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Aims: To evaluate the 15-year incidence of development and progression of diabetic retinopathy (DR) in type 1 diabetic patients (T1DM) and determine the associated risk factors. Methods: 123 T1DM were included in this prospective cohort study and followed for 15 years. Demographic, clinical, laboratory parameters, and retinal photographs were collected and analyzed. Risk factors for DR development and progression were identified using Cox regression analysis. Results: At baseline, 87 (71%) patients had no DR, and 36 (29%) had nonproliferative DR (NPDR). After 15 years, 54 patients (43.9% ; 29.3/1000 person- years) developed NPDR or progressed to proliferative DR (PDR) ; 24 (27.6%) developed new NPDR, and 30 (83.3%) progressed to PDR. HbA1c (HR = 1.48, p = 0.008) and urinary albumin excretion rate (AER) (HR = 1.58, p = 0.045) were associated with the risk of DR development and progression, and a protective association was found for HDL cholesterol (HR = 0.17, p = 0.021). The presence of DR at baseline (HR = 2.95, p = 0.023) was associated with the risk of its progression to PDR. Conclusions: The 15-year incidence of DR development and progression in T1DM is still very high, which points to the need for close monitoring of T1DM, especially those with higher HbA1c, higher AER, the initial presence of DR, and lower HDL cholesterol.

Patients with diabetes have up to five times higher incidence of cataract, mainly at a younger age, and cataract in these patients progresses more rapidly than senile cataract, especially in eyes affected with sight-threatening diabetic retinopathy (DR). This study aimed to investigate the risk factors associated with cataract development in patients with type 2 diabetes (T2DM). This case-control cross-sectional study included 90 T2DM (56M/34F). Metabolic risk factors glycated hemoglobin (HbA1c), total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were determined using routine laboratory methods. Blood pressure was measured with a mercury sphygmomanometer after a 10-min resting period. Lens opacity was graded according to the Lens Opacity Classification System version III (LOCS III). According to the LOCS III, patients were divided into two groups: group 1—patients with clear crystalline lens, and group 2—patients with initial cataract. Compared to patients with a clear crystalline lens, those with initial cataract had longer diabetes duration (p = 0.002), higher HbA1c (p = 0.037), higher total cholesterol (p = 0.029), higher diastolic blood pressure (DBP) (p = 0.014), and lower creatinine clearance (p = 0.017). Cataract was positively associated with diabetes duration (p = 0.001), HbA1c (p = 0.035), LDL cholesterol (p = 0.042), and DBP (p = 0.009), while negatively with creatinine clearance (p = 0.005). Logistic regression analysis showed that the influence of DBP (AOR = 1.06, p = 0.014) and creatinine clearance (AOR = 2.93, p = 0.045) on cataract development remained significant even after adjustment for diabetes duration and HbA1c. Diabetes duration and various metabolic risk factors, particularly poor glycemic control, hypercholesterolemia, DBP, and diabetic nephropathy's coexistence, are associated with cataract development in T2DM.

Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-age adults associated with devastating personal and socioeconomic consequences. The increasing use of anti-vascular endothelial growth factor (anti-VEGF) agents over the past decade and telemedicine implementation in systematic DR screening resulted in a decliningtrend of new blindness due to diabetes in several countries. Telemedicine is the remote delivery of healthcare services over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose, and treat patients without the need for an in-person visit. Teleophthalmology is a telemedicine branch, mostly focused on diabetic retinopathy and retinopathy of prematurity. Screening for DR in Croatia is commonly performed annually, only by ophthalmologists using dilated slit-lamp biomicroscopic fundus examination. Due to the insufficient number of ophthalmologists and the lack of a formal call system, many diabetic patients do not perform annual screening. In an ideal DR screening model in Croatia, each diabetes center in university or general hospitals throughout Croatia (17 centers) would have one small digital fundus camera and an educated nurse who would perform dilated fundus photography. Electronic images from diabetes centers would be transferred for remote grading to the same hospitals’ ophthalmology departments or a central grading center for DR screening in Croatia. Grading for DR would be performed by an ophthalmologist, medical retina specialist. Patients would be annually invited by mail from the National Diabetes Registry to come to the nearest diabetes center for a fundus photographing and DR screening. Each patient with a positive result would be promptly referred to the medical retina specialist at the closest ophthalmology department for further examination and treatment.

The aim of this study was to investigate risk factors and role of systemic inflammation, dyslipidemia and obesity in development of diabetic retinopathy (DR) in type 1 and type 2 diabetes and determine the differences in risk factors between these two types of diabetes. 84 type 1 and 107 type 2 diabetic patients were included in this cross-sectional study. Diabetes duration, body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. C- reactive protein (CRP), fibrinogen (FIB), glycated hemoglobin (HbA1c), fasting and postprandial blood glucose (fBG, ppBG), HDL and LDL cholesterol and triglycerides (TG) were determined using routine methods. HbA1cmedian was obtained by statistical analysis of the CroDiabNet data and used as a marker of long- term glycemic control. Albumin excretion rate (AER) was measured in a 24-hour urine collection. Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to EURODIAB (EUROpe and DIABetes) protocol and optical coherence tomography. DR was positively related to diabetes duration (p < .001), HbA1cmedian (p < .001) and AER (p=.008) in type 1, and diabetes duration (p < .001), HbA1cmedian (p=.018), AER (p < .001), CRP (p=.048) and TG (p=.041) in type 2 diabetes. Regression analysis showed that diabetes duration (OR 1.20, p=.005) and HbA1cmedian (OR 6.92, p=.007) were the main predictors of DR in type 1, and diabetes duration (OR 1.17, p

This study aimed to assess the role of plasma homocysteine (Hcy) in the development of nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes (T2DM) without chronic kidney disease.This was a cross-sectional study that included 94 T2DM. Hcy, serum 25-hydroxy (25-OH) vitamin D, vitamin B12, and folate were determined by the CMIA method. NPDR was determined according to the EURODIAB retinal photography methodology and optical coherence tomography (OCT) of the macula.Compared to patients without NPDR, patients with NPDR had longer diabetes duration (p 0.001), higher Hcy (p 0.001), lower vitamin B12 (p = 0.028) and lower estimated glomerular filtration rate (eGFR) (p = 0.004). NPDR was positively associated with diabetes duration (p 0.001), HbAHigher Hcy is associated with NPDR and may play a role as a risk factor for its development in T2DM. Vitamins B12 and D seem to modify this association.

Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide.

Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide., Dijabetes je jedan od vodećih svjetskih javnozdravstvenih problema. Dijabetički makularni edem (DME) je glavni uzrok sljepoće u osoba oboljelih od dijabetesa. Idealna metabolička regulacija bolesti je primarni cilj liječenja i osnovni način sprječavanja i zaustavljanja progresije DME-a. Iako je laserska fotokoagulacija u posljednja tri desetljeća smatrana standardnim načinom liječenja DME-a, bolji ishod moguće je postići primjenom nove intravitrealne anti-VEGF ili steroidne terapije. Novi pristup liječenju DME-a ovisi o vidnoj oštrini i smještaju/veličini makularnog zadebljanja utvrđenog optičkom koherentnom tomografijom. Prema Međunarodnoj kliničkoj klasifikaciji DME se dijeli na DME koji ne zahvaća centar makule (ne CI-DME) i DME sa zahvaćenim centrom (CI-DME). Nove smjernice preporučuju intravitrealno liječenje kao prvi izbor liječenja za bolesnike s CI-DME i umjerenim padom vidne oštrine, dok bolesnike s ne CI-DME i blagim padom vidne oštrine treba liječiti modificiranom ETDRS laserskom fotokoagulacijom i pažljivo pratiti. Operativni zahvat vitrektomija izbor je liječenja bolesnika s trakcijski izazvanim DME-om. U današnje vrijeme je sprječavanje sljepoće kao tradicionalni cilj liječenja DME-a zamijenjen novim ciljevima, a to su oporavak oštećene vidne oštrine, sprječavanje daljnjeg slabljenja vida i poboljšanje vidne funkcije pa se danas u tu svrhu provode brojna znanstvena i klinička istraživanja širom svijeta.

The aim of the study was to perform qualitative and quantitative analysis of residency curriculum in ophthalmology. A structured anonymous questionnaire was distributed to 73 medical doctors who were at least on the second year of their residency training in ophthalmology or young ophthalmologists with maximum 4 years of experience. The questionnaire consisted of 52 questions covering every segment of education from the current Protocol for Residency Education of Health Care Professionals in Ophthalmology. Forty-two (58%) doctors answered the questionnaire. Qualitative analysis showed that most of the procedures were mastered by residents. Diagnostic and/or examination procedures were mastered better than surgical and/or interventional procedures. Quantitative analysis showed that the majority of residents failed to reach the prescribed number of surgical procedures. Thirty-three (79%) participants were not satisfied with the current residency curriculum. Although residents mastered most of the prescribed procedures, current residency curriculum is far from being perfect and needs improvements. We think that objective assessment tools for monitoring the progress and competencies of residents during their residency training need to be developed., Cilj rada bio je provesti kvalitativnu i kvantitativnu analizu programa specijalističkog usavršavanja iz oftalmologije metodom anonimne ankete. O anonimnoj anketi obaviještena su ukupno 73 doktora medicine koji su bili najmanje na drugoj godini specijalizacije iz oftalmologije, odnosno oftalmolozi s maksimalno 4 godine specijalističkog staža. Anketa se sastojala od 52 pitanja vezana uza sve dijelove izobrazbe iz aktualnog Pravilnika o specijalističkom usavršavanju zdravstvenih djelatnika iz oftalmologije. Anketu su ispunila 42 (58%) doktora. Kvalitativna analiza pokazala je kako je većina predviđenih zahvata uspješno svladana za vrijeme specijalizacije. Dijagnostički zahvati i/ili razne metode pregleda svladani su bolje nego kirurški i/ili interventni postupci. Prema kvantitativnoj analizi većina specijalizanata nije ispunila predviđeni broj kirurških zahvata. Trideset troje (78%) sudionika nije zadovoljno trenutnim programom specijalističkog usavršavanja. Dakle, premda su specijalizanti ovladali većinom predviđenih zahvata, sadašnji program specijalističkog usavršavanja daleko je od savršenog i potrebna su poboljšanja. Smatramo da je potrebno razviti kvalitetne metode za objektivnu procjenu napretka i kompetentnosti specijalizanata za vrijeme specijalizacije.

The aim of the study was to show the effect of combined photodynamic therapy and intravitreal injection of triamcinolone acetonide in the treatment of choroidal neovascularization due to age-related macular degeneration. This retrospective, nonrandomized study included 20 patients with predominantly classic choroidal neovascularization due to age-related macular degeneration with no prior treatment. At baseline, all patients underwent ophthalmologic examination. Fluorescein angiography and optical coherent tomography were performed and analyzed. Triamcinolone acetonide, 4 mg, was intravitreally applied at 24-48 hours after standard photodynamic therapy. Follow up was scheduled at 3, 6 and 9 months. After 9 months, visual acuity improved in four, remained unchanged in 14 and decreased in two patients. In all patients, complete closure of choroidal neovascularization occurred after 9 months. At that time, a decrease in the central foveal thickness was also recorded in all patients. Combined photodynamic therapy and intravitreal injection of triamcinolone acetonide is a safe method in the treatment of choroidal neovascularization due to age-related macular degeneration, and leads to complete closure of choroidal neovascularization. To prove these promising results, a carefully designed, randomized, controlled study in a larger group of patients is needed., Prikazuju se rezultati kombinirane intravitrealne primjene triamcinolona i fotodinamske terapije kod razvoja koroidnih neovaskularizacija koje su nastale kao posljedica senilne makularne degeneracije. U retrospektivnu nerandomiziranu studiju bilo je uključeno 20 bolesnika s pretežito klasičnom koroidnom neovaskularizacijom, koji do tada nisu bili liječeni. Kod svih bolesnika učinjen je standardni oftalmološki pregled, fluoresceinska angiografija i optička koherentna tomografija. Triamcinolon acetonid, 4 mg, apliciran je intravitrealno 24-48 sati nakon fotodinamske terapije. Praćenje bolesnika je provedeno nakon 3, 6 i 9 mjeseci. Nakon 9 mjeseci kod 4 bolesnika došlo je do poboljšanja vidne oštrine, kod 14 bolesnika vidna oštrina je ostalna stabilna, dok je kod 2 bolesnika zabilježen pad vidne oštrine. Potpun nestanak koroidne neovaskularizacije kod svih je bolesnika zabilježen nakon 9 mjeseci. Kombinirana primjena triamcinolona i fotodinamske terapije sigurna je metoda u liječenju pretežito klasičnih koroidnih neovaskularizacija, koja dovodi do njihovog potpunog zatvaranja i nestajanja, no za potvrdu ovih rezultata potrebna je randomizirana analiza na većem broju bolesnika.

To show the results of photodynamic therapy according to the size of choroidal neovascular membrane size.A retrospective analysis included 94 patients undergoing photodynamic therapy at University Department of Ophthalmology, Sestre MilosrdniceUniversity Hospital from 2001 till 2005. There were 61 patients with age related macular degeneration (AMD) and 33 patients with high myopia. All patients had a predominantly classic choroidal neovascular membrane. Patients were divided into two subgroups according to the lesion size. The first subgroup included patients with a lesion equal to or less than one disc diameter, and the second subgroup had a lesion greater than one disc diameter. All patients were followed up for a minimum of 3 months.In the group of patients with AMD statistical analysis showed no significant difference in total closure and decrease in the size of choroid neovascularization (CNV) between the two subgroups. In the group of patients with high myopia a statistically significant difference was found in total closure and decrease in the size of CNV between patients with lesions smaller or equal to one disc diameter and those with lesions greater than one disc diameter. The former group also had better visual outcome.The size of CNV was not a prognostic factor in patients with AMD. In patients with high myopia, better outcome was recorded in the subgroup with CNV smaller or equal to one disc diameter.