Lorina Petrescu, Mirela Crișan, Călin Lazăr, Cristina Stan
Anterior uveitis is the most common extra-articular manifestation in children diagnosed with Juvenile idiopathic arthritis (JIA). It is typically a non-granulomatous, chronic, and asymptomatic uveitis. The lack of acute symptoms often delays the diagnosis with the incidence of severe ocular complications. Chorioretinitis lesions have been described in only 1% of cases. The absence of fundus changes can be explained by the impossibility of performing fundoscopy through the cloudy ocular media, secondary to inflammation. A 7-year-old female with a 3-month history of painless reduced vision came to have an eye examination. An initial diagnosis of bilateral anterior granulomatous uveitis complicated with glaucoma and cataract was formulated. Because of the concomitant diagnosis of COVID-19 disease (same day as the eye examination), the child was hospitalized in a hometown COVID-19 patient ward, so both local and general treatment, monitorization, and investigations were discontinued. The following eye examination revealed the persistence of anterior uveitis, inflammatory glaucoma, cataract, and the appearance of band keratopathy. Fundoscopy revealed numerous disseminated lesions of choroiditis. Further examinations established JIA-associated uveitis diagnosis, so systemic corticosteroids were initiated followed by Methotrexate and Adalimumab. Monitoring with fundoscopy in a patient diagnosed with JIA-U is necessary to detect possible chorioretinal or vascular damage. Abbreviations: BVA = best visual acuity, CVA = corrected visual acuity, CS = corticosteroids, IOP = Intraocular pressure, JIA = Juvenile idiopathic arthritis, JIA-U = Juvenile idiopathic arthritis associated uveitis, LE = left eye, MTX = Methotrexate, OU = both eyes, OCT = Optical Coherence Tomography, RE = right eye, TNF = tumor necrosis factor.
{"title":"Anterior and posterior uveitis associated with juvenile idiopathic arthritis -case report.","authors":"Lorina Petrescu, Mirela Crișan, Călin Lazăr, Cristina Stan","doi":"10.22336/rjo.2022.36","DOIUrl":"https://doi.org/10.22336/rjo.2022.36","url":null,"abstract":"<p><p>Anterior uveitis is the most common extra-articular manifestation in children diagnosed with Juvenile idiopathic arthritis (JIA). It is typically a non-granulomatous, chronic, and asymptomatic uveitis. The lack of acute symptoms often delays the diagnosis with the incidence of severe ocular complications. Chorioretinitis lesions have been described in only 1% of cases. The absence of fundus changes can be explained by the impossibility of performing fundoscopy through the cloudy ocular media, secondary to inflammation. A 7-year-old female with a 3-month history of painless reduced vision came to have an eye examination. An initial diagnosis of bilateral anterior granulomatous uveitis complicated with glaucoma and cataract was formulated. Because of the concomitant diagnosis of COVID-19 disease (same day as the eye examination), the child was hospitalized in a hometown COVID-19 patient ward, so both local and general treatment, monitorization, and investigations were discontinued. The following eye examination revealed the persistence of anterior uveitis, inflammatory glaucoma, cataract, and the appearance of band keratopathy. Fundoscopy revealed numerous disseminated lesions of choroiditis. Further examinations established JIA-associated uveitis diagnosis, so systemic corticosteroids were initiated followed by Methotrexate and Adalimumab. <b>Monitoring with fundoscopy in a patient diagnosed with JIA-U is necessary to detect possible chorioretinal or vascular damage</b>. <b>Abbreviations:</b> BVA = best visual acuity, CVA = corrected visual acuity, CS = corticosteroids, IOP = Intraocular pressure, JIA = Juvenile idiopathic arthritis, JIA-U = Juvenile idiopathic arthritis associated uveitis, LE = left eye, MTX = Methotrexate, OU = both eyes, OCT = Optical Coherence Tomography, RE = right eye, TNF = tumor necrosis factor.</p>","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"66 2","pages":"185-190"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40686612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: To report the cases of five children with unilateral advanced glaucoma in isolated congenital ectropion uveae (CEU) with ipsilateral ptosis and myopia. Methods: This is an ambispective observational case series. After diagnosing one patient with CEU and glaucoma, consecutive patients presenting with unilateral ptosis, congenital iris anomaly, and glaucoma between 2014 to 2020, and had completed a minimum one-year postoperative follow-up, were analyzed. Results: Of the 1421 newly registered pediatric glaucoma patients in the period under review, five children were diagnosed with CEU. All patients presented with gradual painless diminution of vision in the left eye in early adolescence. The left eye of all patients had peculiar clinical features: mild congenital ptosis, high iris insertion, crypt-less smooth iris surface, congenital ectropion uveae, pigments over anterior lens capsule, high myopia, advanced glaucomatous optic disc cupping, and very high intraocular pressure (IOP), which was > 45 mmHg in all cases. The right eye showed signs of angle dysgenesis with mild anterior iris insertion and numerous fine iris processes. Antiglaucoma medications and angle surgery failed to control the IOP, and all children required glaucoma filtration surgery, resulting in reasonable IOP control. Despite the older age, postoperative strict amblyopia treatment resulted in significant improvement in vision. Conclusions: Although ectropion uveae and ptosis have been present since birth, unilaterality, and the asymptomatic nature of the disease led to the late presentation with irreversible damage. Early surgical management and amblyopia therapy are the cornerstones of management. Abbreviations: CEU = Congenital ectropion uvea, CIES = Congenital Iris Ectropion Syndrome, ASD = Anterior segment dysgenesis syndrome, BCVA = Best-corrected visual acuity, IOP = Intraocular pressure.
{"title":"Unilateral advanced glaucoma in isolated congenital ectropion uveae with ipsilateral ptosis: A pictorial description of five children.","authors":"Sagarika Snehi, Manpreet Kaur, Ashok Kumar Singh, Faisal Thattarattody, Srishti Raj, Surinder Singh Pandav, Sushmita Kaushik","doi":"10.22336/rjo.2022.25","DOIUrl":"https://doi.org/10.22336/rjo.2022.25","url":null,"abstract":"<p><p><b>Aim:</b> To report the cases of five children with unilateral advanced glaucoma in isolated congenital ectropion uveae (CEU) with ipsilateral ptosis and myopia. <b>Methods:</b> This is an ambispective observational case series. After diagnosing one patient with CEU and glaucoma, consecutive patients presenting with unilateral ptosis, congenital iris anomaly, and glaucoma between 2014 to 2020, and had completed a minimum one-year postoperative follow-up, were analyzed. <b>Results:</b> Of the 1421 newly registered pediatric glaucoma patients in the period under review, five children were diagnosed with CEU. All patients presented with gradual painless diminution of vision in the left eye in early adolescence. The left eye of all patients had peculiar clinical features: mild congenital ptosis, high iris insertion, crypt-less smooth iris surface, congenital ectropion uveae, pigments over anterior lens capsule, high myopia, advanced glaucomatous optic disc cupping, and very high intraocular pressure (IOP), which was > 45 mmHg in all cases. The right eye showed signs of angle dysgenesis with mild anterior iris insertion and numerous fine iris processes. Antiglaucoma medications and angle surgery failed to control the IOP, and all children required glaucoma filtration surgery, resulting in reasonable IOP control. Despite the older age, postoperative strict amblyopia treatment resulted in significant improvement in vision. <b>Conclusions:</b> Although ectropion uveae and ptosis have been present since birth, unilaterality, and the asymptomatic nature of the disease led to the late presentation with irreversible damage. Early surgical management and amblyopia therapy are the cornerstones of management. <b>Abbreviations:</b> CEU = Congenital ectropion uvea, CIES = Congenital Iris Ectropion Syndrome, ASD = Anterior segment dysgenesis syndrome, BCVA = Best-corrected visual acuity, IOP = Intraocular pressure.</p>","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"66 2","pages":"125-131"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40686614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Consuela-Mădălina Gheorghe, Victor Lorin Purcărea, Iuliana-Raluca Gheorghe
During the last decade, it seems that we have witnessed an upsurge in medical tourism and its documentation. Definitions often refer more to the terms themselves rather than to the medical tourists and frequently approach discussions using the principles of motivation, procedures, and tourism. The aim of this review was to investigate the existing literature on medical tourism in health care services, and in Ophthalmology, and to assess whether the principles of medical tourism are successfully applied in health care services, with a specific interest in Ophthalmology services.
{"title":"Medical tourism in ophthalmology - review.","authors":"Consuela-Mădălina Gheorghe, Victor Lorin Purcărea, Iuliana-Raluca Gheorghe","doi":"10.22336/rjo.2022.22","DOIUrl":"https://doi.org/10.22336/rjo.2022.22","url":null,"abstract":"<p><p>During the last decade, it seems that we have witnessed an upsurge in medical tourism and its documentation. Definitions often refer more to the terms themselves rather than to the medical tourists and frequently approach discussions using the principles of motivation, procedures, and tourism. The aim of this review was to investigate the existing literature on medical tourism in health care services, and in Ophthalmology, and to assess whether the principles of medical tourism are successfully applied in health care services, with a specific interest in Ophthalmology services.</p>","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"66 2","pages":"108-111"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40686616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Aguilar-González, E. Marín-Payá, M. Pérez-López, Maria Ángeles Bort-Martínez, J. Aviñó-Martínez, E. España-Gregori
We present the case of a 35-year-old female patient, pregnant in her third trimester, with no ophthalmologic history of interest and a medical history of IgA deficiency syndrome with bronchiectasis as the only symptomatology, who came to another center with clinical symptoms of ocular discomfort. She was initially diagnosed with anterior uveitis and treated with topical and periocular corticosteroids. Edema and palpebral erythema appeared a few days later and she was diagnosed with idiopathic orbital inflammation and was treated with intravenous (I.V.) corticosteroids, which led to the appearance of a purulent palpebral and subconjunctival collection with a diagnosis of orbital cellulitis. At this time, she came to our center, where ultrasound and magnetic resonance imaging (MRI) showed intraocular and scleral destructuring with scleral perforation. The subconjunctival abscess was drained, being positive for pseudomonas aeruginosa, and sputum culture was positive for Pseudomonas aeruginosa, so she was diagnosed with endogenous endophthalmitis due to transient Pseudomonas aeruginosa bacteremia in the context of IgA deficiency syndrome and treated with antibiotherapy. Despite the improvement of the infectious clinic, the persistence of positive cultures for pseudomonas aeruginosa and the evolution to phthisis bulbi at 2 months led to definitive treatment with evisceration. To our knowledge, this is the first reported case of endogenous endophthalmitis associated with IgA deficiency and the first reported case of endogenous bacterial endophthalmitis caused by pseudomonas aeruginosa during pregnancy.
{"title":"Posterior scleral perforation due to endogenous endophthalmitis in a pregnant with selective IgA deficiency","authors":"M. Aguilar-González, E. Marín-Payá, M. Pérez-López, Maria Ángeles Bort-Martínez, J. Aviñó-Martínez, E. España-Gregori","doi":"10.22336/rjo.2022.19","DOIUrl":"https://doi.org/10.22336/rjo.2022.19","url":null,"abstract":"We present the case of a 35-year-old female patient, pregnant in her third trimester, with no ophthalmologic history of interest and a medical history of IgA deficiency syndrome with bronchiectasis as the only symptomatology, who came to another center with clinical symptoms of ocular discomfort. She was initially diagnosed with anterior uveitis and treated with topical and periocular corticosteroids. Edema and palpebral erythema appeared a few days later and she was diagnosed with idiopathic orbital inflammation and was treated with intravenous (I.V.) corticosteroids, which led to the appearance of a purulent palpebral and subconjunctival collection with a diagnosis of orbital cellulitis. At this time, she came to our center, where ultrasound and magnetic resonance imaging (MRI) showed intraocular and scleral destructuring with scleral perforation. The subconjunctival abscess was drained, being positive for pseudomonas aeruginosa, and sputum culture was positive for Pseudomonas aeruginosa, so she was diagnosed with endogenous endophthalmitis due to transient Pseudomonas aeruginosa bacteremia in the context of IgA deficiency syndrome and treated with antibiotherapy. Despite the improvement of the infectious clinic, the persistence of positive cultures for pseudomonas aeruginosa and the evolution to phthisis bulbi at 2 months led to definitive treatment with evisceration. To our knowledge, this is the first reported case of endogenous endophthalmitis associated with IgA deficiency and the first reported case of endogenous bacterial endophthalmitis caused by pseudomonas aeruginosa during pregnancy.","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"61 1","pages":"97 - 100"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77128675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Treating fungal keratitis is always a challenge due to limited antifungal medication, their poor penetration, and often, the delay in diagnosis. The purpose of this study is to present new routes of medication delivery, such as intrastromal application for advanced cases not responding to topical therapy. Methods: A 60-year-old female presented with fungal keratitis, complaining of decreased vision, redness in her left eye followed by frequent pain, which got worse a few days prior. Visual acuity was limited to hand motion. Slit-lamp examination showed advanced conjunctival hyperemia, a very deep white feathery lesion in the central cornea, with satellite lesions on the periphery, and pseudohypopyon of 3 mm in the anterior chamber. She was started on oral fluconazole 100 mg b.i.d, followed by corneal debridement and topical hourly voriconazole eye drops and intrastromal voriconazole application as her local findings did not show any improvement. Results: After repeating the procedure three times, the inflammatory reaction was decreased, the central ulcer healed, satellite lesions disappeared and pseudohypopyon did not recur even after discontinuation of the topical therapy. Conclusion: Intrastromal voriconazole application showed its safety and efficacy in treating advanced fungal keratitis with deep intrastromal lesions. Abbreviations: NSAID = non-steroid anti-inflammatory drugs, BCVA = best corrected visual acuity, MIC = mean inhibitory concentration
{"title":"Challenging case of treating fungal keratitis","authors":"Darko Ler, Aida Pidro, Ajla Pidro Mioković","doi":"10.22336/rjo.2022.14","DOIUrl":"https://doi.org/10.22336/rjo.2022.14","url":null,"abstract":"Objective: Treating fungal keratitis is always a challenge due to limited antifungal medication, their poor penetration, and often, the delay in diagnosis. The purpose of this study is to present new routes of medication delivery, such as intrastromal application for advanced cases not responding to topical therapy. Methods: A 60-year-old female presented with fungal keratitis, complaining of decreased vision, redness in her left eye followed by frequent pain, which got worse a few days prior. Visual acuity was limited to hand motion. Slit-lamp examination showed advanced conjunctival hyperemia, a very deep white feathery lesion in the central cornea, with satellite lesions on the periphery, and pseudohypopyon of 3 mm in the anterior chamber. She was started on oral fluconazole 100 mg b.i.d, followed by corneal debridement and topical hourly voriconazole eye drops and intrastromal voriconazole application as her local findings did not show any improvement. Results: After repeating the procedure three times, the inflammatory reaction was decreased, the central ulcer healed, satellite lesions disappeared and pseudohypopyon did not recur even after discontinuation of the topical therapy. Conclusion: Intrastromal voriconazole application showed its safety and efficacy in treating advanced fungal keratitis with deep intrastromal lesions. Abbreviations: NSAID = non-steroid anti-inflammatory drugs, BCVA = best corrected visual acuity, MIC = mean inhibitory concentration","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"49 1","pages":"69 - 74"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82253474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During the last decade, Internet has become an essential element in Marketing due to the benefits that come along with it, especially, in services that may promote and distribute products and services easily. In scientific literature, any activity that involved on online selling of a product or a service was classified as being e-commerce. In the last few years, since the pandemic started, many sellers had to find innovative distribution methods by implementing the principles of Affiliate Marketing (AM). Unfortunately, the implementation of AM principles in health care services has not gained too much attention because there are not so many specialists who would identify AM guidelines and take into consideration the full potential of this form of Marketing. The aim of this review was to investigate the existing literature on health care services and Affiliate Marketing and to assess whether the principles of AM might be successfully applied in health care services, with a specific interest in Ophthalmology products.
{"title":"Affiliate Marketing in ophthalmological services","authors":"C. Gheorghe, V. Purcarea, I. Gheorghe","doi":"10.22336/rjo.2022.5","DOIUrl":"https://doi.org/10.22336/rjo.2022.5","url":null,"abstract":"During the last decade, Internet has become an essential element in Marketing due to the benefits that come along with it, especially, in services that may promote and distribute products and services easily. In scientific literature, any activity that involved on online selling of a product or a service was classified as being e-commerce. In the last few years, since the pandemic started, many sellers had to find innovative distribution methods by implementing the principles of Affiliate Marketing (AM). Unfortunately, the implementation of AM principles in health care services has not gained too much attention because there are not so many specialists who would identify AM guidelines and take into consideration the full potential of this form of Marketing. The aim of this review was to investigate the existing literature on health care services and Affiliate Marketing and to assess whether the principles of AM might be successfully applied in health care services, with a specific interest in Ophthalmology products.","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"9 1","pages":"17 - 21"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84249110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Dascalescu, V. Potop, V. Coviltir, M. Corbu, C. Dijmărescu
A 36-year-old female patient presented to our clinic with a two months history of diplopia and dizziness. The symptoms appeared gradually and increased in frequency and intensity. She had no significant medical history and she did not take any medication. A full ophthalmological consult was performed, which revealed restricted ocular motility in the left eye (LE), in left gaze. Otherwise, the examination showed no pathological findings: best corrected visual acuity (BCVA) both eyes (OU) 1 (Snellen chart), normal slit lamp examination and pupillary reflexes, normal intraocular pressure (IOP) and fundus aspect. Diplopia tests revealed a horizontal diplopia, exacerbated in left gaze. Sixth nerve palsy suspicion was raised and the patient was directed to the neurology department. Following magnetic resonance imaging, with angiographic sequence, a complex intracerebral vascular malformation that interacted with the cranial nerves and determined horizontal diplopia, was found. For a correct diagnosis, we needed a good collaboration between various medical specialties, especially ophthalmology and neurology, because patients with diplopia often present for the first time at the ophthalmologist. Abbreviations: BCVA = best corrected visual acuity, IOP = intraocular pressure, LE = left eye, RE = right eye
{"title":"Diplopia due to a neurovascular compression","authors":"D. Dascalescu, V. Potop, V. Coviltir, M. Corbu, C. Dijmărescu","doi":"10.22336/rjo.2022.15","DOIUrl":"https://doi.org/10.22336/rjo.2022.15","url":null,"abstract":"A 36-year-old female patient presented to our clinic with a two months history of diplopia and dizziness. The symptoms appeared gradually and increased in frequency and intensity. She had no significant medical history and she did not take any medication. A full ophthalmological consult was performed, which revealed restricted ocular motility in the left eye (LE), in left gaze. Otherwise, the examination showed no pathological findings: best corrected visual acuity (BCVA) both eyes (OU) 1 (Snellen chart), normal slit lamp examination and pupillary reflexes, normal intraocular pressure (IOP) and fundus aspect. Diplopia tests revealed a horizontal diplopia, exacerbated in left gaze. Sixth nerve palsy suspicion was raised and the patient was directed to the neurology department. Following magnetic resonance imaging, with angiographic sequence, a complex intracerebral vascular malformation that interacted with the cranial nerves and determined horizontal diplopia, was found. For a correct diagnosis, we needed a good collaboration between various medical specialties, especially ophthalmology and neurology, because patients with diplopia often present for the first time at the ophthalmologist. Abbreviations: BCVA = best corrected visual acuity, IOP = intraocular pressure, LE = left eye, RE = right eye","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"119 1","pages":"75 - 78"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88989516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ainul Basirah Ibramsah, Aliff Irwan Cheong, Wan Norliza Wan Muda, Mohtar Ibrahim
Objective: To report the effectiveness of recombinant human tissue plasminogen activator (rtPA) in severe post-operative fibrinous reaction. Method: The presentation of a case series. Result: Four patients developed severe post-operative inflammation about six days after an otherwise uneventful cataract surgery. Three women, with an average age of 63.25 years old, were included. At the same time, three patients had underlying comorbidities such as diabetes mellitus and hypertension. The average duration of the operation was 31.25 minutes. All operations were performed by different surgeons. All underwent uneventful cataract surgery. They presented with a dense fibrin in anterior chamber within a week of post-operative review. All patients received 25 micrograms in 0.1 mL of intracameral rtPA injection. Assessment included anterior chamber fibrin reaction before and after injection by slit lamp biomicroscopy two hours, 24 hours and one week after rtPA application. Serial visual acuity and intraocular pressure (IOP) were taken pre and one-week post rtPA application. Injection of rtPA effectively caused fibrinolysis in all the cases presented. Conclusion: Fibrinolysis after cataract surgery with conventional topical medications can be time consuming and less efficient. Intracameral application of 25 μg rtPA is an efficient management of fibrin reaction in cataract surgery. Abbreviations: rtPA = recombinant tissue plasminogen activator, IOP = intraocular pressure, BCVA = best corrected visual acuity, PCIOL = posterior chamber intraocular lens
{"title":"The efficacy of recombinant tissue plasminogen activator in severe post-operative fibrinous reaction after uneventful phacoemulsification - a case series and review","authors":"Ainul Basirah Ibramsah, Aliff Irwan Cheong, Wan Norliza Wan Muda, Mohtar Ibrahim","doi":"10.22336/rjo.2022.7","DOIUrl":"https://doi.org/10.22336/rjo.2022.7","url":null,"abstract":"Objective: To report the effectiveness of recombinant human tissue plasminogen activator (rtPA) in severe post-operative fibrinous reaction. Method: The presentation of a case series. Result: Four patients developed severe post-operative inflammation about six days after an otherwise uneventful cataract surgery. Three women, with an average age of 63.25 years old, were included. At the same time, three patients had underlying comorbidities such as diabetes mellitus and hypertension. The average duration of the operation was 31.25 minutes. All operations were performed by different surgeons. All underwent uneventful cataract surgery. They presented with a dense fibrin in anterior chamber within a week of post-operative review. All patients received 25 micrograms in 0.1 mL of intracameral rtPA injection. Assessment included anterior chamber fibrin reaction before and after injection by slit lamp biomicroscopy two hours, 24 hours and one week after rtPA application. Serial visual acuity and intraocular pressure (IOP) were taken pre and one-week post rtPA application. Injection of rtPA effectively caused fibrinolysis in all the cases presented. Conclusion: Fibrinolysis after cataract surgery with conventional topical medications can be time consuming and less efficient. Intracameral application of 25 μg rtPA is an efficient management of fibrin reaction in cataract surgery. Abbreviations: rtPA = recombinant tissue plasminogen activator, IOP = intraocular pressure, BCVA = best corrected visual acuity, PCIOL = posterior chamber intraocular lens","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"1 1","pages":"27 - 31"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83029741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Eshraghi, H. Ghadimi, Safoora Karami, M. Nikdel
Objective: Complex congenital nasolacrimal duct obstruction (CNLDO) is caused by pathologies other than the typical incomplete perforation of the thin membrane in the distal end of the nasolacrimal duct (NLD). Our purpose was to determine the success of silicone tube insertion for such complex CNLDO cases. Methods: Children who met the defined criteria for complex CNLDO and underwent monocanalicular silicone tube insertion between April 2016 and December 2020 were included. The tube was retained for 6-8 weeks and the final outcome was measured 3-4 months after tube removal. If the patients were totally symptom free, the outcome was recorded as complete success. Acceptable outcome was defined as Munk score ≤ 1 (requiring less than twice daily dabbing) and others were classified as failed. Results: Initially, 147 eyes of 132 patients underwent NLD intubation. However, after exclusion of the 11 cases with spontaneous tube extrusion (7.48%), 136 eyes of 121 patients entered the final analysis. The mean age was 23.9 ± 13.0 months (range 8-73 months). The outcome was complete success in 100 eyes (73.5%), acceptable in 16 (11.8%), and failure in 20 eyes (14.7%). The differences in the outcome of the procedure for the eyes based on history of previous probing and age was not statistically significant. Conclusions: NLD intubation with monocanalicular stent is effective in the resolution of complex CNLDO in 85% of cases. This procedure is associated with infrequent complications, like tube loss. The success is not negatively affected by older age and previously failed probing history. Abbreviations: CNLDO = congenital nasolacrimal duct obstruction, NLD = nasolacrimal duct
{"title":"Outcome of monocanalicular intubation for complex congenital nasolacrimal duct obstruction: the role of age","authors":"B. Eshraghi, H. Ghadimi, Safoora Karami, M. Nikdel","doi":"10.22336/rjo.2022.11","DOIUrl":"https://doi.org/10.22336/rjo.2022.11","url":null,"abstract":"Objective: Complex congenital nasolacrimal duct obstruction (CNLDO) is caused by pathologies other than the typical incomplete perforation of the thin membrane in the distal end of the nasolacrimal duct (NLD). Our purpose was to determine the success of silicone tube insertion for such complex CNLDO cases. Methods: Children who met the defined criteria for complex CNLDO and underwent monocanalicular silicone tube insertion between April 2016 and December 2020 were included. The tube was retained for 6-8 weeks and the final outcome was measured 3-4 months after tube removal. If the patients were totally symptom free, the outcome was recorded as complete success. Acceptable outcome was defined as Munk score ≤ 1 (requiring less than twice daily dabbing) and others were classified as failed. Results: Initially, 147 eyes of 132 patients underwent NLD intubation. However, after exclusion of the 11 cases with spontaneous tube extrusion (7.48%), 136 eyes of 121 patients entered the final analysis. The mean age was 23.9 ± 13.0 months (range 8-73 months). The outcome was complete success in 100 eyes (73.5%), acceptable in 16 (11.8%), and failure in 20 eyes (14.7%). The differences in the outcome of the procedure for the eyes based on history of previous probing and age was not statistically significant. Conclusions: NLD intubation with monocanalicular stent is effective in the resolution of complex CNLDO in 85% of cases. This procedure is associated with infrequent complications, like tube loss. The success is not negatively affected by older age and previously failed probing history. Abbreviations: CNLDO = congenital nasolacrimal duct obstruction, NLD = nasolacrimal duct","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"7 1","pages":"49 - 54"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73083188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present the difficulties in choosing the right IOL, when facing a great variability of the keratometric measurements, in the case of a patient operated for epiretinal membrane and lamellar macular hole, who developed complicated cataract in the operated eye. Upon commencing the biometric measurements, inconsistency in keratometric values led to further investigations. Repeated placido disc topography initially showed corneal ectasia, which posed a problem on selecting the right type of intra-ocular lens. Ocular surface pathology was suspected, and after treatment, the topography was repeated with a Scheimpflug topographer, that showed an improved keratometric profile. The surgical solution was to implant an aspheric monofocal IOL, in the bag, with extended depth of focus that enhances intermediate vision, disregarding the previous keratometric measurements. Refractive and functional outcomes were good. In cases of biometric measurements that show inconsistency in keratometric values, ocular surface disease as well as corneal ectasia should be taken into consideration. The right implant should not be chosen based on a single measurement, but rather several measurements should be made and compared and the choice should not be made before treating the ocular surface.
{"title":"Difficulties in choosing the right intraocular lens in a previously vitrectomized patient - the role of the tear film","authors":"Monica Mălăescu, Bogdana Tăbăcaru, H. Stanca","doi":"10.22336/rjo.2022.18","DOIUrl":"https://doi.org/10.22336/rjo.2022.18","url":null,"abstract":"We present the difficulties in choosing the right IOL, when facing a great variability of the keratometric measurements, in the case of a patient operated for epiretinal membrane and lamellar macular hole, who developed complicated cataract in the operated eye. Upon commencing the biometric measurements, inconsistency in keratometric values led to further investigations. Repeated placido disc topography initially showed corneal ectasia, which posed a problem on selecting the right type of intra-ocular lens. Ocular surface pathology was suspected, and after treatment, the topography was repeated with a Scheimpflug topographer, that showed an improved keratometric profile. The surgical solution was to implant an aspheric monofocal IOL, in the bag, with extended depth of focus that enhances intermediate vision, disregarding the previous keratometric measurements. Refractive and functional outcomes were good. In cases of biometric measurements that show inconsistency in keratometric values, ocular surface disease as well as corneal ectasia should be taken into consideration. The right implant should not be chosen based on a single measurement, but rather several measurements should be made and compared and the choice should not be made before treating the ocular surface.","PeriodicalId":21385,"journal":{"name":"Romanian journal of ophthalmology","volume":"55 1","pages":"89 - 96"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77597549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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