PRIMARY OPEN-ANGLE GLAUCOMA AND FARMACOECONOMICS - REVIEW

Primary open-angle glaucoma (POAG) is defined as a chronic and progressive disease. Date suggested that it is the second most common cause of the blindness in the world. Blindness, as global problem, is partially consequences of poor health insurance, low medical education, etc. The only modifiable risk factor for glaucoma is intraocular pressure. Cost of the antiglaucomatous treatment increased by prescribing and using wide spectrum of antiglaucomatous drugs. If an ophthalmologist is not satisfied with glaucomatous disease control, need for the laser or surgical treatment is appeared. Disease stadium also determines the cost of the treatment. The social and economic burden of glaucoma can be changed by increased life expectancy, older population age and higher per capita GDP. Unique opinion about cost effectiveness cannot be reached, due to nonconforming findings of many studies. Treatment approach must be individualized to every patient, according to the disease's stadium, availability of therapeutic modalities and approaches, life expectancy and the level of GDP. Efficacy, compliance and potential side-effects of prescribed medication also determine the proper treatment choice

Evaluation of the patients with Grave's ophthalmopathy after the corticosteroids treatment

Background/Aim. Graves' ophthalmopthy is one of the most common causes of exophthalmos as well as the most common manifestation of Graves' disease. The treatment of Graves' ophthalmopathy includes ophthalmological and endocrinological therapy. The aim of this study was to clinically evaluate the patients with Graves' ophthalmopathy treated with corticosteroids. Methods. Evaluation of 21 patients was performed in the Ophthalmology Clinic and Endocrinology Clinic, Clinical Centre Kragujevac, in the period from 2009 to 2010. They were treated with pulse doses of intravenous corticosteroids. They were referred to ophthalmologist by endocrinologist in euthyroid condition in the active phase of Graves' ophthalmopathy (ultrasonography of orbit findings and positive findings of antithyroid stimulating hormone receptor antibody - anti-TSH R Ab). The clinical activity score (CAS) and NO SPECS classification for evaluation of disease severity were used. Ophthalmological examination includes: best corrected visual acuity, slit-lamp exam, Hertels' test, direct ophthalmoscopy and ultrasonography of the orbit. Results. According to our results 76.19% of the patients were female; mean age of the patients was 35.2 ± 5.6 years. According to CAS classification after 6 months of the treatment recovery was shown in 23.81% of the patients, partial amelioration in 47.62% and no clinical amelioration in 28.57% of the patients. We achieved better results with male, young patients with high clinical activity score. Good results were observed after the first dose of corticosteroids, much better CAS after the third dose, which maintained until 6 months after the first treatment. Conclusion. Our results signify that intravenous pulse dose of corticosteroids treatment of the patients with Graves' ophthalmopthy is safe, comfortable, clinically justified and accessible for the clinicians and patients. Positive results are achieved after the first dose with increasing trend up to the third dose, which was maintained for the next three months

PREVENTION OF ADENOVIRAL EYE INFECTION - REVIEW

Epidemic viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. The exact incidence of adenoviral conjunctivitis is still poorly known, but there are two well-defined adenoviral keratoconjunctivitis clinical syndromes: epidemic keratoconjunctivitis (EKC) and pharyngoconjunctival fever (PCF). Epidemic keratoconjunctivitis is also the most severe form and presents with watery discharge, hyperemia, chemosis and ipsilateral lymphadenopathy. Diagnosis is mainly clinical, but its etiology can be confirmed using cell cultures, antigen detection, polymerase chain reaction or immune-chromatography. Multiple treatments have been tried for this disease, but none of them seem to be completely effective. Viruses are resistant to desiccation and certain common surface disinfectants. Prevention is the most reliable and recommended strategy to control this epidemic infection. Global epidemic surveillance system definitely needs to be established to monitor and analyze the epidemic conjunctivitis in the future. There is clearly a need for the national and the military public health institutions to work together on guidelines to handle future challenges

PRIMARY OPEN-ANGLE GLAUCOMA AND FARMACOECONOMICS - REVIEW

Primary open-angle glaucoma (POAG) is defined as a chronic and progressive disease. Date suggested that it is the second most common cause of the blindness in the world. Blindness, as global problem, is partially consequences of poor health insurance, low medical education, etc. The only modifiable risk factor for glaucoma is intraocular pressure. Cost of the antiglaucomatous treatment increased by prescribing and using wide spectrum of antiglaucomatous drugs. If an ophthalmologist is not satisfied with glaucomatous disease control, need for the laser or surgical treatment is appeared. Disease stadium also determines the cost of the treatment. The social and economic burden of glaucoma can be changed by increased life expectancy, older population age and higher per capita GDP. Unique opinion about cost effectiveness cannot be reached, due to nonconforming findings of many studies. Treatment approach must be individualized to every patient, according to the disease's stadium, availability of therapeutic modalities and approaches, life expectancy and the level of GDP. Efficacy, compliance and potential side-effects of prescribed medication also determine the proper treatment choice

Tumor of orbit

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and it's by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome

PARASITIC EYE INFECTION BY ASCARIS LUMBRICOIDES — CASE REPORT

The parasitic infection is an affection of the body as well as the eye with parasites, protozoa’s, worms and ectoparasites, with world incidence of 30%. These diseases are chronic, systemic diseases because of weak innate immunity and ability of parasites to evade immune answer of the host or increasing the resistance to the adaptive immunity of the host. Parasites can evade immunity of the host by: antigens variations, forming cysts, changing the hosts and by synthesis of some cytokines, which decrease immunity of the host. Ascaris lumbricoides is the largest intestinal nematode parasitizing man. The worm is known to cause subconjunctival mass, granulomatous iridocyclitis, choroiditis, recurrent vitreous hemorrhage, chronic dacryocystitis and invasion into the subretinal space. The goal of this case was to analyze the affection of the eye, caused by the Ascaris lumbricoides as very rare ocular pathology

Systemic manifestations of pseudoexfoliation

Objective: The aim of our study was to establish a correlation between pseudoexfoliation and its systemic manifestation. Findings: Pseudoexfoliation syndrome is an agerelated systemic disorder that leads to the overproduction and accumulation of the pseudoexfoliated materials in the visceral organs and in the eye. Many vascular diseases are closely related with pseudoexfoliation manifestations. Our results indicated that there were no statistically significant differences (p>0.05) among patients regarding the presence of hypertension in all groups: PEX glaucoma - 45% (9 patients); PEX syndrome- 40% (8 patients); and control groups- 35% (7 patients). Ischemic heart disease was statistically significant present in the sPEX syndrome- 20% (5 patients) and PEX glaucoma- 25% (5 patients) patient groupss, in comparison with those of the control group-10%, (p<0.05). Aortic aneurism was statistically significant present in patients with PEX (syndrome-5% or glaucoma-15%), compared to those in the control group, which included no patients with aneurisms, (p<0.05). Our results indicated that a statistically significant number of patients with aneurism were in the group of patients who developed PEX glaucoma (p<0.05). Cerebrovascular diseases were detected in all groups of patients, but a significant decrease in this metric was noted in the control group- 5% (2 patients), compared with patients with PEX syndrome- 15% and PEX glaucoma-25%, (p<0.05). Hearing loss, as a concomitant sign of PEX manifestation, was recorded in all patients, but in the group with PEX (syndrome-55% or glaucoma-75%), these results showed a statistically significant increase (p<0.05) in comparison with those of patients in the control group (10%). Among the patients with PEX (syndrome and glaucoma), there were no statistically significant differences in the selected categories of systemic manifestations (p<0.05). This result indicates that the main risk for systemic manifestation is the presence of PEX and that other ocular and vascular complications are, in fact, consequences of PEX. Conclusion: Pseudoexfoliation is strongly related to systemic vascular disturbances. A detailed examination of patients with PEX by specialists in internal disease or by neurologists should be performed. Such recommended examinations can be helpful in the prevention of different vascular diseasess among patients with PEX, especially atthose in the early stages

Prostatic carcinoma bilateral iris metastases

We described a patient with bilateral iris metastases resulted from prostatic cancer. Slit lamp and ultrasonography examination of the both eye demonstrated tumor of the iris, as an amelanotic vascular mass located on the superior temporal quadrant. On open biopsy revealed undiff erentiated tissue that stained strongly positive for prostate carcinoma, conrming the diagnosis of metastasis prostate adenocarcinoma. Early diagnostic procedures are essential for the causal therapy of prostate carcinoma as the primary neoplasm. © 2012 Association of Basic Medical Sciences of FBIH. All rights reserved

Clinical evaluation of graves ophthalmopathy

Introduction: Graves ophthalmopathy is an autoimmune disease, which is the consequence of thyroid dysfunction. Ocular manifestations occur in 50% of patients with Graves disease. The changes occur due to the inflammatory cell infiltration of retrobulbar fat tissue and extraocular muscles. Ultrasonography of eye orbit provides important information about the condition of retrobulbar adipose tissue and the thickness of extraocular muscles. Objective: The aim of our study was to show the clinical significance of orbital ultrasonography in the diagnostics and follow-up of patients with Graves disease. Methods: The authors examined 154 patients with Graves ophthalmopathy at the Clinic of Ophthalmology of the Clinical Centre in Kragujevac during the period 2008-2010. Ophthalmological examination included visual acuity testing (Snellen chart), biomicroscopy and applanation tonometry, direct and indirect ophthalmoscopy, dry eye testing and exophthalmometry (Hertel). Orbital ultrasonography examination and extraorbital muscle measurement was done by ultrasound B-scan. Results: The disease was more frequent in women (79.87%) aged from 36-45 years. Most patients had hyperthyreoidism (54.55%). In relation to the duration of the disease, the most frequent clinical signs were bilateral ptosis, conjunctival chemosis and periorbital edema. According to our data the highest number of patients had enlarged medial straight muscle. Conclusion Graves ophthalmopathy is the most frequent sign of thyroid disease. By orbital ultrasonography we detected extended echogram and measured the thickness of the extraocular muscle. Computerized tomography and magnetic resonance scan were utilized for cases of insufficiently manifested clinical signs of the disease. The advantages of ultrasonography lie in easy handling, patients'comfort, short time of examination and possibilities of repetition

Acute intermittent porphyria - A case report

Introduction. Acute intermittent porphyria is a rare inherited metabolic disorder caused by a decreased level of porphobilinogen deaminase. Subsequent accumulation of byproducts in neural elements causes a classic triad of abdominal pain, neurological dysfunction, and psychiatric disturbances. Case report. A 22-year-old female patient with convulsions, episodes of blindness and progressive development of quadriparesis, bulbar paralysis, and respiratory failure was admitted to our intensive care unit twelve days after undergoing colon resection at the local hospital. The diagnosis was confirmed by a high level of porphobilinogen in urine. Previous use of oral contraceptives, antidepressants, and thiopental as induction agents for general anesthesia could represent precipitating factors. The patient was treated conservatively with high carbohydrate intake and human hemin. Six months after admission, the patient was transferred to the Department of Physical Medicine and Rehabilitation. Conclusion. Early diagnosis of acute intermittent porphyria is the cornerstone for successful treatment. The next step includes adequate therapy followed by the prevention of attacks