Conjunctival Melanoma - A Case Report

Konjunktivni melanom je relativno rijetka maligna bolest. Obično se javlja kao jednostrana, pigmentirana lezija koja zahvaća intrepalpebralnu bulbarnu spojnicu perilimbalno, a najčešće se razvija iz primarne stečene melanoze. Muškarac star 81 godinu, inače zdrav, došao je na pregled zbog protrudirajućeg tumora desnoga oka koji je polagano rastao unazad dvije godine. Biomikroskopski pregled otkrio je masivan, smeđe pigmentirani tumor koji se izdizao iznad temporalne 4/5 rožnice i susjednih 3 mm bjeloočnice temporalno od limbusa uzrokujući mehanički ektropij s keratiniziranom sponicom donje vjeđe. Samo limbus od 2 do 4 sata nije bio prekriven tumorom. Površina tumora širine 10 mm u bazi i visine 7 mm bila je nepravilna, nekrotična, s bogatom mrežom krvnih žila i točkastim krvarenjima. Citološkim brisom površine tumora nađene su samo upalne stanice. Bojanja na melanomske antigene HMB 45 i BerEp4(EA) bila su negativna. Zahvaljujući nekrotičnoj površini tumora bilo je moguće uzeti komadić tumora i poslati ga na histopatološku analizu kojom je postavljena dijagnoza melanoma. Kao najmanje invazivna palijativna operacija učinjena je enukleacija bez primarnog orbitalnog implanta. Također je cirkularno izrezano 4 mm susjedne vizualno nepromijenjene spojnice. Histopatološkom analizom tumora postavljena je konačna dijagnoza konjunktivnog melanoma.Conjunctival melanoma is a relatively rare malignancy. It is usually a pigmented, unilateral lesion, often in the perilimbal interpalpebral bulbar conjunctiva, mostly arising from primary acquired melanosis. An 81-year-old male, otherwise healthy, presented with a 2-year history of a slowly growing protruding massive pigmented tumor of the right eye. Biomicroscopy showed a massive pigmented brown tumor protruding from 3 mm of the temporal sclera and 4/5 of the temporal cornea causing mechanical ectropion with keratinized conjunctiva of the lower eyelid. The extent of the tumor was 10 o\u27clock with only the limbus from 2 to 4 o\u27clock being tumor-free. The surface of the tumor of 10 mm in size at the base and 7 mm in height was rough, necrotic, with rich feeder vessels and spotting bleedings. Cytology of the tumor surface revealed only inflammatory cells. Melanoma cell staining was negative for both HMB 45 and BerEp4(EA). Since the tumor surface was highly necrotic, a fragment was obtained and referred for histopathology. The diagnosis was: melanoma. Enucleation with no primary orbital implant was performed as a less invasive palliative surgery. An additional 4-mm fragment of the healthy-looking marginal conjunctiva was also excised. Histopathology of the tumor indicated conjunctival melanoma

Ultraviolet Light and Pterygium

The purpose of this study was to evaluate the contribution of ultraviolet light (UV) as a causal factor of primary and pterygium recurrence. A conjuctival autograft transplantation was a surgical method of pterygium treatment. In the first group (38 eyes) were patients with primary and recurrent pterygium exposed to sun (worked outdoors), evaluating geodemographic status, and in the second group (20 eyes) were patients who were not. During 6–12 months of follow up recurrence rate after surgical removal was 27% in the first group and 10% in the second one. UV light seems to have an important role in cause of primary and recurrent pterygium

Oxidative stress impact on growth hormone secretion in the eye

Aim To evaluate the influence of oxidative stress on extrapituitary growth hormone (GH) secretion in the eye and to analyze the interdependence between eye and serum GH levels under normal and hypoxic conditions. Methods Pars plana vitrectomy (PPV) was performed in 32 patients with developed proliferative diabetic retinopathy (PDR) and 49 non-diabetic controls, both of whom required this procedure as part of their regular treatment in the period from April 2013 to December 2014. During PPV, vitreous samples were taken and blood was simultaneously collected from the cubital vein. GH levels in serum and vitreous samples were measured by electrochemical luminescence assay. Oxidative stress was measured by enzyme- linked immunosorbent assay of advanced oxidation protein products (AOPP) and lipid hydroperoxide (LPO) in serum and vitreous. Results Serum AOPP levels were significantly higher than vitreous levels in both groups (P < 0.001 for each group) and LPO levels were significantly higher only in PDR group (P < 0.001). There was a significant positive correlation between serum and vitreous LPO levels in PDR group (r = 0.909; P < 0.001). Serum GH levels were significantly higher than vitreous levels in both groups (P < 0.001 for each group). Serum GH levels were significantly higher in PDR group than in controls (P = 0.012). Vitreous GH values were slightly higher in PDR group, but the difference was not significant. Conclusion Our study confirms that GH production in the eye is autonomous and independent of oxidative stress or pituitary GH influence

The Expression of Human Corneal MMP-2, MMP-9, proMMP-13 and TIMP-1 in Bullous Keratopathy and Keratoconus

We aim to find a link between keratokonus (KC) and bullous keratopathy (BK), and extra cellular matrix re-modellation molecules. The activities of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), pro-matrix metalloproteinase-13 (proMMP-13) and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) were measured using immunoassay in three human corneal tissue layers (epithelium, stroma and endothelium) supernatants of the patients with KC and BK which underwent the perforative keratoplasty. MPP-2, MMP-9, proMMP-13 and TIMP-1 activity was detected in all samples. The epithelial layer showed significantly higher levels of MMP-9 and proMMP-13 in BK than in KC. Increased levels of MMP-2 (p=0.07) levels were found in bullous keratopathy compared to keratoconus patients. Epithelial TIMP-1 showed no significant difference in activity between KC and BK. All these findings suggest an active degradation of the extra-cellular matrix in epithelial corneal layer in Bullous Keratopathy. No difference in the concentration of MMP-2, MMP-9, proMMP-13 and TIMP-1 between KC and BK in corneal stroma and endothelium suggest that neither of these molecules play important role in KC or BK pathogenesis, at least not in stroma and endothelium

Sunshine on Holidays – Eye Risks

Ultraviolet (UV) light is the most common cause of radiation injury to the eye wich in acute exposure causes photokeratitis and photoconjunctivitis. After a hole day exposure to the sun on the Mediteranian coast patient presented with mixed conjunctival injection, chemosis, edematous corneal epithelium with superficially present fluoresceine positive small pinpoint defects. Epithelial bullous changes, circular stromal infiltration in the middle stromal perifery and reduction of corneal transparency were more pronounced on the left eye. After treatment moderate conjunctival injection remained together with circular stromal infiltration in the middle perifery, corneas were transparent, epithelialised and fluorescein negative. Anterior chambers and lenses were clear. One month after patient regained bilateral visual acuity of 1. 0. To our kownoledge, this case shows for the first time connection between acute ultraviolet radiation exposure and persistent circular stromal infiltration in the middle corneal perifery in humans

Toxoplasmotic Retinochoroiditis: Case Report and Review of the Literature

Toksoplazmotski retinokoroiditis bolest je oka uzrokovana parazitom Toxoplasma gondii. U ljudskome oku infekcija toksoplazmom najčešće se očituje kao fokalni nekrotizirajući retinitis, uz sekundarni razvoj koroiditisa koji zahvaća unutarnje slojeve mrežnice, a očituje se kao fokalna žuto-bijela lezija s okolnim edemom mrežnice i upalnim infiltratom staklovine. Te promjene, uslijed reakcije preosjetljivosti na antigen, prate različiti oblici prednjega ili stražnjega uveitisa. Lezija obično cijeli unutar razdoblja od jednoga do četiri mjeseca uz formiranje oštro ograničenoga atrofičnog ožiljka pigmentiranih rubova. Liječenje u većini slučajeva nije potrebno. Ako je potrebno, klasično liječenje sastoji se od peroralne primjene pirimetamina, sulfadiazina i folinične kiseline. U liječenju toksoplazmotskoga retinokoroiditisa makularne lokalizacije dodatno se primjenjuju kortikosteroidi s ciljem smanjenja upalne reakcije i ubrzanja oporavka vida, što je prikazano u ovome slučaju.Toxoplasmotic retinochoroiditis is a disease of the eye caused by the Toxoplasma gondii parasite. In the human eye, toxoplasma infection mostly presents itself as a focal necrotizing retinitis with secondary choroiditis, involving the inner retinal layers and appearing as a focal yellow-white lesion with surrounding retinal edema and focal vitreous infiltrate. This is followed by varying degrees of posterior and anterior uveitis due to hypersensitivity reaction of antigens. The lesion usually heals within one to four months and is replaced with a sharply demarcated atrophic scar with pigmented borders. In most cases there is no need for treatment. When treatment is necessary, classic therapy consists of oral administration of pyrimethamine, sulfadiazine, and folinic acid. In treatment of ocular toxoplasmotic retinochoroiditis that affects the macular area, additional administration of corticosteroids to diminish inflammatory reaction and hasten visual acuity recovery has its place, as it is showed in this case

Painless Acanthamoeba Keratitis in a Soft Contact Lens Wearer – Case Report

Aim of our paper is to present a case of painless Acanthamoeba keratitis in a soft contact lens wearer. A 17-year-old male, highly myopic, prolonged soft contact lens wearer, presented to us with painless red watery right eye having remarkably diminished vision. Last six weeks he was treated elsewhere for the microbial keratitis with no improvement. No pain was reported and on the direct questionnaire about it he denied it. There was marked mixed conjunctival and ciliary injection. A central stromal opacity with a pronounced surrounding corneal ring of inflammatory infiltration and epithelial defect was seen on biomicroscopy of the right eye. Circular pannus was already formed reaching epithelial defect overlying corneal ring infiltrate. Acanthamoeba spp in the corneal sample was confirmed. Prolonged therapy with 0.02% chlorhexidine digluconate solution combined with 0.1% hexamidine solution resulted in corneal healing left with a large central dense stromal opacity with circular pannus reaching peripheral third of the cornea but with very thin blood vessels and the best corrected visual acuity of 0.1 tested on Snellen chart. In conclusion, even in a lack of typical symptom for Acanthamoeba keratitis such as pain, this amoeba should be ruled out especially in a soft contact lens wearer

Utjecaj čimbenika okoliša na pojavu alergijskih bolesti u populaciji školske djece u Zagrebu

Most scientists believe that increasing number of people with allergic diseases may be connected with some aspects of the “Western lifestyle”. This paper discusses data obtained from questionnaires originally designed by the International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee concerning exposure to different environmental factors. The study included 1047 children. Allergic and non-allergic groups showed statistically significant differences in the attendance of kindergarten, vaccination against pertussis, pertussis infection, and parasite infestation. Exposure to tobacco smoke during pregnancy and exposure to dampness and moulds also entailed a risk for allergy. We speculate that changing some conditions, such as use of carpets and use of feather pillows, were connected with the expression of allergic diseases. Some correlations were consistent with earlier observations of other authors, while others differed and need further confirmation on a larger sample.Većina istraživača smatra da je sve veći broj ljudi s alergijskim bolestima povezan s pojedinim aspektima “zapadnjačkog načina života”. Cilj je ovog članka razmotriti podatke dobivene iz originalnih upitnika koje je razradio ISAAC-ov tim stručnjaka, a koji se odnose na izloženost različitim čimbenicima iz okoliša. U istraživanje je uključeno ukupno 1047-ero djece u dobi od 10 godina 0 mjeseci do 10 godina 11 mjeseci iz zagrebačkih osnovnih škola. Prirodna izloženost različitim mikroorganizmima, vakcinacije te izloženost drugim čimbenicima okoliša, kao što su duhanski dim, vlaga, plijesni itd. analizirani su kao potencijalni rizični čimbenici za pojavu alergijske bolesti. U skupini ispitanika koji su išli u vrtić između treće i šeste godine života bio je statistički značajno viši postotak djece sa simptomima alergijske bolesti. Među ispitanicima koji su primili pertusisnu vakcinu opažen je značajno niži postotak alergične djece, dok je kod djece koja su preboljela pertusis taj postotak bio značajno viši. Također je dobiven značajno viši postotak alergične djece među ispitanicima koji su preboljeli infestacije crijevnim parazitima. Djeca majki koje su pušile za vrijeme trudnoće i tijekom prve godine života djeteta, bila su pod većim rizikom za pojavu alergijske bolesti, za razliku od djece koja su duhanskom dimu izložena u sadašnjosti. Ekspozicija vlazi i plijesnima predstavlja rizik za alergijsku bolest. Među ispitanicima koji imaju tepih u spavaćoj sobi, kao i kod onih koji rabe pernati jastuk, bio je značajno niži postotak alergične djece, dok je kod djece koja imaju goli pod taj postotak bio značajno viši. Neki naši rezultati u skladu su s prethodnim opažanjima drugih autora, dok se neki razlikuju. Najzanimljiviji rezultat je potencijalni zaštitni učinak pertusisne vakcine protiv razvoja alergijskih bolesti. Ove će rezultate svakako biti potrebno provjeriti na većem uzorku