Study to Identify and Evaluate Predictor Factors for Primary Open-Angle Glaucoma in Tertiary Prophylactic Actions.

The aim of this study is to develop a predictive model with several explanatory variables that can guide ophthalmologists to make a more objective assessment of the evolution of open-angle glaucoma (OAG) during tertiary prevention. Objectives: The evaluation of risk factors and different predictors of symptom progression between patients with POAG and non-glaucoma patients (NG), as well as between primary open-angle glaucoma with high intraocular pressure (POAG) and primary open-angle glaucoma with normal intraocular pressure (NTG), in tertiary prophylactic activities. Methods: This research is an analytical epidemiological study of a prospective cohort. For the study, we took into account personal medical history, physical ophthalmological examination, intraocular pressure (IOP) values, and visual field (VF) parameters, examined with the Opto AP-300 Automated Perimeter using the "fast threshold" strategy. The results of gonioscopy were inconsistently recorded; they were not considered in the study due to missing values, the processing of which would have seriously distorted the statistical analysis. Ophthalmological examination was completed with a dichotomous questionnaire entitled "Symptom Inventory", made according to the accusations of patients resulting from a "focus group" study. The study was carried out in the ophthalmology office within the Integrated Outpatient Clinic of the Emergency Clinical Hospital of Oradea, Bihor County (IOCECHO) between January−December 2021. The threshold of statistical significance was defined for p value < 0.05. The obtained results were statistically processed with specialized software SPSS 22. Results: The study included 110 people, of which 71 (64.54%) had POAG (IOP > 21 mmHg) and 39 people (35.46%) had NTG (IOP < 21 mmHg), the two groups being statistically significantly different (χ2 = 9.309, df = 1, p = 0.002). For the POAG group, glaucomatous loss was early, AD < −6 dB, according to the staging of glaucomatous disease, HODAPP classification. In addition, the groups of POAG and NTG patients was compared with a group of 110 NG patients, these three groups being statistically significantly different (χ2 = 34.482, df = 2, p = 0.000). Analysis of confounding factors (age, sex, residence, marital status) shows a statistically significant relationship only for age (F = 2.381, df = 40, p = 0.000). Sex ratio for the study groups = 5.11 for OAG and =5.87 for NG. After treatment (prostaglandin analogues and neuroprotective drugs) IOP decreased statistically significantly for both POAG and NTG. Conclusions: this study identified possible predictors of OAG, at the 5% level (risk factors and symptoms as independent variables) using a dichotomous questionnaire tool with a complementary role in tertiary prophylactic activities. The implementation of the focus group interview results as a socio-human research technique will be supportive to clinicians.

Detection of Intraocular Hypertension during Opportunity Screening (Check-Up Medical Inspections).

The aim of the study is the early detection of OHT (Ocular hypertension) in patients, in the activity of secondary prophylaxis (opportunity screening-medical check-up), to prevent blindness caused by POAG (Primary Open Angle Glaucoma). In Romania, medical examination of personnel with responsibilities in Transport Safety (TS) is legally regulated, being mandatory as a result of the internal transposition of European legislation in the field. The addressability of the patients for examination was determined by personal choice, depending on the accessibility of the medical service on the profile market (availability and price). The design of the study is epidemiological, observational, descriptive and retrospective. The standardized medical protocol included: personal medical history (anamnesis), physical ophthalmological examination, Intraocular pressure (IOP) measurement and Visual Field (VF) performance, with Automated Perimeter "Optopol PTS 910" through "Fast Threshold" strategy. The specialized medical research was completed with a dichotomous questionnaire entitled "Symptom Inventory", made according to the recommendations of patients resulting from "Focus group" research. The study was carried out within the "Check-up" type medical controls upon request, only for personnel with positions in Transport Safety (TS), during January−December 2021 at S.C. ARTIMED S.R.L. Oradea, Bihor County. Health analysis was performed for 820 people, of whom 71 people (8.65%) tested positive for IOP > 21 mmHg, (suspected OHT) compared to 749 (91.35%) with normal values (Normal intraocular pressure-NIOP); the two lots being statistically significantly different (x2 = 560.590, df = 1, p = 0.000). The study involved 754 men (92.0%) and 66 women (8.0%), the sex ratio is 11.42 (Exp (B) = 0.782, Sig = 0.558, 95% CI = 0.343−1783; sex is not a significant predictor at the 5% level). The prevalence of OHT was 8.66% for the whole group, 8.48% for men and 10.60% for women. In the screening action for the whole group of patients the following was determined: IOP reference = 20.85 mmHg, Sensitivity (Se) = 91.5% and 1-Specificity (Sp) = 0.073, (Sp = 92.7%). The predictive value of the screening test was: Positive Predictive Value (PPV) = 90.1% and Negative Predictive Value (NPV) = 91.7%; Area under the ROC Curve (Receiver Operating Characteristic) = 0.986, Sig. = 0.000, CI95% = 0.979−0.993. A binary logistical model of a questionnaire was developed to determine the screening parameters which significantly predicted OHT: IOP (OR = 4.154, 95% CI: 3.155−5.469), Age < 40 years (OR = 0.408, 95% CI: 0.239−0.698) and Pattern Defect (PD) (OR = 1.475% CI: 1.130−1.925). The results of this study assess health status through regular medical examinations, and highlight their importance and usefulness in secondary prevention activity. The particularity of this "check-up" type for personnel with attributions in transport safety is based on two essential aspects: the legal obligation to perform it and the fact it is financed by the beneficiary (the employer). In patients suspected of OHT after antiglaucoma treatment, IOP statistically significantly decreased.

Children with Disabilities/Special Health Needs and Ocular Refractive Disorders.

Children with special needs face many eye problems that should be promptly addressed. Many eye diseases can be treatable if discovered in infancy. There is data showing these children have a higher prevalence of refractive errors than their non-disabled peers. If diagnosed and treated promptly, refractive errors can provide a good quality of life for special needs children.

Observations on Refractive Status and Risk Factors for Visual Impairment in Children with Disabilities.

Vision integrates all the senses and plays a fundamental role in the acquisition of different skills and the general development of a child. Recently, refractive errors and visual impairment have become serious health problems among children. Background and Objectives: The aim of this study was to identify the prevalence of refractive errors and visual impairment in children with disabilities. Moreover, this study aimed to explore the risk factors for visual impairment in children with respect to vitamin D levels, parental smoking, and the use of spectacles. Materials and Methods: We retrospectively analyzed 161 children aged 5-16 years old, divided into two groups: a group of 80 children with disabilities and a control group consisting of 81 clinically healthy children. All the children underwent refraction measurements, visual acuity testing, and plasmatic vitamin D level dosing, measured in ng/mL. Results: Refractive errors and visual impairment were found to have a higher prevalence in the group of children with disabilities than in the control group. Moreover, the plasma level of vitamin D was lower in the group of children with special health needs. Conclusions: Given the present results, children with disabilities should undergo special eye examinations as soon as possible to ensure the quality of their socio-academic lives.

The Burden of Assessing Ocular Status of Children - Causes and Control.

Pediatric ocular diseases can be detectable through a comprehensive eye examination and most of them are preventable once they are discovered. There is a well known fact that children can have ocular pathology such as cataract, refractive errors, strabismus and amblyopia. In children, low vision can have a negative impact on their growth and development; therefore, any visual impairment must be detected as soon as possible to prevent amblyopia development.

Choroidal melanoma, unfavorable prognostic factors. Case report and review of literature.

Uveal melanoma is the most common intraocular tumor characterized by increased metastatic potential. The tumor develops from uveal melanocytes that, from an embryological point of view, derive from the cells of the anterior neural crest. The risk factors associated with melanoma development are close related to patient phenotype: light-colored hair and iris, fair skin. Recent studies have shown the link between choroidal melanoma and choroidal pigmentation of white-haired and light-colored eyes individuals. Increased pigmentation of the choroid is associated to marked increase in melanocyte density, which from a histological point of view can be a starting point for choroidal carcinogenesis. This case report is about a 36-year-old patient who presented in an outpatient ophthalmological examination for intermittent vision blurring. The ophthalmological examination revealed a view of 0.8 and nasally from the optic nerve head, a prominent tumor-shaped formation was detected during the fundus examination. The presence of a choroidal melanoma was suspected and eye ultrasound, angio-fluorography, optical coherence tomography (OCT) were performed and confirmed the diagnosis. Due to the small size, a team of three ophthalmologists decided to make brachytherapy. The procedure consisting of brachytherapy was temporarily applied to the scleral wall and was done at Debrecen University Hospital, Hungary, the follow-up monitoring being done at the Clinic in Oradea, Romania. Although the initial prognosis was optimistic, after four years of brachytherapy the tumor recurred, the dimensions found were over 14 mm, which is why enucleation was decided. Prior to enucleation, no computed tomography (CT) metastases were detected. Five months after enucleation, hepatic metastases occurred and after another two months, death occurred.

Morphological study of upper wisdom tooth.

The article presents aspects of crown and root morphology of the superior wisdom teeth, aiming to several parameters: size, shape crown and occlusal surface, number, topography and orientation of the roots in order to determine which the most common morphological types are. For this purpose, the upper wisdom teeth were collected. According to studies, the dominant form of the dental crown is parallelepipedic, the rectangular or parallelogram shape of the occlusal surface has large mesial and distal-oriented sides. The positive occlusal forms are generally poorly demarcated; cusps are less tall and rarely individualized. In half of the cases, the root is unique, voluminous, straight or with a curved distal tip.

Anatomic variants in Dandy-Walker complex.

Dandy-Walker complex (DWC) is a malformative association of the central nervous system. DWC includes four different types: Dandy-Walker malformation (vermis agenesis or hypoplasia, cystic dilatation of the fourth ventricle and a large posterior fossa); Dandy-Walker variant (vermis hypoplasia, cystic dilatation of the fourth ventricle, normal posterior fossa); mega cysterna magna (large posterior fossa, normal vermis and fourth ventricle) and posterior fossa arachnoid cyst. We present and discuss four cases with different morphological and clinical forms of the Dandy-Walker complex. In all four cases, diagnosis was reached by incorporation of clinical (macrocephaly, seizures) and imaging [X-ray, computed tomography (CT), magnetic resonance imaging (MRI)] data. Two patients were diagnosed with Dandy-Walker complex, one patient was diagnosed with Dandy-Walker variant in a rare association with neurofibromatosis and one patient was diagnosed with a posterior fossa arachnoid cyst associated with left-sided Claude Bernard-Horner syndrome, congenital heart disease (coarctation of the aorta, mitral stenosis) and gastroesophageal reflux. In all forms of DWC, the clinical, radiological and functional manifestations are variable and require adequate diagnostic and therapeutic measures.

Fulminant evolution in one case of choroidal melanoma - predictive factors for general metastasis.

Comparing with other malignant tumors, uveal melanomas determine tardive general spreading. Even in the absence of local treatment, general metastasis is less than 20%, in the first five years, many factors being involved. This paper present a particular case of choroid melanoma with very unusual and unpredictable evolution of the disease; the high growth of tumor size (in only half year the tumor almost doubled up dimensions), was associated with hepatic metastasis developed in only several months. In our opinion, this case, presenting a very atypical evolution may contribute to increase our knowledge of the mechanisms underlying metastasis and the identification of reliable progression parameters as prognostic markers in primary uveal melanoma. Several histological characteristics and demographic factors have been associated with disease evolution: presence of retinal neovessels and neovascular glaucoma, rapid increasing tumor thickness, scleral invasion, epithelioid cell types with large nucleoli, lymphocytic infiltration, and vascular pattern with networks of loops. Sclera invasion is uncommon in choroid tumors, but it is associated with an unfavorable bad prognosis, giving a great propensity to metastasize and to affect the liver. The median survival following diagnosis of hepatic metastasis is only several months.

PRESERVATIVES FROM THE EYE DROPS AND THE OCULAR SURFACE.

The use of preservatives in eye drops (eyewashes) has known glory at the beginning, but the side effects that they have on the ocular surface have led to a decrease of their popularity. Lachrymal film dysfunction, ocular hyperemia, dotted keratitis or toxic keratopathy were reported and analyzed in terms of pathophysiological mechanism of the role played by preservatives in ophthalmic drops (eyewashes). This article reviews the most common preservatives and the existing alternatives for the maintenance of the eye sterile drops. Keywords: preservatives, eye drops, ocular surface

[Antiangiogenic agents in ARMD treatment]. / Substante antiangiogenice în tratamentul DMLV--prezentare de caz.

The aim of antiangiogenic agents in the treatment of age related senile macular degeneration is to destroy coroidian neoformation vessels by minimally affecting the central vision. We present a case of important central vision recovery after 3 intravitreal injections of Avastin. The therapeutic decision and patient monitoring have been made using imaging studies, such as OCT and AFG. A modern therapeutic approach of neovascular forms of age related macular degeneration, backed up by AFG and OCT is a modern treatment method of this disabling illness which brings patients optimal functional and structural improvement.

[First 5 years in facoemulsification in Department of Ophthalmology in Oradea County Hospital]. / Primii 5 ani de experienta în implementarea operatiei prin facoemulsificare la pacientii cu cataracta în sectia de oftalmologie a Spitalului Judetean Clinic de Urgenta Oradea.

The retrospective study of cataract surgery with new technique, phacoemulsification, prove that the method implementation was a success in Ophthalmology Department of University Emergency Hospital Oradea. The phacoemulsification demonstrated it is superior in functional rehabilitation and in the socio/professional reintegration of patient. In year 2005 the number of patients with cataract with phacoemulsification surgery was 98 of total of 521 cataracts. The number of intervention increased from year to year to amount that the phacoemusification was practiced in all patients in 2009. The small incision reduced the risk of intra-operator incidents and some post-operator complications, the hospitalization period was reduced by half.

Endometrial stromal sarcoma developed on outer endometriosis foci.

INTRODUCTION: Endometrial stromal tumor is a rare mesenchymal uterine tumor. Endometriosis, an affection of the women during her fertile period, is reported in the pertinent literature to have an incidence varying from 1% to 53%, which shows a wide difference from one study to another. The pathology that grafts onto the endometriosis foci is rare, and the malignant tumoral pathology is extremely rare. The most frequent malignant tumors quoted in the pertinent literature are of the adenocarcinoma type, on the endometriosis, and the alterations of the sarcomatous type can appear extremely rarely. Most sarcomas appear on the foci of the rectosigmoid endometriosis. These rare tumors should not be taken for the mesenchymal gastrointestinal tumors. The recurrence of the malignant alterations of the endometriosis foci is estimated at about 0.7-1% in the pertinent literature. MATERIALS AND METHODS: We are presenting a case of endometrial stromal sarcoma, developed on foci of outer endometriosis (sigmoid and appendicular endometriosis), diagnosed in our laboratory on two operatory pieces taken from the same woman, at a 2-month interval. The macroscopic and microscopic study was done on operatory pieces, with the routine procedure, macroscopic examination, fixing in 10% formalin, embedding in paraffin and staining with Hematoxylin-Eosin and than we used immunohistochemical markers, for endometrial stroma. RESULTS: The endometrial stromal sarcoma developed on foci of endometriosis is very rare, has an incidence of 6% within the endometrial malignant tumors, with various degrees of malignancy, low malignancy, or high malignancy. CONCLUSIONS: We do not exclude the appearance of the endometrial sarcoma on the outer endometriosis foci. Moreover, the endometriosis foci can be considered as pre-malignant conditions.

Squamous carcinoma of the conjunctiva.

We present the case of a 63-year-old patient who was hospitalized for pain and loss of vision in the right eye (RE). Clinical examination reveals a conjunctival tumor of 1.5/1 cm infiltrating the cornea and sclera. Biopsy and histopathological examination showed the existence of a spinocellular carcinoma.

Eyelid tumors: histopathological and clinical study performed in County Hospital of Oradea between 2000-2007.

The work assessment is to analyze eyelid tumors diagnosed in the last years in our hospital. We found 471 tumoral and pseudotumoral cases, in which malignant tumors predominated, with 255 cases. The most affected age range was the sixth decade and the majority of tumors were located to lower eyelid. The histopathological study allowed us to establish the lesions type and subtype. The Meibomian gland cysts, squamous papillomas and basal cell carcinomas were the most frequent related with this three of category lesions represented by pseudotumors, benign tumors and malignant tumors. Early diagnosis of these lesions can determine a favorable prognosis, especially in cases of malignant tumors.

Ocular migraine and antiphospholipid antibodies--where we stand?

There is no doubt that ocular migraine also known as retinal migraine or ophthalmic migraine should not to be confused with ophthalmoplegic migraine. The hallmark of ocular migraine is the unilateral visual loss or "monocular transient loss of vision" associated or followed by the headache. Better safe than sorry, therefore an ophthalmologic examination during the migraine attack is the most diagnostic method. age with typical history for ocular migraine. Importantly supportive data sustain that different neuro-ophthalmologic manifestations as amaurosis fugax, retinal vascular thrombosis and optic neuropathy, may be considered as the ocular hallmarks of the Hughes's syndrome. Clues for the evaluating of antiphospholipid antibodies include recurrent thrombosis especially in young people, recurrent fetal loss, and thrombocytopenia. There are no studies that focus exclusively on the prophylaxis of ocular migraine. Ocular features due to antiphospholipid antibodies - induced thrombosis or Hughes's syndrome should be treated with anticoagulant therapy.

Ocular manifestations of antiphospholipid (Hughes)' syndrome--minor features?

The ocular manifestations are described in autoimmune disease, being most common associated with systemic lupus erythematosus, scleroderma, rheumatoid arthritis, insulin-dependent diabetes mellitus, and dermatomyositis. Nonetheless, the antiphospholipid syndrome is a relatively newly recognized autoimmune disorder. Ocular conditions in which to consider antiphospholipid syndrome include amaurosis fugax, transient ischemic attack, retinal haemorrhages and cotton wool spots, central retinal vein and artery occlusion, anterior ischemic optic neuropathy, ophthalmic and cilioretinal artery occlusions. Ocular features due to antiphospholipid antibodies - induced thrombosis should be treated with anticoagulant drugs. In opposition, for the treatment of ocular features due to immunological mechanisms such as vasculitis, immunosuppressants seem to be more suitable. The aim of this article is to underline the mainly ocular features of Hughes' syndrome and for the most part attention should be paid to the patients with central retinal vascular occlusion with no cause but most likely caused by lupus anticoagulant.

[Malignant non-Hodgkin conjunctival-orbital lymphoma in the years 1990-2005 at the Ophthalmology Clinic of Oradea]. / Limfoamele maligne non-hodgkiniene conjunctivo-orbitare internate în perioada 1990-2005 în clinica de oftalmologie oradea.

Non-Hodgkin conjunctival-orbital Malignant Lymphoma, there are rare tumors, difficult to be diagnosed. We've made a clinical and paraclinical retrospective study, along 15 years (1990-2005) period of time, analyzing from the point of view, clinical features and anatomo-pathological results, each of the 11 cases that we found.

[Epidemiologic study of amblyopia in children between 7 and 11 years of age in Bihor county, Romania]. / Studiu epidemiologic al ambliopiei la copiii în varsta de 7-11 ani în judetul Bihor.

This descriptive epidemiologic study is effectuated on a representative children's group in Bihor County, aged to 7-11 years old. We studied the incidence and prevalence of amblyopia in children and the importance of early trace to the adequate treatment.

Non-Hodgkin Malignant Lymphoma Study--admitted cases during 1990-2005 in Ophthalmologic Clinical Department, Oradea.

Non-Hodgkin Malignant Lymphomas are rare tumors, difficult to be diagnosed. We've made a clinical and paraclinical retrospective study, along 15 years (1990-2005), estimating the moment of onset, clinical and anatomo-pathological features, in each of the 11 cases.