode koje nam omogućavaju bolje praćenje morfoloških promjena mrežnice, RPE-a i žilnice, kao i širenja područja atrofije. Oksidativni stres, kronična upala, insuficijentni koroidalni protok krvi te depoziti lipofuscina za koje se pretpostavlja da bi imali važniju ulogu u razvoju bolesti predstavljaju potencijalne mete za djelovanje lijekova. Velik je broj tekućih studija koje istražuju moguća rješenja, kao što su protuupalni i neuroprotektivni lijekovi te matične stanice, dok će samo neki od lijekova biti dostupni na tržištu i pružiti nadu pacijentima za očuvanje centralnog vida, pa ih je potrebno dugoročno pratiti. Uključiti treba i tretman ispodpražnim i mikropulsnim laserom koji je kod nekih oboljenja mrežnice pokazao određene rezultate u revitalizaciji tkiva, a koji koristimo i na našoj Klinici, te su prvi kratkoročni rezultati skromni ali ohrabrujući i zahtijevaju daljnje tretmane i praćenje.Age-related macular degeneration (AMD) is one of the most important cause of central vision lost in elderly. AMD is “wet” or “dry”, depending on choroidal neovascularization (CNV) presence. Currently, no treatment iz approved for geographic atrophy (GA), late form of “dry” AMD because of imposibillity to restore retinal pigment epithelium (RPE) and photoreceptors. So, all earlier treatment only tried to slow down disease and spreading of GA. This review focuses on current data about potential targets for therapies evaluated in novel clinical trials. Novel diagnostic tools are available today for better monitoring of morfological changes in retina, RPE and choroid and spreading of atrophy zone. Several pathways, including oxidative stress, deposits of lipofuscin, chronic inflammation andchoroidal blood flow insufficiency, seem to play an important role in the pathogenesis of “dry” AMD and represent possible targets for new therapies. A great number of treatment for GA such as anti-inflammatory agents, neuroprotective agents and stem cells are under investigation with promising results in preliminary study, and only few will enter the market. Besides them we need to mention subtreshold and micropulse laser treatment with ability to revitalize tissue. We, also, used them on our Eye clinic with “short-term” follow-up and modest but encouraging results, so we need other studies with “long-term” follow-up

Novel possibilities in treatment of dry age-related macular degeneration

Senilna makularna degeneracija (engl. age-related macular degeneration; AMD) jedan je od najvažnijih uzroka gubitka centralnog vida kod starije populacije. Dijelimo je na „vlažnu” i „suhu” formu, ovisno o prisutnosti koroidne neovaskularizacije (engl. choroidal neovascularization; CNV). Do sada nijedna terapija nije potvrđena i odobrena za liječenje geografske atrofije (engl. geographic atrophy; GA), najtežeg oblika „suhog” AMD-a, jer nije bilo moguće popraviti oštećenja retinalnog pigmentnog epitela (engl. retinal pigment epithelium; RPE) i fotoreceptora. Liječenje se svodilo na pokušaje zaustavljanja progresije oboljenja i širenja geografske atrofije. Namjera ovog članka je prikazati podatke novijih dovršenih i tekućih kliničkih ispitivanja s naglaskom na mjesto djelovanja potencijalnih lijekova. Danas su nam dostupne brojne nove dijagnostičke metode koje nam omogućavaju bolje praćenje morfoloških promjena mrežnice, RPE-a i žilnice, kao i širenja područja atrofije. Oksidativni stres, kronična upala, insuficijentni koroidalni protok krvi te depoziti lipofuscina za koje se pretpostavlja da bi imali važniju ulogu u razvoju bolesti predstavljaju potencijalne mete za djelovanje lijekova. Velik je broj tekućih studija koje istražuju moguća rješenja, kao što su protuupalni i neuroprotektivni lijekovi te matične stanice, dok će samo neki od lijekova biti dostupni na tržištu i pružiti nadu pacijentima za očuvanje centralnog vida, pa ih je potrebno dugoročno pratiti. Uključiti treba i tretman ispodpražnim i mikropulsnim laserom koji je kod nekih oboljenja mrežnice pokazao određene rezultate u revitalizaciji tkiva, a koji koristimo i na našoj Klinici, te su prvi kratkoročni rezultati skromni ali ohrabrujući i zahtijevaju daljnje tretmane i praćenje.Age-related macular degeneration (AMD) is one of the most important cause of central vision lost in elderly. AMD is “wet” or “dry”, depending on choroidal neovascularization (CNV) presence. Currently, no treatment iz approved for geographic atrophy (GA), late form of “dry” AMD because of imposibillity to restore retinal pigment epithelium (RPE) and photoreceptors. So, all earlier treatment only tried to slow down disease and spreading of GA. This review focuses on current data about potential targets for therapies evaluated in novel clinical trials. Novel diagnostic tools are available today for better monitoring of morfological changes in retina, RPE and choroid and spreading of atrophy zone. Several pathways, including oxidative stress, deposits of lipofuscin, chronic inflammation andchoroidal blood flow insufficiency, seem to play an important role in the pathogenesis of “dry” AMD and represent possible targets for new therapies. A great number of treatment for GA such as anti-inflammatory agents, neuroprotective agents and stem cells are under investigation with promising results in preliminary study, and only few will enter the market. Besides them we need to mention subtreshold and micropulse laser treatment with ability to revitalize tissue. We, also, used them on our Eye clinic with “short-term” follow-up and modest but encouraging results, so we need other studies with “long-term” follow-up

Purtscher’s retinopathy: case report

Cilj: Cilj rada je prikazati slučaj Purtscherove retinopatije, rijetke hemoragijske i vazookluzivne vaskulopatije koju obilježava nagli značajni pad vida povezan s teškom traumom glave bez značajne ozljede oka. Može se javiti i u sklopu nekih netraumatskih stanja i tada se naziva retinopatija slična Purtcherovoj. U većini slučajeva javlja se bilateralno, dok je rjeđa unilateralna pojava. Budući da još uvijek ne postoje službene smjernice za liječenje Purtscherove retinopatije, ona svakako predstavlja izazov za kliničare. Prikaz slučaja: 28-godišnji muškarac požalio se na izrazito pogoršanje vida lijevog oka dva dana nakon traume glave zadobivene pri padu s motocikla. Detaljnim oftalmološkim pregledom ustanovljen je uredan nalaz očne pozadine desnog oka, dok su lijevo ustanovljene promjene papile vidnog živca, te krvarenja i blijede, jasno ograničene zone retine (Purtscherove mrlje) te pamučasti eksudati. Idući korak uključivao je kompjutoriziranu tomografiju orbita, optičku koherentnu tomografiju makula i vidnog živca, fluoresceinsku angiografiju i perimetriju te je postavljena konačna dijagnoza Purtscherove retinopatije, a u konzultaciji s neurokirurgom uvedena je pulsna terapija metilprednizolonom. Gotovo potpun oporavak vida i promjena na očnoj pozadini postignut je za 3 mjeseca. Zaključci: Purtscherova retinopatija razmjerno je rijetka bolest, a jednostrano pojavljivanje još je i rjeđe. Nema egzaktnih smjernica za liječenje ove bolesti, naime, neki autori navode poboljšanje nakon terapije metilprednizolonom, a neki su zabilježili i određeni stupanj oporavka bez liječenja. Svakako je potrebno sistematsko praćenje slučajeva koji se pojave te razmjena iskustava u svrhu preciznijeg određivanja adekvatne, eventualno i nove terapije.Aim: To present a case of Purtscher\u27s retinopathy, rare haemorrhagic and vasoocclusive vasculopathy characterized by sudden blindness associated with severe head trauma with non-ocular trauma. It can occur in the complete absence of trauma and the term Purtscher-like retinopathy is used. In most cases it occurs bilaterally, less common unilateral occurence. Since there are still no official guidelines for Purtscher\u27s retinopathy treatment, it represents a challenge. Case report: A 28-year-old male patient who had head trauma secondary to motorcycle accident was referred to our Clinic two days after the trauma for left unilateral visual loss. The patient underwent a detailed ophthalmological examination with no remarkable signs on the right eye and changes of optic nerve head and retinal hemorrhages, multiple white retinal patches (Purtscher\u27s flecken) and cotton wool spots on the left eye. The next step including orbital computerized tomography , macular and optic nervae head optic coherent tomography, fluorescein angiography and perimetry was performed and the patient was finally diagnosed as Purtscher\u27s retinopathy. After consultation with neurosurgeon the patient was treated with pulse methylprednisolone. Almost complete recovery of vision and retinal changes was achieved in 3 months. Conclusions: Purtscher retinopathy is a relatively rare disease; unilateral appearance is less common. There are no exact guidelines for the treatment, some authors cite improvement after therapy with methyl-prednisolone, and some have recorded a certain degree of recovery without treatment. It is necessary to monitor systematically the cases that arise and exchange experiences for the purpose of more precise determination of adequate, possibly new, therapies

Progression of Age Related Maculopathy in Phakic Versus Pseudophakic Eyes

Age-related maculopathy (ARM) is one of the leading causes of central visual acuity loss in older western population. Many factors are responsible for the fast development of ARM. One of this is significant increases of optical radiations through artificial lens after removal of the catarctous lens. The aim of this study was to compare progression of ARM in phakic and pseudophakic patients and to calculate the possibility of pseudophakia as a risk factor for faster progression of ARM. Medical records of 76 patients, older than 60 years (32 male and 44 female) with early forms of ARM were randomly evaluated. They had undergone cataract removal by phacoemulsification with intraocular lens implantation from January 2002 to December 2006 at the Department of Ophthalmology, Rijeka University Hospital, Croatia. Patients were examined two weeks after the surgery and followed up for two years. The control group consisted of 48 patients (21 males and 27 females) with also early forms of ARM, older than 60 years, examined at the Policlinic Department from January 2006 to December 2006 and followed up at least for two years without any cataract surgery. Comparing progression of ARM in these two groups, a total of 19 patients (25%) in pseudophakic group showed progression to late forms of ARM, but only 6 patients (12.5 %) in the control group developed these aggressive ARM forms. More aggressive forms of ARM in pseudophakic group indicate that pseudophakia should be considered as a risk factor for development of ARM

Progression of Age Related Maculopathy in Phakic Versus Pseudophakic Eyes

Age-related maculopathy (ARM) is one of the leading causes of central visual acuity loss in older western population. Many factors are responsible for the fast development of ARM. One of this is significant increases of optical radiations through artificial lens after removal of the catarctous lens. The aim of this study was to compare progression of ARM in phakic and pseudophakic patients and to calculate the possibility of pseudophakia as a risk factor for faster progression of ARM. Medical records of 76 patients, older than 60 years (32 male and 44 female) with early forms of ARM were randomly evaluated. They had undergone cataract removal by phacoemulsification with intraocular lens implantation from January 2002 to December 2006 at the Department of Ophthalmology, Rijeka University Hospital, Croatia. Patients were examined two weeks after the surgery and followed up for two years. The control group consisted of 48 patients (21 males and 27 females) with also early forms of ARM, older than 60 years, examined at the Policlinic Department from January 2006 to December 2006 and followed up at least for two years without any cataract surgery. Comparing progression of ARM in these two groups, a total of 19 patients (25%) in pseudophakic group showed progression to late forms of ARM, but only 6 patients (12.5 %) in the control group developed these aggressive ARM forms. More aggressive forms of ARM in pseudophakic group indicate that pseudophakia should be considered as a risk factor for development of ARM