Strabismul adultului: beneficiile tratamentului chirurgical

Studiul a inclus 43 de pacienţi strabici. 27 de pacienţi au prezentat esodeviaţii, iar 16 – exodeviaţii. Intervenţiile chirurgicale au constat în recesie musculară (43,33% esotropii şi 11,77% exotropii), rezecţie musculară (6,67% esotropii şi 29,41% exotropii), recesie-rezecţie (50,00% esotropii şi 58,82% exotropii). Postoperatoriu deviaţia strabică s-a redus la nivel de ortotropie (6-8 DP) în 77,77% din cazuri pentru esotropii şi 81,25% cazuri pentru exotropii, iar în câteva cazuri (16,26% ) s-a înregistrat succes din punct de vedere al binocularităţii

Corneal cecity

Catedra Oftalmologie, USMF «Nicolae Testemiţanu»The cornea is a perfectly transparent membrane that is a part of optic system of the eye and plays a main role in the visual process. According to the WHO statistic the corneal cecity represent 7% of all causes of cecity. Causes can be: genetic errors, injury, conjunctivitis, avitaminosis A, xerosis of the eye, et al. The only method of treatment of corneal scar is keratoplasty which has same very particularly requests but depend on the material and financial condition in developing countries. Corneea este o membrană perfect transparentă, care face parte din sistemul optic al globului ocular şi joacă un rol esenţial în procesul vederii. Conform statisticii OMS cecitatea de origine corneană ocupă un loc deloc neglijabil: 7% din ansamblul cauzelor cecităţii. Cauzele pot fi multiple: erorile genetice, traumatismele, conjunctivitele, avitaminoza A, xeroza oculară etc. Singura metodă de tratament a cicatricilor corneene este keratoplastia, care la rîndul ei presupune reuniunea cîtorva condiţii foarte particulare dar, care rămîn în mare parte dependente de condiţiile materiale şi financiare în tările în curs de dezvoltare

Strabismul adultului – particularități și provocări.

Strabismul adultului, în marea majoritate a cazurilor este un strabism dezvoltat în copilărie neglijat sau insuficient tratat la timpul corespunzător. Diversitatea simptomatologiei, dificultatea evaluării precum și managementul acestora este adesea o provocare pentru strabologi. Raportăm cazul unei esotropii congenitale monolaterale asociate cu hiperfuncția bilaterală a mușchilor oblici inferior și Deviație Verticală Disociată unilaterală

Protocolul operator în implantarea dispozitivului antiglaucomatos cu supapă la animale de laborator

Department of Ophthalmology, Nicolae Testemitanu SUMPh, Timofei Mosneaga Republican Clinical HospitalBackground. Glaucoma treatments represent a challenge, as they may differ depending on the type of disease, severity, and response to the selected management. As the number of patients with glaucoma is expecting to grow by 111.8 million people by 2040 (Allison, K., Cureus. 2020) the researches continue. Objective of the study. To present the surgery of implantation of the antiglaucomatous shunt with valve in the rabbit that is a part of the Project Implementation of a surgical method in the treatment of glaucoma with implantation of the elaborate valve shunt. Material and Methods. After obtained the induced ocular hypertension in laboratory animals, it was performed the filtration surgery in aseptic conditions, under general and local anesthesia. The surgery was performed on 2 New Zealand White Rabbits. During the surgery, it was implemented the methods and techniques of implantation of the filtering device. Results. The surgical procedure was started with the incision of the conjunctiva in aseptic condition and hat the aim to form the scleral flap, at 12 o’clock with a 2/3 from its thickness (triangle-shaped, 2,5 x2,5 mm). Subsequently, under the scleral flap at its base in the area of the cameral angle, a 1.5 mm incision was made with the implantation of the antiglaucoma shunt with valve, followed by fixing the scleral flap with 1 suture and suturing the conjunctival incision. Conclusion. The surgical procedure of antiglaucomatous shunt with valve implantation is an efficient one in the induced ocular hypertension in rabbits, which opens new possibilities in glaucoma treatment research.Introducere. Tratamentul glaucomului reprezintă o provocare, deoarece se poate diferenția în funcție de tipul de boală, severitatea și răspunsul la tratamentul selectat. Deoarece numărul pacienților cu glaucom este în creștere, estimând 111,8 milioane de oameni afectați până în 2040 (Allison, K., 2020) cercetările continuă. Scopul lucrării. Prezentarea protocolului chirurgical de implantare a șuntului antiglaucomatos cu supapă la iepure, parte a Proiectului „Implementarea unei metode chirurgicale în tratamentul glaucomului cu implantarea șuntului cu supapă elaborat”. Material și Metode. După obținerea la animalele de laborator a hipertensiunii oculare induse, s-a efectuat intervenția chirurgicală de filtrare în condiții aseptice, sub anestezie generală și locală. Intervenția a fost efectuată la 2 iepuri de rasă neozeelandeză. În timpul intervenției chirurgicale au fost implementate metodele și tehnicile de implantare a dispozitivului de filtrare. Rezultate. Procedura chirurgicală reprezentată de formarea în condiţii aseptice după incizia conjunctivei a lamboului scleral la ora 12, care a constituit 2/3 din grosimea sclerei (de formă triunghiulară, 2,5 x2,5 mm). Ulterior sub voletul scleral la baza acestuia în zona unghiului camerural s-a efectuat o incizie de 1,5 mm cu implantarea prin aceasta a șuntului antiglaucomatos cu supapă, urmată de fixarea lamboului scleral cu o sutură și suturarea inciziei conjunctivale. Concluzii. Procedura chirurgicală de implantare a șuntului antiglaucomatos cu valvă este eficientă în hipertensiunea oculară indusă la iepuri şi oferă noi posibilități în tratamentul antiglaucomatos

A new approach in the treatment of retinopathies and optic nerve atrophy using mesenchymal stem cells

Background: The tissue engineering is the evolving science that combines cells, biomaterials and biochemical factors aimed at restoring, maintaining and substituting different types of tissue. An important role is played by the use of the stem cells in various fields of medicine, including ophthalmology, namely in cases of retinopathies and optic nerve atrophy. Conclusions: Current treatment of the optic nerve atrophy is based on the etiological causes or late complications. Considering the availability of advanced therapies, stem cell therapy offers a new approach in the treatment of the atrophy of the optic nerve. Being easy to harvest and cultivate, mesenchymal stem cells are most commonly used in regenerative medicine, they can be induced to differentiate into cartilage, tendons, adipose tissue and other cell lines. Mesenchymal stem cell harvesting has no ethical issues compared to embryonic stem cell harvesting. The major histocompatibility factor II is not expressed on the surface of mesenchymal stem cells, and this great advantage allows their use in autologous or allogenic form. Mesenchymal stem cells produce growth factors with paracrine action that are thought to activate endogenous repair mechanisms, due to these properties mesenchymal stem cells have been used in several clinical studies in optic nerve disorders where immunomodulatory and neuroprotective properties have been demonstrated. All of the properties mentioned above stand for the clinical use of mesenchymal stem cells in case of optic nerve atrophy

The treatment of the optic nerve atrophy using stem cells (review)

Introduction. Tissue engineering is the evolving science that combines cells, biomaterials and biochemical factors aimed at restoring, maintaining and substituting different types of tissue. An important role is played by the use of the stem cells in various fields of medicine, including ophthalmology, namely in cases of the optic nerve atrophy. The optic nerve atrophy is the main cause of decreased visual acuity and blindness. It is considered that the use of the stem cells can be an important strategy in the treatment of the optic nerve atrophy, as the stem cells restore the structure and the function of the optic nerve due to the organotypic tissue induction and vascularization. The optic nerve atrophy is caused by irreversible apoptosis of the neuronal cells. In the absence of a specific treatment of the optic nerve atrophy, the current therapies are based on the etiological cause or late complications. Considering the availability of the advanced therapies, the therapy using stem cells offers a new approach in the treatment of the optic nerve atrophy. Aim of study. The evaluation of the latest advances of using mesenchymal stem cells based on clinical trials that included patients with optic nerve atrophy. Methods and materials. This study is a literature review, based on synthesis of clinical trials published in the period between 2009-2022. This article includes publications identified through Google Search Engines, PubMed Databases, National Bibliometric Tool, etc. The information was systematized, highlighting both aspects of the use of mesenchymal stem cells in the pathologies associated with the optic nerve atrophy, as well as the results of 24 clinical trials published on clinictrials.gov. Results. Current treatment of the optic nerve atrophy is based on the etiological causes or late complications. Considering the availability of advanced therapies, stem cell therapy offers a new approach in the treatment of the atrophy of the optic nerve. Being easy to harvest and cultivate, mesenchymal stem cells are most commonly used in regenerative medicine, they can be induced to differentiate into cartilage, tendons, adipose tissue and other cell lines. Mesenchymal stem cell harvesting has no ethical issues compared to embryonic stem cell harvesting. Also, mesenchymal stem cells are considered to be immunoprivileged because the major histocompatibility factor II is not expressed on their surface, and this great advantage allows the use of mesenchymal stem cells in autologous or allogenic form. Mesenchymal stem cells produce growth factors with paracrine action that are thought to activate endogenous repair mechanisms, due to these properties mesenchymal stem cells have been used in several clinical studies in optic nerve disorders where immunomodulatory and neuroprotective properties have been demonstrated. All of the properties mentioned above stand for the clinical use of mesenchymal stem cells in case of optic nerve atrophy. Conclusion. The clinical use of the stem cells is a great possibility for the regeneration of pathologically modified tissues. This fact requires further studies to determine how to use the cell therapy in the case of optic nerve atrophy

Alice in wonderland syndrome as aura of migraine

Alice in Wonderland Syndrome is a perceptual disorder, involving visual and somesthetic integration, described by Lewis Carroll in Alice in Wonderland book. Alice in Wonderland syndrome is a disorder characterized by transient episodes of visual hallucinations and perceptual distortions, during which objects or body parts are perceived as metamorphopsia, macropsia or micropsia, distortions of body image, and perceptual distortions of form, size, movement or color. Migraine aura is a transient neurological symptom that occurs before the headache phase. Aura symptoms include the perception of flashing lights that begin in the center of vision and expand in jagged patterns out into the periphery, may also involve a profound alteration of the perception of space and time - the "Alice in Wonderland" syndrome. We present cases of 4 children that had Alice in Wonderland syndrome as aura of migraine

INTRAOCULAR PRESSURE VALUES AFTER IMPLANTATION OF ANTIGLAUCOMATOUS ELABORATED SHUNT WITH VALVE. EXPERIMENTAL STUDY

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Glaucomul impune o problemă majoră pentru sănătatea publică, reprezentând a doua cauză la nivel mondial de orbire care poate fi prevenită conform OMS. Strategiile de tratament includ multiple opțiuni care trebuie să fie selectate în dependență de numeroși factori și evoluție clinică. Scop. A evalua controlul presiunii intraoculare (PIO) după implantarea șuntului antiglaucomatos în cazul hipertensiunii induse. Materiale și metode. Cercetarea preclinică a inclus inducerea hipertensiunii intraoculare la iepurii neozeelandezi, dintre care la 20 a fost efectuată implantarea șuntului antiglaucomatos cu supapă elaborat și s-a comparat cu operația de trabeculectomie. Au fost studiate valorile PIO la ambele loturi de studiu cu ajutorul Tono-PenXL Reichert. Rezultate. Valorile PIO normale în Grupul A (supuși implantării dispozitivului de filtrare) a fost de 13,72±1,38 mmHg, comparativ cu grupul B(servit drept control și supus trabeculectomiei) - 13,77±1,47 mmHg. Hipertensiunea oculară indusă de steroizi în Grupul A a fost de 28,22±1,60 mmHg și 28,36±1,36 mmHg în Grupul B. Pentru ambele grupuri, intervențiile chirurgicale au fost efectuate sub anestezie generală, iar animalele de laborator au primit aceeași antibioterapie topică și corticosteroizi în perioada postoperatorie. PIO după 3 luni postoperator pentru Grupul A a fost de 15,2±1,19 mmHg și pentru Grupul B - 14,65±1,08 mmHg. Ambele grupuri au avut reduceri semnificative ale PIO după intervenția chirurgicală (p < 0,001). Concluzii. Implantarea șuntului cu supapă elaborat poate fi o procedură eficientă pentru chirurgia glaucomului drept alternativă trabeculectomiei, deoarece scăderea postoperatorie a PIO a fost circa de 30% sau mai mult.Background. Glaucoma imposed an important challenge in public health problems as being the second worldwide cause of avoidable blindness according to WHO. The surgical treatment strategies include multiple options, which must be selected in dependence on various factors and clinical evolution. Purpose. To evaluate the intraocular pressure (IOP) control after elaborated antiglaucomatous shunt with valve implantation in induced hypertension. Methods and materials. Preclinical research included induced hypertension in New Zealand rabbits in whom 20 antiglaucomatous shunt with valve implantation was carried out and made a comparison to trabeculectomy group surgery. It was studied the IOP values in both study groups by using Tono-PenXL Reichert. Results. The normal values of IOP in Group A (undergoes filtering device implantation) was 13.72±1.38 mmHg, compared with Group B (served as control and undergoes trabeculectomy) was 13.77±1.47 mmHg. The steroid-induced ocular hypertension in Group A was 28.22±1.60 mmHg and 28.36 ± 1.36 mmHg in Group B. For both groups, the surgeries were performed under general anesthesia and laboratory animals received the same topical antibiotherapy and corticosteroids during the postoperative period. The IOP after 3 months of surgery for Group A was 15.2±1.19 mmHg and for Group B- 14.65±1.08 mmHg. Both groups had significant reductions in IOP following surgery (p < 0.001). Conclusion. The shunt implantation may be an effective procedure for glaucoma surgery as an alternative to trabeculectomy, as the decrease in IOP was 30% or above postoperatively

Surgical treatment in induced ocular hypertension in rabbit

Department of Ophthalmology and Optometry, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Nowadays, glaucoma imposes a major issue for public health, representing the second worldwide leading cause of blindness (WHO Resnikoff 2002). It is a group of complex and heterogeneous ocular diseases, characterized by progressive optical atrophy (Almasieh 2012; Yanoff, 2014; Salmon, 2020). Glaucomatous damage is irreversible; therefore understanding its pathology and selection of optimal management minimizes the risk of progression and development of visual loss. That is why the researches continue. We report a case of filtration surgery treatment in experimentally induced ocular hypertension. Case report. Since for reliable tonometry in awake rabbits, it is advisable to keep the animals as quiet and unfrightened as possible, avoiding excessive manipulation and stimulation, we thought of using Tono-PenXL© Reichert at New Zealand rabbit and to take the measurement of normal IOP (intraocular pressure) after surface anesthesia. An ocular hypertension model in rabbit was induced by using a model proposed by Hester (1987), Melena (1997), just because using other proposed methods found in literature can block the filtering device. The hypertension was obtained by a local subconjunctival injection of 0,7ml betamethasone suspension in one eye. The procedure was repeated for 3 weeks. The injections were done in aseptic conditions under local anesthesia. It was observed the elevated IOP after the last injection with corticosteroid. After obtained ocular hypertension, it was performed the filtration surgery by implantation of a new design model of antiglaucoma shunt and it was monitoring the IOP postoperative and the ocular status. Conclusions. We aim to highlight the possibility of using a new device for glaucoma filtration surgery, its influence on IOP and ocular surface. Good results in the experimental implementation of this way of glaucoma surgery seem to be the most important step in treating this pathology except the classic trabeculectomy, which has also limitations

Valorile presiunii intraoculare după implantarea șuntului antiglaucomatos cu supapă elaborat. Studiu experimental

Background. Glaucoma imposed an important challenge in public health problems as being the second worldwide cause of avoidable blindness according to WHO. The surgical treatment strategies include multiple options, which must be selected in dependence on various factors and clinical evolution. Purpose. To evaluate the intraocular pressure (IOP) control after elaborated antiglaucomatous shunt with valve implantation in induced hypertension. Methods and materials. Preclinical research included induced hypertension in New Zealand rabbits in whom 20 antiglaucomatous shunt with valve implantation was carried out and made a comparison to trabeculectomy group surgery. It was studied the IOP values in both study groups by using Tono-PenXL Reichert. Results. The normal values of IOP in Group A (undergoes filtering device implantation) was 13.72±1.38 mmHg, compared with Group B (served as control and undergoes trabeculectomy) was 13.77±1.47 mmHg. The steroid-induced ocular hypertension in Group A was 28.22±1.60 mmHg and 28.36 ± 1.36 mmHg in Group B. For both groups, the surgeries were performed under general anesthesia and laboratory animals received the same topical antibiotherapy and corticosteroids during the postoperative period. The IOP after 3 months of surgery for Group A was 15.2±1.19 mmHg and for Group B- 14.65±1.08 mmHg. Both groups had significant reductions in IOP following surgery (p < 0.001). Conclusion. The shunt implantation may be an effective procedure for glaucoma surgery as an alternative to trabeculectomy, as the decrease in IOP was 30% or above postoperatively.Introducere. Glaucomul impune o problemă majoră pentru sănătatea publică, reprezentând a doua cauză la nivel mondial de orbire care poate fi prevenită conform OMS. Strategiile de tratament includ multiple opțiuni care trebuie să fie selectate în dependență de numeroși factori și evoluție clinică. Scop. A evalua controlul presiunii intraoculare (PIO) după implantarea șuntului antiglaucomatos în cazul hipertensiunii induse. Materiale și metode. Cercetarea preclinică a inclus inducerea hipertensiunii intraoculare la iepurii neozeelandezi, dintre care la 20 a fost efectuată implantarea șuntului antiglaucomatos cu supapă elaborat și s-a comparat cu operația de trabeculectomie. Au fost studiate valorile PIO la ambele loturi de studiu cu ajutorul Tono-PenXL Reichert. Rezultate. Valorile PIO normale în Grupul A (supuși implantării dispozitivului de filtrare) a fost de 13,72±1,38 mmHg, comparativ cu grupul B(servit drept control și supus trabeculectomiei) - 13,77±1,47 mmHg. Hipertensiunea oculară indusă de steroizi în Grupul A a fost de 28,22±1,60 mmHg și 28,36±1,36 mmHg în Grupul B. Pentru ambele grupuri, intervențiile chirurgicale au fost efectuate sub anestezie generală, iar animalele de laborator au primit aceeași antibioterapie topică și corticosteroizi în perioada postoperatorie. PIO după 3 luni postoperator pentru Grupul A a fost de 15,2±1,19 mmHg și pentru Grupul B - 14,65±1,08 mmHg. Ambele grupuri au avut reduceri semnificative ale PIO după intervenția chirurgicală (p < 0,001). Concluzii. Implantarea șuntului cu supapă elaborat poate fi o procedură eficientă pentru chirurgia glaucomului drept alternativă trabeculectomiei, deoarece scăderea postoperatorie a PIO a fost circa de 30% sau mai mult