Photochemical Crosslinking of Tarsal Collagen as a Treatment for Eyelid Laxity: Evaluation in Ex Vivo Human Tissue.

PURPOSE: Experimental investigation in human eyelids to confirm that exposing excised tarsal plates to ultraviolet-A radiation can induce a stiffening effect through the riboflavin-photosensitized crosslinking of tarsal collagen. METHODS: Thirteen tarsal plates excised from nonfrozen human cadavers were irradiated with ultraviolet-A rays (365 nm wavelength) at an irradiance of 75 mW/cm2 for 3 minutes, equivalent to a radiation fluence of 13.5 J/cm2, in the presence of a riboflavin derivative as a photosensitizer. The tensile stress (strength) and Young's modulus (stiffness) of both nonirradiated and irradiated specimens were measured with the BioTester 5000 in the uniaxial mode at a strain of 10% and analyzed statistically. Individual specimens excised from 2 cadavers were also examined by routine histopathologic protocols to assess the effect of radiation on the Meibomian glands and collagen organization. RESULTS: The irradiation enhanced both stiffness and strength of the human tarsal specimens, the difference between the test samples and controls being statistically significant (p < 0.0002 for n = 13). Histology indicated no damage to tarsal connective tissue or to Meibomian glands, and revealed a more compact packing of the collagen network located around the glands, which may be beneficial. The existence of collagen compaction was also supported by the reduction of samples' thickness after irradiation (p = 0.0645). CONCLUSIONS: The irradiation of tarsal tissue with ultraviolet-A light of tarsus appears to be a safe and effective method for reducing eyelid laxity in human patients.

Fusarium spp. in Human Disease: Exploring the Boundaries between Commensalism and Pathogenesis.

Fusarium is a large fungal genus that is widely distributed in the environment, mostly known for its plant pathogenicity. Rarely, it is involved in human pathology, where the type of infection caused is highly dependent upon the portal of entry and the immune status of the host. The study at hand aims to summarize routine methods used in diagnosing such infections as well as more advanced molecular diagnostic methods, techniques that can play a huge role in differentiating between colonization and infection when trying to decide the therapeutic outcome. Consequently, to further support our findings, two different strains (one isolated from corneal scrapings and one isolated from purulent discharge) were analyzed in a clinical context and thoroughly tested using classical and modern diagnostic methods: identification by macroscopical and microscopical examinations of the culture and mass spectrometry, completed by molecular methods such as PCR for trichothecene and ERIC-PCR for genetic fingerprinting. Isolation of a clinically relevant Fusarium spp. from a sample still remains a diagnostic challenge for both the clinician and the microbiologist, because differentiating between colonization and infection is very strenuous, but can make a difference in the treatment that is administered to the patient.

NONICHEMIC CENTRAL RETINAL VEIN OCCLUSION ASSOCIATED WITH HEREDITARY THROMBOPHYLIA.

Retinal vein occlusion (RVO) is the second most common retinal vein disease with significant visual loss via thrombus or compression of vein wall. Thrombophilia is the predisposition to vascular thrombosis with the existence of genetic defect that leads to blood hypercoagulability. This report describes the case of a 55 year old male patient, with an active life who presented himself at the emergency room with acute visual lose, insidious and progressive visual field constriction, without any known history of neurological or vascular diseases. The examinations revealed unilateral optic nerve head edema, the fluorescein angiography was specific for nonischemic central retinal vein occlusion CRVO complicated with macular edema. Blood examinations has emphasized the presence of the heterozygous mutation A1298C in the methylenetetrahydrofolate reductase gene (MTHFR), the only one presented from the thrombophilia screen panel and a slightly elevated cholesterol level. During the follow-up period, the patient received anti-VEGF treatment (Bevacizumab, 3x 0.1 ml intravitreal injections) with improved visual acuity and amendment of macular edema. The complex etiology calls for interdisciplinary approach to determine better the cause of this ophthalmological disease. Although studies have found a correlation between some thrombophilia mutations and retinal vein occlusion, more studies that contain a larger number of patients are necessary in order to determine the final role of these gene variants.

Correlation between urological alpha1-AR antagonist medication and changed intraoperative iris behavior.

The aim of our study was to report on the incidence, the etiology and the management of intraoperative floppy iris syndrome (IFIS) during phacoemulsification. A non-randomized, observational, prospective study was performed for 1 year, in which 439 eyes of 438 patients (320 men and 118 women) undergoing cataract surgery by the same surgeon were enrolled. The surgeon was blinded to the patients' drug history. The use or non-use of alpha blockers (especially tamsulosin for benign prostatic hyperplasia), duration of the treatment, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded. A 3.2 mm incision was performed on 316 eyes and a 2.4 mm incision on 123 eyes. IFIS occurred in 2.96% of the patients who were taking an alpha1 antagonist. In 5.47% we identified an intraoperative iris behaviour which imitated an incipient IFIS stage called IFI-like syndrome. In cases of insufficiently dilated pupils, diluted intracameral epinephrine as well as irrigation fluid was used. Vertical chop, stability of the anterior chamber by decreasing the corneal wound size, and reducing turbulence into the anterior chamber, enhanced the surgery on eyes with IFIS. There were no intraoperative or postoperative complications. The incidence of IFIS in our study was linked to alpha blocker medication. We postulate that IFIS may be caused by other medication, but this could not be demonstrated statistically. IFIS can be well controlled during surgery, intracameral epinephrine being the main stabilizing factor.

[The treatment of secondary Sjogren syndrome]. / Tratamentul sindromului Sjogren secundar.

Sjogren syndrome is a chronic autoimmune disease witch affects mostly lachrymal and salivary glands. The exocrinopathy can be encountered alone (primary Sjogren syndrome) or in association with other autoimmune disorders (secondary Sjogren syndrome). Visual prognosis of the patients with secondary Sjogren syndrome depends on the early diagnosis, applied therapy follow-up controls along with an effective collaboration between ophthalmologist and rheumatologist. We present therapeutic options in secondary Sjogren syndrome: hygiene and protective measures, medical nonspecific substitution treatment, treatment to stimulate tear secretion, autoimmune disease-specific medical treatment and 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.

[Corneal collagen cross-linking in the treatment of keratoconus--preliminary results]. / Cross-linkingul colagenului cornean în tratamentul keratoconului--rezultate preliminare.

PURPOSE: The aims of our study were to evaluate the effectiveness of riboflavin-ultraviolet type A (UV-A) induced corneal collagen cross-linking (CCCL) in reducing the progression of keratoconus and to assess the improvement of visual acuity in patients with progressive keratoconus. MATERIAL AND METHOD: 32 eyes of 27 patients with progressive keratoconus were treated with combined riboflavin-UV-A rays CCCL. Postoperative examinations were performed at 1, 3, 6 and 12 months, including: uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), refraction, keratometry, corneal topography slit-lamp examination and these were referred to the preoperative dates. RESULTS: In all treated cases the progression of keratoconus was stopped. Comparative preoperative and postoperative results showed: increase of UCVA (p < 0.001), and BSCVA (p < 0.001), reduction of mean K (p < 0.001) and of the refractive errors--mean spherical equivalent (SE) (p < 0.001), mean cylinder values (Cyl) (p < 0.001). CONCLUSIONS: CCCL is an effective treatment option for progressive keratoconus stages I, II and III. This simple procedure can stop the progression of keratectazia in keratoconus and helps to avoid or delay the need for penetrating keratoplasty.

[Endophthalmitis or TASS--case report]. / Endoftalmita sau TASS--caz clinic.

We present the case of a 65-years-old female with a history of endophthalmitis after residual cortex aspiration postextracapsular cataract extraction. The patient was admitted for cataract surgery on the other eye. After phacoemulsification she developed a series of signs and symptoms on the anterior eye segment which plead for the diagnosis of endophthalmitis or toxic anterior segment syndrome (TASS). Under specific therapy the evolution has been favorable.

[Diagnostic and therapeutic problems in a case of non-Hodgkin lymphoma with ocular involvement]. / Probleme de diagnostic si tratament într-un caz de LMNH cu extindere oftalmologica.

The majority of malignant non-Hodgkin lymphomas are located in lymph nodes, but there are other localizations such as orbital, conjunctival, in the eyelids, or very rare intraocular. The aim of this case is to discuss the diagnostic and therapeutic problems in a case of LMNH with ophthalmologic extension.