Rezumate Congres

The Phakic Posterior Chamber IOL ( ICL ) Used To Correct Refractive Errors (video)

Dr. Tomi Teodor, Dr. Lăzan Nicoleta, Dr. Vişan Oana, Dr. Rus Ioana

Optilens Clinic-Cluj, Romania

The phakic posterior chamber IOL can be an alternative for solving refractive errors: myopia, hypermetropia, astigmatism.

This indication is especially applicable to young  pacients having refractive errors that cannot be solved by Laser Excimer surgery (insufficient cornea) or an alternative for lens refractive exchange.

The surgical technique is presented, along with the indications, contraindications, complications that might occur.

The procedure is reversible.

TRAUMATIC CATARACT AND CORNEAL LEUCOMA – SURGICAL APPROACH

Vlad Chercotă, M.D, (video)

Eye Clinic Timisoara, Romania

Aim: to present the difficult elements of phacoemulsification in such cases.

Method: the use of modern phacomachines with Venturi pumps and microcoaxial method are giving you a good chamber stability and higher control during surgery.

Results: because postoperative astigmatism is minimal and corneal transparency is higher, visual recovery is faster compared with 10-15 years before when older phacomachines were used.

Conclusions: microcoaxial phacoemulsification represents an excelent choice in both standard and complicated cases.

Anterior Ishaemic optic neuropathy associated with metabolic syndrome.

Assoc.Professor Natalija Kosanovic-Jakovic, Belgrad, Serbia

Abstract:

Metabolic Syndrome denotes  a common cluster of naturally connected risk factors including obesity, elevated blood pressure, insulin resistance, dyslipidemia, proinflamatory and prothrombotic state.Anterior ishaemic optic neuropathy is an acute ishaemic disorder of the optic nerve head and may lead to severe visual loss. We considered three patients with moderate degree of diabetic retinopathy and AION. They were submitted to endocrinological and cardiological examination and the diagnosis of metabolic syndrome was established.

We observed that a variety of well-known risk factors in metabolic syndrome may be involved in serious eye and cardiological complications.The early diagnosis and treatment of these patients can not only improve visual function bat also prevent cardiovascular complications.

RETROSPECTIVE RESULTS IN CATARACT SURGERY IN OPHTHALMOLOGIC CLINIC OF CRAIOVA

Carmen Mocanu, Doina Bărăscu, Stefănescu Alin, Parfeni Galina, Ion Anca

Ophtalmology Clinic Craiova, U.M.F. Craiova, Romania

Material and Methods: We analyzed the retrospective results of incidents, and complications of cataract surgery by facoemulsification at patients hospitalized in Ophthalmologic Clinic of Craiova in the last 5 years.

Results and Discussions: Lens facoemulsification and the implant of foldable artificial lens represernts a very modern technique of cataract surgery. The postoperative recovery is very short. The incision is very small, comparative with conventional surgery. Intra and postoperative complications are very small than classical extraction an PMMA implant. Postoperator recovery time in several days; this surgery is realized with local anesthesy. Postoperator astigmatism is less severe, because the incision less than 2,7 mm. This intervention is utilized in senile cataract, congenital cataract, and traumatic cataract. The most frequent complications were represented by corneal edema, in most cases regressive after several days of local or general antiinflamatory treatment.

Conclusions: The treatment by facoemulsification represents the most adequate treatment of cataract in this moment. The small incision reduced very much the complications intra or postoperatoperatory and the time of hospitalization of patents.

OCULAR TRAUMAS AT CHILDREN AND YOUTH – CLINICAL AND ETIOPATOGENIC ASPECTS

Doina Bărăscu, Carmen Mocanu, Rodica Mănescu, Alin Stefănescu, Daniela Burcă, Elena Calciu

Ophtalmology Clinic Craiova, U.M.F. Craiova, Romania

Ocular and anexial traumas represent one of the most important cause of decreasing or even loss of visual function. These traumatic lesions are important when they appear at children  or youth for their very bad prognostic who affects their professional or social status.

Purpose: To reveal principal clinical and etiopatogenic in ocular traumas at children and youth.

Material and methods: A retrospective study including all all ocular and anexial traumas in 2004-2006. The study included all patients bellow 30 years. The study used medical datas from medical records.

Results and discussions: In the last 2 years 190 young patients with ocular traumas were hospitalized in our clinic. (3,5 %  from all hospitalized patients) We`discussed the prevalence on age, sex, provenience, mechanisms, clinical forms, the time to presentation, complications, visual acuity. We noted a prevalence of cases at male patients (75,78 %), especially from rural areas (60,52 %), with open lesions of the eye and annexes. (65,265). The most severe complications were presented at patients who delayed the presentation to hospital.

Conclusions: Prophylactic measures like supervision of children or avoid dangerous jokes and applied the protection measures in sport, industry or agriculture are the principal actions that must be taken in oculat traumas in this age category.

Comparative study between Normal Tension Glaucoma and Primary Open Angle Glaucoma in Clinical Emergency Hospital of Craiova (poster)

Carmen Mocanu, Doina Bărăscu, Dana Preoteasa, Felicia Iliuşi, Stefănescu Alin, Rodica Mănescu

Ophtalmology Clinic Craiova, U.M.F. Craiova, Romania

The purpose of this study was to evaluate the prognostic factors for the progression of visual field damage in patients with normal tension glaucoma (NTG), and to evaluate the risk factors in this form of glaucoma, comparing with primary open angle glaucoma (POAG).

Methods: Ninety patients with NTG and 180 patients with POAG were followed up Universitary Hospital of Craiova, with a minimal period of surveillance of cases of 3 years. The diagnostic criteria for NTG were glaucomatous optic disc changes and corresponding glaucomatous visual field damage, IOP lower than 21mmHg without antiglaucoma medication, two diurnal curves, and normal open angle at gonioscopy. General examination protocol consisted in complete metabolic and cardio-vascular screening, applied for all patients with NTG.

Results: Major ocular risk factors, including patient age, refraction, mean IOP of diurnal variation, mean IOP during follow-up, magnitude of IOP fluctuation during follow-up, level of initial visual field damage, and occurrence of disc haemorrhage, were evaluated in all patients with NTG and POAG. General evaluation of patients with NTG has revealed a high association with systemic cardiovascular diseases: arterial hypotension, arterial hypertension, vascular pressure fluctuations, arteriosclerosis, vasospastic syndrome, ischemic cardiopathy, and diabetes mellitus. Color Doppler imaging variables in patients with stable and deteriorating clinical course, have been compared and have been correlated with visual field progression. The family history of glaucoma and vascular diseases was carefully evaluated for each patient and revealed a predisposition for in appearance of both diseases. 

Conclusions: NTG represented 6.82% of cases of open angle glaucoma in patients hospitalized in the Center of Glaucoma of Universitary Hospital (42 cases males, and 48 cases females). Between local risk factors, tcolor:#292526; he rate of progression of visual field damage differed according to the severity of initial visual field damage and the presence of  disc haemorrhages. The Doppler imaging revealed a better correspondence between ophthalmic artery resistivity index and the visual field loss in NTG than POAG. The level of intraocular pressure seems not to influence considerable the prognostic of papillo-perimetric evolution in NTG.

Malignant palpebral tumors – retrospective study on 130 cases (poster)

Rodica Manescu, Doina Barascu, Carmen Mocanu, Horia Parvanescu, Oksana Doholich

Ophtalmology Clinic Craiova, U.M.F. Craiova, Romania

Abstract:

We presented a retrospective study on 130 malignant palpebral tumors, hospitalized and treated in Ophthalmologic Clinic of Craiova between 2004-2008.

The maxim incidence was recorded at patients over 60 years. The most cases presented inferior palpebral lesions. The anatomo-pathological exam revealed 10 cases of spino-celular epitelioma, 3 cases adenocarcinoma of Meibomian glands, the rest being represented by bazo-celular forms of epithelioma, 4 extended to orbicular muscles. In 5 cases were recidives, in all cases patients did not accept the radiotherapy. The treatment consisted in tumour extirpation and plastic surgery.

Conclusions:

-         the number of cases of epitelioma increased in last years:

-         the risk of recidives increased if the radiotherapy is under-evaluated.

-         the success of treatment successful of treatment depends of collaboration between ophthalmologist and oncologist; the role of general practitioner is very important to sent the patient as soon as possible to the specialist.

The prognostic value of the oculo-orbital circulation changes in the primitive open angle glaucoma and in diabetes

Elekes Ella Mária*, Csiszár Anna Adrienn**, Vig Júlia**,Popescu Ovidiu**,  Szatmári Judit**, Mészáros Ferenc**

* Optica Optofarm Târgu-Mureş, Romania

**Ophtalmology Clinic Târgu-Mureş, Romania

In this paper we study the severity of glaucomatosus and diabetical ophthalmological changes trough the modifications of the visual field, intraoculat pressure and the oculo-orbital vascular status. The vascular status was observed with Doppler-ultrasonography which indicated the circulation velocity and rezistivity index in the oculo-orbital vessels. We tried to find the eventualy physiopathological connections between the clinical and ultrasonographical vascular status to elaborate some early, non-ivasive diagnostical method.

The extracranial Doppler-ultrasonographical vascular modifications (Art. carotis communis and interna) gave some unchanged peack sistolic velocity (PSV) and end-diastolic velocity (EDV) values and unchanged rezistivity index (RI) in comparation with the control group, but they are significant lower than the normal value of the control group. The same relation is present at the ophthalmic arthery and the central retinal arthery.

NEUROFIBROMATOSIS TYPE 1 - OPTIC NERVE GLIOMA. CLINICAL CASE.

Monica Rusu, Karin Horváth, Anna Csiszár, Doina Pop, Theodora Orbán, Anna Papp, Diana Constantinescu, Marc Tiberiu

Ophtalmology Clinic, Târgu Mureş, Romania

Eight year old PD, presents in our department for unilateral exophthalmia and severe visual loss at the right eye. Patient has a known history of neurofibromatosis type 1. During general examination we found multiple café au lait spots on the body, axillary and inguinal freckling. Papilledema and palor of the optic disc were observed at ocular examination. Magnetic resonance imaging of the head and orbit was obtained to investigate a possible optic nerve or intracranial tumor. A retrobulbar space occupying condition was found with the enlargement of the right optic nerve, which findings confirmed the suspicions of an optic nerve glioma with intracranial extension. We give a short review of the disease and present the therapeutic guidelines of the optic nerve glioma and the possible surgical approaches.

So, we can affirm that the local haemodinamical analysis based on the Doppler-ultrasonography indicate significant diagnostcal and prognostical changes within the complex management of the glaucomatosus and diabetical patientes.

Endophthalmitis prophylaxis using intracamerular Cefuroxime: our experience

Karin Horvath, Doina Pop, Z. Madaras, Florina Vultur, A. Albert, O. Popescu, Ludmila Katan

Ophthalmology Clinic Targu Mures, Romania

The purpose of this study was to evaluate the effects of intracamerular Cefuroxime as Endophthalmitis prophylaxis in cataract surgery. According to ESCRS recommendations the use of intracamerular Cefuroxime has been introduced in our daily practice since April, 2007.

Materials and methods: We have evaluated the effects of intracamerular Cefuroxime on cataract surgery using phaco between April 2007 and October 2008. The new method replaced the use of subconjunctival injection of Dexamthasone and Gentamicin. The Cefuroxime dilution was made in the operating room, 1 mg was added to 0,1 ml physiological serum.

Results: In the analyzed period no postoperative Endophthalmitis was registered. Intracamerular Cefuroxime was well tolerated in most of the cases. In a few cases tough, there has been a persistent corneal epithelial edema, toxic anterior segment syndrome (TASS). We had observed corneal decompensation with bullous keratopathy too.

Conclusions: The voluntary or involuntary administration of any substance in the anterior chamber is an act of high responsibility. To the appearance of adverse effects several factors play role: type of the substance, concentration of it and the status of the patient’s cornea.

Learning curve in cataract surgery: a resident’s experience (poster)

Dr Madaras Zoltán, Dr Pop Doina, Şef lucr Dr Horváth Karin

Ophthalmology Clinic, TgMures, Romania

The purpose of this study was to follow the steps of the learning curve in cataract surgery of a resident. We have also followed the difficulties met, the intraoperative and postoperative short and long term complications that have occured.

Matherial and method: 50 eyes of 48 patients were operated in a period of 9 months. The operating surgeon had experience in other type of anterior segment operations, but only assisted cataracts before. All operations were assisted by an experienced surgeon.

Results: Biometries were done by the operating surgeon, using contact method and SRK-T formula. All patients underwent local retrobulbar anesthesia. 5 operations were ECCE, the rest were planned phaco, 42 of them were finished so. 8 patients had PMMA lens implanted, 42 foldable IOL. The capsulorexis was done with a needle, at phaco stop&chop technique was used. There were no major intraoperatory complications, posterior capsule rupture occured only once. In the postoperative period we have noticed persistent epithelial corneal oedema in 4 cases, one patient developed bullous keratopathy.

Discussions: The causes of the complications are analized: the capsule rupture was due to inadequate surgical technique, while the persistent corneal oedemas and the bullous keratopathy were caused by the toxic effect of the sterilizing liquid left on the surgical instruments and canules. As soon as the sterilizing liqiud was changed, all the edemas disappeared.

Conclusions: We consider that starting with ECCE is useful, later changing to phaco. The combination of needle capsulorexis and stop&chop technique was a successfull combination in our case, we recommend it to other beginners too.

Management problems in penetrating keratoplasty performed on patients with previous vitreo-retinal surgery

Daniela Selaru, Ileana Serghiescu, I. Bivolaru

Eye Clinic, Central Military Hospital, Bucharest, Romania

Purpose: to analyze anatomic (tectonic) and functional (optic) results after penetrating keratoplasty (PK) performed on patients with complex ocular pathology, who have previously undergone vitreo-retinal surgery.

Materials and method: we monitored patients on whom we performed PK in the past two years, for edematous keratopathy or adherent leukomas (irregular or linear), associated with traumatic cataracts, aniridia or iris colobomas and retinal detachment, obstructive thrombo-embolic retinal syndromes.

All these patients had undergone 3-24 months before PK, complex surgical procedures: cataract surgery, with IOL implants (anterior chamber, posterior chamber or scleral suture) and vitreo-retinal surgery for retinal detachment or central retinal vein occlusion.

Results: transparent corneal grafts could be maintained for some of the patients, with useful visual acuity increase; in other cases, PK was repeated, once or twice, after 6-12 months.

Conclusions: PK on eyes with previous complex surgery is extremely difficult. Failure causes: long-standing corneal lesions, secondary glaucoma, unavoidable vitreo-endothelial contact, the necessity of maintaining intraocular silicon oil.

RETROSPECTIVE STUDY OF PATIENTS WITH KERATOCONUS

Nicolette Sohar, Akos Skribek, Zsuzsanna Fulop, Lajos Kolozsvári

Department of Ophthalmology, University of Szeged, Szeged, Hungary

Purpose: To study the results of the examinations of the patients with keratoconus, with the details of their therapy and their status.

Methods: We examined 165 patients with keratoconus at our department between 2002 and 2007. 83 patients used HGP contact lenses, and we performed penetrating keratoplasty at sixteen patients’ twenty-one eyes.

We followed the course of keratoconus by corneal topography and ultrasound biomicroscopy.

Results:53 patients used contact lense on both eyes, and 30 patients only on one eye.

Early complications after penetrating keratoplasty occured at nine, late complications at seven patients.

One patient needed repeated penetrating keratoplasty because of allograft rejection.

Conclusions: The visual acuity became stable in cases of patients, who tolerated the rigid lenses well. The results of the penetrating keratoplasty were as good as in the literature. The refraction changed after removing the sutures. UBM is an effective device to follow the progression of keratoconus and to determine the timing of these patients’ operations.

THE EFFECTS OF COMBINATE THERAPY FOR INSULINODEPENDENT DIABETES CASE WITH RECIDIVANTES VITREOUS HEMORRHAGES

Daniela Dacia Hîncu ¹, Anda Sireteanu Cucui ², Diana Popa ³

¹ Vizual Med S.R.L. Targu Mures, Romania

² Ophtalmology Clinic, U.M.F. Targu Mures, Romania

³Eye Clinic, Emergency Military Hospital Cluj Napoca, Romania

The case present in this paper offer us a vision of needs for combinate therapy: laser-therapy, vascular trofic drugs and inhibitory of vascular formation for an diabetes insulinodependent patient with hypertension which present recidivante vitreous hemorrhages from prepapilary ghost vessels, with good vision between this episodes.

Retineal Vein Occlusion – clinical study

Csiszár Anna Adrienn*, Elekes Ella Mária**, Papp Anna*, Ferencz Attila*

*Ophtalmology Clinic, Targu Mures, Romania

**Optica Optofarm Targu Mures, Romania

The purpose of this paper was the retrospectiv epidemiological and clinical study of the retineal vein occlusion in the five years (2004-2008) casuistic of the Clinic of Ophtalmology from Târgu-Mureş. The vein occlusion was present in 1,5% and 60% was central retineal vein occlusion (CRVO). We analised the risc factors, the appearance of the ocular complications like rubeosis and secundar glaucoma and the eficacity of the medical and laser treatment.

We can say, that in spite of the possibility of  the modern treatment the visual fuction remain low and far complications like neovascular glaucoma can appear. Because of these, the prevention trough elimination of the risc factors remain the main procedur.

Pars plana vitrectomy in aphakic eyes with retinal detachment after complicated cataract extraction – surgical strategy

Robert Rejdak¹, Dariusz Haszcz¹, Tomasz Zarnowski¹, Anselm Junemann²

¹ Departament of Ophthalmology, Medical University of Lublin, Poland

² Departament of Ophthalmology, Medical University of Erlangen, Germany

To propose the management of retinal detachment in eyes after complicated cataract surgery.

A 76-year old woman was referred due to total retinal detachment and PVR reaction following cataract surgery. Cataract surgery was done elsewhere 4 months ago. The patient presented with dislocated IOL into the vitreous, anterior and posterior capsular defects, remained part of the nucleus attached to the corneal endothelium and total retinal detachment with PVR reaction. The different steps of the surgery were as followed: encircling band, removal of the remained nucleus, extraction of the IOL and the remnants of the capsule, chromovitrectomy, membrane peeling, PFCL, secondary IOL implantation with scleral fixation, Ando iridectomy, filling of the anterior chamber with viscoelastics, and silicone oil tamponade. Visual acuity postoperatively was 20/400.

We propose IOL implantation (sulcus implantation, scleral fixation, iris claw IOL) in combination with vitreoretinal procedures as a treatment of retinal detachment in aphakic eyes after complicated cataract surgery.

Posterior vitrectomy in the treatment of the lens dislocations – preliminary results

Simona Țălu, Simona Lupaşcu, Erika Sebestyén, Laura Toader

Eye Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Aims. The paper aims to present the preliminary results that we obtained, by the use of the posterior vitrectomy techniques, in the treatment of the lens dislocations.

Material. Method. The 10 cases of lens subluxations and luxations in the vitreous, that were treated surgically, by posterior vitrectomy, during the last 6 months, are retrospectively analized. We followed the next patameters: the preoperative functional and objective findings, the associated ocular lesions and complications, the technique that we used, the intra and postoperative complications, the postoperative functional and objective findings.

Results. In 5 of the 10 cases, the aphakia has been corrected in the same session, by the implantation of a scleral-fixated lens. No intraoperative complication has been noted. In one case, retinal detachment has been diagnosed, 6 weeks after the posterior vitrectomy. Immediate surgery has been performed, with the reattachment of the retina. In all the 10 cases, the visual acuity improved significantly, as compared to the preoperative situation.

Conclusion. The posterior vitrectomy has proven its efficacy in the surgical treatment of the lens dislocations, as proven by our cases.

Clasic and Modern Treatmentsin Diabetic Retinopathy

Dr. Codruta Blajan, Dr. Cosmin Rosca

"Optilens" Clinic Cluj-Napoca, Romania

The paper presents the case of a 40 years-old female with diabetes mellitus and aplastic anaemia who presents a quick and serious evolution of the diabetic retinopathy. It' s described the efficacity of the treatments:photocoagulation, vitreal surgery and intravitreal injection with anti-VEGF, Triamcinolon.

Conclusions: the modern treatments improve the prognosis of the disease.

Intravitreal Avastin Therapy for Neovascular Age-Related Macular Degeneration with Large Macular Hemorrhages

Dr. Codruta Blajan, Dr. Cosmin Rosca

„Optilens” Clinic, Cluj-Napoca, Romania

Purpose: to evaluate anatomic and functional effects of intravitreal Avastin in patients with neovascular age-related macular degeneration (AMD) with large macular hemorrhages.
Methods: retrospectiv clinical study of 11 eyes with AMD and macular hemorrhages involving fovea comprising more than 50% of total lesion.The patients have been treated with up to 4 injections (1mg/0.04ml) at 4 weeks intervals and they have been at least 5 months complete followed-up after the last injection (monthly evaluation). Their visual acuity scores have been analyzed, retinal thickness has been measured and their angiographic lesion caracteristics have been evaluated before and after the therapy.

Results: VA was stable or improved in all pacients, retinal thickness decreased at least 50 microns after the first injection at 1 month and at least 80 microns after the last injection; the hemorrhages and the leakage dissapeared.

Conclusion: intravitreal Avastin therapy seems to be efficacious in AMD with large macular hemorrhages.

OCT IN DIAGNOSTIC, MANAGEMENT AND TREATMENT OF RETINAL DISEASES

Dana Preoteasa, Felicia Iliuşi

ONIOPTIC, Craiova, Romania

OCT is a non-invasive technique that provides a cross-sectional image of high-resolution of tissue (≤10 microns of axial resolution) and is a first technique that offers in vivo images. The conventional bi-dimensional techniques (fundus stereo-photography and angio-fluorography) offer a topographical view of the retina that helps us in delimits of treated lesions, but that have not the capability to describe the changes that occur in retinal level.

OCT helps us in practical management of the patients with retinal diseases, by grading of type of diseases, changes and second associations and pursuit the answer to different type of treatment.

DIAGNOSTIC ROLE OF OCT IN ARMD

Felicia Iliuşi, Dana Preoteasa

ONIOPTIC, Craiova, Romania

Aim of this paper is to evaluate the role of OCT in detecting chorioretinal changes in aged-related macular degeneration.

Patients and methods. We performed HD-OCT examinations to patients with ophthalmoscopic changes suggestive for ARMD.

Results. Ocular Coherence Tomography has been found to be useful in evaluating and documenting classic and occult CNV. OCT demonstrates increased foveal thickness, cystoid macular edema, serous retinal detachment, RPE elevation and detachment. It also identifies and quantifies subretinal, intraretinal and sub-RPE fluid.

Conclusions. These findings correlate well with angiofluorography, suggesting the utilization of both methods in conjunction will provide a more complete diagnostic picture and will help to determine the best management strategy.

Multiple optic papilla: myth or reality

Mihnea Munteanu, Ileana Zolog, Stela Giuri

Universitary Eye Clinic Timisoara, Romania

Objective: To study the clinical aspects of multiple optic papilla.

Clinical observation: We present 2 cases with multiple optic papilla. First case, with an aspect of duplicated double papilla, where at the supranumerary papilla we noticed a cilioretinal artery. The second case, with pseudo-double papilla, in context of a medium myopia, with visualization of the choroidal circulation.

Discussions and Conclusions: The diagnosis of multiple optic papilla is difficult. Its support requires the presence of multiple conditions: double papillary margins, central vascularization with separate emergence, synchronous vascular pulsation, imagistic and morphopathologic arguments. So far, no clinical case with those required conditions was ever published.

OCT – A  NEW APPROACH IN RETINAL PATOLOGY

Prof. Dr.Marie-Jeanne Koos (1),Dr. Cristiana Lehaci (2) Dr. Luana Bistreanu(3) , Dr. Florina Stoica (4)

1: Universitary Eye Clinic Timisoara

2: Universitary Eye Clinic Timisoara,Vista Vision Medical Oftalmology Center Timisoara

3: Centre Hospitalier Mouscron, Belgia

4: No. 5 Clinical Hospital Timisoara

Introduction: Optic coherence tomography (OCT) is the second revolution in the retinal imagery after the ‘60s  fluorescein angiography revolution. OCT works up on the spectral interferometry physic principle and it uses the coherent light. The resulting images are retinal sections (between 128-518 sections) on a macular surface of 6x6 mm².

Material and Method: Our study is focusing on OCT evaluation of different ocular pathologies, but it is also overviewing multiple methods paraclinic evaluation of eye diseases.

Results: The OCT image of the patients with different etiology cystoid macular oedema shows the thicken retina caused by intraretinal cystoid cavities.  It is able to see the posterior hyaloid with persistant macular attachment and tractions in patients with posterior vitros detachment syndrome. It is also able to sharply diagnose the macular hole threatening, the lamellar macular hole and full-thickness macular hole. In the patients with central serous retinopathy, OCT directly visualize the retinal fluid accumulation.

Conclusions: The advantages of this new imagistic method are obvious: while the fluorescein angiography show us the fluorescein flowing inside the vessels or accumulating in the intraretinal and under-retinal abnormal spaces, the OCT show us the very retinal tissue with its morphology and even much more, the non-dye filling pathological  cavities. It should be emphasize that the OCT exam can show us the transparent posterior hyaloid barely detached and the tractions with their consequences and therefore it is considerably completing the biomicroscopic eye fundus examination.

RETINOPATHY OF PREMATURITY—timing and team examination

Prof.Dr. Marie-Jeanne Koos*,Dr. Florina Stoica**, Dr.Gabriela Olariu**, Dr.Corina Bugeag*

*Universitary Eye Clinic Timisoara, **No. 5 Clinical Hospital Timisoara, Romania

Introduction: The retinopathy of  prematurity ( ROP ) is a serious disorder of the premature infants.ROP often regresses or heals, but can lead to severe visual impairment or blindness.

Purpose: A retrospective study , carried out 1 year long ( screening,therapeutic indication, laser treatment, anatomical outcomes after laser )

Material and Methods: Between January-December 2008,in NICU Department of no 5 Clinical Hospital Timisoara 369 infants have been examined ( from Timisoara and neighboring areas ),with GA < 32 weeks and BW < 1500g.

Indirect ophthalmology is the gold standard for detecting and following ROP.The classification was made according to ICROP. The indirect infrared diode laser has been used.

Results: The incidence of retinopaty was 41,19%( 152 infants ),in risk category.

We have the following repartition on stages :st 1=72 infants ( 19,51 %), st2=46 ( 12,46 %), st3=31 ( 8,40 % ), st4=3 ( 0,81% ), st5=0 ( 0% ).

 23 infants reached the threshold and required laser photocoagulation.7 infants needed re-treatment.From the entire group of infants, 6 were diagnosed with retinal detachment ( in the case of 4 infants, the parents choose the Budapest Vitreoretinian Surgery Centre and  the  other 2 infants did not attend follow up)

Conclusions: The ROP screening is justified by the high number of infants with low BW and GA (better access to medical care , improved neonatal care),and also by multiple factors  associated with it.

The timing of examination and follow-up are very important for diagnosis and treatment of ROP.

A good evolution of the infants with ROP requires a continued interdisciplinary approach (from clinic and therapeutic point of view).The laser photocoagulation performed by a ,,Neonatalogist-Ophthalmologist Team”  was a real success .

The infants can be discharged or transfered from NICU while their retina is still immature.For an appropriate follow-up  a good communication with  parents(ensuring that parents are aware of the significance of ROP) is  very important.

There are still some difficulties concerning the feedback doctor/parents.The parents hardly accept the true connotation of their child ,which ,,doesn t complains  “, ,,he is too young “ and the distances to the screening and treatment centres are ,, too big “.

CYSTOID MACULAR EDEMA AFTER POSTERIOR UVEITIS – OCT DIAGNOSIS - case report

Cristiana Lehaci, Viorica Frantescu, Alina Muntean

Ophtalmology Center Vista Vision, Timisoara, Romania

Introduction: Cystoid macular edema, commonly called CME, is a painless disorder Nwhich affects the central retina or macula. When this condition is present, multiple cyst-like (cystoid) areas of fluid appear in the macula and cause retinal swelling or edema. Although the exact cause of CME is not known, it may accompany a variety of diseases such as retinal vein occlusion, inflammatory conditions or diabetes.

Purpose: To emphasize the importance of OCT (optical coherence tomography), in diagnosis of cystoid macular edema developed after uveitis.

Method: We present two cases of cystoid macular edema after intermediate uveitis. The patients in study were complaining of blurred and distorted central vision, even the ocular inflammatory process was solved in the past by medical therapy or surgical treatment (vitrectomy).

Results: Using a Stratus OCT (Carl Zeiss Meditec) it was possible to confirm the presence of cystoid macular edema.

Discussions: For some diseases, cystoid macular edema, central serous retinopathy, age –related macular degeneration and macular holes, Stratus OCT may provide more information than is available from a fluorescein angiogram alone.

Conclusions: Optical coherence tomography is an imaging method similar to ultrasound that uses light instead sound to scan the retina. This investigation has become an important component of the retina examination in many clinical cases.

Difficulties in managing the subluxed lens

Dana Preoteasa, Felicia Gabriela Iliuşi, Marga Ciuică

ONIOPTIC Craiova, Romania

We present a few cases of posterior subluxed lens pathologic associated with pseudo-exfoliative syndrome, primary opened angle glaucoma, ocular trauma.

Anterior segment approach without or minimizes vitreous loss represents one of the greatest challenges in contemporany lens surgery. The most difficult part of the surgery was: achieving a central curviliniar capsulorrhexis, place the CTR for provides the best stability of the lens capsule diaphragm, lens extraction, bag recentration and fixation, in the bag IOL implantation.

For the long time it must to reduce the risk of the late subluxation/ dislocation of the IOL and posterior capsular opacity.

THE PROBLEMS OF MANAGING CHILDREN CATARACT

Adriana Stanila, A. Teodoru, Elena Mihai

SIBIU, Romania

The aim of study is to reveal the problems involved of uni- or bilateral cataract at children.

Material and Method: We studied 18 cases of congenital and traumatic cataract, operated in the Ophthalmology Clinic Sibiu, under the age of 14 years. There were 12 congenital cataracts and 6 traumatic cataracts.

The method used was EEC with IOL-PC, under general anesthesia. In most cases we performed posterior capsulorhexis. 

Results: Children cataract is a special problem in ophthalmology surgery, concerning the ambliopya, the binocular vision, the wound management.

The results were good related to the morphologic aspect, but the problem remains the functional recovery.

Conclusions:

-         The main technique of managing children cataract is EEC with aspiration of the bag content.

-         We consider necessary the posterior capsulorhexis, especially in cataracts at children under 4 years.

-         The results were good in most cases.

PTERYGIUM SURGERY – A MODERN APROACH

Adriana Stanila, Elena Mihai, A.Teodoru

Sibiu, Romania

Introduction: NPterygium is one of the oldest ocular diseases known.

The ethiology Nand the treatment of pterygium are still discussed and uncertain. The rate of recurrence is high.

The aim of our sNtudy is to show a surgical technique which we hope to reduce the recurrence of pterigyum. We hope to find a solution for the management of primary pterigyum and for the recurrences.

Material and Method: We studied the patients with pterigyum operated in the last 3 years, using a new method.

In small pterigyums, after its complete removal, we fitted a TCL. In large pterigyums and in recurrences we applied amniotic membrane and TCL.

Results: We applied TCL in the first or second postoperative day in all cases;

In large pterigyums and in aggressive recurrences after surgical excision we considered insufficient only the application of TCL, so we combined it with an amniotic membrane application.

Conclusions:

-         The postoperatory pain and the inflammatory reaction were reduced.

-         The healing was accelerated.

-         This technique is repetitive and the costs are low.

-         The transparency of the cornea and the aesthetic aspect of the eye are improved using this method.

THE TREATMENT OF NEUROTROPHIC KERATOPATHY – CASE PRESENTATION

Adriana Stanila, Elena Mihai, A. Teodoru

Sibiu, ROMANIA

Abstract:

Neurotrophic keratopathy is a corneal degenerative disease caused by the lack of sensitive innervations which has a trophic role on the corneal epithelium. This determines a great susceptibility at aggressions and the decrease of the lachrymal reflex.

We present the case of C.I., 49 years old – LE: neurotrophic keratopathy stage 3 (corneal perforation), after recidivated herpetic keratitis

The topic treatment: nonsteroidian anti-inflammatories antitivirals, corneal trophics, therapeutic contact lens.

It was necessary to apply an amniotic membrane with favorable post operatory evolution.

Ocular complications of hepatitis C treatment

Mihaela Coroi*, Viorica Todor*, Gabriela Muţiu*, Diana Bembea*, T Coroi**, Anca Robotin*

* Medicine and Pharmacy Faculty, University of Oradea, Romania

** Medicine and Pharmacy University “Iuliu Hatieganu”, Cluj-Napoca, Romania

Hepatitis C treatment, well standardized as well, could generate, beside classical side effects, well known world around, also ophthalmological side effects, less frequents but with variable prognostics. Ocular complications of the Interferon and Ribavirine treatment are also rarely diagnosed at the present. They are recorded only for patients addressing the specialists for decreased visual acuity.

We present a 57years female’s case which received in the year 2004, Interferon and Ribavirine and after two month of treatment consults the doctor for a barbarous bilateraldecreased visual acuity. The patient has no other diseases (HTA, DZ<, etc.) except C Hepatitis.

Ophthalmological examination put in evidence AV=0,3nc meantime ophthalmoscope examination revealed the presence of cotton-wool spots. Medical investigations for establishing the aetiology, including the angioflorography with Fluorescine, conduct to normal results. It was suggested to the Hepatholog doctor to interrupt the administration of Interferon and Ribavirine and after four weeks the patient’s visual acuity turned normal and the ophthalmoscope examination no more revealed the cotton-wool presence; functional and anatomical recover was completely. The case was interpreted like a toxic retinopathy induced by Interferon treatment.

The physio-pathological mechanism it’s still unknown but it’s supposed to be a vasculite interesting little vessels.

An activated C5 complement’s immune complexes deposits increase involve a leukocytary infiltration, a leucocytes activation causing an increasing adherence to the vascular endothelium and a retina capillary block.

Correlations between corneal hysteresis, corneal resistance factor, central corneal thickness, scleral thickness and intraocular pressure.

Dr. Bugari Dan^1,3, Dr. Haidar Adriana^2,3, Asis. Univ. Dr. Turcin Luminita³

S.C.M.U.Timisoara. Ophthalmology Clinic, Timisoara, Romania

S.C.M.U.Arad. Ophthalmology Department, Dr. Turcin Policlinic Arad, Romania

Dr. Turcin Policlinic, Arad, Romania

Purpose: The present study wants to underline any eventual correlations between corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), scleral thickness (ST), corneal-compensated intraocular pressure (IOPcc), Goldmann-correlated IOP and their importance in the diagnoses and management of glaucoma.

Patients and methods: We investigated 144 patients from which 36 with primary open angle glaucoma (POAG), 36 with normal tension glaucoma (NTG), 36 with ocular hypertension (OH) and 36 control subjects. CH, CRF, IOPcc were measured using Ocular Response Analyzer, CCT with ultrasound pachimetry, ST with ultrasound biomicroscopy (2mm medial and lateral of the limb) and IOPG with Goldmann tonometry. The investigators did not know the diagnostic of the tested subjects. All the data gathered was analyzed with specific statistic tests.

Results: CCT is statistically higher in OHT (548um) group then POAG (518um) and NTG (504um). There is no difference in CCT for control (545um) and OHT group (548um, p=0.6). CCT in control group is statistically higher then NTG group. Regarding ST one correlation was establish between OHT (755um) and NTG group (710um, p<0.001).

For control group CH (11.8mmHg) is positively correlated with CCT (551um). Both CCT and CH have significantly lower values in glaucoma patients (518um, P=0.003, 9.5mmHg in POAM si 504um, P<0.001, 8.1mmHg in NTG) then control (551um, 11,8mmHg). The range in which CH varies is much wider in glaucoma patients. Low CH values represent an independent risk factor for glaucoma. We want to underline the importance of CH in evaluating therapy efficiency and the necessity of applying more aggressive approaches in some cases.  

Conclusions:

1. For control group CH is positively correlated with CCT
2. Both CH and CCT have statistically lower values in glaucoma group over control group. In comparison with control, glaucoma patients have lower CH values and a larger variation range.
3. There is a correlation between CCT and ST in the NTG group. This correlation is not true among other group: OHT, POAG and control
4. CRF is strongly linked with IOP
5. IOPG and IOPcc measurements presents significant variations that can support the idea that goldmann tonometry is not precise.
6. IOPcc is less influenced by corneal proprieties.

THE EFFICIENCY AND TOLERANCE IN THE TREATMENT  WITH OLOPATADINE IN ALLERGIC SEASONAL CONJUNCTIVITIS (poster)

Dr. Ţurlea Magdalena, Dr. Mârza Flavia, Dr. Ţurlea Cristian

Ophthalmology department, Municipal Hospital Arad, Romania

Introduction: Allergic conjunctivitis is becoming one of the most frequent forms of conjunctivitis encountered in daily ophthalmologic care. Seasonal conjunctivitis still remains one of the most frequent clinical entities, but in most cases they are not well defined. The antiallergic therapy has to reduce the clinilcal  and subjective signs of  conjunctivitis, so  that it is less aggressive and well tolerated by the patients eye.

Patients and Methods: Our retrospective study included 30 patients, 17 females and 13 males between the ages of 5 to70  in the year 2007 between april and august. All these patients presented seasonal allergic conjunctivitis. We evaluated the severity of allergic conjunctivitis by summing up the scores of the 3 cardinal signs of  the disease: itching, redness, tearing. The sum of the 3 cardinal signs was evaluated in the firs day, seventh day and thirtieth day.

All patients were treated with olopatadine 1% eye drops twice a day for a month.

Results: All patients have shown allergic symptoms in the past, altered allergic balance, high IgE serum and eosinofile levels, positive skin tests. The majority of these are only present when the patient comes in contact with pollen. The clinical score was initially higher in patients with ages up to 16 years age. A lower score has been presented in the eighth day and in the thirtieth day,  the symptoms were highly reduced. Olopatadine 0.1% was administered in a safe and well tolerated manner to all subjects without having to interrupt the treatment

Conclusions: In  moderate cases of allergic conjunctivitis the treatment with olopatadine 0,1% is well tolerated and efficient. Cardinal signs decrease beginning with the 8 day of treatment and the association of another drug is not necessary because of the double action witch is antihistaminic and mast cell stabilizer.

A retrospective of N&D therapeutic lens

Simona Dimitrescu

Optimed, Brasov, Romania

Abstract:

Ten years ago, the bandage and therapeutic usage of contact lenses started to change dramatically. Silicone hydrorgel lenses allowed for over night application of these lenses without the concerns that came with the overnight use of hydrogels. The high oxygen transmissibility of these lenses was a welcomed additional factor in restoring or keeping the eye’s metabolism unchanged and thus even support healing. In the first years, the short-term (lasting from a few hours to a few days) or long term applications (up to 30 nights, maybe repeated with new lenses thereafter) were off label, the use as a bandage / therapeutic lens was not yet approved. It took four years, until Night&Day received the FDA and CE mark approval for these uses. In all these ten years, several articles have been published, posters been presented on the therapeutic use of these lenses. The paper reviews some of them.

Clinical aspects after treatment in an eyelid tumor

Ileana Zolog,

Eye Clinic Timisoara, Romania

The case of the giant eyelid tumor of a 68-year old male is  reported. Histopathological diagnosis was acanthoma. The differential diagnosis according the carcinoma, clinically, is very difficult.

The tumor was treated with injection of 5-fluorouracil and quickly disapear; after an year a verruqueos papilloma was on place. The treatment of this tumor is original, because the surgical exeresis, usually done, would have been to mutilating for the eyelid.

Spontaneous hyphema caused by Ginkgo biloba extract - Case report

Ileana Zolog, Cosmina Carabas,

Eye Clinic Timisoara, Romania

We report a case of a pacient in whom Ginkgo biloba extract proved to be the unique cause of spontaneos hyphema. Extensive ophthalmological acut biological investigations were undertaken in order to assess to role of Gingo biloba: platelet numbering, hemostasis factors, Willebrand antigen, ristocetin cofactor, platelet glycoprotein immunophenotyping, glycoprotein expression after activation by thrombin, inflammatory makers, B-scan ultrasonography. Anamnesis identified Ginkgo biloba extract ingestion during 2 years before the apparance of the patient’s visual  trouble. Ginkgo biloba is known for platelet inhibition and is extensively used in the eldery or diabetes because of its beneficial effects as a vascular protector. The hyphema dissapeared after 3 weeks of pause in Ginkgo biloba administration. The paper suggests that Ginkgo biloba may cause hemorrhage and hyphema even in the absence of any other predisposing factor.

DIA-TRIUM study. Efficiency and Indications of Trium Therapy on Diabetic Patients

Giuri S, Frantescu V, Lehaci C, Munteanu M, Muntean A

Timisoara, Romania

Purpose: Evaluation of trium treatment efficiency on diabetic patients with sicca syndrome.

Material and method: Fourth phase study (post-marketing), prospective, cohort type, non-randomized, open label, unicentrical. The diabetic patients have been questioned on the specific symptomatology of the dry eye according to questionnaire OSDIm2 and ophthalmological completely examined; they followed a topic trium treatment during a minimum period of 90 days.

Results: A sample of 180 diabetic patients with dry eye symptoms (OSDIm2 score over 12) were divided into three groups: (1) patients operated of cataract, (2) patients who follow a photo-coagulant laser treatment for diabetic retinopathy, (3) diabetic patients with sicca syndrome without medical and surgery interventions on the eye sphere. They were evaluated regarding the efficiency of trium treatment by estimating the OSDIm2 score, the Schirmer test, the fluoresceine stain and the rose Bengal stain (lisaminne green) before the treatment, at 45 days and at 90 treatment days.

Discussions: The effect of trium topic applications is due to the lubricating features of hyaluronic acid, to the nerves regeneration effect of gingko-biloba extract and to the lack of cyto-toxicity of the EDTA associated N-IG preservative agent.

Conclusions: Diabetic patients with sicca syndrome can benefit from the neuroprotective effect of the topically applied gingko-biloba extract.

Comparative study between cataract patients with cornea guttata and cataract patients without any other ocular pathology

Dr. Berghian Adina

Ophtalmology Clinic, Timisoara, Romania

Objective: To evaluate some cases with endothelial pathology (cornea guttata) using specular microscopy and to compare it with normal corneas before and after cataract surgery.

Material And Method: We studied 24 patients with cataract (12 with cornea guttata; 12 with no corneal pathology associated to cataract) operated with phakoemulsification at the Ophthalmology Clinic, Timişoara. We performed specular microscopy in all cases.

Results: Preoperatively we observed statistically very significant differences (p=0,012) in endothelial cell density – the cell density is lower in “cornea guttata” group. Also in mean endothelial cell area (p=0,012) – the area is bigger in “cornea guttata” group. The decrease in endothelial cell density was statistically significant (p=0,039) postoperatively in cornea guttata group compared to the other group.

CONCLUSIONS: After cataract surgery, endothelial cell loss is due to surgical trauma, even more in the cases with suffering endothelium (ex. cornea guttata). This indicates the need to protect the endothelium during surgery but also points to closer examination of the endothelial cell population before surgery including specular microscopy.

REDUCED EYE PATCHING FOR AMBLYOPIA

Codruta Moise

Pediatric Hospital ”Louis Turcanu” Timisoara, Romania

Amblyopia is the leading cause of monocular visual impairment in childhood and middle age adults in developed countries.

The occlusion with patching is the most commonly prescribed treatment. Over the past decade, thePediatric Eye Disease Investigator Group (PEDIG) demonstrated that: for children younger than 7 years old with severe amblyopia, prescribing 6 hours of daily patching is as effective as full-time occlusion; for moderate amblyopia patching 2 hours per day is as effective as patching 6 hours per day.

This study evaluates visual acuity in 207 children with amblyopia, treated with occlusion therapy on Hospital for Children "Louis Turcanu" from Timisoara; 162 patients received full time and 45 patients part-time patching.

After six months of treatment,children with part-time patching showed similar improvement in vision as those with full time patching.

The findings should had to better compliance with treatment and improved quality of life for children with amblyopia.

TRABECULECTOMY: EFICIENCY AND COMPLICATIONS – retrospective study

Cristiana Lehaci, M. Poenaru, Marie-Jeanne Koos, Ileana Zolog, Roxana Tranc

Eye Clinic Timisoara, Romania

Introduction: Filtering surgery is indicated when the patient’s glaucoma is observed to worsen at the present level of intraocular pressure, usually after establishing maximum tolerated medical therapy and possibly following laser trabeculoplasty. Surgery may also be indicated when the target intraocular pressure has not been achieved by other means and the disease is expected to worsen.

Purpose: The aim of the study is to show the complications of filtering surgery depending on the preoperative medication, and to establish the importance of surgical technique over the visual outcome.

Methods: The retrospective study follows up a number of patients with open angle glaucoma hospitalized during 2001-2008 at the Eye Clinic Timisoara. The patients supported a filtering surgery and the complications of trabeculectomy were studied in two groups: first group had been previously treated with prolonged medication, the second group had short term pre-operative medication.

Results: This study confirmed that trabeculectomy predictably reduces the intraocular pressure. It also revealed the complications shortly after surgery, like hypotony, hyphema, shallow anterior chamber, uveitis, choroidal detachment, and in some cases - long term complications, like late onset of cataract or reductions of visual field. Hypotony with the formation of choroidal effusion has been cited as a major cause of postoperative problems. Bleb failure, which is the most likely to occur immediately after surgery as a result of fibrosis of the episcleral and conjunctival tissues, occur in young and/or pigmented eyes.

Discussions: The amount and type of preoperative medication did not seem to have any effect on the outcome of trabeculectomy. The presence of a preoperative cataract leaded to the aggravation of the cataract in postoperative stage.

Conclusions: In many patients, glaucoma filtration surgery can halt or at least retard what would otherwise be relentlessly progressive vision loss from glaucoma. Trabeculectomy requires diligent attention to details of performance.

RECURENCE OF A BILATERAL HYPERTENSIVE PANUVEITIS ACTIVATED BY AN INFLAMATORY RHEUMATIC DISEASE, BASED ON AN OLD TOXOPLASMOTIC INFESTATION AND CMV INFECTION – case report

M. Poenaru, Cristiana Lehaci, Roxana Tranc

Eye Clinic Timisoara, Romania

Introduction: Panuveitis is often a hard challenge for physician and is usually followed by scar lesions, accompanied by the decrease of visual function. If panuveitis is bilateral and if has recurrences, the patient’s prognostic becomes more reserved.

Aim of study: We report a case with bilateral panuveitis in a young patient (23 years old) from the country, presented in our service for the first time in November 2008. Patient complains of ocular pain, strongly decrease of visual acuity and photophobia in both eyes. The clinical examination easily established the diagnosis of bilateral panuveitis, but the etiology raises the difficulties. The therapeutic approach of the case was aggressive.

Results: The imagistic exam made on the two hospitalization periods showed incipient bones and joins alterations which suggested an inflammatory rheumatic disease. The laboratory tests confirmed this suspicion and showed a high concentration of antitoxoplasmotic and anti CMV antibodies in the patient’s serum, which demonstrates an old infestation with Toxoplasma Gondi and cytomegalovirus.

Conclusions: Although establishing the diagnosis of panuveitis is easy, finding its etiology is often hard, because there are no specific clinical features for each cause. Sometimes the causes are different and the treatment has to match the multiple etiologies.