Bilateral endogenous Candida endophthalmitis after induced abortion.

AIM: Analysis of the development and treatment of bilateral Candida endophthalmitis after induced abortion in a healthy 31-year-old patient. METHOD: A diagnosis of bilateral Candida endophthalmitis was established on the basis of positive vaginal culture, serological finding, and culture for Candida hyphae from the vitreous aspirate. The treatment of the disease consisted of prolonged systemic therapy with amphotericin B and fluconazole and pars plana vitrectomy with intravitreal amphotericin B injection. RESULTS: After the combined systemic therapy with antibiotics, fungistatics, and corticosteroids proved to be insufficient, pars plana vitrectomy with intravitreal instillation of amphotericin B was performed, which led to the improvement of visual function. After surgery, visual function was maintained with prolonged systemic therapy with fluconazole and methylprednisolone. CONCLUSION: Complicated induced abortion may cause bilateral Candida endophthalmitis in a young healthy woman. Elimination of the cause of fungemia and adequate systemic treatment did not cure bilateral endophthalmitis. Pars plana vitrectomy with intravitreal instillation of 5-microg amphotericin B proved as a method of choice in treating this severe ophthalmic disease.

The effect of vitrectomy with silicone oil tamponade on intraocular pressure and anterior chamber morphology.

We measured the tamponading effect of silicone oil, saline and air after vitrectomy, on intraocular pressure and aqueous humor outflow in 85 patients with highly proliferative retina and vitreous changes. Silicone oil as retinal tamponading agent after vitrectomy was used in 45 patients, and saline or air in 39 patients. The mean intraocular pressure measured at one month after treatment was greatly elevated in patients with silicone oil tamponade as compared to those with saline or air tamponade. At 6 and 12 months examinations, mean intraocular pressures were compared in these two groups of patients. Gonioscopy revealed silicone oil emulsification and presence of emulsified bubbles in the anterior chamber in 22.22% of patients, and narrowing of the chamber angle in several patients with silicone oil tamponade. Intraocular pressure elevation following vitrectomy with silicone oil tamponade was found to be of transient rather than permanent nature, since it regressed after silicone oil removal. This transient elevation was due to silicone oil tendency to emulsify. Silicone oil bubbles changed the morphology of the anterior chamber angle and fine trabecular structures by creating a barrier to aqueous humor outflow.

Protein carbonylation and glycation in human lenses.

It has been observed protein carbonylation and glycation in the lens epithelial cell fractions of lenses in people with mature cataract. We used lenses of diabetic patients, weak and strong cigarette smokers and people who had senile cataract. The protein glycation is the highest in a diabetic senile cataract patients and the lowest in non-diabetic senile cataract patients. The protein carbonylation is extremely high in mitochondrial epithelial cells of the strong cigarette smokers. These results show that the glycation and carbonylation of the human lens proteins are the part of the cataract development in people. Specific factors, such as high glucose in diabetes and the tobacco smoke (in cigarette smokers), can change the lens structure, thus stimulating cataract development.

Senile cataract and the absorption activity of cytochrome C oxidase.

The aim of the study was to determine the activity of cytochrome c oxidase in mitochondrial fractions of cataractogenic epithelial cells of lenses of 60 patients (34 females and 26 males). According to clinical criteria patients were divided into three groups: group 1--patients with senile cataract, group 2--active smokers with senile cataract, and group 3--diabetic patients with cataract as diabetic complication. In the extracted lenses we determined the absorption activity of mitochondrial enzyme cytochrome c oxidase. Biochemical researches using the method of Yonetani and Ray were applied. We also applied the statistical Student t-test (p < 0.05) and the variance analysis (R. Fisher) with three parameters and Snedecor F distribution (s = p < 0.001). The activity of cytochrome c oxidase in mitochondrial fraction of lens epithelial cells is twice as low in patients who are active smokers than in the non-smoking patients with senile cataract. We measured a significantly different activity of cytochrome c oxidase between active smokers and the non-smoking patients with senile diabetic cataract (tp < 0.05, sp < 0.001). Cigarette smoke decreases the activity of cytochrome c oxidase in mitochondrial fraction of lens epithelial cells. This enzyme is a terminal oxidase in the synthesis of ATPs. We suggest that smoking decreases the synthesis of energy in the lens of cigarette smokers. This emphasizes the significance of giving up smoking in order to preserve the structure and function of the lens.

The role of visual evoked potentials in the diagnosis of optic nerve injury as a result of mild head trauma.

The curve of visual evoked potentials was observed and compared with changes of visual acuity and visual field during a 24-month period in a group of 39 patients with optic nerve injury as a result of mild cerebral trauma. Results of the study showed great improvement of visual acuity and visual field after treatment, and slower and continuous improvement of visual evoked potentials. The main abnormality of visual evoked potentials is the shortening of amplitude, which is recorded to gradually recede after treatment in half of the patients. Authors conclude that the shortening of amplitude can be partially explained by the edema and the compression of fibers in the optic canal. Also, they emphasize that in this type of optic nerve injury visual acuity testing is the best indicator of the promptness and scope of the injury, while visual field research presents the best method for following later delicate changes of visual function.

Surgical treatment of uveitis.

The results obtained by pars plana vitrectomy in 24 eyes with chronic uveitis, including endogenous intermediate and other types of uveitis, were retrospectively analyzed. Vitrectomy and lensectomy were performed in 8, and vitrectomy alone in 16 eyes. The mean follow-up period was 50 months, and mean patient age 38 years. There were 15 (71.4%) male and 6 (28.6%) female patients. Improvement of visual acuity was achieved in 79% (19), and visual acuity of > or = 0.1 in 58% of eyes. Visual acuity of < 0.2, recorded in 14 eyes, was due to optic disc atrophy in 4, cystoid macular edema in 3, macular pucker in 2, vascular obliteration in 2, and chorioretinal scars in 3 eyes. Postoperative complications included cataract in 4, vitreous hemorrhage in 2, glaucoma in 1, and retinal detachment in 3 eyes. Vitrectomy considerably reduced the severity of inflammatory reaction, and allowed reduction or discontinuation of local and systemic steroid therapy.

Types of central serous retinopathy, analysis of shape, topographic distribution and number of leakage sites.

The analysis of 212 fluorescein angiograms of the same number of eyes showed that Type I is by far the most prevalent form of central serous retinopathy. Type I appeared in 92.45%, Type II in 6.60% and the Intermediate type in 0.95% of the examined eyes. The patients were mostly male (81.13%) between 30 and 49 years of age (95.28%). The number of leakage sites in Type I central serous retinopathy varied from 1 (83.67%) to 5 (1.02%). Solitary leakage appeared in 83.67%, while uniform spreading of fluorescein into the subretinal blister in Type I central serous retinopathy appeared in 85.71% of eyes. Most leakage sites (32.50%) were located in the upper nasal quadrant, while the lower temporal quadrant was least affected (15.83%). The foveal avascular zone was affected in 4.14% and the papillomacular bundle in 20.83% of the examined eyes.

Brachytherapy--optional treatment for choroidal neovascularization secondary to age-related macular degeneration.

Age-related macular degeneration (ARMD) presents the main cause of irreversible loss of central vision in older population, due to a progressive neuroretinal damage and damage of retinal pigment epithelium of foveal area. This observation emphasizes the insufficiency of all presently used therapeutic procedures. Therefore, investigation has been conducted at the University Eye Clinic Zagreb for the last three years testing the effects of brachytherapy with direct episcleral application of ruthenium applicators to the posterior pole of the globe. Forty-two patients aged 58-79 were followed for a min. of 12 months. During this period their central visual acuities remained stable. Six patients showed one-line improvement of visual acuity and 8 patients showed no changes. Twenty-one patient lost 1-2 lines of visual acuity and 7 patients lost more than 2 lines. According to this we can conclude that patients treated with brachytherapy showed significantly better results compared to the control subjects, which is very encouraging.

Surgical treatment of war lesions to the posterior segment of the eye.

OBJECTIVE: The aim of this study was to assess the outcome of surgical treatment of war lesions to the posterior eye segment. METHODS: During a 1-year period, 96 patients with severe eye lesions, 54 of them with intraocular foreign bodies (56.2%), were operated on at the Institute for Posterior Eye Segment Diseases and Trauma, Zagreb Clinical Hospital. Surgical procedures performed included high-quality primary microsurgery of the wound, extraction of intraocular foreign bodies, treatment of double perforating wounds by silicone oil tamponade and gas, and emergency vitrectomy when necessary. RESULTS: A varying degree of vision function improvement was achieved in 67 patients (69.7%). Most of the foreign bodies removed were metal and nonmagnetic. Only six foreign bodies were made of glass, and two 2 were of plastic material. In 29 patients (30.3%), the vision function remained unchanged or deteriorated after vitrectomy. CONCLUSION: Although satisfactory results were achieved, definitive evaluation of the procedures will be possible only after long-term follow-up.

Choroidal leiomyoma of vascular origin.

A 38-year-old female patient was admitted for serious retinal detachment. Clinical examination revealed detachment in the lower half of the retina, with a suspect hemispherical tumorous formation. Echography did not positively demonstrate the presence of tumor. Vitrectomy was performed and a tumor fragment was taken for histologic analysis. The finding indicated the presence of leiomyoma choroideae, a very rare and benign smooth muscle tumor.

Classic migraine and visual field defects.

A series of 116 patients with classic migraine were studied to record visual field defects. Thirty-four (29.3%) subjects had defects of the field of vision, 11 of them bilaterally, which made a total of 45 (19.4%) eyes. Downward isopter depression from above and contraction of the field of vision were the most common damages. A homonymous hemianopic defect was found in seven patients. The area of depressed vision helps to some extent in anatomical localization of the damage. Its etiology has not been fully clarified. The authors recommend more extensive clinical examinations of the visual field, i.e. follow-up of each patient with classic migraine by periodical testing of the field of vision.

A new approach to surgical treatment of diabetic retinopathy.

Results of surgical treatment performed in 48 patients with proliferative diabetic retinopathy are presented. The technique of excision and vitrectomy of the posterior cortex and neovascular membranes was used in a single act. The authors are inclined to believe that membranes can be more completely and with less bleeding removed using this technique than with the technique of circumcision and segmentation. The procedure was most frequently complicated by perioperative formation of posterior ruptures (13 patients) and peripheral ruptures (11 patients). All ruptures were treated by endolaser photocoagulation. Additional or panretinal photocoagulation was carried out when necessary. During the postoperative period, retina remained attached in 33 patients, whereas in 15 patients complications in terms of reproliferation and neovascular glaucoma occurred.

[Eye injuries in traffic accident traumatology]. / Ozljede oka u prometnoj traumatologiji.

The authors discuss traffic eye injuries on the basis of their own clinical patients. A total of 334 patients were treated surgically or conservatively. Reviewing the results of the cure, they point out new possibilities and perspectives of treatment.