Comparison of efficacy and safety of parenteral versus parenteral and oral glucocorticoid therapy in Graves' orbitopathy.

BACKGROUND/AIMS: The most effective and safe treatment protocol for Graves' orbitopathy (GO) needs to be further assessed. The aim of the present study was to evaluate the efficacy, safety and outcome of parenteral versus parenteral and oral glucocorticoid (GC) protocols in euthyroid patients with untreated and active moderate to severe GO. METHODS: This was a retrospective observational study in 140 patients comparing intravenous GC pulses only (IVGC group, 74 patients, 51 ± 11 years) with historical controls of combined oral and intravenous GC therapy (CombGC group, 66 patients, 49 ± 10 years, P = ns). IVGC therapy included infusions of 500 mg of methylprednisolone weekly for the first six weeks, followed by infusions of 250 mg weekly for the remaining six weeks (cumulative dose 4.5 g). CombGC therapy included 500 mg of methylprednisolone in 500 mL of saline solution for two alternative days, followed by oral prednisone tapering dose repeated each month for the next 5 months (cumulative dose 10.2 g). RESULTS: The overall success of the treatment was 43/66 (65%) in the CombGC group and 37/73 (51%, P = .071) in the IVGC group. Deterioration of GO developed in four (6%) patients during CombGC therapy and in nine (12%, P = .214) patients during IVGC therapy. After 6 months, relapse of GO was observed in 10/37 (26%) in the IVGC group, whereas none of the patients in CombGC had a relapse (P < .001). There were significantly more side effects in the CombGC versus IVGC group (49/66, 74% vs 28/74, 38%, P < .001). CONCLUSIONS: Our data suggest that CombGC therapy was more efficient with significantly less relapse rate, but with more side effects in comparison to IVGC therapy.

Is the Use of Refrigerated Fixed Combination of Dorzolamide 2%-Timolol 0.5% (COSOPT) Associated with Less Ocular Discomfort: A Pilot Study.

PURPOSE: To test the hypothesis that the use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% solution (COSOPT®) is associated with less ocular discomfort compared with the use of this solution kept at room temperature. METHODS: In this prospective comparative study, 30 primary open-angle patients and 30 healthy subjects filled in the questionnaire on symptoms (Ocular Surface Disease Index) and subjective stinging feeling scale (1-10), at the start of study and 30 days after continuous use of refrigerated fixed combination or placebo eye drops. Results were processed by applying the methods of descriptive (arithmetical mean, standard deviation) and analytical statistics for evaluation of significance of the difference (Student's t-test). RESULTS: Ocular discomfort parameters were significantly lower after the use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% solution (t-test, P < 0.0001). Breakup time, Schirmer 1 test, and intraocular pressure values did not differ. CONCLUSIONS: The use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% (COSOPT) solution is associated with less ocular discomfort than the use of the same fixed combination at room temperature.

Determination of olopatadine in human tears by hydrophilic interaction liquid chromatography-MS/MS method.

AIM: The objective of the study was development of hydrophilic interaction liquid chromatography-ESI/MS/MS method for the determination of olopatadine in tear matrix. MATERIALS & METHODS: Separation was performed on Acquity BEH amide column (2.1 × 100 mm, 1.7 µm). The mobile phase was consisted of 0.1% formic acid in water and acetonitrile. Mianserin hydrochloride was implemented as an internal standard. The artificial tear fluid was used as matrix. The tear samples were collected using Schirmer test strips. For the optimization of ultra pressure liquid chromatography conditions, Box-Benhken design was utilized. RESULTS: The optimal values of the ion source and collision cell parameters were found. Quantification was performed in multiple reaction monitoring mode. The optimized method was fully validated. CONCLUSION: The proposed method was utilized for monitoring of olopatadine in human tear.

Bilateral ocular panadnexal mass as initial presentation of systemic blastoid variant of mantle-cell lymphoma.

A 66-year-old man developed a slowly enlarging, bilateral, painless, periorbital, and orbital swelling with ptosis, nonaxial proptosis, chemosis, exposure keratopathy, and decreased vision in both eyes. He had fever, night sweats, and weight loss (B-symptoms), along with lymphadenopathy and elevated serum lactate dehydrogenase, with no prior history of lymphoma. A transpalpebral incisional biopsy revealed a rare case of mantle-cell lymphoma of blastoid variant, stage IVB. The main immunophenotype characteristics were cyclin D1+, CD5+, CD10-, CD23-, Bcl-6-/+, and a high (up to 80%) Ki-67 proliferation index. Following an excellent response to the immune-chemotherapy treatment plan, all ocular adnexal lymphoma manifestations disappeared completely; however, 13 months after the initial presentation, there was a recurrence of the disease with rapid worsening and death. The blastoid variant of mantle cell lymphoma, a rare subtype of mantle-cell lymphoma, is a highly aggressive neoplasm, ultimately having a fatal outcome. As the initial manifestation of the disease, ocular adnexal region blastoid variant of mantle-cell lymphoma is an exceptional event, with only one previous case reported.

Clinical significance of routine lacrimal sac biopsy during dacryocystorhinostomy: A comprehensive review of literature.

The main purpose of this paper is to provide the information about the incidence and types of pathology of secondary acquired obstructions of the lacrimal excretory outflow system caused by primary lacrimal sac non-neoplastic and neoplastic lesions. After a thorough literature search, 17 case-control studies were found and selected, data were extracted and categorized, to evaluate specific lacrimal sac pathology mimicking inflammation. A total of 3865 histopathologically examined lacrimal sac wall biopsy specimens from 3662 patients, taken during dacryocystorhinostomy for clinically presumed primary chronic dacryocystitis, were analyzed. The most common reported histopathological finding was non-specific chronic inflammation with or without fibrosis (94.15% of cases). Lacrimal sac-specific pathologies were present in 226 (5.85%) cases. Unsuspected lacrimal sac-specific pathologies were present in 55/226 (24.34%) cases. Almost 45% of primary lacrimal sac malignant neoplasms were not suspected, preoperatively and intraoperatively. Tumor-like lesions of the lacrimal sac were the most common pathology found: (1) lacrimal stones-dacryoliths, (2) pyogenic granuloma, (3) granulation tissues, (4) reactive lymphoid hyperplasia, and (5) lacrimal sac-specific inflammation (Wegener's granulomatosis and sarcoidosis). Neoplastic pathology was found in 55/3865 (1.42%) lacrimal sac wall biopsy specimens; of those, malignant cases were 2.24 times more frequent than benign. Lymphoma was the most common preoperatively unsuspected or intraoperatively unexpected neoplastic pathology. This analysis of the relevant literature highlights the value of routine lacrimal sac biopsy during surgery for clinically presumed primary acquired nasolacrimal duct obstruction.

Quantitation of brinzolamide in dried blood spots by a novel LC-QTOF-MS/MS method.

In the current study, a rapid and sensitive LC-QTOF-MS/MS method for the determination of brinzolamide in dried blood spots (DBS) was developed and validated. This novel sample collection, storage and transfer technique was suitable for analyzing a drug with high distribution into red blood cells and negligible plasma levels. The method included an isocratic mobile phase consisting of methanol and 10mM ammonium formate (90:10, v/v) and detection in positive electrospray mode (ESI+). The flow rate was adjusted to 0.350mL/min yielding retention times of 1.7min for both brinzolamide and internal standard (IS) rabeprazole on a Cyano analytical column, respectively. The validation of the proposed method over the concentration range 0.500-20.0µg/mL was performed in compliance with EMEA and FDA guidelines, assessing all major performance characteristics. Inter- and intra- assay precisions were less than 14%, while inter- and intra- assay accuracies varied from 92.2 to 111%. No matrix effect was observed and the mean brinzolamide extraction recovery was 93.5%. The method was successfully applied to real DBS samples from patients in steady state condition, receiving brinzolamide ophthalmic suspension 1% (w/v) for several months. Initial concentrations were corrected due to hematocrit effect, using image processing algorithm written in Matlab.

PREGO (presentation of Graves' orbitopathy) study: changes in referral patterns to European Group On Graves' Orbitopathy (EUGOGO) centres over the period from 2000 to 2012.

BACKGROUND/AIMS: The epidemiology of Graves' orbitopathy (GO) may be changing. The aim of the study was to identify trends in presentation of GO to tertiary centres and initial management over time. METHODS: Prospective observational study of European Group On Graves' Orbitopathy (EUGOGO) centres. All new referrals with a diagnosis of GO over a 4-month period in 2012 were included. Clinical and demographic characteristics, referral timelines and initial decisions about management were recorded. The data were compared with a similar EUGOGO survey performed in 2000. RESULTS: The demographic characteristics of 269 patients studied in 2012 were similar to those collected in the year 2000, including smoking rates (40.0% vs 40.2%). Mild (60.5% vs 41.2%, p<0.01) and inactive GO (63.2% vs 39.9%, p<0.01) were more prevalent in 2012. The times from diagnosis of thyroid disease to being seen in EUGOGO centres (6 vs 16 months) and from first symptoms of GO (9 vs 16 months) or from diagnosis of GO (6 vs 12 months) to first consultation in EUGOGO centres were shorter in 2012 (p<0.01). The initial management plans for GO were no different except surgical treatments for patients with mild inactive disease were more frequently offered in the 2012 cohort than in 2000 (27.3% vs 17%, p<0.05), and selenium supplements were offered only in the 2012 cohort (21.2% vs 0%, p<0.01). CONCLUSIONS: These findings suggest that the clinical manifestations of patients with GO may be changing over time in Europe.

Methicillin-resistant Staphylococcus aureus biofilm formation on dacryocystorhinostomy silicone tubes depends on the genetic lineage.

PURPOSE: The aim of this study was to investigate biofilm formation on silicone tubes by genetically diverse methicillin-resistant Staphylococcus aureus (MRSA) strains. METHODS: Capacity of biofilm formation on dacryocystorhinostomy silicone tubes was tested on 30 MRSA strains. Identification and methicillin resistance were confirmed by PCR for nuc and mecA genes. Strains were genotypically characterised (SCCmec, agr and spa typing). Biofilm formation was tested in microtiter plate and on silicone tubes. RESULTS: Tested MRSA strains were classified into SCCmec type I (33.3%), II (3.3%), III (20.0%), IV (26.7%) and V (16.7%), agr type I (56.7%), II (36.7%) and III (6.6%), and eight spa clonal complexes (CCs). All tested MRSA strains showed ability to form biofilm on microtiter plate. Capacity of biofilm formation on silicone tubes was as follows: 33.3% of strains belonged to the category of low biofilm producers, and 66.7% to moderate biofilm producers. There was statistically significant correlation between spa CC and the category of biofilm production on silicone tubes (p = 0.01): CC5 and CC45 with moderate amount of biofilm, and CC8 with low amount of biofilm. A moderate amount of biofilm formed on silicone tubes correlated with agr type II MRSA strains (p = 0.008). CONCLUSIONS: Biofilm formation by MRSA on silicone tubes is highly dependent on genetic characteristics of the strains. Therefore, MRSA genotyping may aid the determination of the possibility of biofilm-related ocular device infections. Genotyping and biofilm quantification may be helpful in determining when decolonisation and cohort isolation are required to prevent device-related infections.

Efficacy and safety of combined parenteral and oral steroid therapy in Graves' orbitopathy.

OBJECTIVE: Glucocorticoids (GC) are the treatment of choice for moderate-to-severe and active Graves' orbitopathy (GO), but optimal treatment is still . The aim of the present study was to analyze the efficacy and tolerability of combined parenteral GC pulse therapy followed by oral GC in the interpulse period. DESIGN: The study included 50 patients (48 ± 10 years; 37 female) with untreated, active and moderate-to-severe GO. Patients received 500 mg of methylprednisolone in 500 ml of physiologic saline. Infusion was repeated after 48 h and then followed by tapering doses of oral prednisone and the cycle repeated each month for the next 5 months. The cumulative dose was 10.2g.Ophthalmic assessment was performed before and 6 months after start of treatment. Side effects of GC therapy were evaluated and recorded each month. RESULTS: GC showed the greatest effectiveness on soft tissue changes (incorporated in the CAS). Median CAS values decreased from 4.5 to 2 (p>0.001). Improvement was demonstrated in 37 patients (74%), there was no change in 13 patients (26%) and none of the patients presented with deterioration of inflammatory status. Diplopia improved in 21 patients (42%), was unchanged in 28 patients (56%) and deteriorated in 1 patient (2%). Improvement in visual acuity occurred in 36% of patients. At 6 months, 33/50 patients (66%) demonstrated overall treatment response. Response to GC therapy was influenced by CAS, TSHRAb and smoking behavior. The only independent parameter associated with positive treatment response was CAS ≥ 4 (p<0.001). Side effects occurred in 35/50 patients (70%) and the vast majority of them were mild to moderate. During the 6-months follow-up period, 2/33 patients (6%) had relapsing GO. CONCLUSION: With appropriate selection of patients and careful monitoring during and after treatment, combined parenteral and oral GC therapy is effective and safe.

Mechanical eye injuries in children aged 0-15 years treated at the clinic of eye diseases in Belgrade: frequency, causes and preventive measures.

INTRODUCTION: Eye injuries represent a significant problem in children. OBJECTIVE: The aim of the study was to determine the incidence and causes of the eye injury and to propose measures of the eye injury prevention in children up to 15 years of age. METHODS: This was a retrospective study of 552 children with the eye injuries treated at the Clinic of Eye Diseases in Belgrade during the period March 1999 to February 2010. Gender and age of the children, time of injury, the type and site of injuries, visual acuity upon admission and at discharge, as well as the time of surgery in relation to time of injury were analysed. RESULTS: The ratio between the injured boys and girls was 3.6:1.The highest percentage of injured children was in the group 6-10 years old (39.7%); the injuries were almost evenly distributed according to months during the year and days during the week. The percentages of severe closed and open injuries of the eyeball were almost equal. Visual acuity upon discharge and subsequent follow-up examinations were significantly improved after the applied treatment in comparison with the visual acuity upon admission. CONCLUSION: Eye injuries in children still represent a severe health problem. Regarding the youngest age group of children, adults are mainly responsible for these injuries due to their lack of attention, while in older children these injuries are the result of the production and distribution of inappropriate toys and a failure to implement the legal traffic regulations applicable to children.The prevention of eye injuries is essential.

Causes of eye removal--analysis of 586 eyes.

BACKGROUND/AIM: Eye enucleation is one of the oldest surgical procedures. The aim of the study was to determine the causes of enucleation as seen in a major reference eye center in Serbia. METHODS: Retrospective case series involving a review of all enucleation procedures performed in the period between January 2000 and December 2008 at the Institute for Eye Diseases, Clinical Center of Serbia, Belgrade. The collected information included the basic demographic data and, diagnosis of the affected eye. The diagnosis was made based on history, clinical and histological examinations. Clinical indications for enucleation were categorized as tumors, glaucoma, trauma, infections and other diseases. A statistical analysis was made using the Student's t-test. RESULTS: There were 586 patients, 315 male and 271 female in our series. The mean age was 57.81, ranging from 3 months to 96 years. The most common cause of enucleations was tumor (76.11%), (p < 0.05). Choroid melanoma was the most common etiology leading to enucleation (81.18%), followed by retinoblastoma (12.34%). A total of 8.02% of enucleations were performed due to glaucoma that was primarily neovascular in 42.55% of cases or caused by trauma in 38.8% of cases. Trauma was the third common etiology of enucleation, and it was acute in 56.26% of cases or resulted in phthisis bulbi in 31.25% of cases. Enucleation caused by inflammation was performed in 2.90% of cases, out of which 52.94% of enucleations occurred after perforation of the cornea. In the group of other diseases the most common cause of enucleation was atrophy of the eye ball. CONCLUSION: Neoplasm, neovascular glaucoma, acute eye injury and atrophy of the eye ball are the most common causes of enucleation.

Ocular pulse amplitude in patients with thyroid-associated ophthalmopathy.

PURPOSE: To determine ocular pulse volume values in patients with thyroid-associated ophthalmopathy with normal intraocular pressure, and to test the hypothesis that changes in orbital tissue that accompany thyroid-associated ophthalmopathy can in turn give changes in choroidal perfusion.
 METHODS: In a prospective study, we evaluated 30 eyes of 30 consecutive patients with TAO, and 30 eyes of 30 healthy subjects. Complete ophthalmologic examination including dynamic contour tonometry was done. Possible differences in ocular parameters between the tested groups were assessed.
 RESULTS: . No significant difference was found in ocular pulse volume values between the tested subjects (paired test p=0.23).
 CONCLUSIONS: . The orbit tissue changes that are involved in thyroid-associated ophthalmopathy do not have much implication on choroidal perfusion, at least when intraocular pressure values remain within the normal range.

[Orbital decompression in Graves' orbitopathy].

INTRODUCTION: This paper was aimed at presenting our experience and results in the surgical management for proptosis in patients with Graves' orbitopathy. MATERIAL AND METHODS: This is a retrospective, interventional, non-comparative case series review. Seventeen eyes often patients underwent orbital decompression between 2008 and 2009. Depending on case, the surgery involved one to 3 orbital walls with or without fat removal, being approached through combined transcaruncular and lower fornix incision. RESULTS: All the operated patients were females, their mean age being 48, with proptosis ranging from 21 to 28 mm, and 18 to 22 mm three months after surgery. A mean reduction in proptosis of 4.59 +/- 1.58 mm was attained. Intra-operative course was uneventful and post-operatively transient infraorbital hypoesthesia was seen in twelve patients (70.57%). CONCLUSION: Orbital decompression proved to be a safe, reliable and effective way to reduce proptosis provided that the procedure is carefully planned and properly performed.

Comparison of postoperative pain and satisfaction after dacryocystorhinostomy in patients operated on under local and general anesthesia.

BACKGROUND: There has been only 1 study on postoperative pain after external dacryocystorhinostomy (DCR) that compared pain between 2 groups of patients; 1 group received local anesthesia and the other received general anesthesia. To further characterize the relationship between these 2 types of anesthesia and postoperative pain, we designed a study in which a single patient received these 2 different anesthesia modalities for a short interval on 2 different sides. MATERIAL/METHODS: There were 50 participants in this study. External DCR was performed on the same participant on both sides using local anesthesia on 1 side and general anesthesia on the other. Postoperative pain was measured using the visual analogue scale (VAS), and localization and timing of pain were reported by the participants. Postoperative nausea and vomiting (PONV) were documented if present. RESULTS: Pain levels were significantly higher with general anesthesia 3 hours post-surgery, and 6 hours post-surgery the pain remains higher following general anesthesia but is borderline insignificant (p=0.051). However, 12 hours post-surgery, there is no significant difference in the pain level (p=0.240). There was no significant difference in the localization of pain with local and general anesthesia. Postoperative nausea is significantly more frequent after general anesthesia, and vomiting only occurs with general anesthesia. Local anesthesia was preferred by 94% of the participants (47 out of 50). CONCLUSIONS: The vast majority of patients in our study who have undergone both GA and LA DCR would choose LA again, providing a compelling case for use of the LA technique.

A 7-year prospective study of routine histopathological evaluation of the lacrimal sac wall incisional biopsy specimens obtained during external dacryocystorhinostomy in adults and a review of the literature.

The most common lacrimal sac pathology is chronic inflammation with or without occlusive fibrosis. However, a substantial number of lacrimal sac-specific pathologies were reported throughout the literature which may mimic chronic inflammation and be misdiagnosed. From a tertiary ophthalmic care centre in Serbia, in a single ophthalmic pathology laboratory, during a 7-year period (January 2004 to October 2010), a 599 consecutive lacrimal sac wall biopsy samples routinely obtained during external dacryocystorhinostomy in adult patients with clinically presumed primary acquired lacrimal drainage system obstruction were analysed. Although non-specific lacrimal sac pathology was present in the vast majority of cases (578 biopsy specimens; 96.49%), this report also reveals a relatively substantial number (21 biopsy specimens; 3.51%) of clinically non-suspected or intraoperatively unexpected primary lacrimal sac-specific pathology--among them, six lesions with malignant biological behaviour were identified: one microinvasive squamous cell carcinoma and five malignant lymhoproliferative lesions. Usefulness of routine lacrimal sac wall biopsy during surgery for primary acquired lacrimal drainage system obstruction is undoubtful and commensurate with the constant need for better understanding of the pathological processes that involve lacrimal drainage system.

Ocular injuries caused by airsoft guns - ten-year experience.

INTRODUCTION: The study describes ocular injuries caused by airsoft guns pellets, type of these injuries and their incidence in different age groups. METHODS: This is a retrospective review of medical charts of patients who were hospitalized due to airsoft guns ocular injuries in ten-year period (from 2000 to 2009). Patient's age, gender, duration of hospitalization, type of treatment and initial and final visual acuity were analyzed. RESULTS: Overall 92 patients with ocular injuries caused by airsoft gun pellets were hospitalized in ten-year period. In all patients only one eye was injured and there were 72 (78.3%) male patients. Injuries involved ocular adnexa, anterior and posterior segment of the eye. On initial examination 41 (44.6%) patients were presented with subconjunctival hemorrhages, 42 (45.6%) with corneal abrasion, 42 (45.6%) patients had corneal edema, 6 (6.5%) had traumatic mydriasis, 90 (97.8%) patients exhibited hyphema, 10 (10.9%) iridodialysis, in 27 (29.3%) patients high intraocular pressure (IOP) was measured, one patient had subluxation of intraocular lens (IOL) and one patient had traumatic cataract. Posterior segment findings included vitreous hemorrhage in 3 (3.3%) patients, retinal hemorrhage in 15 (16.3%) patients, retinal edema in 35 (38.0%) patients and one patient had globe rupture. Average duration of hospitalization was 5.7 days (range from 1 to 18 days). Three patients (3.3%) required eye surgery, eight patients (8.7%) had anterior chamber washout while rest of the patients were conservatively managed. Visual acuity at hospital release was significantly improved comparing to initial visual acuity, ranging from counting fingers at 1 meter to 20/60 in 7 (8.6%) patients, from 20/50 to 20/30 in 13 (16.0%) patients and from 20/25 to 20/20 in 61 (75.3%) patients. In 11 patients testing the visual acuity was not possible because of their young age. CONCLUSION: Injuries attributed to airsoft guns were confined mostly to anterior segment. There was also high percentage of severe posterior segment trauma requiring hospital admission. The most important factors in preventing such injuries are restricting access to airsoft guns, especially to minors, as well as mandatory use of protective equipment such as protective eyeglasses.

Pain during external dacryocystorhinostomy with local anesthesia.

BACKGROUND: External dacryocystorhinostomy (DCR) is often performed under local anesthesia (LA) without adequate knowledge of the pain experienced by the patient. MATERIAL/METHODS: We subdivided our surgical technique into stages easily understood by the patients (introducing cotton tipped applicators, performing parabulbar injection, creating the incision, bone cracking (opening the ostium), manipulating the nose, intubating, closing the wound, and packing with gauze). A total of 50 patients ranging in age from 31 to 83 years of age (63.64±9.64) underwent external DCR. Each patient was asked 30 minutes after surgery to indicate the intensity of pain experienced at each stage of the surgery and during intramuscular (i.m.) injection of an antibiotic using a visual analog scale (VAS). RESULTS: Analysis of the VAS-based pain scores indicated 3 statistically equal occurrences of pain coinciding with the opening of the ostium, and receiving both parabulbar anesthetic and i.m. antibiotic injections. CONCLUSIONS: The level of pain experienced during the most unpleasant stage of external DCR (ostium opening) was similar to the pain experienced from an i.m. injection. Patients can be informed that pain during external DCR with local anesthesia is comparable to receiving an i.m. gluteal injection.

Simultaneous injuries to both eyes in traffic accidents.

BACKGROUND: In traffic accidents, eye injuries occur as isolated or with polytrauma. They may involve just one eye, but simultaneous injuries to both eyes do happen occasionally. The aim of our paper was to reveal the risk factors, in an effort to reduce the number of such accidents and to prevent bilateral ocular damage. METHODS: All patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, due to traffic accidents with bilateral eye injuries in a period of 9 years from the beginning of 2000 to the end of 2008 were analyzed. RESULTS: In this 9-year period, a total of 36 patients were hospitalized and treated for bilateral ocular injury (72 eyes). There were 23 males among them, the male-female ratio being 1.8:1. Mean age was 33.9 years. The occupations of injured persons were the following: the most common were workers--15, followed by clerks--seven, while less common were pupils, students, pensioners and housewives-three of each of them, and farmers--two. Front-seat passengers were the most common among the injured--20 (55.6%), then drivers--15 (41.7%), with only one passenger from the back seat on the right side (2.7%). As many as 33 (91.7%) of them failed to fasten their seat belts, while 18 (50.0%) were drunk. Penetrating bulbar injuries or eyeball ruptures were predominant--66.7%, while blunt injuries were found in only two (2.8%) eyes in one single person; but in 22 cases (30.5%) there was adnexal damage, too. Visual acuity at discharge and subsequent controls was as follows: amaurosis in 21 (29.2%), less than 0.3 in nine (5.6%), 0.4 and better in 42 (58.1%), and normal visual acuity of 1.0 in 28 patients (38.3%). CONCLUSION: The major risk factors for getting bilateral eye injuries in traffic accidents proved to be: sitting in the front car seats, not fastening the seat belt and alcohol intoxication. Prevention of these risk factors would result in a decrease in such a large number of bilateral eye injuries.

Changes in the retrobulbar arterial circulation after decrease of elevated intraocular pressue in patients with primary open angle glaucoma.

INTRODUCTION: An altered perfusion of the optic nerve head has been proposed as a pathogenic factor in glaucoma. OBJECTIVE: To evaluate changes of haemodynamic parameters in the retrobulbar arterial circulation after a decrease of elevated intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG). METHODS: Twenty-six patients were examined, 14 men and 12 women, 21 up to 50 years old and 5 below, all with previously diagnosed and treated POAG, and all examined at the Eye Clinic, Clinical Centre of Serbia. IOP was measured both with a Goldmann aplanation tonometer and dynamic contour tonometer. Central corneal thickness was measured with ultrasound pachymeter. Imaging of the retrobulbar arterial circulation by colour Doppler was performed at the Neurology Clinic, Clinical Centre of Serbia. It involved measuring of haemodynamic parameters of the ophthalmic artery, central retinal artery, and posterior ciliary arteries. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) and pulsatility index (PI) were calculated. RESULTS: Haemodynamic arterial parameters PSV and EDV in the ophthalmic and central retinal artery after decrease of IOP were lower, while RI and PI were higher. In the posterior ciliary arteries PSV, EDV and PI were lower, and RI was higher. CONCLUSION: Changes of the retrobulbar arterial circulation after elevated LOP in POAG patients are important for approach and treatment, while the role of vascular factors in the supplement of the optic disc neuroretinal rim could be a key for progression backlash of glaucoma and the radix of neuroprotection.