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Brănişteanu DE, Porumb-Andrese E, Porumb V, Stărică A, Moraru AD, Nicolescu AC, Zemba M, Brănişteanu CI, Brănişteanu G, Brănişteanu DC. New Treatment Horizons in Uveal and Cutaneous Melanoma. Life (Basel) 2023; 13:1666. [PMID: 37629523 PMCID: PMC10455832 DOI: 10.3390/life13081666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Melanoma is a complex and heterogeneous malignant tumor with distinct genetic characteristics and therapeutic challenges in both cutaneous melanoma (CM) and uveal melanoma (UM). This review explores the underlying molecular features and genetic alterations in these melanoma subtypes, highlighting the importance of employing specific model systems tailored to their unique profiles for the development of targeted therapies. Over the past decade, significant progress has been made in unraveling the molecular and genetic characteristics of CM and UM, leading to notable advancements in treatment options. Genetic mutations in the mitogen-activated protein kinase (MAPK) pathway drive CM, while UM is characterized by mutations in genes like GNAQ, GNA11, BAP1, EIF1AX, and SF3B1. Chromosomal aberrations, including monosomy 3 in UM and monosomy 10 in CM, play significant roles in tumorigenesis. Immune cell infiltration differs between CM and UM, impacting prognosis. Therapeutic advancements targeting these genetic alterations, including oncolytic viruses and immunotherapies, have shown promise in preclinical and clinical studies. Oncolytic viruses selectively infect malignant cells, inducing oncolysis and activating antitumor immune responses. Talimogene laherparepvec (T-VEC) is an FDA-approved oncolytic virus for CM treatment, and other oncolytic viruses, such as coxsackieviruses and HF-10, are being investigated. Furthermore, combining oncolytic viruses with immunotherapies, such as CAR-T cell therapy, holds great potential. Understanding the intrinsic molecular features of melanoma and their role in shaping novel therapeutic approaches provides insights into targeted interventions and paves the way for more effective treatments for CM and UM.
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Affiliation(s)
- Daciana Elena Brănişteanu
- Department of Medical Specialties (III)-Dermatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Railway Clinical Hospital, 700506 Iasi, Romania;
| | - Elena Porumb-Andrese
- Department of Medical Specialties (III)-Dermatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Railway Clinical Hospital, 700506 Iasi, Romania;
| | - Vlad Porumb
- Department of Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Military Emergency Clinical Hospital “Dr. Iacob Czihac”, 700506 Iasi, Romania
| | | | - Andreea Dana Moraru
- Department of Ophthalmology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | | | - Mihail Zemba
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | | | - George Brănişteanu
- “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.I.B.); (G.B.)
| | - Daniel Constantin Brănişteanu
- Railway Clinical Hospital, 700506 Iasi, Romania;
- Department of Ophthalmology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
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Zemba M, Ionescu MA, Pîrvulescu RA, Dumitrescu OM, Daniel-Constantin B, Radu M, Stamate AC, Istrate S. Biomarkers of ocular allergy and dry eye disease. Rom J Ophthalmol 2023; 67:250-259. [PMID: 37876509 PMCID: PMC10591437 DOI: 10.22336/rjo.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
The most common disorders of the ocular surface are dry eye disease (DED) and ocular allergy (OA). These conditions are frequently coexisting with or without a clinical overlap and can cause a severe impact on the patient's quality of life. Therefore, it can sometimes be hard to distinguish between DED and OA because similar changes and manifestations may be present. Atopic patients can also develop DED, which can aggravate their manifestations. Moreover, patients with DED can develop ocular allergies, so these two pathological entities of the ocular surface can be considered as mutual conditions that share the same background. Nowadays, by using different techniques to collect tissue from ocular surfaces, the changes in molecular homeostasis can be detected and this can lead to a precise diagnosis. The article provides an up-to-date review of the various ocular surface biomarkers that have been identified in DED, OA, or both conditions. Abbreviations: DED = dry eye disease, OA = ocular allergy, SS = Sjogren syndrome, TBUT = tear break up time, TFO = tear film osmolarity, AKC = Atopic keratoconjunctivitis, ANXA1 = Annexin 1, ANXA11 = Annexin 11, CALT = Conjunctival associated lymphoid tissue, CCL2/MIP-1 = Chemokine (C-C motif) ligand2/Monocyte chemoattractant protein 1, CCL3/MIP-1α = Chemokine (C-C motif) ligand 3/Macrophage inflammatory protein 1 alpha, CCL4/MIP-1β = Chemokine (C-C motif) ligand 4/Macrophage inflammatory protein 1 beta, CCL5/RANTES = Chemokine (C-C motif) ligand 5 /Regulated on Activation, Normal T cell Expressed and Secreted, CCR2 = Chemokine (C-C motif) receptor 2, CCR5 = Chemokine (C-C motif) receptor 5, CD3+ = Cluster of differentiation 3 positive, CD4+ = Cluster of differentiation 4 positive, CD8+ = Cluster of differentiation 8 positive, CGRP = Calcitonin-gene-related peptide, CX3CL1 C-X3 = C motif -chemokine ligand 1 /Fractalkine, CXCL8 = Chemokine (C-X-C motif) ligand 8, CXCL9 = Chemokine (C-X-C motif) ligand 9, CXCL10 = Chemokine (C-X-C motif) ligand 10, CXCL11 = Chemokine (C-X-C motif) ligand 11, CXCL12 = Chemokine (C-X-C motif) ligand 12, CXCR4 = Chemokine (C-X-C motif) receptor 4, EGF = Epidermal growth factor, HLA-DR = Human leukocyte antigen-D-related, ICAM-1 = Intercellular adhesion molecule 1, IFN-γ = Interferon-gamma, IgG = Immunoglobulin G, IgE = Immunoglobulin E, IL-1 = Interleukin-1, IL-1α = Interleukin-1 alpha, IL-1β = Interleukin-1 beta, CGRP = Calcitonin-Gene-Related Peptide, IL-3 = Interleukin-3, IL-4 = Interleukin-4, IL-6 = Interleukin-6, IL-8 = Interleukin-8, IL-10 = Interleukin-10, IL-17 = Interleukin-17, IL-17A = Interleukin-17A, LPRR3 = Lacrimal proline-rich protein 3, LPRR4 = Lacrimal proline-rich protein 4, MUC5AC = Mucin 5 subtype AC, oligomeric mucus/gel-forming, MUC16 = Mucin 16, OCT = Optical coherence tomography, OGVHD = Ocular graft versus host disease, PAX6 = Paired-box protein 6, VKC = Vernal keratoconjunctivitis, TGF-β = Transforming growth factor β, S100 = proteins Calcium activated signaling proteins, Th1 = T helper 1 cell, Th17 = T helper 17 cell, MGD = Meibomian gland dysfunction, TFOS = Tear film and ocular surface society, SS-KCS = Keratoconjunctivitis Sicca, MMP-9 = Matrix metalloproteinase 9, MMP-1 = Matrix metalloproteinase 1, ZAG = Zinc alpha glycoprotein, CBA = Cytometric bead array, MALDI TOF-MS = matrix assisted laser desorption ionization-time of flight, SELDI TOF-MS = surface-enhanced laser desorption ionization-time of flight, IVCM = in vivo confocal microscopy, AS-OCT = anterior segment optical coherence tomography, iTRAQ = Isobaric tags for relative and absolute quantitation, LC-MS = Liquid chromatography-mass spectrometry, LCN-1 = lipocalin 1, PIP = prolactin induced protein, NGF = Nerve growth factor, PRR4 = proline rich protein 4, VIP = Vasoactive intestinal peptide, ELISA = enzyme linked immunoassay, TNF-α = tumor necrosis factor alpha, PAC = perennial allergic conjunctivitis, SAC = seasonal allergic conjunctivitis, IC = impression cytology, RT-PCR = reverse transcription polymerase chain reaction, PCR = polymerase chain reaction, APCs = antigen-presenting cells, NK cells = natural killer cells, HEL = hexanoyl-lysine, 4-HNE = 4-hydroxy-2-nonenal, MDA = malondialdehyde.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Mihai-Alexandru Ionescu
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | | | - Otilia-Maria Dumitrescu
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | | | - Mădălina Radu
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Alina-Cristina Stamate
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- ArenaMed Clinic Bucharest, Bucharest, Romania
| | - Sînziana Istrate
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Brănișteanu DE, Porumb-Andrese E, Stărică A, Munteanu AC, Toader MP, Zemba M, Porumb V, Cozmin M, Moraru AD, Nicolescu AC, Brănișteanu DC. Differences and Similarities in Epidemiology and Risk Factors for Cutaneous and Uveal Melanoma. Medicina (Kaunas) 2023; 59:medicina59050943. [PMID: 37241175 DOI: 10.3390/medicina59050943] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/17/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Both cutaneous melanoma (CM) and uveal melanoma (UM) represent important causes of morbidity and mortality. In this review, we evaluate the available knowledge on the differences and similarities between cutaneous melanoma and uveal melanoma, focusing on the epidemiological aspects and risk factors. Uveal melanoma is a rare condition but is the most prevalent primary intra-ocular malignant tumor in adults. Cutaneous melanoma, on the other hand, is significantly more common. While the frequency of cutaneous melanoma has increased in the last decades worldwide, the incidence of uveal melanoma has remained stable. Although both tumors arise from melanocytes, they are very distinct entities biologically, with complex and varied etiologies. Both conditions are encountered more frequently by individuals with a fair phenotype. ultraviolet-radiation is an important, well-documented risk factor for the development of CM, but has shown not to be of specific risk in UM. Although cutaneous and ocular melanomas seem to be inherited independently, there are reported cases of concomitant primary tumors in the same patient.
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Affiliation(s)
- Daciana Elena Brănișteanu
- Dermatology Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
- Railway Clinical Hospital, 700506 Iasi, Romania
| | - Elena Porumb-Andrese
- Dermatology Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
- Railway Clinical Hospital, 700506 Iasi, Romania
| | - Alexandra Stărică
- Dermatology Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
- Railway Clinical Hospital, 700506 Iasi, Romania
| | - Anca Catalina Munteanu
- Dermatology Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
- Railway Clinical Hospital, 700506 Iasi, Romania
| | | | - Mihail Zemba
- Ophthalmology Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Vlad Porumb
- Department Surgery, 'Grigore T. Popa' University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Mihai Cozmin
- Clinical Department, Apollonia University of Iasi, 700511 Iasi, Romania
| | - Andreea Dana Moraru
- Ophthalmology Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin Codruț Nicolescu
- Roma Medical Center for Diagnosis and Treatment, 011773 Bucharest, Romania
- "Agrippa Ionescu" Emergency Clinical Hospital, 011773 Bucharest, Romania
| | - Daniel Constantin Brănișteanu
- Railway Clinical Hospital, 700506 Iasi, Romania
- Ophthalmology Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Camburu G, Zemba M, Tătaru CP, Purcărea VL. The measurement of Central Corneal Thickness. Rom J Ophthalmol 2023; 67:168-174. [PMID: 37522018 PMCID: PMC10385715 DOI: 10.22336/rjo.2023.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
We aimed to compare five different devices that measure Central Corneal Thickness. The Central Corneal Thickness (CCT) is an important parameter in ophthalmology. It is involved in the management of various eye conditions such as: glaucoma, keratoconus, contact lens wearing, corneal dystrophies, refractive surgery and keratoplasty. We measured the CCT using OCT, Topographer (TOPO), Ultrasonography Pachymeter (US), Specular Microscope (MS), and Non-contact Tonometer (TONO). In the analysis of the data collected from 59 patients we found the following mean values: US - 554.51 ± 29.849 μm, OCT - 548.73 ± 31.080 μm, TOPO - 553.76 ± 29.845 μm, MS - 564 ± 32.637 μm, and TONO - 538.9 ± 35.657 μm. Our results confirmed the strong correlation between techniques. Abbreviations: OCT = Optical Coherence Tomography, CCT = Central Corneal Thickness, TOPO = Topographer, US = Ultrasonography Pachymeter, MS = Specular Microscope, TONO = Non-contact Tonometer.
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Affiliation(s)
- Georgiana Camburu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihail Zemba
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Cherecheanu MP, Romanitan MO, Pirvulescu R, Iancu R, Garhöfer G, Iancu G, Cherecheanu AP, Zemba M, Vasile V, Simonov A, Branisteanu D. Uncommon association between vascular Ehlers–Danlos syndrome and ocular complications. Front Med (Lausanne) 2023; 10:1089652. [PMID: 37064021 PMCID: PMC10090385 DOI: 10.3389/fmed.2023.1089652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Ehlers–Danlos syndromes (EDS) represent a group of rare inherited disorders that affect connective tissues. There are 13 types of disease, most of them affecting joints or skin; symptoms usually include loose joints, joint pain, stretchy velvety skin, abnormal scar formation. However, the most serious type of disease is vascular EDS (vEDS), or EDS type 4 because patients may suffer vessels dissections or internal organs lesions, followed by bleeding, which endangers patient’s life, but also thromboembolic events. We present two clinical cases of vEDS managed in our clinic in 1 year distance. In both cases, patients were active young persons (in their thirties, and respectively, twenties), both with multiple non-traumatic vascular dissections, and severe ocular complications: arterio-venous fistula with massive exophthalmia, and central retinal artery occlusion, respectively. Both cases were challenging since the life of the patients were threatened by their condition. However, in both cases, prompt treatment and finding the right trigger of the ocular pathology and vascular injuries helped doctors to provide proper and prompt medical care, in order to prevent future similar events to happen and to preserve a good quality of life for these patients.
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Affiliation(s)
- Matei Popa Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Cardiovascular Surgery Clinic, Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucharest, Romania
| | - Mihaela Oana Romanitan
- Department for Emergency Internal Medicine and Neurology, Stockholm South General Hospital, Stockholm, Sweden
- *Correspondence: Mihaela Oana Romanitan, ; Ruxandra Pirvulescu, ; ; Raluca Iancu,
| | - Ruxandra Pirvulescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
- *Correspondence: Mihaela Oana Romanitan, ; Ruxandra Pirvulescu, ; ; Raluca Iancu,
| | - Raluca Iancu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
- *Correspondence: Mihaela Oana Romanitan, ; Ruxandra Pirvulescu, ; ; Raluca Iancu,
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - George Iancu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Filantropia Clinical Hospital, Bucharest, Romania
| | - Alina Popa Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Mihail Zemba
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Clinical Military Emergency Hospital, Bucharest, Romania
| | - Victor Vasile
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrei Simonov
- Department of Interventional Radiology, University Emergency Hospital, Bucharest, Romania
| | - Daniel Branisteanu
- Department of Ophthalmology, University of Medicine and Pharmacy Grigore T. Popa Iasi, Iasi, Romania
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Zemba M, Radu M, Istrate S, Dumitrescu OM, Ionescu MA, Vatafu A, Barac IR. Intrastromal Injections in the Management of Infectious Keratitis. Pharmaceutics 2023; 15:pharmaceutics15041091. [PMID: 37111577 PMCID: PMC10146496 DOI: 10.3390/pharmaceutics15041091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Infectious keratitis is a major global cause of vision loss and blindness. Prompt diagnosis and targeted antibiotic treatment are crucial for managing the condition. Topical antimicrobials are the most effective therapy for bacterial keratitis, but they can lead to unsatisfactory results due to ocular perforation, scarring, and melting. Intrastromal injection is a newer technique for delivering antimicrobials directly to the site of infection and has been successful in treating severe, treatment-resistant infectious keratitis, especially when surgery is not recommended. In cases where deep stromal disease is resistant to topical treatment, intrastromal antimicrobial injections may be necessary to achieve higher drug concentration at the infection site. However, the use of intrastromal antibiotics is limited, as topical antibacterial agents have better penetration than antifungal agents. Bacterial and fungal keratitis have been extensively researched for intrastromal medication injections, while there is limited evidence for viral keratitis. This review emphasizes the potential of intrastromal antimicrobial injections as an alternative for managing severe refractory infectious keratitis. The technique offers direct targeting of the infection site and faster resolution in some cases compared to topical therapy. However, further research is needed to determine the safest antimicrobials options, minimal effective doses, and concentrations for various pathogens. Intrastromal injections may serve as a non-surgical treatment option in high-risk cases, with benefits including direct drug delivery and reduced epithelial toxicity. Despite promising findings, more studies are required to confirm the safety and efficacy of this approach.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Madalina Radu
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
- Correspondence:
| | - Sinziana Istrate
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Mihai Alexandru Ionescu
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Andrei Vatafu
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Ileana Ramona Barac
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
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Romanitan MO, Popa-Cherecheanu M, Vasile VA, Stanca S, Iancu G, Zemba M, Branisteanu D, Iancu R, Pirvulescu RA. Highlights on Genetic Polymorphism Associated with Thromboembolic Risk; Implications in Ophthalmic and Autoimmune Disorders—A Review. Diagnostics (Basel) 2023; 13:diagnostics13071267. [PMID: 37046485 PMCID: PMC10093669 DOI: 10.3390/diagnostics13071267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
The present paper explores genetic polymorphism and its association with thromboembolic retinal venous disorders, such as central/hemi-retinal vein occlusion, as well as possible correlations with other ocular findings, such as closed angle glaucoma, but also with autoimmune general disorders. In this review, we are highlighting the importance of establishing a correspondence between all of the above, since they all have complex etiopathogeneses; sometimes, when all coexist together, they could generate effects that may be very difficult to manage. There are studies supporting that genetic polymorphism, such as the variant MTHFR A1298C, may increase the risk for developing glaucoma, especially in the heterozygote model. Being aware of all these aspects may prove to be useful in patients with several associated diseases, as a combined effort between several medical specialties may prove to the benefit of these patients. Our review, completed with an exemplifying clinical case, shows that it is necessary to raise awareness of all aspects of a complex medical situation, including the genetic one, of a patient being at risk for thromboembolic episodes, for preventing them or managing them promptly and properly in the future.
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Zemba M, Dumitrescu OM, Gheorghe AG, Radu M, Ionescu MA, Vatafu A, Dinu V. Ocular Complications of Radiotherapy in Uveal Melanoma. Cancers (Basel) 2023; 15:cancers15020333. [PMID: 36672282 PMCID: PMC9856287 DOI: 10.3390/cancers15020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Uveal melanoma is the most common primary malignant intraocular tumor in adults. Radiation therapy has replaced enucleation and is now the preferred treatment in most cases. Nonetheless, around 70% of patients develop radiation-related complications, some of which are vision-threatening. The objective of this review is to present the most important complications associated with radiotherapy in the treatment of uveal melanoma and their pathogenesis, incidence, risk factors, and available preventive and therapeutic measures. The most common complications are cataracts, with a reported incidence ranging from 4% to 69%, and radiation retinopathy, reported in 5-68% of cases. Radiation-related complications are responsible for approximately half of secondary enucleations, the leading cause being neovascular glaucoma. A poor visual outcome is mainly associated with the presence of radiation retinopathy and radiation optic neuropathy. Therapeutic options are available for the majority of complications with the notable exception of optic neuropathy. However, many studies report a final visual acuity of less than 20/200 in more than 60% of treated eyes. Reducing complication rates can be achieved by lowering the dose of radiation, with the use of eccentric, customized plaques and careful planning of the irradiation delivery in order to protect structures vital to vision and by associating radiation therapy with other methods with the aim of reducing tumor volume.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
- Correspondence:
| | - Alina Gabriela Gheorghe
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania
| | - Madalina Radu
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Mihai Alexandru Ionescu
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Andrei Vatafu
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Valentin Dinu
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania
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Baltă F, Dinu V, Zemba M, Baltă G, Barac AD, Schmitzer S, Dragosloveanu CDM, Barac RI. Choroidal Thickness Increase after Subliminal Transscleral Cyclophotocoagulation. Diagnostics (Basel) 2022; 12:diagnostics12071513. [PMID: 35885419 PMCID: PMC9316627 DOI: 10.3390/diagnostics12071513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study is to estimate the success rate of subliminal transscleral cyclophotocoagulation for refractory glaucoma and to determine the correlation between the decrease in intraocular pressure and the variation in choroidal thickness. Methods: A pre−post study was conducted over a period of 3 years, including 81 eyes from 67 patients with different types of drug-refractory glaucoma who underwent subliminal transscleral cyclophotocoagulation. The variables included best-corrected visual acuity, intraocular pressure and choroidal thickness. Results: We observed the following success rates (defined as IOP < 21 mmHg): 80% at 1 month (65 patients), 74% at 3 months (60 patients), 64% at 6 months (52 patients) and 50.6% at 1 year (41 patients). A strong correlation was noted between the decrease in intraocular pressure and the increase in the average choroidal thickness at 1 year (318.42 µm) compared to the average preoperative thickness (291.78 µm). A correlation of increased choroidal thickness at 1-month with the success rate of the procedure was also observed. Conclusions: We observed a statistically significant correlation between the success rate, decrease in intraocular pressure and choroidal thickness. The correlation of increased choroidal thickness at 1-month with the success rate of the procedure could be used clinically as a predictive factor for the final outcome of patients. Further experimental research is warranted to determine whether the increase in choroidal thickness after subliminal transscleral cyclophotocoagulation is indeed evidence of increased uveoscleral drainage.
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Affiliation(s)
- Florian Baltă
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (F.B.); (M.Z.); (A.D.B.); (S.S.); (C.D.M.D.); (R.I.B.)
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania;
| | - Valentin Dinu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (F.B.); (M.Z.); (A.D.B.); (S.S.); (C.D.M.D.); (R.I.B.)
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania;
- Correspondence: ; Tel.: +40-726195486
| | - Mihail Zemba
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (F.B.); (M.Z.); (A.D.B.); (S.S.); (C.D.M.D.); (R.I.B.)
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - George Baltă
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania;
| | - Andreea Diana Barac
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (F.B.); (M.Z.); (A.D.B.); (S.S.); (C.D.M.D.); (R.I.B.)
| | - Speranța Schmitzer
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (F.B.); (M.Z.); (A.D.B.); (S.S.); (C.D.M.D.); (R.I.B.)
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania;
| | - Christiana Diana Maria Dragosloveanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (F.B.); (M.Z.); (A.D.B.); (S.S.); (C.D.M.D.); (R.I.B.)
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania;
| | - Ramona Ileana Barac
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (F.B.); (M.Z.); (A.D.B.); (S.S.); (C.D.M.D.); (R.I.B.)
- Bucharest Emergency Eye Hospital, 030167 Bucharest, Romania;
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Zemba M, Dumitrescu OM, Vaida F, Dimirache EA, Pistolea I, Stamate A, Burcea M, Branisteanu D, Balta F, Barac I. Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma. Exp Ther Med 2022; 23:278. [PMID: 35317447 PMCID: PMC8908348 DOI: 10.3892/etm.2022.11207] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 11/11/2022] Open
Abstract
Neovascular glaucoma (NVG) is a refractory form of glaucoma, associated with important morbidity, for which no consensus exists regarding the optimal choice of therapy. The primary aim of our study was to compare the performances of micropulse transscleral cyclophotocoagulation (MP-TSCPC) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) in the treatment of neovascular glaucoma (NVG). A total of 24 eyes for MP-TSCPC and 22 eyes for CW-TSCPC, all with NVG were included. The procedures were performed using either the Iridex Cyclo G6 (IRIDEX Laser System), the MP3, or the G-Probe devices. Intraocular pressure (IOP), visual acuity (VA), the mean number of antiglaucoma medications, and postoperative complications were monitored. The minimum follow-up was 12 months. The success rate at 12 months was 54.5% in the CW-TSCPC group and 33.3% in the MP-TSCPC group. The mean IOP at baseline was 35.82 mm Hg for CW-TSCPC and 34.71 mm Hg for MP-TSCPC. The change from baseline in IOP at 12 months was 11.95 mm Hg in the CW-TSCPC group and -8.04 mm Hg in the MP-TSCPC group. There was a significant difference in the occurrence of serious complications (worsening of VA, hypotony, and phthisis bulbi) between the two methods, with CW-TSCPC associated with more important adverse effects (P=0.045). There was a decrease in the number of topical antiglaucoma medications in both groups: in the MP-TSCPC group from a mean number of 2.6 at baseline, to 1.7 at 3 months, followed by a slight increase to 2.1 at 12 months and in the CW-TSCPC group from 2.8 at baseline, to 1.4 at 3 months and 1.9 at 12 months. Our study concluded that both MP-TSCPC and CW-TSCPC could manage NVG, but, while CW-TSCPC revealed higher IOP control in the long term (which did not reach statistical significance), it also had a significantly lower safety profile.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 01082 Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 01082 Bucharest, Romania
| | - Florin Vaida
- Division of Biostatistics and Bioinformatics, University of California, San Diego, CA 92093, USA
| | - Elena-Andreea Dimirache
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 01082 Bucharest, Romania
| | - Iulia Pistolea
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 01082 Bucharest, Romania
| | - Alina Stamate
- Department of Ophthalmology, Arena Med Clinic, 022117 Bucharest, Romania
| | - Marian Burcea
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniel Branisteanu
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Florian Balta
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ileana Barac
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Branisteanu D, Cojocaru C, Diaconu R, Porumb E, Alexa A, Nicolescu A, Brihan I, Bogdanici C, Branisteanu G, Dimitriu A, Zemba M, Anton N, Toader M, Grechin A, Branisteanu D. Update on the etiopathogenesis of psoriasis (Review). Exp Ther Med 2022; 23:201. [PMID: 35126704 PMCID: PMC8794554 DOI: 10.3892/etm.2022.11124] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Daciana Branisteanu
- Department of Dermatology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Catalina Cojocaru
- Department of Dermatology, Railway Clinical Hospital, 700506 Iasi, Romania
| | - Roxana Diaconu
- Department of Dermatology, Railway Clinical Hospital, 700506 Iasi, Romania
| | - Elena Porumb
- Department of Dermatology, ‘Sf. Spiridon’ Clinical Emergency County Hospital, 700111 Iasi, Romania
| | - Anisia Alexa
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin Nicolescu
- Department of Dermatology, ‘Roma’ Medical Center for Diagnosis and Treatment, 011773 Bucharest, Romania
| | - Ilarie Brihan
- Department of Dermatology, Dermatology Clinic, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Camelia Bogdanici
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
| | - George Branisteanu
- Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Dimitriu
- Department of Dermatology, ‘Arcadia’ Hospitals and Medical Centers, 700620 Iasi, Romania
| | - Mihail Zemba
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Nicoleta Anton
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Mihaela Toader
- Department of Oral Dermatology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adrian Grechin
- Department of Ophthalmology, ‘Sf. Spiridon’ Clinical Emergency County Hospital, 700111 Iasi, Romania
| | - Daniel Branisteanu
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
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Baltă F, Cristescu IE, Mirescu AE, Baltă G, Zemba M, Tofolean IT. Investigation of Retinal Microcirculation in Diabetic Patients Using Adaptive Optics Ophthalmoscopy and Optical Coherence Angiography. J Diabetes Res 2022; 2022:1516668. [PMID: 35097129 PMCID: PMC8791707 DOI: 10.1155/2022/1516668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/21/2021] [Accepted: 01/03/2022] [Indexed: 01/08/2023] Open
Abstract
The current research approaches the retinal microvasculature of healthy volunteers (17 subjects), patients with diabetes mellitus without retinopathy (19 subjects), and of diabetic patients with nonproliferative (17 subjects) and proliferative (21 subjects) diabetic retinopathy, by using adaptive optics ophthalmoscopy and optical coherence ophthalmoscopy angiography. For each imaging technique, several vascular parameters have been calculated in order to achieve a comparative analysis of these imaging biomarkers between the four studied groups. The results suggest that diabetic patients with or without diabetic retinopathy prove signs of retinal arteriole structural alterations, mainly showed by altered values of wall to lumen ratio, calculated for the superior or inferior temporal branch of the central retinal artery, near the optic nerve head, and significant changes of the vascular density in the retinal superficial capillary plexus. Both adaptive optics ophthalmoscopy and optical coherence ophthalmoscopy angiography are providing useful information about the retinal microvasculature from early onset of diabetic disease, having a promising diagnostic and prognostic role in the future.
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Affiliation(s)
- Florian Baltă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
- “Retina” Clinic, 014142 Bucharest, Romania
| | - Irina-Elena Cristescu
- “Retina” Clinic, 014142 Bucharest, Romania
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Andrada-Elena Mirescu
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
- Department of Ophthalmology, “Ovidius” University of Medicine, 900470 Constanta, Romania
| | - George Baltă
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
| | - Mihail Zemba
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Ioana Teodora Tofolean
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Retina” Clinic, 014142 Bucharest, Romania
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Zemba M, Dumitrescu OM, Dimirache AE, Branisteanu D, Balta F, Burcea M, Moraru A, Gradinaru S. Diagnostic methods for the etiological assessment of infectious corneal pathology (Review). Exp Ther Med 2021; 23:137. [PMID: 35069818 PMCID: PMC8756399 DOI: 10.3892/etm.2021.11060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 12/28/2022] Open
Abstract
Infectious keratitis is a leading cause of visual morbidity, including blindness, all across the globe, especially in developing countries. Prompt and adequate treatment is mandatory to maintain corneal integrity and to recover the best possible final visual acuity. Although in most of the cases practitioners chose to employ empirical broad-spectrum antimicrobial medication that is usually effective, in some instances, they face the need to identify the causative agent to establish the appropriate therapy. An extensive search was conducted on published literature before December 2020 concerning the main laboratory investigations used to identify the microbial agents found in infectious keratitis, their indications, advantages, and disadvantages, as well as the results reported by other studies concerning different diagnostic tools. At present, the gold standard for diagnosis is still considered to be the isolation of microorganisms in cultures, along with the examination of smears, but other newer techniques, such as polymerase chain reaction (PCR), next-generation sequencing (NGS), and in vivo confocal microscopy (IVCM) have gained popularity in the last decades. Currently, these newer methods have proved to be valuable adjuvants in making the diagnosis, but technological advances hold promise that, in the future, these methods will have increased performance and availability, and may become the new gold standard, replacing the classic cultures and smears.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Andreea-Elena Dimirache
- Department of Ophthalmology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Daniel Branisteanu
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Florian Balta
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Marian Burcea
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Moraru
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Sinziana Gradinaru
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Branisteanu DC, Bogdanici CM, Branisteanu DE, Maranduca MA, Zemba M, Balta F, Branisteanu CI, Moraru AD. Uveal melanoma diagnosis and current treatment options (Review). Exp Ther Med 2021; 22:1428. [PMID: 34707709 PMCID: PMC8543295 DOI: 10.3892/etm.2021.10863] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Uveal melanoma is a rare condition accounting for only 5% of all primary melanoma cases. Still, it is the most frequently diagnosed primary intraocular malignant tumor in adults. Almost 90% of the tumors involve the choroid and only a small percentage affects the ciliary body or the iris. There is a consistent difference in incidence between different regions with individuals of northern European descent having a significantly higher risk as compared to Hispanics, Asians, and Blacks. Among the many risk factors, mutations in the G protein subunit alpha Q (GNAQ) or G protein subunit alpha 11 (GNA11) genes and different receptors are highly suggestive. While iris melanoma can easily be noticed by the patient itself or diagnosed at a routine slit-lamp evaluation, a consistent percentage of posterior uveal tumors are incidentally diagnosed at funduscopic evaluation as they can evolve silently for years, especially if located in the periphery. Uveal melanoma classifications rely on the tumor size (thickness and basal diameter) and also on intraocular and extraocular extension. The differential diagnosis with pseudomelanomas is carried out according to the tumor aspect and position. Iris melanoma has a better prognosis and a lower mortality rate as compared to choroidal melanoma that has a much higher rate of metastasis (50% of the patients) and a subsequent limited life expectancy from 6 to 12 months. While conservative therapeutic options for the primary tumor, relying on different surgical excision techniques and/or irradiation therapies, offer good local tumor control, the treatment options for metastatic disease, although numerous, are still inadequate in preventing a fatal outcome.
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Affiliation(s)
| | | | - Daciana Elena Branisteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Minela Aida Maranduca
- Department of Physiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florian Balta
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Andreea Dana Moraru
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Zemba M, Rogoz RE, Zaharia AC, Dimirache AE, Dumitrescu OM, Dărăbuş DM. Challenges in HIV-Negative Cytomegalovirus Retinitis - case report. Rom J Ophthalmol 2021; 65:247-254. [PMID: 35036645 PMCID: PMC8697781 DOI: 10.22336/rjo.2021.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 20-year-old girl with severe combined seronegative immunodeficiency who developed a bilateral decrease in visual acuity due to retinal necrosis. After further investigations, increased serological viral levels of Cytomegalovirus (CMV) were detected and confirmed the diagnosis of CMV retinitis in both eyes. After three weeks of systemic therapy with oral valganciclovir, her condition improved, with the best corrected visual acuity of the most affected eye changing from finger counting at presentation to 6/ 12. Although financial matters determined her to discontinue the antiviral treatment after three months, her ophthalmological status remained stable, and she resumed therapy after four weeks of pause. At the four months follow-up, despite an unchanged visual function, her general condition deteriorated. In the absence of appropriate treatment for her immunodeficiency both the patient's ophthalmological and systemic prognosis were poor.
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Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Farmacy Bucharest, Romania
| | - Roxana-Elena Rogoz
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Alexandra Cătălina Zaharia
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Andreea Elena Dimirache
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Otilia-Maria Dumitrescu
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
| | - Diana-Maria Dărăbuş
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
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Tătaru CI, Tătaru CP, Costache A, Boruga O, Zemba M, Ciuluvică RC, Sima G. Congenital cataract - clinical and morphological aspects. Rom J Morphol Embryol 2021; 61:105-112. [PMID: 32747900 PMCID: PMC7728133 DOI: 10.47162/rjme.61.1.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Congenital cataract is one of the main causes of blindness in newborns and children. According to the World Health Organization (WHO), there are about 14 million children suffering from congenital cataract. Our study is based on 82 children, males – 46 (56.1%) and females – 36 (43.9%), with congenital cataract operated in the same ophthalmological centre in Bucharest, Romania. Of the 82 patients, 49 (59.76%) had bilateral cataract and 33 (40.24%) unilateral cataract. Clinically, the most frequent was the total cataract, followed by lamellar, nuclear and cerulean. We employed nine surgical approaches in our patients, depending on the type of intraocular lens (IOL). Morphologically, obvious changes were rendered evident at the level of anterior and posterior capsules, as well as subcapsular.
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Affiliation(s)
- Cătălina Ioana Tătaru
- Department of Ophthalmology, Department of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; ,
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Abstract
Endophthalmitis remains a serious complication following intraocular procedures. Preoperative prophylactic measures for endophthalmitis decrease the morbidity associated with this disease and represent a standard of care prior to ophthalmic surgery. The literature supports as measures for ocular antisepsis: povidone-iodine solution for ocular surface preparation, chlorhexidine in patients with iodine allergy and application of topical antibiotics. Povidone-iodine is regarded as the most effective antiseptic associated with significant reduction in ocular surface bacterial counts. Currently, the recommended preoperative management is the application of 5% povidone-iodine solution in the conjunctival fornix, prior to surgery. This paper reviews the preoperative measures for ocular antisepsis, used in order to decrease the risk of culture-proven endophthalmitis.
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Affiliation(s)
| | - Otilia-Maria Dumitrescu
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
| | - Roxana-Elena Rogoz
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
| | - Andreea Elena Dimirache
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
| | - Mihail Zemba
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, Romania
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Abstract
Aim: To evaluate the clinical efficacy of a selective, partial, pedicle conjunctival flap in the treatment of deep corneal ulcers with or without perforation, resistant to medical treatment. Method: This interventional self-controlled retrospective study included 31 eyes of 31 patients with deep corneal ulcers who underwent conjunctival flap surgery in a tertiary eye care unit between 2017 and 2019. Of these, 9 eyes exhibited corneal perforation. The follow-up period was 12 months. The primary outcome measures were restoring ocular surface integrity and secondary outcome measures were improvement in visual acuity and postoperative complications encountered. Results: Out of the total of 31 patients, 17 patients (55%) were males and 14 patients (45%) were females. The mean age was 56.03 ± 15.46 years. The mean disease duration was 64.10 ± 35.01 days, the mean diameter of the ulcer was 3.61 ± 1.02 mm and the mean depth of the ulcer was 70.65 ± 20.28% of the thickness of the cornea. The etiology was extensive and the corneal ulcers were categorized as infectious (12), noninfectious (16), and unknown (3). An anatomic cure was obtained in 29 (94%) of 31 eyes. Conjunctival flap surgery was unsuccessful in 2 eyes that required evisceration. The postoperative visual acuity (BCVA) improved in 13 (42%) of the 31 eyes, decreased in 9 eyes (29%) and remained unchanged in 9 eyes (29%). The most frequent complications after conjunctival flap surgery were pseudopterygium, cataract and corneal opacity and less frequent complications were glaucoma, astigmatism, flap retraction, corneal perforation and endophthalmitis. Conclusions: Conjunctival flap surgery can successfully treat refractory deep corneal ulcers. It can restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. Also, it can avoid emergency penetrating keratoplasty or create appropriate conditions for a future optic keratoplasty.
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Affiliation(s)
- Alina-Cristina Stamate
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Arena Med Clinic, Bucharest, Romania
| | - Călin Petru Tătaru
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
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20
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Barac IR, Balta G, Zemba M, Branduse L, Mehedintu C, Burcea M, Barac DA, Branisteanu DC, Balta F. Accelerated vs. conventional collagen cross-linking for infectious keratitis. Exp Ther Med 2021; 21:285. [PMID: 33603892 PMCID: PMC7851670 DOI: 10.3892/etm.2021.9716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/28/2022] Open
Abstract
Infectious keratitis represents a serious concern for ophthalmologists, with a progressively growing incidence in the last few years. In this prospective comparative study, we evaluated two groups of patients with infectious keratitis or corneal ulcer resistant to antimicrobial and antifungal therapy, treated respectively with conventional and accelerated photoactivated chromophore collagen cross-linking. Eight patients were assigned to each group and they were monitored for 12 months. We investigated the differences between groups, comparing on one side the mean of the quantitative variables using the t-test and on the other side the frequencies of qualitative variables using the Fisher exact test. The time to healing for the group treated with conventional cross-linking was 2 days longer than for the group undergoing accelerated cross-linking (34.9±11.4 vs. 32.9±9.4 days), a difference that did not reach statistical significance (P=0.708). We conclude that the accelerated protocol is as safe and efficient as the classic procedure. The accelerated protocol has an important advantage, both for the doctor and the patient, of being time sparing (the time for accelerated cross-linking is 3 times shorter than in the case of the conventional protocol).
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Affiliation(s)
- Ileana Ramona Barac
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - George Balta
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Lacramioara Branduse
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Claudia Mehedintu
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Marian Burcea
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Diana Andreea Barac
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Florian Balta
- Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Zemba M, Dimirache AE, Rogoz RE. Idiopathic intracranial hypertension in child. Rom J Ophthalmol 2020; 64:423-431. [PMID: 33367182 PMCID: PMC7739010 DOI: 10.22336/rjo.2020.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 12-year-old boy with bilateral papilledema, relating moderate symptomatology and without an important medical history. Ophthalmological examination revealed a significant alteration of visual acuity, an important papilledema and macular edema in both eyes. Further investigations excluded infectious and autoimmune diseases, intracranial masses and congenital affliction. Because of an elevated opening pressure in lumbar puncture procedure, the diagnosis of intracranial hypertension was confirmed. After two weeks of treatment with corticosteroids, carbonic anhydrase inhibitor and hyperosmotic drug, the patient had an important structural and functional ophthalmological improvement.
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Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, "Dr. Carol Davila" Central Military University Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Andreea-Elena Dimirache
- Ophthalmology Department, "Dr. Carol Davila" Central Military University Emergency Hospital, Bucharest, Romania
| | - Roxana-Elena Rogoz
- Ophthalmology Department, "Dr. Carol Davila" Central Military University Emergency Hospital, Bucharest, Romania
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Săftescu S, Popovici D, Oprean C, Negru A, Croitoru A, Zemba M, Yasar I, Preda M, Negru Ș. Endurance of erythrocyte series in chemotherapy. Exp Ther Med 2020; 20:214. [PMID: 33149778 PMCID: PMC7604759 DOI: 10.3892/etm.2020.9344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 11/12/2022] Open
Abstract
Hematopoietic bone marrow toxicity is most often the limiting factor for chemotherapy doses. Increasing the intensity of chemotherapy doses (higher doses or more frequent administration) would improve antitumor effects, but the hematological toxicity does not allow these dose increases. This study evaluated the impact of chemotherapies on the parameters belonging to the red blood cell series in the hemogram and aimed to identify some particular evolution profiles. We selected 855 evaluations performed before the administration of chemotherapy belonging to the treatments initiated during the period December 2018-February 2020, containing 5-fluorouracil, cisplatin, docetaxel, epirubicin or pemetrexed. The data of the 644 evaluations related to the cycles 1-4 of chemotherapy were subject to this processing. The average relative loss of hemoglobin is -11% after the first three cycles of treatment, with statistically significant differences in hemoglobin levels in favor of men. There are risk factors associated with higher average losses, such as age <50 years or >65 years (statistically significant), body mass index (BMI) >25, cisplatin treatment (insufficient number of cases to reach statistical significance).
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Affiliation(s)
- Sorin Săftescu
- Department of Oncology, 'Victor Babe?' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dorel Popovici
- Department of Oncology, 'Victor Babe?' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Oprean
- Department of Oncology, 'Victor Babe?' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alina Negru
- Department of Cardiology, 'Victor Babe?' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adina Croitoru
- Department of Medical Oncology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ionela Yasar
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Maria Preda
- Department of Ophthalmology, 'Victor Babe?' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Șerban Negru
- Department of Oncology, 'Victor Babe?' University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Ochinciuc R, Balta F, Branisteanu DC, Burcea M, Zemba M, Ochinciuc U, Barac R. Subretinal alteplase injections in massive subretinal hemorrhage due to age-related macular degeneration: A case report series. Exp Ther Med 2020; 20:208. [PMID: 33123237 PMCID: PMC7588788 DOI: 10.3892/etm.2020.9338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022] Open
Abstract
This report describes a series of cases with massive subretinal hemorrhage (SRH) due to age-related macular degeneration (AMD) treated by subretinal alteplase injections. In all cases, the surgical technique consisted in 25-gauge pars plana vitrectomy (PPV) and alteplase injection under the retina using a 38-gauge cannula. After the fluid-gas exchange, bevacizumab injection was performed in all patients. Three cases of SRH in which this technique was used, as well as their evolution at one week and one month postoperatively are described. Visual acuity was hand motion in all three cases at presentation. After surgery, a significant anatomical and functional improvement was noted in all cases. One month postoperatively, none of the patients had blood under the macula, and visual acuities significantly improved to 0.8, 0.2 and 0.16 (decimal fraction). A consistent reduction of central retinal thickness was observed on optical coherence tomography (OCT) from the first week postoperatively. No intra and postoperative complications were noted. Subretinal alteplase injection proved as a viable solution in these severe SRH with early presentation. There was no need to change the systemic anticoagulant and antiaggregant therapy. Bevacizumab intravitreal injection at the end of surgery has an important role in preventing further bleeding.
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Affiliation(s)
- Radu Ochinciuc
- Department of Ophthalmology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Florian Balta
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Marian Burcea
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Uliana Ochinciuc
- Department of Ophthalmology, 'Dr. Carol Davila' Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Ramona Barac
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Zemba M, Stamate AC. Imagery – ultrasound biomicroscopy and anterior segment Optical Coherence Tomography – in the diagnosis of anterior segment pathology. Rom J Ophthalmol 2020. [DOI: 10.22336/rjo.2020.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Branisteanu DC, Branisteanu DE, Feraru CI, Branisteanu CI, Moraru A, Zemba M, Balta F. Influence of unilateral intravitreal bevacizumab injection on the incidence of symptomatic choroidal neovascularization in the fellow eye in patients with neovascular age-related macular degeneration (Review). Exp Ther Med 2020; 20:182. [PMID: 33101472 PMCID: PMC7579776 DOI: 10.3892/etm.2020.9312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Neovascular age-related macular degeneration (neovascular ARMD) represents only 10% of ARMD cases but is responsible, if untreated, for quick and severe central vision loss due to major macular changes. The presence of choroidal neovascularization (CNV) in one eye is associated with an approximately 10% risk of CNV development in the fellow eye each year. Intravitreal anti-VEGF therapy has quickly evolved as the standard treatment in neovascular ARMD in the last decade due to significant anatomical and functional improvements, especially in the early stages. In many reports an improvement in the untreated fellow eye was mentioned and systemic exposure was soon confirmed for all anti-VEGF agents after unilateral intravitreal injection. In particular, bevacizumab intravitreal injection is followed by a consistent reduction of serum VEGF levels and the drug was shown to have the longest serum half-life raising important debates about its safety. Once bevacizumab was detected in the fellow eye of an animal model after unilateral injection, the possible influence on fellow eye conversion rate into neovascular ARMD was questioned. Although comparative studies have not found statistically significant differences between drugs regarding the incidence of symptomatic CNV in the fellow eye during treatment, we observed, on a retrospective 36-month evaluation, a reduced incidence of symptomatic CNV in the fellow eye that might be explained by the consistent systemic exposure of bevacizumab.
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Affiliation(s)
- Daniel Constantin Branisteanu
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,'Retina Center' Eye Clinic, 700126 Iasi, Romania
| | - Daciana Elena Branisteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Crenguta Ioana Feraru
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,'Retina Center' Eye Clinic, 700126 Iasi, Romania
| | | | - Andreea Moraru
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florian Balta
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Branisteanu DC, Stoleriu G, Branisteanu DE, Boda D, Branisteanu CI, Maranduca MA, Moraru A, Stanca HT, Zemba M, Balta F. Ocular cicatricial pemphigoid (Review). Exp Ther Med 2020; 20:3379-3382. [PMID: 32905166 PMCID: PMC7465597 DOI: 10.3892/etm.2020.8972] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/06/2020] [Indexed: 01/07/2023] Open
Abstract
Ocular cicatricial pemphigoid is a particular form of mucous membrane pemphigoid and it is characterized by a chronic bilateral conjunctivitis with relapsing-remitting periods. Without therapy 75% of the cases develop visual loss due to major ocular complications (e.g. severe dry-eye syndrome, corneal erosions, corneal keratinization, entropion, symblepharon). Pathogenesis remains uncertain and probably linked to an autoimmune type II hypersensitivity response in patients with a genetic predisposition and exposure to different environmental triggers. With a worldwide distribution, no racial predilection and an estimated incidence that largely varies from 1/10,000-1/60,000, ocular cicatricial pemphigoid predominantly affects women aged ~60 years. Conjunctival biopsy with direct immunofluorescence is the gold standard in diagnosis confirmation, but up to 40% of the patients have a negative biopsy result that does not rule out the diagnosis. The skin and many other mucous membranes (e.g. oral, trachea, esophagus, pharynx, larynx, urethra, vagina and anus) may be involved. The disease grading relies on Foster staging system (based on clinical signs) and Mondino and Brown system (based on the inferior fornix depth loss). The differential diagnosis includes atopy, allergies, trauma, chemical burns, radiation, neoplasia, infectious, inflammatory and autoimmune etiologies. The main goals of the treatment are to stop disease progression, to relieve symptoms and to prevent complications. With long-term systemic therapy 90% of the cases can be efficiently controlled. While Dapsone is the first-line treatment in mild to moderate disease in patients without G6PD deficiency, more severe cases require immunosuppressant therapy with azathioprine, mycophenolate mofetil, methotrexate or cyclosporine. Cyclophosphamide, biologics (etanercept or rituximab) and intravenous immunoglobulin therapy are usually reserved for recalcitrant disease and unsatisfactory results to conventional therapy. Dry eye syndrome requires constant lubricating medication and topical steroids, cyclosporine-A and tacrolimus. Surgery should be planed only in quiescent phase as minor conjunctival trauma can significantly worsen the disease.
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Affiliation(s)
| | - Gabriela Stoleriu
- Clinical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galaţi, 800008 Galaţi, Romania
| | - Daciana Elena Branisteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Minela Aida Maranduca
- Department of Physiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Moraru
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Horia Tudor Stanca
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florian Balta
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Zemba M, Stamate AC, Tataru CP, Branisteanu DC, Balta F. Conjunctival flap surgery in the management of ocular surface disease (Review). Exp Ther Med 2020; 20:3412-3416. [PMID: 32905115 PMCID: PMC7465514 DOI: 10.3892/etm.2020.8964] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
Literature regarding conjunctival flap surgery was reviewed to describe and discuss the rationale for this type of procedure. The conjunctival flap is an acknowledged surgery for the treatment of various corneal diseases with a chronically compromised ocular surface, such as severe dry eye, neurotrophic or neuroparalytic disease, or bullous keratopathy. The purpose of this surgery is to restore the integrity of the corneal surface and thus to prevent gradual corneal ulceration and secondary infection, as well as to ameliorate pain, reduce the need for frequent medications, improve cosmetic appearance, and offer an alternative to invasive surgery or enucleation. Since the introduction of more effective methods of treating severe ocular surface diseases, conjunctival flap surgery has rarely been the primary modality of treatment and has usually followed a range of medical and surgical treatments. The availability of improved ocular lubricants, more effective antimicrobials, bandage contact lenses, tissue adhesives, and other corneal and conjunctival surgical interventions, has reduced the need for conjunctival flaps. However, conjunctival flaps remain extremely useful in selected cases and deserve a place in the ophthalmologist's repertoire for the management of ocular surface disease.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Alina-Cristina Stamate
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Calin Petru Tataru
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
| | | | - Florian Balta
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
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Tăbăcaru B, Stanca S, Mocanu V, Zemba M, Stanca HT, Munteanu M. Intraoperative flap-related complications in FemtoLASIK surgeries performed with Visumax ® femtosecond laser: A ten-year Romanian experience. Exp Ther Med 2020; 20:2529-2535. [PMID: 32765745 PMCID: PMC7401922 DOI: 10.3892/etm.2020.8907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Abstract
Incidence and clinical results of intraoperative flap and interface-related complications were investigated after Femtosecond-LASIK surgery, where flap creation was performed with VisuMax® femtosecond laser. A retrospective 10-year cohort study was conducted including all eyes treated for all refractive errors by Femtosecond-LASIK technique. All the flaps were made by the same refractive surgeon with the VisuMax® (Carl Zeiss Meditec) femtosecond laser. We report the intraoperative flap and interface-related complications in these eyes, also describing their management. The study included 4,032 eyes. Flap and interface-related complications were: opaque bubble layer (OBL) 21.18%, suction loss 1.29%, difficult docking 0.69%, difficult dissection of the flap 0.59%, bleeding from limbal blood vessels 0.35%, de-epithelialization of the flap 0.12%, and interface debris 0.025%. These situations were appropriately addressed, with favorable outcomes. Flap creation is an important step in LASIK surgery. The predictability and safety have improved since the flap incision is assisted by a femtosecond laser, but complications of the flap and interface can still occur during the flap creation. Refractive surgeons should be aware and properly manage any unusual situation.
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Affiliation(s)
- Bogdana Tăbăcaru
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Simona Stanca
- Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Valeria Mocanu
- Department of Ophthalmology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Horia Tudor Stanca
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihnea Munteanu
- Department of Ophthalmology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Camburu G, Zemba M, Purcărea VL. Is Central Corneal Thickness a reliable independent factor in decision-making regarding the management of patients with high IOP? Rom J Ophthalmol 2020. [DOI: 10.22336/rjo.2020.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zemba M, Zaharia AC, Dumitrescu OM. Association of retinitis pigmentosa and advanced keratoconus in siblings. Rom J Ophthalmol 2020; 64:313-321. [PMID: 33367168 PMCID: PMC7739560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective. The aim of the article was to present the rare association of retinitis pigmentosa and bilateral keratoconus in two brothers, one of whom developed corneal hydrops bilaterally, within a short period of time. Methods. A 29-year-old man presented to our service with corneal hydrops in the right eye, complaining of ocular pain and photophobia. He had a history of retinitis pigmentosa, having been diagnosed as an infant. He also had a younger brother carrying the same diagnosis. Slit lamp examination revealed bilateral keratoconus with corneal hydrops in the right eye, posterior subcapsular cataract, macular atrophy and the characteristic retinal signs of retinitis pigmentosa. The patient's brother was also examined, with the same findings being noted, apart from the corneal hydrops. We documented the changes using a slit lamp biomicroscope, a fundus camera, a corneal topography, Anterior Segment Optical Coherence Tomography and visual field testing. Right hydrops regressed in one month after hyperosmolar 5% sodium chloride treatment. However, 4 weeks later, the patient presented with the same corneal findings in the left eye. The same treatment was prescribed for the left eye. Results. Corneal hydrops regressed in both eyes with remaining paracentral corneal scars. However, no other treatment for keratoconus was suitable in the case of this patient. Discussion: Retinitis pigmentosa is currently not amenable to any form of treatment, from vitamin supplementation, medical therapy, gene transfer-based therapy, stem cell-based therapy to retinal implantation. However, molecular genetics may someday provide new therapeutic prospects, that could modify the course of RP. Conclusions. The association of retinitis pigmentosa with keratoconus is a fairly rare finding, worth taking into consideration. Also, presentation with keratoconus in such an advanced state is uncommon and, in our case, it was presumably due to the patient's reduced visual function since childhood, secondary to retinitis pigmentosa, that has prevented him from perceiving any visual modifications caused by keratoconus.
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Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency Hospital, Bucharest, Romania
| | | | - Otilia-Maria Dumitrescu
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency Hospital, Bucharest, Romania
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Zemba M, Stamate AC. Imagery - ultrasound biomicroscopy and anterior segment Optical Coherence Tomography - in the diagnosis of anterior segment pathology. Rom J Ophthalmol 2020; 64:292-298. [PMID: 33367163 PMCID: PMC7739559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: The aim of this paper was to show the usefulness of imagery in better documenting the pathology of the anterior segment. Methods: The article comprises clinical cases, insisting on how imagery was essential in establishing the diagnosis or the therapeutic plan. Results: Lack of imagery would have made establishing a proper diagnosis much more difficult. Conclusions: Although clinical examination is simple and offers a fairly good amount of information, some particular cases of anterior segment pathology need additional investigations, every method having its indications and limits.
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Affiliation(s)
- Mihail Zemba
- “Dr. Carol Davila” Central Military Emergency Hospital, Bucharest, Romania
,“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Camburu G, Zemba M, Purcărea VL. Is Central Corneal Thickness a reliable independent factor in decision-making regarding the management of patients with high IOP? Rom J Ophthalmol 2020; 64:25-27. [PMID: 32292854 PMCID: PMC7141911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As time passes, we discover that things that were supposedly considered to be well known are in fact not as they seemed. Maybe the process is like this because we try to simplify our daily practice, but by doing so, don't we tend to trespass the whole picture? However, what happens if these factors affect our decision-making? Clinicians should incorporate CCT into the thinking process and should not focus on "corrected IOPs", because, besides CCT, there are many factors of corneal biomechanics that affect IOP.
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Affiliation(s)
- Georgiana Camburu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihail Zemba
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Stamate AC, Tătaru CP, Zemba M. Update on surgical management of corneal ulceration and perforation. Rom J Ophthalmol 2019; 63:166-173. [PMID: 31334396 PMCID: PMC6626930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Corneal ulcerations are a medical emergency, and in recalcitrant cases, leading to perforation, a surgical ophthalmological emergency. The urgency of the treatment is dictated by the necessity of preventing complications that can lead to serious ocular morbidities. Medical treatment represents the first therapeutic approach and is a defining step in the further management of a patient with corneal ulceration. Multiple surgical strategies are available, but the option depends on the etiology and parameters of the ulceration: size, depth, and location.
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Affiliation(s)
- Alina-Cristina Stamate
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania
,Arena Med Clinic, Bucharest, Romania
| | - Călin Petru Tătaru
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania
,Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania
,Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
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Zemba M. EBO accredited first centre in Romania. Rom J Ophthalmol 2018. [DOI: 10.22336/rjo.2018.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Penetrating keratoplasty is a surgical intervention that despite the progress of surgical techniques and of postoperative treatment continues to have numerous complications. Many of them, such as graft rejection, significant astigmatism, cystoid macular edema, or cataract lead to important limitations of the visual function. Glaucoma is possibly the most dangerous complication following PK, leading to loss of the visual potential of the eye due to irreversible damage to the optic nerve. Identifying the risk factors permits an attentive follow-up and rapid treatment of the postoperative IOP rises. Maybe the most important is that preexisting glaucoma should be rightly diagnosed and controlled before PK, medically or, if necessary, surgically. Abbreviations: PK = penetrating keratoplasty, IOP = intraocular pressure, PAS = peripheral anterior synechiae, TM = trabecular meshwork, DM = Descemet membrane, GAT = Goldmann applanation tonometry, MMC = mitomycin C, CAI = carbonic anhydrase inhibitors, 5-FU = 5-fluorouracil
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina-Cristina Stamate
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Arena Med Clinic, Bucharest, Romania
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Zemba M, Neacsa R, Cucu BI. Stromal corneal dystrophy (possible Schnyder’s dystrophy) with peripheral corneal degeneration – diagnostic and therapeutic challenges. Rom J Ophthalmol 2018. [DOI: 10.22336/rjo.2018.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Uveitis-Glaucoma-Hyphaema Syndrome (UGH syndrome, or "Ellingson" Syndrome) is a rare condition caused by the mechanical trauma of an intraocular lens malpositioned over adjacent structures (iris, ciliary body, iridocorneal angle), leading to a spectrum of iris transillumination defects, microhyphaemas and pigmentary dispersion, concomitant with elevated intraocular pressure (IOP). UGH Syndrome can also be characterized by chronic inflammation, secondary iris neovascularization, cystoid macular edema (CME). The fundamental step in the pathogenesis of UGH syndrome appears to arise from repetitive mechanical iris trauma by a malpositioned or subluxed IOL. These patients have uncomplicated cataract implants and return for episodes of blurry vision weeks to months after surgery. This may be accompanied by pain, photophobia, erythropsia, anterior uveitis, hyphaema along with raised intraocular pressure. A careful history and examination, as well as appropriate investigations can confirm the diagnostic. Treatment options are IOL Explantation exchange, topical and systemic medication, and cyclophotocoagulation, the placement of a Capsular Tension Ring to redistribute zonular tension and Anti-vascular endothelial growth factor (anti-VEGF) Therapy.
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Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Georgiana Camburu
- Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
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Zemba M, Neacsa R, Cucu BI. Stromal corneal dystrophy (possible Schnyder's dystrophy) with peripheral corneal degeneration - diagnostic and therapeutic challenges. Rom J Ophthalmol 2018; 62:175-180. [PMID: 30206563 PMCID: PMC6117528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: to highlight the diagnostic and therapeutic challenges in a case with central and peripheral corneal lesions. Methods: We present the preoperative investigations: anterior segment optical coherence tomography and ultrasound biomicroscopy; The excised cornea has been examined histopathologically. Results: Preoperative assessment showed that peripheral lesion was not ectatic; Histopathological examination points to a possible corneal degeneration, with posttraumatic or infectious etiology for the peripheral lesion and gives some reasons to sustain the diagnosis of Schnyder's dystrophy for the central lesion. Conclusions: The association of different corneal lesions may need many investigations to establish the diagnosis and choose the most appropriate therapeutic solution.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Neacsa
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
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Stamate AC, Tătaru CP, Zemba M. Emergency penetrating keratoplasty in corneal perforations. Rom J Ophthalmol 2018; 62:253-259. [PMID: 30891520 PMCID: PMC6421488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Corneal perforations represent an ophthalmological emergency due to their devastating consequences. Emergency treatment is mandatory to try to restore the anatomical integrity of the globe, to salvage useful vision as much as possible and to reduce the possible complications to a minimum. The underlying conditions or disorders responsible for corneal ulcerations, and subsequently for corneal perforations are numerous, and can be either isolated or superimposed. Emergency penetrating keratoplasty is a difficult surgical procedure that is associated with various complications, which can jeopardize the outcome of the eye.
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Affiliation(s)
- Alina-Cristina Stamate
- Department of Ophthalmology, “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania
,Arena Med Clinic, Bucharest, Romania
| | - Călin Petru Tătaru
- Department of Ophthalmology, “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania
,Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, “Carol Davila” University of Medicine
and Pharmacy, Bucharest, Romania
,Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency
University Hospital, Bucharest, Romania
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Zemba M, Danilova T, Pulbere L, Stamate AC. Uncommon form of normal-tension glaucoma. Rom J Ophthalmol 2017. [DOI: 10.22336/rjo.2017.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zemba M, Malciolu RA. Choroidal melanoma suspect. Conservative treatment and evolution. Case report. Rom J Ophthalmol 2016; 60:264-269. [PMID: 29450360 PMCID: PMC5711292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 06/08/2023] Open
Abstract
We present the case of a 42-year-old female who presented to our clinic for phosphenes in the left eye, occurring along with eye movement. A diagnosis of choroidal melanoma suspect was made. Due to the patient's profile, young, active woman, surgeon, and the limited therapeutic options in Romania, a conservative treatment and brachytherapy were chosen, which were successfully performed abroad. The patient has been followed-up, so far, for five years after the procedure, with spectacular results.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, “Dr. Carol Davila” Central Military
University Emergency Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Alexandru Malciolu
- Department of Ophthalmology, “Dr. Carol Davila” Central Military
University Emergency Hospital, Bucharest, Romania
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Zemba M, Burcea M, Camburu G. Atopic keratoconjunctivitis with corneal ulcer. Case report. Rom J Ophthalmol 2016; 60:200-206. [PMID: 29450349 PMCID: PMC5720135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 06/08/2023] Open
Abstract
Purpose: To report the case of a 14-year-old male patient, with bilateral atopic keratoconjunctivitis with corneal ulcer. Methods: The patient complained of bilateral red, itchy eyes, decreased vision, photophobia, difficulty opening the eyelids upon awakening, palpebral edema, excessive tearing, along with yellowish mucous discharge. He had a two-year history of chronic blepharitis and recurrent episodes of conjunctivitis that were treated with Tobramycin and corticosteroid eye drops over the years. The patient's past medical history was significant for atopic dermatitis (AD) and he had a family history for atopy. At the eye exam: his best-corrected visual acuity at the initial presentation was 0.2 in the right eye and 1.0 in the left eye. The following elements were found upon the slit lamp biomicroscopy: Eyelids - +4 palpebral edema (pseudoptosis), Dennie-Morgan fold and Herthoge's sign were both present, tylosis; Conjunctiva - hyperaemia, cobblestone appearance of the tarsal papillae in both eyes, +2 chemosis; Cornea - corneal edema with a 8 mm × 4 mm epithelial defect in the inferior part of the cornea, covered partially by the lied, that stained positive with fluorescein dyes. Using the Evaluation Signs Severity for Allergic Ocular Diseases, a diagnosis of bilateral atopic keratoconjunctivitis with a grade 3 status for the right eye and a grade 2 status, was made. It was decided that he should be administered Olopatadine hydrochloride and Sodium cromoglicate eye drops, along with Moxifloxacin and steroid eye drops. The microbiological exam tested positive for staphylococcus aureus, and, based on the sensitivity pattern, Chloramphenicol eye drops had to be added to the treatment. After 2 weeks, his symptoms diminished, pain was significantly relieved and inflammation was markedly reduced, but the corneal ulcer persisted. In order to prevent corneal perforations, amniotic membrane transplantation (AMT) was used to promote epithelialization. Results: A month later, the epithelial defect healed smoothly in an underlying vascular stromal scar and the visual acuity improved to 0.4 RE. Conclusions: This case demonstrated the role of patient history and close clinical obser-vation in the diagnosis of AKC. As this case showed, the use of topic medication along with amniotic membrane transplantation (AMT) was successful in the treatment of atopic keratoconjunctivitis and secondary staphylococcal aureus keratitis.
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MESH Headings
- Administration, Ophthalmic
- Adolescent
- Anti-Allergic Agents/therapeutic use
- Anti-Asthmatic Agents/therapeutic use
- Anti-Bacterial Agents/therapeutic use
- Blepharitis/drug therapy
- Blepharitis/etiology
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/drug therapy
- Conjunctivitis, Allergic/etiology
- Corneal Ulcer/diagnosis
- Corneal Ulcer/drug therapy
- Corneal Ulcer/microbiology
- Cromolyn Sodium/therapeutic use
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/etiology
- Drug Therapy, Combination
- Eye Infections, Bacterial/diagnosis
- Eye Infections, Bacterial/drug therapy
- Eye Infections, Bacterial/microbiology
- Fluoroquinolones/therapeutic use
- Glucocorticoids/therapeutic use
- Humans
- Male
- Moxifloxacin
- Olopatadine Hydrochloride/therapeutic use
- Ophthalmic Solutions
- Staphylococcal Infections/diagnosis
- Staphylococcal Infections/drug therapy
- Staphylococcal Infections/microbiology
- Staphylococcus aureus/isolation & purification
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Affiliation(s)
- Mihail Zemba
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University
Hospital, Bucharest, Romania
| | - Marian Burcea
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University
Hospital, Bucharest, Romania
| | - Georgiana Camburu
- Ophthalmology Department, “Dr. Carol Davila” Central Military Emergency University
Hospital, Bucharest, Romania
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Schmitzer S, Butea-Simionescu C, Gheorghe A, Zemba M, Cioboata M. Iridociliary melanoma - Clinical case. J Med Life 2016; 9:88-91. [PMID: 27713771 PMCID: PMC5052490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
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.
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Affiliation(s)
- S Schmitzer
- Emergency Eye Hospital, Bucharest, Romania,OFTALMESTET Clinic, Bucharest, Romania
| | | | - A Gheorghe
- Emergency Eye Hospital, Bucharest, Romania
| | - M Zemba
- “Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Romania
| | - M Cioboata
- Emergency Eye Hospital, Bucharest, Romania
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Chiotoroiu SM, Noaghi M, Stefaniu GI, Secureanu FA, Purcarea VL, Zemba M. Tobacco-alcohol optic neuropathy--clinical challenges in diagnosis. J Med Life 2014; 7:472-6. [PMID: 25713605 PMCID: PMC4316121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 10/18/2014] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
| | - M Noaghi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest
| | | | | | - V L Purcarea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest
| | - M Zemba
- "Carol Davila" University of Medicine and Pharmacy, Bucharest
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Burcea M, Avram CI, Stamate AC, Malciolu R, Oprea S, Zemba M. [Ocular hypertension in herpes simplex keratouveitis]. Oftalmologia 2014; 58:23-28. [PMID: 25842621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
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.
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Stamate AC, Avram CI, Malciolu R, Oprea S, Zemba M. [Peripheral ulcerative keratitis]. Oftalmologia 2014; 58:10-15. [PMID: 26117925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
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.
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Zemba M, Stamate AC, Papadatu CA, Avram CI, Malciolu R, Ochinciuc U, Burcea M. [The significance of imaging in a case of intraorbital cystic tumor]. Oftalmologia 2014; 58:18-24. [PMID: 25300124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
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.
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