Initial Clinical Experience with Ahmed Valve Implantation in Refractory Pediatric Glaucoma

The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve (AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management of refractory pediatric glaucoma observed during one-year follow up period. A retrospective chart review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and 2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma medications) and changes in visual acuity. Complications were recorded. After AGV implantation, IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively high complication rate limiting the overall success rate.

Macular thickness after glaucoma filtration surgery.

The aim of present study was to analyze early postoperative changes in the macular area using optical coherence tomography (OCT) after uncomplicated glaucoma filtration surgery. This prospective study included 32 patients (34 eyes) with open-angle glaucoma, which underwent trabeculectomy with or without use of mitomycin C. Exclusion criteria were macular edema, uveitis, age-related macular degeneration, blurred optical media, secondary glaucoma and angle-closure glaucoma. All standard clinical examinations were made before surgery, at the 2nd day, 1 week and 1 month after surgery. Tomography of the macula was performed during every examination using Cirrus HD OCT for the analysis of central subfield thickness. Results show that thickening of the macula was slightly higher 1 week and 1 month after operation in comparison with baseline end 2nd day postoperativelly. There was no significant difference in the change of macular thickness in patients who have used topical prostaglandins compared with those who have used other topical medications. Also, there was no difference in macular changes between patients treated with or without mitomycin C. In conclusion, we found a slight subclinical increase in macular thickness after uncomplicated trabeculectomy, for which we considered that was the result in reduction of intraocular pressure after glaucoma surgery. Macular thickening after glaucoma filtering surgery could be a physiological reaction to the stress of the retina caused by a sudden reduction of intraocular pressure and it is the consequence of altered relationship between capillary pressure and interstitial fluid pressure.

Macular thickness and volume parameters measured using optical coherence tomography (OCT) for evaluation of glaucoma patients.

The aim of this study was to evaluate macular thickness parameters in glaucoma patients and to compare them to normal subjects using Optical Coherence Tomography (OCT). This prospective, observational study included 20 primary open angle glaucoma patients (POAG) and 20 healthy subjects in control group. Exclusion criteria were diabetes and other macular pathology, like age-related macular degeneration, macular oedema, central serous retinopathy and high myopia >4.00 dsph. OCT imaging of peripapillar retina and macular area were performed using Cirrus HD OCT In these two groups of patients we analyzed changes of macular thickness parameters (central subfield thickness, macular volume, and average macular thickness). The group of glaucoma patients had decreased values of the two macular thickness parameters: macular volume and average macular thickness, compared to control group. There was no difference in central macular thickness, presumably because of the absence of the ganglion cells in this layer. Macular imaging can be a useful additional method to determine glaucoma status and has a potential for tracking glaucoma progression.

Comparison of evening and morning dosing of travoprost 0.004%/timolol 0.5% fixed combination in 6 month period.

An open label, multi-center, 6 months observational study of new fixed combination (travoprost 0.004%/timolol 0.5%), in order to evaluate both efficacy (intraocular pressure lowering) and tolerability (patient and investigator satisfaction) of two dosing regimens--evening (PM) and morning (AM). After screening for enrollment, to 40 patients (79 eyes with primary open angle glaucoma or ocular hypertension), new fixed combination travoprost 0.004%/timolol 0.5% was prescribed once a day in the evening (PM). Patients were enrolled according to each investigator decision on indication for travoprost 0.004%/timolol 0.5% fixed combination once a day, without washout period after previous medication. Intraocular pressure was measured at 9 AM at all time control points: at baseline, after 1 month, after 3 months and after 6 month. After 1 month, screening for nonresponders (criteria: 20% intraocular pressure lowering) and subjects with major side effects was performed. At second control visit, after 3 months PM dosing, intraocular pressure was measured and patients were instructed to continue once a day the same medication, but in the morning (AM) for consequent 3 months. After 1 month, reduction in mean intraocular pressure value was 21.66%. At the visit after 3 month, the mean intraocular pressure was 15.67 +/- 2.17 mm Hg (reduction 21.14%). 3 month after dosing regimen changed to AM (6 month after beginning of travoprost 0.004%/timolol 0.5% combination therapy), reduction in intraocular pressure value was 19.86%. The differences (mean +/- standard deviation) in intraocular pressure values after 1, 3 and 6 month were all highly statistically significant compared to baseline values. The tolerability was evaluated in five steps (Likert scale) ranging from unsatisfactory to excellent by both patient and investigator--taken at 3 and 6 month control visit. 95% of patients and 100% of investigators were satisfied with the possibility of choosing dosing regimen for travoprost 0.004%/timolol 0.5% fixed combination. Travoprost 0.004%/timolol 0.5% fixed combination proved sufficient intraocular pressure control dosed either PM or AM with no statistically significant difference between two dosing regimens. Possibility to choose between two dosing regimens gives each practitioner additional reassurance that glaucoma therapy will be individualised to needs of each patient.

Botulinum toxin A injection for primary and recurrent chalazia.

BACKGROUND: To study the efficacy and safety of subcutaneous botulinum toxin A injections in the treatment of primary and recurrent chalazia. METHODS: Prospective, placebo-controlled consecutive case-series trial. Sixty three patients were divided into two groups: group 1 consisting of 32 patients previously diagnosed with and treated for primary or recurrent chalazia with 2-5 international units (IU) in 0.2-0.5 ml of preserved saline solution of botulinum toxin injection, and group 2 consisting of 31 patients receiving placebo. The main outcome measures were localization and duration of the disease, size of chalazion before and after treatment, clinical resolution of chalazion, time to resolution, and complications of treatment. RESULTS: There was a clinically and statistically significant between-group difference in the rate of therapeutic success and post-therapeutic chalazion regression, but not in the rate of complications. CONCLUSIONS: Botulinum toxin A injection is effective and safe treatment for primary and recurrent chalazia. Lesion regression that did not respond to the average of two injections would benefit more from surgical excision or systemic antibiotic therapy.

[Ophthalmological causes of headache]. / Okularni uzroci glavobolje.

Ophthalmologic causes of headache represent a very complex and extensive problem, and very often differential diagnostic problem too. Many various reasons of headache can be caused by ophthalmologic diseases like those of anterior and posterior eye segments, acute and subacute angle closed glaucoma and orbital diseases. Headache can be caused by no or poor correction of the refraction anomalies. Ophthalmologic causes of headache are quite frequently connected with conditions that affect other body systems apart from the eyes, nervous and/or vascular system in particular. Although ophthalmologic examination very provides the clue in patients with headache, the diagnostic and therapeutic approach to the problem has to be interdisciplinary.

Comparison of preoperative and postoperative astigmatism after superotemporal or superonasal clear corneal incision in phacoemulsification.

The aim of this work was comparison of preoperative and postoperative astigmatism after superotemporal or superonasal clear corneal incision. Twenty eight eyes of 28 patients treated with phacoemulsification through superotemporal or superonasal 3 mm clear corneal incision were examined by kerato-refractometer preoperatively and six months postoperatively. Adequate score was assigned to each preoperative and postoperative K-value with associated axis of astigmatism to enable comparison. Wilcoxon paired samples test was used for statistical analysis. Postoperative uncorrected Snellen visual acuity was 0.5 or better in 26 patients. In one patient visual acuity was 0.3 because of diabetic maculopathy. Postoperative astigmatism was less or equal than preoperative in 18 and greater in 10 patients. There was no statistical difference between the preoperative and postoperative astigmatism (Wilcoxon paired samples test, p = 0.966) and therefore the conclusion can be made that the superotemporal or superonasal clear corneal incision has minimal effect on corneal astigmatism.

Analysis of the qualitative dermatoglyphics of the digito-palmar complex in patients with primary open angle glaucoma.

The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10-30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito-palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.

[Pars plana vitrectomy and intravitreal triamcinolone for chronic pseudophakic cystoid macular edema]. / Pars plana vitrektomija kod kronicnog pseudofaknog cistoidnog makularnog edema.

AIM: To report on the results of pars plana vitrectomy and intravitreal triamcinolone in patients with chronic pseudophakic cystoid macular edema unresponsive to medical treatment. PATIENTS AND METHODS: A retrospective analysis of 9 eyes in 9 patients with chronic pseudophakic cystoid macular edema was performed. All patients had cystoid macular edema confirmed on fluorescein angiography, and were unresponsive to medical treatment. In all patients pars plana vitrectomy and intravitreal application of 4 mg of triamcinolone was performed. In one patient with vitreous prolapse into the anterior chamber, anterior vitrectomy was also required. RESULTS: The mean interval between cataract surgery and vitrectomy was 16.28 +/- 2.1 months. The mean preoperative best corrected visual acuity was 0.1 +/- 0.11, and the mean final best corrected visual acuity 0.25 +/- 0.24, after a mean follow up of 6.6 +/- 3.5 months. In all 9 eyes there was a marked reduction of cystoid macular edema, as verified on fluorescein angiography. Intraocular pressure was raised in 4 patients, and it was controlled by topical antiglaucomatous treatment. CONCLUSION: Pars plana vitrectomy and intravitreal triamcinolone in eyes with chronic pseudophakic cystoid macular edema resulted in a reduction of cystoid macular edema, and visual acuity improvement.

[Argon laser trabeculoplasty or selective laser trabeculoplasty in the treatment of open-angle glaucoma]. / Argonska ili selektivna laserska trabekuloplastika u lijecenju glaukoma otvorenog kuta?

Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are effective treatment modalities for intraocular pressure (IOP) lowering in open angle glaucoma patients. SLT and ALT produce equivalent IOP reduction. The choice of either option will depend on the state of glaucoma, previous and current treatment, side effects and patient's reference. Preservation of the angle trabecular meshwork structures and effective retreatment for IOP lowering after ALT has failed, offer some theoretical advantage of SLT.

[Correlation of photodynamic therapy outcome with choroidal neovascular membrane size]. / Procjena uspjesnosti fotodinamske terapije s obzirom na velicinu korioidalnih neovaskularizacija.

AIM: To show the results of photodynamic therapy according to the size of choroidal neovascular membrane size. PATIENTS AND METHODS: A retrospective analysis included 94 patients undergoing photodynamic therapy at University Department of Ophthalmology, Sestre MilosrdniceUniversity Hospital from 2001 till 2005. There were 61 patients with age related macular degeneration (AMD) and 33 patients with high myopia. All patients had a predominantly classic choroidal neovascular membrane. Patients were divided into two subgroups according to the lesion size. The first subgroup included patients with a lesion equal to or less than one disc diameter, and the second subgroup had a lesion greater than one disc diameter. All patients were followed up for a minimum of 3 months. RESULTS: In the group of patients with AMD statistical analysis showed no significant difference in total closure and decrease in the size of choroid neovascularization (CNV) between the two subgroups. In the group of patients with high myopia a statistically significant difference was found in total closure and decrease in the size of CNV between patients with lesions smaller or equal to one disc diameter and those with lesions greater than one disc diameter. The former group also had better visual outcome. CONCLUSION: The size of CNV was not a prognostic factor in patients with AMD. In patients with high myopia, better outcome was recorded in the subgroup with CNV smaller or equal to one disc diameter.

[Combined laser treatment in the management of acute and subacute primary angle closure glaucoma]. / YAG laserska iridotomija i argonska laserska iridoplastika--kombinirani laserski zahvat u lijecenju akutnog i subakutnog primarnog glaukoma zatvorenog kuta.

UNLABELLED: Primary angle closure glaucoma remains a disease with high visual morbidity worldwide. Patients with primary angle closure glaucoma may have dramatic signs and symptoms that can lead to permanent blindness in a short period of time if not properly treated. Conventionally, medical treatment was used to lower the intraocular pressure (IOP), followed by laser peripheral iridotomy. It acts by elevating pupillary block present in the condition. Laser peripheral iridoplasty is a tehnique using low energy contraction burns to mechanically pull open the angle, thereby reducing the IOP. AIM: The aim of this study was to evaluate the therapeutic effect and safety of combined laser technique (argon laser iridoplasty and YAG laser peripheral iridotomy) in the management of medically unresponsive acute and subacute angle closure glaucoma. PATIENTS AND METHODS: Sixteen eyes with acute and subacute primary angle closure glaucoma unresponsive to medical treatment were included in the study. All patients were treated by laser tehnique that included YAG laser peripheral iridotomy and argon laser iridoplasty in the eye without satisfactory response to previous laser treatment. We also documented complications of laser treatment. The IOP levels were documented by applanation tonometry. RESULTS: In 14 of 16 eyes combined laser treatment resulted in rapid IOP reduction. Only two patients failed to respond to the combined laser therapy and were surgically treated (clear lens extraction). No serious laser complications were recorded during the early period after laser therapy. CONCLUSION: YAG laser peripheral iridotomy and argon laser iridoplasty as a combined treatment may be useful for IDP lowering in the management of medically unresponsive acute and subacute primary angle closure glaucoma.

[Intravitreal application of triamcinolone--our experiences]. / Nasa iskustva u intravitrealnoj primjeni triamcinolona.

AIM: To show the results of intravitreal application of triamcinolone used as a primary or adjuvant therapy. PATIENTS AND METHODS: We analyzed 48 patients with different ocular disorders: exudative age related macular degeneration, diabetic retinopathy, or central retinal vein occlusion. We analyzed color fundus photography, visual acuity, fluorescein angiography and complications of intravitreal triamcinolone application. RESULTS: There was a marked reduction of macular edema in 70% of patients verified on fluorescein angiography. Visual acuity improved in 62% of patients. The most common complication was transient rise in intraocular pressure. There was no case of endophthalmitis. CONCLUSION: Intravitreal application of triamcinolone is relatively safe and efficacious in selected patiens with different ocular disorders.

[Intraocular pressure after ND: YAG laser capsulotomy in pseudophakic patients with glaucoma]. / Intraokularni tlak nakon Nd: YAG laserske kapsulotomije u pseudofaknih bolesnika s glaukomom.

AIM: The aim of the study was to analyze changes in intraocular pressure after Nd: YAG laser capsulotomy in pseudophakic patients with glaucoma. PATIENTS AND METHODS: Intraocular pressure was recorded before, and 1 and 3 hours after YAG laser capsulotomy in 69 pseudophakic patients with glaucoma. Twenty eight patients received no therapy before capsulotomy, 21 patients received topical brimonidine 0.2%, and 20 patients received topical dorzolamide 2% 1 hour before laser capsulotomy. All patients received topical tropicamide 1% and tetracaine 0.5%. Nd: YAG laser posterior capsulotomy was performed using inverted-U technique to make a 3-4 mm diameter capsulotomy. After capsulotomy, all eyes received topical fluorometholone for 10 days. RESULTS: A pressure rise was greater in patients without any therapy before YAG laser capsulotomy. Eight patients with glaucoma showed intraocular pressure rise of 5 mm Hg, and 2 patients pressure rise of 10 mm Hg after laser capsulotomy. A reduction of intraocular pressure rise was found in patients who received dorzolamide 2% or brimonidine 0.2%, only 1 patient in each group developed a pressure rise of 5 mm Hg. In all patients a significant pressure rise developed within the first hour. DISCUSSION: It is difficult to compare different studies due to different techniques of cataract surgery and different intraocular lense material and design. Barnes showed that 6 of 29 (21%) developed a pressure rise of 5 mm Hg, and 1 of 29 (3%) patients a pressure rise of 10 mm Hg. In our study, 29% of patients had a pressure rise of > or =5 mm Hg, and 7% of patients had a rise of > or =10 mm Hg after laser capsulotomy. These results may be associated with a large proportion of extracapsular cataract extraction (71%) versus phacoemulsification (29%) in our patients. CONCLUSION: Pretreatment with dorzolamide 2% or brimonidine 0.2% reduce the intraocular pressure rise after Nd: YAG laser capsulotomy in pseudophakic patients with glaucoma.

[Use of antiglaucoma therapy to reduce acute intraocular pressure rise following neodymium: YAG laser iridotomy in angle-closure glaucoma patients]. / Lokalna terapija glaukoma u redukciji akutnog povisenja intraokularnog tlaka u bolesnika s glaukomom zatvorenog kuta nakon neodymium: YAG laserske iridotomije.

AIM: To evaluate the efficacy of topical antiglaucoma therapy in reducing acute intraocular pressure (IOP) elevation after neodymium: Yag laser iridotomy. PATIENTS AND METHODS: Primary angle-closure glaucoma (PACG) eyes were randomized to receive premedication with latanoprost and pilocarpine, brimonidine 0.2% and pilocarpine or only with pilocarpine before Yag laser iridotomy. Postoperative IOP changes were compared with Wilcoxon signed-ranks test using the fellow eyes in each group. RESULTS: Postoperative pressure spikes were significantly lower in the groups of patients with local antiglaucoma therapy with pilocarpine than in the control group. Mean elevation of IOP was less in the groups of patients with local antiglaucoma therapy with pilocarpine at 2 hours postoperatively. CONCLUSION: Local antiglaucoma therapy may reduce the acute IOP rise following Yag laser iridotomy in PACG eyes.

[Triamcinolone acetonide in the treatment of inflammation after cataract surgery]. / Triamcinolon acetonid u lijecenju upale nakon operacije katarakte.

AIM: To compare the use of single injection of triamcinolone acetonide and steroid drops in the treatment of inflammation after cataract surgery. PATIENTS AND METHODS: This retrospective study included 80 patients operated on by phacoemulsification with intraocular lens implantation. After the operation, patients were divided into two groups. Group A received dexamethasone-neomycin drops for four weeks, whereas group B received single application of triamcinolone acetonide into the subtenon space. Postoperative evaluation included the degree of inflammation, intraocular pressure and therapeutic response. RESULTS: Triamcinolone acetonide appeared to be an as valuable therapy in minimizing inflammation after cataract surgery as steroid drops on days 7, 14 and 21 postoperatively, a significantly lower intraocular pressure was recorded in the group of patients administered a single injection of triamcinolone acetonide. CONCLUSION: Single application of triamcinolone acetonide appeared to be as efficient as steroid drops in controlling postoperative inflammation after uncomplicated cataract surgery.

[Sulcus fixation of a foldable acrylic intraocular lens]. / Sulkus fiksacija savitljive intraokularne lece.

AIM: To describe a surgical technique for sulcus fixation of a foldable single-piece acrylic intraocular lens (IOL) through a 3.0 mm clear cornea incision. PATIENTS AND METHODS: Between 2003 and 2004, this technique was used in 10 eyes at Sestre Milosrdnice University Hospital. Seven eyes were aphakic secondary to a capsule defect during phacoemulsification, one eye had a perforating injury with lens destruction, and two eyes were aphakic after congenital cataract extraction in childhood. In all eyes an AcrySof Natural SN60AT foldable single-piece acrylic IOL (Alcon, Forth Worth, TX, USA) was implanted. RESULTS: The median age of patients at surgery was 41 (range 31-68) years, and the median follow up was 11 (range 4-18) months. In all cases, the intraocular lens was placed and fixed in the anatomic sulcus without complications. Slight IOL decentration (up to 1.0 mm) was seen in 2 eyes, and transient hypotonia and transient cystoid macular edema in 1 eye each. DISCUSSION: In the absence of adequate posterior capsule support, scleral sutured posterior chamber intraocular lens implantation has become a popular technique. The reduction in incision, from 7 mm for the implantation of poly(methyl methacrylate) (PMMA) IOL to 3 mm for foldable IOL, represents an improvement in the technique, allowing for good postoperative vision recovery. Small incision helps maintain adequate intraoperative intraocular pressure in the anterior chamber. The design of single-piece AcrySof Natural lens allows for easy and safe fixation of the Prolene suture to the IOL. Also, this technique with scleral flaps that protects the exposed suture helps reduce the risk of endophthalmitis. Longer follow up is needed to ascertain the stability of this suture fixed IOL. CONCLUSION: Sulcus fixation of a foldable IOL offers an acceptable alternative for rehabilitation of vision function. The unique design characteristics of the single-piece AcrySof Natural IOL make possible the suture fixation through a small clear corneal incision.

[Ocular findings in Fabry's disease]. / Fabryjeva bolest i promjene na ocima.

INTRODUCTION: Fabry's disease is a recessive X-linked disorder that results from a deficiency of the lysosomal hydrolase a-galactosidase A (alpha-Gal A). The absence of alpha-Gal A enzyme activity leads to accumulation of glycosphingolipid globotryaosyl ceramide (GL-3) in the lysosomes of a variety of cell types. Subsequently, angiokeratoma and ocular signs develop until, in most cases after the third decade of life, severe renal dysfunction or cardiomyopathy becomes obvious. Corneal opacities (cornea verticillata) occur in 90% conjunctival vascular changes in 60%, retinal vessel tortuosity in 55%, and cataracts in 50% of cases. Recently, enzyme replacement therapy has been shown to be an effective treatment modality that can eliminate glycolipid stores and reverse the disease pathology. CASE REPORT: A male patient born in 1971 was admitted for clinical examination due to proteinuria and erythrocyturia. During further evaluation nephrologist suspected Fabry's disease, because patient had skin changes early referred as petechiae, and acroparesthesias. He had also low heat tolerance and virtually no sweat. Physical status: angiokeratoma on gluteat regions and upper arms. Urine analysis in several occasions 10-15 E in sediment, alb. positive. On ECG, 2-mm depression of ST in precordial region. Heart ultrasound: low mitral regurgitation angio stage 1, left ventricle hypertrophy. Abdomen ultrasound: both kidneys around 12 cm large, parapyelic cysts in both kidneys of 2.5 cm in diameter. Biomicroscopy of both eyes: cornea verticillata. Fundus of both eyes: papillae n. optici with poorly defined edges, but without prominence, very tortuotic retinal blood vessels. In March 2002, very low alpha GAL enzyme activity in blood (alpha-Gal A = 0.5 +/- 0.2 nmol of substrate hydrolyzed hourly per serum mL--normal serum enzyme level 8.5-18.9 nmol/mL/h). In May 2002, enzyme replacement therapy was started with recombinant alpha-Gal A enzyme (Fabrazyme) 1 mg/kg every 14 days. Control evaluation and examination showed good cardiac and renal function. The patient felt better and stronger with improved heat tolerance. CONCLUSION: Fabry's disease occurs in all ethnic groups. It is estimated that one in 200 people is a carrier, and one in 40,000-100,000 has the disease. Today in Croatia, Fabry's disease has been diagnosed in only one patient, and according to the usual prevalence there are still 45-100 unrecognized patients. The ophthalmologists are in excellent position to diagnose Fabry's disease in early stages. Therefore it is very important that the ophthalmologists in Croatia become aware of the importance of ocular findings in Fabry's disease, so they can participate in the identification of unrecognized patients.

[Distichiasis]. / Distihijaza.

Distichiasis is a rare congenital or acquired eyelid anomaly in which an accessory row of eyelashes arises from the openings of meibomian glands or near them. The abnormal cilia are posterior to the normal row of cilia and may abrade the eye causing ocular irritation and corneal damage. We describe a 9-year-old Caucasian girl with bilateral and symmetric distichiasis. This condition was treated with lid splitting followed by cryotherapy to the posterior lid lamella. The technique has been used in four eyelids with congenital distichiasis, with very good results.

[Primary non-Hodgkin orbital lymphoma: case report]. / Primarni non-Hodgkin limfom orbite: prikaz bolesnice.

The aim of this case report is to present a very rare case of primary malignant non-Hodgkin orbital lymphoma, found in an 80-year-old female patient with rapid orbital structure compression. Detailed ophthalmologic, radiologic, hematologic and oncologic examinations and laboratory tests were done before, during and after treatment. Diagnostic ultrasonography and computed tomography images of the right orbital cavity demonstrated a solid naoplastic process which dislocated the eyeball without invasion of orbital structures. Upon diagnostic evaluation, tumor lesion was surgically removed including orbitotomy with lower transpalpebral approach. Histopathologic diagnosis and type of tumor tissue were defined by histology and immunohistochemistry analyses of open biopsy material obtained ex tempore. Finally, the diagnosis was confirmed by histopathology of the resected tumor mass: lymphoma malignum non-Hodgkin, diffuse large B-cell type, with high mitotic activity. Neoplastic B lymphocytes showed CD 20 positive surface antigens and kappa light chain expression. The treatment was continued with hematologic therapy. The patient received three cycles of systemic chemotherapy (CHOP protocol). Upon combined therapy completion, control examinations showed the patient to have no signs of disease in the orbital region. Interdisciplinary approach in the diagnostic evaluation, therapy and long-term observation proved to be necessary in patients with malignant non-Hodgkin lymphoma.