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Biomedical subjects

Zdravko Mandić

Publications and source records attributed to Zdravko Mandić.

At least 19 recordsLinked to original sources
PubMed2006

Analysis of the qualitative dermatoglyphics of the digito-palmar complex in patients with primary open angle glaucoma.

The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10-30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito-palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.

Case-Control Studies↗
PubMed2006

[Correlation of photodynamic therapy outcome with choroidal neovascular membrane size].

AIM: To show the results of photodynamic therapy according to the size of choroidal neovascular membrane size. PATIENTS AND METHODS: A retrospective analysis included 94 patients undergoing photodynamic therapy at University Department of Ophthalmology, Sestre MilosrdniceUniversity Hospital from 2001 till 2005. There were 61 patients with age related macular degeneration (AMD) and 33 patients with high myopia. All patients had a predominantly classic choroidal neovascular membrane. Patients were divided into two subgroups according to the lesion size. The first subgroup included patients with a lesion equal to or less than one disc diameter, and the second subgroup had a lesion greater than one disc diameter. All patients were followed up for a minimum of 3 months. RESULTS: In the group of patients with AMD statistical analysis showed no significant difference in total closure and decrease in the size of choroid neovascularization (CNV) between the two subgroups. In the group of patients with high myopia a statistically significant difference was found in total closure and decrease in the size of CNV between patients with lesions smaller or equal to one disc diameter and those with lesions greater than one disc diameter. The former group also had better visual outcome. CONCLUSION: The size of CNV was not a prognostic factor in patients with AMD. In patients with high myopia, better outcome was recorded in the subgroup with CNV smaller or equal to one disc diameter.

Adult↗
PubMed2006

[Pars plana vitrectomy and intravitreal triamcinolone for chronic pseudophakic cystoid macular edema].

AIM: To report on the results of pars plana vitrectomy and intravitreal triamcinolone in patients with chronic pseudophakic cystoid macular edema unresponsive to medical treatment. PATIENTS AND METHODS: A retrospective analysis of 9 eyes in 9 patients with chronic pseudophakic cystoid macular edema was performed. All patients had cystoid macular edema confirmed on fluorescein angiography, and were unresponsive to medical treatment. In all patients pars plana vitrectomy and intravitreal application of 4 mg of triamcinolone was performed. In one patient with vitreous prolapse into the anterior chamber, anterior vitrectomy was also required. RESULTS: The mean interval between cataract surgery and vitrectomy was 16.28 +/- 2.1 months. The mean preoperative best corrected visual acuity was 0.1 +/- 0.11, and the mean final best corrected visual acuity 0.25 +/- 0.24, after a mean follow up of 6.6 +/- 3.5 months. In all 9 eyes there was a marked reduction of cystoid macular edema, as verified on fluorescein angiography. Intraocular pressure was raised in 4 patients, and it was controlled by topical antiglaucomatous treatment. CONCLUSION: Pars plana vitrectomy and intravitreal triamcinolone in eyes with chronic pseudophakic cystoid macular edema resulted in a reduction of cystoid macular edema, and visual acuity improvement.

Aged↗
PubMed2006

[Argon laser trabeculoplasty or selective laser trabeculoplasty in the treatment of open-angle glaucoma].

Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are effective treatment modalities for intraocular pressure (IOP) lowering in open angle glaucoma patients. SLT and ALT produce equivalent IOP reduction. The choice of either option will depend on the state of glaucoma, previous and current treatment, side effects and patient's reference. Preservation of the angle trabecular meshwork structures and effective retreatment for IOP lowering after ALT has failed, offer some theoretical advantage of SLT.

Glaucoma, Open-Angle↗
PubMed2006

[Intraocular pressure after ND: YAG laser capsulotomy in pseudophakic patients with glaucoma].

AIM: The aim of the study was to analyze changes in intraocular pressure after Nd: YAG laser capsulotomy in pseudophakic patients with glaucoma. PATIENTS AND METHODS: Intraocular pressure was recorded before, and 1 and 3 hours after YAG laser capsulotomy in 69 pseudophakic patients with glaucoma. Twenty eight patients received no therapy before capsulotomy, 21 patients received topical brimonidine 0.2%, and 20 patients received topical dorzolamide 2% 1 hour before laser capsulotomy. All patients received topical tropicamide 1% and tetracaine 0.5%. Nd: YAG laser posterior capsulotomy was performed using inverted-U technique to make a 3-4 mm diameter capsulotomy. After capsulotomy, all eyes received topical fluorometholone for 10 days. RESULTS: A pressure rise was greater in patients without any therapy before YAG laser capsulotomy. Eight patients with glaucoma showed intraocular pressure rise of 5 mm Hg, and 2 patients pressure rise of 10 mm Hg after laser capsulotomy. A reduction of intraocular pressure rise was found in patients who received dorzolamide 2% or brimonidine 0.2%, only 1 patient in each group developed a pressure rise of 5 mm Hg. In all patients a significant pressure rise developed within the first hour. DISCUSSION: It is difficult to compare different studies due to different techniques of cataract surgery and different intraocular lense material and design. Barnes showed that 6 of 29 (21%) developed a pressure rise of 5 mm Hg, and 1 of 29 (3%) patients a pressure rise of 10 mm Hg. In our study, 29% of patients had a pressure rise of > or =5 mm Hg, and 7% of patients had a rise of > or =10 mm Hg after laser capsulotomy. These results may be associated with a large proportion of extracapsular cataract extraction (71%) versus phacoemulsification (29%) in our patients. CONCLUSION: Pretreatment with dorzolamide 2% or brimonidine 0.2% reduce the intraocular pressure rise after Nd: YAG laser capsulotomy in pseudophakic patients with glaucoma.

Administration, Topical↗
PubMed2006

[Use of antiglaucoma therapy to reduce acute intraocular pressure rise following neodymium: YAG laser iridotomy in angle-closure glaucoma patients].

AIM: To evaluate the efficacy of topical antiglaucoma therapy in reducing acute intraocular pressure (IOP) elevation after neodymium: Yag laser iridotomy. PATIENTS AND METHODS: Primary angle-closure glaucoma (PACG) eyes were randomized to receive premedication with latanoprost and pilocarpine, brimonidine 0.2% and pilocarpine or only with pilocarpine before Yag laser iridotomy. Postoperative IOP changes were compared with Wilcoxon signed-ranks test using the fellow eyes in each group. RESULTS: Postoperative pressure spikes were significantly lower in the groups of patients with local antiglaucoma therapy with pilocarpine than in the control group. Mean elevation of IOP was less in the groups of patients with local antiglaucoma therapy with pilocarpine at 2 hours postoperatively. CONCLUSION: Local antiglaucoma therapy may reduce the acute IOP rise following Yag laser iridotomy in PACG eyes.

Aged↗
PubMed2006

[Combined laser treatment in the management of acute and subacute primary angle closure glaucoma].

UNLABELLED: Primary angle closure glaucoma remains a disease with high visual morbidity worldwide. Patients with primary angle closure glaucoma may have dramatic signs and symptoms that can lead to permanent blindness in a short period of time if not properly treated. Conventionally, medical treatment was used to lower the intraocular pressure (IOP), followed by laser peripheral iridotomy. It acts by elevating pupillary block present in the condition. Laser peripheral iridoplasty is a tehnique using low energy contraction burns to mechanically pull open the angle, thereby reducing the IOP. AIM: The aim of this study was to evaluate the therapeutic effect and safety of combined laser technique (argon laser iridoplasty and YAG laser peripheral iridotomy) in the management of medically unresponsive acute and subacute angle closure glaucoma. PATIENTS AND METHODS: Sixteen eyes with acute and subacute primary angle closure glaucoma unresponsive to medical treatment were included in the study. All patients were treated by laser tehnique that included YAG laser peripheral iridotomy and argon laser iridoplasty in the eye without satisfactory response to previous laser treatment. We also documented complications of laser treatment. The IOP levels were documented by applanation tonometry. RESULTS: In 14 of 16 eyes combined laser treatment resulted in rapid IOP reduction. Only two patients failed to respond to the combined laser therapy and were surgically treated (clear lens extraction). No serious laser complications were recorded during the early period after laser therapy. CONCLUSION: YAG laser peripheral iridotomy and argon laser iridoplasty as a combined treatment may be useful for IDP lowering in the management of medically unresponsive acute and subacute primary angle closure glaucoma.

Acute Disease↗
PubMed2006

[Triamcinolone acetonide in the treatment of inflammation after cataract surgery].

AIM: To compare the use of single injection of triamcinolone acetonide and steroid drops in the treatment of inflammation after cataract surgery. PATIENTS AND METHODS: This retrospective study included 80 patients operated on by phacoemulsification with intraocular lens implantation. After the operation, patients were divided into two groups. Group A received dexamethasone-neomycin drops for four weeks, whereas group B received single application of triamcinolone acetonide into the subtenon space. Postoperative evaluation included the degree of inflammation, intraocular pressure and therapeutic response. RESULTS: Triamcinolone acetonide appeared to be an as valuable therapy in minimizing inflammation after cataract surgery as steroid drops on days 7, 14 and 21 postoperatively, a significantly lower intraocular pressure was recorded in the group of patients administered a single injection of triamcinolone acetonide. CONCLUSION: Single application of triamcinolone acetonide appeared to be as efficient as steroid drops in controlling postoperative inflammation after uncomplicated cataract surgery.

Aged↗
PubMed2006

[Intravitreal application of triamcinolone--our experiences].

AIM: To show the results of intravitreal application of triamcinolone used as a primary or adjuvant therapy. PATIENTS AND METHODS: We analyzed 48 patients with different ocular disorders: exudative age related macular degeneration, diabetic retinopathy, or central retinal vein occlusion. We analyzed color fundus photography, visual acuity, fluorescein angiography and complications of intravitreal triamcinolone application. RESULTS: There was a marked reduction of macular edema in 70% of patients verified on fluorescein angiography. Visual acuity improved in 62% of patients. The most common complication was transient rise in intraocular pressure. There was no case of endophthalmitis. CONCLUSION: Intravitreal application of triamcinolone is relatively safe and efficacious in selected patiens with different ocular disorders.

Anti-Inflammatory Agents↗
PubMed2006

[Sulcus fixation of a foldable acrylic intraocular lens].

AIM: To describe a surgical technique for sulcus fixation of a foldable single-piece acrylic intraocular lens (IOL) through a 3.0 mm clear cornea incision. PATIENTS AND METHODS: Between 2003 and 2004, this technique was used in 10 eyes at Sestre Milosrdnice University Hospital. Seven eyes were aphakic secondary to a capsule defect during phacoemulsification, one eye had a perforating injury with lens destruction, and two eyes were aphakic after congenital cataract extraction in childhood. In all eyes an AcrySof Natural SN60AT foldable single-piece acrylic IOL (Alcon, Forth Worth, TX, USA) was implanted. RESULTS: The median age of patients at surgery was 41 (range 31-68) years, and the median follow up was 11 (range 4-18) months. In all cases, the intraocular lens was placed and fixed in the anatomic sulcus without complications. Slight IOL decentration (up to 1.0 mm) was seen in 2 eyes, and transient hypotonia and transient cystoid macular edema in 1 eye each. DISCUSSION: In the absence of adequate posterior capsule support, scleral sutured posterior chamber intraocular lens implantation has become a popular technique. The reduction in incision, from 7 mm for the implantation of poly(methyl methacrylate) (PMMA) IOL to 3 mm for foldable IOL, represents an improvement in the technique, allowing for good postoperative vision recovery. Small incision helps maintain adequate intraoperative intraocular pressure in the anterior chamber. The design of single-piece AcrySof Natural lens allows for easy and safe fixation of the Prolene suture to the IOL. Also, this technique with scleral flaps that protects the exposed suture helps reduce the risk of endophthalmitis. Longer follow up is needed to ascertain the stability of this suture fixed IOL. CONCLUSION: Sulcus fixation of a foldable IOL offers an acceptable alternative for rehabilitation of vision function. The unique design characteristics of the single-piece AcrySof Natural IOL make possible the suture fixation through a small clear corneal incision.

Acrylic Resins↗
PubMed2006

[Ocular findings in Fabry's disease].

INTRODUCTION: Fabry's disease is a recessive X-linked disorder that results from a deficiency of the lysosomal hydrolase a-galactosidase A (alpha-Gal A). The absence of alpha-Gal A enzyme activity leads to accumulation of glycosphingolipid globotryaosyl ceramide (GL-3) in the lysosomes of a variety of cell types. Subsequently, angiokeratoma and ocular signs develop until, in most cases after the third decade of life, severe renal dysfunction or cardiomyopathy becomes obvious. Corneal opacities (cornea verticillata) occur in 90% conjunctival vascular changes in 60%, retinal vessel tortuosity in 55%, and cataracts in 50% of cases. Recently, enzyme replacement therapy has been shown to be an effective treatment modality that can eliminate glycolipid stores and reverse the disease pathology. CASE REPORT: A male patient born in 1971 was admitted for clinical examination due to proteinuria and erythrocyturia. During further evaluation nephrologist suspected Fabry's disease, because patient had skin changes early referred as petechiae, and acroparesthesias. He had also low heat tolerance and virtually no sweat. Physical status: angiokeratoma on gluteat regions and upper arms. Urine analysis in several occasions 10-15 E in sediment, alb. positive. On ECG, 2-mm depression of ST in precordial region. Heart ultrasound: low mitral regurgitation angio stage 1, left ventricle hypertrophy. Abdomen ultrasound: both kidneys around 12 cm large, parapyelic cysts in both kidneys of 2.5 cm in diameter. Biomicroscopy of both eyes: cornea verticillata. Fundus of both eyes: papillae n. optici with poorly defined edges, but without prominence, very tortuotic retinal blood vessels. In March 2002, very low alpha GAL enzyme activity in blood (alpha-Gal A = 0.5 +/- 0.2 nmol of substrate hydrolyzed hourly per serum mL--normal serum enzyme level 8.5-18.9 nmol/mL/h). In May 2002, enzyme replacement therapy was started with recombinant alpha-Gal A enzyme (Fabrazyme) 1 mg/kg every 14 days. Control evaluation and examination showed good cardiac and renal function. The patient felt better and stronger with improved heat tolerance. CONCLUSION: Fabry's disease occurs in all ethnic groups. It is estimated that one in 200 people is a carrier, and one in 40,000-100,000 has the disease. Today in Croatia, Fabry's disease has been diagnosed in only one patient, and according to the usual prevalence there are still 45-100 unrecognized patients. The ophthalmologists are in excellent position to diagnose Fabry's disease in early stages. Therefore it is very important that the ophthalmologists in Croatia become aware of the importance of ocular findings in Fabry's disease, so they can participate in the identification of unrecognized patients.

Adult↗
PubMed2006

[Distichiasis].

Distichiasis is a rare congenital or acquired eyelid anomaly in which an accessory row of eyelashes arises from the openings of meibomian glands or near them. The abnormal cilia are posterior to the normal row of cilia and may abrade the eye causing ocular irritation and corneal damage. We describe a 9-year-old Caucasian girl with bilateral and symmetric distichiasis. This condition was treated with lid splitting followed by cryotherapy to the posterior lid lamella. The technique has been used in four eyelids with congenital distichiasis, with very good results.

Child↗
PubMed2006

[Primary non-Hodgkin orbital lymphoma: case report].

The aim of this case report is to present a very rare case of primary malignant non-Hodgkin orbital lymphoma, found in an 80-year-old female patient with rapid orbital structure compression. Detailed ophthalmologic, radiologic, hematologic and oncologic examinations and laboratory tests were done before, during and after treatment. Diagnostic ultrasonography and computed tomography images of the right orbital cavity demonstrated a solid naoplastic process which dislocated the eyeball without invasion of orbital structures. Upon diagnostic evaluation, tumor lesion was surgically removed including orbitotomy with lower transpalpebral approach. Histopathologic diagnosis and type of tumor tissue were defined by histology and immunohistochemistry analyses of open biopsy material obtained ex tempore. Finally, the diagnosis was confirmed by histopathology of the resected tumor mass: lymphoma malignum non-Hodgkin, diffuse large B-cell type, with high mitotic activity. Neoplastic B lymphocytes showed CD 20 positive surface antigens and kappa light chain expression. The treatment was continued with hematologic therapy. The patient received three cycles of systemic chemotherapy (CHOP protocol). Upon combined therapy completion, control examinations showed the patient to have no signs of disease in the orbital region. Interdisciplinary approach in the diagnostic evaluation, therapy and long-term observation proved to be necessary in patients with malignant non-Hodgkin lymphoma.

Aged, 80 and over↗
PubMed2005

Doppler-echocardiographic characteristics of left ventricular function in patients with pseudoexfoliation glaucoma: a preliminary report.

Glaucoma is associated with an increased incidence of cardiovascular disease and risk factors. The aim of the study was to assess the left ventricular (LV) function in patients with pseudoexfoliation (PEX) glaucoma using doppler-echocardiographic examinations. Two-dimensional and pulsed Doppler echocardiography of transmitral flow was performed in 21 patients with (PEX) glaucoma and 24 controls. LV systolic contraction and ejection were assessed using the LV ejection fraction (EF) and fractional shortening (FS). LV diastolic filling assessed parameters were: early, fast diastolic filling (E wave), late diastolic filling (A wave), ratio E/A, velocity time integral E wave (VTIE) and A wave (VTIA), their ratio (VTIE /VTIA), pressure at the end of filling (LVEDP) and a pulmonary capillary wedge pressure (PCWP). A significant difference was found concerning LV filling flow parameters in E, E/A, VTIA and ratio VTIA/ VTIE. No significant difference was found in EF, FS, A, VTIE, LVEDP and PCWP tested parameters. Our study indicates the possibility of slightly impaired diastolic function of LV in patients with PEX glaucoma assessed by Doppler-echocardiographic examinations.

Aged↗
PubMed2005

Postoperative outcomes after implantation of intraocular lenses in eyes with cataract and uveitis.

Despite advances in surgical technique and implant materials, cataract surgery in patients with uveitis is still a challenging procedure. We retrospectively evaluated postoperative outcomes of cataract surgery in 35 eyes of 29 patients with uveitis. Phacoemulsification with posterior chamber intraocular lens implantation was performed in all eyes. Postoperative evaluations were performed at day 2, and then at 7 days, 1, 3, and 6 months respectively. There were 16 males, and 13 females, aged 31 to 68 years. Follow-up ranged from 4 to 35 months. At final follow-up 33 eyes (94%) had an improvement in visual acuity compared with preoperative levels (p < 0,05). Giant cells were observed in the intraocular lens optic in 7 eyes (20%). Posterior capsule opacification occurred in 10 eyes (29%). Clinical cystoid macular edema was observed in 4 eyes, and 2 eyes required trabeculectomy with mitomycin C due to secondary glaucoma. Cataract surgery in patients with uveitis leads to successful visual results after correct surgical timing, and adequate anti-inflammatory therapy. There were no significant differences in the degree of inflammation after implantation of various types of intraocular lenses.

Adult↗
PubMed2005

Phacoemulsification, vitrectomy and the implantation of an intraocular lens in diabetic patients.

The purpose of this study was to evaluate results of combined phacoemulsification, intraocular lens implantation and pars plana vitrectomy in patients with advanced diabetic retinopathy. We retrospectively evaluated postoperative outcomes and complications in 102 eyes of 102 patients who underwent a combined procedure. All patients had a visually significant cataract. Forty two patients had vitreous hemorrhage and mild proliferative diabetic retinopathy. Sixty patients had a mild tractional retinal detachment. The median follow up was 14 months (range 6-36 months). 80% of patients had an increase of visual acuity of at least 2 Snellen lines. The most frequent early postoperative complication was elevated intraocular pressure, followed by mild fibrinous reaction. The most frequent late postoperative complication was the presence of posterior synechia, followed by glaucoma. Eleven patients required a repeated pars plana vitrectomy. Combined phacoemulsification, posterior chamber intraocular lens implantation and pars plana vitrectomy can be successfully performed in selected diabetic patients with favorable postoperative outcome.

Adult↗
PubMed2005

Trabeculectomy with mitomycin C in glaucoma associated with uveitis.

The patients with uveitic glaucoma are at high risk for failure following drainage surgery because of young age of these patients, preoperative long-term control of inflammation and postoperative complications. Twenty-two trabeculectomies performed in 22 patients with uveitic glaucoma were retrospectively evaluated to analyze the effect of intraoperative application of mitomycin C (MMC). Success rates, postoperative levels of intraocular pressure (IOP) and postoperative complications were studied. After a mean follow-up of 10.6 months (range, 5-28 months), 15 patients (68.2%) achieved IOP of 21mmHg or less without antiglaucoma medications. There were statistically significant reduction in IOP postoperatively during the period studied (p < 0.001). Early postoperative complications included chorioidal detachment (9.1%), shallow anterior chamber (9.1%), hyphema (13.6%), macular edema (4.5%) and raised IOP (27.3%). Late postoperative complications included exacerbation of uveitis (4.5%), macular edema (4.5%), cataract (22.7%) and raised IOP (31.8%). The eyes with raised IOP needed additional antiglaucoma medication. The results of this retrospective and uncontrolled study suggest that intraoperative application of MMC may be a good option for enhancement of short-term trabeculectomy success rates in patients with uveitic glaucoma.

Adult↗