FUCHS ENDOTHELIAL CORNEAL DYSTROPHY: IS FEMTOSECOND LASER-ASSISTED CATARACT SURGERY THE RIGHT APPROACH?

INTRODUCTION: Femtosecond Laser-assisted cataract surgery represents a modern technology that hopes to lower the risk of complications for patients suffering from Fuchs endothelial dystrophy by using a reduced level of energy that causes less damage to the endothelium, the main concern for patients with Fuchs endothelial dystrophy. The femtosecond laser performs 3 important steps in cataract surgery: corneal incisions, capsulorhexis and nucleus fragmentation without intraocular instrument manipulation. PURPOSE: The purpose of this study is to determine the efficiency of Femtosecond Laser-assisted cataract surgery in Fuchs endothelial dystrophy. MATERIAL AND METHODS: 5 patients with 6 eyes underwent cataract surgery assisted by Femtosecond Laser LensX at Laser Optisan Clinic. Corneal changes before and after surgery and cumulative dissipated energy (CDE) were analyzed. RESULTS: Before surgery, our patients presented BCVA between 0.16-0.4, Pachymetry between 450-590 Lm, endothelial cells between 789-2008 mm2. The medium cumulative dissipated energy (CDE) used was 4.58 seconds. After surgery, BCVA improved in all patients and none of them developed corneal decompensation so far. CONCLUSIONS: Femtosecond Laser-assisted cataract surgery represents a safe alternative in patients with Fuchs endothelial dystrophy and has a low risk of corneal decompensation.

PERSISTENT PUPILLARY MEMBRANE OR ACCESSORY IRIS MEMBRANE?.

Frequently, in literature and curent practice, accessory iris membrane (AIM) and persistant pupillary membrane (PPM) are confused. Both AIM and PPM are congenital iris anomalies in which fine or thick iris strands arrise form the collarette and obscure the pupil. AIM, which is also called iris duplication, closely resembles the normal iris tissue in color and thickness and presents a virtual second pseudopupil aperture in the centre while PPM even in its extreme forms presents as a translucent or opaque membranous structure that extends across the pupil and has no pseudopupil. Mydriatiscs, laser treatment or surgery is used to clear the visual axis and optimize visual development. Surgical intervention is reserved for large, dense AIMs and PPMs. Our patient, a 29 year old male, has come with bilateral dense AIM, bilateral compound hyperopic astigmatism, BCVA OD = 0.6, BCVA OS = 0.4, IOP OU = 17 mmHg. To improve the visual acuity of the patient we decided to do a bilateral membranectomy, restoring in this way transparency of the visual axis. After surgery, the visual acuity improved to BCVA OD= 0.8, BCVA OS=0.8.

[Retinal pneumopexy in the treatment of rhegmatogenous retinal detachment]. / Tratamentul dezlipirilor de retina regmatogene prin metoda pneumopexiei retiniene.

PURPOSE: To evaluate the efficiency of retinal pneumopexy in patients with rhegmatogenous retinal detachment. METHODS: This clinical prospective study unrolled between november 2010-june 2012 in the Ophthalmology Department of the Military Hospital in Cluj-Napoca and Satu Mare Emergency Hospital included 20 patients (20 eyes) with rhegmatogenous retinal detachment. Patients were treated with retinal pneumopexy followed by laser photocoagulation. RESULTS: Anatomical and functional results were evaluated 1, 3, 6, 12 and 19 months after treatment. In 17 eyes out of 20, we achieved retinal reattachment and visual recovery. Three cases yelded no success, these being further treated with posterior vitrectomy. CONCLUSION: Retinal pneumopexy is a minimally invasive treatment method of rhegmatogenous retinal detachment with very good results in well selected cases.

[Toric intraocular lens implantation in cataract patients--6 months results]. / Implantarea cristalinului artificial toric la pacientii cu cataracta. Rezultate la 6 luni.

UNLABELLED: The purpose of this paper is to evidence the advantages of artificial Acrysof Toric IOL implantation in patients with cataract and corneal astigmatism. MATERIAL AND METHODS: Prospective clinical study on 30 patients with cataract operated on with phacoemulsification and implantation of Acrysof Toric IOL on 32 eyes, between September 2007- March 2008. RESULTS: The predictability between estimated and obtained astigmatism is 96.87%. In most of the cases the IOL was well centered in the capsular bag and stable on the predetermined axis, in 1 eye the IOL was rotated with about 30 degrees. The astigmatism evaluated in all patients at 6 months postoperatively being corrected in 78.13% of cases and reduced in 21.87% of cases. The UCVA between 2/3-5/5 was in 65.63% of cases and BCVA was in 34.37% of cases. To mention that 63.63% of patients with BCVA wanted to remain with myopia. CONCLUSIONS: Phacoemulsification and Acrysof Toric IOL implantation are an attractive alternative for patients with cataract and corneal astigmatism. The Acrysof Toric IOL eliminates or reduces preoperatively astigmatism, providing many patients a clear distance vision without glasses.

[Our experience with Acrysof Natural intraocular lens]. / Experienta noastra în implantarea cristalinelor artificiale Acrysof Natural.

UNLABELLED: The purpose of this paper is to appreciate the Acrysof Natural IOL comportment during the implantation after phacoemulsification, and to evaluate the visual acuity at 2 months and 2 years postoperative. MATERIAL AND METHODS: Prospective clinical study which comprises 48 patients( 48 eyes) with cataract operated on with phacoemulsification and implantation of Acrysof Natural IOL with the Monarch II injector and the implantation forceps. RESULTS: The patients' age was between 4- 82 years; The IOLs were introduced with the Monarch II injector in 47 cases and with the implantation forceps in 1 case; No IOL was damaged during the implantation; The unfolding and the rotation of the IOL were possible in all cases, without incidents; The visual acuity appreciated 2 months and 2 years postoperative was good in the most of the cases; the chromophore pigment did not influence the quality of vision and the color perception. CONCLUSIONS: The implantation of the Acrysof Natural IOL is identical with the implantation of the Acrysof single piece IOL, is easy to perform and completely atraumatic.

[Mechanisms of laser photocoagulation in diabetic retinopathy]. / Mecanismele fotocoagularii laser în retinopatia diabetica.

The aim of laser photocoagulation in diabetic retinopathy is to stop the development of retinal neovessels and even to determine their involution. Early applied, laser photocoagulation can significantly reduce the risk of severe visual loss. The knowledge of the multiple mechanisms of laser photocoagulation leads to the possibility to introduce a well dosed treatment that is appropriate for the clinical stage of the retinopathy.

[Combined surgery--cataract and glaucoma]. / Operatie combinata de cataracta si glaucom, prezentare de caz.

We present the case of a 70 years old female patient with bilateral senile cataract, more advanced at the RE; Primary open angle glaucoma, poor compensation with drugs at the RE (with timolol 0.5% and xalatan 0.005%). Combined cataract and glaucoma surgery was performed, using different surgical approach zones. The article describes the therapeutic options in the morbid association of cataract and glaucoma, pointing out the advantages and the indications for each method.

[Phacoemulsification with Advan-Tec system and Neosonix handpiece]. / Facoemulsificarea cu sistemul Advantec si sonda Neosonix.

PURPOSE: The comparative analyses of the standard Legacy 20000 efficiency and the AdvanTec Legacy efficiency take into consideration the effective phacoemulsification time, power, and the postoperative clinical outcomes. MATERIAL AND METHODS: Retrospective clinical study which comprises 2 groups of patients operated on with phacoemulsification: 200 eyes were operated on using the classic handpiece of the Legacy 20000 system; 200 eyes were operated on using the AdvanTec Legacy system and the NeoSoniX handpiece. RESULTS: The effective phacoemulsification time in the standard Legacy group was under 0.4 min in 40 cases (20%), between 0.4-1.2 min in 120 cases (60%), and more than 1.2 min in 40 cases (20%). The effective phaco time in the AdvanTec-NeoSoniX group was under 0.4 min in 118 cases (59%), between 0.4-1.2 min in 72 cases (36%) and more than 1.2 min in 10 cases (5%). The mean phacoemulsification power varied between 19-38% in the first group and 14-22% in the second group. Descemetic striae and corneal edema on the first postoperative day were observed in 38 eyes (19%) in the Legacy standard group, and 18 eyes (9%) in the AvanTec-NeoSonix group. CONCLUSIONS: The progression from the standard Legacy to the AdvanTec Legacy system with NeoSoniX handpiece led to the reduction in phacoemulsification power by two mechanisms, oscillation, which breaks the nucleus, and vacuum, which removes and evacuates the nuclear material.

[Cataract surgery in biphakia patients]. / Chirurgia cataractei la ochii cu bifachie.

INTRODUCTION: Although the IOL implantation was used initially just for cataract surgery, in the last period IOLs are used in treating myopia more than -12D and hyperopia more than +4D, in phakic eyes, when the indications of excimer laser are limited. OBSERVATION: We present the case of a 40 years old patient with the diagnosis: biphakia, complicated cataract and high myopia in both eyes. VA-RE = 2/50 cc, VA-LE = 3/50 cc, IOP-RE:15 mmHg, IOP-LE:16 mmHg. We performed, in two separate surgeries, the explantation of the intraocular lens, then the extraction of the opacified crystalline lens through the same incision and the implantation of an AcrySof foldable lens with an adequate power, in the bag. We discuss the causes of cataract formation in eyes with posterior chamber phakic intraocular lens, the choice of the IOL power, the incision for explantation and implantation, and the intraoperative technical difficulties. CONCLUSIONS: The association of phakic IOLs and cataract represents a new challenge to the ophthalmic surgeon, taking into account that these IOLs are becoming more and more popular to correct high refractive errors.

[Phacoemulsification and intraocular lens implantation in myopic eye]. / Facoemulsificarea si implantul de cristalin artificial la ochiul miop.

UNLABELLED: The purpose of this study is to estimate the technical difficulties and the intraoperative complications which appear in patients with high myopia who had been operated on cataract through phacoemulsification technique; to establish the IOL refractive power and to estimate the functional results at 45 days postoperative. MATERIAL AND METHOD: We performed a study on 44 eyes with high myopia and cataract operated in the Emergency Military Hospital from Cluj-Napoca during 15th of January -15th of June 2003. We analyzed the patients' age, the technical difficulties and intraoperative complications, the IOLs choosing and the functional results. RESULTS: The greatest frequency of patients with high myopia and cataract met into the study was between 50-60 years old (43.18%). The intraoperative complications were represented by the posterior capsule's refraction without loss of vitreous in one case, zonular rupture in one case and one case with loss of the nucleus into vitreous. CONCLUSIONS: In patients with high myopia and cataract the surgical procedure solves both visual problem and refractive deficiency. For the myopic eye is important to use IOL with 6 mm, 6.5 mm diameter.

[Phacoemulsification in white cataract]. / Facoemulsificarea în cataracta alba, intumescenta.

PURPOSE: The study presents the technical difficulties of the capsulorhexis and phacoemulsification in the white, intumescent cataract and the incidences occurred during the foldable IOL implantation with the Monarch II injector. METHODS: The clinical study comprises a number of 70 eyes with white intumescent cataract operated during 15 January-15 December 2003 by the same surgeon. The surgical intervention consisted of lens extraction by phacoemulsification with clear corneal incision, using the Monarch II injector for the foldable IOL implantation. In 56 eyes, the anterior capsule was stained with trypan blue. RESULTS: The intraoperative complications include: failed capsulorexis in 4 cases (5.71%), rupture of posterior capsule in 1 case (1.43%) and the conversion to classical extracapsular extraction in 3 cases (4.29%). IOL implantation was made with the help of the Monarch II injector in 67 cases (95.71%). The foldable IOL implantation in the bag was realised a single time in 44 cases (62.9%). We had the following incidences in the other cases: the upside down turning of the IOL during unfolding in 2 cases, the second haptic capture in the tunnel of the cartridge in 2 cases, the second haptic stucks outside or in the anterior chamber in 18 cases, the first haptic stays in the sulcus and the second one stays outside in 1 case. CONCLUSIONS: In eyes with 1 intumescent cataract we can perform the continuous curvilinear capsulorhexis using trypan blue, but also without staining the anterior capsule using mechanical or manual aspiration of the liquefied cortex and viscoelastic substances. The foldable intraocular lens implantation with the injector proves to be an easy and comfortable method after it has been practiced for a longer period of time if the right size of the cartridge is used.

[Phacoemulsification--personal experience on my first 507 cases]. / Facoemulsificarea--experienta personala pe primele 507 cazuri operate.

PURPOSE: The evaluation of the intra and post operative early complications of the phacoemulsification with posterior chamber artificial lens implant on my first 507 cases. METHODS: A retrospective study on 507 eyes operated by cataract through phacoemulsification technique at the Emergency Military Hospital from Cluj-Napoca during the 1st of May-30th of June 2002. The surgeries were performed by the same surgeon through a corneal or a scleral incision using rigid and foldable artificial lenses. The evaluation period lasted 2 months, the types and frequency of the intraoperative and early postoperative complications being analyzed. RESULTS: The intraoperative complications were represented by the posterior capsule's efraction in 17 cases (3.37%); zonular rupture in 3 cases (0.59%); the loss of the nucleus into vitreous 4 cases (0.79%); the luxation of the crystalline lens in the anterior chamber in 5 cases (0.99%); the hyphaema and iris trauma in 14 cases (2.76%); incomplete cortical clean-up in 9 cases (1.78%); the failed capsulorhexis in 7 cases (1.38%) and the conversion to ECCE in 8 cases (1.58%). The early postoperative complications met into the study were: the corneal edema in 34 cases (6.71%); raised IOP in 18 cases (3.55%); the retained lens material in 9 cases (1.78%); the late inflammatory reactions in 6 cases (1.18%); hypopyon in 3 cases (0.59%); endophthalmitis in 3 cases (0.59%); retinal detachment in 1 case (0.2%) and the anterior capsule fibrosis in 4 cases (0.79%). CONCLUSIONS: The phacoemulsification is a high security technique because of the small incision and the sharp accuracy. The complications correlate themselves with the surgeon experience and with some particularities of the cataract (the brunescent cataract at the old patient, the medium dilatation of the pupil, etc.).

[Phacoemulsification in posterior polar cataract]. / Facoemulsificarea in cataracta polara posterioara.

PURPOSE: To evaluate the technical particularities of phacoemulsification and the intraoperative complications in posterior polar cataract. MATERIAL AND METHODS: Prospective study which comprises 10 eyes with posterior polar cataract (8 patients), operated on between May 2001 and April 2004 in the ophthalmology department of the Military Hospital Cluj-Napoca, by the same surgeon. Phacoemulsification with low parameters was performed in all cases, and acrylic and PMMA intraocular lenses were implanted in 9 eyes. RESULTS: The patients' age was between 24 and 80 years, with a mean age of 55.12 years. The majority of the patients presented bilateral posterior polar cataract (70%), but only 2 patients were operated on the both eyes in the analyzed period. The posterior capsule rupture occurred in 4 eyes (40%). A posterior residual plaque was attended in one case, but did not influence the short term visual acuity. The visual acuity of the 3 cases which were affected unilaterally was not influenced by the surgery, which was without complications in 2 cases. The causes were preexisting amblyopia. CONCLUSIONS: The study confirms the high risk to posterior capsule rupture during posterior cataract surgery and the high incidence of the bilateral form (70%).