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.

[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.

Modern approach to topical treatment of aging skin.

The main processes involved in skin aging are intrinsic and extrinsic. Apart from them, so called stochastic aging connotes cell damage caused by metabolic processes, free radicals and cosmic irradiation. The clinical expression of intrinsic aging include smooth, dry, and thinned skin with accentuated expression lines. It is inevitable and time dependent. Extrinsically aged skin shows signs of photodamage which include appearance of wrinkles, pigmented lesions, actinic keratoses and patchy hypopigmentations. Therapeutic modalities imply photoprotection with sunscreens that prevent sunburns and block ultraviolet irradiation. Other modalities include use of retinoids which regulate gene transcription with subsequent cellular differentiation and proliferation. The topical and peroral administration of network antioxidants, such as vitamin E and C, coenzyme Q10, alpha-lipoic acid and glutathione, enhance antiaging effect. The other antioxidants such as green tea, dehydroepiandrosterone, melatonin, selenium and resveratrol, have also antiaging and anti-inflammatory effects. Topical bleaching agents such as hydroquinone, kojic acid and azelaic acid can reduce signs of aging. Studies confirm the efficacy of these topical agents in combination with superficial and/or medium depth or deep peeling agents for photodamaged skin treatment. Indications for type of chemical peels according to various clinical diagnosis are done, as well as advantages and disadvantages of different types of chemical peels.

[Frequency and characteristics of dyspepsia in coronary artery disease patients]. / Ucestalost i karakteristike dispepsije u bolesnika s koronarnom bolescu srca.

The aim of the study was to determine the frequency of functional and organic dyspepsia and possible predictors for organic dyspepsia in coronary artery disease (CAD) patients. The 150 patients (109 men; mean age 62.61 +/- 10.23 yr) undergoing coronary artery by-pass grafting because of stable pectoral angina due to significant CAD were enrolled in the study. Dyspepsia was determined by the existence of epigastralgy, heartburn, nausea and vomiting. Dyspepsia with endoscopic lesions was defined as organic, and dyspepsia with normal endoscopy was defined as functional. Multivariate analysis (logistic regression) was used to estimate predictive values of some independent clinical and demographic variables in relation to organic dyspepsia (dependent variable). One hundred thirty-five (90%) patients had at least one symptom of dyspepsia. Eighty five patients (63%) had organic dyspepsia, and 50 (37%) patients had functional dyspepsia (P < 0.001). Patients with organic dyspepsia had more dyspeptic symptoms than patients with functional dyspepsia (1.92 +/- 0.88 vs. 1.38 +/- 0.87, P < 0.001). More dyspeptic symptoms correlated with heavy GD lesions (r = 0.267; P < 0.0001). Multivariate analysis revealed independent correlation of consuming low-dose aspirin (standardized coefficient beta = 11.701, P = 0.004), diabetes (beta = 2.921, P = 0.027), cigarette smoking (beta = 2.910, P = 0.037) and nausea (beta = 3.620, P = 0.015) with organic dyspepsia. The study showed high frequency of dyspepsia, especially organic dyspepsia, in CAD patients. Three or more dyspeptic symptoms, low-dose aspirin, cigarette smoking, diabetes and nausea, increased the probability of organic dyspepsia. Therefore, for patients with combination of dyspeptic symptoms and present risk factors the endoscopic examination should be considered.

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.

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.

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.