Uloga vitamina u liječenju s dobi povezane degeneracije makule

The role of vitamins in the treatment of age related macular degeneration was reviewed. The following studies were selected for review: Eye Disease Case Control Study (EDCCS), Beaver Dam Eye Study, Blue Mountains Eye Study, Pathologies Oculaires Liees a l\u27Age Study (studija POLA) and Age Related Eye Disease Study (AREDS). These studies showed that antioxidant intake could be recommended in patients with certain forms of age related macular degeneration. A definite answer concerning the role of antioxidants is expected to be provided by additional studies.Pregledno je prikazana uloga vitamina u liječenju s dobi povezane degeneracije makule. Za pregled su izabrane slijedeće studije: Eye Disease Case Control Study (EDCCS), Beaver Dam Eye Study, Blue Mountains Eye Study, Pathologies Oculaires Liees a l.Age Study (studija POLA) i Age Related Eye Disease Study (AREDS). Ove su studije pokazale kako se unos antioksidansa može preporučiti u bolesnika s određenim oblicima s dobi povezane degeneracije makule. Od budućih se studija očekuje konačan odgovor u svezi s ulogom antioksidansa

Utjecaj oštećenja vida na kvalitetu života bolesnika s glaukomom

The aim of this study was to assess the eff ect of diff erent visual impairment levels on diff erence in the subjective quality of life estimation. We included 150 patients with glaucoma whose best-corrected visual acuity in the better-seeing eye was 0.5 and less. All of them were in advanced stage of the disease, with visual fi eld defect worse than 12 dB in mean defect, when measured with the Octopus Visual Field Analyzer. In order to assess the quality of life, we used the Impact of Vision Impairment questionnaire. Additionally, we used General Information Questionnaire, which was developed for the purpose of this study. The information obtained from the questionnaires was analyzed using the Robust Discriminant Analysis program. Diff erence analysis was performed for each of the three areas of the questionnaire (reading and accessing information, mobility and independence, and emotional well-being). Results of this study confi rmed the diff erence between the groups of patients with diff erent levels of visual impairment, varying from total visual loss up to visual acuity 0.5 on the better-seeing eye in the eff ects of visual impairment on the quality of life. All levels of visual impairment had the largest eff ect in the area of reading and accessing information, slightly less in the area of mobility and independence, and the least eff ect was in the area of emotional well-being. Based on the results, it is concluded that all levels of visual impairment have negative eff ect on the quality of life in glaucoma patients.Cilj istraživanja bio je utvrditi utjecaj oštećenja vida na kvalitetu života bolesnika s glaukomom. Istraživanjem je obuhvaćeno 150 bolesnika s glaukomom, s ostatkom vida od 50% i manje na boljem oku (vidna oštrina ≤0,5). Svi su bili u terminalnoj fazi bolesti, s oštećenjem vidnoga polja većim od 12 dB u Mean Defects (MD) mjerenim analizatorom vidnog polja Octopus. Za mjerenje utjecaja oštećenja vida na kvalitetu života primijenjen je upitnik Th e Impact of Vision Impairment (IVI), a dodatno je primijenjen upitnik vlastite izrade General Information Questionnaire. Prikupljeni podaci su obrađeni modelom robustne diskriminacijske analize (ROBDIS). Utvrđena je razlika između skupina ispitanika s različitim stupnjem oštećenja vida, od potpunog gubitka vida do ostatka vida na boljem oku od 50%. Za svako od tri područja (čitanje i pristup informacijama, kretanje i samostalnost te emocionalno blagostanje) učinjena je razlikovna analiza. Rezultati istraživanja potvrdili su da oštećenje vida utječe na kvalitetu života bolesnika s glaukomom. Najveći utjecaj različitih stupnjeva oštećenja vida bio je očit u području čitanja i pristupa informacijama, nešto manji u području orijentacije i kretanja, a najmanji u području emocionalnog blagostanja

Annotated retinal optical coherence tomography images (AROI) database for joint retinal layer and fluid segmentation

Optical coherence tomography (OCT) images of the retina provide a structural representation and give an insight into the pathological changes present in age-related macular degeneration (AMD). Due to the three-dimensionality and complexity of the images, manual analysis of pathological features is difficult, time-consuming, and prone to subjectivity. Computer analysis of 3D OCT images is necessary to enable automated quantitative measuring of the features, objectively and repeatedly. As supervised and semi-supervised learning-based automatic segmentation depends on the training data and quality of annotations, we have created a new database of annotated retinal OCT images – the AROI database. It consists of 1136 images with annotations for pathological changes (fluid accumulation and related findings) and basic structures (layers) in patients with AMD. Inter- and intra-observer errors have been calculated in order to enable the validation of developed algorithms in relation to human variability. Also, we have performed the automatic segmentation with standard U-net architecture and two state-of-the-art architectures for medical image segmentation to set a baseline for further algorithm development and to get insight into challenges for automatic segmentation. To facilitate and encourage further research in the field, we have made the AROI database openly available

Rezultati vitrektomije - lensektomije nakon komplikacija fakoemulzifikacije

In this study we presented visual results and complications in patients treated by vitrectomy and lensectomy for posterior dislocation of lens fragments during phacoemulsification. This retrospective study was carried out between 1998-2000. Eighteen patients had a vitrectomy and lensectomy done for posterior dislocation of lens fragments. The median age of the patients was 71. The median timing of the surgery was 13 days. One patient had a vitrectomy performed at the time of cataract surgery (day 0). Uveitis was present in 14 (78%) patients, corneal edema in 9 (50%) and ocular hypertension in 10 (55,5%) patients. After vitrectomy visual acuity was 0,5 or better in 9 patients (50%), 4 patients (22%) had intraocular hypertension, 2 patients (11%) had corneal edema, and 4 patients (22%) had uveitis. Visual acuity improved in most (17) our patients after vitrectomy. There was no statistically significant difference in final visual outcome considering timing of the vitrectomy-lensectomy. Vitrectomy significantly reduces ocular hypertension, uveitis and corneal edema.U ovoj studiji prikazani su rezultati vidne oštrine i komplikacije kod pacijenata za koje je rađena vitrektomija i lensektomija nakon dislokacije lećnih fragmenata za vrijeme fakoemulzifikacije. Studija je rađena od listopada 1998. godine do siječnja 2001. godine. Kod 18 pacijenata urađena je vitrektomija i lensektomija lećnih fragmenta nakon dislokacije u stražnji dio oka. Srednja dob pacijenata je bila 71 godinu. Srednje vrijeme od operacije pri kojoj se dogodila komplikacija do vitrektomije bilo je 13 dana. Kod jednog bolesnika rađena je vitrektomija odmah po komplikaciji (dan 0). Uveitis je bio prisutan u 14 (78%) bolesnika, kornealni edem u 9 (50%) i povišen intraokularni tlak u 10 (55,5%) bolesnika. Nakon vitrektomije vidnu oštrinu 0,5 ili bolju imalo je 9 bolesnika (50%), 4 bolesnika (22%) imalo je povišen intraokularni tlak, 2 bolesnika (11%) su imali kornealni edem i 4 bolesnika (22%) imali su uveitis. Poboljšanje vidne oštrine postignuto je kod većine bolesnika (17) nakon vitrektomije. Nije bilo statistički značajne razlike u konačnom ishodu operacija obzirom na vrijeme izvođenja vitrektomije- lensektomije. Vitrektomija značajno reducira intraokularni tlak, uveitis i kornealni edem

Subkonjunktivna fragmentacija XEN gel stenta nakon prethodno uspješne implantacije i posljedičnog formiranja filtracijskog jastučića: prikaz slučaja

The XEN gel stent is one of the available minimally invasive glaucoma surgery devices, a new generation implant, which is designed to reduce intraocular pressure in patients with primary open angle glaucoma if past medical treatments have failed. This report presents a case of subconjunctival fragmentation of the XEN gel stent after a three-month follow-up of successful XEN gel implantation. A 70-year-old male patient was treated for primary open angle glaucoma. He underwent successful phacoemulsification and intraocular lens implantation two years before. Due to medical therapy failure in controlling glaucoma, XEN gel stent implantation was suggested to the patient. The implant was successfully placed in both eyes, and extended bleb and drainage aqueous humor from the anterior chamber to the subconjunctival space was obtained. Three months after the surgery, at a regular follow-up visit, three fragments of the subconjunctival part of the XEN gel implant were found in his left eye. Neither serious complications nor intraocular pressure increase were detected. A new potential complication of the XEN gel implant is described.XEN gel stent je implantat nove generacije koji se rabi u minimalno invazivnoj kirurgiji glaukoma, namijenjen za snižavanje intraokularnog tlaka u bolesnika s glaukomom primarno otvorenog kuta kada prethodno liječenje nije dovelo do željenog rezultata. Prikazan je slučaj bolesnika kod kojega je nakon tri mjeseca praćenja uspješno implantiranog XEN gel stenta došlo do njegove subkonjunktivne fragmentacije. Muškarac u dobi od 70 godina liječen je zbog glaukoma otvorenog kuta. Dvije godine ranije imao je uspješnu operaciju katarakte s ugradnjom intraokularne leće. Zbog neuspješne kontrole glaukoma medikamentnom terapijom bolesniku je predložena implantacija XEN gel stenta. Implantat je uspješno implantiran u oba oka te je omogućen protok očne vodice iz prednje očne sobice u subkonjunktivni prostor uz formiranje filtracijskog jastučića. Tri mjeseca nakon operacije lijevoga oka, na redovnoj kontroli vizualizirana su tri fragmenta subkonjunktivnog dijela XEN gel stenta, bez da je prethodno bilo ozbiljnijih komplikacija ili porasta intraokularnoga tlaka. Opisana je nova moguća komplikacija XEN gela implantata

Obostrani endogeni endoftalmitis uzrokovan bakterijom pseudomonas aeruginosa u imunokompetentnog bolesnika s nozokomijalnom urosepsom nakon abdominalnog kirurškog zahvata

Endogenous endophthalmitis is a vision-threatening condition that results from hematogenous spread of infection to the eye, originating from a distant primary focus. It is considered as a rare entity that predominantly occurs in immune-compromised patients. We present a case of a critically ill immune-competent patient who underwent abdominal surgery later followed by nosocomial urosepsis complicated with bilateral Pseudomonas aeruginosa endogenous endophthalmitis that resulted in blindness. This case is clinically important because of the absence of predisposing factors for this kind of eye infection.Endogeni endoftalmitis je akutna komplikacija hematogenog rasapa infekcije iz udaljenog žarišta u oči, što u najvećem broju slučajeva rezultira sljepilom. Bolest je rijetka, a najčešće se javlja u imuno kompromitiranih bolesnika. Prikazujemo imuno kompetentnog bolesnika kod kojega se nakon hitne operacije inkarcerirane ingvinalne hernije razvila nozokomijalna urosepsa komplicirana obostranim endogenim endoftalmitisom uzrokovanim bakterijom Pseudomonas aeruginosa, koji je rezultirao sljepilom. Budući da se radi o bolesniku bez prethodno opisanih predisponirajućih čimbenika za razvoj ove teške bolesti, smatramo ovaj prikaz klinički važnim za rano prepoznavanje i što ranije agresivno liječenje ove teške bolesti

Analiza programa specijalističke izobrazbe iz oftalmologije

The aim of the study was to perform qualitative and quantitative analysis of residency curriculum in ophthalmology. A structured anonymous questionnaire was distributed to 73 medical doctors who were at least on the second year of their residency training in ophthalmology or young ophthalmologists with maximum 4 years of experience. The questionnaire consisted of 52 questions covering every segment of education from the current Protocol for Residency Education of Health Care Professionals in Ophthalmology. Forty-two (58%) doctors answered the questionnaire. Qualitative analysis showed that most of the procedures were mastered by residents. Diagnostic and/or examination procedures were mastered better than surgical and/or interventional procedures. Quantitative analysis showed that the majority of residents failed to reach the prescribed number of surgical procedures. Thirty-three (79%) participants were not satisfied with the current residency curriculum. Although residents mastered most of the prescribed procedures, current residency curriculum is far from being perfect and needs improvements. We think that objective assessment tools for monitoring the progress and competencies of residents during their residency training need to be developed.Cilj rada bio je provesti kvalitativnu i kvantitativnu analizu programa specijalističkog usavršavanja iz oftalmologije metodom anonimne ankete. O anonimnoj anketi obaviještena su ukupno 73 doktora medicine koji su bili najmanje na drugoj godini specijalizacije iz oftalmologije, odnosno oftalmolozi s maksimalno 4 godine specijalističkog staža. Anketa se sastojala od 52 pitanja vezana uza sve dijelove izobrazbe iz aktualnog Pravilnika o specijalističkom usavršavanju zdravstvenih djelatnika iz oftalmologije. Anketu su ispunila 42 (58%) doktora. Kvalitativna analiza pokazala je kako je većina predviđenih zahvata uspješno svladana za vrijeme specijalizacije. Dijagnostički zahvati i/ili razne metode pregleda svladani su bolje nego kirurški i/ili interventni postupci. Prema kvantitativnoj analizi većina specijalizanata nije ispunila predviđeni broj kirurških zahvata. Trideset troje (78%) sudionika nije zadovoljno trenutnim programom specijalističkog usavršavanja. Dakle, premda su specijalizanti ovladali većinom predviđenih zahvata, sadašnji program specijalističkog usavršavanja daleko je od savršenog i potrebna su poboljšanja. Smatramo da je potrebno razviti kvalitetne metode za objektivnu procjenu napretka i kompetentnosti specijalizanata za vrijeme specijalizacije

Retinopathy and Nephropathy in Type 1 Diabetic Patients – Association with Polymorphysms of Vitamin D-Receptor, Tnf, Neuro-D and Il-1 Receptor 1 Genes

Retinopathy and nephropathy are common late type 1 diabetes mellitus (T1D) complications. In this study we investigated whether individual differences in 4 candidate genes significantly contribute to development and progression of late complications in T1D patients. We examined 121 patients for the presence of diabetic retinopathy and nephropathy. We genotyped variants in vitamin D receptor (VDR) and tumor necrosis factor (TNF) genes in 47 patients and in NeuroD1 and interleukin-1 receptor 1 (IL1R1) genes in 35 patients. Diabetic retinopathy had 66 (55%) patients after a median of 13.0 years after diagnosis. Diabetic nephropathy had 14 (11.66%) patients, all of whom had already developed retinopathy. A significant correlation between the degree of diabetic retinopathy and mean microalbuminuria (MA) value has been found (c2=54.18, p<0.001). After correcting for duration of disease, only the VDR gene BsmI genotypes showed significant association with cumulative prevalence of diabetic retinopathy, while no investigated genetic polymorphysms could reliably predict diabetic nephropathy