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M Dujić

Publications and source records attributed to M Dujić.

8 recordsLinked to original sources
PubMedDate not supplied

[Role of electroretinography in the prognosis of central retinal vein occlusion].

UNLABELLED: The aim of the study is to evaluate the role of electroretinography in diagnosis of central retinal vein occlusion CRVO. There are two forms of this entity, each of them having a different prognosis. While haemorrhagic form has a better outcome, with fairly good prognosis for vision, ischaemic form usually develops many complications: macular oedema, neovascularisation of the retina or optic disk, neovascular glaucoma, and possible blindness. Three months after the onset, when oedema and retinal haemorrhages are usually resolved, it is possible to perform fundus fluorescein angiography (FFA) and make differentiation between the two forms of the disease. However, neovascular glaucoma may challenge the vision even before the diagnosis of ischaemic form becomes possible by observing the fundus or by performing FFA. Trying to foresee the course of the disease, and thus to help a patient with panretinal photocoagulation, we performed electroretinography (ERG) in each patient just after the onset of the disease. The prospective study included 40 patients with CROV which lasted less than three months and without any complication. Two parameters were examined: scotopic "b" wave and photopic b/a ration. By ERG action potentials from the retina after its stimulation with light, are recorded. Scotopic "b" wave generates in bipolar layer from Muller's and bipolar cells. Photopic b/a ratio is a ration of two waves, "b" and "a" in photopic conditions and is a good indicator of saturation of the retina with blood and oxygen. Visual acuity, applanation tonometry, examination of the fundus after dilatation of pupils with Sol. Mydriacili were performed in each patient. Each patient was examined by ERG in scotopic and photopic conditions. The results were as follows: Scotopic b wave per se could not indicate potential complications, while b/a ratio was a good predictor of possible complications when its value was less than 1.25. CONCLUSION: Electroretinography, which can be performed at any time after the onset of the disease may be a good indicator of retinal perfusion and oxygen saturation, by giving the ratio of b and a waves under photopic conditions. The status of Muller's cells and bipolar cells is reflected in the scotopic b wave. In a prospective study forty patients with CRVO of less than three months duration and without neovascularisation were studied with the use of ERG, both in scotopic and photopic conditions. Our results suggest that the b/a ratio may be a good predictor of the development of retinal, disk and iris neovascularisation by showing the degree of retinal ischaemia, while the scotopic b wave cannot be used for such evaluation. Predicting the new vessel development by ERG may save the useful vision and prevent a disastrous outcome, blinding and painful neovascular glaucoma by performing panretinal photocoagulation.

Aged↗
PubMedDate not supplied

[Changes in intraocular pressure during dialysis].

We studied 29 patients on dialysis for terminal uremia, of whom one showed a dramatic rise in intraocular pressure (IOP) during dialysis. We examined the blood pressure (BP) and body weight (BW) before and after treatment in each patient and visual acuity by gonioscopic examination and optic disk status. After dialysis the statistically significant fall in BP and BW was observed in all patients, and in 28 subject an significant rise in IOP was noted. Only one patient experienced a dramatic rise in IOP, and he was the only one suffering from angular glaucoma during the last two years. All this time he was continually treated for glaucoma. After dialysis his IOP was 45 mmHg. With the adequate medication, his IOP lowered to the point when he was able to bear iridectomy which was done with argon and YAG laser. After the surgery his IOP reached the normal values. His visual acuity was good (1.0), visual field was normal, gonioscopic findings showed a narrow angle (Shaffer I, with normal pigmentation), and the optic disk had no abnormalities. It is not yet clear what was the cause of IOP rise during dialysis. It might be that the increased production of aqueous humor, which has been reported in such cases, might be caused by imbalance between blood and aqueous osmolality. If dialysis causes decrease in blood osmolality and if, at some time, blood becomes hypotonic in relation to ocular fluid, then the regular osmotic forces transfer the fluid to the ocular fluid into the eye. This case suggests that all patients on dialysis should undergo a minute ocular anamnesis and examination, and if needed administered adequate medication during the treatment.

Adult↗
PubMedDate not supplied

[Neuroendocrine response in patients with uveitis].

Uveitis is a group of inflammatory eye diseases whose origin is not yet known. It is supposed that they are autoimmune diseases, mediated by T cells, but the triggering mechanism is unknown. In the past few years the role of prolactin, as an immunomodulator, has been investigated. Its effect on cellular and humoral immunity has been brought in evidence by the presence of its receptors on the surface of immune cells. It has also been shown, that the presence of PRL is necessary for proliferation and maturation of immune cells. On the other hand, PRL-like molecule, whose effect is similar to that of pituitary PRL, is secreted by human lymphoid tissue as well as by peripheral mononuclear cells. The role of glucocorticoids in immunomodulation is based on their effects on immune system by inhibition of production of immune cells and their products, cytokines. Cytokines, which are produced during the immune reactions mediated by T cells, demonstrate their effect in autocrine and paracrine fashion, but when delivered in higher concentrations, can be found in blood, when they act at the hypothalamo-pituitary level. There are three opinions how they act at this level. The aim of the study was to investigate the role of prolactin and cortisol in the development of endogenous uveitis. The prospective study comprised 42 patients suffering from endogenous uveitis. Ten patients were controls. Prolactin concentrations were within normals, while cortisol concentrations were significantly decreased. We speculated the possible causes of such conditions, supposing that the hypothalamo-pituitary-adrenal axis disturbance could be the one. In conclusion, we would like to emphasize that in uveitis there is a disturbance at neuroendocrine/immune system level, and that uveitis is a systemic disease with ocular manifestation.

Enzyme-Linked Immunosorbent Assay↗
PubMedDate not supplied

[Occurrence of changes in the eye in diabetic retinopathy with significant myopia].

The optic disc and retinal neovascularization are less prominent and less frequent in myopic eyes in patients suffering from diabetes mellitus. The exact mechanisms of this phenomenon are not well known, but there is some evidence that there is a reduced blood flow in myopic eyes which is associated with less damaged microcirculation in eyes of patients with diabetes mellitus. The aim of our study was to evaluate the correlation between myopic refractive error and degree of diabetic retinopathy. We conducted a retrospective study in a group of randomized patients, divided into the following groups according to their refractive error: emmetropia (30 eyes), myopia simplex (30 eyes) and high myopia, over -6.5 dsph (21 eyes). Among patients with high myopia, seven had monocular myopia. All patients suffered from non insulin dependent diabetes mellitus for more than ten years, and their average age was 52.37-3.48 years. We did not observe patients with rubeosis iridis and neovascular glaucoma or patients with myopia less than -2.0 dsph. Our results indicated that there was no significant difference in the appearance of fundus between the studied groups. In all patients the incidence rate of non proliferative and proliferative diabetic retinopathy was the same as well as the absence of retinopathy (Fisher's test). The only exception were the patients with monocular myopia over -13.o dsph who had no signs of diabetic retinopathy in myopic eye, while the other, emmetropic eye, showed various stages of retinopathy, from severe non proliferative to proliferative. Some of the risk factors which influence the incidence rate of ocular complications in diabetic patients are well known, as are duration of diabetes mellitus, blood sugar level, blood pressure, ocular pressure and eye perfusion. On the other hand, it is also known that amblyopia, optic atrophy, low blood pressure in central retinal artery and retinitis pigmentosa are ocular conditions which are not associated with proliferative diabetic retinopathy. It was also noticed that complications of diabetes in high myopic eyes are less prominent than in emmetropic eyes. This finding is in harmony with our results. Sultanov et al. observed diabetic changes in the retina in 40.9% of myopic refraction patients, 65.2% of emmetropia cases and 70.4% of hypermetropia cases. The severity of involvement was less in myopia than in other types of refraction. In medium severe myopia, no proliferative diabetic retinopathy was observed, and in high myopia (10 eyes) no diabetic involvement of the fundus oculi was found. In anisometropia diabetic symptoms on the myopic side were either absent or poorly manifest. The possible cause of such findings could be the changes in retinal perfusion in myopic eyes and eyes in patients with diabetes mellitus. In 1973 a lower blood flow was detected in the retina and the choroid, proportionally to the degree of myopia. In 1982, Perkins indicated that the circulation time and pulsation rate in the central retinal artery in myopic eyes were reduced proportionally to the degree of myopia. In cases with early diabetic retinopathy Coscas detected a lesser blood flow in retinal veins. On the other hand, it has been found that high blood pressure increases the risk of diabetic retinopathy. These data suggest that the reduced blood flow in high myopia is a protective factor regarding the occurrence of complications in diabetes. Anisometropia and amblyopia in cases with monocular myopia, which presents a particular group in our study, could be factors which also prevent the occurrence of proliferative diabetic retinopathy. Instead of conclusion, we would like to point out that pathophysiologic mechanisms of these phenomena are not discussed enough. It is, nevertheless, important to appropriately examine the fundus in patients with high myopia and diabetes mellitus, because if the complications appear, they may be disastrous and must be treated immediately.

Diabetic Retinopathy↗