Retreatment by series of three intravitreal injections of ranibizumab in neovascular age-related macular degeneration: long-term outcomes.

BACKGROUND: The purpose of this study was to analyze the results of a retreatment regimen using a series of three monthly intravitreal ranibizumab injections (IVR), instead of one injection, and to determine if this treatment scheme can safely reduce the number of injections and the number of visits compared to the widely used PrONTO study retreatment protocol. METHODS: >Sixty-six eyes of 60 patients with exudative age-related macular degeneration (AMD) were included. The mean follow-up period was 27 months (range, 11-48 months). The mean age of the patients was 79 years (range, 65-93 years). All patients received three initial IVRs, and were retreated with a new series of three monthly IVRs when needed. The retreatment criteria were: visual loss of ≥5 ETDRS letters and/or signs of retinal exudation on OCT, new macular hemorrhage, expansion of new vessels. Follow-up visits were conducted 1 month after the last IVR of each series, and renewed on a monthly basis when no retreatment was required. Each visit included a comprehensive ophthalmological examination with BCVA measurement and OCT examination. RESULTS: Mean VA did not improve during follow-up (53.18 letters at the initial visit versus 54.18 at the last visit, p > 0.05). However, VA stabilized or improved in 66.6 % of the eyes. A gain of ≥15 letters was observed in 28.8 % of eyes. On average, over 2 years, the number of IVRs was five per year, and the number of follow-up visits was four per year. CONCLUSION: Even if no gain in VA is observed after 2 years, this treatment regimen reduces the number of IVRs and control visits. The proportion of patients with a VA gain of three lines or more was smaller than the one reported in the original PrONTO study, but higher than the rates reported in other studies implementing the PrONTO recommendations in everyday practice. The benefit of the three IVR retreatment scheme should be prospectively studied and compared to the PRN regimen.

[Specular microscopy and pseudoexfoliative syndrome]. / Microscopia speculara in sindromul pseudoexfoliativ.

Focal production of pseudoexfoliative material is a stress to the endothelial cells, leading to a secondary degeneration and corneal decompensation. This typically occurs as a bilateral, asymmetrical, slowly progressive corneal endotheliopathy, more frequent in women, after the seventh decade of age. A severe decrease of endothelial cell density occurs--shown by specular microscopy. A persistent high level of the intraocular pressure and the metabolic disturbance in glaucoma affect the endothelium function. A severe decrease of the endothelial cell density occurs (up to 35%) in pseudoexfoliative keratopathy were glaucoma is associated.

[Age related macular degeneration and C-reactive protein]. / Degenerescenta maculara legata de vârsta si Proteina C reactiva.

C-reactive protein (CRP) is a systemic inflammatory marker associated with the cardiovascular risk profile. Some of the cardiovascular risk factors are linked with the development of age related macular degeneration (AMD), but the correlation between CRP and AMD is not yet well documented. Our current study is trying to emphasize the correlation between plasma CRP levels and the risk for AMD. In our study we used two groups of subjects homogenous by age and gender--group A formed of patients diagnosed with AMD and a group B with normal subjects to whom we measured the plasma levels of C-reactive protein using standard testing with high sensitivity. Our data suggests that there is a correlation between the elevated plasma levels of CPR and the stages of age related macular degeneration possibly implicating the inflammation in the etiopathogenic mechanism.

[Cataract surgery and postoperative endophthalmitis]. / Chirurgia cataractei si endoftalmita post-operatorie.

UNLABELLED: The purpose of this paper is to evaluate the incidence of endophthalmitis after the phacoemulsification. MATERIAL AND METHODS: Retrospective clinical study that includes all the patients that have been operated and all cases of endophthalmitis survived after that in the period between 1.06.2007-31.05.2008 in the Central Military Hospital. RESULTS: There were 3 cases of exogenous endophthalmitis after the cataract surgery. In all of these cases: the inflammatory reaction was limited in the anterior chamber; phacoemulsification; there were no accidents in the cataract surgery; it was performed 2.75 mm clear corneal incision; it was no suture. CONCLUSION: There is a possibility of infections even after phacoemulsification without sutures.

[Macular involvement in glaucoma]. / Implicarea maculei în evolutia glaucomului.

PURPOSE: To assess the macular structural changes in primary open angle glaucoma (POAG) patients. METHODS: A prospective clinical study, 6 months, two groups of patients--group A--case control--healthy subjects, and group B--POAG patients, divided in B1--early glaucoma and B2--advanced glaucoma. The groups were homogeneous about age and sex distribution. In all patients we have performed Humphrey Visual Field, 24-2 Sita Standard, and macular OCT. EXCLUSION CRITERIA: other ocular or systemic conditions. RESULTS AND CONCLUSIONS: In POAG group, we found macular changes comparing to the case-control group. Macular assessment in glaucoma is an important element to consider in the future.

[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.

[Prostaglandin analogues and central corneal thickness]. / Sanalogii de prostaglandina si grosimea corneeana centrala.

UNLABELLED: Prostaglandin analogs reduce intraocular pressure (IOP) by activation of matrixmetalloproteinase enzymes (MMP) and increasing uveoscleral outflow. MMP's were found in cornea and their activation could change the central corneal thickness (CCT). PURPOSE: To compare the effects of different prostaglandin analogues on central corneal thickness (CCT). METHODS: Clinical, observational, prospectively and randomised study during 3 month on 26 patients (52 eyes) newly diagnosed with primary open angle glaucoma or ocular hypertension. The patients were distributed in two groups concerning topical treatment: - group I: 15 patients treat with travoprost 0,004%; - group II: 11 patients treat with latanoprost 0,005%. The treatment was administrated daily at 9:00 pm, one drop. The CCT was measured for each patient for 3 times by ultrasound pachimetry: at the beginning of the study, at one month and three months. The groups were homogeneous concerning age and sex distribution. Exclusion criteria were: any topical eye drug usage, history of corneal disease or intraocular surgery. The statistic analyse was realised with Mann-Whitman test. RESULTS: The mean central corneal thickness for the two groups was similar: 521,27+/-28,54 microm for group I and 522,18+/-27,52 microm for group II. A statistically significant CCT reduction was observed in both groups: 516,88+/-28,61 microm at one month and 515,04+/-27,59 microm at three month for group I; respectively 518,41+/-27,36 microm at one month and 517,98+/-27,86 microm at three month for group II. CONCLUSIONS: The results of this study show that both classes of prostaglandin analogs reduce the mean CCT, the effect being equivalent for the both studied groups.

[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.

[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.