OFTALMOLOGIA 4 / 2009

DEPARTMENT OF OPHTHALMOLOGY, SEMMELWEIS UNIVERSITY, BUDAPEST
CORRESPONDENCE:
GABOR HOLLO, MD, PHD, DSC
1083 BUDAPEST, T0m0 U. 25-29. HUNGARY
TEL: +36-1-21-00-280/51627, FAX: +36-1-21-00-309
E-mail: hg@szem1.sote.hu
SPONSORSHIP: SUPPORTED IN PART BY HUNGARIAN NATIONAL HEALTH GRANT (ETT)
001/2009 (DR. HOLLO)

SUMMARY

The use of modern GDx technology (GDx-VCC and GDx-ECC) provides sufficient technical background for polarimetric diagnosis of glaucoma in eyes previously undergone cornea! refractive surgery. This is of clinical importance, since the number of young myopic individuals treated with LASIK for ametropia correction is large. Most of them have not yet reached the age in which the prevalence of glaucoma increases, thus the majority of these potentially problematic cases are ahead of the ophthalmologists.

Myopic persons have higher risk for glaucoma, and for those who have undergone LASIK, intraocular pressure with the usual applanation to no metric methods is underestimated. Thus the clinical importance of routine use of imaging techniques in this population is especially high.

METODE DE DIAGNOSTIC SI TRATAMENT ÎN KERATOCONUS

DR. COSMIN ROŞCA
CLINICA PARTICULARĂ OPTILENS CLUJ-NAPOCA

REZUMAT

Keratoconul este o afectiune relativ rara ce apare la tineri, diagnosticata mult mai frecvent si in stadii incipiente in ultimul timp datorita metodelor moderne de diagnostic (pahimetria, topografia corneeana) si beneficiind de tratamente noi si eficiente precum cross-linking, implantare de inele corneene intrastromale.

CUVINTE CHEIE:

' keratocon,
' Topografie corneana,
' Inele corneene intrastromale,
' Cross-linking.

ABSTRACT

Keratoconus is a rare disease that appears at teenagers. This condition is diagnosed frequently and at early stages in the last years with the means of modern diagnosis (pachymetry, cornea! topography). The treatments for this disease are new and efficient as cornea! cross-linking and intrastromal rings.

KEY WORDS:

' keratoconus,
' cornean tipography
' intrastromal rings,
' Cross-linking.

TRABECULOPLASTIA LASER - O TRECERE ÎN REVISTĂ A LITERATURII

DR. ALIN ŞTEFAN ŞTEFĂNESCU-DIMA¹²³, DR. CARMEN MOCANU¹², DR. DOINA BĂRĂSCU¹², DR. MIHAELAFLORESCU¹'CLINICA UNIVERSITARĂ DE OFTALMOLOGIE, SCJUCV²UMF CRAIOVA³CLINICAOCULARIUS

REZUMAT

Terapia laser In glaucoamele cu unghi deschis constitute un pas important In managementul acestor boli, subiect intens cercetat In a doua jumătate a seco-lului XX. Entuziasmul initial, suspnut de rezultatele spectaculoase obpnute cu riscuri şi complicapi minime, a fost ulterior temperat de menpnerea acestora pe un interval limitat de timp. Intervenpile laser sunt In momentul de faţă considerate ca mijloace terapeutice de a doua sau a treia linie, alternative la intervenpa chirurgi-cală sau etapă intermediară între tratamentul medical şi eel chirurgical. Există însă şi situapi în care laserul ocupă pozipe de primă linie In tratamentul glaucomului cu unghi deschis.

ABSTRACT

Laser therapy in open angle glaucomas represents an important step in their management, a topic of intense research during the second part of the XXth century. The initial enthousiasm generated by spectacular results obtained with minimal risks and complications, was soon tampered by their short survival. Nowadays, laser therapy is considered a second or third line therapy, alternative to surgery or intermediate stage between medication and surgery. There are selected cases in which laser therapy may be first line treatment in open angle glaucomas.

EXOFTALMIE AXIALĂ PROGRESIVĂ - CAZ CLINIC

BIANCA SZABO*, I. SZABO**, OANATEODOSESCU*, ROXANA BELICIOIU*
*CLINICA OFTALMOLOGIE
**CLINICA NEUROCHIRURGIE
UNIVERSITATEA DE MEDICINĂŞI FARMACIE "IULIU HAŢIEGANU" CLUJ-NAPOCA
SPITALUL CLINIC JUDEŢEAN DE URGENŢĂ

REZUMAT

Introducere

Lucrarea de faţă expune un caz de exoftalmie axială progresivă în cadrul unei boli orbitale inflamatorii idiopatice (pseudotumoră inflamatorie a orbitei), bilaterală, operată şi recidivată la OD.

Material şi metodă

Se prezintă cazul clinic al unui pacient de 67 de ani, sex masculin, a flat sub observaţie clinică şi tratament de 10 ani. Diagnosticul a fost stabilit prin metode clinice şi examinări imagistice (ecografie oculo-orbitală, tomografie computerizată şi rezonanţă magnetică nucleară) şi prin examen histopatologic postoperator.

Rezultate

Diagnosticul clinic a fost suspnut de scăderea progresivă a acuităţii vizuale, exoftalmie axială progresivă, dureroasă, nereductibilă, nepulsatilă, asociată cu tul-burări ale motilităţii oculare initial la nivelul OD, ulterior la AO. Ecografia oculo-orbitala OD şi examenul RMN au evidenţiat o formaţiune omogenă retrobulbară, care comprimă şi depăşeşte caudal nervul optic. Leziunea de masă din orbita dreaptă a fost ulterior îndepărtată partial prin intervenţie neurochirurgicală.

S-a instituit tratament general cu antiinflamatorii streoidiene şi non-steroi-diene în cure repetate, sub protecţie de antibiotice şi antisecretorii, evoluţia sub tratament fiind nefavorabilă. în timp exoftalmia s-a accentuat progresiv, fapt ce a impus orbitotomie decompresivă dreaptă, cu ablarea chirurgicală a peretelui lateral al orbitei.

La aproximativ 1 an de la intervenţia neurochirurgicală simptomele clinice initiate s-au reinstalat insidios, pe parcursul a 3-4 ani. Examinarea ultrasonografi-că, completată de examenele CTşi RMN cranian au identificat prezenţa bilaterală a miozitei.

Discuţii

în ciuda tuturor mijloacelor terapeutice folosite în timp, atâta tratamentului medical (corticoterapia generală) cât şi a celui chirurgical (cu efect paleativ), evoluţia pacientului a fost nefavorabilă; exoftalmia axială persistă, este dureroasă şiireductibilă. Evoluţia este agravată şi de faptul că au fost afectate ambele orbite; în literatura de specialitate sunt citate cazuri cu afectare frecvent unilaterală.

Concluzii

în cazul prezentat exoftalmia axială este progresivă şi ireversibilă; este determinată de o pseudotumoră inflamatorie a ambelor orbite, ce reprezintă o

afecţiune inflamatorie cronică, idiopatică, cu evoluţie clinică imprevizibilă.

Diagnosticul este de obicei unul de excludere, examinările imagistice complementare fiind necesare în vederea excluderii altor patologii ale orbitei.

CUVINTE CHEIE:

' exoftalmie axială,
' pseudotumoră inflamatorie,
' miozită intraorbitală.

ABSTRACT

Introduction

It is being presented the clinical case of a 67 year old male patient who has been under clinical observation and treatment for 10 years. The diagnosis rests upon clinical methods, imaging techniques (ocular - orbital examination, computerized tomography and magnetic resonance imaging) as well as post - operative histopathology reports.

Results

The clinical diagnosis was supported by the progressive decrease in visual acuity, painful, irreducible, non -pulsating axial progressive exophthalmia, associated with disorders of the ocular motility initially at the level of the RE, followed by bilateral involvement. The RE ocular- orbital ultrasound and the MRI examination point out a homogenous retro bulbar formation that caudally compresses and exceeds the optic nerve. The mass lesion from the right orbit was afterwards partially removed by neurosurgical excision.

The general treatment was initiated with steroidal and non - steroidal anti - inflammatory drugs in repetitive cures, under protection of antibiotics and anti-secretory drugs, the response to treatment being unfavorable. In time, the exophthalmia increased progressively, fact that imposed right de-compressive orbitotomy with the surgical ablation of the lateral orbital wall.

About 1 year after the neurosurgical intervention the initial clinical symptoms insidiously reinstalled throughout 3-4 years. The ultrasound, completed by the cranium CTand MRI examinations have identified the bilateral presence of myositis.

Debates

Regardless of all the therapeutical means applied in time, not only the medical treatment (the systemic corticotherapy), but also the surgical one (with palliative effect), the patient's evolution was unfavorable; the axial exophthalmia persists, it is painful and irreducible. The evolution is aggravated also by the fact that both orbits have been affected; the specialty literature mentions cases with frequent unilateral involvement.

Conclusions

In the case presented the axial exophthalmia is irreversible; it is determined by an inflammatory pseudotumor of both orbits, that represents a chronic inflammatory, idiopathic disease, with unpredictable clinical evolution. The diagnosis is usually one of exclusion, the complementary imaging examinations being necessary to rule out other pathologies of the orbit.

KEY WORDS:

' axial exophthalmia,
' inflammatory pseudotumor of the orbit,
' intraorbital tumor.

CAR ACCIDENT LEADING TO „TRAUMATIC MACULAR HOLE FORMATION PROVEN DY OPTICAL COHERENCE TOMOGRAPHY

GABOR MARK SOMFAI, MD, PHD*, GYORGY SALACZ, MD, PHD
DEPARTMENT OF OPHTHALMOLOGY (MARIA STREET), SEMMELWEIS UNIVERSITY,
FACULTY OF MEDICINE, MARIA STR. 39., 1085 BUDAPEST, HUNGARY
CORRESPONDING AUTHOR: DEPARTMENT OF OPHTHALMOLOGY (MARIA STREET)
SEMMELWEIS UNIVERSITY, FACULTY OF MEDICINE, MARIA STR. 39., 1085 BUDAPEST, HUNGARY
TEL.: +361-4591500, FAX: +361-3179061, EMAIL: SOMFAIGM@YAHOO.COM
FINANCIAL INTEREST: NONE
THE WORK WAS SUPPORTED BY PHD GRANT (2/10) OF SEMMELWEIS UNIVERSITY, SCHOOL OF DOCTORAL STUDIES.

ABSTRACT

Background

We present the case of a car accident where the cause-consequence of the subsequent visual loss in one eye of the victim was proven by optical coherence tomography (OCT).

Methods

A 66-year-old woman was hit by a car from her right side and complained of immediate visual loss after the accident in her right eye. The patient was referred to our outpatient clinic 2.5 months after the car accident in order to elucidate the cause-consequence of the visual loss and the car accident. Following routine oph-thalmologic examination OCT was performed in both eyes.

Results

Fundus biomicroscopy revealed a full thickness macular hole in the affected eye which was proven by OCT, while OCT showed an arrested stage of macular hole development in the unaffected left eye. Pars plana vitrectomy was performed resulting in closure of the hole.

Conclusions

The arrested stage of macular hole formation seen by OCT in the fellow eye lead us to the conclusion that the accident could have been the trigger in the pathologic changes of the retina in the affected eye. The authors review the current literature related to head injury and macular hole formation.

KEYWORDS:

' car accident,
' macular hole,
' optical coherence tomography (OCT).

CATARACT SURGERY (PHACOEMULSIFICATION) IN DIFFICULT CASES

N. CZUMBEL¹², A. ALBERT^3

1DEPARTMENT OF OPHTHALMOLOGY, JAHN FERENC HOSPITAL OF SOUTH PEST, BUDAPEST, HUNGARY²MEDSYSTEM EYECLINIC, ORADEA
³DEPARTMENT OF OPHTHALMOLOGY OF THE UNIVERSITY HOSPITAL TÂRGU MURES

ABSTRACT

By presenting three cataract surgeries, we discuss the difficulties of the interventions and the key moments.

Case I: Mature cataract surgery on a patient with cornea! opacities (maculas) Case II: Posterior polar cataract

Case III: Small pupil, shallow anterior chamber (dilating with Malyugin ring) Conclusions:

- The surgery of a mature cataract on an eye with cornea! opacities can be performed by a surgeon with enough experience. The final visual acuity depends on the clarity of the center of the cornea.

- During the operation of a posterior polar cataract we have to be prepared to the rupture of the posterior capsule, which is more frequent than in other cases. These interventions are better to be made in centers with posterior pole surgery capabilities.

- The Malyugin ring is a novel PMMA device, which dilates the pupil, creating decent conditions for a cataract surgery. This device can be inserted and pulled out through a standard2,8 mm incision.

KEYWORDS:

' phacoemulsification,
' posterior polar cataract,
' Malyugin ring.

COROIDEREMIE FAMILIALA - CAZ CLINIC

DR. ALINA STINGHE, PROF. ANDREW J. LOTERY MD FRCOPHTH OPHTHALMOLOGY DEPARTEMENT, SOUTHAMPTON GENERAL HOSPITAL

REZUMAT

Prezentam un caz familial de coroideremie studiat pe 3 generatiisuccesive urmarit de-a lungul mai multor ani, la care diagnosticul a reprezentat o provocare, confirmarea fiind furnizata prin testare genetica.

ABSTARCT

We present a case of familial choroideremia followed up during several years in 3 successive generations and which represented a diagnostic challenge as the final diagnosis was provided only by genetic testing.

EYELID LASH IN THE ANTERIOR CHAMBER

P. VÂMOSI¹, KARIN HORVATH²'DEPARTMENT OF OPHTHALMOLOGY OF SZENT ROKUS HOSPITAL BUDAPEST, HUNGARY
²UNIV EYE CLINIC TG.-MURES, ROMANIA
CORRESPONDING ADDRESS: DR. PETER VAMOSI, VAMOSIPETER@FREEMAIL.HU

ABSTRACT

We present the case of a patient who had surgery for cataract extraction by phacoemulsification method and that the first day after surgery one lash was found in the anterior chamber of the eye.

The lash is removed the same day the postoperative refraction being 1.0. Starting from this case, therapeutic attitude is presented in different intracameral foreign bodies.

KEYWORDS:

' Intracameral foreign body
' phacoemulsification.

MELANOCITOZA OCULARA CONGENITALĂ Sl ÎNTÂRZIERE ÎN DEZVOLAREĂ PSIHOINTELECTUALĂ=0 ALTĂ ASOCIERE?!

DR. IVAN BIVOLARU, DR. DANIELA SELARU , DR. ILEANA SERGHIESCU CLINICADE OFTALMOLOGIE , SCUMC-BUCUREŞTI
Adresa pentru corespondenţă: bvlrjohn@yahoo.com

REZUMAT

Melanocitoza oculara congenitala (MOC) este o hiperplazie melanocitara extrem de rara(0.038% in populatia alba), care afecteaza tesuturile subconjuncti-vale + episclera si sclera. Epiteliul conjunctiva! nu este afectat ,spre deosebire de melanoza conjunctiva/a. Pigmentarea este de o tenta gri albastruie, nu poate fi deplasata odata cu conjunctiva de pe planurile subiacente (este profunda) = ele-mente esentiale de diagnostic diferential. MOC poate fi izolata sau in asociere cu pigmentare cutanata -forma ce poarta denumira de melanocitoza oculodermala sau nevul Ota.

MOC poate asocia: hipercromie iriana, "iris mammiiiations", hipercromie a FO, melanom uveal (cel mai frecvent coroidian) si glaucom (10%).

In MOC s-au pus in evidenta melanocite si in creier, orbita, mucoasa bucala, timpan.

CUVINTE CHEIE:

' Melanocitoza oculara,
' Melanoza conjunctivala,
' Melanom uveal,
' Hipercromie iriana,
' «Iris mammiiiations»,
' Hipercromia FO,
' Glaucom.

ABSTRACT

Congenital ocular melanocytosis (COM) is an extremely rare melanocytic hyperplasia (0.038% in Caucasian population); it affects episclera and sclera. The conjunctiva! epithelium is not affected, as opposed to conjunctiva! melanosis. The pigmentation is grayish-blue and its consistency with the underlying tissues as the conjunctiva moves (deep pigmentation) is an essential diagnostic clue. COM may be isolated or associated with facial pigmentation, in the area innervated by the trigeminal nerve - known as oculodermal melanocytosis or nevus of Ota.

COM may associate the following findings: iris hypercromia, iris mammillations, fundus hypercromia, uveal melanoma (most frequent choroidal melanoma) and glaucoma (10%).

Melanocytes have been found in the brain, orbit, bucal mucosa in COM

KEY WORDS:

' Ocular melanocytosis,
' Conjunctiva! melanosis,
' Melanoma,
' Iris hyperchromia,
' Iris mammillations,
' Fundus hyperchromia,
' Glaucoma.

DOAR TUMORA CONJUNCTIVALA...

DR MONICA ARMEGIOIU, DR ANDREEA CRAIU, DR VLAD BERARU, DR CRISTINA MALCEA, DR IRINA NAE, DR ANA-LAVINIA CARSTOCEA-TAINA - SECTIA DE OFTALMOLOGIE, SCUMC, BUCURESTI

REZUMAT

Autoriiprezinta cazul unei paciente cu o formatiune tumorala conjunctiva/a. Se pune intrebarea daca este doar tumora melanocitara conjunctiva/a sau o formatiune tumorala intraoculara exteriorizata scleral,care infiltreaza si corneea. Se decide aplicarea unei solutii chirurgiale minim invazive, cu rezultate foarte bune intra- si postoperator. Nu au aparut complicatii la 1 an de supraveghere comuna oftalomolog - oncolog.

CUVINTE-CHEIE:

' Melanom conjunctiva!
' Formatiune tumorala intraoculara, exteriorizata scleral
' Extensie / metastaza / recidiva

ABSTRACT

The authors present the case of a patient diagnosed with a conjunctiva! tumor. Questions are being asked about the nature of the tumor - is there just a melanocitic conjunctiva! tumor or a scleral extension of a intraocular tumor (that also infiltrates the cornea). A minimally invasive surgical approach is decided, with excellent intra- and post-op results. There have been no complications during 1 year of combined ophthalmologist - oncologist surveillance.

KEYWORDS:

' Conjunctival melanoma
' Sclera extension of intraocular tumor
' Extension /metastasis /reccurence

EFICIENTA TRATAMENTULUI CU OLOPATADINA ÎN CONJUNCTIVITELE ALERGICE SEZONIERE

DR. MAGDALENAŢURLEA, DR. FLAVIA MÂRZA, DR. C. ŢURLEA SPITALUL MUNICIPAL ARAD SECŢIAOFTALMOLOGIE

REZUMAT

OBIECTIVE

Studiulare ca scop urmărirea eficacităţii tratamentului cu olopatadina 0,1% care acţionează printr-un dublu mecanism, pe de-o parte antagonizează histami-na şi pe de altă parte acţionează asupra celulelor mastocitare inhibând eliberarea mediatorilor inflamatori.

MATERIAL SIMETODA

Pacientii inclusi in studiu in număr de 30, consultati In ambulatorul oftalmo-logic in perioada aprilie-august 2007au fost diagnosticap prin mijloace specifice cu conjunctivita acută sezonieră acută. La toti pacienţii s-au dozat IgE şi eozinofilele serice şi s-a evaluat severitatea conjunctivitei prin însumarea scorului a 3 semne cardinale: prurit, hiperemie conjunctivală, lăcrimare. Au fost incluşi pacientii cu conjunctivita alergică uşoară sau moderată. Timp de o lună fiecare pacient a făcut tratament cu olopatadina 0,1% 2X1 pic/zi după care a beneficiat de trei consultatii, Tn ziua 1 (Z1), 8 (Z8), 30 (Z30) şievoluţia semnelor oculare a fost evaluată în funcţie de rezultatele scorului. Toleranta tratamentului a fost evaluată în funcţie de dis-pariţia simptomelor după instilarea colirului.

REZULTATE

Scorul In Z1 a consultapei a fost mai mare la copiii până la 16 ani predo-minând pruritul şi lăcrimarea. După Z8 de tratament s-a observat o scădere sem-nificativă a acestor scoruri iar după o lună de tratament scorurile au scăzut într-un procent cuprins între 60-85%.

CONCLUZII

Alegerea terapiei In conjunctivitele alergice implică studierea mecanismu-lui de actiune care a declanşat alergia. Olopatadina 0,1% prin dublul său mecanism a dovedit o eficacitate sporită în conjunctivitele alergice sezoniere moderate.

CUVINTE CHEIE:

' Conjunctivita
' Sezonier
' Antihistaminic
' Scor clinic

ABSTRACT

PURPOSE

The study shows the antihistaminic and anti-inflammatory efficient treatment with olopatadi-naO,1%.

METHOD

The study group consisting of 30 patients evaluated in the ophthalmological ambulatory between the period of april-august 2007 were diagnosed with acute seasonal allergic conjunctivites. Ig E and seric eosinofiles were quantified for all patients and the severity of conjunctivitis was evaluated by summing up the scores of the cardinal signs of allergic conjunctivitis: itching, conjunctiva! hyperemia and tearing. For a month every patients was treated with olopatadina 0,1% 2X1 drop/day They were evaluated in day 1, day 8 and day 30. The tolerance of the treatment was judged by the reduced symptoms after olopatadine instilation.

RESULTS

The score in day 1 was higher in children under 16 years of age who presented itching and tearing. After day 8 of treatment the scores droped significantly and after a month the scores decresed highly to a percentage from 60-85%.

CONCLUSIONS

Choosing the best theraphy in allergic conjunctivitis involves studying the mechanism implicated in triggering the allergy. Olopatadina 0,1% with its double mechanism has proven to be efficient in moderate seasonal allergic conjunctivitis.

KEY WORDS:

' Conjunctivitis
' Seasonal
'Antihistaminic
' Clinical score

IOL TETRAFLEX, KH 3500 - PRESBYOPIA TREATMENT

FERKO J. M.D.; FERKOVAA. M.D.
3F, MIKROCHIRURGIAOKA, KOSICE, SLOVAKIA

INTRODUCTION

Presbyopia is a loss of accommodative capacity of the eye determined by age. The possible solutions for its treatment are spectacle correction (mono-, bi- or multifocal), multifocal contact lenses, conductive keratoplasty excimer laser surgery and surgical solution - CLE.

AIM

Four-year experience with using IOL Tetraflex KH 3500 by Lenstec.

MATERIAL AND METHODOLOGY

Between 2005 and2009, 71 eyes of 35patients with the average age of 52 were operated at the private ophthalmological clinic 3F Microsurgery of the Eye in Kosice. The patients were selected by strict indication criteria recommended by the producer.

We have evaluated the ability of the implanted lens to substitute for the presbyopic correction.

The subjective criterion of patient's evaluation was the expression of content in common life situations on the scale of 1 to 10.

The objective evaluation was constituted by the measurement of the accommodation width, the presence ofPCO, its solution by means ofYAG capsu-lotomy and the subsequent influence on the pseudo accommodative capacity of the lense.

RESULTS

92% of operated patients expressed their complete satisfaction with the surgery results. By objective accommodometer measurement, we have identified the average accommodation width of +1,5 dioptres on the operated eyes. The presence ofPCO was discovered in 42,2% cases. All cases were treated by YAG Capsulotomy By further observation we have tried to determine the influence of YAG Capsulotomy on the accommodation width and pseudo accommodative capacity of the eye.

CONCLUSION

The selection and use of TETRAFLEX lens is an appropriate alternative to presbyopia treatment with suitable patients.

KEYWORDS:

' Presbyopia,
' TETRAFLEX IOL,
'Accommodation Width,
'PCO.

RESULTS OF LASER TREATMENT-PRP TO THE DIABETIC RETINOPATHY

HALILAJVAZI¹, ILHAMI GORANCI¹, ARDIANA GORANCI¹,
VALBONAGOVORI¹, DAFINA GORANCI².
'UNIVERSITY CLINICAL CENTER, EYE CLINIC IN PRISHTINA, KOSOVO,
'HOSPITAL REGIONAL CENTER IN PRIZREN.

ABSTRACT

Introduction: Diabetic retinopathy-(DR) presents the most agressive form of the retinopathy that has progressive movement and often it ends with optic-atrophic blindness end includes heavy complications unless carried out by laser pan-retinal-photocoagulation.

Purpose of the study: The aim of this study was analyzing the diabetic retinopathy and impact of the PRP laser treatment, proposition of the precautious as well to managing the complications and PDR prevention.

Material: In this study were presented the treatment results of diabetic retinopathy treated in the Eye's Clinic in Prishtina, during the period of time (2004-2009). There were examined and diagnosed 42 patients with DR of whom 24 males or (57,14%) and 18 females or (42,85%). In 18 patients or (27%) we have had improvement, in 35 cases or (53%) stabilization and 13 cases or (20%) worsening of state after laser treatment with PRP to DR. The most frequently complications were vitreous hemorrhage in 5 cases or (38,46%) and blindness in 3 cases or (23,07%).

Metods: There have been used statistical metods of procesing and analysis according to the WHO standards.

Conclusions: We consider that through an advanced education and research programs for inovative projects that meet criterias of our strategic targets to protecting the retina and optic-nerv by understanding DR and PDR and developing a better laser treatment and accurately monitoring of DM, we can manage to prevent complications and heavy consequences of DR. In order to achieve this aim we have to work hard to standardized protocols

KEYWORDS:

DM,
DR,
PRP,
PDR.

CORNEAL PATHOLOGY AND INDICATIONS FOR CORNEAL TRANSPLANT AT THE TG. MURES OPHTHALMOLOGY CLINIC

Z. MADARAS¹, AFERENCZ¹, DOINAPOP¹, KARIN HORVÂTH¹, L MODIS²,
¹OPHTALMOLOGY CLINIC TG. MURES, ROMANIA ²OPHTALMOLOGY CLINIC DEBRECEN, UNGARIA

RO, TG. MURES, CLINICADE OFTALMOLOGIE, 540058, STR MÂRTON ÂRON NR26, EMAIL: MADARASZOLTAN1@YAHOO.COM

REZUMAT

Scopul lucrării este de a evalua conduita terapeutică în afecpunite corneene care prezintă indicaţie de transplant la pacienpi din Clinica de Oftalmologie Tg. Mures.

Material şi metodă: am efectuat un studiu retrospectiv folosind cazuistica Cliniciide Oftalmologie Tg. Mureş înperioada 01.01.2008-31.12.2008, incluzând cazurile cu patologie corneană, dar cu structurile oculare profunde intacte. Am examinat tratamentul acestor cazuri şi adresabilitatea la transplantul de cornee.

Rezultate: din cei 3246 pacienp internap In anul 2008 la 326 au existat afecpuni corneene. Dintre aceştia în 99 de cazuri a existat indicape de transplant cornean. Cele maifrecvente motive au fost leucoamele corneene, ulcerul cornean, keratopatia buloasă, degenerescenţele şi distrofiile corneene. 14 pacienp au încer-cat să ajungă în străinătate prin Casa deAsigurări de Sănătate, câpva şi-au supor-tat cheltuielile intervenpei chirurgicale. în total patru pacienp s-au prezentat la control la Clinică după transplantul de cornee.

Concluzii: în cazuistica Clinicii de Oftalmologie Tg. Mures la 99 de pacienp s-a stabilit indicapa transplantării de cornee. Doar la 4 cazuri s-a efectuat transplantul cornean, denotând o accesibilitate scăzută la această procedură. Putem afirma că prin imbunătăprea metodologiei donării respectiv a funcponării unor band corneene regionale s-ar putea ameliora accesul la transplant cornean in Romania.

CUVINTE CHEIE:

' Corneea,
' de transplant,
' transplant de cornee.

ABSTRACT

The purpose of this study was to evaluate the incidence of cornea! pathology that presents indication for cornea! transplant, treatment and follow-up of these patients.

Materials and methods: a retrospective analysis has been undertaken at the Tg. Mures Ophthalmology Hospital. In the study we have included all patients who had cornea! pathology with intact deeper ocular structures. We have examined the treatment of these cases and their admittance to cornea! transplantation.

Results: in 2008 in 99 cases of the 3246 hospitalized patients such a cornea! condition has been described that presented indication for cornea! transplantation. Most common causes were cornea! leucomas, cornea! ulcers, bullous keratopathy and cornea! dystrophies and degenerations. Fourteen patients tried to benefit from cornea! transplant abroad financed by the National Health Insurance Office; others went on their own expense. All together four patients appeared for postoperative control at our Hospital.

Conclusions: We have found 99 cases of cornea! transplant indication at our Hospital's patients and only a fraction of them have undergone surgery. We can point out a very low level of admittance and a great need for a regional cornea! transplantation centers.

KEYWORDS:

' Cornea,
' indications for transplant,
' corneal transplant.

NOU INSERT OFTALMIC PE BAZA DE HIDROGEL TERMOSENSIBIL

MIHAELA HAMCERENCU¹³⁴ MARCEL POPA, DANUT COSTIN², PAUL BUCATARIU², JACQUES DESEBRIERES³, GERARD RIESS⁴

¹«Gh. Asachi» Technical University, Faculty of Chemical Engineering, Department of Natural and Synthetic Polymers, Bd. D. Mangeron, nr. 71 A,700050 lasi, ROMANIA²"Gr.T.Popa" University of Medicine and Pharmacy lasi, Str. Universitatii 16, 700015 lasi, Romania³lnstitut Pluridisciplinaire de Recherche sur I'Environnement et les Materiaux - Equipe de Physique et Chimie des Polymeres (IPREM/EPCP), UMR 5254 CNRS - Pau and Pays de I'Adour University, Helioparc Pau Pyrenees, 2, av. President Angot, 64053 Pau Cedex 09, FRANCE
⁴Universite de Haute Alsace, Ecole Nationale Superieure de Chimie de Mulhouse, Laboratoire de Chimie Macromoleculaire,3 rue Alfred Werner, 68093 Mulhouse Cedex, FRANCE

REZUMAT

EHberarea controlata a medicamentelor, la nivel ocular, reprezinta o pre-ocupare importanta pentru farmacologia moderna. Abordarile cercetarii moderne sunt orientate spre produsele medicamentoase oftalmice cu actiune prelungita (eliberare controlata, eliberare la nivelul tintei).

In acest sens hidrogelurile termosensibile ocupa un loc privelegiat.

SCOPUL acestei lucrari este acela de a evalua un hidrogel monolitic ter-mosensibil in vederea aplicarii in unele scheme terapeutice.

MATERIAL SI METODA

In vederea realizarii inserturilor oftalmice termosensibile au fost utilizate mai multe materiale ce au fost supuse unor procese tehnologice complexe (sin-teza hidrogelului, stabilirea gradului de umflare, includerea medicamentului in hidrogel, stabilirea cineticiide eliberare a medicamentelor in vitro, testarea in vivo).

REZULTATE

Rezultatele studiului arata ca hidrogelul pe baza de MA-G si PNIPAm este un hidrogel inteligent care are capacitatea de a colapsa la o temperatura apropia-ta de cea fiziologica, rezultand eliberarea medicamentelor incluse in doza dorita. Hidrogelul in ansamblul sau este perfect tolerat, fapt dovedit prin studiul experimental.

CONCLUZII

Eliberarea controlata a substantei active, aceasta fiind intr-o cantitate suficienta pentru a avea un raspuns clinic, se face pe domeniul de concentratii mici, fara reactii adverse. Este o eliberare tintita.

CUVINTE CHEIE:

' Insert oftalmic termosensibil,
' Hidrogel termosensibil,
MA-G si PNIPAm HIDROGEL,
' Actiune prelungita.

ABSTRACT

Controlled release of drugs on ocular level is an important care for modern pharmacology. New studies targets are medical ophthalmic products with prolonged action (controlled release, target release). The hydrogel is an important segment in these studies. The purpose of this study is to assess a monolithic thermosensible hydrogel for releasing a certain medical product.

MATERIAL AND METHOD

We used several materials for making thermosensible ophthalmic inserts that were processed (hydrogel sinthesis, establish the inflation degree, hydrogel drug inclusion, establish the kinetics of in vitro drug releasing, in vivo studies).

RESULTS

The study show that MA-G and PNIPAm basis hydrogel is a smart one that have the ability to collapse on a temperature closed to the physiological one, the result is the drug release in a desired doses. The hydrogel is perfectly tolerated, an experimental study prove that.

CONCLUSIONS

Controlled release of active drug that are highly adequate to have a clinical response is based on small doses, without adverse effects. Is a target release.

KEY WORDS:

' thermosensible ophthalmic inserts,
' thermosensible hydrogel,
' MA-G and PNIPAm basis hydrogel,
' prolonged action.

ENHANCEMENT OF REFRACTIVE RESULTS AFTER CATARACT SURGERY AND IOL-IMPLANTATION WITH A SUPPLEMENTARY IOL IMPLANTED IN THE CILIARY SULCUS

MICHAEL AMON1
ACADEMIC TEACHING HOSPITAL OF ST. JOHN VIENNA

DOZAREA IG E ÎN LACRIMI LA CAZURILE CU CONJUNCTIVITĂ ALERGICĂ

DR. MAGDALENAŢURLEA*, DR. D.P. CIOCA**, DR. FLAVIA MÂRZA*, DR. C. ŢURLEA*
*SPITALUL MUNICIPAL ARAD SECŢIAOFTALMOLOGIE
** UNIVERSITATEA DE MEDICINĂ Şl FARMACIE "VICTOR BABEŞ" TIMIŞOARA

REZUMAT

OBIECTIVUL LUCRĂRII

In lucrarea de faţă se intenponează a se prezenta studiul dozării IgE in lacrimi la cazurile de conjunctivită alergică comparativ cu un lot martor.

MATERIAL Şl METODĂ

Determinate cantitative ale IgE din lacrimi s-au facut pe două loturi de pacienp - lotu/A, 124 pacienp cu manifestări alergice oculare (58 pacienp cu con-junctivită alergică sezonieră, 43 pacienp cu teren atopic fără manifestări alergice oculare, 23 pacienp are au fost tratap cu olopatadină 0,1% timp de 10 zile) si lotul B martor, 40 pacienti sănătoşi fără manifestări alergice generate sau locale, exami-nati In ambulatorul Clinicii de Oftalmologie Arad In perioada 2007-2008. Materialul biologic utilizat a constat din proba de lacrimi. Pentru determinarea IgE s-a utilizat metoda imunoenzimatică ELISA kitul HUMAN IMUNO IG E QUANTITATION (Bethyl Laboratoires, Montgomery, TX).

REZULTATE

S-au obpnut creşteri statistic semnificative ale concentrapei Ig E faţă de lotul martor (67,25±8,89ng/ml) atât în lotul cu conjunctivită alergică sezonieră (331,11±125,22ng/ml) cât şi în lotul cu teren atopic (177,18±56,70). S-au obpnut diminuări semnificative ale concentrapei IgE In lotul cu conjunctivită alergică sezonieră după tratament (71,70±9,94).

CONCLUZII

Metoda dozării concentrapei Ig E in lacrimi s-a dovedit a fi eficientă în sta-bilirea etiologiei alergiei oculare şi in depistarea in masă a conjunctivitei alergice.

CUVINTE CHEIE:

' Conjunctivită alergică,
IgE

ABSTRACT

PURPOSE

To present the study regarding Ig E tears dosation in cases with allergic conjunctivitis.

METHOD

The IgE tear dosation was done on two study groups - group A with 124 patients presenting allergic conjunctivitis symptoms (58 with seasonal allergic conjunctivitis, 43 with atopic allergic ocular symptoms, 23 treated with olopatadina 0,1% for 10 days) and compare group B consisting of 40 healthy patients (no local or general allergic symptoms) evaluated in the the Ophthalmolgy Clinic Arad between 2002-2008. The biological material used in the study was that of tears samples. For the determination of Ig E we used ELISA method, HUMAN IMUNO IG E QUANTITATION (Bethyl Laboratoires, Montgomery, TX) test.

RESULTS

Significant statistic high levels of IgE concentration were observed in study group A in patients with allergic seasonal conjunctivitis (331,11±125,22ng/ml) and patients with atopic terrain (177,18±56,70) compared to group B (67,25±8,89ng/ml) with healthy patients. In the study group with allergic seasonal conjunctivitis there have been significant diminished IgE levels (71,70±9,94) after treatment.

CONCLUSION

The method of IgE tears dosation proved to be efficient in establishing the ethiology of ocular allergies and in the screening of new cases with allergic conjunctivitis.

KEY WORDS:

'Allergic conjunctivitis,
'IgE

EXPERIENTA PERSONALA IN RECONSTRUCTIA PLEOAPELOR DUPĂ REZECTIA TUMORALA

O. IVAN*, F. DODEA, B. ALDES, AL. GEORGESCU*
*UMF - IULIU HATIEGANU, CLUJ NAPOCA

REZUMAT

Obiectiv

Lucarea isi propune sa analizeze principalele metode de reconstructie a pleoapelor dupa excizia tumorilor palpebrale.

Material si metoda

Am urmarit cazuistica personala pe 59 de pacienti pe parcursul a 7 ani, cu tumori afectind pleoapa inferioara, superiora sau ambele. In urma exciziei in limite oncologice s-au aplicat variate metode de reconstructie, de la sutura simp/a la refacerea complexa cu lambouri si grefe compozite condro-cutanate.

Rezultate

Am incercat sa evidentiem avantajele si dezavantajele principalelor metode de reconstructie, sa stabilim principii de tratament si sa aducem ceva nou in tratamentul si reconstructia functional a pleoapelor.

Concluzii

Excizia larga oncologica si refacerea in planuri anatomice cu structuri simi-lare celorlezate reprezinta cheia reconstructie/' functionate si estetica a pleoapelor.

CUVINTE CHEIE:

' Tumori palpebrale,
' lambouri,
' grefe condrocutanate, ' biopsie excizionala.

ABSTRACT

Purpose

To evaluate the main reconstructive methods in paipebrai reconstruction after tumor excision.

Material and method

We followed my personal experience of 59 cases operated in last 7 years, with tumors interesting the lower lid, the upper lid or both. After oncological resection we used the main methods in paipebrai reconstruction from direct suture to complexe repair with flaps and compozite chondro -cutaneous flaps.

Results

We try to analize the advantages and desadvantages of the main reconstructive methods, to establish treatment strategies and to bring something new in functional eyelid reconstruction.

Conclusions

The key in functional and aesthetical reconstruction of the eyelids is the corect oncological resection and anatomical reconstruction with similar tissues.

KEY WORDS:

' eyelid tumours,
' flaps,
' chondrocutaneous grafts,
' excisional biopsy.

INELE INTRASTROMALE CORNEENE ÎN TRATAMENTUL CHIRURGICAL AL KERATOCONULUI

DR. COSMIN ROSCA- CLINICA PARTICULARAOPTILENS CLUJ-NAPOCA

REZUMAT

Scopul lucrarii

Este de a evalua rezultatele functionate obtinute prin implantarea intrastro-mala a inelelor corneene la pacientii cu keratocon stadiile I, II, III.

Material si metoda

S-au luat in studiu un numar de 26 pacienti, respectiv 34 globi oculari. S-a urmarit: AV fara corectie, AV cu corectie, keratometria, refractia, topografia corneeana, inregistrandu-se determinarile la 1,3,6,9 si 12luni.

Rezultate

Implantarea inelelor corneene intrastromale aduce un castig substantial al acuitatii vizuale cu corectie postoperator la 1 an de la interventia chirurgicala.

Concluzii

Implantarea inelelor corneene intrastromale reprezinta o alternativa a transplantului de cornee, cu rezultate bune in imbunatatirea parametrilor studiati: acuitate vizuala, refractie, topografie corneana.

CUVINTE CHEIE:

' Keratocon,
' Inele corneene intrastromale.

TRABECULOPLASTIA LASER - UN STUDIU PROSPECTIV (REZULTATE DE ETAPĂ)

DR. ALIN ŞTEFAN ŞTEFĂNESCU-DIMA¹²³, DR. CARMEN MOCANU¹², DR. RODICAMĂNESCU¹², DR. MIHAILALIN ŞFĂNESCU-DIMA^3

1CLINICA UNIVERSITARă DE OFTALMOLOGIE, SCJUCV²UMF CRAIOVA³CLINICAOCULARIUS

REZUMAT

Scop şi metodă

Studiu prospectiv pe un lot de 22 pacienp glaucomatoşi, 31 globi oculari (glaucom pseudoexfoliativ şi GPUD) la care s-a efectuat trabeculoplastie laser neselectivă în cursul anului 2007, propunându-se o perioadă de urmărire de 5 ani, cu un raport preliminar la 2 ani, pentru a evalua eficienţa şisiguranţa acestei inter-venpi.

Rezultate şi discuţii

Rata inip'ală de succes a fost de 100% Tn toate cazurile; degajarea pre-sională medie a fost de 11 mmHg (38%) pentru glaucoamele pseudoexfoliative, respectiv de 5 mmHg (20%) pentru GPUD. Rata de supravieţuire la 2 ani a rezul-tatelor obpnute este de 79% pentru glaucoamele pseudoexfoliative, respectiv de 100% pentru GPUD.

Concluzii

Rezultatele la 2 ani de urmărire sunt mai favorabile decât datele descrise de literatură, fapt explicat probabil prin structura nonrandomizată a lotului de studiu.

ABSTRACT

Purpose and method

Prospective study on 22 glaucoma patients (31 eyes) - pseudoexfoliation glaucoma and POAG - who underwent nonselective laser trabeculoplasty during 2007. The follow-up time is intended to be 5 years, with a preliminary report at 2 years. Our study wants to evaluate the efficiency and safety of the laser procedure.

Results and discussions

The initial success rate was 100%; the mean IOP lowering was 11 mmHg (38%) for the pseudoexfoliation glaucoma and 5 mmHg (20%) for POAG. At 2year interval, the success rate of trabeculoplasty was 79% for pseudoexfoliation glaucoma and still 100% for POAG.

Conclusions

The preliminary results provided by our study are better than those described in the literature; we find an explanation in the fact that our group was not randomized.

KERATOPLASTY IN HUNGARY

LASZLO MODIS, ANDREA FACSKO, ANDRAS BERTA
DEPARTMENT OF OPHTHALMOLOGY, MEDICAL AND HEALTH SCIENCE CENTER,
UNIVERSITY OF DEBRECEN, DEBRECEN, HUNGARY
H-4012 DEBRECEN, NAGYERDEI KRT. 98., HUNGARY, TEL.: +36-52-255-626, FAX: +36-52-255-456
EMAIL: LMODIS@DRAGON.KLTE.HU
INTERNET: http://CORNEA.HU

ABSTRACT

The first keratoplasty was performed in Hungary in 1909, but the transplantations were started in large numbers after the Second World War in Debrecen. Since 1992 a National Keratoplasty Register is functioning at the Department of Ophthalmology Debrecen.

The present paper gives an overview on the current status of keratoplasty in Hungary based on the data of this Register.

The number of cornea! transplantations more than doubled in the past two decades. In the past 3 years (2005 to 2008) the number of transplantation seemed to stabilize around a bit more than 700. The ratio of preserved corneas disclosed a constant increase.

The turning point was 1997, few years after the establishment of the Debrecen Eye Bank in 1994, when more preserved corneas were transplanted than fresh ones. The law regulating the procurement and the transplantation of corneas in our country is based on presumed consent and explicit objection which is the better type of regulation for the performance of keratoplasties in large numbers. The number of cornea! transplantations in Hungary in the past decades was similar to the figures of industrial countries.

KEYWORDS:

' corneal preservation,
' eye bank,
' keratoplasty