Imatinib for the treatment of patients with unresectable or metastatic malignant KIT-positive gastrointestinal stromal tumours: an open-label Belgian trial

BACKGROUND

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract. They are defined immunohistologically as KIT positive tumours. The only effective treatment for malignant GIST was surgery until 2000. Imatinib mesylate (STI571, Glivec) has shown substantial anticancer activity in patients with metastatic or unresectable GIST.

PATIENTS AND METHODS

57 patients who were diagnosed with unresectable or metastatic malignant GIST were entered into this study. The patients were given 400 mg Glivec orally once daily. The dose could be increased to 600 mg orally once daily and then to 400 mg twice daily if tumour progression was noticed. Daily treatment was interrupted or dose was decreased only in the case of limiting toxicities. We evaluated the tumour response and the safety of the drug.

RESULTS

85% of GIST patients showed a partial response or stable disease after 8 weeks of treatment with imatinib. The main side effects were nausea, vomiting, anorexia, skin rash, periorbital oedema and diarrhea.

CONCLUSION

This study confirms that imatinib is an active agent against malignant GIST with manageable toxicities.

Modulation of purinergic signaling by NPP-type ectophosphodiesterases

Extracellular nucleotides can elicit a wide array of cellular responses by binding to specific purinergic receptors. The level of ectonucleotides is dynamically controlled by their release from cells, synthesis by ectonucleoside diphosphokinases and ectoadenylate kinases, and hydrolysis by ectonucleotidases. One of the four structurally unrelated families of ectonucleotidases is represented by the NPP-type ectophosphodiesterases. Three of the seven members of the NPP family, namely NPP1–3, are known to hydrolyze nucleotides. The enzymatic action of NPP1–3 (in)directly results in the termination of nucleotide signaling, the salvage of nucleotides and/or the generation of new messengers like ADP, adenosine or pyrophosphate. NPP2 is unique in that it hydrolyzes both nucleotides and lysophospholipids and, thereby, generates products that could synergistically promote cell motility. We review here the enzymatic properties of NPPs and analyze current evidence that links their nucleotide-hydrolyzing capability to epithelial and neural functions, the immune response and cell motility.

[Evolution of secondary pseudoexfoliative glaucoma after cataract surgery in patients with cataract-glaucoma combination]

PURPOSE

To assess the effects of the cataract surgery on the evolution of the secondary open angle glaucoma (SOAG) in patients with pseudoexfoliative syndrome (PEX) that present the association cataract--SOAG.

METHODS

A prospective study on 2 years on a group of 12 eyes with PEX syndrome presenting the association cataract-secondary open angle glaucoma, that have been operated by phacoemulsification + PC IOL, without intra-operator complications. We have monitored the effects of the cataract surgery on the evolution of the glaucomatous disease, evaluated by: monitoring of the IOP dynamics, the analysis of the visual field defects and the aspect of the FO, the evolution of the visual acuity and the morphology of the specific changes of PEX. The analysed group has been compared with a control group (5 eyes) presenting the association cataract--POAG, operated by phacoemulsification by the same surgeon. We have used the SPSS programme for statistical analysis.

RESULTS

In the follow-up period we have observed almost similar evolutions of the IOP dynamic, but we obtained in PEX group statistically significant lowering of the IOP than in the control group. In PEX group the papillo-perimetric results have presented significantly different characteristics than in the control group, without having an influence on the visual acuity.

CONCLUSIONS

Although the cataract extraction has produced in both groups, on a medium follow-up, an IOP decrease from the pre-operator values, the glaucomatous disease in PEX patients, probably because of other specific risk factors, continues to progress.

[IOP diurnal fluctuations in patients presenting pseudoexfoliative syndrome]

PURPOSE

To analyze the IOP diurnal fluctuations in patients presenting pseudoexfoliative syndrome (PEX) compared to those without PEX.

METHOD

A clinical observational prospective study, one year, on 2 groups of patients: group A (13 patients)--with pseudoexfoliative syndrome (PEX) and group B, control, (11 patients)--without PEX. The groups were homogeneous about the age and sex distribution. At each visit 4 IOP measurements were taken using Goldmann aplanotonometry.

RESULTS

In PEX patients the IOP had greater values during the study period compared to the control group. By comparing the two groups have been observed significant differences about the maximum IOP, the mean IOP and the diurnal fluctuations, also about the incidence of the complications.

CONCLUSIONS

The IOP diurnal fluctuations in PEX patients are significantly greater than the physiological ones and therefore influence the therapeutic attitude and the prognostic. The significant fluctuations in the IOP diurnal curve are an important predictive factor for the eyes that will develop secondary glaucoma. The pseudoexfoliative syndrome is an independent risk factor for glaucoma in patients with intraocular hypertension.

[Ocular changes in demyelinating diseases]

To synthetize the main ocular changes in the demyelinating diseases of CNS. The most important changes in this diseases are the neuro-ophthalmological ones: retrobulbar optic neuritis, papillitis, oculomotor nerves palsies. Also the demyelinating diseases can have an ophthalmological involvement represented by: retinal periphlebitis, pars planitis.

Post-traumatic bacterial keratitis--a microbiological prospective clinical study

PURPOSE

The aim of this study was to define the microbiological and clinical profile of traumatic bacterial keratitis, the management and outcome of this disease.

METHODS

The patients with traumatic bacterial keratitis were prospectively enrolled from 1 June 2004 to 30 June 2006. Clinical features (age, risk factors, visual acuity, corneal ulcer size), microbiological profile, management and outcomes were analyzed.

RESULTS

The 68 consecutive patients were analyzed. Corneal scraping was performed in 96% of cases and in 86, 7% it was positive. 76% of the infections involved Gram positive bacteria, 14% involved Gram negative bacteria, and 8, 8% were polymicrobial. The most commonly isolated bacteria was Staphylococcus epidermidis - 41, 7%. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.003), as well as greater surface of infiltrates (p=0.04). Antimicrobial treatment was changed on the basis of culture results in 9 cases (13, 2%). 95, 5% of ulcers resolved with treatment, but only 75% of patients had visual acuity better than the level at admission, and 4, 4% had poor visual outcome with indication for corneal transplant.

CONCLUSIONS

Infectious keratitis is an important cause of ocular morbidity. Ocular trauma represents the main risk factor for bacterial keratitis. The ulcer size was statistical significantly correlated with patient's age and also the most important predictor of a positive culture result. Fluoroquinolones appear to be the first choice therapy, but based upon these in vitro studies, some strains may be resistant.

[Protein C reactive and glaucoma]

PURPOSE

To observe the possible implications of the C reactive protein in pathogenesis of the glaucoma.

METHODS

A clinical observational prospective study on 2 groups: group A 14 glaucomatous patients and group B--control (12 normal subjects) without history of ocular pathology or general pathology known to be associated with high plasma levels of CRP. The groups were homogeneous about the age and sex distribution. CRP levels were evaluated by tests with high specificity.

RESULTS

The plasma CRP level reveals important differences (p < 0,0001) on the two groups: 3,87 +/- 0,8 mg/dl in the group A and 0,68 +/- 0,13 mg/dl in the control group.

CONCLUSIONS

Glaucoma is associated with high plasma levels of CRP. In the complex pathogenesis of glaucoma, in which the vascular factor has his well known place, the inflammatory vascular modifications may represent an important component.

[Refractive stability of foldable intraocular lenses]

PURPOSE

To compare the refractive stability of different kind of foldable intraocular lenses.

METHOD

There was performed a two years (mean follow-up 7,4 +/- 1,2 months) prospective interventional case series study on 108 with senile cataract, without another ocular pathology which underwent cataract surgery by phacoemulsification and implantation of foldable intraocular lens (the same surgeon). Each patient had their refractive status measured at the 1-month postoperative visit, 3-months and at the 6-months follow-up visit. The results have been statistically analyzed using the Wilcoxon test.

RESULTS

The postoperative refractive results were correlated with IOL design and material. The acrylic hydrophobic foldable intraocular lens with rigid haptics was more likely to move to hypermetropia and the acrylic hydrophobic foldable intraocular lens with pliable haptics showed minimal myopic movement.

CONCLUSIONS

On long-term, the 1-piece acrylic hydrophobic IOL with soft acrylic loops had the most stable refractive results.

[Central serous chorioretinopathy--clinical aspects and course]

PURPOSE

To investigate and to identify the clinical aspects and outcomes in military patients with central serous chorioretinopathy (CSC).

METHODS

Prospective, comparative, observational case series study during 01.01.2004-31.12.2005 on two groups with central serous chorioretinopathy: group A (12 eyes) from military environment compared with group B (9 eyes) from civil patients. The evaluations were performed based on visual acuity, functional symptoms, fundus biomicroscopy, fluorescein angiography and optical coherence tomography. The relationship of CSC to the age, gender, psychosomatic symptoms, personality profiles, systemic associated diseases or risk factors and the rate of recurrence were evaluated. The statistical Anova multivariate analysis was performed.

RESULTS

There were no significant differences between the two groups regarding distribution to the age and gender. In the military patients, by use of a multivariate analysis steroid use, infection with Helicobacter pylori and type A behavior pattern were strongly associated with CSC. The mean duration of disease was significant prolonged in the group A as compared with group B (p=0,0012). In the military patients, there were 5 cases (41,66%) with recurrence and 1 case (11,11%) in the civil patients (p=0,0009). Laser photocoagulation was used in 3 cases (25%), respectively 1 case (11,11%) in the group B.

CONCLUSIONS

Although CSC usually resolves spontaneously, the associated diseases and risk factors, the clinical aspects and outcomes in military patients may be different, with residual visual deficits, despite recovering normal visual acuity.

NPP-type ectophosphodiesterases: unity in diversity

Nucleotide pyrophosphatase/phosphodiesterase (NPP)-type ectophosphodiesterases are found at the cell surface as type-I or type-II transmembrane proteins, but are also found extracellularly as secreted or shedded enzymes. They hydrolyze pyrophosphate or phosphodiester bonds in a variety of extracellular compounds including nucleotides, (lyso)phospholipids and choline phosphate esters. Despite their structurally related catalytic domain, each enzyme has well-defined substrate specificity. Catalysis by NPPs affects processes as diverse as cell proliferation and motility, angiogenesis, bone mineralization and digestion. In addition, there is emerging evidence for non-catalytic functions of NPPs in cell signaling. NPP-type ectophosphodiesterases are also implicated in the pathophysiology of cancer, insulin resistance and calcification diseases, and they hold great promise as easily accessible therapeutic targets.

Proteolytic maturation and activation of autotaxin (NPP2), a secreted metastasis-enhancing lysophospholipase D

Autotaxin (NPP2) is an extracellular protein that is upregulated in various malignancies, including breast and lung cancer. It potently stimulates cell proliferation, cell motility and angiogenesis, which is accounted for by its intrinsic lysophospholipase-D activity that generates the lipid mediators lysophosphatidic acid and sphingosine-1-phosphate. Based on its structural similarities with the better characterized nucleotide pyrophosphatase/phosphodiesterase NPP1, it has always been assumed that NPP2 is also synthesized as a type-II integral membrane protein and that extracellular NPP2 is generated from this membrane precursor. We show here, however, using domain swapping and mutagenesis experiments as well as N-terminal protein sequencing, that NPP2 is actually synthesized as a pre-pro-enzyme and that the proteolytically processed protein is secreted. Following the removal of a 27-residue signal peptide by the signal peptidase, NPP2 is subsequently cleaved by proprotein convertases (PCs). The removal of an N-terminal octapeptide by PCs is associated with an enhanced activity of NPP2 as a lysophospholipase D. These novel insights in the maturation of NPP2 have also implications for the development of NPP2 inhibitors as potential anti-cancer agents.

[Axial length of the ocular globe and hypotensive effect in glaucoma therapy with prostaglandin analogs]

PURPOSE

To observe the possible correlations between the hypotensive effect of the prostaglandin analogs and the axial length of the ocular globe.

METHOD

A prospective, observational and randomized study (one year) on 27 patients with POAG treated by prostaglandin analogs monotherapy. The patients have been divided in two groups according to the type of the prostaglandin analogs used: group A - 12 patients - travoprost 0,004 % (Travatan) and group B - 15 patients - latanoprost 0,005 % (Xalatan). The IOP and the axial length have been evaluated at the beginning of the study and at 1, 3, 6, 9, 12 months using Goldmann aplanotonometry and echo-biometry. The results have been statistically analyzed using the Wilcoxon test.

RESULTS

The mean IOP reduction was similar in both groups, without statistically significant differences. Between the IOP reductions and the axial length of the ocular globe were demonstrated significant correlations according to the patients distribution on the echo-biometry results.

CONCLUSIONS

The IOP reduction with prostaglandin analogs monotherapy may also depend of the axial length of the ocular globe.

[Retinal venous occlusion and intraocular pressure]

PURPOSE

To highlight the etiopathogenic correlations between the changes of intraocular pressure (IOP) and the retinal venous occlusion (RVO).

METHOD

A prospective clinical study for a period of 2 years (01.01.2003-12.31.2004) that included two groups of patients: group A (31 patients) with POAG and group B (14 patients) with OHT, homogeneous concerning the repartition on groups of age, sex, associated systemic conditions. We have evaluated the incidence of RVO and its characteristics and the evolution of IOP. The data have been statistically analysed using the Wilcoxon test.

RESULTS

In the A group we have recorded a significantly higher incidence of RVO comparing to the B group (p=0.0031). In most of the cases, the site of OVR in both groups has been localised at the optic nerve head and accompanied by the fall of IOP comparing to the fellow eye.

CONCLUSIONS

The rise of IOP represents an important risk factor for RVO, and particularly in the presence of other risk factors, the normalisation of IOP is necessary. The glaucomatous changes of optic nerve head have a major role in the apparition of this type of retinal vascular pathology. The changes of IOP can be "hidden" by the occurrence of RVO.

[Color vision in glaucoma]

This article is a general view of evaluated acquired color vision defects in the early stages of primary glaucoma and in patients at risk for glaucoma. The articles published until now indicates a decrease in color discriminating sensitivity in the short wavelength part of the visible spectrum in patients with glaucoma as well as in patients with ocular hypertension. It has been found a positive correlation between the blue-yellow color vision defects and the perimetric changes in the glaucomatous eyes. Blue-yellow color vision testing with the anomaloscope may serve as an additional test in the early diagnosis of glaucoma but the absence of dyschromatopsia does not exclude the disease.

Substrate-specifying determinants of the nucleotide pyrophosphatases/phosphodiesterases NPP1 and NPP2

The nucleotide pyrophosphatases/phosphodiesterases NPP1 and NPP2/autotaxin are structurally related eukaryotic ecto-enzymes, but display a very different substrate specificity. NPP1 releases nucleoside 5'-monophosphates from various nucleotides, whereas NPP2 mainly functions as a lysophospholipase D. We have used a domain-swapping approach to map substrate-specifying determinants of NPP1 and NPP2. The catalytic domain of NPP1 fused to the N- and C-terminal domains of NPP2 was hyperactive as a nucleotide phosphodiesterase, but did not show any lysophospholipase D activity. In contrast, chimaeras of the catalytic domain of NPP2 and the N- and/or C-terminal domains of NPP1 were completely inactive. These data indicate that the catalytic domain as well as both extremities of NPP2 contain lysophospholipid-specifying sequences. Within the catalytic domain of NPP1 and NPP2, we have mapped residues close to the catalytic site that determine the activities towards nucleotides and lysophospholipids. We also show that the conserved Gly/Phe-Xaa-Gly-Xaa-Xaa-Gly (G/FXGXXG) motif near the catalytic site is required for metal binding, but is not involved in substrate-specification. Our data suggest that the distinct activities of NPP1 and NPP2 stem from multiple differences throughout the polypeptide chain.

Improved HPLC methodology for monitoring thiopurine metabolites in patients on thiopurine therapy

OBJECTIVE

Standardization of thiopurine metabolite testing is currently lacking. This paper presents in-depth methodological analysis and optimization of two currently available HPLC procedures (Lennard-Singleton [J. Chromatogr. 583 (1992) 83] and Dervieux-Boulieu [Clin. Chem. 44 (1998) 551]) to improve precision, turn-around time, ruggedness, and cost effectiveness.

DESIGN AND METHODS

Reversed-phase chromatography with UV detection was performed on a Waters HPLC system. The two protocols were improved with regards to internal standardization (IS), chromatographic conditions, as well as reagent preparation, storage, and use. 6-Thioguanine nucleotides (6-TGNs) were analyzed by our optimized techniques in samples from patients on thiopurine therapy (n = 24) and the results were compared.

RESULTS

6-Mercaptopurine (6-MP) was an ideal internal standard in either procedure. Isocratic elution with 5% acetonitrile (ACN) in 20 mmol/l phosphate buffer pH 2.5 allowed for minimal background interference in both protocols. 6-Thioguanine, 6-mercaptopurine, and 6-methylmercaptopurine (6-MMP) eluted at around 4, 5, and 6 min, respectively. Dithiothreitol (DTT) was critical only during the acid hydrolysis step. Less mercury-containing waste was generated in the Lennard-Singleton procedure. With our optimized protocols recovery of 6-TGNs was on average 1.38-fold higher in the Dervieux-Boulieu method over a range of 10-678 pmol/8 x 10(8) RBC and no interfering peaks hindered analysis. Specific extraction of thiopurines before their analysis as per Lennard-Singleton procedure may be redundant.

CONCLUSIONS

We improved the quality and cost effectiveness of two known procedures for thiopurine metabolite assay. Through common chromatographic conditions and internal standardization, future comparison studies are now facilitated a great deal. The less tedious Dervieux-Boulieu procedure for routine thiopurine metabolite testing is warranted.

[ Pediatric glaucoma--case report]

Pediatric glaucoma is an interdisciplinary problem because of it's many systemic abnormalities which may encounter with this disease. In this paper we present the follow up and the treatment of a clinical case. We point once again that the therapy used is a most important attitude for the future prognosis.

[Visual fields defects in cerebral hemorrhagic vascular accident]

Interpretation of the fields of vision forms a key part of ophthalmic and neurologic examinations. The homonymous hemianopa is a hallmark of a retrochiasmal lesion. Postchiasmal lesions that interrupt the visual pathway may have multiple causes which the circulatory disturbances is one of the most important. The authors present the case of a woman who has an isolated homonymous hemianopa produced by a vascular accident of occipital lobe, dwell upon the only manifestation of the cerebral acute hemorrhagic vascular accident was represented by an visual field defect.

[Macula in glaucoma patients]

Recent studies show that early glaucoma changes consist in decrease of macular and retinal nerve fiber layer thickness. When visual acuity and visual field are modified there are 50% ganglion cells loss in retina. Retinal evaluation becomes a new method in early detection of glaucoma.

[Structural and immunohistochemical changes of conjunctiva induced by topical glaucoma medication]

PURPOSE

The topical medication represents the first line therapy for the primary open angle glaucoma. The study is aimed at assessing the structural and immunohistochemical changes of conjunctiva induced by topical glaucoma medication.

METHODS

For this purpose, we carried out a 40 weeks, prospective, experimental, epidemiological-operational and randomized study enrolling 18 patients (36 eyes) with recently primary open angle glaucoma. The eyes were divided into treatment (non-selective beta blockers or selective, prostaglandin analogues, topical carbonic anhydrase inhibitors) in four groups. The assessment was performed by comparison with control group (4 patients) who was instilled with natural tears (with different preservative). Both the cytology and the conjunctival biopsy specimens were investigated by histological exams and immunohistochemistry using different monoclonal antibodies. The study was performed by collaboration with The National Institute of Research and Development in Pathology and Biomedical Sciences-"V. Babes"-Bucharest.

RESULTS

The morphometric analysis of histological sections of conjunctiva showed the following changes: squamous metaplasia (significant increases in the thickness and number of epithelial cell layers), inflammation (increase the number of lymphocytes, macrophages and fibroblasts) and subconjunctival fibrosis. According to the type of medication, we observed the significant increase of subepithelial collagen density and degenerative changes of fibrocytes, the reduction of extracellular matrix and also the up-regulation of antibodies against matrix metalloproteinase and allergic changes. According to structural changes, the immunohistochemistry confirmed the tendency of chronic inflammation.

CONCLUSIONS

This study revealed important structural and immunohistochemical changes of conjunctiva after topical glaucoma medication. The category and the intensity of these changes are dependent on the sort of therapy and the topical treatment period. The findings showed that benzalkonium chloride (the most common preservative of antiglaucoma drugs) is a major factor for conjunctival metaplasia.

[Phacoemulsification and pseudoexfoliative syndrome]

PURPOSE

To compare the results and the complications of cataract surgery by phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) and without pseudoexfoliation syndrome.

METHODS

A retrospective clinical study (January 2001 - January 2004; mean follow-up 21.5 months) of 116 cases divided in two groups: group A (55 eyes) with senile cataract and pseudoexfoliation syndrome and group B (61 eyes) with senile cataract but without pseudoexfoliation syndrome. The eyes were without another associated ophthalmological diseases and the phacoemulsifications were performed by the same surgeon. Intraoperative observations included anterior chamber depth, pupil size after maximal mydriasis, zonular dehiscence, capsule tear, vitreous loss and postoperatively: best corrected visual acuity, intraocular pressure (IOP), aqueous flare response and IOL stability were evaluated at 1 day, 1 week, 1 month and until 3 years. The Student-t test was used for statistical analyses.

RESULTS

There were determined significant correlations between pupil size, anterior chamber depth and the rate of complications in the group A. The visual acuities were similar in both groups. IOP reduction was superior in the eyes with PEX as compared with control group, but without statistically significantly difference. In group A, there were a non-statistically significantly percentage of IOL dislocation as compared with group B. In the eyes with PEX, it is necessary to utilize IOLs with bigger optic size.

CONCLUSIONS

Phacoemulsification represents a safe method in cataract surgery in eyes with pseudoexfoliation syndrome in the presence of careful surgical technique: maximal mydriasis, circular continuous curvilinear capsulorhexis, adequate hydrodissection. On the long run, the postoperative results were comparable between eyes with PEX and the control group (without PEX).

[Posterior capsule rupture in lens surgery]

PURPOSE

The paper studies the breaks of the posterior capsule in lens surgery, specifically the incidence, causes, types, management and the methods of IOL implantation.

METHODS

For this purpose, a retrospective clinical trial was performed, within: 01.06.1999-31.05.2002, on 346 eyes group operated for senile cataract (without other ocular diseases) Patients were split in two groups, based on surgical technique: group 1 with 208 eyes operated using phacoemulsification and group 2 with 138 eyes operated using extracapsular extraction technique.

RESULTS

The incidence of the breaks of the posterior capsule was 8.17% for group 1 (17 eyes out of 208) and 5.07% for group 2 (7 eyes out of 138). In all cases an IOL was used, most of them being placed in the posterior chamber (in bag, in sulcus or sclera-sutured) and infrequently IOL for anterior chamber or with irian support.

CONCLUSIONS

Breaks of the posterior capsule is a complication of cataract surgery, but appropriate management (viscoelastic substances, anterior vitrectomy) leads to a good outcome, with no influence on the subsequent evolution.

[The role of Brinzolamide 1% ophtalmic suspension in corneal edema]

PURPOSE

The study is aimed at assessing the efficacy and safety of topical carbonic anhydrase inhibitor (IAC--i.e. ophthalmic suspension of brinzolamide 1%--Azopt) in the treatment of corneal edema.

METHOD

For this purpose, we carried out an experimental, epidemiological-operational, randomised, placebo-controlled and double blind study, on three groups of laboratory animals (rabbits): group 1 (5 rabbits) included endothelial corneal injuries inflicted by ultrasound exposure by means of a phacoemulsification sound in both eyes group 2 (5 rabbits) included endothelial corneal injuries inflicted by direct trauma in both eyes group 3 (3 rabbits)--no endothelial corneal lesions (control group) In each group we instilled, all the animals, with ophthalmic suspension of brinzolamide 1% (Azopt), 1 drop t.i.d., in one eye for 14 days (starting the following day after infliction of endothelial injuries, when the corneal edema was evidenced by biomicroscopic examination) and placebo (saline solution 0.9% with the same osmolar and pH values as the Azopt) in the other eye. The assessment was performed throughout the following stages: To: preceding the infliction of corneal endothelial injuries, resorting to: biomicroscopic examination ultrasound pahimetry direct specular microscopy T1: the following day after infliction of corneal endothelial injuries, resorting to: biomicroscopic examination (the assessment of corneal edema) ultrasound pahimetry (measurement of corneal thickness and, hence edema) direct specular microscopy (cell density and endothelial ultrastructure evaluation: cellular polimegetism, pleiomorphism) T2: in the wake of 14 days therapy (after eye removal), adding to the previous examinations: indirect specular microscopy (with the same aim as the direct examination, yet examination carried out from the endothelial side) pathologic examination (using hematoxilin-eosin dye and Van-Gieson dye).

[Primary open angle glaucoma evolution after surgery]

The authors present a four year (01.02.1998-01.02.2002) clinical retrospective trial, including 209 eyes operated for Primary Open Angle Glaucoma (POAG). 52 eyes (24.8%) out of 209 eyes the progression of the disease was discovered observing the increase of the intraocular pressure (IOP), failure in achieving "IOP target" due to the insufficient filtration, the obstruction of the filtration and the deterioration of the papiloperimetrics parameters. The therapeutic approach consisted of additional medication, filtration revision, subsequent surgical treatment physical end/or classic. The authors suggest a sequence for the operated cases of POAG, but that continued to progress, postoperative IOP "seemingly normal" requiring the follow-up for t e disease, in spite of using entire methods of the treatment.