Je li tablica ETDRS bolja od Snellenove tablice u procjeni vidne oštrine kod operacije katarakte?

This study was designed to explore practical differences between visual acuity (VA) scores measured on Snellen chart versus ETDRS chart, to grade cataracts using LOCS III system, and to compare VA on both charts depending on cataract grade and type. Prospective evaluation of uncorrected and best-corrected visual acuity was carried out on the eye scheduled for cataract surgery preoperatively and postoperatively on the Snellen and ETDRS charts. The study was carried out at Department of Eye Diseases, Clinical Center of Serbia, during a two-year period. Inclusion criteria were met by 540 patients who underwent testing, surgery, data collection and analysis. The mean VA score was better on ETDRS than on Snellen chart. The mean difference was 6.05 letters or 1.21 lines. VA results correlated with all types of cataract regardless of the chart used, with the highest statistical significance (p<0.0001) for subcapsular cataract. The ETDRS chart was found to be more discriminative and precise than Snellen chart, especially for poor VA.Cilj studije bio je procijeniti razlike vidne oštrine mjerene Snellenovom tablicom nasuprot tablici ETDRS, odrediti stupanj katarakte primjenom sustava LOCS III i usporediti vidnu oštrinu dobivenu pomoću oba optotipa ovisno o tipu i stupnju katarakte. Provedena je prospektivna procjena nekorigirane i najbolje korigirane vidne oštrine primjenom tablica Snellen i ETDRS prije i nakon operacije katarakte. Ova dvogodišnja studija izvedena je na Klinici za očne bolesti Kliničkog centra Srbije. Kriterije za uključivanje u studiju ispunilo je 540 bolesnika koji su podvrgnuti testiranju, operaciji, prikupljanju i analizi podataka. Srednja vrijednost zbroja vidne oštrine procijenjena tablicom ETDRS bila je bolja u usporedbi sa Snellenovom tablicom. Srednja vrijednost bila je 6,05 slova ili 1,21 linija. Rezultati vidne oštrine korelirali su sa svim tipovima katarakte bez obzira na tablicu koja se primijenila, s najvećom statističkom značajnošću (p<0,0001) za subkapsularnu kataraktu. Grafikon ETDRS pokazao se više diskriminativnim i preciznijim nego Snellenov, osobito za slabu vidnu oštrinu

Sudden cardiac arrest in Belgrade emergency medical technician occurring at workplace – a brand new case

Sudden cardiac arrest (SCA) is always an important topic, which catches physicians and health professionals’ attention. According to the Occupational Safety and Health Organization, 15% of workplace fatalities are due to SCA. While the incidence of SCA among employees in other Emergency services, i.e. firefighters (1) and police (2) has been described in the literature, there are no recorded data or published studies about SCA among medical staff employees in Emergency Medical Services (EMS). We describe the rare case SCA in emergency medical technicians (EMT) while in workplace

Comparative pathological findings in mute swans (Cygnus olor) naturally infected with highly pathogenic Avian influenza viruses H5N1 and H5N8 in Serbia

The aim of this study was to compare pathological lesions and viral antigen expression in the organs of mute swans (Cygnus olor) naturally infected with highly pathogenic avian influenza virus subtypes H5N1 and H5N8. The examination was conducted on the carcasses of 22 mute swans which died during the avian influenza outbreaks in Serbia in 2006 and 2016-2017. Avian influenza virus subtype H5N8 isolated from mute swans in 2016-2017 was clustered within the 2.3.4.4 Glade group B. After necropsy, lung, liver, spleen, pancreas, kidney and brain tissues were sampled for histopathology and immunohistochemical examination. Avian influenza virus nucleoprotein polyclonal antibodies were used for detecting the viral antigen in the examined tissues. The most significant gross lesions were necrosis and haemorrhages in the pancreas. Major histological lesions were multifocal necroses in the pancreas, spleen and liver, non-purulent encephalitis, lung congestion and oedema. Immunohistochemical demonstration of HPAIV nucleoprotein in pancreas and brain was strongly consistent with histological lesions in both infected groups. Our findings showed that pancreas was the most affected organ in all examined mute swans. In addition to increased mortality rate, similar pathological findings were detected in mute swans naturally infected with highly pathogenic avian influenza viruses H5N1 and H5N8

Leberjeva hereditarna optična nevropatija – pregled bolezni z analizo prisotnosti v Sloveniji

Leberjeva hereditarna optična nevropatija (LHON) je redka dedna mitohondrijska bolezen, ki povzroča slepoto najpogosteje pri mladih odraslih. Navadno se izrazi kot subakutna, neboleča izguba vida na eno oko, ki ji sledi poslabšanje vida drugega očesa v nekaj tednih do mesecih. Bolezen večinoma pušča trajne posledice, le pri nekaterih bolnikih lahko v redkih primerih pride do delnega spontanega izboljšanja vida. Razmerje med moškimi in ženskimi bolniki se ocenjuje na 3 : 1. V zadnjih letih je z razvojem zdravilne učinkovine idebenone možno podporno farmakološko zdravljenje, ki lahko prispeva k delnemu izboljšanju vidne funkcije. Bolezen zaradi svoje redkosti velikokrat ostane ne- ali napačno diagnosticirana. V članku predstavljamo štiri klinične primere bolnikov, pri katerih se je po obsežnem in dolgotrajnem diagnosticiranju izkazalo, da imajo LHON. Od leta 1996 se v Sloveniji vodi baza bolnikov z redkimi dednimi očesnimi boleznimi. Na tej podlagi je ocenjena prevalenca LHON 1/72.000. Ob sumu na bolezen so ključni družinska anamneza slabovidnosti po materini strani, genetsko testiranje in napotitev na obravnavo ter zdravljenje v terciarno ustanovo

Correlation of changes in the mitochondrial genome with phenotypic characteristics in patients with Leber's hereditary optic neuropathy

Cilj ove doktorske disertacije bila je detaljna genotipska i fenotipska karakterizacija grupe pacijenata sa kliničkom slikom Leberove hereditarne optičke neuropatije (LHON) u akutnoj ili hroničnoj fazi bolesti i funkcionalna analiza mitohondrijske funkcije kod nosilaca mogućih novih patogenih mutacija. Metodologija: U grupi od 82 pacijenata sa kliničkom slikom LHON-a urađena je genetska analiza (MLPA, sekvenciranje nove generacije mitohondrijske DNK [mtDNK], celog egzoma i genoma), kao i detaljna fenotipska karakterizacija (vidna oštrina, kolorni vid, optička koherentna tomografija [OCT] i elektrofiziologija). Karakteristike genetski različitih grupa međusobno su poređene. Kod nosilaca novih mogućih patogenih mutacija izvedeni su testovi mitohondrijske funkcije (respirometrija visoke rezolucije Oroboros i protočna citometrija). Metodom spekularne mikroskopije, utvrđivali smo i broj endotelnih čelija rožnjače. Rezultati: Kod 17 pacijenata je identifikovan genetski uzrok LHON-a, a kod 6 pacijenata promene u mitohondrijskoj DNK (retke mutacije) koje su mogući uzročnici pojave LHON-a. Testovi mitohondrijske funkcije su kod ovih pacijenata pokazali smanjenu aktivnost kompleksa I lanca prenosilaca elektrona, povećanu produkciju slobodnih kiseoničnih radikala (ROS) i depolarizaciju unutrašnje membrane miohondrija, što ukazuje na patogenu prirodu identifikovanih promena. Kod 2 pacijenta, čije su fenotipske karakteristike prikazane zasebno, potvrđen je autozomno recesivni LHON. Kod nekoliko pacijenata sa genetski potvrđenim LHONom došlo je do poboljšanja vidne oštrine. Poređenjem fenotipskih karakteristika ovih pacijenata sa pacijentima bez poboljšanja utvrđena je bolja očuvanost pojedinih slojeva retine u srednjem ETDRS prstenu, kao i bolje elektrofiziološke karakteristike u akutnoj i u hroničnoj fazi bolesti. Kod izvesnog broja pacijenata i pored jasnog fenotipa LHON-a nije identifikovana genetska osnova, ali su upoređivane fenotipske karakteristike ovih pacijenata sa grupom genetski potvrđenih LHON pacijenata radi identifikovanja kliničkih biomarkera bolesti. Utvrđeno je postojanje bolje očuvanosti debljine unutrašnje retine kod LHON pacijenata što se stoga može smatrati potencijalnim biomarkerom bolesti, kao i smanjen broj endotelnih ćelija rožnice. Zaključak: Rezultati prikazani u okviru ove teze pomogli su boljoj karakterizaciji pacijenata sa LHON-om, kao i identifikaciji potencijalnih biomarkera bolesti. Takođe su identifikovane nove promene u mtDNK, i potvrđena je njihova potencijalna patogenost.The goal of this doctoral dissertation was to genotypically and phenotypically characterize a group of patients with a clinical presentation of Leber’s Hereditary Optic Neuropathy (LHON) in the acute and chronic phase of the disease and perform functional analysis of the mitochondrial function in carriers of the possible pathogenic novel changes in mitochondrial DNA. Methodology: Genetic analysis (MLPA, next-generation sequencing of the mtDNK, whole exome, and genome) and detailed clinical work-up (visual acuity testing, color vision, optical coherent tomography (OCT), and electrophysiology) were performed in a group of 82 patients with phenotypic characteristics of LHON. Patients were divided into groups based on the genetic testing results and their phenotypic characteristics were compared. In patients with identified novel mtDNK changes testing of mitochondrial function was performed. We have also determined the count of endothelial cells in patients with confirmed LHON. Results: We have identified the genetic cause of LHON in 17 patients, and possible causative pathogenic mtDNK changes (rare mutations) in 6 patients. Mitochondrial function testing in these patients showed decreased complex I-based respirometry, membrane depolarizationand increased ROS production. These results indicate the pathogenic nature of the novel changes. Autosomal recessive LHON as a distinct entity has been identified in two patients and presented separately. The improvement of the visual function has been noticed in 4 LHON patients. By comparing the phenotypic characteristics of LHON patients with and without visual function improvement we have concluded that there is better preservation of the retinal layers in the middle ETDRS ring and that these patients have better electrophysiology results both in the acute and the chronic phase in patients with improvement. A certain number of patients remained unclarified regardless of the typical LHON phenotype. We have compared the phenotypic characteristics of these patients with a group of patients with genetically confirmed LHON in order to identify clinical biomarkers of the disease and concluded that in genetically confirmed LHON patients there is a better preservation of the ETDRS center which could be a novel biomarker of the disease. We have also found a small decrease in the endothelial cell count in the cornea of LHON patients. Conclusions: The results presented in this doctoral dissertation have attributed to a better characterization of LHON patients and the identification of novel biomarkers of the disease. We have also identified novel changes in the mtDNK whose pathogenicity has been proven by the serial of the mitochondrial function tests

Retinal detachment in the eye with the choroidal coloboma

Introduction. Choroidal coloboma is a congenital defect caused by an inadequate closure of embryonic fissure. About 40% of the eyes with the choroidal coloboma (CHC) develop the retinal detachment (RD). It is extremely difficult to manage these cases due to the lack of pigmentation at the site of choroidal coloboma. Outline of Cases. This is a case series of five patients with CHC and RD who were successfully operated using one of two different surgical techniques: pars plana vitrectomy (PPV) + silicone oil internal tamponade and/or scleral buckle with encircling band with laser photocoagulation (SB+EB+LPC) around the coloboma. The purpose of this paper is to present how to successfully handle patients with CHC, who have concurrent retinal detachment in the same eye and to compare two different techniques and indications for the predominant use of one of them in a specific case. Conclusion. Both surgical techniques can be applied with equal success in the operation of retinal detachment in eyes with the chorioidal coloboma. Which one will be used depends only of the posterior segment of eye findings. We use scleral buckling in cases with RD accompanied by CHC when the peripheral break is evident and there are no breaks in the coloboma itself. We also perform, 2-3 days after surgery, laser burns around the coloboma, which is our modification of this technique. In all other cases it is indicated to perform PPV+silicon oil internal tamponade

Recurrence of a small primary iris stromal cyst following treatment with Nd:YAG laser photodisruption in an adult

Introduction. Primary acquired iris stromal cyst is rare in adults. In this group, they are generally stable lesions which require no treatment. Case outline. We describe a rare case of a small primary iris cyst in a 39-year-old patient, associated with unusual signs of irritation. Ultrasound biomicroscopy demonstrated iris stromal cyst measuring 3 × 2 mm. A neodymium-doped yttrium aluminium garnet (Nd:YAG) laser cystotomy was engaged as the least invasive treatment approach. However, the cyst recurred soon after repeated laser treatment and sector iridectomy with excision of the cyst was performed. Five years after surgery there was no evidence of recurrence. Conclusion. Although more benign clinical course of primary stromal iris cyst is generally assumed in adults as compared to children, complete cyst removal seems to be mandatory for preventing cyst recurrence regardless of the cyst size or patient age. To the authors’ knowledge this is the first documented report of Nd:YAG laser photodisruption of acquired primary iris stromal cyst in an adult

Optic nerve head recovery following the iop-lowering surgery in the eye with early juvenile glaucoma-nine years follow up

Introduction. Congenital uveal ectropion (CEU) is a rare, non-progressive condition often accompanied with eyelid ptosis, anterior insertion of the iris, disgenesis of the iridocorneal angle and glaucoma. Case report. We present a case of a seven-year-old girl with a congential unilateral uveal ectropion and a secondary glaucoma which had daily variations from 13 up to 50 mm Hg. The patient had no other abnormalities of the iris or underlying systemic diseases. Introduced local anti-glaucomatous therapy initially normalized intraocular pressure (IOP), but failed to provide long term normalisation. Trabeculectomy normalized the IOP which resulted in the reduction of the cup/disc ratio and restitution of neuroretinal rim. The rim area increased to 1.716 mm2 (0.958 mm2 preoperative) rim volume, was 0.666 mm3 (0.195 mm3 preoperative) while cupdisc (C/D) ratio decreased to 0.330 (0.626 preoperative) as well as linear C/D=0.574 (0.791 preoperative). Neuroretinal rim (NR) was preoperatively preserved in the Ti segment, damaged in T, Ts, N, Ns segments, and borderline in the Ni segment. Postoperatively, neuroretinal rim was preserved in all segments. Conclusion. In the presented case trabeculectomy induced recovery of the nerve tissue of the optic nerve head which was confirmed by Haidelberg Retina Tomograph II (HRT II). The treatment results have been maintained during the follow-up period of nine years without topical or systemic antiglaucomatous therapy. Although CEU is a non-progressive and benign eye disease, associated glaucoma can cause severe optic nerve damage if not detected early and treated properly. As can be seen in the presented case, an adequate treatment can prevent and even reverse optic disc neuropathy

Highly Pathogenic Avian Influenza H5N8 Outbreak in Backyard Chickens in Serbia

In winter 2016/2017, the highly pathogenic avian influenza virus H5N8 was detected in backyard poultry in Serbia for the first time. The second HPAI outbreak case in backyard poultry was reported in 2022, caused by subtype H5N1. This is the first study that documents the laboratory identification and pathology associated with highly pathogenic avian influenza in poultry in Serbia during the first and second introduction waves. In both cases, the diagnosis was based on real-time reverse transcriptase PCR. The most common observed lesions included subepicardial hemorrhages, congestion and hemorrhages in the lungs, and petechial hemorrhages in coelomic and epicardial adipose tissue. Histologically, the observed lesions were mostly nonpurulent encephalitis accompanied by encephalomalacia, multifocal necrosis in the spleen, pancreas, and kidneys, pulmonary congestion, and myocardial and pulmonary hemorrhages. In H5N8-infected chickens, immunohistochemical examination revealed strong positive IHC staining in the brain and lungs. Following these outbreaks, strict control measures were implemented on farms and backyard holdings to prevent the occurrence and spread of the disease. Extensive surveillance of birds for avian influenza virus did not detect any additional cases in poultry. These outbreaks highlight the importance of a rapid detection and response system in order to quickly suppress outbreaks