Iridociliary melanoma - Clinical case.

Iris and ciliary body melanoma is an aggressive tumor, which, unfortunately, presents symptoms only in advanced stages and is often discovered accidentally during a routine eye examination. There are several treatment options, ranging from in time monitorization in order to observe the tumor's evolution to more aggressive methods such as radiotherapy and enucleation. We present a case of iridociliary melanoma, who underwent conservative surgery, iridocyclectomy under scleral flap, with good results, and maintenance of the function and integrity of the eyeball.

[The significance of imaging in a case of intraorbital cystic tumor]. / Influenta investigatiilor imagistice într-un caz de tumora chistica intraorbitara.

Conjunctival inclusion cyst represents a congenital or, in most cases, an acquired disorder. The most frequent cause of an acquired conjunctival cyst is the implantation of conjunctival epithelium after surgical interventions or ocular trauma. Usually, these cysts are located supero-medially, with a stationary evolution, without a progression in dimension, but in some cases can evolve into enormous translucent cysts. Histologically, they are lined by stratified, nonkeratinized, squamous epithelium and contain desquamated cellular debris, chronic inflammatory cells and mucus, when goblet cells are present. Most cysts can be treated adequately by complete excision with marsupialization of the entire epithelial lining to prevent fluid reaccumulation.

[Peripheral ulcerative keratitis]. / KERATITA ULCERATIVA PERIFERICA.

Ulcerative keratitis is frequently associated with collagen vascular diseases and presents a predilection for peripheral corneal localization, due to the distinct morphologic and immunologic features of the limbal conjunctiva, which provides access for the circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates an immune-mediated vasculitis process, with inflammatory cells and mediators involvement by alteration of the vascular permeability. Peripheral ulcerative keratitis generally correlates with exacerbations of the background autoimmune systemic disease. Associated sceritis, specially the necrotizing form, is usually observed in severe cases, which may evolve in corneal perforation and loss of vision. Although the first-line of treatment in acute phases is represented by systemic administration of corticosteroids, immunosuppressive and cytotoxic agents are necessary for the treatment of peripheral ulcerative keratitis associated with systemic diseases.

Tobacco-alcohol optic neuropathy--clinical challenges in diagnosis.

Part of the large group of nutritional and toxic optic neuropathies, tobacco-alcohol optic neuropathy is a disease often underdiagnosed or detected at a stage when the full recovery of vision is not possible. This article summarizes its signs and symptoms, describes the pathophysiological processes involved and provides the necessary information for diagnosis and treatment of the entity previously known as tobacco-alcohol amblyopia, reporting in the end, a challenging case along with its findings.

[Ocular hypertension in herpes simplex keratouveitis]. / Hipertensiunea intraoculara în keratouveitele date de virusul herpes simplex.

The herpes simplex virus is one of the most common pathogens in humans, who are seropositive for the virus in 90% of the cases at the adult age. It determines reccurent infections in more than a third of the population and these infections depend on the immune response of the host. Ocular infections of newborns are due to the herpes simplex virus type 2, meanwhile type 1 is found predominantly at adults; almost all ocular structures can be affected. HSV-1 in the most frequent etiologic agent in infectious anterior uveitis (with the varicelo-zosterian virus) and it is responsible for 6-10% of all cases of anterior uveitis. More than half of the keratouveitides due to HSV will develop intraocular hypertension and open-angle secondary glaucoma, during reccurences and most of them will resolve after proper control of inflammation.

Use of amniotic membrane in bullous keratopathy palliative care.

BACKGROUND: Assessment of efficiency of amniotic membrane covering in the improvement of bullous keratopathy symptoms. MATERIAL AND METHOD: The paper represents a clinical prospective study, which includes 42 patients diagnosed with bullous keratopathy and operated between January 2009 and November 2013 in the Department of Clinical Ophthalmology from "Dr. Carol Davila" Central Military Emergency Hospital. Follow up between 6 and 48 months, with an average of 22 months. Subject to research: corneal re-epithelisation, epithelial bullae, pain and photophobia relapse. RESULTS: In 37 cases, the symptoms improved, in 8 cases the minimum symptoms persisted and in 29 cases the symptoms completely disappeared. In 5 cases, there were no significant improvements, symptoms reappeared briefly after membrane resorption. CONCLUSIONS: Amniotic membrane covering represents an efficient palliative care means in oedematous keratopathy.

[Alternative therapeutic excision of intraepithelial conjunctival carcinoma with corneal extension]. / Alternative terapeutice la excizia unui carcinom intraepitelial conjunctival cu extensie corneeana.

Surgical treatment for conjunctival neoplasms, with wide local excision, with or without supplemental cryotherapy to the surgical margins represents the treatment of choice for this pathology. In some cases, these neoplasms can be diffuse or multifocal, with borders that are difficult to detect clinically, such that topical therapies offer a more efficient method for treating the entire ocular surface, delivering high drug concentrations at this level, with negligible systemic side effects. Beginning from the clinical case of a patient diagnosed with conjunctival intraepithelial neoplasia, we try to present other therapeutical alternatives, although in this case the therapeutical approach was the classic one.

[Ocular ischemic syndrome--a case report]. / Sindromul de ischemie oculara- pornind de la un caz clinic.

Ocular ischemic syndrome, also known as hypoperfusion/ hypotensive retinopathy or as ischemic oculopathy is a rare ocular disease determined by chronic arterial hypoperfusion through central retinal artery, posterior and anterior ciliary arteries. It is bilateral in 20% of the cases. Most often it appears due to severe occlusion of the carotid arteries (ICA, MCA>ECA), described in 1963 by Kearns and Hollenhorst. Occasionally it can be determined by the obstruction of ophtalmic artery or some arterities (Takayasu, giant cell arteritis). The risk factors are: age between 50-80 years, males (M:F = 2:1), arterial hypertension, diabetes, coronary diseases (5% of the cases develop ocular ischemic syndrome), vascular stroke, hemodialysis. The case we present is of an 63 years old man known with primary arterial hypertension, hypercholesterolemia, diabetes type 2 non insulin dependent and diagnosticated with ischemic cerebral stroke and bilateral obstruction of internal carotid arteries in march 2010, who is presenting for visual impairment in both eyes. The imaging investigations show important carotid occlusion and at the ophthalmologic evaluation there are ocular hypertension and rubeosis iridis at the right eye, optic atrophy at both eyes (complete in the right eye and partial in the left eye), with superior altitudinal visual field defect in left eye. The following diagnosis was established: Chronic ocular ischemic syndrome in both eyes with Neovascular glaucoma at the right eye, Anterior ischemic optic neuropathy at the left eye and laser panphotocoagulation at the right eye was started.

[Computer-assisted phacoemulsification for hard cataracts]. / Intelligent phaco în cataractele dure.

PURPOSE: to evaluate the efficiency of new torsional phacoemulsification software (Ozil IP system) in hard nucleus cataract extraction. METHODS: 45 eyes with hard senile cataract (degree III and IV) underwent phacoemulsification performed by the same surgeon, using the same technique (stop and chop). Infiniti (Alcon) platform was used, with Ozil IP software and Kelman phaco tip miniflared, 45 degrees. The nucleus was split into two and after that the first half was phacoemulsificated with IP-on (group 1) and the second half with IP-off (group 2). For every group we measured: cumulative dissipated energy (CDE), numbers of tip closure that needed manual desobstruction the amount of BSS used. RESULTS: The mean CDE was the same in group 1 and in group 2 (between 6.2 and 14.9). The incidence of occlusion that needed manual desobstruction was lower in group 1 (5 times) than in group 2 (13 times). Group 2 used more BSS compared to group 1. CONCLUSION: The new torsional software (IP system) significantly decreased occlusion time and balanced salt solution use over standard torsional software, particularly with denser cataracts.

[Intelligent phaco--always necessary?]. / Intelligent phaco--întotdeauna necesar?

PURPOSE: To assess the need of /P system use in soft cataract METHODS: prospective study--40 eyes with soft cataract (+/++); surgery with Infinity system, Ozil handpiece; in 20 eyes we used low levels (max 70%) of torsional ultrasound power and IP system; in 20 eyes we used higher levels of torsional ultrasound power without IP system; we assessed: the CME value and the presence of cornela edema. RESULTS: In cases with tosional ultrasound only: average value of CME--2.4; maxim value of CME--4.3; all corneas without edema. In cases with torsional ultrasound and IP system; average value of CME--3.6; maxim value of CME--7.2; 4 eyes with decemetic folds in central cornea. CONCLUSIONS: In soft cataracts is better to not use IP system

[Corneal transplantation activity in Ophthalmology Clinic of Central Military Hospital--2009-2010]. / Activitatea de transplant de cornee in Clinica de Oftalmologie a SUUMC Dr. Carol Davila in perioada 2009-2010.

PURPOSE: To show the cornea/transplantation activity of our clinic in 2009 and 2010 METHODS: We assessed: The number of corneal prelevations. The number of surgeries. The etiology of the disesses which need cornea/transplantation. CONCLUSIONS: Although there is a slow increase, the activity of corneal transplantation has not a satisfactory level.

[Pituitary adenoma--clinical case]. / Adenom hipofizar--caz clinic.

This is a case report of pituitary adenoma diagnosed by a deep ophthalmological examination. We identified a serious neurosurgical and endocrinological condition, potentially lethal, starting from an ocular symptom. The patient did not pay attention to the hormonal changes as they were developing slowly. Visual acuity was the only reason why the patient decided to seek medical attention.

[Intravitreal triamcinolone acetonide treatment in diabetic macular edema]. / Triamcinolonul intravitreean în tratamentul edemului macular diabetic.

PURPOSE: To assess the efficacy and safety of intravitreal triamcinolone acetonide in diabetic macular oedema. METHODS: prospective study; 76 patients, 102 eyes; preoperative assessment: visual acuity, intraocular pressure, fundus biomicroscopy fluoresceine angiography, sometimes OCT; postoperative assessment: visual acuity, intraocular pressure, fundus biomicroscopy, fluoresceine angiography, sometimes OCT. RESULTS: Visual acuity improvement in 42% cases; subjective improvement of visual acuity in 72% of cases CONCLUSIONS: Triamcinolon acetonide may play a role in treatment of diabetic macular oedema.

[Ocular surface in glaucoma patients with topical treatment]. / Suprafata oculara la pacientii cu tratament antiglaucomatos topic.

PURPOSE: Our study is trying to establish the prevalence of Dry Eye Syndrome in glaucoma patients treated with topical medication. MATERIAL AND METHOD: We investigated 40 patients (21 females and 19 males), age over 50, treated with topical antiglaucoma medication for at least one year. The control group was consisted of 40 healthy adults, 20 female and 20 males, age over 50, who didn't took any ocular treatment in the last three months. Each patient completed an Ocular Surface Disease Index questionnaire (OSDI) and underwent evaluation by Schirmer test and tear break-up time (TBUT). RESULTS: In the control group we diagnose 9 patients (23%) with Dry Eye Syndrome. In glaucoma group 25 patients (63%) had Dry Eye Syndrome. Tear break-up time showed abnormal tear quality in all of those 25 patients. Schirmer testing showed 23 patients with decrease in tear production. Using Ocular Surface Disease Index 22 patients reported ocular symptoms. Unlike the control group, at the glaucoma patients we didn't notice any difference between the two genders. Regarding the age, we found at the control group the Dry Eye Syndrome at patients over 70 years old, and at the glaucoma group the average age was 55 years old. CONCLUSIONS: In general population the prevalence of Dry Eye Syndrome is about 20%, mainly affecting females over 60 years old. In our study 63% of glaucoma patients had Dry Eye Syndrome--as a result of long term topical therapy that affects the integrity of the tear film and the ocular surface.

[The secret of red eyes]. / Secretul ochilor rosii.

"Red eye" is a sign and the same time a symptom frequently met in the ophthalmological practice. The "red eye" is not always the clinical manifestation of a common conjunctivitis. We will present a case report of a patient who accused conjunctival hyperemia, lacrimation, foreign--body sensation; she was also describing recurrent conjunctivitis for the past year. After an detailed ophthalmologic examination and interdisciplinary consultations. She was diagnosed with Basedow Disease and paraselar meningioma with invasion in the pterigoid fossa. The authors are suggesting that there is an indirect left carotid - cavernous fistula.

[Neuroprotection in glaucoma]. / Neuroprotectia in boala glaucomatoa'sa.

The present paper is a revue of the basic terms related to the neuroprotection, an up-to-date on the pathophysiology of glaucoma. There are emphasized some of the main directions of evolution in the antiglaucomatous and neuroprotective treatment.

[Ocular siderosis]. / Siderosos bulbi--caz clinic.

We show a clinical case of siderosis bulbi with absolute secondary glaucoma. The initial diagnosis was primary open angle glaucoma in both eyes, and the patient was treated with eye drops for 4 years. After reassessment of anamnesis, clinical and paraclinical investigations we find that one eye is normal and the real diagnosis in the involved eye.

[Refractive stability of artificial crystallins--acrysof TORIC]. / Stabilitatea refractiva a cristalinelor artificiale acrysof TORIC.

PURPOSE: To evaluate the results of AcrySof Toric intraocular lens (Alcon) implantation to correct pre-existing astigmatism and rotational stability in patients having cataract surgery or not. METHODS: Retrospective study three surgical teams, between February 2009-August 2010, included 37 eyes with more than 1 diopter (D) of preexisting corneal astigmatism having or not cataract surgery. RESULTS: Rotation at 6 M post-op: 32 patients (87%)--> rotation between aprox. 0-5 degrees, 4 patients (11%)--> rotation between A 5-10 degrees, 1 patient (2%) rotation of A 20 degrees. The mean refractive cylinder decreased significantly after surgery: 34 (91.90%) of cases between 0.25-0.75 D--2 (5.40%) of cases 1.5 D--1 (2.70%) of cases > 1.5 D. CONCLUSIONS: In conclusion the results indicate that TheAcrySof Toric IOL is a viable option of preoperative corneal astigmatism in carefully selected cases. The Toric IOL showed good rotational stability The most frequent cause of turnover is the: viscoelastic left in the capsular bag (early rotation); fibrosis of the bag (late rotation).

[Glomus tumor with diplopia]. / Diplopie prin tumora glomica--caz clinic.

This paper highlights the case of a 46-year-old female patient who seeks ophthalmic medical advice for her complaint about double vision on right gaze. Patient's medical history reveals several symptoms like headaches, progressive hearing loss on right side and dysphonia for which all investigations proved irrelevant. Thourough clinical examination, lab exams and imaging techniques revealed the cause for this symptoms i.e. glomic tumour with middle ear extention. We find this case to be exceptional as ocular symptoms led to the diagnose of a non-ocular serious, possible life threatening condition, bearing in mind that previously occured non-ocular symptoms couldn't elucidate the cause.