Nataša Vidovic Valentinčič | University of Ljubljana (original) (raw)

Papers by Nataša Vidovic Valentinčič

Slovenian Medical Journal, 2016

Intermediate uveitis is a chronic inflammatory eye disease where the vitreous is the major site o... more Intermediate uveitis is a chronic inflammatory eye disease where the vitreous is the major site of the inflammation. It mostly affects younger patients. The inflammation can be idiopathic or related to either infectious or autoimmune systemic disease. The leading cause of visual deterioration in intermediate uveitis is cystoid macular edema and cataract is the most common complication. Criteria for treating intermediate uveitis depend on the cause of the disease. We consider the presence of cystoid macular edema, vitreous haze 2+ or more, retinal neovascularization or vasculitis. We decide to treat the patient early, because it is easier to preserve visual function and ocular structures. The basic approach to treatment is a »step approach«. We start the treatment with periocular, intraocular or systemic corticosteroids. If the treatment is ineffective we use immunosuppressants/immunomodulators. Prognosis is improved with early control of inflammation and early treatment of the com...

Slovenian Medical Journal, Jul 26, 2016

Diagnostics, treatment and follow-up of an adult patient with intermediate uveitis Saša Počkar, n... more Diagnostics, treatment and follow-up of an adult patient with intermediate uveitis Saša Počkar, nataša vidović valentinčič Izvleček Intermediarni uveitis je kronično očesno vnetje z glavnino vnetja v steklovini. Najpogosteje prizadene mlajše osebe. Vnetje je lahko idiopatsko ali pa se pojavi v sklopu sistemske infekcijske ali avtoimunske bolezni. Najpogostejši vzrok okvare vida pri intermediarnem uveitisu je nastanek cistoidnega makularnega edema, najpogostejši zaplet pa je katarakta. Merila za zdravljenje intermediarnega uveitisa so odvisna od osnovnega vzroka bolezni. Upoštevamo prisotnost cistoidnega makularnega edema, eksudacija v steklovino 2+ in več, mrežnične neovaskularizacije ali vaskulitisa. Za zdravljenje se odločimo zgodaj, saj lahko tako uspešneje ohranimo vidno funkcijo in očesne strukture. Osnovni pristop k zdravljenju je stopenjski. V prvi vrsti zdravimo s periokularnimi, intraokularnimi ali sistemskimi kortikosteroidi. V primeru neuspešnega nadzora vnetja se odločimo za imunosupresive/imunomodulatorje. Nadzor vnetja in zdravljenje zapletov zgodaj v poteku bolezni izboljšata končni izid.

Journal of Ophthalmology, Sep 19, 2020

Purpose. To report on patients who needed hospitalization due to acute anterior uveitis (AAU) and... more Purpose. To report on patients who needed hospitalization due to acute anterior uveitis (AAU) and within this group to compare clinical features and outcomes of treatment of HLA-B27+ and HLA-B27− AAU in the population of Slovenian patients. Methods. Retrospective study of hospitalized patients with AAU in the last 39 months at the Eye Hospital in Ljubljana. e data of AAU patients were retroactively studied and compared on the basis of HLA-B27 antigen presence: visual acuity upon admission, visual outcome, the presence of hypopyon, fibrinous reaction, posterior iris synechiae, and complications, such as elevated intraocular pressure, cataract, and cystoid macular edema (CME). We compared the investigations in the diagnostic process, the associated systemic disease, and the treatment administered. Statistical analyses included Student's t-test Fisher's exact test, and the Kolmogorov-Smirnov test. A p value of <0.05 was considered statistically significant. Results. A total of 37 hospitalized patients with AAU were included. HLA-B27 antigen was detected in 73% of patients. In the HLA-B27+ group, women were more commonly affected, while the males were more affected in the HLA-B27− group. e occurrence of fibrin was significantly more common in HLA-B27+ patients, as well as hypopyon and posterior synechiae; only fibrin reached the statistical significance (p < 0.05). e incidence of cataracts, ocular hypertension, and glaucoma did not differ significantly between the two groups. HLA-B27+ AAU was more often associated with systemic diseases, and patients in this group were more frequently treated with systemic immunomodulatory drugs, however, no difference reached the statistical significance. We did not notice any major differences in the final visual acuity in the comparing groups. Conclusion. Almost ¾ of AAU patients that required hospitalization were HLA-B27+. In this group, disease was more severe, more frequently associated with ocular complications and systemic disease, but final visual acuity was the same in both groups. HLA-B27 typing has no prognostic value in our group of complicated AAU patients, but it eases the decision about necessary diagnostics and treatment.

Slovenian Medical Journal, Jul 19, 2022

Dolgoročni potek in izid bolezni pri bolnikih z intermediarnim uveitisom s spremljanjem vsaj 20 l... more Dolgoročni potek in izid bolezni pri bolnikih z intermediarnim uveitisom s spremljanjem vsaj 20 let Avtorske pravice (c) 2022 Zdravniški Vestnik. To delo je licencirano pod Creative Commons Priznanje avtorstva-Nekomercialno 4.0 mednarodno licenco.

Slovenian Medical Journal, Jan 15, 2017

Očesni simptomi v sklopu okužbe z virusom imunske pomanjkljivosti (HIV) so lahko prvi znak sistem... more Očesni simptomi v sklopu okužbe z virusom imunske pomanjkljivosti (HIV) so lahko prvi znak sistemskega razsoja HIV, zato je pomembno zgodnje odkrivanje in diagnosticiranje očesnih stanj, ki so neodzivna na standardno zdravljenje. Očesna stanja HIV-okuženih lahko prizadenejo sprednji segment, kot so tumorji in okužbe periokularnih tkiv, ali zadnji segment, kot so npr. retinopatija ali številne oportunistične okužbe mrežnice in žilnice. Približno 70 % okuženih s HIV ima v poteku bolezni vsaj eno očesno stanje v sklopu primarne okužbe, zato so pri teh osebah smiselni rutinski oftalmološki pregledi, saj z zgodnjim diagnosticiranjem in zdravljenjem lahko preprečimo vid ogrožujoča stanja. Članek v prvem delu predstavlja očesna stanja pri bolnikih z okužbo s HIV, v drugem delu pa predstavljamo svoje izkušnje pri oftalmološki obravnavi teh bolnikov v zadnjih letih ter priporočila za oftalmološko obravnavo in spremljanje okuženih s HIV.

Acta Ophthalmologica, Sep 1, 2011

ABSTRACT

International Journal of Molecular Sciences, Feb 17, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

World Journal of Clinical Cases, Jul 6, 2022

Ocular Immunology and Inflammation, Apr 7, 2021

ABSTRACT Purpose: To summarize ophthalmic manifestations of coronavirus disease (COVID-19) report... more ABSTRACT Purpose: To summarize ophthalmic manifestations of coronavirus disease (COVID-19) reported in the literature thus far. Methods: The PubMed database was systematically searched through October 24, 2020, to identify relevant articles using the following search terms: (“COVID-19” OR “SARS-CoV-2”) AND (“eye” OR “ophthalmology” OR “retina” OR “retinal findings” OR “cornea” OR “conjunctiva”). Only articles published in English were included in this review. Results: The reported prevalence of ophthalmic manifestations is generally low, but correlates positively with the severity of the disease. Most commonly reported ocular manifestations are conjunctivitis, conjunctival hyperemia and chemosis. Retinal findings include microhemorrhages and flame-shaped hemorrhages, cotton wool spots, dilated veins, and tortuous vessels. Conclusion: Considering the COVID-19 cases have reached pandemic dimensions and are surging, yet again, it is of utmost importance to determine its ophthalmic manifestations and prevent their vision threatening complications. Further studies are warranted to establish whether the retinal findings appear due to the COVID-19 or are an incidental finding in patients with a preexisting diabetic or hypertensive retinopathy.

Ophthalmic surgery, lasers & imaging retina, Dec 1, 2022

Purpose: To expand understanding of presentation, diagnosis, and outcomes of hemorrhagic occlusiv... more Purpose: To expand understanding of presentation, diagnosis, and outcomes of hemorrhagic occlusive retinal vasculitis (HORV). Design: Retrospective case series. Participants: Thirty-six eyes of 23 patients. Methods: The American Society of Cataract and Refractive Surgery (ASCRS) and the American Society of Retina Specialists (ASRS) formed a joint task force to define clinical characteristics of HORV and to study its prevalence, cause, treatment, and outcomes. An online registry was established on both societies' web sites. Surveys were e-mailed to members of both societies soliciting cases of suspected HORV. A literature search was performed to uncover additional cases. Main Outcome Measures: Historical data including intraoperative characteristics, images, treatment regimens, and visual and anatomic outcomes. Results: Characteristic findings of HORV included unremarkable postoperative day 1 undilated examination, delayed-onset painless vision loss, mild anterior chamber and vitreous inflammation, sectoral retinal hemorrhages in areas of ischemia, and predilection for venules and peripheral involvement. Based on predetermined diagnostic criteria, 36 eyes of 23 patients were diagnosed with HORV. All eyes received intraocular vancomycin via intracameral bolus (33/36), via intravitreal injection (1/36), or through the irrigation bottle (2/36). Patients sought treatment with HORV 1 to 21 days after surgery or intravitreal injection. Visual results usually were poor: 22 of 36 eyes (61%) had 20/200 or worse visual acuity and 8 of 36 eyes (22%) had no light perception (NLP). Neovascular glaucoma developed in 20 of 36 eyes (56%). Seven eyes received additional intravitreal vancomycin after surgery; 5 of these 7 eyes had NLP visual acuity at the most recent examination. Three eyes received intravitreal corticosteroids and had final visual acuities of 20/40, 20/70, and hand movements. Conclusions: Hemorrhagic occlusive retinal vasculitis is a rare, potentially devastating condition that can develop after cataract surgery or intraocular injection. All cases in this series were associated with intraocular vancomycin. Disease course and findings suggest that HORV is caused by a delayed hypersensitivity reaction to vancomycin. Early treatment with corticosteroids likely is beneficial. Subsequently, antievascular endothelial growth factor injections and panretinal photocoagulation are important to prevent neovascular glaucoma, a common complication. Avoidance of additional intravitreal vancomycin is recommended if HORV is suspected. Ophthalmology 2016;-:1e13 Published by Elsevier on behalf of the American Academy of Ophthalmology

Acta Ophthalmologica, Sep 1, 2009

Purpose To evaluate the ultrastructure changes of anterior lens capsule in patients with differen... more Purpose To evaluate the ultrastructure changes of anterior lens capsule in patients with different forms of uveitis, who underwent cataract surgery at the University Eye Clinic Ljubljana, Slovenia between years 2001 and 2007. Methods Anterior lens capsules were obtained during cataract surgery, fixated and prepared for semi‐thin sections technique and transmission electron microscopy. Results 22 uveitic cataract were studied (idiopathic anterior uveitis‐9, Fuchs‐5, panuveitis‐5, HSV‐1, toxoplasmosis‐1, uveitis in RA‐1). The cataract was mature‐1, cortical‐14, fibrotic‐1 or nuclear‐6. The anterior capsule thickness showed irregularity in and between the cases spanning from 8,8 to 25,2 μm (average 16,33, SD 4,85μm). In 12 samples intrusions of capsule at the capsule‐epithelial border embedding cellular material were found. Capsule itself showed ultrastructure changes in 18 samples, including: filaments, rarefication of capsule or its anterior chamber boarder, and lamellae. In 5 samples the amorphous material at the anterior chamber boarder was seen. Epithelial changes were observed in all 22 samples, including: vacuolisation, multilayered epithelium, detached epithelium, intercellular space, star‐shaped nuclei, necrotic cells, lipofucsin granules. In 4 samples the epithelium was unrecognizable due to extensive fibrosis or necrosis. Conclusion All studied uveitic cataracts showed epithelial and most also capsular changes. Some capsules showed extensive changes with unrecognizable structures. The findings did not correlate to clinical appearance or diagnosis and most probably resulted from nonspecific response to inflammation. Amorphous depositions could be inflammatory debris. Further studies need to be done to explain the underlying processes.

Annals of the Rheumatic Diseases, Mar 27, 2023

The 'MHC-I (major histocompatibility complex class I)-opathy' concept describes a family of infla... more The 'MHC-I (major histocompatibility complex class I)-opathy' concept describes a family of inflammatory conditions with overlapping clinical manifestations and a strong genetic link to the MHC-I antigen presentation pathway. Classical MHC-Iopathies such as spondyloarthritis, Behçet's disease, psoriasis and birdshot uveitis are widely recognised for their strong association with certain MHC-I alleles and gene variants of the antigen processing aminopeptidases ERAP1 and ERAP2 that implicates altered MHC-I peptide presentation to CD8+T cells in the pathogenesis. Progress in understanding the cause and treatment of these disorders is hampered by patient phenotypic heterogeneity and lack of systematic investigation of the MHC-I pathway. Here, we discuss new insights into the biology of MHC-Iopathies that strongly advocate for disease-overarching and integrated molecular and clinical investigation to decipher underlying disease mechanisms. Because this requires transformative multidisciplinary collaboration, we introduce the EULAR study group on MHC-I-opathies to unite clinical expertise in rheumatology, dermatology and ophthalmology, with fundamental and translational researchers from multiple disciplines such as immunology, genomics and proteomics, alongside patient partners. We prioritise standardisation of disease phenotypes and scientific nomenclature and propose interdisciplinary genetic and translational studies to exploit emerging therapeutic strategies to understand MHC-I-mediated disease mechanisms. These collaborative efforts are required to address outstanding questions in the etiopathogenesis of MHC-I-opathies towards improving patient treatment and prognostication.

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2012

Purpose: To summarize available literature on physiologic and pathologic ocular changes during pr... more Purpose: To summarize available literature on physiologic and pathologic ocular changes during pregnancy. Methods: Narrative review of literature. Results: Ocular changes occur commonly during pregnancy. Although most of these are benign physiologic responses to the metabolic, hormonal, and immunologic modifications to adopt the gestational product, there is some serious pathology that may develop, exacerbate, or even resolve over the course of pregnancy which requires prompt diagnosis and management. The pathological eye conditions can be classified into preexisting pathologies and emerging ocular diseases. Regardless of the different mechanisms by which these ocular changes occur, the key point is the establishment of an effective perinatal screening program to monitor the new development or successive progression of these ocular abnormalities. Irrespective of the visual health status of the pregnant women, regular perinatal eye examination should be scheduled in order to assure continuous surveillance of healthy eyes. Treatment of pathologic ocular conditions or functionally disturbing benign changes relies on an appropriate patient selection. Conclusions: Discriminating pathological eye disease from physiologic ocular changes is important in order to establish an individualized treatment or preventive plan and constitutes the mainstay of obstetric ophthalmology. This individualized approach should always weigh the ocular benefits of treatment to the mother against the potential harms to the fetus.

Ocular Immunology and Inflammation, Dec 8, 2015

ABSTRACT Purpose: To investigate the prevalence of suggestive signs for ocular sarcoidosis propos... more ABSTRACT Purpose: To investigate the prevalence of suggestive signs for ocular sarcoidosis proposed by the International Workshop on Ocular Sarcoidosis (IWOS) in patients with sarcoidosis-associated uveitis. Methods: A retrospective study included 53 patients (77% female), with uveitis, who were seen in the period of 2010–2013 at the University Eye Hospital Ljubljana, Slovenia. All patients had confirmed pulmonary sarcoidosis based on clinical presentation, imaging and lung biopsy according to the ATS/ERS criteria. The presence of the seven clinical signs, suggested by the IWOS was determined in 47 patients with sufficient clinical data. Results: Patients commonly exhibited bilaterality (79%), keratic precipitates/iris nodules (49%), and multiple chorioretinal peripheral lesions (36%). Three or more signs were observed in 40% (19/47) of patients or 79% (11/14) of patients with primary ocular involvement. Conclusions: Results add to the validation of IWOS criteria and emphasize the high percentage of at least three suggestive for ocular sarcoidosis in patients with primary ocular involvement.

Research Square (Research Square), Mar 7, 2022

The aim of this retrospective study was to evaluate the long-term visual outcomes of patients wit... more The aim of this retrospective study was to evaluate the long-term visual outcomes of patients with various etiologies of uveitis, undergoing cataract surgery and to identify possible factors in uencing the visual outcome and the rate of postoperative complications. Methods: Patients who underwent cataract surgery between January 2015 and February 2020 were included. Results: A total of 102 eyes of 78 patients were included in this study. There was a statistically signi cant difference in the postoperative BCVA between the groups based on anatomical localization as well as etiology. Standard procedure with phacoemulsi cation and lens implantation was associated with statistically signi cant better nal BCVA than surgery with an additional iris procedure. Conclusions: Visual outcome varies between the subtypes of uveitis. Post-operative BCVA correlates strongly with preoperative values; prolonged delay of surgery may not be indicated. Meticulous control of pre-operative in ammation, peri-operative treatment adjustment, and close postoperative follow-up is essential for a favorable outcome.

DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2017

Retina-the Journal of Retinal and Vitreous Diseases, Apr 1, 2007

To ascertain the effect of tinted optical filters (TFs) on visual function in patients with infla... more To ascertain the effect of tinted optical filters (TFs) on visual function in patients with inflammatory cystoid macular edema (CME). A prospective study included 14 patients with inflammatory CME and best-corrected visual acuity between 0.1 and 0.8 (CME group) and 16 sex-, age-, and best-corrected visual acuity-matched patients with macular disorders but no CME (non-CME group). All patients from both groups underwent the following tests: determination of visual acuity at distance, contrast sensitivity (CS) testing; and subjective grading of each TF for best-corrected visual acuity and CS compared with no TFs. All tests were performed with the following TFs: Corning photochromic filter with a cutoff at 450 nm; Zeiss filter with a cutoff at 560 nm; and cheap widely available yellow filter with a cutoff at 489 nm. Without TFs, the CME and non-CME groups did not differ in best-corrected visual acuity (P = 0.79). Using the TFs, a clinically significant improvement was not achieved by any patient. However, using the definition of any improvement, best-corrected visual acuity with all TFs showed a significant improvement in the CME group compared with no TFs (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). The CME group rated the Corning photochromic filter with a cutoff of 450 nm significantly higher than the other TFs when determining visual acuity (P = 0.05) and CS (P = 0.01) in contrast to no improvement in the non-CME group. Although the use of TFs for the CME patients was not associated with criteria of clinically significant improvement, our results indicate that visual acuity and CS in patients with inflammatory CME might benefit from the use of TFs.

Graefe's Archive for Clinical and Experimental Ophthalmology

Purpose To quantify retinal microvascular findings in the acute phase of COVID-19 using multimoda... more Purpose To quantify retinal microvascular findings in the acute phase of COVID-19 using multimodal imaging and compare them with healthy, age-matched controls. Methods Hospitalized patients in the acute phase of COVID-19 without known systemic comorbidities (n = 75) and healthy controls (n = 101) aged 18-65 were enrolled in this prospective cross-sectional study. The retinal microcirculation and microvasculature impairments were assessed using fundus photography, swept-source optical coherence tomography, and swept-source optical coherence tomography angiography in the COVID-19 unit and compared with healthy, age-matched controls. Results Retinal findings were predominately observed in patients with severe disease (P = 0.006). Patients with severe disease were shown to have increased both mean vein diameter (Coef. = 19.28, 95% CI: 7.34-31.23, P = 0.002) and mean artery diameter (Coef. = 11.07, 95% CI: 0.84-21.67, P = 0.044). Neither blood vessel diameters were correlated with any confounding variables (age, sex, treatment with oxygen, LDH, or ferritin). Patients with severe COVID-19 were shown to have significantly increased retinal nerve fiber layer thickness in the superior and inferior quadrants both in the inner (S: P = 0.046; I: P = 0.016) and outer (S: P = 0.026; I: P = 0.014) ring and significantly increased GCL thickness in the outer temporal quadrant (P = 0.038). There were no statistically significant differences in vessel density or the foveal avascular zone area between the groups. Conclusion The severity of COVID-19 was significantly correlated with the presence of retinal microangiopathy, which could become a biomarker of angiopathy in patients with COVID-19. Key messages The severity of COVID-19 is correlated with the presence of retinal findings. Patients with severe disease had a notable increase in the mean vein as well as the mean artery diameter. Patients with severe COVID-19 were shown to have significantly increased RNFL thickness in the superior and inferior quadrants both in the inner and outer ring and significantly increased GCL thickness in the outer temporal quadrant.

International Journal of Molecular Sciences

Pathogenic variants in DNA-damage regulated autophagy modulator 2 gene (DRAM2) cause a rare autos... more Pathogenic variants in DNA-damage regulated autophagy modulator 2 gene (DRAM2) cause a rare autosomal recessive retinal dystrophy and its disease course is not well understood. We present two Slovenian patients harboring a novel DRAM2 variant and a detailed review of all 23 other patients described to date. Whole exome and whole genome sequencing were performed in the two patients, and both underwent ophthalmological examination with a 2-year follow-up. PubMed was searched for papers with clinical descriptions of DRAM2 retinopathy. Patient 1 was homozygous for a novel variant, p.Met1?, and presented with the acute onset of photopsia and retina-wide retinopathy at the age of 35 years. The patient was first thought to have an autoimmune retinopathy and was treated with mycophenolate mofetil, which provided some symptomatic relief. Patient 2 was compound heterozygous for p.Met1? and p.Leu246Pro and presented with late-onset maculopathy at the age of 59 years. On review, patients with D...