[Encapsulated filtering blebs--incidence and methods of treatment]. / Inkapsulisano filtraciono jastuce--ucestalost i metodi lecenja.

Encapsulation of the filtering bleb occurs as a complication of glaucoma filtering surgery in 8.3-28% of all eyes filtered, often between 2-4 weeks after surgery. It has a characteristic clinical appearance--highly elevated localized bleb, prominent surface vessels and patent sclerostomies on gonioscopy. This study retrospectively reviewed the results of 100 filtering operations, performed in the Prof. Dr. I. Stankovitsh Eye Department, focused on the incidence, possible risk factors and management of encapsulated filtering blebs. Trabeculectomy was done in all patients with limbus-based conjunctival flap, rectangular scleral flap 4 x 4 mm, and sclerostomy 2 x 2 mm. Two or three interrupted 10-0 nylon sutures were used to tether the flap, the conjunctiva with Tenon's capsule was closed with a running suture. All eyes received topical dexamethasone drops, mydriatics-homatropin or tropicamide and antibiotic ointment for three weeks. Possible risk factors were considered: sex, age, other eye or systemic disease, type of glaucoma, previous ocular procedure and antiglaucoma medical therapy, early postoperative complications, postoperative and final intraocular pressure (IOP). All eycs with encapsulated filtering bleb were given topical beta-blocker initially and carbonic anhydrase inhibitor, and if IOP continued to be uncontrolled incisional surgical management was performed. Success was defined as IOP maintained at less than 22 mmHg, with or without medication. An encapsulated filtering bleb developed in 9% of eyes. Previous argon laser trabeculoplasty was associated with an increased frequency of bleb encapsulation. The mean postoperative IOP was 11.30 +/- 1.90. Encapsulation of filtering bleb was developing at mean time of 19.9 +/- 3.0 after surgery. Six eyes returned to IOP below 21 (mean IOP was 20.17 +/- 0.90) within 4 weeks, and 4 of them continued on a topical beta-blocker. Four eyes required incisional surgery. A week after surgery mean IOP was 18 mmHg. Haemophthalmus occurred after one incision performed in a patient suffering from diabetes mellitus. Late scarring of the filtering bleb was developed in 2 eyes. Seven months and 2 years after filtration surgery mean IOP was 21.30 +/- 4.00 mmHg. The cause of bleb encapsulation is not known. Male patients, surgical glove powder, topical corticosteroids, previous argon laser trabeculoplasty and beta-blockers are some of potential risk factors for the development of encapsulated filtering bleb. This study suggests the association between development of encapsulated bleb and previous argon laser trabeculoplasty--40% in the eyes with encapsulation and 18% in the eyes without encapsulation. The optimal management of bleb encapsulation has not been defined. In this study topical antiglaucoma therapy achieved IOP control and cyst's remodeling in 60% of cases. Forty percent of all cysts required incisional surgical management. Encapsulation of the filtering bleb is not an uncommon complication of glaucoma filtration surgery. It is important to examine postoperative eyes frequently during the first 2 months to detect this complication. Fortunately, most eyes have their IOPs controlled with antiglaucoma therapy.

[Secondary cataracts in extreme myopia]. / Sekundarna katarakta u jako miopiom oku.

INTRODUCTION: After cataract surgery there is a higher incidence of posterior capsular opacification (secondary cataract) in myopia than in normal population, and it varies from 40 to 60% [1, 2]. METHODS: Fifty myopic eyes operated for cataract at Prof. Dr. Ivan Stankovitsh Eye Department from 1988 to 1995 were examined for capsular opacification (secondary cataract). Extracapsular cataract extraction was performed in all patients and in 32 patients the posterior intraocular lens was placed. Capsular opacification was classified by type and treated with Nd:YAG laser or discussion at least 9 months to 3 years and 3 months from the operation. RESULTS: There were 13 secondary cataracts (26%) in our series of patients, of whom 22% with intraocular lenses, and 33% were aphakic patients. Visual acuity was 4/60 to 0.5. In 11 patients YAG-laser capsulotomy was performed and in one patient capsular discussion, and in one subject there was no treatment. Consequent visual acuity was 0.3 to 1.0. No correlation was found between the age, type of intraocular lens and capsular opacification. DISCUSSION: Capsular opacification is more often seen in myopic eyes and its treatment is associated with a higher rate of complications (cystoid macular oedema, rupture of anterior hyaloid, retinal detachment...) [3, 4]. It seems that posterior lens implants reduce the chance for development of posterior capsular opacification. The safest treatment is YAG-laser capsulotomy.

[Inhibition of angiogenesis in the cornea with amiloride]. / Inhibicija angiogeneze roznja ce amiloridom.

INTRODUCTION: For its transparency, avascularity and possibility of measurement of the new vessels ingrowth, cornea is a frequent model for angiogenesis research. New vessels are made in several phases: after the action of the stimulus, there is a localised fragmentation of the basal membrane and the extracellular matrix around the involved capillary. Then, endothelial cells migrate through the openings in the capillary wall and the lysis of the extracellular matrix continues as a new vessel is being formed. Enzymes, plasminogen-activators, convert plasminogen from the blood and tissues to plasmin which starts proteolytic cascade of the lysis of the extracellular matrix. Amilorid, previously known as a diuretic, is found to be a competitive inhibitor of plasminogen activator-urokinase (u-PA). Its effect was shown in the prostaglandin-induced model of corneal vascularization [6]. PURPOSE: The purpose of this work is to show that amilorid acts as an angiostatic in the traumatic model of corneal vascularization. MATERIALS AND METHODS: There were two groups of experimental animals (rabbits, weight 1.5-3 kg). Deepitelisation and trephination were performed on all corneas (traumatic model of vascularisation). The first group of animals (17 eyes) was given 15 mg of amilorid (Sigma) intraperitoneally for five days, while the control group consisted of 7 eyes. Neovascularization was measured after 5 and 15 days. Animals were sacrificed on day 15. Three eyes from each group were tested for corneal wound tensile strength. RESULTS: In the experimental group there was a 0.5 mm ingrowth of the new vessels after the first five days and no further ingrowth till the end of the experiment. In the control group there was a 2 mm ingrowth after five days, and a further 1 mm after the next ten days. No statistical difference was found with regard to tensile strengths of the corneal wounds between the two groups. DISCUSSION: Although the traumatic model is closer to the clinical situation than the prostaglandin-induced vascularization model, more potential angiogenic factors are involved. Trephination damages basal membrane which may liberate angiogenic substances (heparan-sulphate, for example) [9]. Products of damaged cells attract leucocytes by haemotaxis. Also, hyopxia in the depth of the wound may be the site of macrophage induced angiogenesis [10]. It is difficult to say at which point amilorid acts but, considering the new vessel ingrowth for only 0.5 mm, it might be at the beginning of the process (lysis of extracellular matrix). CONCLUSION: Amilorid acts as angiogenesis inhibitor in the traumatic corneal vascularization model without changing the tensile strength of the wound.

[A case of attempted suicide with an enormous quantity of food]. / Prikaz pokusaja samoubistva sa enormnom kolicinom hrane.

Presented is a suicide attempt with an enormous amount of food in a young female affected with Anorexia mentalis of symptomatic alcoholism. Reacting to a conflict situation with her boyfriend, in a fit of anxiety and depression on a principal of a "short circuit reaction" she took an uncontrollably large amount of food. After an attempt of gastric lavage which was unsuccessful, a laparotomy and gastrotomy was carried out because of vital reasons. Eight kilograms of various types of undigested food and mushy contents were removed from the stomach. The surgical treatment lasted for 26 days, and treatment was resumed at the department for neuropsychiatry and the patient was released to go home as recovered after 84 days of treatment. The authors have presented this case as a very rare suicide attempt, because they have not found a description of a suicide attempt with food in domestic nor available world literature.

Effect of pregnenolone-16alpha-carbonitrile (PCN) on drug response in man.

Pregnenolone-16alpha-carbonitrile (PCN), which alters drug responses and induces hepatic microsomal drugs-metabolizing enzymes in experimental animals, is well-tolerated in man. There were no marked changes in the concentrations of blood sugar and urea; marked changes in the concentrations of blood sugar and urea; bromsulphophthalein (BSP) clearance; serum alkaline phosphatase activity; hematocrit, erythrocyte and leukocyte counts; as well as in ecg patterns. When the steroid was given by mouth for 4 days to patients treated with electroshock for psychiatric disorders, it decreased suxamethonium-induced skeletal muscle fasciculation and shortened thiopentone as well as propanidid anaesthesia. Breathing was resumed more rapidly than in control subjects. The protective effect of PCN is probably mediated through induction of activation or hepatic drug-metabolizing enzymes, or both.