Role of optical coherence tomography in the early detection of macular thinning in rheumatoid arthritis patients with chloroquine retinopathy.

BACKGROUND: Chloroquine and hydroxychloroquine are drugs that are primarily used for the treatment of malaria and are also recommended for treating connective tissue disorders, autoimmune diseases, and some dermatological and inflammatory diseases. Treatment with these drugs has potential risk for the development of retinopathy, clinically characterized by bilateral pigment changes in the macula, as one serious ocular complication. The aim of this research was to evaluate the parafoveal and perifoveal macular retinal thickness, as central foveal thickness in adult patients with rheumatoid arthritis (RA) on chloroquine therapy using optical coherence tomography (OCT). MATERIALS AND METHODS: In this cross-sectional study, 56 RA patients (56 eyes) were included and examined. All patients were treated with chloroquine (tablets resochin or delagil) at a dose of 250 mg/day without treatment with steroids and other immunosuppressive drugs. Patients were divided into two groups, namely, Group I patients - no visible changes in the macula (26 patients) and Group II patients- with visible changes in the macula (30 patients). The central fovea thickness and parafoveal and perifoveal retinal thickness in all quadrants were measured by OCT and compared in both groups. RESULTS: There are a significantly higher number of eyes without thinning of the macula in Group I patients than in Group II (P < 0.001) patients. There are a higher number of patients with recorded parafoveal thinning in Group II patients, especially in the inferior, nasal, and temporal sectors, respectively (P < 0.05). CONCLUSION: Maculopathy is the main side effect of chloroquine therapy in RA patients that can be detected by OCT in the early stages of the macular involvement.

Ganglion Cell-Inner Plexiform Layer Thickness in Different Glaucoma Stages Measured by Optical Coherence Tomography.

AIM: To compare ganglion cell (GCL) and inner plexiform layer (IPL) thickness in patients at different stages of primary open-angle glaucoma (POAG), determine their sensitivity and specificity values, and correlate thickness values with mean deviations (MD). METHODS: This prospective, cross- sectional study was conducted in a group of patients with confirmed POAG who were compared to an age- and gender-matched control group. Glaucomatous damage was classified according to the Hodapp-Parrish-Anderson scale: glaucoma stage 1 (early), glaucoma stage 2 (moderate), and glaucoma stage 3 (severe). The average, minimum, and all 6 sectoral (superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal) GCL + IPL thicknesses were measured and compared between groups. RESULTS: The average GCL + IPL thickness of 154 eyes of 93 patients in glaucoma stages 1, 2, 3, and 94 eyes of 47 persons in the control group were 76.79 ± 8.05, 65.90 ± 7.92, 57.38 ± 10.00, and 86.01 ± 3.68 µm, respectively. There were statistically significant differences in the average, minimum, and all 6 sectoral GCL + IPL values among the groups. The areas under the receiver operating characteristic curve for average and minimum GCL + IPL thickness values were 0.93 and 0.94, respectively, sensitivity 91.5 and 88.3%, and specificity 98.9 and 100%, respectively. Both thickness values showed significant correlations with MD. Each micrometer decrease in the average GCL + IPL thickness was associated with a 0.54-dB loss in MD. CONCLUSION: GCL + IPL layer thickness is a highly specific and sensitive parameter in differentiating glaucomatous from healthy eyes showing progressive damage as glaucoma worsens. Loss of this layer is highly correlated with overall loss of visual field sensitivity.

Ocular surface disease incidence in patients with open-angle glaucoma.

Introduction: Ocular surface disease (OSD) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, tear film instability with potential damage to the ocular surface, accompanied by increased tear film osmolarity and inflammation of the ocular surface. It is a consequence of disrupted homeostasis of lacrimal functional unit. The main pathogenetic mechanism stems from tear hyperosmolarity and tear film instability. The etiological classification is hyposecretory (Sy-Sjögren and non-Sjögren) and evaporative (extrinsic and intrinsic) form. Delphi panel classification grades disease stages. Antiglaucoma topical therapy causes exacerbation or occurrence of symptoms of dry eye due to main ingredients or preservatives (benzalkonium chloride ­ BAK), which are dose- and time-dependent. BAK reduces the stability of the lipid layer of tears, the number of goblet cells, induces apoptosis and inflammatory infiltration. Objective: The aim of this study was the analysis of the OSD incidence in open-angle glaucoma patients caused by topical medicamentous therapy. Methods: Retrospective analysis of examined patients with open-angle glaucoma was used. Results: Increased incidence of moderate and advanced OSD Index degrees in the group of primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma. According to the Delphi Panel Scale the most common grade is IIb (POAG and pseudoexfoliative glaucoma). Evaporative form of OSD prevailed in all treatment groups. High percentage of dry eye in patients with higher concentrations of preservatives applied was noticed. Conclusion: OSD should be timely diagnosed and treated. Dry eye has an impact on surgical outcome and postoperative visual acuity, and in order to improve patient compliance and quality of life, symptoms of dry eye should be addressed and medications with lower concentrations of preservatives should be applied.

120 YEARS SINCE THE DISCOVERY OF X-RAYS.

This paper is intended to celebrate the 120th anniversary of the discovery of X-rays. X-rays (Roentgen-rays) were discovered on the 8th ofNovember, 1895 by the German physicist Wilhelm Conrad Roentgen. Fifty days after the discovery of X-ray, on December 28, 1895. Wilhelm Conrad Roentgen published a paper about the discovery of X-rays - "On a new kind of rays" (Wilhelm Conrad Roentgen: Ober eine neue Art von Strahlen. In: Sitzungsberichte der Wurzburger Physik.-Medic.- Gesellschaft. 1895.). Therefore, the date of 28th ofDecember, 1895 was taken as the date of X-rays discovery. This paper describes the work of Wilhelm Conrad Roentgen, Nikola Tesla, Mihajlo Pupin and Maria Sklodowska-Curie about the nature of X-rays . The fantastic four - Wilhelm Conrad Roentgen, NikolaTesla, Mihajlo ldvorski Pupin and Maria Sklodowska-Curie set the foundation of radiology with their discovery and study of X-rays. Five years after the discovery of X-rays, in 1900, Dr Avram Vinaver had the first X-ray machine installed in abac, in Serbia at the time when many developed countries did not have an X-ray machine and thus set the foundation of radiology in Serbia.

DR AVRAM JOZEF VINAVER (1862-1915) - PIONEER OF RADIOLOGY IN SERBIA.

INTRODUCTION: Dr Abraham Joseph Vinaver (1862-1915), a Jew from Poland, was a pioneer of radiology in Serbia. He graduated from the Faculty of Medicine in Warsaw (1887), but lived and worked in abac (the Kingdom of Serbia) since 1890. Dr Abraham Joseph Vinarev - Career Development. He procured the first X-ray machine and developed radiological service in Sabac five years after the discovery of X-rays. These were the beginnings of radiology in Serbia. He introduced the application of artesian wells. Dr Abraham Joseph Vinarev - a Participant at the First Congress of Serbian Physicians and Naturalists, Belgrade 1904. "The diagnostic importance of X-rays in lung disease, especially in initial tuberculosis" and "Five Years of Treatment by X-Ray Machines" were the first works in the field of radiology in Serbia by this author. Dr Abraham Joseph Vinaver - Reserve Medical Officer in the Serbian Army. During the Balkan Wars, he was a volunteer with the rank of major engaged in military corps and he participated in the First World War as well. He died of malaria in 1915 in Gevgelija. "Dr Avram Vinaver"- Stanislav Vinarev. His dedication to work during the typhus epidemics was put into verses of a poem by his son Stanislav Vinarev. CONCLUSION: Dr Avram Vinaver Joseph was a noble man with a great heart, who selflessly sacrificed himself for the Serbian people and Serbia. He gave his contribution to the development of health services in Serbia, both in peacetime and wartime conditions. Dr Abraham Joseph Vinaver laid the foundations for today's radiology in Serbia.

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.

[Medicine in notafilia--part II].

Only a few countries in the world have issued banknotes featuring portraits of doctors and health workers who have made their people and medicine world famous. The hereby presented banknotes are those issued in Germany featuring the portrait of Dr. Paul Ehrlich, a Nobel laureate; the Austrian banknotes with the portrait of a Nobel laureate Dr. Karl Landsteiner and of Dr. Sigmund Freud, the founder of modern psychoanalysis; the Greek one featuring the portrait of Georgios Nicholas Papanikolaou, who was a pioneer in early detection of pre-cancerous cervix lesions in women and who gave his name to the test "Papa test"; and, the one issued in Sweden featuring the portrait of Carl von Linnd, a court physician and the first President of the Royal Swedish Academy of Science.

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.

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.

[Laza K. Lazarevic--doctor, lawyer, writer and warrior in three wars].

INTRODUCTION: Laza K. Lazarevic was born on the 13th of May, 1851 in Sabac. He died on the 11th of January, 1891 in Belgrade. Laza K. Lazarevic was a Serb, lawyer, warrior, doctor and writer. He spoke Russian, German and French. Laza Lazarevic's road to the title of doctor of medicine. He studied law in Belgrade and graduated in 1871 and he graduated from the Faculty of Medicine in Berlin on the 28th of January, 1879. He took his doctor's degree in Berlin on the 8th of March, 1879 at the same Faculty. His road to the title of doctor of medicine was thorny and complicated. LAZA K. LAZAREVIC AS A WARRIOR: He took part in the Serbian-Turkish war and the Serbian-Bulgarian war. During the Serbian-Bulgarian War (1885) he was first given the rank of reserve medical major and later the rank of active medical colonel and then he was appointed assistant chief of the Supreme Command of Health Care with the task to establish the Great reserve military hospital in Nis. PROFESSIONAL AND SCIENTIFIC WORK OF DR. LAZA K. LAZAREVIC: He had seventy two professional and scientific medical papers published, a great number of which referring to nervous diseases, such as paralysis agitans, sclerosis of medulla spinalis, aphasia and others. Therefore, it can be rightly said that Dr. Laza K. Lazarevic was the first Serbian neurologist. The very first operation of cataract in Serbia was performed by Dr. Laza K. Lazarevic in aseptic conditions, when cocaine was applied for anesthesia. He was the first doctor to be sent by the Ministry of Internal Affairs to Vienna in 1884 to learn how to prepare animal lymph. In 1879 he was appointed the physician of the Belgrade District and in 1881 he was promoted to the position of head doctor and Chief of Internal Department of the General State Hospital in Belgrade. He was the personal doctor of King Milan Obrenovic. LAZA K. LAZAREVIC AS A WRITER: Laza Lazarevic is considered to be the originator of psychological stories in Serbian realistic literature and had nine stories published, while eight remained unfinished. CONCLUSION: Thanks to his intelligence, hard work, determination and persistence and the financial help of Serbia Medical Colonel Dr Laza K. Lazarevic gained the best of knowledge across Europe, having studied at the most prestigious school in Europe - the fact that can be admired and envied even today.

[Medicine in the notaphily].

INTRODUCTION: Apart from literature, painting and philately, some of the greatest names of medicine found their place in the field of numismatics. They popularised their people and nations, as well as the medical science worldwide. The paper exhibits banknotes with the portraits of famous and world-wide recognised people in world and national history. MEDICINE IN THE NOTAPHILY IN FORMER YUGOSLAVIA, SERBIA AND MONTENEGRO AND SERBIA: Among these are the poet and pediatrician, Jovan Jovanovic Zmaj; the doctor and botanist, Josif Pancic; the academic painter, Nadezda Petrovic, as well as the motifs from our national history. MEDICINE IN THE NOTAPHILY IN THE WORLD: The banknotes from China with the image of the surgeon, Dr. Sun Yat Sen, from Spain with the portrait of the histologist Dr. Santiago Ramón y Cajal, from Austria with the face of the Nobel Prize winner and psychiatrist, Dr. Julius Wagner Jauregg and from France with the portrait of the great scientist, Louis Pasteur are also presented. CONCLUSION: These are some of the examples of great names of medicine, who brought world fame to their nations and medical science, and who were, apart from literature, painting, philately, interested in numismatics.

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.

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.

[Ocular pseudoexfoliation syndrome].

INTRODUCTION: This study was aimed at providing an update on most recent developments regarding ocular and systemic manifestations and complications, clinical diagnosis and management, and molecular patophysiology of pseudoexfoliation syndrome. METHOD: Review of recent literature and own clinical and laboratory studies. RESULTS: Pseudoexfoliation syndrome is an age-related disease in which abnormal fibrillar extracellular material is produced and accumulated in many ocular tissues. Recent progress and advances have led to improvements in clinical management by understanding the effects of the pseudoexfoliation process on the ocular tissues, by refining diagnostic criteria and applying new treatment regimes, and by developing preventive strategies to reduce surgical complications. Increasing evidence of systemic associations of cardiovascular, cerebrovascular, abdominal aorta aneurysm can provide better understanding and management of this condition, and new therapeutic goal. The current pathogenesis concept describes psuedoexfoliation syndrome as an elastic microfibrillopathy involving transforming growth factor-beta, matrix metalloproteinase oxidative stress. CONCLUSION: Despite extensive research, the exact chemical composition of exfoliation material remains unknown. The presence of pseudoexfoliation should alert the physician to the increased risks of intraocular surgery, most commonly zonular dehiscence, capsular rupture, and vitreous loss during cataract extraction. Its associated clinical signs are important in the detection and management of glaucoma.

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.