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As large language models (LLMs) continue to gain popularity due to their human-like traits and the intimacy they offer to users, their societal impact inevitably expands. This leads to the rising necessity for comprehensive studies to fully understand LLMs and reveal their potential opportunities, drawbacks and overall societal impact. With that in mind, this research conducted an extensive investigation into seven LLMs, aiming to assess the temporal stability and inter-rater agreement on their responses on personality instruments in two time points. In addition, LLMs' personality profile was analysed and compared with human normative data. The findings revealed varying levels of inter-rater agreement in the LLMs' responses over a short time, with some LLMs showing higher agreement (e.g. Llama3 and GPT-4o) compared with others (e.g. GPT-4 and Gemini). Furthermore, agreement depended on used instruments as well as on domain or trait. This implies the variable robustness in LLMs' ability to reliably simulate stable personality characteristics. In the case of scales which showed at least fair agreement, LLMs displayed mostly a socially desirable profile in both agentic and communal domains, as well as a prosocial personality profile reflected in higher agreeableness and conscientiousness and lower Machiavellianism. Exhibiting temporal stability and coherent responses on personality traits is crucial for AI systems due to their societal impact and AI safety concerns., Competing Interests: We declare we have no competing interests., (© 2024 The Author(s).)

L-leucyl-leucine methyl ester (LLOMe) is a lysosomotropic detergent, which was evaluated in clinical trials in graft-vs-host disease because it very efficiently killed monocytic cell lines. It was also shown to efficiently trigger apoptosis in cancer cells, suggesting that the drug might have potential in anticancer therapy. Using U-937 and THP-1 promonocytes as models for monocytic cells, U-87-MG and HeLa cells as models for cancer cells, and noncancerous HEK293 cells, we show that the drug triggers rapid cathepsin C-dependent lysosomal membrane permeabilization, followed by the release of other cysteine cathepsins into the cytosol and subsequent apoptosis. However, monocytes were found to be far more sensitive to the drug than the cancer and noncancer cells, which is most likely a consequence of the much higher intracellular levels of cathepsin C-the most upstream molecule in the pathway-in monocytic cell lines as compared to cancer cells. Overexpression of cathepsin C in HEK293 cells substantially enhances their sensitivity to the drug, consistent with the crucial role of cathepsin C. Major involvement of cysteine cathepsins B, S, and L in the downstream signaling pathway to mitochondrial cell death was confirmed in two gene ablation models, including the ablation of the major cytosolic inhibitor of cysteine cathepsins, stefin B, in primary mouse cancer cells, and simultaneous ablation of two major cathepsins, B and L, in mouse embryonic fibroblasts (MEFs). Deletion of stefin B resulted in sensitizing primary murine breast cancer cells to cell death without affecting the release of cathepsins, whereas simultaneous ablation of cathepsins B and L largely protected MEFs against cell death. However, due to the extreme sensitivity of monocytes to LLOMe, it appears that the drug may not be suitable for anticancer therapy due to risk of systemic toxicity., (© 2020 Federation of European Biochemical Societies.)

The aim of this study was to assess the prevalence of oral allergy syndrome (OAS) in patients with seasonal allergic rhinitis (SAR) and the possible risk factors for its development. This cross-sectional study was conducted in primary care offices in the Split-Dalmatia County during the period from March 1 to September 30, 2012. Data sources were medical history with confirmation of SAR (positive skin-prick test to seasonal inhalant allergens: grass, tree and weed pollens), anthropometric patient data (age, sex, weight and height), and a questionnaire in which patients evaluated their nasal and ocular symptoms, comorbidities and lifestyle. The χ2-test, Pearson χ2-test, Spearman's rho correlation coefficient and Kolmogorov-Smirnov test were used on statistical analysis. The prevalence of OAS was 45.7%. The risk factors for OAS development were diabetes (p < 0.001), severity of nasal symptoms (p < 0.05) and severity of ocular symptoms (p < 0.001). In conclusion, the prevalence of OAS in the Split-Dalmatia County is very high. The risks factors for OAS in patients with SAR are diabetes and severity of nasal and ocular symptoms.

Vascular endothelial dysfunction is a basic etiologic factor for the development of late clinical complications in patients with diabetes mellitus type 1, such as diabetic retinopathy, diabetic nephropathy (which is characterized at the very beginning by microalbuminuria), and left ventricular cardiac dysfunction. The aims of this study were to determine the prevalence of asymptomatic left ventricular systolic dysfunction in patients with diabetes mellitus type 1 and with or without diabetic retinopathy and microalbuminuria, and to correlate the duration of diabetes with the dynamics of diabetic retinopathy, microalbuminuria and asymptomatic left ventricular dysfunction development in these patients. One-hundred and twenty selected patients with diabetes mellitus type 1 were examined by ophthalmologist and cardiologist. All patients underwent ergometric testing and two-dimensional (2-D) echocardiography with pulsed Doppler. Patients were divided into three groups according to their fundus findings and microalbuminuria: (1) patients without diabetic retinopathy and without microalbuminuria (n = 40); (2) patients with diabetic retinopathy without microalbuminuria (n = 40); and (3) patients with diabetic retinopathy and microalbuminuria (n = 40). All three groups of patients with diabetes mellitus type 1 (with low cardiovascular risk, regulated blood sugar, and without diabetic neuropathy) had echocardiographic values in the normal range. We found no statistically significant correlation between the duration of diabetes mellitus type 1 and echocardiographic values.

The aim of the study was to determine the incidence of acute angle-closure attacks among residents of the Split-Dalmatia County, Croatia, during a 6-year period. In this retrospective, interventional case series study, hospital records of 53 consecutive patients (33 female, mean age 71.7 +/- 16.6 and 20 male, mean age 66.2 +/- 23.2) with acute angle-closure attacks, treated at University Department of Ophthalmology, Split University Hospital Center, Split, Croatia, from January 2002 to December 2007 were reviewed. The annual incidence of acute angle-closure attacks was 2 cases per 100,000 (95% CI, 0-3.4). The incidence of acute angle-closure was 0.6 (95% CI, 0-1.4) cases/100,000 per year. The incidence of acute angle-closure glaucoma was 1.5 (95% CI, 0-2.8) cases/100,000 per year. The incidence was 1.5 (95% CI, 0-3.4) cases/100,000 per year in males and 2.3 (95% CI, 0-4.6) in females. Nine (17%) patients were treated by medicamentous therapy, peripheral iridectomy was performed in 19 (36%) patients and laser iridotomy in 16 (30%) patients, whereas nine (17%) patients underwent filtering surgery. Median time between the onset of symptoms to presentation at the hospital was two days (range 1-21 days). There was no statistically significant association between the acute angle-closure attacks and seasonal variation (chi2-test = 4.6; p = 0.20). In conclusion, the number of patients with acute angle-closure attacks in the Split-Dalmatia County is relatively small; however, the significant incidence of acute angle-closure glaucoma could pose a social and health care problem in the County.

The aim was to investigate the effectiveness of the fixed drug combination dorzolamide 2%/timolol 0.5% as monotherapy, substitutive and as adjunctive therapy in patients with primary open angle glaucoma. 130 patients were divided in three different study groups and treated by the combination dorzolamide 2%/timolol 0.5% as monotherapy, substitutive therapy and additional therapy. After three months using fixed combination dorzolamide 2%/timolol 0.5%, the mean IOP decreased by 5.6 mmHg. After prescribing substitutive therapy with fixed drug combination dorzolamide 2%/timolol 0.5% for 3 months, the intraocular preassure increased by 0.13 mmHg. Three months after the treatment with fixed combination dorzolamide 2%/timolol 0.5% as an additional antiglaucomatous drug, we have noticed a decrease of the mean IOP of 3.28 mmHg. Itching and soarness were reported by 43% patients. In conclusion, glaucoma drug therapy with fixed drug combination dorzolamide 2%/timolol 0.5% achieves effective lowering of intraocular preassure levels as monotherapy or as adjunctive therapy. As a substitutive therapy, the combination had the same IOP lowering effect. Simple drug administration and good drug tolerance indicate the effectiveness of the same drug.

Diabetic retinopathy (DR) represents the most common chronic complication of diabetes, and it is the leading cause of new cases of blindness in patients between 20-74 years old in developed countries. Laser photocoagulation (LF) represents an efficacious approach to the treatment of DR. Oxidative factors, such as free radicals (FR), are continuously generated in aerobic organisms as a result of different metabolic processes. It is well known that oxidative stress plays a role in the development of DR. The aim of this study was to evaluate the thermal effects of the scatter retinal laser photocoagulation technique on the production of FR. A total of 90 patients were enrolled in this study. They were divided in 3 groups: 30 diabetic patients with DR, 30 diabetic patients without DR, and 30 control individuals without diabetes mellitus (DM). Full scatter retinal LF was performed in all patients with DR. We measured the concentrations of superoxide dismutase (SOD), glutathione peroxidase (GPOD), catalase, and total antioxidative status (TAS). Of the 30 DR patients, 13 showed the appearance or worsening of macular edema after LEF, whereas the other 17 patients showed no change. Thirty days after LF, improvement in visual acuity was observed, but this change was not statistically significant. The mean plasma or erythrocyte lysate concentrations of various antioxidants were significantly lower in the diabetic patients without DR compared to the individuals without DM and in the diabetic patients with DR compared to the individuals without DM; the diabetic patients with DR did not show lower concentrations of the antioxidants compared to the diabetic patients without DR. The concentrations of SOD, GPOD, catalase, and TAS were significantly lower in the diabetic patients with DR after retinal scatter LF, which could be the consequence of retinal oxidative stress caused by the LF thermal effect.

The aim of this work is to examine the role of circulating platelet aggregates (CPA) at pseudoexfoliation glaucoma (PXG), haemodynamic changes in the ophthalmic artery by ultrasonic color Doppler, searching for visual field progression. Vascular component at PXG and its role in VF progression dynamics has not been sufficiently explained, as well as CPA influence to ischaemic events related to optic nerve damage and VF progression. The examination included 80 patients, where of 35 (44%) men average age 68.3 +/- 7.0 and 45 (56%) women average age 65.7 +/- 7.0 (t = 1.66; p = 0.101). Forthy of them suffered from primary open angle glaucoma (POAG) as a control group (healthy), and 40 from pseudoexfoliative glaucoma (PXG) as an experimental group. All the examinees underwent complete ophthalmological examination: visual acuity, ocular fundus, intraocular pressure measured, anterior eye segment biomicroscopy with gonioscopy performed. Also VF examination was performed three times at 6 months intervals. Laboratory testing of CPA proportion values was performed by means of Wu an Hoak method and ultrasonic measurement of blood perfusion in the carotid tree, particularly concerning ophthalmic artery by means of color Doppler. Obtained decreased values of CPA proportion resulted in hypercoagulability of blood in PXG group. At PXG were also found increased blood flow resistivity indexes in ophthalmic artery (RI AO) and internal carotid artery (RI ACI), resulting with ischemia and hypoxia and finally progression of the visual filed damage. In conclusion, our study shows that examining CPA and ultrasonic monitoring of vascular parameters in ophthalmic artery with color Doppler may be the way of better understanding the vascular role in PXG prognosis.

Aim: The aim of this ten-year study (from the end of 1998 to the end of 2008) was to assess the prevalence of congenital dyschromatopsia in unselected healthy male population aged 15-45 from two Croatian regions, i.e. inland and Mediterranean parts of Croatia. Results collected in these two regions were compared and respective conclusions drawn. The results primarily referred to the prevalence of color vision disturbances and their differences according to the main color groups (dichromacy and anomalous trichromacy) and subgroups (protanopia, deuteranopia, protanomaly, deuteranomaly, and others). To our knowledge, no such a long-term study in a large population sample has been carried out in southeast Europe to date., Methods: Color vision was examined after complete ophthalmologic examination in all subjects presenting for examination required for amateur driver license. Color vision examination was performed by use of pseudoisochromatic Ishihara tables, Nagel II anomaloscope and Panel D-15 color test at industrial medicine offices and ophthalmology departments in the two regions. There were 12,974 and 9,974 subjects in inland and Mediterranean Croatia, respectively., Results: The results confirmed the hypothesis and clinical perception of a lower prevalence of color vision disturbances in southern parts, i.e. in Mediterranean Croatia (8.50%) as compared with inland Croatia (8.90%). The rate of dichromacy was higher in Mediterranean Croatia (2.40%), while the rate of anomalous trichromacy was greater in inland Croatia (6.93%)., Conclusion: The results of this study provide better insight in the status of color vision disturbances and possible differences between the relatively close areas of north (inland) and south (Mediterranean) Croatia.

Choroidal melanoma is the most common primary intraocular malignant tumour in adults. The aim of the study was to examine epidemiological characteristics of choroidal melanoma in Split-Dalmatia County from 1990 to 2009. In this retrospective study, data on 46 patients from medical documentation of the University Department of Ophthalmology, Split University Hospital Center, were analyzed. According to 2001 census, the Split-Dalmatia County population was 467,676 inhabitants. The incidence of choroidal melanoma was 0.49 per 100,000 inhabitants, which is somewhere in the middle of the incidence between south and north Europe. Choroidal melanoma most commonly appeared in the 7th decade of life. The average dimensions of choroidal melanoma (basis x height) were 13.4 x 8.0 mm. Histopathologic findings according to Callender classification showed the following types of melanoma: epithelioid cell type 8%, spindle cell type 40%, and mixed type 52%. The most common forms of therapy were enucleation 47.8% and brachytherapy 28.3%, which means that patients presented relatively late when choroidal melanoma advanced in size. The Split-Dalmatia County has 1/10 of the Croatian population, so it could be supposed that approximately 25 new cases of malignant melanoma of the choroid are discovered annually in Croatia. For early detection of the disease, regular and complete checkups are necessary, especially in presbyopic population. Study results enabled better evaluation of the disease and better planning of ophthalmologic service in the treatment of this serious eye disease.

Purpose: To assess the safety and efficacy of changing antiglaucoma therapy to the travoprost 0.004%/timolol 0.5% (TTFC) fixed combination from previous monotherapies., Methods: Prospective, open-label, observational, multicenter cohort. A change was done from prior monotherapy at day 0 to TTFC dosed once a day, regardless in the evening or in the morning, without washout period. Active evaluation of systemic and local tolerability (adverse events), and efficacy. i.e., intraocular pressure (IOP) lowering was done at control 1 (day 30), control 2 (day 90) and control 3 (day 120)., Results: 40/155/170 patients (79/309/339 eyes) completed the study (120 days/ 90 days/baseline, respectfully). At control 1 excluded were patients with low tolerability (severe hyperemia (6 patients), discomfort (4), chest pain (1)) and non responders (IOP lowering less than 15% from baseline IOP or target IOP >18 mmHg (4 patients)). Mean IOP at control 1 was 15.92 +/- 1.85 mm Hg (21.66% reduction) for 155 patients (non responders excluded), at control 2 was for 155 patients 15.67 +/- 2.17 mm Hg (21.14% reduction), and at control 3 for 40 patients 16.28 +/- 1.59 mm Hg (19.86% reduction). At control 2 analysis of IOP reduction by 4 groups of previous monotherapy (timolol 0,5% (N = 33/66), latanoprost 0.005% (N = 49/98), betaxolol 0.5% (N = 30/60), and travoprost 0.004% (N = 43/85) was performed. 40 patients/79 eyes endured to control 3 (after day 90 free samples were not available for all patients). Analysis of IOP reduction by 4 groups of previous monotherapy medications was performed (timolol 0.5% (N = 7/14), latanoprost 0.005% (N = 14/28), betaxolol 0.5% (N = 7/14), travoprost 0.004% (N = 12/23))., Conclusions: Changing patients from prior monotherapy to TTFC can provide on average a further reduction in IOP, while demonstrating a favorable safety profile.

An open label, multi-center, 6 months observational study of new fixed combination (travoprost 0.004%/timolol 0.5%), in order to evaluate both efficacy (intraocular pressure lowering) and tolerability (patient and investigator satisfaction) of two dosing regimens--evening (PM) and morning (AM). After screening for enrollment, to 40 patients (79 eyes with primary open angle glaucoma or ocular hypertension), new fixed combination travoprost 0.004%/timolol 0.5% was prescribed once a day in the evening (PM). Patients were enrolled according to each investigator decision on indication for travoprost 0.004%/timolol 0.5% fixed combination once a day, without washout period after previous medication. Intraocular pressure was measured at 9 AM at all time control points: at baseline, after 1 month, after 3 months and after 6 month. After 1 month, screening for nonresponders (criteria: 20% intraocular pressure lowering) and subjects with major side effects was performed. At second control visit, after 3 months PM dosing, intraocular pressure was measured and patients were instructed to continue once a day the same medication, but in the morning (AM) for consequent 3 months. After 1 month, reduction in mean intraocular pressure value was 21.66%. At the visit after 3 month, the mean intraocular pressure was 15.67 +/- 2.17 mm Hg (reduction 21.14%). 3 month after dosing regimen changed to AM (6 month after beginning of travoprost 0.004%/timolol 0.5% combination therapy), reduction in intraocular pressure value was 19.86%. The differences (mean +/- standard deviation) in intraocular pressure values after 1, 3 and 6 month were all highly statistically significant compared to baseline values. The tolerability was evaluated in five steps (Likert scale) ranging from unsatisfactory to excellent by both patient and investigator--taken at 3 and 6 month control visit. 95% of patients and 100% of investigators were satisfied with the possibility of choosing dosing regimen for travoprost 0.004%/timolol 0.5% fixed combination. Travoprost 0.004%/timolol 0.5% fixed combination proved sufficient intraocular pressure control dosed either PM or AM with no statistically significant difference between two dosing regimens. Possibility to choose between two dosing regimens gives each practitioner additional reassurance that glaucoma therapy will be individualised to needs of each patient.

New estimates show reduction in the number of people who are blind or suffer from vision impairment as a sequel of infectious diseases, while there is an increase in the number of people who are blind due to conditions related to longer life span and diabetes. Diabetic retinopathy is the leading cause of blindness in active population in developed countries. Epidemiological studies evaluated the incidence and describe many facets of this disease the incidence of which is being followed in most countries. The aim of this paper is to present some epidemiological data on diabetic retinopathy caused by type 1 diabetes in Croatia, to compare them with other countries, and to evaluate its importance in causing severe visual impairments and blindness. These data are considered highly relevant because they are changing constantly and require continuous monitoring in spite of all advances in understanding the distribution, causes and severity of diabetic retinopathy. It is of great importance because the increasing burden of diabetes will pose ever greater burden on the population at large and on healthcare systems providing care for these patents.

The paper describes the life and work of an ophthalmologist, Juraj Curin (Gdinj, 1887 - Split, 1947). In 1921, he founded Department of Ophthalmology in Split, although permanent ophthalmologic service had existed at the Old City Hospital in Split from 1902. Dr. Juraj Curin headed Department of Ophthalmology from 1921 till 1936. He graduated from the Prague School of Medicine in 1914 and served residency in ophthalmology in Zagreb in 1921. In 1923, he attended the course on biomicroscopy at University Department of Ophthalmology in Zagreb, organized by Professor L. Koeppe and Professor A. Botteri. Dr. Curin performed a vast range of ophthalmologic surgeries for cataract, glaucoma, strabismus, oculoplastic surgery, dacryocystectomy, retinal detachment, etc. Dr. Curin was also head of trachoma service he founded in 1923. He wrote a scientifically instructive booklet on trachoma and several other papers. From 1923 till 1935, he was the only ophthalmologist in Split. Until 1926, he occasionally was going to Dubrovnik for his private practice there. Between two World Wars, he was working at the Institute of Public Health, Social Insurance Eye Service, for active population in Split. During World War II, he was active in the National Liberation Movement. In 1925, he was treasurer of the Doctors' Free Organization of Dalmatia, and in 1931 auditor at the main board of the Croatian Medical Chamber in Split. Besides his doctor practice, he was also very active in social and political life.

Our aim was to draw attention of clinicians, dermatovenereologists and ophthalmologists to the possible association of vitiligo and ocular findings characteristic of primary open angle glaucoma (POAG). According to our clinical experience, POAG is relatively often diagnosed or previously diagnosed in patients treated for vitiligo. We found no literature report directly connecting vitiligo and POAG. The articles mentioning glaucoma, i.e. increased intraocular pressure (IOP), are mainly based on secondary type of glaucoma as a direct consequence of vitiligo treated by corticosteroids. On the other hand, there is a substantial number of articles elaborating the association of vitiligo with ocular findings in known clinical syndromes. During a 2-year period, from May 2007 to May 2009, 42 patients with vitiligo were examined at University Department of Dermatology and Venereology and referred for previously appointed ophthalmologic examination at University Department of Ophthalmology, Split University Hospital Center. All patients with vitiligo underwent complete ophthalmologic examination including visual field analysis, in order to treat and follow up or diagnose newly discovered POAG. Of 42 patients with vitiligo suspect of glaucoma, POAG was confirmed in 24 (57%) patients. Age median of all vitiligo patients was 56 (range 19-82) years. In patients with vitiligo and glaucoma, the duration of vitiligo was twofold that recorded in patients with vitiligo alone, the difference being statistically significant (z=3.3; P<0.001). The risk of developing glaucoma in vitiligo patients was 4.4-fold in >56 age group versus <56 age group and 3.5-fold in patients with >13 year versus patients with <13 year duration of vitiligo. Multivariate logistic regression for glaucoma development according to vitiligo duration (< or =13 years vs. > or =13 years) and patient age (< or =56 years vs. > or =56 years) pointed to the association of glaucoma development and age and yielded a 92% probability for the association of glaucoma development and vitiligo duration. Therefore, we believe that patients treated for vitiligo should regularly undergo complete ophthalmologic examination with special attention paid to POAG irrespective of age, sex, severity, localization and duration of the disease. Although performed in a relatively small sample and over short period of time, the results of this pilot study demonstrated that this association was not accidental. Additional studies in a greater sample of vitiligo patients and POAG are expected to provide definitive answers and conclusion on the association of these two diseases.

The aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) on intraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy (TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX-A injections were applied. Intraocular pressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2-4 weeks after BTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX-A injection using a Hertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6 +/- 2.8 mmHg and 2-4 weeks after BTX-A injection was 16.9 +/- 3.3 mmH; (p = 0.001). There was no statistically significant difference in Hertel egzophthalmometer readings before and after BTX-A injection, 21.5 +/- 2.7 mm vs. 22.0 +/- 2.6 mm; (p = 0.678). In conclusion, BTX-A injection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influence on proptosis.

Dr. Erwin Treu (Kotor, 1875-Skopje, 1937) was the first permanent ophthalmologist in Split, Croatia. He finished his ophthalmological specialization at the Eye Clinic in Prague in 1900 at W.P. Czermak. He originates from Tirol. Dr. Treu led and organized ophthalmological service in Split and worked from 1902 to 1921 in the Split Hospital, and had a private practice until 1923. From 1904 to 1910 he temporarily worked outside Split, in Sibenik, Zadar, Dubrovnik, Kotor and Cetinje. During the First World War he was a military doctor in Split and Trogir. He performed ophthalmological operations, cataracts, glaucomas (iridectomy), strabismus (tenotomies), ocular adnexa, injuries, trachoma etc. In 1923 he left for Skopje where he at first worked as a medical major in Military Hospital, and after that as a primarius in Civil Hospital at the Department of Ophthalmology till the end of his life.

The aim of this study was to determine the incidence of nonarteritic ischemic optic neuropathy (NAION) in the Split-Dalmatia County, Croatia, as part of the Mediterranean region of southern Europe, during a 7-year period (2001-2007). This retrospective study included 87 NAION patients (36 female, median age 68 years, and 51 male, median age 69.5 years) treated at University Department of Ophthalmology, Split University Hospital Center, from January 2001 till December 2007. In each case the diagnosis was confirmed by review of patient records. The annual incidence of NAION was 2.9 per 100,000 (95% CI 1.1-4.8); 3.8 (95% Cl 0.76-6.8) per 100,000 per year in male and 2.5 (95% CI 0.12-4.9) per 100,000 per year in female patients. There was no statistically significant sex difference in the annual incidence of NAION (chi2 = 1.17; P = 0.279). NAION involvement showed a statistically significant male predominance in the > 65 year age group, yielding a relative risk for men vs. women of 1.75. In conclusion, the incidence of NAION in the Split-Dalmatia County was found to be moderate.

The aim of the study was to compare the efficacy of travoprost 0.004% eye drops added to therapy with timolol 0.5%. The study included 40 patients (80 eyes) with open angle glaucoma and intraocular pressure (IOP) above 18 mm Hg treated with topical beta blocker (timolol 0.50% twice a day). Travoprost 0.004% was added to timolol 0.5% therapy once daily in the evening. Follow up examinations were scheduled at 7 days, one month and three months. IOP lowering was achieved in all patients. Substantial lowering of 2.42 mm Hg was achieved after the first week of treatment. Further lowering and stabilization of IOP was recorded at three months, with total IOP decrease of 3.97 mm Hg; the difference was statistically significant (chi2=6.7743; p<0.01). At three months, target IOP was recorded in 64 eyes (16.4+/-0.7 mm Hg) and failed to be achieved in 16 eyes (21.1+/-2.3 mm Hg). Mild hyperemia was found in two patients and discrete hyperemia in 26 patients. Burning sensation associated with the use of travoprost 0.004% eye drops was reported by 68 patients. In conclusion, the use of travoprost 0.004% eye drops resulted in successful lowering of IOP and achievement of target IOP.

The aim of this study was to determine the incidence of acute angle-closure glaucoma in Split-Dalmatia County and correlation between visual acuity and time (days) elapsed from the disease onset to hospital admission. Twenty-nine cases were retrospectively analyzed. There were 19 female patients aged 36-91 (median age 68) years and 10 male patients aged 35-88 (median age 70) years, with attacks of acute closure glaucoma treated at University Department of Ophthalmology, Split University Hospital Center from January 2002 until December 2005. Annual incidence was 1.6 cases per 100,000. The time elapsed from the disease onset to hospital admission was 1-21 (median 2) days. Visual acuity before and after treatment was reversely proportional to the number of days to hospital admission (d = -0.466; p = 0.011). Visual acuity was found to depend on age as well (z = 1.999; p = 0.044). The best visual acuity was obtained in those cases that were admitted within two days (z = 2.014; p = 0.044). There was no significant sex difference in the incidence of angle-closure glaucoma (t = 0.389; p = 0.699). No statistically significant association was found between acute angle-closure glaucoma and seasonal variation (chi2 = 5; p = 0.167). In conclusion, earlier recognition of the symptoms of acute angle-closure glaucoma and initiation of treatment within two days of the disease onset were associated with better visual acuity.

Sleep apnea is a breathing disorder characterized by cessation of breathing during sleep, oxygen desaturation and awakenings during night. There are several types of breathing disorders during sleep. Obstructive sleep apnea (OSA) is also characterized by snoring and excessive daytime sleepiness. Central sleep apnea (CSA) is less common and characterized by reduced respiratory drive from the central nervous system. Upper airway resistance syndrome (UARS) is characterized by excessive daytime sleepiness, absence ofapneas, hypopneas and lack of significant oxygen desaturation. The consequences of the abnormal breathing during sleep include excessive daytime sleepiness, development of arterial hypertension, ischemic cardiac disease, neurocognitive dysfunction, glaucomic optico-neuropathy, metabolic dysfunction. The early diagnosis requires detailed anamnestic data, standardized questionnaires for detection of sleep disordered breathing and whole-night polysomnography in the sleep laboratory. Obstructive sleep apnea can be treated with continuous positive airway pressure (CPAP), oral appliances, and surgery (e.g., uvulopalatopharyngoplasty, UPPP). Early diagnosis of OSA enables early treatment, improvement of its symptoms and eventually reduces development of co-morbidities.

Inhibitors of carboanhydrase (ICA) in the form of dorzolamide 2% drops and brinzolamide 1% drops are in use for 8-10 years, with a significant intraocular pressure (IOP) lowering effect. The goal of the present study was to obtain precise data on the efficacy of local ICA in conjunction with timolol 0.5% drops, and to evaluate the incidence of side effects. This was a prospective study that lasted 2 years and included 110 patients. Initial IOP values, before therapy with ICA, amounted to 19 +/- 8.4 mm Hg in group A and 20.5 +/- mm Hg in group B. Although the results obtained demonstrated statistically significant lowering of IOP (in group A by 4.5 +/- 2.4 mm Hg, and in group B by 4.6 +/- 2.1 mm Hg) after therapy with ICA, the difference between the groups was not found. Dorzolamide more frequently caused local side effects like aching, itching and pain in the eye. Aditional lowering of lOP in our patients was somewhat greater than reported before (4.6:4.3). Side effects (itching, aching, pain) were three times more frequent in the group treated with dorzolamide than reported by other authors; this difference could be due to patient age, as our patients were mostly elderly people and the data are subjective. The results of this study suggested the effectiveness of additional local therapy with ICA in patients with open angle glaucoma.

The aim of this study was to determine the incidence of monosymptomatic optic neuritis (MON) and progression of MON to multiple sclerosis (MS) from the Mediterranean region of southern Europe in the County of Split-Dalmatia, Croatia during the 11 years period from 1991 to 2001. This study was made retrospectively on the 87 cases (59 female, aged 25.9 +/- 11.3 and 28 male aged 29.9 +/- 9.2) of MON, which were treated at the Department of Ophthalmology and Department of Neurology, Split, University Hospital, from January 1991 to December 2001. In each case the diagnosis was confirmed by a chart review and cases were ascribed to the data of admittance at hospital. The annual incidence of MON was 1.9 per 100,000 (95% CI, 0.4-3.5). The incidence among males was 1.2 (95% CI, 0-2.9) cases / 100,000 per year and 2.5 (95% CI, 0.1-4.9) among females. A significant seasonal variations in the incidence of MON was not found (chi2 = 6.81, p = 0.08). MS developed in 20 of 87 patients (22.9%) and median time was 25 (SE 8) months, (95% CI, 9-41) after the MON onset. After two years 12.6% of patients with MON developed MS, 20.6% after 5 years and 22.9% after 10 years. MS was slightly but not significantly more frequent in women than in men (chi2 = 0.72, p = 0.3). In conclusion, the progression of MON to MS in the County of Split-Dalmatia, Croatia was at a relatively moderate frequency.

Carotid-cavernous fistula is uncommon consequence of craniocerebral trauma. Earlier recognition of the patients with carotid-cavernous fistula and shorter time of delay in treatment could save patients from complications and vision loss. A 27-year-old man presented with severe craniocerebral injury after an car accident. He required emergent craniotomy for an open depressed cranial fractures, haemostasis and epidural hematoma. Three months later, the patient began to exhibit progressive chemosis and proptosis of left eye. Computed tomography and cerebral angiography revealed findings consistent with a carotid-cavernous fistula. Angiography revealed a fistula between carotid artery and the cavernous sinus. The patient was treated by transarterial embolization resulting in immediate and permanent occlusion of the fistula and improved visual acuity after six months follow-up. Posttraumatic carotid-cavernous fistula may be treated successfully with the use of transarterial coil embolization.

Internuclear ophthalmoplegia is a syndrome that develops due to a lesion of the medial longitudinal fasciculus. This lesion is mostly caused by multiple sclerosis (usually bilaterally), and only rarely by head injury. A case is presented of unilateral internuclear ophthalmoplegia as an isolated sequel of minor head trauma, which eventually resolved. A 40-year-old woman with isolated internuclear ophthalmoplegia secondary to closed head trauma with anatomical lesions of the mesencephalon in the region of medial longitudinal fasciculus is described. A minor contusion was detected by magnetic resonance imaging. Diplopia resolved in 5 months. In conclusion, internuclear ophthalmoplegia should be considered in the differential diagnosis in patients with recent head injuries showing adduction impairment. The connection between the clinical picture and anatomical lesions is visualized by magnetic resonance imaging.

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.

Background: The purpose of this study was to investigate the frequency of asymptomatic left ventricular dysfunction in patients with pseudoexfoliation syndrome., Methods: Two-dimensional and pulsed Doppler echocardiography of transmitral flow was performed on 27 patients with pseudoexfoliation syndrome, aged 66.9+/-5.6 years, and 24 healthy volunteers aged 63.9+/-6.5 years. Left ventricular (LV) systolic contraction and ejection were assessed by LV ejection fraction (EF) and fractional shortening (FS). LV diastolic filling parameters tested 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)., Results: Systolic parameters EF and FS, diastolic filling parameters such as A, LVEDP and PCWP were not significantly different between patients with pseudoexfoliation syndrome and controls (P>0.05). A significant difference (P<0.05) was found with regard to the diastolic filling parameters: E (61.6+/-15.1 vs 83.7+/-21.4), ratio E/A (0.8+/-0.1 vs 1.1+/-0.2), VTIE (8.6+/-1.8 vs 9.8+/-1.9), VTIA (10.3+/-2.4 vs 7.8+/-1.6) and ratio VTIA/VTIE (1.2+/-0.2 vs 0.8+/-0.2)., Conclusion: Our study suggests the possibility of an association between patients with pseudoexfoliation syndrome and a discrete asymptomatic myocardial diastolic dysfunction.

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.

The authors report clinical features of ocular manifestations in patients with multiple sclerosis (MS), those that affect the visual sensory system and those that affect the ocular motor system. Disturbances of visual sensory function may precede, manifest coincidentally or follow the neurologic manifestations. Visual disturbances are common in MS and often a result of acute demyelinating optic neuropathy. Careful examination of MS patients, who have never suffered optic neuritis, may also reveal asymptomatic visual loss. Asymptomatic visual loss seems to be a universal feature of MS. Patients with multiple sclerosis may develop disorders of fixation, ocular motility and ocular alignment. Disorders of ocular motor system are frequently the initial sign of multiple sclerosis and occur as its presenting sign weeks, month, or years before other neurologic symptoms and signs develop.

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.

The aim of this work is the specify of rare neurological disorder, bilateral cortical blindness and Anton syndrome. It is about loss of vision in the presence of intact anterior pathways and a form of visual anosognosia, with resulting patient denial of blindness. This is a case of 72-year old man with history of diabetes and hypertension. Diagnosis is based on the exclusion of disease in the anterior visual tract by history and complete neuro-ophthalmological and radiological evaluation.

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.

The aim of the study was to determine the incidence of monosymptomatic optic neuritis (MON) in residents of Split-Dalmatia County, Croatia. The 127 cases (83 female, aged 26.2+/-9.9 and 44 male aged 26.9+/-11.2) with MON presented between January 1985 and December 2001 were analyzed from hospital data. The annual incidence was 1.6 per 100,000 (95% CI, 0-3). The incidence among females was 2.2 (95% CI, 0-4.6) cases / 100,000 per year and 1.1 (95% CI, 0-3) among males. The difference in incidence rates for women vs. men was not significant (chi2=0.41; p=0.52), although it is more likely that a true difference exists. The peak incidence in both sexes observed in the group 20-29 years of age was 4.2 (95% CI, 0-10). The highest incidence of MON was found in spring (46 cases). In summary, the incidence of MON in Split-Dalmatia County during the 17 years period is relatively low.

Aim: To compare the efficacy and safety of fornix-based and limbus-based conjunctival flaps of phacotrabeculectomy with mitomycin C in patients with primary open angle glaucoma and cataract., Methods: The study included 16 patients (6 men and 10 women) with primary open angle glaucoma and bilateral cataract. In each patient, phacotrabeculectomy with mitomycin C was performed on both eyes: the eye first operated received a fornix-based conjunctival flap, whereas the fellow eye was assigned to the limbus-based group. We compared preoperative and postoperative visual acuity, intraocular pressure, number of antiglaucoma medications, and postoperative complications between flap-based and limbus-based groups., Results: There was no difference in the decrease in the mean intraocular pressure between the fornix-based and limbus-based groups after phacotrabeculectomy: from 22.1+/-4.4 mm Hg to 16.2+/-3.4 mm Hg in the fornix-based group, and from 22.4+/-4.5 mm Hg to 15.9+/-3.2 mm Hg in the limbus-based group. The two groups also did not differ in the number of medications received either before or after the surgery. Early bleb leak was observed only in the fornix-based group (2 eyes)., Conclusions: Phacotrabeculectomy with intraoperative mitomycin C was successful in regard to both reduction of intraocular pressure and glaucoma medications. There was no difference in the safety or efficacy of the procedure between groups receiving either fornix- or limbus-based flap, except for the early bleb leak, which was observed only in the fornix flap group.

Aim: To investigate the incidence of acute angle-closure glaucoma among residents of Dalmatia, southern part of Croatia., Methods: We reviewed hospital records of 176 patients with acute angle-closure glaucoma treated between January 1995 and December 2001 at the Departments of Ophthalmology at four hospitals in Dalmatia. There were 122 women, aged between 29 and 89 years (median age; 68 years), and 54 men, aged between 33 and 88 years (median age, 70 years)., Results: The unadjusted crude incidence was 2.9/100,000 (95% confidence interval [CI], 1.6-4.5). The unadjusted crude incidence among men and women was 1.9 (95% CI, 0.3-3.8) and 3.9 (95% CI, 1.7-6.1) cases/100,000 per year, respectively. The relative risk (RR) of developing acute angle-closure glaucoma was 2.1 (95% CI, 1.5-2.9) times higher for women as compared to men. The RR of acute angle-closure glaucoma was 1.9 (95% CI, 0.6-6.2) in the 40-49 years group, 6.5 (95% CI, 2.3-18.8) in the 50-59 years group, 17 (95% CI, 6.3-47.8) in the 60-69 years group, and 28 (95% CI, 10.4-77.3) in the over 69 years group. The median time from the onset of symptoms to presentation at the hospital was 2 days (range, 1-15 days). In 87 (48%) patients intraocular pressure control was achieved by medical treatment, 41 (23%) patients underwent peripheral iridectomy, and 48 (27%) patients required a trabeculectomy. In 35 (73%) out of 48 patients managed by filtering surgery, the delay in treatment was 3 or more days. In 34 (19%) eyes with final visual acuity 0.1 or worse, the delay in presentation was 3 days or more. No statistically significant association was found between acute angle-closure glaucoma and seasonal variation (chi-square=0.85; p=0.8)., Conclusion: Earlier recognition of the patients with acute angle-closure glaucoma and a shorter time of delay in presentation could have saved many patients from surgery and vision loss each decade.

The aim of the study was to evaluate the efficacy of replacing current dual local therapy (timolol and pilocarpine) with latanoprost 0.005% in 71 pseudoexfoliation glaucoma patients with controlled intraocular pressure (IOP). 39 patients switched to latanoprost 0.005%) and 32 patients continued timolol-pilocarpine therapy. Mean diurnal (IOP) was measured at baseline, after 0.5, 1, 3 and 6 months of treatment. After 6 months 38 patients with latanoprost and 30 patients with timolol-pilocarpine had completed the study. At baseline the mean diurnal IOP was 20.4 +/- 2.0 mmHg for patients in latanoprost treatment group and 21.4 +/- 2.1 mmHg for patients in timolol-pilocarpine group. At the end of the study, after 6 months of treatment, the mean diurnal IOP values were 16.6 +/- 2.4 and 17.9 +/- 2.0 mmHg respectively. IOP was statistically significantly reduced from baseline (p < 0.001). The mean diurnal IOP change from baseline was -3.3 +/- 0.5 mmHg (mean +/- SEM, ANCOVA) for the patients treated with latanoprost and -3.2 +/- 0.4 mmHg for the patients treated with timolol + pilocarpine. This difference in IOP reduction between groups was not statistically significant (z = 0.69; p = 0.49). This study showed that combination therapy (timolol plus pilocarpine) in pseudoexfoliation glaucoma can effectively be replaced by latanoprost monotherapy.

This review gives a summary of all colour vision disorders (dyschromatopsias) and diagnostic methods and tests. Colour vision is inadequately treated in current literature with regard to the choice of diagnostic methods and the interpretation of results for a single disorder, which contributes to wrong dyschromatopsia diagnosing seen every day in specialist practice. Examination for colour disorders is usually outpatient and is carried out by ophthalmology or neurology departments or occupational health services under the supervision of an ophthalmologist to prevent misinterpretation of results and wrong occupational choices. The problem is very serious, and proper education should be able to provide guidelines for correct and early diagnosis of dyschromatopsia. As the examination is not well defined, it is very important to set unique criteria in diagnosing any single colour vision disorder.

A population of 9974 healthy male subjects (aged 15-45 years) was screened for congenital dyschromatopsia. The study group consisted of subjects applying for a driving license in the Split-Dalmatian County between 1996 and 1999. The aim was to establish colour vision deficiency (dichromats) and borderline deficiencies (anomalous trichromats) in candidates through complete ophthalmologic examination including the Ishihara pseudoisocromatic plates, anomaloscope Nagel II, and Hue Lanthony colour test. The frequency of congenital dyschromatopsias was 8.48%. This frequency includes 2.39% dichromats (1.49% protanops and 0.90% deuteranopes) and 6.09% anomalous trichromats (1.27% protanomals, 4.20% deuteranomals, 0.21% extreme protanomals and 0.41% extreme deuteranomals). It is important to recognise and classify dyschromatopsias according to type and severity in order to avoid misinterpretation of results and consequent unjustified limitations imposed on anomalous trichromats in the selection of a profession.

Objective of this study was to evaluate the intraocular pressure-reducing effect of latanoprost as monotherapy after replacing current dual therapy in glaucoma patients. The 6-months study comprised 189 patients with primary open angle glaucoma who were treated at least 6 months with two different kind of topical medications (beta-blockers, pilocarpine, dorzolamide and brimonidine). Due to local side effects, multiple dosing regime and inadequately controlled intraocular pressure (IOP), they where switched to latanoprost 0.005% monotherapy. After switched to latanoprost, mean (IOP) was measured at baseline, after 15 days, 2 and 6 months of treatment. After six-months 178 patients had completed the study. These analyses enrolled all patients (n = 189), thus, the Intention-To-Treat (ITT) results were shown instead of the results of the reduced population. IOP was clinically importantly reduced from baseline level. Five patients had uncontrolled IOP. The difference between IOP before (21.9 +/- 2.4) and after 15 days (17.4 +/- 1.7), 2 months (16.7 +/- 1.8) and 6 months (16.6 +/- 1.4) was statistically significant (p < 0.001). 90% patients has reached target IOP < or = 18 mm. A conjunctional hyperaemia in 18 (9%), stinging and itching in 7 (4%) patients was reported. Increased iris pigmentation was seen in 3 (2%) patients. The results of this study indicate that dual therapy in open-angle glaucoma can effectively be replaced by latanoprost monotherapy in many patients.

The purpose of this study was to evaluate a nonfiltering glaucoma technique viscocanalostomy alone or in combination with small incision phacoemulzification and intraocular lens (IOL) implantation. From January 1999 to February 2001 viscocanalostomy was performed in 18 patients with medically uncontrolled primary open angle glaucoma. In 10 patients with cataract and primary open angle glaucoma combined operation phacoemulsification and viscocanalostomy was performed. The mean IOP reduction remained statistically significant after 12 months in both groups (p < 0.01). There was also a significant decrease in the antiglaucoma medications in both groups postoperatively. Perforation of trabeculo-Descemet's membrane occurred in two eyes with POAG and the procedure was completed as trabeculectomy, and those patients were excluded from the study. Good hypotensive effect with very low complications rate was achieved. Such a low complication rate makes this operation particularly attractive to surgeons who perform an increasing number of operations in outpatient's bases.

The aim of the study was to assess a relationship between circulating platelet aggregates (CPA) and progression of visual field loss in primary open-angle glaucoma patients. CPA was determined in 27 patients with open-angle glaucoma with nonprogressive visual field loss and 15 patients with open-angle glaucoma and progression of visual field loss. Intraocular pressure (IOP) under topical therapy was < 18 mmHg in all patients. CPA in glaucoma patients with progression of visual field loss was not significantly higher than those without visual field progression (p = 0.59). In conclusion, our study shows that increased platelet aggregability is not solely responsible for progression of visual field loss in glaucoma patients, and indicates the role of IOP in the pathogenesis of visual field loss.

The purpose of this study was to determine whether abnormal antepartum cervical cytologic findings result in differing postpartum regression rates. Between 1993 and 2000, 107 pregnant women with antepartum abnormal cervical cytologic findings were identified. Papanicolaou smear data were separated into three groups by use of the CIN classification system. Postpartum regression rates of antepartum Papanicolaou smears were analyzed six months after delivery. Normalization of Papanicolaou smears in the postpartum period were observed in 50 of 107 women (46.7%). Regression of cervical cytologic findings was noted in 61 of 107 women (57%). Respectively, persistence of Papanicolaou smear was noted in 43 of 107 patients (40%). Only 3 of 107 (3%) antepartum findings progressed after delivery. Desquamation of the cervical epithelium or enhancement of a localized reparative immunologic response after vaginal delivery could play an important role in the spontaneous regression of cervical dysplasia in the postpartum period.

The influence of war circumstances on tumor morphological characteristics in patients with breast cancer has not been studied up to now. The aim of this study is to investigate if war circumstances have influenced breast cancer incidence. The study covered both the patients in which during a period of observation a breast cancer was diagnosed as well as those who died of the same disease in the same period. Three sources of data were used: 1) The archives of the Oncology and Radiotherapy Center of the University Hospital "Split" (UHS): hospital data of 768 patients were reviewed. The war sample consisted of 380 patients aged 59.4+/-12.1 (31 to 86) (including 5 males), whereas the pre-war sample was made up of 388 patients aged 58.4+/-12.7 (19 to 88) (including 3 males); 2) Register of death of the Pathology Department of UHS with 162 analyzed persons whose death was caused by breast cancer in the six-year period between 1988 and 1993. The list of 162 dead patients included 79 people who died from breast cancer diagnosed in that period (1988-1993) and another 83 people that had been diagnosed before that period; 3) The biopsy register of the Pathology Department of UHS with 851 breast biopsies performed between 1988 and 1993. Breast cancer is predominantly a female illness (99.1%). The war circumstances influenced the of T, N and M rate. The rate of N2, N3, Ml were conspicuously higher in the war period. There were significantly more malignant histological diagnoses found in new patients and also significantly more patients died due to breast cancer. Stress and other war circumstances undoubtedly have a negative impact on the numerous markers of breast cancer which we have proved in this study.

Recent advances in understanding the effects of hyperbaric oxygen (HBO) on retinal anoxia gave rise to new interest in the possibility of using it as therapeutic treatment for ischemic conditions of the retina and optic nerve. Two patients with non-arteritic anterior ischemic optic neuropathy due to a high-grade ophthalmic artery stenosis were treated with HBO at 2 atm abs in an effort to increase oxygen delivery for the eye. Both patients showed marked improvements of visual acuity and visual field 3-5 months following the event. Our results are intriguing although the achieved improvement could be coincidental.

Snoring and obstructive sleep apnea are similar disorders in etiology, with differences in clinical presentation and treatment. 5-20% of young and 40-50% of older population are affected by either of these disorders. Etiology of snoring should be sought in the anatomic irregularities of commencing portions of the upper respiratory and gastrointestinal tracts, obesity, alcohol abuse, use of some medications as well as in the sleep architecture disturbance. Treatment success depends on correctly established diagnosis and precise localisation of anatomic irregularity implicated in snoring. A wide array of diagnostic tests exist some of which are mandatory while the others are used on a case-by-case basis. Treatment is either conservative or surgical. The success rate is 30-90% depending on the type and the management of disorder. An algorithm for diagnosis and treatment of snoring and obstructive sleep apnea is shown at the end of the paper.

This study is a retrospective analysis of medical findings of patients treated at the Department of Ophthalmology, Clinical Hospital Split, Croatia in the period of 1995-1999. Seventy-three cases of acute closed-angle glaucoma were analyzed and compared in relation to the meteorological factors--hours of sunshine, air temperature and atmospheric pressure. No significant statistical correlation was found between the development of acute closed-angle glaucoma and air temperature, atmospheric pressure and mean sunshine hours in all months, except in November (z = 2.1; p = 0.03). The mean daily sunshine hours on the day of the acute closed-angle glaucoma onset were found to be lower than the mean monthly sunshine hours. An increased incidence of acute closed-angle glaucoma was found in the the winter months (chi 2 = 14.4; p < 0.01). Seasonal variations of the incidence of acute closed-angle glaucoma in Split cannot be directly attributed to the meteorological factors, although the correlation between acute glaucoma and sunshine seems to have a slightly inverse ratio.

In this study pigmented glaucoma was diagnosed in 29 out of 4350 patients suffering from glaucoma. In clinical analysis of those cases main attention was put on Krukenberg spindle with emphasis on the process and reason of its development. In all cases of Krukenberg spindle moderate myopia and myopic astigmatism were present. The main axis of the spindle lies in the principal meridian of corneal astigmatism. The principal meridian of the anterior cornea surface corresponds with the axis of the principal meridian of the posterior corneal surface. The higher degree of astigmatism more pronounced Krukenberg spindle. This corresponds to a number of cases in which the spindle is hardly recognisable in the astigmatism, of only +/- 0.25 to +/- 0.50 Dcyl. The axis of meridian corresponds to direct astigmatism (from 110 degrees to 70 degrees). The authors conclude that there is no pigmented Krukenberg spindle without myopic astigmatism. It is for this reason and because of the inheritance factor that this type of glaucoma should be considered primary glaucoma and a separate clinical entity.

The aim of the study was to determine the relationship between hypertensive retinopathy and the severity of pre-eclampsia. Forty women with pre-eclampsia, mean age 29.1 (+/- 7.4; range, 19-44) years, were retrospectively analyzed. They were treated at the Department of Obstetrics and Gynecology of the Clinical Hospital Split, from January 1997 to December 1999. The mean age of gestation was 36.0 +/- 2.8 weeks (range, 28-39). Pre-eclampsia was classified according to Goecke. Based on the ophthalmoscopic fundus examinations the patients were divided into four groups, according to Keith-Wagner classification system of grading retinal changes. Of 40 analyzed women, 18 (45%) had ophthalmologically verified hypertensive retinopathy. Ten of them were classified as grade I, six as grade II and two as grade III. Twenty-two patients had mild pre-eclampsia, ten patients had moderate pre-eclampsia, and eight patients had severe pre-eclampsia. A statistically significant correlation (t-test) was found between the degree of hypertensive retinopathy and patient age, Apgar score, trophism, Goecke's index, proteinuria, systolic and diastolic pressure (P < 0.001) and edema (P = 0.01). The degree of hypertensive retinopathy was directly proportional with the severity of pre-eclampsia and significant correlation was found between them (r = 0.338, p = 0.033). These findings showed that the degree of hypertensive retinopathy in women with pre-eclampsia is a valid and reliable prognostic factor in determining the severity of the pre-eclampsia. Therefore, it can be concluded that the examination of the fundus is a valuable and necessary diagnostic procedure in pregnant women with pre-eclampsia.

We studied the epidemiological characteristics of nontraumatic phakic rhegmatogenous retinal detachment (RRD) in a defined population of Split-Dalmatia County, Croatia. A total of 278 eyes of 272 patients developed RRD during an 11-year period, 1988-1998, with a population of 465,947. The annual incidence was 5.4 per 100,000 population. The mean age of patients was 58.3 years, and the sex distribution corresponded with that in the general population. There was insignificant preponderance of right eye involvement. Bilaterality was observed in 2.2%. The presence of myopia was diagnosed in 46.9% eyes., (Copyright 2000 S. Karger AG, Basel)