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Cilj ove studije bio je procijeniti izgled glave vidnoga živca i debljinu retinalnog nervnog sloja (RNFL) u zdravim očima, očima s očnom hipertenzijom i glaukomskim očima pomoću optičke koherentne tomografije (OCT). U ovoj usporedbenoj analizi bila su uključena 62 oka i to 24 zdrava oka, 16 očiju s očnom hipertenzijom i 22 glaukomska oka. Topografski parametri OCT kao promjer ekskavacije, područje ekskavacije, područje ruba i omjer promjera ekskavacije u odnosu na promjer papile bili su značajno veći u očima s očnom hipertenzijom u odnosu na zdrave oči. Parametri su također bili značajno veći u glaukomskim očima u odnosu na zdrave oči i one s očnom hipertenzijom. Retinalni nervni sloj je bio značajno tanji u donjem kvadrantu u očima s očnom hipertenzijom u odnosu na zdrave oči, te značajno tanji u glaukomskim očima u odnosu na zdrave oči i one s očnom hipertenzijom u prosjeku i u sva četiri kvadranta. Optička koherentna tomografija je osjetljiva metoda za otkrivanje ranih organskih oštećenja u glaukomu, dok su parametri glave vidnoga živca i debljina retinalnog nervnog sloja dobiveni tom metodom isto tako korisni u kliničkoj procjeni glaukoma., The aim of the study was to evaluate optic disk appearance and retinal nerve fiber layer (RNFL) thickness in normal, ocular hypertensive (OHT) and glaucomatous eyes using optical coherence tomography (OCT). This comparative analysis included 62 eyes: 24 normal, 16 OHT and 22 glaucomatous. OCT topographic parameters of cup diameter, cup area, rim area and cup/disk area ratio were significantly greater in OHT eyes than in normal eyes, and significantly greater in glaucomatous eyes than in normal and OHT eyes. RNFL was significantly thinner in OHT eyes than in normal eyes in the inferior quadrant, and in glaucomatous eyes as compared with OHT and normal eyes on an average and in all four quadrants. OCT is a sensitive method for detection of the earliest organic damage in glaucoma, while optic disk parameters and RNFL by use of OCT may prove useful on clinical assessment of glaucoma.

The aim of the study was to retrospectively analyze changes in the results of automated perimetry in open angle glaucoma patients, including Mean Defect (MD), Loss Variance (LV) and Corrected Loss Variance (CLV) before and after cataract surgery, and also to note how the presence of dense scotoma preoperatively could influence postoperative results. MD is a mean of all local visual field defects. LV and CLV are indexes of localized field damages. Increased values of these indicators are even more specific for glaucomatous damage than MD. We investigated 18 eyes of 14 patients with open angle glaucoma who were scheduled for cataract extraction with intraocular lens implantation. The diagnosis of open angle glaucoma was based on the presence of glaucomatous optic disk cupping and abnormal results on glaucoma field testing. The intraocular pressure (IOP) criterion was IOP higher than 21 mm Hg. On gonioscopy, all angles of the anterior chamber were open. All patients underwent Octopus Field Analyzer dG2 testing within two months before and three months after cataract surgery. The eyes were divided into two groups based on the presence of absolute or near absolute (dense) scotomata before surgery. Dense (absolute or near absolute) scotomata noted on automated perimetry were found not to be caused by the cataract. Their existence before surgery could be explained by glaucomatous visual field defects. Cataract can induce various degrees of relative scotoma, which can induce worsening of local field defects (LV and CLV) after surgery. This implies that the real size of glaucomatous damage (expressed as difference between LV and CLV before and after cataract surgery) can only be seen and properly measured after cataract extraction. Therefore, it is concluded that LV and CLV can be used as reliable indicators in distinguishing the role of coexisting cataract in glaucomatous damage, however, additional studies in the area are needed., Cilj ove studije bio je retrospektivno istražiti promjene u rezultatima kompjutorizirane automatske perimetrije bolesnika s glaukomom otvorenog kuta, uključujući pokazatelje glaukomskog oštećenja: MD (Mean Defect), LV (Loss Variance) i CLV (Corrected Loss Variance) prije i poslije operacije katarakte te ocijeniti kako prisutnost apsolutnog skotoma preoperacijski utječe na poslijeoperacijske rezultate. MD je prosječna vrijednost svih lokalnih oštećenja vidnog polja, dok su LV i CLV pokazatelji lokalnog oštećenja vidnog polja. Povišene vrijednosti ovih pokazatelja još specifičnije ukazuju na glaukomsko oštećenje u odnosu na vrijednosti MD. Ispitivali smo 18 očiju u 14 bolesnika s glaukomom otvorenog kuta koji su bili predviđeni za ekstrakciju katarakte s implantacijom intraokularne leće. Dijagnoza glaukoma je bila postavljena na osnovi kliničkog nalaza ekskavacije glave vidnog živca i patološkim nalazom vidnog polja. Intraokularni tlak je morao biti veći od 21 mm Hg te gonioskopski utvrđen otvoren kut prednje očne sobice. Svi bolesnici su testirani pomoću kompjutoriziranog perimetra Octopus, program dG2, dva mjeseca prije i tri mjeseca poslije operacije katarakte. Oči su podijeljene u dvije skupine prema prisutnosti apsolutnog skotoma prije operacije. Utvrđeno je kako apsolutni skotom, potvrđen kompjutoriziranom perimetrijom prije operacije, nije uzrokovan kataraktom te da je posljedica stvarnog glaukomskog oštećenja. U skupini bolesnika s apsolutnim skotomom pokazatelji lokalnog oštećenja vidnog polja (LV i CLV ) pogoršali su se poslijeoperacijski, što ukazuje na to da se uklanjanjem relativnih skotoma uzrokovanih kataraktom dobiva stvarna veličina glaukomskog oštećenja koje može donekle biti skriveno kataraktom (izraženo u razlici vrijednosti parametara LV i CLV prije i poslije operacije katarakte). Stoga se zaključuje da LV i CLV mogu biti pouzdani pokazatelji u razlikovanju oštećenja vidnog polja uzrokovanih glaukomom i pratećom kataraktom, no potrebne su daljnje studije u tom smjeru.

The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10–30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito- -palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.

AIM:5-flurouracil, an antimetabolic agent, improves the success rate of trabeculectoies by inhibiting subconjuctival fibrosis. The study was performed to evaluate efficasy and safety of subconjctival 5-flurouracil(5-FU) with ocular massage(OM) after trabeculectomy in patients with medically uncontrolled primary open angle glaucoma(POAG). PATIENTS AND METHODS:The study included patients with medically uncontrolled primary open angle glaucoma. We reviewed retrospectively 24 eyes that had undergone needling revision for failed trabeculectomy.. The needling revisions were performed with 5-FU. All patients were needling under an operating microscope. The main outcome mesaures were IOP and the number of medications used. . The mean follow up time was 10.5+ 7.3 months.RESULTS:The ten eyes achived success, defined as IOP 18mmHg without medication, eight eyes achived qualiffied sucess, defined as IOP 18mmHg with medication, and six eyes were classified as failure, defined as IOP more than 18mmHg with medication. Complications were minor.CONCLUSION: This stuy suggest that bleb needling with 5-FU is safe and effective procedure for managing failing filtering bleibs following a trabeculectomy.

The aim of this study was to examine whether any correlation exists between long term use of high doses of inhaled corticosteroids and the occurrence of intraocular hypertension or open angle glaucoma. The study included 30 patients with bronchial asthma, treated with long term high doses of inhaled corticosteroids, and a control group of 30 age-matched healthy subjects. Apart from family history, the clinical examination included ophthalmologic examination, measurement of intraocular pressure, automated perimetry and photography of the optic nerve head. At least two of the following parameters were required for the diagnosis of glaucoma: intraocular pressure level, visual field defects, and characteristic appearance of the optic nerve head. The level of intraocular pressure (without therapy from 22 to 30 mmHg, daily pressure curve) was a criterion for the diagnosis of intraocular hypertension. In glaucoma free subjects, all parameters were within the normal limits. The study pointed to a correlation between long term use of high doses of inhaled corticosteroids and the occurrence of intraocular hypertension in patients with a positive family history of glaucoma., Cilj ovoga rada bio je ispitati postoji li veza između dugotrajne upotrebe visokih doza inhalacijskih kortikosteroida i pojave intraokularne hipertenzije ili glaukoma otvorenog kuta. Ispitivanjem je obuhvaćeno 30 bolesnika s bronhalnom astmom koji su bili na dugotrajnoj terapiji visokim dozama inhalacijskih kortikosteroida, a kontrolnu skupinu je činilo 30 dobno prispodobivih zdravih ispitanika. Uz detaljnu obiteljsku anamnezu, kliničko ispitivanje obuhvatilo je oftalmološki pregled, mjerenje intraokularnog tlaka, automatiziranu perimetriju i fotografiju glave vidnoga živca. Za dijagnozu glaukoma potrebna su najmanje dva od slijedećih parametara: visina intraokularnog tlaka, ispadi u vidnom polju, te znakovit izgled glave vidnoga živca. Kriterij za dijagnozu intraokularne hipertenzije je visina intraokularnog tlaka (bez terapije od 22 do 30 mm Hg, dnevna krivulja tlaka). Ispitanici bez glaukoma su imali sve parametre u granicama normale. Istraživanje je pokazalo povezanost između dugotrajne upotrebe visokih doza inhalacijskih kortikosteroida i pojave intraokularne hipertenzije u bolesnika s pozitivnom obiteljskom anamnezom za glaukom.

The aim of the study was to assess the intraocular hypotensive effect of 1.0% brinzolamide (b.i.d.) as monotherapy in patients with primary and secondary glaucoma. The six-month study included 2 patients of which 19 completed the study (one patient was excluded due to allergic drug reaction). All patients had previously received local antiglaucoma therapy. Because of local undesired side effects and inadequate control of intraocular pressure they were switched to treatment with 1.0% brinzolamide as monotherapy. Intraocular pressure was measured on the day of therapy introduction, and then at 15 days, one month, three months and six months of therapy. Nineteen patients successfully completed the six-month study. A clinically significant decrease in the intraocular pressure was recorded. The difference in intraocular pressure between the baseline (23.8 ± 2.4), and 15-day (18.2 ± 2.8), one-month (18.2 ± 2.7), three-month (18.5 ± 2.9) and six-month (18.8 ± 3.2) levels was statistically significant (p, Cilj rada bio je utvrditi intraokularni hipotenzivni učinak brinzolamida 1,0% % b.i d.) kao monoterapije u bolesnika s primarnim i sekundarnim glaukomom. Šestomjesečno ispitivanje uključilo je 20 bolesnika od kojih je ispitivanje završilo njih 19 (jedan je bolesnik isključen zbog alergijske reakcije na lijek). Svi bolesnici su do tada bili na lokalnoj antiglaukomskoj terapiji. Zbog lokalnih neželjenih popratnih pojava te neodgovarajuće kontrole intraokularnog tlaka prebačeni su na liječenje brinzolamidom 1,0% kao monoterapijom. Intraokularni tlak je mjeren na dan zamjene, te 15 dana, 1 mjesec, 3 mjeseca i 6 mjeseci od zamjene terapije. Nakon 6 mjeseci 19 bolesnika uspješno je završilo ispitivanje. Došlo je do klinički značajnog sniženja intraokularnog tlaka. Razlika tlaka prije (23,8 ± 2,4) i 15 dana (18,2±2,8), 1 mjesec (18,2±2,7), 3 mjeseca (18,5±2,9) i 6 mjeseci (18,8±3,2) od promjene terapije bila je statistički značajna (p

The aim of the study was to point out the role of inheritage of primary open angle glaucoma (POAG) and frequency of POAG among other glaucoma diseases. The study included 52 relatives from 12 families with family history of POAG through 3 generations. The examination consisted of complete ophthalmologic status, automated perimetry and optic nerve photography. A detailed anamnesis and family trees were taken. Individuals were diagnosed with POAG if they fulfilled two or three of the criteria for making a diagnosis: the level of intraocular pressure visual field loss or characteristic disc appearance. Subjects were considered "suspected POAG" if they fulfilled only one of the preceding three criteria. All three parameters had to be normal for an individual to be considered unaffected. Seven relatives (l2%) were diagnosed with POAG; fifteen (29%) relatives were classified as glaucoma suspects. Siblings of POAG patients had the highest risk of POAG developing compared with children or other blood relatives. The study presented results of investigation the frequency of POAG among other glaucoma diseases and 16% patients had a family history of POAG at least in 3 generations. Detailed anamnesis confirms familial appearance of POAG and examination of all available members enables the discovery of new cases (12%)., Cilj istraživanja bio je naglasiti ulogu nasljeđa kod primarnog glaukoma otvorenog kuta te ukazati na njegovu učestalost među drugim glaukomskim oboljenjima. Ukupno je 52 elana iz 12 obitelji kod kojih se primarni glaukom otvorenog kuta pojavljuje kroz najmanje 3 generacije, obuhvaćeno je ispitivanjem. Pored detaljne obiteljske anamneze i izrade obiteljskog stabla, kliničko ispitivanje obuhvaćalo je: sveukupni oftalmološki pregled, automatiziranu perimetriju i fotografiju glave vidnog živca. Ispitanici su utvrđeni kao glaukomski bolesnici ako su ispunjavali 2 ili 3 uvjeta koji čine dijagnozu: visina intraokularnog tlaka, ispadi u vidnom polju te karakterističan izgled glave vidnog živca. Granični slučajevi ispunjavali su samo jedan postavljeni uvjet, a zdravi ispitanici su imali sve parametre u granici normale. Sedam rođaka (12%) dijagnosticirano je kao primarni glaukom otvorenog kuta a 15 (29%) kao granični slučajevi. Braća i sestre pacijenata s primarnim glaukomom otvorenog kuta imaju veći rizik pojave oboljenja u usporedbi s djecom ili ostalim rođacima. Studija pokazuje da je među glaukomskim pacijentima 16% onih s pozitivnom obiteljskom anamnezom za primarni glaukom otvorenog kuta kroz najmanje 3 generacije. Detaljna obiteljska anamneza potvrđuje obiteljsku pojavu primarnog glaukoma otvorenog kuta, a ispitivanje svih dostupnih članova omogućuje otkrivanje novih, dotad neregistriranih slučajeva - l2%.

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 očnog tlaka iznose ? 21 mmHg bez ili s lokalnom terapijom, da ostane sačuvana funkcija vidnog živca, što smo provjeravali nalazom papile n. optici i vidnim poljem. Pregledavani su i filtracijski jastučići, te analizirana vidna oštrina. Od 1990.do 1995.g. na Klinici za očne bolesti KB. Sestre milosrdnice. u Zagrebu operirano je 359 oeiju metodom trabekulektomije. Bili smo u mogućnosti detaljno analizirati samo 186 očiju. Pet godina iza operacije IOT je bez ili s terapijom bio ? 21 mmHg u 90 % očiju, dok je nakon 10 godina IOT bio reguliran jo. uvijek u 75% očiju. Progresiju atrofije papillae n. optici našli smo u 17% slučajeva, a pogoršanje vidnog polja u 18% očiju.Vidna oštrina je smanjena u 62% od toga zbog katarakte u 49% očiju. Iza operacije katarakte vid se popravio u 73%. Veličina ili cistična promjena filtracijskog jastučića nisu presudni za visinu IOT, dok je njegovo zarastanje direktno odgovorno za neuspjeh operacije. Držimo da je trabekulektomija do daljnjega metoda izbora među antiglaukomskim operacijama.

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's 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.