[Susceptibility genes, HLA and diabetic retinopathy in the Algerian population]. / Gènes de susceptibilité HLA et rétinopathie diabétique chez la population algérienne.

BACKGROUND: Diabetic retinopathy (DR) is the most frequent microvascular complication of type I diabetes (T1D). Some well-controlled type I diabetics may develop DR, while other poorly-controlled diabetics do not develop DR. This might be explained by certain susceptibility genes or protective genes. The purpose of our study is to search for any association between the HLA class I and II markers and DR in the Algerian population. PATIENTS AND METHODS: This study was carried out in 52 T1D subjects with and without DR compared to 140 healthy controls. HLA typing was performed using the "microlymphocytotoxicity" technique. RESULTS: The frequency of HLA-A29 and HLA-DR9 antigens is higher in T1D with DR compared to T1D without DR and to controls with frequencies of HLA-A29 (59.26% vs. 0%, OR=∞, pc=4.6×10(-7)), (59.26% vs. 5.66%, OR=24.24, pc=7.6×10-10) and HLA-DR9 (29.63% vs. 0%, OR=∞, pc=1.310(-3)), (29.63% vs. 4.29%, OR=9.40, pc=7.010(-5)) respectively. However, the frequency of HLA-B49 antigen is significantly lower in T1D with DR than in T1D without DR (3.7% vs. 28%, OR=0.10, pc=8.8×10(-3)) and compared to controls (3.7% vs. 22.64%, OR=0.13, pc=0.011). CONCLUSION: HLA-A29 and HLA-DR9 antigens are probably markers of susceptibility for DR while HLA-B49 antigen is probably associated with a protective effect in the Algerian population.

Understanding ocular torticollis in children.

Ocular abnormal head posture (AHP) or torticollis is a frequent sign in pediatric pathology The incidence is 5.6% in ophthalmological practice and 3.19% in pediatric ophthalmological practice. The abnormal head posture is adopted to improve visual acuity maintain binocular single vision, center residual visual field with the body or for cosmetic reasons. Face turn is the most frequent abnormal head posture in pediatric ophthalmology. The more common diseases causing face turn are Duane syndrome, congenital fibrosis of extraocular muscles, nystagmus, refractive errors, visual field defects. The most frequent ocular causes of head tilt in children are congenital nystagmus, superior oblique paresis, dissociated vertical deviation, Brown syndrome, refractive errors. Chin-up or chin-down abnormal head postures are most commonly caused by "A" and "V"-pattern strabismus, palpebral ptosis, nystagmus, refractive errors. Torticollis is not a diagnosis, but it is a sign of an underlying disease. There are ocular diseases which diagnosis is straightforward for general practitioner, pediatricians or pediatric surgeons (horizontal nystagmus, lateral rectus paralysis, ptosis, esotropia), but others less obvious (superior oblique paralysis, Duane syndrome, A and V-pattern strabismus, torsional nystagmus) because of the compensatory head posture, and these last disorders are predisposed to confusion with congenital AHP Interdisciplinary collaboration between ophthalmologist, pediatrician, pediatric surgeon, ENT specialist and neurologist is mandatory in establishing the etiology of AHP Every child with AHP must be examined by an ophthalmologist.

[Hypertensive retinopathy--assessment]. / Opinii critice privind aprecierea retinopatiei hipertensive.

The authors intend to make a synthesis of several recent studies available on the Internet regarding hypertensive retinopathy. From the physiopathologic point of view, it is considered that the blood circulation at the level of the retina, choroid and optical nerve has distinct anatomo-physiological properties. It has a different response to the changes in the blood pressure, the result consisting of distinct individual types of the hypertensive disease which can be rendered evident during the optical fundus examination. The retina is considered to be one of the target organs in the hypertensive disease. Ascertaining the retinal changes has advanced from ophthalmoscopy to digital photography studied with appropriate software. The assessment of the hypertensive microangiopathy is subjected to a wide intra- and interobserver variability an accurate assessment requiring specialized software and standardized protocols. There is also a lack of consensus regarding the classification of hypertensive retinopathy and the usefulness of retinal examination in the assessment of cardiovascular risk. The Keith and Scheie staging scales are still in use, but they do not allow the clinician to differentiate slight or even moderate changes at the level of the retina of hypertensive patients. Furthermore, they do not correlate enough with the severity of the high blood pressure and they are not supported by the angiofluorography studies. There are not enough motives for the recommendation of a routine ophthalmoscopic examination for all hypertensive patients. It is required for patients with stage-3 hypertension. It is also recommended when the initial clinical signs are equivocal, as in borderline or fluctuating high blood pressure without any other obvious signs from the target organs, for diabetic patients, or in the presence of visual symptoms. The clinical implications of hypertensive retinopathy being unclear, many of the authors do not recommend ophthalmoscopic examination as a rule, or they don't consider the retinal signs as being useful for therapeutic decisions.

[Ocular correction in children]. / Prescrierea corectiei optice la copii.

The article is an up-to-date of the principles of spectacles prescription in children, based upon the published guidelines and personal experience. The prescribing of spectacles for children is different from that for adults because of the unique morphological and functional characteristics of the children's eye. Most of the recommendations for refractive errors correction are based on clinical consensus (experience) rather than populational studies (evidence). This explains the great variability of the indications for refractive errors correction in children.

[Ophthalmologist and "computer vision syndrome"]. / Oftalmologul practician si "computer vision syndrome".

The authors had tried to collect the data available on the Internet about a subject that we consider as being totally ignored in the Romanian scientific literature and unexpectedly insufficiently treated in the specialized ophthalmologic literature. Known in the specialty literature under the generic name of "Computer vision syndrome", it is defined by the American Optometric Association as a complex of eye and vision problems related to the activities which stress the near vision and which are experienced in relation, or during, the use of the computer. During the consultations we hear frequent complaints of eye-strain - asthenopia, headaches, blurred distance and/or near vision, dry and irritated eyes, slow refocusing, neck and backache, photophobia, sensation of diplopia, light sensitivity, and double vision, but because of the lack of information, we overlooked them too easily, without going thoroughly into the real motives. In most of the developed countries, there are recommendations issued by renowned medical associations with regard to the definition, the diagnosis, and the methods for the prevention, treatment and periodical control of the symptoms found in computer users, in conjunction with an extremely detailed ergonomic legislation. We found out that these problems incite a much too low interest in our country. We would like to rouse the interest of our ophthalmologist colleagues in the understanding and the recognition of these symptoms and in their treatment, or at least their improvement, through specialized measures or through the cooperation with our specialist occupational medicine colleagues.

[Dissociated horizontal deviation--a diagnostic problem in strabismus]. / Deviatia orizontala disociata--capcana diagnostica în strabism.

Dissociated horizontal deviation (DHD) is one of the four components of the dissociated strabismus complex which also includes dissociated vertical deviation, dissociated torsional deviation and manifest-latent or latent nystagmus. These dissociated deviations may co-exist with concomitant strabismus (exotropia, esotropia, hyperopia). Sometimes it is difficult to make the difference between dissociated and non-dissociated component of the deviation. We report 3 cases of strabismus and DHD with special emphasis on the diagnostic difficulties and the therapeutic possibility. A careful clinical examination with additional measurement tests makes the difference between DHD and associated tropias. The reversed fixation test is a decisive test for the diagnosis of DHD. The therapeutic approach depends on the type of DHD (uni or bilateral, latent or manifest), the magnitude of the deviation, the fixation behavior and the association of the DHD with exotropia, esotropia or orthotropia.

[A model follow-up record for diabetic retinopathy (DR). Its staging in the order of severity]. / Model de fisa de urmarire a retinopatiei diabetice (DR) stadializare în ordinea gravitatii.

Based on up-to-data in the literature, a practical possibility to classify as possible the opportunity, in order to appreciate as fast, correct and efficient as possible the opportunity for sending patients to laser therapy. The defining elements for every important sign of diabetic retinopathy are analyzed. They are grouped on their evolutive stages (according to the international standards) in the order their gravity and urge in applying laser therapy. Then a personal model for a follow-up sheet (algorithmic type) is presented. Ist main advantage consists of the fact that the recognized and only mentioned signs lead to the stage grouping, to the evaluation of therapeutical possibilities and may replace a photo-document still hard to be obtained.

[The applications of informatics in ophthalmology]. / Aplicatii ale informaticii în oftalmologie.

The paper reports on the applications of information science in Romania in ophthalmology, and mainly in glaucoma, in the diagnosis of: degenerative affections of the fundus oculi, uveitis, strabismus, in functional exploration of the chromatic sense, ergo-ophthalmology, pupillary reflex and forms of the pupil, etc. The Romanian made computers Felix, Independent, Coral, Cobra, etc. were used.

[An experimental model of data base organization in glaucoma with computer processing (a preliminary note)]. / Model experimental de organizare de baze de date pentru glaucom, cu prelucrare pe calculator (nota preliminara).

The authors report on an experimental model of data base set up for glaucoma with possibilities of statistical-mathematical processing. The application is designed for miniprocessors of the INDEPENDENT or CORAL type in FORTRAN 77. The paper presents the level structure of the display, and the ways of using the information under the form of assisted diagnosis and prognosis, according to which the attention is then directed to the rhythm and detailed content of the future examination.

[The electronic computer in ophthalmology]. / Calculatorul electronic în oftalmologie.

The present paper is an introduction to and information about information processing, the principal notions and mains of approach in ophthalmology. Part one is dedicated to a general presentation of computers, and information processing, giving details about the equipment, operating systems and programmes, data bases and their structure. Part two presents different aspects of the information processing involved in ophthalmology. The following applications are discussed: beginning by simple data collection and evidence for medical purposes, statistical processing, bibliography classification, teaching, continuing with problems of diagnosis and therapeutical decisions, as well as the application of medical robots and computer assistance for specific functional explorations.