Therapeutic modalities of exudative age-related macular degeneration.

INTRODUCTION: Age-related macular degeneration (AMD) is a leading cause of irreversible serious vision damage in persons over 50 years of age. In treating AMD many medicaments are applied such as inhibitors of vascular endothelial growth factor (VEGF), have been very carefully included over the last few years after a series of study research. AIMS: To analyze the past methods of treatment, discuss emerging therapies which could advance the treatment of exudative AMD. The past anti-VEGF therapies require frequent repetitions of administration, with uncertain visual acuity recovery, as not all patients react to anti-VEGF therapy. Consequently, there is a need to find out additional therapies which could improve the treatment of exudative AMD. The real aim in the treating of AMD is to prevent CNV development. METHODS: A survey of the current clinical research and results in the field of the present and future treatments of exudative AMD. RESULTS: There are many areas of research into new methods of the exudative AMD treatment. CONCLUSION: The future therapies for exudative AMD treatment have a potential not only to reduce the frequency of administration and follow-up visits, but also to improve effects of treatment by targeting additional ways of CNV development, increasing the aptitude of target binding and extending durability of treatment.

C-reactive protein and chitinase 3-like protein 1 as biomarkers of spatial redistribution of retinal blood vessels on digital retinal photography in patients with diabetic retinopathy.

The aim of the study was to investigate the correlation between the levels of C-reactive protein (CRP) and chitinase 3-like protein 1 (YKL-40) in blood samples with morpohometric parameters of retinal blood vessels in patients with diabetic retinopathy. Blood laboratory examination of 90 patients included the measurement of glycemia, HbA1C, total cholesterol, LDL-C, HDL-C, triglycerides and CRP. Levels of YKL-40 were detected and measured in serum by ELISA (Micro VueYKL-40 EIA Kit, Quidel Corporation, San Diego, USA). YKL-40 correlated positively with diameter and negatively with number of retinal blood vessels. The average number of the blood vessels per retinal zone was significantly higher in the group of patients with mild non-proliferative diabetic retinopathy than in the group with severe form in the optic disc and all five retinal zones. The average outer diameter of the evaluated retinal zones and optic disc vessels was significantly higher in the group with severe compared to the group with mild diabetic retinopathy. Morphological analysis of the retinal vessels on digital fundus photography and correlation with YKL-40 may be valuable for the follow-up of diabetic retinopathy.

Correlation of atherogenic risk factors with retinal artery occlusion in adults.

AIM: To evaluate correlation of atherogenic risk factors between patients with retinal artery occlusion (RAO) and matched population, including those with central RAO and branch RAO. METHODS: Seventy-two participants from 2 groups were evaluated: a group with diagnosed RAO (first group; 45 participants) and a matched control group including those without RAO or any other ophthalmological disease (second group; 27 participants). From those with diagnosed RAO patients with central RAO and patients with branch RAO were evaluated separately. Additional parameters that were observed included body mass index (BMI), blood pressure, fasting glucose levels, triglycerides, LDL and HDL cholesterol fractions levels, presence of metabolic syndrome and hyperlipoproteinemia. RESULTS: There was a significant increase of LDL mean values in the group of patients with RAO. Hypertension (88.9%), hyperlipoproteinemia (68.9%) and metabolic syndrome (53.3%) were significantly more frequent in patients with RAO, while gender and diabetes mellitus were not in direct correlation with the development of RAO. The group of patients with RAO had no significantly higher values of BMI compared to the control. High density lipoprotein fraction was significantly higher in the group of patients with central RAO as compared with those with branch RAO. CONCLUSION: Patients with atherogenic risk factors are more prone to the development of RAO. Furthermore, we demonstrated that HDL had more protective effects on smaller blood vessels (branch retinal artery) than on larger blood vessels (central retinal artery).

Therapeutic Modalities of Exudative Age-related Macular Degeneration.

INTRODUCTION: Age-related macular degeneration (AMD) is a leading cause of irreversible serious vision damage in persons over 50 years of age. In treating AMD many medicaments are applied such as inhibitors of vascular endothelial growth factor (VEGF), have been very carefully included over the last few years after a series of study research. AIMS: To analyze the past methods of treatment, discuss emerging therapies which could advance the treatment of exudative AMD. The past anti-VEGF therapies require frequent repetitions of administration, with uncertain visual acuity recovery, as not all patients react to anti-VEGF therapy. Consequently, there is a need to find out additional therapies which could improve the treatment of exudative AMD. The real aim in the treating of AMD is to prevent CNV development. METHODS: A survey of the current clinical research and results in the field of the present and future treatments of exudative AMD. RESULTS: There are many areas of research into new methods of the exudative AMD treatment. CONCLUSION: The future therapies for exudative AMD treatment have a potential not only to reduce the frequency of administration and follow-up visits, but also to improve effects of treatment by targeting additional ways of CNV development, increasing the aptitude of target binding and extending durability of treatment.

Ocular melanoma: an overview of the current status.

Ocular melanoma is the second most common type of melanoma after cutaneous and the most common primary intraocular malignant tumor in adults. Large majority of ocular melanomas originate from uvea, while conjunctival melanomas are far less frequent. Incidence of uveal melanoma has remained stable over last three decades. Diagnosis is in most cases established by clinical examination with great accuracy. Local treatment of uveal melanoma has improved, with increased use of conservative methods and preservation of the eye, but survival rates have remained unchanged. Recent advances in cytogenetics and genetics enhanced prognostication and enabled to determine tumors with high metastatic potential. However, due to lack of effective systemic therapy, prognosis of patients with metastasis remains poor and metastatic disease remains the leading cause of death among patients with uveal melanoma. Conjunctival melanoma is rare, but its incidence is increasing. It mostly occurs among white adults. In majority of cases it originates from preceding primary acquired melanosis. Current standard treatment for conjunctival melanoma is wide local excision with adjuvant therapy, including brachytherapy, cryotherapy and topical application of chemotherapeutic agent. Rarity of this tumor limits conduction of controlled trials to define the best treatment modality. As well as for uveal melanoma, prognosis of patients with metastasis is poor because there is no effective systemic therapy. Better understanding of underlying genetic and molecular abnormalities implicated in development and progression of ocular melanomas provides a great opportunity for development of targeted therapy, which will hopefully improve prognosis of patients with metastatic disease.

Transforming growth factor beta1, matrix-metalloproteinase-2 and its tissue inhibitor in patients with pseudoexfoliation glaucoma/syndrome.

BACKGROUND/AIM: Transforming growth factor-beta1 (TGF-beta1), oxidative stress and imbalance between matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) may play an important role in pathogenesis of pseudoexfoliation syndrome/glaucoma (PEX Sy/Gl). The aim of the study was to measure concentrations of TGF-beta1, MMP-2, TIMP-2 in the aqueous humor in the examined group, as well as to compare the biochemical findings with the following clinical parameters: degree of chamber angle pigmantation, presence of pseudoexfoliation and the value of intraocular pressure (IOP). METHODS: Aqueous samples from 30 patients with cataract, 30 patients with PEX Sy, 36 patients with PEX Gl, and 42 patients with primary open-angle glaucoma (POAG) were collected during phacoemulsification cataract surgery. TGF beta1, MMP-2, TIMP-2 Fluotokine Multi Analyze Profiling kits and Luminex technology were used to simultaneously measure TGF beta1, MMP-2 and TIMP-2. RESULTS: TGF-beta1, MMP-2, TIMP-2 were detected in human aqueous from all the groups with the highest level in the group with PEX Gl. Statistically, a significant correlation between the levels of TGF beta1, MMP-2, TIMP-2 in the aqueous humor of the patients with PEX Gl and the IOP value was confirmed (p < 0.05). In this group, the positive correlations between the TGF beta1 concentration in the aqueous humor and the presence of pseudoexfoliation (p < 0.01), on the one hand, and between the TIMP-2 level and the presence of pseudoexfoliation (p < 0.05), on the other, were reported. A statistically significant positive correlation of TGF-beta1 and MMP-2, and the degree of chamber angle pigmentation in the PEX Gl group was confirmed (p < 0.05). In the POAG group, TIMP-2 values were in a negative correlation with the degree of pigmentation (p < 0.05), and the IOP value (p < 0.05). CONCLUSION: TGF beta1 and MMP-2 affect the degree of chamber angle pigmentation and the degree of pseudoexfoliation in patients with pseudoexfoliative glaucoma.

Unilateral optic nerve aplasia associated with microphthalmos.

INTRODUCTION: Optic nerve aplasia is a rare developmental anomaly characterised by the congenital absence of the optic nerve, central retinal vessels and retinal ganglion cells that is seen most often in a unilaterally malformed eye. CASE REPORT: We reported a girl with a very rare anomaly of the eye, unilateral aplasia of the optic nerve and microphthalmia. We carried out a complete ophthalmological examination, A- and B-scan ultrasonography, magnetic resonance imaging (MRI) of the orbit and brain, pediatrician, neurological examinations and karyotype determination. The examined child was a third child from the third regular pregnancy, born at term (39 GS, BM 3100 g). Family ocular history was negative. The right corneal diameter was 7.5 mm and left 10 mm. On dilated fundus examination, the right eye showed the absence of op tic nerve and central retinal vessels. B-scan echography showed a small right globe (axial length 13.80 mm), normal size left globe (axial length 18.30 mm) and the absence of optic nerve on the right eye. Physical and neurological findings and karyotype was normal. MRI of the orbits and brain marked asymmetry of globe size and unilateral absence of the optic nerve. The patient is under the control of a competent ophthalmologist and prosthetic. CONCLUSION: Further aesthetic and functional development of a young person is the primary goal in tracking this rare congenital optic nerve anomalies in the malformed eye.

Idiopathic polypoidal choroidal vasculopathy.

BACKGROUND: Idiopathic polypoidal choroidal vasculopathy (IPCV) is uncommon condition. It is considered to be a variant of neovascular age-related macular degeneration, but it can be also found in younger patients. CASE REPORT: We presented a case of otherwise healthy, 36-year-old women, with sudden unilateral visual impairment in the left eye and metamorphosia. Slit lamp biomicroscopy examination of the eye anterior segment was normal. Intraocular pressure determined by aplanation tonometry was 16 mmHg in both eyes. Indirect slit lamp biomicroscopy examination showed signs of serosanquinous detachments of the retinal pigment epithelium. Fluorescein angiography showed a subretinal vessel network through the pigment epithelial atrophy with hyperfluorescence in superior part of serohemorrhagic pigment epithelial detachment and the inferior hypofluorescence, caused by hemorrhage. Optical coherence tomography proved detachment of the retinal pigment epithelium. CONCLUSION: In patients with IPCV a mild, natural course with spontaneous resorption of exudations and hemorrhage and improvement in visual acuity can be observed. There is no approved treatment at present.

[Autologous serum in treatment of dry eye].

INTRODUCTION. The treatment of dry eye by autologous serum is a simple and inexpensive treatment option. It is particularly effective in severe forms of dry eye as well as for chemical eye injuries, and it is justified by the presence of essential tear components which are not found in preparations of artificial tears. The aim of this study was to analyze the effects of autologous serum therapy in the patients with dry eye. MATERIAL AND METHODS. We monitored the effect of one-month treatment of dry eye by autologous serum (used with artificial tear preparations) in 50 rheumatology patients (23 men and 27 women) aged 26-65 years at the Department of Ophthalmology, Clinical Center Nis. We analyzed ocular discomfort and the values of objective parameters for the evaluation of tear film at baseline and one month later (Schirmer I, Tears Break Up Time and Rose Bengal). RESULTS. A statistically significant reduction of subjective complaints was found in the patients after the treatment by autologous serum (p<0.05), along with a minimal improvement of objective tests for checking the tear film quality. DISCUSSION AND CONCLUSION. The use ofautologous serum in dry eye therapy should provide benefit to the patients, relieve symptoms and improve objective parameters for the evaluation of dry eye. Both doctors and patients should be adequately informed, and proper screening of potential users of this method should be done. Not only additional tests of therapeutic effect of autologous serum (as well as of umbilical cord serum or autologous plasma) are needed but also parallel clinical and histopathological examination and analysis of the effects of this type of treatment of dry eye.

Identical twins with "mirror image" anisometropia and esotropia.

INTRODUCTION: Identical twins account for 0.2% of the world population and 8% of all twins. A "mirror image" variation can be found in 25% of identical twins. Studies of twins assume a special place in human genetics due to the possibility of comparing genetic and other factors. We present two pairs of identical male twins with mirror-image astigmatism and esotropia. CASE OUTLINE: The first was a pair of twelve-year old identical twins with "mirror image" myopic astigmatism. The Twin 1 had myopic astigmatism in the right eye, while the Twin 2 was affected by the left eye myopic astigmatism. The second was a pair of six-year old identical twins with esotropia and hypermetropic astigmatism. The Twin 1 had esotropia in the left eye, while the right eye was affected in the Twin 2. Esotropia was surgically corrected. CONCLUSION: In this study we pointed to the role of genetic factors in the development of refractive error, as well as the type of strabismus. Refraction anomalies (myopia, hypermetropia and astigmatism) are complex heterogeneous disorders and ideal for genetic investigation. The knowledge of genetic mechanisms involved in refractive error susceptibility may allow treatment to prevent progression or to further examine gene-environment interactions. We hope that this paper will initiate further investigation of refraction anomalies in twins and future multicentre studies, which, to our knowledge, have not been conducted in our country so far.

[Multifocal choroidopathy syndrome--a case report].

INTRODUCTION: Multifocal choroidopathy syndromes are a group of rare disorders, which involve a primary pathologic process occurring at or near the level of the retinal pigment epithelium, with or without choriocapillaris involvement. The aetiology of multifocal choroidopathy syndrome is still unknown. A CASE REPORT: We present a case of multifocal choroidopathy syndrome. A 54-year-old woman was referred to our department with blurred vision on both eyes, mild ocular pain, accompanied by metamorphopsia, floaters, scotomas and photopsia. The anterior segment examination showed small to medium size keratic precipitates, posterior synechiae, and iris atrophy. Mild to moderate aqueous inflammation with cells and flair was present in the anterior chamber. The fundus examination showed multiple small yellow--white spots, round-shaped changes located at the level of the retinal pigment epithelium and choriocapillaris. According to the fluorescein angiography the active lesions exhibited blockage of the early choroidal fluorescence followed by late staining The old inactive lesions corresponded to the retinal pigment epithelium windows defects. The laboratory examination showed high level of blood glucose, C reactive protein, cholesterol HDL, LDL, triglycerides. According to the immunological examination the C3 component of complement was lower (0.630), as well as the C4 component of complement (0.158), and the immunological complex in blood was elevated (171). ELIZA test on viral infection showed Citomegalo viruses IgG positive, Herpes Simpler Virus lgG positive, Varichela Zoster Virus lgG positive. The results of human leucocyte antigen typization were humuan leucocyte antigen A1:A2, human leucocyte antigen A2:A24(9), human leucocyte antigen B1:B44(12), human leucocyte antigen B2:B60(40), human leucocte antigen C1:Cw3, human leucocyte antigen C2:Cw5. The radiological examination of lungs, the Mantoux test, Treponemnal serology, Toxocara and Toxoplasma serology, magnetic resonance of endocranium and orbit were also performed. The multiple viral infection, which was detected in our patient with immunological abnormalities pointed to an underlying autoimmune mechanisnm, possibly triggered by an infectious agent, a virus.

[Evaluation of body mass index and lipid fractions levels in patients with retinal artery occlusion].

BACKGROUND/AIM: There are studies stressing out that atherosclerosis is most common associated systemic condition in patients with retinal artery occlusion. The aim of this study was to analyze values of body mass index and lipid fractions in healthy individuals and patients with retinal artery occlusion. METHODS: This study included 90 participants during a 6-year period. The population was divided into 2 groups: the group with the diagnosed retinal artery occlusion and the group without retinal artery occlusion. The observed parameters were as follows: body mass index, low and high density lipoproteins and triglycerides. RESULTS: The study revealed no significant difference regarding body mass index and triglycerides values between the two evaluated groups, while low and high density lipoproteins values were significantly higher in the group of patients with retinal artery occlusion. CONCLUSIONS: The study demonstrated that body mass index and triglycerides have less important role in atherogenic pathogenesis of retinal artery occlusion, while low density lipoprotein is the fraction that is shown to be most potent in such etiological processes.

Anticardiolipin antibodies in patients with Behcet's disease.

The aims of this study are to determine anticardiolipin antibodies in patients with Sy Behcet and to determine correlation between the levels of anticardiolipin antibodies in serum in patients with clinic systemic and ocular manifestations. The study was conducted on 11 patients with Behcet disease (group I), and on 11 healthy subjects (group II). Anticardiolipin antibodies -aCL were determined by the standard ELISA method, where 1GPL= 1 microgram/ml IgG aCL and 1 MPL= 1 microgram/ ml IgM, and were considered negative < 10 GPL or MPL, low positive (10-40 GPL and MPL), or high positive (>40 GPL and MPL). In the group of 11 patients with the diagnosis Sy Behcet, 6 of them were (54.5%) with values of anticardiolipin antibodies over 10 positive. In the control group of the healthy examinees aCl were positive in 2 cases (18.2%). There are no statistically significant differences in the presence of systemic clinic characteristics between aCl positive and negative patients. All the patients with SY Behcet in whom anticardiolipn antibodies were found have extremely severe visual damage which is not present in the group of those patients where the values of aCl were low. The difference is statistically significant. The level of anticardiolipin antibodies is increased in the patients with Behcet. There are no statistically significant differences in the presence of systemic clinical characteristics between aCL positive and negative patients. Visual acuity in patients with SY Behcet is statistically significantly much lower in patients who had increased values of aCL.

Application of ultrasound in diagnosing and follow-up of endocrine orbitopathy.

Endocrine orbitopathy or ophthalmopathy is an organ-specific, genetically conditioned autoimmune disease, resulting from a thyroid disorder. It is the most common cause of unilateral and bilateral proptosis in adults. Endocrine orbitopathy occurs most frequently in women aged 30 to 50 years. Ultrasound diagnostic is of primary importance in orbital pathology because of its safety, non-invasiveness, rapid application, and no need for preparation of the patient. The A scan in endocrine orbitopathy shows the echographical widening of the peripheral orbital space, a widening of the muscle echo, and the B scan shows a high internal echo of the connective tissue septa, increased reflection of the muscle belly, and distension of the retrobulbar optic nerve sheaths, enlargement of lacrimal gland and dilatation of the superior ophthalmic vein. All ultrasound features of the endocrine orbitopathy can be explained by immunological abnormalities and histological changes in orbital adipose tissue and extraocular muscles.

Ocular manifestation of rheumatoid arthritis-different forms and frequency.

Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-articular organ manifestations. Ocular manifestations involved with RA are keratoconjunctivitis sicca, episcleritis, scleritis , corneal changes, and retinal vasculitus. The etiopathogenesis of this autoimmune disorder is still unknown. Aim of our study was to present different ocular manifestations of RA and their frequency. We have examined 691 patient with the diagnoses of RA. All examined patients were in I or II stage of the disease according to criteria of The American College of Rheumatology. Ophthalmological exam obtained: visual acuity by Snellen sings, biomicroscopy of anterior segment, Schirmer test, tear break-up time (BUT), applanation tonometry and indirect ophthalmoscopy. In all patients with retinal vasculitis fotofundus and in indicated cases fluorescein angiography was preformed. The most common manifestation of ocular involvement was keratoconjunctivitis sicca. Episcleritis was diagnosed in 5.06% patients with RA, while scleritis was present in 2.06% of patients. Diffuse scleritis was present in one patient, while nodular was present in 13 patients. There were no patients with posterior or necrotizing scleritis among examined patients. Sclerosing keratitis was diagnosed in 11 female patients. It is characterized with peripheral thickening and opacification of the stroma adjacent to the site of inflammation. Posterior scleritis or scleromalacia of cornea was not present in our patients, because all of them were in I or II stage of disease. Retinal vasculitis was present in three patients, two male and one female patient (0.45%). Ocular manifestation was present in 27.2% of patients. Women were more affected.

Oxidative stress in cataractogenesis.

The aim of our study was to compare levels of antioxidative agent -total SH groups and the final product of lipid peroxidation- malondialdehyde (MDA) in serum, and glutathione (GSH) and MDA in nucleocortical parts of lens after extracapsular extraction of cataract. Patient were (38 with cataract and 38 controls) matched by sex and years of life. Diagnosis of cataract was established by complete ocular examination. All results are expressed as mean ± S.D. A Student's t-test was used to estimate differences between the groups. The level of significance was p<0.05. Total sulfhydryl groups were determined in serum by the method of Ellman as well as GSH content in nucleocortical parts of lenses using the method of Sedlak and Lindsay. Lipid peroxidation, evidenced by formation of thiobarbituric acid reactive substances (TBARS), was determined in nucleocortical parts of the lens and in serum. Our results show a statistical significance in concentration of total SH groups (225.37±82.19µmol/L, controls 311.03±60.37µmol/L p<0.05) and MDA (20.24±8.12, and controls 8.73±2.53µmol/L, p<0,001) in serum among patients with age related cataract and controls. There was no statistical significance in concentration of total SH groups and MDA in serum among patients with different type of age related cataract and in nucleocortical parts of lens. The present study concludes that there is a statistical significance in concentration of total SH groups and MDA in serum among patients with age related cataract and controls, but there were no statistical significance in concentration of GSH and MDA in serum and nucleocortical parts of lens in patient with different type of cataract.

Optic disc abnormalities - diagnosis, evolution and influence on visual acuity.

Congenital abnormalities of the optic disc are not so rare. The etiology for the most of them is unknown. Visual acuity of affected eye may be minimally or severely affected, depending on the extent of lesion. All of these conditions can be unilateral or bilateral. Children who have unilateral optic disc abnormalities generally present during the preschool years with sensory esotropia. Visual acuity may be unaffected like in optic disc pit, optic disc drusen, fibre medullares, ect. However, during the evolution they may cause a decrease in visual acuity like serous retinal detachment in optic disc pit, atrophy or subretinal neovascularisation in optic disc drusen. Some of them like fibre medullares needs only a good diagnose and they do not have any evolution. Fluorescein angiography and ultrasonography may be crucial diagnostic procedures to discover some of them, like optic disc drusen. Optic disc abnormalities may be associated with other congenital disorders of the eye and often central nervous system malformations. Secondary they may be associated retinal detachment, retinochisis, macular edema, choroid neovascularisation and lipid exudation. Some of these conditions may be found on routine ophthalmologic exam such as optic disc drusen and fibre medullares and often are diagnostically problem. The aim of our study was to present some of our cases with different optic disc abnormalities such as fibre medullares, optic disc coloboma, hypoplasio disc, optic disc drusen and optic disc pit.

Psammoma bodies - friends or foes of the aging choroid plexus.

Psammoma bodies are structures classified in the group of dystrophic calcifications, which occur in some kind of tumors and in choroid plexus during the aging process. Despite early discovery of their presence in choroid plexus stroma, mechanisms responsible for their formation remained unclear. Their presence in some kind of tumors was even more extensively studied, but significant breakthrough in the field of their etiology was not attained, too. However, till today correlation between their presence in tumors and aging is not established. Also, there are not any data about structural differences between ones found in tumors and ones found in choroid plexus. This might points to the assumption that besides the aging, some other causes might be involved in their formation in choroid plexus. Furthermore, it is contradictory that forms, like psammoma bodies, present in such malignant formations as tumors, represent quite benign phenomenon in choroid plexus. Literature data and the results of our previous researches revealed that there might be connections between, these, on the first sight quite different processes. Firstly, psammoma bodies are present in stroma of tumors with predominantly papillomatous morphology, which is present in choroid plexus, too. Initial forms of psammoma bodies might be formed in fibrovascular core of choroid plexus villi, similarly like in tumors papillae of papillary thyroid cancer. Their further growth leads to the progressive destruction of both tumors papillae and choroidal villi. Choroid plexus stroma is characterized by the fenestrated blood vessels presence, which are similar to newly formed vessels in tumors. This makes it vulnerable to the noxious agents from circulation. It can contain lymphocytes, macrophages, dendritic cells and myofibroblasts in cases with psammoma bodies, similarly to tumors stroma which is in activated, proinflammatory state. So, all these facts can suggest that similar processes can lead to psammoma bodies formation in both tumors and choroid plexus and, that they might have harmful effect on choroid plexus structure and function during the aging process. Significantly higher degree of choroidal epithelial cells atrophy, in cases with present psammoma bodies proves that partially. Further researches should be focused on detection of osteopontin and nanobacteria, already detected in tumors psammoma bodies, in choroid plexus ones. Discovery of choroidal psammoma bodies mechanisms formation can be important for elucidation of some aspects in pathogenesis of some tumors, too. Application of choroid plexus epithelial cells functional markers in cases with psammoma bodies should show their functional status.

[Therapeutical approach to dry eye syndrome].

INTRODUCTION: Dry eye disease or dysfunctional tear syndrome is among the most frequently established diagnoses in ophthalmology. It can be defined as a disorder of the tear film resulting in changes in the ocular surface. MECHANISMS IN DEVELOPMENT OF DRY EYE DISEASE: There are many factors causing dry eye and they, can be related to deficiency in any of the components of the tear film. It has been suggested that dry eye is an inflammatory disorder that affects the ocular surface and lacrimal gland. Inflammation is the most important mechanism of corneal and conjunctival cell damage, which is responsible for the symptoms and signs of ocular surface pathology. Hormonal imbalance (particularly androgens), neural dysfunction, increased levels of pro-inflammatory cytokines and loss of immune homeostasis of the lacrimal gland and ocular surface could be possible mechanisms in the pathogenesis of dry eye disease. DISCUSSION: The aim of this paper was to review the advances in the pathogenesis and management of the dry eye disease. The appropriate dry eye treatment presupposes knowledge of all existing pharmacologic and non-pharmacologic therapeutic modalities. The mainstay of therapy is still artificial tears, with anti-inflammatory therapy and punctual occlusion therapy as second and third line therapies.

Central retinal artery occlusion in a patient with metabolic syndrome x.

PURPOSE: To report a case of central retinal artery occlusion (CRAO) in a patient with metabolic syndrome X. CASE REPORT: A 64 year-old-man presented with abrupt, painless, and severe loss of vision in his left eye. Indirect ophthalmoscopy disclosed signs compatible with CRAO and laboratory investigations revealed erythrocyte sedimentation rate of 74 mm/h, C-reactive protein (CRP) level of 21 mg/l, hyperglycemia, hyperuricemia, hypertriglyceridemia and hypercholesterolemia. Fluorescein angiography and immunological studies excluded other systemic disorders. The patient met the full criteria of the National Cholesterol Education Program for metabolic syndrome X. CONCLUSION: In addition to different vascular complications such as stroke, and cardiovascular disease, metabolic syndrome X may be associated with retinal vascular occlusions.