Browsing by Author "Jakšić, Vesna (23667666000)"

Introduction/Objective The study aims to analyze the thickness of both the ganglion cell layer and the inner plexiform layer (GCL + IPL) among patients suffering from dry and wet form of age-related macular degeneration (AMD). Methods One hundred ninety-five patients with AMD participated in the study, along with 94 healthy individuals (mean age 75.2 ± 7.8 years; range 55–86). They were divided into three groups: the first group, or group I, included 100 patients suffering from wet AMD; the second group, or group II, included 95 patients afflicted with dry AMD; the final 94 patients made up the control group, group III, of healthy individuals without systemic or ocular diseases. Measurements such as the average macular thickness, the average and minimum GCL + IPL thickness, and the GCL + IPL thickness in all six sectors were obtained by Cirrus spectral-domain optical coherence tomography (SD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA, USA). SPSS version 20.0 was used to analyze the data, while the level of statistical significance was set at p < 0.05. Results In the case of patients with wet AMD, the average value for GCL + IPL thickness was 43.13 μm, for patients with dry AMD the value was 66.73 μm, and the average thickness measured for the control group was 86.23 μm. There was a statistically significant difference between the average GCL + IPL and minimum GCL + IPL thicknesses between the groups (p < 0.001). Lower values were noted for patients with wet AMD (p < 0.001) than those with dry AMD. In the latter, the average GCL + IPL and the minimum GCL + IPL thicknesses were lower than those of the healthy participants, at a level of statistical significance (p < 0.001). Conclusion Participants with AMD exhibited thinner GCL + IPL than the healthy participants, as did the participants with wet AMD when compared to the participants with dry AMD. © 2020, Serbia Medical Society. All rights reserved.

Purpose: To analyze clinical characteristics of ocular sarcoidosis in a group of biopsy-proven sarcoid patients treated at the single referral center for sarcoidosis in Serbia. Methods: A prospective study carried out on 88 biopsy-proven sarcoid patients between January 2012 and December 2014. All patients underwent complete ophthalmological examination. Results: Ocular sarcoidosis was present in 32 patients (36.4% of all) and included: eyelid skin lesions (2.3%); orbital inflammation (2.3%); conjunctival lesions (7.9%); anterior uveitis (2.3%); intermediate uveitis (1.1%); posterior uveitis (15.9%); panuveitis (5.7%), and neuro-ophthalmologic manifestations (9.1%). Complications included cataract (20.4%); glaucoma (5.7%); cystoid macular edema (3.4%); epiretinal membrane formation (4.5%); macular atrophy (2.3%); and choroidal neovascularization (1.1%). Binocular visual impairment was present in one patient (1.1%), due to complications of posterior uveitis (macular scars). Conclusions: Patients in Serbia demonstrated ocular sarcoidosis as the first most common site of extrapulmonary sarcoid manifestations, with more often neuro-ophthalmologic lesions than in other European populations. © Taylor & Francis Group, LLC.

Background: Retinitis pigmentosa (RP) is one of the most common form of inherited retinal dystrophies. Identification of disease-causing mutations is a prerequisite for applying targeted therapeutic approaches. The present study aimed to identify disease-associated mutations in a large Serbian family, in which two brothers have suffered from RP starting in the first decade of their lives. Methods: The index patient and 12 additional members of a four-generation family were analyzed. All participants underwent detailed ophthalmic examinations. Genomic DNA was isolated from family members to perform whole exome sequencing (WES) and Sanger sequencing of candidate genes. Results: An early onset RP phenotype was presented in both ocular fundi of the index patient and his brother: arteriolar attenuation, as well as retinal pigmentary changes in peripheral fundus and waxy disc pallor. Both brothers showed foveal thinning. The index patient showed epiretinal membranes in both eyes and a parafoveal cystic lesion in his right eye, whereas the brother of the index patient showed choroid folds and vitreomacular adhesion in his left eye. We identified compound heterozygous mutations in the RPE65 gene (a novel c.1338+1G>A splice donor site mutation in addition to the frame-shifting mutation c.1207_1210dup (p.Glu404Alafs*4)) using an in-house WES pipeline. Conclusions: Evaluation of all previously described RPE65 mutations showed that the sequence variants identified in the present study located to rarely altered exons and likely effect a highly conserved region of the RPE65 protein. Gene augmentation therapies might be a promising treatment option for the patients described. © 2020 The Authors. The Journal of Gene Medicine published by John Wiley & Sons Ltd

Background: Retinitis pigmentosa (RP) is one of the most common form of inherited retinal dystrophies. Identification of disease-causing mutations is a prerequisite for applying targeted therapeutic approaches. The present study aimed to identify disease-associated mutations in a large Serbian family, in which two brothers have suffered from RP starting in the first decade of their lives. Methods: The index patient and 12 additional members of a four-generation family were analyzed. All participants underwent detailed ophthalmic examinations. Genomic DNA was isolated from family members to perform whole exome sequencing (WES) and Sanger sequencing of candidate genes. Results: An early onset RP phenotype was presented in both ocular fundi of the index patient and his brother: arteriolar attenuation, as well as retinal pigmentary changes in peripheral fundus and waxy disc pallor. Both brothers showed foveal thinning. The index patient showed epiretinal membranes in both eyes and a parafoveal cystic lesion in his right eye, whereas the brother of the index patient showed choroid folds and vitreomacular adhesion in his left eye. We identified compound heterozygous mutations in the RPE65 gene (a novel c.1338+1G>A splice donor site mutation in addition to the frame-shifting mutation c.1207_1210dup (p.Glu404Alafs*4)) using an in-house WES pipeline. Conclusions: Evaluation of all previously described RPE65 mutations showed that the sequence variants identified in the present study located to rarely altered exons and likely effect a highly conserved region of the RPE65 protein. Gene augmentation therapies might be a promising treatment option for the patients described. © 2020 The Authors. The Journal of Gene Medicine published by John Wiley & Sons Ltd

Aim To evaluate correlation of atherogenic risk factors between patients with retinal artery occlusion (RAO) and matched population, including those with central RAO and branch RAO. Methods Seventy-two participants from 2 groups were evaluated: a group with diagnosed RAO (first group; 45 participants) and a matched control group including those without RAO or any other ophthalmological disease (second group; 27 participants). From those with diagnosed RAO patients with central RAO and patients with branch RAO were evaluated separately. Additional parameters that were observed included body mass index (BMI), blood pressure, fasting glucose levels, triglycerides, LDL and HDL cholesterol fractions levels, presence of metabolic syndrome and hyperlipoproteinemia. Results There was a significant increase of LDL mean values in the group of patients with RAO. Hypertension (88.9%), hyperlipoproteinemia (68.9%) and metabolic syndrome (53.3%) were significantly more frequent in patients with RAO, while gender and diabetes mellitus were not in direct correlation with the development of RAO. The group of patients with RAO had no significantly higher values of BMI compared to the control. High density lipoprotein fraction was significantly higher in the group of patients with central RAO as compared with those with branch RAO. Conclusion Patients with atherogenic risk factors are more prone to the development of RAO. Furthermore, we demonstrated that HDL had more protective effects on smaller blood vessels (branch retinal artery) than on larger blood vessels (central retinal artery).

Introduction Behçet disease (BD) is a chronic multi-system disorder with manifestations in the ocular, urological, articular, and vascular systems. Tumor necrosis factor alpha is believed to play a pivotal role in BD. Therapeutic blockade of its activity by infliximab is a novel therapeutic approach and has successfully led to remission of the disease. The aim is to report two cases of refractory BD-associated panuveitis (PU) treated with infliximab. The patients were followed for 12 months. The main therapy assessment parameters were the best corrected visual acuity (BCVA) in the better eye, slit lamp and fluorescein angiography (FAG) from baseline findings and from the final examination. Case outline A male patient (45 years old, 25 years of BD history) and a female patient (45 years old, 15 years of BD history), both with posterior synechia, 3+ flare and complicated cataract, while the female also had hypopyon, were treated with infliximab administered at the dose of 5 mg/kg at weeks 0, 2, 6, and 14. The results for the male patient were as follows (baseline vs. the final examination): BCVA – 0.5 vs. 0.8; cellular reaction – 3+ vs. 1+; FAG – 1/2 vs. 0. The results for the female patient were as follows: BCVA – 0.1 vs. 0.3; FAG – 2/3 vs. 0. After 12 months, relapses or side-effects were not observed. Conclusion Infliximab is an effective and promising drug in treating refractory BD-associated PU. It promptly reduces acute symptoms of PU, but it still remains to be seen if a long-term remission in a great number of patients will be achieved. © 2017, Serbia Medical Society. All rights reserved.

Introduction Ultrastructural changes in corneas of patients with diabetes mellitus have been previously described.; Objective The aim of this study was to compare central corneal thickness (CDR) values in diabetic patients without retinopa-thy at the stage of diabetic nonproliferative and proliferative retinopathy and CDR in a control group of healthy subjects.; Methods The study included 121 diabetic patients and 125 healthy subjects matched according to gender and age. Each patient underwent ophthalmological examination involving a dilated fundus examination and CDR measurement using the ultrasound pachymeter. The eyes of diabetic patients were classified according to Early Treatment Diabetic Retinopathy Study into three groups: without diabetic retinopathy (NDR), with nonproliferative diabetic retinopathy (NPDR) and a group with proliferative diabetic retinopathy (PDR). Only one eye of each subject was chosen for the study.; Results The mean CDR value was significantly higher in the diabetic group (570.52±31.81 µm) compared with the control group (541.42±27.82 µm). The difference between the two groups was statistically significant (p<0.0001). The highest mean CDR value was recorded in the PDR group (585.97±28.58 µm), followed by the NPDR group (570.84±30.27 µm), whereas the lowest mean CDR value was recorded in the NDR group (559.80±31.55 µm). There was a statistically significant difference in CDR between the NDR and PDR groups, as well as between the NPDR and PDR groups (p<0.001, p<0.05 respectively). No significant difference was recorded between the NDR and NPDR groups (p>0.05).; Conclusion CDR of diabetic patients was higher compared to healthy subjects. The highest mean value of CDR was registered in the PDR group, followed by the NPDR and the NDR groups. © 2014, Srpsko Lekarsko Drutsvo. All rights reserved.

Introduction Iris melanocytoma (IM) is a rare benign tumor, but unavoidable in differential diagnosis of pigmented iris lesions. According to the best knowledge of the authors it is for the first time in Serbia that a well-documented case of IM is presented and that the problem of this tumor is discussed. Case Outline In the left eye of a 47-year-old white female at the iris in a six o’clock position, a highly pigmented, dome shaped lesion with a crater-like cavity in the center and with feathery margins was noticed. There were no signs of infiltration of surrounding tissue or intrinsic vessels and the lens was clear. Visual acuity and intraocular pressure were normal. An ultrasound biomicroscopy (UBM) revealed a well-defined lesion with high internal reflectivity, with a base diameter of 1.25 mm and a thickness of 0.80 mm in the periphery, and 0.53 mm in the central part. The diagnosis of IM of the left eye was established and regular checkups were performed for ten years. No changes in clinical or UBM presentation were established. Conclusion Awareness of clinical presentation of IM is most important for correct diagnosis. Ultrasound biomicroscopy is a useful diagnostic procedure in the following up of IM. © 2016, Serbia Medical Society. All rights reserved.

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 fuorescein angiography shows dilated capillaries of the optic disc with leakage in the early phase and diffuse hyperfuorescence 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 fuorescein 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. © Versita Sp. z o.o.

Background/Aim. One of the most reliable methods for structural measurements of glaucomatous damage is spectral domain optical coherence tomography (SD-OCT). The aim of this study was to measure peripapillary retinal nerve fiber layer (RNFL) thickness with SD-OCT in eyes with different stages of glaucoma, as well as to determine which sector in the peripapillary circle is the most vulnerable to glaucomatous damage. Methods. The study included 153 eyes of 93 patients with confirmed primary open angle glaucoma (POAG). All the patients underwent a complete ophthalmic examination, including visual field testing and peripapillary RNFL thickness measured by SD-OCT. They were divided into three subgroups: early, moderate and severe stage of glaucoma based on the mean deviation (MD) index of visual field. The results were presented as mean RNFL thickness: total, in the four quadrants and 12 clock-hour RNFL thickness. Results. The overall mean peripapillary RNFL was 74.95 ± 14.51 µm. The lower quadrant had the thickest RNFL (92.78 ± 25.84 µm), followed by upper (88.82 ± 22.04 µm), nasal (64.31 ± 11.67 µm) and temporal ones (54.02 ± 12.76 µm), showing a significant difference (χ2 = 273.36, DF = 3, p < 0.001). Comparison between RNFL thickness in early glaucoma and moderate and severe stages revealed that the most sensitive sectors were inferior and superior ones, as well as sectors at 5-7 clock hour position. The greatest decrease in RNFL thickness was observed in the 9 o’clock hour sector in all three glaucoma subgroups (46.99 ± 13.28 µm), while the RNFL was the thickest in the 6 o’clock hour sector (102.63 ± 34.12 µm). Conclusion. Peripapillary RNFL thickness is inversely proportional to the degree of glaucomatous damage: the greater the damage, the thinner peripapillary RNFL. © Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Optical coherence tomography angiography (OCTA) was used to analyze the alterations in the density of retinal blood vessels and the choriocapillaris (VD) in patients suffering from type 2 diabetes mellitus (T2DM). One hundred sixty-six eyes of 83 patients (43 of whom were men and 40 women, with a mean age of 58.59 ± 14.04) with T2DM and without diabetic retinopathy were examined for the purpose of conducting the observational prospective study. The control group (CG) consisted of 66 eyes in 33 healthy subjects (15 male and 18 female, with a mean age of 55.12 ± 12.70). The measurement regions of vessel density (VD) included the deep capillary plexus (DCP), the superficial capillary plexus (SCP), and the choriocapillaris. The results indicate considerable differences in the VD of the DCP and SCP when comparing the control group with the study groups (p<0.001). In comparison with the control group (p<0.001), there was a statistically significant reduction in the VD of the choriocapillaris in the study group. Furthermore, patients with T2DM showed a significantly decreased VD concerning the control in different macular regions. Thickness in several macular regions in the study group significantly decreased compared to the ones in the control group. OCTA was used to gather relevant information about the vascular changes which occurred in T2DM patients, assessed through the quantitative analysis of the blood flow in the retina and choriocapillaris. © 2021 Marko Zlatanović et al.

Introduction/Objective During hemodialysis (HD) treatment great fluctuations were recorded in the systemic hemodynamic parameters and in the volume and composition of ocular fluid. There are only a few studies that analyzed the effect of HD on retinal and macular thickness with conflicting results. Objective of this study was to determine macular thickness, marked as central foveal thickness, average macular thickness and macular volume, shortly before and after HD. Methods This prospective study included 30 chronic renal failure (CRF) patients of HD treatment. Thorough ophthalmologic examinations were performed including evaluation of best corrected visual acuity, intraocular pressure and slit-lamp examination of all eye segments. Macular thickness was determined by optical coherence tomography shortly before and after HD. The next parameters were evaluated: central foveal thickness, average macular thickness and macular volume. The correlation between systemic parameters and macular thickness changes during HD was tested. Results There were significant changes in body weight and blood pressure pre-and post-HD. Results showed macular thickness (central foveal thickness, average macular thickness and macular volume) decreased, but the change was not significant. There was no significant correlation between systemic hemodynamic parameters and macular thickness changes. Conclusion Results of this study showed there was no statistically significant changes in macular thickness CRF patient undergoing HD. Further research on a larger group of patients and a longer follow-up time are required to confirm these findings. © 2022, Serbia Medical Society. All rights reserved.

Introduction/Objective Iridocorneal endothelial (ICE) syndrome incudes 3 clinical forms: progressive iris atrophy, Chandler’s syndrome, and Cogan–Reese syndrome. It is characterized by various degrees of iris atrophy, corneal endothelial changes, uveal ectropion, corectopia, peripheral anterior synechiae (PAS) and secondary glaucoma. The aim of the study was to illustrate forms of ICE syndrome, determine frequency of secondary glaucoma with emphasis on cases with uveal ectropion, analyze response to medicament treatment and the need for surgical treatment in intraocular pressure (IOP) control. Methods Patients underwent slit lamp examination, applanation tonometry, gonioscopy, ophthalmoscopy, Humphrey visual field testing and Heidelberg retina tomography. Patients were divided into two groups: group I, without uveal ectropion (22 patients) and group II, with uveal ectropion (14 patients). Results A total of 36 patients were examined in a 10-year period. The average age was 38 years, male to female ratio 1:2. Secondary glaucoma was confirmed in 26 (72.2%) patients, out of which 12 (54.5%) in group I and 14 (100%) in group II. PAS were more frequent in group II. In group I, mean initial IOP was 37 mmHg, and after medicament treatment 26 mmHg. Secondary glaucoma was controlled in 50% and remaining 50% underwent surgical treatment. In group II, mean initial IOP was 49 mmHg, and after medicament treatment 32 mmHg. All 14 patients (100%) underwent surgical treatment in order to achieve IOP control. Conclusion ICE syndrome is a rare, progressive disease, with high incidence of secondary glaucoma, which is more frequent in cases with uveal ectropion. In these cases, medicament treatment is not effective and trabeculectomy with antimetabolite application is necessary. © 2017, Serbia Medical Society. All rights reserved.