Endogenous Endophthalmitis with Panophthalmitis – case report

INTRODUCTION/OBJECTIVES: Endophthalmitis is defined as inflammation of the internal ocular structures and it could be of exogenous or endogenous origin. Endogenous bacterial endophthalmitis (EBE) accounts for about 2%-6% of all cases and occurs during bacteremia when infective agent penetrates the blood- ocular barriers.. Endogenous panophthalmitis (EP) results in the most extensive ocular involvement withinflammation of periocular tissues . All therapeutic options are aimed to stop the spreading of infective inflammation from orbital space into cavernous sinus and is considered to be a life saving treatment

Promjene broja druza i središnje mrežnične debljine u bolesnika sa senilnom makularnom degeneracijom kroz dvije godine

Age-related macular degeneration (ARMD) is the leading cause of blindness in developed world but there are still much unknown facts about the disease itself. Age, genetic factors and smoking are the three main risk factors for the development of ARMD, but the exact pathophysiological mechanism of the disease remains unknown. Current high resolution optical coherence tomography devices provide ample new information on retinal layers, drusen characteristics and their interaction. In this study, we analyzed 44 eyes with drusiform dry ARMD using high resolution optical coherence tomography over a 2-year period. Our results showed a statistically significant increase in drusen number in both females and males in the 2-year period. On average, increment by 4 and 5 drusen per eye during the 2-year period was recorded in female and male patients with drusiform dry ARMD, respectively. Also, statistical analysis of the central retinal thickness showed that women with drusiform dry ARMD had a statistically significantly thinner macula than their male counterparts.Iako je senilna makularna degeneracija (SMD) vodeći uzrok sljepoće u razvijenom svijetu, još uvijek postoje mnoge nepoznanice oko nastanka i tijeka bolesti. Visoka životna dob, genetska predispozicija i pušenje najvažniji su čimbenici rizika za nastanak bolesti. Moderna optička koherentna tomografi ja visoke rezolucije (engl. optical coherence tomography, OCT) pruža mnogo novih informacija o retinalnim slojevima, karakteristikama druza i njihovoj uzajamnoj interakciji. U ovom istraživanju usporedili smo nalaze OCT u 44 oka bolesnika koji boluju od suhe druziformne SMD kroz razdoblje od 2 godine. Otkrili smo da se broj druza kroz 2 godine kod žena prosječene dobi od 70 godina uvećao za 4 druze, dok se kod muškaraca prosječne dobi od 68 godina broj druza u istom razdoblju povećao za 5 druza. Uspoređujući centralnu retinalnu debljinu kod muškaraca i žena otkrili smo da žene imaju statistički značajno tanju centralnu retinalnu debljinu od muškaraca

QUALITY OF LIFE AND DEPRESSION LEVEL IN PATIENTS WITH WATERY EYE

Background: The aim of this study was to assess subjective, human aspect of the medical condition, evaluate the quality of life (QOL) and level of depressive symptoms in patients with watery eye and compare it with patients with two most common causes of visual deterioration: cataract and macular region pathology. The results of this study may serve to raise awareness of watery eye impact on a large number of patients and subsequently promote their treatment in order to restore full visual and life quality necessary for normal human functioning. Subjects and methods: In this prospective, randomised, questionnaire-based study, we have surveyed three groups of patients with a total of 210 patients: group with the watery eye of different etiology (n=69), group with one pseudophakic eye and one cataract eye (n=73) and group with the unilateral pathology of the macular region (n=68). All three groups underwent a complete ophthalmologic examination. To examine the overall quality of life we have used a modified vision-related quality of life questionnaire (VR-QOL) and to evaluate depression level "Beck Depression Inventory - 2". The results were analyzed with statistical program STATISTICA 13. Results: Compared to group with unilateral cataract eye and to group with unilateral pathology of the macular region, the results of this study show that patients with watery eye have significantly decreased quality of life in all daily activities, particularly in outdoor activities (F=125.80, df=2/143, p<0.01), during sports (F=36.67, df=2/143, p<0.01) and interpersonal relations (F=18.73, df=2/143, p<0.01). Results between three groups showed that group with watering eye expressed highest depression level and group with one pseudophakic eye and the other cataract eye the lowest (F=25.86, df=2/207, p<0.01). Conclusion: Watery eye has a significant impact on vision-related quality of life. Our research showed that patients with watery eye had expressed more depressive symptoms than other groups, but still without statistically significant value. Since it affects a large and heterogenic group of patients it is important to be recognized on time and treated etiologically in attempt to restore full function and life quality. The results of this study may serve to raise awareness of watery eye impact on a large number of patients and subsequently promote their treatment in order to restore full visual and life quality necessary for normal functioning

Cystoid macular edema in gyrate atrophy of choroid and retina associated with hyperornithinemia – case report

Cilj: Cilj rada je prikazati klinički tijek, dijagnostiku i liječenje šestgodišnje djevojčice s giratnom atrofijom i obostranim cistoidnim edemom makule. Prikaz slučaja: U četverogodišnje djevojčice tijekom sistematskog pregleda nađeni su slabija vidna oštrina i konvergentni strabizam. Nakon dvogodišnjeg liječenja slabovidnosti primjećuje se obostrani makularni edem te se dijete upućuje na daljnju obradu na Kliniku za oftalmologiju. Djevojčica je tada imala vidnu oštrinu 0.15 na oba oka, obostrani edem makule i ovalne zone korioretinalne atrofije na periferiji mrežnice. Uvedena je antiedematozna terapija. Učinjena je cjelovita klinička i laboratorijska obrada i u plazmi nađena visoka koncentracija ornitina, te je postavljena dijagnoza giratne atrofije (GA) korioretine. U terapiju je uveden piridoksin (vitamin B6). Po terapiji je došlo do neznatnog smanjenja koncentracije ornitina u plazmi te je uvedena i prehrana s ograničenim unosom proteina kojom se također nije postigao željeni učinak. Naposljetku je uz navedeno započeto liječenje aminokiselinom L-lizinom. Kombinacija navedenih terapijskih mjera dovela je do značajnog smanjenja koncentracije ornitina u plazmi, koja je smanjena na oko trećinu u odnosu na koncentracije prije početka liječenja. Uz laboratorijske pokazatelje bolje kontrole bolesti zamijećeno je prolazno kliničko poboljšanje, smanjenje makularnog edema, ali se progresija perifernih atrofičnih lezija nije zaustavila. Zaključak: Cistoidni edem makule u pacijenata s giratnom atrofijom praćen je oslabljenom vidnom oštrinom. Unatoč intenzivnom liječenju edem makule perzistira te je vidljiva daljnja progresija atrofičnih žarišta na periferiji fundusa. Smanjenje koncentracija ornitina u plazmi bitan je preduvjet za usporenje progresije bolesti i odgađanje trajnog gubitka vidne funkcije.Aim: The aim is to present the clinical course, diagnostics and treatment of six-year-old girl with gyrate atrophy and bilateral cystoid macular edema. Case report: Four-year old girl was found with low vision and convergent strabismus in a systematic medical examination. After two years of the amblyopia treatment bilateral macular edema was detected and the child was refered to The Department of Ophthalmology. She presented with the both eyes best corrected visual acuity 0.15, bilateral cystoid macular edema and peripheral, oval zones of chorioretinal atrophy. Antiedematous therapy was administered. Clinical work-up revealed extremely high plasma concentrations of ornithine and the diagnosis of gyrate atrophy (GA) of the chorioretina due to the lack of mitochondrial enzyme ornithine aminotransferase was established. The therapy with pyridoxine (vitamin B6) was started. This treatment led to slight reduction of serum ornithin concentrations; hence, low-protein diet was introduced, but decrease of ornithine concentrations was still insufficient. Therefore, the treatment with amino acid L-lysine was introduced in the therapy. Plasma ornithine concentrations successfully decreased to almost one third of the initial concentration. There was a transient decrease of cystoid macular edema, but atrophic lesions of the peripheral fundus progressed. Conclusion: Cystoid macular edema in patients with gyrate atrophy was followed by impaired visual acuity. Despite the intensive treatment macular edema persisted and further progression of atrophic lesion on the fundus periphery was detected. The maintenance of low plasma ornithine levels is an essential prerequisite for slowing the development of the disease and postponing the permanent loss of visual function

Progression of Conjunctival Primary Acquired Melanosis (PAM) to Widely Spreaded Malignant Melanoma

Primary acquired melanosis (PAM) is an acquired pigmentation of the conjunctival epithelium, a preinvasive pigmented lesion. When it is associated with cellular atypia it can lead to the developement of melanoma. We report a case report of malignant melanoma of the conjuntiva, which arrised from the conjuntival PAM. The disease was too extensive for ocular conservation, therefore exenteration was performed. This case highlights the need for regular follow-up of patients with melanocytic lesions of the ocular adnexa, and particular attention to the surgical technique, and careful followup to detect further disease activity

Presentation of Graves' orbitopathy within European Group On Graves' Orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III)

Background: Graves' orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves' Orbitopathy (EUGOGO) tertiary referral centres and initial management over time. Methods: Prospective observational multicentre study. All new referrals with diagnosis of GO within September-December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012. Results: Besides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p&lt;0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0-350) vs 6 (0-552) months; p&lt;0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p&lt;0.001) or selenium (22.3% vs 3.0%; p&lt;0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p&lt;0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027). Conclusion: GO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment

Progression of conjunctival primary acquired melanosis (PAM) to widely spreaded malignant melanoma [Progresija primarne melanoze spojnice u rasprostranjeni maligni melanom spojnice]

Primary acquired melanosis (PAM) is an acquired pigmentation of the conjunctival epithelium, a preinvasive pigmented lesion. When it is associated with cellular atypia it can lead to the developement of melanoma. We report a case report of malignant melanoma of the conjuntiva, which arrised from the conjuntival PAM. The disease was too extensive for ocular conservation, therefore exenteration was performed. This case highlights the need for regular follow-up of patients with melanocytic lesions of the ocular adnexa, and particular attention to the surgical technique, and careful follow-up to detect further disease activity