[Current trends in neovascular glaucoma treatment]. / Actualitati in tratamentul glaucomului neovascular.

Neovascular glaucoma is divided in three clinical stages: rubeosis iridis, secondary open-angle glaucoma, and synechia of the angle-closure glaucoma. 36% of neovascular glaucomas occurs after central retinal vein occlusion, 32% after diabetic proliferative retinopathy, and 13% occurs after carotid artery obstructive. The key of success in the treatment of neovascular glaucoma is the early and rightly diagnosis, the treatment is aimed mainly at relieving pain, as the prognosis for maintaining visual function is extremely poor. The most important surgical procedures are trabeculectomy, artificial drainage shunts and cyclo-distraction by trans-scleral diode laser. This essay presents a synthesis of modern principle data concerning neovascular glaucoma.

[Considerations regarding Goldmann's rheologic equation]. / Cu privire la conceptul si ecuatia rheologica a lui Goldmann.

PURPOSE: The aim of this paper is to verify if Goldmann's rheological concept is still valid. That is because the validity of this concept has been contested. (Beneyto P., Fernandez-Vila P.C., Perez T.M--An experimental approximation to the law of Goldmann: study of the dynamics of the aqueous humor outflow. Ann. Ophthalmol. Glaucoma, 1995, 27, 3, 160-166, Abstract in Glaucoma abstracts 1995, Vol. 6, nr. 3, 63.) MATERIAL: The authors sustained that Goldmann's equation has never been verified. On 42 normal eyes and 54 glaucomatous eyes (POAG) they determined aqueous flow by fluorophotometry, IOP by aplanotonometry and considered a value of 9mmHg as normal episcleral veins pressure. The results they obtained showed that in 47% of the cases the fluorophotometric values were with over 1microl/min higher then the calculated values using Goldmann's equation. So, they concluded that Goldmann's equation could be wrong. METHOD: There are two outflow pathways for the aqueous humor, trabecular and uveoscleral. Obviously, the uveoscleral outflow (Fu) summed with the trabecular outflow (Ftr) must be equal with the aqueous flow (FIN), and the total outflow facility (CTRU) must be the sum of the trabecular outflow facility (Ctr) and uveoscleral facility (Cu). Thereby Goldmann's equation can be written: FIN = Ftr + Fu = (Pio-Pv) * CTRU and Ftr = (Pio-Pv) * Ctr, Fu = (Pio-Pv) * Cu. With the authors' data we verified the previous equations. RESULTS: There is correspondence between clinical and mathematically deducted parameters. CONCLUSIONS: 1. Goldmann's rheological concept is still valid. 2. With proper modifications Goldmann's equation is still valid.

[Individual pressure tolerance--a "target" pressure?]. / Toleranta presoare individuala--presiune "tinta"?

In literature there are many meanings for the limit between normal and pathological intraocular pressure: "normative pressure", "critic pressure", "individual tolerance pressure" and "target pressure". The aim of this paper is to demonstrate that these terms are synonymous.

[The effect of chronic beta-blocker treatment on the evolution of primary open-angle glaucoma]. / Influenta tratamentului cronic cu beta-blocante în evolutia glaucomului primitiv cu unghi deschis.

UNLABELLED: Comparative analysis of the results of the trabeculectomy in primary open-angle glaucoma (POAG) when it was chosen as a primary treatment and when was preceded by chronic use of topic beta-blockers. MATERIAL AND METHOD: Retrospective study of 59 patients (group A) with primary trabeculectomy and 42 patients (group B) with topic beta-blockers treatment for at least 3 years subsequent to trabeculectomy was performed. The average postoperative follow-up period was 3 years and 5 months. RESULTS: Postoperative IOP lowering was similar in both groups; There are no statistical differences between group A and B concerning stationary cases (76.27% in group A and 75.4% in group B), regressive cases (6.8% and 7.14% respectively) and progressive cases (18.6% and 17.9% respectively); Preoperative and postoperative complication rates were similar in the 2 groups. CONCLUSIONS: The chronic beta-blockers use does not influence the evolution of operated POAG.

[Primary trabeculectomy for early-onset congenital glaucomas]. / Trabeculectomia tratament de prima intentie al glaucomului congenital precoce.

OBJECTIVE: Analysis of the results of primary trabeculectomy in the treatment of congenital glaucoma. MATERIALS AND METHOD: Retrospective study of a series of 62 patients with primary trabeculectomy for congenital glaucoma, with a mean follow-up period of 2.22+/-2.86 years. RESULTS: The last controlled intraocular pressure (IOP) was higher for the patients in the age group 0-1 year (16.9+/-8) as compared with the patients older than 1 year (14.9+/-7). An intraocular pressure < or = 20 mmHg without additional medication has been found in 58.3% of the cases in the 0-1 year age group, versus 65.8% in the group of patients older than 1 year. The number of reoperations was higher in the 0-1 year age group (14), as compared with the group of patients older than 1 year (8). The rate of qualified therapeutic success (IOP < or = 20 mmHg) was 79.1% in the 0-1 year age group, versus 85.5% in the group of patients older than 1 year. CONCLUSIONS: Primary trabeculectomy is effective in the treatment of congenital glaucoma. The poorer results in the group of patients under 1 year of age is correlated with disease severity. The rate of favorable results is increased by reoperation, the majority of surgical failures belonging to the group of patients who needed reoperations.

[Primary trabeculectomy in the surgery of primary open angle glaucoma]. / Trabeculectomia tratament primar al glaucomului primitiv cu unghi deschis.

OBJECTIVE: Comparative analysis of the results of trabeculectomy in the surgery of primary open angle glaucoma (POAG) as the primary therapeutical approach and after the medical treatment failure. MATERIALS AND METHOD: Retrospective study including two therapeutical groups: A (59 patients) with primary trabeculectomy; and B (60 patients) with trabeculectomy following a medical treatment failure; mean follow-up period was 3 years and 5 months. RESULTS: Postoperative drop in intraocular pressure was similar in the two groups; there is no statistical significant difference between the two groups regarding stationary disease (76.27% in group A, versus 73.33% in group B), regressive disease (6.8% versus 6.7% respectively) and progressive disease (18.6% in group A, versus 21.6% in group B). At an intraocular pressure < or = 21 mmHg 13.6% of glaucoma cases do progress. The rate of peroperative and postoperative complications is similar in the two groups. CONCLUSIONS: The prior medical treatment of glaucoma doesn't affect the evolution of operated POAG. Primary trabeculectomy is indicated for non-compliant patients and for patients in whom administration of combined medical treatment for short time periods doesn't lower the intraocular pressure at safe levels. Surgical treatment has the advantage of an important and constant lowering of the intraocular pressure which is an absolute requirement for an efficient control of advanced glaucoma.

[The effect of the pseudoexfoliative syndrome on the evolution and treatment of pseudoexfoliative glaucoma and senile cataract]. / Influenta sindromului de pseudoexfoliere în evolutia si tratamentul glaucomului pseudoexfoliativ si cataractei senile.

PURPOSE: The natural course of pseudoexfoliative syndrome (PES), its influence on the progression and treatment of pseudoexfoliative glaucoma (PEG) and senile cataract. METHODS: 28 cases of PES followed up for 10 years were subjected to complete examination including IPT (intraocular pressure tolerance) and AGF (aggressive glaucomatous factor = IPT-IOP determinations). RESULTS: 1) The isolated form of PES shows a tendency towards bilateralization in 38% of the cases; 2) the occurrence of open angle glaucoma in 20% of the initially isolated PES cases with a rapid progression of papilloperimetric damage; 3) poorer postoperative results in PEG and PES-associated cataract as compared to those obtained in open angle glaucoma and senile cataract; the high incidence of pre- and postoperative complications (fibrous exudate in aqueous humor, ruptured posterior capsule and vitreous loss respectively). CONCLUSIONS: 1) PES is a risk factor in the evolution and treatment of PEG and cataract; 2) the necessity for a more aggressive management in PEG given the rapid alterations of papilloperimetric parameters: 3) poorer functional outcome and increase incidence of pre- and postoperative complications following surgery for PEG and senile cataract.

[A comparison of the long-term results and complications of trabeculectomy]. / Compararea rezultatelor pe termen lung si a complicatiilor trabeculectomiei.

PURPOSE: Comparing the efficiency and incidence of postoperative complications of classical limited trabeculectomy (30-35 degrees trabecular excision) and large and adapted trabeculectomy (60-120 degrees). METHOD: A prospective study of 40 patients with symmetric bilateral glaucoma in whom limited trabeculectomy was performed in one eye and large and adapted trabeculectomy in the opposite eye. All operations were performed by the same surgeon, and the follow up interval was 4.2 years. RESULTS: Postoperative and long-term pressure drop are similar for both types of trabeculectomy. Following limited trabeculectomy the incidence of postoperative complications is 30% lower, the incidence of severe complications is very low and patient's functional rehabilitation is faster. CONCLUSIONS: Except for the clinical conditions where IOP has to be decreased to very low levels (below an intraocular pressure tolerance level of 11-12 mmHg) when a large trabeculectomy is required, limited trabeculectomy is to be preferred as it is safer and obviously beneficial.

[The ocular hypotonic effect induced by an angiotensin-converting enzyme inhibitor (captopril)]. / Efectul hipotonizant ocular indus de un inhibitor al enzimei de conversie a angiotensinei (Captopril).

UNLABELLED: The investigation aims at analysing in healthy and glaucoma subjects the effects of an angiotensin conversion enzyme inhibitor (Captopril) on intraocular pressure, local tolerance, influence on systemic circulation and to ascertain (or suggest) the mechanisms inducing this pressure lowering. The study is prospective, masked, in acute test (10 days) and includes a series of 14 healthy subjects and 18 patients with open angle primitive glaucoma. Following numerous experimental and clinical tests, Captopril isotonic solution 2.5% administered in ocular instillation 4 times/day proved to be the most appropriate. RESULTS: Captopril solution 2.5% lowers intraocular pressure both in the normal subjects (average relief of 6.5 mm Hg) and in the glaucoma patients (8.9 mm Hg); hypotonic effects lasts for 6-8 hours; local tolerance is good; has no influence on systemic arterial pressure; tonography with constant Pt shows a 12% increase of C (insufficient to explain such a relief in intraocular pressure). The hypotesis that pressure lowering occurs (partially) by the stimulation of prostaglandin activity and consequently by improved uveoscleral drainage is suggested. CONCLUSIONS: Captopril solution 2.5% administered topically lowers intraocular pressure without adversely influencing systemic and local circulation; local tolerance is good; the mechanisms of ocular hypotonizing effect are unknown.

[The surgical results in traumatic cataract]. / Rezultate în chirurgia cataractei traumatice.

The retrospective analysis of the postoperative course in 204 traumatic cataracts (140 isolated, simple cataracts and 64 aggravated ones) showed an apparent functional improvement in the simple cases (preoperative and postoperative visual acuity 0.0139 and 0.8520, respectively); the incidence of postoperative detachment of retina was of 4.9%, that of postoperative endophthalmitis that of cystoid macular edema of 3.2%; complications more commonly occurred in aggravated traumatic cataracts and partially accounted for the poorer functional results. During the investigated interval (1988-1992) a rapid shift to extracapsular cataract extraction and posterior chamber lens implants was made. The crystalline grafts preserved binocular vision in 92% of the cases and contact lens in 50% of the cases. Lens implant remains a matchless solution for the visual rehabilitation of the patients with aphakia.

[Surgery in the treatment of primary advanced open-angle glaucoma]. / Chirurgia în tratamentul glaucomului primitiv cu unghi deschis avansat.

A series of 25 cases of advanced open-angle primitive glaucoma (C/D higher than 0.8, visual field stages C, D, E according to Greve's classification), operated upon by extended and adapted trabeculectomy, surgery being the initial step in the treatment of this affection, was reviewed. After a 18.5-month follow up, the progression of glaucoma was arrested in 60% of the cases, and a regression of papilloperimetric alterations was found in 8% of the cases. There was a significant correlation between the obtained IOP level and glaucoma course (in the cases with a favourable course postoperative IOP was of 15.5 mmHg, while in those evolving unfavorably IOP was of 18 mmHg). Our experience suggests that antiglaucoma surgery may be recommended as an initial treatment in those patients in whom a short-term drug trial (topic administration of 3 drugs for few days) induces a lowering of IOP to less than 15.5 mmHg, and life expectancy is not short.

[Functional results in the surgery of congenital cataract]. / Rezultatele functionale în chirurgia cataractei congenitale.

During 1983-1993, 202 patients (a total of 230 eyes), 113 males and 117 females, were operated. From these, 47 selected cases could not be properly followed and the functional results were established only after repeated checking. In these cases, the surgical techniques consisted of 7 cryoextractions, 47 extracapsular extractions and 18 irrigations-aspirations in double stream. 47 lens implants have been introduced, 43 were Fedorov [correction of Fyodorov]-type with pupillary fixation and 4 were posterior chamber implants. The visual acuity was almost the same to both the patients who have benefited from implants and to those corrected with contact lens or glasses.

[The surgical treatment of high myopia with dura mater. The results obtained long term (a clinical study)]. / Tratamentul chirurgical al miopiei forte cu dura-mater. Rezultate obtinute pe termen lung (studiu clinic).

The paper presents the postoperative results obtained by performing scleroplasty with dura-mater in 127 progressive myopic eyes. The authors consider that the homologue dura-mater represents a high quality material to make scleral plasties. The evolution of myopia has ceased in over 60% of the cases.

Lamellar keratoplasty in keratoconus.

The authors present the results of 11 keratoplasties in cases of keratoconus, comparing the visual acuity and the ocular refraction before and after the operation (ophtalmometry, objective and subjective refractometry). The statistical data indicate a meaningful flattening of the corneal curvature (12.84 dpt average) and a mean reduction of the myopia for 8.227 dpt. In fact, the basic regular astigmatism of the cornea had not been altered. The mean visual acuity was 0.68 (with an improvement of 0.495). No further damage of acuity had been observed. After 10 to 69 months a medical checkup revealed transparent grafts in five cases; four presented small maculae; one, thin folds of Descemet's membrane. Based on the authors' experience and on the literature, the paper recommends lamellar keratoplasty in cases of keratoconus, the surgeon must choose the appropriate moment in the course of the development of this disease.

[34 epibulbar malignant tumours (author's transl)]. / Réflexions sur 34 tumeurs malignes épibulbaires.

Based on a study of 34 cases, the authors make therapeutical and diagnostical references concerning the epibulbar malignant tumours. These were met with a frequency of 10% of the total amount of the malignant tumours of the visual apparatus. The most frequent setting were at the level of the bulbar conjunctiva and of the sclero-corneal limb, especially in front of the opening of the palpebral slit and in the temporal area. The histological examination of the tumours pointed out the following morphological types; epitheliomas (61%), especially spino-cellular, malignant melanomas (32%) and sarcomas (6%). The therapeutical attitude was the surgical one -- the accurate extirpation -- in the limited tumours, followed by radiotherapy when neoplasic lesions were found at the limit of section. In the invaded tumours, the exenteration of the orbit was performed followed by radiotherapy. On the terms of such a therapeutical conduct, the distant prognosis proved to be dependent on two factors: a. The early diagnosis, that is the stage of the therapeutical action. It is insisted upon the importance of the signs of malignization of some benign tumors: papillomas or naevi. b. The nature and origin of the tumour: the secondary tumours are more severe from the beginning.