EFFICACY OF CYCLOCRYOTHERAPY AND TRANSSCLERAL DIODE LASER CYCLOPHOTOCOAGULATION IN THE MANAGEMENT OF REFRACTORY GLAUCOMA.

Treating advanced glaucoma often requires numerous therapeutic modalities in order to achieve the desired intraocular pressure (IOP) reduction. The purpose of this study was to evaluate the IOP lowering efficacy of both cyclocryotherapy (CCT) and transscleral diode laser cyclophotocoagulation (TS-DCPC) in the management of refractory primary open-angle glaucoma. This prospective, randomized, controlled clinical trial included 40 patients (40 eyes) with refractory glaucoma treated at the Eye Department, Clinical Center of Vojvodina, Novi Sad, Serbia, between January 2016 and June 2019. Twenty patients underwent CCT (group 1), while another twenty patients were treated with TS-DCPC (group 2). Each patient underwent complete eye examination on the treatment day, as well as follow-up eye examinations 7 days and 1, 6 and 12 months after the intervention, when IOP and number of anti-glaucoma drugs used were recorded. The median baseline IOP was 36.50 mm Hg (IQR, 28.75-42.00) in group 1 and 27.00 mm Hg (IQR, 22.00-35.00) in group 2. Follow-up measurements of IOP in group 1 showed the following results: 16.50 mm Hg (IQR, 7.75-20.00) (60% decrease from the baseline value), 12.00 mm Hg (IQR, 9.25-18.00) (67% decrease from the baseline value), 9.00 mm Hg (IQR, 2.00-13.75) (73% decrease from the baseline value), and 9.50 (IQR, 2.50-12.00) (75% decrease from the baseline value) after 7 days, 1, 6 and 12 months, respectively. Follow-up measurements of IOP in group 2 showed the following results: 16.00 mm Hg (IQR, 10.00-17.00) (48% decrease from the baseline value), 14.00 mm Hg (IQR, 10.00-16.00) (56% decrease from the baseline value), 14.00 mm Hg (IQR, 12.25-16.50) (43% decrease from the baseline value) and 14.00 mm Hg (IQR, 11.25-15.75) (53% decrease from the baseline value) after 7 days, 1, 6 and 12 months, respectively. The mean number of antiglaucoma drugs used decreased from 4 to 0.65±0.81 and 2.25±1.07 in groups 1 and 2, respectively. In conclusion, study results confirmed the CCT and TS-DCPC to have a rapid and statistically significant ocular hypotensive effect in eyes with refractory glaucoma at one-year follow-up.

The role of apraclonidine in Horner's syndrome ­ A case report.

Introduction: Horner's syndrome is an interruption of the sympathetic nervous system at any point along its course between the hypothalamus and the orbit. Horner's syndrome is classically presented as an ipsilateral miosis, subtle ptosis, and facial anhidrosis. Pharmacologic testing is very useful in the diagnosis of Horner's syndrome as it could help to localize the lesioned neuron in the sympathetic pathway, suggesting an etiology. Case Outline: We present a case report of a 41-year-old woman who reported right eyelid drooping immediately after operation of sympathetic chain schwannoma. We performed apraclonidine test for the diagnosis of Horner's syndrome, which produced mydriasis on the affected eye, while there was no significant change of the normal eye. Based on the clinical presentation of anisocoria and one-sided ptosis, and previous medical history of surgical removal of the mediastinal tumor, the patient was diagnosed with a right-sided, partial Horner's syndrome. Conclusion: Timely recognition, exact localization of the lesioned neuron, and referral for urgent imaging studies are important for ophthalmologists in order to prevent and treat life-threatening conditions. Besides its diagnostic value in Horner's syndrome, topical apraclonidine could correct ptosis for the sake of esthetics or when ptosis reduces the superior visual field.

Severe vaso-occlusive retinopathy associated with systemic lupus erythematosus.

Introduction: Systemic lupus erythematosus (SLE) is a systemic idiopathic autoimmune inflammatory disease, with multiple organ involvement. Severe vaso-occlusive retinopathy is a rare, sight threatening lupus-related manifestation of the disease, which is more common in patients with coexisting antiphospholipid syndrome. Case report: We reported a 36-year-old female with severe vaso-occlusive retinopathy that manifested in the absence of antiphospholipid syndrome. In a 4-year follow-up, despite aggressive systemic corticosteroid and immunosuppressive therapy and panretinal laserphotocoagulation treatment, the disease progressed to retinal neovascularisation, neovascular vitreoretinopathy, neovascular glaucoma and, consecutively, severe visual loss. As the final option for preservation of visual function, pars plana vitrectomy with laserphotocoagulation was performed and had good results. Progression of ophthalmological findings indicated the progression of the systemic disease, as well as neurolupus. Conclusion: Severe vaso-occlusive retinopathy occurred as the ophthalmological manifestation of SLE in the absence of antiphospholipid syndrome, but correlated with neurolupus and led to visual deterioration despite the treatment.

ENERGY SYSTEMS IN SURGERY.

INTRODUCTION: The systems of energy in surgery are applied in order to achieve better and more effective performing of procedures. Whereas various energy sources, including electricity, ultrasound, laser and argon gas, may be used, the fundamental principle involves tissue necrosis and hemostasis by heating. ELECTRO SURGERY: Electro Surgery is a surgical technique by which surgical procedures are performed by focused heating of the tissue using devices based on high-frequency currents. It represents one of the most frequently used energy systems in laparoscopy. ULTRASOUND ENERGY: The basic principle of operation of the ultrasound surgical instruments is the usage of low-frequency mechanic vibrations (ultrasound energy within the range of 20-60 kHz) for cutting and coagulation of tissue. LASER: Laser is the abbreviation for Light Amplification by Stimulated Emission of Radiation, aimed at increasing light by stimulated emission of radiation and it is the name of the instrument which generates coherent beam of light. ARGON PLASMA COAGULATION: It has been in use since 1991 for endoscopic hemostasis. It uses high-frequency electric current and ionized gas argon. The successful application of devices depends on the type of surgical procedure, training of the surgeon and his knowledge about the device. Surgeons do not agree on the choice of device which would be optimal for a certain procedure. CONCLUSION: The whole team in the operating room must have the basic knowledge of the way an energy system works so as to provide a safe and effective treatment of patients. The advantages and shortcomings of different systems of energy have to be taken into account while we use a special mode.

PHARMACOLOGICAL INTRAVITREAL TREATMENT FOR MACULAR EDEMA IN BRANCH RETINAL VEIN OCCLUSION - THREE-MONTH RESULTS.

INTRODUCTION: Macular edema is the main cause of visual loss in patients with branch retinal vein occlusion. Macular edema is initially reversible, but over time, permanent loss ofvision occurs from structural damage to the macula. For this reason, there is a need for more rapid and effective treatments than laser photocoagulation which has been established as a gold standard. There are several pharmacologic agents which have changed the management of macular edema. MATERIAL AND METHODS: Twenty eyes of 20 consecutive patients of the Department of Eye Diseases, Clinical Center of Vojvodina, in Novi Sad, were enrolled in this prospective, randomized and consecutive study conducted from January 2012 to January 2013. The patients were randomly assigned into two treatment groups, and they were given an intravitreal injection of bevacizumab 1.25 mg/0.05 mL (Avastin®), or triamcinolone acetonid injection 4 mg/0.1 mL (Kenalog®). Reinjections were performed according to the following retreatment criteria a loss of visual acuity or increase in central retinal thickness. RESULTS: Both intravitreal bevacizumab and triamcinolon-acetonid were very effective in reducing macular edema and improving visual acuity in the eyes with macular edema secondary to retinal vein occlusion. The effect of the treatment was more pronounced if it started early after the onset of macular edema. The reported temporary effects of intravitreal triamcinolon-acetonide and bevacizumab could be explained by their clearance from the eye. CONCLUSION: The short-term results of our clinical trial showed that pharmacological intravitreal agents, such as bevacizumab and triameinolon-acetonid, lead to rapid resolution of macular edema and significant improvement of visual acuity.