Browsing by Author "Marković, Vujica (56233157100)"

Introduction An altered perfusion of the optic nerve head has been proposed as a pathogenic factor of glaucoma. Objective The aim of this study was to evaluate the changes of the hemodynamic parameters in the retrobulbar arterial circulation after decrease of the elevated intraocular pressure (IOP) in women and men with primary open angle glaucoma. Methods The study included 60 patients (33 males and 27 females) older than 50 years, with diagnosed and treated primary open angle glaucoma (77 eyes of 39 patients had increased IOP, >25 mm Hg). They were examined at the Clinic of Eye Diseases (complete ophthalmologic exam) and Clinic of Neurology, Clinical Center of Serbia, Belgrade, from December 2009 to December 2010. Imaging of hemodynamic parameters of three retrobulbar arterial vessels: ophthalmic, central retinal and posterior ciliary arteries with color Doppler was performed. Results Among women, hemodynamic arterial parameter of the peak-systolic velocity was increased in the central retinal artery and decreased in the ophthalmic artery and posterior ciliary arteries; enddiastolic velocity was increased in all three retrobulbar vascular levels; Pourcelot resistivity index was increased, but pulsatility index was decreased in all three vessels. Among men, peak-systolic velocity, end-diastolic velocity and pulsatility index were decreased in all three vessels; resistivity index was increased in the ophthalmic artery, but decreased in the central retinal artery and posterior ciliary arteries. There was a significant change of the ophthalmic artery pulsatility index in women, and the end-diastolic velocity of the ophthalmic artery in men. Conclusion There was a difference of the retrobulbar arterial circulation between women and men with primary open angle glaucoma after decrease of the elevated intraocular pressure. The role of vascular factors in the supply of the optic disc neuroretinal rim is important.

Introduction Ocular blood flow (OBF) disturbances could be involved both in the pathogenesis and in progression of glaucomatous damage. Objective The aim of the study was to compare the retrobulbar hemodynamic parameters in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior cilliary arteries (SPCA) after decreasing the elevated intraocular pressure (IOP) in primary open-angle glaucoma (POAG) patients by using color Doppler imaging (CDI). Methods We examined 60 patients (21 male and 39 female) with diagnosed and treated POAG. Thirty-nine patients had increased IOP (>25 mm Hg). Peak-systolic velocity (PSV), end-diastolic velocity (EDV), Pourcelot resistance index (RI), and pulsatility index (PI) were assessed in the OA, CRA, and SPCA. IOP was measured both with the Goldmann Applanation tonometer (GAT) and with the Dynamic Contour tonometer (DCT), three times respectively. Ocular pulse amplitude (OPA) was measured using DCT. Results The retrobulbar parameters between the baseline and after IOP reduction showed no difference in measurements. After Bonferroni correction (p<0.0056, alpha/9) statistical significance was recorded only in the following retrobulbar hemodynamic parameters; DCT (29.8±6.2 vs. 15.5±5.0), GAT (33.8±9.0 vs. 15.0±6.6) and OPA measurements (4.3±1.0 vs. 3.0±1.6), as compared to the baseline. There was no correlation between the changes in IOP measured with either DCT or GAT and changes in the hemodynamic parameters (p>0.05 for all). Pearson correlation coefficient (95% CI) showed very good correlation for IOP measurements between DCT and GAT: at baseline 0.83 (0.71 to 0.90) and at the end 0.71 (0.55 to 0.83); p<0.0001 for both measurements, but without any difference between them (p>0.05). Conclusion There was a lack of correlation between the changes in IOP measured with either DCT or GAT and the changes in the hemodynamic parameters. © 2014, Serbia Medical Society. All rights reserved.

Introduction This is an observational case report presenting retinitis pigmentosa associated with pseudoexfoliative glaucoma. Case outline A 69-year-old man presented with retinitis pigmentosa. On examination, pseudoexfoliative material was detected on anterior segment structures, and intraocular pressure was 26 mmHg in the right and 24 mmHg in the left eye. The patient was commenced on topical antiglaucomatous therapy (timolol + dorzolamide twice daily, latanoprost once in the evening) to both eyes. Conclusion To the best of our knowledge, this is the first reported case of retinitis pigmentosa associated with pseudoexfoliative glaucoma. Although rare, retinitis pigmentosa and glaucoma can occur in the same eye. © 2017, Serbia Medical Society. All rights reserved.

Introduction/Objective Evaluation of the optic nerve head (ONH) is an inevitable procedure in the diagnosis of glaucoma. One of the most common imaging techniques for a quantitative assessment of the topography of the ONH is the Heidelberg retinal tomography II (HRT II). The aim of this study was to determine quantitative stereometric parameters of the ONH by using HRT II and to investigate any damage of neuroretinal rim in children with suspected glaucoma and compare these data with a group of adults also with suspected glaucoma. Methods This comparative study included 167 children (167 eyes) aged between five and 16 years (mean age of 11 ± 3 years) with suspected juvenile glaucoma and 175 adult participants (175 eyes), aged 55–66 years (mean age of 60 ± 3 years) also with suspected glaucoma. All of them were examined between January 2013 and April 2014. ONH topography and retinal nerve fiber layer thickness measurements were assessed using HRT II. Results Data analysis in this study showed that the average mean values for children/adults were as follows: disc area (mm²) 2.828 ± 0.489/2.663 ± 0.412 (p < 0.001); rim area (mm²) 1.873 ± 0.391/1.667 ± 0.275 (p < 0.001); cup/disc area ratio 0.369 ± 0.125/0.369 ± 0.101 (p = 0.530); mean retinal nerve fiber layer thickness (mm) 0.223 ± 0.078/0.219 ± 0.055 (p = 0.494). Statistically significant difference in damage of neuroretinal rim, between children and adults, was found in the temporal and temporal-inferior segments. Conclusion There were differences in some of the investigated quantitative parameters of the ONH between children and adults, as optic disc size, cup and rim area, and rim volume. By using Moorfields regression analysis, differences in the damage of the neuroretinal rim, when comparing children and adult optic discs, appeared only in the temporal and temporal-inferior segments, which means that optic disc cupping has spread more in the children than in the adults. © 2018, Serbia Medical Society. All rights reserved.

Background/Aim. Trabeculectomy is a safe procedure which effectively reduces the intraocular pressure (IOP). IOP is the most frequent indicator of success after glaucoma surgery. The aim of this work was to evaluate the long-term pressure control in primary open-angle glaucoma (POAG) and in pseudoexfoliative glaucoma (XFG) after primary trabeculectomy without the use of mitomycin-C (MMC), 3 to 5 years after trabeculectomy. Methods. This study involved a retrospective evaluation of 332 consecutive patients (352 eyes), 174 patients (188 eyes) with POAG (mean age of 64.0 ± 8.6 years) and 158 patients (164 eyes) with XFG (mean age of 70.7 ± 8.9 years) who underwent primary trabeculectomy between January 2007 and December 2009 at the Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade. A successful control of IOP was defined as achieving IOP ≤ 21 mmHg without medication (complete success), or with a single topical medication (qualified success). Results. According to the type of glaucoma POAG/XFG preoperative IOP was 28.4 ± 6.3/30.4 ± 8.4 mmHg, respectively (p = 0.311) and last postoperative IOP was 16.9 ± 5.2/18.7 ± 5.9 mmHg, respectively (p = 0.681). According to the Kaplan-Meier survival curve, the complete success in the group with POAG in 1, 3 and 5 years were 85%, 75% and 58% and in the group with XFG were 82%, 70% and 56%, respectively. There was no statistically significant difference in the complete success rates between the patients with POAG and XFG. Conclusion. The primary goal of surgery was to achieve a sufficiently low IOP without additional medication, thus preventing progression of glaucomatous damage. In our study, the complete success in the group with POAG was achieved in 75% and 58% of the patientsin the period of 3 and 5 years after surgery, respectively and in the group with XFG complete success was achieved in 70% and 56% of the patients respectively. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. Congenital uveal ectropion (CEU) is a rare, non-progressive condition often accompanied with eyelid ptosis, anterior insertion of the iris, disgenesis of the iridocorneal angle and glaucoma. Case report. We present a case of a seven-year-old girl with a congential unilateral uveal ectropion and a secondary glaucoma which had daily variations from 13 up to 50 mm Hg. The patient had no other abnormalities of the iris or underlying systemic diseases. Introduced local anti-glaucomatous therapy initially normalized intraocular pressure (IOP), but failed to provide long term normalisation. Trabeculectomy normalized the IOP which resulted in the reduction of the cup/disc ratio and restitution of neuroretinal rim. The rim area increased to 1.716 mm2 (0.958 mm2 preoperative) rim volume, was 0.666 mm3 (0.195 mm3 preoperative) while cupdisc (C/D) ratio decreased to 0.330 (0.626 preoperative) as well as linear C/D=0.574 (0.791 preoperative). Neuroretinal rim (NR) was preoperatively preserved in the Ti segment, damaged in T, Ts, N, Ns segments, and borderline in the Ni segment. Postoperatively, neuroretinal rim was preserved in all segments. Conclusion. In the presented case trabeculectomy induced recovery of the nerve tissue of the optic nerve head which was confirmed by Haidelberg Retina Tomograph II (HRT II). The treatment results have been maintained during the follow-up period of nine years without topical or systemic antiglaucomatous therapy. Although CEU is a non-progressive and benign eye disease, associated glaucoma can cause severe optic nerve damage if not detected early and treated properly. As can be seen in the presented case, an adequate treatment can prevent and even reverse optic disc neuropathy. © 2018, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim: Neovascular glaucoma (NVG) is a secondary glaucoma caused by occlusion of the trabecular network of newly formed blood vessels. The aim of this study was to evaluate the efficacy and safety of intravitreal injections of bevacizumab before trabeculectomy with mitomycin C (MMC) for the treatment of NVG. Methods: A prospective and open-label study was conducted from May 2013 to December 2014 on consecutive NVG patients who underwent intravitreal injections of bevacizumab and a primary trabeculectomy with MMC. All patients were followed-up at least for 12 months. Success was defined as an intraocular pressure (IOP) of ≤ 21 mm Hg with or without topical ocular hypotensive medication. Results: Fourteen eyes of 12 diabetic patients fulfilled the respective demands of the inclusion and exclusion criteria. The mean (± standard deviation) follow-up period was 15.0 (± 2.0) months (range, 12 to 19 months). After one year of follow-up, 11 (78.6%) eyes had an IOP ≤ 21 mmHg. The mean IOP was significantly reduced from 42.4 (± 9.7) mmHg preoperatively to 18.4 (± 2.9) mmHg postoperatively (p < 0.0001). Regarding surgical complications, 6 months of trabeculectomy, hyphaema was observed in 3 (21.4%) eyes, macular edema in one (7.1%) eye and recurrence of neovascularization requiring intravitreal bevacizumab injection in 2 (14.2%) eyes. Conclusion: Preoperative intravitreal bevacizumab may be effective as adjunctive treatment for trabeculectomy with mitomycin-C for neovascular glaucoma patients. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Purpose: To evaluate the relationship between retrobulbar hemodynamic parameters in the ophthalmic artery (OA), central retinal artery, and short posterior ciliary artery and 24-hour blood pressure (BP) measurements in dipper and nondipper patients with primary open-angle glaucoma (POAG). Methods: A prospective, cross-sectional, and observational study was conducted on consecutive patients, referred or recruited, attending the outpatient service of our ophthalmology department. Ambulatory BP monitoring, Doppler imaging, and ocular pulse amplitude measurements were performed on the same day. Patients with nocturnal BP decrease up to 10% of the diurnal BP were defined as dippers and those with BP decrease less than 10% were defined as nondippers. Results: A total of 114 patients (36 nondippers and 78 dippers) were included in the study. The end-diastolic velocity was significantly lower and the resistivity index (RI) was significantly higher in the dippers than in the nondippers (p<0.0001 and p<0.0001, respectively). The RI in the OA was significantly correlated with daytime and nighttime systolic BP and with the daytime mean arterial pressure in the dippers. Conclusions: The RI in the OA significantly correlates with BP in patients with POAG with nocturnal BP dips. Additionally, retrobulbar blood flow parameters are reduced in dippers as compared with nondippers with POAG. © 2016 Wichtig Publishing.

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.

Introduction Extreme dippers are patients with a nocturnal fall of blood pressure (BP) of more than 20%, dippers have normal diurnal rhythm and decrease of BP of 10-15%, while patients with a nocturnal BP fall of less than 10% are considered to be non-dippers. Objective The aim of this study was to compare 24-hour ambulatory BP monitoring results of normaltension glaucoma (NTG) patients with NTG suspects, as well as to determine whether NTG patients are more prone to daytime/nighttime systemic arterial BP and heart rate oscillations in comparison to NTG suspects. Methods This was a prospective, cross-sectional and observational study of 57 hypertensive patients (39 female and 18 male), all examined at the Eye and the Cardiology Clinic, Clinical Center of Serbia in Belgrade, between November 2011 and March 2012. Before 24-hour ambulatory BP monitoring, complete ophthalmological examination was performed (intraocular pressure was measured with both Goldmann applanation and dynamic contour tonometer, as well as with computerized perimetry and Heidelberg retinal tomography). Results There was no statistically significant difference between NTG patients and NTG suspects both in systolic daytime (131.86-141.81 mmHg, SD=±14.92 vs. 129.67-141.83 mmHg, SD=±13; p=0.53) and nighttime measurements (117.1-129.7 mmHg, SD=±18.96 vs. 112.11-127.59 mmHg, SD=±16.53; p=0.53) as well as diastolic daytime (74.55-80.37 mmHg, SD=±8.72 vs. 75.19-82.41 mmHg, SD=±7.72; p=0.58) and nighttime measurements (65.66-71.48 mmHg, SD=±8.73 vs. 67.12-73.78 mmHg, SD=±7.11; p=0.34). There was no statistically significant difference between NTG patients and NTG suspects in heart rate during the day (72.73-76.36 beats per minute [bpm], SD=±5.44 vs. 72.15-76.45 bpm, SD=±4.59; p=0.43) nor during the night (64.4-71.9 bpm, SD=±6.74 vs. 68.02-72.48 bpm, SD=±4.76; p=0.11). Conclusion No statistically significant difference was found between NTG patients and NTG suspects in regard to their systolic and diastolic BP measured both during daytime and nighttime. NTG patients had lower nocturnal BP fall (both systolic and diastolic) than NTG suspects. © 2015 Serbia Medical Society. All rightsreserved.

The analysis of ten unusual eye injuries, and the discussion of appropriate preventive measures. Ten patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, in the period from January 2000. to December 2009. were presented. Following data were taken in account: sex and age of the patient, injured eye, the mechanism of injury, type of the injury, applied treatment and final visual acuity. The circumstances of the eye injuring of ten patients were described. The eye injuries in all cases occurred in a bizarre way and they were severe enough to require hospital admission. The surgery was necessary in seven patients. Three injured eyes resulted in blindness, and two additional had subnormal vision. In three quarters of discussed cases injuries can be avoided. It is necessary to implement protective measures constantly and consistently and to think about the possible consequences of certain activities. Particular attention should be paid on safety of children. The iatrogenic injuries require special consideration.