Meningeomi orbite - kliničko 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 46.5±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 često predstavljaju dijagnostički i terapijski izazov. Cilj rada bio je ispitati incidenciju meningeoma orbite tijekom 5 godina (siječanj 2001. - prosinac 2005.) na Klinici za očne bolesti Kliničke bolnice Split. Retrospektivnom analizom su ispitane povijesti bolesti petoro bolesnika s kliničkom dijagnozom meningeoma orbita, liječenih na našoj Klinici. Analiza je obuhvatila četiri žene srednje dobi 46,5±14,5 godina i jednog muškarca starog 68 godina. Incidencija meningeoma orbite u našem ispitivanju bila je 0,2 na 100.000 stanovnika, iako je moguće da su neki bolesnici dijagnosticirani i liječeni na drugim klinikama u Hrvatskoj. Meningeomi orbita su bili češći kod žena nego kod muškaraca (4:1). Srednja vidna oštrina je bila 0,7 (raspon 0,4-0,9). Diskretna proptoza s nejasnim granicama i blagim edemom glave vidnog živca nađena je u dva slučaja, a diskoloracija vidnog živca u druga tri slučaja. Kod jednog bolesnika meningeom orbite je očitovao intrakranijsku ekstenziju. Blagi i bezbolni pad oštrine vida jednoga oka, diskoloracija i nejasne granice vidnog živca na očnoj pozadini, naročito kod žena, mogu biti prvi znaci meningeoma orbite

Meningeomi orbite - kliničko 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 46.5±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 često predstavljaju dijagnostički i terapijski izazov. Cilj rada bio je ispitati incidenciju meningeoma orbite tijekom 5 godina (siječanj 2001. - prosinac 2005.) na Klinici za očne bolesti Kliničke bolnice Split. Retrospektivnom analizom su ispitane povijesti bolesti petoro bolesnika s kliničkom dijagnozom meningeoma orbita, liječenih na našoj Klinici. Analiza je obuhvatila četiri žene srednje dobi 46,5±14,5 godina i jednog muškarca starog 68 godina. Incidencija meningeoma orbite u našem ispitivanju bila je 0,2 na 100.000 stanovnika, iako je moguće da su neki bolesnici dijagnosticirani i liječeni na drugim klinikama u Hrvatskoj. Meningeomi orbita su bili češći kod žena nego kod muškaraca (4:1). Srednja vidna oštrina je bila 0,7 (raspon 0,4-0,9). Diskretna proptoza s nejasnim granicama i blagim edemom glave vidnog živca nađena je u dva slučaja, a diskoloracija vidnog živca u druga tri slučaja. Kod jednog bolesnika meningeom orbite je očitovao intrakranijsku ekstenziju. Blagi i bezbolni pad oštrine vida jednoga oka, diskoloracija i nejasne granice vidnog živca na očnoj pozadini, naročito kod žena, mogu biti prvi znaci meningeoma orbite

Procjena točnosti korekcije hiperopije na osnovi retinoskopije i vidnih evociranih potencijala kod djece s teškoćama u razvoju

The aim of this study was to evaluate the possibility of evaluation of optimal hyperopic correction based on visual evoked potential (VE P) examination results in children that do not cooperate. There are relatively few studies that evaluated the correlation between visual acuity and especially in young hyperopes. We examined 80 children (160 eyes) with hyperopia, divided into two groups: children that were cooperative during examination and children that could not cooperate with the examiner. Upon determination of the eye refractive state by other objective methods, the prescribed refraction was checked by following the change in VE P P100 wave amplitude and prescribed the correction for which these values were highest. The first VE P curve was recorded without any correction, then more VE P curves were recorded after increasing correction between +1.0 and +6.0 D, in the range found by retinoscopy, with 1 D step. The correction values that caused VE P curves with highest amplitude and shortest P100 wave latency were recorded. In conclusion, the VE P curve parameters were confirmed to depend on the refractive state of the eye.Cilj ovoga rada bio je ispitati mogućnost procjene optimalne hipermteropne korekcije na temelju ispitivanja vidno evociranim potencijalima (VE P) kod djece koja ne surađuju s ispitivačem. Povezanost između vidne oštrine i VE P istraživala se u samo nekoliko studija, osobito kod mlađe hipermetropne djece. Obradili smo 80 hipermetropne djece (160 očiju) podijeljene u dvije skupine. U prvoj skupini bila su djeca koja surađuju s ispitivačem (kontrolna skupina), a u drugoj skupini bila su djeca koja ne surađuju s ispitivačem. Nakon što se refrakcija ispitala drugim objektivnim metodama, provjeravala se propisana korekcija refrakcije na temelju najviše vrijednosti amplitude P100 vala krivulje VE P. Prva krivulja VE P napravljena je bez korekcije, a ostale krivulje dobivene su uz povećanje hiperopijske korekcije, u okviru skijaskopskog nalaza od +1 D do +6 D s povećanjem od po 1 D. Bilježile su se vrijednosti dobivenih krivulja s najvišom amplitudom i najkraćim vremenom (latencija) vala P100. Krivulja koja je imala najkraće vrijeme i najvišu amplitudu vala P100 označena je kao “najbolja”. Ovaj rad potvrdio je mogućnost uporabe VE P u svrhu utvrđivanja najbolje prihvaćene hiperopijske korekcije za propisivanje naočala kod djece koja ne surađuju s ispitivačem. Time se može potvrditi povezanost vrijednosti parametara krivulje VE P s refrakcijskim stanjem oka

The Role of Oxidative Stress after Retinal Laser Photocoagulation in Nonproliferative Diabetic Retinopathy

Diabetic retinopathy (DR) represents the most common chronic complication of diabetes, and it is the leading cause of new cases of blindness in patients between 20–74 years old in developed countries. Laser photocoagulation (LF) represents an efficacious approach to the treatment of DR. Oxidative factors, such as free radicals (FR), are continuously generated in aerobic organisms as a result of different metabolic processes. It is well known that oxidative stress plays a role in the development of DR. The aim of this study was to evaluate the thermal effects of the scatter retinal laser photocoagulation technique on the production of FR. A total of 90 patients were enrolled in this study. They were divided in 3 groups: 30 diabetic patients with DR, 30 diabetic patients without DR, and 30 control individuals without diabetes mellitus (DM). Full scatter retinal LF was performed in all patients with DR. We measured the concentrations of superoxide dismutase (SOD), glutathione peroxidase (GPOD), catalase, and total antioxidative status (TAS). Of the 30 DR patients, 13 showed the appearance or worsening of macular edema after LF, whereas the other 17 patients showed no change. Thirty days after LF, improvement in visual acuity was observed, but this change was not statistically significant. The mean plasma or erythrocyte lysate concentrations of various antioxidants were significantly lower in the diabetic patients without DR compared to the individuals without DM and in the diabetic patients with DR compared to the individuals without DM; the diabetic patients with DR did not show lower concentrations of the antioxidants compared to the diabetic patients without DR. The concentrations of SOD, GPOD, catalase, and TAS were significantly lower in the diabetic patients with DR after retinal scatter LF, which could be the consequence of retinal oxidative stress caused by the LF thermal effect

Optički neuritis i multipla skleroza: naša 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 optički neuritis je upala vidnoga živca nepoznatog uzroka. Multipla skleroza je kronični upalni demijelinizirajući proces središnjega živčanog sustava, koji se najčešće javlja kod žena u dobi od 20 do 40 godina. Moderne dijagnostičke metode (magnetska rezonanca, vidni evocirani potencijali i kompjutorizirana perimetrija) omogućavaju potvrđivanje ili isključivanje demijelinizacijske etiologije procesa. U ovu studiju bio je uključen 31 bolesnik hospitaliziran između 1. siječnja 2004. i 31. prosinca 2005. godine u Klinici za očne bolesti Kliničke bolnice Split u Splitu, Hrvatska. Incidencija optičkog neuritisa u Klinici bila je 3,2/100.000 stanovnika u 2004. te 3,4/100.000 stanovnika u 2005. godini. Većina bolesnika je bila u dobi od 20 do 40 godina. Magnetska rezonanca je pokazala demijelinizacijske promjene u 22 (84,62%) bolesnika. Većina bolesnika je imala produžene VEP latencije. Incidencija idiopatske optičke neuropatije je pokazala značajan porast u posljednje dvije godine. Magnetska rezonanca mozga je bila ključna dijagnostička metoda uza značajne simptome i znakove idiopatske optičke neuropatije. Pulsna terapija kortikosteroidima u visokim dozama, kako je to prethodno objašnjeno, pokazala se je korisnom za brz oporavak vidne oštrine te za produljenje vremena do recidiva

Effect of Botulinum Toxin-A Injection on Intraocular Pressure and Proptosis in Thyroid Associated Orbitopathy

The aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) on intraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy (TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX -A injections were applied. Intraocular pressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2–4 weeks after BTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX -A injection using a Hertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6± 2.8 mmHg and 2–4 weeks after BTX-A injection was 16.9±3.3 mmH; (p=0.001). There was no statistically significant difference in Hertel egzophthalmometer readings before and after BTX-A injection, 21.5±2.7 mm vs 22.0± 2.6 mm; (p=0.678). In conclusion, BTX-A injection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influence on proptosis

Uloga frequency-doubled Nd-YAG lasera (532 nm) u liječenju dijabetičnog makularnog edema

The aim of the study was to compare various laser wavelengths for photocoagulation treatment in clinically significant (focal) macular edema (CSME) in diabetics. Two different laser wavelengths (frequency-doubled Nd:YAG-532 nm vs. argon green-514 nm) were used to treat 54 eyes (28 eyes were treated with double frequency Nd:YAG laser and 26 eyes were treated with argon-green laser) of 35 patients with diabetes mellitus type 2. The mean follow up was 6 months. Therapeutic effect was evaluated by repeat visual acuity testing, color fundus photography and fundus fluorescein angiography. Reduction/elimination of CSME was observed in 73% (n=19) of frequency-doubled Nd:YAG-treated eyes and 75% (n=21) of argon-treated eyes. These results indicate that frequency-doubled Nd:YAG laser (532 nm) is equivalent to argon-green (514 nm) laser in the treatment of CSME. Frequency-doubled Nd:YAG laser (532 nm) therapy is effective in the treatment of CSME in diabetics and has a number of advantages (less scattering and less absorption by macular xanthophyll, ergonomic, high optical efficiency, long operating life-time, etc.).Cilj studije bio je usporediti različite valne duljine lasera rabljenih za fotokoagulacijsku terapiju kod klinički značajnih (fokalnih) makularnih edema u dijabetičara. Rabili smo dvije različite valne duljine lasera (frequency-doubled Nd:YAG-532 nm i argon green-514 nm) kod 54 očiju (28 očiju liječeno je frequency-doubled Nd-YAG laserom, a 24 oka su liječena argon-green laserom) u 35 bolesnika sa šećernom bolešću tip 2. Srednje vrijeme praćenja bilo je 6 mjeseci. Učinkovitost terapije smo procijenili ponovljenim ispitivanjem vidne oštrine, fotografiranjem u boji fundusa i fluoresceinskom angiografijom. Smanjenje/nestanak klinički značajnih makularnih edema zabilježeno je u 73% (n=19) bolesnika liječenih frequency-doubled Nd-YAG laserom i 75% (n=21) bolesnika liječenih argon-green laserom. Ovi rezultati pokazuju da frequency-doubled Nd:YAG laser (532 nm) ima jednaku učinkovitost kao i argon-green laser (514 nm) u liječenju klinički značajnog makularnog edema. Frequency-doubled Nd:YAG laser je učinkovit u liječenju klinički značajnog makularnog edema u bolesnika sa šećernom bolešću i ima niz prednosti (manje rasipanje i manja apsorpcija u makularnom ksantofilu, veća ergonomija, visoka kakvoća optike, dugotrajnost itd.

Optički neuritis i multipla skleroza: naša 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 optički neuritis je upala vidnoga živca nepoznatog uzroka. Multipla skleroza je kronični upalni demijelinizirajući proces središnjega živčanog sustava, koji se najčešće javlja kod žena u dobi od 20 do 40 godina. Moderne dijagnostičke metode (magnetska rezonanca, vidni evocirani potencijali i kompjutorizirana perimetrija) omogućavaju potvrđivanje ili isključivanje demijelinizacijske etiologije procesa. U ovu studiju bio je uključen 31 bolesnik hospitaliziran između 1. siječnja 2004. i 31. prosinca 2005. godine u Klinici za očne bolesti Kliničke bolnice Split u Splitu, Hrvatska. Incidencija optičkog neuritisa u Klinici bila je 3,2/100.000 stanovnika u 2004. te 3,4/100.000 stanovnika u 2005. godini. Većina bolesnika je bila u dobi od 20 do 40 godina. Magnetska rezonanca je pokazala demijelinizacijske promjene u 22 (84,62%) bolesnika. Većina bolesnika je imala produžene VEP latencije. Incidencija idiopatske optičke neuropatije je pokazala značajan porast u posljednje dvije godine. Magnetska rezonanca mozga je bila ključna dijagnostička metoda uza značajne simptome i znakove idiopatske optičke neuropatije. Pulsna terapija kortikosteroidima u visokim dozama, kako je to prethodno objašnjeno, pokazala se je korisnom za brz oporavak vidne oštrine te za produljenje vremena do recidiva

Uloga dijabetične retinopatije u sljepoći i slabovidnosti u Splitsko-Dalmatinskoj županiji 2000.-2010.

Diabetic retinopathy is the fifth leading cause of blindness in the world. The aim of this study was to determine the number of blind persons in the Split-Dalmatia County in the 2000-2010 period and how many of them are blind due to diabetic retinopathy. Records of 160 members of the Association of the Blind in the Split-Dalmatia County, enrolled from 2000 to 2010, were retrospectively analyzed. The leading causes of blindness were diabetic retinopathy (25.6%), glaucoma (13.1%), retinal dystrophy (16.2%), and age related macular degeneration (11.8%). The annual incidence of blindness was 8.4/100,000 inhabitants. The largest number of the blind were found in the 70-80 (21.2%) to >80 (24.3%) age group. Diabetic retinopathy was the cause of blindness in 24 (15%) men and 17 (10.6%) women. The annual incidence of diabetic retinopathy was 2.16 per 100,000. No case of blindness due to diabetic retinopathy was diagnosed in patients younger than 30 years of age, while the highest prevalence was found in the 70-80 age group (34%). Proliferative diabetic retinopathy was the cause of blindness in 92.7% and nonproliferative diabetic retinopathy in 7.3% of cases. Study results show that diabetic retinopathy remains the leading cause of blindness. Early identification of high-risk patients is the key factor in prevention and timely detection of ophthalmoscopic changes, thus enabling effective and duly treatment.Dijabetična retinopatija je peti najčešći uzrok sljepoće u svijetu. Cilj ove studije bio je istražiti broj slijepih u Splitskodalmatinskoj županiji u razdoblju od 2000. do 2010. godine te istražiti koliko je slijepih zbog dijabetične retinopatije. Retrospektivno smo analizirali 160 članova Udruge slijepih Splitsko-dalmatinske županije koji su registrirani između 2000. i 2010. godine. Najčešći uzroci sljepoće su: dijabetična retinopatija (25,6%), glaukom (13,1%), distrofija mrežnice (16,2%) i staračka makularna degeneracija (11,8%). Godišnja incidencija sljepoće je iznosila 8,4/100.000 stanovnika. Najveći broj slijepih je bio u dobnoj skupini od 70-80 godina (21,2%) i >80 godina (24,3%). U 24 (15%) muškarca i 17 (10.6%) žena sljepoća je bila uzrokovana dijabetičnom retinopatijom. Godišnja incidencija dijabetične retinopatije je iznosila 2,16/100.000 stanovnika. Nije pronađen niti jedan slučaj sljepoće uzrokovane dijabetičnom retinopatijom u dobi ispod 30 godina, dok je najveća učestalost nađena u dobnoj skupini od 70-80 godina (34%). U 92,7% slučajeva uzrok sljepoće je bila proliferativna dijabetična retinopatija, a u 7,3% neproliferativna dijabetična retinopatija. Ova studija ukazuje na dijabetičnu retinopatiju kao vodeći uzrok sljepoće. Rano otkrivanje rizičnih skupina je osnova prevencije i pravodobnog otkrivanja oftalmoloških promjena, na temelju čega se može pravodobno započeti s odgovarajućim liječenjem

Sljepoća i poremećaji vida kod dijabetičara u Hrvatskoj

New estimates show reduction in the number of people who are blind or suffer from vision impairment as a sequel of infectious diseases, while there is an increase in the number of people who are blind due to conditions related to longer life span and diabetes. Diabetic retinopathy is the leading cause of blindness in active population in developed countries. Epidemiological studies evaluated the incidence and describe many facets of this disease the incidence of which is being followed in most countries. The aim of this paper is to present some epidemiological data on diabetic retinopathy caused by type 1 diabetes in Croatia, to compare them with other countries, and to evaluate its importance in causing severe visual impairments and blindness. These data are considered highly relevant because they are changing constantly and require continuous monitoring in spite of all advances in understanding the distribution, causes and severity of diabetic retinopathy. It is of great importance because the increasing burden of diabetes will pose ever greater burden on the population at large and on healthcare systems providing care for these patents.Najnovije procjene ukazuju na smanjenje broja slijepih osoba i osoba sa slabijim vidom uzrokovanih zaraznim bolestima, no sve je veći broj ljudi slijepih zbog bolesti vezanih za produženje životnog vijeka ljudi i dijabetes. Dijabetična retinopatija je vodeći uzrok sljepoće u radnoj populaciji u razvijenim zemljama. Mnoge epidemiološke studije su procijenile incidenciju i sagledale ovu bolest iz svih njezinih aspekata. Cilj ovoga rada je prikazati epidemiološke podatke o dijabetičnoj retinopatiji uzrokovanoj dijabetesom tip 1 u Hrvatskoj, te ih usporediti s podatcima iz drugih zemalja i ocijeniti koliko ona utječe na broj slijepih osoba i osoba sa slabijim vidom. Smatramo ove podatke bitnima unatoč napretku u saznanjima o mehanizmima, raspodjeli i uzrocima bolesti. Treba također naglasiti da se ovi podatci neprestance mijenjaju i zbog toga ih valja stalno pratiti. To je osobito važno zbog toga što dijabetes uzrokuje veliko opterećenje za zajednicu i zdravstveni sustav koji se skrbi o ovim bolesnicima