Congenital upper eyelid coloboma with ipsilateral eyebrow hypoplasia.

INTRODUCTION: Coloboma is a Greek word, which describes the defect of all layers of the organ, and it can be congenital or as the result of an injury, operation, or some disease. Congenital upper eyelid coloboma is a rare anomaly, with the unknown incidence. The size of the defect is different, but it always involves all layers of the eyelid. This malformation is more frequent at the upper eyelid, and unilaterally, at the junction of the medial two thirds. Sometimes, it can also involve the eye, and may be a component of many syndromes (Goldenhar, Fraser, Manitoba, CHARGE, Cat eye). CASE REPORT: We are describing the case of the upper eyelid coloboma with the rare eyebrow anomaly at the three- month old girl, and the result of reconstruction. The baby was treated conservatively with lubricants and overnight patching. Pentagonal excision of the defect was performed in general anesthesia. Three layers of the eyelid were prepared: the skin, muscle and tarsoconjunctival layer. Because of orbicularis muscle malposition, reinsertion and reposition of the muscle fibres were performed. Then, lateral canthotomy was made and the suture of three layers of the eyelid. Catgut suture 7-0 was used for the conjunctiva and muscle. Nylon 6-0 was used for skin suture. Z-plasty was done on the upper part of the pentagonal excision in order to reduce skin tension at the suture line. The operation lasted about 60 minutes and the hospitalization three days. The occlusive dressing was applied for two days. The stitches were removed after seven days. The postoperative swelling of the upper and lower eyelid disappeared in five days. There were no complications in the postoperative period. CONCLUSION: The main principle of the treatment of eyelid coloboma is surgical reconstruction of all layers of the eyelid, in optimal period, using different surgical methods, which depends on the size of the defect. An early diagnosis is of the greatest importance, as well as the treatment of associated anomalies. Complications of the upper eyelid coloboma depend on the size of the defect, presence of the eye anomalies and the method of reconstruction.

Panophthalmitis after spontaneous perforation in glaucomatous eye.

Panophthalmitis is an acute, purulent inflammation of the eyeball that involves all its structures and extends into the orbit. A case of a fifty-seven year old male treated earlier due to glaucoma and trophic ulcus of the cornea, was presented in this paper. He was admitted to hospital with intensive orbital pain and redness of the right eye, elevated body temperature, bulbus protrusion with limited movement, chemosis, edematous cornea, hypopyon, iris of invisible drawing and relief. The ocular fundus was not visible. At the admittance, amaurosis of the right eye was present as well as spontaneous cornea perforation. The patient was treated with antibiotic, corticosteroid, analgesic and antiglaucomatous therapy. Intravitreal administration of antibiotics was impossible due to spontaneous cornea perforation. The patient was discharged from the hospital in a good general condition. The condition of the right eye was stable, there was no danger of eye loss, while infection of the same eye was cured.

Evaluation of the patients with Grave's ophthalmopathy after the corticosteroids treatment.

BACKGROUND/AIM: Graves' ophthalmopthy is one of the most common causes of exophthalmos as well as the most common manifestation of Graves' disease. The treatment of Graves' ophthalmopathy includes ophthalmological and endocrinological therapy. The aim of this study was to clinically evaluate the patients with Graves' ophthalmopathy treated with corticosteroids. METHODS: Evaluation of 21 patients was performed in the Ophthalmology Clinic and Endocrinology Clinic, Clinical Centre Kragujevac, in the period from 2009 to 2010. They were treated with pulse doses of intravenous corticosteroids. They were referred to ophthalmologist by endocrinologist in euthyroid condition in the active phase of Graves' ophthalmopathy (ultrasonography of orbit findings and positive findings of antithyroid stimulating hormone receptor antibody--anti-TSH R Ab). The clinical activity score (CAS) and NO SPECS classification for evaluation of disease severity were used. Ophthalmological examination includes: best corrected visual acuity, slit-lamp exam, Hertels' test, direct ophthalmoscopy and ultrasonography of the orbit. RESULTS: According to our results 76.19% of the patients were female; mean age of the patients was 35.2 +/- 5.6 years. According to CAS classification after 6 months of the treatment recovery was shown in 23.81% of the patients, partial amelioration in 47.62% and no clinical amelioration in 28.57% of the patients. We achieved better results with male, young patients with high clinical activity score. Good results were observed after the first dose of corticosteroids, much better CAS after the third dose, which maintained until 6 months after the first treatment. CONCLUSION: Our results signify that intravenous pulse dose of corticosteroids treatment of the patients with Graves' ophthalmopthy is safe, comfortable, clinically justified and accessible for the clinicians and patients. Positive results are achieved after the first dose with increasing trend up to the third dose, which was maintained for the next three months.

Cyclocryotherapy in neovascular glaucoma treatment.

The main goal in the struggle with neovascular glaucoma is to control intraocular pressure (IOP) and pain. 152 patients, e.g., 203 eyes, were examined at the Clinic of Ophthalmology, Clinical Centre of Kragujevac, Serbia, in period between 01. 01. 2005 - 31. 12. 2010. Cyclocryoanemisatio was performed for all patients. Measurments of IOP showed statistical significant changes before and after the treatment for every patients. There was no difference in sex distribution, but a difference was noted in age distribution. Early posttreatment complications included hyphema, fibrin's exudation, chemosis. Cyclocryotherapy is usefull and accessible method for control of intensive pain in neovascular glaucoma.

Traumatic anterior dislocation of the crystalline lens and its surgical management.

This paper reports a case of a 57-year old female who had sustained a blunt ocular trauma resulting in anterior dislocation of the crystalline lens and acute painful visual loss in the left eye. The patient was managed with anterior chamber intracapsular phacoemulsification through a small anterior capsulotomy, pars plana vitrectomy, and surgical iridotomy. Aphakia was corrected by a contact lens. Two months after the surgery, the best corrected visual acuity was 0.9 in the left eye. The vision and retina remained stable in her follow-up examination 1 year later. Anterior dislocation of the crystalline lens can cause severe complications so that dislocated lens should be removed immediately.

Prostatic carcinoma bilateral iris metastases.

We described a patient with bilateral iris metastases resulted from prostatic cancer. Slit lamp and ultrasonography examination of the both eye demonstrated tumor of the iris, as an amelanotic vascular mass located on the superior temporal quadrant. On open biopsy revealed undifferentiated tissue that stained strongly positive for prostate carcinoma, confirming the diagnosis of metastasis prostate adenocarcinoma. Early diagnostic procedures are essential for the causal therapy of prostate carcinoma as the primary neoplasm.

[Clinical evaluation of Graves ophthalmopathy].

INTRODUCTION: Graves ophthalmopathy is an autoimmune disease, which is the consequence of thyroid dysfunction. Ocular manifestations occur in 50% of patients with Graves disease. The changes occur due to the inflammatory cell infiltration of retrobulbar fat tissue and extraocular muscles. Ultrasonography of eye orbit provides important information about the condition of retrobulbar adipose tissue and the thickness of extraocular muscles. OBJECTIVE: The aim of our study was to show the clinical significance of orbital ultrasonography in the diagnostics and follow-up of patients with Graves disease. METHODS: The authors examined 154 patients with Graves ophthalmopathy at the Clinic of Ophthalmology of the Clinical Centre in Kragujevac during the period 2008-2010. Ophthalmological examination included visual acuity testing (Snellen chart), biomicroscopy and applanation tonometry, direct and indirect ophthalmoscopy, dry eye testing and exophthalmometry (Hertel). Orbital ultrasonography examination and extraorbital muscle measurement was done by ultrasound B-scan. RESULTS: The disease was more frequent in women (79.87%) aged from 36-45 years. Most patients had hyperthyreoidism (54.55%). In relation to the duration of the disease, the most frequent clinical signs were bilateral ptosis, conjunctival chemosis and periorbital edema. According to our data the highest number of patients had enlarged medial straight muscle. CONCLUSION: Graves ophthalmopathy is the most frequent sign of thyroid disease. By orbital ultrasonography we detected extended echogram and measured the thickness of the extraocular muscle. Computerized tomography and magnetic resonance scan were utilized for cases of insufficiently manifested clinical signs of the disease. The advantages of ultrasonography lie in easy handling, patients' comfort, short time of examination and possibilities of repetition.

Orbital metastases from breast cancer: a case report.

We present a patient with a corneal ulcer of the right eye, with eye protrusion and without anamnesis of cancer. On CT examination there was a bulky soft tissue mass in the cranial aspect of the right orbit, without increasing in signal intensity after injection of contrast. Open biopsy revealed undifferentiated tissue that stained strongly positive for breast carcinoma, confirming the diagnosis of metastases of breast carcinoma.

[Epidemic keratoconjunctivitis].

INTRODUCTION: Keratocnjunctivitis is corneal and conjunctival inflammation. Clinical signs involve the irritating trio: mixed hyperemia of conjunctival membranes, corneal subepthelial infiltrates and regional lymphadenopathy. The most common causes of epidemic are adenovirus, herpes virus, and rarely cytomegalovirus, which are now occurring with higher frequency as secondary infections. OBJECTIVE: The aim of the study was to present and analyze keratoconjunctival epidemics in the region of Kragujevac from September 2008 to February 2009, as well as to analyze clinical features related to virusological findings and etiology. METHODS: In 329 patients we performed clinical examination (biomicroscopy, fluorescent test, corneal sensitivity test), collecting standard specimen of the conjuctiva and cornea, made serological examination, and sent the specimens to the Virusology Institute "Torlak" in Belgrade for the confirmation of epidemic etiology. The patients were treated with local and symptomatological therapy. The epidemic was eradicated in cooperation with a regional referent institution. All outpatients activities were ceased, while hospital hygienic, sanitary, intra-, extra-hospital and therapeutic procedures were undertaken. RESULTS: The distribution of 329 patients by gender was equivalent. Most patients were aged from 27 to 34 years (25%) of working population. The distribution of patients by clinical features showed the predominance of follicular hyperplasy (93.62%). The distribution according to the time of the first symptoms onset showed the frequency of 50% of corneal infiltrate in the second week. The period elapsed from the diagnosis to cure was three weeks in 50% of patients. Serological tests confirmed the mixed distribution of the cause. CONCLUSION: Based on the authors' experience, in order to eradicate epidemics as fast as possible and achieve efficient treatment, it is recommended that the epidemic should be reported, guidelines of referent institutions be obeyed, all of which diminishes the recognizable professional risk and decreases mistakes.

Bilateral retinal detachment in a case of preeclampsia.

Serous retinal detachment is an unusual cause of visual loss in preeclampsia. We report the case of 24-years-old primipara with severe preeclampsia who developed bilateral serous retinal detachment a few hours after delivery. A few weeks after delivery there was spontaneous resorption of the subretinal fluid and complete resolution bilateral serous retinal detachment, with residual pigmentary changes of the retinal pigment epithelium. Visual acuity was normal in each eye. The management of retinal detachment as a complication in preeclampsia is conservative and the prognosis is usually good.