Igor Kovacevic

Ocular pulse amplitude after panretinal photocoagulation in normotensive eyes with proliferative diabetic retinopathy

Purpose To assess the effect of panretinal laser photocoagulation on ocular pulse amplitude (OPA) in normotensive eyes with proliferative diabetic retinopathy. Methods Prospectively, we performed unilateral argon laser panretinal photocoagulation (PRP) in 30 patients with diabetes mellitus type II and previously untreated bilateral proliferative diabetic retinopathy. Before and 7 and 30 days after the treatment, OPA was measured using dynamic contour tonometer. Results Compared with the untreated contralateral eyes, laser photocoagulation led to a reduction of OPA. Ocular pulse amplitude did not significantly differ in photocoagulated eyes 7 days after the treatment, but there was a significant difference in OPA 30 days after the treatment. The decrease in OPA values was 15% 7 days after PRP and 40% 30 days after PRP. Conclusions Ocular pulse amplitude reduction after PRP indirectly informs us about choriocapillary closure, already reported in previous studies.

Central retinal artery occlusion following embolization in juvenile nasopharyngeal angiofibroma: A case report

Introduction. Juvenile nasopharyngeal angiofibromas are highly vascular, locally aggressive lesions, that affect male adolescents. The surgery is the treatment of choice, although it shows a strong propensity to bleed during surgical removal. Preoperative embolization enables the surgical approach in a less bloody way and also a complete resection of the tumor. However, this procedure is not without complications. The most severe complication of this technique is a migration of an embolus into the intracranial circulation. Case report. We present a 9-year-old boy who lost vison on his left eye following preoperative embolisation of juvenile nasopharyngeal angiofibromas as a result of central retinal artery occlusion. A recent review of the literature reported only three previously documented cases of central retinal artery occlusion occurring after embolization for a nasopharyngeal angiofibroma. We want to point out the possibility of this rare but devastating complication and the importance of rapid and accurate diagnosis and treatment so that a visual outcome could be better when applying an early medical treatment. Conclusion. Described case of central retinal artery occlusion is a rare and unusual, iatrogenic vascular event, that could arise as a complication from embolisation of nasopharingeal tumors. However, physicians (ophthalmologists and ear-nose-throat surgeons) should be aware od this devastating complication, and the close evaluation of angiograms for detection of any vascular abnormality before and during the embolization is crucial.

[Pars plana vitrectomy with extraction of intraocular foreign body in patients with siderosis of the eye: report of two cases].

INTRODUCTIONnPenetrating injury is characterized by the existence of entry wound only, and it can be with or without an intraocular foreign body (IOFB). IOFB can lead to a mechanical injury of the eye and to cause infection or to manifest other toxic effects on intraocular structures. Iron and copper can dissolve and cause siderosis, i.e. chalcosis of the eye. Ocular siderosis is diagnosed by clinical and electroretinogram (ERG) findings.nnnOUTLINE OF CASESnThe first patient was a 37-year-old male who was injured by a metal foreign body. He presented at the Clinic two years after the injury. Visual acuity of the right eye (VOD) on admission was VOD=L+P+ (light projection). Pars plana phaco-vitrectomy with IOFB extraction was done. Visual acuity on discharge was VOD=3/60 cc + 7.50 Dsph=0.2. The second patient was a 55-year-old male who presented at the clinic 18 months after injury. On admission visual acuity in his left eye was VOS 1/60. Pars plana phacovitrectomy with IOFB extraction was done.Visual acuity on discharge was VOS=0.7 through the stenopeic slit.nnnCONCLUSIONnIn penetrating injuries caused by a metal IOFB pars plana vitrectomy with IOFB extraction is indicated. In cases with IOFB, when visual acuity is preserved, the lens is transparent, while the eye is without signs of infection, urgent pars plana vitrectomy is not necessary. Such patients need regular followup with obligatory ERG findings.

The thickness of the retrobulbar portion of the optic nerve in Graves ophthalmopathy measured by ultrasound

INTRODUCTIONnThe clinical diagnostic of Graves ophthalmopathy is based on the association of ocular signs and the disease of the thyroid gland. The evolution of the disease involves the development of eye globe protrusion, extraocular muscle thickening pressuring the optic nerve, which can result in its thickness.nnnOBJECTIVEnThe aim of the paper is to find whether the retrobulbar optic nerve thickened and if there was a correlation between its possible thickening and the thickness of the muscles in Graves ophthalmopathy. We also wished to test the theory of compressive aetiology of such thickening using a 30-degree test.nnnMETHODSnWe examined 28 patients with Graves ophthalmopathy. The thickness of the retrobulbar optic nerve was measured by ultrasound on a B-scan using the Schraeders method and by the largest thickness of the internal muscle.nnnRESULTSnThe thickness of the retrobulbar portion of the optic nerve in the 52 analyzed eyes with signs of the disease ranged between 3.24 mm to 6.30 mm, with median of 5.13 mm, indicating that the majority of the patients had optic nerve thickening rating at this value. Forty-eight eyes had a marked retrobulbar optic nerve thickening, with the thickening over 4 mm, while in 4 eyes with signs of Graves ophthalmopathy the thickness of the optic nerve was within normal limits. We detected that 92.3% of the patients with muscular thickening also had a directly proportional thickening of the retrobulbar optic nerve. By using the 30-degree test we confirmed the diagnosis of compressive neuropathy.nnnCONCLUSIONnPatients with Graves ophthalmopathy and thickened muscles, also have a thickening of the retrobulbar optic nerve; the rate of the thickness directly depends on the degree of the muscular thickness. The word is of compressive neuropathy, i.e. the thickness of the optic nerve is the result of subarachnoid fluid stasis caused by the compression on the optic nerve.