Biomedical subjects
Publications and source records attributed to R Cucea.
Secondary posttraumatic glaucoma. Blunt ocular trauma may cause transient or permanent high IOP, occurring immediately or in time after the injury. This study presents some clinical and therapeutical considerations about 16 cases which developed secondary glaucoma. The elevation of IOP was associated with hyphema, iridodialysis, zonular tears (with lens luxation or subluxations), alterations of the iridocorneal angle.
During the last two decades, glaucoma drainage devices (GDD) have been increasingly applied to the treatment of complicated glaucoma in which standard surgical therapy has failed. Most GDD's consist of a segment of silicone rubber attached to a rigid plastic or flexible rubber explant and evolved from the Molteno glaucoma implant, on which clinical studies first appeared in 1969. GDD's should be reserved for the most difficult cases because of the difficulty of the surgical procedure and the complications that can attend their use.
Many adjunctive therapies have been proposed to increase the success and prevent or reduce the incidence of complications associated with filtering surgery. Intraoperative or postoperative use of an antimetabolite has found a place as adjunctive therapy for eyes with otherwise pour prognosis following glaucoma filtering surgery.
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 viscoelastic substances are very useful generally in cataract surgery, but absolutely useful in phacoemulsification. In present is used for viscoelastic compounds two terms that assemble the rheologic and physics-chemical properties: is said about the viscoelastic substance that is cohesive and dispersive (respective cohesivity or dispersivity property). Thus both types of viscoelastic substances--cohesive and dispersive--is used, sequentially, in one system. This double technique provides a fluid, heterogeneous work environment, which differ from the other techniques that use only one viscoelastic substance and provide a fluid, homogeneous work environment.
The study realised in the Eye Clinic of the Central Military Hospital during February 1995-November 1997 analyses the impact of the vascular risk factors on the evolution of the primary glaucoma. The group consists in 533 patients which primary open angle glaucoma, from which 90.6% patients with primary open angle glaucoma and 9.3% with normal tension glaucoma. The assessment of the patients in order to identify the vascular risk factors it was performed on the basis of anamnestic questionnaire, following: degenerative vasculopathies, spastic vasculopathies, arterial hypotension and coronary insufficiency. 70.5% of the patients presented minimum one vascular risk factor. In the case of the patients with primary open angle glaucoma, we found a high frequency of the degenerative vasculopathies. In the patients with normal tension glaucoma the most frequent factor were: arterial hypotension and spastic vasculopathies. The coronary insufficiency had equal distribution in the primary open angle glaucoma and normal tension glaucoma. The parameters of the disease were affected faster in the patients with vascular risk factors. The outcomes of the study allow to estimate that the screening of the vascular risk factors has a distinct importance in the evolution and accurate treatment of glaucoma.
Exfoliation syndrome is more frequently in the older age and represents a risk factor for cataract surgery. This paper presents the results of a clinical trial made on 436 patients with troubles of transparency of the lens who were investigate in our clinic during January 1995-January 1997, and in whom, clinic and paraclinic exams have not revealed any associated ocular disease. In 14% of these patients who presented troubles of transparency of the lens were found uni- or bilateral exfoliation. The authors present the treatment applied both in patients in clinical follow-up (50% of patients with exfoliation syndrome develop secondary glaucoma) and patients who underwent surgical treatment. The patients with exfoliation syndrome and cataract have had a high risk to develop intra- and postoperative complications. The surgical treatment suggested by authors is extracapsular cataract extraction, either or without lens implantation and peripheral iridectomy which represents a compulsory step.
It is presented a case of a secondary tumoral retinal detachment that clinical examination and all paraclinical investigation go for a choroidal malignant melanoma. The anatomopathological examination of the enucleated eyeball has surprisingly put in evidence some choroidal consumptive lesions.