High-risk eye disease in the neonatal age

In clinical practice, rare congenital and co-natal eye diseases in newborns require special attention of the ophthalmologist and the neonatologist because of the possible deleterious functional consequences if not recognized and treated on time. Presented are three congenital eye diseases: retinopathy of prematurity, congenital cataract and congenital glaucoma in which surgical treatment is generally successful if performed early, up to the first year of the newborns' life. The pathophysiological development mechanisms, the clinical picture and treatment methods of congenital eye diseases are described. Late treatment represents a risk of developing impaired vision and blindness with all the sociomedical consequences of a handicapped child, with regard to intellectual development, education, socialization and integration into the work-effective population

Endemski glaukom u naseljima Mune i Brgud

In the past century, research into the prevalence of congenital glaucoma among the Mune and Brgud villagers showed that glaucoma was present in 38% of the population. Genealogical studies established the presence of congenital glaucoma through six generations of the villagers. Tradition has it that members of the Šori family have diseased eyes from time immemorial and that other families have through generations been linked to this family, in a repeated circle of conjugal relationships. From the considerable documentation collected, it appears that approximately 50% of the population are genetically linked to the central Šori family. In this group, about half of the offspring show symptoms of this congenital disease. Clinical characteristics of the Mune-Brgud congenital glaucoma are similar to those of the late congenital glaucoma. It is caused by a congenital anomaly of the iridocorneal angle, and is clinically manifested between the age of 10 and 40. It is characterized by goniodysgenesis and high insertion of the iris, remnants of undifferentiated mesodermal embryonic tissue, widening of the trabecular meshwork, decreased aqueous outflow, and regularly present markedly deep anterior chamber. Megalocornea, hypoplasia of the corneal stroma and moderate myopia are present sporadically.U prošlom stoljeću su istraživanja učestalosti kongenitalnog glaukoma kod stanovnika naselja Mune i Brguda pokazala kako je glaukom bio prisutan u 38% ove populacije. Genealoškim ispitivanjem utvrđeno je da se prisutnost kongenitalnog glaukoma prati kroz šest naraštaja stanovnika. Predaja govori kako su članovi obitelji Šori od davnina imali bolesne oči te da su druge obitelji kroz naraštaje bile vezane uz obitelj Šori kroz opetovani krug bračnih veza. Iz obilne sakupljene dokumentacije proizlazi da je oko 50% populacije ovih sela genetski vezano za središnju obitelj Šori. U toj skupini prosječno polovica potomstva pokazuje simptome ove nasljedne bolesti. Kliničke značajke kongenitalnog glaukoma Mune-Brgud slične su onima kod kasnog kongenitalnog glaukoma. Glaukom Mune-Brgud uzrokovan je kongenitalnom anomalijom u iridokornealnom kutu i klinički se očituje u dobi od 10. do 40. godine života. Obilježava ga goniodisgeneza i visoka insercija šarenice, ostatak nediferenciranog embrijskog mezodermalnog tkiva, prošireni trabekulum, smanjeno istjecanje sobne vodice i redovito prisutna izrazito duboka prednja sobica. Megalokornea, hipoplazija rožnične strome i umjerena miopija su rijetko prisutne

Comparison of 23 Gauge and 25 Gauge PPV in the Treatment of Epiretinal Membranes and Macular Holes

The aim of this study was to show the long term recovery after the operative procedure of pars plana vitrectomy (PPV) in patients with epiretinal membranes (ERM) and macular holes. We wanted to show if there is a difference in operative approach and results of 23 and 25 gauge PPV. Twenty eight patients underwent to operative treatment of idiopatic ERM and macular holes grade III and IV. In our study there was not a statistical signifi cant difference in visual acuity (VA) between 23 gauge and 25 gauge operated patients, both ERM and macular holes. Although both approaches are good, morphological restitution do not always follow the functional recovery

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

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

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

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