Biomedical subjects

D Chiseliţă

Publications and source records attributed to D Chiseliţă.

18 recordsLinked to original sources

PubMed2005

[Learning effect in computerized perimetry].

PURPOSE: To highlight the learning effect in automated perimetry and to assess the value of the first visual field in glaucoma diagnosis. METHOD: A prospective study that included 48 patients (91 eyes)--glaucoma suspects--who performed 3 visual field tests in no more than 12 months. RESULTS: 32 eyes were diagnosed with intraocular hypertension and the others with POAG. An improvement (expression of the learning effect) was noted in 45.05% of eyes (in an average of 3.39 2,72 points) in the second visual field and in 37.36% of eyes (3.05 2.13 points) in the third visual field. Considering (as a hypothesis) the third visual field as gold standard, the first test had a sensitivity of 87.03% and a specificity of 89.18% in detecting visual field defects (efficiency 89,01%). The second test had a sensitivity of 92.59% and a specificity of 89.18% (efficiency 91.2%). CONCLUSIONS: The learning effect was present in the first three tests, but seems to have little influence on the diagnosis of visual field defects. A possible explanation is the presence to a large extent of important visual field loss (obvious from the first test) in the included patients.

Adolescent↗

PubMed2005

Comparative analysis of the efficacy and safety of latanoprost, travoprost and the fixed combination timolol-dorzolamide; a prospective, randomized, masked, cross-over design study.

PURPOSE: To analyse comparatively the efficacy and tolerance of latanoprost, travoprost and the fixed combination timolol-dorzolamide in the treatment of primary open angle glaucoma and ocular hypertension. METHOD: Prospective, investigator masked, randomized study that included 38 patients (38 eyes) with primary open angle glaucoma uncontrolled under beta blockers. Each patient received latanoprost, travoprost and the fixed combination timolol-dorzolamide (for 3 months each). The first drug and the order of the next drugs administered were randomized. The follow up period was 9 months. At the baseline and at the end of each therapeutic period (3 months) we determined the IOP (at 8, 10 a.m. and 4 p.m.), visual acuity, C/D ratio, blood pressure, heart rate and local tolerance. We have also photographed the eyelids, lashes, conjunctiva and iris. After each month of treatment we determined the IOP (at 8 and 10 am), visual acuity, blood pressure, heart rate and local tolerance. RESULTS: The mean initial IOP was 25.1 2.89 mmHg and after 9 months of treatment 21.67 4.59 mmHg. Each drug induced a statistically significant IOP decrease (the fixed combination timolol-dorzolamide decreased IOP with 14.33%, travoprost with 18.39% and latanoprost with 22.1%). The IOP lowering was comparable for the prostaglandin derivatives and superior to the fixed combination timolol-dorzolamide. None of these drugs had a negative influence on the visual field, C/D ratio, visual acuity, blood pressure and heart rate. There was good local tolerance. The side effects were more frequent after travoprost (37) and latanoprost (22) than after the fixed combination timolol-dorzolamide (4 cases). The most important adverse events for the prostaglandin derivatives were conjunctival hyperemia, eyelashes pigmentation and growth, iris pigmentation. There was no necessary to stop the medication because of these effects. CONCLUSIONS: Travoprost, latanoprost and the fixed combination timolol-dorzolamide are efficient in the treatment of primary open angle glaucoma. The prostaglandin derivatives determined similar IOP decrease, which was superior to the fixed combination timolol-dorzolamide; the local tolerance was good, the fixed combination causing the fewest side effects.

Aged↗

PubMed2000

[Open angle glaucoma. Identification of vascular risk factors].

Although the clinical picture of primary open-angle glaucoma (POAG) is well described, the exact mechanism leading to this specific type of damage is still under investigation. Among the vascular risk factors, hypotension and vasospasm seem to have an important role in the pathogenesis of this disease. This review presents the importance of hypotension and vasospasm in the pathogenesis of POAG and an inventary of the principal methods for their detection.

Blood Pressure↗

PubMed1999

[Alpha-2 adrenergic agonists in the treatment of glaucoma].

The study represent an up-to-date of the role and place of alpha 2-adrenergic agonists in glaucoma treatment. The first available alpha 2-agonist, clonidine is of historical importance today. Apraclonidine decrease the aqueous humor secretion and episcleral venous pressure. It is employed to prevent or blunt the acute intraocular pressure rise after ocular laser therapy. It is not recommended as long term therapy due to its high incidence of local adverse reactions and tachyphylaxis. Brimonidine became the alpha 2-agonist of choice in glaucoma chronic treatment, acting by decreasing aqueous humor secretion and increasing uveoscleral outflow. It has a lower incidence of the ocular adverse effects because of greater alpha 2 selectivity. Brimonidine has neuroprotective effect, which is an important feature in the new contexts of glaucoma pathogenesis. Brimonidine has hypotensor effect similar with timolol but with a greater incidence of adverse local reactions. It has been no effects on cardiopulmonary function. Brimonidine would be of value as first-line therapy in patients who have contraindications to beta-blockers.

Adrenergic alpha-2 Receptor Agonists↗

PubMed1999

[Cataract surgery in diabetic patients].

PURPOSE: Analysis of functional results, per- and postoperative complications after cataract surgery in diabetic patients. MATERIAL AND METHOD: Retrospective study including 100 non-diabetic patients and 50 patients with type II diabetes, with extracapsular extraction and IOL implantation in the postoperator chamber followed for 10.3-7.3 months postoperative complications. RESULTS: Postoperative visual acuity was lower in diabetic patients (0.317 +/- 0.24) versus non-diabetic patients (0.634 +/- 0.30); postoperative visual acuity was lower in diabetic patients without retinopathy (0.437 +/- 0.26) versus diabetic patients with non-proliferative retinopathy (0.348 +/- 0.26) or diabetic proliferative retinopathy (0.116 +/- 0.11); the incidence of per- and postoperative complications (early and late) is higher in diabetic patients compared with the control group. CONCLUSIONS: Cataract surgery in diabetic patients is followed by higher rate of per- and postoperative complications. The postoperative functional result is dependent, in principal, on the retinal status of the diabetic patient and, secondary, on the per- and postoperative complications.

Aged↗

PubMed1999

[Modern pathogenetic-therapeutic approaches in glaucoma].

The review presents briefly the new orientations in pathogenically research of glaucoma, the actual theory of apoptosis in generating glaucomatous neuropathy. The substances and transmitters that interfere in the process of apoptosis are also discussed. It is also discussed the new neuroprotective medication. The conclusion is that this new therapy will be an adjunctive one to the classical antiglaucomatous therapy.

Apoptosis↗

PubMed1997

[Intra- and postoperative use of 5-fluorouracil in the surgical treatment of refractory glaucoma].

OBJECTIVE: Analysis of the safety and efficiency of various modalities of 5-FU administration in the surgery of refractory glaucoma. MATERIALS AND METHOD: A prospective, randomized study including 36 patients with refractory glaucoma who received 5-FU in the following protocols: group A (10 patients)--intraoperative application of 50 mg 5-FU, group B (12 patients)--postoperative subconjunctival injections of 5 mg 5-FU, group C (14 patients)--intra and postoperative administration of 5-FU. Mean follow-up interval is 6 months. RESULTS: Last controlled intraocular pressure is lower in C group patients (13.92 mmHg) versus group A and group B patients (< or = 15.7 mmHg). The real therapeutic success rate (intraocular pressure < or = 15 mmHg) and the qualified success rate (intraocular pressure < or = 21 mmHg) are higher in group C (85.7% and 92.8% respectively) as compared with group A and group B (50% and 82% respectively). The rate of side-effects in highest in group B and lowest in group C. CONCLUSIONS: Association of intra and postoperative use of 5-FU in refractory glaucoma increases the rate of therapeutic success and a lower incidence of side-effects.

Antimetabolites↗

PubMed1997

[Primary trabeculectomy for early-onset congenital glaucomas].

OBJECTIVE: Analysis of the results of primary trabeculectomy in the treatment of congenital glaucoma. MATERIALS AND METHOD: Retrospective study of a series of 62 patients with primary trabeculectomy for congenital glaucoma, with a mean follow-up period of 2.22+/-2.86 years. RESULTS: The last controlled intraocular pressure (IOP) was higher for the patients in the age group 0-1 year (16.9+/-8) as compared with the patients older than 1 year (14.9+/-7). An intraocular pressure < or = 20 mmHg without additional medication has been found in 58.3% of the cases in the 0-1 year age group, versus 65.8% in the group of patients older than 1 year. The number of reoperations was higher in the 0-1 year age group (14), as compared with the group of patients older than 1 year (8). The rate of qualified therapeutic success (IOP < or = 20 mmHg) was 79.1% in the 0-1 year age group, versus 85.5% in the group of patients older than 1 year. CONCLUSIONS: Primary trabeculectomy is effective in the treatment of congenital glaucoma. The poorer results in the group of patients under 1 year of age is correlated with disease severity. The rate of favorable results is increased by reoperation, the majority of surgical failures belonging to the group of patients who needed reoperations.

Age of Onset↗

PubMed1997

[Primary trabeculectomy in the surgery of primary open angle glaucoma].

OBJECTIVE: Comparative analysis of the results of trabeculectomy in the surgery of primary open angle glaucoma (POAG) as the primary therapeutical approach and after the medical treatment failure. MATERIALS AND METHOD: Retrospective study including two therapeutical groups: A (59 patients) with primary trabeculectomy; and B (60 patients) with trabeculectomy following a medical treatment failure; mean follow-up period was 3 years and 5 months. RESULTS: Postoperative drop in intraocular pressure was similar in the two groups; there is no statistical significant difference between the two groups regarding stationary disease (76.27% in group A, versus 73.33% in group B), regressive disease (6.8% versus 6.7% respectively) and progressive disease (18.6% in group A, versus 21.6% in group B). At an intraocular pressure < or = 21 mmHg 13.6% of glaucoma cases do progress. The rate of peroperative and postoperative complications is similar in the two groups. CONCLUSIONS: The prior medical treatment of glaucoma doesn't affect the evolution of operated POAG. Primary trabeculectomy is indicated for non-compliant patients and for patients in whom administration of combined medical treatment for short time periods doesn't lower the intraocular pressure at safe levels. Surgical treatment has the advantage of an important and constant lowering of the intraocular pressure which is an absolute requirement for an efficient control of advanced glaucoma.

Aged↗

PubMed1997

[Rupture of the posterior capsule and the implantation of an artificial lens].

OBJECTIVE: Study of the incidence and side effects of the posterior capsule ruptures in a clinical trial. MATERIAL AND METHODS: Retrospective study of cases with posterior capsule ruptures encountered in a series of 162 with elective extracapsular extraction and posterior chamber lens implantation. RESULTS: Intraoperative posterior capsule ruptures occurred in 16 cases (10.12%), 4 cases without vitreous loss and 12 cases with vitreous loss. 12 cases were managed by simple posterior chamber lens implantation of with scleral or iris suture; in 4 cases we preferred anterior chamber implants with flexible haptic: average postoperative visual acuity was 0.74 in the group with intact posterior capsule and 0.45 in the group with posterior capsule ruptures; average postoperative visual acuity was 2 lines higher in the group with posterior capsule ruptures without vitreous loss as compared with the group with posterior capsule ruptures and vitreous loss; postoperative complications were more frequent in the group with posterior capsule ruptures; intraocular lens descentrations were more frequent and more serious in the group with posterior capsule ruptures. CONCLUSIONS: Posterior capsule ruptures negatively affects the late functional results due to higher rate of major complications and to difficulties in artificial lens implantation.

Humans↗

PubMedDate not supplied

[The efficacy of a microtrabecular prosthesis in the surgery of refractory glaucomas].

A new model of intermediate artificial drainage system (called microtrabeculoprosthesis--MTP) in the surgery of refractory glaucoma is suggested. The prospective study includes 37 operated cases followed up for an average interval of 18.2 months (ranges 11 and 72 months). Surgery is not difficult, and MTP is very well tolerated. A relief of elevated intraocular pressure (IOP < or = 20 mm Hg) was obtained in 73% of the cases (with or without additional antiglaucoma drugs); the irritative phenomena have disappeared in preterminal and absolute glaucoma; the overall therapeutic success rate was 86.5%. The results obtained with MTP are definitely superior to those by conventional surgery but inferior to modern posterior artificial drainage systems (with ameliorative techniques); the rate of postoperative complications is small, and their severity is minimal. In the absence of modern posterior artificial drainage systems. MTP is an efficient solution for the treatment of refractory glaucoma.

Adolescent↗

PubMedDate not supplied

[The surgical results in traumatic cataract].

The retrospective analysis of the postoperative course in 204 traumatic cataracts (140 isolated, simple cataracts and 64 aggravated ones) showed an apparent functional improvement in the simple cases (preoperative and postoperative visual acuity 0.0139 and 0.8520, respectively); the incidence of postoperative detachment of retina was of 4.9%, that of postoperative endophthalmitis that of cystoid macular edema of 3.2%; complications more commonly occurred in aggravated traumatic cataracts and partially accounted for the poorer functional results. During the investigated interval (1988-1992) a rapid shift to extracapsular cataract extraction and posterior chamber lens implants was made. The crystalline grafts preserved binocular vision in 92% of the cases and contact lens in 50% of the cases. Lens implant remains a matchless solution for the visual rehabilitation of the patients with aphakia.

Cataract↗

PubMedDate not supplied

[Late postcontusion secondary glaucoma].

The investigation of 33 patients with late postcontusional glaucoma subjected to surgery and followed up for 25 +/- 8.24 months has revealed: the interval accident-surgery is shorter in the close-angle combined forms; the essential mechanisms responsible for glaucoma occurrence are: the alteration of trabecular meshwork (for open-angle glaucoma) and pupillary block (for close angle glaucoma); simple cases required antiglaucoma surgery (trabeculectomy, peripheral iridectomy) and the mixed ones required combined (trabeculectomy, lens extraction, lens implant) or sequential surgeries (antiglaucoma surgery, vitrectomy etc); the glaucomatous process was stopped in 83.4% of the open-angle glaucoma cases and progressed in 23.5% of the close-angle glaucoma cases; the functional improvements post antiglaucoma surgery combined with removal of opacities are lessened by the higher frequency of severe per- and post-operative complication.

Contusions↗

PubMedDate not supplied

[Surgery in the treatment of primary advanced open-angle glaucoma].

A series of 25 cases of advanced open-angle primitive glaucoma (C/D higher than 0.8, visual field stages C, D, E according to Greve's classification), operated upon by extended and adapted trabeculectomy, surgery being the initial step in the treatment of this affection, was reviewed. After a 18.5-month follow up, the progression of glaucoma was arrested in 60% of the cases, and a regression of papilloperimetric alterations was found in 8% of the cases. There was a significant correlation between the obtained IOP level and glaucoma course (in the cases with a favourable course postoperative IOP was of 15.5 mmHg, while in those evolving unfavorably IOP was of 18 mmHg). Our experience suggests that antiglaucoma surgery may be recommended as an initial treatment in those patients in whom a short-term drug trial (topic administration of 3 drugs for few days) induces a lowering of IOP to less than 15.5 mmHg, and life expectancy is not short.

Disease Progression↗

PubMedDate not supplied

[Functional results in the surgery of congenital cataract].

During 1983-1993, 202 patients (a total of 230 eyes), 113 males and 117 females, were operated. From these, 47 selected cases could not be properly followed and the functional results were established only after repeated checking. In these cases, the surgical techniques consisted of 7 cryoextractions, 47 extracapsular extractions and 18 irrigations-aspirations in double stream. 47 lens implants have been introduced, 43 were Fedorov [correction of Fyodorov]-type with pupillary fixation and 4 were posterior chamber implants. The visual acuity was almost the same to both the patients who have benefited from implants and to those corrected with contact lens or glasses.

Adolescent↗

PubMedDate not supplied

[The ocular hypotonic effect induced by an angiotensin-converting enzyme inhibitor (captopril)].

UNLABELLED: The investigation aims at analysing in healthy and glaucoma subjects the effects of an angiotensin conversion enzyme inhibitor (Captopril) on intraocular pressure, local tolerance, influence on systemic circulation and to ascertain (or suggest) the mechanisms inducing this pressure lowering. The study is prospective, masked, in acute test (10 days) and includes a series of 14 healthy subjects and 18 patients with open angle primitive glaucoma. Following numerous experimental and clinical tests, Captopril isotonic solution 2.5% administered in ocular instillation 4 times/day proved to be the most appropriate. RESULTS: Captopril solution 2.5% lowers intraocular pressure both in the normal subjects (average relief of 6.5 mm Hg) and in the glaucoma patients (8.9 mm Hg); hypotonic effects lasts for 6-8 hours; local tolerance is good; has no influence on systemic arterial pressure; tonography with constant Pt shows a 12% increase of C (insufficient to explain such a relief in intraocular pressure). The hypotesis that pressure lowering occurs (partially) by the stimulation of prostaglandin activity and consequently by improved uveoscleral drainage is suggested. CONCLUSIONS: Captopril solution 2.5% administered topically lowers intraocular pressure without adversely influencing systemic and local circulation; local tolerance is good; the mechanisms of ocular hypotonizing effect are unknown.

Administration, Topical↗

PubMedDate not supplied

[The effect of the pseudoexfoliative syndrome on the evolution and treatment of pseudoexfoliative glaucoma and senile cataract].

PURPOSE: The natural course of pseudoexfoliative syndrome (PES), its influence on the progression and treatment of pseudoexfoliative glaucoma (PEG) and senile cataract. METHODS: 28 cases of PES followed up for 10 years were subjected to complete examination including IPT (intraocular pressure tolerance) and AGF (aggressive glaucomatous factor = IPT-IOP determinations). RESULTS: 1) The isolated form of PES shows a tendency towards bilateralization in 38% of the cases; 2) the occurrence of open angle glaucoma in 20% of the initially isolated PES cases with a rapid progression of papilloperimetric damage; 3) poorer postoperative results in PEG and PES-associated cataract as compared to those obtained in open angle glaucoma and senile cataract; the high incidence of pre- and postoperative complications (fibrous exudate in aqueous humor, ruptured posterior capsule and vitreous loss respectively). CONCLUSIONS: 1) PES is a risk factor in the evolution and treatment of PEG and cataract; 2) the necessity for a more aggressive management in PEG given the rapid alterations of papilloperimetric parameters: 3) poorer functional outcome and increase incidence of pre- and postoperative complications following surgery for PEG and senile cataract.

Adult↗

PubMedDate not supplied

[A comparison of the long-term results and complications of trabeculectomy].

PURPOSE: Comparing the efficiency and incidence of postoperative complications of classical limited trabeculectomy (30-35 degrees trabecular excision) and large and adapted trabeculectomy (60-120 degrees). METHOD: A prospective study of 40 patients with symmetric bilateral glaucoma in whom limited trabeculectomy was performed in one eye and large and adapted trabeculectomy in the opposite eye. All operations were performed by the same surgeon, and the follow up interval was 4.2 years. RESULTS: Postoperative and long-term pressure drop are similar for both types of trabeculectomy. Following limited trabeculectomy the incidence of postoperative complications is 30% lower, the incidence of severe complications is very low and patient's functional rehabilitation is faster. CONCLUSIONS: Except for the clinical conditions where IOP has to be decreased to very low levels (below an intraocular pressure tolerance level of 11-12 mmHg) when a large trabeculectomy is required, limited trabeculectomy is to be preferred as it is safer and obviously beneficial.

Combined Modality Therapy↗