Left ventricular systolic function in selected type 1 diabetic patients with or without diabetic retinopathy and microalbuminuria.

Vascular endothelial dysfunction is a basic etiologic factor for the development of late clinical complications in patients with diabetes mellitus type 1, such as diabetic retinopathy, diabetic nephropathy (which is characterized at the very beginning by microalbuminuria), and left ventricular cardiac dysfunction. The aims of this study were to determine the prevalence of asymptomatic left ventricular systolic dysfunction in patients with diabetes mellitus type 1 and with or without diabetic retinopathy and microalbuminuria, and to correlate the duration of diabetes with the dynamics of diabetic retinopathy, microalbuminuria and asymptomatic left ventricular dysfunction development in these patients. One-hundred and twenty selected patients with diabetes mellitus type 1 were examined by ophthalmologist and cardiologist. All patients underwent ergometric testing and two-dimensional (2-D) echocardiography with pulsed Doppler. Patients were divided into three groups according to their fundus findings and microalbuminuria: (1) patients without diabetic retinopathy and without microalbuminuria (n = 40); (2) patients with diabetic retinopathy without microalbuminuria (n = 40); and (3) patients with diabetic retinopathy and microalbuminuria (n = 40). All three groups of patients with diabetes mellitus type 1 (with low cardiovascular risk, regulated blood sugar, and without diabetic neuropathy) had echocardiographic values in the normal range. We found no statistically significant correlation between the duration of diabetes mellitus type 1 and echocardiographic values.

The role of diabetic retinopathy in blindness and poor sight in Split-Dalmatia County 2000-2010.

Diabetic retinopathy is the fifth leading cause of blindness in the world. The aim of this study was to determine the number of blind persons in the Split-Dalmatia County in the 2000-2010 period and how many of them are blind due to diabetic retinopathy. Records of 160 members of the Association of the Blind in the Split-Dalmatia County, enrolled from 2000 to 2010, were retrospectively analyzed. The leading causes of blindness were diabetic retinopathy (25.6%), glaucoma (13.1%), retinal dystrophy (16.2%), and age related macular degeneration (11.8%). The annual incidence of blindness was 8.4/100,000 inhabitants. The largest number of the blind were found in the 70-80 (21.2%) to > 80 (24.3%) age group. Diabetic retinopathy was the cause of blindness in 24 (15%) men and 17 (10.6%) women. The annual incidence of diabetic retinopathy was 2.16 per 100,000. No case of blindness due to diabetic retinopathy was diagnosed in patients younger than 30 years of age, while the highest prevalence was found in the 70-80 age group (34%). Proliferative diabetic retinopathy was the cause of blindness in 92.7% and nonproliferative diabetic retinopathy in 7.3% of cases. Study results show that diabetic retinopathy remains the leading cause of blindness. Early identification of high-risk patients is the key factor in prevention and timely detection of ophthalmoscopic changes, thus enabling effective and duly treatment.

The role of oxidative stress after retinal laser photocoagulation in nonproliferative diabetic retinopathy.

Diabetic retinopathy (DR) represents the most common chronic complication of diabetes, and it is the leading cause of new cases of blindness in patients between 20-74 years old in developed countries. Laser photocoagulation (LF) represents an efficacious approach to the treatment of DR. Oxidative factors, such as free radicals (FR), are continuously generated in aerobic organisms as a result of different metabolic processes. It is well known that oxidative stress plays a role in the development of DR. The aim of this study was to evaluate the thermal effects of the scatter retinal laser photocoagulation technique on the production of FR. A total of 90 patients were enrolled in this study. They were divided in 3 groups: 30 diabetic patients with DR, 30 diabetic patients without DR, and 30 control individuals without diabetes mellitus (DM). Full scatter retinal LF was performed in all patients with DR. We measured the concentrations of superoxide dismutase (SOD), glutathione peroxidase (GPOD), catalase, and total antioxidative status (TAS). Of the 30 DR patients, 13 showed the appearance or worsening of macular edema after LEF, whereas the other 17 patients showed no change. Thirty days after LF, improvement in visual acuity was observed, but this change was not statistically significant. The mean plasma or erythrocyte lysate concentrations of various antioxidants were significantly lower in the diabetic patients without DR compared to the individuals without DM and in the diabetic patients with DR compared to the individuals without DM; the diabetic patients with DR did not show lower concentrations of the antioxidants compared to the diabetic patients without DR. The concentrations of SOD, GPOD, catalase, and TAS were significantly lower in the diabetic patients with DR after retinal scatter LF, which could be the consequence of retinal oxidative stress caused by the LF thermal effect.

The ophthalmic anomalies in children with Down syndrome in Split-Dalmatian County.

UNLABELLED: Our aim was to present the ophthalmic anomalies in patients with Down syndrome in Split-Dalmatia County born from 1992 until 2009 year. It was a cross-sectional study. 153 children with Down syndrome aged 0-18 years from the Split-Dalmatia County were examined. One hundred twelve participants were borne in Split, 13 in Vrgorac,16 in Makarska, 12 in Sinj. All enrolled children underwent a complete ophthalmological examination (anterior segment, ocular motility, refractive status, fundus, measuring intraocular pressure (IOP). Of 89.5% percent of responders with refractive errors, 48.1% had myopia, 35.0% had hypermetropia, astygamtism in 16.7%, 28.7% strabismus, nystagmus (8.4%), cataracts (1.3%), glaucoma (1.9%), supernumerary optic disc vessels (24.1%) and keratoconus (1.3%). CONCLUSION: In patients with Down syndrome the prevalence of refractive errors (myopia prevalence), as well as other ophthalmological diseases was determined.

Acute bilateral cataract with phacomorphic glaucoma in a girl with newly diagnosed type 1 diabetes mellitus.

The authors present a rare case of acute bilateral cataract with phacomorphic glaucoma in a girl with newly diagnosed type 1 diabetes mellitus without a known history of ocular problems. Within 3 months after the diagnosis of diabetes mellitus, she presented with high intraocular pressure. Her visual acuity was limited to hand motions. The patient required immediate surgical intervention. Postoperatively, the intraocular pressure normalized and bilateral visual acuity was 6/6.

Blindness and visual impairment in diabetic patients in Croatia.

New estimates show reduction in the number of people who are blind or suffer from vision impairment as a sequel of infectious diseases, while there is an increase in the number of people who are blind due to conditions related to longer life span and diabetes. Diabetic retinopathy is the leading cause of blindness in active population in developed countries. Epidemiological studies evaluated the incidence and describe many facets of this disease the incidence of which is being followed in most countries. The aim of this paper is to present some epidemiological data on diabetic retinopathy caused by type 1 diabetes in Croatia, to compare them with other countries, and to evaluate its importance in causing severe visual impairments and blindness. These data are considered highly relevant because they are changing constantly and require continuous monitoring in spite of all advances in understanding the distribution, causes and severity of diabetic retinopathy. It is of great importance because the increasing burden of diabetes will pose ever greater burden on the population at large and on healthcare systems providing care for these patents.

[Relationship between phacoemulsification and extracapsular cataract extraction at University Department of Ophthalmology, Split University Hospital Center, during the 1997-2009 period]. / Odnos fakoemulzifikacijskei i klasicne ekstrakapsularne methode operacije sive mrene na klinici za ocne bolesti KBC-a Split u razdoblju od 1997. do 2009. godine.

The aim of the study was to show the relationship between phacoemulsification and extracapsular cataract extraction at University Department of Ophthalmology, Split University Hospital Center (assessing the length of postoperative hospital stay and postoperative visual acuity), during the 1997-2009 period. We also wanted to explore the tendency of using different types of intraocular lenses. The study was designed as a retrospective analysis of operative records. Data were collected on all patients operated for cataract at our Department during the study period. We compared the mean duration of postoperative hospital stay and mean postoperative visual acuity between 1997/1998 (more than 90% were treated with ECCE technique) and 2007/2008 (more than 90% were treated with PHACO technique). Information was also collected on the type of lenses implanted. The rate of cataract extraction by phacoemulsification was less than 10% in 1997/1998, then progressively rising to reach 99.2% in 2009. The mean hospital stay was 5.73 (range 2-19) days in 1997/1998 as compared with 1.99 (range 0.02-1) days in 2007/2008. The mean uncorrected postoperative visual acuity was 0.71 (range 0.01-1.0) in 2007/2008. In conclusion, the number of cataract patients operated on by the phacoemulsification technique progressively and significantly increased during the 1997-2009 period, confirming the method as the most acceptable and less traumatic technique that is applicable in most of cataract patients.

[Bilateral choroidal metastases of kidney carcinoma]. / Metastaze zilnice oba oka kod karcinoma bubrega.

Metastatic tumors are among the most common intraocular malignancies, and are exclusively localized in the uvea, 88% in the choroids. A 54-year-old male patient was admitted to Urology Department for macrohematuria. A tumor of the left kidney was found. Upon nephrectomy, histopathology indicated papillary carcinoma of the kidney with some focal sarcomatous differentiation. The left suprarenal gland was normal, but one of the regional lymph nodes was invaded. Three years later, the patient was hospitalized again for tumor of the right suprarenal gland and para-aortic tumor. At the same time, the patient complained of visual acuity worsening on the left eye. Fundus examination and fundus photography revealed yellowish subretinal lesions with serous retinal detachment. Metastatic eye lesions may anticipate or follow the diagnosis of kidney carcinoma. All tumors with a tendency of hematogenous metastasizing have a high affinity of metastasizing into the uvea because of its abundant blood flow. Posterior pole is the most common localization; over 40% of lesions are found in macular region, which is attributed to the higher posterior choroidal blood flow and easy macular symptom detection. That is why kidney carcinoma has to be ruled out in all patients with such yellowish subretinal lesions.

Visual evoked potential can be used to detect a prediabetic form of diabetic retinopathy in patients with diabetes mellitus type I.

The aim of this study was to evaluate the usefulness of visual evoked potential (VEP) testing in detecting retinal ganglion cell damage in patients with Diabetes Mellitus type I (DMI). VEP arise before diabetic retinopathy signs become ophthalmoscopically detectable. VEP testing was performed in 45 patients divided into three groups; 15 children with recently discovered DMI, 15 children with long-lasting DMI, and 15 healthy children as the control group. A statistically significant difference in VEP P100 wave amplitudes (Z = 4.02, p < 0.001) and latencies (Z = -4.66, p < 0.001) was found between children with established DMI and those with recently discovered DMI. Amplitude values decrease progressively and latency values increase progressively in children with DMI as the years pass. Progressive increases in VEP latency values are a direct sign of retinal ganglion cell damage, which takes place even before the first ophthalmoscopically detectable signs of diabetic retinopathy arise. Therefore, VEP should be considered as a valid method for detecting prediabetic retinopathy, which could contribute greatly to the prevention of diabetic retinopathy complications.

Retinoscopy and visual evoked potential based evaluation of the exactness of hyperopia correction in children with developmental difficulties.

The aim of this study was to evaluate the possibility of evaluation of optimal hyperopic correction based on visual evoked potential (VEP) examination results in children that do not cooperate. There are relatively few studies that evaluated the correlation between visual acuity and especially in young hyperopes. We examined 80 children (160 eyes) with hyperopia, divided into two groups: children that were cooperative during examination and children that could not cooperate with the examiner. Upon determination of the eye refractive state by other objective methods, the prescribed refraction was checked by following the change in VEP P100 wave amplitude and prescribed the correction for which these values were highest. The first VEP curve was recorded without any correction, then more VEP curves were recorded after increasing correction between +1.0 and +6.0 D, in the range found by retinoscopy, with 1 D step. The correction values that caused VEP curves with highest amplitude and shortest P100 wave latency were recorded. In conclusion, the VEP curve parameters were confirmed to depend on the refractive state of the eye.

[Changes in visual evoked potentials curve parameters in children with amblyopia]. / Djecja slabovidnost i vrijednosti parametara krivulje vidno evociranih potencijala.

AIM: The aim of the study was to correlate visual evoked potential (VEP) parameters (amplitude and latency) with visual acuity of the amblyopic eye. PATIENTS AND METHODS: The study included 30 children aged 4.5-6 years, tested for visual acuity before refractive correction, with correction, and after pleoptic therapy. In addition, VEP parameters were recorded according to changes in visual acuity. RESULTS: VEP curves were found to change with visual acuity of the amblyopic eye. A statistically significant correlation was obtained between amplitude values and visual acuity as well as between latency values and visual acuity (P<0.001 both). DISCUSSION: Some authors have reported differences in VEP curve parameters according to visual acuity. We performed VEP assessment in children with anisometropic amblyopia and found statistically significant differences among the values obtained before refractive correction, with refractive correction and after pleoptic treatment of amblyopic eye. VEP curve values changed with improvement in visual acuity: the P100 wave amplitude was higher and latency shorter. CONCLUSION: VEP may be a valid method to determine amblyopia.

[Automatic refractometer in the evaluation of eye refraction in children]. / Automatski refraktometar u procjeni refrakcije u djece.

Recent publications state that automatic refractometer is more precise than retinoscopy. The purpose of this study was to determine if there is significant difference in refractive values obtained by retinoscopy and by automatic refractometer. We examined 39 children (78 eyes) aged between 4 and 6 years. Retinoscopy after atropine midriasis and automatic refractometer measurements were done in all patients. We compared the values obtained with retinoscopy and automatic refractometer and found statistically significant differences in the sphere (T-test: t = 17,929, p < 0.001) and cylinder diopters (T-test: t = 3.052, P = 0.005) but in the axes (T-test: t = 0.319, P = 0.751). Therefore, we believe that retinoscopy remains the only precise method to evaluate eye refraction.

Retinopathy and nephropathy in type 1 diabetic patients--association with polymorphysms of vitamin D-receptor, TNF, Neuro-D and IL-1 receptor 1 genes.

Retinopathy and nephropathy are common late type 1 diabetes mellitus (T1D) complications. In this study we investigated whether individual differences in 4 candidate genes significantly contribute to development and progression of late complications in T1D patients. We examined 121 patients for the presence of diabetic retinopathy and nephropathy. We genotyped variants in vitamin D receptor (VDR) and tumor necrosis factor (TNF) genes in 47 patients and in NeuroD1 and interleukin-1 receptor 1 (IL1R1) genes in 35 patients. Diabetic retinopathy had 66 (55%) patients after a median of 13.0 years after diagnosis. Diabetic nephropathy had 14 (11.66%) patients, all of whom had already developed retinopathy. A significant correlation between the degree of diabetic retinopathy and mean microalbuminuria (MA) value has been found (chi2 = 54.18, p < 0.001). After correcting for duration of disease, only the VDR gene BsmI genotypes showed significant association with cumulative prevalence of diabetic retinopathy, while no investigated genetic polymorphysms could reliably predict diabetic nephropathy.

Afect of botulinum toxin-A injection on intraocular pressure and proptosis in thyroid associated orbitopathy.

The aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) on intraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy (TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX-A injections were applied. Intraocular pressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2-4 weeks after BTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX-A injection using a Hertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6 +/- 2.8 mmHg and 2-4 weeks after BTX-A injection was 16.9 +/- 3.3 mmH; (p = 0.001). There was no statistically significant difference in Hertel egzophthalmometer readings before and after BTX-A injection, 21.5 +/- 2.7 mm vs. 22.0 +/- 2.6 mm; (p = 0.678). In conclusion, BTX-A injection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influence on proptosis.

Parents' influence on the treatment of amblyopia in children.

Amblyopia in children is a great problem that has to be identified on time and treatment initiated as early as possible to achieve optimal therapeutic result. Therapeutic success depends greatly on the children's parents' collaboration. It was the reason for us to embark upon this study to evaluate the parents' role in amblyopia treatment and their influence on the final therapeutic result. The aim of the study was to assess compliance with therapy prescribed, the degree to which the parents understood their children's health condition, and whether they were satisfied with their child's ophthalmologist. The study included 105 parents divided into three groups of 35 persons according to their educational level. All study parents filled out a questionnaire. The children's visual acuity measured before and after prescribed therapy was compared with the parents' answers to the questions. Among 105 children, post-therapeutic improvement in visual acuity was recorded in 66 (62.8%) children, whereas the rest of 39 (37.1%) children showed no therapeutic success. Statistical analysis yielded no significant difference in the rate of therapeutic success according to parent's educational level (P = 0.61). The best results were obtained in children with highest therapy compliance. It is of utmost importance for the ophthalmologist to gain parents' trust, which then leads them to better compliance with the therapeutic measures prescribed. This mode of approach requires more time, which, unfortunately, may not always be possible due to the great number of visits the ophthalmologist has to cover during working hours. Frequent ophthalmologic follow ups are mandatory to be sure that therapy is performed correctly and to prevent the possible unfavorable effects of noncompliance.

Strabismus incidence in infants born in Split-Dalmatia County 2002-2005.

The aim of the study was to determine the incidence of strabismus in preterm infants born between 2002 and 2005 in Split-Dalmatia County, and to compare it with term infants. Data were collected from Department of Public Health, Split-Dalmatia County and Strabology Outpatient Department, University Department of Ophthalmology, Split University Hospital Center. Strabismus was present in 796 (3.97%) children born between 2002 and 2005. Strabismus was diagnosed in 1.37% of term infants and 17.57% of preterm infants. Various factors can produce disorders in preterm infants, such as diffuse and focal defects of the white brain matter, and disorders of oligodendroglial cells, which may explain the higher incidence of strabismus in preterm infants as compared with term infants.

[The role of clinical and metabolic factors in the genesis and development of diabetic retinopathy]. / Uloga klinickih i metabolickih cimbenika u pojavi i razvoju dijabeticke retinopatije.

AIM: Diabetes is a complex polygenic, auto-aggressive disease caused by many different factors. Diabetic retinopathy is the leading cause of new cases of blindness in people aged between 25 and 65 years (working population) in industrialized countries. The aim was to determine whether disease duration, diabetes type and blood concentrations of some metabolites may be risk factors for the genesis and development of diabetic retinopathy. METHODS: This retrospective study included 402 diabetic patients from the Split-Dalmatia County. Laboratory testing included blood glucose, glycosylated hemoglobin A1c, total cholesterol, HDL and LDL cholesterol fractions, and apolipoprotein A and B concentrations. DISCUSSION: The incidence of diabetic retinopathy is increasing in our region, with nonproliferative form as the most common type. Women suffer more frequently from diabetic retinopathy, those aged 60 being at the highest risk. The genesis of diabetic retinopathy is directly correlated with the type and duration of diabetes. Changes in total cholesterol concentration, especially LDL fraction, and apolipoproteins A and B (especially B) indicate an increased relative risk of developing diabetic retinopathy. CONCLUSION: In our opinion, testing of glycosylated hemoglobin, HDL and LDL cholesterol fractions, and apolipoproteins A and B in the standard follow-up protocol for diabetic patients would significantly contribute to the prevention and reduction of diabetic retinopathy as the most common and most difficult diabetic eye complication.

Doppler-echocardiographic characteristics of left ventricular function in patients with pseudoexfoliation glaucoma: a preliminary report.

Glaucoma is associated with an increased incidence of cardiovascular disease and risk factors. The aim of the study was to assess the left ventricular (LV) function in patients with pseudoexfoliation (PEX) glaucoma using doppler-echocardiographic examinations. Two-dimensional and pulsed Doppler echocardiography of transmitral flow was performed in 21 patients with (PEX) glaucoma and 24 controls. LV systolic contraction and ejection were assessed using the LV ejection fraction (EF) and fractional shortening (FS). LV diastolic filling assessed parameters were: early, fast diastolic filling (E wave), late diastolic filling (A wave), ratio E/A, velocity time integral E wave (VTIE) and A wave (VTIA), their ratio (VTIE /VTIA), pressure at the end of filling (LVEDP) and a pulmonary capillary wedge pressure (PCWP). A significant difference was found concerning LV filling flow parameters in E, E/A, VTIA and ratio VTIA/ VTIE. No significant difference was found in EF, FS, A, VTIE, LVEDP and PCWP tested parameters. Our study indicates the possibility of slightly impaired diastolic function of LV in patients with PEX glaucoma assessed by Doppler-echocardiographic examinations.

Bilateral cortical blindness--Anton syndrome: case report.

The aim of this work is the specify of rare neurological disorder, bilateral cortical blindness and Anton syndrome. It is about loss of vision in the presence of intact anterior pathways and a form of visual anosognosia, with resulting patient denial of blindness. This is a case of 72-year old man with history of diabetes and hypertension. Diagnosis is based on the exclusion of disease in the anterior visual tract by history and complete neuro-ophthalmological and radiological evaluation.