Interleukin 6 and its soluble receptor are elevated in aqueous humor of patients with uveitis.

PURPOSE: To determine the levels of interleukin 6 (IL-6) and its soluble receptor (sIL-6R) in the aqueous humor (AH) of patients with different uveitis entities. PATIENTS AND METHODS: AH and serum samples were collected from 35 patients (39 eyes) who underwent surgery for uveitis complications and from 10 controls (senile cataract). In the studied group, seven patients had HLA-B27(+) anterior uveitis, two had Fuchs' heterochromic iridocyclitis, 12 had chronic anterior uveitis of unknown etiology, and in the remaining 14 the causative agent was exogenous. The cytokine and receptor levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: In controls, the median IL-6 level in AH was higher than that in corresponding sera (40.4 pg/ml and 5.2 pg/ml, respectively). In contrast, sIL-6R showed an inverse relation: there were less sIL-6R in control AH than in control sera (378.9 pg/ml and 52749.0 pg/ml, respectively). The same qualitative relationship was observed in patients with uveitis. Quantitatively, in comparison to controls, elevated levels of IL-6 and sIL-6R were found in AH of patients with uveitis. As expected, the maximal IL-6 and sIL-6R values were observed in the patients with uveitis of exogenous etiology (1558.3 and 1326.2 pg/ml, respectively). sIL-6R was also significantly elevated in AH of patients with HLA-B27( +) anterior uveitis (p<0. 01). In all individuals under study, sIL-6R levels in AH samples were 2-10 times higher than IL-6 levels. In serum samples, sIL-6R level were 10000 times higher than corresponding IL-6 values. CONCLUSION: The results confirmed the role of IL-6 in intraocular inflammation and gave new information regarding the presence of its sR in normal and inflamed eyes. Low levels of sIL-6R in AH compared to those found in serum suggest the presence of active local regulatory mechanisms that require further investigation.

Timing of cataract surgery in diabetics.

In their retrospective study, the authors investigated the outcome of extracapsular cataract extraction (ECCE) followed by posterior chamber intraocular lens implantation (PCIOL), in 2864 operated eyes, out of which 546 (19%) were in diabetics. The preoperative retinal status was recorded in all subjects. In 6 (1%) patients, laser photocoagulation was performed preoperatively. The obtained visual acuity was 0.4 or better in 90.0% of diabetics and in 91.8% of control subjects, showing no significant difference in the postoperative complications between diabetics and non-diabetics. The results indicated the cataract operation (ECCE + PCIOL) to be a well tolerated surgical procedure in diabetic patients with lenticular opacity, in whom it should be even earlier performed than in nondiabetics, because cataract prevents the diagnosis or treatment of a suspect retinal disorder.

Complications following two methods of posterior chamber intraocular lens suturing.

The aim of this study is to compare complication rates in two different operative techniques applied for the secondary, posterior chamber intraocular lens (PCIOL) implantation with sulcus fixation. 179 eyes with partial or no posterior capsule support underwent surgery. Applied techniques were: transscleral fixation of the IOL by passing with the fixation needle through the sulcus from the inside (70 eyes) or from the outside (109 eyes) of the bulbus. The most frequent intraoperative complications were haemorrhages and vitreous prolaps with no significant difference between used techniques. In the 'from the inside' group, following late postoperative complications developed: astigmatism of > 4D (24%), cystoid macular oedema (20%), pupil distortion (14%), partial posterior capsule opacification (10%), suture exposure (10%), IOL decentration (8%) and hemophthalmus (3%). In the 'from the outside' group same complications showed a decreased rate: 17%, 16%, 8%, 8%, 9%, 5% and 1%, respectively. Other late complications like high intraocular pressure, synechiae and uveitis were adequately represented in both techniques. After 24 months follow-up, best corrected visual acuity > or = 0.8 was achieved in 48.5% of eyes when 'from the inside' and in 57.7% of eyes when 'from the outside' technique was used.

Triple procedure 'a chaud'.

Although it is widely accepted that acute uveitis is the main contraindication for intrabulbar procedures, conditions in the presented group of 24 patients (mean age 63 years, ranging from 35 to 74) required immediate surgery. The corneal pathologies included: perforated corneal ulcer in 12, imminent corneal perforation in ten and corneal melting syndrome in two patients. Partial perforative keratoplasty was accompanied by various combinations of surgical procedures, depending on the preoperative status. In cases of aphakia (N = 5) and anterior chamber pseudophakia (N = 5) secondary PCIOL implantation with sulcus fixation was performed, combined with ACIOL explanation in the latter group. The largest group included patients with complicated cataract (N = 14), where classic triple procedure was performed in ten patients. In three patients, the surgery had to be completed with sulcus fixation of the PCIOL, due to posterior capsule rupture. Associated glaucoma in one patient required trabeculectomy along with triple procedure. Postoperative complications that could not be treated with conservative measures for subsequent corneal decompensation, required rekeratoplasty in three (12.5%) patients. Visual acuity amelioration, ranging from 0.2-0.8, was achieved in seven (29.2%) and nine (37.5%) patients after 3 and 6 months, respectively.

Prognostic value of visual evoked responses in childhood amblyopia.

We assessed the possible clinical utility of pattern reversal visual evoked potentials in predicting the success of pleoptic treatment. Thirty amblyopic children--16 strabismic, 11 anisometropic and three of refractive type (in all cases the amblyopia was monocular)--and ten children without amblyopia (control group) were examined by conventional psychometric methods. Visual evoked potentials (VEP) to pattern reversal stimulation were also recorded. The amblyopic group was treated with occlusion of the preferred eye for three to six months. Psychometric and VEP tests were repeated in 15 amblyopic children after the treatment. The pre-treatment VEP amplitude side-differences (between amblyopic and better fellow eye) were significant, with first positive wave, P1, being invariably lower on the amblyopic side. We correlated the side-differences in visual acuity with the corresponding side-differences in amplitude and latency of the P1 wave. In the former the correlation coefficient was r = 0.47 (p < 0.01), and in the latter r = 0.65 (p < 0.01). Latency was prolonged in the eyes with significantly reduced visual acuity in which the wave form was also typical for amblyopia. We then correlated the difference between pre- and post-treatment visual acuity of the amblyopic eye with the pre- and post-treatment difference in amplitude (correlation coeff. r-0.51 (p = 0.05)) and latency of the P1 wave (correlation coeff. r = 0.40 (p > 0.05)).(ABSTRACT TRUNCATED AT 250 WORDS)

A brief review of the development of ophthalmology in Croatia.

Autochtonous folk medicine practice in Croatia was mostly based on the use of herbs in the treatment of eye diseases. The first document on the presence of medical activity was one in which the Republic of Venice gave Draga Slava permission to practice medicine in 1330. The 19th century was the turning-point for the development of ophthalmology in Croatia. The basis for well-organized clinical, preventive and social ophthalmological care was established. The Cathedra for Ophthalmology was founded in 1920 and its first head was Albert Botteri, who was along with Nizetic, Spanic, Gradilicic and Meixner, the most prominent ophthalmologist in the first half of the century. Zvonimir Pavisic and Kresimir Cupak were the leading persons in Croatian ophthalmology in the second half of the century. Croatian ophthalmologists were organized in the Section for Ophthalmology as the part of the Medical Association of Croatia from 1926 up to 1992, when the Section changed its name to the Croatian Ophthalmological Society, with more than 250 members. Inspite of the difficulties, Croatian ophthalmologists tend to use almost all modern diagnostic and therapeutic methods in use in the world.

Risks of retrobulbar application of anesthetics and drugs.

In spite of hundreds of harmless retrobulbar applications of anesthetics and drugs, a certain risk still exists. In the past ten years in our Department with 7200 retrobulbar procedures performed in local anesthesia and 12500 retrobulbar applications of the drugs (corticosteroids, antibiotics, vasodilatators) 14 incidents were registered. Palpebral chemosis and retrobulbar hematoma or eyeball protrusion were transient in 11 patients. Acute disturbance of the chorioretinal circulation occurred in three patients. In one of them vascular occlusion was total with permanent loss of vision, while in the other two recuperation of vision was the sign that vascular spasm was transient.

Follow-up study of HLA-B-5-associated uveitis.

Six young female patients suffering from recurrent uveitis, all of them HLA B-5 positive, were followed-up 2-7 years (mean 4.5 years). Anterior hypopyon uveitis was present in two patients, retinal vasculitis in all, exudative recurrent retinal detachment in two, resulting in phthysis in one patient. Complete clinical work-up as well as serology were within normal limits. The effect of the corticosteroid therapy applied in all patients was dubious, while Cyclosporine gave only temporary relief in one patient. Promising vitreoretinal surgery was suggested to one patient.

Postnucleation orbital implants.

A follow-up study of a group of 40 patients after the enucleation completed by the intra-orbital acrylic spherical magnetic implant (Roper-Hall style) is presented. The mean postoperative observation time is 3.3 years. Late complications were present in two patients: the extrusion of the implant in one of them was probably caused by his poor state due to chronic dialysis, while the traumatic luxation of the implant in the other was surgically repaired. Postoperative results in all other patients were satisfactory with the adequate orbital volume substitution and the ability of the prosthesis to twist and turn in any axis without fitting problems.

[Comparative analysis of the results after implantation of a "one piece" and other types of intraocular lenses]. / Usporedna analiza rezultata nakon implantacije "one piece" i drugih modela intraokularnih leca.

The authors analysed the results obtained in 100 patients with the "one piece" posterior chamber lens and compared them with those in 85 patients with soft haptics. All procedures followed the extracapsular cataract extraction. The incidence of intraoperative and postoperative complications was compared. Special attention was paid to the positioning of the implant after a period of at least 6 months. The advantages of "one piece" implant lenses were established and better postoperative results obtained in this group of patients.