The Impact of Intraocular Treatment on Visual Acuity of Patients Diagnosed with Branch Retinal Vein Occlusions.

Branch retinal vein occlusions are a significant cause of vision loss and present several ophthalmic and systemic risk factors, including age, hypertension, hyperlipidemia and glaucoma. Retinal vein occlusion is the second-most-common retinal vascular disease. This study evaluated the effects of Ozurdex in contrast to a combination therapy with anti-vascular endothelial growth factor (VEGF) and cortisone in treatment-naive branch retinal vein occlusions-macular edema (BRVO-ME) cases, at 4-month and 6-month follow-ups. Thirty eyes were included in the study, which were divided into two groups. The first group consisted of 15 eyes, and each received 1 injection of dexamethasone intravitreal implant Ozurdex (DEX). The second group of 15 eyes received 3 intravitreal injections, the first and second with the anti-vascular endothelial growth factor aflibercept and the third one with 4 mg of triamcinolone acetonide (Vitreal S), spaced at one month. The best corrected visual acuity (BCVA) results suggested that the peak efficacy was at 4 months for both groups, with mean values of 0.5 LogMAR and 0.4 LogMAR. Regarding macular edema, there were no significant changes between the 4- and 6-month follow-up periods, with mean values of 361 µm and 390 µm. Six patients experienced transient raised intraocular pressure at one week after treatment. This study highlights the benefits to visual acuity of the combination of anti-vascular endothelial growth factor and cortisone, which represents a viable solution with similar results to Ozurdex therapy.

Clinical outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma-18 months follow-up.

The aim of this study is to evaluate the clinical outcomes of micropulse transscleral cyclophotocoagulation (mTSCPC) in cases of refractory glaucoma. Patients with refractory glaucoma were selected to undergo mTSCPC, using the MP3 handpiece from Iridex Laser Systems. Follow-up examinations occurred on a regular basis for 18 months after the procedure. One hundred eyes of 97 patients were treated. Mean pre-laser intraocular pressure (IOP) was 39.14 ± 13.84 mmHg. This was reduced significantly to 22.77.8 ± 10.48 mmHg (41.82% reduction; p < 0.001) at week 1. At months 1, 3, 6, 12, and 18 the IOP mean was 23.81 ± 9.44, 24.27 ± 9.17, 23.09 ± 8.47, 22.76 ± 8.14, and 22.77 ± 8.13 mmHg. The success rate at 18 months was the highest 90.91% for the group with IOP below 26 mmHg and the lowest 70.00% for the IOP group 26-30 mmHg. The mean number of anti-glaucoma drops decreased from 2.63 ± 0.87 to 1.78 ± 0.95. The number of treatments performed was 1.26. The pain felt during the procedure was reported as being moderate. No major postoperative complications were noted. Micropulse transscleral cyclophotocoagulation is a non-invasive, repeatable laser procedure that offers both good and stable results in lowering IOP and decreases the use of antiglaucoma medications for up to 18 months.

Giant and multiple cardiac papillary fibroelastomas masquerading as acute cerebrovascular events.

Cardiac papillary fibroelastomas are rare benign cardiac tumors. Their clinical significance results from their very high propensity for embolization. We present two such cases, which are rare regarding the size and multiplicity of these tumors.

Primary tonsillar tuberculosis - case report.

We report the case of a 44-year-old male patient with tonsillar tuberculosis (TB) diagnosed in the Department of Ear, Nose & Throat (ENT), "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. The patient addressed to our Clinic with intense odynophagia, referred otalgia, sore throat, fever periods and weight loss. During the ENT clinical exam, we identified an enlarged left tonsil, partially covered with yellowish-white plaque, with ulceration and bleeding spots localized on tonsillar inferior pole. A high suspicion of tonsillar malignancy was raised, and a biopsy was performed revealing extrapulmonary TB. Taking into consideration the normal chest X-ray, a primary tonsillar TB diagnosis was established. The patient was addressed to Department of Pneumophthisiology for anti-tuberculous therapy for six months. At the end of the treatment, the patient was symptoms-free.

New perspectives in the use of laser diode transscleral cyclophotocoagulation. A prospective single center observational cohort study.

PURPOSE: The paper intends to present the results of using new methods of a new generation diode laser transscleral cyclophotocoagulation (TSCPC) in patients with different types of glaucoma. PATIENTS, MATERIALS AND METHODS: There have been treated 53 eyes from 59 patients with glaucoma refractory to medical, laser or surgical treatment. We have used the newest generation of 810 nm wavelength diode laser. There have been used two protocols of continuous-wave diode laser emitting radiation for cyclophotocoagulation. The first technique - the standard cyclophotocoagulation (high power and low exposure duration) - has been used for the eyes with limited visual function [visual acuity (VA) extremely low or eyes disorganized]. The second technique - slow coagulation, also named "slow burn" (lower power and greater exposure duration) - has been used for the eyes with apparently better visual prognosis (VA≥20∕400). For evaluation, we followed both subjective parameters (eye pain decrease) and objective parameters [intraocular pressure (IOP) lowering and VA evolution]. Patients have been evaluated before laser intervention and postoperative at one, three and six months. RESULTS: IOP has significantly decreased in both patient groups. In the eyes with better visual function (VA≥1∕20), where we have used the "slow coagulation" technique, we found no decrease of VA. Eye pain has disappeared in almost all treated cases. CONCLUSIONS: The diode laser TSCPC is an efficient method of lowering IOP and decreasing eye pain. The "slow burn" technique has been shown its efficiency for extending the indications of cyclophotocoagulation also in glaucomatous eyes with better functional prognosis.

The management of the oropharyngeal anterior wall cancer.

INTRODUCTION: Anterior wall of the oropharynx or the base of the tongue is the site of different types of cancers, most of them usually diagnosed in advanced stages. The most common histological type of cancer diagnosed in these patients is squamous cell carcinoma (SCC). The treatment methods are multiple, but the optimal therapeutic option with best results on outcome and on the patients' quality life has not been established. The objectives of our study were to evaluate the tongue base SCCs treated by transhyoid approach and the oncological outcomes of the surgery combined with radiotherapy. PATIENTS, MATERIALS AND METHODS: The retrospective study was performed over a period of 10 years (2001-2010) on 37 previously untreated patients. All the tumors were biopsied and after histopathological (HP) diagnosis, the tumors were excised. All the specimens were fixed in 4% (v/v) buffered formalin and sent for the HP evaluation. RESULTS: In the study were included only the patient diagnosed on biopsy with different types of SCC. The mean age was 61 years old, most of the patients (94.59%) being males. We performed a tongue base transhyoid tumor resection in 23 (62.17%) cases followed by epiglottectomy in five (13.51%) cases or horizontal supraglottic laryngectomy in nine (24.32%) cases, respectively. Bilateral neck dissections and postoperative radiotherapy were performed in all cases. The postoperative and post-therapeutic evolution was favorable at three years (81.1%) and five years (75.67%). There were no signs of local or regional recurrences. The tumor specific three-year and five-year survival rates were: pT2 100%, pT3 87.5%, pT4a 71.42% and 57.14%, and pT4b 50% and 25%, respectively. The stage specific three-year and five-year survival rates were: stage II 100%, stage III 85.71%, stage IVA 83.33% and 79.16%, and stage IVB 50% and 25%, respectively. CONCLUSIONS: The prognosis for the SCC of the tongue base is poor. Cancer resection by transhyoid approach is a feasible procedure, which permits a good tumor control with limited postoperative morbidity, with an important benefit on the life quality of the patients.

Femtosecond-LASIK outcomes using the VisuMax®-MEL® 80 platform for mixed astigmatism refractive surgery.

AIM: To evaluate the predictability, efficacy and safety of Femtosecond-laser-assisted in situ keratomileusis (LASIK) procedure for mixed astigmatism. PATIENTS, MATERIALS AND METHODS: We prospectively evaluated for 12 months 74 eyes (52 patients) with mixed astigmatism that underwent Femtosecond-LASIK treatment. The preoperative mean refractive sphere value was +1.879±1.313 diopters (D) and the mean refractive cylinder value was -4.169±1.091 D. The anterior corneal flap was cut using the VisuMax® femtosecond laser and then the stromal ablation was done using the MEL® 80 excimer laser. RESULTS: Mean age was 30.22±6.421 years with 61.53% female patients. Postoperative spherical equivalent at 12 months was within ±0.5D of emmetropia in 75.8% of eyes and within ±1D in 97.3% of eyes. Postoperative uncorrected distance visual acuity was equivalent to or better than the preoperative corrected distance visual acuity in 91.9% of eyes. Compared to the preoperative corrected distance visual acuity (CDVA), 8.1% of eyes gained one line, 2.7% gained two lines and 2.7% gained three lines of visual acuity. CONCLUSIONS: Femtosecond-LASIK using the VisuMax®-MEL® 80 platform appears to have safe, effective and predictable results in mixed astigmatic eyes. The results are impressive for high refractive error treatment and for improvement of both uncorrected and corrected distance visual acuity.

Caruncular late-onset junctional nevus: apropos of an anatomo-clinical observation.

Conjunctival nevi are benign tumors, most often located at the nasal or temporal limbus, and rarely in the fornix or tarsus. The vast majority of caruncular tumors are benign and only few are malignant. Most of the caruncular tumors (either benign or malignant) are nevi. We report a case of a 75-year-old female patient presenting caruncular atypical late-onset junctional nevus that clinically arose malignancy suspicion. Ophthalmologic macroscopic examination and slit lamp examination of the right eye were performed. Further blood tests were performed. Carunclectomy was performed two days after admission to hospital. Microscopy revealed the junctional localization, diffuse proliferation of the nevocytes. Immunoreactions with S100 and human melanoma black 45 (HMB45) antibodies were performed. Differential diagnosis of these lesions represents a great challenge. The greatest challenge represents the differential diagnosis between a benign tumor and a malignant life-threatening one, the malignant melanoma, especially with unusual presentation. The presence of a late-onset caruncular tumor with uncertain evolution requires excision biopsy to determine the diagnosis and to establish the best management.