Dexamethasone-netilmicin: a new ophthalmic steroid-antibiotic combination. Efficacy and safety after cataract surgery.

PURPOSE: The purpose of this study was to evaluate both efficacy and safety of a new ophthalmic steroid-antibiotic fixed combination containing dexamethasone and netilmicin in the postsurgical management of cataract surgery. METHODS: In total, 223 patients were randomly treated with dexamethasone 1 mg/ml plus netilmicin 3 mg/ml (n=148), or dexamethasone 1 mg/ml plus tobramycin 3 mg/ml (n=75, TOBRADEX) four times in a day for 7+/-1 days starting immediately after surgery. Efficacy (anterior chamber (AC) inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia and tearing) and safety (burning, stinging, blurred vision, intraocular pressure, and visual acuity) were analysed in the operated eye after 1 and 7+/-1 days. A follow-up visit was performed at day 14+/-2. The extent of AC inflammation, measured by slit-lamp according to a standard scoring system, was used as primary efficacy parameter. RESULTS: At the primary end point (day 7) both fixed combinations were equally effective in reducing postoperative inflammation. The safety profile of the dexamethasone/netilmicin combination was excellent with no evidence of poor local tolerance or adverse reaction. CONCLUSIONS: A new fixed combination of dexamethasone and netilmicin was effective and safe in controlling ocular inflammation after cataract surgery.

Photodynamic occlusion of ocular neo-vascularization with B2 vitamin.

Photodynamic therapy (PDT) of cancer has been known for over twenty years and is based on the dye-sensitized photooxidation of different biological targets in the tumoral tissue yielding to a photochemically induced cell's death via apoptotic pathways. Several parameters affect clinical trials in PDT and influence the therapeutic outcome. A potentially major application of PDT in a non-cancer field is its use in treatment of age-related macular degeneration. This condition, caused by proliferation of neovasculature in the retina, is the major cause of blindness in the over 50s. Using a photosensitiser which enters neovasculature very rapidly following administration and is subsequently quickly moved from the circulation. Ocular neovascular disease represents an important cause of blindness today. In this paper, was used an animal model (rabbit) to evaluate the vaso-occlusive potential of photodynamic therapy with B2 vitamin. Neovascularization induced in the rabbit cornea consists of an easily accessible monolayer-like neovascular net within a transparent matrix. This fact allows studying the efficiency of occlusion in an isolated neovascular structure.

[Ophthalmologic involvement of intracranial tumors--report of a case]. / Implicatii oftalmologice ale proceselor intracraniene înlocuitoare de spatiu--referire la un caz.

Bilateral papillary edema is considered to be the expression of a tumoral process that reduces the intracranial space resulting in elevation of the intracranial cerebrospinal fluid pressure. The authors present the case of a 21-year-old man consulting for mild visual loss of the left eye. The ophthalmologic examination showed bilateral papilledema and visual field defects in the left eye (enlargement of the blind spot), with no clinic or imagistic signs of increased intracranial pressure. Intracranial pathologic processes that bear like a tumor, reducing the intracranial space are not always associated with papilledema, but papilledema is always associated with intracranial tumor. Increased intracranial pressure is frequently associated with intracranial tumoral processes, but in this case was not showed increasing of intracranial pressure.

[Optical coherence tomography in surgical management of macular diseases]. / Tomografia în coerenta optica în managementul chirurgical al bolilor maculare.

Optical coherence tomography is a new imagistic technique recently introduced in ophthalmology. It is useful for diagnosis of macular diseases and it is extremely important in the management of those surgical ones. The most suitable diseases for postoperative evaluation by optical coherence tomography are: macular holes, epi and subretinal membranes, macular edema of diverse etiology and severe proliferative diabetic retinopathy.

[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.

[Surgical principles and techniques in severe proliferative diabetic retinopathy]. / Principii si tehnici chirurgicale în retinopatia diabetica proliferanta severa.

The development and new achievements of the last 30 years in vitreo-retinal surgery, since Machemer developed pars plana vitrectomy as surgical treatment of diabetic retinopathy, have led to a marked change of indications as well as surgical techniques which are applied in this disease. Surgical indications in severe proliferative diabetic retinopathy are: severe vitreous hemorrhage, tractional retinal detachment recently involving the macula, combined tractional and regmatogenous retinal detachment, severe fibrovascular proliferation, premacular dense hemorrhage, chronic macular edema, hemolytic glaucoma and anterior segment neovascularization with media opacity.

[High-altitude retinopathy]. / Retinopatia de mare altitudine.

High-altitude retinopathy is a very rare ocular disease in our country, which can occur isolately or as a part of high-altitude illness. This paper presents the case of a patient with high-altitude illness and the diagnosis and treatment problems of this case.

[Specular microscopy--its clinical implications]. / Microscopia speculara--implicatii clinice.

Specular microscopy has multiple advantages in the clinical practice, allowing the study of the corneal endothelium in-vivo. We can observe corneal disorders, as well as the corneal status after intraocular surgery, of the posterior pole as well as of the anterior pole of the eye.

[Optical coherence tomography]. / Tomografia în coerenta optica.

Optical coherence tomography is a novel, noninvasive, noncontact and repetitive imaging technique which produces high depth resolution cross-sectional tomographs of ocular tissue. It's value is given by the possibility of achieving pseudo-histological images of the target tissue. It is optically based, analogue to ultrasound B-scan examination and similar to laser reflectometry. Optical coherence tomography involves shining low-level infrared light on a tissue specimen, an interferometer and a computerized imaging system. The most attractive applications of optical coherence tomography are the diseases of the retina such as: central serous retinopathy, macular hole, chronic macular edema, age-related macular degenerescence.

[An inclusion cyst of the anterior chamber]. / Chist de invazie al camerei anterioare.

Our paper present a clinical case of inclusion cyst of the anterior chamber. We discuss the clinical course, the specific investigations, the surgical management and the histopathologic diagnosis.

Topical netilmicin compared with tobramycin in the treatment of external ocular infection.

In a pilot double-blind, randomized, prospective controlled study the effectiveness and safety of 0.3% netilmicin ophthalmic solution were compared with those of 0.3% tobramycin in treating external bacterial ocular infections in 45 eligible patients. The treatment with both study medications resulted in a significant (p < 0.001, Wilcoxon test) reduction in the mean cumulative score of the signs and symptoms. However, no statistically significant differences were observed between the two groups. The clinical improvement rate was almost complete with either antibiotics. There was a statistically positive trend in the netilmicin group with regard to the microbiological improvement that was achieved in (87% of the netilmicin patients) compared with 77% of the tobramycin patients (77%). Antibiotic sensitivity revealed that 84% of the organisms isolated were sensitive to netilmicin whereas only 64% of them were sensitive to tobramycin. Only minor adverse events occurred in patients treated with either netilmicin or tobramycin. In conclusion, this study demonstrates that netilmicin is a promising new antibiotic for treating external ocular infections.

[Prostaglandin esters--new directions in the treatment of glaucoma]. / Esterii de prostaglandine--noi directii în tratamentul glaucomului.

The therapeutically approach of glaucoma still represent a problem of the ophthalmology. Latanoprost, a new prostaglandin derivative, fall the intraocular pressure as good in the night as during the day by its special way of action. Since January 1998, in the Eye Clinic of the Central Military Hospital, we studying the ocular hypotensive effects of the latanoprost. Our results seems to confirm the efficacy of this prostaglandin analogue.

[Emergency keratoplasty]. / Keratoplastia de necesitate.

In some ocular diseases may occur the corneal perforation. This condition requires an emergency penetrating keratoplasty. We show in this paper the conditions, surgical techniques and the complications in this kind of surgical intervention, with examples from our clinical cases.

[A giant arterial aneurysm with an inferior paramacular location--a clinical case]. / Anevrism arterial gigant cu localizare paramacular inferior--caz clinic.

The authors report the case of a 72-year-old patient with a sudden loss of the visual acuity of her unifunctional right eye. The ophthalmoscopy and the angiofluorography of the right eye showed a vascular tumour that is situated paramacular inferior, a long temporal arterial branch. Clinical and biochemical investigations permitted the diagnostic of arterial aneurysm developed on systemic hypertension and vascular fragility of the patient. It is very possible that an occlusive or a spastic downstream component to be at the origin of the aneurysm.

[HLA antigens and ocular pathology]. / Antigenele HLA si patologia oculara.

The HLA antigen system is a complex of genes which have the control of a lot of cellular receptors with high role in histocompatibility, genes which code the born of all molecules may play a significant role in graft reaction and in starting the immunologic answer. The immunological study was demonstrated that many ophthalmological diseases are very deep linked by the HLA antigens.

[A recurrent adenoid-type basal-cell epithelioma of the superior portion of the ala nasi and of the left internal palpebral angle (rodent ulcer)--a clinical case]. / Epiteliom bazocelular tip adenoid recidivat al partii superioare a aripii nazale si unghiului intern palpebral stâng (ulcus rodens)--caz clinic.

The palpebral basocellular epithelioma is the most frequent neoformation of the ocular adnexa. It has a local invasive potential, necessitating a complete and also oncological excision. This paper presents a case in which an insufficient treatment has gone to the recurrence of the tumor.

[The anterior segment ischemia syndrome]. / Sindromul de ischemie a segmentului anterior.

Starting from a clinical case, the paper presents a rare complication of the strabismus and retinal detachment surgery: the anterior segment ischemia syndrome. In this context, we discuss the clinical and pathogenetic circumstances of apparition, underlining the great importance of primary prophylaxis.