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.

Phenolic Profile, Antiradical and Antitumour Evaluation of Raspberries Pomace Extract from Serbia.

Raspberry waste, obtained from two cultivars, Meeker (ERM) and Willamette (ERW) was subjected to evaluation antioxidants and antitumour activities as a potential source of phenolics. Some phenolic acids and flavonoids were identified and quantified by HPLC. Antioxidant activity was tested by measuring ability to scavenge DPPH• and •OH by ESR spectroscopy. IC50DPPH• varied from 0.67 for ERM to 0.54 mg/mL for ERW, while IC50•OH values varied from 3.73 for ERM to 1.23 mg/mL for ERW. Cytotoxic activity was investigated using in vivo model of Ehrlich Ascite carcinoma cells (EAC) in mice. Pretreatment with extracts exhibited potent cytotoxic activity against EAC cells (up to 60%) and both extracts inhibited the tumour growth. Activity of xanthine oxidase (XOD) was extremely increased in pretreated animals, while the activity of enzyme complex glutathione reductase (GR) and glutathione peroxidase (GSHPx) was significantly increased. This study suggests that raspberry pomace could be used as nutraceutic resource and functional food ingredient.

Intravitreal bevacizumab injection alone or combined with macular photocoagulation compared to macular photocoagulation as primary treatment of diabetic macular edema.

BACKGROUND/AIM: Within diabetic retinopathy (DR), diabetic macular edema DIE) is one of the leading causes of the loss of visual acuity. The aim of this study was to determine the efficacy of the intravitreal vascular endothelial growth factor (VEGF) inhibitor application alone or combined with macular focal/grid lasephotocoagulation compared with laser treatment alone. METHODS: This prospective randomized clinical trial included 72 patients (120 treated eyes) with varying degrees of DR and DME. The DME treatment included intravitreal VEGF inhibitor bevacizumab (Avasting) application, with and without laser treatment. Bevacizumab (1.25 mg/0.05 mL) was administered intravitreally in 4-6-week intervals. Laser is applied 4-6 weeks after last dose of the drug as a part of combined treatment, or as the primary treatment. RESULTS: The mean reduction in central macular thickness (CMT) for the eyes (n = 31) treated with bevacizumab alone was 162.23 .rm, for the eyes (n = 53) treated with combined treatment the mean reduction in CMT was 124.24 pm, both statistically significant at p < 0.001. Laser macular photocolagulation as a part of combined treatment (in 53 eyes) significantly contributed to the CMT reduction, based on the paired t-test results (366.28 vs. 323.0 pLm at p < 0.05). In our study, the mean visual acuity improvement of 0.161 logMAR was achieved in the group of eyes treated with bevacizumab alone, and 0.093 logMAR in the group with combined treatment, both statistically significant atp < 0.05. The effect of laser photocolagulation alone on visual acuity and'CMT was not statistically significant. CONCLUSION: Treatment with bevacizumab alone or within combined treatment is more effective in treating DME than conventional macular laser treatment alone, both anatomically and functionally.

Effect of diode laser cyclophotocoagulation in treatment of patients with refractory glaucoma.

BACKGROUND/AIM: Refractory glaucoma is glaucoma resistant to conventional management (maximally tolerated medical therapy, one or more glaucoma surgeries) and glaucoma in cases of neovascularisation after panretinal photocoagulation or cryoablation. The aim of the study was to determine the intraocular pressure (IOP) lowering efficacy of transscleral diode laser cyclophotocoagulation (DCPC) treatment in the management of pain and IOP in patients with refractory glaucoma. METHODS: This nonrandomized, retrospective study, included 95 patients (95 eyes) with refractory glaucoma treated at the University Eye Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia, between November 2007 and November 2012 in accordance with the established protocols (16-18 spots, 270°, up to 5J of energy). All the eyes were treated with transscleral DCPC (Iris Medical OcuLight SLx, Iridex Co, Mountain View, USA). Patient's symptoms, bests corrected visual acuity and IOP were recorded 7 days, and 1, 3 and 6 months after the DCPC treatment. RESULTS: Out of 95 patients (95 eyes) enrolled in this study 24 (25.2%) were with primary (the group I), and 71 (74.5%) with secondary (the group II) glaucoma. The mean baseline IOP in these two groups was similar: 36.08 ± 8.39 mmHg for the first group and 37.36 ± 8.19 mmHg in the second group. Measurement of the mean IOP in the group I showed the following results: on the day 7 it was 13.96 ± 8.30 mmHg (62.1% decrease of the baseline value), on the day 30 it was 18.44 ± 8.85 mmHg (48.9% decrease regarding the baseline value), after 3 months it was 22.44 ± 7.36 mmHg (37.8% decrease regarding the baseline value), and after 6 months it was 25.92 ± 7.65 mmHg (28.2% decrease regarding the baseline value). Measurement of IOP in the group II showed the following results: on the day 7 it was 15.77 ± 9.73 mmHg (57.8% decrease of the baseline value), on the day 30 it was 20.14 ± 10.20 mmHg (46.1% decrease regarding the baseline value), after 3 months it was 23.46 ± 9.83 mmHg (37.2% decrease regarding the baseline value) and after 6 months it was 27.23 ± 9.87 mmHg (27.2% decrease regarding the baseline value). Pain was the main symptom in 70 (73.6%) patients before the treatment and it persisted in only 4 (4.2%) of our patients. Other complaints (burning, stinging, foreign body sensation) were experienced by 39 (41%) of the patients, postoperatively. A total of 52 (54.7%) patients had no com- plaints after the treatment. CONCLUSION: Our study confirmed that transscleral DCPC is a useful, effective and safe procedure with predictable amount of IOP decrease, which makes it the treatment of choice for refractory glaucoma.

Antiradical, antimicrobial and cytotoxic activities of commercial beetroot pomace.

The by-product of food processing is often utilized as feed, and for the preparation of dietary fiber and biofuel. However, these products are also promising sources of bioactive antioxidants and color giving compounds, which could be used as additives in the food, pharmaceutical and cosmetic industry. The aim of this study was to investigate the phytochemical profile, and the antiradical, antimicrobial and cytotoxic activities of industrial beetroot pomace extract (BPE). The content of phenolics (45.68 mg gallic acid equivalents g(-1)), flavonoids (25.89 mg rutin equivalents g(-1)) and betalains (4.09 mg betanin g(-1); 7.32 mg vulgaxanthin I g(-1)) were determined spectrophotometrically. The antiradical activity on DPPH (EC(50)(DPPH·) = 0.0797 mg ml(-1)), hydroxyl (EC(50)(·OH) = 0.0655 mg ml(-1)) and superoxide anion (EC(50)(O2·-) = 1.0625 mg ml(-1)) radicals were measured by electron spin resonance (ESR) spectroscopy. The antimicrobial activity was determined using the agar-well diffusion method. Gram(-) bacteria (Salmonella typhimurium, Citrobacter freundii) and Gram(+) bacteria, (Staphylococcus aureus, Staphylococcus sciuri, Bacillus cereus) showed high susceptibility, while yeasts and moulds were resistant. BPE exhibits cytotoxic properties against Ehrlich carcinoma (EAC) cells in vivo due to induction of oxidative stress. The largest decreases in EAC cell numbers were observed in the pre-treated male (approximately 53%) and female (approximately 47%) mice, and also the EAC cell viability was decreased after administration of BPE. The activities of the antioxidant enzymes, xanthine oxidase (XOD) and peroxidase (Px), were significantly different between the untreated EAC control group and all other groups that were treated with BPE. The XOD and Px activities were very low in untreated malignant cells, but increased significantly after administration of BPE. Our results show that BPE holds promise in the food industry as a source of bioactive compounds.

Postoperative visual recovery following surgical treatment of suprasellar meningiomas.

INTRODUCTION: The purpose of this study was to investigate pre- and postoperative visual acuity in patients with meningioma in the area of optic chiasm. MATERIAL AND METHODS: This retrospective study included 43 patients with meningioma in the area of optic chiasm, who had been found to have impaired visual function according to anamnestic data and neuro-ophthalmologic examination which excluded the presence of any other eye diseases. The visual status was analyzed both preoperatively and postoperatively, i.e., 10 days, one month and six months after surgery. RESULTS: An improvement in visual acuity was recorded in 50% of the examined eyes (68.42% of patients), the most expressed changes being in terms of higher number of the eyes with normalized visual acuity and lower number of the eyes with severely reduced visual acuity after surgery. These changes were particularly prominent immediately after surgery, during the first ten days. CONCLUSION: The recovery of visual acuity after decompression in the area of optic chiasm is possible in cases where mechanical pressure on the nerve fibres and resulting fibre ischemia have not lasted long enough to lead to their irreversible damage.

Heterophoria and fusional convergence and divergence in preschool children.

AIM: To determine the prevalence of heterophoria, fusional convergence and divergence values and the degree of relationship between heterophoria and fusional vergence in preschool children. METHODS: For assessment of far and near heterophoria in 152 children aged 6-7, cover and prism cover tests were used. Far and near fusional vergences were measured by step vergence testing using prism bars. RESULTS: Orthophoria (-tropia) with the average values of heterophoria around 0 PD (prism diopter) were most common at far, and exophoria around 2 PD at near. The average break values of far fusional convergence and divergence were 13.7 ± 4.4 PD and 7.3 ± 2.1 PD, respectively. Near fusional convergence and divergence break values were 29.6 ± 6.6 PD and 16.2 ± 4.1 PD, respectively. The recovery values were from 1/3 to 1/2 lower than the break values. The correlation between heterophoria at far and far fusional convergence and heterohoria at near and near fusional convergence and divergence was weak, yet significant (r = 0.18 - 0.26; p less than 0.05). CONCLUSION: In preschool children the prevalence of heterophoria, and values of fusional vergence were in the ranges of values for elementary school children and adults cited in the literature. Heterophoria and fusional convergence at far, and heterophoria and fusional vergences at near have shown a weak relationship.

[Adjunctive therapy with brinzolamide in patients on travoprost treatment].

INTRODUCTION: This study was aimed at evaluating the safety and efficacy of brinzolamide 1% suspension (Azopt 1%) and travoprost 0.004% (Travatan) combined therapy in patients with open-angle glaucoma or ocular hypertension who are in need of additional intraocular pressure lowering. MATERIAL AND METHODS: This is a prospective, three-month, open-label, clinical study. Forty patients (80 eyes) with primary open-angle glaucoma or ocular hypertension on Travatan treatment and with unsatisfactory results in lowering intraocular pressure were included in the study. The qualifying intraocular pressure on previous treatment with Travatan (at least 6 weeks) was 22-36 mmHg in at least one eye at 8 a.m. intraocular pressure measurements at three eligibility visits. The patients received brinzolamide 1% twice a day in addition to travoprost 0.004% given once a day in the evening for 3 months. The follow-up examinations assessing the safety and efficacy of combined therapy of brinzolamide 1% and travoprost 0.004% were performed after 1 and 3 months. RESULTS: Adjunctive therapy with brinzolamide resulted in statistically significant reductions in intraocular pressure from the travoprost baseline at all visits. Treatment with brinzolamide/travoprost caused statistically significant sustained reduction in intraocular pressure with the reduction of 17.39% (p < 0.001) after 4 weeks and 20.08% (p < 0.001) after 12 weeks. The intraocular pressure change from the baseline ranged from -3.9 mmHg after 4 weeks to -4.48 mmHg after 12 weeks. The most frequently related adverse effect was abnormal taste and blurred vision. CONCLUSION: Brinzolamide 1% (b.i.d) used adjunctively with travoprost 0.004% (q.d.) lowers intraocular pressure significantly compared to travoprost alone. Both drugs were well tolerated and safe in the studied patients.

Detection and treatment of amblyopia in children.

Refractive errors are a common cause of decreased visual acuity. They can be found in 2-4% of preschool children. If not discovered on time and not properly treated, they can lead to amblyopia and strabismus. The active participation of parents and paediatricians is of great importance in timely discovering and treatment of amblyopia. The most common causes of amblyopia are strabismus (50.1%) and refractive error (44.7%). The best treatment results are achieved in amblyopic children with strabismus. The cooperation of physicians of all specialties, above all paediatricians and ophthalmologists, as well as a good collaboration of parents based on their being well-informed, must exist in the process of timely diagnosing and treating of amblyopia.

[Oxidation stress role in age-related cataractogenesis].

INTRODUCTION: Age-related cataract not only diminishes human life quality but it also represents a big impact on healthcare budget of almost every country as the population ages globally. Hence, cataract prevention is a big and true challenge, but a very difficult task to be accomplished. Nowadays cataract is more than a routinely recognized and almost always successfully operated ophthalmologic disease. The diagnosis of age-related cataract diagnosis might alert doctors to some systemic disorders on the whole body level. Increasing age is certainly the most essential age-related cataract risk factor. However, it seems that cataract could be a multifactor disease because of its individual, familiar, racial and gender expression differences. OXIDATION STRESS: Oxidation stress and its form caused by ultraviolet light- photo-oxidative stress--are considered to be crucial in the etiopathogenesis of cataract. All biomolecules suffer damages during cataract formation. On the other side, the lens possess a range of antioxidant elements and mechanisms of their action, which enable long lasting maintenance of lens transparency and functioning. Although they are primary characteristics of the lens, these antioxidant elements also depend on their systemic availability and consumption. This paper is a short literature review of the relation between oxidation stress and age-related cataract.

Radical scavenging, antibacterial, and antiproliferative activities of Melissa officinalis L. extracts.

The aromatic herb Melissa officinalis L. can be used as an easily accessible source of natural antioxidants and as a possible food supplement and as a phytochemical. Radical scavenging, antibacterial, and antiproliferative activities of petroleum ether, chloroform, ethyl acetate, n-butanol, and water extracts of M. officinalis L. extracts were investigated. The results of antioxidative activity, obtained by electron spin resonance spectroscopy, confirmed that investigated extracts suppressed the formation of 2,2-diphenyl-1-picrylhydrazyl (DPPH), hydroxyl, and lipid peroxyl radicals in all investigated systems in a dose-dependent manner. The maximum DPPH and hydroxyl radical scavenging activities (SA(DPPH) = SA(OH) = 100%) were achieved in the presence of n-butanol extract at concentrations of 0.4 mg/mL and 0.5 mg/mL, respectively. The highest lipid peroxyl scavenging activity (93.20%) was observed at a higher concentration (5 mg/mL) of n-butanol extract in the lipid peroxidation system. The most effective antibacterial activities were expressed by petroleum ether and ethyl acetate extracts on Sarcina lutea. Chloroform extract showed the strongest antiproliferative effect with 50% inhibitory concentration values of 0.09 mg/mL and 0.10 mg/mL for HeLa and MCF-7 cell lines, respectively. The present study demonstrated the high phenolic content and radical scavenging, antibacterial, and antiproliferative activities of extracts of M. officinalis L. originating from Serbia.

[Vision related quality of life--a cataract study].

INTRODUCTION: Since 1996, advanced methods and new instruments for the assessment of vision quality of life (VisQoL) index (37 and 15) have been developed and applied at the University Eye Clinic in Novi Sad. Many researches assume that postoperative results should not be evaluated only by postoperative visual acuity, but also by subjective perception of visual function and the patients ability to perform everyday activities, i.e. by quality of life. Therefore, our clinical results were based on both parameters of visual function, as the most objective attributes for assessing outcomes of certain types of cataract surgery. MATERIAL AND METHODS: Based on the results of the Cataract Study in Vojvodina in 2004, 5.7% of patients waiting for cataract surgery were already blind, 16.5% had low vision with cataract on both eyes, and 57% of patients had monocular blindness. RESULTS AND DISCUSSION: With improvement of visual acuity to 0.5 or higher, after cataract surgery in 96.5% of patients, the cumulative VisQoL 15-index changed from 59.3 to 95.5. Intraocular lens implantation contributed most to the significant improvement in the vision related quality of life. Our study showed that pseudophakic patients had better qualitiy of life than aphakic patients, who had the same visual acuity and refractive correction. Difficulties in performing everyday activities, such as shopping, using the telephone and reading, were found in 12.7% of aphakic, but only in 3% of pseudophakic patients. CONCLUSION: Advanced phacoemulsification techniques enable operated cataract patients immediate vision recovery, better quality of life, and personal satisfaction with visual function in everyday activities.