[Comparative follow-up study of unselected male population with congenital defective color vision from inland and Mediterranean areas of Croatia]. / Komparativna studija pracenja kongenitalnih kolornih poremecaja vida neselektirane muske populacije kontinentalne i mediteranske Hrvatske.

AIM: The aim of this ten-year study (from the end of 1998 to the end of 2008) was to assess the prevalence of congenital dyschromatopsia in unselected healthy male population aged 15-45 from two Croatian regions, i.e. inland and Mediterranean parts of Croatia. Results collected in these two regions were compared and respective conclusions drawn. The results primarily referred to the prevalence of color vision disturbances and their differences according to the main color groups (dichromacy and anomalous trichromacy) and subgroups (protanopia, deuteranopia, protanomaly, deuteranomaly, and others). To our knowledge, no such a long-term study in a large population sample has been carried out in southeast Europe to date. METHODS: Color vision was examined after complete ophthalmologic examination in all subjects presenting for examination required for amateur driver license. Color vision examination was performed by use of pseudoisochromatic Ishihara tables, Nagel II anomaloscope and Panel D-15 color test at industrial medicine offices and ophthalmology departments in the two regions. There were 12,974 and 9,974 subjects in inland and Mediterranean Croatia, respectively. RESULTS: The results confirmed the hypothesis and clinical perception of a lower prevalence of color vision disturbances in southern parts, i.e. in Mediterranean Croatia (8.50%) as compared with inland Croatia (8.90%). The rate of dichromacy was higher in Mediterranean Croatia (2.40%), while the rate of anomalous trichromacy was greater in inland Croatia (6.93%). CONCLUSION: The results of this study provide better insight in the status of color vision disturbances and possible differences between the relatively close areas of north (inland) and south (Mediterranean) Croatia.

Corneal thickness in pseudoexfoliative glaucoma.

Measurements of central cornea thickness (CCT) have a very important value in glaucoma patients; if the central cornea is thinner than it suggests, then the intraocular pressure is falsely low. This study compares the central cornea thickness between patients with pseudoexfoliative glaucoma, open angle glaucoma, angle closure glaucoma and control group. This study included 34 patients with pseudoexfoliative glaucoma, 31 patient with open angle laucoma, 28 patients with angle closure laucoma and 36 normal subjects in a control group. Patients in all groups and also normal subjects in control group had no other corneal disorders, no history of trauma, corneal surgery and were not patients with contacts lens use. Patients with pseudoexfoliative glaucoma and also patients with open angle glaucoma had significantly lower values of central cornea thickness compared with normal subjects in control group. Tomey EM 3000 is a non contact specular microscope which was used to measure central corneal thickness in this study. Pachymetry is an important method for diagnoses of glaucoma and for examination of the intraocular pressure in glaucoma patients, because values of the central corneal thickness affect the exact intraocular pressure readings.

Corneal thickness in congenital glaucoma.

Central corneal thickness is very important measurement in glaucoma treatment because it influences the eye pressure measurements. A thinner cornea gives us artifactually lower intraocular pressure and a thicker cornea gives higher intraocular pressure reading, so it has to be corrected in both cases. The aim of this study is to compare central corneal thickness between congenital glaucoma patients and normal subjects. Prospective study included 27 patients with congenital glaucoma and 35 patients in control group. First group was subdivided in two subgroups: A--8 earlier operated patients, B--19 patients treated with topic therapy. Patients had no other corneal disorders, history of trauma, corneal surgery and they were not contact lens wearers. Measurements were performed by specular microscope Tomey EM 3000 on central corneas. This study showed that patients with congenital glaucoma have lower central corneal thickness than normal subjects. Also, the study showed that antiglaucomatous operation doesn't influence central corneal thickness. Central corneal thickness need to be a routine part of examination measurements because of need to correct intraocular pressure according to it, but also the thinner corneas values can suggest congenital glaucoma diagnosis beside the other parameters.

The role of omega6 to omega3 ratio in development and progression of age-related macular degeneration.

The aim of this study is to investigate possible connection between omega-6/omega-3 fatty acid ratio and development and progression of Age-Related Macular Degeneration (ARMD). We examined 125 patients diagnosed with ARMD and divided into 5 groups of 25 patients according to CARMS (Clinical Age-Related Maculopathy Staging System). Control group consists of 51 patients with similar ages, without ARMD. All of them underwent stereobiomicroscopy, fundus photography and fluorescein angiography. Dietary fatty acids intake was measured using food frequency questionnaire (FFQ). The FFQ was based on previously validated questionnaire (DIETQ, Tinuviel Software, Warington, Ches, UK) and FFQ2 from Blue MountainEye Study. The data were analysed using food nutritient dana from McCance and Widdowson's Food Composition Tables, supplemented with a food fatty acid content database (Foodbase, London, UK). We noticed statistically significant difference between omega-6/omega-3 ratio in neovascular ARMD (stage 5) and all other groups including control group (p = 0.000020). The ratio in Stage 5 was about 11:1 like in Western diet. Stage 4-geographic atrophy (GA) has statistically significant difference in o-mega-6/omega-3 ratio compared with stage 1 (p = 0.000571), stage 2 (p = 0.000112) and stage3 (p = 0.000430). The ratio in first three groups is about 7-7.5:1 (greater then Mediteran-4-5:1, but lower then Western Diet-10-20:1). There is no statistically significant difference between first three stages (p > 0.05) and stage 4 and control group (p = 0.172388). Omega-6/omega-3 ratio is connected with development of neovascular ARMD. Decreased ratio protects against neovascular ARMD. On the contrary, GA seems to be connected with prolonged sunlight exposure (the ratio is about 6:1). It is good to know that changing nutrition habits someone can prevent development of severe neovascular form of ARMD because intravitreal anti-VEGF therapy limitations.

The circulatory influence on development of age-related macular degeneration and hearing and equilibrium impairments.

This study attempts to answer the question if any level of head and neck circulation takes a part in development of Age-Related Macular Degeneration (ARMD) and hearing and equilibrium impairments. Condition of large blood vessels was examined by Color-Doppler ultrasound, and carotid and ophthalmic arteries were included. The microcirculatory changes were examined directly by fundus photography and fluorescein angiography and indirectly testing hearing and equilibrium. The study group included 40 patients (21 females, 19 males) aging from 53 to 84 years with different stages of ARMD. The control group included 40 patients (18 females, 22 males) aging from 51 to 82 years without ARMD. Patients were inhabitants of Primorsko-Goranska County. There was no relationship between ARMD and condition of large blood vessels because significant stenosis of carotid arteries was found in 2 patients (5%) in study group and 3 patients (7.5%) in the control group (p > 0.05). On the contrary, we found correlation between ARMD and hearing (p = 0.0127) and equilibrium impairments (p = 0.0242). Fluorescein angiograms shows raised number of ischemic retinal capillaries in patients with ARMD (p = 0.0053). Results lead to conclusion that circulatory disorders on microcirculatory level take a great part in development of ARMD and hearing and equilibrium impairments in the elderly. The key is damage of sensory cells of the retina and inner ear caused by microcirculatory disorders. Interesting data was noticed that 9 patients with more serious ARMD on one side of head had greater hearing loss on the same side. If we find a new treatment for microcirculatory disorders, maybe we can treat both sensory impairments in earlier stage.

Distribution of age-related macular degeneration in Primorsko-Goranska County.

The aim of this study is to show what part of our County has the most population with age-related macular degeneration (ARMD) and how some types frequently appear in same parts. The County includes 3 different geographic areas: Gorski Kotar, Coast and Islands. ARMD is the leading cause of visual impairment and blindness in developed countries. There are two categories of ARMD: atrophic or "dry" ARMD and exudative or"wet" ARMD. Our epidemiological study group includes 60 patients (33 females, 27 males) with both types of ARMD and they mostly spent their life times in our County. Patients were examined and treated in our Clinic during 2008 and 2009. We also examined which contribution factor (age, genetics, UV-exposure, diet, iris and macular pigment) is more common and found a links with occupation, residence and habits. Our study shows that ARMD in our County is most frequent in interval of 61-80 years. Incidence of ARMD is mild increased in female (55%). Significant incidence of ARMD is connected with patients who work outdoor more than 5 hours daily (70 %). There were no significant difference between patients in different areas[-Gorski Kotar and Coast (p = 0.9260), Gorshi Kotar and Islands (p = 0.8382) and Coast and Islands (p = 0.8546) connected with occupations. Regions Coast and Islands had more cases of ARMD than Gorski Kotar, but in Gorski Kotar patients had greater percent of "wet" type. Difference is statistically significant between areas Gorski Kotar and Islands (chi2 = 4.675, p = 0.0306). Also, there were statistically significant difference in nutrition between Gorski Kotar and Islands (chi2 = 4.17, p = 0.0411). Incidence of ARMD is related with less iris and macular pigment--47 patients (77%). There was an increased risk for exudative type in Trsce and Cabar in Gorski Kotar

Pseudoexfoliative syndrome and pseudoexfoliative glaucoma in Primorsko-Goranska County.

The aim of this study is to evaluate pseudoexfoliative glaucoma (PEX) in Primorsko-Goranska County, Croatia, and its characteristics comparing to primary open angle glaucoma (POAG). In the study a hundred patients with open angle glaucoma were examined, twenty six of them had a pseudoexfoliative glaucoma diagnosed. We were following intraocular pressure (IOP) values, visual acuities, visual fields and optical nerve head changes retrospectively. Comparing to primary open angle glaucoma pseudoexfoliative glaucoma in Primorsko-Goranska County has less good prognosis because the IOP is usually higher and more difficult to control, we found progressive loss of retinal ganglion cells and visual field loss develop more rapidly. Because of that pseudoexfoliative glaucoma requires special treatment and following.

Specular microscopy in glaucoma patients.

The endothelial cells are one of the most important structures in a donor cornea. Morphology and concentration of endothelial cells must be carefully evaluated with a specular microscope before transplantation. The aim of this study is to evaluate the status of corneal endothelium in glaucoma patients. Prospective study included 50 patients suffering from glaucoma and 50 patients in control group. Patients had no corneal disease, ocular inflammation, previous trauma or ocular surgery. Patients were not contact lens wearers. They were also analyzed in groups according to type of glaucoma. Specular microscopy was performed on central corneas. This study showed that patients with glaucoma have lower central corneal endothelial cell density than those without glaucoma of the same age group. Also, patients with pseudoexfoliative glaucoma had lower values of central endothelial cell density comparing to patients with open angle or angle closure glaucoma.

Intravitreal bevacizumab for the management of age-related macular degeneration.

The aim of this study is to report short-term effect of the treatment of "wet" ARMD (age-related macular degeneration) with intravitreal bevacizumab (Avastin). Prospective study included 36 patients (36 eyes) with "wet' form of ARMD. All patients were over 60 year old (22 female, 14 male). Changes of macula included minimally classic CNV (choroidal neovascularisation) (24), occult subfoveal CNV (10) and first stage of cicatrial CNV (2). Bevacizumab 1.25 mg was administered intravitreally through pars plana using a 27-gauge needle. Patients had no previous eye treatment. Ophthalmic exam before and after the treatment included: Snellen VA (visual acuity) and examination including measurement of IOP (intraocular pressure), FA (fluorescein angiography) and interview with patients. After 4-6 weeks 28 (78%) patients had significant improvement of VA. Median VA improved from 0.083 to 0.200 (p<0.01). Eight patients (22%) had no significant improvement in VA but three of them reported to see more light. FA showed complete resolution of macular edema in 6 patients (17%), partially resolved in 23 patients (64%) and no change in 7 patients (19%). No systemic side-effect was found. Short-term results suggest that intravitreally administered bevacizumab is well tolerated treatment for ARMD with very high number of patients showing improvement in VA.

Dental inflammation and central retinitis--it is important to protect the retina from the harmful sunlight.

During 3-year study of 73 patients with dental inflammation, sinusitis, otitis and 5 cases with granuloma, in 9 cases we observed the development of central retinitis. All patients were medicated with the same antibiotics and parabulbar depo of Prednisolonacetate. To 50% of these patients, we suggested eye protection with Yellow Medical filters during two months. In the first group with medication we observed better vision in 69%, but in the second group with eye protection with Yellow Medical filters we observed normalization of vision in 100%.