[Malignant hypertension--case report]

The authors present the case of a 25 year old man who presented in our clinic because of an important decreasing of his visual acuity at AO (OS > OD) which had installed progressively 3 months before his presentation. After the FAO examination there were found important changes with the bilateral presence of the papilledema, macular edema, hemorrhages in flame on the route of big vessels and the presence of multiple hard and soft exudates. After the clinical examination, it was found the presence of arterial hypertension TA = 240/140. The investigations from the laboratory pointed out important changes of the values of urea and creatinine, values which are characteristic for advanced stages of IR. After setting up the hypertensive treatment and the tension re-balancing it was found a slightly improvement of the ocular symptomatology, the patient prognosis remains reserved because of advanced renal lesions. The purpose of this case presentation is to make sensible doctors in general and eye doctors in particular about the importance of general clinical examination in establishing the final diagnosis. We mention that before presenting in our clinic, the patient did various ophthalmologic checking and complementary investigations suspecting a retinal vasculitis.

[Comparative study of endothelial changes in cataract surgery with phacoemulsification technique]

PURPOSE

The comparative analysis of the corneal endothelium modifications (density, pleiomorphism and poly-megetism) appeared as a result of the phacoemulsification through divide and conquer (D-C) respectively phaco-chop (P-C) technique.

MATERIAL AND METHOD

One year prospective, observational and interventional clinical study on 60 eyes with cataract surgery through phacoemulsification by the same surgeon. They were split in 2 groups of study according to the hardness of the cataract (Group A-30 eyes with the hardness of the cataract 3+ and Group B-30 eyes with the hardness of the cataract 4+). In both groups half of the patients were treated with P-C technique surgery and the other half with D-C technique surgery. The groups were homogeneous in relation to age, cataract density, and without associated systemic and ocular pathology.

RESULTS

In all cases the endothelial analysis was performed using the endothelial direct microscope and the ultrasonic pachymetry in presurgery, in the second postoperative day, at 14 days and 2 months. At the end of the study in Group A (3+) there were not noticed any significant modifications in loss of the endothelial cells through both technique surgery. In Group B (4 =) appeared significant modifications with much more losses in (D-C) technique surgeries. Ultrasonic pachymetry in the second day of postsurgery has shown temporary increase of corneal thickness compared to presurgery due to corneal edema, with recovery two months post surgery.

CONCLUSIONS

Regardless of the technique, phacoemulsification leads to endothelial modifications. In our study the P-C technique maintained a better endothelial structure homeostasis.

[Conjunctival nevus--clinical case]

The authors present the case of a four-year-old patient who came to our clinic because of a tumor formation localized at the sclero-corneal level. The ophthalmologic examination resulted in the diagnosis of conjunctival malignant melanoma and the decision for excision was made. The postoperative anatomo-pathologic examination disproved the malignant character of the lesion and established the diagnosis of conjunctival nevus.

[Value of ophthalmologic examination in early diagnosis of slow-growing intracranial tumors]

We report a case of clinically mute median fore brain tumor with meningeal origin and optic chiasm compression. The patient required the ophthalmological examination for "changing glasses".

[Malignant non-Hodgkin diffuse lymphoma with extranodal orbital involvement--a clinical case]

We present the case of a 63 years old patient, hospitalized in our Clinic with the suspicion of preseptal cellulitis. The subsequent evolution of the disease required extensive investigations which provide the definitive diagnosis of non-Hodgkin, diffuse B-cell lymphoma, with extranodal orbital involvement. In this case, the treatment of choice it must be systemic chemotherapy.

[Changes of the tear film in patients with cataract and pseudoexfoliative syndrome]

The paper's aim is to evidence the quantitative and qualitative modifications of the tear film before and after operation, in accordance with the presents of the pseudoexfoliative syndrome at the cataract operated patients.

[The therapeutical approach in the unilateral congenital cataract of the child]

The management of pediatric cataracts is, by far, more complex than the management of cataracts in adults and depends not only on deterioration of visual acuity, but also on the status of the other eye, the general health of the child, the motivation and the financial situation of the parents and last, but not least, on the surgeons' experience and skill, and the technical support. The therapeutically approach involves: the preoperative evaluation to establishes the indication and the timing of surgery the adaptation of the surgical technique for each case the choice of the aphakic correction the visual rehabilitation in the context of amblyopia management.

[Optic nerve bilateral atrophy in a suprachiasmatic astrocytoma]

The paper presents a clinical case of a 5 years old child with bilateral optic atrophy and the specific diagnosis and treatment problems of this case. The image investigations have a major part in establishing the positive diagnosis: computerized tomography, magnetic resonance imaging and the elective treatment belongs to the field of neurosurgery.

[Acrylic IOL implantation with the Monarch II injector]

PURPOSE

To study the technical difficulties using the MONARCH II injector, intraoperative incidents, postoperative astigmatism.

METHODS

Retrospective study which included 135 eyes with cataract who underwent cataract surgery between March 2002-August 2003. The surgical intervention consisted of lens extraction by phacoemulsification technique and IOL implantation with the MONARCH II injector. We recorded the following parameters: problems during the loading of the IOL in the cartridge, difficulties during the implant, problems due to the damage of the IOL during the passage in the cartridge, IOL centration in the capsular bag, induced postoperative astigmatism.

RESULTS

We had no major difficulties using this type of injector. We did not recorded important differences between the hydrophobic and hydrophilic IOLs. We had a number of 17 intraoperative incidents (12.6%). We met the following intraoperative incidents: the last haptic capture in the tunnel of the cartridge in 5 cases (3.7%), small marks on the optic surface left by the tip of the injector in 3 cases (2.2%), the leading haptic stuck on the optic surface in 2 cases (1.4%), breaking of the last haptic (multi-piece IOL) in 1 case (0.7%), the turning up side down of IOL during unfolding (hydrophilic IOLs) in 6 cases (4.4%). Postoperative astigmatism was less than 1D cylinder in 88% of cases.

CONCLUSIONS

The IOL implantation using MONARCH II injector is easy and doesn't need learning curve. The technique is superior compared with forceps implantation (especially for acrylic hydrophilic IOLs). No significant differences between implantation of acrylic IOLs. IOL centration was good. The design of the injector tip preserved optic surface and haptic from damage. The conical tip of the cartridge didn't change the architecture of the corneal wound. The postoperative astigmatism was small.

[Premature elevated intraocular pressure after cataract surgery]

We evaluated the frequency of elevated intraocular pressure (IOP) the first 1-3 postoperative days for a group of patients undergoing standard or phacoemulsification extracapsular cataract extraction (ECCE). IOP was measured in the pre and postoperative period using non-contact tonometer. From the 356 operated patients, 21 patients (6%) had early elevated IOP. The frequency of elevated IOP was greater among the patients that received anterior chamber (AC) IOL (25%) as compared to that of patients that received posterior chamber (PC) IOL (5.5%). The viscoelastic substance was responsible for a great percentage of cases (51%). The results show that the majority of elevated IOP is transient, recovered spontaneously or by treatment with carbonic anhydrase inhibitors or beta-adrenergic blockers. Elevated postoperative IOP occurs more frequently in the presence of glaucoma, cataract associated with systemic diseases, in complicated and traumatic cataract.

[Post-traumatic glaucoma]

This paper presents theoretical aspects concerning the physiopathological mechanisms involved in producing the glaucoma following trauma, especially the lens related glaucoma, correct identification of the ethiopathogeny of the intraocular pressure elevation in this situation is essential for the appropriate management. These aspects are illustrated by two cases of recent glaucoma following trauma lens related (lens subluxation) treated by medication and surgery. The surgical procedure consisted of intracapsular extraction of the lens, anterior vitrectomy, iridectomy and implantation of sulcus sutured posterior chamber lens. We present the technique, the difficulties met intra- and postoperative, evolution and prognosis.

[Left temporal arachnoid cyst]

Ocular onset is seldom for an arachnoid cyst. We present the case of a young man whose only symptom when hospitalized, was the unilateral peripheral field contraction. It was afterwards specified the presence of the arachnoid cyst and it's pathogenic feature, the compression of the optic nerve.

[Penetrating ocular trauma--therapeutic approach]

The most important factor for functional and anatomic prognosis of an injured eye is the appropriate emergency assistance. This paper presents a case of penetrating ocular trauma with minor clinical sings which associates severe lesions of posterior pole discovered intraoperatively. Careful history and clinical examination allowed the best surgical management, with complete anatomical and functional recovery of the eye.

[The nonfunctional pituitary adenoma, The optic chiasm syndrome]

We present the case of patient D. E., 48 years old, whose diagnosis is nonfunctional pituitary adenoma. The diagnosis was revealed by the presence of bitemporal hemianopia. This observation led us to remember the principal neuro-ophthalmological manifestations and to emphasize the part of the ophthalmologist in the diagnosis of this disease.

[Total rhegmatogenous retinal detachment - late postoperative complication]

This paper presents the case of a pacient operated for organized hemoftalmus after central retinal vein thrombosis (total vitrectomy) and whom five days after surgery a macular hole was observed and internal indendation with gas was performed. Postoperative evolution was good. Two months after surgery the pacient returns with cvasitotal regmatogen retinal detachment. The possible causes in bringing about of the retinal detachment in this case will be discussed as well as the factors that condition the success in posterior pole surgery.

[Functional recuperation in unilateral congenital cataract--a clinical case]

The management of a monocular congenital cataract is dominated by the problems of amblyopia, always present. The paper shows the case of an eight years old child, who was operated when he was 6 month of age for monocular congenital cataract. After YAG-Nd treatment of secondary cataract, aerian correction and intense pleoptic and orthoptic treatment, the visual acuity rise up to 1/4, when was possible to made an IOL implantation. We consider that is important to try to solve the monocular congenital cataract, even at higher ages, because the results is possible to be satisfactorily.

[A comparative study of the results of 2 technical variants of protective trabeculectomy]

The paper presents a comparison between two glaucoma surgery techniques: classic trabeculectomy and trabeculectomy done with the punch. Both postoperative intraocular pressure and per and postoperative complications were similar. We consider that punch trabeculectomy is as valuable as classic trabeculectomy.

[Comparison between two therapeutic approaches in patients with cataract and glaucoma]

The paper presents a comparison between two therapeutic approaches in patients with cataract and glaucoma: combined filtering-cataract surgery and two-step surgery (initially glaucoma surgery, then cataract surgery). There are shown the criteria which sustain one or other condition, the kind of control of intraocular pressure, the evolution of visual acuity, and postoperative complications.

[Echography in ophthalmology]

Echography represents an extremely valuable method in exploration of the eye for knowledge of some ocular parameters or detect and localize intraocular pathological process when the classical ophthalmological investigations are insufficient because of the affected transparent mediums. It is also used in the orbit pathology which is inaccessible to direct examination. This work contains the echographic exploration of the most common oculo-orbital diseases reached by ultrasonography (echography). The direct access of the ophthalmologist to the echograph enables the correlation between the anamnestic and clinical datum with those obtained by echographic explorations, meaning a more precise diagnosis.