Dusan Todorovic

Updates on the Treatment of Pterygium

Abstract Pterygium is an ocular disease characterised by the growth of fibrovascular conjunctiva on the cornea. It occurs more often in men, at an older age, and in individuals exposed to ultraviolet radiation. Surgical treatment is the primary treatment for pterygium and there are two common procedures for pterygium excision. In the first method, the head of the pterygium is separated from the corneal surface using a surgical blade. The second method is based on avulsion. Other approaches to excising the pterygium include the use of argon laser and excimer laser. Because of a high recurrence rate, adjuvant therapies, including radiotherapy, chemotherapy, and graft procedures, are used after pterygium excision. These procedures have become the standard long-term treatments for pterygium. Radiotherapy is based on beta irradiation. Chemotherapy includes the use of mitomycin C, 5-fluorouracil, bevacizumab, and loteprednol etabonate. Graft procedures include amniotic membrane grafts and conjunctival autografts. Many surgeons believe that using mitomycin C and conjunctival autografts provides the best outcomes in terms of recurrence, cosmetics and patient satisfaction.

Nanotechnology in Ophthalmology

Nanotechnology has already been used for the purpose of the measurement as well as treatment of great number of ophthalmological diseases. The applications of Nanotechnology to Ophthalmology refer to the following: delivery of drugs, peptides and genes, biomedical imaging and diagnostics of distinct disorders of the eye, study of pathogenesis of the eye disease. Regenerative nanomedicine is considered to be a prospective approach for treating retinal degenerations and the second cranial nerve regeneration. Our manuscript included possible different application for ophthalmological drug using nanotechnology. Also, we described the importance of nanotechnology for imaging, diagnostic and monitoring of ocular diseases. Nanobiotechnology for glaucoma treatment, as well as nanoparticles for gene delivery therapy of retinal degenerative disease, is most attractive approach for the ophthalmological treatment.

The Efficacy of a Posterior sub-Tenon’s Capsule Triamcinolone Injection in Patients with Non-infectious Intermediate Uveitis and Posterior Uveitis

Abstract To investigate the efficacy of a posterior sub-Tenon’s capsule triamcinolone injection for treating eyes with non-infectious posterior and intermediate uveitis. A total of 31 eyes from 20 patients with non-infectious posterior uveitis and 18 eyes from 10 patients with non-infectious intermediate uveitis that inadequately responded to treatment with systemic corticosteroids and second-line immunosuppressive agents were enrolled in the study. All patients received a posterior sub-Tenon’s injection of 20 mg/ml triamcinolone. The parameters we examined included the following: best corrected visual acuity, central foveal thickness, fluorescein angiography score and intraocular pressure. The mean best corrected visual acuity was significantly improved from the control visit, 0.15±0.30 logMAR (Snellen equivalent 0.7), compared to the baseline measurements, 0.60±0.30 logMAR (Snellen equivalent 0.25; P<0.05). The mean central foveal thickness (CFT) and the mean score for fluorescein angiography (FA) were significantly decreased from the baseline (CFT: 320±34 μm; FA mean score: 5.9±1.9) compared to the twelve-week control visit (CFT: 235±30 μm; FA mean score: 1.2±1.1; P<0.001). Five eyes had intraocular pressure spikes that required a topical anti-glaucomatous treatment. A posterior sub-Tenon’s injection of triamcinolone can significantly improve visual acuity and decrease macular oedema in patients with non-infectious posterior and intermediate uveitis. Complications were minimal, and there were no eyes that required surgical treatment for elevated intraocular pressure. The results suggest that the posterior sub-Tenon’s injection of triamcinolone is an important form of therapy for non-infectious posterior and intermediate uveitis.

Thrombotic Thrombocytopenic Purpura: Etiopathogenesis, Diagnostics and Basic Principles of Treatment

Abstract Thrombotic thrombocytopenic purpura (TTP) is a clinical syndrome that manifests with thrombocytopenia, microangiopathic haemolytic anaemia and symptoms and signs of kidney and brain damage, but it rarely involves other organs. The main pathophysiological cause of TTP is diminished metalloproteinase ADAMTS13 activity; the main function of ADAMTS13 is to degrade large multimers of the von Willebrand factor. Diminished activity of ADAMTS13 is caused either by a genetic mutation in the gene that codes ADAMTS13 (congenital TTP) or by antibodies that block ADAMTS13 enzyme activity or accelerate the degradation of ADAMTS13 (acquired TTP). Clinically, TTP presents most frequently with signs and symptoms of brain and kidney damage with concomitant haemorrhagic syndrome. TTP is suspected when a patient presents with a low platelet count, microangiopathic haemolytic anaemia (negative Coombs tests, low haptoglobine concentration, increased serum concentration of indirect bilirubin and lactate dehydrogenase, increased number of schysocytes in peripheral blood) and the typical clinical presentation. A definitive diagnose can be made only by measuring the ADAMTS13 activity. The differential diagnosis in such cases includes both typical and atypical haemolytic uremic syndrome, disseminated intravascular coagulation, HELLP syndrome in pregnant women and other thrombotic microangiopathies. The first line therapy for TTP is plasma exchange. In patients with acquired TTP, in addition to plasma exchange, immunosuppressive medications are used (corticosteroids and rituximab). In patients with hereditary TTP, the administration of fresh frozen plasma is sometimes required.

Tear Film Stability in Patients with Pseudexfoliation

Abstract Pseudoexfoliation syndrome is an age related disorder, characterized by abnormal fibrous fiber production and accumulation in different visceral organs as well as in the eye and periocular tissues. Hystological examination recorded the presence of the pseudoexfoliation in the conjunctiva, and they can disturb the accessory lacrimal gland and goblet cell function. This can explain tear film instability in patients with pseudoexfoliations. In our study, we examined the tear film stability in patients with and without pseudoexfoliation, using Schirmer test and tear break up time test. Our results indicated that patients with pseudoexfoliation had lower values of Schirmer and tear break up time tests than patients without it. Pseudoexfoliation is the main reason for the instability of the tear film, because of its negative impact on the conjucntival goblet cells. In conclusion, ophthalmologists must have these data on their mind in the process of the pseudoexfoliation glaucoma treatment and controlling.

Extramedullary Involvement of Lymph Nodes in Multiple Myeloma

Abstract Myeloma multiplex is a malignant disease of bone marrow plasma cells. It is usually confined to the bone marrow, but in rare cases, patients can develop extramedullary disease. The involvement of lymph nodes is rare and can be a diagnostic challenge. Here, we describe a 36-year-old male patient who presented with abdominal pain and discomfort initially. An abdominal ultrasound followed by computed tomography (CT) revealed retroperitoneal and mesenteric lymph node enlargement. Biopsies of the abdominal lymph node and infiltrated colon showed a plasma cell infiltrate positive for CD79α, CD38, CD138, kappa light chain and VEGF2. Multiple myeloma with extramedullary localization was diagnosed. After six cycles of chemotherapy consisting of doxorubicin, dexamethasone and thalidomide followed by autologous haematopoietic cell transplantation, the patient achieved complete remission. Specifically, a CT scan after therapy showed enlarged lymph nodes in the abdomen, but PET CT scans did not detect any metabolically active foci. Thee years after the completion of therapy, the patient remains in remission. This case illustrates a rare presentation of extramedullary myeloma involving the abdominal lymph nodes, which could have been potentially mistaken for a lymphoid malignancy.

Infections caused by Clostridium difficile bacterium

Toxigenic strains of Clostridium difficile are the major cause of intestinal tract diseases of hospitalized patients. For a long time, Clostridium difficile was considered to produce both types of toxins (A+/B+ strain). However, the investigations conducted in the last ten years point to the existence of clinically significant isolates which produce only toxin B, i.e. toxin A negative. Toxigenic strains Clostridium difficile are present in our country so this bacterium sort has to be considered in differential causal diagnosis of diarrhea syndrome. Considering that it can cause a difficult form of the disease, it is an obligation to establish the presence of some toxins in stool samples of patients and/or production of some toxins in liquid culture of isolates.