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Background. Biliopancreatic tumors (BPT) are among the most aggressive solid malignancies, and their incidence is rising. Good patient outcome relies heavily on a multidisciplinary approach to therapy, including timely access to endoscopy, surgery and chemo/radiotherapy. We aimed to evaluate current practices as reflected in the management and outcome of patients diagnosed with BPT in the setting of a low-resource medical system in order to identify areas suitable for improvement.

Vaccination is considered to be one of the most effective means of protecting individuals and populations from the risks associated with exposure to various pathogens. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), affected people of all ages worldwide. In response, several pharmaceutical companies rapidly leveraged their resources to develop vaccines within a very short period of time, leading to the introduction of new, improved, and combination vaccines for community-wide immunization. This review aims to provide a summary of the available literature on the efficacy and safety of COVID-19 vaccines in the pediatric population ranging from 0 to 18 years. An analysis of recent published studies reveals that the majority of clinical trials have reported a sustained immune response following COVID-19 vaccination in children across various age groups worldwide. The majority of the authors highlighted the effectiveness and safety of immunization schedules in children and adolescents. The population-level efficacy of this vaccination remains to be determined, provided that the benefits outweigh the potential risks. Long-term side effects must still be monitored to enable the development of safer and more effective vaccines for future pandemics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Azoicai, Miron, Lupu, Alexoae, Starcea, Alecsa, Lupu, Danielescu, Nedelcu, Salaru, Dragan and Ioniuc.)

Background: Numerous conditions, both physiological and pathological, can influence changes in the retinal vascular architecture. In order to be able to highlight pathological aspects of systemic diseases with ocular activity, it is necessary to understand how physiological fluctuations can influence circulation at the retinal level. The present study attempts to evaluate retinal and choroidal vascular and structural changes in healthy female subjects over the course of a menstrual cycle using OCT-A. Methods: We analyzed 22 eyes from healthy reproductive women with a regular menstrual cycle. We performed five OCT-A scans of the subjects every 7-8 days over the course of a month starting from the first day of the menstrual cycle and ending with the first day of the next cycle, measuring perfusion density in the superficial and deep vascular plexuses, choroidal thickness, and FAZ perimeter. Results: There are physiological variations in retinal hemodynamics that can be identified using OCT-A, choroidal thickness having statistically significant increased values in the parafoveal nasal sector during the ovulatory phase (289.18 µm) compared to the early follicular phase (281.9 µm), and the subfoveal sector during the ovulatory phase (319.04 µm) compared to the early follicular phase (308.27 µm). Conclusions: These findings along with abnormally small FAZ perimeters indicate that the menstrual cycle phase should be considered whenever interpreting OCT-A results. Further studies that include larger cohorts, control groups, and hormone serum levels are necessary to confirm and correlate retinal vascular alterations and the phase of the menstrual cycle using OCT-A.

Diabetes is a complex condition with a rising global incidence, and its impact is equally evident in pediatric practice. Regardless of whether we are dealing with type 1 or type 2 diabetes, the development of complications following the onset of the disease is inevitable. Consequently, contemporary medicine must concentrate on understanding the pathophysiological mechanisms driving systemic decline and on finding ways to address them. We are particularly interested in the effects of oxidative stress on target cells and organs, such as pancreatic islets, the retina, kidneys, and the neurological or cardiovascular systems. Our goal is to explore, using the latest data from international scientific databases, the relationship between oxidative stress and the development or persistence of systemic damage associated with diabetes in children. Additionally, we highlight the beneficial roles of antioxidants such as vitamins, minerals, polyphenols, and other bioactive molecules; in mitigating the pathogenic cascade, detailing how they intervene and their bioactive properties. As a result, our study provides a comprehensive exploration of the key aspects of the oxidative stress-antioxidants-pediatric diabetes triad, expanding understanding of their significance in various systemic diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lupu, Miron, Trandafir, Jechel, Starcea, Ioniuc, Frasinariu, Mocanu, Petrariu, Danielescu, Nedelcu, Salaru, Revenco and Lupu.)

We report a case of a 16-year-old girl presenting to our clinic with decreased visual acuity and increased intraocular pressure in both eyes. The ophthalmological examination revealed best-corrected visual acuity (BCVA) of 0.3 in the right eye (R.E.) and 0.4 in the left eye (L.E.) and intraocular pressure (IOP) of 46 mmHg in the R.E. and 42 mmHg in the L.E., with a 360° closed angle on gonioscopy, pupillary block due to bulging, a hyper-spherical lens and high corneal thickness, without ectopia lentis or cataract. The eyes responded poorly to pharmacological mydriasis; therefore, the lens equator could not be visualised. The patient had a history of pulmonary stenosis, short stature and no significant cognitive deficits. These elements point to the diagnosis of Weill-Marchesani syndrome, and the ophthalmological management was surgical, including lens extraction and the installation of a capsular tension ring, an intraocular lens and a Shunt ExPress implantation. Evolution was favourable, with improved BCVA of 0.7 in the R.E. and 0.63 in the L.E. and IOP of 14 mmHg in the R.E. and 13 mmHg in the L.E., without topical or systemic treatment at the 6-month follow-up. Weill-Marchesani syndrome has a complex presentation, with ophthalmological, musculoskeletal, cardiac and psychiatric manifestations. Usually, this leads to a need for a multidisciplinary approach. The ophthalmologic symptoms are often the cause of presentation to a specialist, and glaucoma is the most threatening of the ocular pathologies, with possible evolution into irreversible blindness; therefore, prompt surgery and careful follow-up become key components of the treatment plan. As a take-home message, we encourage a high degree of suspicion of Weill-Marchesani syndrome in such cases.

Introduction: To evaluate the long-term effects of intense pulsed light (IPL) therapy on patients with dry eye disease (DED) associated with meibomian gland dysfunction (MGD)., Methods: A retrospective case series was performed with 110 participants undergoing IPL therapy. Assessments included the eye fitness test (EFT) to gauge subjective symptoms, along with objective measures using the Tearcheck ® device (ESW Vision, Houdan, France) noninvasive first breakup time (NIFBUT), noninvasive average breakup time (NIABUT), central tear meniscus height (CTMH), thinnest tear meniscus height (TTMH), and ocular surface inflammatory risk evaluation (OSIE) assessed using the SCHWIND SIRIUS device (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany)., Results: This study documented significant improvements in subjective and objective symptoms associated with DED and MGD. Subjective symptoms measured by the EFT showed an average increase of 9.74 points (range -10 to 28, standard deviation [SD] ± 7.54), indicating reduced symptoms. Objective measures of tear film stability, represented by NIABUT, increased by an average of 4.04 s (range -15.00 to 14.40, SD ± 4.91). Tear film stability evaluation (TFSE) scores decreased by 229.12 points on average (range -1775 to 528, SD ± 384.94), suggesting enhanced tear film stability. OSIE type 1 showed a reduction in inflammation, with a percentage decrease of 4.98% (range -45 to 5, SD ± 7.33). Additionally, OSIE capture time decreased by 3.25 s on average (range -27 to 22, SD ± 10.35), further indicating an improvement in ocular surface health., Conclusion: IPL therapy was shown to be a promising, noninvasive approach for improving quality of life in patients with DED by effectively managing symptoms and stabilizing tear film. The findings support the use of IPL as a sustainable treatment modality for DED associated with MGD., (© 2024. The Author(s).)

Neovascular age-related macular degeneration is a progressive, blinding macular disease that has become a burden both in healthcare systems and the global economy. The vascular endothelial growth factor (VEGF) is the main agent involved in the pathogenic process of the disease. The main goal of the age-related macular degeneration treatment is to maintain and improve visual acuity by injecting intravitreal anti-VEGF agents in either a reactive or proactive manner. Subretinal and intraretinal fluids are the main biomarkers that should be considered when managing the frequency of the therapy. This review discusses both functional and morphological treatment criteria according to current recommendations as opposed to real-life situations encountered during day-to-day clinical practice and highlights situations in which the benefits of continuing therapy are arguable in terms of improving patients' quality of life. Optimizing the treatment regimen represents an important aim of current clinical ophthalmological practice, as age-related macular degeneration patients usually have a long follow-up period.

Introduction: The triangular recess (TR), also called triangular fossa or vulva cerebri, represents the anterior extension of the diencephalic ventricle, located between the anterior columns of the fornix and the anterior white commissure. Over time, this structure of the third cerebral ventricle generated many disputes. While some anatomists support its presence, others have opposite opinions, considering that it only becomes visible under certain conditions. The aim of the study is to demonstrate the tangible structure of the triangular recess. Secondly, the quantitative analysis allowed us to establish an anatomical morphometric standard, as well as the deviations from the standard., Materials and Methods: Our study is both a quantitative and a qualitative evaluation of the triangular fossa. We dissected 100 non-neurological adult brains, which were fixed in 10% formaldehyde solution for 10 weeks. The samples are part of the collection of the Institute of Anatomy, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi. We highlighted the triangular fossa by performing dissections in two stages at the level of the roof of the III ventricle., Results: The qualitative analysis is a re-evaluation of the classical data concerning the anatomy of the fossa triangularis. We proposed an original 3D model of the triangular recess in which we described a superficial part called vestibule and a deep part called pars profunda . We measured the sides of the communication between the two proposed segments, as well as the communication with the III ventricle. By applying the Heron's formula, we calculated the area of the two communications. Statistical evaluations have shown that these communications are higher than they are wide. In addition, there is a statistical difference between the surfaces of the two communications: 34.07 mm 2 ± 7.01 vs. 271.43 mm 2 ± 46.36 ( p  = 0.001)., Conclusion: The outcome of our study is both qualitative and quantitative. Firstly, we demonstrated the existence of the triangular fossa and we conceived a spatial division of this structure. Secondly, the measurements carried out establish an anatomo-morphometric norm of the triangular recess, which is useful in assessing the degree of hydrocephalus during the third endoscopic ventriculoscopy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nedelcu, Lupu, Lupu, Tepordei, Ioniuc, Stan, Vicoleanu, Haliciu, Statescu, Ursaru, Danielescu and Tarniceriu.)

TNF inhibitors (TNFi) have revolutionized the therapeutic management of various chronic immune-mediated inflammatory diseases. Despite their known benefits, these therapies are related to paradoxical adverse effects (PAEs), including paradoxical psoriasis (PP). Although the underlying mechanism remains somewhat unclear, some theories suggest that genetic factors, particularly certain single-nucleotide polymorphisms (SNPs), may play an important role. The present review aimed to research and analyze recent findings regarding the pathomechanisms involved in the appearance of PP and the association between various genetic factors and PP in individuals treated with TNFi. We performed a literature search and found that certain genes (IL23R , TNF , FBXL19 , CTLA4 , SLC12A8 , TAP1 ) are strongly associated with the occurrence of PP in pediatric and adult patients during therapy with TNFi. The identification of the specific SNPs involved in the appearance of PP and other PAEs in patients treated with TNFi for various diseases and in different populations may later favor the recognition of those patients at a high risk of developing such adverse effects and could guide personalized therapeutic strategies in future years.

Background: Hepatitis B, a vaccine-preventable liver infection, remains a global public health problem. Dedicated groups of experts and funding are focusing on achieving a functional cure to eradicate this disease by 2030., Areas of Uncertainty: With more than 40 molecules available or under investigation as new treatments for hepatitis B virus (HBV) infection, none of them is curative so far. Available treatments are effective in suppressing HBV replication and in decreasing the risk of developing cirrhosis, liver failure, hepatocellular carcinoma, and death, but do not eliminate the virus, and the risk of hepatocellular carcinoma remains. Nucleoside/nucleotide analogs are recommended as first-line therapy for patients with chronic hepatitis B infection to inhibit viral replication and lower the HBV DNA values, but long-term therapy is usually needed to maintain suppression. Cessation of the therapy in accordance with clinical guidelines can result in virological and clinical relapse., Data Sources: PubMed, Web of Science, clinicaltrials.gov , and gray literature sources were searched for articles discussing HBV management and new therapies., Results: With current nucleoside/nucleotide analog therapies, fewer than 5% of patients lose hepatitis B surface antigen after 12 months, which underscores the need for new drugs that can achieve a functional cure. New therapies are being developed, including small interfering RNAs. Bepirovirsen, a modified antisense oligonucleotide, shows promising results and a good safety profile, but requires further exploration in larger number of patients to determine whether a functional cure is possible., Conclusions: Eradication of HBV infection with currently available therapies is not yet possible. Experts are developing innovative treatments, such as bepirovirsen, to achieve functional cure for this disease and to reduce morbidity and mortality associated with hepatic cirrhosis and hepatocellular carcinoma., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Having increased popularity during the Covid-19 pandemic, vitamin D3 is currently impressing thanks to the numerous researches aimed at its interactions with the body's homeostasis. At the same time, there is a peak in terms of recommendations for supplementation with it. Some of the studies focus on the link between autoimmune diseases and nutritional deficiencies, especially vitamin D3. Since the specialized literature aimed at children (patients between 0-18 years old) is far from equal to the informational diversity of the adult-centered branch, this review aims to bring up to date the relationship between the microbial and nutritional balance and the activity of pediatric systemic lupus erythematosus (pSLE). The desired practical purpose resides in a better understanding and an adequate, individualized management of the affected persons to reduce morbidity. The center of the summary is to establish the impact of hypovitaminosis D in the development and evolution of pediatric lupus erythematosus. We will address aspects related to the two entities of the impact played by vitamin D3 in the pathophysiological cascade of lupus, but also the risk of toxicity and its effects when the deficiency is over supplemented (hypervitaminosis D). We will debate the relationship of hypovitaminosis D with the modulation of immune function, the potentiation of inflammatory processes, the increase of oxidative stress, the perfusion of cognitive brain areas, the seasonal incidence of SLE and its severity. Finally, we review current knowledge, post-pandemic, regarding the hypovitaminosis D - pSLE relationship., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer COM declared a shared affiliation with the author RB to the handling editor at time of review., (Copyright © 2024 Lupu, Lupu, Jechel, Starcea, Stoleriu, Ioniuc, Azoicai, Danielescu, Knieling, Borka-Balas, Salaru, Revenco and Fotea.)

Being defined as an autoimmune, chronic pathology, frequently encountered in any age group, but especially in pediatrics, celiac disease (also called gluten enteropathy), is gaining more and more ground in terms of diagnosis, but also interest in research. The data from the literature of the last decades attest the chameleonic way of its presentation, there may be both classic onset symptoms and atypical symptoms. Given the impact played by celiac disease, especially in the optimal growth and development of children, the current narrative review aims to highlight the atypical presentation methods, intended to guide the clinician towards the inclusion of the pathology in the differential diagnosis scheme. To these we add the summary presentation of the general data and therapeutic lines regarding the underlying condition and the existing comorbidities. In order to place the related information up to date, we performed a literature review of the recent articles published in international databases. We bring forward the current theories and approaches regarding both classic celiac disease and its atypical manifestations. Among these we note mainly constitutional, skin or mucous, bone, neuro-psychic, renal, reproductive injuries, but also disorders of biological constants and association with multiple autoimmunities. Knowing and correlating them with celiac disease is the key to optimal management of patients, thus reducing the subsequent burden of the disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lupu, Sasaran, Jechel, Starcea, Ioniuc, Mocanu, Rosu, Munteanu, Nedelcu, Danielescu, Salaru, Knieling and Lupu.)

Background: The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients., Materials and Methods: We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery., Results: Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges., Conclusions: ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.

Eales disease manifests as an obliterative periphlebitis affecting the retina; it originates from the periphery and progresses posteriorly. It is characterized by retinal vessel wall inflammation, ischemia, and retinal neovascularization. In this report, we present the case of a 34-year-old male who attended our clinic with a sudden blurring of vision in his right eye. A diagnosis of bilateral retinal vasculitis with vitreal hemorrhage was ascertained in his RE. A dilated ocular fundus examination revealed perivenous sheathing of the peripheral vessels in both eyes. Fluorescein angiography indicated dye staining, vessel obliteration, capillary drop-out, areas of non-perfusion and the formation of new vessels. Laboratory tests revealed positive results for Borrelia; a PPD skin test and QuantiFERON TB assay were also positive. The patient underwent bilateral retinal laser pan-photocoagulation, followed by systemic treatment with oral steroids, cephazoline, isoniazid, azathioprine, and entecavir. The steroid dose was progressively reduced over 10 months; the treatment with azathioprine continues, as we are monitoring the patient over the long term. After 3 months, the vasculitis had regressed without any vitreal hemorrhage recurrence. Vision acuity improved from 0.4 to 1 in the patient's right eye. A multidisciplinary approach, which included collaborative management with gastroenterology, infectious disease, pulmonology, and rheumatology specialists, was essential for the diagnosis, treatment, and long-term follow up of the patient.

Leber's hereditary optic neuropathy (LHON) is the most common maternally inherited disease linked to mitochondrial DNA (mtDNA). The patients present with subacute asymmetric bilateral vision loss. Approximately 95% of the LHON cases are caused by m.3460G>A ( MTND1 ), m.11778G>A ( MTND4 ), and m.14484T>C ( MTND6 ) mutations. The hallmark of hereditary optic neuropathies determined by mitochondrial dysfunction is the vulnerability and degeneration of retinal ganglion cells (RGC). We present the case of a 28-year-old man who came to our clinic complaining of a subacute decrease in visual acuity of his left eye. From his medical history, we found out that one month before he had the same symptoms in the right eye. From the family history, we noted that an uncle has had vision problems since childhood. We carried out complete blood tests, including specific antibodies for autoimmune and infectious diseases. Laboratory tests and MRI were within normal limits. A blood test of the mtDNA showed the presence of 11778 G>A mutation on the mtND6 gene. The medical history, the fundus appearance, the OCT, and the paraclinical investigations, made us diagnose our patient with Leber's hereditary optic neuropathy. As soon as possible, we began the treatment with systemic idebenone, 900 mg/day. We examined the patient 2, 6, and 10 weeks after initiating the treatment. Abbreviations: LHON = Leber's Hereditary Optic Neuropathy, mtDNA = mitochondrial DNA, VA = visual acuity, RE = right eye, LE = left eye, OCT = Optical coherence tomography, pRNFL = peripapillary retinal nerve fiber layer, GCL = retinal ganglion cells layer, MRI = magnetic resonance imaging, VEP = visual evoked potentials, VEP IT = VEP implicit time, VEP A = VEP amplitude., (#x00A9; The Authors.Romanian Society of Ophthalmology.)

The study of retinal vessels in relation to cardiovascular risk has a long history. The advent of a dedicated tool based on digital imaging, i.e., the retinal vessel analyzer, and also other software such as Integrative Vessel Analysis (IVAN), Singapore I Vessel Assessment (SIVA), and Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE), has led to the accumulation of a formidable body of evidence regarding the prognostic value of retinal vessel analysis (RVA) for cardiovascular and cerebrovascular disease (including arterial hypertension in children). There is also the potential to monitor the response of retinal vessels to therapies such as physical activity or bariatric surgery. The dynamic vessel analyzer (DVA) remains a unique way of studying neurovascular coupling, helping to understand the pathogenesis of cerebrovascular and neurodegenerative conditions and also being complementary to techniques that measure macrovascular dysfunction. Beyond cardiovascular disease, retinal vessel analysis has shown associations with and prognostic value for neurological conditions, inflammation, kidney function, and respiratory disease. Artificial intelligence (AI) (represented by algorithms such as QUantitative Analysis of Retinal vessel Topology and siZe (QUARTZ), SIVA-DLS (SIVA-deep learning system), and many others) seems efficient in extracting information from fundus photographs, providing prognoses of various general conditions with unprecedented predictive value. The future challenges will be integrating RVA and other qualitative and quantitative risk factors in a unique, comprehensive prediction tool, certainly powered by AI, while building the much-needed acceptance for such an approach inside the medical community and reducing the "black box" effect, possibly by means of saliency maps.

Background: Diabetic retinopathy (DR) is a neurodegenerative disease of the retina. The aim of our study was to analyze latency changes in a full-field electroretinogram (ERG) in patients with type 2 diabetes., Material: This prospective study included 15 diabetic patients without DR, 16 diabetic patients with non-proliferative DR, 14 patients with pre-proliferative DR, 15 patients with proliferative DR, and 14 age-matched controls. All the participants underwent ophthalmologic examination and full-field ERGs. The ERGs were recorded with the Metrovision MonPackOne system. The latencies were analyzed for "a"- and "b"-waves in the dark-adapted (DA) 0.01 ERG, DA 3.0 ERG, DA oscillatory potentials, light-adapted (LA) 3.0 ERG, and 30 Hz flicker ERG., Results: The delayed responses of healthy subjects compared to diabetic patients without DR were the DA oscillatory potentials (25.45 ± 1.04 ms vs. 26.15 ± 0.96 ms, p = 0.027). When comparing diabetic patients without DR and with non-proliferative DR, we did not obtain statistically significant delays. Significant delays in the DA 0.01 "b"-wave (61.91 ± 5.52 ms vs. 66.36 ± 8.12 ms, p = 0.029), DA 3.0 "b"-wave (41.01 ± 2.50 ms vs. 44.16 ± 3.78 ms, p = 0.035), and LA 3.0 "a"-wave (16.21 ± 0.91 ms vs. 16.99 ± 1.16 ms, p = 0.045) were found between non-proliferative DR and pre-proliferative DR. When comparing the groups of patients with pre-proliferative DR and proliferative DR, the LA 3.0 ERG "b"-wave (32. 63 ± 2.53 ms vs. 36.19 ± 3.21 ms, p < 0.0001), LA 30 Hz flicker ERG "a"-wave (19.56 ± 3.59 vs. 21.75 ± 4.74 ms, p = 0.025), and "b"-wave (32.23 ± 4.02 vs. 36.68 ± 3.48 ms, p = 0.017) were delayed., Conclusions: the electrophysiological findings from our study indicate that there is a substantial dysfunction of the neural retina in all stages of DR.

The prevalence of multiple sclerosis (MS) has been increasing among young people in developing countries over the last years. With the continuous development of new technology, the diagnosis and follow-up of these patients has received new parameters that physicians may use in their practice. This paper reviews the main biomarkers identified through Optical Coherence Tomography Angiography (OCT-A) involved in the development and progression of MS and investigates the role it may have in detecting changes to the central nervous system (CNS).

Diabetic macular edema (DME) is one of the main ocular complications of diabetes mellitus (DM) that can lead to important vision loss in diabetic patients. In clinical practice, there are cases of DME with unsatisfying treatment responses, despite adequate therapeutic management. Diabetic macular ischemia (DMI) is one of the causes suggested to be associated with the persistence of fluid accumulation. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality, able to give in-depth information about retinal vascularization in a 3-dimensional manner. The OCTA devices currently available can provide various OCTA metrics that quantitatively assess the retinal microvasculature. In this paper, we reviewed the results of multiple studies that investigated the changes in OCTA metrics in the setting of DME and their possible contribution to the diagnosis, therapeutic management, follow-up and prognosis of patients with DME. We analyzed and compared relevant studies that investigated OCTA parameters related to changes in macular perfusion in the setting of DME and we evaluated the correlations between DME and several quantitative parameters, such as vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ)-related parameters, as well as complexity indices of retinal vasculature. The results of our research showed that OCTA metrics, evaluated especially at the level of the deep vascular plexus (DVP), are useful instruments that can contribute to the assessment of patients with DME.

Background and Objectives : There are few data in the literature concerning the learning curve of tractional retinal detachment (TRD) surgery. We have analyzed the experience gained by a vitreoretinal surgeon over 10 years. Materials and Methods : A retrospective, comparative study of 34 TRD cases operated using 20G instruments between 2008 and 2011 (group A) and 94 cases operated using 23G instruments between 2015 and 2019 (group B). The preoperative characteristics, the type of endotamponade, and the anatomical and functional success were reviewed. Results : The group A patients had a significantly higher rate of concomitant vitreous hemorrhage (VH) at presentation (64.7% vs. 37.2%) and of non-macular retinal detachments (52.9% vs. 39.3%). The rate of silicone oil endotamponade was high in both groups (76.4% vs. 68.1%), but in group B 25.5% were left without a tamponade (vs. none in group A). A postoperative anatomical success was obtained in 76.5% of eyes in group A and 84.04% of eyes in group B (where it was improved to 89.3% by reinterventions). The presenting visual acuity (VA) was very low in both groups (0.01 and 0.05, respectively). The proportion of eyes with improved or stabilized VA was 85.3% in group A and 79.8% in group B (statistically non-significant difference). Conclusions : The anatomical success rate improves quite slowly with increasing surgeon experience and can be further improved by reinterventions. Visual improvement does not match the rate of anatomical improvement. With increasing experience and self-confidence, the surgeon will approach more difficult cases, a fact that may slow down the increase in surgical success rates.

In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism found in most cases of endogenous FE. However, we must keep in mind that prevalence of fungal species varies with the geographical area. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. The most important shortcoming of PCR-the limited number of pathogens that can be simultaneously searched for-may be overcome by newer techniques, such as next-generation sequencing. There are even hopes of searching for genetic sequences that codify resistance to antifungals. We must not forget the potential of simpler tests (such as galactomannan and β-d-glucan) in orienting towards a diagnosis of FE. There are few reports about the use of newer antifungals in FE. Echinocandins have low penetration in the vitreous cavity, and may be of use in cases of fungal chorioretinitis (without vitritis), or injected intravitreally as an off-label, salvage therapy.

Currently, surgical techniques, such as internal limiting membrane peeling, are used widely for macular holes, macular puckers, epiretinal membranes, diabetic macular edema, retinal detachment, retinal vein occlusions, vitreomacular traction, optic pit maculopathy, and Terson syndrome. This study aimed to highlight any differences regarding visual acuity and ocular tomography coherence changes after staining the internal limiting membrane with dilutions of Brilliant Blue G vs. lutein/zeaxanthin-based dyes. This study involved 30 eyes of 30 patients who had undergone posterior pole vitrectomy for idiopathic stage 4 macular hole. The study lot was divided in two subgroups, 15 eyes colored with Brilliant Blue and the other 15 eyes colored with lutein and zeaxanthin dyes. The association between visual prognosis, ocular tomography coherence changes and intraocular pressure was analyzed. The surgical treatment with required endoillumination levels and a 2-min period of dye using the Alcon Constellation Vision System had no negative impact on cell viability and improved visual acuity by 30%. Staining makes it easier to remove, to be quick and precise while performing macular surgeries. In has been observed that lutein and zeaxanthin dyes offer an intraoperative protective screen that protects photoreceptors more than Brilliant Blue while performing pars plana vitrectomy. Both study groups had good results in time. Surgical visualization is an evolving technology., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Popescu et al.)

The present study evaluated the efficacy, the safety and the predictability of the Femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) procedure for hyperopia and hyperopic astigmatism. We retrospectively analyzed the postoperative 12-month evolution of 593 eyes with hyperopia and hyperopic astigmatism that underwent Femto-LASIK treatment. The procedure was predictable and effective. No eye lost 2 lines of corrected distance visual acuity (CDVA), demonstrating a safety profile of the procedure. Nine percent of the eyes gained at least one line of CDVA. The accuracy of the spherical equivalent after 12 months was 74% within ±1.0 diopter (D) of emmetropia. The refractive outcomes were stable during the follow-up period. There were no significant complications during the procedure. Femto-LASIK using the VisuMax ® -MEL ® 80 platform was demonstrated to be a suitable option to correct selected cases of hyperopia and hyperopic astigmatism. A longer follow-up period is required to better assess the refractive results and to detect any further regression., (Copyright: © Tăbăcaru et al.)

This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus ; the most frequent Gram-negative organism is Pseudomonas , and yeasts, probably Candida , usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Ciprian Danielescu et al.)

Accuracy of intraocular lens (IOL) calculation formulas SRK/T, Hoffer Q, Holladay 1, Haigis and Barrett Universal II were compared in prediction of postoperative refraction for multifocal and implants using a single optical biometry device. The authors included 88 refractive lens exchange and cataract surgeries, with AcrySof IQ PanOptix implant (Alcon Laboratories, Inc.). All eyes were divided into three groups based on axial length (AL), group 1: <22 mm (14 eyes), group 2: 22-24.5 mm (68 eyes) and group 3: >24.5 mm (6 eyes). The refractive prediction error (RPE) and mean absolute error (MAE) were calculated for 5 different formulas: SRK/T, Hoffer Q, Holladay 1, Haigis and Barrett Universal II. For eyes with the AL between 22 mm and 24.5 mm the greatest percentage of eyes with RPEs within ±0.25 D was 32.4% for Haigis formula, followed by Barrett Universal II, Hoffer Q and Holladay 1 with 29.4%. The percentage of eyes with RPEs within ±0.50 D was 100% only for Barrett Universal II and Holladay 1, 94.1% for SRK/T and 91.2% for Haigis and Hoffer Q. The first and third group with AL <22 and >24.5 mm were too small to have statistical significance due to the reluctancy to use multifocal IOLs on extreme ALs. ANOVA test showed no statistical difference (P=0.166) between the RPEs measured for each formula in this cohort. This study showed no statistical difference between formulas for this trifocal lens implant. There was a tendency for the RPE to be within ±0.25 D for most of the eyes with the Haigis formula, and within ±0.50 D for all the eyes with the Barrett Universal II formula in the group with the AL between 22 and 24.5 mm., (Copyright: © Mălăescu et al.)

This literature review aims to provide the retina specialist with answers to patient's questions related to the management of lamellar macular holes (LMHs). Most LMHs are stable over time, but 13-21% present an anatomic decline after 18-24 months of follow-up. Nineteen point five percent of the eyes may experience a visual acuity (VA) loss of more than 5 letters after 3 years. Many surgeons choose to perform surgery when there is significant metamorphopsia or documented decline in VA over time. The typical surgery is phacovitrectomy with the epiretinal membrane and the internal limiting membrane peeling in previously phakic eyes (41.9 to 85.3% of the eyes). In the eyes that remained phakic, cataract surgery was often necessary within the first year of follow-up (19.2 to 40% of eyes). After surgery, a VA gain was recorded in 63-94% of eyes, but some eyes (between 0 and 20%) suffered some VA loss. Progression to full-thickness macular hole may occur after surgery, and thus a second surgical intervention may be needed., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Ciprian Danielescu et al.)

Keratoconus (KC) is a controversial ophthalmological disease, often considered both multifactorial and multigenic with poor or not entirely understood etiopathogenesis. Corneal collagen crosslinking (CXL) procedure is the most common surgical therapy for KC which both slows corneal thinning and halts disease progression. While extensive studies provide consistent evidence on systemic oxidative stress in KC patients and animal models, little is known on the tear fluid oxidative stress markers such as antioxidant enzymes activity or lipid peroxidation markers. Also, little is known considering the oxidative status dynamics following CXL. In this way, we aimed to evaluate three oxidative stress markers in the tears of KC patients before and after CXL procedure. Total superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymatic activity and malondiladehyde (MDA) levels were assessed from the tears of 20 kC patients who received the recommendation for CXL procedure. Significantly decreased SOD activity (p = 0.0014) was observed in KC patients tears, as compared to age and sex-matched controls which could lead to significant lipid peroxidation boost (p < 0.001). Significantly higher GPx enzyme activity was observed in KC patients, as compared to control (p < 0.001), suggesting a compensatory response to intense lipid peroxidation. Following CXL, SOD activity significantly decreases and GPx activity extensively increases, as compared to baseline KC levels and controls (p < 0.001). This work provides additional evidence on oxidative stress status in the tears of KC considering general oxidative stress markers dynamics both before and after the CXL procedure. We also demonstrated that the CXL procedure could have further relevance in the management of this disorder., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The purpose of this retrospective study was to report the results of iontophoretic corneal collagen crosslinking (I-CXL) with riboflavin and ultraviolet A irradiation in patients affected by keratoconus, each with thinnest pachymetry values of <400 μ (with epithelium) and not treatable using standard epithelium-off technique.Fifteen eyes of 15 patients affected by progressive keratoconus and with thinnest pachymetry values <400 μ underwent I-CXL. The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, maximum and minimum keratometry (K max and K min) readings, corneal thickness at the thinnest point (CTTP), endothelial cell density (ECD), and intraocular pressure (IOP) were assessed before I-CXL, at 1, 3, 6, and 12 months postoperatively.The mean UDVA and CDVA significantly increased 12 months after I-CXL (P = .002 for both comparisons). The K max readings significantly decreased at 6 and 12 months postoperatively (P = .04 and P = .02, respectively). The mean CTTP improved at the end of the follow-up (P = .008). ECD was unchanged. No side effects or damage to the limbal region was observed during the follow-up period.I-CXL has been proved to be effective in halting keratoconus progression in eyes with very thin corneas, with no side effects during the follow-up period. This procedure could be used in patients with more advanced keratoconus., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To compare 3-year iontophoretic corneal collagen cross-linking (I-CXL) outcomes with epithelium-off corneal collagen cross-linking (epi-off CXL) for early stage of progressive keratoconus., Methods: Eighty eyes of 80 patients with early progressive keratoconus treated by I-CXL (n = 40) or epi-off CXL (n = 40) were included in this study. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, corneal topography and pachymetry were assessed at baseline and at 1, 3, 6, 12, 24 and 36 months of follow-up., Results: Visual acuity (VA) showed a significant improvement (p < 0.05) at the end of follow-up in both groups. In the I-CXL group, the UDVA showed a rapid recovery after 3 months (p = 0.04). There was a statistically significant different trend in CDVA between groups with a more favourable outcome for the standard CXL group (p < 0.01). The cylinder improved beginning with 3 months after CXL in both groups. Maximum keratometry showed a significant reduction by 0.9 dioptres (D) in the I-CXL group and by 1.2 D in the epi-off CXL group after 36 months (p = 0.283). Pachymetry values decreased at 3 months while a statistically significant increase occurred in both groups at 24 months. Progression occurred to one patient (2.5%) in I-CXL group. Adverse effects occurred to eight eyes (20%) in the epi-off CXL group., Conclusion: Iontophoretic corneal collagen cross-linking (I-CXL) is non-inferior to epi-off CXL for stopping the progression of keratoconus in its early stages with a higher degree of safety for the patients and a faster recovery of VA., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Introduction: The purpose of this study was to evaluate the efficacy and safety of iontophoretic collagen cross-linking (I-CXL) compared to epithelium-off standard collagen cross-linking (CXL) in treating the early stages of progressive keratoconus., Methods: This retrospective cohort study at Oftaprof Clinic, Iasi, Romania included 40 eyes of 40 patients with progressive keratoconus stage I according to the Amsler classification who underwent I-CXL and the results were compared with a matched group of 40 eyes from 40 patients who received standard CXL. The follow-up period was 24 months. Uncorrected (UCVA) and corrected (CDVA) distance visual acuities, corneal topography, and pachymetry were evaluated in all patients., Results: The mean patient age was 26.52 ± 3.77 years for the standard CXL group and 28.32 ± 4.91 for the I-CXL group. The mean UCVA and CDVA improved significantly in both groups. At 12 months, the improvement of UCVA was greater in the I-CXL group (P < 0.05). There was a statistically significant different trend in CDVA between groups with a more favorable outcome for the standard CXL group (P < 0.01). The manifest cylinder decreased by a mean of 0.962 ± 0.114 D in the epithelium-off CXL group and by 0.831 ± 0.082 D in the I-CXL group (P < 0.001). At 24 months, the K max values improved by 1.2 ± 0.199 D in the standard group and by 0.908 ± 0.177 D in the I-CXL group (P < 0.001)., Conclusion: All parameters either improved or remained unchanged after the iontophoretic collagen cross-linking intervention. I-CXL was found to be as effective as the standard technique.

Fungal endophthalmitis is a rare condition often associated with poor prognosis. We present a case of postoperative acute fungal endophthalmitis caused by the yeast-like fungus Stephanoascus ciferrii (Candida ciferrii). The fungus was resistant to fluconazole, voriconazole, and amphotericin B but susceptible to caspofungin. Because the degree of vitreal penetration of caspofungin after its intravenous administration is unclear, we performed multiple intravitreal injections, first with 50 µg/0.1 ml and then with 250 µg/0.1 ml caspofungin. Despite the recurrence of symptoms, intravitreal injection of caspofungin finally abolished the inflammation and achieved ambulatory vision that persisted until 1 year of follow-up. To our knowledge, this is the first report of S. ciferrii endophthalmitis and its successful treatment with intravitreal caspofungin.

We present the case of a patient who was diagnosed by chance with macular hypopyon during a conventional interdisciplinary examination. The clinical context and the association of a systemic disease, such as uncontrolled type 1 diabetes, rendered further investigations in this patient. Due to his immunocompromised status, etiology such as ocular fungi, lymphomas, tuberculosis was taken into account. Thorough complex investigations oriented the diagnosis towards ocular tuberculosis involvement.

We report the case of a 53-year-old female patient who developed bilateral sudden visual acuity loss after 15 weeks from the initiation of Peg-Interferon and Ribavirin treatment for hepatitis C. Debut was simultaneous and asymmetric, reported in the morning, at awakening. No pain or other symptom was reported by the patient. Results. At presentation, visual acuity was 0.2 in RE and 3/ 50 in LE. Pupillary reflexes were sluggish and severe dyschromatopsia was documented in both eyes (Ishihara plates). Fundus examination revealed bilateral pale optic disc edema, more prominent in LE, with splinter hemorrhages in the RNFL around the optic disk. Visual field exam demonstrated severe defects in 3 quadrants of the RE, whereas in the LE, it was impossible to perform the investigation due to VA<0.1. Neurologic evaluation was normal; other possible causes of systemic vasculitis were excluded by negative lab tests. Acute inflammatory markers (fibrinogen and ESR) and mild pancytopenia were the only documented laboratory changes in this patient. Anamnesis cleared the traditional risk factors for conventional AION (hypertension, diabetes, ischemic heart disease, and hypercholesterolemia). Cranial and orbital CT scan and MRI findings were normal. Patient was withdrawn from the Interferon and Ribavirin treatment and was administered methyl prednisolone pulse therapy (1g/ day) for 3 days, continued with oral Prednisone (60 mg/ day) tapered slowly for over 12 weeks. VA increased to 0.8 during treatment in the RE, but visual recovery in the LE was not as spectacular (0.16) as in the fellow eye. Modified latencies and amplitudes in evoked visual potentials examination during 4 months time emphasized bilateral optic atrophy. Optic nerve sufferance was amplified by a low level of vitamin B12, detected by chance at the last eye visit. Due to the general condition, dietary supplementation was not possible. Conclusion. A case of a patient with bilateral and simultaneous NAION caused by IFN and Ribavirin treatment for hepatitis C, who was also vitamin B12 deficient, was analyzed. Therefore, a combined etiology for optic atrophy was explained.

Aim: To present the anatomical and functional outcomes of surgery in cases of rhegmatogenous retinal detachment complicated (at presentation) by proliferative vitreoretinopathy (PVR)., Material and Methods: Retrospective study of the cases operated upon by a single surgeon between October 2012 and September 2014., Results: A total of 49 eyes of 49 patients had PVR at presentation (12 cases with PVR stage B, 21 with stage C and 16 with stage D). 82% had a VA < or = 0.05 at presentation. Peripheral retinectomy was the primary surgery in 57% of cases. Reinterventions was required in 16.3% of the cases (silicon oil extraction was not considered reintervention). Although at the first postoperative examination 32% of eyes had an IOP > 21 mmHg without medication, only 8% retained a high lOP at the last visit. At the last visit 73.4% of eyes presented attached retina (an additional 6% had an attached macula under silicone oil, but sub retinal fluid in the inferior quadrants). A final VA > or = 0.05 was recorded in 67.3% of eyes (of which half had VA > or = 0.1) CONCLUSIONS: In cases presenting with retinal detachment complicated by PVR the possibility of reinterventions and the risk of intraocular hypertension should be considered. Unfortunately, even some cases with favorable anatomical outcome will not present ambulatory vision. Keywords:

Unlabelled: Proliferative vitreoretinopathy (PVR) is one of the most frequent causes of failure of rhegmatogenous retinal detachment (RRD) surgery., Aim: To measure the vitreous levels of granulocyte colony stimulating factor (G-CSF) and monocyte chemoattractant protein 1 (MCP-1) in eyes with RRD and in a control group., Material and Methods: A prospective study of 40 patients operated for RRD (study group) and 20 patients with epiretinal membrane or macular holes (selected as control group since they needed vitrectomy but had attached retinas). Vitreous samples were collected during vitrectomy and were assessed for the presence of cytokines using a fluorescent bead-based multiplex assay., Results: The concentration of G-CSF (8.59 pg/ml) and MCP-1 (1615.2 pg/ml) were significantly increased in the study group, when compared to the control group (0 and 469.13 pg/ml, respectively). MCP-1 was also significantly increased in the subgroup of patients with PVR compared to the patients with uncomplicated RRD., Conclusions: The levels of these biomarkers support the idea that proliferative vitreoretinopathy has an inflammatory component.

Purpose: To identify threshold values above which the intersession reduction of the retinal nerve fibers layer (RNFL) can be considered significant., Method: In 79 eyes (41 patients) we have performed RNFL measurements with the Stratus OCT twice in the same session. The differences between these measurements were used to calculate the test-retest variability (on clock hours, quadrants and the average RNFL thickness) using the formula: Test-retest variability = 1.96 x standard deviation (95% confidence) The resulted "threshold values" were used to identify the possible progression in a study group of 119 eyes (61 patients), followed for an average of 2 years., Results: RNFL reduction exceeding the "threshold values" in 2 consecutive sessions was noticed in 18 eyes (15.12%). 12 eyes (10.08%) have fulfilled this criterion on 2 or more clock hours. 3 patients have had the criterion present on both eyes., Conclusions: This appears to be a plausible method for identifying the progression of structural damage in glaucoma, deserving further researches for validation.

Objectives: evaluation of the treatment with bevacizumab for advanced exudative AMD., Material and Method: prospective study on 163 patients (December 2006-February 2009). All patients received a series of 3 intravitreal injections with bevacizumab (1.25 mg/0.05 ml) at 6 weeks intervals followed by surveillance and continuation or restart of therapy based on clinical criteria and central macular thickness (CMT). The series was subdivided in three groups based on initial VA (VA < or = 0, 1; VA = 0, 1-0, 3; VA > or = 0,3)., Results: Final VA increased or remained constant in 88% of patients. VA increased in all three groups: from 0.029 to 0.069 in the first group; from 0.152 to 0.245 in the second group; and from 0.409 to 0.612 in the third group. In all three groups the increase in VA achieved statistical significance (p < 0.001). The whole series manifested an anatomical improvement (final mean CMT of 243.3 microm, as compared to initial mean CMT of 345.3 microm)., Conclusion: intravitreal treatment with bevacizumab is efficient but should be followed by aggressive follow-up and rapid resume of the treatment if recurrence is diagnosed.

This is a case report concerning a patient that was subject to non-penetrating deep sclerectomy (with intraoperative Mytomicin C) for the management of advanced open angle glaucoma in the only functional eye. The surgery was uneventful, the visual acuity was preserved and the intraocular pressure was reduced. After 2 months the patient presented with symptoms of postoperative bleb-related endophthalmitis. The treatment of this condition (including pars plana vitrectomy) did not succeed in preventing a severe retinal necrosis that resulted in the loss of visual acuity This is, to our knowledge, the first published case of endophthalmitis after non-penetrating deep sclerectomy.

Purpose: To assess the effect of panretinal photocoagulation (with or without focal macular photocoagulation) on central retinal thickness measured by OCT METHOD: Prospective, interventional, non-comparative case series. Panretinal photocoagulation (PRP) was performed in 3 sessions in 28 eyes with proliferative diabetic retinopathy In 9 eyes who had also initial macular edema we have associated focal macular laser treament concomitant with the first PRP session. Macular thickness was assessed by optical coherence tomography at baseline and after 4 and 10 weeks., Results: Baseline mean central retinal thickness was 252 +/- 95 microm. It was modified to 260 +/- 105 microm at 4 weeks, then to 232 +/- 49 microm at 10 weeks. There was no statistical significance of these variations. In 2 eyes (7, 14%) we have noticed an increase of more than 100 microm in central retinal thickness. In the subgroup of 9 eyes with associated initial macular edema, combined PRP-focal treatment resulted in the decrease of central retinal thickness from 306 +/- 123 microm to 236 +/- 49 microm at 10 weeks., Conclusions: Panretinal photocoagulation can be associated with a significant increase of central retinal thickness in a small percentage of eyes. The PRP-focal macular laser combination is effective in eyes who present with proliferative diabetic retinopathy and macular edema.

Purpose: To analyze the course of the disease and the management of patients with pseudoexfoliative glaucoma in our clinic, a tertiary center for glaucoma., Method: Retrospective chart review of patients admitted in the last 8 years (2000-2007)., Results: We have collected data concerning 330 eyes (238 patients). The mean follow-up period was 13.85 +/- 11.03 months (limits 0.5-91 months). The mean visual acuity was 0.31 +/- 0.33 and did not alter significantly. The mean initial IOP was 27.25 +/- 13.64 mmHg (50% of eyes were already under treatment, receiving an average of 1.66 +/- 0.72 drugs). During the follow-up period 66.66% of eyes were subject to antiglaucoma surgery. The mean interval from diagnosis to surgery was 10.24 +/- 23.34 months. The final IOP was significantly decreased to 17.02 +/- 7.77 mmHg (68.96% of eyes were receiving topical antiglaucoma therapy, the mean number of drugs being 1.57 +/- 0.71). The C/D ratio increased from 0.76 +/- 0.26 to 0.81 +/- 0.24 (p = 0.01). In automated perimetry the mean deviation increased from 17.13 +/- 11.68 to 17.51 +/- 10.83 (the increase was not significant, p = 0.87). The pattern standard deviation increased from 5.92 +/- 3.83 to 6.16 +/- 3.19 (p = 0.63). A number of 75 patients (31.51%) had cardiovascular diseases, most frequently arterial hypertension (27.31%) and myocardial ischemia (9.66%)., Conclusions: A large proportion of our pseudoexfoliative glaucoma patients needed antiglaucoma surgery. Even after surgery, about 2/3 of eyes were still under topical therapy. Under this management, we have noted a progression of the C/D ratio, but not of the visual field parameters during the follow-up period.

Purpose: To study the short-term variability of retinal nerve fiber layer (RNFL) and optic disc measurements using Stratus OCT., Method: Transversal comparative study with repeated measurements. For each eye, the Fast Optic Disc and Fast RNFL protocols were repeated twice in the same session. The resulted measurements were compared using correlation and variation coefficients., Results: 62 eyes (34 patients) were included in the study. For every analyzed parameter there was a highly significant correlation between the first and the second measurement (p < 0.001). For the C/D ratio (vertical, horizontal and area) the correlation coefficients varied from 0.939 to 0.961 (coefficients of variation 6.43 to 8.75%). Concerning the RNFL parameters, the correlation coefficients took values between 0.818 (for the nasal quadrant) and 0.964 (for the Average Thickness). The variation coefficients were between 4.24 and 15.14%., Conclusions: We have found an excellent reproducibility of C/D measurements (vertical, horizontal and area)--less studied in the OCT-related literature. From the RNFL parameters, the best reproducibility was found for the superior and inferior quadrant, and especially for the average thickness.

Purpose: To establish correlations between structural and functional parameters in glaucoma suspects., Method: In 43 patients (83 eyes) of glaucoma patients we have performed standard automated perimetry, scanning laser polarimetry (GDx-VCC) of the retinal nerve fiber layer (RNFL) and optical coherence tomography (Stratus OCT) of the RNFL and optic disc., Results: Diagnostic concordance (achieved if one eye is deemed normal--respectively abnormal--by both tests) was 60.24% between perimetry and OCT respectively 61.44% between perimetry and GDx. The Areas under the Receiver Operating Characteristic curve were between 0.524-0.574 for OCT parameters and 0.518-0.548 for GDx parameters (considering the visual field examination as "gold standard"). The correlation between RNFL measurements in OCT and GDx took values between r = 0.481 and r = 0.352., Conclusions: Structural and functional damage are not consistent with each other in early glaucoma, resulting in the fact that both tests should be used in the diagnostic strategy

Purpose: To determine and compare 24-hour fluctuations of intraocular pressure (IOP) and systemic blood pressure (BP) in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG) versus non-glaucoma patients., Methods: Applanation IOP and BP were measured every 2 hours by one observer for 24 hours in 102 patients. The patients were classified: group 1 - 21 patients with OHT and POAG without treatment, group 2 - 40 patients with OHT and POAG with a satisfactory diurnal therapeutic control of IOP (daytime IOP ? 21 mmHg), group 3 - 13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP > 21 mmHg), and group 0-28 non-glaucoma patients (control group)., Results: In all glaucoma patients groups 24-hour IOP fluctuations were greater than in the control group (group 0 - 3.62 +/- 0.82 mmHg, ANOVA p < 0.001). Untreated OHT/POAG had 24-hour IOP fluctuations significantly greater than those with good therapeutic control (group 1 - 5.66 +/- 1.66 mmHg versus group 2 - 4.27 +/- 1.86 mmHg, p = 0.0001). POAG with uncontrolled IOP under maximal tolerated medication had the 24-hour IOP fluctuations significantly greater than the other groups (group 3 - 8.38 +/- 3.78 mmHg, p?0.0001). In these patients there was an evident nocturnal mean IOP peak between 0-2 am which temporally correlates with nocturnal systemic BP "dip". Nocturnal IOP peaks (between 11 pm-7 am) were found more frequently in treated glaucoma patients (45.28% - groups 2 and 3 versus 10.2% - groups 0 and 1, p < 0.0001)., Conclusions: Circadian lOP fluctuations in glaucoma patients, even with a satisfactory diurnal therapeutic control, are greater than in the age-matched control subjects. Patients with uncontrolled lOP under topical maximal tolerated medication had the greatest 24-hour lOP fluctuations. Nocturnal lOP peaks occur more often in medically treated patients and 24-hour monitoring of lOP may be useful in this patients.

Purpose: To study the concordance of nictemeral IOP variations between fellow eyes in patients with treated and untreated OHT/POAG versus non-glaucoma patients. Also, we evaluate the symmetry or asymmetry level of mean, peak and IOP fluctuations between fellow eyes in glaucoma patients compared with normal controls., Design: Cross-sectional study., Methods: Applanation IOP and blood pressure were measured every 2 hours by one observer for 24 hours in 124 patients. The patients were classified: group 1--36 non-glaucoma patients (control group), group 2--32 patients with OHT and POAG without treatment, group 3--43 patients with OHT and POAG with a satisfactory diurnal therapeutic control of IOP (daytime IOP>21 mmHg) and group 4--13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP>21 mmHg)., Results: The nictemeral curves of fellow eyes exhibited parallel profiles; according to the paired t-test there were no significant differences between fellow eyes throughout all measurement intervals. There is a high correlation of 24 h IOP between fellow eyes in all our study groups (r=0.8632, p<0.0001). There were no significant differences between fellow eyes in moment or value of peak IOP (paired t-test p=0.53). Comparing the mean absolute differences in IOP between fellow eyes throughout all 12 measurement points, the smallest differences between fellow eyes were found in groups 1 and 3 (0.85 mmHg, respectively 0.90 mmHg, p=0.47). The differences between fellow eyes were significantly greater in groups 2 and 4 (1.28 mmHg, respectively 2.6 mmHg, p<0.0001). The greatest probability of IOP differences to be in +/- 3 mmHg interval was found in normal patients (97.91%) and in patients with therapeutic control of IOP (97.26%). The greatest asymmetry of IOP was found in the group with therapeutically uncontrolled IOP (over 1/5 measurements were outside the +/- 3 mmHg interval)., Conclusions: The nictemeral variation of IOP in glaucoma patients were largely concordant between fellow eyes and the 24-hour IOP curves of fellow eyes exhibited parallel profiles. There were no significant differences between fellow eyes in mean, peak and IOP fluctuations. The asymmetry over +/- 3 mmHg between fellow eyes varied from 2.09% in normals to 20.53% in patients with therapeutically uncontrolled IOP.

Purpose: To compare the intraocular pressure values after small-incision cataract surgery using either Provisc or Viscoat, separately or in combination., Design: Prospective, randomized and masked clinical study., Participants: 147 eyes of 147 consecutive cataract patients., Methods: The patients were randomly assigned to receive either Provisc (P group), Viscoat (V group) or both (V+P group) and intraocular pressure was measured at 1, 2, 3, 6, 9 and 24 h after surgery., Results: There were no statistically significant differences in intraocular pressure between the P and V+P group at any point in time during the follow-up period (p>0.05); however, in the V group the intraocular pressure was higher than in the other 2 groups at 1 h (p=0.005 and p=0.006 respectively) and 2 h (p<0.001 and p<0.001 respectively). In the V group, intraocular pressure was also higher than the P group at 3 h (p<0.001). Over 50% of patients from the V group had intraocular pressure values of 30 mmHg and over after 2 h and 3 h from surgery. There were no statistically significant differences between the study groups concerning the intraocular pressure values measured at 6 h, 9 h and 24 h postoperatively (p>0.05)., Conclusions: Viscoat results more frequently in high intraocular pressure values during the initial 6 h after small-incision cataract surgery with frequent cases in which the intraocular pressure could increase over 30 mmHg; therefore, close follow-up of these patients is necessary.