Tilted Optic Disc Frequency in Myopia of Different Degree.

INTRODUCTION: Change in the fundus in myopic patients are often characterized by partially atrophic and tilted optic disc insertions. Due to the altered nerve fiber arrangement, it is more difficult to detect the initial pathological changes of the optic disc. This subject is important because myopia represents well known risk factor for glaucoma. AIM: This study explored frequency of tilted optic disc in different degree of myopia which has major effect on glaucoma assesment due to unreliable OCTs parameters of the neuroretinal rim in patients with tilted disc. METHODS: Between September 2013 and December 2014, total number of 150 patiens from ophtalmic polyclinic "Dr Sefic" underwent complete ophtalmic examniation. Total of 300 eyes were tested. Patients were separated in 3 groups by diagnosis. Each group was divided by the size of the optic disc diameter into three categories. ANOVA test was used in analysis. RESULTS: Subjects with tilted disc shape have the highest degree of myopia, and there is a statistically significant difference with other forms of optic disc regardless of the size of the disc itself (p <0.05). The patients with a large disc (4.05 ± 0.65) had the highest degree of myopia in subclass of tilted discs, and these values decreased linearly in relation to the size of the tilted disc. CONCLUSION: Myopia height values decreased linearly with respect to the size of the tilted disc.

Challenges In Early Glaucoma Detection.

INTRODUCTION: Glaucoma is the most common optic neuropathy which is characterized by progressive loss of retinal ganglion cells, the excavation of the optic nerve head, associated with defects in the visual field. It is not a disease, but the final result of united and yet completely unidentified cellular and subcellular processes and effects of many factors responsible for changes in retinal ganglion cells leading to their accelerated apoptosis. METHODS: This is a prospective-retrospective, comparative, randomized clinical trial that included 150 patients, 97 were female and 53 male. The age of patients ranged from 18 to 80 years. RESULTS: The highest degree of myopia in category of tilted optic discs had patients with large disc (4.05 + -0.65). Values of the degree of myopia have linearly declined in relation to the size of the oblique disc. The analysis of the results revealed that the subjects who had a higher degree of myopia associated with glaucoma had frequent parapapillar atrophy of alpha and beta zones. The highest percentage of subjects with parapapillar changes were in the group of patients who had other than glaucoma and myopia (62%), then in the group of patients with glaucoma only (56%). CONCLUSION: Previous studies on the relationship between myopia and open-angle glaucoma are based on the results of observational studies. However, according to recent findings, based on the available studies, the systematic approach to estimate the association between myopia and glaucoma does not exist. Disc Damage Likelihood Scale (DDLS) is a new system for assessing glaucomatous damage of the optic disc which strongly correlates with the degree of visual field loss.

Influence of the optic disc size on cup diameter in patients with glaucoma simplex chronicum.

INTRODUCTION: The relationship between the optic disc size, neuroretinal rim and cup diameter is the key in identifying glaucomatous changes in optic nerve head. Like some other biological characteristics, changes of the optic disc differ among healthy populations, thus hindering detection of pathological changes. MATERIAL AND METHODS: From the total number of 90 patients, we selected those that have optic disc diameter less than 1.30 mm, greater than 2.10 mm, as well as patients with a size of disc diameter ranging from 1.31mm to 2.09 mm. In all patients after anamnesis and standard ophthalmologic examination (best corrected visual acuity-BCVA, Goldman aplanatic tonometry, pachymetry, gonioscopy), we also performed the OCT analysis of the optic nerve head. RESULTS AND DISCUSSION: Glaucomatous changes in small optic discs may remain unnoticed unless there is a high degree of suspicion. The assesment of the optic disc size is an important, but often overlooked component of the diagnostic evaluation in glaucoma. There was a statistically significant strong positive correlation between the size of the optic disc diameter and cup diameter, larger optic disc diameter means greater cup diameter. Due to the large variation in the cup size in healthy subjects, the assessment of the morphology of the neuroretinal rim or cup diameter can be more helpful in evaluation of glaucomatous optic disc damage than the value of C/D ratio itself. CONCLUSION: Evaluation of the optic disc size and C/D ratio is an essential part in diagnostic procedure and management of glaucoma. OCT analysis in patients with small optic disc diameter showed the least sensitivity in all three categories (normal, abnormal and uncertain OCT results). The OCT results in the small optic disc diameter are the least reliable in the diagnosis of glaucoma. More complexed long-term study is needed to evaluate this complicated relations between optic disc diameter, C/D ratio, neuroretinal rim and other important clinical factors in emerging glaucoma disease.

The secondary composite temporoparietal lobe-modification.

Orbital defects after malignant tumor removal represent a major problem for satisfactory reconstruction. Treatment and surgical reconstruction according to the regular surgical protocol improves with each new case contributing to continuous improvement of surgical techniques in order to achieve better reconstruction of the defect. In our modification in 20 patients there was presented a new method of reconstruction of the defect where the orbits included also a part of the muscle (sternocleidomastoid muscle) for better stabilization at the desired position on the immediate ocular prosthesis installation site in order to quickly overcome the postoperative defect after orbital exenteration. Application of modified temporoparietal slice gives good functional and cosmetic results, and is recommended to be used for reconstruction of defects after orbital exenteration.