<p>Katarakta i glaukom su po svom toku hronične i progresivne bolesti koji predstavljaju dva vodeća uzroka slepila u svetu. Obe bolesti su karakteristične za stariju životnu dob i često se sreću zajedno kod iste osobe. Katarakta podrazumeva hirur&scaron;ko lečenja, dok se lečenje glaukoma zasniva na snižavanju visine intraokularnog pritiska (IOP), medikamentoznim i hirur&scaron;kim sredstvima. Cilj ovog istraživanja bio je da se utvrdi da li i u kojoj meri dolazi promene IOP-a i dubine prednje komore oka (ACD) nakon operacije katarakte, da li su preoperativne vrednosti IOP-a i ACD povezane sa postoperativnom visinom IOP-a i da li postoje razlike u ovim pojavama kod osoba operisanih od katarakte sa i bez prisutnog primarnog glaukoma otvorenog ugla (POAG). Rezultati ove studije pokazuju da postoji statistički značajno sniženje IOP-a 6 meseci nakon operacije katarakte. U poređenju sa preoperativnim vrednostima, ono iznosi prosečno 1,2 mmHg (7,5%) u grupi pacijenata bez POAG i 1,24 mmHg (6,49%) u grupi pacijenata sa POAG. Između dve grupe pacijenata nije postojala razlika u stepenu sniženja (p&gt;0,05). Ustanovljen je statistički značajano veći (p&lt;0,05) porast dubine ACD u grupi pacijenata sa POAG (1,03 mm; 34,8%) u odnosu pacijente bez glaukomske bolesti (0,92 mm; 30,37%). Rezultati korelacione analize, kao i regresionih univarijantih i multivarijantnih modela, pokazali su da statistički značajna povezanost postoji između preoperativne visine IOP-a i njegovog sniženja nakon operacije katarakte. Povezanost je bila pozitivnog smera i nije se uočena značajna razlika između obe grupe pacijenata. Ustanovljena je i pozitiva korelacija, bez statistički značajne razlike u obe grupe pacijenata, između PD indeksa (odnos preoperativnog IOP-a i ACD) i promene IOP-a nakon operacije katarakte. Preoperativna dubina prednje komore oka nije ispoljila povezanost sa postoperativnom promenom IOP-a. Na&scaron;a studija je pokazala statistički značajno postoperativno sniženje IOP-a i povećanje dubine ACD nakon operacije katarakte, koja se održava &scaron;est meseci nakon operacije katarakte. Nije ustanovljena razlika u redukciji IOP-a između pacijenata sa i bez POAG. Ustanovljena je pozitivna korelacija preoperativne visine IOP-a i PD indeksa sa postoperativnom promenom IOP-a, &scaron;to može biti od koristi prilikom odluke o optimalnom lečenju katarakte kod pacijenata sa POAG.</p> / <p>Cataract and glaucoma are chronic and progressive diseases and they are two of the leading causes of blindness wold wide. Both diseases are typical for an older age and often coincide within the same person. Treatment of cataract is surgical, while glaucoma treatment is based on lowering the level of intraocular pressure (IOP) with various medical and surgical options. The aims of this research were to determine whether there is a change in IOP and in the depth of anterior chamber of the eye (ACD) after cataract surgery, whether preoperative values of IOP and ACD are related to postoperative IOP values and to determine if there are differences in these events between people operated from cataract with or without primary open angle glaucoma (POAG). Results of this study show that there is a statistically significant decrease of IOP six months after cataract surgery. Comparing with preoperative values, it was found to be 1.2 mmHg (7.5%) in group of patients without POAG, and 1.24 mmHg (6.49%) in patients with POAG. There was no statistically significant difference found between two groups of patients (p&lt;0.05). Group of patients with POAG had significantly higher (p&lt;0.05) deepening of ACD (1.03 mm; 34.8%), in comparison with patients with no glaucoma (0.92 mm; 30.37%). Results of correlation analysis, as well as univariate and multivariate regression models, have shown significant correlation of preoperative IOP and its reduction after cataract surgery. Correlation was of positive direction with no statistically significant differences among two groups of patients. There was a positive correlation found, with no statistically significant differences in both groups of patients, between PD index (ratio of preoperative IOP and ACD) and IOP change after cataract surgery. Preoperative anterior chamber depth has shown no correlation with postoperativeIOP change. Our study showed statisticallysignificant postoperative reduction ofIOP and deepening of ACD, lasting for six months aftercataract surgery. No difference inpostoperativeIOP decrease has been detected betweenpatients with or without POAG. A positivecorrelation of preoperativeIOP height and PDindex with postoperativeIOP change has beenestablished, which mayprove usefulfordecision of optimal treatmentof cataract among POAG patients.</p>

This thesis is focused on texture analysis methods. The project contains an overview of widely used methods. The main aim of the thesis is to develop a method for texture analysis of retinal images, which will be used for distinction of two patient groups, one with glaucoma eyes and one healthy. It is observed that glaucoma patients don´t have a texture on the eye ground. Preprocessing of the images is found by transfer of the image to different color spaces to achieve the best emphasis of the eye ground texture. Co-occurrence matrix is chosen for texture analysis of this data. The thesis contains detail description of the chosen solutions and feature discussion and the result is a list of features, which can be used for distinction between glaucoma and healthy eyes. The method is implemented in Matlab environment.

This thesis is deals with the nerve fibre layer in the colour ophthalmology images of retina. The thesis describes how can we use finding of nerve fibre layer and how was it solved in the past. In the thesis are proposed the methods that are based on processing and scoring frequency spectrums of individual sample of retina. At first here are described the methods of detection on the artificial generated samples that just simulate the nerve fibre layer. Then the thesis concentrates on processing of real images of retina. Because of the bloodstream, that depreciates processing at real images, are all surveyed samples are chosen manually. Except detection the nerve fibre layer itself, the thesis also deals with determination of direction their dissemination.

This work deals with mathematical description of nerve fiber bundle trajectories for the diagnosis of glaucoma. Also gives a brief explanation in the principle of fundus camera and glaucoma. Its aim is to implement the model into MATLAB software, to project a~methodics of its use and also to realize it.

<p>Cilj ovog istraživanja bio je da se utvrdi razlika u debljini sloja retinalnih nervnih vlakana (RNFL) i parametara glave očnog živca kod pacijenata sa preperimetrijskim glaukomom i pacijenata sa glaukomom otvorenog ugla (POAG) u odnosu na zdravu populaciju, kao i da se utvrdi razlika u debljini RNFL i parametara glave očnog živca kod pacijenata sa POAG u odnosu na stepen progresije bolesti. Materijal i metode: U ovu kliničku, analitičku i opservacionu, po tipu &bdquo;slučaj-kontrola&ldquo; studiju, bilo je uključeno 120 pacijenata. Na osnovu kliničkog nalaza formirane su četiri grupe. Prva grupa (grupa zdravih): 30 pacijenata bez glaucoma i drugih očnih bolesti. Druga grupa (grupa sa početnim POAG): 30 pacijenata sa POAG, sa karakterističnim o&scaron;tećenjem glave očnog živca i RNFL, kod kojih je srednja vrednost devijacije standardizovane automatske perimetrije MD&lt;-6dB (prema Hodap klasifkaciji) sa karakterističnim glaukomskim ispadima u vidnom polju. Treća grupa (grupa sa srednje uznapredovalim POAG): 30 pacijenata sa POAG, kod kojih je srednja vrednost devijacije standardizovane automatske perimetrije MD od -6dB do -12dB (prema Hodap klasifkaciji). Četvrta grupa (grupa sa preperimetrijskim glaukom): 30 pacijenata sa promenama na glavi očnog živca karakterističnim za glaukomsku neuropatiju, kod kojih ne postoje funkcionalni ispadi tj. standardna automatizovana perimetrija pokazuje normalne vrednosti MD parametara (od -2 dB do +2dB). Kod svih pacijenata bio je urađen kompletan oftalmolo&scaron;ki pregled, kompjuterizovano vidno polje i optička koherentna tomografija peripapilarne regije RNFL i glave očnog živca (na aparatu Stratus OCT 3000, Carl Zeiss Meditec). Rezultati su pokazali da je debljina RNFL-a kod pacijenata sa početnim POAG manja u odnosu na zdravu populaciju. Najveće sniženje debljine RNFL je u sektorima 1,6,7 i 8h. Jedino u sektoru 4h i 9h ne dolazi do smanjenja debljine RNFL-a. Najveće smanjenje debljine RNFL je u gornjem i donjem kvadrantu, te oni imaju visoku specifičnost za diskriminaciju između zdravih i pacijenata sa početnim POAG. Parametri glave očnog živca: volumen ekskavacije, vertikalni C/D, horizontalni C/D i ukupni C/D odnos kod pacijenata sa početnim POAG povećani su u odnosu na zdravu populaciju. Parametri glave očnog živca: povr&scaron;ina neuroretinalnog oboda i volumen neuroretinalnog oboda, kod pacijenata sa početnim POAG smanjeni su u odnosu na zdravu populaciju. Debljina RNFL kod pacijenata sa srednje uznapredovalim POAG smanjena je i u odnosu na pacijente sa početnim POAG i u odnosu na zdravu populaciju (59,69&plusmn;10,63 &mu;m vs 73,44&plusmn;12,16&mu;m vs 105,57&plusmn;11,34 &mu;m). Parametri glave očnog živca prate ove promene. Ukupna povr&scaron;ina glave očnog živca se statistički značajno ne menja između zdravih osoba, pacijenata sa početnim i srednje uznapredovalim glaukomom otvorenog ugla i kod pacijenata sa preperimetrijskim glaukomom, te ovaj parametar ne determini&scaron;e glaukomsku bolest. Postojanje i napredovanje glaukoma kod pacijenata dovodi do istanjenja&nbsp; peripapilarnog RNFL &scaron;to je praćeno povećanjem ekskavacije glave očnog živca. Sa smanjenjem MD vrednosti dolazi do sledstvenih promena većine parametara. Postoji pozitivna korelacija između uznapredovalosti galukoma i srednje vrednosti debljine RNFL. Promena ove vrednosti najbolje pokazuje da dolazi do progresije POAG. Parametri glave očnog živca koji najbolje oslikavaju progresiju glaukoma su: ukupni C/D, vertikalni C/D i horizontalni C/D odnos. Debljina RNFL-a kod pacijenata sa preperimetrijskim glaukomom je značajno manja u od nosu na zdravu populaciju (83,65&plusmn;9,24&mu;m vs 105,57&plusmn;11,34&mu;m). To se posebno izražava u gornjem kvadrantu, dok u temporalnom kvadrantu ne dolazi do promena. Parametar S zajedno sa srednjom vrednosti debljine RNFL predstavljaju najbolje pokazatelje nastajanja preperimetrijskog glaukoma. Sektor 1h je sektor sa visokom specifično&scaron;ću za diskriminaciju izmeĎu zdravih i pacijenata sa preperimetrijskim glaukomom. Parametri glave očnog živca: volumen ekskavacije, vertikalni C/D, horizontalni C/D i srednji C/D odnos, kod pacijenata sa preperimetrijskim glaukomom statistički su značajno povećavani i u odnosu na zdravu populaciju. Parametri glave očnog živca: povr&scaron;ina neuroretinalnog oboda i volumen neuroretinalnog oboda, kod pacijenata sa preperimetrijskim glaukomom statistički su značajno manji u odnosu na zdravu populaciju. Najbolji prediktori nastanka i napredovanja glaukomske bolesti su sledeći parametri: AvgThic, debljina RNFL po kvadrantima-S,I,N; parametric debljine RNFL: Smax, Savg, Iavg; kao i parametri PNO: RimArea, RimVol, DiscArea, CupAear, C/DHorRat, C/DVertRat, C/DAreaRat. ROC kriva je pokazala da su sledeću parametri lo&scaron;i marker za progresiju bolesti: debljine RNFL kavdranta T, Imax i upVol. Zaključak: Određivanje parametara glave očnog živca i debljine peripapilarnih RNFL kod pacijenata sa glaukomom, optičkom koherentnom tomografijom, predstavlja metodu koja izdvaja pacijente sa preperimetrijskim glaukomom od zdrave populacije. Ono posebno ukazuje na sektore, kvadrante i parametre koji su najosetljiviji na glaukomsku noksu i koji prvi postaju patolo&scaron;ki pri nastanku glaukoma. Takođe, ukazuje i na razliku između pojedinih stepena glaukomske bolesti. Na ovaj način se omogućuje sigurna i rana dijagnoza glaukoma, njegovo pravovremeno lečenje i bolja prognoza kod pacijenata sa POAG.</p> / <p>Aim: The aim of this study was to determine the difference in thickness of retinal nerve fibre layer (RNFL) and parameters of optic nerve head in patients with preperimetric glaucoma and in patients with open angle glaucoma (POAG) in comparison to healthy population, as well as to determine the difference in thickness of RNFL and parameters of optic nerve head in patients with POAG according to progression of the disease. Material and methods: This clinical study was analytical and opservational, &bdquo;case-control&ldquo; type of study. 120 patients were included. On the basis of clinical finding 4 groups were formed. First group (healthy): 30 patients without glaucoma and with no other ocular disease. Second group (group of patients with mild POAG): 30 patients with POAG, with characteristical optic nerve head and RNFL damage, in whom the value of standard deviation of standardised automatic perimetry is MD&lt;-6dB (according to Hodap classification) with typical glaucomatous visual field defects. Third group (group of patients with moderate POAG): 30 patients with POAG in whom the mean value of standard deviation of standardised automatic perimetry, MD is from -6dB to -12dB (according to Hodap classification). Fourth group (group of patients with preperimetric glaucoma): 30 patients with changes of optic nerve head that are typical of glaucomatous neuropathy in whom there are no functional changes and with normal values of MD parameters of standardised automatic perimetry. In all patients complete ophthalmological examination, complete visual field and optic coherent tomography of peripapillar region of RNFL and optic nerve head (using Stratus OCT 3000, Carl Zeiss Meditec) were performed.The results showed that thickness of RNFL in patients with mild POAG is lesser than in healthy subjects. The greatest decrease in RNFL thickness is in sectors 1,6,7 and 8h. Only in sectors 4h and 9h there is no decrease in RNFL thickness. The greatest decrease in RNFL thickness is in upper and lower quadrant, so they are highly specific in determination between healthy subjects and patients with mild POAG. Parameters of optic nerve head such as: excavation volume, vertical C/D, horisontal C/D and total C/D ratio in patients with mild POAG are higher comparing to healthy population. Parameters of optic nerve head such as: neuroretinal rim area and neuroretinal rim volume in patients with mild POAG are lower than in healthy population. RNFL thickness in patients with moderate POAG is lesser than in patients with mild POAG, as well as in healthy subjects. Optic nerve head parameters follow these changes. Total optic nerve head area does not change in healthy subjects, in patients with mild and moderate open angle glaucoma and in patients with preperimetric glaucoma, so this parameter does not determine glaucomatous disease. The existence and progression of glaucoma in patients leads to thinning of peripapillar RNFL which is followed by increase of excavation of optic nerve head. With decrease of MD value there are consecutive changes in most parameters. There is positive correlation between progression of glaucoma and average thickness of RNFL. The change of this value shows the best if there is progression of POAG. Paremeters of optic nerve head that are the best determinants of progression of glaucoma are: total C/D, vertical C/D and horisontal C/D ratio. Thickness of RNFL in patients with preperimetric glaucoma is significantly lesser than in healthy subjects. It is particularly seen in upper quadrant, while in temporal quadrant there are no changes. Parameter S together with mean value of RNFL thickness is the best parameter of appearance of preperimetric glaucoma. Sector 1h is the sector that is highly specific in discrimination between healthy subjects and patients with preperimetric glaucoma. Optic nerve head parameters such as: volume of excavation, vertical C/D, horizontal C/D and C/D mean ratio in patients with preperimetric glaucoma are statistically significantly higher than in healthy population. Optic nerve head parameters such as: neuroretinal rim area and neuroretinal rim volume in patients with preperimetric glaucoma are statistically significantly lower than in healthy population. The best predictors of appearance and progression of glaucomatous disease are: AvgThic, RNFL thickness in quadrants: S,I,N; RNFL:Smax, Savg, Iavg; as well as PNO: RimArea, RimVol, DiscArea, CupAear, C/DHorRat, C/DVertRat, C/DAreaRat. ROC curve has shown that the following parameters are bad markers for progression of the disease: RNFL thickness in quadrant T, Imax and CupVol. Conclusion: Determination of parameters of optic nerve head and peripapillar RNFL in patients with glaucoma using optical coherent tomography represents the method that distinguishes the patients with preperimetric glaucoma from healthy subjects. It particularly points the sectors, quadrants and parameters that are the most sensitive to glaucomatous disease and that first become pathological when disease appears. It also indicates the difference between certain levels of glaucomatous disease. In this way safe and early diagnosis of glaucoma is provided, as well as adequate therapy and better prognosis in patients with POAG.</p>

Ralph Schönfelder Untersuchungen zum Einfluss verschiedener Dosierungsintervalle von Dorzolamid, Dorzolamid-Timolol und Latanoprost auf den Intraokulardruck normotensiver Hunde Klinik für Kleintiere, Veterinärmedizinische Fakultät der Universität Leipzig Eingereicht im März 2010 Bibliografische Angaben: 93 S., 27 Abb., 14 Tab., 224 Lit., Anhang mit 2 Abb., 4 Tab. Schlüsselwörter: Glaukom, Intraokulardruck, Prostaglandine, Karboanhydrasehemmer, Timolol, Hund Das Glaukom beim Hund ist ein Notfall, der eine rasche Senkung des erhöhten Intraokulardruckes verlangt, um dem Verlust der Sehfähigkeit und den auftretenden Schmerzen entgegen zu wirken. Die medikamentöse Behandlung ist dabei ein wichtiger Bestandteil. Das Ziel der vorliegenden Arbeit war es, den Effekt der lokal applizierten Wirkstoffe Dorzolamid, Dorzolamid-Timolol und Latanoprost zur Senkung des Intraokulardruckes bei verschiedenen Dosierungsintervallen zu untersuchen. Für jeden Wirkstoff wurden an vier aufeinander folgenden Tagen tonometrische Messungen des Intraokulardruckes mit dem Tonopen-XL als Kontrolle durchgeführt. Anschließend erfolgte eine Verlaufsuntersuchung, in welcher der Einfluss jedes der drei Wirkstoffe auf den Intraokulardruck bei ein- und zweimal täglicher Applikation jeweils vier Tage lang untersucht wurde. Dabei erfolgten Messungen von Intraokularduck, Pupillendurchmesser und konjunktivaler Irritation beider Augen von zehn Hunden (Beagle) jeweils 8.00; 10.00; 12.00; 16.00; 20.00; 22.00; 24.00; 4.00 Uhr. Bei dreimal täglicher Applikation von Dorzolamid und Dorzolamid-Timolol erfolgten zusätzlich 7.00, 15.00 und 23.00 Uhr Tonometrien. Die einmalige Applikation des Wirkstoffes erfolgte 8.00, die zweimalige Applikation 8.00 und 20.00 Uhr sowie 7.00, 15.00 und 23.00 Uhr die dreimalige Applikation. Für jeden Wirkstoff wurde an Tag fünf, nach Beendigung der Applikationen, die Normalisierung des Intraokulardruckes überprüft. Die Ergebnisse wurden nach Applikationshäufigkeit sowie vergleichend analysiert. Dies erfolgte mittels Friedman-Test für drei und mehr k-verbundene Stichproben als Zwei-Weg Varianzanalyse. Ohne Dorzolamidapplikation betrug der Mittelwert des Intraokulardruckes ± SEM am 91 ersten Tag 12,3 ± 0,5 sowie am zweiten, dritten und vierten Tag 12,5 ± 0,4 mmHg, 11,2 ± 0,4 mmHg und 11,0 ± 0,4 mm Hg. Die einmal tägliche Applikation von Dorzolamid führte mit 7,6 ± 0,4 mm Hg am ersten Tag sowie nachfolgend 8,7 ± 0,3 mmHg, 8,6 ± 0,2 sowie 8,3 ± 0,2 mm Hg zu einer signifikanten Drucksenkung. Die zweimalige Applikation von Dorzolamid wies mit 9,6 ± 0,4 mmHg am ersten Tag sowie 7,4 ± 0,4 mmHg, 6,7 ± 0,3 mmHg und 6,6 ± 0,3 mmHg am zweiten, dritten und vierten Tag, das größte Potential zu einer signifikant stärkeren Absenkung des Intraokulardruckes im Vergleich zu Dorzolamid-Timolol und Latanoprost auf. Nach dreimal täglicher Applikation von Dorzolamid trat mit 8,0 ± 0,2 mmHg am ersten Tag und 7,0 ± 0,3 am zweiten sowie 7,6 ± 0,3 mm Hg am dritten und vierten Tag, eine signifikant stärkere, den Intraokulardruck senkende Wirkung im Vergleich zu Dorzolamid-Timolol ein. Ohne Applikation von Dorzolamid-Timolol lag der Mittelwert des IOD ± SEM vom ersten bis vierten Tag bei 10,6 ± 0,4 mmHg, 11,6 ± 0,5 mm Hg, 11,6 ± 0,6 mmHg und 11,2 ± 0,4 mmHg. Bei einmal täglicher Applikation wurden vom ersten bis vierten Tag folgende Werte mit signifikanter Senkung des IOD bestimmt: 7,6 ± 0,4 mmHg, 7,1 ± 0,3 mmHg, 8,6 ± 0,3 mmHg und 9,6 ± 0,3 mmHg. Bei zweimal täglicher Applikation lag der Mittelwert des IOD bei 9,8 ± 0,5 mmHg, am zweiten bis vierten Tag 8,2 ± 0,4 mmHg, 8,6 ± 0,4 mmHg und 7,3 ± 0,2 mmHg. Die dreimalige Applikation führte zu einem Mittelwert des IOD von 8,1 ± 0,3 mmHg am ersten Tag sowie 8,7 ± 0,3 mmHg, 7,8 ± 0,3 mmHg und 7,3 ± 0,3 mmHg am zweiten bis vierten Tag der Studie. Bei der Untersuchung von Latanoprost lag der Mittelwert des IOD ± SEM ohne Applikation bei 9,9 ± 0,3 mmHg am ersten sowie 10,0 ± 0,3 mmHg, 10,0 ± 0,3 mmHg und 9,8 ± 0,2 mmHg am zweiten bis vierten Tag. Bei einmaliger Applikation lag dieser entsprechend bei 9,8 ± 0,3 mmHg, 8,7 ± 0,2 mmHg, 9,0 ± 0,3 und 10,1 ± 0,4 mmHg Nach zweimaliger Applikation betrug er am ersten Tag 9,9 ± 0,3 mmHg, am zweiten bis vierten Tag 9,3 ± 0,4 mmHg, 8,9 ± 0,4 mmHg sowie 8,9 ± 0,3 mmHg. Der Einfluss alller drei Wirkstoffe auf den mittleren Pupillendurchmesser wurde untersucht. Bei einmal- und zweimal-täglicher Applikation von Latanoprost trat mit einer Differenz im Median von 2,5 bzw. 4,7 im Vergleich ohne Applikation eine ausgeprägte Miosis auf. Schließlich wurde die Wirkung auf die Bindehaut durch Ermittlung des Grades der konjunktivalen Irritation bestimmt. Die Applikation von Latanoprost führte dabei zu deutlichen Reizungen der Konjunktiva bis hin zu verstärkter Hyperämie, in einigen Fällen zu konjunktivalem Ödem sowie vereinzelt zu Juckreiz.

Die vorliegende Arbeit diskutiert methodische Aspekte und Ergebnisse eigener pharmakoepdemiologischer Untersuchungen zum Risiko von okulärer Hypertension, Glaukom und Katarakt unter verschiedenen Darreichungsformen von Glukokortikoiden. Prospektive Studien der frühen 60er Jahre haben gezeigt, daß die Verabreichung topischer Glukokortikoide am Auge bei ca. einem Drittel der Bevölkerung zu einem Augeninnendruckanstieg führt. Bei langdauernder Therapie kann sich ein Kortikosteroidglaukom entwickeln, das in seiner Symptomatik und den klinischen Befunden einem primären Offenwinkelglaukom entspricht. Für orale Glukokortikoide untersuchten wir das Risiko von okulärer Hypertension und Offenwinkelglaukom in einer großen Fall-Kontroll-Studie, die 9.793 augenärztliche Patienten mit neu diagnostizierter okulärer Hypertension und Offenwinkelglaukom einschloß und 38.325 augenärztliche Kontrollpatienten ohne diese Erkrankungen. Die Einnahme oraler Glukokortikoide war mit einem Risikoanstieg von über 40% verbunden. Es zeigte sich ein deutlicher Anstieg des Risikos mit zunehmender Glukokortikoid-Tagesdosis: Für Patienten, die mehr als 80 mg Hydrokortisonäquivalent pro Tag erhalten hatten, war das Risiko über 80% erhöht. Unsere Berechnungen zeigten, daß unter solch hohen Dosen 93 zusätzliche Fälle von okulärer Hypertension oder Offenwinkelglaukom pro 10.000 Patienten und Jahr auftreten können. In derselben Fall-Kontroll-Studie analysierten wir auch das Risiko für inhalative und nasale Glukokortikoide. Zwar ist für diese Glukokortikoidformen das Risiko systemischer Glukokortikoidnebenwirkungen durch die topische Applikation deutlich reduziert, doch legen verschiedene klinisch-pharmakologische Untersuchungen nahe, daß inhalative Glukokortikoide in hoher Dosierung systemische Effekte ausüben können. Verschiedene Einzelfallberichte ließen ein erhöhtes Risiko von okulärer Hypertension und Glaukom für inhalative und nasale Glukokortikoide möglich erscheinen. Unsere Fall-Kontroll-Studie zeigte, daß inhalative Glukokortikoide, wenn sie in hohen Tagesdosen kontinuierlich über 3 Monate verabreicht werden, das Risiko von okulärer Hypertension und Offenwinkelglaukom um über 40% erhöhen. Wir beobachteten kein erhöhtes Risiko für nasale Glukokortikoide. In einer weiteren Fall-Kontroll-Studie untersuchten wir das Kataraktrisiko für inhalative Glukokortikoide. Orale Glukokortikoide sind ein etablierter Risikofaktor für eine Katarakt. Für inhalative Glukokortikoide lagen widersprüchliche Studienergebnisse vor. Während mehrere kleine Studien an Kindern kein erhöhtes Risiko gezeigt hatten, war in einer großen populationsbasierten australischen Studie ein erhöhtes Kataraktrisiko unter inhalativen Glukokortikoiden beobachtet worden. Wir konnten das Ergebnis der australischen Studie in unserer Fall-Kontroll-Studie bestätigen, die 3.677 Fallpatienten und 21.868 Kontrollpatienten einschloß. Eine Verabreichung inhalativer Glukokortikoide über mehr als 3 Jahre führte zu einer Verdreifachung des Risikos einer Kataraktextraktion. Das Risiko war nur für hohe Dosen inhalativer Glukokortikoide statistisch signifikant erhöht, nicht jedoch für niedrige bis mittlere Tagesdosen. Zusammengefaßt zeigen die Ergebnisse unserer Studien, daß inhalative Glukokortikoide in hoher Dosierung trotz topischer Applikation zu systemischen Glukokortikoidkomplikationen am Auge führen können. Dies läßt es geboten erscheinen, bei Patienten, die inhalative Glukokortikoide in hoher Dosierung erhalten, augenärztliche Kontrolluntersuchungen durchführen zu lassen / This work presents methodological aspects and results of own pharmacoepidemiologic studies investigating the risk of ocular hypertension, glaucoma and cataract for different forms of glucocorticoids.. Prospective studies of the early 60ies have shown that administration of topical glucorticoids at the eye will lead to ocular hypertension in about one third of the population. If ophthalmic glucocorticoid treatment is prolonged, a corticosteroid glaucoma may develop which closely resembles primary open-angle glaucoma.. We investigated the risk of ocular hypertension or open-angle glaucoma for oral glucocorticoids in a large case-control-study which included 9,793 ophthalmology patients with newly diagnosed ocular hypertension or open-angle glaucoma and 38,325 ophthalmology patients without these diseases (controls). Intake of oral glucocorticoids led to an increase in risk by over 40%. The risk increased markedly with the daily dose of glucocorticoid. For patients who had received more than 80 mg hydrocortisone-equivalent per day, the risk was more than 80% elevated. Our calculations showed that for such high doses, 93 additional cases of ocular hypertension or glaucoma per 10,000 patients and year may be expected. In the same case-control study, we analysed the risk of ocular hypertension and open-angle glaucoma for inhaled and nasal glucocorticoids. These forms of glucocorticoids have been developed to reduce the risk of systemic glucocorticoid complications by topical administration. Some clinical pharmacology studies have shown that high doses of inhaled glucocorticoids may cause systemic effects. Some published case reports suggested an increased risk of ocular hypertension and glaucoma for inhaled and nasal glucocorticoids. Our case-control study showed that high dose, continuous administration of inhaled glucocorticoids for more than 3 months increases the risk of ocular hypertension or open angle glaucoma by more than 40%. We did not observe an increased risk for nasal glucocorticoids. In another case-control study, we investigated the risk of cataract for inhaled glucocorticoids. Oral glucocorticoids are an established risk factor for cataract. For inhaled glucocorticoids, there have been contradictory results from several studies. Whereas some small studies in children did not show an increased risk, a population-based larger study from Australia demonstrated an elevated risk. We confirmed this increase in risk in our case-control study which included 3,677 elderly cases and 21,868 elderly controls. We observed a more than 3-fold risk of cataract extraction in patients who had been treated with inhaled glucocorticoids for more than three years. The risk was significantly increased only for high daily doses of glucocorticoids, but not for low-to-medium doses. In summary, the results of our studies show that high doses of inhaled glucocorticoids despite their topical administration may lead to systemic complications of glucocorticoids at the eye. Therefore it is recommended to have patients who are prescribed high daily doses of inhaled glucocorticoids examined by an ophthalmologist.

<p>Cilj ovog istraživanja je bio da se utvrdi da li postoji razlika u debljini makule kod pacijenata sa glaukomom otvorenog ugla (POAG) u odnosu na zdravu populaciju i u zavisnosti od stepena progresije bolesti, kao i da se utvrdi da li postoji povezanost između promene debljine makule i stepena o&scaron;tećenja vidnog polja i debljine peripapilarnog sloja nervnih vlakana u zavisnosti od stepena progresije bolesti. Materijal i metode: U ovu kliničku prospektivnu studiju je uključeno 186 pacijenata. Na osnovu kliničkog nalaza formirane su tri grupe. Prva grupa (kontrolna &ndash; grupa zdravih): 68 pacijenata bez očnih oboljenja, sa najboljom korigovanom vidnom o&scaron;trinom &ge; 0.9, intraokularnim pritiskom (IOP) &le; 21 mmHg, normalnim odnosom ekskavacije i povr&scaron;ine glave vidnog živca i normalnim nalazom vidnog polja. Druga grupa (rani glaukom): 78 pacijenata sa klinički dijagnostikovanim primarnim glaukomom otvorenog ugla (sa karakterističnim o&scaron;tećenjem glave vidnog živca i sloja nervnih vlakana retine i kod kojih je srednja vrednost devijacije standardne automatske perimetrije MD &gt; -6 dB, prema Hodap klasifikaciji), bez drugih očnih ili sistemskih oboljenja, koja bi imala uticaj na nastanak glaukoma i sa najboljom korigovanom vidnom o&scaron;trinom &ge; 0.5. Treća grupa (glaukom srednjeg stepena): 40 pacijenata sa klinički dijagnostikovanim primarnim glaukomom otvorenog ugla (sa karakterističnim o&scaron;tećenjem glave vidnog živca i sloja nervnih vlakana retine i kod kojih je srednja vrednost devijacije standardne automatske perimetrije -6 dB &gt; MD &gt; -12 dB, prema Hodap klasifikaciji), bez drugih očnih ili sistemskih oboljenja, koja bi imala uticaj na nastanak glaukoma i sa najboljom korigovanom vidnom o&scaron;trinom &ge; 0.5. Svim pacijentima je bio urađen kompletan oftalmolo&scaron;ki pregled, kompjuterizovano vidno polje (Humphrey Field Analyzer, Carl Zeiss Meditec, Jena, Germany, SITA Standard, test C 24-2) i optička koherentna tomografija sloja nervnih vlakana peripapilarno i u predelu makule (SOCT Copernicus HR, Optopol Tech. SA, Zawiercie, Poland). Rezultati: Perifovea i parafovea, pokazuju statistički značajno smanjenje debljine i zapremine sloja nervnih vlakana u odnosu na stepen progresije glaukoma otvorenog ugla, pri čemu je ono nagla&scaron;enije u perifovei (p&lt;0,05). U svim segmentima makule (TPeriF, IPeriF, SPeriF, NPeriF, TParaF, SParaF, IParaF i NParaF) dolazi do smanjenja debljine i zapremine sloja nervnih vlakana sa progresijom bolesti (p&lt;0,05). Segmenti makule TPeriF, IPeriF, a potom i SPeriF, prema navedenom redosledu, predstavljaju segmente sa najvećim potencijalom za predikciju ranih glaukomskih o&scaron;tećenja s obzirom na uočeno najveće smanjenje debljine i zapremine nervnih vlakana (p&lt;0,05). Segmenti makule SParaF i NParaF predstavljaju segmente sa najvećim potencijalom za predikciju napredovanja glaukomskih o&scaron;tećenja srednjeg stepena s obzirom na uočeno najveće smanjenje debljine i zapremine nervnih vlakana (p&lt;0,05). Debljina RNFL glave vidnog živca se statistički značajno smanjuje sa progresijom bolesti u svim posmatranim segmentima (p&lt;0,05). Međusobni odnos između grupe zdravih i grupe pacijenata sa ranim glaukomom ukazuje da je statistički značajno smanjenje debljine RNFL prisutno u svim segmentima osim u segmentima P3 i P4 (p&gt;0,05). Merenja debljine RNFL u segmentu P6 imaju najbolji potencijal za predikciju ranog glaukoma s obzirom na najizraženije smanjenje debljine nervnih vlakana upravo u ovom segmentu (p&lt;0,05). Merenja debljine RNFL u segmentu P1 ima najbolji potencijal za predikciju dalje progresije bolesti. Debljina sloja nervnih vlakana makule srazmerna je smanjenju debljine RNFL na glavi vidnog živca, pri čemu je ona uočljivija na nivou segmenata koji su okarakterisani kao dobri prediktori za nastanak, odnosno progresiju bolesti (P6 sa IPeriF i TPeriF, odnosno P1 sa SPeriF), &scaron;to dodatno nagla&scaron;ava njihovu važnost u dijagnostici glaukoma otvorenog ugla. Debljina makule kod pacijenata sa glaukomom otvorenog ugla je opisana umerenom do dobrom povezano&scaron;ću sa stepenom o&scaron;tećenja vidnog polja, pri čemu je ona najjača kod TPeriF, IPeriF i SPeriF segmenata i srazmerna je stepenu o&scaron;tećenja vidnog polja. Koeficijenti korelacije između vrednosti srednje devijacije vidnog polja i debljine RNFL, odnosno&nbsp; sloja nervnih vlakana makule, pokazuju snažniju povezanost u odnosu na parametre dobijenog smanjenja debljine nervnih vlakana u makuli, &scaron;to otvara mogućnost za dalja istraživanja. Segmenti glave vidnog živca i makule, koji su pokazali najbolju diskriminaciju u smislu predikcije nastanka POAGa, kao i oni koji sugeri&scaron;u na njegovu progresiju, sme&scaron;teni su na lokacijama koje su međusobno povezane opisanim prirodnim tokom nervnih vlakana.&nbsp; Zaključak: Optička koherentna tomografija makule je važna pomoćna metoda u dijagnostici glaukoma kojom je moguće izdvojiti pacijente sa ranim glaukomom u odnosu na zdravu populaciju, odnosno utvrditi progresiju glaukoma otvorenog ugla.</p> / <p>All patients underwent complete ophthalmologic examination, SAP (Humphrey Field Analyzer, Carl Zeiss Meditec, Jena, Germany, SITA Standard, test C 24-2) and optical coherent tomography scans of RNFL and macula (SOCT Copernicus HR, Optopol Tech. SA, Zawiercie, Poland). Results: Perifoveal and parafoveal nerve fiber layer have shown significant reduction of thickness and volume compared to stage of POAG progression, where perifovea showed higher significance (p&lt;0,05). All macular segments (TPeriF, IPeriF, SPeriF, NPeriF, TParaF, SParaF, IParaF i NParaF) showed reduction in thickness and volume compared to disease progression (p&lt;0,05). Macular segments TPeriF, IPeriF, as well as SPeriF, represent segments with highest potential to predict early glaucomatous damage according to the most significant reduction of nerve fiber layer thickness and volume (p&lt;0,05). Macular segments SParaF and NParaF represent segments with highest potential to predict progression of POAG according to the most significant reduction of nerve fiber layer thickness and volume (p&lt;0,05). Optic nerve head (ONH) RNFL thickness showed reduction compared to POAG progression in all segments (p&lt;0,05). All ONH segments except P3 and P4 showed significant reduction of RNFL comparing control group to early glaucoma group patients (p&gt;0,05). ONH segment P6 was found to be the highly specific for early glaucoma prediction according to the most significant reduction of RNFL thickness (p&lt;0,05), while segment P1 was found to have highest potential for POAG progression. Macular nerve fiber layer thickness reduction follows ONH RNFL thickness reduction and there is mutual relation between both macular and ONH segments (P6 to IPeriF and TPeriF, P1 to SPeriF) with highest specificity for early defects and POAG progression. It was shown that macular thickness changes have moderate to good correlation with visual filed changes and it was highest in TPeriF, IPeriF and SPeriF segments. This correlation was found to be higher in macula then in ONH RNFL thickness changes, compared to visual field changes. Both macular and ONH RNFL segments, which were found to have highest specificity to POAG prediction and progression, are located in areas which mutually connect following natural course of nerve fiber layer between them. Conclusion: Optical coherence tomography of macula represents important ancillary method in POAG diagnosis and follow up, allowing to differentiate between early glaucoma patients and healthy individuals, as well as to determine progression of glaucomatous disease.</p>

The thesis is focused on detection of local disappearance of the neural layer on retina in fundus-camera images. The first chapter describes the human eye physiology, the glaucoma disease and the analyzed data. The second chapter compares four different approaches that should enable automatic detection of a possible damage to the retinal neural layer. These four approaches have been tested and evaluated; three of them showed an acceptable correlation with the medical expert conclusions – the directional spectral approach, the edge based approach and the difference local brightness. The last approch via local co-occurrence matrices has not turned out to be informative with the respect to the issue concerned. Then a program for the automatic detection of the nerve fibre layer loss areas has been designed, realized and evaluated. This task is solved in the last chapter. A relatively good agreement between the medical expert conclusions and the conclusions detected automatically by this program has been reached.

This work describes completely new approach to detection of retinal nerve fibre layer (RNFL) loss in colour fundus images. Such RNFL losses indicate eye glaucoma illness and an early diagnosis of RNFL changes is very important for successful treatment. Method is presented with the purpose of supporting glaucoma diagnosis in ophthalmology. The proposed textural analysis method utilizes local binary patterns (LBP). This approach is characterized especially by computational simplicity and insensitivity to monotonic changes of illumination. Image histograms of LBP distributions are used to gain several textural features aimed to classify healthy or glaucomatous tissue of the retina. The method was experimentally tested using fundus images of glaucomatous patients with focal RNFL loss. The results show that the proposed method can be used in order to supporting diagnosis of glaucoma with satisfactory efficiency.