Gordana Stanković-Babić

Therapeutical approach to dry eye syndrome

INTRODUCTION Dry eye disease or dysfunctional tear syndrome is among the most frequently established diagnoses in ophthalmology. It can be defined as a disorder of the tear film resulting in changes in the ocular surface. MECHANISMS IN DEVELOPMENT OF DRY EYE DISEASE There are many factors causing dry eye and they, can be related to deficiency in any of the components of the tear film. It has been suggested that dry eye is an inflammatory disorder that affects the ocular surface and lacrimal gland. Inflammation is the most important mechanism of corneal and conjunctival cell damage, which is responsible for the symptoms and signs of ocular surface pathology. Hormonal imbalance (particularly androgens), neural dysfunction, increased levels of pro-inflammatory cytokines and loss of immune homeostasis of the lacrimal gland and ocular surface could be possible mechanisms in the pathogenesis of dry eye disease. DISCUSSION The aim of this paper was to review the advances in the pathogenesis and management of the dry eye disease. The appropriate dry eye treatment presupposes knowledge of all existing pharmacologic and non-pharmacologic therapeutic modalities. The mainstay of therapy is still artificial tears, with anti-inflammatory therapy and punctual occlusion therapy as second and third line therapies.

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.

Refractive errors in premature infants with retinopathy of prematurity after anti-vascular endothelial growth factor (anti-VEGF) therapy

Background/Aim. Retinopathy of prematurity (ROP) is a vasoproliferative retinopathy which affects the blood vessels of the retina during its development. The aim of this study was to evaluate the incidence and the degree of refractive errors in premature infants with severe ROP treated with anti-vascular endothelial growth factor (anti-VEGF) (bevacizumab). Methods. This prospective study included 21 patients (42 eyes) nine months old who received intravitreal injection of anti-VEGF therapy. The control group consisted of 45 patients (90 eyes) who were subjected to laser treatment. In cycloplegia each patient underwent retinoscopy, keratorefractometry, and A-scan ultrasonography. Results. Myopia was present in 47.62% of the eyes in the study group and in 33.33% of the eyes in the control group, but there were no statistically significant differences between these groups. Seven (16.67%) eyes in the study group and 17 (18.89%) eyes in the control group were discovered to have high myopia (SE–spherical equivalents < -3.0 D – dioptre). Clinically significant hypermetropia was higher in the study group (47.62%) than in the control group (34.44%), but with no statistically significant difference. In addition, high hypermetropia was significantly greater in the control group (15.56%) than in the study group (11.90%) (p < 0.001). Astigmatism was more common in the control group than in the study group (81.11% vs 71.43%, respectively), especially high astigmatism (56% vs 43%, respectively). Also the more common form of astigmatism was with the rule (WTR) both in the study and the control group (42.86% vs 55.56%, respectively). Anisometropia was significantly greater in the control group (24.44%) than in the study group (9.52%) (p < 0.05). The children from the study group had significantly greater lens thickness, and a shorter anterior chamber depth than children from the control group (p < 0.01). There was no significant difference in the axial length of the eye between the groups. Conclusion. At the 9-month follow-up myopia was present in the patients with severe ROP treated with anti-VEGF, but high myopia was present to a lesser degree than in the laser treated patients. This difference is possibly related to anterior segment development. Research into the longer-term refractive outcomes is necessary with observation of the biometric components, visual acuity, and the visual field in order to monitor the real effects of this therapy.

Ankyloblepharon Filiforme Adnatum with a bilateral cleft lip and palate

Online fi rst: November 17, 2017 SUMMARY Introduction Ankyloblepharon filiforme adnatum (AFA) is a rare congenital abnormality of the eyelids that has been reported as an isolated anomaly, but may also be associated with other anomalies or as a part of well-defined syndromes. The aim of this work was to present a case of familial AFA associated with bilateral cleft lip and palate. Case outline A full-term female newborn (40 weeks’ GA, BM 3,700 g) had bilateral partially fused eyelids at birth, associated with a cleft lip and palate. The surgical treatment was performed five days after AFA was diagnosed. The baby’s mother also had AFA, without a cleft lip or palate. The baby girl has been followedup by a plastic surgeon, a specialist in orthodontics, as well as an ophthalmologist and a pediatrician. Conclusion This case indicates familial clustering of AFA, whereby it assumes a more severe form in the following generation. A cleft lip and palate in our patient has required surgical treatment, oral and dental rehabilitation, as well as the need for more intensive care and regular follow-ups by multidisciplinary teams.

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.

HYDATIDOSIS: RADIOLOGICAL AND CLINICAL ASPECTS

Hydatidosis is a parasitic disease (of the liver, lungs, kidneys, bones and other organs) caused by larva cestodes of the species Echinococcus granulosus (dog tapeworm). The aim of the paper was to present the X-ray aspects of echinococcal (hydatid) cysts. We will illustrate the radiological findings and pictures of hydatigenih cysts in the liver, lungs, kidneys and bones. The authors conclude that radiographic image of the hydatid cyst is typical, while the radiological examination methods are relevant to the diagnostics of hydatidosis. Acta Medica Medianae 2017;56(1):82-92.

Papilledema as a diagnostic challenge — report of three cases

We present three different cases of patients with papilledema: one case with a primary tumour of the optic nerve, and two cases with secondary involvement of the optic nerve (breast carcinoma and non-Hodgkin lymphoma). The visual acuity varies from sudden, painless, decrease of vision, to blurred vision and proptosis on the affected eye. A characteristic ophthalmoscopic examination shows a swollen optic disc and promonence with tortuosity of blood vessels. A fluorescein angiography shows dilated capillaries of the optic disc with leakage in the early phase and diffuse hyperfluorescence during the late phase. A ultrasonography B-scan of the affected eye shows prominent optic nerves with widened optic nerve sheath. An exhaustive history and complete ophthalmological examination are essential for the diagnosis, to which fluorescein angiography, B-scan ultrasonography, ocular coherent tomography, computerized tomography, and magnetic resonance can be used as useful additional tests. Treatment and prognosis depend on the primary process. We emphasize the crucial role of ophthalmologist in the early diagnosis of CNS neoplasia.