[Effect of cataract surgery for visual field in glaucoma patients]. / Influenta operatiei de cataracta asupra câmpului vizual la pacientii cu glaucom.

PURPOSE: To study the influence of cataract surgery on the quantitative and qualitative parameters of visual field in patients previously operated for glaucoma. METHOD: Retrospective study that included 42 eyes with primary open angle glaucoma that had been previously subjected to trabeculectomy. The glaucoma was therapeutically controlled in all patients. Then they all underwent cataract extraction and artificial lens implantation. All eyes were evaluated pre- and postoperatively at short intervals to avoid glaucoma progression. Throughout the follow-up period the IOP remained under 21 mmHg, with or without antiglaucoma drugs. RESULTS: After cataract surgery the visual acuity increased significantly (preoperative VA 0.22 +/- 0.15, postoperative VA 0.57 +/- 0.27, p < 0.0001). The parameters used for glaucoma evaluation and follow-up remained unchanged (preoperative IOP 17 +/- 6.71 mmHg, postoperative IOP 17.04 +/- 4.56 mmHg, p = 0.97; preoperative C/D ratio 0.59 +/- 0.26, postoperative C/D ratio 0.62 +/- 0.26, p = 0.69). The quantitative parameters of visual field did not change significantly (preoperative MD -15.52 +/- 8.69, postoperative MD -13.33 +/- 9.97, p = 0.28; preoperative PSD 5.86 +/- 3.25, postoperative PSD 6.11 +/- 3.39, p = 0.79). In about 60% of cases the MD value improved and in 24% it worsened. The PSD was ameliorated in 33% of cases and aggravated in 26% of cases. CONCLUSION: Cataract surgery in patients with previously operated, therapeutically controlled glaucoma does not influence significantly the synthetic parameters of visual field.

[FDT versus automated standard perimetry in healthy subjects]. / FDT vs. perimetria statica automata la voluntari sanatosi.

PURPOSE: To assess the frequency of visual field defects in frequency doubling technology (FDT) perimetry performed in healthy volunteers and the correlations between FDT and standard automated perimetry (SAP). METHOD: A transversal study that included 57 healthy volunteers who were subject to visual field testing in both FDT and SAP (randomly effectuated in the same day). The studied parameters were: the frequency of visual field defects in the two techniques, the correlation of the quantitative parameters (MD, PSD) with the C/D ratio and also between techniques, the test reliability and the test duration. The subjects have been questioned about their preference for one test or another. RESULTS: The frequency of visual field defects was 47.35% in FDT and 22.8% in SAP. The MD values were significantly higher in FDT (MD FDT= -1.45+/-1.91, MD SITA= -0.77+/-1.58, p< 0.0001). Also the PSD values were higher in FDT (PSD FDT= 3.76+/-0.96, PSD SITA= 1.94+/-1.05). The correlation of quantitative parameters between the two techniques was low (r = 0.369 for MD and 0.206 for PSD). The correlation between the PSD value and the C/D ratio was extremely weak in both methods (because the subjects were healthy). The mean duration of a FDT test (4 '29") was significantly lower than that of a SITA test (5'18") - p < 0.00001. The reliability indices (fixation losses, false negative and false positive errors) were significantly better in FDT, and 3/4 of subjects declared that they preferred the FDT test. CONCLUSIONS: In normal subjects the frequency of visual field defects was greater in FDT than in SAP. There was a low correlation of quantitative parameters (MD, PSD) between SAP and FDT, and also with the C/D ratio. Better reliability indices, shorter test duration and better patient compliance are arguments for using FDT as a screening test for glaucoma.

[Ring iris melanoma]. / Melanom irian de forma inelara.

We are presenting a case of diffuse (ring) iris melanoma with secondary glaucoma, together with the differential diagnosis issues. The tumor extension and the high IOP imposed the enucleation of an eye that still had a good visual acuity. The pathology confirmed the diagnosis and showed the extension to the anterior chamber angle and the ciliary processes. The prognosis in this rare type of uveal melanoma is worse than in other iris melanomas.

[The influence of cataract surgery on the efficacy of trabeculectomy in patients with open-angle glaucoma]. / Influenta operatiei de cataracta asupra eficientei trabeculectomiei la pacientii cu glaucom cu unghi deschis.

PURPOSE: To study the influence of cataract surgery on the intraocular pressure decreasing effect of trabeculectomy in patients with open angle glaucoma. METHOD: Retrospective study that included two groups: --32 patients with open angle glaucoma, their intraocular pressure being controlled after filtering surgery; they were subject to cataract surgery at least 6 months after the trabeculectomy (the CT group)--44 patients with open angle glaucoma (primary or secondary) with intraocular pressure controlled after trabeculectomy (the T group). The evaluation included: preoperative intraocular pressure, early (at 2 months) and late (at 18 months) postoperative intraocular pressure, intra- and postoperative complications of the cataract surgery, the need for antiglaucoma medication. RESULTS: The cataract surgery in patients with trabeculectomy increases the intraocular pressure (initial mean IOP = 15.31 mmHg, final mean IOP = 18.53 mmHg, mean IOP = 3.22 mmHg). The intraocular pressure increase is more important after extracapsular extraction than after phacoemulsification (3.7 vs. 2.01 mmHg). Qualified therapeutical success was obtained in 81.25% of CT patients. In the T group the postoperative intraocular pressure maintained constant throughout the entire follow-up period. The number of additional antiglaucoma drugs was larger in the T group (0.7 versus 0.5). The patients that suffered intra and postoperative complications had increased intraocular pressure when compared to those without complications (mean IOP early = 3.1 mmHg, mean IOP late = 1.1 mmHg). CONCLUSIONS: Cataract surgery in patients with previous filtering surgery increases the intraocular pressure and the need for antiglaucoma drugs. The intraocular pressure rise was more important after extracapsular extraction than after phacoemulsification. Intra and postoperative complications result in a more important increase in intraocular pressure, in the first months after the cataract operation.