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    Клинички случај на централна серозна ретинопатија
    (Лекарска комора на Македонија, 2014-06)
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    Игор Саздовски
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    Евалуација на трансплантационите техники на хируршко лекување на птеригиу и хистоморфолошка проценка на ризик од рецидив - докторска дисертација
    (2012)
    Pterygium as an active invasive inflammatory process, a key feature of which is focal limbal failure. The pterygium is a long term and recurrent illness, one that leads to permanent decrease of the visual acuity and anterior segment. Due to the inefficient prophylaxis and the frequent postoperative recurrence, the pterygium is still an intriguing problem in ophthalmology. The aim of the research was to evaluate the success rate of the surgical excision of pterygium with modification of the reconstructive method of liberal conjunctival auto transplantation with grаft from the inferior temporal bulbar conjunctiva, while at the same time to define the advantages and disadvantages of the same, compared to the method of liberal conjunctival auto transplantation with graft from the superior temporal bulbar conjunctiva. The correlation between the stationary and progressive primary pterygium and recurrent pterygium, was determined histopathologically and immunohistochemically by evaluating the fibroblastic proliferation, the degenerative changes of the connective tissue, the angiogenesis, the chronic inflammatory infiltration, the elastosis and the metaplasia of the conjunctival epithelium. Histomorphologically, the structure of the primary pterygia in stationary and progressive stadium, recurrent pterygium and healthy conjunctiva was evaluated. The tear film at the primary stationary and progressive pterygium, and the recurrent pterygium, was evaluated before and postoperative. In the prospective-retrospective study two groups of patients with primary stationary (60 patients) and progressive pterygium (60 patients) were compared, both surgically treated with two different refractive surgical methods of liberal conjunctival auto transplantation with graft from the inferior temporal or superior temporal bulbar conjunctiva. Also, a group of patients (30 patients) with recurrent pterygium was examined and treated with the modified conjunctival auto transplantation with graft from the inferior temporal bulbar conjunctiva. The surgeries were performed at the University Eye Clinic within the Medical Faculty – UKIM in Skopje in the periods of January 2001 to December 2003 and January 2009 to April 2011. The patients were continually followed before and post operatively with Haag-Streit 900 slit lamp to measure the size of the pterygium and to discover its subjective and objective complications and their nature, as well as the incidence of occurrence. Using the Snellen optotype the uncorrected visual acuity before and postoperatively was determined. Furthermore, before and postoperatively the corneal astigmatism was followed with a Javal keratometer and an auto refractometer. Before and postoperatively, the patients were photographed with Topcon Red Camera in the FFA Cabinet at the Eye Clinic. With standard tests for examination of the tear film before and post operatively are followed the patients (90 patients) operated with the modified conjunctival auto transplantation with graft from the inferior bulbar conjunctiva, as well at the Eye Clinic in the period of January 2009 to May 2011. The representative sample of pterygium and healthy conjunctiva were histopathologically, histochemically and immunohistochemically examined at the Institute of Pathology within the Medical Faculty in Skopje in the period of January 2009 to June 2011. A smaller number of early subjective and objective postoperative complications, better visual acuity, decrease of the postoperative astigmatism and smaller number of postoperative recurrence were distinguished at the patients operated with the modified surgical method with graft from the inferior temporal bulbar conjunctiva. Based on the results, the statistical research, as well as on the discussion, the following conclusions were drawn: 1. The modified surgical method with graft from the inferior temporal bulbar conjunctiva proves to be the most successful surgical method for primary stationary and progressive pterygia, as well as recurrent pterygia, based on the following advantages: a) insignificant subjective and objective postoperative complications; b) improvement of the postoperative visual acuity; c) small frequency of recurrence; d) postoperative improvement of the tear functions and the tear film; e) safe, efficient and affordable surgical method; f) outstanding esthetic results; g) preservation of the superior bulbar conjunctiva for future surgical interventions especially recommended for the glaucoma patients. 2. The intensity of the inflammation, the angiogenesis and the degenerative changes, were noted more at the primary progressive and the recurrent pterygia, and are also in correlation with the structure of the pterygium that helps predict the postoperative recurrence and the evolutionary stadium of the pterygium. 3. The correlation between the pterygium and low stability of the tear film was clearly shown by the tear film test results.
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    COMPARATIVE STUDY OF PTERYGIUM SURGERY
    (Macedonian Academy of Sciences and Arts, 2011)
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    Stankovic Babic, G
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    Zdravkovska Jankuloska, M
    Aim: To compare and evaluate the success rates of various surgical techniques of pterygium excision, including pterygium excision with complete suture of conjunctivae (PESC), pterygium excision with conjunctival auto graft transplantation with graft from the inferior temporal bulbar conjunctiva (ITBC) and pterygium excision with conjunctival auto graft transplantation with graft from the superior temporal bulbar conjunctiva (STBC). Material and methods: 120 cases with primary unilateral nasal pterygium were evaluated. Outcomes were evaluated in terms of complication and recurrence after pterygium excision. The patients were divided into 3 groups: 1. Group of 40 patients with primary pterygium (pterygium’s length over the cornea 1,0 mm and more) treated by the technique of pterygium excision with complete suture of conjunctiva (PESC). 2. Group of 40 patients with primary pterygium (pterygium’s length over the cornea 1,0 mm and more) treated by the technique of pterygium excision with the conjunctival auto graft transplantation with graft from the inferior temporal bulbar conjunctivae(ITBC). 3. Group of 40 patients with primary pterygium (pterygium’s length over the cornea 1,0 mm and more) treated by the technique of pterygium excision with conjunctival auto graft transplantation with graft from the superior temporal bulbar conjunctivae(STBC). Results: Mean follow up time after the surgery was 15 months (6 to 24 months). 12 out of 40 (30%) recurred after the pterygium excision with complete suture of conjunctivae (PESC). Three out of forty (7,5%) pterygium recurred after the modified surgical techniques of pterygium excision with conjunctival auto graft transplantation with graft from the inferior temporal bulbar conjunctiva (ITBC). Five out of forty (10,2%) recurred after the pterygium excision with conjunctival auto graft transplantation with graft from the superior bulbar conjunctivae (STBC). All the recurrences (8 cases) in both pterygium groups treated by the transplantation procedures were after excision of progressive pterygium when the pterygium reaches more than 3 mm of corneae. Only one surgeon performed all 120 surgeries. Conclusion: A comparison of the group’s demonstrated that the recurrence rate was highest in the group without transplantation, using only complete suture of the conjunctiva. The excision of pterygium with conjunctival autograft transplantation from the inferior or superior temporal bulbar conjunctiva are highly efficient in terms of low recurrence rates. The modified surgical technique using the graft from the inferior temporal bulbar conjunctivae is preferred because the superior bulbar conjunctiva is intact for eventual future surgical intervention.
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    Перфоративни повреди на око здобиени во воен конфликт
    (Меѓународен комитет на Црвен крст, 2001)
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    Антова Велевска М.
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    Ивановска М.
    Вовед: Повредите на окото во воени услови се се почести и потешки. Перфоративните повреди најчесто се предизвикани од остри страни тела или страни тела кои се движат со голема брзина, од магнетна или од не магнетна приода присатни интрабулбарно или не. Перфоративни повреди се: 1. Perforatio Simplex (со влезно перфоративна рана), 2. Perforatio Duplex или пенетрантна повреда (со влезна и излезна перфоративна рана). Цел: Приказ на случаи со перфоративни повреди на очното јаболко лекувани на Клиниката за очни болести од март до крајот на август 2001ва година. Материјал и метод: Пациент со пенетрантна повреда без страно тело и 4 пациенти со Perforatio Simplex од кои еден пациент со интра булбарно страно тело, еден пациент со страно тело во м. ректи интерни и двајца пациенти со странотело субконјунктивално. Сите пациенти биле хируршки обработени со примарна хируршка тоалета на булбус, а секундарно е изведена парсплана витректомија кај пациент со пенетрантна повреда и пациент со перфоративна симплекс повреда со страно тело интрабулбарно. Дискусија: Успехот на лекувањето зависи од брзата дијагностика, благовремено и правилно лекување, локализација и големина на разорување на структурите на очното јаболко и брзиот транспорт во лежечка положба до офталмолог хирург. Триажата на перфоративните повреди е од втор ред на итност. Заклучок: Употребата на соодветен протокол на лекување треба да се примени веднаш уште во првите санитетски етапи со превентивна антибиотска и антитетаничка профилакса. Оптималното време за давање на дефинитивната специјалистичка помош е во интервал од 6 до 12 часа по настанувањето на повредата.
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    РЕТИНАЛЕН ВАСКУЛИТИС КАКО ЕДНА ОД МАНИФЕСТАЦИИТЕ НА COVID 19
    (SHMSHM / AAMD, 2022-08)
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    Трпеска, Ана
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    Јованов, Зоран
    Цел: Да се прикаже случај на ретиналенваскулитис кај пациент со потврдена инфекција со вирусот SARS-CoV-2. Презентација на случај: Пациент на возраст од 37 години, маж, се јави на офталмолошки преглед поради заматеност на видот на десното око. Кај пациентот беше потврдена инфекција со вирусот SARS-CoV-2 со ПЦР тест, 7 дена пред јавување на офталмолошките симптоми. Резултати: Најдобрата видна острина со корекција на десното око беше 0.9, а на левото 1,0. Интраокуларниот притисок беше во граници на нормала на двете очи. При прегледот, предниот сегмент на двете очи беше нормален. Кај десното око е забележан витритис, додека витреалното тело на левото око беше без знаци за инфламација. На задниот сегмент на десното око, се забележа следниов наод-папилата на очниот нерв беше побледа и со нејасна граница во горната и долна половина, присутни беа cotton woоl плаки, поединачнимекиексудати и хеморагии по целата медиоретина и средна периферија.Венските крвни садови беа обвиткани со муфови, додека долж долната артериска темпорална гранка се пратеше исхемија. Кај фундусот на левото око присутни беа сите погоре опишани знаци на васкулит, забележано беше сиво-беличестапапила на оптичкиот нерв, со нормалнапрстеновидна јасно ограничена граница, освен во назалната половина, каде границата јасно не се пратеше.Направени беа ОКТ и Флуресцеинскaангиографија. На ОКТна десно око се забележа проширување помеѓу надворешнитеретиналнислоеви и плексиформниот слој како и лесен дисконтинуитет на пигментниот епител во макуларната регија, додека на левото око се забележаа бројни цистоиднипроширувањапомеѓу надворешниот ретинален слој и плексиформниот слој. При направената флуресцеинскaангиографија, по дадената системска и локална терапија,на десниот ангиограм се забележа недостаток на флуресценција во горната и долна темпорална периферна артерија и закаснето исполнување на венските крвни садови кои ги пратат опишаните артерии-артериоли. Ангиограмот на левото око беше со нормален наод при што макулата остана нема. Пациентот беше поставен на локална и системска кортикостероидна терапија, антикоагулантна терапија, даден бешеи протектор на гастрична лигавица. Заклучок: Офталмолошките манифестации при инфекција со SARS-CoV-2 не треба да се занемаруваат во однос на лекувањето на инфекцијата на другите органи, односно потребно е рано препознавање и правилно и навремено лекување.
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    ACANTAMOEBA KERATITIS-a case report
    (Ophthalmological Society of Northern Greece, 1998)
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    Antova Velevska M.
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    Bron A.
    Acanthamoeba keratitis still is a problem in ophthalmology because of diagnostic and therapeutic difficulties. To date, Acanthamoeba keratitis is an increasing pathology because of the more widespread use of the contact lenses. The patient was 22 year old myopic student, soft lens wearer. He complained of progressive pain and redness in his left eye since a week. The patient was unsuccessfully treated with topical antibiotics and steroids, including antiviral and antihistamininics. After three months, he complained redness and photophobia with comeal ulcer and Acantamoeba keratitis was suspected. Methods :the essential parasitological diagnosis was confirmed after comeal scarping inoculation onto agar with lown of Eschericia coli and morphological identification and according to the Pussard and Pons classification were done .A therapy with 0,02 PHMB for three months with prolonged decreasing dosage has begun with resolution of the infection. Conclusion: success factor for diagnosis and therapy are early identification of the parasite and the use of intensive therapy with 0,02%PHMB for considerable period of time.
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    Ocular findings in patients with Down syndrome
    (Montenegrin Society of Ophthalmology, 2015)
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    Ismaili, Iljaz
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    Pterygium excision with limbal autograft transplantation and its histopathological caracteristics of the epithelium
    (2015)
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    INTRODUCTION: Pterygium is a chronic fibro vascular and degerenative process and originates from the basal limbal stem cells. AIM: The eximination of morphology and cytoceratin expresion of the epithelium of primary stationary and progressive pterygium. Also the method of pterygium excision with limbal autographt transplantation was evaluated. The post operative complications as recidives were evaluated. MATHERIAL AND METHOD: Impression cytology and imunohistohemical staining with antikeratin antibodies were performed in 140 eyes with pterygium. The pterygium was surgically excised using the limbal grapht from imferior or superior bulbar conjunctiva. Avidin – Biotin (ABC and LSAB) technique was performed for the imuno histochemical investigation of the tissue slides of pterygium on Poly-L-lysine-glasses. RESULTS: There were epithelial diversity in the tissues slides of primary stationary and progressive pterygium. Diversity of epithelium was found between the different cuts of the same pterygium depending which part of the pterygium was examined. The areas of squamous epithelial prone to keratinisations was relatively frequent. Also there were areas of erosion and even dysplastic areas. Goblet cells were found isolated or associated and were intensively PAS positive. The post operative incidence of recidivating pterygium was 7%. CONCLUSION: Pterygium shows significant changes in the epithelium even in the different slides of the same pterygium and its not associated with the stadium of the primary pterygium. Pterygium excision with limbal autographt transplantation is a surgical method of choice for primary stationary and progressive pterygium.