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

Complications after Primary and Secondary Transsclerally Sutured Posterior Chamber Intraocular Lens Implantation

This retrospective study analyses and compares early complications during the first month after primary and secondary posterior chamber implantation of transsclerally sutured IOL. The analysis covered medical records of 65 patients who underwent posterior chamber implantation of transsclerally sutured IOL at the Eye Clinic in Rijeka between 1998 and 2003. In 30 patients (group 1) lenses were implanted in one eye during complicated cataract surgery (primary implantation), whereas 35 patients (group 2) had lenses implanted afterwards (secondary implantation). There were 77 early complications, equally represented in both groups, i.e. 40 in (51.9%) the first and 37 (48.1%) in the second group. The most frequent complications were: vitreous hemorrhages 24.7% (14.3% and 10.4%), cystoid macular edema 19.5% (9.1% and 10.4%), keratopathy 14.3% (6.5% and 7.8%), pupil distortion 11.7% (9.1% and 2.6%), IOL decentration and tilt 10.4% (6.5% and 3.9%), high intraocular pressure 9.1% (2.6% and 6.5%), inflammation 6.5% (2.5% and 3.9%). Retinal and choroidal detachment had low incidence: 2.6% (1.3% and 1.3%) and 1.3% (0% and 1.3%) respectively. As concerns early complications, there were no statistically significant differences between the two groups, except for pupil distortion, which was more frequent in primary IOL implantation (p=0.045). After primary implantation of IOL, the average visual acuity was 0.38±0.27, whereas after secondary implantation visual acuity was 0.52±0.21. The difference was not statistically significant

Complications after Primary and Secondary Transsclerally Sutured Posterior Chamber Intraocular Lens Implantation

This retrospective study analyses and compares early complications during the first month after primary and secondary posterior chamber implantation of transsclerally sutured IOL. The analysis covered medical records of 65 patients who underwent posterior chamber implantation of transsclerally sutured IOL at the Eye Clinic in Rijeka between 1998 and 2003. In 30 patients (group 1) lenses were implanted in one eye during complicated cataract surgery (primary implantation), whereas 35 patients (group 2) had lenses implanted afterwards (secondary implantation). There were 77 early complications, equally represented in both groups, i.e. 40 in (51.9%) the first and 37 (48.1%) in the second group. The most frequent complications were: vitreous hemorrhages 24.7% (14.3% and 10.4%), cystoid macular edema 19.5% (9.1% and 10.4%), keratopathy 14.3% (6.5% and 7.8%), pupil distortion 11.7% (9.1% and 2.6%), IOL decentration and tilt 10.4% (6.5% and 3.9%), high intraocular pressure 9.1% (2.6% and 6.5%), inflammation 6.5% (2.5% and 3.9%). Retinal and choroidal detachment had low incidence: 2.6% (1.3% and 1.3%) and 1.3% (0% and 1.3%) respectively. As concerns early complications, there were no statistically significant differences between the two groups, except for pupil distortion, which was more frequent in primary IOL implantation (p=0.045). After primary implantation of IOL, the average visual acuity was 0.38±0.27, whereas after secondary implantation visual acuity was 0.52±0.21. The difference was not statistically significant

Progression of macular oedema following cataract surgery in a diabetic patient

Operacija katarakte najizvođenija je operacija u medicini. Šećerna bolest, kao jedno od najčešćih kroničnih oboljenja, povezana je s češćim i ranijim nastankom katarakte u odnosu na zdravu populaciju. Budući da je riječ o mikroangiopatskoj bolesti, u većini slučajeva imamo prisutan određeni stupanj oštećenja hematookularne barijere radi čega su pacijenti skloniji postoperativom padu vidne oštrine. Uzroci pada vidne oštrine postoperativno kod pacijenta sa šećernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojećeg dijabetičkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspješno liječiti.Cataract surgery is the most performed surgery in modern medicine. Furthermore, diabetes mellitus is related to higher incidence and the earlier onset of cataract compared to a healthy population. As it is a microangiopathic disease, commonly there is a degree of hematoocular barrier damage which makes the patients susceptible to the postoperative drop in eye acuity. The causes of postoperative eye acuity reduction in diabetic patients following uncomplicated cataract surgery are related to the either onset of postoperative cystoid macular oedema or progression of existing diabetic macular oedema.Making the correct diagnosis and ensuring correct and timely therapy, postoperative complications can be succesfully treated

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

Progression of macular oedema following cataract surgery in a diabetic patient

Operacija katarakte najizvođenija je operacija u medicini. Šećerna bolest, kao jedno od najčešćih kroničnih oboljenja, povezana je s češćim i ranijim nastankom katarakte u odnosu na zdravu populaciju. Budući da je riječ o mikroangiopatskoj bolesti, u većini slučajeva imamo prisutan određeni stupanj oštećenja hematookularne barijere radi čega su pacijenti skloniji postoperativom padu vidne oštrine. Uzroci pada vidne oštrine postoperativno kod pacijenta sa šećernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojećeg dijabetičkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspješno liječiti.Cataract surgery is the most performed surgery in modern medicine. Furthermore, diabetes mellitus is related to higher incidence and the earlier onset of cataract compared to a healthy population. As it is a microangiopathic disease, commonly there is a degree of hematoocular barrier damage which makes the patients susceptible to the postoperative drop in eye acuity. The causes of postoperative eye acuity reduction in diabetic patients following uncomplicated cataract surgery are related to the either onset of postoperative cystoid macular oedema or progression of existing diabetic macular oedema.Making the correct diagnosis and ensuring correct and timely therapy, postoperative complications can be succesfully treated

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

Progression of macular oedema following cataract surgery in a diabetic patient

Operacija katarakte najizvođenija je operacija u medicini. Šećerna bolest, kao jedno od najčešćih kroničnih oboljenja, povezana je s češćim i ranijim nastankom katarakte u odnosu na zdravu populaciju. Budući da je riječ o mikroangiopatskoj bolesti, u većini slučajeva imamo prisutan određeni stupanj oštećenja hematookularne barijere radi čega su pacijenti skloniji postoperativom padu vidne oštrine. Uzroci pada vidne oštrine postoperativno kod pacijenta sa šećernom bolesti nakon nekomplicirane operacije katarakte odnose se na nastanak postoperativnog cistoidnog makularnog edema ili na progresiju postojećeg dijabetičkog edema makule. Pravilnim postavljanjem dijagnoze te ordiniranjem pravilne i pravodobne terapije, navedene postoperativne komplikacije mogu se uspješno liječiti.Cataract surgery is the most performed surgery in modern medicine. Furthermore, diabetes mellitus is related to higher incidence and the earlier onset of cataract compared to a healthy population. As it is a microangiopathic disease, commonly there is a degree of hematoocular barrier damage which makes the patients susceptible to the postoperative drop in eye acuity. The causes of postoperative eye acuity reduction in diabetic patients following uncomplicated cataract surgery are related to the either onset of postoperative cystoid macular oedema or progression of existing diabetic macular oedema.Making the correct diagnosis and ensuring correct and timely therapy, postoperative complications can be succesfully treated

Novel possibilities in treatment of dry age-related macular degeneration

Senilna makularna degeneracija (engl. age-related macular degeneration; AMD) jedan je od najvažnijih uzroka gubitka centralnog vida kod starije populacije. Dijelimo je na „vlažnu” i „suhu” formu, ovisno o prisutnosti koroidne neovaskularizacije (engl. choroidal neovascularization; CNV). Do sada nijedna terapija nije potvrđena i odobrena za liječenje geografske atrofije (engl. geographic atrophy; GA), najtežeg oblika „suhog” AMD-a, jer nije bilo moguće popraviti oštećenja retinalnog pigmentnog epitela (engl. retinal pigment epithelium; RPE) i fotoreceptora. Liječenje se svodilo na pokušaje zaustavljanja progresije oboljenja i širenja geografske atrofije. Namjera ovog članka je prikazati podatke novijih dovršenih i tekućih kliničkih ispitivanja s naglaskom na mjesto djelovanja potencijalnih lijekova. Danas su nam dostupne brojne nove dijagnostičke metode koje nam omogućavaju bolje praćenje morfoloških promjena mrežnice, RPE-a i žilnice, kao i širenja područja atrofije. Oksidativni stres, kronična upala, insuficijentni koroidalni protok krvi te depoziti lipofuscina za koje se pretpostavlja da bi imali važniju ulogu u razvoju bolesti predstavljaju potencijalne mete za djelovanje lijekova. Velik je broj tekućih studija koje istražuju moguća rješenja, kao što su protuupalni i neuroprotektivni lijekovi te matične stanice, dok će samo neki od lijekova biti dostupni na tržištu i pružiti nadu pacijentima za očuvanje centralnog vida, pa ih je potrebno dugoročno pratiti. Uključiti treba i tretman ispodpražnim i mikropulsnim laserom koji je kod nekih oboljenja mrežnice pokazao određene rezultate u revitalizaciji tkiva, a koji koristimo i na našoj Klinici, te su prvi kratkoročni rezultati skromni ali ohrabrujući i zahtijevaju daljnje tretmane i praćenje.Age-related macular degeneration (AMD) is one of the most important cause of central vision lost in elderly. AMD is “wet” or “dry”, depending on choroidal neovascularization (CNV) presence. Currently, no treatment iz approved for geographic atrophy (GA), late form of “dry” AMD because of imposibillity to restore retinal pigment epithelium (RPE) and photoreceptors. So, all earlier treatment only tried to slow down disease and spreading of GA. This review focuses on current data about potential targets for therapies evaluated in novel clinical trials. Novel diagnostic tools are available today for better monitoring of morfological changes in retina, RPE and choroid and spreading of atrophy zone. Several pathways, including oxidative stress, deposits of lipofuscin, chronic inflammation andchoroidal blood flow insufficiency, seem to play an important role in the pathogenesis of “dry” AMD and represent possible targets for new therapies. A great number of treatment for GA such as anti-inflammatory agents, neuroprotective agents and stem cells are under investigation with promising results in preliminary study, and only few will enter the market. Besides them we need to mention subtreshold and micropulse laser treatment with ability to revitalize tissue. We, also, used them on our Eye clinic with “short-term” follow-up and modest but encouraging results, so we need other studies with “long-term” follow-up