Suvremeno liječenje glaukoma otvorenog kuta

In recent years, a large number of drugs have been developed for treatment of glaucoma with the increasing choices of alternative medications. A wide choice of newer local agents is now available for the treatment of glaucoma, each with differing efficacy and side effects. New treatment options for reducing IOP provide an opportunity to improve both compliance and therapeutic results while at the same reducing the level of side effects seen with multiple conventional drug regimens. This drug review considers the mode of action and properties of the various treatments, followed by practical advice to offer patients about their medication. Clinicians need to understand, synthesize and use data about medications that have specific benefits and risks for their glaucoma patients. Glaucoma is a progressive optic neuropathy characterized by optic disc cupping and concomitant characteristic visual field defects. The term glaucoma describes a number of different disorders that affect the eye, all of which culminate in the death of the retinal ganglion cells of the optic nerve and visual field defects intraocular pressure (IOP) lowering is still the mainstay of treatment, the goal of which is to preserve visual function for the remainder of patients lifetime, whilst optimizing the quality of life. Most of the drugs now used to treat glaucoma are primarily directed at lowering IOP. In sense they are like cholesterol lowering agents in that they are designed to manage the risk factors for the diseases which led to glaucoma, rather than its basic underlying cause. The concept of target IOP is worth considering. At the onset of treatment, it is helpful to establish a target IOP at which further damage to the optic nerve is deemed unlikely to occur. Commonly this is a 20 to 30 per cent reduction from the IOP at which damage occurred. If the glaucomatous optic neuropathy is worsening during the course of treatment, the target IOP may need to be adjusted. Compliance tends to fall off as the number of medications and dosing instructions increases and therefore, it is well worth reviewing a patient\u27s list of medications to determine if some of the newer agents on the market may allow consolidation of treatments. This review deals with open angle glaucoma where medical therapy is commonly the initial form of management.U posljednjih nekoliko godina svjedoci smo razvoja velikog broja lijekova za liječenje glaukoma, sa sve većim izborom alternativnih medikacija. Danas nam liječenju glaukoma stoji na raspolaganju širok izbor novih lijekova, svaki sa različitom efikasnošću i nuspojavama. Nove terapijske mogućnosti za sniženje intraokularnog tlaka omogućavaju nam da poboljšamo compliance i terapijske rezultate, a istovremeno se smanjuje broj lokalnih nuspojava koje se susreću kod konvencionalnih terapijskih shema. Ovaj pregledni članak bavi se načinom djelovanja i svojstvima različitih terapijskih mogućnosti, nakon eega slijede praktični savjeti o lijekovima. Kliničari bi, u liječenju glaukomskih bolesnika, trebali shvatiti, sintetizirati i upotrijebiti svoje znanje o lijekovima koji imaju posebne korisne i štetne strane. Glaukom je progresivna optikoneuroterapija, karakterizirana ekskavacijom vidnog živca i popratnim oštećenjima vidnog živca i popratnim oštećenjima vidnog polja. Sam pojam glaukoma označava određen broj različitih poremećaja koji zahvaćaju oko, a koji svi kulminiraju smrću retinalnih ganglijskih stanica vidnog živca i oštećenjima vidnog polja. Okosnicu terapije i dalje čini sniženje intraokularnog tlaka, čiji je cilj obuvanje vidne funkcije uz istovremeno poboljšanje kvalitete života. Većina lijekova koji se danas koriste u liječenju glaukoma su prvenstveno usmjereni na sniženje intraokularnog tlaka. Oni se mogu usporediti sa lijekovima za sniženje kolesterola, jer su razvijeni da bi kontrolirali čimbenike rizika koji su doveli do glaukoma, a ne da bi liječili njegov osnovni uzrok. Vrijedno je spomenuti i koncept ciljnog intraokularnog tlaka. Na samom početku terapije korisno je postaviti ciljni intraokularni tlak pri kojem će daljnja oštećenja vidnog živca biti malo vjerojatna. Obično je ta vrijednost manja za 20-30% od intraokularnog tlaka kod kojeg je došlo do oštećenja. Ako se oštećenje vidnog živca uzrokovano glaukomom pogoršava tijekom terapije, tada je potrebno postaviti novi ciljni intraokularni tlak - primijećeno je da se compliance pogoršava što se više povećava broj lijekova uključenih u terapiju i upute o njihovom uzimanju. Stoga je mudro provjeriti pacijentovu listu lijekova i utvrditi da li neki novi lijekovi na tržištu omogućavaju konsolidaciju terapije. Ovaj pregledni članak odnosi se na primarni glaukom otvorenog kuta gdje je medikamentozna terapija inicijalni način liječenja

Komplikacije lokalne anestezije u oftalmologiji

The local anaesthesia given in ophthalmic surgery, if performed correctly has been proved to be highly successful with low incidence of complications. This review article outlines the possibility of the complication of local anaesthesia in ophthalmic surgery.Pravilno davanje lokalne anestezije u očnoj kirurgiji veoma je uspješno s malom učestalošću komplikacije. Ovaj članak opisuje moguće komplikacije lokalne anestezije u očnoj kirurgiji

Pripravci ljekovitih biljaka u liječenju prehlade i gripe

Influenza viruses represent a permanent global health threat with approximately one billion people infected each year. Although influenza is usually self-limited infection, there are specific populations in which complications are common and sometimes fatal. Therefore, antiviral therapy with neuraminidase inhibitors and less often with adamantanes is becoming preferable course of action. Nevertheless, herbal plants, reviewed in this article, and plant preparations are still a widespread option for influenza and other viral diseases both in developed and developing countries

Meningeomi orbite - kliničko zapažanje

The aim of the study was to assess the characteristics and clinical features of orbital meningiomas during a 5-year period (2001-2005). Due to their typical posterior location, slowly progressive and painless visual loss, orbital meningiomas are intriguing and challenging lesions to diagnose and manage. This prospective study identified five cases (four female, mean age 46.5±14.5 years and one male aged 68 years) of orbital meningiomas, treated at University Department of Ophthalmology, Split University Hospital in Split from January 2001 until December 2005. In each case, the diagnosis was confirmed by history review. In our study, the incidence of orbital meningiomas was 0.2 per 100,000 inhabitants, however, some cases may have been recognized and treated at other hospitals in Croatia. In this study, orbital meningiomas showed a female predominance (F/M, 4:1). The mean visual acuity was 0.7 (range 0.4-0.9). Discrete proptosis was found in two cases with a slightly blurred optic disc margin and discrete optic disc edema. Optic nerve discoloration was observed in three cases. In one case, meningioma showed intracranial extension. Mild optic disc discoloration and blurred optic disc margin with slow and painless visual loss, particularly in females, may be the first signs of orbital meningioma.Meningeomi orbite zbog svoje stražnje lokalizacije i polaganog bezbolnog gubitka vida često predstavljaju dijagnostički i terapijski izazov. Cilj rada bio je ispitati incidenciju meningeoma orbite tijekom 5 godina (siječanj 2001. - prosinac 2005.) na Klinici za očne bolesti Kliničke bolnice Split. Retrospektivnom analizom su ispitane povijesti bolesti petoro bolesnika s kliničkom dijagnozom meningeoma orbita, liječenih na našoj Klinici. Analiza je obuhvatila četiri žene srednje dobi 46,5±14,5 godina i jednog muškarca starog 68 godina. Incidencija meningeoma orbite u našem ispitivanju bila je 0,2 na 100.000 stanovnika, iako je moguće da su neki bolesnici dijagnosticirani i liječeni na drugim klinikama u Hrvatskoj. Meningeomi orbita su bili češći kod žena nego kod muškaraca (4:1). Srednja vidna oštrina je bila 0,7 (raspon 0,4-0,9). Diskretna proptoza s nejasnim granicama i blagim edemom glave vidnog živca nađena je u dva slučaja, a diskoloracija vidnog živca u druga tri slučaja. Kod jednog bolesnika meningeom orbite je očitovao intrakranijsku ekstenziju. Blagi i bezbolni pad oštrine vida jednoga oka, diskoloracija i nejasne granice vidnog živca na očnoj pozadini, naročito kod žena, mogu biti prvi znaci meningeoma orbite

Meningeomi orbite - kliničko zapažanje

The aim of the study was to assess the characteristics and clinical features of orbital meningiomas during a 5-year period (2001-2005). Due to their typical posterior location, slowly progressive and painless visual loss, orbital meningiomas are intriguing and challenging lesions to diagnose and manage. This prospective study identified five cases (four female, mean age 46.5±14.5 years and one male aged 68 years) of orbital meningiomas, treated at University Department of Ophthalmology, Split University Hospital in Split from January 2001 until December 2005. In each case, the diagnosis was confirmed by history review. In our study, the incidence of orbital meningiomas was 0.2 per 100,000 inhabitants, however, some cases may have been recognized and treated at other hospitals in Croatia. In this study, orbital meningiomas showed a female predominance (F/M, 4:1). The mean visual acuity was 0.7 (range 0.4-0.9). Discrete proptosis was found in two cases with a slightly blurred optic disc margin and discrete optic disc edema. Optic nerve discoloration was observed in three cases. In one case, meningioma showed intracranial extension. Mild optic disc discoloration and blurred optic disc margin with slow and painless visual loss, particularly in females, may be the first signs of orbital meningioma.Meningeomi orbite zbog svoje stražnje lokalizacije i polaganog bezbolnog gubitka vida često predstavljaju dijagnostički i terapijski izazov. Cilj rada bio je ispitati incidenciju meningeoma orbite tijekom 5 godina (siječanj 2001. - prosinac 2005.) na Klinici za očne bolesti Kliničke bolnice Split. Retrospektivnom analizom su ispitane povijesti bolesti petoro bolesnika s kliničkom dijagnozom meningeoma orbita, liječenih na našoj Klinici. Analiza je obuhvatila četiri žene srednje dobi 46,5±14,5 godina i jednog muškarca starog 68 godina. Incidencija meningeoma orbite u našem ispitivanju bila je 0,2 na 100.000 stanovnika, iako je moguće da su neki bolesnici dijagnosticirani i liječeni na drugim klinikama u Hrvatskoj. Meningeomi orbita su bili češći kod žena nego kod muškaraca (4:1). Srednja vidna oštrina je bila 0,7 (raspon 0,4-0,9). Diskretna proptoza s nejasnim granicama i blagim edemom glave vidnog živca nađena je u dva slučaja, a diskoloracija vidnog živca u druga tri slučaja. Kod jednog bolesnika meningeom orbite je očitovao intrakranijsku ekstenziju. Blagi i bezbolni pad oštrine vida jednoga oka, diskoloracija i nejasne granice vidnog živca na očnoj pozadini, naročito kod žena, mogu biti prvi znaci meningeoma orbite

Učinak Travoprosta 0,004% kao dodatne terapije uz Timolol 0,5%

The aim of the study was to compare the efficacy of travoprost 0.004% eye drops added to therapy with timolol 0.5%. The study included 40 patients (80 eyes) with open angle glaucoma and intraocular pressure (IOP) above 18 mm Hg treated with topical beta blocker (timolol 0.50% twice a day). Travoprost 0.004% was added to timolol 0.5% therapy once daily in the evening. Follow up examinations were scheduled at 7 days, one month and three months. IOP lowering was achieved in all patients. Substantial lowering of 2.42 mm Hg was achieved after the first week of treatment. Further lowering and stabilization of IOP was recorded at three months, with total IOP decrease of 3.97 mm Hg; the difference was statistically significant (χ2=6.7743; p<0.01). At three months, target IOP was recorded in 64 eyes (16.4±0.7 mm Hg) and failed to be achieved in 16 eyes (21.1±2.3 mm Hg). Mild hyperemia was found in two patients and discrete hyperemia in 26 patients. Burning sensation associated with the use of travoprost 0.004% eye drops was reported by 68 patients. In conclusion, the use of travoprost 0.004% eye drops resulted in successful lowering of IOP and achievement of target IOP.Cilj studije bio je ispitati uspješnost terapije travoprostom 0.004% pridodanog već postojećoj terapiji timololom 0,5%. U studiju je bilo uključeno 40 bolesnika s glaukomom otvorenog kuta i intraokularnim tlakom (IOT) iznad 18 mm Hg liječenih lokalnim beta blokatorom (timolol 0,5% dva puta na dan). Travoprost 0,004% se davao uz već postojeću terapiju jedanput na dan, navečer. Kontrolni pregledi uslijedili su nakon 7 dana, 1 mjeseca i 3 mjeseca. Sniženje IOT je postignuto kod svih bolesnika. Značajno sniženje IOT od 2,42 mm Hg postignuto je nakon tjedan dana terapije. Daljnje sniženje IOT se postiglo i stabiliziralo nakon 3 mjeseca, s ukupnim sniženjem od 3,97 mm Hg; razlika je bila statistički značajna (χ2=6,7743; p<0.01). Nakon 3 mjeseca ciljni tlak postignut je kod 64 očiju (16,4±0,7 mm Hg), a nije postignut kod 16 očiju (16,4±0,7 mm Hg). Blaga hiperemija utvrđena je kod dvoje, a diskretna hiperemija kod 26 bolesnika. Peckanje pri ukapavanju lijeka opisalo je 68 bolesnika. Zaključuje se kako je primjena kapi travoprosta 0.004% dovela do sniženja IOT i postizanja ciljnog tlaka

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

Incidencija okluzije središnje mrežnične vene

Epidemiologic reports on retinal vein occlusion are quite scanty in the ophthalmologic literature. In the present study, the incidence of central retinal vein occlusion (CRVO) was assessed in a defined population of the Split - Dalmatia County, Croatia. The study was designed as a retrospective review of the medical records of inpatients and outpatients with the development of CRVO during a 15-year period (1985 - 1999). Study results revealed CRVO to have occurred in 167 subjects in the population of 465,947 during the study period, yielding an annual incidence of 2.4 per 100,000. The highest incidence of CRVO was recorded above the age of 70. The results of the study should improve the disease evaluation and planning of the ophthalmologic service for better management of this serious disease.U oftalmološkoj literaturi su rijetke epidemiološke studije o okluziji središnje mrežnične vene. U ovoj je studiji ispitana incidencija okluzije središnje mrežnične vene u definiranoj populaciji Splitsko-dalmatinske županije. Studija je bila retrospektivna, a zasnovana je na kartoteci hospitaliziranih i ambulantno pregledanih bolesnika s okluzijom središnje mrežnične vene u razdoblju od 15 godina, od 1985. do 1999. godine. U ovoj studiji je 167 od 465.947 stanovnika dobilo okluziju središnje mrežnične vene za vrijeme ispitivanog razdoblja. Godišnja incidencija bila je 2,4 na 100.000 stanovnika. Najviša incidencija okluzije središnje mrežnične vene zabilježena je iznad 70. godine života. Rezultati ovoga ispitivanja omogućiti će bolju procjenu bolesti i planiranje oftalmološke službe za rješavanje ove ozbiljne bolesti

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.