Gonioscopic findings in patients with acute central/hemicentral retinal vein occlusions.

OBJECTIVES: To evaluate prospectively the gonioscopic findings and their changes during a 3-year follow-up period in patients with acute central/hemicentral retinal vein occlusions (C/HRVOs). MATERIAL AND METHODS: A comprehensive ophthalmological examination of both eyes including static and dynamic gonioscopy as well as ocular biometric measurements was performed in 57 patients with acute C/HRVOs. The angle configuration and its changes, the axial length of the globe, the anterior chamber depth and the corneal thickness were assessed. RESULTS: 12 C/HRVO patients presented with narrow drainage angles (< or = 20 degrees) and 45 had normal angles (> 20 degrees). Ocular globes with narrow angles had axial length and anterior chamber depth significantly smaller as well as cornea thickness significantly greater than the eyes with normal angles. Out of the 12 patients with narrow angles, 6 cases had primary angle closure suspect (PACS), 5 cases had primary angle closure (PAC) and one case primary angle closure glaucoma (PACG). 3 of the 6 PACS patients progressed to PAC in the 6th, 10th, and 18th months of the follow-up period. From the 8 PAC cases existing during the whole study interval, one case progressed to PACG during the 24th month of the folow-up interval. CONCLUSIONS: In the context of an ocular globe having its size significantly smaller than the normal eye, narrow angle may represent a local risk factor predisposing to C/HRVO. Intermittent episodes of angle closure may contribute by increasing the intraocular pressure to the occurrence of C/HRVO as well to the progression of the gonioscopic configuration from PACS to PAC and from PAC to PACG.

In vitro expansion and characterization of corneal stem cells isolated from an eye with malignant melanoma.

PURPOSE: The objective of this study was the identification, characterization and in vitro replication of the human corneal stem cells, taking into consideration the difficulties in obtaining sufficient corneal material from living donors. The study explored a variety of stem cell markers, usually found in embryonic or adult mesenchymal stem cells. Culture medium and replication substrates had to be identified, with no data available on this subject in our country (there are no other reports on corneal stem cells in Romania, to our knowledge). MATERIALS AND METHODS: Corneal epithelial limbus was harvested from an enucleated eye, containing also a choroid malignant melanoma. Stem cells from the limbus were isolated and cultivated in vitro. Expression of specific stem cell markers was evaluated with immunocytochemistry. RESULTS: Corneal stem cell expansion in primary culture was slow, achieving 70-80% confluence after 28 days. Stem cells were easily isolated in standard medium, showed fibroblastoid morphology and were positive for certain stem cell specific markers in immunocytochemical staining: Oct3÷4, SOX2, Nanog, SSEA4, CD44, CD90, CD133, and CD34. They also expressed pan-cytokeratin. Donor age (72 years) and the presence of a malignant tumor close to limbal stem niche could have had an impact on the proliferation rate and the characteristics of the corneal stem cells. CONCLUSIONS: Isolated limbal cells were adult type stem cells with an epithelial orientation. The characterization of these cells with immunocytochemistry allowed us to observe surface markers that other stem cells also express.

[Methods for sealing of corneal perforations]. / Metode de sigilare a perforatiilor corneene.

A variety of corneal pathology can lead to corneal ulcers and perforations. A deep corneal ulcer may need surgical treatment to allow good volume restoration and reepithelisation. Corneal perforation must be sealed and when the perforation is large, the task of repairing the defect can be underwhelming. The elegant solution is the corneal transplant, but this is not always readily available, especially in undeveloped countries. We present here two cases with different solutions to seal the perforated cornea: the first one has a large peripheral defect and it is successfully sealed with scleral patch and the second one is central with small perforation and is successfully sealed with multilayered amniotic membrane. Both cases are followed for over 12 months and demonstrate good corneal restoration (both on clinical examination and corneal topography). Sclera and amniotic membrane can be used to seal corneal defects when corneal transplant is not readily available.

[Neovascular glaucoma--etipathogeny and diagnosis]. / Glaucom neovascular: etiopatogenie si diagnostic.

Neovascular glaucoma is defined as an iris and/or anterior chamber angle neovascularization associated with increased intraocular presure. It is a secondary glaucoma most frequently determined by a severe retinal ischemia. The most common diseases responsible for the development of neovascular glaucoma are diabetic retinopathy, ischemic central retinal vein occlusion and ocular ischemic syndrome; the uncommon causes include ocular radiation, ocular tumors, uveitis and other miscellaneous conditions. Vascular endothelial growth factor is an important and probably predominant agent in the pathogenesis of both intraocular neovascularization and neovascular glaucoma. The evolution of clinical and histopathological changes from predisposing conditions to the occurrence of rubeosis iridis as well as neovacular glaucoma is divided into four grades that is prerubeotic, preglaucomatous, open-angle and angle closure glaucoma stages.

[Treatment of neovascular glaucoma]. / Tratamentul glaucomului neovascular.

Neovascular glaucoma management is divided into preventive and curative procedures.Pre vention therapy consists of the treatment of the common underlying causes of the disease (ie diabetic retinopathy, ischemic central retinal vein occlusion and ocular ischemic syndrome) as well as the less frequent causes attributed to ocular radiation, ocular tumors, uveitis and other miscellaneous condi tions.Curative therapy includes both the neovascularization treatment and the treatment of the in creased intraocular pressure.lntravitreal Bevacizumab injection enables us to block up the neovascular trigger preparing thereby the pacient to a complement of panretinal photocoagulation or surgical treatment. Since Bevacizumab injection activity is transient, the retinal ischemia treatment by panretinal photocoagulation is mandeited in order to avoid neovascular recurrence.Short term efficacy of Bevacizumab injection is obvious with a constant, marked and swift intraocular pressure lowering espe cially in less severe and/or early forms of the disorder. In more advanced stages of neovascular glaucoma after closing the chamber angle by peripheric anterior synechiae the outcomes of this treatment are inconstant, most of cases necessitating the resorting to surgery (trabeculectomy with antifi brosis drugs or glaucoma drainage implants).

[Azarga, a new and useful fixed combination in glaucoma treatment]. / Azarga,o noua si utila combinatie medicaméntoasa fixa în tratamentul glaucomului.

Azarga is a new fixed combination product that consists of the carbonic anhydrase inhibitor brinzolamide 1% and the betablocker timolol 0,5%. Its efficacy in lowering intraocular pressure is similar to that of Cosopt, a fixed combination that combines another carbonic anhydrase inhibitor (eg dorzolamide 2%) with the betablocker timolol 0,5%. The main difference between these two ocular hypotensive agents lies in their safety profiles with Cosopt causing more ocular discomfort to appear while instilling (burning,stinging and smarting sensations) probably due to the differences between the pH of these two fixed combinations agents. Its similar efficacy and enhanced tolerability compared with Cosopt make Azarga represent a resonable alternative for the patients who do not achieve an adequate intraocular pressure control while treating with a monotherapeutic agent.

[The latest developments in glaucoma therapy using fixed combination products]. / Actualitati în tratamentul glaucomului cu combinatii fixe medicamentoase.

Modern fixed-combination products simplify medication dose regimen without sacrificing their effectiveness.Potential benefits of the therapy with fixed-combination products are enhanced tolerability increased convenience,better compliance,cost and time economy and removal of the wash out effect. Regarding intraocular pressure lowering effect, fixed-combination agents are superior to monotherapy with the two medication components, with the exception of Duotrav that is not superior to travoprost action.Fixed-combination products are noninferior to concomitant administration of the two components of medication (nonfixed-combination agents) relative to their ocular hypotensive efficacy with the exception of Ganfort that is however inferior to concurrent administration of both the bimatoprost and timolol.

[Monotherapy with lipid structural derivatives in glaucoma]. / Monoterapia cu derivate structurale lipidice în glaucom.

Lipid structural derivatives (latanoprost, travoprost and bimatoprost) are ocular hypotensive agents that significantly lower ocular tension with more than 30% from baseline by once-daily dosing.Ocular tension reduction from baseline is statistically significantly greater for bimatoprost than for latanoprost at all time points measured. Compared with travoprost, ocular tension decrease was statistically greater with bimatoprost at 8AM and 12PM. This trend was also seen at 4PM and 8PM, even though the difference was not statistically significant at the former time point and borderline at the latter time point. The findings for latanoprost and travoprost indicate that these two agents are comparable in their ability to reduce ocular pressure with no statistically significant difference seen at any time point measured. There does not exist any evidence, excepting conjunctival hyperemia which has been lesser with latanoprost compared to both the bimatoprost and travoprost, that any of these 3 medications significantly differs with respect to their adverse effects.

[Steroid induced ocular hypertension and glaucoma]. / Hipertensiune oculara si glaucom induse steroidic.

Steroid induced ocular hypertension and glaucoma represent iatrogenic changes of pharmacogenic nature. They are mainly due to exogenous steroids following ocular periocular, intravitreal and systemic administration. Elevated ocular pressure is brought about by structural trabecular changes as well as obstruction of the outflow ways of the aqueous humor localized within the trabecular juxtacanalicular area. Although mostly raised ocular pressure spontaneously descends to basal values after ceasing the steroid therapy, progressive optic nerve damages and glaucomatous visual field defects may occur. Therapy of steroid induced ocular hypertension and glaucoma is similar to that of ocular hypertension and primary open-angle glaucoma.

[Bimatoprost therapy in glaucoma]. / Terapia cu bimatoprost în glaucom.

Bimatoprost is a neutral lipid, a fatty acid amide that pharmacologically acts in both its paternal amide form and through its hydrolysis product (active free fatty acid of bimatoprost). Hypotensive ocular efficacy of bimatoprost is significantly superior to that of timolol and latanoprost. Mean ocular pressure decreases as well as percentages of reaching and sustaining the low targeting ocular pressures are higher comparing with travoprost. Conjunctival hyperemia produced by bimatoprost is statistically greater than that caused by timolol, latanoprost and travoprost; nevertheless it is well tolerated and mild in severity. Bimatoprost prostamide lowers ocular tension significantly and clinically relevant in patients uncontrolled with latanoprost; that is why bimatoprost can be used as additive or replacement therapy in patients who already receive maximal tolerated dose of latanoprost.

[The role of Cosopt in glaucoma treatment]. / Locul cosoptului in tratamentul glaucomului.

The fixed combination of dorzolamide and timolol (Cosopt) represents a high effective therapy and is generally well tolerated. It produces a baro-protection similarly to that caused by both the prostaglandin analogs and the other topically fixed combinations. Cosopt is the only hypotensive medication that produces a direct vasoprotection by increasing retrobulbar, choroidal, retinal and optic nerve head blood flow. Its major indication is as second line therapy e.g. after the failure of a previously given monotherapy Cosopt is also indicated as an initial therapy (first line therapy) in ocular hypertensions associated with high risk factors of conversion, in some well chosen cases of primary open-angle glaucoma (e.g. glaucomas with untreated intraocular pressure of greater than 30 mmHg), in exfoliation glaucoma as well as in the majority forms of secondary glaucoma.