[Medical therapy of primitive hypertensive glaucoma-therapeutic principles, perspectives]

The present-day glaucoma therapy is aiming to preserve visual function by decreasing the intraocular pressure below a certain level, that prevents the optic nerve damage to occur. The target IOP must be individualized, considering the IOP level at presentation, the severity of the optic nerve damage, life expectancy and associated risk factors. In order to prevent the glaucoma progression, the more serious the damages are at presentation, the lower the target IOP level must be. New ocular hypotensive agents that have been created during the last few years allowed a more efficient control of the glaucoma progression.

[Refractive stability of foldable intraocular lenses]

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

[Visual fields defects in cerebral hemorrhagic vascular accident]

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

[Postcontusion glaucoma]

Secondary posttraumatic glaucoma. Blunt ocular trauma may cause transient or permanent high IOP, occurring immediately or in time after the injury. This study presents some clinical and therapeutical considerations about 16 cases which developed secondary glaucoma. The elevation of IOP was associated with hyphema, iridodialysis, zonular tears (with lens luxation or subluxations), alterations of the iridocorneal angle.

[The vitreoretinal complications of cataract surgery]

The paper reports a retrospective study performed between January 1996 and January 1999 which comprised 423 patients who underwent eye cataract surgery. Vitreoretinal complications (retinal detachment, cystoid macular edema, choroidal detachment, endophthalmitis, luxation of the lens into the vitreous body) were related to age, sex, other general and local diseases and surgical complications, like disruption of the posterior capsule. The study presents also vitreoretinal complications after Nd:YAG laser posterior capsulotomy. The outcomes of the study show that 18 cases (4.25%) had retinal detachment, 11 (2.60%) had cystoid macular edema, 2 cases had endophthalmitis, while choroidal detachment and luxation of the lens into the vitreous body were reported each in 1 case. Retinal detachment following Neodymium:YAG laser capsulotomy (performed in 109 cases) was found in 2 cases. All of those vitreoretinal complications were reported with a higher incidence in patients with vascular diseases (diabetes mellitus, arterial hypertension, angiosclerosis) and also in patients who had axial lengths of 25 mm or greater.

[The use of antimetabolites in the treatment of glaucoma]

Many adjunctive therapies have been proposed to increase the success and prevent or reduce the incidence of complications associated with filtering surgery. Intraoperative or postoperative use of an antimetabolite has found a place as adjunctive therapy for eyes with otherwise pour prognosis following glaucoma filtering surgery.

[Artificial drainage devices in glaucoma]

During the last two decades, glaucoma drainage devices (GDD) have been increasingly applied to the treatment of complicated glaucoma in which standard surgical therapy has failed. Most GDD's consist of a segment of silicone rubber attached to a rigid plastic or flexible rubber explant and evolved from the Molteno glaucoma implant, on which clinical studies first appeared in 1969. GDD's should be reserved for the most difficult cases because of the difficulty of the surgical procedure and the complications that can attend their use.

[The use of viscoelastic compounds in cataract surgery]

The viscoelastic substances are very useful generally in cataract surgery, but absolutely useful in phacoemulsification. In present is used for viscoelastic compounds two terms that assemble the rheologic and physics-chemical properties: is said about the viscoelastic substance that is cohesive and dispersive (respective cohesivity or dispersivity property). Thus both types of viscoelastic substances--cohesive and dispersive--is used, sequentially, in one system. This double technique provides a fluid, heterogeneous work environment, which differ from the other techniques that use only one viscoelastic substance and provide a fluid, homogeneous work environment.

[Cataract and the exfoliative syndrome]

Exfoliation syndrome is more frequently in the older age and represents a risk factor for cataract surgery. This paper presents the results of a clinical trial made on 436 patients with troubles of transparency of the lens who were investigate in our clinic during January 1995-January 1997, and in whom, clinic and paraclinic exams have not revealed any associated ocular disease. In 14% of these patients who presented troubles of transparency of the lens were found uni- or bilateral exfoliation. The authors present the treatment applied both in patients in clinical follow-up (50% of patients with exfoliation syndrome develop secondary glaucoma) and patients who underwent surgical treatment. The patients with exfoliation syndrome and cataract have had a high risk to develop intra- and postoperative complications. The surgical treatment suggested by authors is extracapsular cataract extraction, either or without lens implantation and peripheral iridectomy which represents a compulsory step.

[Vascular risk factors in glaucoma]

The study realised in the Eye Clinic of the Central Military Hospital during February 1995-November 1997 analyses the impact of the vascular risk factors on the evolution of the primary glaucoma. The group consists in 533 patients which primary open angle glaucoma, from which 90.6% patients with primary open angle glaucoma and 9.3% with normal tension glaucoma. The assessment of the patients in order to identify the vascular risk factors it was performed on the basis of anamnestic questionnaire, following: degenerative vasculopathies, spastic vasculopathies, arterial hypotension and coronary insufficiency. 70.5% of the patients presented minimum one vascular risk factor. In the case of the patients with primary open angle glaucoma, we found a high frequency of the degenerative vasculopathies. In the patients with normal tension glaucoma the most frequent factor were: arterial hypotension and spastic vasculopathies. The coronary insufficiency had equal distribution in the primary open angle glaucoma and normal tension glaucoma. The parameters of the disease were affected faster in the patients with vascular risk factors. The outcomes of the study allow to estimate that the screening of the vascular risk factors has a distinct importance in the evolution and accurate treatment of glaucoma.

[Pseudotumoral tuberculous choroiditis]

It is presented a case of a secondary tumoral retinal detachment that clinical examination and all paraclinical investigation go for a choroidal malignant melanoma. The anatomopathological examination of the enucleated eyeball has surprisingly put in evidence some choroidal consumptive lesions.

[Pseudoexfoliative glaucoma]

The pseudoexfoliative glaucoma was find in our study at approximately 10% of the patients. Both clinical evolution and treatment results were less good at the patients with pseudoexfoliative glaucoma.