Učinak botulinum toksina tip A u bolesnika s esencijalnim blefarospazmom

The aim of this study was to determine the effect of botulinum toxin type A and satisfaction in patients with essential blepharospasm. The study included 12 subjects suffering from essential blepharospasm who received therapy with botulinum toxin type A injections. Respondents were given a Blepharospasm Disability Index (BSDI) survey before and three weeks after the procedure with questions related to quality of life. They were also given a Jankovic Rating Scale with questions related to the severity and frequency of symptoms. The overall level of difficulties was reduced, meaning the quality of life increased after the application of botulinum toxin, and the study found that the increase was statistically significant (p = 0.003). The severity of symptoms after the application of botulinum toxin was reduced, which meant that there was a decrease in the severity of the difficulties, and the study found a statistically significant difference (p=0.003). The frequency of symptoms was reduced after botulinum toxin administration, and the study revealed a statistically significant difference (p = 0.012). From the results of this study, we can determine that the use of botulinum toxin type A increases the quality of life and that the severity and frequency of symptoms are statistically significantly reduced.Cilj je bio utvrditi učinak botulinum toksina tip A i zadovoljstvo u bolesnika s esencijalnim blefarospazmom. U istraživanje je uključeno 12 ispitanika u dobi od 49 do 86 godina s esencijalnim blefarospazmom kojima je primijenjena terapija injekcijama botulinum toksina tip A. Ispitanicima je prije te tri tjedna nakon postupka dana anketa Blepharospasm Disability Index (BSDI) u kojoj su bila pitanja vezana za kvalitetu života. Dana im je i ljestvica Jankovic Rating Scale s pitanjima koja se odnose na težinu i učestalost simptoma. Ukupna razina poteškoća je smanjena, što znači da se kvaliteta života povećala nakon primjene botulinum toksina, a studija je pokazala da je povećanje statistički značajno (p = 0,003). Ozbiljnost simptoma nakon primjene botulinum toksina smanjena je, što znači da je došlo do smanjenja težine poteškoća, a istraživanje je utvrdilo statistički značajnu razliku (p=0,003). Učestalost simptoma smanjena je nakon primjene botulinum toksina, a studija je pokazala statistički značajnu razliku (p = 0,012). Iz rezultata ovog istraživanja možemo utvrditi da primjenom botulinum toksina tipa A dolazi do povećanja kvalitete života, te da se ozbiljnost i učestalost simptoma statistički značajno smanjuju

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

Poremećaji cirkulacije u krvnim žilama orbite dijagnosticirani obojenim dopplerovim ultrazvukom kod bolesnika s ranim stadijem distiroidne optičke neuropatije

Thyroid-associated orbitopathy (TAO) is a common manifestation of Graves’ disease. Th e aim of the study was to assess the six percent of patients with TAO that develop dysthyroid optic neuropathy (DON), which is the most serious complication of TAO. As DON can cause permanent damage, it is essential to detect DON early when visual loss is still reversible. Color Doppler ultrasound is a noninvasive diagnostic method, which may be useful in early detection of DON. Th irty-six patients with confi rmed Graves’ disease and active TAO were included, 21 (58%) of them with early DON (eDON) and 15 (42%) free from any signs of eDON. All study patients underwent Doppler ultrasound examination to determine the blood fl ow rates in the internal carotid artery, ophthalmic artery, and central retinal artery. Study results showed color Doppler ultrasound examination to have a potential to detect orbital blood fl ow changes in patients with eDON. Early detection of DON may result in earlier treatment and prevention of permanent optic nerve damage.Problemi štitnjače i povezane orbitopatije (TAO) najčešća su manifestacija Gravesove bolesti. Cilj ove studije bio je objasniti 6% bolesnika s TAO kod kojih se razvila distiroidna optička neuropatija (DON), koja je ujedno najozbiljnija komplikacija TAO. S obzirom na to da DON može izazvati trajno oštećenje vida, vrlo ga je važno rano prepoznati dok je vidna funkcija još očuvana i reverzibilna. Obojeni Dopplerov ultrazvuk je neinvanzivna dijagnostička metoda koja je vrlo djelotvorna u ranom otkrivanju DON-a. U studiju je bilo uključeno 36 bolesnika s dijagnosticiranom Gravesovom bolesti i TAO-om, od kojih je 21 (58%) bolesnik imao rani DON (early DON, eDON), dok 15 (42%) bolesnika nije imalo znakova eDON-a. Svakom ispitaniku učinjen je obojeni Dopplerov ultrazvuk kako bi se odredio stupanj protoka krvi (cirkulacije) u unutarnjoj karotidnoj arteriji, oftalmičkoj arteriji i središnjoj retinalnoj arteriji. Rezultati su pokazali da pregled obojenim Dopplerovim ultrazvukom ima visok potencijal u ranoj dijagnostici promjena cirkulacije u orbiti kod bolesnika s ranim eDON-om. Rano otkrivanje DON-a može pomoći u ranijem liječenju i prevenciji trajnog oštećenja vidnoga živca

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

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

Effect of Botulinum Toxin-A Injection on Intraocular Pressure and Proptosis in Thyroid Associated Orbitopathy

The aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) on intraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy (TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX -A injections were applied. Intraocular pressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2–4 weeks after BTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX -A injection using a Hertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6± 2.8 mmHg and 2–4 weeks after BTX-A injection was 16.9±3.3 mmH; (p=0.001). There was no statistically significant difference in Hertel egzophthalmometer readings before and after BTX-A injection, 21.5±2.7 mm vs 22.0± 2.6 mm; (p=0.678). In conclusion, BTX-A injection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influence on proptosis

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.

Uloga dijabetične retinopatije u sljepoći i slabovidnosti u Splitsko-Dalmatinskoj županiji 2000.-2010.

Diabetic retinopathy is the fifth leading cause of blindness in the world. The aim of this study was to determine the number of blind persons in the Split-Dalmatia County in the 2000-2010 period and how many of them are blind due to diabetic retinopathy. Records of 160 members of the Association of the Blind in the Split-Dalmatia County, enrolled from 2000 to 2010, were retrospectively analyzed. The leading causes of blindness were diabetic retinopathy (25.6%), glaucoma (13.1%), retinal dystrophy (16.2%), and age related macular degeneration (11.8%). The annual incidence of blindness was 8.4/100,000 inhabitants. The largest number of the blind were found in the 70-80 (21.2%) to >80 (24.3%) age group. Diabetic retinopathy was the cause of blindness in 24 (15%) men and 17 (10.6%) women. The annual incidence of diabetic retinopathy was 2.16 per 100,000. No case of blindness due to diabetic retinopathy was diagnosed in patients younger than 30 years of age, while the highest prevalence was found in the 70-80 age group (34%). Proliferative diabetic retinopathy was the cause of blindness in 92.7% and nonproliferative diabetic retinopathy in 7.3% of cases. Study results show that diabetic retinopathy remains the leading cause of blindness. Early identification of high-risk patients is the key factor in prevention and timely detection of ophthalmoscopic changes, thus enabling effective and duly treatment.Dijabetična retinopatija je peti najčešći uzrok sljepoće u svijetu. Cilj ove studije bio je istražiti broj slijepih u Splitskodalmatinskoj županiji u razdoblju od 2000. do 2010. godine te istražiti koliko je slijepih zbog dijabetične retinopatije. Retrospektivno smo analizirali 160 članova Udruge slijepih Splitsko-dalmatinske županije koji su registrirani između 2000. i 2010. godine. Najčešći uzroci sljepoće su: dijabetična retinopatija (25,6%), glaukom (13,1%), distrofija mrežnice (16,2%) i staračka makularna degeneracija (11,8%). Godišnja incidencija sljepoće je iznosila 8,4/100.000 stanovnika. Najveći broj slijepih je bio u dobnoj skupini od 70-80 godina (21,2%) i >80 godina (24,3%). U 24 (15%) muškarca i 17 (10.6%) žena sljepoća je bila uzrokovana dijabetičnom retinopatijom. Godišnja incidencija dijabetične retinopatije je iznosila 2,16/100.000 stanovnika. Nije pronađen niti jedan slučaj sljepoće uzrokovane dijabetičnom retinopatijom u dobi ispod 30 godina, dok je najveća učestalost nađena u dobnoj skupini od 70-80 godina (34%). U 92,7% slučajeva uzrok sljepoće je bila proliferativna dijabetična retinopatija, a u 7,3% neproliferativna dijabetična retinopatija. Ova studija ukazuje na dijabetičnu retinopatiju kao vodeći uzrok sljepoće. Rano otkrivanje rizičnih skupina je osnova prevencije i pravodobnog otkrivanja oftalmoloških promjena, na temelju čega se može pravodobno započeti s odgovarajućim liječenjem

FAMOUS DOCTORS WHO STAYED ON THE CROATIAN COAST AT THE TURN OF THE 20th CENTURY

Krajem 19. i početkom 20. stoljeća brojne poznate osobe boravile su na hrvatskoj obali najčešće iz turističko-lječilišnih razloga, zatim zbog prirodnih ljepota, znanstvenih ili iz političkih razloga. Najčešće su dolazili iz područja tadašnje Austro-Ugarske i Njemačke, iz Rusije, ali i iz naših krajeva. Među njima su bili i mnogobrojni liječnici od kojih su neki i svjetski poznati. Najistaknutiji su bili kirurg Theodor Billroth, bakteriolog i nobelovac Robert Koch, patolog Rudolf Virchow, psihijatar Sigmund Freud. Oni su ostavili dubok trag i veliku korist na području na kojem su boravili.At the end of the 19th and the beginning of the 20th century many famous persons stayed on the Croatian coast mostly because of touristic and health reasons, than because of natural beauties, scientific or political reasons. Most often they came from Austro-Hungary, Germany or Russia but also from our homelands. Among them were also many famous doctors, some known worldwide. The most distinguished were the surgeon Theodor Billroth, the bacteriologist and a Nobel prize winner Robert Koch, the pathologist Rudolf Virchow, and the psychiatrist Sigmund Freud. They left a deep impression and a big benefit at the area they stayed in

The Incidence of Optic Neuritis in Split-Dalmatia County, Croatia

The aim of the study was to determine the incidence of monosymptomatic optic neuritis (MON) in residents of Split-Dalmatia County, Croatia. The 127 cases (83 female, aged 26.2+/-9.9 and 44 male aged 26.9 +/-11.2) with MON presented between January 1985 and December 2001 were analyzed from hospital data. The annual incidence was 1.6 per 100,000 (95% CI, 0–3). The incidence among females was 2.2 (95% CI, 0–4.6) cases / 100,000 per year and 1.1 (95% CI, 0–3) among males. The difference in incidence rates for women vs. men was not significant (x2=0.41; p=0.52), although it is more likely that a true difference exists. The peak incidence in both sexes observed in the group 20–29 years of age was 4.2 (95% CI, 0–10). The highest incidence of MON was found in spring (46 cases). In summary, the incidence of MON in Split-Dalmatia County during the 17 years period is relatively low