Results at 7years after cross-linking procedure in keratoconic patients.

PURPOSE: Long-term evaluation of functional results based on visual acuity, keratometry, spherical equivalent and refractive cylinder in patients with progressive keratoconus treated with corneal collagen cross-linking (CXL). MATERIALS AND METHODS: We studied a group of 114 eyes of 91 consecutive patients treated from 2006 to 2009 by "Epi-off type" CXL. In the preoperative period, all patients had a complete ophthalmologic examination. The inclusion criteria were: patients aged 15 to 54years, with various stages of keratoconus, with a corneal thickness of at least 400µm at the thinnest point. The exclusion criteria were: patients with a corneal thickness of less than 400µm at the thinnest point, with Vogt's striae or herpetic keratitis, dry eye syndrome or aphakia. The patients were then followed at 1, 3 and 6months, and then every year between 1 and 7years postoperatively. RESULTS: There was a decrease in the minimum K and maximum K, respectively 1.6 and 2.0, at 7years postop. (P<0.05). The cylinder decreased from -4.45 D to -3.50 D at 7 years postop (P<0.05). The spherical equivalent decreased by 1.66 D at 7 years (P<0.05). Uncorrected visual acuity increased from an average of 0.78 to 0.679 log MAR (P<0.05) at 7 years postop. The best-corrected visual acuity increased from a mean of 0.64 to 0.52 log Mar (P<0.05) at 7 years postop. CONCLUSIONS: The results of CXL were stable at 7 years in all patients, consisting of reduction of keratometric values and refraction, and improvement in visual acuity.

Corneal collagen cross-linking in keratoconus -- long-term prospective study.

PURPOSE: To determine the refractometric, keratometric and functional results 3 years after cross-linking therapy in patients with keratoconus. PATIENTS AND METHODS: Eighty-one patients in various stages of keratoconus were studied, all meeting eligibility criteria for the cross-linking technique. RESULTS: The results showed a decrease both in the K-values, of about 1.5 D, and in the refraction. Visual acuity improved by 1, 2 or 3 Snellen lines in 70% of the cases. CONCLUSIONS: The cross-linking technique is a modern method for stopping the progression of keratoconus.

[Preliminary results of treatment with aflibercept]. / PRIMELE REZULTATE ALE TRATAMENTULUI CU AFLIBERCEPT.

The paper presents the first results concerning the Aflibercept (Eylea) treatment, the last antiVEGF approved for treatment of the age related macular degeneration (AMD), neovascular form and for macular edema due to the central retinal vein occlusion. The treatment was applied to patients presenting AMD, ME and other diseases: myopic and idiopatic choroidal neovascularisation, central serous choroidopathy (CSC) or diabetic macular edema (DME). The results were good: improvement of the visual acuity, resolution of the intraretinal fluids and macular edema. Although we did not notice major side-effects, resistance or tachyphylaxis, we noticed some recurrences.

[Bilateral anterior uveiopapillitis, suspicious of Lyme disease--case report]. / Uveopapilita anterioara bilaterala--suspiciune boala lyme--prezentare de caz.

We present the case of a patient which associated bilateral anterior uveitis manifestations with those of bilateral anterior inflammatory optic neuropathy. We followed the evolution of the case under treatment and we discussed the differential diagnosis and the association of the two ocular pathologies.

[Intraoperative floppy iris syndrome--a prospective study]. / Sindromul de flaciditate iriana intraoperatorie (IFIS)--studiu prospectiv.

PURPOSE: is to evaluate the incidence and typical signs of floppy iris syndrome intraoperatory revealed in patients diagnosed with cataracts. METHODS: We studied a total of 15 eyes diagnosed with cataracts, belonging to 14 patients who had been treated chronically with Tamsulosin for benign prostatic hyperplasia. RESULTS: In 80% of cases we have seen a preoperative semimidriasis which required iris hooks in 5 eyeballs. On 1 eye preoperative semimidriasis was sufficient for capsulorhexis, but later pupil became miotic, requiring iris hooks. On 4 eye flaccid iris was noticed, that prolabated in corneal incision. CONCLUSIONS: floppy iris syndrome occurs in patients treated with Tamsulosin for benign prostatic hyperplasia, generating a series of difficulties during cataract surgery.

[Treatment of keratoconus with minimum invasive methods--case report]. / Tratamentul keratoconului cu metode minim invazive--prezentare de caz.

We report the case of a 19-year-old male diagnosed with progressive keratoconus in both eyes. The therapeutic option was: intrastromal ring segment implantation in both eyes, followed by corneal collagen cross-linking with riboflavin and ultraviolet type A at left eye. The postoperative results were favorable: early improvement of vision, no intra- or postoperative complications and without signs of disease progression.

[Refractive surgery of the lens in severe myopia]. / Chirurgia refractiva a cristalinului în miopia forte.

PURPOSE: To evaluate the visual outcomes in high myopic eyes undergoing clear lens extraction with intra ocular implant. MATERIAL AND METHODS: 33 high myopic eyes (range: -10 to -25 D) underwent clear corneal lens extraction and implantation of posterior chamber intraocular lens. RESULTS: 84,84 % myopic eyes had postoperative corrected visual acuity > 0,3. In 1 case we had a posterior capsular rupture during the insertion of IOL, requiring a sulcus fixation of the IOL. In 3 eyes we had opacification of the posterior capsule. CONCLUSIONS: 1. Clear lens extraction with PC-IOL performed in high myopic eye at adults older than 45 years is a safe and effective refractive procedure. 2. Preoperative patient education and counseling regarding visual is critical in maximizing patient satisfaction. 3. The functional results depend on the chorioretinal myopic lesions.

[Correction of refractive errors in children with contact lenses]. / Corectia vicilor de refractie cu lentile de contact la copii.

PURPOSE: To appreciate the indications, complications and visual outcomes in the correction of refractive errors with contact lenses at children. MATERIAL AND METHOD: We studied 15 eyes from nine kids. The times prescription included: history (motivation of wearing contact lenses), ocular refraction (with cycloplegia), best corrected visual acuity, keratometry, the corneal diameter, slit lamp examination, the selection of contact lens and follow up. RESULTS: The age of patients varied between several months to twelve years. The refractive errors in which we used contact lenses were: aphakia--6 eyes, myopia--6 eyes, hyperopia--3 eyes. The types of contact lenses were for permanent use--8 eyes and discontinuity use--7 eyes. We didn't have any major complication. The best corrected visual acuity with contact lenses was: 0.1-0.3 at 4 eyes, 0.4-0.6 at 2 eyes and one at 7 eyes. CONCLUSIONS: (1) Contact lenses represent the optimal correction of anisometropia after congenital or traumatic cataract operation in children. (2) The quality of vision obtained with contact lenses represents an important factor in the prevention and treatment of amblyopia.

[Explantation and replacement of intraocular lenses]. / Explantarea si înlocuirea cristalinelor artificiale.

PURPOSE: to evaluate the reasons for explantation of different types of intraocular lenses. MATERIAL AND METHOD: We studied 27 eyes operated previously for cataract and which developed in postoperative period intraocular induced complication, demanding explantation. RESULTS: In 51.85% cases we explanted anterior chamber IOL, in 40.74% eyes posterior chamber IOL and in the rest pupillary IOL. Reasons of explantation were according to the artificial lens: in 4 cases for edematous keratopathy, chronic uveitis in 2 eyes and descentration in 8 eyes. Reimplantation was performed at 19 eyes, in 10 cases with standard posterior chamber IOL and in 9 cases with scleral sutured posterior chamber IOL. CONCLUSIONS: The main reason for explantation in anterior chamber IOL is the edematous keratopathy and malpositions for posterior chamber IOL.

[Postoperative complications of refractive cornea surgery with excimer laser, Lasik technique]. / Complicatiile postoperatorii ale chirurgiei refractive corneene cu laserul excimer, tehnica LASIK.

PURPOSE: To determine the postoperative complications of laser Excimer surgery, LASIK technique. MATERIAL AND METHOD: We studied 142 eyes with different refractive defects operated with laser Excimer. RESULTS: The early postoperative complications were: DLK stage II/III--6 eyes, Hase--24 eyes, Epitelial Ingrowth in 2 eyes and Central Islands in 2 cases. Late postoperative complications were: secondary glaucoma after steroids administration in 1 case and subcorrection in 19 eyes. CONCLUSION: A quickly treatment of postoperative complications after LASIK technique assure the estimated functional results.

[Postoperative complications of refractive surgery, Lasik technique]. / Complicatiile postoperatorii ale chirurgiei refractive corneene cu laserul Excimer, tehnica Lasik.

PURPOSE: To determine the postoperative complications of laser Excimer surgery, LASIK technique. MATERIAL AND METHOD: We studied 142 eyes with different refractive defects operated with laser Excimer. RESULTS: The early postoperative complications were: DLK stage 11/III--6 eyes, Hase--24 eyes, Epitelial Ingrowth în 2 eyes and Central Islands în 2 cases. Late postoperative complications were: secondary glaucoma after steroids administration în 1 case and subcorrection în 19 eyes. CONCLUSION: A quickly treatment of postoperative complications after LASIK technique assure the estimated functional results.

[Postoperative endophthalmitis]. / Endoftalmita postoperatorie.

PURPOSE: Is to establish the risk factors, the treatment and the prognostic factors at the patients operated for cataract, who developed earl endophtalmitis after the operation. MATERIAL AND METHOD: We studied 14 eyes which were operated for cataract who developed endophtalmitis after the the operation. RESULTS: At all patients the general treatment associated antibiotics (Cefalosporine) with steroids (high doses) and the local one was with mydriatics and steroids. After the treatment, we obtained a visual acuity between 0.7-1 at 11 eyes, visual acuity between 0.400,6 in 3 eyes and 2 eye had a visual acuity under 0.1. CONCLUSIONS: The postoperative endophthalmities is a complication which affect the functional prognosis of the patients operated for cataract.

[Secondary implantation of posterior chamber intraocular lenses]. / Implantarea de cristalin artificial de camera posterioara per secundam.

PURPOSE: Is to establish the possibilities of secondary implantation of posterior chamber intraocular lenses, complications and functional results obtained. MATERIAL AND METHOD: We revied 26 aphakic eyes which were secondary implanted with posterior chamber intraocular lenses s PC IoL). RESULTS: At 16 eyes were implanted standard PC IaL and at 1 o eyes we used scleral fixation PC IoL. Early postoperative complications of standard PC IoL were: uveitis in 4 eyes, dislocation at one case and late postoperative complications were: bulous keratopathy in one eye, secondary cataract in 4 eyes and at 3 eyes dislocations. At scleral fixation PC IQL we had in the early postoperative period secondary glaucoma in 2 eyes and in the late period one eye had retinal detchement and in 2 eyes persist ocular hypertonia. CONCLUSIONS: Posterior chamber intraocular lenses is the optimal solution in correction of aphakia.

[Correlations between ocular biometry and post-surgical refraction]. / Corelatii între biometria oculara si refractia postoperatorie.

PURPOSE: To show the importance of ocular biometry in establishing the power of intraocular lens. MATERIAL AND METHOD: We studied 212 eyes operated in the University Eye Hospital from Cluj-Napoca by planned extracapsular extraction with intraocular lens implantation. Before operation there was performed ocular biometry, using SRK II formulas for calculation of intraocular lens. At 6 weeks after operation, we checked the ocular refraction by dioptronometry and we established the optical correction of the patients. RESULTS: The standard error was statistically significantly in all cases. In 84.19% of cases it was performed visual acuity with optimal correction over 0.7. CONCLUSION: The ocular biometry represents significant factor in obtaining a very good visual acuity after cataract operation.

[The explantation and implantation of artificial crystalline lenses]. / Explantarea si înlocuirea cristalinelor artificiale.

UNLABELLED: THE PURPOSE of the study is to evaluate the causes of explantation and replacement of different types of intraocular lenses. MATERIAL AND METHOD: We performed a study of 1060 eyes operated for cataract in the University Eye Hospital between 1992-1996, following the number of explantation and replacement of intraocular lenses (IOL), the types of IOL and the causes of explantation. RESULTS: We performed 8 explantation of IOL (0.75 g) for pseudophakic bullous keratopathy (1 case), chronic uveitis (3 cases), secondary glaucoma (2 cases), suppurative uveitis (1 case), cystoid macular oedema (1 case). From the 8 explantation of IOL, 3 were anterior chamber intraocular lenses (AC-IOL) and 5 posterior chamber intraocular lenses (PC-IOL). We performed reposition in 4 cases of IOL. The most frequent cause of explantation was chronic uveitis and secondary glaucoma. CONCLUSION: Explantation is indicated in certain cases of IOL complications without response on medical treatment.

[Etiopathogenic consideration in the development of retinal detachment in aphakic and pseudoaphakic eye]. / Consideratii etiopatogenetice în aparitia dezlipirii de retina pe ochi afak si pseudofak.

PURPOSE: Is to evaluate the risk factors implicated in the development of retinal detachment in aphakic and pseudophakic eyes. MATERIAL AND METHOD: We studied 46 cases operated for cataract by planned extracapsular cataract extraction with or without intraocular lens, wich developed after the operation retinal detachments. RESULTS: Retinal detachment appeared in 2.98% cases of EEC with AC-IOL and in 0.56% in EEC with PC-IOL. We performed Yag laser capsulotomy in 4 cases. Retinal detachment appeared in 12 cases between 6-12 months. The most frequent breaks causing retinal detachment where "horse shoe tears" in 23.4% of cases and tears in 14.89% cases. CONCLUSIONS: 1. High myopia and peripheral retinal degenerations are risk factors in the development of retinal detachment after the cataract operation. 2. Vitreous loss facilitates the appearing of vitreo-retinal tractions followed by retinal detachment. 3. PC-IOL reduces the frequency of retinal detachment by the stabilisation of the eye and limiting the ophthalmodonesis.

[Postoperative induced astigmatism]. / Astigmatismul indus operator.

PURPOSE: Is to evaluate the astigmatism induced by cataract surgery, ethiological factors and ways of prophilaxies and treatment. MATERIAL AND METHOD: We followed a number of 211 eyes operated for cataract by planned extracapsular extraction with intraocular lens implantation, in Ophthalmological Clinic from Cluj-Napoca. All the pacients had limbal incision and the suture was performed with 9.0 suture, after the operation the treatment consisted in local drops with steroids. REZULTS: The astigmatism induced by the surgery was direct in 53.08% of cases and indirect in 46.92%. The position of the axes was 0-900 in 72.51% and oblique in 27.48%. The optical correction of astigmatism was with combined spherocylinder glases in 57.34% and only with cilinder in 42.65% of cases. CONCLUSIONS: 1. The induced astigmatism by cataract surgery is in relation with the incision, suture and IOL. 2. Correction of astigmatism is possible with optical correction, repearing the suture or with refractive surgery. 3. The prevention of astigmatism over 1.5 D is by using Troutmann keratometer and to evidence the congenital astigmatism.

[The therapeutic aspects in intermittent divergent strabismus]. / Consideratii terapeutice în strabismele divergente intermitente.

PURPOSE: Is to evaluate the possibilities of treatment in intermittent divergent squint at children and young adults. MATERIALS AND METHOD: We studied an group of 66 patients treated in the University Clinic of Ophthalmology from Cluj-Napoca. RESULTS: The most frequent type of intermiTtent divergent squint (IDS) is the type of excess of divergency (25.76%). In 46.9% the onset was between 2-6 years. In 69.7% visual acuities were equal and stereopsis was present in 74.24%. Hyperopia +/- astigmatism was present in 69.7%. The treatment of intermittent exodeviation was conservative in 51.5% and surgical for first intention in 39.3%. CONCLUSIONS: 1. The most frequent type of intermittent exodeviation is by excess of divergency. 2. The treatment of exodeviation is an optical, orthoptic and surgical treatment. 3. The surgical technique depends on the type of intermittent exodeviation.

[A clinical case of functional recovery after an extensive, perforating corneoscleral wound with partial evisceration of the membranes and crystalline lens]. / Caz clinic de recuperare functionala dupa plaga corneo-sclerala perforanta, întinsa, cu evacuare partiala de membrane si cristalin.

The article presents a clinical case of functional recuperation after perforated corneo-scleral wound with partial evisceration of the eye and lens. The authors describe the possibilities of evolution and the surgical modalities for correction of aphakia.

[YAG laser capsulotomy in secondary cataract]. / Capsulotomia laser YAG în cataracta secundara.

UNLABELLED: The purpose of the study is to evaluate the modern possibilities of performed by laser YAG in secondary cataract. MATERIAL AND METHOD: We performed a study on 200 eyes with secondary cataract operated in the University Eye Hospital from Cluj-Napoca during 1991-1997. RESULTS: We had 95 male and 105 female, with age between 30-90 years old. The capsular fibrosis was present in 86% of the cases. Secondary cataract was present in 13.33% of the cases with PC-IOL. Functional results showed a visual acuity between 0.7-1 in cases from the 50 cases review after 1 week after YAG Laser. CONCLUSIONS: 1. Secondary cataract is the most frequent complications of PC-IOL which influence the visual acuity. 2. YAG laser capsulotomy is a modem, efficient and non-invasive method to solve the secondary cataract.