[Cataract surgery in pseudoexfoliative syndrome]. / Particularitatile chirurgiei cataractei in sindromul pseudoexfoliativ.

The pseudoexfoliative syndrome is a group of important ocular manifestations of a systemic anomaly. Cataract surgery in pseudoexfoliative syndrome implies high intra and postoperative risks, because the irido-ciliary and lens changes create the background for more frequent complications. Phacoemulsification is the preferred method for these patients, and if an adequate and detail-oriented surgical technique is used, comparable results can be obtained.

[Pseudoexfoliative glaucoma]. / Glaucom pseudoexfoliativ--prezentare de caz.

The pseudoexfoliative syndrome is a systemic anomaly that primarily affects the eye. The presence of the pseudoexfoliative material causes important changes to the cornea, camerular angle, lens and zonules. Pseudoexfoliative glaucoma is aggressive, with great pressure differences between the two eyes, also with important circadian variations of intraocular pressure and has a poor prognostic. We present the case of a patient with pseudoexfoliative glaucoma.

[Cataract surgery and diurnal fluctuations of IOP in non-glaucoma patients]. / Chirurgia cataractei si fluctuatiile diurne ale PIO la pacientii neglaucomatosi.

PURPOSE: To study the effect of cataract surgery on diurnal IOP fluctuations. METHODS: Three months clinical, observational, prospective study on one group of 34 patients (34 eyes) with cataract surgery (phacoemulsification technique) performed by the same surgeon. The IOP was measured, every two hours, for each patient (from 8am to 18pm) preoperative and postoperative by Goldman aplanotonometry. EXCLUSION CRITERIA: not normal open angle in gonioscopy examination and ocular or general associated diseases. The group was homogeneous about age and sex distribution. Statistic analyse was realised by t student test. RESULTS: Cataract surgery reduced IOP at all time points of measurement (p<0.05). The mean IOP was decreased from a preoperative level of 12.3+/-2.5mmHg to 11.2+/-2.2mmHg at follow-up (p<0.05). The maximum and minimum IOP also showed significant difference. There was no difference in the range of IOP before (3.0+/-1.5mmHg) and after surgery (2.75+/-1.5mmHg) (p<0.05). CONCLUSION: Cataract surgery significantly decreases IOP and has no effect on diurnal IOP fluctuation.

Post-traumatic bacterial keratitis--a microbiological prospective clinical study.

PURPOSE: The aim of this study was to define the microbiological and clinical profile of traumatic bacterial keratitis, the management and outcome of this disease. METHODS: The patients with traumatic bacterial keratitis were prospectively enrolled from 1 June 2004 to 30 June 2006. Clinical features (age, risk factors, visual acuity, corneal ulcer size), microbiological profile, management and outcomes were analyzed. RESULTS: The 68 consecutive patients were analyzed. Corneal scraping was performed in 96% of cases and in 86, 7% it was positive. 76% of the infections involved Gram positive bacteria, 14% involved Gram negative bacteria, and 8, 8% were polymicrobial. The most commonly isolated bacteria was Staphylococcus epidermidis - 41, 7%. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.003), as well as greater surface of infiltrates (p=0.04). Antimicrobial treatment was changed on the basis of culture results in 9 cases (13, 2%). 95, 5% of ulcers resolved with treatment, but only 75% of patients had visual acuity better than the level at admission, and 4, 4% had poor visual outcome with indication for corneal transplant. CONCLUSIONS: Infectious keratitis is an important cause of ocular morbidity. Ocular trauma represents the main risk factor for bacterial keratitis. The ulcer size was statistical significantly correlated with patient's age and also the most important predictor of a positive culture result. Fluoroquinolones appear to be the first choice therapy, but based upon these in vitro studies, some strains may be resistant.

[Central serous chorioretinopathy--clinical aspects and course]. / Corioretinita seroasa centrala - aspecte clinice si evolutive.

PURPOSE: To investigate and to identify the clinical aspects and outcomes in military patients with central serous chorioretinopathy (CSC). METHODS: Prospective, comparative, observational case series study during 01.01.2004-31.12.2005 on two groups with central serous chorioretinopathy: group A (12 eyes) from military environment compared with group B (9 eyes) from civil patients. The evaluations were performed based on visual acuity, functional symptoms, fundus biomicroscopy, fluorescein angiography and optical coherence tomography. The relationship of CSC to the age, gender, psychosomatic symptoms, personality profiles, systemic associated diseases or risk factors and the rate of recurrence were evaluated. The statistical Anova multivariate analysis was performed. RESULTS: There were no significant differences between the two groups regarding distribution to the age and gender. In the military patients, by use of a multivariate analysis steroid use, infection with Helicobacter pylori and type A behavior pattern were strongly associated with CSC. The mean duration of disease was significant prolonged in the group A as compared with group B (p=0,0012). In the military patients, there were 5 cases (41,66%) with recurrence and 1 case (11,11%) in the civil patients (p=0,0009). Laser photocoagulation was used in 3 cases (25%), respectively 1 case (11,11%) in the group B. CONCLUSIONS: Although CSC usually resolves spontaneously, the associated diseases and risk factors, the clinical aspects and outcomes in military patients may be different, with residual visual deficits, despite recovering normal visual acuity.

[IOP diurnal fluctuations in patients presenting pseudoexfoliative syndrome]. / Fluctuatiile diurne ale presiunii intraoculare la pacientii cu sindrom pseudoexfoliativ.

PURPOSE: To analyze the IOP diurnal fluctuations in patients presenting pseudoexfoliative syndrome (PEX) compared to those without PEX. METHOD: A clinical observational prospective study, one year, on 2 groups of patients: group A (13 patients)--with pseudoexfoliative syndrome (PEX) and group B, control, (11 patients)--without PEX. The groups were homogeneous about the age and sex distribution. At each visit 4 IOP measurements were taken using Goldmann aplanotonometry. RESULTS: In PEX patients the IOP had greater values during the study period compared to the control group. By comparing the two groups have been observed significant differences about the maximum IOP, the mean IOP and the diurnal fluctuations, also about the incidence of the complications. CONCLUSIONS: The IOP diurnal fluctuations in PEX patients are significantly greater than the physiological ones and therefore influence the therapeutic attitude and the prognostic. The significant fluctuations in the IOP diurnal curve are an important predictive factor for the eyes that will develop secondary glaucoma. The pseudoexfoliative syndrome is an independent risk factor for glaucoma in patients with intraocular hypertension.

[Evolution of secondary pseudoexfoliative glaucoma after cataract surgery in patients with cataract-glaucoma combination]. / Evolutia glaucomului secundar pseudoexfoliativ dupa operatia de cataracta la pacientii cu asociere cataracta-glaucom.

PURPOSE: To assess the effects of the cataract surgery on the evolution of the secondary open angle glaucoma (SOAG) in patients with pseudoexfoliative syndrome (PEX) that present the association cataract--SOAG. METHODS: A prospective study on 2 years on a group of 12 eyes with PEX syndrome presenting the association cataract-secondary open angle glaucoma, that have been operated by phacoemulsification + PC IOL, without intra-operator complications. We have monitored the effects of the cataract surgery on the evolution of the glaucomatous disease, evaluated by: monitoring of the IOP dynamics, the analysis of the visual field defects and the aspect of the FO, the evolution of the visual acuity and the morphology of the specific changes of PEX. The analysed group has been compared with a control group (5 eyes) presenting the association cataract--POAG, operated by phacoemulsification by the same surgeon. We have used the SPSS programme for statistical analysis. RESULTS: In the follow-up period we have observed almost similar evolutions of the IOP dynamic, but we obtained in PEX group statistically significant lowering of the IOP than in the control group. In PEX group the papillo-perimetric results have presented significantly different characteristics than in the control group, without having an influence on the visual acuity. CONCLUSIONS: Although the cataract extraction has produced in both groups, on a medium follow-up, an IOP decrease from the pre-operator values, the glaucomatous disease in PEX patients, probably because of other specific risk factors, continues to progress.

[Protein C reactive and glaucoma]. / Proteina C reactiva si glaucomul.

PURPOSE: To observe the possible implications of the C reactive protein in pathogenesis of the glaucoma. METHODS: A clinical observational prospective study on 2 groups: group A 14 glaucomatous patients and group B--control (12 normal subjects) without history of ocular pathology or general pathology known to be associated with high plasma levels of CRP. The groups were homogeneous about the age and sex distribution. CRP levels were evaluated by tests with high specificity. RESULTS: The plasma CRP level reveals important differences (p < 0,0001) on the two groups: 3,87 +/- 0,8 mg/dl in the group A and 0,68 +/- 0,13 mg/dl in the control group. CONCLUSIONS: Glaucoma is associated with high plasma levels of CRP. In the complex pathogenesis of glaucoma, in which the vascular factor has his well known place, the inflammatory vascular modifications may represent an important component.

[Refractive stability of foldable intraocular lenses]. / Stabilitatea refractiva a cristalinelor artificiale foldabile.

PURPOSE: To compare the refractive stability of different kind of foldable intraocular lenses. METHOD: There was performed a two years (mean follow-up 7,4 +/- 1,2 months) prospective interventional case series study on 108 with senile cataract, without another ocular pathology which underwent cataract surgery by phacoemulsification and implantation of foldable intraocular lens (the same surgeon). Each patient had their refractive status measured at the 1-month postoperative visit, 3-months and at the 6-months follow-up visit. The results have been statistically analyzed using the Wilcoxon test. RESULTS: The postoperative refractive results were correlated with IOL design and material. The acrylic hydrophobic foldable intraocular lens with rigid haptics was more likely to move to hypermetropia and the acrylic hydrophobic foldable intraocular lens with pliable haptics showed minimal myopic movement. CONCLUSIONS: On long-term, the 1-piece acrylic hydrophobic IOL with soft acrylic loops had the most stable refractive results.

[Color vision in glaucoma]. / Simtul cromatic în glaucom.

This article is a general view of evaluated acquired color vision defects in the early stages of primary glaucoma and in patients at risk for glaucoma. The articles published until now indicates a decrease in color discriminating sensitivity in the short wavelength part of the visible spectrum in patients with glaucoma as well as in patients with ocular hypertension. It has been found a positive correlation between the blue-yellow color vision defects and the perimetric changes in the glaucomatous eyes. Blue-yellow color vision testing with the anomaloscope may serve as an additional test in the early diagnosis of glaucoma but the absence of dyschromatopsia does not exclude the disease.

[Axial length of the ocular globe and hypotensive effect in glaucoma therapy with prostaglandin analogs]. / Lungimea axiala a globului ocular si degajarea presionala în monoterapia cu analogi de prostaglandine.

PURPOSE: To observe the possible correlations between the hypotensive effect of the prostaglandin analogs and the axial length of the ocular globe. METHOD: A prospective, observational and randomized study (one year) on 27 patients with POAG treated by prostaglandin analogs monotherapy. The patients have been divided in two groups according to the type of the prostaglandin analogs used: group A - 12 patients - travoprost 0,004 % (Travatan) and group B - 15 patients - latanoprost 0,005 % (Xalatan). The IOP and the axial length have been evaluated at the beginning of the study and at 1, 3, 6, 9, 12 months using Goldmann aplanotonometry and echo-biometry. The results have been statistically analyzed using the Wilcoxon test. RESULTS: The mean IOP reduction was similar in both groups, without statistically significant differences. Between the IOP reductions and the axial length of the ocular globe were demonstrated significant correlations according to the patients distribution on the echo-biometry results. CONCLUSIONS: The IOP reduction with prostaglandin analogs monotherapy may also depend of the axial length of the ocular globe.

[Retinal venous occlusion and intraocular pressure]. / Ocluzia venoasa retiniana si presiunea intraoculara.

PURPOSE: To highlight the etiopathogenic correlations between the changes of intraocular pressure (IOP) and the retinal venous occlusion (RVO). METHOD: A prospective clinical study for a period of 2 years (01.01.2003-12.31.2004) that included two groups of patients: group A (31 patients) with POAG and group B (14 patients) with OHT, homogeneous concerning the repartition on groups of age, sex, associated systemic conditions. We have evaluated the incidence of RVO and its characteristics and the evolution of IOP. The data have been statistically analysed using the Wilcoxon test. RESULTS: In the A group we have recorded a significantly higher incidence of RVO comparing to the B group (p=0.0031). In most of the cases, the site of OVR in both groups has been localised at the optic nerve head and accompanied by the fall of IOP comparing to the fellow eye. CONCLUSIONS: The rise of IOP represents an important risk factor for RVO, and particularly in the presence of other risk factors, the normalisation of IOP is necessary. The glaucomatous changes of optic nerve head have a major role in the apparition of this type of retinal vascular pathology. The changes of IOP can be "hidden" by the occurrence of RVO.

[Structural and immunohistochemical changes of conjunctiva induced by topical glaucoma medication]. / Tratamentul topic antiglaucomatos--modificarile conjunctivale structurale si imunohitochimice.

PURPOSE: The topical medication represents the first line therapy for the primary open angle glaucoma. The study is aimed at assessing the structural and immunohistochemical changes of conjunctiva induced by topical glaucoma medication. METHODS: For this purpose, we carried out a 40 weeks, prospective, experimental, epidemiological-operational and randomized study enrolling 18 patients (36 eyes) with recently primary open angle glaucoma. The eyes were divided into treatment (non-selective beta blockers or selective, prostaglandin analogues, topical carbonic anhydrase inhibitors) in four groups. The assessment was performed by comparison with control group (4 patients) who was instilled with natural tears (with different preservative). Both the cytology and the conjunctival biopsy specimens were investigated by histological exams and immunohistochemistry using different monoclonal antibodies. The study was performed by collaboration with The National Institute of Research and Development in Pathology and Biomedical Sciences-"V. Babes"-Bucharest. RESULTS: The morphometric analysis of histological sections of conjunctiva showed the following changes: squamous metaplasia (significant increases in the thickness and number of epithelial cell layers), inflammation (increase the number of lymphocytes, macrophages and fibroblasts) and subconjunctival fibrosis. According to the type of medication, we observed the significant increase of subepithelial collagen density and degenerative changes of fibrocytes, the reduction of extracellular matrix and also the up-regulation of antibodies against matrix metalloproteinase and allergic changes. According to structural changes, the immunohistochemistry confirmed the tendency of chronic inflammation. CONCLUSIONS: This study revealed important structural and immunohistochemical changes of conjunctiva after topical glaucoma medication. The category and the intensity of these changes are dependent on the sort of therapy and the topical treatment period. The findings showed that benzalkonium chloride (the most common preservative of antiglaucoma drugs) is a major factor for conjunctival metaplasia.

[Phacoemulsification and pseudoexfoliative syndrome]. / Facoemulsificarea în sindromul pseudoexfoliativ.

PURPOSE: To compare the results and the complications of cataract surgery by phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) and without pseudoexfoliation syndrome. METHODS: A retrospective clinical study (January 2001 - January 2004; mean follow-up 21.5 months) of 116 cases divided in two groups: group A (55 eyes) with senile cataract and pseudoexfoliation syndrome and group B (61 eyes) with senile cataract but without pseudoexfoliation syndrome. The eyes were without another associated ophthalmological diseases and the phacoemulsifications were performed by the same surgeon. Intraoperative observations included anterior chamber depth, pupil size after maximal mydriasis, zonular dehiscence, capsule tear, vitreous loss and postoperatively: best corrected visual acuity, intraocular pressure (IOP), aqueous flare response and IOL stability were evaluated at 1 day, 1 week, 1 month and until 3 years. The Student-t test was used for statistical analyses. RESULTS: There were determined significant correlations between pupil size, anterior chamber depth and the rate of complications in the group A. The visual acuities were similar in both groups. IOP reduction was superior in the eyes with PEX as compared with control group, but without statistically significantly difference. In group A, there were a non-statistically significantly percentage of IOL dislocation as compared with group B. In the eyes with PEX, it is necessary to utilize IOLs with bigger optic size. CONCLUSIONS: Phacoemulsification represents a safe method in cataract surgery in eyes with pseudoexfoliation syndrome in the presence of careful surgical technique: maximal mydriasis, circular continuous curvilinear capsulorhexis, adequate hydrodissection. On the long run, the postoperative results were comparable between eyes with PEX and the control group (without PEX).

[Visual fields defects in cerebral hemorrhagic vascular accident]. / Modificarile câmpului vizual în accidentele vasculare cerebrale caz clinic.

Interpretation of the fields of vision forms a key part of ophthalmic and neurologic examinations. The homonymous hemianopa is a hallmark of a retrochiasmal lesion. Postchiasmal lesions that interrupt the visual pathway may have multiple causes which the circulatory disturbances is one of the most important. The authors present the case of a woman who has an isolated homonymous hemianopa produced by a vascular accident of occipital lobe, dwell upon the only manifestation of the cerebral acute hemorrhagic vascular accident was represented by an visual field defect.

[Surgical decision in both cataract and glaucoma]. / Decizia chirurgicala în asocierea cataracta-glaucom.

The authors try to establishes the algorithm for the treatment in patients who have both cataract and glaucoma. Clinicians must decide when to do cataract surgery, when to do glaucoma surgery and when to do a combined procedure, as well as decide which technique is appropriate. The paper presents a comparative analyze on three groups of patients who have this pathological association, regarding the factors involved in the surgery decision process and the postoperative results (visual acuity--VA, intraocular pressure--IOP, complications).

[Birdshot retinochoroidopathy]. / Retinocoroidopatia birdshot.

Birdshot retinochoroidopathy is a rare, chronic, bilateral, posterior uveitis with a distinctive clinical presentation and a strong genetic association. Middle aged white people of northern European extraction are most commonly. The pathogenesis is unknown, but HLA-A29 positivity appears to confer predisposition and retinal autoimmunity seems to play a role. Clinically, there are patches of postequatorial choroidal and retinal pigment epithelial depigmentation, vitreal cells, macular and disc edema, and venous sheathing. This review provides an updated summary of the current state of knowledge about birdshot retinochoroidopathy. It includes results of visual field and electrophysiological tests.

[Travatan--preliminary results]. / Travatan--rezultate preliminarii--studiu observational.

PURPOSE: The prostaglandin analogues represent the first option for the treatment of primary open angle glaucoma. The aim of this paper was to evaluate the efficacy and the safety of Travatan în treatment for different type of glaucoma. METHODS: It was performed an observational clinical study between November 2002 and March 2003 on 33 patients (62 eyes), who were divided into treatment with Travatan în 4 groups. RESULTS: The reduction of IOP was between 3.80-7.80 mm Hg, with 70.94% complete success (IOP < 18 mm Hg) and qualified success (IOP < 22 mm Hg) în 88.31% cases. CONCLUSIONS: Travatan was effective as single therapy or adjunctive therapy, with important and stable lowering IOP. The product was safe, well tolerated and easy for administration.

[Conjunctival changes related to topical treatment and effectiveness of surgery in glaucoma]. / Modificarile conjunctivale legate de tratamentul topic si eficienta chirurgiei filtrante în glaucom.

PURPOSE: The topical treatment for a long run in glaucoma rises histopathological changes of conjunctiva. The study is aimed at assessing the correlations between conjunctival changes bound of the type and duration of medical glaucoma therapy and the efficiency of subsequent filtering surgery. METHOD: For this purpose, we carried out a three years clinical prospective study (01.05.2000-30.04.2003), with a mean follow-up period of 18.5 months, enrolling 22 cases (38 eyes) operated by trabeculectomy for primary open angle glaucoma (POAG), with the same technique and the same surgeon. There were excluded both the patients with previous ophthalmic surgical interventions and ocular/systemic chronic inflammatory disease. The cases were divided according to type and duration of topical treatment. There were recorded the conjunctival changes (by histological exam and immunohistochemistry), dynamic evolution of intraocular pressure (IOP) and the morphological aspects of filtering blebs. Statistical analysis was performed by Wilcoxon test. RESULTS: In all groups, the efficiency of filtering surgery was correlated with the duration of topical medication; the survey presents the correlations between topical treatment, conjunctival changes and postoperative evolution. CONCLUSIONS: These results suggest that exhaustive topical treatment in POAG, for a long period, with many drugs may represent a negative prognostic factor for the subsequent filtering surgery. Therefore it is necessary an individual approach for the first line therapy in POAG.

[Ocular injuries due to allergic mechanism]. / Afectiuni oftalmologice prin mecanism alergic.

The paper presents the main ocular injuries due to allergic mechanism and it point out the actual data about etiopathogenesis of type 1 hypersensitivity and immunologic mechanism involved in allergic keratoconjunctivitis. Then are exposed the classification of ocular allergy, the main signs and symptoms, the paraclinical methods of diagnosis and the actual agents of therapy.