IRIDEX MicroPulse P3: innovative cyclophotocoagulation.

Purpose: To present the new IRIDEX MicroPulse P3 (MP3) technology in patients with refractory glaucoma and our preliminary results at 1 week and 1 month postoperatively. Methods: IRIDEX MP3 laser cyclophotocoagulation was performed in 7 eyes of 7 patients under retrobulbar anaesthesia with lidocaine 2% in the operating room. Each eye received two treatments of 80-90s over the superior and inferior hemisphere, avoiding the temporal- and nasal-most clock hours. 810nm IRIDEX MP3 was set to 31,3% duty cycle (0,5ms treatment pulse followed by 1,1 ms of rest). Postoperative topical steroids were prescribed for 1 week. Results: Mean IOP decrease at 1 week was 60,3% and 33,4% at 1 month, with a mean topical hypotensive treatment reduction of 0,71 therapeutic agents. The procedure was safe in all cases and effective in 71% of the patients. Neovascular glaucoma patients registered high IOP levels 1 month postoperatively in spite of medical and MP3 laser treatment. BCVA remained unchanged after undertaking the laser procedure. No significant inflammation, discomfort, or pain was reported. There were no complications such as hypotony, phthisis bulbi, and macular edema. Conclusions: IRIDEX MP3 represents an innovation in cyclophotocoagulation. It is non-destructive, repeatable, non-invasive, with a high safety profile. A mean IOP decrease of 33,4% was registered at 1 month. Patient comfort and recovery are favorable. Long-term results will prove its efficacy in the future.

THE ADVANTAGES OF FEMTOSECOND LASER-ASSISTED CATARACT SURGERY.

PURPOSE: To present the advantages of performing femtosecond laser-assisted (Alcon-LenSx Inc.) cataract surgery. METHODS: Cataract surgery was performed with the LenSx femtosecond laser (Alcon-LenSx Inc.) in 50 eyes of 50 patients. The laser was programmed to perform a 4,9-4,5 mm capsulorhexis, a 2,3 mm main corneal incision, two 1,3 mm side-port incisions and either a hybrid-pattern or a cylinder-pattern fragmentation of the nucleus. The evaluated parameters were the capsulotomy, the corneal wounds and the nucleus fragmentation. Phacoemulsification of the nucleus and aspiration of the cortex were performed with the Alcon Centurion Vision System and monofocal, toric and multifocal IOLs were successfully implanted. RESULTS: A continuous, central, curvilinear capsulorhexis was performed in 48 cases, 96% (free-floating capsulotomy). In 2 cases, micro-adhesions were reported and detached with the Utrata forceps. Femtolaser capsulotomy resulted in a complete overlap of the anterior capsule over the IOL optics in all cases. Horizontal decentration was found in 2 cases, 4% and vertical decentration in 1 case, 2%. The main corneal incision was self-sealing in 49 cases, 98%. Sutures were used in 1 case, 2%. The hybrid pattern of nucleus fragmentation was used in 42 cases, 84% and the cylindrical pattern in 8 cases, 16%. The fragmentation was incomplete in one case of white cataract and in one case of traumatic cataract. CONCLUSIONS: The main advantages of femtolaser cataract surgery are standardized corneal incisions, perfectly centered, round capsulorhexis, and lens nucleus fragmentation even in eyes with hard cataracts. The laser precision is due to the real time OCT software programs, which cover the whole anterior segment, up to the posterior lens capsule.

[Current therapeutic management in retinoblastoma with invasion of the optic nerve--a case report]. / Conduita terapeutica actuala în retinoblastomul cu invadarea nervului optic--prezentare de caz.

INTRODUCTION: Retinoblastoma is the most frequent primitive intraocular tumour in children. The extension of retinoblastoma at the optic nerve level gives a dark prognosis implying a complex treatment and a long period of supervision. OBSERVATION: An eleven-months-old child, female, is taken in the hospital with the suspicion of retinoblastoma left eye. The diagnosis was suspected when the child was six months old within another ophthalmologic department, but the treatment was postponed. Surgical treatment consisted of enucleation with at least a 10 mm resection of the optic nerve. The anatomo-pathologic examination shows a retinoblastoma with the optic nerve invasion (stage II b 2--after Grabowski's classification). Because of the early age of the patient, we are obliged to give up applying radiotherapy (technical reasons) and systemic chemotherapy is recommended, in six cycles, under very severe clinic and paraclinic control. CONCLUSIONS: The extension of retinoblastoma at the optic nerve level indicates a severe prognosis with high lethal risk. The correct treatment during thus phase implies the association of radiotherapy (40-45 Gy) and chemotherapy. After 24 months from the finishing of the treatment the patient is in total remission (clinic and paraclinic), but the supervision is going on for at least another 3 years. The early enucleation as well as its appliance with the removal of a large part of the optic nerve represents a therapeutical manner and leads to an important prognosis.

[Controversies connected with the therapeutic approach in palpebral epitheliomas]. / Controverse legate de atitudinea terapeutica în epitelioamele palpebrale.

OBJECTIVE: We try to clarify some controversies related to the palpebral epitheliomas, controversies related to the therapeutical applied attitude (surgery, radiotherapy or the association of the two therapeutical methods), to the indications and contraindications of their application. MATERIAL AND METHOD: It is a review study of the Military Hospital and Oncologic Institute Cluj-Napoca casuistry between 1984-1994, which comprises 244 patients with palpebral epitheliomas, histologically confirmed. This casuistry was followed taking into consideration the age, sex, histological type, anatomo clinical presentation, TNM clinical stage, the localisation of the tumor, the type of the applied treatment, complications, healing and the therapeutical failures. RESULTS: The efficiency of the applied therapeutical methods was considered related to their obtained results to the therapeutical failures. The rate of healing at 5 years was 90.57% for the whole group. CONCLUSIONS: 1. The two methods of treatment seems to be equally sensible concerning the therapeutical efficiency in stages I and II. 2. In the advanced stages (III and IV) our option is for mixing the two methods. An optimum treatment for each patient is possible only if there is a close cooperation between the ophthalmologist-surgeon, plastic surgeon and the radiation oncologist.

[Carcinomas of the inner canthus--combined treatment]. / Carcinoamele cantusului palpebral intern--tratament asociat.

It is described a therapeutical protocol which combines surgery and radiotherapy in a "particular" way for carcinomas of the medial palpebral canthus. This consist of a surgical excision of tumors without covering the denuded area after 2-3 weeks of external radiotherapy--Chaoul type.