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The aim of this paper is to clarify specific aspects of the impact of the brain-machine interface on our understanding of subjectivity. The brain-machine interface is presented as a phase of cyborgization of humans. Some projects in the field of brain-machine interface are aimed at enabling consensual telepathy - communication without symbolic mediation. Consensual telepathy refers to one of potential ways of transmission of information within singularity. Therefore, consensual telepathy is an important aspect of singularity. Singularity or human-machine symbiosis shows some similarities with child-mother unity. Therefore, the psychodynamic perspective might be considered useful in thinking about human-machine symbiosis. Knowledge from developmental psychodynamic psychology combined with insights by Slavoj Žižek and Jean Baudrillard provides an additional perspective looking at human-machine symbiosis. The paper claims that if consensual telepathy becomes another way of communication, it will have the potential to annihilate subjectivity making it schizophrenic. At the same time, we look at the possibility of an escape from our inner world through the prism of addictions.

Both tech companies and AI algorithms exercise immense power in today's globally interconnected world, which is based on big data and digital footprints of online users. This paper analyses the transfer of power from societies to tech companies and algorithms with the aim of examining whether recommender algorithms can be considered a public good. Deployed methods include content analysis and literature reviews. The study has found that control exercised over public opinion, decisions and moods of online users is unprecedented to such a high degree in human history. The above-mentioned control is based on the impact of both tech companies and algorithms. The limitation of this research is the lack of quantitative analysis. Future research should concentrate on defining recommender algorithms as a public good and analyzing how different media content, including virtual reality, affects citizens' psychology.

Social media are becoming an indispensable communication tool today, including political communication. Therefore, technological companies running them have a great power. Every intervention they have in the public sphere may have far-reaching consequences. We will focus on two cases of the influence of technological companies on media, election and legislative processes as basic factors of democracy. We will consider the implications of the prohibition of Donald Trump's use of Twitter, as well as the conflict of Australia's media policy with Facebook and Google. We have reached the conclusion that in these cases technological companies took over the power that used to belong to the judicial and legislative branch of power, in terms of defining what hate speech, as well as media regulation is. Accordingly, this threatens the information system and sovereignty of the countries where these interventions are made. These events indicate that the world is entering a period of domination of technological companies, which may be called technocracy or technofeudalism. Further considerations should be directed towards defining social media as a public good that should be influenced by societies and not only technological companies as the owners of these communication platforms.

Whistleblowing cases that shook intelligence community in the last decade have something in common. Edward Snowden, Bradley Manning, and Reality Winner are all members of a single generation - Millennials. We challenge the viewpoint that depicts this generation as a potential "insider threat." Millennials do have certain psychological traits and attitudes that can be related to tendencies towards whistleblowing, but these findings still do not approve the rhetoric that creates distrust towards the generation. This paper proposes a shift from the cultural to the socio-psychological level of analysis, with respect to both cultural and individual characteristics of whistleblowers, but puts more emphasis on the social dimension. In comprehending recent cases of leaking classified information, it is not enough to reduce explanation to some individual personality traits or hide behind an abstraction, such as the concept of generation. To shed more light on the issue, we introduce the concept of the imagined community, such as the open source community, promoting free Internet and transparency of information and knowledge. Therefore, mental membership in an imagined community might be more decisive for blowing the whistle than the global set of values related to the whole generation of Millennials.

5G is a critical sensitive technology that could endanger public safety. Recent progress of Huawei in the number of patents relating to 5G caused a trade war over the issue, with multiple actions from the U.S., including restrictions towards Chinese companies. This paper seeks to explore the issue of 5G around global security and the struggle for geopolitical dominance. Identified gap in the literature is related to the question if there is a safe side in terms of choices that countries make around 5G vendors. Earlier studies have not considered this question appropriately in a comprehensive way, because of one sided look and policy approach. The second question attempts to find the best solution for countries to escape dominance of 5G vendors, ensure high safety and avoid potential hazards. To put 5G technology in context, we present geopolitical issues around a global information infrastructure, provide information into China's 5G strategy and history of tech struggles between China and the United States (U.S.). We further present emerging geopolitical safety issues regarding 5G technology and elaborate Serbia's geopolitical turmoil related to 5G. In conclusion we classify countries based on their position about this issue to the West, the East and the Neutral corpuses. The focus on Serbia and politics of 5G diversity is then examined to conclude that this geopolitical position of 5G Neutrality could be beneficial for the balanced world in which new technologies will be a base for multilateral dominance. This paper is limited in technical and legal analysis of the issue. Further research should propose encryption and quality control standards together with legal framework, to ensure diversity in social interest.

State represents a social phenomenon which is constantly changing - just like all political actors. The direction of that evolution is determined by the development and current state of the art in technological domain. That explains how the rise of social media and new ICTs has shaped the contemporary political communication. This paper sheds light on the manner in which digital tools are exploited in an unpredictable social ambience which is characterized by numerous political crises. Special attention has been given to the phenomenon of digital astroturfing and political disinformation trends in Venezuela and Brazil. We have found that the dynamic technological development combined with the use of political bots has been creating the potential for fake news, thus impacting election processes and endangering democracy. Therefore, these phenomena need further scientific examination.

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.

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.

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.