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

Intraocular Lens (IOL) Materials

In 1949, first intraocular lens (IOL) insertion after cataract surgery was performed by Sir Harold Ridley, in London. Only in the 1970s, the IOL insertion after cataract surgery began to be a standard procedure. The material the first IOL-s were composed of was polymethyl methacrylate (PMMA). The PMMA is a rigid material and the corneal incision had to be at least as big as the IOLs optic and it became its biggest disadvantage in the cataract surgery. The main goal of modern cataract surgery is as smallest incision possible, so the IOL-s had to be flexible and therefore foldable. This goal was achieved by improvements in the IOL design and materials that made them foldable. First foldable IOL-s were made of hydrogel but they were unstable and the development of the first silicone IOL-s overcame that problem. Foldable silicone IOL-s were first implanted in 1978 by Kai-yi Zhou. Foldable IOL’s benefits are its compatibility with a small incision surgery that is self-sealing procedure and the possibility of insertion by a single-use applicators that made the surgery safer. In the future, we can expect some new, different and innovative approaches in the IOL design and materials

Usporedna analiza mjerenja očnog tlaka različitim oftalmološkim uređajima

The aim of the study was to assess accuracy and reliability of automated intraocular pressure (IOP) measurement. This prospective study was carried out at outpatient glaucoma clinic, University Department of Ophthalmology, Split University Hospital in Split, over a 5-month period (September 2005 - January 2006). IOP measurements were performed by Goldman\u27s applanation tonometry and automated non-contact tonometry (Reichert AT 555). The study included 105 patients (210 eyes). In chronic open angle glaucoma (210 eyes) under therapy, the mean IOP value measured by Goldman\u27s applanation tonometry and automated non-contact tonometry was 19.85 mm Hg and 20.41 mm Hg, respectively. The difference was not statistically significant (χ2=0.01215; p>0.05). Accordingly, Goldman\u27s applanation tonometry and automated non-contact tonometry yielded similar results in chronic open angle glaucoma patients, confirming the accuracy and reliability of automated IOP measurement by non-contact tonometry.Cilj studije bio je provjeriti točnost i pouzdanost mjerenja očnog tlaka (IOT) automatskom metodom bez dodira. Studija je provedena u Klinici za očne bolesti Kliničke bolnice Split, u Ambulanti za glaukom, a obuhvatila je bolesnike s glaukomom liječene u razdoblju od 5 mjeseci, od rujna 2005. do siječnja 2006. godine. U ovoj prospektivnoj studiji ispitano je 105 bolesnika (210 očiju). Mjerenja IOT izvedena su Goldmannovom aplanacijskom tonometrijom i automatskim mjerenjem IOT bez dodira tonometrom Reichert AT 555, s međuvremenom u mjerenjima od 10 minuta. Mjerenjem IOT pod terapijom za kronični glaukom otvorenog kuta (210 očiju) Goldmannovom aplanacijskom tonometrijom dobivena je srednja vrijednost od 19,85 mm Hg, a automatskim mjerenjem IOT bez dodira 20,41 mm Hg. Nije bilo statistički značajne razlike između ovih rezultata (÷2=0,01215; p>0,05). Dakle, mjerenje IOT kod kroničnog glaukoma otvorenog kuta Goldmannovom aplanacijskom tonometrijom i automatskom metodom bez dodira pokazalo je statistički slične vrijednosti, .to potvrđuje točnost i pouzdanost mjerenja IOT tehnikom automatskog mjerenja bez dodira

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

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

The Implantation of Single-Piece Intraocular Lens with Blue-Light Filter

Cilj rada bio je ispitati intraoperacijske i poslijeoperacijske značajke kod ugradnje jednodijelne intraokularne leće s filtrom za plavo svjetlo nakon operacije katarakte fakoemulzifikacijom. Ova prospektivna studija je uključila 18 bolesnika (18 očiju) podvrgnutih operaciji i ugradnji jednodijelne savitljive akrilatne leće AcrySof SN60AT u razdoblju od prosinca 2005. do veljače 2006. godine. Analizirana je priprema leće za ugradnju, operacijske i poslijeoperacijske komplikacije, ugradnja leće kroz operacijski rez od 3,2 mm, centriranje leće, fleksibilnost haptika, vidna oštrina, zamućenje stražnje kapsule i test na boje. Prilikom pripreme leće za ugradnju nije bilo poteškoća. U tri slučaja vodeći haptik je teže ulazio u operacijski rez, a nakon ugradnje leća se vrlo brzo vraćala u prvobitan oblik. Nije bilo poteškoća s centriranjem unutar kapsularne vreće. Poslijeoperacijska korigirana vidna oštrina je bila 0,85 (Snellenova tablica), što je bilo u skladu s nalazom na fundusu. Bolesnici se nisu žalili na percepciju boje na operiranom oku. Ugradnja jednodijelne intraokularne leće AcrySof s filtrom za plavo svjetlo ne razlikuje se od ugradnje drugih savitljivih leća i ne utječe na percepciju boja i vidnu oštrinu.The aim of the study was to evaluate intraoperative and postoperative performance of the single-piece intraocular lens with blue light filter after cataract phacoemulsification. This prospective study included 18 patients (18 eyes) undergoing operation and implantation of a single-piece AcrySof SN60AT foldable acrylic lens (Alcon, Forth Worth, TX, USA) between December 2005 and February 2006. Intraocular lens (IOL) folding, operative and postoperative complications, easiness of IOL implantation through a 3.2-mm incision, haptic flexibility, IOL centration in the capsular bag, visual acuity, posterior capsular opacification and color test were analyzed. Lens folding was easy in all cases. In three cases, the leading haptic did not pass easy through the incision, but unfolding was also easy. After six months, the best corrected visual acuity was 0.85 (Snellen chart), which correlated with the preexisting posterior segment pathology. Color perception was not affected in patients without ocular pathology. Accordingly, implantation of the single-piece AcrySof Natural IOL was found to be easy. The implantation was the same as in other types of foldable lenses and there was no impairment of color perception or visual acuity

CLINICO-EPIDEMIOLOGICAL ANALYSIS OF CHOROIDAL MELANOMA IN SPLIT AREA, CROATIA

Melanom žilnice je najčešći primarni maligni tumor oka u odraslih. Cilj rada je ispitivanje epidemioloških značajki melanoma žilnice u Splitsko-dalmatinskoj županiji od 1990. do 2009. godine. U ovoj su retrospektivnoj studiji uporabljeni podaci 46 bolesnika iz medicinske dokumentacije Klinike za očne bolesti KBC-a Split. Broj stanovnika županije iz popisa stanovništva 2001. godine bio je 463.676. Incidencija melanoma žilnice iznosila je 0,49 na 100 tisuća stanovnika što je između vrijednosti incidencije sjeverne i južne Europe. Melanom žilnice najčešće se javlja u 7. desetljeću života. Prosječne dimenzije melanoma žilnice (baza x visina) bile su 13,4 x 8,0 mm. Patohistološki nalaz po Callenderovoj klasifikaciji pokazao je sljedeće vrste melanoma: vretenasti 40%, epiteloidni 8% i miješani 52%. Najčešća provedena terapija bila je enukleacija (47,8%), zatim brahiterapija (28,3%) što znači da bolesnici relativno kasno dolaze na pregled, tj. kada melanom žilnice uznapreduje svojom veličinom. Splitsko-dalmatinska županija ima stanovnika gotovo 1/10 Hrvatske; može se pretpostaviti da se godišnje otkrije oko 25 novih slučajeva malignog melanoma žilnice u Hrvatskoj. Za rano otkrivanje bolesti potrebni su redoviti i kompletni oftalmološki pregledi posebno presbiopne populacije. Ovo je istraživanje važno zbog bolje evaluacije bolesti i boljeg planiranja oftalmološke službe u rješavanju te teške očne bolesti.Choroidal melanoma is the most common primary intraocular malignant tumour in adults. The aim of the study was to examine epidemiological characteristics of choroidal melanoma in Split-Dalmatia County from 1990 to 2009. In this retrospective study,data on 46 patients from medical documentation of the University Department of Ophthalmology, Split University Hospital Center,were analyzed. According to 2001 census, the Split-Dalmatia County population was 467,676 inhabitants. The incidence of choroidal melanoma was 0.49 per 100,000 inhabitants, which is somewhere in the middle of the incidence between south and north Europe. Choroidal melanoma most commonly appeared in the 7th decade of life. The average dimensions of choroidal melanoma (basis x height) were 13.4x8.0 mm. Histopathologic findings according to Callender classification showed the following types of melanoma: epithelioid cell type 8%, spindle cell type 40%, and mixed type 52%. The most common forms of therapy were enucleation 47.8% and brachytherapy 28.3%, which means that patients presented relatively late when choroidal melanoma advanced in size. The Split-Dalmatia County has 1/10 of the Croatian population, so it could be supposed that approximately 25 new cases of malignant melanoma of the choroid are discovered annually in Croatia. For early detection of the disease, regular and complete checkups are necessary, especially in presbyopic population. Study results enabled better evaluation of the disease and better planning of ophthalmologic service in the treatment of this serious eye disease

Rezultati liječenja prijeloma klavikula u djece

Treatment of clavicle fracture is principally outpatient. Operative treatment is accompanied by the need for more x-rays and possible complications. Fractures with absolute indications for operative treatment occur only sporadically and these indications are relatively clear, but children often undergo surgery because of relative indications (shortening, fragment displacement, multifragmentary fractures), which are open to debate. In a retrospective study on 256 children, of 44 (17%) patients that received operative treatment only one 17-year-old boy had an absolute indication for surgical intervention. Other indications were fragment distraction (22 mm on average), age, associated injuries, and multifragmentary fracture. The placement of K-wire of appropriate thickness is often difficult, since the wire tends to bend and break, and patients have to undergo two additional operations of plate and screw fixation and later removal. In this retrospective study, we considered the advantages of using titanium or an elastic steel pin. All patients had favorable outcome, although some experienced numbness around the operation scar (4.5%), skin infections around the wire (15%), and/or the implanted K-wire damage (7%).Liječenje fraktura klavikule je prevenstveno ambulantno. Operativno liječenje zahtijeva dodatne rentgenske snimke i praćeno je mogućim komplikacijama. Frakture s apsolutnom indikacijom za operativno liječenje se pojavljuju sporadično i te indikacije su jasne, ali često djeca budu operirana zbog relativnih indikacija koje nisu sasvim jasne. U retrospektivnoj studiji na 256 djece, od kojih je 44 (17%) operativno liječeno, samo jedan dječak od 17 godina je imao apsolutnu indikaciju za operaciju. Ostale indikacije su bile distrakcija (prosječno 22 mm), dob, udružene ozljede i multifragmentarne frakture. Postavljanje Kirschnerove žice odgovarajuće debljine je često nemoguće zbog savijanja i pucanja žice pa bolesnici moraju ići na dva dodatna zahvata, fiksaciju pločicom i vijcima i vađenje osteosintetskog materijala. U sklopu ove studije razmotrili smo prednosti korištenja titanskog čavla. Svi bolesnici su imali dobar ishod, iako se u određenom broju operiranih pojavila utrnutost oko ožiljka (4,5%), infekcija rane (15%) i oštećenje Kirschnerove žice (7%)