Sub-inner limiting membrane hemorrhage in a patient with Terson syndrome.

PURPOSE: To report a case of bilateral Terson Syndrome with sub inner limiting membrane hemorrhage associated with a rare finding: perimacular fold. METHODS: The patient, a 34 years old female with aneurysmal subarachnoid hemorrhage and bilateral Terson syndrome was admitted to the Ophthalmology department, complaining of blurred vision. Core vitrectomy, hyaloid detachment, peeling of the ILM and aspiration of the sub inner limiting membrane hemorrhage was performed. Once the inner limiting membrane of the left eye was peeled off, we noticed a particular aspect: the perimacular fold. RESULT: Although our patient suffered from a massive vitreous haemorrhage the postoperative outcome was favorable with a final best corrected visual acuity of 20/30. CONCLUSIONS: In patients with billateral Terson syndrome we recommend early surgery, especially if the neurological status allows it, a good visual acuity being helpful for the neurophysical rehabilitation of the patient.

[Serous macular detachment associated with circumscribed choroidal hemangioma: a case report]. / Decolare seroasa maculara asociata hemangiomului coroidian circumscris--apropo de un caz clinic.

INTRODUCTION: Choroidal hemangiomas are benign vascular hamartomas that typically present from second to fourth decade of life, when they can cause visual disturbance due to exudative retinal detachment. They represent uncommon benign choroidal vascular tumors, usually occuring sporadically in the absence of systemic disease. MATERIAL AND METHODS: We report the case of a young female patient, presenting a juxtapapillary circumscribed choroidal haemangioma complicated with serous macular detachment. The patient underwent photodynamic therapy with verteporfin (PDT). Systematic follow-up using ophthalmoscopy, ultrasonography, Fluorescein angiography and Indocyanine green angiography was performed. RESULTS: The patient presented regression with flattening of tumour, resolution of the subretinal fluid, and significant improvement of vision. DISCUSSIONS, CONCLUSIONS: Mostly asymptomatic, the choroidal hemangiomas can be associated with serous retinal detachment, leading to reduced vision and metamorphopsia; in those cases, the long term visual prognosis is poor, even in adequately treated patients. PDT is effective in eliminating the subretinal fluid and improving vision in patients with circumscribed choroidal hemangioma.

[Eales disease. Idiopathic retinal vasculopathy--diagnostic and therapeutic problems]. / Boala Eales. Vasculita retiniana idiopatica provocare diagnostica si terapeutica.

The Eales disease is a retinal idiopathic vasculitis which has raised big problems in diagnosis and especially in therapeutic approach. The complications secondary to neovascularization as well as fibrovascular proliferation has surpassed for many times the therapeutical possibilities from nowadays.

[Age related macular degeneration surgery]. / Chirurgia degenerescentei maculare senile.

Age related macular degeneration (ARMD) is a disease in which the retinal pigment epithelium (RPE) is damaged in the central retinal area. In the exudative form, the vision loss is due to choroidal neovascularization, while in the nonexudative or atrophic form, there is a vision loss because of the retinal pigment epithelium atrophy. Treatment which proved to be efficient in lowering the risk of severe vision loss in the exudative form includes laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and as surgical treatment, the controversial subretinal membrane extraction. In all these situations the RPE is damaged by the disease itself and by the therapeutic procedure too. Retinal translocation is a surgical procedure that intends to remove the neurosensory retina from an area with damaged RPE to an healthy RPE area, through a 360 degrees retinotomy or through a limited one. This paper present some ARMD cases treated by subretinal membrane extraction and one by limited retinal translocation. The question which is still remaining is which are the risks and benefits for the following treatment procedures: laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and surgical approach?

[Internal tamponade in proliferative diabetic retinopathy surgery]. / Tamponamentul intern în chirurgia retinopatiei diabetice proliferante.

Vitreous hemorrhage has been the most common indication of posterior vitrectomy in diabetic retinopathy. Now, the leader is tractional retinal detachement and many others: rhegmatogenous retinal detachement, fibrovascular proliferations membranes, huge premacular hemorrhage. During vitrectomy procedure it may be necessary internal tamponade using air, expanding gases, silicon oil and/or perfluorocarbon liquids.

[Pain in Ophthalmology]. / Durerea în oftalmologie.

The pain, one of the most common and unpleasant symptoms of human experience, is a psychophysiological phenomenon made of physical (elementary) pain and psychological pain. The ocular pain may result from stimulation of trigeminal nerve fibres anywhere within the eye, the surrounding tissues, the deep orbit, and the base of the middle and anterior cranial fossae. An ocular pain which is accompanied by another ocular signs can easily suggest a diagnosis for ophthalmologist, but a deep pain which involves the frontal bone and the deep orbit often asks an interdisciplinary consultation.

[Difficulties in cataract surgery of patient with old glaucoma]. / Dificultati în chirurgia cristalinului la bolnavul vechi glaucomatos.

Cataract surgery of glaucoma patients treated with Pilocarpine several years, with a small and miotic pupil, with synechiae is an important problem of management. The self-retaining flexible iris retractor is a microsurgical innovation that allows adequate enlargement of the pupil without iris incision. Each retractor is inserted through a separate self-sealing beveled incision made as far posteriorly in the cornea as possible. The retractors are spaced 90 degree apart and can easily be removed following implant insertion. The conclusion is that if we obtain an adequate enlargement of the pupil we can choose any cataract surgery technique, even phacoemulsification or EEC.