Heidelberg Retina Tomography II parameters in evaluating high- and normal-pressure glaucoma progression.

BACKGROUND/AIM: Heidelberg retina tomography II (HRT II) haves been employed to quantitatively assess the topography of optic discs in eyes with high-pressure glaucoma (HPG) and normal-pressure glaucoma (NPG), in order to determine which of global and segmental optic disc parameters will prove to be most suitable for monitoring the progression of these two conditions. METHODS: The results of 73 eyes of 73 patients with HPG and NPG were analyzed in relation to age, refractive error, quality of HRT images and stereometric parameters. RESULTS: A statistically significant difference (p < 0.05) between the global baseline and follow-up results was found in: rim volume, maximum cup depth and cup shape measure (in the HPG group), and C/D ratio, cup volume, rim volume and cup shape measure (in the NPG group). The baseline and follow-up results of the retinal nerve fiber layer in the temporal and inferotemporal sectors show a significant difference in both groups. CONCLUSION: Several HRT stereometric parameters are useful for monitoring the progression of changes of the optic disc and local retina in eyes with HPG and NPG. Both segmental and global scanning is of importance in glaucoma progression analysis.

Ocular complications after kidney transplantation: a case report and review of literature.

Membranoproliferative glomerulonephritis type II (MPGN II), also known as a dense deposit disease, is a chronic progressive kidney disease that often progresses to end-stage renal disease within 10 years. Most patients also have multiple subretinal white spots or drusen-like deposits that are histopathologically identical to the glomerular basement membrane deposits. The purpose is to determine ocular findings in a patient with MPGN II before and after renal transplantation and to correlate them with clinical characteristics related to transplantation and review of literature. We present a case of a 45-year-old female with MPGN II who developed bilateral serous retinal detachment and retinal hemorrhages in the left eye, which appeared 6 months after a renal transplant. Ocular complications in our case, with the exception on the retina, were present at the cornea and iris. Changes to the eyes were independent of the renal disease, because there was no recurrence of MPGN II on the renal graft.

Retrobulbar hemodynamic parameters in men and women with open angle glaucoma.

BACKGROUND/AIM: Several factors may have influence on systemic circulation. Additionally, peripheral circulation also demonstrates sex differences, in young women presenting significantly lower finger blood flow in comparison to men of the same age, a finding that disappears in women after menopause. The aim of this study was to compare the retrobulbar hemodynamic parameters measured by means of color Doppler imaging in women and men with open-angle glaucoma and elevated intraocular pressure. METHODS: A total of 52 eyes from 52 open-angle glaucoma (OAG) patients, with elevated intraocular pressure (lOP), were included in this cross-sectional study. Peak-systolic velocity (PSV), end-diastolic velocity (EDV), and Pourcelot resistivity index (RI) were assessed in the ophtalmic artery (OA), central retinal artery (CRA), and posterior cilliary arteries (PCA). IOP was measured both with Goldmann Applanation tonometer (GAT) and with the dynamic contour tonometer (DCT), three times respectively. Ocular pulse amplitude (OPA) appeared during the DCT measurement. RESULTS: The retrobulbar hemodynamic parameters did not show any difference between men and post-menopausal women. CONCLUSION: The results of our study did not find any difference between sexes in patients with open-angle glaucoma and elevated intraocular pressure.

Individual phenotypic variances in a family with Avellino corneal dystrophy.

BACKGROUND: Avellino corneal dystrophy (ACD) is an autosomal dominant disorder, characterized by the presence of deposits in the anterior stroma, and results from a specific mutation (R124H) in the transforming growth factor beta-induced gene (TGFBI). This report presents corneal dystrophy of the Bowman layer as a rare phenotypic appearance of ACD and a high intra-familial variability of phenotype in patients with ACD. CASE PRESENTATION: A 56 year-old Caucasian woman with recurrent corneal erosions was diagnosed with corneal dystrophy of the Bowman layer after a clinical examination. Optical coherence tomography of the anterior segment (AS-OCT) mainly demonstrated deposits in the Bowman layer and a few deposits in the superficial stroma. Her son, a 36 year-old man, has a typical clinical presentation of ACD with all the deposits arranged in stromal layers. In his case, the opacities resemble snowflakes between the granular deposits, and AS-OCT shows large, snowflake-like deposits in the superficial and deep stroma without accumulation in the Bowman layer. Genetic screening in both cases shows the heterozygous R124H mutation in the TGFBI gene. CONCLUSION: The clinical finding of the granular-lattice corneal dystrophy in which deposits are located in the Bowman layer may be an atypical presentation of ACD. This paper demonstrates a high degree of variability in the quantity and form of deposits between ACD heterozygotes. This is the first description of Avellino corneal dystrophy in the Balkans and in Serbia.

The role of confocal scanning laser ophthalmoscopy in stereometric differentiation of eye papilla in ocular hypertension, normal tension glaucoma and primary open-angle glaucoma.

BACKGROUND/AIM: Primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) demonstrate the same structural changes in the optic disc along with visual field defects but only POAG includes an abnormal elevation of intraocular pressure. Heidelberg retina tomograph based on confocal scanning laser ophthalmoscopy (HRT) and Moorfields regression analysis (MRA) have been employed to quantitatively assess the topography of eye papilla. We measured stereographic parameters of eye papilla in patients with POAG, NTG, and ocular hypertension (OH) using an HRT in order to determine whether HRT topographic parameters can be used to differentiate those conditions. METHODS: The results of 145 eyes of 145 patients with OH, NTG and POAG were analyzed by age, refractive error, quality of HRT images, stereometric and MRA parameters. RESULTS: Significant differences were found between NTG and other two groups for a majority of the HRT parameters, and also no differences between OH and POAG patients for a majority of the investigated parameters, except thickness of retinal nerve fiber layer. By reading the MRA no differences were found in the distribution of mostly damaged and mostly preserved neuroretinal rim sectors between NTG and POAG patients, and also all sectors of the neuroretinal rim in OH patients were preserved. CONCLUSION: HRT stereometric parameters are useful to differentiate patients with OH and NTG, and also for differentiation between NTG and POAG patients, but most of parameters showed no difference between OH and POAG patients. MRA may serve to confirm the diagnosis of OH, but not for precise distinction between NTG and POAG.

Morphometric characteristics of optic disc in patients with myopia and primary open-angle glaucoma.

BACKGROUND/AIM: Primary open-angle glaucoma is a multifactorial and progressive neuropathy, characterised by the acquired loss of ganglion cells of the retina and their axons. One of the risk factors for primary open-angle glaucoma is myopia over 5 diopters (D). The aim of our work was to investigate two groups of patients with primary open-angle glaucoma and myopia by using confocal scanning laser ophthalmoscopy, and to find out if the size of refractive error influences optic disk morfometric characteristics. METHODS: One hundred eyes of one hundred patients with primary open-angle glaucoma and myopia were involved in our study. All the patients were classified into two groups, the first one with myopia < 5 D, and the second one with myopia > or = 5 D. The Heidelberg retina tomograph is a technique we used in our study. We analized morfometric parameters of patients optic discs, with the aim to find a correlation between the parameters in each group separeatly, and also to find differences between the same parameters from both groups. RESULTS: There were significant differences in disc area, cup area, rim area and mean RNFL thickness between the two groups. The size of damage of neuroretinal rim in the group with high myopia was 27%, and in the group with lower myopia 14%. The most frequently damaged segment of neuroretinal rim in the patients with high myopia was nasal segment and in the patients with low myopia infero-temporal one. The least frequently damaged segment of neuroretinal rim in both groups was temporal one. CONCLUSION: Optic discs of glaucomatous patients with high myopia have bigger diameter, also bigger and more irregularly distributed damaged zone of neuroretinal rim, and also thinner retinal nerve fiber layer compared to glaucomatous patients with lower myopia.

Ocular injuries caused by airsoft guns - ten-year experience.

INTRODUCTION: The study describes ocular injuries caused by airsoft guns pellets, type of these injuries and their incidence in different age groups. METHODS: This is a retrospective review of medical charts of patients who were hospitalized due to airsoft guns ocular injuries in ten-year period (from 2000 to 2009). Patient's age, gender, duration of hospitalization, type of treatment and initial and final visual acuity were analyzed. RESULTS: Overall 92 patients with ocular injuries caused by airsoft gun pellets were hospitalized in ten-year period. In all patients only one eye was injured and there were 72 (78.3%) male patients. Injuries involved ocular adnexa, anterior and posterior segment of the eye. On initial examination 41 (44.6%) patients were presented with subconjunctival hemorrhages, 42 (45.6%) with corneal abrasion, 42 (45.6%) patients had corneal edema, 6 (6.5%) had traumatic mydriasis, 90 (97.8%) patients exhibited hyphema, 10 (10.9%) iridodialysis, in 27 (29.3%) patients high intraocular pressure (IOP) was measured, one patient had subluxation of intraocular lens (IOL) and one patient had traumatic cataract. Posterior segment findings included vitreous hemorrhage in 3 (3.3%) patients, retinal hemorrhage in 15 (16.3%) patients, retinal edema in 35 (38.0%) patients and one patient had globe rupture. Average duration of hospitalization was 5.7 days (range from 1 to 18 days). Three patients (3.3%) required eye surgery, eight patients (8.7%) had anterior chamber washout while rest of the patients were conservatively managed. Visual acuity at hospital release was significantly improved comparing to initial visual acuity, ranging from counting fingers at 1 meter to 20/60 in 7 (8.6%) patients, from 20/50 to 20/30 in 13 (16.0%) patients and from 20/25 to 20/20 in 61 (75.3%) patients. In 11 patients testing the visual acuity was not possible because of their young age. CONCLUSION: Injuries attributed to airsoft guns were confined mostly to anterior segment. There was also high percentage of severe posterior segment trauma requiring hospital admission. The most important factors in preventing such injuries are restricting access to airsoft guns, especially to minors, as well as mandatory use of protective equipment such as protective eyeglasses.

[Results of asymmetric bilateral medial rectus retroposition in unilateral Duane retraction syndrome type I]. / Rezultati asimetricne bilateralne retropozicije medijalnih rektusa kod unilateralnog Duane-ovog retrakcionog sindroma tip I.

OBJECTIVE: To describe the results of asymmetric bilateral medial rectus retroposition in unilateral Duane retraction syndrome-this type I. METHOD: This is a retrospective study involving 18 patients, mean age 11.2 years (3-37 years) with unilateral Duane retraction syndrome's type who were operated in 2009 up to 2011 year. The aim was to investigate the existence of ocular torticollis, size deviation before and after surgery and presence of amblyopia, anisometropia, type of refractive errors and lateralization. RESULTS: All 18 patients were surgically treated by asymmetric retroposition of internal rectus (for 1-2mm more on the healthy eye). All patients preoperatively demonstrated ocular torticollis. Size of mean preoperative deviation was +22.2 pD of primary angle PD and +46 pD of secondary angle. Postoperative finding: deviation of > +10 PD is noted to the presence of mild torticollis in one patient. Intermediate follow-up period was 9.8 months. Unilateral Duane's syndrome is common among members of women (67%) compared to males (33%). Lateralization of Duane's syndrome is more common in the left eye compared to the right (83% vs. 17%). Amblyopia was present in two patients and anisometropia (11.1%). As for refractive errors: hyperopia was found in 9 patients (50%), hypermetric astigmatism in 7 cases (39%), myopia and 1 (5.5%) and emmetropia (5.5%). None of the patients had no pathological changes in the fundus and anterior segment. CONCLUSION: Asymmetric bilateral medial rectus retroposition is extremely effective in the treatment of ocular torticollis and esotropia in patients with unilateral Duane retraction syndrome-this type I.

Anterior ischemic optic neuropathy associated with metabolic syndrome.

PURPOSE: Metabolic syndrome denotes a common cluster of naturally connected risk factors including obesity, elevated blood pressure, insulin resistance, dyslipidemia, proinflammatory state and prothrombotic state. Anterior ischemic optic neuropathy is an acute ischaemic disorder of the optic nerve head and may lead to severe visual loss. METHODS: We considered three patients with moderate degree of diabetic retinopathy and anterior ischemic optic neuropathy. They were submitted to endocrinological examination and the diagnosis of metabolic syndrome was established. RESULTS: Cardiological examination revealed that blood pressure control was not optimal. The signs of left ventricular hypertrophy and diastolic dysfunction were confirmed by echocardiography. They are possible markers of preclinical cardiovascular disease. CONCLUSION: We observed that a variety of well-known risk factors in metabolic syndrome may be involved in serious eye and cardiological complications. The early diagnosis and treatment of these patients can not only improve visual function but also prevent cardiovascular complications.

Anterior ischemic optic neuropathy associated with metabolic syndrome

PURPOSE: Metabolic syndrome denotes a common cluster of naturally connected risk factors including obesity, elevated blood pressure, insulin resistance, dyslipidemia, proinflammatory state and prothrombotic state. Anterior ischemic optic neuropathy is an acute ischaemic disorder of the optic nerve head and may lead to severe visual loss. METHODS: We considered three patients with moderate degree of diabetic retinopathy and anterior ischemic optic neuropathy. They were submitted to endocrinological examination and the diagnosis of metabolic syndrome was established. RESULTS: Cardiological examination revealed that blood pressure control was not optimal. The signs of left ventricular hypertrophy and diastolic dysfunction were confirmed by echocardiography. They are possible markers of preclinical cardiovascular disease. CONCLUSION: We observed that a variety of well-known risk factors in metabolic syndrome may be involved in serious eye and cardiological complications. The early diagnosis and treatment of these patients can not only improve visual function but also prevent cardiovascular complications.

OBJETIVO: A síndrome metabólica indica um grupo comum dos seguintes achados clinicos: obesidade, hipertensão arterial, variações nos níveis de glicemia, dislipidemia, estado proinflamatório e o estado protrombótico. Neuropatia óptica isquêmica anterior é um distúrbio agudo isquêmico da cabeça do nervo óptico que pode levar à perda de visão. MÉTODOS: Consideramos três pacientes com retinopatia diabética não proliferativa moderada e neuropatia óptica isquêmica anterior. Os pacientes foram examinados por endocrinologistas e o diagnóstico de síndrome metabólica foi confirmado. RESULTADOS: O exame cardiológico revelou que o controle da pressão sangüínea não era adequado e tal anormalidade foi corrigida. A ecocardiografia confirmou os indícios de hipertrofia ventricular esquerda e disfunção diastólica. Estes são os marcadores possiveis da doença cardiovascular pré-clinica. CONCLUSÃO: Concluímos que os fatores de risco bem conhecidos, combinados na síndrome metabólica levaram às complicações oculares e às complicações cardiológicas. O diagnóstico anticipado e o tratamento destes pacientes pode não apenas melhorar a função visual mas também impedir as complicações cardiovasculares.

[Binocular vision and vertical strabismus].

BACKGROUND/AIM: Elevation in adduction is the most common pattern of vertical strabismus, and it is mostly treated with surgery. The results of weaking of inferior oblique muscle are very changeable. The aim of this study was to evaluate binocular vision using sensory tests before and one and six months after the surgery. METHODS: A total of 79 children were divided in two groups: the first, with inferior oblique muscle of overaction (n = 52), and the second with dissociated vertical deviation (DVD), and primary inferior oblique muscle overaction (n = 27). We tested them by polaroid mirror test (PMT), Worth test at distance and near, fusion amplitudes on sinoptofore, Lang I stereo test and Wirt-Titmus stereo test. We examined our patients before and two times after the surgery for vertical strabismus. RESULT: Foveal suppression in the group I was found in 60.5% of the patients before, and in 56.4% after the surgery. In group II Foveal suppression was detected in 64.7% of the patients before, but in 55.6% 6 months after the surgery with PMT. Worth test revealed suppression in 23.5% of the patients before, and in 40.7% after the vertical muscle surgery. Parafoveal fussion persisted in about 1/3 of the patients before the surgery, and their amplitudes were a little largen after the surgery in the group I patients. Lang I stereo test was negative in 53.9% before and 51.9% after the surgery in the group I, and in 48.2% of the patients before and after the surgery in the group II patients. Wirt-Titmus stereo test was negative in 74.5% of the patients before and in 72.9% after the surgery in the group I, but in the group II it was negative in 70.8% before and in 68.0% of the patients 6 months after the surgery. CONCLUSION: Binocular responses were found after surgury in 65.7% of the patients the group I and in 55.6% patients the group II. There was no significant difference between these two groups, but binocular responses were more often in the patients of the group I.

Long-term outcome of strabismus and ptosis surgery in a mother and daughter with congenital fibrosis of extraocular muscles.

BACKGROUND: Congenital fibrosis of extraocular muscles (CFEOM) is a very rare congenital condition, characterized by variable amounts of restriction of the extraocular muscles, with or without ptosis. The aim of this report was to describe a severe, atypical, exposure-induced corneal stromal lysis in two patients. CASE REPORT: A mother and a daughter with a severe CFEOM were presented. The surgery of both extraocular muscles and ptosis led to a fair outcome in mother even 30 years after, and a very good outcome in daughter 4 years after the treatment. CONCLUSION: Though frequently challenging and dissapointing the outcome of surgery of both extraocular muscles and ptosis in CFEOM can be favorable even in rather severe cases. To the best of our knowledge, the atypical keratolysis we described has not been highlighted in the literature on CFEOM so far.

[Treatment of esotropia with a high AC/A ratio]. / Lecenje ezotropije sa visokim AC/A odnosom.

We have treated 55 children with accommodative esotropia and high AC/A ratio with progressive addition lenses, measured by heterophoria method. All of them wear full hyperopic refraction for distance and addition of +1.00 to 3.5 spheres for near vision. The minimal add that allowed the maximal reduction in the near deviation was prescribed appointed to follow-up control three months after the use of the new lenses, and thereafter every six months. A progressive reduction of the abnormally high AC/A ratio (difference between distance and near deviation measurements) showed 45 children (81.81%) but ten of them (18.19%) deteriorated into non-accommodative esotropia requiring surgical treatment. The age of initial use of progressive-addition lenses ranged from 26 months to 7 years (average: 63.2 months). The age of onset of the esotropia ranged from 7 months to 82 months (average: 28.7 months). The initial add was of +3.00 diopters in 39 children (70.8%). The mean add prescription for whole study group was 2.96 diopters. A progressive improvement of the AC/A ratio achieving normal after a mean of 18 to 24 months in a significant number of cases.

[Changes in the horizontal angle in strabismus after surgery of the vertical ocular muscles]. / Promena horizontalnog ugla razrokosti posle operacija na vertikalnim misicima oka.

We have operated 79 children with vertical strabismus. We have treated 52 children with primary overaction of the inferior oblique muscles and 27 of them with DVD and primary overaction of the inferior oblique muscles. In all of them, we have done recession of the inferior oblique muscles (for 4, 6, 8 or 10 mm). In only seven of them, from the second group, we did recession of the superior recti (for 7, 8 or 9 mm) simultaneously. This surgery very significantly and adequately ameliorate vertical strabismus (p = 0.004). Mentioned surgery on vertical extraocular muscles theoretically may product more esodeviation. In our practice with 79 operated children we didn't prove that (p = 0.148).

[Effect of surgery of the vertical muscles on refraction and visual acuity]. / Uticaj operacije na vertikalnim misicima na refrakciju i vidnu ostrinu.

BACKGROUND: The aim of this paper was to determine whether the surgery on vertical muscles of the eye influenced the change in refraction and visual acuity. METHODS: This prospective study included testing of 79 children with infantile esotropia who suffered from the vertical strabismus after the surgery on horizontal muscles. Patients were divided into two groups: the first group of 52 children (the test group) had only vertical component (overaction of m. obliqui inferior) and the second group (the control group) had two vertical components (dissociated vertical deviation-DVD and overaction of m. obliqui inferior). Refraction and visual acuity were tested before the surgery on the vertical muscles and one month and six months after the surgery. There was no significant difference between the results of the objective refraction in those three different periods of time. RESULTS: In both groups mild hypermetria (according to Costenbander) occurred in 40-48% of the examinees of both groups, while moderately-expressed hypermetropia occurred in 40-50% of the examinees. There was neither statistically significant difference between the results of the three observed measurings among every group, nor between the observed groups of patients (p > 0.05). By the analysis of the results of visual acuity it could be concluded that it was significantly improved 6 months after the surgery on cyclovertical muscles. This change was more significant in the sample group of patients (p < 0.01) than in the children from the control group (p < 0.05), who were much older. CONCLUSION: Objective refraction in patients was in the range of low values of hypermetropia (+2.00 Dsph--t 3.00 Dsph). Significant improvement of visual acuity occurred 6 months after the surgery performed on vertical muscles of the eye. These results were achieved by the repeated measuring of objective refraction and the precise correction of every new accommodative element.