Browsing by Author "Stankovic, Branislav (16205536900)"

Background/Aims: The most effective and safe treatment protocol for Graves’ orbitopathy (GO) needs to be further assessed. The aim of the present study was to evaluate the efficacy, safety and outcome of parenteral versus parenteral and oral glucocorticoid (GC) protocols in euthyroid patients with untreated and active moderate to severe GO. Methods: This was a retrospective observational study in 140 patients comparing intravenous GC pulses only (IVGC group, 74 patients, 51 ± 11 years) with historical controls of combined oral and intravenous GC therapy (CombGC group, 66 patients, 49 ± 10 years, P = ns). IVGC therapy included infusions of 500 mg of methylprednisolone weekly for the first six weeks, followed by infusions of 250 mg weekly for the remaining six weeks (cumulative dose 4.5 g). CombGC therapy included 500 mg of methylprednisolone in 500 mL of saline solution for two alternative days, followed by oral prednisone tapering dose repeated each month for the next 5 months (cumulative dose 10.2 g). Results: The overall success of the treatment was 43/66 (65%) in the CombGC group and 37/73 (51%, P =.071) in the IVGC group. Deterioration of GO developed in four (6%) patients during CombGC therapy and in nine (12%, P =.214) patients during IVGC therapy. After 6 months, relapse of GO was observed in 10/37 (26%) in the IVGC group, whereas none of the patients in CombGC had a relapse (P <.001). There were significantly more side effects in the CombGC versus IVGC group (49/66, 74% vs 28/74, 38%, P <.001). Conclusions: Our data suggest that CombGC therapy was more efficient with significantly less relapse rate, but with more side effects in comparison to IVGC therapy. © 2020 John Wiley & Sons Ltd

Purpose: Our aim is to report the co-existence of Duane's retraction syndrome and Wyburn-Mason syndrome, a rare condition characterized by arteriovenous malformations (AVMs) in the central nervous system and retina. Methods: An 11-year-old boy was referred for evaluation of strabismus present since birth. On examination his uncorrected visual acuity was 6/6 in each eye, with small angle left eye esotropia in the primary position, ipsilateral face turn, abduction deficit, lid fissure narrowing in adduction and widening in abduction; plus typical features of left-sided type I Duane syndrome were present. The left fundus demonstrated localized, well-compensated, markedly convoluted, dilated and tortuous retinal vessels and venous congenital retinal macrovessel, which traverse the macular region. The right fundus was unremarkable. In order to elucidate if this retinal vascular malformation is associated with similar lesions in the orbit, paranasal sinuses and/or brain, magnetic resonance imaging (MRI) was performed, followed by digital subtraction angiography of the brain vessels. Results: Clinical features of retinal disease (typical retinal vascular malformation) and brain imaging studies have led to the diagnosis of Wyburn-Mason syndrome. Digital subtraction angiography of the brain revealed an AVM of 30 mm maximal diameter in the left occipital lobe. Conclusions: Intracranial AVM might have affected the normal vascular development during the second month of gestation, causing involutional changes of the sixth nerve and resulted in Duane's syndrome by "steal phenomenon." Retinal AVM may point to concomitant intracranial AVMs, thus warranting neurological assessment. Patients with AVM of the retina should be examined early with brain and orbital neuroimaging to rule out cerebral AVMs. © 2013 Informa Healthcare USA, Inc.

Objective: Glucocorticoids (GC) are the treatment of choice for moderate-to-severe and active Graves' orbitopathy (GO), but optimal treatment is still undefined. The aim of the present study was to analyze the efficacy and tolerability of combined parenteral GC pulse therapy followed by oral GC in the interpulse period. Design: The study included 50 patients (48±10 years; 37 female) with untreated, active and moderate-to-severe GO. Patients received 500mg of methylprednisolone in 500ml of physiologic saline. Infusion was repeated after 48h and then followed by tapering doses of oral prednisone and the cycle repeated each month for the next 5 months. The cumulative dose was 10.2g. Ophthalmic assessment was performed before and 6 months after start of treatment. Side effects of GC therapy were evaluated and recorded each month. RESU LTS: GC showed the greatest effectiveness on soft tissue changes (incorporated in the CAS). Median CAS values decreased from 4.5 to 2 (p>0.001). Improvement was demonstrated in 37 patients (74%), there was no change in 13 patients (26%) and none of the patients presented with deterioration of inflammatory status. Diplopia improved in 21 patients (42%), was unchanged in 28 patients (56%) and deteriorated in 1 patient (2%). Improvement in visual acuity occurred in 36% of patients. At 6 months, 33/50 patients (66%) demonstrated overall treatment response. Response to GC therapy was influenced by CAS, TSHRAb and smoking behavior. The only independent parameter associated with positive treatment response was CAS ≥4 (p<0.001). Side effects occurred in 35/50 patients (70%) and the vast majority of them were mild to moderate. During the 6-months follow-up period, 2/33 patients (6%) had relapsing GO. Conclus Ion: With appropriate selection of patients and careful monitoring during and after treatment, combined parenteral and oral GC therapy is effective and safe.

Purpose: To examine the characteristics of patients with endophthalmitis after strabismus surgery (PSSE), the characteristics of the strabismus surgery, treatment, and prognosis as reported by pediatric ophthalmologists who are members of the American Association for Pediatric Ophthalmology and Strabismus (AAOPS) around the world. Methods: An email communication was sent to all members of AAPOS. The email included a web link to a survey that included 34 questions that examined the characteristics of patients with endophthalmitis after strabismus surgery. Results: Three hundred forty-nine ophthalmologists responded to the questionnaire. Two hundred sixty four (76%) had practiced pediatric ophthalmology for over 10 years. Twenty-seven cases of endophthalmitis were reported. The medial rectus muscle (MR) was the most common muscle undergoing surgery (55%). In 5 patients (21%), perforation was observed at the time of surgery. In all cases, endophthalmitis was diagnosed 3–7 days after surgery. The final visual acuity of 34% was no light perception (NLP). Discussion: This series is the largest existing series on PSSE. Our data suggest that PSSE can occur also in healthy patients and in patients without a visualized scleral perforation. The majority of PSSE occurs during the first week after surgery. Therefore, we believe that all patients that underwent strabismus surgery should be examined in this time frame. The prognosis was poor with 48% demonstrating a visual acuity of LP or NLP at the final follow-up. © 2017 Taylor & Francis.

Purpose: To examine the characteristics of patients with endophthalmitis after strabismus surgery (PSSE), the characteristics of the strabismus surgery, treatment, and prognosis as reported by pediatric ophthalmologists who are members of the American Association for Pediatric Ophthalmology and Strabismus (AAOPS) around the world. Methods: An email communication was sent to all members of AAPOS. The email included a web link to a survey that included 34 questions that examined the characteristics of patients with endophthalmitis after strabismus surgery. Results: Three hundred forty-nine ophthalmologists responded to the questionnaire. Two hundred sixty four (76%) had practiced pediatric ophthalmology for over 10 years. Twenty-seven cases of endophthalmitis were reported. The medial rectus muscle (MR) was the most common muscle undergoing surgery (55%). In 5 patients (21%), perforation was observed at the time of surgery. In all cases, endophthalmitis was diagnosed 3–7 days after surgery. The final visual acuity of 34% was no light perception (NLP). Discussion: This series is the largest existing series on PSSE. Our data suggest that PSSE can occur also in healthy patients and in patients without a visualized scleral perforation. The majority of PSSE occurs during the first week after surgery. Therefore, we believe that all patients that underwent strabismus surgery should be examined in this time frame. The prognosis was poor with 48% demonstrating a visual acuity of LP or NLP at the final follow-up. © 2017 Taylor & Francis.

Rationale:Eye rubbing (ER) is a proven factor that can trigger the onset and progression of keratoconus (KC). Apart from allergy, ER is a repetitive motor stereotypy. Eye rubbing is frequently observed in children with autism spectrum disorders (ASDs) and in individuals who may be at risk for developing KC. We present a child with ASD who developed progressive KC following standard corneal cross-linking (CXL), most likely because of abnormal ER associated with allergy and repetitive behavior due to ASD symptoms.Patient concerns:A 14-year-old boy was referred to our clinic because of asymmetric visual acuity reduction.Diagnosis:The child was diagnosed as having keratoconus. He had a strong ER habit. The child had been previously diagnosed as having ASD.Interventions:Corneal cross-linking was performed in both the eyes. On account of keratoconus progression, most likely associated with persistent ER habit, he was retreated with CXL in the right eye. Behavioral modification intervention for ER habit reversal was also applied.Outcomes:Corneal cross-linking in combination with behavioral modification intervention for ER habit reversal prevented further KC progression.Lessons:Behavioral interventions are likely to provide positive results in an ER habit reversal in children with ASD. Keratoconus treatment with CXL combined with behavioral management for ER reversal seemed effective in halting keratoconus progression in a young patient with ASD. © 2020 Lippincott Williams and Wilkins. All rights reserved.

Purpose: To investigate whether different types of ocular manifestations are associated with congenital heart disease (CHD) in a large Caucasian population of children and young adults with Down syndrome (DS). Methods: Population-based, case-control study which included 185 subjects with DS (mean age 13.2 ± 7.9 years), who reported presence or absence of CHD; DS with CHD group (51 subjects, mean age 10.6 ± 5.6 years) and DS without CHD (134 subjects, mean age 14.2 ± 8.4 years). Results: In our sample with DS and CHD, strabismus was found in 15 subjects (29.4%), nystagmus in 1 (2.0%), epiblepharon in 21 (41.2%) and Brushfield spots in 15 (31.3%). In the DS without CHD group, strabismus was found in 38 participants (28.4%), nystagmus in 13 (9.7%), epiblepharon in 31 (23.5%) and Brushfield spots in 21 (16.0%). Only the variables epiblepharon and presence of Brushfield spots differed significantly between the two groups (p = 0.02 and p = 0.03, respectively). Hyperopia was present in 26 participants (53.1%) in the DS with CHD group, and in 65 (57.0%) in the DS without CHD group. Oblique astigmatism was present in 25 (52.1%) in the DS with CHD group and in 61 (53.5%) in the DS without CHD group. Conclusions: Frequencies of DS participants presenting with strabismus, nystagmus, hyperopia and oblique astigmatism were not statistically different between those with CHD and those without CHD in this sample. Further studies are needed to confirm if there are associations between the presence of Brushfield spots or epiblepharon and CHD in patients with DS. © Informa Healthcare USA, Inc.

Purpose: The aims of the present population-based, cross-sectional study were to examine the frequency and type of strabismus, refractive errors and nystagmus in children and young adults with Down syndrome (DS) in Macedonia and Croatia. Methods: A total of 170 unselected children and young adults with DS aged 1-34 years were examined for ocular findings. The ocular examination included: a visual acuity assessment, cycloplegic refraction, ocular alignment and ocular motility. Results: Strabismus was found in 45 of 170 children (26.5%), and esodeviation was the most common type. Nine (20%) had exodeviation and 4 (8.9%) vertical deviation. In 27 of 32 esotropic patients, the strabismus was regarded as acquired esodeviations. The frequency of strabismus was lowest in the high-grade hyperopia group (5%). Concerning esodeviations, fewer cases (3%) were in the high-grade hyperopia group. Most of the cases with esodeviations were in correlation with low-grade hyperopia (31%), myopia (28 %) and emetropia (16%). Hyperopia was the most common refractive error and high myopia increased in prevalence in the over 20 age group. Astigmatism was present in 72.4% of patients. Nystagmus was observed in 18 patients. Ten of 18 patients with nystagmus were associated with the presence of strabismus (9 esodeviations, 1 exotropia). Conclusion: In our study, the high prevalence of strabismus can not be attributed to the presence of hyperopia. Our data show no association between refraction and strabismus in children with DS. Oblique astigmatism has been found to be the most common type of astigmatism in our study group. © 2011 Informa Healthcare USA, Inc.

Background and Objective: This study aims to investigate the prevalence of systemic and ophthalmic manifestations in different refractive groups in children and young adults with Down syndrome (DS). Materials and Methods: The study was a population-based, cross-sectional study that included 141 Caucasian children and young adults with DS. They were classified into the following three groups: myopia DS group (37 subjects, mean age 15.8 years), emmetropia DS group (41 subjects, mean age 11.7 years) and hyperopia DS group (63 subjects, mean age 10.9 years). The participants underwent inspection, slit-lamp examination, cycloplegic refraction, ocular alignment and ocular motility examination. Ten systemic manifestations were analyzed. Results: There was no difference in the prevalence of any systemic manifestations between the groups. Considering the ophthalmic manifestations, there was statistical difference in the distribution of proportions among the three groups for nystagmus (p = 0.011), iris-stromal atrophy (p = 0.048) and strabismus (p = 0.031). The prevalence of strabismus in our DS myopia group was 35.1%, and in DS hyperopia group 38.1%. Conclusions: The results of our study suggest that DS children and young adults with any refractive error do not have a higher chance of additional systemic manifestations. Myopia in DS was associated with a higher prevalence of nystagmus and iris stromal atrophy, whereas astigmatism was found to be more frequent in hyperopia. © 2022 by the authors.