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Penetrating wounds with intraocular foreign body are ophthalmologic emergencies due to their severity and complexity and may require multiple surgeries for final resolution.30-years-old patient with penetrating wound and metallic intraocular foreign body in the posterior vitreous requires successive operations for IOFB extraction, lensectomy, posterior vitrectomy for rhegmatogenous retinal detachment and then silicone oil extraction with final visual acuity 0, 4 PH.

Vitreous role in the pathophysiology of retinal diseases has increased importantly over the recent years. This was possible using Optical Coherence Tomography which reviewed the way the vitreoretinal interface should be looked at and defined and classified new pathologies such as Vitreoretinal Traction Syndrome. Vitreous is not an empty space but an important anatomical structure with role in ocular physiology. With age biochemical changes occur so that vitreous starts to liquefy. Once the vitreous is liquefied (sinchisis) it collapses and passes in the retrohialoid space (sineresis). In complete PVD besides sinchisis there is a weakness of the adherence between the posterior cortex and ILM with total detachment of posterior cortex. Abnormal adhesions are associated with incomplete PVD. The definition and understanting of vitreoretinal pathology is an active and continuous process, PVD being the trigger of a lot of retinal pathologies: epiretinal membrane, macular hole, tractional macular oedema, VMTS, myopic traction maculopathy, exacerbations of exudative ARMD.

To assess the anatomical and visual outcome and also the retinal complications following vitreoretinal surgery for posterior segment intraocular foreign bodies (IOFBs).Retrospective analysis of 59 IOFBs, with different locations within posterior segment,removed during pars plana vitrectomy (PPV) between January 1999 and January 2011, by the same surgeon, in Eye Clinic 1 Iasi. 47 out of 59 IOFBs (79.66%) were removed immediately after primary wound closure and 12 with a delay ranging from 48 hours to 5 years. All IOFBs were metallic. Total 20G pars plana vitrectomy with IOFB removal by forceps or intraocular magnet, careful membrane peeling and laser photocoagulation around the retinal injury (if present) was performed. Relaxing retinotomy was necessary in 3 cases of retinal incarceration. Endotamponade with SF6 (26 cases) or silicone oil (8 cases) were performed, if needed, at the end of surgery. The average follow-up period after surgery was 17.9 month (ranging 6 - 36 months).18 out of 59 IOFBs (30.5%) were intraretinal. 39 out of 59 eyes (66.10%) showed signs of endophthalmitis at the time of surgery. Preoperative visual acuity ranged from light perception to 0.6. The mean visual acuity significantly increased after surgery from 0.16 preoperatively to 0.5 at the end of follow-up (range hand movements--1). 51 out of 59 cases (86.44%) had stable anatomical result. A final visual acuity equal or better than 0.1 was obtained in 45 cases (76.27%). Mild retinal folding could be noticed in some cases around the laser-treated retinal injury. In 8 out of 59 cases (13.56%) visual acuity remained low or decreased due to macular injury or PVR associated retinal detachment requiring additional surgery.IOFBs, and especially those intraretinal, require an early, complex and customized approach during PPV. Functional results do not match anatomical restoration if macula or optic nerve are impacted. Main postoperative complications were represented by retinal folds and PVR associated retinal detachment.

The purpose of the study is to evaluate the preliminary results of the treatment with Bevacizumab (Avastin) in the neovascular (wet) form of Age-Related Macular Degeneration (AMD).The study is retrospective and includes 20 consecutive patients (27 eyes) who had received Avastin intravitreally, hospitalized in the Ophthalmology Clinic from Cluj-Napoca, between September 2007-March 2009, for wet AMD. Every patient had received 3 Avastin injections, approximately one month apart. Each dosis consisted of 0.05 ml (1.25 mg) Avastin. The therapeutical effect has been evaluated by: the value of the visual acuity (VA), the foveolar thickness (FT) and the total macular volume (TMV), before and after the treatment. In order to measure the VA, the classical optotipe has been used and the FT and the TMV have been evaluated by Time Domain (TD)-OCT. The follow-up period has varied between 4-10 months. The statistical interpretation of the results has been performed by the use of the Student t test, a p value0.05 being considered statistically sirgnificant.Of the 27 treated eyes, 8 (30%) had a favorable evolution of the VA, 15 (55%)--a stationary one and 4 eyes (15%) had an unfavorable outcome. The FT decreased (favorable evolution) in 18 eyes (66.66%) and increased (unfavorable evolution) in 9 eyes (33.33%). The TMV had a favorable evolution (decrease) in 21 eyes (77.77%) and an unfavorable one (increase), in 6 eyes (22.22%).The quantitative evolution of the VA has been predominantly stationary (55% of the eyes). Most patients described an improvement in the quality of vision, even if the VA has remained unchanged. The evolution of the FT and of the TMV has been predominantly favorable: 66.66%, 77.77% respectively. We noted the direct correlation between the evolution of the VA and of the morphological parameters evaluated by OCT, only in 33.33% of the treated eyes.

A rhegmatogenous retinal detachment is defined by accumulation of subretinal fluid between neurosensory retina and retinal pigment epithelium, through a retinal break. In an ocular globe affected by rhegmatogenous retinal detachment, a series of anatomical and functional changes appear.

Vitreous fluorophotometry is an investigation that facilitates the quantitative study of the blood-retinal barrier (thus allowing a better understanding of its physiopathology and opening new therapeutical research fields). It can be performed for the vast majority of the ocular diseases: diabetic retinopathy, arterial hypertension, uveitis, post-cryotherapy/laser photocoagulation, retinal vascular diseases, choroidal melanoma, optic nerve diseases etc.

The vitreous is a part of the ophthalmological pathology not well enough known and explored. For the moment it is considered the poor relative of the examination of the posterior pole. The new technical progresses had brought though many usefull information in interpreting the vitreoretinal changes.

The direct intravitreal administration represents the easiest and quickest method for obtaining efficient substance concentrations closer to the lesions and is reserved to the pathology which is resistant to the common treatments.

to report the difficulties in biometry in patients with cataract and synchysis scintillans and the way to avoid the biometrical errors in such patients.Observational study on 4 patients (from 3 different surgeons) with cataract and synchysis scintillans.In two patients, the biometry obtained an increased IOL dioptrical value (+29D, and +28D, respectively) which proved to be wrong by not obtaining the planed emmetropia postoperatively. Instead, the postoperative refraction showed increased myopia (-9D and -6.5D spherical equivalent, respectively), and explantation with re-implantation was needed. The secondary implant was chosen based on the postoperative refraction and primary implant value (+20D, and +24D respectively). In other two cases, the biometrical error was avoided by manually selecting the real antero-posterior axis value, not the mean value calculated by the computer. This method proved to be correct by obtaining near-emmetropia postoperatively.The association between cataract and synchysis scintillans is frequent, and the presence of synchysis scintillans could be a cause of errors in biometry. The biometrical errors could be avoided by amending the method of measurement. These observations stress the necessity of ocular echography in the case of opaque ocular media.

The paper propose to point out the modifications in the conjunctiva, cornea, iris, ciliary body, lens, vitreous body and choroid due to the diabetic disease. The alterations were mainly demonstrated by optic and electronic microscopy. It has been also studied the relationship between the type and the severity of this lesions, the stages of the diabetic retinopathy and the glycemic level. In conclusion, the complete ophthalmologic examination of diabetic patients can provide extremely useful information for the therapeutical management and visual prognosis.

The paper presents the case of a 18 years old male suffering from persistent hyperplastic primary vitreous (PHPV) associated with congenital retinal folds. The clinical features and the pathogenic correlations of the two affections are discussed. Comparing to the PHPV, consequence of a embryogenesis flow appeared in the development of the primary hyaloid-vitreous complex, the congenital retinal folds are considered to be the expression of secondary changes, generated by the background of a varied vitreo-retinal pathology.

Pathogenesis of idiopathic macular hole is very discussed subject now, the macular changes result after the vitreal surface changes of the macular region. The use of SLO and OCT has renewed interest in the early stages of macular hole and has shown that a foveal cystoid space or pseudocyst is the primary lesion in macular hole formation, together with incomplete perifoveal posterior hyaloid detachement.

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 clinical study done on 19 cases with posterior primitive vitreous persistency and hyperplasia showed the predilection affectation of youth (average age: 11.2 year old), the frequent lateral localization (17 cases), microcornea (7 eyes), hypermetropia (average value + 3D). The visual acuity was between 1 and unregistered device values, being a function of the papillar ant retinal lesion extension. The ophthalmoscopical aspect was balanced, from a simple prepapillar veil to complex ophthalmological syndromes. Etiopathogenetically, the affection is considered to be a embryogenesis flaw, appeared in the development of the primary hyaloid-vitreous complex, described by an incomplete resorption and a hyperplasia of its elements. The problems of differential diagnosis and treatment are extensively presented.

The early diagnosis of PHPV is often difficult to be established, because of the frequent opacification of the ocular transparent media. So the echography and the computerized tomography, the early surgical intervention using up-to-date techniques in vitreous surgery is imposed, in order to maintain functionally or anatomically the affected globe.

The paper reports on the main pathogenic types of anatomical blocking of the aqueous humor circulation in malignant glaucoma: pupillary, secondary iridolenticular, ciliovitreolenticular, iridociliovitreous blocks and in suprachoroidal effusion. The paper also presents some of the entities correlated with malignant glaucoma: glaucoma with blocked angle following the administration of miotics, traumatisms, the operations of scleral obstruction for retina detachment, panretinal photocoagulation and thrombosis of the retina central vein.

The normal vitreous defends the posterior pole damping the traumatic and tension shocks coming from the anterior pole reducing their intensity according to formula P = F/S The buffering function decreases in direct proportion to the degree of fluidity of the vitreous, fluidity that enlarges the volume of the vitreous whereas the mass does not change according to the density formula p = m/v, the density of the liquefied vitreous being greatly diminished. The liquefied vitreous may lead to degenerative lesions of the retina due to prolonged tension of the retina resulting in ruptures and detachment. An anterior pole pressure of 15-16 mmHg transmitted non-modified to the posterior pole through the liquefied vitreous, exceeding by far the pressure of the opticoretinal tissular fluid pressure which in 9 mmHg leads to papillary excavation and glaucoma without tension; hence the liquefied vitreous must be replaced by a normal one or its density built up again.

Starting from a case of endophthalmitis secondary to a stung plague, the authors show the present treatment trends in this ophthalmic disease. The paper also reports on the importance of intravitreous administration of antibiotics associated or not with vitrectomy, corticotherapy, and other adjuvant treatments and on the possible complications induced by this new therapeutic trend.