REFERATE GENERALE

  1. A. Bărar, loana Daniela Apătăchioaie, C. Apătăchioaie, L. Marceanu - Opinii critice privind aprecierea retinopatiei hipertensive.
  2. Angela Popa, Liliana Voinea, Monica Pop, Daniela Stana. Ana Maria Dascalu, Cristina Alexandrescu, R. Ciuluvica -Sindrom antifosfolipidic primar.
  3. Alina Mihaela Ciocâlteu - Răsunetul tulburărilor metabolis-mului fosfocalcic asupra ţesuturilor oculare la hemodializaţii cronic.
  4. H. Stanca - Sindromul macular.
  5. Diana Melinte Dumitricăa, Cornel Stefan - Glaucomul nor-motensiv.
  6. Oana Mihalcea, Arnold A.C. - Efect advers al radioterapiei capului şi gâtului - neuropatia optică.
  7. Andreea Craiu, Radu Asandi - Complicaţiile anesteziei locale oculare.
  8. A. Nenciu - Particularităţile chirurgiei cataractei în sindromul pseudoexfoliativ.

CAZURI CLINICE

  1. Cristina Nicula, Laura Stănila - Boala Lyme - prezentare de caz.
  2. Irina Nae, C. Stefan - Glaucom juvenil.
  3. Daniela Şelaru, Robertina Radocea - Ocluzie ram temporal inferior al arterei centrale a retinei, forma acută.
  4. Silvia Chiotoroiu, Mihaela Pandelescu, I. Ştefaniu - Nev conjunctival - caz clinic.

STUDII CLINICE

  1. Elena Neacşu, Camelia Bogdănici, N. lanovici - Edemul papilarîn procesele expansive intracraniene.
  2. Adina Berghian - Influenţa substanţelor vâscoelastice asupra endoteliului în timpul operaţiei de cataractă prin facoemulsificare.
  3. Simona Ţălu, Gabriela Zaharie, Cristina Vladuţiu, Claudia Ştefănuţ, Monica Popa - Fotocoagularea laser în retinopatia prematurităţii - rezultate preliminarii.
  4. Silvia Chiotoroiu, Mihaela Pandelescu, Corina Epure, I. Stefaniu - Studiu comparativ al modificărilor endotehale prin două tehnici de facoemulsificare.
  5. Aurora Nicodin, M. Maori - Este sindromul de ochi uscat boală profesională pentru personalul aeronavigant?
  6. Carmen Mocanu, Doina Bărăscu, Rodica Mănescu, Felicia lliuşi - Evaluarea eficacităţii systane în formele severe de ochi uscat.
  7. D. Chiseliţă, C. Danielescu, Alina Apostol - Corelaţii între analiza structural şi cea funcţionala la suspecţii de glaucom.
  8. D. Chiseliţă, Irina Moţoc, C. Danielescu - Fluctuaţiile diurne şi nocturne ale presiunii intraoculare şi tensiunii arteriale sistemice la pacienţii glaucomatoşi ş neglaucomatoşi.

PROBLEME DE TERAPEUTICA

  1. Cristina Vladuţiu, Andreea Seceleanu, Mara Ciuică, Ana Maria Pop - Opţiuni terapeutice în oftalmopatia tiroidiană.

GENERAL REPORTS

  1. A. Barar, loana Daniela Apatachioaie, C. Apatachioaie, L. Marceanu - Hypertensive retinopathy assessment.
  2. Angela Popa, Liliana Voinea, Monica Pop, Daniela Stana. Ana Maria Dascalu, Cristina Alexandrescu, R. Ciuluvica -Primary Antiphospholipid syndrome.
  3. Alina Mihaela Ciocâlteu - The effects of changes in phos-phocalcic metabolism to ocular tissues in patients with ccronic hemodyalisis.
  4. H. Stanca - Macular syndrome.
  5. Diana Melinte Dumitrica, Cornel Stefan - Normotensive glaucoma.
  6. Oana Mihalcea, Arnold A.C. - Side effect of head and neck radiotherapy - optic neuropathy.
  7. Andreea Craiu, Radu Asandi - Complications of ocular local anesthesia.
  8. A. Nenciu - Cataract surgery in pseudoexfoliative syndrome

CLINICAL CASES

  1. Cristina Nicula, Laura Stanila - Lyme'disease - case report.
  2. Irina Nae, C. Stefan - Juvenile glaucoma.
  3. Daniela Selaru, Robertina Radocea - Inferior temporal branch arterial occlusion - acute form.
  4. Silvia Chiotoroiu, Mihaela Pandelescu, I. Stefaniu -Conjunctival nevus - clinical case.

CLINICAL CASES

  1. Elena Neacsu, Camelia Bogdanici, N. lanovici - Papillary edema in expansive intracranian tumors.
  2. Adina Berghian - The influence of viscoelastic substances on the corneal endothelium during cataract surgery by pha-coemulsification.
  3. Simona Talu, Gabriela Zaharie, Cristina Vladutiu Claudia Stefanut Monica Popa - Laser photocoagulation in retinopathy of prematurity - preliminary results.
  4. Silvia Chiotoroiu, Mihaela Pandelescu, Corina Epure, I. Stefaniu - Comparative study of endothelial changes in cataract surgery through two methods of phacoemulsification.
  5. Aurora Nicodin M. Maori - Is dry eye syndrome a profe-sional disease for eronautical pesonnel?
  6. Carmen Mocanu, Doina Barascu, Rodica Manescu, Felicia lliusi -Assessment of systane in severe dry eye.
  7. D. Chiselita, C. Danielescu, Alina Apostol - Correlation between structural and functional analysis in glaucoma suspects.
  8. D. Chiselita, Irina Motoc, C. Danielescu - Day and nights fluctuation of intraocular pressure and blood pressure in glaucoma and non-glaucoma patients.

THERAPEUTICAL PROBLEMS

  1. Cristina Vladutiu, Andreea Seceleanu, Mara Ciuica, Ana Maria Pop - Therapeutical oportunities in tiroidian ophthal-mopathy.

■   REDACTOR ŞEF

Conf. Dr. Mircea FILIP

Clinica Ama Optimex - Bucureşti E-mail: mirceafilip@amaoptimex.ro

■   REDACTOR ŞEF ADJUNCT

Dr. loan ŞTEFANIU

Spitalul Clinic de Urgenţă Militar Central E-mail: med-optic@xnet.ro

■   SECRETAR DE REDACŢIE

Dr. Mihail ZEMBA

E-mail:mhlzmb@yahoo.com

■   SECRETAR ADJUNCT DE REDACŢIE

Dr. Gheorghe ANGHEL

■   CONSILIU ŞTIINŢIFIC

F. Baltă (Bucureşti), E. Bendelic (Chişinău), Camelia Bogdănici (laşi),

M. Călugăru (Cluj-Napoca), B. Cârstocea (Bucureşti), D. Chiseliţă (laşi),

Cătălina Corbu (Bucureşti), Anna Csziszar (Tg. Mureş),

Denislam Dogan (Constanta), Marieta Dumitrache (Bucureşti),

C. Ştefan (Bucureşti), M. Filip (Bucureşti),

Marie-Jeanne Koos (Timişoara), loana Venusa Mihu (Hunedoara),

C. Moraru (Bucureşti), Gheorghe Munteanu (Timişoara),

Monica Pop (Bucureşti), M. Pop (Bucureşti), Daniela Şelaru (Bucureşti),

loan Ştefaniu (Bucureşti), Cristina Vlăduţiu (Cluj),

Liliana Voinea (Bucureşti), lleana Zolog (Timişoara).

■    MEMBRII DE ONOARE

P. Cernea (Craiova), Ghe. Chercotă (Timişoara),

I. Horge (Cluj-Napoca), Florica Ignat (Craiova), S. Lupan (Chişinău),

M. Olteanu (Cluj-Napoca), Rodica Pop (Cluj-Napoca),

■   REDACŢIA

Spitalul Clinic de Urgenţă Militar Central, Str. Mircea Vulcănescu nr. 86, Sector 1, Bucureşti, Telefon: 021 319 30 51, int. 228, 462; Telefon/Fax: 021 313 71 89; E-mail: milophtha@digicom.ro.


Lucrare prezentată la Simpozionul de Oftalmologie Timişoara 2006 şi la Zilele Medicale ale Braşovului 2006

OPINII CRITICE PRIVIND APRECIEREA RETINOPATIEI HIPERTENSIVE

DR. A. BARAR, DR. IOANA - DANIELA APATACHIOAIE, DR. C. APATACHIOAIE, DR. L MARCEANU

REZUMAT

Autorii isi propun o sinteza a unor studii recente disponibile pe internet, privind retinopatia hipertensiva. Fiziopatologic se considera ca circulatia la nivelde retina, coroida si nerv optic, are proprietati anatomo fiziologice distincte. Aceasta raspunde diferitla modificarile tensiunii arteriale, rezultand tipuri distincte de boa/a hipertensiva, evidentiabile la fundul de ochi. In boala hipertensiva retina se considera ca fiind unul din organele tinta. Detectarea modificarilor retiniene a evoluat de la oftlamoscopie la fotografia digitala studiata cu soft adecvat.

Evaluarea microangiopatiei hipertensive este supusa unei largi variabilitati intra si interobservatori, o apreciere corecta necesitind software specializat si pro-tocoale standardizate.

Un consens nu exista nici in privinta clasificarii retinopatiei hipertensive, si nici daca examenul retinei este util in aprecierea riscului cardiovascular. Se uti-lizeaza inca stadializarile Keith siScheie, dar ele nu permit clinicianului sa diferen-tieze modificari usoare sau chiar moderate, la nivelul retinei pacientilor hiperten-sivi. In plus ele nu coreleaza indeajuns cu severitatea hipertensiunii arteriale si nu sunt sprijinite de studiile angiofluorografice.

Nu sunt suficiente motive pentru a recomanda un examen oftalmoscopic de rutina pentru toti hipertensivii. Obligatoriu se va face la hipertensivii stadiul 3. Se recomanda insa si atunci cand semnele clinice initiate sunt echivoce cum este hipertensiunea la limita sau inconstanta fara alte semne evidente de organ tinta, la cei cu diabet sau cand apar simptome vizuale. Implicatiile clinice ale retinopatiei hipertensive fiind neclare, multi autori nu recomanda cu regularitate examenul oftalmoscopic, sau nu considera semnele retiniene utile pentru decizia terapeuti-ca.

CUVINTE CHEIE:

• Retinopatia hipertensiva,

• hipertensiune arteriala.

ABSTRACT

The authors intend to make a synthesis of several recent studies available on the Internet with regard to the Hypertensive retinopathy From the physiopathologic point of view, it is considered that the blood circulation at the level of the retina, choroid and optical nerve has distinct anatomo-physiological properties. It has a different response to the changes in the blood pressure, the result consisting of distinct individual types of the hypertensive disease which can be rendered evident during the optical fundus examination. The retina is considered to be one of the target organs in the hypertensive disease. The ascertaining of the retinal changes had advanced from ophthalmoscopy to digital photography studied with adequate software.

The assessment of the hypertensive microangiopathy is subjected to a wide intra and inter-observer variability an accurate assessment requiring specialized software and standardized protocols.

There is also a lack of consensus with regard to the classification of the Hypertensive retinopathy and to the usefulness of the retinal examination in the assessment of the cardiovascular risk. The Keith and Scheie stadialization scales are still in use, but they do not allow the clinician to differentiate slight or even moderate changes at the level of the retina of hypertensive patients. Furthermore, they do not correlate enough with the severity of the high blood pressure and they are not supported by the angiofluorography studies.

There are not enough motives for the recommendation of a routine ophthalmoscopic examination for all hypertensive patients. It is compulsory for the patients with Stage 3 High blood pressure. It is also recommended when the initial clinical signs are equivocal, as in limit or oscillating high blood pressure without any other obvious signs from the target organs, for the diabetic patients, or in the presence of the visual symptoms. The clinical implications of the Hypertensive retinopathy being unclear, many of the authors do not recommend the ophthalmoscopic examination as a rule, or they don't consider the retinal signs as being useful for the therapeutic decision.

KEYWORDS:

• hypertensive retinopathy,

• blood pressure.


SINDROMUL ANTIFOSFOLIPIDIC PRIMAR

ANGELA POPA1, LILIANA VOINEA2, MONICA POP3, DANIELA STANA4, ANA-MARIA DASCALU5, CRISTINAALEXANDRESCU6, R. CIULUVICA7

1 "SPITALUL UNIVERSITAR DE URGENTABUCURESTI, CLINICAOFTALMOLOGIE

2 3567UMF "CAROL DAVILA" BUCURESTI

REZUMAT

Sindromul antifosfolipidic primar reprezintă o asociere de tromboze arteri-ale si/sau venoase cu diferite localizări, avorturi recurente şiprezenţa in plasma a anticorpilor antifosfolipidici (aFL), eel mai frecvent lupus anticoagulant (LA) şi anti-cardiolipinici (aCL). Atingerea oculara poate fiprezenta in pana la 80% din cazuri, dar aproximativ 30 %dintre pacienti sunt asimptomatici. Diagnosticul de sindrom antifosfolipidic (SAFL) trebuie considerat la toti pacientii care prezinta tromboze vasculare recurente,in absenta altor factori de rise cunoscuti.

CUVINTE CHEIE:

• sindromul antifosfolipidic primar(SAFL)

• anticorpi antifosfolipidici (aFL)

• lupus anticoagulant (LA)

• anticorpi anticardiolipinici (aCL)

ABSTRACT

Antiphospholipid syndrome (APS) is a disorder characterised by recurrent arterial or venous thrombosis and/or pregnancy losses, in the presence of persistently elevated levels of anticardiolipin antibodies and/or evidence of circulating lupus anticoagulant (these abnormalities are detected by blood tests). Primary APS occurs when there is no evidence of associated diseases. APS in the presence of an underlying disease, usually systemic lupus erythematosus, is called secondary APS

KEYWORDS:

• antiphospholipid syndrome

• antiphospholipid antibodies

• lupus anticoagulants

• anticardiolipin antibodies


RĂSUNETUL TULBURĂRILOR METABOLISMULUI FOSFOCALCIC ASUPRA TESUTURILOR OCULARE LA HEMODIALIZATII CRONIC

ALINA-MIHAELA CIOCALTEU

REZUMAT

Calcificările extrascheletice reprezintă o complicaţie frecventă în cazul pacienţilor cu insuficienţă renală cronică. Este bine cunoscut faptul că la pacienţii dializaţi nivelurile crescute ale produsului calciu X fosfor se asociază cu dez-voltarea calcificărilor corneo-conjunctivale, însă nu există o asociere clară între gradul calcificărilor limbo-conjunctivale şi nivelurile crescute ale produsului CaXP.

Lucrarea de faţă propune o prezentare sintetică a principalelor ipoteze ce stau la baza explicării mecanismului formării acestor depozite de săruri de calciu la nivelul polului anterior alglobului ocular.

CUVINTE CHEIE:

• Calcificări corneo-conjunctivale

• Calciu

• Fosfor

• Parathormon

• Calcifilaxia

• Metabolism osos

SUMMARY

Extraskeletal calcification is a common complication of chronic renal failure. It is well known that in dialysis patients the elevated calcium phosphate product is associated with the de velopment of cornea! and conjunctiva! calcification, but there is no association between the degree of the calcifications and the levels of calcium phosphate product.

This paper is supposed to present briefly the main hypothesis who explain the mechanism that generates the deposition of the calcium salts to the anterior segment of the globe.

KEYWORDS:

• Corneo-conjunctival calcifications

• Calcium

• Phosphorus

• Parathyroid hormone

• Calciphylaxis

• Bone metabolism


SINDROMUL MACULAR
- ETIOLOGIE / CLINICĂ / DIAGNOSTIC -

HORIAT. STANCA

SPITALUL MILITAR DE URGENTA"PROF. DR. AGRIPPA IONESCU"

REZUMAT

Sindromul este o notiune ce presupune asocierea unui complex de simp-tome si semne, ce survin frecvent intr-un tablou clinic similar, dar care corespund unor etiologii variate.

Sindromul macular poate fi definit ca un ansamblu de simptome, asociate modificarilor vederii centrale, respectiv semne ale modificarilor macro- sau micro-scopice ale structurii maculei, ce survin intr-un tablou clinic definit de alterarea vederii centrale si care corespund unor cauze diverse.

Lucrarea urmareste trecerea in revista a cauzelor care produc alterarea maculei, a elementelor clinice asociate acestei disfunctii, precum si a metodelorde diagnostic clinic siparaclinic in bolile maculei.

CUVINTE CHEIE:

• Sindrom macular

•  Vedere centra/a

• Degenerescenta maculara legata de varsta

• Neovascularizatie coroidiana

ABSTRACT

The syndrome consists of signs and simptoms associated in a similar clinical picture, yet induced by diferent causes.

The macular syndrome represents a complex of signs (changes in macular architecture) and simptoms asociated with central vision disturbances, obviously induced by different causes.

Our paper reviews the macula alteration causes, the clinical elements of this disfunction and the clinical and paraclinical methods of diagnosis in macular diseases.

KEYWORDS:

• Macular syndrome

• Central vision

• Age-related macular degeneration

• Choroidal neovascularization


GLAUCOMUL NORMOTENSIV (CU PRESIUNE SCAZUTA)

DR. DIANA MELINTE DUMITRICA, DR. CORNEL STEFAN

SPITALUL CLINIC DE URGENŢĂ MILITAR CENTRAL "CAROL DAVILA" BUCUREŞTI

CLINICADE OFTALMOLOGIE

ADRESA DE CORESPONDENŢĂ: DIANAMELINTE2004@YAHOO.COM

REZUMAT

Glaucomul normotensiv este o forma a glaucomului primitiv cu unghi deschis in care presiunea intraoculara este in limite normale. In acest caz cea mai mare provocare o reprezinta diagnosticarea corecta si cat maiprecoce. Evaluarea clinica a unui pacient suspectat de glaucom normotensiv trebuie sa raspunda la doua intrebari: 1) presiunea intraoculara este in limite normale si 2) ne aflam in fata uneineuropatii optice glaucomatoase sau de alta natura?

ABSTRACT

Normal tension glaucoma is a form of primary open angle glaucoma where the intraocular pressure remains within the normal range. In this case the main challenge is to establish the correct diagnosis. The clinical evaluation of a patient suspected of a normal tension glaucoma must answer two questions: 1) is the intraocular pressure normal and 2) is it a glaucomatous optic neuropathy or another type of optic neuropathy?


SIDE EFFECT OF HEAD AND NECK RADIOTHERAPY: OPTIC NEUROPATHY

OANA MIHALCEA, ARNOLD A.C.

1.   CENTRAL CLINIC EMERGENCY MILITARY HOSPITAL, CLINIC OF OPHTHALMOLOGY BUCHAREST ROMANIA

2.  CORRESPONDING AUTHOR, SENIOR, PROFESSOR OF OPHTHALMOLOGY, JULES STEIN EYE INSTITUTE, DEPARTMENT OF NEURO-OPHTHALMOLOGY, UCLA, LOS ANGELES, USA

ABSTRACT

Therapeutic irradiation of the head and neck region for control of tumor growth and for palliation of tumor mass effect, as well as stereotactic surgery increased in use in recent years, having a wide applicability. Despite technological advances, radiation-induced optic neuropathy is serious complication of this kind of treatment. Very important is early recognition of the disorder and treatment in incipient phases.

Radiation damage could be acute (appearing during radiotherapy), early-delayed (occurring within 3 months after initial exposure) and late-delayed (delayed radionecrosis, within 6 months to 10 years after exposure). Theories of vascular occlusion, demyelination, free radical injury, direct damage to cellular DNA, damage to the blood-brain barrier have been proposed to explain the patho-physiology

Patients commonly presents with unexplained, painless visual loss in one or both eyes, visual field defects, pupillary abnormalities and defective color vision. For both detection and management an important tool is Magnetic Resonance Imaging with and without contrast agents.

Systemic corticosteroids, hyperbaric oxygen therapy, free-radical scavengers showed some efficiency in treatment, especially in acute phases. A promise in treatment shows intravitreal triamcinolone acetonide injections and anti-VEGF molecules. But there is still no therapy that has been proven effective.

The visual prognosis is poor, so we want to raise a alarm signal with this paper: awareness of this side-effect and mostly its prevention should be the way in managing patients who receive therapeutic irradiation for intracranial, sinus, nasopharyngeal, intraorbital and intraocular tumors.

KEYWORDS:

• radiation optic neuropathy,

• cerebral radionecrosis,

• radiotherapeutic doses.


COMPLICATIILE ANESTEZIEI LOCALE OCULARE

DR. ANDREEACRAIU1, DR. RADU ASANDI2 'CLINICADE OFTALMOLOGIE ASCUMC, BUCUREŞTI 2CLINICADE ANESTEZIE Şl TERAPIE INTENSIVĂASCUMC

REZUMAT

Desi tendintele moderne se indeparteaza de blocul retrobulbar, iar anestezia topica are din ce in ce mai multi sustinatori, anestezia oculara se efectueaza, eel mai frecvent, injectabil. In ciuda faptului ca sunt rare, au fost descrise numeroase complicatii, mergand de la banale hemoragii pana la situatii amenintatoare de viata.

CUVINTE-CHEIE:

• Anestezie retrobulbara

• Anestezie peribulbara •Anestezie subTenoniana

• Anestezie locala

ABSTRACT

Even as current trends move away from retrobulbar block and topical anesthesia gains greater widespread acceptance, ocular anesthesia is most commonly administered with a needle. Although rare, complications have been described, ranging from innoucuous hemorrhage to life-threatening systemic situations.

KEYWORDS:

• Retrobulbar Block

• Peribu I bar Block

• SubTenon's Block

• Topical Anesthesia


PARTICULARITĂTILE CHIRURGIEI CATARACTEI ÎN SINDROMUL PSEUDOEXFOLIATIV

DR. A. NENCIU

CMDTA"ACAD. ŞTEFAN MILCU", BUCUREŞTI

ADRESA PENTRU CORESPONDENŢĂ: ADI_OPHTA@YAHOO.COM

REZUMAT

Sindromul pseudoexfoliativ reprezinta un grup de manifestari oculare importante in cadrul unei anomalii sistemice. Chirurgia cataractei in sindromul pseudoexfoliativ este una cu rise crescut intra si postoperator, pentru ca prezenta modificarilor irido-ciliare si cristaliniene creeaza premisele aparitiei unor compli-catii mai frecvente. Facoemulsificarea reprezinta metoda de electie pentru acesti pacienti, iar in conditiile unei observari atente a detaliilor si a unei tehnici chirurgi-cale "ingrijite"se pot obtine rezultate comparabile.

CUVINTE CHEIE:

• sindrom pseudoexfoliativ,

• cataracta,

• facoemulsificare.

ABSTRACT

The pseudoexfoliative syndrome is a group of important ocular manifestations of a systemic anomaly. Cataract surgery in pseudoexfoliative syndrome implies high intra and postoperative risks, because the iridocilliary and lens changes create the premises for more frequent complications. Facoemulsification is the election method for these patients, and if a detail-oriented and adequate surgical technique is used, comparable results can be obtained.

KEYWORDS:

• pseudoexfoliative syndrome,

• cataract,

• facoemulsification


BOALA LYME PREZENTARE DE CAZ

CONF. DR. CRISTINANICULA, DR. LAURASTANILA CLINICAOFTALMOLOGICA CLUJ-NAPOCA

REZUMAT

Autorii prezinta cazul unei paciente tinere la care s-a pus diagnosticul de boala Lyme.Se iau in discutie modalitatile de debut, evolutie si mijloacele ter-apeutice aplicate la cazul de fata .

ABSTRACT

The authors presents a female case ofLyme disease. There are presented types of onset, evolution and treatment in this case.


GLAUCOM JUVENIL 
- CAZ CLINIC -

IRINANAE, STEFAN C.

SECŢIA CLINICĂ DE OFTALMOLOGIE

SPITALUL CLINIC DE URGENŢĂ MILITAR CENTRAL

REZUMAT

Se prezinta cazul unei paciente in varsta de 24 de ani diagnosticata cu glaucom juvenil in stadiu avansat.

CUVINTE CHEIE:

• glaucom juvenil

• OCT, HRT

• trabeculectomie

ABSTRACT

We present the case of a 24 years old patient with advanced juvenile glaucoma.

KEYWORDS:

• Juvenile glaucoma

• OCT, HRT

• trabeculectomy


OCLUZIE RAM ACR (TEMPORAL INFERIOR), FORMA ACUTĂ

DANIELAŞELARU, ROBERTINA RADOCEA

CLINICA DE OFTALMOLOGIE, SPITALUL CLINIC DE URGENŢĂ MILITAR CENTRAL -

BUCUREŞTI

HORIASTANCA- CLINICA DE OFTALMOLOGIE, SPITALUL DE URGENŢĂ

"PROF. DR. AGRIPPA IONESCU" - BUCUREŞTI

REZUMAT

Autorii prezinta cazul unei paciente in varsta de 72 ani, fumatoare de 50 ani, cu o patologie incarcata-cardiovasculara (cardiopatie ischemica cu insuficienta car-diaca cl.II, sdr. de hipercoagubilitate si 40% stenoza pe artera carotida stanga) si car-cinom mamar-operat, care se interneaza in Clinica de Oftalmologie SCUMC, Bucuresti cu diagnosticul OS Ocluzie ram ACR(temporal inferior) forma acuta- survenita in urma cu 10 zile. Motivul internarii a fost amputarea campului vizual la OS-orizontala(altitu-dinala), in 1/2 superioara a CV, dar neacompaniata de afectarea AV la OS(AVcu cea mai buna corectie la OS a fost 1 - datorita particularitatii cazului de prezenta a 2 artere cilio-retiniene la OS).

Se fac investigatii complete oculare si sistemice. Se decide ca in acest stadiu de la debutul ocluziei ram ACR, sepoate tenta foto-emboliza trans-luminala a embolu-lui localizat la originea ramului temporal inferior alACR cu ajutorul laserului Nd.YAG -tehnica ce a fost utilizata in premiera nationala in Romania.

CUVINTE CHEIE:

• Ocluzie ram ACR

• Emboliza laser Nd.YAG trans-luminala

ABSTRACT

The authors present the case of a female patient, 72 years old, smoker for 50 years, with a complex pathology - cardiovascular (coronary artery disease with heart failure, hypercoagulable state and 40% left carotid artery stenosis) and breast carcinoma- surgically treated, who was admitted in the Ophthalmology Clinic of the Emergency Central Military Hospital Bucharest, with the diagnosis of Left Eye Branch Retinal Artery Occlusion (temporal inferior) acute form - which occured 10 days ago. The reason of the hospital admission was left eye visual field deficit - horizontal (altitu-dinal), in the superior 1/2 of the visual field, but not accompanied by the left eye visual acuity decreasefleft eye best -corrected visual acuity was 20/20 - due to the particularity of the case by the existence of 2 cilio-retinal arteries at the left eye).

Complete ocular and sistemic work-up was performed. It was decided that at this stage from the beginning of the Branch Retinal Artery Occlusion, can be tempted trans-luminal photo-embolysis of the embolus located at the origin of the temporal inferior branch of the Central Retinal Artery with the Nd: YAG laser - technique which was used as national premiere in Romania.

KEYWORDS:

• Branch Retinal Artery Occlusion

•  Trans-luminal Nd: YAG laser embolysis


NEV CONJUNCTIVAL 
- CAZ CLINIC -

DR. SILVIA CHIOTOROIU, DR. MIHAELA PANDELESCU, DR. I. STEFANIU SPITALUL CLINIC MILITAR DE URGENTA "CAROL DAVILA'-BUCURESTI CLINICADE OFTALMOLOGIE

REZUMAT

Se prezinta cazul unui pacient in varsta de 4 ani care vine in clinica noas-tra pentru existenta unei formatiuni tumorale cu localizare la nivelul limbului scle-ro-cornean.

Examenul oftalmologic stabileste diagnosticul de melanom malign conjunctiva! si se decide excizia formatiunii tumorale.

Examenul anatomopatologic efectuat postoperator a infirmat caracterul malign al leziunii si a stabilit diagnosticul de nev conjunctiva! cu localizare limbica.

CUVINTE CHEIE:

• nev conjunctiva!

• melanom

• tumori conjunctivale

ABSTRACT

The authors present the case of a four-year-old patient who comes in our clinic because of the existence of a tumoral formation localized at the sclero-cornean level.

The opthalmological examination establishes the diagnostic of conjunctiva! malign melanoma and it is taken the decision of tumora! formation excision.

The anatomophatological examination which was done post-surgery has refuted the malign character of the lesion and has established the diagnostic of conjunctiva! nevus.

KEYWORDS:

• conjunctiva! naevus

• melanoma

• onjunctival tumours


EDEMUL PAPILAR ÎN PROCESELE EXPANSIVE INTRACRANIENE

ELENA NEACŞU*, CAMELIABOGDĂNICI**, N. IANOVICI*

*SPITAL "SF. TREIME" IAŞI

**CLINICA I OFTALMOLOGIE, SPITAL SE SPIRIDON IAŞI

REZUMAT

Scopul lucrării este de a determina relaţia între frecvenţa de aparipe a edemului papilar în tabloul clinic al proceselor expansive intracraniene (in special al tumorilor intracraniene) şi localizarea lor, respectiv tipul histologic al acestora.

Un al doilea scop a fost de a verifica rolul examenului fundului de ochi in verificarea stării de sănătate, conform legislapei in vigoare. S-au analizat retrospects pe o perioadă de 2 ani, 446 de pacienp internap in Spitalul "Sf. Treime" laşi la Secpa de Neurochirurgie cu diagnosticul principal de proces expansiv intracran-ian.

S-au urmărit semnele şi simtomele oculare (prezenţa edemului papilar). Vârsta medie a fost de 50,76±18,30 ani şi 46,87% din cazuri au prezentat edem papilar in stadii diferite de evolupe. Rezultatele studiului au demonstrat că aparipa edemului papilar depinde de localizarea tumorii intracraniene, de mărimea ei, de tipul histologic şi implicit de agresivitatea acesteia.

CUVINTE CHEIE:

• edem papilar,

• tumori intracraniene,

• legislape medicală

ABSTRACT

The aim was: correlation between frequency of papillary edema in intracranian tumours and to verify Romanian medical legislation for ophthal-moscopy

This paper is a retrospective study for a period of 2 years (2005-2006). We included in study 446 patients treated in Hospital "Sf. Treime" laşi, Romania for expansive intracranian tumours. Ocular signs and symptoms (especially papillary edema) were observed for these patients. Mean age was 50,76± 18,30 years and in 46,87% of cases we found papillary edema in different stages.

Conclusions: papillary edema depends after localization and size of intracranian tumours, histological aspects and its agressivity

KEYWORDS:

• papillary edema,

• intracranian tumours,

• medical legislation


INFLUENTA SUBSTANTELOR VÂSCOELASTICE ASUPRA ENDOTELIULUI CORNEEAN IN TIMPUL OPERATIEI DE CATARACTĂ PRIN FACOEMULSIFICARE

DR. BERGHIANADINA

CLINICA DE OFTALMOLOGIE TIMIŞOARA

REZUMAT

OBIECTIV: Studiul a avut ca scop compararea abiHtăţii diferitelor sub-stanţe vâscoelastice oftalmice (OVD) de a proteja endoteliul corneean In timpul facoemulsificării urmate de implantarea de pseudofak de camera posterioară (IOL).

MATERIAL şi METODĂ: Studiul a cuprins 50 pacienţi cu cataractă (gradul 1-3) şi cu densitate celulară endotelială corneeană > 2000 celule/mnf. Pacienţiiau fost împărţiţi în două grupuri, în funcţie de vâscoelasticul folosit (Provisc&Viscoat/DisCoVisc). Răspunsul corneean la trauma chirurgicală a fost evaluat măsurând densitatea de celule endoteliale corneene (CD), coeficientul de variape a Iarieicelulare endoteliale (CV) şigrosimea centra lă a corneei pre şi post-operator Măsurătorile au fost făcute cu un microscop specular noncontact TOP-CON SP2000P.

REZULTATE: Preoperator nu au fostgăsite diferenţe semnificative statistic între pacienpistudiapîn ceea cepriveşte CD, CVsau pahimetrie. Postoperator top pacienpiau suferit o pierdere celulară semnificativă statistic (p<0,001) şiocreştere semnificativă în acuitate vizuală (p<0,001). Postoperator nu au fost găsite difer-enţe semnificative statistic între grupuri.

CONCLUZII: "intre vâscoelasticele folosite (Provisc&Viscoat/ DisCoVisc) nu au existat diferenţe semnificative din punct de vedere al rezultatului postoperator şi nici din prisma aspectului sau a funcpei endoteliului corneean. Toate aceste date due la concluzia că DisCo Visc-ul este vâscoelasticul care conferă o bună pro-tecpe a endoteliului şi o bună vizualizare pe tot parcursul operapei de facoemulsi-ficare.

CUVINTE CHEIE:

• celule endoteliale;

• substanţe vâscoelastice oftalmice;

• microscopie speculară.

ABSTRACT

PURPOSE: To compare the ability of different ophthalmic viscoelastic devices to protect the cornea! endothelium following in-the-bag phacoemulsification with posterior chamber intraocular lens (IOL) implantation.

MATERIAL&METHODS: We studied 50 patients with soft to moderately dense (Grade 1-3) cataract and cornea! endothelial cell density of >2000cells/mnf. The cornea! response to surgery was evaluated by measuring the endothelial cell loss, the variation in the mean cell area of the endothelial cells (CV), and the central cornea! thickness, all that by using a TOPCON SP 2000P non-contact, specular microscope. Data were recorded preoperatively and postoperatively

RESULTS: Preoperatively no statistical significant difference was observed in cell count, CV, or pachymetry among groups. Postoperatively all the groups had a statistically significant decrease (p<0,001) in endothelial cell count. There was an equal and significant (p<0,001) increase in visual acuity. Between groups there was no statistically significant difference (p>0.17) in any of the parameters we studied.

CONCLUSIONS: Between the OVDs we used, eitherDisCoVisc orProVisc&VisCoat, there was no statistical significant difference neither in surgical outcome nor in endothelial layer aspect and function. DisCoVisc protected better the endothelium cells even if it was not statistically significant, and is the one that can be used for the entire surgical procedure.

KEYWORDS:

• endothelial cells;

• ophthalmic viscoelastic device;

• specular microscopy.


Fotocoagularea laser in retinopatia prematuritatii 
- rezultate preliminarii -

SIMONAŢĂLU*, GABRIELAZAHARIE**, CRISTINAVLĂDUŢIU*, CLAUDIAŞTEFĂNUŢ*, MONICA

POPA**

* CLINICA DE OFTALMOLOGIE, SPITALUL CLINIC JUDEŢEAN CLUJ-NAPOCA

** CLINICA DE NEONATOLOGIE, SPITALUL CLINIC JUDEŢEAN CLUJ-NAPOCA

LUCRAREAESTE SUSŢINUTĂ PRIN PROGRAMUL MSF NR. 1.3, OBIECTIV 13: "PROFILAXIA CECITĂŢII LA PREMATURI PRIN DEPISTAREA PRECOCE Şl TRATAREA RETINOPATIEI DE PREMATURITATE ŞI PROFILAXIA AMBLIOPIILOR LACOPII"

REZUMAT

Scop. Studiul de faţă îşi propune să demonstreze, pe de oparte, eficaci-tatea fotocoagulării laser In ROP, iar, pe de alta, să răspundă la două întrebări:

1.  De ce există cazuri de ROP care evoluează nefavorabil, In ciuda trata-mentului laser?

2.  Ce se poate face pentru a preveni acest lucru?

Material. Metodă. S-a efectuatun studiu retrospectiv, asupra celor21 nou - născuţiprematur care au fost tratapprin fotocoagulare laser, pentru HOP, in Cluj-Napoca, In perioada aprilie 2006 - septembrie 2007. Fotocoagularea laser s-a efectuat cu un laser diodă (810nm) fixat pe oftalmoscopul indirect, In condipi de sedare a prematurului, In secp'a de Neonatologie a Spitalului Clinic Judeţean din Cluj.

Rezultate. Global, rezultatele tratamentuluiaplicatau fost: evolupe favora-bilă (regresia bolii)- la 32 ochi (84.21%) şi nefavorabilă - la 6 ochi (15.79%). Fotocoagularea laser a fost efectuată la 29 ochi aflap In stadiul III al bolii şi a pro-dus regresia sa la 27 dintre aceştia (93.10%). HOP zona I a fost identificată şi tratată la 3 cazuri, dintre care - două au evoluat favorabil (66.66%), iarunul a pro-gresat spre stadiul IV (33.33%). HOP In stadiul IVa a fost identificată la 3 cazuri, totalizând 5ochi. Dintre aceştia, fotocoagularea laser a fostposibilă doarla 3 ochi, cu evolupe favorabilă la un singur ochi (33.33%) şi nefavorabilă, la 2 ochi (66.66%).

Discuţii. Analizăm rezultatele tratamentului laser, In funcpe de doi para-metri: situapa obiectivă oculară înainte de fotocoagularea laser (stadiul şi zona ROP) şi momentul efectuării acesteia (vârsta postconcepponală şi postnatală).

Concluzii

1.  Fotocoagularea laser a fost efectuată la timp (stadiul III), In 17 din cele 21 cazuri tratate (80.95%).

2.  Fotocoagularea laser indirectă a produs regresia ROP In 15 din cele 17

cazuri tratate la timp (88.22%).

3. Fotocoagularea laser indirectă a putut fi efectuată la 4 din cei 7 ochi ajunşiprea târziu la tratament şi a produs regresia HOP la 3 dintre aceştia (42.85%).

4.  Dacă nu este susţinută de un screening cored, efectuat la timp, fotocoagularea laser In HOP nu îşipoate valida la maxim potenţialul său curativ.

CUVINTE CHEIE:

• retinopatia prematurităţii,

• fotocoagulare laser.

ABSTRACT

Purpose. The present study aims to reveal, on one hand, the efficiency of the laser photo-coagulation in the Retinopathy of Prematurity (HOP) and, on the other one, to answer two questions:

1.  Why do some ROPs still go wrong, inspite of laser therapy?

2.  What can we do about it?

Material. Method. A retrospective study has been performed, including the 21 prematurely new-borns that have been treated by laser photocoagulation, for HOP, in Cluj-Napoca, between april 2006 - September 2007. The photocoagulation has been carried out with a diode laser fixed on an indirect ophthalmoscope, under sedation, in the Neonatology Department of the County Clinical Hospital from Cluj.

Results. Globaly the results of the laser treatment are the following: favourable outcome (regression of HOP) - in 32 eyes (84.21%) and unfavourable outcome - in 6 eyes (15.79%). Laser photocoagulation has been performed in 29 eyes in stage III zone 2 and produced the regression of HOP in 27 of them (93.10%). HOP zone I has been identified and treated in 3 cases, of which - two had a favourable evolution (66.66%), and one has progressed to stage IV (33.33%). HOP in stage IVa has been identified in 3 cases (5 eyes). The laser photocoagulation has been possible only in 3 eyes, with favourable evolution in one eye (33.33%) and unfavourable, in 2 eyes (66.66%).

Discussion. The results of the treatment are analized according to two parameters: the objective situation prior to laser photocoagulation (stage and zone of HOP) and the moment of the treatment (postconceptional and postnatal age).

Conclusions.

1.  The laser photocoagulation has been performed at the right moment, in 17 of the 21 treated cases (80.95%).

2.  The indirect laser photocoagulation produced the regression of HOP in 15 of the 17 cases that were treated at the right moment (88.22%).

3.  The indirect laser photocoagulation has been possible in 4 of the 7 eyes that arrived too late for the treatment and produced the regression of HOP in 3 of them (42.85%).

4.  If it is not sustained by a correct screening, performed at the right moment, the laser photocoagulation cannot maximally validate its healing potential in HOP.

KEYWORDS:

•ROP,

• laser photocoagulation

STUDIU COMPARATIV AL MODIFICĂRILOR ENDOTELIALE ÎN CHIRURGIA CATARACTEI

PRIN DOUĂ TEHNICI DE FACOEMULSIFICARE

DR. SILVIA CHIOTOROIU, DR. MIHAELA PANDELESCU,

DR. CORINAEPURE ,DR. I. ŞTEFANIU

CLINICADE OFTALMOLOGIE

SPITALUL CLINIC DE URGENŢĂ MILITAR CENTRAL-BUCUREŞTI

REZUMAT

SCOP:Analiza comparativa a modificarilorendoteliuluicornean (densitate, pleiomorfism si polimegetism),survenite in urma facoemulsificarii, prin tehnica divide and conqer (D-C) respectiv phaco - chop (P-C).

MATERIAL SI METODA: Studiu clinic prospectiv observational, interven-tional ,cu durata de un an pe 60 de ochi operati de cataracta, prin facoemulsificare de acelasi chirurg. Au fost impartiti in 2 loturi de studiu in functie de duritatea cataractei( lot A - 30 ochi cu duritatea cataractei 3+ si lot B -30 ochi cu duritatea cataractei 4 +). In ambele loturi,jumatate din pacienti au fost operati prin tehnica P-C, iar cealalta jumatate prin tehnica D-C. Loturile au fost omogene in ceea ce priveste varsta, densitatea cataractei, fara patologie sistemica si oculara asociata.

REZULTATE: In toate cazurile s-au efectuat analiza endoteliala folosind microscopul endotelial direct si pahimetria ultrasonica, preoperator, a 2-a zi post-operator, la 14 zile si 2 luni. La finalul studiului, in lotulA (3+) nu s-au constatat difer-ente semnificative in pierderea de celule endoteliale prin cele doua tehnici. In lotul B (4+) au aparut diferente semnificative cu pierderi mai man pentru tehnica D-C. Pahimetria efectuata la 2 zile postoperator a evidentiat o crestere tranzitorie a grosimii corneene fata de preoperator datorita edemului cu revenire la normal la doua luni postoperator.

CONCLUZII: Indiferent de tehnica, facoemulsificarea determina modificari endoteliale. In studiul nostru tehnica P-C a mentinut mai bine structura si home-ostazia endoteliala.

ABSTRACT

Purpose: The comparative analysis of the cornea! endothelium modifications ( density, pleiomorfism and polimegetism) appeared as a result of the phacoemulsification through divide and conquer (D-C) respectively phaco-chop (P-C) technique.

Material and Method: One year prospective, observational and interventional clinical study on 60 eyes with cataract surgery through phacoemulsification by the same sugeron. They were split in 2 groups of study according to the hardness of the cataract(Group A-30 eyes with the hardness of the cataract 3+ and Group B-30 eyes with the hardness of the cataract 4+). In both groups half of the patients were treated with P-C technique surgery and the other half with D-C thechnique surgery. The groups were homogeneous in relation to age, cataract density, and without associated systemic and ocular pathology.

Results : In all cases the endothelial analysis was performed using the endothelial direct microscope and the ultrasonic pachimetry in presurgery, in the second postoperate day, at 14 days and 2 months. At the end of the study in Group A(3+) there were not noticed any significant modifications in loss of the endothelial cells through both technique surgery. In Group B(4=) appeared significant modifications with much more losses in (D-C) technique surgeries. Ultrasonic pachimetry in the second day of postsurgery has show temporary increase of cornea! thickness compared to presurgery due to cornea! edema, with recovery two months post surgery.

Conclusions: Regardless of the technique phacoemulsification leads to endothelial modifications. In our study the P-C technique maintained a better endothelial structure homeostasis.


ESTE SINDROMUL DE "OCHI USCAT" BOALA PROFESIONALA PENTRU PERSONALUL AERONAVIGANT?

DR. AURORA NICODIN, DR. MARIAN MACRI

INSTITUTUL NATIONAL DE MEDICINĂ AERONAUTICĂ Şl SPAŢIALĂ-BUCUREŞTI

ADRESĂ DE CORESPONDENŢĂ: AURORANICODIN@YAHOO.COM

REZUMAT

Ne-am propus să evidenţiem In ce măsură condipile ambientale din aparatele de zbor (avioane) influenţează confortul ocular a I personalului activ aeronautic.

1. Am inipat un studiu clinic pe un număr de 68 de pacienp (lotul 1), femei şi bărbap, personal activ aeronautic cu vârste cuprinse între 35 şi 55 de ani, per-soane aparent sănătoase ocular. Inipal pacienpi au fost supuşi unui chestionar ce urmărea aprecierea subiectivă a confortului ocular. Examinarea propriu zisă a cuprins: biomicroscopia polului anterior, colorarea cu floresceină, determinarea timpului de rupere a filmului lacrimal, testul Schirmer

S-au depistat forme subclinice, medii şi moderate de ochi uscat; s-au administrat substituenp de lacrimi.

Pacienpi au fost urmărip la interval de 3 luni, pe perioada a 9 luni de zile.

2.  Rezultatele au fost comparate cu cele obpnute la un lot martor - 20 de persoane (lotul 2), femei şi bărbap, cu vârste cuprinse între aceleaşi intervale, per-soane fără legătură cu mediul a viatic şi care au solicitat consult oftalmologic pen-tru corecpe optică.

Rezultatele ridică suspiciunea: poate fi considerat sindromul de ochi uscat o boală profesională pentru personalul aerona vigant? Răspunsul arputea fi: "prob-abil nu", cu condipa respectării regulilor impuse de autoritatea aeronautică inter-naponală (ex. hidratare periodică şi suficientă cantitativ), dar categoric factorii de mediu - ambientul aeronavelor au mare potenpal In favorizarea aparipei acestei afecpuni oculare.

"in timpulzborului, pentru personalul aeronautic este indicată utilizarea sub-stituenplor de lacrimi, pentru a contracara umiditatea scăzută din incinta aparatelor de zbor.

ABSTRACT

The purpose of this study is to analyze the eye comfort of the aeronautical personnel. This study has been conducted in ophthalmologic office of the National Institute of Aeronautical and Space Medicine, for 68 patients (group 1), men and women, active aeronautical personnel, between 35-55 years old, apparently ophtalmologically normal subjects.

First the patients were subjected to a questionnaire that was meant to provide the subjective evaluation as such included: biomicroscopy fluorescein stain, tear break up time (BUT), Schirmer tear test. There have been found subclinical, mild and moderate dry eye; tear substitutes have been prescribed.

The patients were checked up each 3 months, for a period of 9 months. Results were compared with those obtained from a control group -20 people (group 2), women and men, with ages in the same range, people not involved in the aviation field who requested ophtalmological examination for optical correction.

The results raise the question: can the "Dry eye syndrom" be considered a work-related disease?.

The answer will be "probably no" indulging oneself conditions required by International Aeronauticaly Authority (ex. periodicaly hydration and enough in volume), even if categorically envi-roment element - conditions inside the aircraft can produce this disorders. During the flight the aeronautical personnel should use tear substitutes, because of the low humidity of the air inside the craft.


EVALUAREA EFICACITATII SYSTANE ÎN FORMELE SEVERE DE OCHI USCAT

CARMEN MOCANU, DOINA BĂRĂSCU, FLORI BÎRJOVANU, RODICA MĂNESCU, FELICIA ILIUŞI - CLINICA DE OFTALMOLOGIE CRAIOVA

REZUMAT

Studiul îşi propune evaluarea efectului Systane la persoane ce prezintă senzaţie severă de ochi uscat, cu complicaţii corneene sau conjunctivale. Pentru aceasta s-a adop-tat un protocol de studiu care a constat în: compararea valorilor timpului de rupere a filmu-luilacrimal, înainte şi după tratamentul cu Systane, compararea colorării corneene şi conjunctivale, compararea testului de cristalizare înainte şi după tratament, compararea aspectului amprentei conjunctivale înainte şi după tratament, acceptabilitatea generala a Systane.

Rezultatele studiului au arătat că în cazurile severe de ochi uscat Systane creşte timpul de rupere al filmului lacrimal, cu aproximativ 2-3 secunde fata de valoarea iniţială, în paralel cu reducerea considerabila a coloraţiei corneene, conjunctivale si a hiperemiei conjunctivale in cheratoconjunctivita Sicca. Amprentele conjunctivale au relevat după tratament proliferarea celulelor conjunctivale si a celulelor caliciforme, cu aspect morfologic normal al celulelor nou formate. In toate cazurile, a fost evident efectul reepitelizant al preparatului Systane, care este determinat de acţiunea directa a HP guarului, formând un strat protector care are efect lubrifiant si ajuta la iniţierea proceselor de reparaţie tisulară.

CUVINTE CHEIE:

• Sindrom Sicca,

• Systane,

• Break-up time

ABSTRACT

The study proposes the evaluation of the Sysane effect on people that have severe dry eye sensation, with cornea or conjunctive complications. In order to do this, a study protocol has been adopted which meant comparing the values of lacrimal film break-up time, before and after Systane treatment, comparing cornea and conjunctive staining, comparing the cristalization test before and after treatment, comparing the conjunctiva! impression before and after treatment, and the general acceptibility of Systane. The study results have shown that in severe dry eye cases, Systane increases lacrimal film break-up time by 2-3 seconds than the initial value, as well as considerable reduction in corneanl/conjunctival staining and in conjunctiva! hiperemia in Sicca keratoconjunctivitis.

After treatment, conjunctiva! impression have shown the proliferation of conjunctiva! and goblet cells, with normal morphologic aspect of the new-formed cells. In every case, the regenerating effect on epithelia of Systane was obvious, which is determined by the direct action of the HP-guar, forming a protective layer with lubricative effect, helpful to the initiation of tisular repairing processes.

KEYWORDS:

• Sicca Syndrom,

• Systane,

• Break-up time


CORELATII INTRE ANALIZA STRUCTURALĂ SI CEA FUNCTIONALA LA SUSPECTII DE GLAUCOM

D. CHISELIŢĂ, C. DANIELESCU, ALINAAPOSTOL CLINICA I OFTALMOLOGIE, IAŞI

REZUMAT

Scopul lucrării: Stabilirea unor corelaţii între parametrii structural!' şi cei functional'! la suspecpi de glaucom.

Material şi metodă: La 43 pacienp (83 ochi) suspecp de glaucom s-au efectuat perimetria automata standard, scanning laser polarimetria (GDx-VCC) stratului fibre/or nervoase retiniene (SNFR) şi tomografia In coerenţă optică a SNFR şi discului optic (Stratus OCT).

Rezultate: Concordanţa diagnostică (realizată dacă un ochi este consider-at normal -respectiv a normal- în ambele teste efectuate) a fost de 60,24% între perimetrie şi OCT, respectiv 61,44% între perimetrie şi GDx. Ariile situate sub curba Receiver Operating Characteristic au fost între 0,524-0,574 pentru parametrii OCT, respectiv între 0,518-0,548 pentru parametrii GDx (considerând ca "gold standard" examenul câmpului vizual). Corelapa între măsurătorile SNFR în OCTşi GDxia valori între r=0,481 şir=0,352.

Concluzii: Afectarea structural şi cea funcponală nu se supra pun la debu-tul bolii glaucomatoase, astfel că strategia diagnostică ar trebui să includă ambele tipuri de teste.

CUVINTE CHEIE:

• suspecp de glaucom,

• perimetrie automata,

• scanning laser polarimetrie,

• tomografie In coerenţă optică

ABSTRACT

Purpose: To establish correlations between structural and functional parameters in glaucoma suspects.

Method: In 43 patients (83 eyes) of glaucoma patients we have performed standard automated peri metry, scanning laser polarimetry (GDx-VCC) of the retinal nerve fiber layer (RNFL) and optical coherence tomography (Stratus OCT) of the RNFL and optic disc.

Results: Diagnostic concordance (achieved if one eye is deemed normal - respectively abnormal - by both tests) was 60.24% between perimetry and OCT, respectively 61.44% between perimetry and GDx. The Areas under the Receiver Operating Characteristic curve were between 0.524-0.574 for OCT parameters and 0.518-0.548 for GDx parameters (considering the visual field examination as "gold standard"). The correlation between RNFL measurements in OCT and GDx took values between r=0.481 and r=0.352.

Conclusions: Structural and functional damage are not consistent with each other in early glaucoma, resulting in the fact that both tests should be used in the diagnostic strategy.

KEYWORDS:

• glaucoma suspects,

• automated perimetry,

• scanning laser polarimetry,

• optical coherence tomography


FLUCTUATIILE DIURNE SI NOCTURNE ALE PRESIUNII INTRAOCULARE SI TENSIUNII ARTERIALE SISTEMICE LA PACIENTII GLAUCOMATOSI SI NONGLAUCOMATOSI

D. CHISELIŢA, IRINAMOŢOC, C. DANIELESCU

CLINICAI OFTALMOLOGIE, SR "SF. SPIRIDON", IAŞI

*POSTER PREZENTATÎN CADRUL "6th INTERNATIONAL GLAUCOMA SYMPOSIUM"

29 MARTIE 2007, ATENA- GRECIA

REZUMAT

Scopul studiului: Determinarea şi compararea fluctuapilor presiunii intraoculare (PIO) şi ale tensiunii arteriale sistemice (TA) la pacienpi cu hipertensi-une intraoculară (HTIO) şi glaucom primitiv cu unghi deschis (GPUD) versus pacienţi non-glaucomatoşi.

Material şi metodă: Studiu observational comparativ In care s-a efectuat monitorizarea pe 24 de ore a PIO şi TA sistemice la 102 pacienp care au fost clasi-ficap astfel: grupul 1-21 pacienp cu HTIO netratate şi GPUD nou diagnosticate, grupul 2-40 pacienp cu HTIO şi GPUD cu control medicamentos satisfăcător al PIO pe timpulzilei (PIO diurnă? 21 mmHg), grupul 3 -13 pacienp cu GPUD cu control nesatisfăcător al PIO sub medicape maximal tolerată (PIO diurnă>21 mmHg) şi grupul 0-28 pacienp non-glaucomatoşi ce au constituit grupul de control.

Rezultate: Fluctuapile circadiene ale PIO la pacienpi glaucomatoşi sunt semnificativ mai man faţă de cele din grupul de control (grupul 0 -3,62±0,82mmHg, ANOVA p<0,001). La pacienpi cu HTIO/GPUD netratate fluctuapile PIO au fost semnificativ mai man faţă de cele întâlnite la pacienpi glauco-matoşi cu control medicamentos satisfăcător (grupul 1 - 5,66±1,66mmHg versus grupul 2 - 4,27±1,86mmHg, p=0,0001). Pacienpi necontrolap sub medicape maximal tolerată au prezentat fluctuapi semnificativ mai man faţă de celelalte grupuri (grupul 3-8,38±3,78mmHg, p ?0,0001). La aceşti pacienp între orele 0 - 2am s-a observat creşterea medieiPIO concomitent cu scăderea TA ("dip"ulnocturn al TA). Pacienpi glaucomatoşi tratap medicamentos au înregistrat vârful PIO mai freevent pe timpul noppi între orele 11pm - 7am (45,28% In grupul 2 şi 3 versus 10,2% In grupul0şi 1, p<0,0001).

Concluzii: Fluctuapile circadiene ale PIO la pacienpi glaucomatoşi sunt mai man decât cele din grupul de control, chiar şi In condipile unui control presio-

nal adecvat. Cele mai man fluctuaţii le înregistrează pacienpi a căror PIO nu este controlată sub medicaţie topică maximal tolerată. Pacienpi tratap medicamentos prezintă mai frecvent vârful PIO pe timpul noppi, la aceştia fiind utilă monitorizarea pe 24h a PIO.

CUVINTE CHEIE:

• glaucom

• hipertensiune intraoculară

• fluctuapi circadiene PIO

• tensiune arterială

ABSTRACT

Purpose: To determine and compare 24-hour fluctuations of intraocular pressure (IOP) and systemic blood pressure (BP) in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG) versus non-glaucoma patients.

Methods: Applanation IOP and BP were measured every 2 hours by one observer for 24 hours in 102 patients. The patients were classified: group 1-21 patients with OHT and POAG without treatment, group 2 - 40 patients with OHT and POAG with a satisfactory diurnal therapeutic control of IOP (daytime IOP?21mmHg), group 3 - 13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP>21mmHg), and group 0-28 non-glaucoma patients (control group).

Results: In all glaucoma patients groups 24-hour IOP fluctuations were greater than in the control group (group 0 - 3,62±0,82mmHg, ANOVAp<0,001). Untreated OHT/POAG had 24-hour IOP fluctuations significantly greater than those with good therapeutic control (group 1-5,66± 1,66mmHg versus group 2-4,27± 1,86mmHg, p=0,0001). POAG with uncontrolled IOP under maximal tolerated medication had the 24-hour IOP fluctuations significantly greater than the other groups (group 3 -8,38±3,78mmHg, p?0,0001). In these patients there was an evident nocturnal mean IOP peak between 0 - 2am which temporally correlates with nocturnal systemic BP "dip". Nocturnal IOP peaks (between 11pm- 7am) were found more frequently in treated glaucoma patients (45,28% -groups 2 and 3 versus 10,2% - groups 0 and 1, p<0,0001).

Conclusions: Circadian IOP fluctuations in glaucoma patients, even with a satisfactory diurnal therapeutic control, are greater than in the age-matched control subjects. Patients with uncontrolled IOP under topical maximal tolerated medication had the greatest 24-hour IOP fluctuations. Nocturnal IOP peaks occur more often in medically treated patients and 24-hour monitoring of IOP may be useful in this patients.

KEYWORDS:

• glaucoma

• ocular hypertension

• circadian IOP fluctuations

• arterial blood pressure


OPTIUNI TERAPEUTICE IN OFTALMOPATIA TIROIDIANA

PROF. DR. CRISTINA VLADUŢIU, DR. ANDREEA SECELEANU, DR. MARA CIUICĂ, DR. ANA MARIA POP - CLINICA OFTALMOLOGICĂ CLUJ-NAPOCA

REZUMAT

Oftalmomiopatia tiroidiana reprezinta un epifenomen In cadrul maladiei Graves şi însoţeşte o suferintă tiroidiană care evolueaza cu hiper,hipo sau nor-motiroidie. Miopatia tiroidiana este cea mai frecventă cauză de diplopie la adult

Lucrarea de faţă îşi propune să analizeze evolupa cazurilor de miopatie tiroidiana la care s-a încercat diferite procedee terapeutice conservative şi chirur-gicale.

Material şi metodă

A fost analizată evolutia clinică la un număr de 15 pacienp cu oftal-momiopatie tiroidiana

Pacienpi au fost tratap conservativ cu corticoterapie sistemică, injecpi retrobulbare cu cortizon,şi radioterapie antiinflamatorie. Monitorizarea pacienplor a constat In exoftalmometrie, examinarea diplopiei (ex. Hess Lancaster) şi, la o parte din ei, ecografie orbitară pentru urmărirea dimensiunilor muşchilor oculomo-tori. Trei dintre pacienp au necesitat corecpa chirurgiclă a strabismului restrictiv însopt de diplopie. Doi dintre bolnavi, care prezentau exoftalmie maligna, au sufe-rit o decompresiune orbitară la nivelul peretelui median (operape In echipa ORL-OFTA). Sunt analizate criteriile de orientare a tratamentului, şi timingul operapei de strabism In miopatia tiroidiana.

Este prezentată în detaliu evolupa clinică a uneipaciente cu miopatie tiroidiana operată pentru esotropie şi hipotropie restrictivă şi diplopie.

Discuţii, concluzii

Tratamentul conservativ In oftalmomiopatia tiroidiana este eficient In faza acută a bolii. Tratamentul chirurgical este rezervat numai situapilor In care există fibroză musculară conducând la strabism restrictiv. Tratamentul chirurgical ese indicat numai după 6 luni de "stabilitate" a deviapei strabice. Chirurgia reglabilă este procedeul de elecpe pentru rezolvarea strabismelor restrictive din oftalmomiopatia tiroidiana.

ABSTRACT

One of the most important features in Graves disease is thyroid myopathy. This condition accompanies the thyroid dysfunction, that can lead to hyper-, hypo- or euthyroidism. The thyroid myopathy is the most common cause of acquired double vision in adults.

This paper analyzes the evolution of thyroid myopathy, after conservative and surgical treatment.

Material and methods

The clinical evolution in 15 patients with thyroid myopathy was analyzed. They have been treated conservatively, with systemic corticosteroids. The orbital, local antiinflamatory treatment consisted in Rx antiinflamatory therapy and retrobulbar injections with corticosteroids. Three of the patients with restrictive strabismus and diplopia were operated on. In 2 of them, with malignant exophthalmia (proptosis), orbita decompression was necessary. The surgical strategy and timing in the restrictive strabismus is analyzed.

In the follow up period, the extent of the proptosis (exophthalmometry), the extrocular muscle size (orbital ultrasound) and the diplopia (Hess-Lancaster test) were monitorized.

The clinical evolution in one patient treated conservatively and operated on is presented in detail.

Discussions, conclusions

The conservative treatment of the thyroid myopathy is efficient only in the acute phase. The surgical treatment should be applied when muscular fibrosis and restrictive strabismus are present.

The timing of surgery is indicated after 6 months of stable ocular deviation. Adjustable surgery is the most suitable procedure for the restrictive strabismus in thyroid myopathy.