Quality of Life of Children Engaged in Regular Physical Activities.

Background: We aimed to examine the quality of life of children who engage in regular physical activities. Methods: We conducted a cross-sectional study with intersectional 301 children (182 boys and 119 girls) involved in regular sporting activities and the control group of 100 children (67 boys and 33 girls), not involved in extracurricular sports. Children in both groups were from 8 to 13 years, attending elementary school, and without any associated illnesses. The quality of life (QOL) was assessed using the Quality of Life questionnaire Kidscreen-27 version for parents. For comparison of groups, we used χ2 test, and for comparison of mean values among groups we used ANOVA test. Results: More boys were engaged in sport than girls and the choice of sport is gender-dependent (P<0.01). Boys preferred collective sports, while girls were more oriented towards individual sports (P<0.01). A significant statistical difference in the mean values of the socializing dimension was given to children who trained football (P=0.04) and basketball (P=0.02). In children engaged in volleyball, a statistical difference in the mean values was observed in all dimensions of the questionnaire. In children who trained water polo, a statistically significant difference in the mean values for dimensions of health (P<0.01), mood (P<0.01) and friendship (P=0.01) was seen. Conclusion: KIDSCREEN scores were significantly higher in the examined group than in the control group, with a statistically significant difference between scores for different sports. Children involved in regular extracurricular physical activities had better QOL.

The importance of developing atherosclerosis in pseudoexfoliation glaucoma.

Background/Aim: Pseudoexfoliation syndrome (XPS) is an age-related systemic disorder characterized by increased production and accumulation of elastic microfibrillar material in different tissues of the body: skin, connective tissue portions of visceral organs, periphery blood vessels and the eye, as well. The aim of our study was to determine the significance of atherosclerotic changes in the carotid arteries in the development of XFS and pseudoexfoliation glaucoma (XFG). Methods: The study included 120 patients ­ 40 patients per each of the three defined groups: XFS group, XFG group and age- and sex-matched control subjects (control group) without XFG. Blood samples were collected from the patients before cataract surgery. Serum levels of total cholesterol, low-density lipoprotein ­ LDL, high density lipoprotein ­ HDL and triglycerides were analyzed by standard laboratory techniques. Standard ultrasonography of the carotid blood vessels was performed in all the participants. Results: Lipid's profile was disturbed in the patients with XFS and XFG with statistical significance p control group (p < 0.01). Systolic and diastolic pressure was elevated in the patients with XFS and XFG (p < 0.01). Resistance index was increased in the patients with XFG (p < 0.01). Intima-media thickness was prolonged in patients with XFG (p < 0.01). Conclusion: A disturbed lipid profile with elevated resistancy index and intima-media thickness and increased systolic and diastolic pressure were compulsory findings in patients with developed XFG. So, these factors could be considered as risk. It seems to be difficult to inhibit the process of pseudoexfolation production in the whole body, but it appears that with proper therapy (antihypertnesive, cardiotoncs, etc.) and adequate nourishing, the process of XFG development could be interrupted.

Expression of vascular endothelial growth factor and microvascular density assessment in different histotypes of basal cell carcinoma.

PURPOSE: In this study, we investigated the expression of vascular endothelial growth factor (VEGF) and tumor microvascular density (MVD) in different histotypes of basal cell skin carcinoma (BCC). METHODS: We used a total 101 histological archival specimens, including superficial, nodular, cystic, keratinocytic, adenoid infiltrative types and cases of metatypical BCC. Routine hematoxylin/eosin (H&E) and immunohistochemical ABC method with NOT AE1/AE3, anti VEGF anti CD34 antibodies were used. VEGF expression in tumor cells was studied in relation to the BCC histotype and demographic characteristics. For statistical analysis ANOVA (F test), Student's t-test, and Karl Pearson coefficient were used. RESULTS: VEGF expression was significantly lower in the superficial histotype compared to all other types of BCC. No significant difference in VEGF expression between infiltrative, metatypical, adenoid and nodular types was found, but the highest expression of VEGF was seen in the infiltrative and metatypical types. Significantly higher MVD was found in infiltrative, adenoid, metatypical and nodular types. CONCLUSION: Our results suggest that the angiogenic potential of BCC correlated with tumor histotype, and histological growth pattern BCC enable distinction of the patients with increased risk of recurrence and / or metastasis.

Health-related quality of life, anxiety, and depressive symptoms in children with primary immunodeficiencies.

INTRODUCTION: The aims of this study were to evaluate levels of health-related quality of life (HRQOL) and the presence of anxiety and depressive symptoms in children with primary immunodeficiency disease (PID) in Serbia. MATERIALS AND METHODS: Self- and parent-rated data from 25 children with PID were available. As controls, data from 50 children with juvenile idiopathic arthritis (JIA) and 89 healthy children were included. The Pediatric Quality of Life Inventory was used for HRQOL assessments. Anxiety symptoms were identified using the Screen for Child Anxiety-Related Emotional Disorders questionnaire, while depressive symptoms were identified using the Mood and Feeling Questionnaire. RESULTS: Children with PID had significantly lower Pediatric Quality of Life Inventory total scores compared to children with JIA and healthy children as child-rated (P=0.02) and parent-rated (P<0.001). Specifically, they had significantly lowered emotional functioning compared to children with JIA, and social functioning compared to both children with JIA and healthy children. School functioning was significantly lower among children with PID (parent-rated only). By parent-rated responses, six (24%) out of 25 children with PID had significant anxiety symptoms, while five (20%) children had significant depressive symptoms, which was statistically higher than among children with JIA and healthy controls (P=0.05). CONCLUSION: HRQOL could be significantly compromised in children with PID, particularly across such psychosocial domains as emotional, social, and school. These children were also found to be at an increased risk for suffering significant anxiety and depressive symptoms.

Evaluation of central corneal thickness in patients with ocular hypertension and primary open-angle glaucoma.

AIM: To determine correlation between central corneal thickness (CCT) and applanation intraocular pressure (IOP) in normal patients with primary open angle glaucoma and patients with ocular hypertension. METHODS: Two-year retrospective study designed to determine correlation between CCT and IOP. Records of 121 patients were included in the study. Inclusion criteria were: IOP higher than 22 mm Hg for a group with ocular hypertension but without functional, morphological damage and progression, diagnosis of glaucoma for a group with open-angle glaucoma and normal ophthalmological results for a control group. Patients who were mono-oculus, patients with secondary glaucoma and who had surgical treatment were excluded. The patients were selectively grouped according to types of glaucoma, by gender and age. The IOP values were measured by Goldman's applanation tonometer, CCT values were determined using ultrasonic pachymeter, in the period from January 2011 to December 2012. RESULTS: Of total 121 subjects, 51 had primary open angle glaucoma (POAG), 40 had ocular hypertension (OHT) and 30 had normal ophthalmological findings (control group). The CCT values in OHT group 529.37+/-25.18 µm were greater than of both POAG, 501.02+/-14.04 µm and control group, 497.37+/-14.90 µm. The IOP values in OHT group were 20.25+/- 3.62 mm Hg, and in POAG group were 18.25+/-2.70 mm Hg, while in the control group they were 13.53+/- 3.62 mm Hg. CONCLUSION: Determination of CCT in patients with glaucoma is crucial, considering its impact on IOP values, which represents a parameter in glaucoma diagnosis, as well as monitoring further progress of ocular hypertension and patients diagnosed with glaucoma.

Tumor of orbit / Tumor orbitário

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and it's by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome.

Os hemangiomas cavernosos são os tumores intraorbitais mais comuns encontrados em adultos de meia-idade. Embora histológico benigno, eles podem invadir a área orbital ou intraorbital ou ainda as estruturas adjacentes (nervo óptico) e ser considerado anatomicamente ou posicional maligno. Apresentamos um relato de caso de hemangioma cavernoso orbital da órbita direita em mulheres jovens após a gravidez, a partir de Topola perto Kragujevac (Central Sérvia), com comprometimento visual e medicado por tratamento cirúrgico endoscópico transnasal. O paciente foi controlado e tratado com terapia, terapia tópica sintomático de lágrimas artificiais e tratamento cirúrgico. Nosso paciente tem acuidade visual ideal do olho direito afetada após o tratamento cirúrgico de tumor orbital. O tratamento cirúrgico do sintomático hemangioma cavernoso orbital é segura e eficaz, de modo que os resultados cosméticos são o parâmetro importante para avaliar o resultado clínico.

Vascular changes in the retina in patients with chronic respiratory insufficiency.

BACKGROUND/AIM: Chronic respiratory insufficiency is a pathological state which occurs as a result of respiratory system inability to maintain normal gas exchange between the outside air and circulating blood. For the purposes of human organism's proper functioning, it is necessary that a certain amount of air in the lungs comes into contact with a certain amount of blood within a unit of time, so that an adequate hemoglobin oxygenation could be achieved. Then, hemoglobin from erythrocytes in the blood supply delivers oxygen to all the tissues and cells of the body including the eye. Direct impact of hypoxemia and hypercapnia on the wall of arterioles, venules and capillaries results in a severe vasodilatation along with the increased permeability of the walls causing clinically evident changes in the retina. The aim of this study was to determine the degree of ocular changes in retina with patients suffering from chronic respiratory insufficiency. METHODS: A prospective study was conducted on 80 patients, 40 patients with respiratory failure and 40 patients with chronic obstructive pulmonary disease an and bronchial asthma (the control group). In all the patients direct and indirect ophthalmoscopy and fluoresceine angiography was performed. Clinically visible fundus and retina changes in patients suffering from chronic respiratory failure were categorized as mild (dilatation and retinal veins and arteries tortosion up to the mid-periphery), moderate (retinal hemorrhage) and severe (optic nerve edema, macular edema, superficial and deep retinal hemorrhages and venous occlusion). RESULTS: In the patients suffering from respiratory insufficiency the changes in retinal blood vessels were found [in 18 (45%) mild, in 13 (32.5%) moderate, and in 9 (22%) severe], while in the patients with chronic obstructive pulmonary disease and bronchial asthma (without respiratory insufficiency) no changes were recognized. CONCLUSION: The results of this study indicate the need for ophthalmologic examination in patients with chronic respiratory insufficiency. It is important to recognize, identify and quantify the changes on retinal blood vessels which are clinically significant. It is necessary to provide their monitoring and to prescribe proper therapeutic treatment in order to preserve visual functions.

Congenital blindness and visual impairment cause infection or non infection.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Authors are from reference documentation to archive at Organization of Federation of blind and visually impaired in central Serbia (Kragujevac), by retrograde analysis, of 2007-2012, comprehend two groups by etiology-clinical characteristics of congenital blindness and visually impaired, caused infection or non infection example. AIM: to analyze relationship between infectious and non infectious of congenital blindness and visually impaired in our referent region and compare with world references. MATERIAL/METHODS: With 6-years analysis included the most frequency cases of congenital blindness and visually impaired in two groups, according to presence or absence infectious causes. From infectious causes of congenital blindness and visually impaired are included: CMV - infection, congenital rubella syndrome, congenital toxoplasmosis, congenital syphilis and rare mixed syndrome. From non infectious causes are included: retinitis pigmentosa, retinopathy prematurity, primary congenital glaucoma, Leber's congenital amaurosis and rare syndrome. RESULTS: From total number of registered blind and visually impaired - 1308 (100%), over the last 6 years, the registration was 349 (26.68%) with congenital blindness and visually impaired. From recorder with the number of the most common congenital blindness and visually impaired-194 (55.59%) with infections cause, and 155 (44.41%) non infection cause. CONCLUSION: Congenital blindness has shown permanent increase in past 6 years, in group with infectious and with non infectious causes. Congenital blindness and visually impaired of the most common etiology among registered members of our association in Kragujevac is subject of our correlation and global trends mentioned observation of these diseases.

The effect of intravitreal administration of bevacizumab on macular edema and visual acuity in age-related macular degeneration with subfoveolar choroidal neovascularisation.

BACKGROUND/AIM: Age-related macular degeneration (AMD) is a leading cause of the loss of central visual acuity in population older than 70 years. We can distinguish wet and dry form of AMD. The aim of the study was to present our early results in treatment of the wet (neovascular) form of AMD with intravitreal administration of bevacizumab. METHODS: The study included 39 patients. Each patient underwent a complete ophthalmological examination, fluorescein angiography (FA) and optical coherence tomography (OCT). All the patients received 1.25 mg of intravitreal bevacizumab (0.05 mL of commercial phial of Avastin). The total of three doses was given with a one-month interval between doses. RESULTS: Among 39 patients, 24 were women and 15 men. The average best corrected visual acuity (BCVA) was improved from 0.09 before the therapy to 0.24 after the administration of all the three doses of bevacizumab (p < 0.001). The average central macular thickness (CMT) measured by OCT was improved from 474 microm in the beginning to 341 microm after the administration of all the three doses of the drug (p < 0.001). There were no side effects. CONCLUSIONS: Our short-term experience indicates that intravitreal administration of three doses of bevacizumab in one-month intervals between the doses leads to a significant reduction of macular edema and improvement of BCVA in patients with neovascular AMD.

Congenital upper eyelid coloboma with ipsilateral eyebrow hypoplasia.

INTRODUCTION: Coloboma is a Greek word, which describes the defect of all layers of the organ, and it can be congenital or as the result of an injury, operation, or some disease. Congenital upper eyelid coloboma is a rare anomaly, with the unknown incidence. The size of the defect is different, but it always involves all layers of the eyelid. This malformation is more frequent at the upper eyelid, and unilaterally, at the junction of the medial two thirds. Sometimes, it can also involve the eye, and may be a component of many syndromes (Goldenhar, Fraser, Manitoba, CHARGE, Cat eye). CASE REPORT: We are describing the case of the upper eyelid coloboma with the rare eyebrow anomaly at the three- month old girl, and the result of reconstruction. The baby was treated conservatively with lubricants and overnight patching. Pentagonal excision of the defect was performed in general anesthesia. Three layers of the eyelid were prepared: the skin, muscle and tarsoconjunctival layer. Because of orbicularis muscle malposition, reinsertion and reposition of the muscle fibres were performed. Then, lateral canthotomy was made and the suture of three layers of the eyelid. Catgut suture 7-0 was used for the conjunctiva and muscle. Nylon 6-0 was used for skin suture. Z-plasty was done on the upper part of the pentagonal excision in order to reduce skin tension at the suture line. The operation lasted about 60 minutes and the hospitalization three days. The occlusive dressing was applied for two days. The stitches were removed after seven days. The postoperative swelling of the upper and lower eyelid disappeared in five days. There were no complications in the postoperative period. CONCLUSION: The main principle of the treatment of eyelid coloboma is surgical reconstruction of all layers of the eyelid, in optimal period, using different surgical methods, which depends on the size of the defect. An early diagnosis is of the greatest importance, as well as the treatment of associated anomalies. Complications of the upper eyelid coloboma depend on the size of the defect, presence of the eye anomalies and the method of reconstruction.

Panophthalmitis after spontaneous perforation in glaucomatous eye.

Panophthalmitis is an acute, purulent inflammation of the eyeball that involves all its structures and extends into the orbit. A case of a fifty-seven year old male treated earlier due to glaucoma and trophic ulcus of the cornea, was presented in this paper. He was admitted to hospital with intensive orbital pain and redness of the right eye, elevated body temperature, bulbus protrusion with limited movement, chemosis, edematous cornea, hypopyon, iris of invisible drawing and relief. The ocular fundus was not visible. At the admittance, amaurosis of the right eye was present as well as spontaneous cornea perforation. The patient was treated with antibiotic, corticosteroid, analgesic and antiglaucomatous therapy. Intravitreal administration of antibiotics was impossible due to spontaneous cornea perforation. The patient was discharged from the hospital in a good general condition. The condition of the right eye was stable, there was no danger of eye loss, while infection of the same eye was cured.

Cyclocryotherapy in neovascular glaucoma treatment.

The main goal in the struggle with neovascular glaucoma is to control intraocular pressure (IOP) and pain. 152 patients, e.g., 203 eyes, were examined at the Clinic of Ophthalmology, Clinical Centre of Kragujevac, Serbia, in period between 01. 01. 2005 - 31. 12. 2010. Cyclocryoanemisatio was performed for all patients. Measurments of IOP showed statistical significant changes before and after the treatment for every patients. There was no difference in sex distribution, but a difference was noted in age distribution. Early posttreatment complications included hyphema, fibrin's exudation, chemosis. Cyclocryotherapy is usefull and accessible method for control of intensive pain in neovascular glaucoma.

Traumatic anterior dislocation of the crystalline lens and its surgical management.

This paper reports a case of a 57-year old female who had sustained a blunt ocular trauma resulting in anterior dislocation of the crystalline lens and acute painful visual loss in the left eye. The patient was managed with anterior chamber intracapsular phacoemulsification through a small anterior capsulotomy, pars plana vitrectomy, and surgical iridotomy. Aphakia was corrected by a contact lens. Two months after the surgery, the best corrected visual acuity was 0.9 in the left eye. The vision and retina remained stable in her follow-up examination 1 year later. Anterior dislocation of the crystalline lens can cause severe complications so that dislocated lens should be removed immediately.

Prostatic carcinoma bilateral iris metastases.

We described a patient with bilateral iris metastases resulted from prostatic cancer. Slit lamp and ultrasonography examination of the both eye demonstrated tumor of the iris, as an amelanotic vascular mass located on the superior temporal quadrant. On open biopsy revealed undifferentiated tissue that stained strongly positive for prostate carcinoma, confirming the diagnosis of metastasis prostate adenocarcinoma. Early diagnostic procedures are essential for the causal therapy of prostate carcinoma as the primary neoplasm.

[Clinical evaluation of Graves ophthalmopathy].

INTRODUCTION: Graves ophthalmopathy is an autoimmune disease, which is the consequence of thyroid dysfunction. Ocular manifestations occur in 50% of patients with Graves disease. The changes occur due to the inflammatory cell infiltration of retrobulbar fat tissue and extraocular muscles. Ultrasonography of eye orbit provides important information about the condition of retrobulbar adipose tissue and the thickness of extraocular muscles. OBJECTIVE: The aim of our study was to show the clinical significance of orbital ultrasonography in the diagnostics and follow-up of patients with Graves disease. METHODS: The authors examined 154 patients with Graves ophthalmopathy at the Clinic of Ophthalmology of the Clinical Centre in Kragujevac during the period 2008-2010. Ophthalmological examination included visual acuity testing (Snellen chart), biomicroscopy and applanation tonometry, direct and indirect ophthalmoscopy, dry eye testing and exophthalmometry (Hertel). Orbital ultrasonography examination and extraorbital muscle measurement was done by ultrasound B-scan. RESULTS: The disease was more frequent in women (79.87%) aged from 36-45 years. Most patients had hyperthyreoidism (54.55%). In relation to the duration of the disease, the most frequent clinical signs were bilateral ptosis, conjunctival chemosis and periorbital edema. According to our data the highest number of patients had enlarged medial straight muscle. CONCLUSION: Graves ophthalmopathy is the most frequent sign of thyroid disease. By orbital ultrasonography we detected extended echogram and measured the thickness of the extraocular muscle. Computerized tomography and magnetic resonance scan were utilized for cases of insufficiently manifested clinical signs of the disease. The advantages of ultrasonography lie in easy handling, patients' comfort, short time of examination and possibilities of repetition.

Orbital metastases from breast cancer: a case report.

We present a patient with a corneal ulcer of the right eye, with eye protrusion and without anamnesis of cancer. On CT examination there was a bulky soft tissue mass in the cranial aspect of the right orbit, without increasing in signal intensity after injection of contrast. Open biopsy revealed undifferentiated tissue that stained strongly positive for breast carcinoma, confirming the diagnosis of metastases of breast carcinoma.

[Epidemic keratoconjunctivitis].

INTRODUCTION: Keratocnjunctivitis is corneal and conjunctival inflammation. Clinical signs involve the irritating trio: mixed hyperemia of conjunctival membranes, corneal subepthelial infiltrates and regional lymphadenopathy. The most common causes of epidemic are adenovirus, herpes virus, and rarely cytomegalovirus, which are now occurring with higher frequency as secondary infections. OBJECTIVE: The aim of the study was to present and analyze keratoconjunctival epidemics in the region of Kragujevac from September 2008 to February 2009, as well as to analyze clinical features related to virusological findings and etiology. METHODS: In 329 patients we performed clinical examination (biomicroscopy, fluorescent test, corneal sensitivity test), collecting standard specimen of the conjuctiva and cornea, made serological examination, and sent the specimens to the Virusology Institute "Torlak" in Belgrade for the confirmation of epidemic etiology. The patients were treated with local and symptomatological therapy. The epidemic was eradicated in cooperation with a regional referent institution. All outpatients activities were ceased, while hospital hygienic, sanitary, intra-, extra-hospital and therapeutic procedures were undertaken. RESULTS: The distribution of 329 patients by gender was equivalent. Most patients were aged from 27 to 34 years (25%) of working population. The distribution of patients by clinical features showed the predominance of follicular hyperplasy (93.62%). The distribution according to the time of the first symptoms onset showed the frequency of 50% of corneal infiltrate in the second week. The period elapsed from the diagnosis to cure was three weeks in 50% of patients. Serological tests confirmed the mixed distribution of the cause. CONCLUSION: Based on the authors' experience, in order to eradicate epidemics as fast as possible and achieve efficient treatment, it is recommended that the epidemic should be reported, guidelines of referent institutions be obeyed, all of which diminishes the recognizable professional risk and decreases mistakes.

Bilateral retinal detachment in a case of preeclampsia.

Serous retinal detachment is an unusual cause of visual loss in preeclampsia. We report the case of 24-years-old primipara with severe preeclampsia who developed bilateral serous retinal detachment a few hours after delivery. A few weeks after delivery there was spontaneous resorption of the subretinal fluid and complete resolution bilateral serous retinal detachment, with residual pigmentary changes of the retinal pigment epithelium. Visual acuity was normal in each eye. The management of retinal detachment as a complication in preeclampsia is conservative and the prognosis is usually good.

[Artificial monoblock lenses implantation following rupture of posterior capsule during phacoemulsification surgery].

BACKGROUND/AIM: Phacoemulsification is a modern surgical technique for cataract operations. Through minimal corneal wound (2.2-2.7 mm) lens nucleus is emulsificated and arteficial lens is implanted in capsular bag. Complications during operations are possible, and can vary from minor to very serious one, with consecutive visual loss. One of possible complications is rupture of posterior lens capsule, which could happen in any stage of operation. The aim of this study was to evaluate results of monoblock arteficial lens implantation in sulcus on the remains of anterior capsule and capsulorhexis after posterior capsule rupture during phacoemulsification. METHODS: This prospective, non-comparative study included 19 patients with rupture of posterior capsule as a result of cataract operation with phacoemulsification method. Average monitoring time was 14 months (1-18). We analysed best corrected visual acuity, intraocular pressure, fundus findings, and implanted lens position with wawelight allegro oculizer (Scheimpflug camera). RESULTS: Preoperative visual acuity was from L+P+ to 0.5. On first postoperative day visual acuity 0.02-0.08 was noted in 8 patients, from 0.1-0.4 also in 8 patients and 0.5 and more in 3 patients. After 12 months from the operation 15 patients had visual acuity better than 0.5. Among early complications corneal edema was noted in 6 cases, anterior chamber reaction with or without fibrin reaction in 8 cases and rise of intraocular pressure in 3 cases. All complications were reversibile. CONCLUSION: Posterior capsule rupture/break is a serious complication of phacoemulsification, hardly to prevent. Regarding size of posterior rupture, foldable monoblock arteficial lens can be implanted into the sulcus on the remains of anterior capsule in most of the cases, keeping the advantages of small corneal incision: smaller astigmatism, better postoperative visual acuity, faster wound healing and earlier visual rehabilitation.