Acute optic neuritis is often associated with multiple sclerosis. It is considered to be the most common ocular symptom of multiple sclerosis. In addition to acute optic neuritis, in patients with ...multiple sclerosis, subclinical optic neuritis is also described. It is characterized by slow progression and bilateral involvement, thus being unnoticed by the patient. The purpose of the present study was to assess vision impairment in multiple sclerosis patients without a history of acute optic neuritis, using a number of functional tests including visual field testing by Octopus 101 perimetry N1 program, contrast sensitivity testing by Pelli Robson chart, and color vision by Ishihara pseudoisochromatic plates. The study included 35 multiple sclerosis patients aged 18-50 years, without subjective signs of vision impairment and visual acuity 1.0 according to Snellen. Visual field defects were found in 28 patients. The most common defects of visual fields were retinal sensitivity depression in peripheral zone and nerve fiber bundle defect. Reduced contrast sensitivity was found in 30 (86%) patients. Study results indicated multiple sclerosis patients free from signs of optic neuritis to suffer vision function impairment, as demonstrated by Octopus perimetry and contrast sensitivity testing with Pelli Robson charts.
We describe a case of optical coherence tomography angiography (OCTA) changes in the foveal avascular zone (FAZ) in a patient that had suffered Berlin’s edema after a whiplash neck injury. The ...patient reported central scotoma throughout the 1-year follow-up, confirmed by visual field examination. OCTA showed FAZ enlargement of the left eye as compared to the healthy right eye in the superficial capillary layer and even more in the deep capillary layer. To the best of our knowledge, FAZ enlargement has not been previously described by OCTA after whiplash-related macular injury.
The aim was to assess whether standard automated perimetry (SAP) and frequency doubling technology (FDT) perimetry are able to detect the efect of diabetes mellitus (DM) on retinal function in DM ...patients in the early stage of disease and to analyze which method is more specific and sensitive. A randomized cross-sectional study was conducted in three diferent groups of patients to compare the capability of these two methods to examine visual feld and to detect the change in light sensitivity. Visual function was assessed in 60 adults with normal retinal finding, 60 adults with DM without clinically detectable retinopathy and 60 adults with DM and non-proliferative diabetic retinopathy but normal visual acuity. FDT perimetry and SAP were performed in all study patients. The presence and severity of diabetic retinopathy was determined by taking and evaluating two 50degrees feld color photographs per eye, macula-centered and disc-centered. The following results were obtained by analyzing parameters in the groups of diabetic patients: sensitivity and specificity of SAP and FDT for medium sensitivity 86.7/33.3 (p<0.061) and 71.7/41.7 (p<0.228), respectively; for medium deficit 41.7/76.7 (p<0.063) and 65/50 (p<0.362), respectively; for loss of variance/pattern standard deviation (LV/PSD) 51.7/61.7 (p<0.536) and 61.7/51.7 (p<0.666), respectively; and for foveal sensitivity 81.7/36.7 (p<0.096) and 23.3/86.7 (p<0.839), respectively. Analysis of parameters between diabetics and control group yielded sensitivity and specificity for medium sensitivity 71.7/61.7 (p<0.001) and 70.8/55 (p<0.002), respectively; for medium deficit 56.7/60 (p<0.058) and 77.5/43.3 (p<0.037), respectively; for LV/PSD 58.3/58.3 (p<0.042) and 33.3/83.3 (p<0.437), respectively; and for foveal sensitivity 82.5/53.3 (p<0.001) and 28.3/85 (p<0.195), respectively. We concluded that neither of these methods was sensitive and specific enough to distinguish diabetics without retinopathy from diabetics with retinopathy. Both of these methods were highly specific and sensitive to distinguish diabetics from healthy subjects, but neither of these methods proved superior. Key words: Diabetes mellitus; Diabetic retinopathy; Visual feld tests; Photophobia; Visual acuity
Posteriorna kortikalna atrofija (PCA) je neurodegenerativno kliničko-radiološko stanje s atrofijom posteriornih dijelova moždanog korteksa uključujući vidni korteks i dijelove parijetalnog i ...temporalnog korteksa. Nespecifični vidni poremećaji često se pogrešno interpretiraju kao oftalmološki, što vodi prema zakašnjeloj pravoj dijagnozi. Razlikovanje PCA od drugih bolesti može biti zahtjevno i može oduzeti mnogo vremena. Prikazuje se bolesnica s PCA u dobi od 57 godina koja godinama pokazuje vidne perceptualne poremećaje koji se inicijalno dijagnosticiraju kao oftalmološke bolesti te potom kao neobjašnjeno oštećenje vida. Dvadeset pet godina ranije obostrano je učinjena radijarna keratotomija, a šest godina prije prijema u oba se oka implantira fakična intraokularna Verisyse leća. Unazad četiri godine liječi glaukomsku bolest. Tijekom neurooftalmološke opservacije nije potvrđena sumnja na optičku neuropatiju niti na makulopatiju. Pažljivom anamnezom saznaje se da obitelj već godinama ranije zapaža tegobe bolesnice kod prepoznavanja lica, pri čitanju i pisanju. Navode se tegobe procjene dubine i prostorne orijentacije, problemi sa stepenicama, osobito pri silasku. Nađena je velika diskrepancija između iskazanih funkcionalnih vizualnih oštećenja (vidna oštrina, vidno polje, Ishihara kolorni test) s jedne strane i s druge strane urednoga oftalmoskopskog nalaza na mrežnicama i urednog morfološkog nalaza OCT dijagnostike. Učinjena MR pretraga također otvara sumnju na kortikalnu problematiku te je bolesnica usmjerena na daljnju neurološku i neuro-radiološku opservaciju uz PET-FDG, što je dovelo do dijagnoze PCA. PCA je važan dijagnostički entitet jer se ti bolesnici obično najprije javljaju oftalmolozima i nerijetko se svrstavaju u skupinu onih s neobjašnjenim oštećenjem vida. Kod diskrepancije vizualnih oštećenja registriranih funkcionalnom dijagnostikom u odnosu na srazmjerno uredan oftalmoskopski nalaz i nalaz OCT dijagnostike, važno je ponovno pažljivo provjeriti anamnezu i heteroanamnezu i pomisliti na mogućnost kortikalnog uzroka iskazanih oštećenja s ciljem ranog otkrivanja uzroka neobjašnjenog oštećenja vida. Tu je važna dobra suradnja s kognitivnim neurolozima specijaliziranim za neurodegenerativne bolesti. Cilj je rada podignuti svijest liječnika o postojanju ovog entiteta kao mogućeg uzroka neobjašnjenog gubitka vida i olakšati rano prepoznavanje uz primjenu odgovarajućih dijagnostičkih metoda.
The aim was to determine whether improvement of near point of convergence (NPC) and binocular vision after orthoptic exercises had any impact on children and adolescents diagnosed with attention ...deficit/hyperactivity disorder (ADHD) and convergence insufficiency (CI). In this clinical trial, 50 children and adolescents aged 6 to 18 years diagnosed with ADHD and CI received orthoptic therapy that included home-based exercises (pencil push-ups and stereograms) and office-based therapy on synoptophore. Binocular vision and NPC were measured before, during and after therapy. Study subjects showed significant improvement (p<0.05) in NPC and binocular vision after orthoptic exercises. We found statistically significant correlation between stereovision improvement (Lang I) and near point of convergence, suggesting that improvement of binocular function is possible in children with ADHD and CI. Our results showed that NPC enhancement improved stereovision in patients with ADHD. Since progress of binocular function has positive effect on near work and diminishes visual symptoms in children and adolescents with ADHD and CI, it might be reasonable to suppose that orthoptic therapy helps these children improve concentration as well. Further studies are needed to determine whether it might have positive impact on attention.
In diabetes, an impaired antioxidant defense system contributes to the development of diabetic retinopathy. The main objective of this paper was to find correlations of oxidative stress parameters ...within and between the vitreous and serum in patients with type 2 diabetes who had developed proliferative diabetic retinopathy.
The study included and compared two groups of patients who underwent vitrectomy: 37 patients with type 2 diabetes and proliferative retinopathy (PDR), and 50 patients with non-diabetic eye disorders (NDED). Vascular endothelial growth factor (VEGF), advanced oxidized protein product (AOPP), and oxidative stress markers (direct lipid hydroperoxidation (LPO), malondialdehyde (MDA), total superoxide dismutase (SOD), and glutathione (GSH)) were measured in the vitreous and serum of both groups and correlated with one another, between humoral compartments and with gender, age, and serum glucose levels.
In the vitreous of PDR patients, VEGF, LPO, and MDA (p<0.05) were increased and SOD values were slightly lowered (p<0.05) than in NDED patients. Vitreous AOPP and GSH showed no differences between the groups. In the serum, AOPP, MDA, and SOD were increased (p<0.05) and VEGF was slightly increased (p<0.05) in the PDR group compared to NDED. With regard to gender, similar changes were recorded for both groups, except for the lower serum MDA in males than females in the NDED group. Advanced age showed no significant effect on changes of measured parameters in the vitreous. In the serum, VEGF was positively correlated (p<0.05) and MDA and SOD negatively correlated (p<0.05) with increasing age. Among measured parameters within and between the vitreous and serum, several correlative links occurred in the PDR group that were not present in the NDED group. The most prominent correlation changes were between serum LPO and vitreal LPO, serum SOD and vitreal LPO, serum LPO and serum SOD, and vitreal VEGF and serum SOD.
Among the selected oxidative stress markers, SOD and LPO were highly correlative in both the vitreous and serum in PDR compared to patients without metabolic disorders. Their correlations suggested that monitoring their mutual alterations might be informative during PDR development and should be considered in further research.
Non-arteritic anterior ischemic optic neuropathy is one of the most common conditions affecting the optic nerve in the elderly. It may lead to severe visual loss. Typical symptoms are painless ...impairment of visual function accompanied by relative afferent pupillary defect, edema of the optic disc and visual field defects. Aim is to present 38 patients with nonarteritic anterior ischemic optic neuropathy who were treated with corticosteroid therapy. This prospective study involved 38 patients, 20 men and 18 women aged 60-75 years who were treated with corticosteroid therapy. The study included patients with visual acuity in the affected eye from 0.1 to 0.8 according to Snellen. Every patient underwent clinical examination, the Octopus 900 perimetry in G program, laboratory testing, while the compressive optic neuropathy was rule out with MSCT of the brain and orbits. The most common forms of visual field defect are altitudinal defect and diffuse depression. Corticosteroid therapy led to recovery in 65% of patient, in 30% of patients did not change, while the deterioration occurred in 5% of patients.
To evaluate visual impairment (VI) in children with cerebral palsy (CP).
This population-based study included 419 children from the Surveillance of Cerebral Palsy in Europe (SCPE) C28 RCP-HR - ...Register of Cerebral Palsy of Croatia born 2003-2008. Vision in children with CP (according to SCPE) was classified as normal or impaired, with the subcategory of severe VI. The proportion of children with VI was assessed in groups with different CP type/subtype, gross and fine motor function, and gestational age (GA).
A total of 266 children had some degree of VI (266/400; 66.5%), 134 had normal vision, and data on VI were unknown for 19 children. Severe VI was present in 44 children (44/400; 11%). The proportion of children with VI and severe VI increased with the Gross Motor Function Classification System and Bimanual Fine Motor Function levels. Children with bilateral spastic CP had the highest frequency of severe VI (14.9%). The percentage of severe VI in children with bilateral spastic CP was 53.8% in the group born <28 weeks of GA, 13.3% in the group born 28-31 weeks of GA, 11.1% in the group born 32-36 weeks of GA, and 24.4% in the group born >36 weeks of GA (λ2=4.95; df=6; P<0.001).
Children with CP have a high prevalence of VI and severe VI, which is increasing with the level of motor impairment. Severe VI is significantly more common in children with bilateral spastic CP, especially among extremely premature infants.
Abstract Purpose This study aims to investigate the association of compliance amongst lens wearers and lens case contamination as assessed by the microbial profile of lens cases. Methods Fifty-two ...asymptomatic lens wearers filled out questionnaires seeking demographic data and several aspects of compliance to lens wear. Subsequently, contamination profiles of the inside bottom and rim of their lens cases was obtained for bacteria, fungi and Acanthamoeba. The association of the self-reported responses in the questionnaire with contamination profile of the lens case was then analyzed. Results Based on compliance criteria, 21% of the participants were described as fully compliant lens wearers. Contamination of lens case was prevalent in 42% of the cases. Frequent non-compliant behaviours reported by study participants included, showering and sleeping with contact lenses, and irregular lens case replacement. In comparison to soft contact lens wearers prevalence of non-compliance and contamination amongst rigid gas permeable (RGP) lens wearers was significantly greater. There was a statistically significant correlation between bacterial contamination and current case age. Conclusion These results suggest that majority of lens wearers do not fully comply with recommendations for lens wear and case care. Crucially, none of the fully compliant patients had contaminated lens cases. However it would appear that several non-compliant behaviours significantly increase the risks of case contamination. These results suggest that greater efforts should be invested with lens wearers to ensure enhanced compliance as this is likely to reduce the possibility of case contamination.
Pterygium is a multifactorial proliferative pathologic change of bulbar conjunctiva. The purpose of this study was to determine the effect of the duration of exposure to solar radiation (expressed in ...years) on the incidence of positive cyclooxygenase-2 (COX-2) finding in conjunctival tissue in two groups of patients. Group 1 consisted of 68 patients with primary pterygium having undergone conjunctival autograft transplantation. Group 2 consisted of 43 patients with morphologically unchanged conjunctivae that were harvested during cataract surgery. All 111 specimens were submitted to immunohistochemical staining for monoclonal COX-2 antibody (1:100; M361701 MO A-HU, Dako, Santa Clara, California, USA). The immunostaining intensity in the surface epithelium was scored using the following grading system: 0 no immunostaining; + weak immunostaining (few cells being positive focally or scattered); ++ medium immunostaining; and +++ strong immunostaining (diffuse staining throughout the tissue). The analysis of COX-2 activity yielded 29 (42.6%) positive findings in group 1 and 27 (62.8%) positive findings in group 2. Group 2 consisted of statistically significantly older individuals with a history of considerably longer sun exposure. Statistical analysis proved the duration of exposure to solar radiation to be the most important factor in positive COX-2 findings.
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