Dusica Risovic

Metabolic control and diabetic retinopathy in patients with diabetes type 2

ZusammenfassungZIELSETZUNG: Die Bewertung der Korrelation zwischen Wechselstoffkontrolle und Präsenz und Schweregrad der diabetischen Retinopathie (DR) bei Patienten mit Typ-2-Diabetes. METHODEN: Diese Querschnittstudie umfasste 80 Patienten, die in vier Gruppen eingeordnet wurden, nach der Dauer der Krankheit: de novo; bis zu 10 Jahren; 11 bis 20 Jahre; und über 20 Jahre. Um die Stoffwechselkontrolle zu bewerten wurden bei jedem Patient die folgenden Parameter getestet: glycosiliertes Hämoglobin (HbA1c), Gesamtcholesterinspiegel (TC), High-Density Lipoprotein Cholesterin (HDL-C), Low-Density Lipoprotein Cholesterin (LDL-C) und Triglyceride (TG). Abhängig von der Änderung an der Netzhaut wurden die Patienten nach der Klassifizierung der Amerikanischen Akademie für Augenheilkunde eingeordnet. ERGEBNISSE: Patienten mit DR hatten deutlich erhöhte HbA1c-Werte (9,5 ± 1,83%) und verringerte HDL-C-Werte (1,1 ± 0,21 mmol/L) im Vergleich zu Patienten ohne DR (6,9 ± 1,29%, t = 5,088; p < 0,001 und 1,3 ± 0,25 mmol/L, t = 3,022; p < 0,01). Die Präsenz und der Schweregrad der DR standen in positiver Wechselwirkung mit HbA1c-Werten (p < 0,001) und schlechter glykämischer Kontrolle (p < 0,001), während sich HDL-C Werte umgekehrt proportional zur Präsenz (p < 0,01) und zum Schweregrad der DR (p < 0,05) verhielten. SCHLUSSFOLGERUNG: Schlechte Stoffwechselkontrolle, gemessen anhand erhöhter HbA1c-Werte und verringerter HDL-C-Werte, steht in Wechselwirkung mit der Präsenz und dem Schweregrad der DR.SummaryAIM: To evaluate the correlation between metabolic control and the presence and severity level of diabetic retinopathy (DR) in patients with diabetes type 2. METHODS: This cross-sectional study included 80 patients divided into four groups according to the duration of the disease: de novo; up to 10 years; from 11 to 20 years; and over 20 years. In order to evaluate the metabolic control each patient was tested for: glycosylated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). According to eye fundus changes patients were classified following the American Academy of Ophthalmology classification. RESULTS: The patients with DR had significantly increased values of HbA1c. (9.5 ± 1.83%) and decreased values of HDL-C (1.1 ± 0.21 mmol/L) compared to patients without DR (6.9 ± 1.29%, t = 5.088; p < 0,001) and (1.3 ± 0.25 mmol/L, t = 3.022; p < 0.01) respectively. The presence and severity level of DR correlated positively with HbA1c values (p < 0.001) and poor glycaemic control (p < 0.001) while HDL-C values correlated inversely with the presence (p < 0.01) and severity level of DR (p < 0.05). CONCLUSION: Poor metabolic control determined by the increased values of HbA1c and decreased values of HDL-C correlates with the presence and severity of DR.

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.

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.

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.

Binocular responses 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. Results. 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 larger 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 surgery 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.

Prevention of stromal cell loss after superfitial corneal injury in rabbits.

For the study of the effects of trauma on the cornea, usually a rabbit eye is used as a model. The aim of this experimental study of corneal surface injury was to evaluate stromal cell loss after epithelial scraping and to indicate the possibilities of preventing it by applying contact lenses or topical heparin. The study was conducted on 21 Chinchilla gray rabbits, which were divided into five groups. The central portion measuring 6mm of corneal epithelium was removed from one eye of 18 experimental animals. Three rabbits in the fifth group, with intact corneas, served as controls. Postoperatively, the first experimental group (n=3) was treated for 24 hours with topically applied heparin. The second group (n=3) was treated for seven days with subconjunctivally applied heparin. In the third group, (n=6) soft contact lenses were placed for five days. The fourth group of (n=6), has not been treated after injury. During the first postoperative day, anterior stromal keratocytes were lost after epithelial removal, but the cell repopulation was completed within two weeks. Twenty four hours after deepithelization the corneas showed decreased density of keratocytes within the anterior stroma compared with the posterior storma. Topically applied heparin for 24 hours after deepithelization prevented keratocyte loss (p 0.05). The eyes treated with contact lenses had a significantly higher number of keratocytes than the control corneas and corneas treated with heparin. We were able to conclude that topical application of heparin during the first day and contact lens application during the first week, can minimize keratocyte loss and may thus be beneficial in the healing process.