[Atrophy of retinal pigment epithelium after macular hole surgery]. / Atrofia epiteliului pigmentar dupa chirurgia gaurii maculare.

We present three cases of macular hole. After macular surgery we observed good anatomical results (closed macular holes) but poor functional results. We try to identified the element who produced atrophy of retinal pigment epithelium.

[Triamcinolone acetonide bevacizumab performance in treatment and idiopathic macular spider veins]. / Eficacitatea bevacizumabului si triamcinolonului acetonid in tratamentul telangiectaziilor idiopatice maculare.

This article evaluated the efficacy of intravitrean injection of anti VEGF agents and triamcinolon in the treatment of macular telangiectasis. The patients were followed six months. We practiced fluorescein angiography, optical coherence tomography. We measured the thickening of macular edema and best corrected of visual acuity.

[Keratinocytes--the cell with multiple phenotypes]. / Keratocitul--celula cu fenotipuri multiple.

The keratocytes play a leading role in maintaining the normal transparent corneal structure, but also in repairing it, following various injuries. Knowledge of phenotype changes of these cells is important, both for explaining corneal pathology and for researching new therapy options.

[Choroidal folds]. / Pliurile coroidiene.

Choroidal folds are quite difficult to recognize and are frequently over-passed, although they have a characteristic aspect at the fundus examination. They are not a diagnosis but a clinical sign, that may be idiopathic or in association with an ocular pathology. Recognizing them can orientate in establishing a certain diagnosis. We present here the main causes of choroidal folds, and a detailed description of their clinical aspects, hoping that this important clinical landmark will be more easier to recognize and interpret.

[Characteristics of ocular detachment after refractive surgery]. / Particularitati ale dezlipirii de retina dupa chirurgia refractiva.

The myopic eye subject to refractive surgery maintains a high risk of retinal detachment (RD). We present the difficulties of endo-ocular surgery on patients with previous radial keratotomy as well as the particular aspects of RD in patient with LASIK. RD in lens refractive surgery eyes is not essentially different from RD on pseudophakic eyes. ReStore pseudophakic lenses rise particular problems following vitreo-retinal surgery (retinal laser photocoagulation, lens des-centering duet of vitreal architecture changes).

Dexamethasone-netilmicin: a new ophthalmic steroid-antibiotic combination. Efficacy and safety after cataract surgery.

PURPOSE: The purpose of this study was to evaluate both efficacy and safety of a new ophthalmic steroid-antibiotic fixed combination containing dexamethasone and netilmicin in the postsurgical management of cataract surgery. METHODS: In total, 223 patients were randomly treated with dexamethasone 1 mg/ml plus netilmicin 3 mg/ml (n=148), or dexamethasone 1 mg/ml plus tobramycin 3 mg/ml (n=75, TOBRADEX) four times in a day for 7+/-1 days starting immediately after surgery. Efficacy (anterior chamber (AC) inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia and tearing) and safety (burning, stinging, blurred vision, intraocular pressure, and visual acuity) were analysed in the operated eye after 1 and 7+/-1 days. A follow-up visit was performed at day 14+/-2. The extent of AC inflammation, measured by slit-lamp according to a standard scoring system, was used as primary efficacy parameter. RESULTS: At the primary end point (day 7) both fixed combinations were equally effective in reducing postoperative inflammation. The safety profile of the dexamethasone/netilmicin combination was excellent with no evidence of poor local tolerance or adverse reaction. CONCLUSIONS: A new fixed combination of dexamethasone and netilmicin was effective and safe in controlling ocular inflammation after cataract surgery.

[Intravitreal administration of drugs]. / Administrarea intravitreana de medicamente.

The direct intravitreal administration represents the easiest and quickest method for obtaining efficient substance concentrations closer to the lesions and is reserved to the pathology which is resistant to the common treatments.

Clinical aspects of photodynamic therapy--Romanian experience.

Photodynamic therapy is an emerging method for local destruction of tissue by generating toxic oxygen species using light absorbed by an administered or an endogenously generated photosensitiser. It is a promising treatment for patients with cancer. More recently it has found increasing use as a method of therapy for non-cancerous illnesses. Following administration of a photosensitiser occurs an accumulation or retention in areas of cancer and disease relative to adjacent normal tissue. The photosensitiser is inactive until irradiated by light, following which cellular destruction occurs. This explanation is a good reason for the scientific and clinical interest in photodynamic therapy.

[Branch retinal arterial occlusions--clinical case]. / Obstructia de ram arterial retinian--consideratii pe marginea unui caz clinic.

Branch retinal arterial occlusion is an ophthalmological emergency, presenting with features of sudden and painless loss of vision and visual field defect. Even if the diagnosis is easy to make, the ophthalmologist is, most of the times, unable to improve the prognosis. We present a clinical case of unilateral branch retinal arterial occlusion with unusual evolution.

Photochemical and photodynamic properties of vitamin B2--riboflavin and liposomes.

Ocular neovascular disease represents an important cause of blindness today. In this paper, it was used a model to evaluate the vaso-occlusive potential of photodynamic therapy with B2 vitamin. Neovascularization induced în an occular cornea consists of an easily accessible monolayer-like neovascular net within a transparent matrix. This fact allows studying the efficiency of occlusion în an isolated neovascular structure. This study is a requirement for the transport evaluation and photodynamic efficiency of this drug. Both riboflavin and the DPBF are embedded în the phospholipid bilayer. The quantum yield of DPBF photooxidation and riboflavin singlet oxygen generation are higher by comparison with water (13-35 s în liposomes and 0.4 s în water), due to the higher lifetime of singlet oxygen în liposomes and due to the special transport mechanism of B2 inside of liposomes. The photochemical behavior of riboflavin (Vitamin B2) aqueous solution and în unilamellar liposomes of dipalmitoyl phosphatidylcholine (DPPC) during the sensitized photooxidation of 1,3-diphenylisobenzofuran (DPBF) are discussed în this paper. Some structural aspects of DPPC liposomes, have been studied, too. The first step în the sequence of vesicle shape transformations, the spherical to polygonal shape transition, occurs în a very narrow temperature range, i.e., during the gel-to-liquid crystalline phase transition. At different temperatures (30,37-42 degrees C) could be seen the sequence for the vesicle form: spherical-polygonal-ellipsoidal, attributable to the lipid domain coexistence on the macroscopic structure of liposomes. The incorporation of B2 Vitamin eliminates the ellipsoidal form of DPPC, even at high temperature, because B2 has a very small molecule able to be encapsulated into DPPC vesicle. Also, the incorporation of B2 increase the DPPC diameter, all these observations being obtained by optical confocal microscopy.

[Age related macular degeneration surgery]. / Chirurgia degenerescentei maculare senile.

Age related macular degeneration (ARMD) is a disease in which the retinal pigment epithelium (RPE) is damaged in the central retinal area. In the exudative form, the vision loss is due to choroidal neovascularization, while in the nonexudative or atrophic form, there is a vision loss because of the retinal pigment epithelium atrophy. Treatment which proved to be efficient in lowering the risk of severe vision loss in the exudative form includes laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and as surgical treatment, the controversial subretinal membrane extraction. In all these situations the RPE is damaged by the disease itself and by the therapeutic procedure too. Retinal translocation is a surgical procedure that intends to remove the neurosensory retina from an area with damaged RPE to an healthy RPE area, through a 360 degrees retinotomy or through a limited one. This paper present some ARMD cases treated by subretinal membrane extraction and one by limited retinal translocation. The question which is still remaining is which are the risks and benefits for the following treatment procedures: laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and surgical approach?

[Ophthalmic cysticercosis-case report]. / Cisticercoza oculara--caz clinic.

This paper presents a particular case regarding ophthalmic cysticercosis with subretinian localization associated with large subretinian hemorrhage, surgically addressed.

[Internal tamponade in proliferative diabetic retinopathy surgery]. / Tamponamentul intern în chirurgia retinopatiei diabetice proliferante.

Vitreous hemorrhage has been the most common indication of posterior vitrectomy in diabetic retinopathy. Now, the leader is tractional retinal detachement and many others: rhegmatogenous retinal detachement, fibrovascular proliferations membranes, huge premacular hemorrhage. During vitrectomy procedure it may be necessary internal tamponade using air, expanding gases, silicon oil and/or perfluorocarbon liquids.

Photodynamic occlusion of ocular neo-vascularization with B2 vitamin.

Photodynamic therapy (PDT) of cancer has been known for over twenty years and is based on the dye-sensitized photooxidation of different biological targets in the tumoral tissue yielding to a photochemically induced cell's death via apoptotic pathways. Several parameters affect clinical trials in PDT and influence the therapeutic outcome. A potentially major application of PDT in a non-cancer field is its use in treatment of age-related macular degeneration. This condition, caused by proliferation of neovasculature in the retina, is the major cause of blindness in the over 50s. Using a photosensitiser which enters neovasculature very rapidly following administration and is subsequently quickly moved from the circulation. Ocular neovascular disease represents an important cause of blindness today. In this paper, was used an animal model (rabbit) to evaluate the vaso-occlusive potential of photodynamic therapy with B2 vitamin. Neovascularization induced in the rabbit cornea consists of an easily accessible monolayer-like neovascular net within a transparent matrix. This fact allows studying the efficiency of occlusion in an isolated neovascular structure.

[Posttraumatic posterior lens luxation]. / Luxatie posterioara posttraumatica de cristalin.

This paper presents a few theoretical considerations about the posttraumatic posterior luxation of the nucleus. We discuss the evolution and surgical treatment of a clinical case, and we remark once more that the posterior luxation of the nucleus is considered to be an delayed surgical emergency.

[Current treatment of endophthalmitis]. / Tratamentul actual în endoftalmite.

This paper presents a few theoretical considerations about the causes and treatment of endophthalmitis, about the high role of endophthalmitis vitrectomy. We discuss the evolution and treatment in 3 different clinical cases.

[Choroidal neovascularization]. / Neovascularizatia coroidiana.

Choroidal neovascularization (CNV) may occur in any ocular condition affecting the integrity of the choriocapillaris-Bruch's membrane-retinal pigment epithelium-outer retinal layer complex. CNV in the macula is a major cause of severe central visual loss. A variety of clinical symptoms suggest the diagnosis of CNV. Fluorescein and indocyanine green angiography play a very important role in the detection and precise localization of CNV in relation to the centre of the foveal avascular zone. In the present, CNV benefits by many treatment possibilities. The goal of treatment is specifically to decrease the risk of visual acuity loss.

[Difficulties in cataract surgery of patient with old glaucoma]. / Dificultati în chirurgia cristalinului la bolnavul vechi glaucomatos.

Cataract surgery of glaucoma patients treated with Pilocarpine several years, with a small and miotic pupil, with synechiae is an important problem of management. The self-retaining flexible iris retractor is a microsurgical innovation that allows adequate enlargement of the pupil without iris incision. Each retractor is inserted through a separate self-sealing beveled incision made as far posteriorly in the cornea as possible. The retractors are spaced 90 degree apart and can easily be removed following implant insertion. The conclusion is that if we obtain an adequate enlargement of the pupil we can choose any cataract surgery technique, even phacoemulsification or EEC.