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The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma medications) and changes in visual acuity. Complications were recorded. After AGV implantation, IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively high complication rate limiting the overall success rate.

Facilitacija uspravljanja iz ležećeg položaja u sjedenje i stajanje važna je od rane faze rehabilitacije. Rano uspravljanje potiće regulaciju normalnijeg mišićnog tonusa i uspostavu motoričke kontrole nad držanjem i pokretanjem tijela.

The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma medications) and changes in visual acuity. Complications were recorded. After AGV implantation, IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively high complication rate limiting the overall success rate., Svrha rada je prikazati sigurnost i učinkovitost implantacije Ahmedove glaukomske valvule (AGV, New World Medical, Inc., Rancho Cucamonga, CA, SAD) kod refraktornog glaukoma dječje dobi tijekom jednogodišnjeg praćenja. Proveden je retrospektivni pregled nalaza 10 očiju u djece mlađe od 11 godina u kojih je ugrađena AGV zbog medikamentima nekontroliranog glaukoma u razdoblju od 2010. do 2014. godine. Pratila se visina intraokularnog tlaka (IOT) i vidna oštrina, a također su bilježene komplikacije. Rezultati su pokazali da su nakon implantacije AGV vrijednosti IOT-a bile od 18 mm Hg do 23 mm Hg (osim kod jednog oka s poslijeoperacijskom hipotonijom zbog suprakoroidnog krvarenja, gdje je poslijeoperacijski IOT bio 4 mm Hg). Broj antiglaukomskih lijekova bio je smanjen: četvoro bolesnika su imali po dva lijeka, jedan je imao jedan lijek, a svi ostali nisu trebali dodatne lijekove na posljednjem pregledu. Kod jednog oka se pojavilo suprakoroidno krvarenje, kod jednog dugotrajna upalna membrana, a kod dva oka kontakt cjevčice s rožnicom. Zaključuje se da implantacija AGV predstavlja izbor u liječenju refraktornog glaukoma dječje dobi i ima uspjeha u kontroli IOT-a. Međutim, relativno velik broj komplikacija ograničava konačan uspjeh.

Limbal stem cell transplantation (LSCT) and amniotic membrane transplantation may improve corneal recovery after a chemical burn. Amniotic membrane was applied as a patch in 5 eyes; LSCT from healthy contralateral eye was performed in 6 eyes, and a combination of these techniques was performed in 4 eyes. There were no complications during surgical procedure. Epithelization was completed after 2 weeks in patients with LSCT, and after 3 weeks in the amniotic membrane transplantation group. Visual acuity improved in all patients. No complication was observed on either the donor or the recipient eye during a follow-up period of >13 months in all groups. Amniotic membrane is effective in promoting re-epithelization and reducing inflammation when applied alone in patients with 3- to 6-hour limbal involvement, as well as combined with LSCT in patients with >6-hour limbal ischemia. LSCT is an effective procedure for rehabilitation after severe chemical trauma of the eye with more than 50% limbal involvement.

Eine 53-jahriger Patientin wurde zur diagnostischen Abklarung und weiteren Behandlung eines Neovaskularisationsglaukoms des rechten Auges uberwiesen. Wir berichten uber den Fall eines kutanen Melanoms mit Metastasierung in den Glaskorperraum und die vordere Augenkammer, was sich klinisch als ein Neovaskularisationsglaukom manifestierte.

We investigated colour vision impairment in 45 male workers occupationally exposedto toluene (mean value of toluene concentration in ambient air = 119.96 ppm) andin 53 controls. Colour vision was evaluated by Lanthony-D-15 desaturated test andexpressed as Age and Alcohol Intake Adjusted Colour Confusion Score (AACDS) ortypes of dyschromatopsia. Exposure was evaluated by measurement of tolueneconcentration in ambient air and blood, and hippuric acid and orthocresoldetermined in urine after the workshift. A statistically significant higher AACDS valuewas established in the exposed subjects compared to the controls (p < 0.0001).There was no significant difference between AACDS values on Wednesday morningcompared to Monday morning. In the exposed group AACDS significantly correlatedwith the concentration of toluene in ambient air, concentration of toluene in bloodand the concentration of hippuric acid in urine after the workshift (all p < 0.0001).Dyschromatopsias were detected in both groups, although no significant differencebetween groups was established. In the -exposed group, concentration of toluene inambient air, alcohol intake and age explained 35.1%, concentration of toluene inblood, age and alcohol intake explained 19.9%, and concentration of hippuric acidin urine and age explained 19.2% of the variation in type III dyschromatopsia.Concentration of toluene in ambient air and age explained 28.3% of the variation intotal dyschromatopsia, and concentration of hippuric acid and age explained 13.8%.In the control group, age and alcohol intake explained 19.6% of the variation in typeIII dyschromatopsia. In exposed workers a significant difference was found in theAACDS value compared to controls. However, no significant difference was found inthe prevalence of colour vision loss in the yellow-blue and/or red-green axis. Basedon the results of this study the authors conclude that the effect of toluene on colourvision can be chronic and that the possible reparation period in colour visionimpairment is longer than 64 hours.Key words: Colour vision; Lanthony-D-15 test; neurotoxicity; solvents; toluene exposure.

Astigmatism represents an inability of the cornea and lens to provide a sharp image onto the retina. Correcting astigmatic errors, whether congenital, contact lens induced or surgically induced, is now an integral part of modern cataract and refractive procedures. Development of modern technology has enabled accurate diagnosis and perfect opportunities for correction; however, while cataract and keratorefractive surgery have come a long way in the last decade, the treatment and diagnosis of astigmatism continue to challenge ophthalmologists. There are several diagnostic procedures and tools available today, some standard and some contemporary that include keratometry, corneal topography, apparatus using wavefront or Scheimpflug analysis like Orbscan, Pentacam, Wavescan, etc. With the introduction of several new diagnostic tools, measurements of astigmatism have become less of an issue, but in some cases it is still difficult to obtain consistent results. What remains still unanswered is the question of the best diagnostic tool on the market. Further research is needed to evaluate both tools as well as their clinical application for optimal use.

Limbal relaxing incisions are one of the more commonly performed procedures with phacoemulsification to correct preexisting astigmatism during cataract surgery. The aim of the study was to evaluate the effect and stability of limbal relaxing incisions in reducing preexisting astigmatism at the time of phacoemulsification. The study included 10 eyes in 12 patients who underwent limbal relaxing incisions during cataract surgery, with preexisting astigmatism of 1-2 diopter (D). Assessments were made preoperatively, and 1 and 3 months postoperatively. Outcome measures included uncorrected distance visual acuity, best corrected distance visual acuity and keratometric astigmatism measures. The mean preoperative and postoperative refractive astigmatism was 1.50 D (+/- 0.75D) and 0.25 D (+/- 0.25 D), respectively. There were no serious postoperative complications. Limbal relaxing incisions provide a viable option for correcting preexisting astigmatism at the time of cataract surgery with mild complications.

The aim of this study was to compare two different refractive surgery approaches in correction of myopia with or without astigmatism. In patients where one eye underwent sub-Bowman keratomileusis (SBK) and the other eye photorefractive keratectomy (PRK), the objective and subjective results were retrospectively compared during the six-month follow-up. Eighty four patients (168 eyes) were involved in this retrospective contralateral study. The mean preoperative spherical refraction was -3.88 diopters (D) and the mean cylinder was -0.82 D for all eyes. Each patient underwent SBK on one eye and PRK on the contralateral eye. The eyes in the PRK group underwent mechanical epithelial removal, which was followed by laser treatment. Mitomycin C 0.02% was used for 15 seconds if ablation was deeper than 50 microns. In the SBK group, the intended 100-microm corneal flap was created with IntraLase femtosecond laser. All eyes underwent customized wavefront guided laser ablation using a VISX Star S4 IR excimer laser. Preoperative and postoperative outcome measures included best spectacle-corrected visual acuity, uncorrected visual acuity, corneal topography, contrast visual acuity, and anterior optical coherence tomography imaging. Patients were asked to complete subjective satisfaction questionnaires at each visit. Through the first 3 months of follow up, the SBK eyes demonstrated clinically and statistically better visual results than PRK eyes, between 3 and 6 months the results in the two groups began to equalize, and after 6 months of follow up there were no clinical and statistical differences between the SBK and PRK groups. SBK seems to be more practical for the patient with less pain, faster visual recovery, fewer medications, and overall superior experience.

The aim of this study was to evaluate clinical outcomes after toric intraocular lens implantation for astigmatism correction in patients undergoing cataract surgery. This prospective observational study included eyes undergoing cataract surgery at Sestre milosrdnice University Hospital Center between February and September 2011. The study enrolled eyes that had visually significant cataract and preexisting regular corneal astigmatism of 1.50 D or greater. Phacoemulsification was performed and all eyes received an AT TORBI 709 M toric foldable intraocular lens. At 3 months, the uncorrected distance visual acuity was 0.8 or better in 9 of 10 eyes. At 3 months postoperatively, the median reduction in refractive cylinder was statistically significant (P0.05). The median intraocular lens axis rotation was 3.0 degrees interquartile range (2.0-4.0 degrees). Our results showed AT TORBI 709 IOL to be an effective surgical option to correct preexisting corneal astigmatism and spectacle dependence after cataract surgery.

The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.

The aim of this study was to evaluate clinical outcomes after toric intraocular lens implantation for astigmatism correction in patients undergoing cataract surgery. This prospective observational study included eyes undergoing cataract surgery at Sestre milosrdnice University Hospital Center between February and September 2011. The study enrolled eyes that had visually significant cataract and preexisting regular corneal astigmatism of 1.50 D or greater. Phacoemulsification was performed and all eyes received an AT TORBITM 709 M toric foldable intraocular lens. At 3 months, the uncorrected distance visual acuity was 0.8 or better in 9 of 10 eyes. At 3 months postoperatively, the median reduction in refractive cylinder was statistically significant (P, Cilj rada bila je analiza poslijeoperacijskih rezultata nakon operacije katarakte kod bolesnika s prijeoperacijskim astigmatizmom i implantiranom toričnom intraokularnom lećom. Ova studija provedena je u KBC Sestre milosrdnice, a bolesnici su operirani u razdoblju od veljače do studenoga 2011. godine. Svi bolesnici uključeni u studiju imali su vizualno značajnu kataraktu i prijeoperacijski rožnični astigmatizam veći od 1,5 D. Nakon operacije katarakte učinjene metodom fakoemulzifikacije kod svih bolesnika ugrađena je savitljiva intraokularna leća AT TORBI. Tri mjeseca nakon operacijskog zahvata nekorigirana poslijeoperacijska vidna oštrina bila je 0,8 ili bolja kod 9 očiju. Smanjenje cilindrične vrijednosti (medijan) 3 mjeseca nakon operacijskog zahvata bilo je statistički značajno (P

The aim of this study was to compare two different refractive surgery approaches in correction of myopia with or without astigmatism. In patients where one eye underwent sub- Bowman keratomileusis (SBK) and the other eye photorefractive keratectomy (PRK), the objective and subjective results were retrospectively compared during the six-month follow-up. Eighty four patients (168 eyes) were involved in this retrospective contralateral study. The mean preoperative spherical refraction was -3.88 diopters (D) and the mean cylinder was -0.82 D for all eyes. Each patient underwent SBK on one eye and PRK on the contralateral eye. The eyes in the PRK group underwent mechanical epithelial removal, which was followed by laser treatment. Mitomycin C 0.02% was used for 15 seconds if ablation was deeper than 50 microns. In the SBK group, the intended 100-μm corneal flap was created with IntraLase femtosecond laser. All eyes underwent customized wavefront guided laser ablation using a VI SX Star S4 IR excimer laser. Preoperative and postoperative outcome measures included best spectacle-corrected visual acuity, uncorrected visual acuity, corneal topography, contrast visual acuity, and anterior optical coherence tomography imaging. Patients were asked to complete subjective satisfaction questionnaires at each visit. Through the first 3 months of follow up, the SBK eyes demonstrated clinically and statistically better visual results than PRK eyes, between 3 and 6 months the results in the two groups began to equalize, and after 6 months of follow up there were no clinical and statistical differences between the SBK and PRK groups. SBK seems to be more practical for the patient with less pain, faster visual recovery, fewer medications, and overall superior experience., Cilj ove studije bio je tijekom šestomjesečnog praćenja bolesnika usporediti subjektivne i objektivne rezultate korekcije miopije s astigmatizmom očiju ili bez njega podvrgnutih dvama različitim zahvatima: refrakcijskoj kirurgiji ultratankog poklopca (sub-Bowman keratomileusis, SBK) ili fotorefraktivnoj keratektomiji (photorefractive keratectomy, PRK). Osamdeset četiri bolesnika (168 očiju) su bila uključena u ovu retrospektivnu studiju. Prosječna kratkovidnost bila je -3,88 sfernih dioptrija s prosječnim astigmatizmom od -0,82 cilindrične dioptrije. U svakog bolesnika je primijenjen SBK na jednom oku i PRK na drugom oku. Rožnični epitel je mehanički uklonjen na očima iz skupine PRK, nakon čega je učinjen laserski zahvat. Zatim je apliciran mitomicin C 0,02% (vrijeme ekspozicije 15 sekunda) ako je ablacija bila dublja od 50 mikrona. Kod očiju iz skupine SBK formiran je ultratanki poklopac od 100 mikrona pomoću IntraLase femtosekundnog lasera. Laserska korekcija je u oba slučaja izvršena metodom wavefront CustomVue laserom VI SX Star S4. Prijeoperacijska i poslijeoperacijska izlazna mjerenja uključivala su određivanje vidne oštrine (nekorigirane i najbolje korigirane), rožničnu topografiju, aberometriju, test kontrastne osjetljivosti i optičku koherentnu tomografiju prednjega očnog segmenta. Bolesnici su na svakom kontrolnom pregledu ispunjavali upitnik o subjektivnoj procjeni rezultata. Klinički i statistički su značajno bolji rezultati bili u skupini očiju operiranih metodom SBK i to poslijeoperacijski do trećeg mjeseca. Od trećeg do šestog mjeseca su se rezultati počeli izjednačavati te nakon 6 mjeseci praćenja više nije bilo statistički i klinički značajnih razlika između dviju skupina očiju. Metoda SBK je objektivno i subjektivno bolja metoda u odnosu na PRK, te bolesniku omogućuje brži oporavak uz manje nuspojava.

Astigmatism represents an inability of the cornea and lens to provide a sharp image onto the retina. Correcting astigmatic errors, whether congenital, contact lens induced or surgically induced, is now an integral part of modern cataract and refractive procedures. Development of modern technology has enabled accurate diagnosis and perfect opportunities for correction; however, while cataract and keratorefractive surgery have come a long way in the last decade, the treatment and diagnosis of astigmatism continue to challenge ophthalmologists. There are several diagnostic procedures and tools available today, some standard and some contemporary that include keratometry, corneal topography, apparatus using wavefront or Scheimpflug analysis like Orbscan, Pentacam, Wavescan, etc. With the introduction of several new diagnostic tools, measurements of astigmatism have become less of an issue, but in some cases it is still difficult to obtain consistent results. What remains still unanswered is the question of the best diagnostic tool on the market. Further research is needed to evaluate both tools as well as their clinical application for optimal use., Astigmatizam predstavlja svojevrsnu nemogućnost rožnice i leće da stvore jasnu i oštru sliku na mrežnici. Korekcija astigmatizma dio je moderne refraktivne i kirurgije katarakte, bilo da se radi o kongenitalnom, uzrokovanom kontaktnim lećama ili kirurški uzrokovanom astigmatizmu. Razvoj moderne tehnologije omogućio je lakše otkrivanje i postavljanje dijagnoze, no unatoč velikom napretku kirurgije terapija i dijagnostika astigmatizma i dalje predstavlja velik izazov. Nekoliko je dijagnostičkih postupaka odnosno uređaja danas dostupno, pa se tako razlikuje keratometrija, kornealna topografija, uređaji za wavefront i Scheimpflug analizu kao Orbscan, Pentacam, Wavescan itd. S uvođenjem novih uređaja mjerenje i dijagnostika astigmatizma je pojednostavljena, no i dalje postoje slučajevi s nezadovoljavajućim rezultatima. Nerazjašnjeno ostaje i dalje pitanje univerzalnog dijagnostičkog postupka i uređaja, pa stoga valja naglasiti i potrebu budućih studija, odnosno daljnjih istraživanja glede evaluacije uređaja i njihove optimalne kliničke primjene.

Limbal relaxing incisions are one of the more commonly performed procedures with phacoemulsification to correct preexisting astigmatism during cataract surgery. The aim of the study was to evaluate the effect and stability of limbal relaxing incisions in reducing preexisting astigmatism at the time of phacoemulsification. The study included 10 eyes in 12 patients who underwent limbal relaxing incisions during cataract surgery, with preexisting astigmatism of 1-2 diopter (D). Assessments were made preoperatively, and 1 and 3 months postoperatively. Outcome measures included uncorrected distance visual acuity, best corrected distance visual acuity and keratometric astigmatism measures. The mean preoperative and postoperative refractive astigmatism was 1.50 D (±0.75D) and 0.25 D (±0.25 D), respectively. There were no serious postoperative complications. Limbal relaxing incisions provide a viable option for correcting preexisting astigmatism at the time of cataract surgery with mild complications., Limbalna relaksirajuća incizija je jedna od čestih metoda koja se primjenjuje za korekciju astigmatizma za vrijeme operacije katarakte metodom fakoemulzifikacije. Svrha ovoga rada bila je analizirati učinak i stabilnost limbalne relaksirajuće incizije u smanjenju prijeoperacijskog astigmatizma. Analiza je obuhvatila deset očiju u dvanaest bolesnika kod kojih je učinjena limbalna relaksirajuća incizija za vrijeme operacije katarakte s prijeoperacijskim astigmatizmom od 1-2 dioptrije (D). Analizirani su prije operacije te l-2 mjeseca poslijeoperacijski uključujući nekorigiranu i najbolje korigiranu vidnu oštrinu na daljinu te keratometrijske vrijednosti. Srednji prijeoperacijski i poslijeoperacijski astigmatizam bio je 1,50 D (±0,75) odnosno 0,25 D (±0,25). Ozbiljne poslijeoperacijske komplikacije nisu nađene. Limbalna relaksirajuća incizija omogućuje održiv izbor za korekciju prijeoperacijskog astigmatizma za vrijeme operacije katarakte s blagim komplikacijama.

The aim of this study was to evaluate macular thickness parameters in glaucoma patients and to compare them to normal subjects using Optical Coherence Tomography (OCT). This prospective, observational study included 20 primary open angle glaucoma patients (POAG) and 20 healthy subjects in control group. Exclusion criteria were diabetes and other macular pathology, like age-related macular degeneration, macular oedema, central serous retinopathy and high myopia >4.00 dsph. OCT imaging of peripapillar retina and macular area were performed using Cirrus HD OCT. In these two groups of patients we analyzed changes of macular thickness parameters (central subfield thickness, macular volume, and average macular thickness). The group of glaucoma patients had decreased values of the two macular thickness parameters: macular volume and average macular thickness, compared to control group. There was no difference in central macular thickness, presumably because of the absence of the ganglion cells in this layer. Macular imaging can be a useful additional method to determine glaucoma status and has a potential for tracking glaucoma progression.

PURPOSE: To assess the safety and efficacy of changing antiglaucoma therapy to the travoprost 0.004%/timolol 0.5% (TTFC) fixed combination from previous monotherapies. METHODS: Prospective, open-label, observational, multicenter cohort. A change was done from prior monotherapy at day 0 to TTFC dosed once a day, regardless in the evening or in the morning, without washout period. Active evaluation of systemic and local tolerability (adverse events), and efficacy. i.e., intraocular pressure (IOP) lowering was done at control 1 (day 30), control 2 (day 90) and control 3 (day 120). RESULTS: 40/155/170 patients (79/309/339 eyes) completed the study (120 days/ 90 days/baseline, respectfully). At control 1 excluded were patients with low tolerability (severe hyperemia (6 patients), discomfort (4), chest pain (1)) and non responders (IOP lowering less than 15% from baseline IOP or target IOP >18 mmHg (4 patients)). Mean IOP at control 1 was 15.92 +/- 1.85 mm Hg (21.66% reduction) for 155 patients (non responders excluded), at control 2 was for 155 patients 15.67 +/- 2.17 mm Hg (21.14% reduction), and at control 3 for 40 patients 16.28 +/- 1.59 mm Hg (19.86% reduction). At control 2 analysis of IOP reduction by 4 groups of previous monotherapy (timolol 0, 5% (N = 33/66), latanoprost 0.005% (N = 49/98), betaxolol 0.5% (N = 30/60), and travoprost 0.004% (N = 43/85) was performed. 40 patients/79 eyes endured to control 3 (after day 90 free samples were not available for all patients). Analysis of IOP reduction by 4 groups of previous monotherapy medications was performed (timolol 0.5% (N = 7/14), latanoprost 0.005% (N = 14/28), betaxolol 0.5% (N = 7/14), travoprost 0.004% (N = 12/23)). CONCLUSIONS: Changing patients from prior monotherapy to TTFC can provide on average a further reduction in IOP, while demonstrating a favorable safety profile.

Purpose: To assess the safety and efficacy of changing antiglaucoma therapy to the travoprost 0,004%/timolol 0,5% (TTF C) fixed combination from previous monotherapies. Methods: Prospective, open-label, observational, multicenter cohort. A change was done from prior monotherapy at day 0 to TTF C dosed once a day, regardless in the evening or in the morning, without washout period. Active evaluation of systemic and local tolerability (adverse events), and efficacy ie. intraocular pressure (IOP) lowering was done at control 1 (day 30), control 2 (day 90) and control 3 (day 120). Results: 40/155/170 patients (79/309/339 eyes) completed the study (120 days/ 90 days/baseline, respectfully). At control 1 excluded were patients with low tolerability (severe hyperemia (6 patients), discomfort (4), chest pain (1)) and non responders (IOP lowering less than 15% from baseline IOP or target IOP >18 mmHg (4 patients)). Mean IOP at control 1 was 15,92±1,85 mm Hg (21,66% reduction) for 155 patients (non responders excluded), at control 2 was for 155 patients 15,67±2,17 mm Hg (21,14% reduction), and at control 3 for 40 patients 16,28±1,59 mm Hg (19,86% reduction). At control 2 analysis of IOP reduction by 4 groups of previous monotherapy (timolol 0,5% (N=33/66), latanoprost 0,005% (N=49/98), betaxolol 0,5% (N=30/60), and travoprost 0,004% (N=43/85) was performed. 40 patients/79 eyes endured to control 3 (after day 90 free samples were not available for all patients). Analysis of IOP reduction by 4 groups of previous monotherapy medications was performed (timolol 0,5%(N=7/14), latanoprost 0,005% (N=14/28), betaxolol 0,5% (N=7/14), travoprost 0,004% (N=12/23)). Conclusions: Changing patients from prior monotherapy to TTF C can provide on average a further reduction in IOP, while demonstrating a favorable safety profile., CILJ: Zabilježiti sigurnost i učinkovitost promjene antiglaukomske terapije u travoprost 0,004%/timolol 0,5% (TTF C) fiksnu kombinaciju s prethodnih monoterapija. METODE: Prospektivna, otvorena, opservacijska, multicentrična populacija. Promjena s prethodne monoterapije na dan 0 u TTF C, doziran jednom dnevno, ili ujutro ili navečer, bez perioda ispiranja. Aktivno je ocijenjena sistemska i lokalna podnošljivost (popratne pojave), i učinkovitost tj.sniženje intraokularnog tlaka (IOT) na prvoj kontroli (dan 30), drugoj kontroli (dan 90) i trećoj kontroli (dan 120). REZULTATI: 40/155/170 bolesnika (79/309/339 očiju) završilo je studiju (120 dana/ 90 dana/početak). Na prvoj kontroli isključeni su svi bolesnici koji su slabo podnosili lijek: ozbiljna hiperemija (6 bolesnika), neugoda (4), bol u prsištu (1) i ne- responderi tj. sniženje IOT-a manje od 15% od početnog IOT ili ciljnog IOT >18 mmHg (4 bolesnika). Prosječni IOT na prvoj kontroli je bio 15,92±1,85 mm Hg (21,66% sniženja) kod 155 bolesnika (isključeni ne-responderi), na drugoj kontroli je kod 155 bolesnika bio 15,67±2,17 mm Hg (21,14% sniženja), i na trećoj kontroli kod 40 bolesnika 16,28±1,59 mm Hg (19,86% sniženja). Na drugoj kontroli je učinjena analiza sniženja IOT-a u 4 grupe prethodno korištene monoterapije: timolol 0,5% (N=33/66), latanoprost 0,005% (N=49/98), betaxolol 0,5% (N=30/60), i travoprost 0,004% (N=43/85). 40 bolesnika/79 očiju praćeno je do treće kontrole. Učinjena je analiza sniženja IOT-a u 4 grupe prethodno korištene monoterapije: timolol 0,5% (N=7/14), latanoprost 0,005% (N=14/28), betaxolol 0,5% (N=7/14), travoprost 0,004% (N=12/23). Zaključak: Promjena terapije s prethodne monoterapije u TTF C može u prosjeku omogućiti dodatno sniženje IOT-a, uz zadovoljavajući profil sigurnosti.

The new generation multifocal lenses provide the surgeon with several options to meet the specific visual needs and desires of patients. A revolution in presbyopia surgery is being driven by two multifocal intraocular lenses, ReStor and ReZoom. Combined implantation of the ReZoom multifocal lens in nondominant eye and ReStor multifocal lens in dominant eye has been demonstrated to produce statistically and clinically superior results in bilateral uncorrected intermediate vision improving vision effectiveness in presbyopia patients after cataract surgery. Also, the mix and match approach can maximize patient vision at both near and far distance, thus improving the patient quality of life.

The aim of the study was to assess short-term efficacy of intravitreal bevacizumab in a series of patients with neovascular glaucoma. Eleven patients with neovascular glaucoma and symptomatic elevation of intraocular pressure were treated with 1.25 mg/0.1 mL of bevacizumab. In three patients, intravitreal bevacizumab was administered preoperatively, one day before pars plana vitrectomy. Additional therapy was only performed if topical medication failed to result in satisfactory control of intraocular pressure. Patients were followed-up for a minimum of 8 weeks. In all study patients, intravitreal application of bevacizumab resulted in marked regression of iris neovascularization within the first three postoperative days. Appropriate control of intraocular pressure was achieved in seven patients, whereas four patients required additional therapy for intraocular pressure regulation. No side effects of intravitreal bevacizumab were recorded. Thus, intravitreal bevacizumab seems to be a potent adjunct in the management of neovascular glaucoma. Additional studies of bevacizumab long-term safety and efficacy are warranted.

A rare case is presented of iridogoniodysgenesis syndrome, an autosomal dominant inheritance disorder that includes abnormalities in the differentiation of the anterior segment structures and increased values of intraocular pressure, which at long run increases the risk of glaucomatous optic neuropathy. The syndrome is diagnosed when ocular changes are accompanied by extraocular structure anomalies such as maxillary hypoplasia, micro- and anodontia, redundant periumbilical skin, inguinal hernia and hypospadias (males). A 44-year-old male patient presented for treatment of retinal detachment on his left eye. Cataract surgery and pars plana vitrectomy with endolaser were done. Due to his vision loss, high intraocular pressure values bilaterally and positive family history of glaucoma, he was rehospitalized for complete glaucomatous diagnostic evaluation. The rare iridogoniodysgenesis syndrome and associated juvenile glaucoma were verified in the patient by positive family history of glaucoma, slit lamp iris hypoplasia and mild pupillary deformities, gonioscopic results of open angle with iridotrabecular synechiae and neovascularizations at the iris root and ciliary body, fundus examination showing optic disk changes with a cup to disk ratio of 0.9 and 0.8 for the right and left eye, respectively, visual field dG2 program abnormalities such as absolute scotomata within 30 degrees on both eyes, and finally optical coherent tomography results of the cup to disk area ratio of 0.9 and 0.8 for the right and left eye, respectively, with average thickness of the retinal nerve fiber layer of 51 mm and 72 mm for the right and left eye, respectively. Disease control was achieved with medicamentous therapy; however, continuous follow up of the patient is a priority to prevent the potential glaucomatous damage.

To study the efficacy and safety of subcutaneous botulinum toxin A injections in the treatment of primary and recurrent chalazia. Prospective, placebo-controlled consecutive case-series trial. Sixty three patients were divided into two groups: group 1 consisting of 32 patients previously diagnosed with and treated for primary or recurrent chalazia with 2–5 international units (IU) in 0.2–0.5 ml of preserved saline solution of botulinum toxin injection, and group 2 consisting of 31 patients receiving placebo. The main outcome measures were localization and duration of the disease, size of chalazion before and after treatment, clinical resolution of chalazion, time to resolution, and complications of treatment. There was a clinically and statistically significant between-group difference in the rate of therapeutic success and post-therapeutic chalazion regression, but not in the rate of complications. Botulinum toxin A injection is effective and safe treatment for primary and recurrent chalazia. Lesion regression that did not respond to the average of two injections would benefit more from surgical excision or systemic antibiotic therapy.

Aims: The aim of the study was to compare the accuracy of A-scan biometry and MRI for the measurement of axial length in silicone oil-filled eyes. Methods: This was a prospective randomised study of 70 patients. Biometry was performed using MRI in 33 patients (MRI group) and A-scan echography in 37 patients (A-scan group). The difference between predicted and final refraction was measured and evaluated statistically. Results: In patients with axial length ⩾26 mm, the mean deviation of the final from predicted refraction was −1.23 (SD 0.67) D in the MRI group and −2.3 (SD 2.02) D in the A- scan group. The difference between these two groups was statistically significant (p = 0.02). In patients with axial length

Syphilis, a disease which used to be terminal up to the 1950s, has become curable with the discovery of penicillin. In the last few years, an increase in its incidence has been recorded in the world as well as in Croatia, primarily with the human immunodeficiency virus (HIV) co-infection. We present a 40-year-old male patient who complained of a sudden decrease of visual acuity on both eyes, accompanied by dizziness. Clinical examination revealed low visual acuity and blurred edges of the optical nerve head without prominence. Pulse corticosteroid therapy failed to produce any recovery of visual acuity. Additional tests were done including Treponemapallidum hemagglutination assay (TPHA), which confirmed the infection with Treponema pallidum. The patient was administered Extencillin therapy. As a reaction to therapy administered, the patient's visual acuity gradually fully recovered. In the medical literature available, there is no report of optical neuritis as the first and only manifestation of HIV and syphilis coinfection.

Ophthalmologic causes of headache represent a very complex and extensive problem, and very often differential diagnostic problem too. Many various reasons of headache can be caused by ophthalmologic diseases like those of anterior and posterior eye segments, acute and subacute angle closed glaucoma and orbital diseases. Headache can be caused by no or poor correction of the refraction anomalies. Ophthalmologic causes of headache are quite frequently connected with conditions that affect other body systems apart from the eyes, nervous and/or vascular system in particular. Although ophthalmologic examination very provides the clue in patients with headache, the diagnostic and therapeutic approach to the problem has to be interdisciplinary.

Since its foundation in 1992, the Croatian Medical Journal (CMJ) has followed the strict standards of quality in the scientific publishing. However, the Journal has been aware that its specific position demands more than just following the already established rules. From the very beginning, the Journal declared an “author-helpful policy,” stating that “journal editors should have a major role in training authors in science communication, especially in smaller and developing scientific communities. Journal authors usually send scientifically acceptable but poorly prepared articles and it is a pity to lose valid data because of their poor presentation.” (1,2). In brief, the editors and editorial staff of the CMJ have been well aware that the skills of scientific reporting and publishing in our academic community are not developed and that valuable research results and valid data are being lost because of poor presentation. To be perfectly honest, ten years ago this statement looked like a nice promise, one of the many we in academic medicine learnt not to take too seriously.

Cilj rada je prikazati učinkovitost transplantacije limbalnih stanica (LSCT) kao načina liječenja recidivirajućih pterigija. Ukupno je 18 očiju s recidivirajućim pterigijem operirano tehnikom LSCT; 12 bolesnika je primarno bilo operirano tehnikom "bare sclera", 3 rotacijom konjunktive i 3 transplantacijom amnijske membrane. Nije bilo značajnijih intraoperacijskih komplikacija osim reverzibilnog edema konjunktivnog grafta kod 2 bolesnika, Tenonovog granuloma kod jednog bolesnika te hematoma također kod jednog bolesnika. Kod 16 bolesnika nije bilo recidiva pterigija tijekom vremena praćenja, dok se kod 2 bolesnika recidiv javio unutar 18 mjeseci. Zaključak rada je da je LSCT uspješna i sigurna metoda u liječenju recidivirajućih pterigija, iako je tehnički i vremenski dosta zahtjevna., The aim of the study was to assess the efficacy of limbal stem cell transplantation (LSCT) as a treatment for recurrent pterygium. Eighteen eyes with recurrent pterygium underwent LSCT. Twelve eyes had been previously operated by the "bare-sclera" technique, 3 by conjunctival rotation and 3 by amnion membrane transplantation. No serious intraoperative complications occurred, except for reversible conjunctival graft edema in 2 eyes, Tenon's granuloma in one case, and hematoma under the graft in one case. In 16 eyes no pterygium recurrence was recorded during the follow up period. Two recurrences were recorded during 18 months after surgery. It is concluded that LSCT is a successful and safe yet time-consuming and technically demanding method in the management of recurrent pterygium.

A rare case is presented of iridogoniodysgenesis syndrome, an autosomal dominant inheritance disorder that includes abnormalities in the differentiation of the anterior segment structures and increased values of intraocular pressure, which at long run increases the risk of glaucomatous optic neuropathy. The syndrome is diagnosed when ocular changes are accompanied by extraocular structure anomalies such as maxillary hypoplasia, micro-and anodontia, redundant periumbilical skin, inguinal hernia and hypospadias (males). A 44-year-old male patient presented for treatment of retinal detachment on his left eye. Cataract surgery and pars plana vitrectomy with endolaser were done. Due to his vision loss, high intraocular pressure values bilaterally and positive family history of glaucoma, he was rehospitalized for complete glaucomatous diagnostic evaluation. The rare iridogoniodysgenesis syndrome and associated juvenile glaucoma were verified in the patient by positive family history of glaucoma, slit lamp iris hypoplasia and mild pupillary deformities, gonioscopic results of open angle with iridotrabecular synechiae and neovascularizations at the iris root and ciliary body, fundus examination showing optic disk changes with a cup to disk ratio of 0.9 and 0.8 for the right and left eye, respectively, visual field dG2 program abnormalities such as absolute scotomata within 30 degrees on both eyes, and finally optical coherent tomography results of the cup to disk area ratio of 0.9 and 0.8 for the right and left eye, respectively, with average thickness of the retinal nerve fiber layer of 51 mm and 72 mm for the right and left eye, respectively. Disease control was achieved with medicamentous therapy; however, continuous follow up of the patient is a priority to prevent the potential glaucomatous damage., Cilj ovoga rada je prikazati bolesnika s rijetkim sindromom iridogoniodisgeneze, autosomno dominantnim poremećajem koji uključuje razvojne poremećaje struktura prednjega segmenta i povišene vrijednosti očnog tlaka, što dugoročno povećava rizik od nastanka glaukomskih oštećenja. Da bi se dijagnosticirao ovaj sindrom, očne promjene moraju biti praćene ekstraokularnim razvojnim poremećajima kao što su zubne nenormalnosti, zaostala periumbilikalna koža, ingvinalna hernija, hipospadija (u muškaraca). Muškarac u dobi od 44 godine hospitaliziran je prvi put zbog ablacije retine lijevoga oka. Izvedena je ekstrakcija katarakte s implantacijom akrilne leće te pars plana vitrektomija s instilacijom silikonskog ulja i endolaserom. Zbog gubitka vida, visokih vrijednosti očnoga tlaka i pozitivne obiteljske glaukomske anamneze (majka) bolesnik je hospitaliziran drugi put radi potpune glaukomske obrade. Osobna anamneza, biomikroskopski pregled, fotodokumentacija šarenica, fundusa, dnevna krivulja tlaka, Octopus dG2 program za vidno polje i rezultati optičke koherentne tomografije dokazali su da se radi o sindromu iridogoniodisgeneze s pratećim juvenilnim glaukomom. Uredne vrijednosti tlaka postignute su medikamentnom terapijom, no daljnje praćenje bolesnika je nužno radi prevencije daljnjih glaukomskih oštećenja.

The aim of the study was to assess short-term efficacy of intravitreal bevacizumab in a series of patients with neovascular glaucoma. Eleven patients with neovascular glaucoma and symptomatic elevation of intraocular pressure were treated with 1.25 mg/0.1 mL of bevacizumab. In three patients, intravitreal bevacizumab was administered preoperatively, one day before pars plana vitrectomy. Additional therapy was only performed if topical medication failed to result in satisfactory control of intraocular pressure. Patients were followed-up for a minimum of 8 weeks. In all study patients, intravitreal application of bevacizumab resulted in marked regression of iris neovascularization within the first three postoperative days. Appropriate control of intraocular pressure was achieved in seven patients, whereas four patients required additional therapy for intraocular pressure regulation. No side effects of intravitreal bevacizumab were recorded. Thus, intravitreal bevacizumab seems to be a potent adjunct in the management of neovascular glaucoma. Additional studies of bevacizumab long-term safety and efficacy are warranted., Cilj ove studije bio je procijeniti kratkotrajni učinak intravitrealne primjene bevacizumaba u skupini bolesnika s neovaskularnim glaukomom. U studiju je bilo uključeno jedanaestoro bolesnika s neovaskularnim glaukomom i simptomatskim povišenjem očnog tlaka. Kod svih bolesnika primijenjen je bevacizumab u dozi od 1,25/0,1 mL intravitrealno. Kod troje bolesnika je bevacizumab primijenjen jedan dan prije pars plana vitrektomije. Dodatna antiglaukomska terapija primijenjena je samo kod onih bolesnika u kojih očni tlak nije bio dobro kontroliran lokalnom antiglaukomskom terapijom. Najkraće razdoblje praćenja bolesnika bilo je 8 tjedana. Intravitrealna primjena bevacizumaba dovela je kod svih bolesnika do značajne regresije neovaskularizacije šarenice, što je trećega dana od primjene bevacizumaba potvrđeno biomikroskopski te fluoresceinskom angiografijom. U sedmoro bolesnika je očni tlak bio dobro kontroliran samo lokalnom antiglaukomskom terapijom. Kod četvoro bolesnika bilo je potrebno daljnje kirurško antiglaukomsko liječenje. Nisu zabilježene nuspojave kao niti komplikacije za vrijeme ili poslije intravitrealne injekcije bevacizumaba. Zaključuje se kako se intravitrealna primjena bevacizumaba čini dobrom dodatnom metodom u kombinaciji s ostalim terapijskim modalitetima liječenja neovaskularnog glaukoma. Dodatne studije kojima se ispituje dugotrajniji učinak i sigurnost intravitrealne primjene bevacizumaba su u tijeku i one će doprinijeti boljem razumijevanju farmakokinetike, toksičnosti i putova primjene bevacizumaba u liječenju neovaskularnog glaukoma.

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.

Cilj ove studije bio je procijentiti kratkotrajni učinak intravitrealne primjene bevacizumaba u skupini bolesnika s neovaskularnim glaukomom. U studiju je bilo uključeno jedanaestero bolesnika s neovaskularnim glaukomom i simptomatskim povišenjem očnog tlaka. Kod svih bolesnika primijenjen je bevacizumab u dozi od 1, 25/0, 1 mL intravitrealno. Kod troje bolesnika je bevacizumab primijenjen jedan dan prije pars plana vitrektomije. Dodatna antiglaukomska terpaija primijenjena je samo kod onih bolesnika u kojih očni tlka nije bio dobro kontroliran lokalnom antiglaukomsom terapijom. Najkraće razdoblje praćenja bolesnika bilo je 8 tjedana. Intravitrealna primjena bevacizumaba dovela je kod svih bolenika do značajne regresije neovaskularizacije šarenice, što je trećega dana od primjene bevacizumaba potvrđeno biomikroskopski te fluoresceinskom angiografijom. U sedmoro bolesnika je očni tlak bio dobro kontroliran samo lokalnom antiglaukomskom terapijom. Kod četvero bolesnika bilo je potrebno daljnje kirurško antiglaukomsko liječenje. Nisu zabilježene nuspojave kao niti komplikacije za vrijeme ili poslije intravitrealne injekcije bevacizumaba. Zaključuje se kako se intravitrealna primjena bevacizumabačini dobrom dodatnom metodom u kombinaciji s ostalim terapijskim modalitetima liječenja neovaskularnog glaukoma. Dodatne studije kojima se ispituje dugotrajniji učinak i sigurnost intravitrealne primjene bevacizumaba su u tijeku i one će doprinijeti boljem razumijevanju farmakokinetike, toksičnosti i putova primjene bevacizumaba u liječenju neovaskularnog glaukoma.

U razdoblju od posljednjih pet godina na Klinici za očne bolesti Kliničke bolnice "Sestre milosrdnice" osam bolesnica je hospitalizirano radi obrade i terapije kavernozne karotidne fistule. Cilj ove studije bio je prikazati naša iskustva u dijagnostici, terapiji i praćenju bolesnika s kavernoznim karotidnim fistulama. Svi pacijenti bile su žene u menopauzi srednje životne dobi 69,75±7,3 godina, bez ikakve traume u anamnezi. Najčešći simptomi bili su proptoza, pad vida i kemoza. Od dijagnostičkih metoda rabili smo ultrazvuk, magnetsku rezonanciju (NMR) i angiografiju. Endovaskularna balonska okluzija bila je terapija izbora kod svih bolesnica, ali je kod jedne došlo do spontanog zatvaranja fistule, dok je jedna odbila takvu vrstu liječenja. Na prvom pregledu, mjesec dana nakon terapije, došlo je do poboljšanja očnog statusa. Simptomi kao bol, šum, kemoza, pulsacije bulbusa, glavobolje i dvoslike nisu bili prisutni. Zamijećen je mnogo manji periorbitalni edem, proptoza i dilatacija retinalnih vena, te niže vrijednosti intraokularnog tlaka. Razdoblje praćenja bilo je šest mjeseci i nije zamijećena ponovna pojava fistule. Takve spontane fistule opisane u ovoj studiji su duralni šantovi s predilekcijom u postmenopauzalnih žena, najvjerojatnije zbog ateroskleroze, hipertenzije i promjena u zgrušavanju krvi povezanih s hormonskim statusom., During the last five-year period, eight patients were hospitalized at University Department of Ophthalmology, Sestre milosrdnice University Hospital, for elaboration and therapy of spontaneous indirect carotid cavernous fistulas. The aim of this report is to present our experiences in the diagnosis, treatment and follow up of patients with carotid cavernous fistulas. All patients were postmenopausal women, mean age 69.75±7.3 years, without any trauma in their history. The most common symptoms were proptosis, low vision and chemosis. Ultrasound, computerized tomography, magnetic resonance imaging and angiography were used as diagnostic methods. Endovascular balloon occlusion was the treatment of choice in all patients except for one with spontaneous closure of the fistula, whereas another one refused this mode of treatment. The first follow up examination at one month after therapy showed improvement of ocular status. There was no pain, bruit, chemosis, pulsations of the globe, headache or double vision, while periorbital edema, proptosis, dilatation of retinal veins and intraocular pressure were reduced. During the six-month follow up period, no recurrence was recorded. Spontaneous fistulas described in this study tend to be dural shunts. These shunts have a predilection to develop in postmenopausal women, possibly due to atherosclerosis, hypertension and alterations in blood coagulation associated with hormonal changes.

Cilj ove studije bio je istražiti učinkovitost monopolarne radiokirurške tehnike kod operacije blefaroplastike. Radilo se o prospektivnom istraživanju gdje su operirane gornje vjeđe 28 bolesnika. Bolesnici su podvrgnuti jednoj operaciji, jedna vjeđa je operirana monopolarnom raiokirurškom tehnikom, dok je druga operirana klasičnom kirurškom metodom, a zatim su bolesnici praćeni u seriji do 6 mjeseci. Operater i liječnik koji nije znao koja je strana operirana određenom tehnikom ocjenjivali su kvalitetu ožiljka. Većina bolesnika imala je do trećeg mjeseca praćenja nešto bolji izgled ožiljka na strani operiranoj radiokirurškom tehnikom, ali ta razika nije bila znatna. Nisu zabilježene veće komplikacije. Gornje vjeđe mogu se sigurno operirati monopolarnom radiokirurškom tehnikom. Uz primjenu radiokirurške tehnologije cijeljenje je jednako ili nešto bolje na strani operiranoj radiokirurškom tehnikom., The aim of the study was to evaluate the efficacy of a monopolar radiosurgery for blepharoplasty. This was a prospective trial in which upper eyelids of 28 patients were treated. Patients underwent a single treatment session: one eyelid was performed with monopolar radiosurgery while contra-lateral eyelid was performed with conventional surgery. The follow-up was 6 months. Assessments were made by the surgeon and by masked physician. The majority of patients, till 3th months postoperatively achieved the slightly better aesthetic results at radiosurgery sides, but no achieved dramatic results were acived. There were no serious adverse sequelae. Human eyelids can be safely treated with monopolar radiosugical device. Using this technology healing were the same or slightly better on side treated with radiosurgery.

Purpose: To determine the incidence of unwanted light images after cataract surgery and the relationship between various intraocular lens (IOL) types. Methods: Prospective study included 50 patients who filled up a written questionnaire where reported on incidence of glare, light sensitivity and unwanted images. Patients were included in the study only if they had uneventful cataract surgery and no additional ocular pathology. They were excluded if they had refractive errors which could cause similar phenomena. The study was performed in three month postoperative period. Results: A significant number of patients reported symptoms. Patients with acrylic IOL were at increased risk. At last control more than 1/3 of symptoms resolved spontaneously. No one reported negative dysphotopsia and there was no IOL exchange. Conclusions: Intraocular lenses can introduce stray light artifacts into the eye. While positive dysphotopsia has been largely attributed to edge effects of the implant, negative dysphotopsia appears to be more related to the patient's anatomical structure than to specific lens designs or materials.

Recurrent corneal erosions, independently of the origin, seem to show a similar tendency to abnormal adhesion between corneal epithelium and stroma. Although, for general ophthalmologist, it may at first seem to be one of the less difficult entities to diagnose and therefore to treat, for a patient suffering from this disorder it may be very frustrating, and sometimes even frightening. The majority of patients will respond to simple measures such as padding and antibiotic ointment, but there are a percentage of patients that require a more complex approach. The common goal of each conservative or surgical treatment is fast healing and encouraging proper formation of adhesion complexes between the epithelium and the stroma, without any infections or recurrences. The objective of this review is to assess the indications and outcomes of current treatment options for recurrent corneal erosion, based on literature survey. Briefly, in spite of the many different treatment options, there is still room for further research in the area. Phototherapeutic keratectomy opens a new line of possibilities and it should be considered as very effective therapy for refractive cases. Also, in spite of our recommendations, each patient should be treated individually., Recidivirajuće erozije rožnice, neovisno o uzroku, pokazuju sličnu tendenciju abnormalnoj adheziji između rožničnog epitela i strome. Iako za općeg oftalmologa dijagnosticiranje ovoga poremećaja, a time i liječenje predstavlja jedno od lakših entiteta, bolesniku ovo stanje može biti vrlo frustrirajuće, a ponekad i zastrašujuće. Većina bolesnika pozitivno reagira na jednostavne mjere kao što su zatvaranje oka zavojem i antibiotske masti, no postoji i dio bolesnika koji zahtijevaju složeniji pristup. Zajednički cilj svakog konzervativnog ili kirurškog liječenja je brzo cijeljenje i poticanje pravilnog formiranja adhezijskih kompleksa između epitela i strome bez infekcije ili recidiva. U ovom osvrtu je cilj predstaviti indikacije i rezultate današnjih opcija liječenja vezanih uz recidivirajuće erozije rožnice zasnovanih na istraženoj literaturi. U zaključku, možemo reći kako usprkos mnogim različitim opcijama liječenja još uvijek ima mjesta za daljnja istraživanja na ovom području. Fototerapijska keratektomija otvara nove mogućnosti i trebala bi se uzeti u obzir kao vrlo uspješna terapija refraktornih sučajeva. Također, usprkos našim preporukama, svakog bi se bolesnika trebalo liječiti individualnim pristupom.

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.

Monofocal intraocular lenses are effective in improving vision after cataract surgery but the loss of accommodation is not restored by implantation of these intraocular lenses. Because multifocal intraocular lenses may improve uncorrected distance and near vision, we compared clinical outcome and patient satisfaction after implantation of multifocal intraocular lenses. The study included eight patients who underwent cataract surgery using phacoemulsification and implantation of multifocal intraocular lenses (ReStor,Tecnis). Intraocular power calculation was measured by standard immersion A-scan ultrasonography using Holladay 2 formula, with target hyperopia +0.50 Dpt. Assessments were made preoperatively, and at 1 and 3 months postoperatively, whereas outcome was evaluated by interview. Satisfaction related to preoperative expectations was similar in all study patients. Visual acuity was 0.9 1.0 in 92% of the patients. All patients were satisfied with near vision without glasses. The perceived quality of corrected near vision showed highest correlation with patient satisfaction. Study results suggested that the patients were satisfied with their intraocular lens performance, and most would have the multifocal intraocular lens implanted again. The frequency of spectacle wear was greatly reduced for both distance and near vision., Monofokalne intraokularne leće su učinkovite u poboljšanju vidne oštrine nakon operacije katarakte, ali se gubitak akomodacije ne može vratiti ugrađivanjem ovih leća. Budući da multifokalne intraokularne leće poboljšavaju vidnu oštrinu na daljinu i blizinu, usporedili smo kliničke rezultate i zadovoljstvo bolesnika nakon ugradnje multifokalnih intraokularnih leća. U istraživanje je bilo uključeno osmoro bolesnika operiranih metodom fakoemulzifikacije, kod kojih je ugrađena multifokalna intraokularna leća (ReStor, Tecnis). Aksijalna duljina je mjerena imerzijskom tehnikom A-scan uz primjenu formule Holladay 2, a željena poslijeoperacijska refrakcija je bila do +0,50 Dpt. Bolesnici su pregledani prijeoperacijski, te 1. i 3. mjeseca poslijeoperacijski, uključujući intervjue. Zadovoljstvo u odnosu na prijeoperacijska očekivanja bilo je slično kod svih bolesnika. Vidna oštrina bez korekcije bila je 0.9-1.0 kod 92% bolesnika i nisu bile potrebne dodatne korekcije na blizinu. Zabilježena kvaliteta vida na blizu kod bolesnika s multifokalnom intraokularnom lećom bila je usko povezana sa zadovoljstvom nakon operacije katarakte. Ova studija je pokazala izrazito zadovoljstvo bolesnika s multifokalnom intraokularnom lećom, te bi oni opet izabrali istu kod ponovne operacije katarakte. Potreba za nošenjem korekcije za daljinu i blizinu je smanjena.

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.

Phototherapeutic keratectomy with excimer laser is commonly used to treat recurrent corneal erosion syndrome. The aim of this case report is to present success of phototherapeutic keratectomy in patients with recurrent epithelial erosion and persistent epithelial defect following initial treatment with phototherapeutic keratectomy. Phototherapeutic keratectomy provides a therapeutic option for refractory recurrent erosions and persistent epithelial defects. The benefit from phototherapeutic keratectomy is fast reepithelialization of the affected area and quick relief of painful symptoms., Fototerapijska keratektomija excimer laserom se upotrebljava za liječenje opetovanih rožničnih erozivnih sindroma. Cilj prikaza dvaju slučajeva je opisati uspjeh fototerapijske keratektomije kod bolesnika s opetovanom refraktornom epitelnom erozijom rožnice te kod bolesnika s tvrdokornim epitelnim defektom. Navedena metoda predstavlja terapijsku mogućnost u liječenju ovih stanja. Korist od fototerapijske keratektomije je brza reepitelizacija zahvaćenog područja i brzo oslobađanje od bolnih simptoma.

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.

U radu je prikazan slučaj pacijenta starog 79 godina, koji je 2001. godine podvrgnut operativnom zahvatu katarakte s ugradnjom hidrofilne savitljive intraokularne leće. Četiri godine kasnije pacijent je primljen na očnu Kliniku radi eksplantacije postojeće intraokularne leće koja je u potpunosti bila strukturno promijenjena i zamućena te ugradnje nove intraokularne leće. Eksplantat je analiziran metodom Ramanspektroskopije, bojanjem Alizarin-crvenom i von-Kossa metodom te pregledom na svjetlosnom mikroskopu te elektronskim mokroskopom. Ramanspektroskopska analiza je pokazala Ramanspektre od 834-900, 971 i 1030-1124 cm -1. Vršci od 834 do 900 cm-1 su govorili u prilog karbonata i/ili fosfata, dok je vršak od 971 cm -1 govorio u prilog postojanja oktakalcisjkihfosfata. Treći vršak je sugerirao postojanost karbonata unutar apatitne strukture. Metodom bojanja alizarin-crvenom i von –Kossa analizom dokazana je postojanost mnoštva različitih globularnih agregata koji su u potpunosti prožimali unutarnju i vanjsku površinu intraokularne leće, dok je analiza elektronskom mikroskopijom dokazala prožetost eksplantata kalcijevim kristalima.

The aim of the study was to determine whether amniotic membrane could be used to treat neuroparalytic keratopathy. Amniotic membrane transplantation was performed in 19 patients with neuroparalytic ulcer. All patients were younger than 61 and all developed corneal problems due to interruption of the sensory afferent fiber innervating the cornea. In all patients, the follow up period was longer than 18 months. Postoperatively, all patients underwent fluorescein test and biomicroscope examination as well as subjective pain evaluation. Postoperatively, the pain was reduced in study patients. In one patient, retransplantation for disease recurrence was performed two months after the first operation. After the second operation, the pain was minimized for more than 18 months. Amniotic membrane transplantation appears to be a good method for pain reduction and better epithelial healing in patients with neuroparalytic keratopathy., Cilj rada bio je utvrditi može li se amnijska membrana rabiti u liječenju neuroparalitične keratopatije. Transplantacija amnijske membrane je učinjena kod 19 bolesnika s neuroparalitičnim ulkusom. Svi bolesnici bili su mlađi od 61 godine i kod svih su se problemi s rožnicom razvili kao rezultat prekida senzornih aferentnih vlakana koja inerviraju rožnicu. Razdoblje praćenja je kod svih bolesnika bio duži od 18 mjeseci. Poslijeoperacijski je kod svih bolesnika učinjen fluoresceinski test i biomikroskopski pregled, kao i subjektivna procjena boli. Nakon operacije bol je bila smanjena kod svih bolesnika. Kod jednog bolesnika učinjena je druga transplantacija, dva mjeseca nakon prve, zbog recidiva. Nakon druge operacije bol je bila smanjena više od 18 mjeseci. Transplantacija amnijske membrane čini se kao dobra metoda smanjenja boli i postizanja boljeg epitelijalnog cijeljenja kod bolesnika s neuroparalitičnom keratopatijom.

The aim of this case report is to present a very rare case of primary malignant non-Hodgkin orbital lymphoma, found in an 80-year-old female patient with rapid orbital structure compression. Detailed ophthalmologic, radiologic, hematologic and oncologic examinations and laboratory tests were done before, during and after treatment. Diagnostic ultrasonography and computed tomography images of the right orbital cavity demonstrated a solid naoplastic process which dislocated the eyeball without invasion of orbital structures. Upon diagnostic evaluation, tumor lesion was surgically removed including orbitotomy with lower transpalpebral approach. Histopathologic diagnosis and type of tumor tissue were defined by histology and immunohistochemistry analyses of open biopsy material obtained ex tempore. Finally, the diagnosis was confirmed by histopathology of the resected tumor mass: lymphoma malignum non-Hodgkin, diffuse large B-cell type, with high mitotic activity. Neoplastic B lymphocytes showed CD 20 positive surface antigens and kappa light chain expression. The treatment was continued with hematologic therapy. The patient received three cycles of systemic chemotherapy (CHOP protocol). Upon combined therapy completion, control examinations showed the patient to have no signs of disease in the orbital region. Interdisciplinary approach in the diagnostic evaluation, therapy and long-term observation proved to be necessary in patients with malignant non-Hodgkin lymphoma.

To show the results of intravitreal application of triamcinolone used as a primary or adjuvant therapy.We analyzed 48 patients with different ocular disorders: exudative age related macular degeneration, diabetic retinopathy, or central retinal vein occlusion. We analyzed color fundus photography, visual acuity, fluorescein angiography and complications of intravitreal triamcinolone application.There was a marked reduction of macular edema in 70% of patients verified on fluorescein angiography. Visual acuity improved in 62% of patients. The most common complication was transient rise in intraocular pressure. There was no case of endophthalmitis.Intravitreal application of triamcinolone is relatively safe and efficacious in selected patiens with different ocular disorders.

To compare the use of single injection of triamcinolone acetonide and steroid drops in the treatment of inflammation after cataract surgery.This retrospective study included 80 patients operated on by phacoemulsification with intraocular lens implantation. After the operation, patients were divided into two groups. Group A received dexamethasone-neomycin drops for four weeks, whereas group B received single application of triamcinolone acetonide into the subtenon space. Postoperative evaluation included the degree of inflammation, intraocular pressure and therapeutic response.Triamcinolone acetonide appeared to be an as valuable therapy in minimizing inflammation after cataract surgery as steroid drops on days 7, 14 and 21 postoperatively, a significantly lower intraocular pressure was recorded in the group of patients administered a single injection of triamcinolone acetonide.Single application of triamcinolone acetonide appeared to be as efficient as steroid drops in controlling postoperative inflammation after uncomplicated cataract surgery.

To evaluate the efficacy of topical antiglaucoma therapy in reducing acute intraocular pressure (IOP) elevation after neodymium: Yag laser iridotomy.Primary angle-closure glaucoma (PACG) eyes were randomized to receive premedication with latanoprost and pilocarpine, brimonidine 0.2% and pilocarpine or only with pilocarpine before Yag laser iridotomy. Postoperative IOP changes were compared with Wilcoxon signed-ranks test using the fellow eyes in each group.Postoperative pressure spikes were significantly lower in the groups of patients with local antiglaucoma therapy with pilocarpine than in the control group. Mean elevation of IOP was less in the groups of patients with local antiglaucoma therapy with pilocarpine at 2 hours postoperatively.Local antiglaucoma therapy may reduce the acute IOP rise following Yag laser iridotomy in PACG eyes.