A RARER FORM OF ANGLE-CLOSURE GLAUCOMA--DIAGNOSIS AND TREATMENT.

PURPOSE: to show how we diagnosed and treated a rarer form of angle-closure glaucoma; the pathogenic mechanism was angle crowding through thick peripheral iris roll. METHODS: we show the investigations: biomicroscopy of the fundus, tonometry, pachymetry, gonioscopy, perimetry, ultrasound biomicroscopy, optical coherence tomography of the anterior segment--that helped us to diagnose the angle-closure glaucoma and its pathogenic mechanism; we also show our choice for surgery--lens extraction--and our arguments for this choice. RESULTS: first postoperative day--intraocular pressure was 14 mmHg; a week postoperatively--intraocular pressure was 13 mmHg; three months postoperatively--intraocular pressure was 13 mmHg. CONCLUSIONS: lens extraction may be a very good choice in several forms of angle-closure glaucoma.

[The significance of imaging in a case of intraorbital cystic tumor]. / Influenta investigatiilor imagistice într-un caz de tumora chistica intraorbitara.

Conjunctival inclusion cyst represents a congenital or, in most cases, an acquired disorder. The most frequent cause of an acquired conjunctival cyst is the implantation of conjunctival epithelium after surgical interventions or ocular trauma. Usually, these cysts are located supero-medially, with a stationary evolution, without a progression in dimension, but in some cases can evolve into enormous translucent cysts. Histologically, they are lined by stratified, nonkeratinized, squamous epithelium and contain desquamated cellular debris, chronic inflammatory cells and mucus, when goblet cells are present. Most cysts can be treated adequately by complete excision with marsupialization of the entire epithelial lining to prevent fluid reaccumulation.

[Peripheral ulcerative keratitis]. / KERATITA ULCERATIVA PERIFERICA.

Ulcerative keratitis is frequently associated with collagen vascular diseases and presents a predilection for peripheral corneal localization, due to the distinct morphologic and immunologic features of the limbal conjunctiva, which provides access for the circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates an immune-mediated vasculitis process, with inflammatory cells and mediators involvement by alteration of the vascular permeability. Peripheral ulcerative keratitis generally correlates with exacerbations of the background autoimmune systemic disease. Associated sceritis, specially the necrotizing form, is usually observed in severe cases, which may evolve in corneal perforation and loss of vision. Although the first-line of treatment in acute phases is represented by systemic administration of corticosteroids, immunosuppressive and cytotoxic agents are necessary for the treatment of peripheral ulcerative keratitis associated with systemic diseases.

[Ocular hypertension in herpes simplex keratouveitis]. / Hipertensiunea intraoculara în keratouveitele date de virusul herpes simplex.

The herpes simplex virus is one of the most common pathogens in humans, who are seropositive for the virus in 90% of the cases at the adult age. It determines reccurent infections in more than a third of the population and these infections depend on the immune response of the host. Ocular infections of newborns are due to the herpes simplex virus type 2, meanwhile type 1 is found predominantly at adults; almost all ocular structures can be affected. HSV-1 in the most frequent etiologic agent in infectious anterior uveitis (with the varicelo-zosterian virus) and it is responsible for 6-10% of all cases of anterior uveitis. More than half of the keratouveitides due to HSV will develop intraocular hypertension and open-angle secondary glaucoma, during reccurences and most of them will resolve after proper control of inflammation.

[Ocular ischemic syndrome--a case report]. / Sindromul de ischemie oculara- pornind de la un caz clinic.

Ocular ischemic syndrome, also known as hypoperfusion/ hypotensive retinopathy or as ischemic oculopathy is a rare ocular disease determined by chronic arterial hypoperfusion through central retinal artery, posterior and anterior ciliary arteries. It is bilateral in 20% of the cases. Most often it appears due to severe occlusion of the carotid arteries (ICA, MCA>ECA), described in 1963 by Kearns and Hollenhorst. Occasionally it can be determined by the obstruction of ophtalmic artery or some arterities (Takayasu, giant cell arteritis). The risk factors are: age between 50-80 years, males (M:F = 2:1), arterial hypertension, diabetes, coronary diseases (5% of the cases develop ocular ischemic syndrome), vascular stroke, hemodialysis. The case we present is of an 63 years old man known with primary arterial hypertension, hypercholesterolemia, diabetes type 2 non insulin dependent and diagnosticated with ischemic cerebral stroke and bilateral obstruction of internal carotid arteries in march 2010, who is presenting for visual impairment in both eyes. The imaging investigations show important carotid occlusion and at the ophthalmologic evaluation there are ocular hypertension and rubeosis iridis at the right eye, optic atrophy at both eyes (complete in the right eye and partial in the left eye), with superior altitudinal visual field defect in left eye. The following diagnosis was established: Chronic ocular ischemic syndrome in both eyes with Neovascular glaucoma at the right eye, Anterior ischemic optic neuropathy at the left eye and laser panphotocoagulation at the right eye was started.

[Alternative therapeutic excision of intraepithelial conjunctival carcinoma with corneal extension]. / Alternative terapeutice la excizia unui carcinom intraepitelial conjunctival cu extensie corneeana.

Surgical treatment for conjunctival neoplasms, with wide local excision, with or without supplemental cryotherapy to the surgical margins represents the treatment of choice for this pathology. In some cases, these neoplasms can be diffuse or multifocal, with borders that are difficult to detect clinically, such that topical therapies offer a more efficient method for treating the entire ocular surface, delivering high drug concentrations at this level, with negligible systemic side effects. Beginning from the clinical case of a patient diagnosed with conjunctival intraepithelial neoplasia, we try to present other therapeutical alternatives, although in this case the therapeutical approach was the classic one.