Operacija kongenitalne mrene

master's thesis

• Title (english): Congenital cataract surgery
• Author: Ivana Kladarić
• Mentor: Miro Kalauz (mentor)
• Committee member: Tomislav Jukić (predsjednik povjerenstva)
• Committee member: Nenad Vukojević (član povjerenstva)
• Committee member: Miro Kalauz (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Kongenitalna mrena je jedan od glavnih uzroka sljepoće djece širom svijeta. Uspjeh liječenja ovisi o vremenu dijagnoze. Nedostatak vizualnih podražaja tijekom osjetljivog razdoblja rasta djeteta dovodi do poremećaja neurobiološkog razvoja vidnih puteva mozga. Preventivni programi ranog otkrivanja slabovidnosti, rana dijagnoza i pravovremena oftalmološka operacija ključni su čimbenici u sprječavanju razvoja ireverzibilne ambliopije. Opširan pregled, koji se sastoji od detaljne anamneze, određivanja morfološkog tipa mrene i potencijalnih pridruženih abnormalnosti, ključan je za određivanje idealne dobi za pristup operaciji i planiranje kirurške intervencije. Temeljita procjena zdravstvenog stanja djeteta korisna je u prepoznavanju mogućih sistemskih bolesti, uključujući metabolička stanja ili genetske sindrome. Dječje oči imaju specifične obilježja koja ih razlikuju od očiju odraslih. Zjenica je uža, leća je manja, vanjska očna ovojnica i lećna kapsula su elastičnije što otežava njihovo upravljanje tijekom operacije. Sadržaj leće je meke konzistencije te se najčešće uklanjanja metodom irigacije i aspiracije. Razvoj prilagođenih kirurških instrumenata i napredak u kirurškim tehnikama omogućili su operacije u vrlo ranoj životnoj dobi s boljom vizualnom prognozom. Miopski pomak, uzrokovan povećanjem aksijalne duljine oka i smanjenjem refrakcijske snage rožnice, ostaje jedan od glavnih izazova u operaciji kongenitalne mrene. Opacifikacija stražnje kapsule, sekundarni glaukom i malpozicija intraokularne leće i dalje su najčešće komplikacije koje zahtijevaju cjeloživotno postoperativno praćenje djece podvrgnute operaciji kongenitalne katarakte.

Abstract (english)

Congenital cataract is one of the main causes of children's blindness worldwide. The success of treatment depends on the time of diagnosis. Lack of visual stimuli during a sensitive period of child growth results in the disruption of the neurobiological development of visual pathways in the brain. Pediatric vision screening, early diagnosis and prompt ophthalmic surgery are essential factors in preventing development of irreversible amblyopia. Detailed examination consisting of detailed history, determination of morphological type of congenital cataract and potential accompanying abnormalities are crucial in finding out the ideal timing and planning the surgical intervention. Thorough assessment of the child's health condition is helpful in identification of possible systemic diseases, including metabolic conditions or genetic syndromes. Child’s eyes have some specific features which distinguish them from adult's eyes. Pupil is narrower, lens is smaller, outer layer of the eye and lens capsule are more elastic, which makes them more complex to manage. Lens substance retains a soft consistency and removal is usually performed by irrigation and aspiration. The development of custom surgical instruments and advances in surgical techniques have enabled surgery at a very early age with better visual prognosis. Myopic shift, caused by increase in the axial length of the eye and decrease of refractive power of the cornea, remains one of the mayor challenges in congenital cataract surgery. Posterior capsule opacification, secondary glaucoma, and intraocular lens malposition are still the most prevalent complications requiring lifelong postoperative follow-up in children subjected to congenital cataract surgery.

• Keywords: kongenitalna mrena; operacija mrene; intraokularne leće
• Keywords (english): congenital cataract; cataract surgery; intraocular lenses
• Language: croatian
• URN:NBN: urn:nbn:hr:105:956013
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-07-30 12:59:37