Browsing by Author "Kovačević, Igor (6701643801)"

Background/Aim. Rhegmatogenous retinal detachment is a potentially blinding condition of the posterior segment of the eye. Currently, the only treatment modality is surgery and surgical options include scleral buckling, pars plana vitrectomy and pneumoretinopexy. Many factors may influence the outcome of the surgery. Well defined indications are essential for achieving the best postoperative results. The aim of this study was to assess anatomical and functional outcome of treatment with scleral buckling for macula-off rhegmatogenous retinal detachments. Methods. This prospective, nonrandomized, interventional study included consecutive patients underwent scleral buckling for macula-off retinal detachment in the tertiary centre for vitreoretinal surgery. Results. A total of 168 consecutive patients (mean age 58.2 ± 13.9 years) were included in the study. Postoperatively, anatomical success was achieved in 152 (90.5%) of the patients. Parameters that influenced the anatomical success included the number of retinal breaks (p = 0.040), lens status (p = 0.041), preoperative proliferative vitreoretinopathy (p < 0.001), patients’ age (p = 0.049), and marginally, the presence of typical symptoms (p = 0.057). Duration of macular detachment, previous ocular trauma and refraction of the eye did not affect the anatomical result. Functional success was evaluated using the postoperative visual acuity and depended mainly on the duration of macular detachment prior the surgery. Visual acuity 0.4 or better was significantly more often achieved if duration of macular detachment was up to seven days (p < 0.001). Refraction and patients’ age did not influence the functional result. Conclusion. Scleral buckling is an efficient surgical procedure for treatment of patients with retinal detachment. Optimal results are achieved if operation is performed within the first seven days of duration of macular detachment. © 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

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. © 2018, Routledge. All rights reserved.

Introduction. Scleroderma (systemic sclerosis) is a severe chronic connective tissue disease, which results in involvement of numerous internal organs. Changes in the eye are the consequences of organ-specific manifestations of scleroderma or adverse effects of immunosuppressive treatment applied. Case report. We reported a 42-year-old woman with systemic sclerosis and acute deterioration of vision in the left eye, with visual acuity 0. 9. After thorough clinical examination, including fluorescein angiography and optical coherence tomography, the diagnosis of nonischemic central retinal vein occlusion was made. Further biochemical, rheumatological and immunological investigation, apart from inactive systemic sclerosis, showed normal findings. Therefore, the cause of central retinal vein occlusion could only be attributed to the microvascular changes in systemic sclerosis. After three months, visual acuity deteriorated to 0.6 due to the development of cystoid macular edema. The patient received intravitreal injection of bevacizumab and after a single dose visual acuity improved to 0. 9. After a 6- month follow-up, macular edema resolved and visual acuity stabilized. Conclusion. According to our knowledge and current data from the literature, central retinal vein occlusion is a rare vision threatening manifestation of scleroderma. There are only few published case reports on central vein occlusion in scleroderma patients. Examination of the ocular fundus is recommended for evaluation of vascular disease in patients with systemic sclerosis. © 2016, Vojnosanitetski Pregled. All rights reserved.

Background/Aim. Ocular trauma is a significant cause of visual impairment worldwide. The aim of the study was to analyze clinical characteristics of patients with penetrating eye injuries with retained intraocular foreign body (IOFB) in posterior segment of the eye. Methods. The retrospective study enrolled medical records of consecutive patients hospitalized in a five year period (2012-2016) in a tertiary referral center in Serbia. Surgical repair included pars plana vitrectomy and IOFB removal. Postoperative results were evaluated using the best corrected visual acuity (BCVA). Results. Out of 130 patients who suffered penetrating eye injury with retained IOFB, 72 had IOFB in posterior segment of the eye (43 in retina, 25 in vitreous, 3 in ciliary body, 1 on the optic nerve). Patients were predominantly young adults (aged 44.3 ± 14.9 years, 97.2% men). Average BCVA at admission was poor (0.27 ± 0.38, measured by Snellen chart), and 52.8% of patients had BCVA of counting fingers at 1 meter or less. The majority of patients had corneal wound (70.8%), medium sized IOFB (48.6%), iris injury (61.1%) and traumatic cataract (69.4%). Complications included retinal detachment (16.7%) and endophthalmitis (15.3%). Two patients had the eye enucleated due to severe endophthalmitis, which could not be otherwise controlled. Significant risk factors for postoperative outcome were: initial BCVA (p < 0.001), ocular hypotony (p = 0.013), medium size of IOFB (p = 0.037), presence of traumatic cataract (p = 0.036), retinal detachment (p = 0.032) and endophthalmitis (p = 0.045). Conclusion. Treatment of posterior segment penetrating eye injuries remains a challenge due to high frequency of low initial visual acuity, retinal detachment and endophthalmitis, all of which are risk factors for poor visual outcome. Patients with better initial BCVA, normal intraocular pressure and small IOFB have better postoperative results. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Retinitis pigmentosa (RP) is a group of inherited retinal dystrophies caused by mutations in various genes. The disease leads to progressive photoreceptors loss (rods predominantly) and retinal pigment epithelium alteration. RP can lead to blindness in the advanced stages of the disease, when the central retina is involved, mostly due to the presence of cystoid macular edema (CME). Several therapeutic approaches for CME in RP patients have been attempted but responses have been variable. Case outline A 51-year-old man was referred due to progressive six-month-long blurring of vision in both eyes. The patient underwent complete ophthalmological examination at baseline. Based on the clinical presentation of mottled mid periphery of the retina and characteristic tubular visual field loss, hence typical fluorescein angiography and optical coherence tomography (OCT) findings, the patient was diagnosed as bilateral retinitis pigmentosa sine pigmento with CME. In an attempt to control the edema, treatment was started with dorzolamide, instilled three times daily in each eye, which resulted in reduction of macular edema in a one-month-period, as documented by OCT. This effect was further monitored for five months and was stable. Conclusion In the presented case, we investigate the six-month therapeutic efficacy of dorzolamide for dealing with the CME secondary to RP. Topical carbonic anhydrase inhibitors are considered as the first option for treatment of CME in RP patients, due to their high efficacy and safety. © 2017, Serbia Medical Society. All rights reserved.

Introduction/Objective Retinopathy of prematurity (ROP) is a developmental vascular proliferative disorder in premature children’s incompletely vascularized retina. Many factors slow down or prevent the normal development of retinal vascularization in premature babies. The aim of our study was to examine the risk factors in premature infants of gestational age (GA) of 25–36 weeks associated with the occurrence of severe ROP. Methods The study was cross-sectional. The research included patients monitored by a screening program for ROP, i.e. prematurely born children with a body weight mass (BMW) ≤ 2000 g, and/or GA of ≤ 36 weeks. Results Statistically significant differences were observed between the ROP and the control group in the mean values of GA, BWM at birth, Apgar score, and days of oxygen therapy. Also, frequencies of respiratory distress syndrome expression, broncho-pulmonary dysplasia, intraventricular hemorrhages, and require-ment for mechanical ventilation were statistically significantly different between the two analyzed groups. Conclusion Our work confirmed that low GA and low BWM are already accepted risk factors for ROP. The presence of perinatal asphyxia, the length of oxygen administration and assisted ventilation are significantly associated with the appearance of active forms of retinopathy. Sepsis and anemia were shown to be significantly associated with more severe forms of retinopathy, while hyperbilirubinemia was approximately present in both examined groups. More severe forms of intraventricular hemorrhages and necrotic enterocolitis are significantly more common in children with active retinopathy. © 2024, Serbia Medical Society. All rights reserved.

Introduction Valsalva retinopathy is an uncommon disorder that usually presents with acute onset of unilateral, or less frequently, bilateral visual impairment varying from subtle scotoma to total vision loss. It occurs as a result of Valsalva’s maneuver. In the vast majority of cases, hemorrhage is preretinal although subretinal, intraretinal and vitreous hemorrhage can be found. Valsalva retinopathy often develops due to numerous triggering activities such as vomiting, coughing, heavy weight lifting, intense aerobic exercise, labor, and general anesthesia. Management options are either clinical observation or invasive techniques. We report a case of premacular hemorrhage due to Valsalva retinopathy induced by gym training. Case outline A 34-year-old woman was referred to the Eye Clinic, University Clinical Center of Serbia, complaining of sudden and painless unilateral decrease in vision occurred during intense physical activity. Best corrected visual acuity was measured as counting fingers at five meters distance. Dilated fundoscopy demonstrated a large, well demarcated premacular subhyaloid hemorrhage with visible rupture of the retinal vein branch. The patient was treated conservatively. Three months after the onset of symptoms, hemorrhage absorbed and best corrected visual acuity was 20/20. Conclusion Valsalva retinopathy, although a rare condition, should not be omitted as a differential diagnosis of retinal and vitreous hemorrhages. Standard, observational treatment is generally sufficient for complete vision recovery; however, literature suggests that an individualized approach to each patient is required. © 2022, Serbia Medical Society. All rights reserved.

Introduction Incontinentia pigmenti (IP) is an X-linked genodermatosis in which skin changes are combined with dental, eye and central nervous system anomalies. Objective The goal of the study was to analyze ocular findings, IP minor criteria in available literature concerning IP cases published until now. Methods We have done meta-analysis of 1931 IP patients found in 302 references published until 2010. Comparison of data published for the 1906-1976 and 1976-2010 periods was made. The collected data were mainly frequencies of ocular anomalies. Chi-square test was used to compare observed frequencies with their expectations. Results Of total number of IP patients, 1,227 were ophthalmologically investigated. In 449 such patients 972 eye anomalies were registered, 2.16 anomalies per patient. Proportion of ophthalmologically investigated IP patients in the period 1906-1975 (70%) was higher than corresponding proportion (60%) for the period 1976-2010. For 1906-2010 period 36.5% IP patients with eye anomalies were diagnosed. The number of amaurotic eyes per patient did not significantly differ for the two periods (p=0.50; >0.05). The total number of eye anomalies per patient significantly differed for the same periods (p=0.00005; <0.05). Retinal anomalies were most frequent in both periods. Conclusion This study suggests that IP is far more frequent than anyone could estimate. We believe that this study, covering 1906-2010 period, gives more reliable information about ophthalmological findings in IP; considering them as severe anomalies. Early detection and treatment of ophthalmological, neurological etc. findings may prevent severe consequences that IP may cause.

The objective of our study was to analyze the presence of persistent submacular fluid after apparently successful scleral buckle surgery for macula-off retinal detachment, using Optical Coherence Tomography (OCT), and to correlate these findings to postoperative visual acuity. Prospective study of consecutive patients hospitalized for macula-off retinal detachment, between February 2008 and April 2010, was carried out at the single referral centre for vitreoretinal surgery in Serbia. Outcomes were evaluated 1, 3, 6 and 12 months postoperatively, using OCT and best corrected visual acuity (BCVA). All 48 patients with macula-off retinal detachment had undergone clinically successful scleral buckle surgery, 3 to 30 days (mean 14.2 ± 6.9) after the onset of symptoms. Reattachment was achieved and one month later, patients were divided in two groups, according to the presence of submacular fluid assessed by OCT: group A with detectable residual submacular fluid (40%) and group B without (60%). The mean BCVA one month postoperatively was significantly lower (p<0.01) in the group A (0.11 ± 0.03) opposed to the group B (0.51 ± 0.11). However, after a 12-month-follow-up, BCVA was similar in both groups (0.52 ± 0.17 and 0.54 ± 0.15 respectively, p=0.541), due to the restitution of normal macular architecture confirmed by OCT. The prolonged recovery of visual acuity in patients with macula-off retinal detachment who had undergone successful scleral buckle surgery could be explained with presence of submacular fluid, diagnosed by OCT. However, final visual outcome was favourable, due to the gradual resorption of submacular fluid in a 12-month-period. © 2012 Association of Basic Medical Sciences of FBIH. All rights reserved.

Introduction Von Hippel–Lindau disease is a hereditary, autosomal dominant, tumor syndrome with a predisposition to developing various benign and malignant tumors. Retinal hemangioblastoma is often the presenting manifestation. We report a case of Von-Hippel–Lindau disease in a 13-year-old girl with bilateral eye involvement. Case outline The patient was referred to the Eye Clinic, University Clinical Center of Serbia, with a diagnosis of Coats disease. Clinical examination revealed that best corrected visual acuity was 20/20 on her right eye, while her left eye showed counting fingers at 20 cm distance. Dilated fundoscopy of the right eye revealed multiple tortuous feeding vessels leading to orange-reddish, sharply demarcated multiple lesions on the far periphery of the upper retina, corresponding to retinal hemangioblastoma. the left eye showed edematous optic nerve head, tortuous retinal vessels, exudates, and retinal detachment including macula. Considering that the patient had multiple bilateral retinal hemangioblastomas and that her father had pathohistologically proven brain hemangioblastoma and numerous visceral tumors, Von Hippel–Lindau disease was assumed. Focal argon laser photocoagulation was performed in the region of all visible vascular tumors and feeding vessels in the right eye. The patient’s visual acuity remained unchanged five months after the disease detection. Conclusion The importance of education about dominant inheritance pattern of Von Hippel–Lindau disease cannot be overemphasized. Role of an ophthalmologist is critical in early diagnosis of both retinal hemangioblastoma and Von Hippel–Lindau disease. © 2023, Serbia Medical Society. All rights reserved.

Introduction. Systemic lupus erythematosus (SLE) is a systemic idiopathic autoimmune inflammatory disease, with multiple organ involvement. Severe vaso-occlusive retinopathy is a rare, sight threatening lupus-related manifestation of the disease, which is more common in patients with coexisting antiphospholipid syndrome. Case report. We reported a 36-year-old female with severe vaso-occlusive retinopathy that manifested in the absence of antiphospholipid syndrome. In a 4-year follow-up, despite aggressive systemic corticosteroid and immunosuppressive therapy and panretinal laserphotocoagulation treatment, the disease progressed to retinal neovascularisation, neovascular vitreoretinopathy, neovascular glaucoma and, consecutively, severe visual loss. As the final option for preservation of visual function, pars plana vitrectomy with laserphotocoagulation was performed and had good results. Progression of ophthalmological findings indicated the progression of the systemic disease, as well as neurolupus. Conclusion. Severe vaso-occlusive retinopathy occurred as the ophthalmological manifestation of SLE in the absence of antiphospholipid syndrome, but correlated with neurolupus and led to visual deterioration despite the treatment. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Introduction Vitreous or retinal hemorrhage occurring in association with subarachnoid hemorrhage is known as Terson’s syndrome. In Terson’s syndrome, intracranial hemorrhages are followed by intraocular hemorrhage, classically in the subhyaloid space, but may also include subretinal, retinal, preretinal, and vitreal collections. Vitreous hemorrhage recovery is usually spontaneous in six to 12 months, otherwise vitrectomy is considered. Outline of Cases We report of two cases of Terson’s syndrome. The first was in a hypertensive middleaged female, following anterior communicating artery aneurismal subarachnoid hemorrhage, after postneurosurgical interventions. The second case report was of a young male who suffered from the bilateral vitreous hemorrhage after a severe traumatic brain injury. Conclusion Terson’s syndrome should be considered in patients who had previous cerebral hemorrhage and are referred to eye specialist because of loss of vision. However, this phenomenon has only rarely been described in association with subdural and epidural hematomas or traumatic subarachnoid hemorrhage. © 2015 Serbia Medical Society. All rightsreserved.

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.

SUMMARY Introduction/Objective Ocular trauma is a globally important cause of visual impairment. The aim of our study was to analyses demographic, epidemiological, and clinical characteristics of blunt ocular trauma. Methods The retrospective study enrolled patients with blunt ocular trauma, hospitalized at the Eye Clinic, University Clinical Centre of Serbia in Belgrade during a four-year period (2018–2022). Demographic characteristics, mechanism of injury, best corrected visual acuity on admission and discharge and injured eye structure were analyzed. Results Out of 283 patients, the majority (n = 233, 82%) were men. People aged 61 and over (n = 82, 29%) were at greatest risk for blunt ocular trauma. Injuries from splitting wood (n = 78, 28%) and various blunt tools and objects (n = 70, 25%) were the most common mechanism in the entire study group, both in men and in women. Visual acuity on admission was better than 0.6 in 147 (52%) patients and at discharge in 185 (65%). The most common eye structure affected are pathological findings in anterior chamber (n = 160, 56%), which are mainly related to hyphemia. Conclusion Present study showed that blunt ocular trauma affects all age groups, but most often elderly and children. Men are injured more often than women. Splitting wood and manipulating blunt tools and objects are activities with the highest risk of blunt ocular trauma. © 2023, Serbia Medical Society. All rights reserved.

Introduction/Objective World Health Organization in January 2020 declared a pandemic of the coro-navirus disease named COVID-19. The state of emergency in the Republic of Serbia began on March 15 2020, which greatly influenced the treatment of those patients who were not affected by COVID-19. The aim of this paper is to compare the most common ophthalmic surgeries during quarantine with those performed in 2019 in the same period. Methods This is a retrospective study. We collected data from the operating protocol of the main ophthalmic operating room. We have followed the changes related to surgical procedures during these two years. Results During the state of emergency, significantly more operations were performed on male patients than on female patients compared to the same period in 2019 (p = 0.043). In the observed period, in 2019 significantly more patients older than 65 were surgically treated (p < 0.001). During 2019, there were 397 (64.3%) elective and 220 (35.7%) urgent procedures, while for the same period next year there were 9 (9.1%) elective and 90 (90.9%) urgent procedures. Significantly more urgent interventions were performed during 2020 compared to 2019 (p < 0.001). Conclusion The coronavirus pandemic has led to numerous changes in the treatment of ophthalmic patients. Many patients did not have access to adequate treatment, which certainly led to the impair-ment of many ophthalmic diseases. © 2022, Serbia Medical Society. All rights reserved.

Introduction Horner’s syndrome is an interruption of the sympathetic nervous system at any point along its course between the hypothalamus and the orbit. Horner’s syndrome is classically presented as an ipsilateral miosis, subtle ptosis, and facial anhidrosis. Pharmacologic testing is very useful in the diagnosis of Horner’s syndrome as it could help to localize the lesioned neuron in the sympathetic pathway, suggesting an etiology. Case Outline We present a case report of a 41-year-old woman who reported right eyelid drooping immediately after operation of sympathetic chain schwannoma. We performed apraclonidine test for the diagnosis of Horner’s syndrome, which produced mydriasis on the affected eye, while there was no significant change of the normal eye. Based on the clinical presentation of anisocoria and one-sided ptosis, and previous medical history of surgical removal of the mediastinal tumor, the patient was diagnosed with a right-sided, partial Horner’s syndrome. Conclusion Timely recognition, exact localization of the lesioned neuron, and referral for urgent imaging studies are important for ophthalmologists in order to prevent and treat life-threatening conditions. Besides its diagnostic value in Horner’s syndrome, topical apraclonidine could correct ptosis for the sake of esthetics or when ptosis reduces the superior visual field. © 2016. Srpski Arhiv za Celokupno Lekarstvo. All right reserved.

Introduction Adie’s (tonic) pupil is a neuro-ophthalmological disorder characterized by a tonically dilated pupil, which is unresponsive to light. It is caused by damage to postganglionic fibers of the parasympathetic innervation of the eye, usually by a viral or bacterial infection. Adie’s syndrome includes diminished deep tendon reflexes. Outline of Cases We report data of a 59-year-old female with unequal pupil sizes. She complained of blurred vision and headache mainly while reading. She had a 35-year history of hepatitis B and liver cirrhosis. On exam, left pupil was mydriatic and there was no response to light and at slit lamp we saw segments of the sphincter constrict. We performed 0.125% pilocarpine test and there was a remarkable reduction of size in the left pupil. The second case is a 55-year-old female who was referred to the University Eye Clinic because of a headache and mydriatic left pupil. She had diabetes mellitus type 2, as well as hepatitis A virus 20 years earlier. On exam, the left pupil was mydriatic, with no response to light. Test with diluted pilocarpine was positive. Neurological examinations revealed no abnormality in either case so we excluded Adie’s syndrome. Conclusion Adie’s tonic pupil is benign neuro-ophthalmological disorder of unknown etiology. Most patients commonly present no symptoms and anisocoria is noticed accidentally. Although the etiology is unknown, there are some conditions that cause tonic pupil. It may be a part of a syndrome in which tonic pupil is associated with absent deep tendon reflexes. © 2015, Serbia Medical Society. All rights reserved.