[Prognostic factors for laser treatment in retinopathy of prematurity]. / Factori prognostici ai tratamentului laser în retinopatia prematuritatii.

PURPOSE: The paper aims to determine the anatomical results of the eyes treated by laser photocoagulation for "threshold" retinopathy of prematurity (ROP) and to identify the potential risk factors for the unfavorable outcomes. MATERIAL/METHOD: A retrospective study including all the consecutive ROPs that were treated by laser photocoagulation between January the 1st 2006 and September the 1st 2009 has been conducted. The followed criteria has been the anatomical result after the laser treatment. The outcomes have been correlated with: the gestational ages, the birth weights, the moment of treatment (postnatal and post-conceptional ages), the sex of the premature infants, the stage and zone of ROR. RESULTS The total number of prematurely newborns that met the screening criteria for ROP in the above-mentioned period has been 474. Of these, 350 (74%) presented no ROP and the remaining 124 (26%) developed various stages of the disease. Within the ROP group, 54 patients required laser therapy (44% of the retinopathies, representing 11% of all the prematures). The anatomical outcome has been favorable in 84% of the treated eyes, the remaining 16% presenting the progression of ROP The results of the treatment depended on the type of ROP, being significantly better in the classic disease as in the agressive posterior disease (APD) (p < 0.05). The gender also influenced the outcome: the results were better in girls as compared with boys (p < 0.05). The precocity of the laser treatment (evaluated by the postnatal and postconceptional age) has positively influenced the ROP evolution (p < 0.05). CONCLUSIONS: Laser photocoagulation has proved its efficacy in the treatment of ROP on our cases. The factors that have negatively influenced the postlaser outcome were: the aggressive posterior disease, the delayed moment of the laser therapy and the male gender.

[Avastin in age related macular degeneration]. / Avastin in degenerescenta maculara legata de vârsta.

OBJECTIVE: The purpose of the study is to evaluate the preliminary results of the treatment with Bevacizumab (Avastin) in the neovascular (wet) form of Age-Related Macular Degeneration (AMD). MATERIAL METHOD: The study is retrospective and includes 20 consecutive patients (27 eyes) who had received Avastin intravitreally, hospitalized in the Ophthalmology Clinic from Cluj-Napoca, between September 2007-March 2009, for wet AMD. Every patient had received 3 Avastin injections, approximately one month apart. Each dosis consisted of 0.05 ml (1.25 mg) Avastin. The therapeutical effect has been evaluated by: the value of the visual acuity (VA), the foveolar thickness (FT) and the total macular volume (TMV), before and after the treatment. In order to measure the VA, the classical optotipe has been used and the FT and the TMV have been evaluated by Time Domain (TD)-OCT. The follow-up period has varied between 4-10 months. The statistical interpretation of the results has been performed by the use of the Student t test, a p value < 0.05 being considered statistically sirgnificant. RESULTS: Of the 27 treated eyes, 8 (30%) had a favorable evolution of the VA, 15 (55%)--a stationary one and 4 eyes (15%) had an unfavorable outcome. The FT decreased (favorable evolution) in 18 eyes (66.66%) and increased (unfavorable evolution) in 9 eyes (33.33%). The TMV had a favorable evolution (decrease) in 21 eyes (77.77%) and an unfavorable one (increase), in 6 eyes (22.22%). CONCLUSIONS: The quantitative evolution of the VA has been predominantly stationary (55% of the eyes). Most patients described an improvement in the quality of vision, even if the VA has remained unchanged. The evolution of the FT and of the TMV has been predominantly favorable: 66.66%, 77.77% respectively. We noted the direct correlation between the evolution of the VA and of the morphological parameters evaluated by OCT, only in 33.33% of the treated eyes.

[Traumatic endophthalmitis--terapeutical indications and results]. / Endoftalmita traumatica--indicatii terapeutice si rezultate.

PURPOSE: The purpose of our study is to analyze the outcome of traumatic endophthalmitis, as revealed by our own experience. MATERIAL METHOD: We conducted a clinical retrospective study including all the consecutive cases with traumatic endophthalmitis that have been hospitalized in the University Ophthalmology Department from Cluj-Napoca (Romania), for a 28 months period of time (September the 1st 2007 - December the 31st 2009). RESULTS/DISCUSSION: The overall incidence of traumatic endophthalmitis has been 4.76% (5 out of 105 open globe injuries). The presence of an Intra Ocular Foreign Body has been associated with the highest risk of endophthalmitis (8%), followed by the penetrating ocular injuries (6.52%). We performed posterior vitrectomy combined with intravitreal antibiotic and steroid injections in 4 of the 5 traumatic endophthalmities (80%). Injection alone of the above mentioned drugs has been indicated in one early traumatic endophthalmitis (20%), with immediate positive response and the complete recovery of the visual acuity. The technical features of the posterior vitrectomy in the infected eyes are discussed, in comparison with the other clinical conditions in which it is indicated. Our results prove the achievement of visual acuities better than 20/40 in 80% of the post-traumatic endophthalmitis eyes. The failure in one case is explained mainly by the delayed vitrectomy (48 hours from the debut), but also by the circumstances of trauma (soil contamination, in a rural setting). CONCLUSION: Immediate action in traumatic endophthalmitis is crucial for the final visual prognosis.

[Ocular changes in preeclampsia]. / Modificari oculare induse de preeclampsie.

The pregnancy is associated with modifications involving multiple systems and organs, including the eye. The retinal vascular changes are present in 30-100% of the PE cases. The most frequent ocular modification is the vasoconstriction of the retinal arterioles. The exudative retinal detachment is a rare cause (under 1%) of visual loss in the PE-E syndrome, being produced by the involvement of the choroidal vascularization. Most cases of blindness during pregnancy have been determined by cortical, occipital anomalies, the used terminology in these circumstances being cortical blindness. The pathogenesis of the Purtscher retinopathy is the embolism of the retinal arterioles, by leucocytic aggregation, as a response to the activation of the complement. The evaluation of the ophthalmic arterial flow by eco Doppler might offer new perspectives regarding the understanding of the physiopathology, the diagnosis and the quantification of the PE severity. The decrease of the IP values and the increase of the median velocity in the ophthalmic artery in pregnant women with PE, suggest a hyperperfusion process and the decrease of the vascular resistances at the level of the orbital vessels, but also in the CNS. In the severe forms of PE, the increase of the impedance of the orbital vessels has been noted. The described vascular changes cannot disappear completely 6 weeks after birth; a residual arteriolar constriction might persist, as a permanent stigma of the PE. The evaluation, monitoring, therapeutical approach of the patients with PE must be performed by a complete team: obstetrician, ophthalmologist, neurologist, radiologist, in order to decrease the materno-fetal risks and improve the prognosis of PE.

[Laser photocoagulation in retinopathy of prematurity--preliminary results]. / Fotocoagularea laser in retinopatia prematuritatii--rezultate pieliminarii.

PURPOSE: The present study aims to reveal, on one hand, the efficiency of the laser photocoagulation in the Retinopathy of Prematurity (ROP) and, on the other one, to answer two questions: 1. Why do some ROPs still go wrong, in spite of laser therapy? 2. What can we do about it? MATERIAL/METHOD: A retrospective study has been performed, including the 21 prematurely newborns that have been treated by laser photocoagulation, for ROP, 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: Globally, the results of the laser treatment are the following: favourable outcome (regression of ROP)--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 ROP in 27 of them (93. 10%). ROP 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%). ROP 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 analyzed according to two parameters: the objective situation prior to laser photocoagulation (stage and zone of ROP) 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 ROP 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 ROP 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 ROP

[Lisch nodules. Markers for a non-invasive diagnosis in Recklinghausen neurofibromatosis]. / Nodulii LISCH. Markeri de diagnostic noninvaziv in neurofibromatoza Recklinghausen.

INTRODUCTION: Von Recklinghausen's neurofibromatosis is an autosomal dominant disorder that affects both sexes at the same rate. The diagnosis is suggested by the family history, the presence of multiple neurofibromas and cutaneous pigmentary macules but is only confirmed by the presence of the Lisch nodules at the iris level and by histological exam. The disease is associated with different nervous system, bone, endocrine, blood vascular abnormalities. PURPOSE: Evaluation of Lisch nodules in patients with Recklinghausen disease or immediate relatives, that do not present characteristic cutaneous lesions. MATERIAL AND METHOD: The study involves three cases of Recklinghausen neurofibromatosis and also a part of their immediate relatives. The diagnosis of NF1 was based on clinical aspects, family pedigree analysis and ophthalmological exam. The histological exam was only performed for complicated cutaneous lesions. RESULTS AND DISCUSSIONS: The clinical exam revealed characteristic cutaneous lesions but also Lisch nodules in all three studied cases. According to the pedigrees, Recklinghausen disease is inherited as an autosomal dominant trait (in 2 patients), but it may also arise as de novo mutations (1 patient). The ophthalmological exam performed for the patients' relatives, identified Lisch nodules in all subjects presenting cutaneous lesions (neurofibromas), and also in children without characteristic cutaneous features. Both pedigree analysis and ophthalmological examination are compulsory, noninvasive methods for precocious diagnosis of the disease and the identification of high-risk patients. CONCLUSIONS: Lisch nodules are ophthalmological and pathognomonic markers of Recklinghausen neurofibromatosis. Lisch nodules facilitate a precocious, noninvasive diagnosis inclusively in children without cutaneous features (neurofibromas) but positive antecedents. Ophthalmological examination and pedigree analysis are compulsory both in patients and their immediate relatives.

[Diode-laser photocoagulation in central serous chorioretinopathy]. / Fotocoagularea cu laser dioda în corioretinopatia seroasa centrala--prezentare de caz.

PURPOSE: This case report reveals the effect of the diode laser photocoagulation in Central Serous Chorioretinopathy. CASE REPORT: A 49 years old male has been referred to us for a decrease in the central vision (2/10) for 4 months. The clinical examination of the retina and the angiophluorography have diagnosed a classical form of Central Serous Chorioretinopathy, with a unique leaking point, situated away from the fovea. The focal diode laser photocoagulation of the leaking point has been performed and 6 weeks after treatment, the visual acuity has normalized (10/10) and the angiophluorography has proven no sign of activity. DISCUSSION: The etiopathogenetic, clinical and evolutive aspects of this case are discussed in comparison to the data in the literature. CONCLUSION: The focal diode laser photocoagulation of the leaking point has led to immediate anatomical and functional success in Central Serous Chorioretinopathy.

[Assessment of retinopathy of prematurity]. / Evaluarea retinopatiei prematuritatii.

PURPOSE: The study aims to evaluate the ROP, the factors that influence this disease in very low birth weight newborns that are included in the neonatal screening program. MATERIAL AND METHOD: It is a retrospective study performed on 82 preterm newborns managed by The Neonatology Department of Obstetrics and Gynecology Clinic I from Cluj over a period of 15 months. There were assessed: prenatal factors, birth, perinatal pathology, therapy received, incidence of ROP and the necessity for laser therapy The statistical analysis has been performed in Epi 6. RESULTS: The group is composed of 82 newborns with gestational age of 30.01+/-2.18 weeks and birth weight of 1240.19 +/- 347.41 g. The diagnosis of ROP is highly correlated with the gestational age (p = 0.000019) and with the birth weight (p=0.00627). We did not find a significant correlation between the duration of the mechanical ventilation and ROP, but the correlation is obvious with the duration of oxygen-therapy (p=0.005) and FiO2 (p=0.005). From the prenatal factors, we distinguished a high percentage (29.5%) of non followed pregnancies in newborns that developed ROP. The incidence of retinopathy was 39.02% and the laser therapy has been necessary in 14.8% of all cases. CONCLUSIONS: The incidence of ROP has been 39.02%. The factors that influenced the ROP incidence were: non followed pregnancies, duration of oxygen-therapy, FiO2 applied, pCO2.

[Retinopathy of prematurity: screening and therapeutic indications]. / Retinopatia prematurului: screening si indicatii terapeutice.

The retinopathy of prematurity is a proliferative disease of the retinal blood vessels, occurring in the prematurely born babies. As the life support conditions for the prematurely born babies have improved, the retinopathy of prematurity has became a problem, both for the neonatologists and the ophthalmologists. This paper discusses the pathogeny, the risk factors, the classification criteria and especially the methods for the screening and therapy of this disease.

[Axial length and branch retinal vein occlusion]. / Lungimea axiala a globului ocular si obstructia de ram venos retinian.

PURPOSE: To determine whether there is a connection between the axial length and the occurrence of the branch retinal vein occlusion (BRVO). METHOD: 18 patients that had been diagnosed with BRVO have been selected retrospectively. The diagnosis has been made according to the clinical criteria (fundus aspect). A control group of 18 patients has ben constituted. The patients in the control group matched the age distribution and the prevalence of high arterial blood pressure and diabetes mellitus of the patients in the BRVO group. The measurements of the axial lengths have been performed by the same examiner, for the affected and fellow eye, in the BRVO group and for the right eye, in the control group. The data were interpreted by the help of the descriptive statistics. The Student t test has been used and was considered significant, if the p value was < 0.05. RESULTS: The mean axial length of the eyes with BRVO was 22.42 mm (range, 21.5 mm-24.1 mm) and of the fellow eyes, 22.44 mm (range, 21.3 mm-24.2 mm). The difference is not statistically significant: p = 0.776. The mean axial length of the eyes in the control group was 23.42 mm (range, 21.5 mm-24.4 mm), the difference being statistically significant when compared with the BRVO eyes: p = 0.00064. DISCUSSIONS: The possible connections between a shorter axial length and the incidence of BRVO are analyzed, taking into account the known factors that are involved in the pathogenesis of this disease. CONCLUSION: The shorter axial length is a risk factor for BRVO.

Ankylosing spondylitis--a systemic disease.

Ankylosing spondylitis (AS), the prototype of seronegative spondylarthropathies, is in fact a systemic disease, causing numerous extraskeletal manifestations that have a significant influence on patients vital prognostic. This article presents the principal systemic manifestations of AS, pointing out pathogenetic, clinical and therapeutic aspects.

[Posttraumatic aniridia--clinical reports]. / Aniridie posttraumatica--prezentare de caz.

The paper illustrates the case of a posttraumatic aniridia, following a domestic accident. The total desinsertion of the iris occurred after a contusive trauma associated with the rupture of the eye ball. The iris left the eye ball through the scleral rupture. The pigmentary impregnation of the conjunctiva in front of the scleral rupture suggests the possible intervention of a mechanism of autophlagia of the iris. The lens kept its normal position, but has became completely opaque. The traumatic aniridia has been associated with the devastating loss of vision, because of the associated vitreo/retinal lesions. The immediate and late postoperative aspects are illustrated.

[Postoperative secondary hypertropia]. / Hipertropie secundara postoperatorie--caz clinic.

The paper illustrates the case of a patient that developed a hypertropia after having removed an episcleral tumour. The data of the functional and objective ocular exam are presented. The pre and intraoperatory arguments that decided the surgical treatment are analyzed. The pre and postoperative aspects are illustrated in images.

[Diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus]. / Retinopatia diabetica la pacientii nou diagnosticati cu diabet zaharat tip II.

PURPOSE: To report the prevalence of the diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus and to evaluate the association between the retinopathy and different clinical variables. METHOD: A prospective study including all the newly diagnosed patients with type II diabetes mellitus between January 2001-March 2002 in the evidence of the Diabetes Center from Cluj has been conducted. The fundus appearance, age, sex, incidence of arterial hypertension and the diabetes therapy (diet alone, oral drugs, insulin) have been evaluated. RESULTS: During January 2001-March 2002, 487 patients have been diagnosed with type II diabetes mellitus in Cluj county. Diabetic retinopathy has been identified in 70 of these patients (14.37%). Most of the newly diagnosed patients with type II diabetes mellitus belonged to the age interval: 40-65 years, with an average of 58-59 years. CONCLUSIONS: Among the 70 patients with diabetic retinopathy at the moment of type II diabetes diagnosis, the first place is occupied by the back-ground diabetic retinopathy. (11.70%), followed by the clinically significant macular edema (1.43%), proliferative diabetic retinopathy (1.02%) and preproliferative diabetic retinopathy (0.20%). Systolic and diastolic arterial hypertension has been associated with higher degrees of severity of the diabetic retinopathy.