Usporedba mjerenja aksijalne duljine očne jabučice ispunjene silikonskim uljem pomoću optičke biometrije i magnetske rezonancije [Comparison of axial length measurement of silicone oil filled eyes using optical coherent biometry and magnetic resonance biometry]

Given the problems of calculating the length of the silicone oil filled eyes, there is no optimal method that can be considered the golden standard at this moment. The aim of this study was to compare the accuracy of the axial length measurement of silicone oil filled eyes, using optical coherent biometry and magnetic resonance imagining. This prospective randomized study included 69 patients, of whom in 35 patients biometry was done using magnetic resonance (A or MR group), while in 34 patients biometry was performed using optical coherent biometry (B or Master group) The median deviation of the final from the predicted refraction in the MR group was -0,50 D, and in the Master group 1,19 D. The difference between groups was statistically significant (p = 0.01). According to the data of this study, magnetic resonance imagining is a more accurate method for measuring the axial length of the silicone oil filled eyes compared to the optical coherent biometry. It also showed a more accurate intraocular lens power calculation before phacoemulsification and evacuation of silicone oil regarding smaller deviation from the final refraction, if the imagining is done with sections of 1,5 mm

Konzervans u očnim kapima kao uzrok pojasaste keratopaije rožnice kod dugotrajne terapije pilokarpin hidrokloridom

The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.Cilj je prikazati slučaj nastanka rožničnih komplikacija uzrokovanih konzervansima pri dugotrajnoj upotrebi kapi 1%- tnog pilokarpin hidroklorida (Pilokarpin, Pliva, Zagreb, Hrvatska) i njihovo liječenje. Bolesnik s glaukomom zatvorenog kuta koji se unazad dvadeset godina liječio antiglaukomskim kapima 1%-tnog pilokarpin hidroklorida tri puta na dan žalio se na slabiji vid, haloe i povremeno crvenilo očiju. Oftalmološkim pregledom nađene su obostrane pojasaste degeneracije rožnice, periferne laserske iriditomije, zjenice u medikamentnoj miozi, tamna nuklearna bilateralna katarakta i scintilirajuća sinhiza desnog oka. Konzervans živin nitrat smatra se uzrokom pojasaste degeneracije rožnice kod ovoga bolesnika. Liječenje bolesnika sastojalo se od dva postupka za oba oka: prvi je bio kombinirani zahvat fakoemulzifikacije katarakte s trabekulektomijom, a nakon šest mjeseci liječenje koje je uključivalo abraziju kornealnog epitela i uklanjanje stromalnih kalcijskih depozita pomoću 3,75%-tne otopine etilendiamintetraoctene kiseline (EDTA). Vidna oštrina nakon fakotrabekulektomije bila je 0,8 na oba oka. Obostrano poboljšanje vida do vidne oštrine 1,0 postiglo se nakon uklanjanja rožničnih depozita pomoću EDTA. Zaključuje se kako se prilikom dugotrajne upotrebe lijekova s konzervansima mogu očekivati nuspojave kao što je pojasasta degeneracija rožnice koja može doprinijeti znatnom smanjenju vidne oštrine. Kirurško liječenje pomoću EDTA je sigurna i učinkovita metoda liječenja pojasaste degeneracije rožnice

Retinopathy of Prematurity as a Cause of Blindness in Croatia

Cilj rada bio je istražiti koliko je često prematurna retinopatija (PR) uzrok sljepoće u Hrvatskoj. Upotrebljeni su podaci Saveza slijepih Hrvatske. Obrađeni su podaci Udruge slijepih grada Zagreba, Udruge slijepih Koprivničko-Križevačke županije i Udruge slijepih Međimurske županije, što čini 25% članstva Hrvatske udruge slijepih. Uzroci sljepoće obrađeni su prema dobi, spolu i razlogu sljepoće. PR je bio uzrok sljepoće u 260 osoba u Hrvatskoj. U cijeloj populaciji slijepih u Hrvatskoj PR je na desetom mjestu po učestalosti te vodeći uzrok sljepoće u dobi do 16 godina. Broj slijepih zbog PR od 1985. g. je u stalnom porastu. U obrađenim udrugama slijepih u razdoblju od 2005. do 2007. godine zbog PR je učlanjeno 7 slijepe djece. S obzirom na velik istraženi uzorak možemo zaključiti da u Hrvatskoj svakog 26. dana jedno dijete oslijepi zbog PR. Preventivi i liječenju PR nužno je pridati veće značenje, od županijskih bolnica do klinika i Ministarstva zdravstva.The aim of our study was to assess the rate of retinopathy of prematurity (ROP) as a cause of blindness in Croatia. Data were collected from the registers of the associations of the blind. In our study, we analyzed 25% of the blind population in Croatia (N=1699) including the City of Zagreb, Koprivnica-Križevci County and Međimurje County Associations of the Blind. Data were analyzed according to sex, age and cause of blindness. According to prevalence, ROP ranked tenth as the cause of blindness in the blind population and was the main cause of blindness by age 16. The rate of ROP as a cause of blindness was on a continuous increase over the past two decades (1985-2007). The number of newly registered blind children during the past two-year period (2005-2007) indicated that every 26th day one child in Croatia goes blind because of ROP. Better prevention and treatment of ROP should be developed within the Croatian health care system

Carotid Cavernous Fistulas in Postmenopausal Women

U razdoblju od posljednjih pet godina na Klinici za očne bolesti Kliničke bolnice "Sestre milosrdnice" osam bolesnica je hospitalizirano radi obrade i terapije kavernozne karotidne fistule. Cilj ove studije bio je prikazati naša iskustva u dijagnostici, terapiji i praćenju bolesnika s kavernoznim karotidnim fistulama. Svi pacijenti bile su žene u menopauzi srednje životne dobi 69,75±7,3 godina, bez ikakve traume u anamnezi. Najčešći simptomi bili su proptoza, pad vida i kemoza. Od dijagnostičkih metoda rabili smo ultrazvuk, magnetsku rezonanciju (NMR) i angiografiju. Endovaskularna balonska okluzija bila je terapija izbora kod svih bolesnica, ali je kod jedne došlo do spontanog zatvaranja fistule, dok je jedna odbila takvu vrstu liječenja. Na prvom pregledu, mjesec dana nakon terapije, došlo je do poboljšanja očnog statusa. Simptomi kao bol, šum, kemoza, pulsacije bulbusa, glavobolje i dvoslike nisu bili prisutni. Zamijećen je mnogo manji periorbitalni edem, proptoza i dilatacija retinalnih vena, te niže vrijednosti intraokularnog tlaka. Razdoblje praćenja bilo je šest mjeseci i nije zamijećena ponovna pojava fistule. Takve spontane fistule opisane u ovoj studiji su duralni šantovi s predilekcijom u postmenopauzalnih žena, najvjerojatnije zbog ateroskleroze, hipertenzije i promjena u zgrušavanju krvi povezanih s hormonskim statusom.During the last five-year period, eight patients were hospitalized at University Department of Ophthalmology, Sestre milosrdnice University Hospital, for elaboration and therapy of spontaneous indirect carotid cavernous fistulas. The aim of this report is to present our experiences in the diagnosis, treatment and follow up of patients with carotid cavernous fistulas. All patients were postmenopausal women, mean age 69.75±7.3 years, without any trauma in their history. The most common symptoms were proptosis, low vision and chemosis. Ultrasound, computerized tomography, magnetic resonance imaging and angiography were used as diagnostic methods. Endovascular balloon occlusion was the treatment of choice in all patients except for one with spontaneous closure of the fistula, whereas another one refused this mode of treatment. The first follow up examination at one month after therapy showed improvement of ocular status. There was no pain, bruit, chemosis, pulsations of the globe, headache or double vision, while periorbital edema, proptosis, dilatation of retinal veins and intraocular pressure were reduced. During the six-month follow up period, no recurrence was recorded. Spontaneous fistulas described in this study tend to be dural shunts. These shunts have a predilection to develop in postmenopausal women, possibly due to atherosclerosis, hypertension and alterations in blood coagulation associated with hormonal changes

Učestalost pseudoeksfolijativnog sindroma i pseudoeksfolijativnog glaukoma u populaciji sjeverozapadne hrvatske u dobi od 40 godina i više

The purpose of this study was to assess the prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma and to evaluate its association with open-angle glaucoma in patients attending the Department of Ophthalmology, Dr Tomislav Bardek General Hospital in Koprivnica, northwestern Croatia. This prospective study was conducted at Dr Tomislav Bardek General Hospital between December 2012 and October 2013. A total of 5349 subjects aged 40 or above presenting for general ophthalmic examination were screened for pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Each patient underwent complete ophthalmologic examination including ocular history, visual acuity testing, slit-lamp examination, applanation tonometry, optic disc evaluation, visual field analysis, and gonioscopy if glaucoma was suspected. Exclusion criteria were pseudophakic and/or aphakic patients of any age, patients with concomitant congenital eye disease, and patients with very dense ocular media opacities. Out of 5349 patients examined, there were 1994 (38.38%) males and 3201 (61.61%) females. The prevalence of pseudoexfoliation syndrome was 3.6% and primary open angle glaucoma 9.4%, out of which 23.6% with pseudoexfoliation glaucoma. The findings of this study improve our knowledge of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Croatia, particularly in the northwest region.Svrha ovoga istraživanja bila je procijeniti učestalost pseudoeksfolijativnog sindroma i pseudoeksfolijativnog glaukoma te njihovu povezanost s glaukomom otvorenog kuta kod bolesnika Očne poliklinike Opće bolnice “Dr. Tomislav Bardek” u Koprivnici, sjeverozapadna Hrvatska. Ovo prospektivno istraživanje provedeno je od prosinca 2012. do listopada 2013. godine. Ukupno je pregledano 5349 ispitanika u dobi od 40 godina i više. Kod svakog je učinjen kompletan oftalmološki pregled uključujući anamnezu, ispitivanje vidne oštrine, pregled na biomikroskopu, aplanacijsku tonometriju, pregled očnoga živca i pozadine oka te vidno polje i gonioskopiju kod onih sa sumnjom na glaukom. Kriteriji za isključenje bili su bolesnici s pseudofakijom/afakijom, bolesnici s prirođenim očnim bolestima te oni s vrlo gustim zamućenjem očnih medija. Od 5349 bolesnika bilo je 1994 (38,38%) muškaraca i 3201 (61,61%) žena. Učestalost pseudoeksfolijativnog sindroma bila je 3,6%, a primarnog glaukoma otvorenog kuta 9,4%, od čega 23,6% spada u skupinu pseudoeksfolijativnog glaukoma. Rezultati ove studije proširuju naše spoznaje o pseudoeksfolijativnom sindromu i pseudoeksfolijativnom glaukomu u Hrvatskoj, osobito u sjeverozapadnoj regiji

Intralezijska injekcija triamcinolon acetonida u liječenju halaziona

The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of15.27±6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.Cilj studije bio je procijeniti učinkovitost intralezijskog injektiranja triamcinolon acetonida kod primarnog i recidivirajućeg halaziona. U ispitivanje je bilo uključeno 30 bolesnika s primarnim i recidivirajućim halazionom (37 slučajeva) i 24 bolesnika kao kontrolna skupina. Bolesnici s primarnim i recidivirajućim halazionom primili su intralezijsku injekciju 0,1 do 0,2 mL triamcinolon acetonida (40 mg/mL), dok su bolesnici kontrolne skupine primili intralezijsku injekciju 0,1 do 0,2 mL 0,9%-tne NaCl. Podatci o veličini lezije, uključujući digitalnu fotografiju u boji, regresiji ili recidivu lezije te o cjelokupnom oftalmološkom pregledu bilježili su se u vrijeme injektiranja te nakon jednog ili dva tjedna do povlačenja ili kirurškog odstranjenja lezije. Uspješnost je definirana kao najmanje 80%-tno smanjenje veličine lezije bez recidiva. Povlačenje lezije utvrđeno je u 35 slučajeva nakon jedne ili dvije injekcije, srednje vrijeme do povlačenja od 15,27±6,12 dana. Potkožno injektiranje steroida triamcinolon acetonida kod primarnog i recidivirajućeg halaziona pokazalo se jednostavnom i učinkovitom terapijom za halazion

Comparison of axial length measurement of silicone oil filled eyes using optical coherent biometry and magnetic resonance biometry

S obzirom na problematiku izračunavanja duljine očne jabučice ispunjene silikonskim uljem danas ne postoji optimalna metoda koju možemo smatrati zlatnim standardom. Cilj ovog rada bio je usporediti točnost mjerenja aksijalne duljine očne jabučice ispunjene silikonskim uljem uz pomoć magnetske rezonancije i optičke koherentne biometrije. U ovu prospektivnu randomiziranu studiju bilo je uključeno 69 bolesnika, od kojih su 35 bolesnika pripadali skupini kojoj je biometrija načinjena pomoću magnetske rezonancije ( B skupina ili MR skupina), a 34 bolesnika skupini kojoj je izračun biometrije načinjen pomoću optičke koherentne biometrije (A skupina ili Master skupina). Kod MR skupine medijan odstupanja od stvarne poslijeoperacijske refrakcijske greške iznosi 0,50 D, dok kod Master skupine 1,19 D. Razlika izmeĎu skupina statistički je značajna (p=0,01). Prema dobivenim podacima ove studije biometrija pomoću magnetske rezonancije je točnija metoda za mjerenje aksijalne duljine očne jabučice ispunjene silikonskim uljem u odnosu na optičku koherentnu biometriju. Time je točnija i za izračunavanje potrebne jačine intraokularne leće prije operacije katarakte ukoliko se MR biometrija radi s presjecima od 1,5 mm, a zbog značajno manjeg odstupanja od ciljane refrakcijske greške u odnosu na optičku koherentnu biometriju.Given the problems of calculating the length of the silicone oil filled eyes, there is no optimal method that can be considered the golden standard at this moment. The aim of this study was to compare the accuracy of the axial length measurement of silicone oil filled eyes, using optical coherent biometry and magnetic resonance imagining. This prospective randomized study included 69 patients, of whom in 35 patients biometry was done using magnetic resonance (A or MR group), while in 34 patients biometry was performed using optical coherent biometry (B or Master group) The median deviation of the final from the predicted refraction in the MR group was -0,50 D, and in the Master group 1,19 D. The difference between groups was statistically significant (p = 0.01). According to the data of this study, magnetic resonance imagining is a more accurate method for measuring the axial length of the silicone oil filled eyes compared to the optical coherent biometry. It also showed a more accurate intraocular lens power calculation before phacoemulsification and evacuation of silicone oil regarding smaller deviation from the final refraction, if the imagining is done with sections of 1,5 mm

Comparison of axial length measurement of silicone oil filled eyes using optical coherent biometry and magnetic resonance biometry

S obzirom na problematiku izračunavanja duljine očne jabučice ispunjene silikonskim uljem danas ne postoji optimalna metoda koju možemo smatrati zlatnim standardom. Cilj ovog rada bio je usporediti točnost mjerenja aksijalne duljine očne jabučice ispunjene silikonskim uljem uz pomoć magnetske rezonancije i optičke koherentne biometrije. U ovu prospektivnu randomiziranu studiju bilo je uključeno 69 bolesnika, od kojih su 35 bolesnika pripadali skupini kojoj je biometrija načinjena pomoću magnetske rezonancije ( B skupina ili MR skupina), a 34 bolesnika skupini kojoj je izračun biometrije načinjen pomoću optičke koherentne biometrije (A skupina ili Master skupina). Kod MR skupine medijan odstupanja od stvarne poslijeoperacijske refrakcijske greške iznosi 0,50 D, dok kod Master skupine 1,19 D. Razlika izmeĎu skupina statistički je značajna (p=0,01). Prema dobivenim podacima ove studije biometrija pomoću magnetske rezonancije je točnija metoda za mjerenje aksijalne duljine očne jabučice ispunjene silikonskim uljem u odnosu na optičku koherentnu biometriju. Time je točnija i za izračunavanje potrebne jačine intraokularne leće prije operacije katarakte ukoliko se MR biometrija radi s presjecima od 1,5 mm, a zbog značajno manjeg odstupanja od ciljane refrakcijske greške u odnosu na optičku koherentnu biometriju.Given the problems of calculating the length of the silicone oil filled eyes, there is no optimal method that can be considered the golden standard at this moment. The aim of this study was to compare the accuracy of the axial length measurement of silicone oil filled eyes, using optical coherent biometry and magnetic resonance imagining. This prospective randomized study included 69 patients, of whom in 35 patients biometry was done using magnetic resonance (A or MR group), while in 34 patients biometry was performed using optical coherent biometry (B or Master group) The median deviation of the final from the predicted refraction in the MR group was -0,50 D, and in the Master group 1,19 D. The difference between groups was statistically significant (p = 0.01). According to the data of this study, magnetic resonance imagining is a more accurate method for measuring the axial length of the silicone oil filled eyes compared to the optical coherent biometry. It also showed a more accurate intraocular lens power calculation before phacoemulsification and evacuation of silicone oil regarding smaller deviation from the final refraction, if the imagining is done with sections of 1,5 mm