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

Fakoemulzifi kacija u očima sa stražnjom polarnom kataraktom

The aim of the study was to evaluate the results of phacoemulsification in eyes with posterior polar cataract and to assess the risk factors for posterior capsular rupture during phaco surgery. This prospective study included 13 patients (14 eyes) undergoing phacoemulsification surgery with intraocular lens implantation. Intact posterior capsule was present in 10 (71.5%) eyes, posterior capsular rupture in 4 (28.5%) eyes, one of them with vitreal loss and requiring anterior vitrectomy. Of the eyes with intact posterior capsule, 5 (35%) had capsular plaque which was removed by gentle aspiration; in one case posterior capsulorrhexis was performed to remove the plaque; and postoperative capsule was clear in 4 (28.5%) eyes. In 3 eyes with capsular rupture, there was soft nucleus and capsular opacification greater than 3 mm in diameter, and the patients were under 40 years old. One capsular rupture occurred in dense cataract. The incidence of posterior capsular rupture in our study was 28.5%; other authors reported the incidence between 7.1% and 36%. Many different techniques have been described by other surgeons to avoid capsular rupture; however, in our opinion, posterior capsular rupture could not be avoided in some cases. In our study, the risk factors for capsular rupture in posterior polar cataract were soft nucleus with large capsular opacification and younger patient age. Our results of visual acuity after phacoemulsification in posterior polar cataracts are consistent with those reported by other authors: in 9 eyes, visual acuity was 0.8 or more (Snellen chart), and in 5 eyes there was no satisfactory improvement of visual acuity, probably due to amblyopia because the majority of the cataracts were unilateral. Accordingly, phacoemulsification in posterior polar cataracts, when done carefully, leads to good postoperative results and good visual improvement in most cases.Cilj istraživanja je bio evaluirati rezultate fakoemulzifikacije u očima sa stražnjom polarnom kataraktom i procijeniti rizične čimbenike za puknuće stražnje kapsule tijekom fakoemulzifikacijskog zahvata. Ovo prospektivno istraživanje uključivalo je 13 pacijenata (14 očiju) koji su podvrgnuti fakoemulzifikacijskom zahvatu s ugradnjom intraokularne leće. Kod 10 očiju (71,5%) imali smo intaktnu stražnju kapsulu, kod 4 oka (28,5%) razvilo se puknuće stražnje kapsule, od kojih smo u jednom slučaju imali gubitak staklovine, stoga je bilo potrebno uraditi prednju vitrektomiju. Kod pacijenata kod kojih je ostala intaktna stražnja kapsula, 5 pacijenata (35%) su imali kapsularni plak koji je odstranjen laganom aspiracijom, kod jednog pacijenta smo napravili stražnju kapsuloreksu da bismo odstranili plak, a kod 4 pacijenta (28,5%) postoperativna kapsula je bila čista. Kod 3 oka koja su imala meki nukleus došlo je do puknuća stražnje kapsule leće, te je kod tih očiju zamućenje stražnje kapsule bilo veće od 3 mm u promjeru. Pacijenti su bili mlađi od 40 godina. U jednom slučaju smo imali puknuće stražnje kapsule, koje se dogodilo kod tvrde katarakte. Incidencija puknuća stražnje kapsule u našem istraživanju je bila 28,5%, dok drugi autori govore o incidenciji između 7,1% i 36%. Drugi autori su opisali mnogo različitih tehnika za sprječavanje puknuća stražnje kapsule, međutim, prema našem istraživanju i kliničkom iskustvu, puknuće stražnje kapsule se u nekim slučajevima ne može izbjeći. U našem istraživanju čimbenici rizika za puknuće stražnje kapsule kod stražnje polarne katarakte bili su meki nukleus s velikim kapsularnim zamućenjem i mlađi pacijenti. Naši rezultati vidne oštrine nakon fakoemulzifikacije kod stražnjih polarnih katarakti su slični onima drugih autora: kod 9 očiju vidna oštrina je bila 0,8 i više (Snelleova tablica), kod 5 očiju vidna oštrina se nije popravila na zadovoljavajući način, najvjerojatnije zbog postojeće ambliopije, jer je većina naših katarakti bila unilateralna. U zaključku možemo reći da fakoemulzifikacija kod stražnjih polarnih katarakti ima dobre postoperativne rezultate i vodi do poboljšanja vidne oštrine u većini slučajeva

Fakoemulzifi kacija u očima sa stražnjom polarnom kataraktom

The aim of the study was to evaluate the results of phacoemulsification in eyes with posterior polar cataract and to assess the risk factors for posterior capsular rupture during phaco surgery. This prospective study included 13 patients (14 eyes) undergoing phacoemulsification surgery with intraocular lens implantation. Intact posterior capsule was present in 10 (71.5%) eyes, posterior capsular rupture in 4 (28.5%) eyes, one of them with vitreal loss and requiring anterior vitrectomy. Of the eyes with intact posterior capsule, 5 (35%) had capsular plaque which was removed by gentle aspiration; in one case posterior capsulorrhexis was performed to remove the plaque; and postoperative capsule was clear in 4 (28.5%) eyes. In 3 eyes with capsular rupture, there was soft nucleus and capsular opacification greater than 3 mm in diameter, and the patients were under 40 years old. One capsular rupture occurred in dense cataract. The incidence of posterior capsular rupture in our study was 28.5%; other authors reported the incidence between 7.1% and 36%. Many different techniques have been described by other surgeons to avoid capsular rupture; however, in our opinion, posterior capsular rupture could not be avoided in some cases. In our study, the risk factors for capsular rupture in posterior polar cataract were soft nucleus with large capsular opacification and younger patient age. Our results of visual acuity after phacoemulsification in posterior polar cataracts are consistent with those reported by other authors: in 9 eyes, visual acuity was 0.8 or more (Snellen chart), and in 5 eyes there was no satisfactory improvement of visual acuity, probably due to amblyopia because the majority of the cataracts were unilateral. Accordingly, phacoemulsification in posterior polar cataracts, when done carefully, leads to good postoperative results and good visual improvement in most cases.Cilj istraživanja je bio evaluirati rezultate fakoemulzifikacije u očima sa stražnjom polarnom kataraktom i procijeniti rizične čimbenike za puknuće stražnje kapsule tijekom fakoemulzifikacijskog zahvata. Ovo prospektivno istraživanje uključivalo je 13 pacijenata (14 očiju) koji su podvrgnuti fakoemulzifikacijskom zahvatu s ugradnjom intraokularne leće. Kod 10 očiju (71,5%) imali smo intaktnu stražnju kapsulu, kod 4 oka (28,5%) razvilo se puknuće stražnje kapsule, od kojih smo u jednom slučaju imali gubitak staklovine, stoga je bilo potrebno uraditi prednju vitrektomiju. Kod pacijenata kod kojih je ostala intaktna stražnja kapsula, 5 pacijenata (35%) su imali kapsularni plak koji je odstranjen laganom aspiracijom, kod jednog pacijenta smo napravili stražnju kapsuloreksu da bismo odstranili plak, a kod 4 pacijenta (28,5%) postoperativna kapsula je bila čista. Kod 3 oka koja su imala meki nukleus došlo je do puknuća stražnje kapsule leće, te je kod tih očiju zamućenje stražnje kapsule bilo veće od 3 mm u promjeru. Pacijenti su bili mlađi od 40 godina. U jednom slučaju smo imali puknuće stražnje kapsule, koje se dogodilo kod tvrde katarakte. Incidencija puknuća stražnje kapsule u našem istraživanju je bila 28,5%, dok drugi autori govore o incidenciji između 7,1% i 36%. Drugi autori su opisali mnogo različitih tehnika za sprječavanje puknuća stražnje kapsule, međutim, prema našem istraživanju i kliničkom iskustvu, puknuće stražnje kapsule se u nekim slučajevima ne može izbjeći. U našem istraživanju čimbenici rizika za puknuće stražnje kapsule kod stražnje polarne katarakte bili su meki nukleus s velikim kapsularnim zamućenjem i mlađi pacijenti. Naši rezultati vidne oštrine nakon fakoemulzifikacije kod stražnjih polarnih katarakti su slični onima drugih autora: kod 9 očiju vidna oštrina je bila 0,8 i više (Snelleova tablica), kod 5 očiju vidna oštrina se nije popravila na zadovoljavajući način, najvjerojatnije zbog postojeće ambliopije, jer je većina naših katarakti bila unilateralna. U zaključku možemo reći da fakoemulzifikacija kod stražnjih polarnih katarakti ima dobre postoperativne rezultate i vodi do poboljšanja vidne oštrine u većini slučajeva

Laser Management of Persistent Pupillary Membrane Prior to Cataract Surgery

Perzistentna pupilarna membrana (PPM) nastaje kod nedovoljne involucije i atrofije pupilarne membrane. Većina PPM ne traži nikakvo liječenje, jer samo rijetko uzrokuje pad vida. Tvrdokorne strukture membrane variraju od nekoliko nepigmentiranih tračaka do debele membrane koja prekriva cijelu zjenicu. Cilj je pokazati prednosti laserskog liječenja PPM kod kojih se planira fakoemulzifikacijska operacija katarakte. Opisuje se slučaj bolesnice s obostranom PPM i kataraktom, kod koje je nastupio znatan pad vida kod vanjskog svjetla na desnom oku i koja je liječena Nd-YAG laserom. Nakon laserske terapije i fakoemulzifikacije katarakte vid se poboljšao s 0,1 na 0,9 bez ikakvih komplikacija. Kao zaključak, ako se planira fakoemulzifikacija, prednost dajemo laserskoj terapiji PPM pred kirurškom ekscizijom PPM koja je udružena s komplikacijama poput infekcije, hifeme, rizika kod anestezije. Lasersko liječenje je relativno jednostavno, ugodnije od kirurškog, nakon zahvata je zjenica savršeno okrugla, što olakšava operaciju katarakte, a uz to se izbjegavaju intraoperacijska krvarenja tijekom kirurškog zahvata koja bi komplicirala fakoemulzifikaciju katarakte.Persistent pupillary membrane (PPM) is a consequence of incomplete involution and atrophy of the pupillary membrane. Most PPMs require no treatment because they rarely cause visual impairment. Remnant structures vary from a few non-pigmented threads to a thick membrane covering the entire pupil. The aim of this case report is to show the advantages of Nd-YAG laser lysis of PPM prior to phacoemulsification cataract surgery. We describe a case of a patient with bilateral PPM and cataract of the right eye having significant visual loss in bright light that underwent Nd-YAG laser lysis and experienced visual acuity improvement from 0.1 to 0.9 after phacoemulsification surgery, without any complications. We conclude that in PPM patients scheduled for cataract surgery, laser lysis of PPM prior to cataract surgery is preferable to surgical excision of PPM that is associated with complications such as infection, hyphema, and risk of anesthesia. Laser lysis of pupillary membranes is a relatively simple procedure. There is less discomfort than with surgical excision, and the procedure results in a perfectly round pupil, thus facilitating cataract surgery while also preventing intraoperative hemorrhage during surgical excision that may complicate the scheduled phacoemulsification cataract surgery

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

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

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

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

Primarna stečena opstrukcija nazolakrimalnog kanala: epidemiološka 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 ± SD of patients was 64.3 ± 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 epidemiološke 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. Godišnja incidencija PSONK-a bila je 1,96 na 100000 stanovnika. Prosjecna dob ± SD bolesnika bila je 64,3 ± 16,0 godina. Bilo je 67 (73,6%) žena i 24 (28,4%) muškaraca. Odnos žena prema muškarcima bio je 2,8, što 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 nešto veca u toplijim godišnjim 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 oftalmološke službe u lijecenju PSONK-a.