Iridociliary melanoma - Clinical case

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.

Tobacco-alcohol optic neuropathy--clinical challenges in diagnosis

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.

[Ocular hypertension in herpes simplex keratouveitis]

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.

[Peripheral ulcerative keratitis]

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.

[The significance of imaging in a case of intraorbital cystic tumor]

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.

Use of amniotic membrane in bullous keratopathy palliative care

BACKGROUND

Assessment of efficiency of amniotic membrane covering in the improvement of bullous keratopathy symptoms.

MATERIAL AND METHOD

The paper represents a clinical prospective study, which includes 42 patients diagnosed with bullous keratopathy and operated between January 2009 and November 2013 in the Department of Clinical Ophthalmology from "Dr. Carol Davila" Central Military Emergency Hospital. Follow up between 6 and 48 months, with an average of 22 months. Subject to research: corneal re-epithelisation, epithelial bullae, pain and photophobia relapse.

RESULTS

In 37 cases, the symptoms improved, in 8 cases the minimum symptoms persisted and in 29 cases the symptoms completely disappeared. In 5 cases, there were no significant improvements, symptoms reappeared briefly after membrane resorption.

CONCLUSIONS

Amniotic membrane covering represents an efficient palliative care means in oedematous keratopathy.

[Ocular ischemic syndrome--a case report]

Ocular ischemic syndrome, also known as hypoperfusion/ hypotensive retinopathy or as ischemic oculopathy is a rare ocular disease determined by chronic arterial hypoperfusion through central retinal artery, posterior and anterior ciliary arteries. It is bilateral in 20% of the cases. Most often it appears due to severe occlusion of the carotid arteries (ICA, MCA>ECA), described in 1963 by Kearns and Hollenhorst. Occasionally it can be determined by the obstruction of ophtalmic artery or some arterities (Takayasu, giant cell arteritis). The risk factors are: age between 50-80 years, males (M:F = 2:1), arterial hypertension, diabetes, coronary diseases (5% of the cases develop ocular ischemic syndrome), vascular stroke, hemodialysis. The case we present is of an 63 years old man known with primary arterial hypertension, hypercholesterolemia, diabetes type 2 non insulin dependent and diagnosticated with ischemic cerebral stroke and bilateral obstruction of internal carotid arteries in march 2010, who is presenting for visual impairment in both eyes. The imaging investigations show important carotid occlusion and at the ophthalmologic evaluation there are ocular hypertension and rubeosis iridis at the right eye, optic atrophy at both eyes (complete in the right eye and partial in the left eye), with superior altitudinal visual field defect in left eye. The following diagnosis was established: Chronic ocular ischemic syndrome in both eyes with Neovascular glaucoma at the right eye, Anterior ischemic optic neuropathy at the left eye and laser panphotocoagulation at the right eye was started.

[Alternative therapeutic excision of intraepithelial conjunctival carcinoma with corneal extension]

Surgical treatment for conjunctival neoplasms, with wide local excision, with or without supplemental cryotherapy to the surgical margins represents the treatment of choice for this pathology. In some cases, these neoplasms can be diffuse or multifocal, with borders that are difficult to detect clinically, such that topical therapies offer a more efficient method for treating the entire ocular surface, delivering high drug concentrations at this level, with negligible systemic side effects. Beginning from the clinical case of a patient diagnosed with conjunctival intraepithelial neoplasia, we try to present other therapeutical alternatives, although in this case the therapeutical approach was the classic one.

[Computer-assisted phacoemulsification for hard cataracts]

PURPOSE

to evaluate the efficiency of new torsional phacoemulsification software (Ozil IP system) in hard nucleus cataract extraction.

METHODS

45 eyes with hard senile cataract (degree III and IV) underwent phacoemulsification performed by the same surgeon, using the same technique (stop and chop). Infiniti (Alcon) platform was used, with Ozil IP software and Kelman phaco tip miniflared, 45 degrees. The nucleus was split into two and after that the first half was phacoemulsificated with IP-on (group 1) and the second half with IP-off (group 2). For every group we measured: cumulative dissipated energy (CDE), numbers of tip closure that needed manual desobstruction the amount of BSS used.

RESULTS

The mean CDE was the same in group 1 and in group 2 (between 6.2 and 14.9). The incidence of occlusion that needed manual desobstruction was lower in group 1 (5 times) than in group 2 (13 times). Group 2 used more BSS compared to group 1.

CONCLUSION

The new torsional software (IP system) significantly decreased occlusion time and balanced salt solution use over standard torsional software, particularly with denser cataracts.

[Ocular surface in glaucoma patients with topical treatment]

PURPOSE

Our study is trying to establish the prevalence of Dry Eye Syndrome in glaucoma patients treated with topical medication.

MATERIAL AND METHOD

We investigated 40 patients (21 females and 19 males), age over 50, treated with topical antiglaucoma medication for at least one year. The control group was consisted of 40 healthy adults, 20 female and 20 males, age over 50, who didn't took any ocular treatment in the last three months. Each patient completed an Ocular Surface Disease Index questionnaire (OSDI) and underwent evaluation by Schirmer test and tear break-up time (TBUT).

RESULTS

In the control group we diagnose 9 patients (23%) with Dry Eye Syndrome. In glaucoma group 25 patients (63%) had Dry Eye Syndrome. Tear break-up time showed abnormal tear quality in all of those 25 patients. Schirmer testing showed 23 patients with decrease in tear production. Using Ocular Surface Disease Index 22 patients reported ocular symptoms. Unlike the control group, at the glaucoma patients we didn't notice any difference between the two genders. Regarding the age, we found at the control group the Dry Eye Syndrome at patients over 70 years old, and at the glaucoma group the average age was 55 years old.

CONCLUSIONS

In general population the prevalence of Dry Eye Syndrome is about 20%, mainly affecting females over 60 years old. In our study 63% of glaucoma patients had Dry Eye Syndrome--as a result of long term topical therapy that affects the integrity of the tear film and the ocular surface.

[Intravitreal triamcinolone acetonide treatment in diabetic macular edema]

PURPOSE

To assess the efficacy and safety of intravitreal triamcinolone acetonide in diabetic macular oedema.

METHODS

prospective study; 76 patients, 102 eyes; preoperative assessment: visual acuity, intraocular pressure, fundus biomicroscopy fluoresceine angiography, sometimes OCT; postoperative assessment: visual acuity, intraocular pressure, fundus biomicroscopy, fluoresceine angiography, sometimes OCT.

RESULTS

Visual acuity improvement in 42% cases; subjective improvement of visual acuity in 72% of cases

CONCLUSIONS

Triamcinolon acetonide may play a role in treatment of diabetic macular oedema.

[Pituitary adenoma--clinical case]

This is a case report of pituitary adenoma diagnosed by a deep ophthalmological examination. We identified a serious neurosurgical and endocrinological condition, potentially lethal, starting from an ocular symptom. The patient did not pay attention to the hormonal changes as they were developing slowly. Visual acuity was the only reason why the patient decided to seek medical attention.

[Intelligent phaco--always necessary?]

PURPOSE

To assess the need of /P system use in soft cataract

METHODS

prospective study--40 eyes with soft cataract (+/++); surgery with Infinity system, Ozil handpiece; in 20 eyes we used low levels (max 70%) of torsional ultrasound power and IP system; in 20 eyes we used higher levels of torsional ultrasound power without IP system; we assessed: the CME value and the presence of cornela edema.

RESULTS

In cases with tosional ultrasound only: average value of CME--2.4; maxim value of CME--4.3; all corneas without edema. In cases with torsional ultrasound and IP system; average value of CME--3.6; maxim value of CME--7.2; 4 eyes with decemetic folds in central cornea.

CONCLUSIONS

In soft cataracts is better to not use IP system

[Corneal transplantation activity in Ophthalmology Clinic of Central Military Hospital--2009-2010]

PURPOSE

To show the cornea/transplantation activity of our clinic in 2009 and 2010

METHODS

We assessed: The number of corneal prelevations. The number of surgeries. The etiology of the disesses which need cornea/transplantation.

CONCLUSIONS

Although there is a slow increase, the activity of corneal transplantation has not a satisfactory level.

[Ocular siderosis]

We show a clinical case of siderosis bulbi with absolute secondary glaucoma. The initial diagnosis was primary open angle glaucoma in both eyes, and the patient was treated with eye drops for 4 years. After reassessment of anamnesis, clinical and paraclinical investigations we find that one eye is normal and the real diagnosis in the involved eye.

[The secret of red eyes]

"Red eye" is a sign and the same time a symptom frequently met in the ophthalmological practice. The "red eye" is not always the clinical manifestation of a common conjunctivitis. We will present a case report of a patient who accused conjunctival hyperemia, lacrimation, foreign--body sensation; she was also describing recurrent conjunctivitis for the past year. After an detailed ophthalmologic examination and interdisciplinary consultations. She was diagnosed with Basedow Disease and paraselar meningioma with invasion in the pterigoid fossa. The authors are suggesting that there is an indirect left carotid - cavernous fistula.

[Refractive stability of artificial crystallins--acrysof TORIC]

PURPOSE

To evaluate the results of AcrySof Toric intraocular lens (Alcon) implantation to correct pre-existing astigmatism and rotational stability in patients having cataract surgery or not.

METHODS

Retrospective study three surgical teams, between February 2009-August 2010, included 37 eyes with more than 1 diopter (D) of preexisting corneal astigmatism having or not cataract surgery.

RESULTS

Rotation at 6 M post-op: 32 patients (87%)--> rotation between aprox. 0-5 degrees, 4 patients (11%)--> rotation between A 5-10 degrees, 1 patient (2%) rotation of A 20 degrees. The mean refractive cylinder decreased significantly after surgery: 34 (91.90%) of cases between 0.25-0.75 D--2 (5.40%) of cases 1.5 D--1 (2.70%) of cases > 1.5 D.

CONCLUSIONS

In conclusion the results indicate that TheAcrySof Toric IOL is a viable option of preoperative corneal astigmatism in carefully selected cases. The Toric IOL showed good rotational stability The most frequent cause of turnover is the: viscoelastic left in the capsular bag (early rotation); fibrosis of the bag (late rotation).

[Neuroprotection in glaucoma]

The present paper is a revue of the basic terms related to the neuroprotection, an up-to-date on the pathophysiology of glaucoma. There are emphasized some of the main directions of evolution in the antiglaucomatous and neuroprotective treatment.

Gastric pentadecapeptide BPC 157 counteracts morphine-induced analgesia in mice

Previously, the gastric pentadecapeptide BPC 157, (PL 14736, Pliva) has been shown to have several beneficial effects, it exert gastroprotective, anti-inflammatory actions, stimulates would healing and has therapeutic value in inflammatory bowel disease. The present study aimed to study the effect of naloxone and BPC 157 on morphine-induced antinociceptive action in hot plate test in the mouse. It was found that naloxone and BPC 157 counteracted the morphine (16 mg/kg s.c.) - analgesia. Naloxone (10 mg/kg s.c.) immediately antagonised the analgesic action and the reaction time returned to the basic values, the development of BPC 157-induced action (10 pg/kg, 10 ng/kg, 10 microg/kg i.p.) required 30 minutes. When haloperidol, a central dopamine-antagonist (1 mg/kg i.p.), enhanced morphine-analgesia, BPC 157 counteracted this enhancement and naloxone reestablished the basic values of pain reaction. BPC 157, naloxone, and haloperidol per se failed to exert analgesic action. In summary, interaction between dopamine-opioid systems was demonstrated in analgesia, BPC 157 counteracted the haloperidol-induced enhancement of the antinociceptive action of morphine, indicating that BPC acts mainly through the central dopaminergic system.

[Antiglaucoma drops--with or without preservatives]

The article show the main adverse reactions of the preservatives used in glaucoma eye drops, the possibilities to avoid this complications, the advantages and disadvantages of preserved and unpreserved eye drops.

[The assessment of optic disk in family member--useful in glaucoma diagnosis?]

PURPOSE

To clarify the diagnosis of open-angle glaucoma in an atypic case.

METHOD

Assessment of intraocular pressure, the aspect of optic nerve head and automated perimetry show interpretable values. We assess the head of optic disc and the visual field in both mother and daughter of the patient.

RESULTS

The optic disc and the automated perimetry in both relatives was normal reassessment of visual field at the patient show a normal appearance.

CONCLUSIONS

When the diagnosis of open-angle glaucoma is unclear, the assessment of members of family may be useful.

[Glomus tumor with diplopia]

This paper highlights the case of a 46-year-old female patient who seeks ophthalmic medical advice for her complaint about double vision on right gaze. Patient's medical history reveals several symptoms like headaches, progressive hearing loss on right side and dysphonia for which all investigations proved irrelevant. Thourough clinical examination, lab exams and imaging techniques revealed the cause for this symptoms i.e. glomic tumour with middle ear extention. We find this case to be exceptional as ocular symptoms led to the diagnose of a non-ocular serious, possible life threatening condition, bearing in mind that previously occured non-ocular symptoms couldn't elucidate the cause.

[Overdiagnosis in glaucoma--a real problem?]

PURPOSE

To reassess the diagnosis in a group of patients with diagnosis and treatment for open-angle glaucoma.

METHOD

Group of 100 patients with diagnosis and treatment for open-angle glaucoma, sent in our clinic for automated perimetry. We assess: intraocular pressure, automated perimetry, the head of optic disc; sometimes we stopped the treatment and reassess the intraocular pressure; sometimes pahimetry. We confirm or not the diagnosis of open-angle glaucoma.

RESULTS

In 41 patients the diagnosis of open-angle glaucoma was not real.

CONCLUSIONS

The diagnosis of open-angle glaucoma is made often without clear medical evidences.

[Corneal transplantation in Romania]

The paper shows the activity of corneal transplantation in Romania. The author discuss about the aspects involved in this activity. The laws about donation, prelevation and surgery. Juridical aspects about activity of tissues banks. Human resources. Material resources. The author tries to find some solutions for improvement of this activity.

[Treatment of thyroid ophthalmopathy--a clinical case]

Thyroid ophthalmopathy is a relatively frequent pathology. Usually it is a self-limited affection but same cases develop visual-threatening complication. The management of thyroid disorders necessitates both treatment of the systemic thyroid disease and management of the thyroid eye disease in order to alleviate the ocular discomfort, to prevent disfigurement and to avoid the visual threatening complications.

[Posttraumatic hyphema?]

The authors present the case of a patient with ocular pain and visual impairment after an ocular trauma. The ophthalmologic exam and the complementary exams show atypical aspects of the traumatic ocular pathology.

[Toxic anterior segment syndrome]

The authors present two cases of TASS which occurred consequent upon anterior chamber administration of cefuroxime(Axetin). The ESCRS guidelines on prevention, investigation and management of postoperative endophthalmitis recommends intracameral injection of an antibiotic agent (cephalosporin) at the conclusion of surgery. In our group of patients TASS occurred. Elements of diagnosis and treatment in TASS are discussed. As a conclusion to our study we decided to discontinue cefuroxime administration.

[Palliative treatment in bullous keratopathy]

The article is a review of the possibilities of palliative treatment for bullous keratopathy, medical methods (hypotensor and hyperosmotic agents) and surgical methods (conjunctival flap, annular keratotomy, anterior stromal puncture, therapeutic photo-keratectomy and amniotic membrane use), each of them with indications, results, advantages and disadvantages.

[Amniotic membrane transplantation in palliative treatment of bullous keratopathy]

PURPOSE

To assess the efficacy of amniotic membrane transplantation for the improvement of symptoms in bullous keratopathy.

MATERIAL AND METHOD

Prospective study. 14 patients were operated between 01.02.2003 - 01.02.2006. the follow-up period: between 6 and 42 months with an average of 18 months. The following parameters were evaluated: corneal re-epithelialisation appearance of epithelial bullae, pain, photophobia.

RESULTS

In 11 cases there was an improvement of the symptomatology: complete in 8 cases and partial in 3 cases.

CONCLUSIONS

Amniotic membrane transplantation is an efficient palliative treatment for bullous keratopathy.

[Genetic aspects of retinoblastoma]

Retinoblastoma is a genetic expression model of the tumors' suppressor genes. This study explains the most important elements of the genetic mechanisms which govern retinoblastoma's appearance and remission. It also attempts to address questions about the risk of patient's relatives getting retinoblastoma.

[Ocular manifestation in amiodarone toxicity--case report]

The authors present the case of a patient having both toxic keratopathy and maculopathy after a medication with amiodarone. Some of the ocular damages are irreversible, even while amiodarone medication is stopped, which recommends the screening as an efficient tracking method for ocular reversible injuries, avoiding major loss of visual function.

[Cataract surgery in an eye with intraocular tumor]

This case present the consequences of performing the cataract surgery on an eye with intraocular tumor, pointing the importance of a detailed and complete examination, even for the benign and easy to diagnostic diseases.

[Histopathological assessment of corneal preservation]

PURPOSE

To show corneal changes after corneal preservation.

MATERIAL AND METHOD

There was studied 10 pig corneas: a fresh cornea; two corneas stored in wet chamber at 4 degrees C, 24 and 48 hours; seven corneas stored in Inosol at 31 degrees C, 24 hours, 7, 10, 14, 18, 20 and 22 days.

RESULTS

We obtained images of every cornea; we followed epithelial, stromal and endothelial changes.

CONCLUSIONS

1. During corneal preservation there are progressive histological changes, early in epithelium and stroma, later at endothelial level. 2. The safe preservation period in wet chamber at 4 degrees C is 24 hours; the changes found after 48 hours are irreversibile. 3. The safe preservation period in Inosol at 31 degrees C is 14 days.

[Cataract surgery in Romania--2003]

AIM

to evaluate cataract surgery performed in Romania analyzing: --the number of cataract surgery performed in 2003; --the surgical technique used: intracapsular extraction, extracapsular extraction, phacoemulsification; --the number and type of intraocular lenses used; --the number of ophthalmologists that performed cataract surgery;

MATERIAL AND METHOD

--a questionnaire was sent to all ophthalmologists which do cataract surgery.

RESULTS

--38,000 surgeries for cataract were performed in 2003; --the surgical techniques used were : Phacoemulsification (18,000 cases), classic extracapsular extraction ( 19,000 cases) and intracapsular extraction (1000 cases); --28,500 rigid and 8,000 foldable intraocular lenses were implanted; - 223 ophthalmologists perform cataract surgery in Romania.

[Usher's syndrome]

PURPOSE

to show the manner of diagnose of this syndrome and to evaluate the possibilities of treatment MATERIAL AND METHOD--there are shown: --ophthalmological and ENT clinical examination --visual field test--adaptometry--audiometry --impedance--auditive evoked potentials--cataract extraction (phacoemulsification).

RESULTS

After cataract extraction the visual acuity increase.

CONCLUSIONS

For the diagnosis we need both the diagnosis of retinitis pigmentosa and neurosensorial deafness. For the certainty of the diagnosis genetic tests are required. The treatment of associate ocular pathology may increase the visual status.

[Post-inflammatory glaucoma--methods of treatment]

We show the mechanisms of postinflammatory secondary glaucoma and the possibilities of treatment of this, all of this concerning to an individual case. We evaluate the benefits and risks for every kind of therapeutical approach and we show our choice.

[Corneal preservation at 4 degrees C--experimental study]

AIM OF STUDY

To evaluate the 4 degrees C method of corneal preservation (in moist chamber or in preservation media To determine the duration of prevention.

MATERIAL AND METHOD

Preservation in moist chamber at 4 degrees C, group of 10 pig eyes. Preservation: the entire globe at 4 degrees C examination: direct specular microscopy with a Tomey device, daily, for 4 days. Preservation in Likorol DX at 4 degrees C, group: 20 pig eyes Preservation: Likorol DX medium, we change the medium after 7 days. examinations: inverse specular microscopy, with a Zeiss device, after 1, 4, 7, 10 and 14 days.

RESULTS

Preservation in moist chamber at 4 degrees C. The average endothelial cell loss was 13.2% after a day of preservation and 27.1% after 2 days. Preservation in Likorol DX at 4 degrees C The average endothelial cell loss was 2.8% after a day of preservation, 13.8% after 7 days and 22.6% after 10 days.

CONCLUSIONS

The corneal preservation in moist chamber at 4 degrees C is a useful method; it is safe to preserve the globe only for 24 hours. It is safe to preserve corneas in Likorol DX medium for 7 days, there is an endothelial cell loss, about 13.8%.

[Interpretation of visual field with Humphrey Zeiss Analyser]

In the beginning of the article where are defined the notions of the soft of automated perimetry: threshold, kind of tests, the strategy of automated perimetry. Then are shown the steps of automated perimetry interpretation: kind of test and strategy, evaluation of patient reliability, interpretation of the visual field defects (artifacts or no) and statistical analysis.

[Decontamination of ocular globes--comparison of three methods]

PURPOSE

Determination of the success degree of the three decontamination methods for the purpose of choosing the decontamination method before the prelevation of the cornea for its best preservation.

MATERIAL AND METHOD

The studied decontamination methods were: 1. Immersion of the ocular globe in Betadina (polividon--iod) 2. Immersion of the ocular globe in Silver Nitrate 3. Washing of the ocular globe with Gentamicina. 30 animal eyes (pig) were used, 10 for each method. A bacteriological sample was prelevated from each ocular globe, before and after the decontamination. Afterwards the cornea was immersed in solution of Inosol type, following the indicator of the Inosol for 10 days.

RESULTS

In each conjunctival the microbial population was present before the decontamination. Positive samples existed after the decontamination for every method, microbial concentration being however greatly reduced in the first 2 samples. The contamination of the conservation environment occurred for a cornea in the case of Betadine, for 2 cornea in the case of Silver Nitrate and for 7 corneas in the case of Gentamicin.

CONCLUSIONS

1. Decontamination with Gentamicin 33 mg/ml solution is inefficient. 2. The efficacy of Silver Nitrate and Betadine solution is similarly. 3. The best option is immersion of the globe in Betadine solution.

[Corneal preservation at 31 degrees C--experimental study]

PURPOSE

To study the cornea, specially the corneal endothelium in preservation media for different periods of time, trying to assess the best period of preservation. To evaluate the endothelial cell loss during preservation, trying to assess the endothelial cell minimum density for a cornea able to be preserved.

MATERIAL AND METHODS

We studied 7 human corneas and 15 pig corneas. We used the inverted specular microscope, Axiovert 100. We used the soft KS 400 for image processing. We used to preservation medium: Inosol-like. We made an initial examination, then after 1,4,7,10 and 14 days.

RESULTS

In human corneas the mean cell loss(%) was 4.1% from initial cell density after 4 days of preservation, 14.7% after 7 days, 18.6% after 10 days and 23.4% after 14 days. In pig corneas the mean cell loss (%) was 2.3% from initial cell density after 4 days of preservation, 8.8% after 7 days, 14.9% after 10 days and 23% after 14 days.

CONCLUSIONS

The best period of preservation in Inosol-like medium is 7-10 days. This period may be extended to 14 days. During preservation there is an endothelial cell loss which after 14 days is about 23% from initial endothelial cell density (about 550 cell/mm2). The minimum initial endothelial cell density for a cornea to be able to be preserved is 2400 cell/mm2.

[The loss of endothelial cells after perforating keratoplasty--clinical study]

PURPOSE OF THE STUDY

To determine endothelial cell loss rate after penetrating keratoplasty. To determine for low long this rate remain high.

MATERIAL AND METHOD

We have three groups of patients. First group consists of 15 patients without ophthalmic pathology. The second group consists of 15 patients, after cataract surgery. The Third group consists of 20 patients after penetrating keratoplasty, 10 of them with edematous keratoplasty and 10 with keratoconus or central leucoma. Every patient was examined with direct specular microscopy, after 1, 3, 6, 9, 12, 15 and 18 months.

RESULTS

In the first group we can't determine an endothelial cell loss. In the second group the endothelial cell loss was 4% per month, 5.9% per month, then the value become normal. In the third endothelial cell was continuous within all intervals.

CONCLUSIONS

After penetrating keratoplasty there is a significant endothelial cell loss that continues over 18 month.

[Bourneville tuberous sclerosis]

The article shows a case of Bourneville's disease, a quite rare neuroectodermal phacomatosis. We show how we establish the diagnosis, beginning with a total unspecifical symptomatology.

[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.