46 research outputs found
Suvremeno lijeÄenje glaukoma otvorenog kuta
In recent years, a large number of drugs have been developed for treatment of glaucoma with the increasing choices of alternative medications.
A wide choice of newer local agents is now available for the treatment of glaucoma, each with differing efficacy and side effects. New treatment options for reducing IOP provide an opportunity to improve both compliance and therapeutic results while at the same reducing the level of side effects seen with multiple conventional drug regimens. This drug review considers the mode of action and properties of the various treatments, followed by practical advice to offer patients about their medication. Clinicians need to understand, synthesize and use data about medications that have specific benefits and risks for their glaucoma patients.
Glaucoma is a progressive optic neuropathy characterized by optic disc cupping and concomitant characteristic visual field defects. The term glaucoma describes a number of different disorders that affect the eye, all of which culminate in the death of the retinal ganglion cells of the optic nerve and visual field defects intraocular pressure (IOP) lowering is still the mainstay of treatment, the goal of which is to preserve visual function for the remainder of patients lifetime, whilst optimizing the quality of life. Most of the drugs now used to treat glaucoma are primarily directed at lowering IOP. In sense they are like cholesterol lowering agents in that they are designed to manage the risk factors for the diseases which led to glaucoma, rather than its basic underlying cause.
The concept of target IOP is worth considering. At the onset of treatment, it is helpful to establish a target IOP at which further damage to the optic nerve is deemed unlikely to occur. Commonly this is a 20 to 30 per cent reduction from the IOP at which damage occurred. If the glaucomatous optic neuropathy is worsening during the course of treatment, the target IOP may need to be adjusted. Compliance tends to fall off as the number of medications and dosing instructions increases and therefore, it is well worth reviewing a patient\u27s list of medications to determine if some of the newer agents on the market may allow consolidation of treatments. This review deals with open angle glaucoma where medical therapy is commonly the initial form of management.U posljednjih nekoliko godina svjedoci smo razvoja velikog broja lijekova za lijeÄenje glaukoma, sa sve veÄim izborom alternativnih medikacija.
Danas nam lijeÄenju glaukoma stoji na raspolaganju Å”irok izbor novih lijekova, svaki sa razliÄitom efikasnoÅ”Äu i nuspojavama. Nove terapijske moguÄnosti za sniženje intraokularnog tlaka omoguÄavaju nam da poboljÅ”amo compliance i terapijske rezultate, a istovremeno se smanjuje broj lokalnih nuspojava koje se susreÄu kod konvencionalnih terapijskih shema. Ovaj pregledni Älanak bavi se naÄinom djelovanja i svojstvima razliÄitih terapijskih moguÄnosti, nakon eega slijede praktiÄni savjeti o lijekovima. KliniÄari bi, u lijeÄenju glaukomskih bolesnika, trebali shvatiti, sintetizirati i upotrijebiti svoje znanje o lijekovima koji imaju posebne korisne i Å”tetne strane.
Glaukom je progresivna optikoneuroterapija, karakterizirana ekskavacijom vidnog živca i popratnim oÅ”teÄenjima vidnog živca i popratnim oÅ”teÄenjima vidnog polja. Sam pojam glaukoma oznaÄava odreÄen broj razliÄitih poremeÄaja koji zahvaÄaju oko, a koji svi kulminiraju smrÄu retinalnih ganglijskih stanica vidnog živca i oÅ”teÄenjima vidnog polja. Okosnicu terapije i dalje Äini sniženje intraokularnog tlaka, Äiji je cilj obuvanje vidne funkcije uz istovremeno poboljÅ”anje kvalitete života. VeÄina lijekova koji se danas koriste u lijeÄenju glaukoma su prvenstveno usmjereni na sniženje intraokularnog tlaka. Oni se mogu usporediti sa lijekovima za sniženje kolesterola, jer su razvijeni da bi kontrolirali Äimbenike rizika koji su doveli do glaukoma, a ne da bi lijeÄili njegov osnovni uzrok.
Vrijedno je spomenuti i koncept ciljnog intraokularnog tlaka. Na samom poÄetku terapije korisno je postaviti ciljni intraokularni tlak pri kojem Äe daljnja oÅ”teÄenja vidnog živca biti malo vjerojatna. ObiÄno je ta vrijednost manja za 20-30% od intraokularnog tlaka kod kojeg je doÅ”lo do oÅ”teÄenja. Ako se oÅ”teÄenje vidnog živca uzrokovano glaukomom pogorÅ”ava tijekom terapije, tada je potrebno postaviti novi ciljni intraokularni tlak - primijeÄeno je da se compliance pogorÅ”ava Å”to se viÅ”e poveÄava broj lijekova ukljuÄenih u terapiju i upute o njihovom uzimanju. Stoga je mudro provjeriti pacijentovu listu lijekova i utvrditi da li neki novi lijekovi na tržiÅ”tu omoguÄavaju konsolidaciju terapije. Ovaj pregledni Älanak odnosi se na primarni glaukom otvorenog kuta gdje je medikamentozna terapija inicijalni naÄin lijeÄenja
Komplikacije lokalne anestezije u oftalmologiji
The local anaesthesia given in ophthalmic surgery, if performed correctly has been proved to be highly successful with low incidence of complications. This review article outlines the possibility of the complication of local anaesthesia in ophthalmic surgery.Pravilno davanje lokalne anestezije u oÄnoj kirurgiji veoma je uspjeÅ”no s malom uÄestaloÅ”Äu komplikacije. Ovaj Älanak opisuje moguÄe komplikacije lokalne anestezije u oÄnoj kirurgiji
Pripravci ljekovitih biljaka u lijeÄenju prehlade i gripe
Influenza viruses represent a permanent global health threat with approximately one billion people infected each year. Although influenza is usually self-limited infection, there are specific populations in which complications are common and sometimes fatal. Therefore, antiviral therapy with neuraminidase inhibitors and less often with adamantanes is becoming preferable course of action. Nevertheless, herbal plants, reviewed in this article, and plant preparations are still a widespread option for influenza and other viral diseases both in developed and developing countries
Meningeomi orbite - kliniÄko zapažanje
The aim of the study was to assess the characteristics and clinical features of orbital meningiomas during a 5-year period (2001-2005). Due to their typical posterior location, slowly progressive and painless visual loss, orbital meningiomas are intriguing and challenging lesions to diagnose and manage. This prospective study identified five cases (four female, mean age 46.5Ā±14.5 years and one male aged 68 years) of orbital meningiomas, treated at University Department of Ophthalmology, Split University Hospital in Split from January 2001 until December 2005. In each case, the diagnosis was confirmed by history review. In our study, the incidence of orbital meningiomas was 0.2 per 100,000 inhabitants, however, some cases may have been recognized and treated at other hospitals in Croatia. In this study, orbital meningiomas showed a female predominance (F/M, 4:1). The mean visual acuity was 0.7 (range 0.4-0.9). Discrete proptosis was found in two cases with a slightly blurred optic disc margin and discrete optic disc edema. Optic nerve discoloration was observed in three cases. In one case, meningioma showed intracranial extension. Mild optic disc discoloration and blurred optic disc margin with slow and painless visual loss, particularly in females, may be the first signs of orbital meningioma.Meningeomi orbite zbog svoje stražnje lokalizacije i polaganog bezbolnog gubitka vida Äesto predstavljaju dijagnostiÄki i terapijski izazov. Cilj rada bio je ispitati incidenciju meningeoma orbite tijekom 5 godina (sijeÄanj 2001. - prosinac 2005.) na Klinici za oÄne bolesti KliniÄke bolnice Split. Retrospektivnom analizom su ispitane povijesti bolesti petoro bolesnika s kliniÄkom dijagnozom meningeoma orbita, lijeÄenih na naÅ”oj Klinici. Analiza je obuhvatila Äetiri žene srednje dobi 46,5Ā±14,5 godina i jednog muÅ”karca starog 68 godina. Incidencija meningeoma orbite u naÅ”em ispitivanju bila je 0,2 na 100.000 stanovnika, iako je moguÄe da su neki bolesnici dijagnosticirani i lijeÄeni na drugim klinikama u Hrvatskoj. Meningeomi orbita su bili ÄeÅ”Äi kod žena nego kod muÅ”karaca (4:1). Srednja vidna oÅ”trina je bila 0,7 (raspon 0,4-0,9). Diskretna proptoza s nejasnim granicama i blagim edemom glave vidnog živca naÄena je u dva sluÄaja, a diskoloracija vidnog živca u druga tri sluÄaja. Kod jednog bolesnika meningeom orbite je oÄitovao intrakranijsku ekstenziju. Blagi i bezbolni pad oÅ”trine vida jednoga oka, diskoloracija i nejasne granice vidnog živca na oÄnoj pozadini, naroÄito kod žena, mogu biti prvi znaci meningeoma orbite
UÄinak Travoprosta 0,004% kao dodatne terapije uz Timolol 0,5%
The aim of the study was to compare the efficacy of travoprost 0.004% eye drops added to therapy with timolol 0.5%. The study included 40 patients (80 eyes) with open angle glaucoma and intraocular pressure (IOP) above 18 mm Hg treated with topical beta blocker (timolol 0.50% twice a day). Travoprost 0.004% was added to timolol 0.5% therapy once daily in the evening. Follow up examinations were scheduled at 7 days, one month and three months. IOP lowering was achieved in all patients. Substantial lowering of 2.42 mm Hg was achieved after the first week of treatment. Further lowering and stabilization of IOP was recorded at three months, with total IOP decrease of 3.97 mm Hg; the difference was statistically significant (Ļ2=6.7743; p<0.01). At three months, target IOP was recorded in 64 eyes (16.4Ā±0.7 mm Hg) and failed to be achieved in 16 eyes (21.1Ā±2.3 mm Hg). Mild hyperemia was found in two patients and discrete hyperemia in 26 patients. Burning sensation associated with the use of travoprost 0.004% eye drops was reported by 68 patients. In conclusion, the use of travoprost 0.004% eye drops resulted in successful lowering of IOP and achievement of target IOP.Cilj studije bio je ispitati uspjeÅ”nost terapije travoprostom 0.004% pridodanog veÄ postojeÄoj terapiji timololom 0,5%. U studiju je bilo ukljuÄeno 40 bolesnika s glaukomom otvorenog kuta i intraokularnim tlakom (IOT) iznad 18 mm Hg lijeÄenih lokalnim beta blokatorom (timolol 0,5% dva puta na dan). Travoprost 0,004% se davao uz veÄ postojeÄu terapiju jedanput na dan, naveÄer. Kontrolni pregledi uslijedili su nakon 7 dana, 1 mjeseca i 3 mjeseca. Sniženje IOT je postignuto kod svih bolesnika. ZnaÄajno sniženje IOT od 2,42 mm Hg postignuto je nakon tjedan dana terapije. Daljnje sniženje IOT se postiglo i stabiliziralo nakon 3 mjeseca, s ukupnim sniženjem od 3,97 mm Hg; razlika je bila statistiÄki znaÄajna (Ļ2=6,7743; p<0.01). Nakon 3 mjeseca ciljni tlak postignut je kod 64 oÄiju (16,4Ā±0,7 mm Hg), a nije postignut kod 16 oÄiju (16,4Ā±0,7 mm Hg). Blaga hiperemija utvrÄena je kod dvoje, a diskretna hiperemija kod 26 bolesnika. Peckanje pri ukapavanju lijeka opisalo je 68 bolesnika. ZakljuÄuje se kako je primjena kapi travoprosta 0.004% dovela do sniženja IOT i postizanja ciljnog tlaka
OptiÄki neuritis i multipla skleroza: naÅ”a iskustva
Idiopathic optic neuritis is idiopathic inflammation of the optic nerve. Multiple sclerosis is a chronic inflammatory demyelinating process of the central nervous system that affects mostly women aged 20-40. Modern diagnostic methods (MRI, VEP, and computerized perimetry) can confirm or exclude demyelinating etiology of the process. The study included 31 patients with optic neuritis hospitalized at University Department of Ophthalmology, Split University Hospital in Split, Croatia, between January 1, 2004 and December 31, 2005. The incidence of idiopathic optic neuropathy at Department was 3.2/ 100,000 in 2004 and 3.4/100,000 in 2005. The majority of patients were in the 20-40 age groups. In 22 (84.62%) patients, MRI showed brain demyelinating lesions. Most patients had prolonged VEP latencies. The incidence of idiopathic optic neuropathy has shown a significant increase in the last two years. Brain MRI was the key diagnostic method, along with significant symptoms and signs of idiopathic optic neuropathy. High dose corticosteroid pulse therapy, as described before, was demonstrated to have a beneficial effect on quick recovery of visual acuity and lengthening of relapse-free period.Idiopatski optiÄki neuritis je upala vidnoga živca nepoznatog uzroka. Multipla skleroza je kroniÄni upalni demijelinizirajuÄi proces srediÅ”njega živÄanog sustava, koji se najÄeÅ”Äe javlja kod žena u dobi od 20 do 40 godina. Moderne dijagnostiÄke metode (magnetska rezonanca, vidni evocirani potencijali i kompjutorizirana perimetrija) omoguÄavaju potvrÄivanje ili iskljuÄivanje demijelinizacijske etiologije procesa. U ovu studiju bio je ukljuÄen 31 bolesnik hospitaliziran izmeÄu 1. sijeÄnja 2004. i 31. prosinca 2005. godine u Klinici za oÄne bolesti KliniÄke bolnice Split u Splitu, Hrvatska. Incidencija optiÄkog neuritisa u Klinici bila je 3,2/100.000 stanovnika u 2004. te 3,4/100.000 stanovnika u 2005. godini. VeÄina bolesnika je bila u dobi od 20 do 40 godina. Magnetska rezonanca je pokazala demijelinizacijske promjene u 22 (84,62%) bolesnika. VeÄina bolesnika je imala produžene VEP latencije. Incidencija idiopatske optiÄke neuropatije je pokazala znaÄajan porast u posljednje dvije godine. Magnetska rezonanca mozga je bila kljuÄna dijagnostiÄka metoda uza znaÄajne simptome i znakove idiopatske optiÄke neuropatije. Pulsna terapija kortikosteroidima u visokim dozama, kako je to prethodno objaÅ”njeno, pokazala se je korisnom za brz oporavak vidne oÅ”trine te za produljenje vremena do recidiva
Incidencija okluzije srediÅ”nje mrežniÄne vene
Epidemiologic reports on retinal vein occlusion are quite scanty in the ophthalmologic literature. In the present study, the incidence of central retinal vein occlusion (CRVO) was assessed in a defined population of the Split - Dalmatia County, Croatia. The study was designed as a retrospective review of the medical records of inpatients and outpatients with the development of CRVO during a 15-year period (1985 - 1999). Study results revealed CRVO to have occurred in 167 subjects in the population of 465,947 during the study period, yielding an annual incidence of 2.4 per 100,000. The highest incidence of CRVO was recorded above the age of 70. The results of the study should improve the disease evaluation and planning of the ophthalmologic service for better management of this serious disease.U oftalmoloÅ”koj literaturi su rijetke epidemioloÅ”ke studije o okluziji srediÅ”nje mrežniÄne vene. U ovoj je studiji ispitana incidencija okluzije srediÅ”nje mrežniÄne vene u definiranoj populaciji Splitsko-dalmatinske županije. Studija je bila retrospektivna, a zasnovana je na kartoteci hospitaliziranih i ambulantno pregledanih bolesnika s okluzijom srediÅ”nje mrežniÄne vene u razdoblju od 15 godina, od 1985. do 1999. godine. U ovoj studiji je 167 od 465.947 stanovnika dobilo okluziju srediÅ”nje mrežniÄne vene za vrijeme ispitivanog razdoblja. GodiÅ”nja incidencija bila je 2,4 na 100.000 stanovnika. NajviÅ”a incidencija okluzije srediÅ”nje mrežniÄne vene zabilježena je iznad 70. godine života. Rezultati ovoga ispitivanja omoguÄiti Äe bolju procjenu bolesti i planiranje oftalmoloÅ”ke službe za rjeÅ”avanje ove ozbiljne bolesti
Primarna steÄena opstrukcija nazolakrimalnog kanala: epidemioloÅ”ka analiza 91 bolesnika
Aim. To investigate the epidemiological characteristics of primary acquired nasolacrimal duct obstruction (PANDO).
Method. The study was a retrospective view of medical records of inpatients and outpatients who developed PANDO during a 10-year study period from 1994-2003 in Split-Dalmatian County managed at
the Eye Clinic of Split University Hospital. The total number of patients was 91.
Result. The annual incidence of PANDO was 1.96 per 100,000 inhabitants. The mean age Ā± SD of patients was 64.3 Ā± 16.0 years. There were 67 (73.6%) females and 24 (28.4%) males. The female to male ratio was 2.8, the difference was statistically significant (p = 0.000007). The differences in occurence were not statistically significant (p = 0.46) and a bilateral involvement was observed in 6 (6.6%) cases. An acute form of PANDO occured in 50 (54.9%) of cases, and a chronic form in 41 (45.1%) of cases. Although
prevalence of an acute form of PANDO was a little greater in warmer seasons (spring and summer) than in colder seasons (autumn and winter), the seasonal variations in the occurrence of PANDO were statistically not significant (p = 0.26).
Conclusion. The findings of this study are important because they make possible a better disease evaluation and better ophthalmological service planning in the treatment of PANDO.Cilj. Istražiti epidemioloŔke znacajke primarne stecene opstrukcije nazolakrimalnog kanala (PSONK).
Metoda. Ova retrospektivna studija daje pregled hospitaliziranih i ambulantnih bolesnika s PSONK-om tijekom razdoblja od 10 godina, tj. od 1994. do 2003. godine u Splitsko-dalmatinskoj županiji, lijecenih na Klinici za ocne bolesti Klinicke bolnice Split. Ukupan broj bolesnika bio je 91.
Rezultat. GodiÅ”nja incidencija PSONK-a bila je 1,96 na 100000 stanovnika. Prosjecna dob Ā± SD bolesnika bila je 64,3 Ā± 16,0 godina. Bilo je 67 (73,6%) žena i 24 (28,4%) muÅ”karaca. Odnos žena prema
muŔkarcima bio je 2,8, Ŕto je statisticki znacajna razlika (p = 0,000007). Razlike u pojavi bolesti izmedu desne i lijeve strane nisu statisticki znacajne (p = 0,64), a bilateralna pojava je primijecena u 6 (6,6%) slucajeva. Akutni oblik PSONK-a javio se u 50 (54,9%) slucajeva, a kronicni oblik u 41 (45,1%) slucaju.
Iako je prevalencija akutnog oblika PSONK-a neŔto veca u toplijim godiŔnjim dobima (proljece i ljeto), nego u hladnijim (jesen i zima), sezonske varijacije u pojavi PSONK-a nisu statisticki znacajne (p = 0,26).
Zakljucak. Rezultati ove studije su važni jer omogucavaju bolju evaluaciju bolesti i bolje planiranje oftalmoloŔke službe u lijecenju PSONK-a.