57 research outputs found
Two Notable Anniversaries in Croatian Ophthalmology In 2007
Head Doctor Jelka Spevec nee Gutchy, MD, PhD
Head Doctor Neven ÄosiÄ, M
Utjecaj oÅ”teÄenja vida na kvalitetu života bolesnika s glaukomom
The aim of this study was to assess the eff ect of diff erent visual impairment levels on diff erence in the subjective quality of life estimation. We included 150 patients with glaucoma whose best-corrected visual acuity in the better-seeing eye was 0.5 and less. All of them were in advanced stage of the disease, with visual fi eld defect worse than 12 dB in mean defect, when measured with the Octopus Visual Field Analyzer. In order to assess the quality of life, we used the Impact of Vision Impairment questionnaire. Additionally, we used General Information Questionnaire, which was developed for the purpose of this study. The information obtained from the questionnaires was analyzed using the Robust Discriminant Analysis program. Diff erence analysis was performed for each of the three areas of the questionnaire (reading and accessing information, mobility and independence, and emotional well-being). Results of this study confi rmed the diff erence between the groups of patients with diff erent levels of visual impairment, varying from total visual loss up to visual acuity 0.5 on the better-seeing eye in the eff ects of visual impairment on the quality of life. All levels of visual impairment had the largest eff ect in the area of reading and accessing information, slightly less in the area of mobility and independence, and the least eff ect was in the area of emotional well-being. Based on the results, it is concluded that all levels of visual impairment have negative eff ect on the quality of life in glaucoma patients.Cilj istraživanja bio je utvrditi utjecaj oÅ”teÄenja vida na kvalitetu života bolesnika s glaukomom. Istraživanjem je obuhvaÄeno 150 bolesnika s glaukomom, s ostatkom vida od 50% i manje na boljem oku (vidna oÅ”trina ā¤0,5). Svi su bili u terminalnoj fazi bolesti, s oÅ”teÄenjem vidnoga polja veÄim od 12 dB u Mean Defects (MD) mjerenim analizatorom vidnog polja Octopus. Za mjerenje utjecaja oÅ”teÄenja vida na kvalitetu života primijenjen je upitnik Th e Impact of Vision Impairment (IVI), a dodatno je primijenjen upitnik vlastite izrade General Information Questionnaire. Prikupljeni podaci su obraÄeni modelom
robustne diskriminacijske analize (ROBDIS). UtvrÄena je razlika izmeÄu skupina ispitanika s razliÄitim stupnjem oÅ”teÄenja vida, od potpunog gubitka vida do ostatka vida na boljem oku od 50%. Za svako od tri podruÄja (Äitanje i pristup informacijama, kretanje i samostalnost te emocionalno blagostanje) uÄinjena je razlikovna analiza. Rezultati istraživanja potvrdili su da oÅ”teÄenje vida utjeÄe na kvalitetu života bolesnika s glaukomom. NajveÄi utjecaj razliÄitih stupnjeva oÅ”teÄenja vida bio je oÄit u podruÄju Äitanja i pristupa informacijama, neÅ”to manji u podruÄju orijentacije i kretanja, a najmanji u podruÄju emocionalnog blagostanja
Usporedba morfologije glave vidnoga živca u bolesnika s primarnim glaukomom otvorenog kuta i nearteritiÄkom ishemijskom optiÄkom neuropatijom
The aim of this study was to assess damage to retinal ganglion cells (RGC) and morphology of the optic nerve head (ONH) in patients with primary open angle glaucoma (POAG) and non-arteritic anterior ischemic optic neuropathy (NAION). The study included three groups of patients, as follows: 40 eyes with POAG, 40 eyes with NAION and 40 eyes with refraction anomaly. All patients underwent standard automated perimetry and analysis of ONH topography by using confocal scanning laser ophthalmoscopy (CSLO)-HRT II. Visual field defects such as decreased retinal sensitivity prevailed in the eyes with POAG, whereas in the eyes with NAION they were mostly manifested as concentrically narrowed visual field and quadrant excesses. Topographic ONH alterations, examined by HRT II, showed the same number of sectors to be affected in the eyes with POAG and NAION. A larger number of sectors in the upper part of ONH were affected in the eyes with NAION. Optic disc morphology differed significantly between the eyes with POAG and NAION by a higher rate of neuroretinal rim thinning and higher mean cup depth in the POAG group.Svrha ovoga rada bila je utvrditi oÅ”teÄenje ganglijskih stanica mrežnice i morfoloÅ”ke promjene glave vidnoga živca u ispitanika s primarnim glaukomom otvorenog kuta (POAG) i nearteritiÄkom prednjom ishemijskom optiÄkom neuropatijom (NAION). Prva skupina ispitanika sastojala se od 40 oÄiju s POAG, druga skupina od 40 oÄiju s NAION i treÄa skupina od 40 oÄiju s refrakcijskom anomalijom (kontrolna skupina).Svim ispitanicima napravljena je automatizirana perimetrija i analiza topografije glave vidnoga živca pomoÄu konfokalne skenirajuÄe laserske oftalmoskopije (CSLO)-HRT II. Smanjena mrežniÄna osjetljivost prevladavala je u bolesnika s POAG, dok su se u bolesnika s NAION defekti oÄitovali u obliku koncentriÄno suženog vidnog polja i kvadrantnih ispada. Topografske promjene glave vidnoga živca ispitivane pomoÄu HRT II ukazale su na to da je u bolesnika s POAG i NAION oÅ”teÄen jednak broj sektora. VeÄi broj sektora u gornjem dijelu glave vidnoga živca bio je oÅ”teÄen u bolesnika s NAION. Morfologija glave vidnoga živca znaÄajno se razlikovala izmeÄu bolesnika s POAG i NAION, pokazujuÄi veÄe stanjenje neuroretinalnog ruba i veÄu dubinu ekskavacije u bolesnika s POAG
Korelacija izmeÄu promjena makule u eksfolijacijskom sindromu i eksfolijativnog glaukoma
The aim of the study was to evaluate macular thickness and macular volume in unilateral and bilateral exfoliation syndrome and to compare them with exfoliative glaucoma and control eyes using optical coherence tomography. This prospective study included 114 subjects (228 eyes) divided into 4 groups according to the presence of exfoliation: 30 patients with unilateral syndrome, 24 patients with bilateral syndrome, 28 patients with bilateral glaucoma and control group without glaucoma or exfoliation syndrome (32 subjects). All subjects were older than 50 years. Patients with visual acuity under 0.6 according to Snellen were excluded, as well as those with refraction errors, i.e. hypermetropia over +3 spherical diopters, myopia over -5 spherical diopters, astigmatism over 2 cylindrical diopters, patients with affections that might affect the macula or the optic nerve, such as diabetic retinopathy, macular degeneration, macular edema, epiretinal membrane, vascular occlusions, neuropathies, and patients having undergone eye surgery except for pseudophakic patients with visual acuity within the set limits. Study results confirmed the hypothesis on the existence of structural changes of macular parameters before the functional ones, thus representing an early sign of glaucomatous damage in risk groups such as unilateral and bilateral exfoliation syndrome. If the glaucoma had already manifested (exfoliative glaucoma in this study) with changes in optic disc and visual field, structural changes confirmed the clinical findings and warned of the disease severity.Cilj studije bio je procijeniti prosjeÄnu debljinu žute pjege i njen volumen kod jednostranog i obostranog eksfolijacijskog sindroma te ih usporediti s eksfolijacijskim glaukomom i kontrolnom skupinom. U tu svrhu koristila se optiÄka koherentna tomografija. Ovo prospektivno ispitivanje ukljuÄilo je 114 ispitanika (228 oÄiju) koji su podijeljeni u 4 skupine s obzirom na prisutnost eksfolijacije: 30 ispitanika s unilateralnim sindromom, 24 ispitanika s bilateralnim sindromom, 28 ispitanika s obostranim glaukomom i kontrolna skupina koju su Äinila 32 ispitanika bez eksfolijacijskog sindroma ili glaukoma. Svi su ispitanici bili stariji od 50 godina. Ispitanici koji su imali vidnu oÅ”trinu manju od 0,6 po Snellenu kao i oni s refrakcijskom
greÅ”kom, tj. hipermetropijom veÄom od +3 sferne dioptrije, miopijom veÄom od -5 sferne dioptrije i astigmatizmom veÄim od 2 cilindriÄne dioptrije iskljuÄeni su iz studije, kao i ispitanici s dijabetiÄnom retinopatijom, makularnom degeneracijom ili edemom, epiretinom membranom, vaskularnom bolesti mrežnice, neuropatijom te ispitanici koji su prethodno imali operacijski zahvat na oku, osim pseudofaknih bolesnika s vidnom oÅ”trinom unutar zadanih vrijednosti. U radu je potvrÄena hipoteza o postojanju strukturnih promjena žute pjege prije funkcionalnih, Å”to predstavlja rani znak glaukomskog
oÅ”teÄenja u riziÄnim skupinama ispitanika kao Å”to su oni s jednostranim ili obostranim eksfolijacijskim sindromom. Ako se veÄ radilo o manifestnom glaukomu (u ovom radu eksfolijacijskom) s postojeÄim promjenama na glavi vidnoga živca i vidnom polju, strukturne su promjene upotpunile kliniÄku sliku i upozorile na težinu bolesti
Granulomatozna upala orbite: dijagnoza, praÄenje i terapija
During the 2000-2005 period, we treated 32 patients with unilateral or bilateral granulomatous inflammation of the orbit. After careful exclusion of specific systemic and local diseases, the diagnosis was based on a combination of clinical and radiological findings. Examinations were performed to exclude the presence of a malignant or other form of tumor. Subsequently, we started treatment with high-dose steroids or a combination of steroids and surgical therapy. After therapy, we analyzed visual acuity, exophthalmometry, intraocular pressure and visual fields. There was no tumor recurrence during the follow up of 1-4 years. The findings suggested the treatment with high-dose steroids or a combination of steroids and surgical therapy to be an efficient therapeutic option for granulomatous inflammation.U razdoblju od 2000. do 2005. godine na Klinici za oÄne bolesti KliniÄke bolnice .Sestre milosrdnice. lijeÄili smo 32 bolesnika s jednostranom ili obostranom granulomatoznom upalom orbite. Nakon pažljivo uÄinjenih pretraga kako bi se iskljuÄilo postojanje specifiÄnih sustavnih ili lokalnih bolesti postavili smo dijagnozu koja se temeljila na kombinaciji kliniÄkih i radioloÅ”kih nalaza. Kod svih bolesnika prije i nakon lijeÄenja analizirana je vidna oÅ”trina, mjeren je oÄni tlak, uÄinjena egzoftalmometrija po Hertelu te vidno polje po Goldmannu. Svi bolesnici najprije su bili podvrgnuti kirurÅ”kom zahvatu orbitotomije, eksploracije i uklanjanja tumorskog tkiva, potom su svi primili pulsnu dozu kortikosteroida kroz tri dana, a nakon toga se nastavilo s lijeÄenjem per os kroz dva mjeseca. Kod 75% bolesnika nakon zavrÅ”etka lijeÄenja doÅ”lo je do porasta vidne oÅ”trine za jedan ili viÅ”e redova po Snellenu, a kod 96.88% bolesnika doÅ”lo je do smanjenja protruzije oÄne jabuÄice za 2 ili viÅ”e mm. Tijekom razdoblja praÄenja nismo zabilježili znakove reaktiviranja upale. ZakljuÄuje se kako se pažljivim kliniÄkim pretraživanjem i primjereno postavljenom dijagnozom te kombiniranim lijeÄenjem steroidima i kirurÅ”kim zahvatom postižu dobri rezultati kod bolesnika s granulomatoznom upalom orbite
Primarne tapetoretinske distrofije kao uzrok sljepoÄe i slabovidnosti u Republici Hrvatskoj
According to records of the Croatian Association of the Blind and Impaired Vision Persons, 5,360 blind and impaired vision persons were registered in 2001, with an incidence of 1.3ā°. The records contain familial and personal data, data on the underlying disease and ophthalmologic examination findings, including visual acuity of both eyes, fundus examination, biomicroscopic examination and field of vision according to Goldman. Adaptometry, electroretinogram and color perception were rarely performed. Patients were classified according to residual visual acuity, which was converted into percentage of residual vision. During the study, tapetoretinal dystrophies were detected in 328 (6.11%) subjects, 177 (53.9%) male and 151 (46.1%) female. In the Republic of Croatia, tapetoretinal dystrophies as the cause of blindness and impaired vision were recorded in 0.007% (1:14,285) of cases. Over the last 30 years, the number of registered blind and impaired vision persons with this disease increased by 4.3% in large cities in Croatia, whereas its distribution in other areas remained uniform. Clinical manifestations of the disease occurred under the age of 40 in 84.4%, under the age of 50 in 95.2%, and after birth or under the age of 10 in 11.6% of subjects, pointing to the malignancy of the gene for dystrophy of retina pigmentosa. Of all blind subjects, 15.3% belonged to this group. During the study, 40 heredograms were completed, which confirmed the disease to be inherited as an autosomal recessive trait in 40% and autosomal dominant trait in 22.5%, whereas a fresh mutation was probably involved in 37.0% of cases.Prema registarskim podacima Saveza slijepih i slabovidnih u Republici Hrvatskoj 2001. godine bilo je registrirano 5.360 slijepih i slabovidnih osoba uz incidenciju od 1,3ā°. Registarski kartoni sadrže obiteljske i osobne anamnestiÄke podatke vezane za osnovnu bolest i nalaze oftalmoloÅ”kog pregleda koji obuhvaÄa vidnu oÅ”trinu oba oka, pregled oÄne pozadine, pregled procjepnom svjetiljkom te vidnog polja po Goldmanu. Ispitivanje adaptacije, elektroretinogram te ispitivanje osjeta za boje rjeÄe su se izvodili. Bolesnici su razvrstavani prema ostatku vidne oÅ”trine koja se preraÄunala u postotak ostatka vida. U okviru ovoga istraživanja pronaÄeno je 328 ili 6,11% osoba s tapetoretinskim distrofijama. Od toga je bilo 177 (53,9%) osoba muÅ”kog spola i 151 (46,1%) osoba ženskog spola. UÄestalost tapetoretinske distrofije kao uzroka sljepoÄe i slabovidnosti u Republici Hrvatskoj iznosila je 0,007% (1:14.285). U zadnja tri desetljeÄa veÄi centri u Hrvatskoj bilježe porast registriranih slijepih i slabovidnih od ove bolesti za 4,3%, dok je u ostalim krajevima Hrvatske rasprostranjenost ravnomjerna. Bolest se kliniÄki manifestirala do 40. godine života u 84,4%, do 50. godine života u 95,2%, a rano nakon roÄenja ili do 10. godine života u 11,6% ispitanika, Å”to ukazuje na malignitet gena za distrofiju mrežnice, pigmentozu. U ovoj se dobnoj skupini nalazi 15,3% svih ispitanika koji su slijepi. U ovom je istraživanju izraÄeno 40 heredograma na temelju kojih je utvrÄeno da se bolest autosomno recesivno nasljeÄuje u 40% i autosomno dominantno u 22,5% sluÄajeva, dok se u 37,0% sluÄajeva najvjerojatnije radilo o svježoj mutaciji
Trabeculectomia - DugoroÄni uÄinci
The aim of this study was to establish the value of trabeculectomy throughout a longer period of time, 5-10 years after the operation. Success of the operations was evaluated by setting the following criteria: postoperative values of IOP < 21 mmHg with or without topical medications, preserved function of the optic nerve checked through the findings of the optic disc and the visual field. Filtering blebs were also examined and visual acuity was analyzed. Between 1990 and 1995, 359 were operated using the method of trabeculectomy at the Department of Ophthalmology, Sestre milosrdnice University Hospital. We were able to examine only 186 eyes thoroughly. Five years after the operation the IOP was < 21 mmHg in 90% of eyes with or without therapy and ten years after the IOP remained regulated in 75% of eyes. We found progression of optic disc atrophy in 17% of the cases, and deterioration of the visual fields in 18% of eyes. Visual acuity was reduced in 62% of the cases and 49% of them was due to cataract. After cataract operation, sight improved in 73 % of the cases. The size or the cystic alterations of the filtering bleb did not have the most significant influence on the value of IOP whereas its healing was directly responsible for failure of the operation. Therefore we consider trabeculectomy to be the method of choice among antiglaucoma operations for now.Svrha ove studije bila je utvrditi vrijednost trabekulektomije kroz dulji vremenski period od 5 do 10 godina iza operacije. Za uspjeh operacije postavili smo kriterije da postoperacijske vrijednosti oÄnog tlaka iznose ? 21 mmHg bez ili s lokalnom terapijom, da ostane saÄuvana funkcija vidnog živca, Å”to smo provjeravali nalazom papile n. optici i vidnim poljem. Pregledavani su i filtracijski jastuÄiÄi, te analizirana vidna oÅ”trina. Od 1990.do 1995.g. na Klinici za oÄne bolesti KB. Sestre milosrdnice. u Zagrebu operirano je 359 oeiju metodom trabekulektomije. Bili smo u moguÄnosti detaljno analizirati samo 186 oÄiju. Pet godina iza operacije IOT je bez ili s terapijom bio ? 21 mmHg u 90 % oÄiju, dok je nakon 10 godina IOT bio reguliran jo. uvijek u 75% oÄiju. Progresiju atrofije papillae n. optici naÅ”li smo u 17% sluÄajeva, a pogorÅ”anje vidnog polja u 18% oÄiju.Vidna oÅ”trina je smanjena u 62% od toga zbog katarakte u 49% oÄiju. Iza operacije katarakte vid se popravio u 73%. VeliÄina ili cistiÄna promjena filtracijskog jastuÄiÄa nisu presudni za visinu IOT, dok je njegovo zarastanje direktno odgovorno za neuspjeh operacije. Držimo da je trabekulektomija do daljnjega metoda izbora meÄu antiglaukomskim operacijama
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