[The use of optical coherence tomography for identifying retinal nerve fiber layer progressive damage]. / Utilizarea tomografului în coerenta optica pentru evidentierea progresiei afectarii stratului fibrelor nervoase retiniene.

PURPOSE: To identify threshold values above which the intersession reduction of the retinal nerve fibers layer (RNFL) can be considered significant. METHOD: In 79 eyes (41 patients) we have performed RNFL measurements with the Stratus OCT twice in the same session. The differences between these measurements were used to calculate the test-retest variability (on clock hours, quadrants and the average RNFL thickness) using the formula: Test-retest variability = 1.96 x standard deviation (95% confidence) The resulted "threshold values" were used to identify the possible progression in a study group of 119 eyes (61 patients), followed for an average of 2 years. RESULTS: RNFL reduction exceeding the "threshold values" in 2 consecutive sessions was noticed in 18 eyes (15.12%). 12 eyes (10.08%) have fulfilled this criterion on 2 or more clock hours. 3 patients have had the criterion present on both eyes. CONCLUSIONS: This appears to be a plausible method for identifying the progression of structural damage in glaucoma, deserving further researches for validation.

[Panretinal photocoagulation with or without focal photocoagulation--the effect on central retinal thickness]. / Panfotocoagularea retiniana cu sau fara fotocoagulare maculara--efectul asupra grosimii retinei centrale.

PURPOSE: To assess the effect of panretinal photocoagulation (with or without focal macular photocoagulation) on central retinal thickness measured by OCT METHOD: Prospective, interventional, non-comparative case series. Panretinal photocoagulation (PRP) was performed in 3 sessions in 28 eyes with proliferative diabetic retinopathy In 9 eyes who had also initial macular edema we have associated focal macular laser treament concomitant with the first PRP session. Macular thickness was assessed by optical coherence tomography at baseline and after 4 and 10 weeks. RESULTS: Baseline mean central retinal thickness was 252 +/- 95 microm. It was modified to 260 +/- 105 microm at 4 weeks, then to 232 +/- 49 microm at 10 weeks. There was no statistical significance of these variations. In 2 eyes (7, 14%) we have noticed an increase of more than 100 microm in central retinal thickness. In the subgroup of 9 eyes with associated initial macular edema, combined PRP-focal treatment resulted in the decrease of central retinal thickness from 306 +/- 123 microm to 236 +/- 49 microm at 10 weeks. CONCLUSIONS: Panretinal photocoagulation can be associated with a significant increase of central retinal thickness in a small percentage of eyes. The PRP-focal macular laser combination is effective in eyes who present with proliferative diabetic retinopathy and macular edema.

[Postoperative endophthalmitis after non-pentrating deep sclerectomy]. / Endoftalmita postoperatorie dupa sclerectomie profuonda nepenetranta--caz clinic.

This is a case report concerning a patient that was subject to non-penetrating deep sclerectomy (with intraoperative Mytomicin C) for the management of advanced open angle glaucoma in the only functional eye. The surgery was uneventful, the visual acuity was preserved and the intraocular pressure was reduced. After 2 months the patient presented with symptoms of postoperative bleb-related endophthalmitis. The treatment of this condition (including pars plana vitrectomy) did not succeed in preventing a severe retinal necrosis that resulted in the loss of visual acuity This is, to our knowledge, the first published case of endophthalmitis after non-penetrating deep sclerectomy.

[Treatment with bevacizumab in exudative age-related macular degeneration]. / Tratamentul cu bevacizumab în forma exudativa a DMLV.

OBJECTIVES: evaluation of the treatment with bevacizumab for advanced exudative AMD. MATERIAL AND METHOD: prospective study on 163 patients (December 2006-February 2009). All patients received a series of 3 intravitreal injections with bevacizumab (1.25 mg/0.05 ml) at 6 weeks intervals followed by surveillance and continuation or restart of therapy based on clinical criteria and central macular thickness (CMT). The series was subdivided in three groups based on initial VA (VA < or = 0, 1; VA = 0, 1-0, 3; VA > or = 0,3). RESULTS: Final VA increased or remained constant in 88% of patients. VA increased in all three groups: from 0.029 to 0.069 in the first group; from 0.152 to 0.245 in the second group; and from 0.409 to 0.612 in the third group. In all three groups the increase in VA achieved statistical significance (p < 0.001). The whole series manifested an anatomical improvement (final mean CMT of 243.3 microm, as compared to initial mean CMT of 345.3 microm). CONCLUSION: intravitreal treatment with bevacizumab is efficient but should be followed by aggressive follow-up and rapid resume of the treatment if recurrence is diagnosed.

[Management of pseudoexfoliative glaucoma in a tertiary center in Romania]. / Managementul glaucomului pseudoexfoliativ într-un centru tertiar din România.

PURPOSE: To analyze the course of the disease and the management of patients with pseudoexfoliative glaucoma in our clinic, a tertiary center for glaucoma. METHOD: Retrospective chart review of patients admitted in the last 8 years (2000-2007). RESULTS: We have collected data concerning 330 eyes (238 patients). The mean follow-up period was 13.85 +/- 11.03 months (limits 0.5-91 months). The mean visual acuity was 0.31 +/- 0.33 and did not alter significantly. The mean initial IOP was 27.25 +/- 13.64 mmHg (50% of eyes were already under treatment, receiving an average of 1.66 +/- 0.72 drugs). During the follow-up period 66.66% of eyes were subject to antiglaucoma surgery. The mean interval from diagnosis to surgery was 10.24 +/- 23.34 months. The final IOP was significantly decreased to 17.02 +/- 7.77 mmHg (68.96% of eyes were receiving topical antiglaucoma therapy, the mean number of drugs being 1.57 +/- 0.71). The C/D ratio increased from 0.76 +/- 0.26 to 0.81 +/- 0.24 (p = 0.01). In automated perimetry the mean deviation increased from 17.13 +/- 11.68 to 17.51 +/- 10.83 (the increase was not significant, p = 0.87). The pattern standard deviation increased from 5.92 +/- 3.83 to 6.16 +/- 3.19 (p = 0.63). A number of 75 patients (31.51%) had cardiovascular diseases, most frequently arterial hypertension (27.31%) and myocardial ischemia (9.66%). CONCLUSIONS: A large proportion of our pseudoexfoliative glaucoma patients needed antiglaucoma surgery. Even after surgery, about 2/3 of eyes were still under topical therapy. Under this management, we have noted a progression of the C/D ratio, but not of the visual field parameters during the follow-up period.

[Variability of optical coherence tomography in assessment of optic disc and retinal nervous fibre layer]. / Variabilitatea OCT (optic coherence tomography) in evaluarea discului optic si stratului fibrelor nervoase retiniene.

PURPOSE: To study the short-term variability of retinal nerve fiber layer (RNFL) and optic disc measurements using Stratus OCT. METHOD: Transversal comparative study with repeated measurements. For each eye, the Fast Optic Disc and Fast RNFL protocols were repeated twice in the same session. The resulted measurements were compared using correlation and variation coefficients. RESULTS: 62 eyes (34 patients) were included in the study. For every analyzed parameter there was a highly significant correlation between the first and the second measurement (p < 0.001). For the C/D ratio (vertical, horizontal and area) the correlation coefficients varied from 0.939 to 0.961 (coefficients of variation 6.43 to 8.75%). Concerning the RNFL parameters, the correlation coefficients took values between 0.818 (for the nasal quadrant) and 0.964 (for the Average Thickness). The variation coefficients were between 4.24 and 15.14%. CONCLUSIONS: We have found an excellent reproducibility of C/D measurements (vertical, horizontal and area)--less studied in the OCT-related literature. From the RNFL parameters, the best reproducibility was found for the superior and inferior quadrant, and especially for the average thickness.

[Correlation between structural and functional analysis in glaucoma suspects]. / Corelatii intre analiza structurala si cea functionala la suspectii de glaucom.

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 perimetry, 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

[Daily and nightly fluctuation of intraocular pressure and blood pressure in glaucoma and non-glaucoma patients]. / Fluctuatiile diurne si nocturie ale presiunii intraoculare si tensiunii arteriale sistemice la pacientii glaucomatosi si nongla'ucomatosi.

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 ? 21 mmHg), group 3 - 13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP > 21 mmHg), 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 +/- 0.82 mmHg, ANOVA p < 0.001). Untreated OHT/POAG had 24-hour IOP fluctuations significantly greater than those with good therapeutic control (group 1 - 5.66 +/- 1.66 mmHg versus group 2 - 4.27 +/- 1.86 mmHg, 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 +/- 3.78 mmHg, p?0.0001). In these patients there was an evident nocturnal mean IOP peak between 0-2 am which temporally correlates with nocturnal systemic BP "dip". Nocturnal IOP peaks (between 11 pm-7 am) 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 lOP fluctuations in glaucoma patients, even with a satisfactory diurnal therapeutic control, are greater than in the age-matched control subjects. Patients with uncontrolled lOP under topical maximal tolerated medication had the greatest 24-hour lOP fluctuations. Nocturnal lOP peaks occur more often in medically treated patients and 24-hour monitoring of lOP may be useful in this patients.

Intraocular pressure after cataract surgery using Provasc, Viscoat either separately or in combination.

PURPOSE: To compare the intraocular pressure values after small-incision cataract surgery using either Provisc or Viscoat, separately or in combination. DESIGN: Prospective, randomized and masked clinical study. PARTICIPANTS: 147 eyes of 147 consecutive cataract patients. METHODS: The patients were randomly assigned to receive either Provisc (P group), Viscoat (V group) or both (V+P group) and intraocular pressure was measured at 1, 2, 3, 6, 9 and 24 h after surgery. RESULTS: There were no statistically significant differences in intraocular pressure between the P and V+P group at any point in time during the follow-up period (p>0.05); however, in the V group the intraocular pressure was higher than in the other 2 groups at 1 h (p=0.005 and p=0.006 respectively) and 2 h (p<0.001 and p<0.001 respectively). In the V group, intraocular pressure was also higher than the P group at 3 h (p<0.001). Over 50% of patients from the V group had intraocular pressure values of 30 mmHg and over after 2 h and 3 h from surgery. There were no statistically significant differences between the study groups concerning the intraocular pressure values measured at 6 h, 9 h and 24 h postoperatively (p>0.05). CONCLUSIONS: Viscoat results more frequently in high intraocular pressure values during the initial 6 h after small-incision cataract surgery with frequent cases in which the intraocular pressure could increase over 30 mmHg; therefore, close follow-up of these patients is necessary.

[Concordance of nictemeral IOP variations between fellow eyes in glaucoma and non glaucoma patients]. / Concordanta fluctuatiilor nictemerale ale presiunii intraoculare între ochii congeneri la pacienti glaucomatosi si non-glaucomatosi.

PURPOSE: To study the concordance of nictemeral IOP variations between fellow eyes in patients with treated and untreated OHT/POAG versus non-glaucoma patients. Also, we evaluate the symmetry or asymmetry level of mean, peak and IOP fluctuations between fellow eyes in glaucoma patients compared with normal controls. DESIGN: Cross-sectional study. METHODS: Applanation IOP and blood pressure were measured every 2 hours by one observer for 24 hours in 124 patients. The patients were classified: group 1--36 non-glaucoma patients (control group), group 2--32 patients with OHT and POAG without treatment, group 3--43 patients with OHT and POAG with a satisfactory diurnal therapeutic control of IOP (daytime IOP>21 mmHg) and group 4--13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP>21 mmHg). RESULTS: The nictemeral curves of fellow eyes exhibited parallel profiles; according to the paired t-test there were no significant differences between fellow eyes throughout all measurement intervals. There is a high correlation of 24 h IOP between fellow eyes in all our study groups (r=0.8632, p<0.0001). There were no significant differences between fellow eyes in moment or value of peak IOP (paired t-test p=0.53). Comparing the mean absolute differences in IOP between fellow eyes throughout all 12 measurement points, the smallest differences between fellow eyes were found in groups 1 and 3 (0.85 mmHg, respectively 0.90 mmHg, p=0.47). The differences between fellow eyes were significantly greater in groups 2 and 4 (1.28 mmHg, respectively 2.6 mmHg, p<0.0001). The greatest probability of IOP differences to be in +/- 3 mmHg interval was found in normal patients (97.91%) and in patients with therapeutic control of IOP (97.26%). The greatest asymmetry of IOP was found in the group with therapeutically uncontrolled IOP (over 1/5 measurements were outside the +/- 3 mmHg interval). CONCLUSIONS: The nictemeral variation of IOP in glaucoma patients were largely concordant between fellow eyes and the 24-hour IOP curves of fellow eyes exhibited parallel profiles. There were no significant differences between fellow eyes in mean, peak and IOP fluctuations. The asymmetry over +/- 3 mmHg between fellow eyes varied from 2.09% in normals to 20.53% in patients with therapeutically uncontrolled IOP.

[Central thickness of the cornea in ocular hypertension and open-angle glaucoma]. / Grosimea centrala a corneei în hipertensiunea intraoculara si glaucomul primitiv cu unghi deschis.

PURPOSES: To assess the necessity for corneal pachimetry in the primary open angle glaucoma (POAG) and ocular hypertension (OHT) diagnosis and follow-up. To establish a correlation between central corneal thickness (CCT) and glaucoma progression. METHOD: Retrospective study that included 199 eyes (108 patients) with POAG, normal tension glaucoma, OHT or glaucoma suspects. The evaluation included the intraocular pressure, CCT, C/D ratio and visual field (standard automated perimetry). For the patients that had performed at least 3 visual fields we have searched the perimetric progression of glaucoma and we have noted the mean lOP throughout the follow-up period. RESULTS: The mean CCT was higher in OHT (559.28 +/- 26.35 m) than in POAG (542.83 +/-31.07 microm). In the 10 cases of newly diagnosed OHT the CCT has influenced the diagnosis (the OHT with a high risk of progression to glaucoma was assigned to antiglaucoma treatment). 57 eyes had at least 3 visual fields. The Kaplan-Meyer survival analysis showed that the eyes with CCT 520 m had significantly earlier glaucoma progression ( the mean IOP was 17.59 +/- 2.33 mmHg, compared to 18.28 +/- 1.55 mmHg in the eyes with CCT> 520 m, p = 0.36). CONCLUSIONS: The central corneal thickness is significantly higher in eyes with ocular hypertension than in those with POAG. In eyes with thin cornea the glaucoma progression tends to appear earlier, which suggests a need for lower target IOP in these cases.

[Efficiency of air tamponade in prevention of early recurrence of vitreal hemorrhage in diabetic patients with vitrectomy]. / Eficienta endotamponadei cu aer in preventia recurentei precoce a hemoragiei vitreene la diabeticul vitrectomizat.

PURPOSE: To evaluate the efficacy and safety of air endo-tamponade in preventing early recurrence of vitreous hemorrhage in diabetic vitrectomy. MATERIALS AND METHODS: Prospective, consecutive, interventional, non-randomized study including 40 eyes (from 40 patients) with persistent or recurrent vitreous hemorrhage related to proliferative diabetic retinopathy. At the end of vitrectomy 20 cases (study group) were assigned to complete fluid--air exchange while the other 20 cases (control group) were left with BSS Plus. RESULTS: Early postoperative bleeding occurred in 9 out of 40 cases--22.5% (3 cases from the study group--15% and 6 cases from the control group--30%, p < 0.05). There was no statistically significant difference in visual acuity, intraocular pressure or incidence of late-onset hemorrhage recurrence between both groups during 6-month postoperative follow-up. In the study group there was a higher rate of lens opacities appearance. CONCLUSIONS: Air endo-tamponade seems a simple and efficient way of preventing early recurrence of vitreous hemorrhage in diabetic vitrectomy. Higher rate of lens opacities appearance may counteract this advantage thus this technique could be safely and electively used in pseudophakic patients.

[FDT versus automated standard perimetry in healthy subjects]. / FDT vs. perimetria statica automata la voluntari sanatosi.

PURPOSE: To assess the frequency of visual field defects in frequency doubling technology (FDT) perimetry performed in healthy volunteers and the correlations between FDT and standard automated perimetry (SAP). METHOD: A transversal study that included 57 healthy volunteers who were subject to visual field testing in both FDT and SAP (randomly effectuated in the same day). The studied parameters were: the frequency of visual field defects in the two techniques, the correlation of the quantitative parameters (MD, PSD) with the C/D ratio and also between techniques, the test reliability and the test duration. The subjects have been questioned about their preference for one test or another. RESULTS: The frequency of visual field defects was 47.35% in FDT and 22.8% in SAP. The MD values were significantly higher in FDT (MD FDT= -1.45+/-1.91, MD SITA= -0.77+/-1.58, p< 0.0001). Also the PSD values were higher in FDT (PSD FDT= 3.76+/-0.96, PSD SITA= 1.94+/-1.05). The correlation of quantitative parameters between the two techniques was low (r = 0.369 for MD and 0.206 for PSD). The correlation between the PSD value and the C/D ratio was extremely weak in both methods (because the subjects were healthy). The mean duration of a FDT test (4 '29") was significantly lower than that of a SITA test (5'18") - p < 0.00001. The reliability indices (fixation losses, false negative and false positive errors) were significantly better in FDT, and 3/4 of subjects declared that they preferred the FDT test. CONCLUSIONS: In normal subjects the frequency of visual field defects was greater in FDT than in SAP. There was a low correlation of quantitative parameters (MD, PSD) between SAP and FDT, and also with the C/D ratio. Better reliability indices, shorter test duration and better patient compliance are arguments for using FDT as a screening test for glaucoma.

[A comparative analysis of standard automated perimetry and short wavelength automated perimetry in early diagnosis of glaucoma]. / Analiza comparativa a perimetriei automate standardizate si a perimetriei "albastru pe galben" in diagnosticul precoce al glaucomului.

PURPOSE: To assess the concordance between standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). To analyze comparatively the early detection and the extent of visual field defects in glaucoma suspects and in early glaucoma. METHOD: A prospective, randomized study that included 55 patients (107 eyes), glaucoma suspects or with early glaucoma who were randomly subject to both SAP and SWAP; the examinations were repeated at 3 and 6 months in order to establish that the visual field defects were real. The studied parameters were the mean value of MD and PSD in the two techniques, the correlation between the results (global and on patients subgroups), the percentage of patients in which the defects were larger, deeper or new defects were found when examined in SWAP. RESULTS: There was no statistically significant difference in the MD value between the two methods (-3.42 +/- 5.17 dB in SWAP, -2.83 +/- 4.84 dB in SAP, p = 0.14); the PSD value was significantly higher (p < 0.0001) in SWAP (3.63 +/- 1.36 dB) than in SAP (2.66 +/- 1.97 dB). There was a high correlation of the MD and PSD values between the two techniques; the highest correlation appeared in POAG patients. The SWAP test has evidenced visual field defects in 10.1% of eyes with normal SAP tests and also larger and deeper defects in 18.7% of cases. CONCLUSIONS: The SWAP and SAP results were concordant; the visual field defects were earlier detected, appeared larger and deeper in SWAP than in SAP.

CONCENTRATIONS OF VITREAL CYTOKINES IN RHEGMATOGENOUS RETINAL DETACHMENT.

UNLABELLED: Proliferative vitreoretinopathy (PVR) is one of the most frequent causes of failure of rhegmatogenous retinal detachment (RRD) surgery. AIM: To measure the vitreous levels of granulocyte colony stimulating factor (G-CSF) and monocyte chemoattractant protein 1 (MCP-1) in eyes with RRD and in a control group. MATERIAL AND METHODS: A prospective study of 40 patients operated for RRD (study group) and 20 patients with epiretinal membrane or macular holes (selected as control group since they needed vitrectomy but had attached retinas). Vitreous samples were collected during vitrectomy and were assessed for the presence of cytokines using a fluorescent bead-based multiplex assay. RESULTS: The concentration of G-CSF (8.59 pg/ml) and MCP-1 (1615.2 pg/ml) were significantly increased in the study group, when compared to the control group (0 and 469.13 pg/ml, respectively). MCP-1 was also significantly increased in the subgroup of patients with PVR compared to the patients with uncomplicated RRD. CONCLUSIONS: The levels of these biomarkers support the idea that proliferative vitreoretinopathy has an inflammatory component.

OUTCOMES OF SURGERY IN PROLIFERATIVE VITREORETINOPATHY.

AIM: To present the anatomical and functional outcomes of surgery in cases of rhegmatogenous retinal detachment complicated (at presentation) by proliferative vitreoretinopathy (PVR). MATERIAL AND METHODS: Retrospective study of the cases operated upon by a single surgeon between October 2012 and September 2014. RESULTS: A total of 49 eyes of 49 patients had PVR at presentation (12 cases with PVR stage B, 21 with stage C and 16 with stage D). 82% had a VA < or = 0.05 at presentation. Peripheral retinectomy was the primary surgery in 57% of cases. Reinterventions was required in 16.3% of the cases (silicon oil extraction was not considered reintervention). Although at the first postoperative examination 32% of eyes had an IOP > 21 mmHg without medication, only 8% retained a high lOP at the last visit. At the last visit 73.4% of eyes presented attached retina (an additional 6% had an attached macula under silicone oil, but sub retinal fluid in the inferior quadrants). A final VA > or = 0.05 was recorded in 67.3% of eyes (of which half had VA > or = 0.1) CONCLUSIONS: In cases presenting with retinal detachment complicated by PVR the possibility of reinterventions and the risk of intraocular hypertension should be considered. Unfortunately, even some cases with favorable anatomical outcome will not present ambulatory vision. Keywords:

[Learning effect in computerized perimetry]. / Efectul de învatare în perimetria standard computerizata.

PURPOSE: To highlight the learning effect in automated perimetry and to assess the value of the first visual field in glaucoma diagnosis. METHOD: A prospective study that included 48 patients (91 eyes)--glaucoma suspects--who performed 3 visual field tests in no more than 12 months. RESULTS: 32 eyes were diagnosed with intraocular hypertension and the others with POAG. An improvement (expression of the learning effect) was noted in 45.05% of eyes (in an average of 3.39 2,72 points) in the second visual field and in 37.36% of eyes (3.05 2.13 points) in the third visual field. Considering (as a hypothesis) the third visual field as gold standard, the first test had a sensitivity of 87.03% and a specificity of 89.18% in detecting visual field defects (efficiency 89,01%). The second test had a sensitivity of 92.59% and a specificity of 89.18% (efficiency 91.2%). CONCLUSIONS: The learning effect was present in the first three tests, but seems to have little influence on the diagnosis of visual field defects. A possible explanation is the presence to a large extent of important visual field loss (obvious from the first test) in the included patients.

Comparative analysis of the efficacy and safety of latanoprost, travoprost and the fixed combination timolol-dorzolamide; a prospective, randomized, masked, cross-over design study.

PURPOSE: To analyse comparatively the efficacy and tolerance of latanoprost, travoprost and the fixed combination timolol-dorzolamide in the treatment of primary open angle glaucoma and ocular hypertension. METHOD: Prospective, investigator masked, randomized study that included 38 patients (38 eyes) with primary open angle glaucoma uncontrolled under beta blockers. Each patient received latanoprost, travoprost and the fixed combination timolol-dorzolamide (for 3 months each). The first drug and the order of the next drugs administered were randomized. The follow up period was 9 months. At the baseline and at the end of each therapeutic period (3 months) we determined the IOP (at 8, 10 a.m. and 4 p.m.), visual acuity, C/D ratio, blood pressure, heart rate and local tolerance. We have also photographed the eyelids, lashes, conjunctiva and iris. After each month of treatment we determined the IOP (at 8 and 10 am), visual acuity, blood pressure, heart rate and local tolerance. RESULTS: The mean initial IOP was 25.1 2.89 mmHg and after 9 months of treatment 21.67 4.59 mmHg. Each drug induced a statistically significant IOP decrease (the fixed combination timolol-dorzolamide decreased IOP with 14.33%, travoprost with 18.39% and latanoprost with 22.1%). The IOP lowering was comparable for the prostaglandin derivatives and superior to the fixed combination timolol-dorzolamide. None of these drugs had a negative influence on the visual field, C/D ratio, visual acuity, blood pressure and heart rate. There was good local tolerance. The side effects were more frequent after travoprost (37) and latanoprost (22) than after the fixed combination timolol-dorzolamide (4 cases). The most important adverse events for the prostaglandin derivatives were conjunctival hyperemia, eyelashes pigmentation and growth, iris pigmentation. There was no necessary to stop the medication because of these effects. CONCLUSIONS: Travoprost, latanoprost and the fixed combination timolol-dorzolamide are efficient in the treatment of primary open angle glaucoma. The prostaglandin derivatives determined similar IOP decrease, which was superior to the fixed combination timolol-dorzolamide; the local tolerance was good, the fixed combination causing the fewest side effects.

[Ring iris melanoma]. / Melanom irian de forma inelara.

We are presenting a case of diffuse (ring) iris melanoma with secondary glaucoma, together with the differential diagnosis issues. The tumor extension and the high IOP imposed the enucleation of an eye that still had a good visual acuity. The pathology confirmed the diagnosis and showed the extension to the anterior chamber angle and the ciliary processes. The prognosis in this rare type of uveal melanoma is worse than in other iris melanomas.