Rezumate SRSOP 2014

A VI-A EDIIE A CONGRESULUI
SOCIETII ROMNE
DE STRABOLOGIE
I OFTALMOPEDIATRIE
THE CONGRESS
OF THE ROMANIAN SOCIETY
OF STRABOLOGY AND PEDIATRIC
OPHTHALMOLOGY
THE VITH EDITION
SINAIA | HOTEL NEW MONTANA
CARTE DE REZUMATE
/ ABSTRACT BOOK
8-I 1/ M0AY
MA
2014
www.medevents.ro/srsop2014
A VI-A EDIIE
A CONGRESULUI SOCIETII ROMNE
DE STRABOLOGIE I OFTALMOPEDIATRIE
8-10 MAI 2014

Cuprins / Table of Contents

Cuprins / Table of Contents .................................................................................................................................... 1
1. Exotropia intermitent- rezultate postoperatorii ................................................................................................. 3
1. Surgical results in intermittent exotropia ............................................................................................................ 4
2. Hipotropia restrictiv dup anestezia parabulbar pentru operaia de cataract- soluii de tratament ............... 5
2. Restrictive hypotropia after parabulbar anesthesia for cataract surgery - treatment solutions ............................ 6
3. Strabismul din oftalmopatia tiroidian - abordare clinic i tratament chirurgical ............................................ 7
3. Strabimus related to thyroid ophthalmopathy - clinical approach and surgical treatment .................................. 8
4. Acurateea msurtorilor efectuate cu dispozitivul PlusoptiX comparativ cu autorefractometria ...................... 9
4. The accuracy of objective refraction measurements obtained by PlusoptiX S08 in comparison with those
performed by the autorefractometer ..................................................................................................................... 10
5. Eficiena programului HTS Amblyopia iNet n ambliopia anisometropic ...................................................... 11
5. HTS Amblyopia iNet software efficiency in anisometropic amblyopia ........................................................... 12
6. Pareza congenital a oblicului superior - diagnostic simplu, decizie chirurgical dificil................................ 13
6. Congenital superior oblique paresis common diagnosis, but difficult surgical decision ............................... 14
7. Myokymia muchiului oblic superior - o entitate rar de strabism ................................................................... 15
7. Superior oblique myokymia- a rare form of strabismus ................................................................................... 16
8. Esotropie i retinoschisis juvenil - o asociere rar i neateptat ..................................................................... 17
8. Esotropia and juvenile retinoschisis - an unexpected and rare association ....................................................... 18
9. Reintervenie pentru exotropie recidivat dup perforarea intraoperatorie a sclererei cu hemoragie vitrean . 19
9. Reintervention for recurrent exotropia after scleral perforation with vitreous hemorrhage ............................. 20
10. Reintervenie pentru esotropie restrictiv la un pacient cu sindrom Goldenhar asociat cu sindrom Duane
bilateral ................................................................................................................................................................. 21
10. A case of reintervention for restrictive esotropia in a patient with Goldenhar syndrome and bilateral Duane
syndrome .............................................................................................................................................................. 22
11. Transpoziia temporal a muchilor drepi verticali n sindromul Duane esotropic ....................................... 23
11. Vertical rectus transposition in esotropic Duane syndrome ............................................................................ 24
12. Definirea succesului n tratamentul ambliopiei de deprivare dup cataract congenital unilaterala cu
microftalmie i persisten de vitros primitiv- limite i semne de ntrebare ........................................................ 25
12. How to define successful treatment in deprivation amblyopia after unilateral congenital cataract with
microphthalmia and PHPV- limits and questions ................................................................................................. 26
13. Standardul de ngrijire al nou-nscutului prematur i retinopatia de prematuritate sever ............................ 27
13. The standard of neonatal premature care and severe retinopathy of prematurity ........................................... 28
14. Adaptarea lentilelor de ortokeratologie la un caz de miopie rapid progresiv ................................................ 29
14. Adapting orthokeratology lenses in rapidly progressive myopia ................................................................... 30
15. Corecia i controlul progresiei miopiei la copii ............................................................................................. 31
15. Correction and control of myopia progression in children ............................................................................. 32
16. Cataract traumatic operat la copil .............................................................................................................. 33
16. Traumatic cataract .......................................................................................................................................... 34
THE CONGRESS OF THE ROMANIAN SOCIETY

OF STRABOLOGY AND PEDIATRIC OPHTHALMOLOGY
THE VITH EDITION
8-10 MAI 2014

17. Administrarea intravitreean de Bevacizumab pentru tratamentul membranei neovasculare coroidiene

asociate distrofiei maculare viteliforme Best ........................................................................................................ 35
17. Intravitreal bevacizumab in the treatment of choroidal neovascular membranes associated with Bests
vitelliform dystrophy ............................................................................................................................................ 36
18. Ectropion uveal congenital cu multiple chiste la nivelul marginii pupilare - rezolvare chirurgical .............. 37
18. Congenital ectropion uveae with multiple epithelial cysts at pupillary margin surgical management ........ 38
19. Hipoplazie foveolar izolat-caz clinic ........................................................................................................... 39
19. Isolated foveal hypoplasia-clinical case report ............................................................................................... 40
20. Uveita anterioar la copil: o provocare diagnostic i terapeutic .................................................................. 41
20. Childhood anterior uveitis: diagnose and therapeutic challenge ..................................................................... 42
21. Tratamentul cu propranolol sistemic pentru hemangiomul capilar periocular................................................ 43
21. Treatment with systemic propranolol for periocular capillary hemangioma .................................................. 44
22. Toxoplasmoza congenital sistemic .............................................................................................................. 45
22. Congenital systemic toxoplasmosis ................................................................................................................ 46
23. Retinopatie pigmentar X-linkat form sever n cazul a 2 frai n prima decad de via ........................... 47
23. Severe form of X-linked pigmentary retinopathy in the first decade in 2 siblings ......................................... 48
24. Tumor versus inflamaie n patologia esuturilor moi extraoculare ale copilului .......................................... 49
24. Tumour versus inflammation in extraocular soft tissues clinical manifestations in children ......................... 50
25. Intubaia de canal lacrimo-nazal cu tub de siliconic sub supraveghere endoscopic nazal ........................... 51
25. Silicon intubation of the nasolacrimal duct under nasal endoscopic survey ................................................... 52
26. Poster: Uveit anterioar hipertensiv la o pacient de 15 ani ........................................................................ 53
26. Poster : Hypertensive anterior uveitis in a 15 year-old girl ............................................................................ 54
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1. Exotropia intermitent- rezultate postoperatorii

I. Velcea, L. Teodorescu
Clinica Oftalmologic Oftalmix SOP, Bucureti
Scopul lucrrii: De a descrie rezultatele postoperatorii n exotropia intermitent i de a le

raporta la parametrii preoperatori i chirurgicali.
Metoda: 72 pacieni operai n clinica noastr pentru exotropie intermitent. Intervenia iniial
a fost recesia bilateral de muchi drept extern iar dozajul chirurgical a fost stabilit n funcie
de mrimea deviaiei la distan. Aprecierea rezultatului postoperator s-a bazat pe msurarea
deviaiei i stereoscopiei postoperatorii.
Rezultate: 64% au avut un rezultat postoperator bun i 36% unul nesatisfctor. Vrsta, deviaia
iniial, stereoscopia preoperatorie i mrimea recesiei nu au influenat rezultatul postoperator.
12,5% din pacieni au avut exotropie rezidual/recurent iar 23,6% esotropie constant.
Apariia esotropiei consecutive nu a putut fi corelat cu parametrii preoperatori sau cu mrimea
recesiei.
Concluzii: Momentul optim al interveniei chirurgicale n exotropia intermitent e nc n
dezbatere. Dei supracorecia conduce la pierderea stereoscopiei i, la vrst mic la apariia
ambliopiei, studiul nu arat diferene semnificative ntre grupele de vrst.Mrimea recesiei a
fost similar la cei supra i subcorectai, indicnd c supracorecia nu poate fi evitat doar
doznd corect gestul chirurgical.

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8-10 MAI 2014

1. Surgical results in intermittent exotropia

I. Velcea, L. Teodorescu
Oftalmix SOP Ophthalmology Clinic, Bucharest
Purpose: To describe surgical outcomes in intermittent exotropia and to relate these to

preoperative and surgical characteristics.
Methods: 72 patients operated in our clinic for intermittent exotropia. The initial surgery
consisted of bilateral lateral rectus recessions. The amount of recession performed was based
on the distance deviation. The outcome measure was motor/sensory result (angle and
stereoacuity).
Results: 64% had good and 36% had poor primary outcome. Age at the time of surgery, initial
angle of deviation, preoperative stereoacuity and surgical dose did not influence primary
outcome. Exotropia remained/ recurred in 12,5% and persistent over-correction occurred in
23,6% of patients. There was no relationship between over-correction and preoperative
characteristics or surgical dose.
Conclusions: The timing of surgical intervention for intermittent exotropia remains a matter of
debate. The concern that overcorrection leads to constant esotropia and, at early age, amblyopia
and loss of stereoscopy is valid but our study showed no significant outcome difference
between age groups. Surgical dose was similar in those under- and over-corrected suggesting
that overcorrection cannot be avoided merely using the right dosage.
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2. Hipotropia restrictiv dup anestezia parabulbar

pentru operaia de cataract- soluii de tratament
D. Cioplean, G. Brlea, M. Dragomir, V. Prun, D. Grigoriu. A.Grigorescu, C. Niulescu
Clinica Oftalmologic Oftapro, Bucureti
Una din cauzele diplopiei dupa operaia de cataract este injectarea accidental a anestezicului
local intramuscular, lucru care induce la pacienii n vrst susceptibili. parez a muchiului
drept inferior urmat de miofibroz.
Obiectiv: Identificarea criteriilor clinice de stabilire a diagnosticului i a soluiilor de tratament.
Material i metod: Se vor prezenta 10 cazuri de hipotropie restrictiv soldat cu diplopie
vertical stanjenitoare pentru pacient, aparut imediat dupa intervenia pentru cataract,
efectuat cu anestezie parabulbar. n toate cazurile. anestezia a fost efectuat de ctre medicul
anestezist.
Rezultate: n toate cazurile, ochiul operat de cataract era hipotropic n momentul examinrii,
prezentnd o limitare a micrii n sursumvergen, deviaia fiind cuprins ntre 6 i 30 DP.
Examinarea a fost facut ntr-un interval de minimum o lun de la intervenia pentru cataract.
n 6 cazuri, chirurgia strabismului efectuat n anestezie topic i constnd n recesia cu suturi
ajustabile a muchiului drept inferior, la minimum 2 luni de instalarea diplopiei, a dus la
dispariia acesteia i restaurarea vederii binoculare n poziie primar i versii, ntr-un caz s-a
remis spontan i n trei cazuri a putut fi corectat mulumitor cu prisme incluse n corecia
optic a pacientului. n nici un caz nu a fost necesar reintervenia, pacienii relundu-i
activitatea normal.
Concluzii: Dei rare n ultimii ani ca urmare a folosirii preponderente a anesteziei topice pentru
operaia de cataract, aceste situaii produc pacientului un discofort profund iar confuziile
diagnostice pot induce o ncrcatur psihologica negativ pacientului. Diagnosticul i
tratamentul corect reabiliteaz viaa pacientului.

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8-10 MAI 2014

2. Restrictive hypotropia after parabulbar anesthesia

for cataract surgery - treatment solutions
D. Cioplean, G. Brlea, M. Dragomir, V. Prun, D. Grigoriu. A.Grigorescu, C. Niulescu,
Ophthalmology Clinic Oftapro, Bucharest
One of the most frequent causes of diplopia following cataract surgery is accidental injection
of the local anaesthetic in an extraocular muscle (mostly the inferior rectus muscle) which
induces initial muscular paresis and finally myofibrosis in susceptible patients.
Purpose: To identify the clinical criteria for diagnosis and to show successful treatment
solutions.
Material and Method: 9 cases of restrictive hypotropia accompanied by embarrassing vertical
diplopia will be presented. In all cases, the diplopia onset was immediately after cataract
surgery provided under parabulbar anaesthesia done by the anaesthesiologist.
Results: In all cases, the operated eye for cataract was hypodeviated presenting a limitation in
up-gaze movement, with a deviation in primary position of 6 to 30 PD.
Our first examination was done at minimum one month after cataract surgery. In 6 cases,
strabismus surgery with adjustable sutures under topical anaesthesia was necessary and it was
provided at least 2 months after cataract surgery. The inferior rectus recession was in all cases
efficient with the binocular field rehabilitation in main gazes. In three cases, prisms included
in glasses were able to satisfy the patient and in one case spontaneous recovery was possible.
In all cases patients came back to their normal life and activities.
Conclusion: Despite the low incidence in the last years due to the topical anaesthesia , these
situations induce a lot of physical and psychological discomfort to the patient. An appropriate
and rapid diagnosis followed by personalized treatment can rehabilitate patients life.
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8-10 MAI 2014

3. Strabismul din oftalmopatia tiroidian

- abordare clinic i tratament chirurgical
L.Teodorescu, I. Velcea
Orbitopatia Graves necesit o abordare clinic i terapeutic multidisciplinar.

Tratamentul chirurgical al strabismului poate ncepe atunci cnd funcia tiroidian este stabil,
exoftalmia, deviaia strabic i motilitatea ocular sunt stabile cel puin o perioad de 4-6 luni.
Chirurgia strabismului poate fi efectuat dup decompresia orbitar (cnd este necesar) i
nainte de chirurgia pleoapelor.
Examinarea oftalmologic include msurarea acuitii vizuale, a motilitii oculare, a deviaiei,
testul duciilor forate i testul forei generate, cmpul vizual.
Scopul chirurgiei strabismului este de a elimina diplopia sau de a lrgii aria de cmp vizual
fr diplopie, de a restabili motiltatea ocular concomitent i de a corecta poziia
compensatorie a capului. Abordarea chirurgical depinde de tipul deviaiei i de gradul de
restricie.
n esotropie este recomandat recesia muchiului drept intern uni sau bilateral. Sunt necesare
recesii mai mari dect cele uzuale pentru deviaii mici i recesii mai mici pentru deviaii mari.
n hipotropie sunt indicate recesii ale muchilor drepi inferiori. Cnd hipotropia este mare,
pentru a evita apariia hipertropiei la privirea n jos, se recomand recesie bilateral, asimetric
a muchilor drepi inferiori sau recesia unui muchi drept inferior cu operaie faden pe
muchiul drept inferior contralateral. Dac dup recesia bilateral a muchilor drepi inferiori
mai exist deviaie rezidual se recomand recesia muchiului drept superior contralateral n
al doilea timp chirurgical.
Cnd exist i deviaie orizontal i vertical, este necesar recesia muchiului drept intern i
inferior uni- sau bilateral. Ateptrile dup operaia de strabism trebuie s fie realiste. Nu este
o chirurgie complet predictibil, pot fi necesare mai multe etape chirugicale, uneori se folosesc
suturile ajustabile.
Obinerea unei arii utile de vedere binocular este considerat un rezultat bun i acceptabil;
diplopia poate persista n versii laterale sau la privirea n sus.

THE VITH EDITION
8-10 MAI 2014

3. Strabimus related to thyroid ophthalmopathy

- clinical approach and surgical treatment
Graves orbitopathy requires a multidisciplinary approach.

Surgical treatment of strabismus can be considered when thyroid function is stable, and the
exophthalmos, deviation and motility measurements are stable for at least 4 to 6 months.
Strabismus surgery should be done after orbital decompression (when it is necessary) and
before the lid surgery.
The ocular examination includes visual acuity and exophthalmos measurements, evaluation of
the ocular motility, the magnitude of deviation, forced duction and force generation testing,
visual field examination.
The aim of strabismus surgery is to eliminate diplopia or to enlarge the field of single binocular
vision, to restore the concomitant eye movements and to correct the head tilt.
The surgical approach depends on the type of the deviation and on the degree of restriction.
For esotropia, medial rectus recession in one or both eyes is recommended. Larger than normal
recessions should be done for small deviation and smaller than normal recessions should be
done for large deviation.
For hypotropia, recession of the inferior rectus is indicated. When hypotropia is large, in order
to minimize the resultant hypertropia on down gaze, often bilateral and asymmetric inferior
recti recession should be done, or the inferior rectus recession in one eye is combined with
faden procedure on the contralateral inferior rectus. If residual deviation persists after bilateral
inferior rectus recession, recession the superior rectus recession should be done as a second
procedure.
When both esotropia and hypotropia are present, medial and inferior rectus recession are
necessary on one or both eyes.
The expectations from surgery should be realistic. It is not a completely predictable surgery,
more than one surgery may be necessary, sometimes adjustable sutures are used.
Obtaining a useful single binocular vision filed is considered a good result, diplopia in lateral
and superior gaze may persist.
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4. Acurateea msurtorilor efectuate cu dispozitivul PlusoptiX

comparativ cu autorefractometria
C.Vladutiu1, 2, O. Teodosescu1, S. Sevan2
1
2
Clinica Oftalmologic, Cluj-Napoca

Clinica Iris , Cluj-Napoca
Scop: Compararea valorilor refractive obinute cu ajutorul autorefractometrului pediatric

Plusoptix i a celor obinute cu autorefractometrul NidekAR 360A.
Metoda: Au fost introdui n studiu 89 pacieni (178 ochi), cu vrste cuprinse ntre 1 i 34 ani.
In toate cazurile s-a efectuat determinarea refraciei cu Plusoptix i prin autorefractometrie pe
pupila nedilatat; n 48 dintre cazuri au foat repetate msurtorile dupa cicloplegie. Valorile
pentru sfer, cilindru i echivalent sferic obinute prin cele dou metode au fost analizate cu
ajutorul programului SPSS versiunea 17.
Rezultate: Vrsta medie a pacienilor a fost de 8.4 ani. In urma prelucrrii statistice a datelor
au fost obinute diferene semnificative statistic ntre valorile sferei 0.2860.996 (p=0.001),
cilindrului 0.0930.479 (p=0.021)i a echivalentului sferic 0.3320.975 (p=0.000)determinate
prin cele dou metode fr cicloplegie. In ceea ce privete diferenele intre determinrile cu
PlusoptiX fr cicloplegie i autorefractometria cu cicloplegie, acestea au relevat valori de 0.6350.821 (p=0.000) n cazul sferei, -0.0230.46 (p=0.726) pentru cilindru i 0.6470.783
(p=0.000) pentru echivalentul sferic. Determinrile efectuate cu dispozitivul PlusoptiX, nainte
i dup cicloplegie prezint variaii de -1.1090.753 (p=0.000), 0.005 0.272 (p=0.895)
respectiv -1.1060.732 (p=0.000) n ceea ce privete sfera, cilindrul i echivalentul sferic.
Concluzii: Datele obtinute n cazul lotului nostru indic faptul c dispozitivul PlusoptiX
prezint acuratee bun numai n ceea ce privete valoarea cilindrului. Mai mult, diferenele
semnificative ntre masurtorile efectuate cu PlusoptiX cu i fr cicloplegie atrag atenia
asupra obligativitii repetrii examinrii dup cicloplegie. Dispozitivul poate fi utilizat ca
modalitate de screening, fiind necesar ca pacienii depistai cu vicii de refracie s fie supui
unui examen oftalmologic complet.

THE VITH EDITION
8-10 MAI 2014

4. The accuracy of objective refraction measurements obtained

by PlusoptiX S08 in comparison with those performed by the
autorefractometer
C.Vladutiu1, 2, O. Teodosescu1, S. Sevan2
1
2
Ophthalmology Clinic, Cluj-Napoca

Iris Pediatric and General Ophthalmology Clinic, Cluj-Napoca
Purpose: To evaluate the objective refraction measurements obtained using PlusoptiX

S08binocular photoscreener in comparison with those performed with NidekAR 360A
autorefractometer.
Methods: A total of 89 patients (178eyes), aged between 1 and 34years were included in the
study. All eyes underwent undilated PlusoptiX and autorefractometer exam, and 48 eyes had
further cycloplegic measurements.The paired t test was done in order to compare the sphere,
cylinder and spherical equivalent amounts determined by the PlusoptiX and the
autorefractometer and analyses were completed by SPSS software version 17.
Results: The average age of the studied population was 8.4 years.The mean differences in the
sphere, cylinder and spherical equivalent between the PlusoptiX and the autorefractometer
findings without cycloplegia were 0.2860.996 (p=0.001), 0.0930.479(p=0.021), respectively
0.3320.975(p=0.000), all of which were statistically significant.The average differences in the
sphere, cylinder and spherical equivalent between PlusoptiX without cycloplegia and the
autorefractometer measurements with cycloplegia were -0.6350.821 (p=0.000), -0.0230.46
(p=0.726), respectively -0.6470.783(p=0.000). Furthermore, measurements performed by the
PlusoptiX with and without cycloplegia also revealed an average difference of1.1090.753(p=0.000), 0.0050.272(p=0.895), respectively -1.1060.732(p=0.000) in the
sphere, cylinder and spherical equivalentwas noticed.
Conclusions: All in all, the data recorded above points out the fact that Plusoptix can be reliable
in determining the cylinder power, but proves rather inaccurate in estimating the shere and
spherical equivalent values. Additionally, the significant difference between Plusoptix
measurements with or without cycloplegia suggest that the PlusoptiX cannot substitute
cycloplegic refraction exams. Accordingly, patients with detected refractive errors should be
referred for more accurate follow-up eye examinations.
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5. Eficiena programului HTS Amblyopia iNet

n ambliopia anisometropic
E. Avram1, A. Stnil1, 2
1
2
Spitalul Judeean Clinic de Urgen Sibiu

Facultatea de Medicin, Universitatea Lucian Blaga
Introducere: Ambliopia reprezint tulburarea sistemului visual caracterizat printr-o acuitate

vizual sczut la un ochi normal din punct de vedere anatomic. Anisometropia, afeciunea n
care ochii prezint vicii de refracie inegale, este considerat a doua cauz a ambliopiei
funcionale.
Obiective: Scopul studiului este de a determina eficiena programului HTS Amblyopia iNet
prin studierea evoluiei acuitii vizuale, sensibilitii la contrast i vederii stereoscopice la
copiii ce sufer de ambliopie anisometropic.
Material si metode: La acest studiu au participat 10 pacieni (vrst: 5-13 ani) tratai n perioada
februarie 2010 - martie 2014 cu programul HTS Amblyopia iNet n cadrul Clinicii OftaTotal
din Sibiu.
Rezultate si discutii: La nceputul tratamentului AV a variat ntre 0.08 i 0.8, sensibilitatea la
contrast ntre 1.35 i 1.80 Unit. Log., iar nici un pacient nu prezenta vedere stereoscopic
optim. La sfritul terapiei AV a variat ntre 0.08 i 1, sensibilitatea la contrast ntre 1.35 i
1.95 Unit. Log., iar 4 pacieni au prezentat vederea stereoscopic optim cu valoarea de 40.
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5. HTS Amblyopia iNet software efficiency

in anisometropic amblyopia
E. Avram1, A. Stnil1, 2
1
2
Emergency Clinical Hospital Sibiu, Ophthalmology Clinic

Lucian Blaga University, Faculty of Medicine
Introduction: Amblyopia represents a disorder of the visual system characterized by poor vision
in one eye that is otherwise physically normal. Anisometropia, the condition in which the two
eyes have an unequal refractive error, is the second most common cause of amblyopia.
Objectives: The purpose of this study is to determine the efficiency of HTS Amblyopia iNet
Software by studying the progress of visual acuity, contrast sensitivity and stereopsis vision in
anisometropic amblyopic children.
Materials and methods: 10 patients (age: 5-13 years), treated with HTS Amblyopia iNet
Software between February 2010 March 2014 at OftaTotal Clinic from Sibiu participated in
this clinical trial.
Results and discussions: Initially, visual acuity ranged from 0.08 to 0.8, contrast sensitivity
from 1.35 to 1.80 Log. Unit. and no patient presented optimal stereoscopic vision. After
treatment, visual acuity ranged from 0.08 to 1, contrast sensitivity from 1.35 to 1.95 Log. Unit.,
4 patients presented optimal stereoscopic vision of 40.
Conclusions: HTS Amblyopia iNet Software represents an effective modern approach in the
treatment of anisometropic amblyopia that enhances the quality of patients life.
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6. Pareza congenital a oblicului superior

- diagnostic simplu, decizie chirurgical dificil
G. Brlea1, M. Dragomir2, A. Pantalon3
1
Clinica Pro Visual, Cluj Napoca, 2 Clinica Oftapro, Bucureti, 3 Spitalul Sf Spiridon, Iai
Lucrarea prezint cazul unui biat n varst de 6 ani care s-a prezentat cu torticolis important
avnd capul nclinat pe umrul drept i deviaie vertical mare pe OS, observate de prini cu
un an nainte de examinare. La examenul clinic pacientul a prezentat semnele tipice ale parezei
congenitale a oblicului superior la nivelul ochiului stng: OS hipertropie 35 DP, mai accentuat
cu capul nclinat pe umr stng, up-shoot n adducie +4, exciclotorsie 10 grade. Decizia
chirurgical s-a bazat pe examenul clinic si testul duciilor forate efectuat intraoperator, care
a artat o laxitate moderat a oblicului superior dar cu aspect simetric ntre cei doi ochi ceea ce
a ndepartat ideea efecturii unui tuck unilateral pe tendonului muschiului oblic superior stng,
pentru a evita un sindrom Brown iatrogen. Procedura chirurgical a constat n: OS miectomia
oblicului inferior si OD recesia muchiului drept inferior 4,5 mm.
Rezultatul imediat postoperator la 2 sptmni a fost favorabil: ortotropie n poziie primar i
n versii cu dispariia torticolisului. La 2 luni postoperator pacientul s-a prezentat cu torticolis
inversat capul nclinat pe umr drept, hipotropie mic pe OS iniial hipertropic, precum i un
test Bielshowsky inversat.
In diagnosticul diferenial intr in discuie supracorecia chirurgical, pareza bilateral mascat
a muchiului oblic superior sau o combinie ntre acestea. Pacientul a primit corecie prismatic
pentru a menine un status fuzional acceptabil pan la o nou interventie chirurgical pentru
obinerea ortoforiei.
Acest caz arat c n ciuda unei deviaii verticale mari ce necesita adordarea chirurgical a 2
muchi i n condiiile unei chirurgii atente, dozat moderat si fr incidente intraoperatorii, ne
putem ntalni postoperator cu un rezultat neateptat care face i mai dificil decizia terapeutic
ulterioar.
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6. Congenital superior oblique paresis

common diagnosis, but difficult surgical decision
G. Brlea1, M. Dragomir2, A. Pantalon3
1
Pro Visual Clinic, Cluj-Napoca, 2Oftapro Clinic, Bucharest, 3Sf. Spiridon Hospital, Iassy
This paper presents the case of one boy 6 years old, who complained about right head tilt and
large vertical deviation in his left eye about one year. Clinically, he had typically signs of left
congenital superior oblique palsy: left hypertropia 35 PD, more pronounced with head tilt on
the left side than the right side, up-shoot in adduction +4, and excyclotorsion about 10 degrees.
We proceed: left inferior oblique myectomy and right inferior rectus recession 4.5 mm. The
surgical decision was based on clinical exam and intraoperative forced duction test which
revealed moderate laxity in the left superior oblique but symmetrical between the eyes and we
wanted to avoid an iatrogenic Brown syndrome after unilateral tuck on left superior oblique
tendon.
The results were excellent during the next 2 weeks: the patient was orthotropic in primary
position and versions, no torticolis. However 2 months later he presented with torticolis on the
opposite side: head tilt on the left side, small hypotropia (15 PD) in the initial paretic left eye,
Bielshowsky positive on the right side, and slight upshoot in adduction in the right eye.
We discuss in this situation about one of the next possibilities: an overcorrection by inferior
rectus slippage, bilateral masked superior oblique paresis or a combination of two. We put the
patient on prism correction to help him to maintain an acceptable fusion before a new surgery
for getting an orthophoric alignment.
This case is an example of unexpected postoperative result despite of moderate surgical dosage
2 muscles surgery for a large hypertropia- and carefully technique without any intraoperative
incidence, making a common congenital superior oblique paresis difficult to treat it in some
circumstances.
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7. Myokymia muchiului oblic superior

- o entitate rar de strabism
M. Dragomir
Clinica Oftapro, Bucureti
Myokymia muchiului oblic superior (SOM) este o form rar de nistagmus rotator
monoocular, caracterizat prin episoade scurte de oscilopsii sau diplopie torsional sau
vertical, repetitive. Etiologia, dei nc insuficient clarificat, se pare c este o suferin a
nervului trohlear care cauzeaz contracii scurte ale muchiului oblic superior.
Metoda: Pacient n vrst de 36 de ani acuz de circa 8 luni episoade scurte de micare,
tremurare a imaginii, monoocular stng repetitive, de cteva ori pe zi pentru care la debut nu
se stabilete un diagnostic sau tratament.
Examenul IRM cerebral arat mic leziune microchistic n pedunculul stng, o anomalie
vascular congenital a arterei cerebrale anterioare stngi i o dolico arter vertebral stng
ce amprenteaz bulbul rahidian.
Examenul oftalmologic, la 8 luni de la debut, o dat cu creterea frecvenei simptomelor,
evideniaz la biomicroscop micri scurte de ciclorotaie a globului ocular, mai ales la privirea
n jos i n adductie, corespunztor senzaiilor de oscilopsie, moment n care se stabilete
diagnosticul de SOM. Cauza poate fi legat de anomaliile vasculare cerebrale situate n
vecintatea emergenei rdacinii nervului trohlear.
Se ncepe tratament cu propanolol 20 mg/zi si anxiolitice cu ameliorarea i dispariia
simptomelor dup 3 luni de tratament, pacientul fiind stabil la 18 luni de urmrire.
Discuii:
SOM este o entitate rar de strabism care trebuie recunoscut, posibilitile de tratament fiind
medical sau chiar chirurgical n formele cronice.
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7. Superior oblique myokymia- a rare form of strabismus

M. Dragomir,
Superior oblique myokymia is a rare monocular rotator nystagmus, characterized by short

episodic oscillopsia or vertical/tilted vision.
Etiology is still unclear and seems to be a damage of trohlear nerve which causes short
contracture of superior oblique muscle.
Methods: A 36 year old man presented from 8 months with brief episodes of image shimmering
on left eye, some times per day. No treatment or diagnosis was done.
Cerebral RMI shows microcystic lesion on left peduncul, congenital vascular anomaly of left
ACA, and dolico left vertebral artery which compress the bulb.
At 8 month from the onset, the biomicroscopical exam reveals shorts rotatory movements of
left eye especially in down and adducted gaze simultaneous with jumping vision.
Diagnosis of SOM was made and treatment with Propanolol 20 mg BD and anxiolitics was
started. Marked improvement in symptoms was noted after 3 months and the patient remains
stable at 18 months of follow up.
Discussion: SOM is a rare form of strabismus, and sometimes remains unrecognized long time.
The treatment could be medical or surgical in chronic, resistant forms.
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8. Esotropie i retinoschisis juvenil

- o asociere rar i neateptat
M. Dragomir
Clinica Oftapro, Bucureti
Retinoschizisul juvenil este o afeciune genetic a retinei caracterizat prin separarea anormal
a straturilor retiniene la nivelul stratului plexiform extern. Apare la sexul masculin cu o
prevalen estimat de 1 caz la 5000 25000 persoane. Acuitatea vizual este afectat cu
variaii ntre 20/20 pn la 20/200 sau mai puin. Media la adulii tineri este de 20/70.
Nu exist tratament disponibil pentru aceast afeciune n acest moment, dar terapia genic ar
putea fi o posibilitate n viitor.
Material i metoda: n anul 2011 s-a prezentat la un consult un biat n vrst de 4 ani i
jumtate, pentru deviaia n convergena a OD observat de circa 1 an. Examenul oftalmologic
arta esotropie de 15 DP, predominant OD, cu acuitate vizual VOD 20/80, VOS 20/40. La
examinarea FO se observ n aria macular, bilateral, striaii radiare i se ridic suspiciunea de
retinoschizis macular, care este confirmat ulterior de examinarea OCT a maculei. Ca tratament
s-a recomandat corecie optic i ocluzie OS care a dus la mbuntirea uoar a acuitii
vizuale: VOD 20/50, VOS 20/30. Aspectul maculei i performana vizual a rmas staionar
fr complicaii pn n prezent.
Concluzii:
Examenul oftalmologic la un copil cu strabism trebuie s fie ct mai complet pentru c pot
exista asociaii de patologii care schimb radical prognosticul.
Retinoschizisul juvenil X linkat se poate complica n timp cu hemoragie vitreeana, dezlipire de
retin i necesit urmrire anual.
Studiile genetice actuale, efectuate pe animale, au artat c prin folosirea unor vectori nonvirali
se poate obine restaurarea expresiei retinoschisinei, proteina absent din aceast boal, cu
imbuntirea funcionrii stratului de fotoreceptori ai retinei.
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8. Esotropia and juvenile retinoschisis

- an unexpected and rare association
M. Dragomir,
Juvenile retinoschisis is a genetic eye disease characterized by the abnormal splitting of the
retinas neurosensory layers, usually in the outer plexiform layer. The prevalence of X-linked
juvenile retinoschisis is estimated to be 1 in 5000 to 25000 males worldwide. The visual acuity
ranges from 20/20 to less than 20/200. The average visual acuity in young adults is around
20/70.
No treatment is available in this moment but gene therapy may be a viable therapeutic option
in the future.
Methods: In 2011, a 4, 5 year boy came for a medical consultation with the suspicion of
deviation in the convergence of OD, noticed for about one year. The ophthalmologic
examination showed a 15 PD right esotropia, with visual acuity of right eye 20/80, and left eye
20/40. At the fundus examination radial striations were noticed in the bilateral macular area
and the suspicion of macular retinoschisis arose, which was later confirmed by the macular
OCT. The recommended treatment consisted of optical correction and left eye occlusion, which
led to slight improvements in visual acuity: RE 20/50, LE 20/30. The macular appearance and
the visual performance remained stationary without complications so far.
Conclusion: The ophthalmologic examination in a child with strabismus should be as complete
as there may be pathologies associations, that radically change the prognosis.
X-linked juvenile retinoschisis may be complicated lately by vitreous hemorrhage, retinal
detachment and therefore needs annual monitoring.
The current genetic studies on animals have shown that by using nonviral vectors there can be
obtained the restoration of the expression of retinoschisine, a protein lacking during this
disease, with the improving of the functioning of the photoreceptor layer of retina.
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9. Reintervenie pentru exotropie recidivat

dup perforarea intraoperatorie a sclererei cu hemoragie vitrean
A.Ciubotaru1, L. Bcanu2, L.ram2, M. Caunei Florescu1, P.I. Grecu2,
1
2
Clinica Oftalmologic Infosan, Bucureti

Spitalul Clinic de Urgene Oftalmologice, Bucureti
Lucrarea prezint cu cazul unui tnr pacient cu strabism divergent, care a fost operat n urm
cu un an n alt clinic pentru exotropie, practicndu-i-se la ochiul drept retropoziia muchiului
drept extern 5 mm. Dei postoperator unghiul de deviaie strabic a fost corectat la -2 grade (4
DP), la scurt timp pacientul a revenit cu scderea acuitii vizuale la ochiul drept i exotropie
recidivat. S-a constatat prezena unei hemoragii vitreene pentru care s-au practicat
vitrectomie, endolaser i ulterior injecii cu triamcinolon (pentru apariia unui edem macular).
La un an dup vitrectomie, am reintervenit la ochiul drept i am practicat re-recesia muchiului
drept extern 5mm cu avansarea muchiului drept intern 5mm (care fusese operat n copilrie),
cu corecia total a deviaiei strabice.
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9. Reintervention for recurrent exotropia

after scleral perforation with vitreous hemorrhage
A.Ciubotaru1, L. Bcanu2, L.ram2, M. Caunei Florescu1, P.I. Grecu2,
1
2
Infosan Eye Clinic, Bucharest

Emergency Eye Hospital, Bucharest
This paper presents the case of a young patient with RE divergent strabismus who was operated
a year ago in another clinic for right exotropia (right lateral rectus recession of 5 mm). Although
postoperatively the deviation angle was corrected to -2 (4 PD), the patient returned shortly
with a decreased visual acuity in the right eye and recurrent exotropia. It was discovered the
presence of a vitreous hemorrhage for which vitrectomy, endolaser and triamcinolon injections
were applied.
In our clinic, we performed a right lateral rectus re-recession of 5 mm with right medial
advancement of 5 mm (we descovered intraoperatively that right medial muscle was operated
in childhood), the final result beeing a favourable one.
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10. Reintervenie pentru esotropie restrictiv

la un pacient cu sindrom Goldenhar asociat cu sindrom Duane bilateral
L. Bcanu, P.I. Grecu
Spitalul Clinic de Urgene Oftalmologice, Bucureti
Un pacient de sex masculin n vrst de 17 de ani se prezint pentru diagnostic i tratament n

serviciul nostru.
n urma examenului clinic diagnosticul stabilit este: Sindrom Goldenhar. AO Sindrom Duane
tip I. Esotropie. Pterigion tip I. Formaiuni pseudotumorale subconjunctivale OD fund de sac
inferior i OS epibulbar inferointern. OD Ptoz palpebral moderat. Miopie forte. Ambliopie
mare.
Pacientul a suferit o intervenie chirurgical de excizie a unor chisturi dermoide limbice AO n
urm cu 9 ani i o retropoziie a muchiului drept intern la OD n urm cu 7 ani pentru
corectarea esotropiei.
La examenul clinic se msoar un unghi de strabism de 25-30 de grade OSF cu limitarea
abduciei i retracia ochiului n orbit, cu ngustarea fantei palpebrale n adducie i cu
fenomen de upshoot la ambii ochi. Ochiul drept nu fixeaz.
n urma evalurii oftalmologice i generale preoperatorii se decide s se intervin asupra OD
sub anestezie local datorit patologiei cardiace asociate. n timpul interveniei se constat o
reacie subconjunctival fibrotic intens n unghiul intern cu prolaps de grsime orbitar
inferonazal. Se descoper muchiul drept intern retropozionat la 7.5 mm fa de inserie, acesta
fiind nglobat n masa fibrotic.
Se excizeaz grsimea orbitar herniat i se desfac aderenele cu muchiul drept intern,
eliberndu-se muchiul din masa organizat fibros. Se hotrte temporizarea interveniei
pentru formaiunea pseudotumoral OS datorit complianei slabe a pacientului i a statusului
su cardiovascular.
Examenul clinic postoperator relev corectarea unghiului de strabism la zero grade.
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10. A case of reintervention for restrictive esotropia

in a patient with Goldenhar syndrome and bilateral
Duane syndrome
L. Bcanu, P.I. Grecu,
Case report: A 17 years old male patient was referred to our clinic for diagnosis and treatment.
After clinical evaluation the established diagnosis was Goldenhar Syndrome. OU Type I Duane
Syndrome. Esotropia. Type I Pterygium. OD Inferior Fornix and OS Epibulbar Inferonasal
Sector Subconjunctival Pseudotumors. OD Moderate Eyelid Ptosis. High Myopia. High
Amblyopia.
The patient underwent a surgical intervention OU for the excision of limbal dermoids 9 years
ago and a RMR retroposition 7 years prior actual presentation for esotropia correction.
The clinical exam revealed a 25-30 degrees angle of squint, the limitation of abduction and
retraction of the globe on attempted adduction with palpebral fissure narrowing and upshoot in
both eyes.
Following preoperatory ophthalmological and general evaluation the decision was taken to
operate the right eye under local anesthesia considering the patient`s cardiological status.
During the intervention it was observed an intense subconjunctival fibrotic reaction in the
internal angle with inferonasal orbital fat prolapse. The RMR was found retropositioned at 7.5
mm from its insertion, being captured in the fibrotic mass.
The herniated orbital fat is excised and the adherences unloosened, the RMR being released
from the fibrotic mass. Due to patient`s bad compliance and his cardiovascular status, it was
decided to delay the surgery for the left eye pseudotumor.
The postoperative clinical exam disclosed the angle of squint correction at 0 degrees.
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11. Transpoziia temporal a muchilor drepi verticali

n sindromul Duane esotropic
Traspoziia temporal a muchilor drepi verticali (VRT) n sindromul Duane esotropic este o
tehnic controversat. Tehnicile chirurgicale clasice au scopul de a reduce esotropia i poziia
compensatorie a capului: recesia uni- sau bilateral a muchilor drepi interni, recesia
muchiului drept intern la ochiul afectat i fir de fixaie posterioar pe muchiul drept intern
la ochiul congener.
Alte tehnici chirurgicale au scopul de a reduce retracia globului i a fenomenului de up- or
down-shoot: recesia ambilor drepi orizontali sau fixarea dreptului extern la periostul orbitei la
ochiul afectat.
Transpoziia temporal a muchilor drepi verticali, jumtate sau ntreaga lime a tendonului
are scopul de a mbuntii abducia i de a lrgii cmpul vizual binocular.
Augmentarea transpoziei cu fir de fixaie Foster este recomandat n cazurile cu esotropie
mare i poziie compensatorie a capului semnificativ, cu scopul de a crete fora abductoare
creat de transpoziie.
VRT poate fi utilizat ca o prim procedur n sindromul Duane esotropic iar recesia
muchiului drept intern la ochiul afectat este utilizat ca o a doua procedur dac exist
esotropia restant dup transpoziie.
VRT este rezervat cazurilor fr retracie sau cu retracie minim a globului i cu limitare
sever a abduciei.
Este contraindicat n cazuri cu retracie sever, up-sau down-shoot.
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11. Vertical rectus transposition in esotropic Duane syndrome

Vertical rectus transposition (VRT) in esotropic Duane Syndrome is a controversial procedure.

The classic surgical options in esotropic Duane Syndrome are aimed to improve esotropia in
primary position and the head turn (unilateral or bilateral recession of the medial recti, medial
rectus recession on the affected eye with posterior fixation suture on the medial rectus of the
sound eye). Other techniques are aimed to improve globe retraction, up- or down-shoot:
recession of both horizontal recti or lateral rectus periost fixation in the affected eye.
VRT half width or full tendon transposition to the lateral rectus is aimed to improve abduction
and to enlarge binocular field.
Augmentation with posterior lateral augmentation suture (Foster suture) of the transposed
muscles is recommended in patients with large esotropia and larger face turn, in order to
increase abduction force.
VRT is used as first procedure in patients with esotropic Duane Syndrome and medial rectus
recession in the affected eye as the second procedure in patients with residual esotropia after
VRT.
VRT is reserved to cases with minimal or no globe retraction and severe limitation of
abduction.
It is contraindicated in severe globe retraction, up- or down-shoot.
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12. Definirea succesului n tratamentul ambliopiei de deprivare

dup cataract congenital unilaterala cu microftalmie
i persisten de vitros primitiv- limite i semne de ntrebare
D. Cioplean
Va fi prezentat un caz de cataract congenital unilateral nsoit persistena de vitros primitiv

i microftalmie, operat cu succes la vrsta de 4 luni ntr-un centru de chirurgie vitreo-retiniana
din straintate. Implantarea unui cristalin artificial nu a fost indicat i nici posibil. Copilul
s-a prezentat n serviciul nostru la vrsta de 7 luni cnd a nceput tratamentul de recuperare al
ambliopiei odat cu aplicarea primei corecii optice i ocluzie. n prima etap ncercarea de
corecie cu lentil de contact a euat dar a fost posibil corecia aeriana. Compliana copilului
i a parinilor au fost exceptionale, pacientul avnd n prezent, la vrsta de 4 ani, o acuitate
vizual pe ochiul operat de 20/50 cu corecie, cu tensiune intraocular normal i retina
ataata.Urmarirea a fost facut in etapa iniial la 3 luni iar dupa vrsta de 2 ani la 5-6 luni.
Corecia cu lentil de contact a fost posibil doar n ultimul an dar sunt multe intrebri care se
ridic pentru viitor. Fetia prezint o exotropie pentru care parinii au refuzat pna n prezent
chirurgia, iridectomia efectuat odat cu chirurgia vitreo retininiana ridic probleme vis-a-vis
de corecia cu o lentil de contact gaz-permeabil iar ntrebarea major este dac alinierea i
corecia optic ideal vor fi bine tolerate n vedere binocular. Va face supresie?
Va avea diplopie ?
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12. How to define successful treatment in deprivation amblyopia

after unilateral congenital cataract with microphthalmia
and PHPV- limits and questions
D. Cioplean,
We will present a case of unilateral congenital cataract accompanied by persistance of

hyperplasic primitive vitreous and microphthalmia, successfully operated abroad in a vitreoretinal surgery center. The intraocular lens implantation was not possible and indicated
resulting unilateral aphakia. The patient was operated at the age 4 months and it was reffered
to us at age 7 months by chance. The correct amblyopia treatment started immediately after
the first check, once the optical correction wearing and patching started. Due to objective
reasons, contact lens fitting was not possible at that time but the child easelly accepted glasses.
The child and parents compliance were exceptional, and now, after 3 years of continuous
patching and adecquate correction she can see 20/50 with the aphakic eye. The intraocular
pressure is normal and the retina attached.
Until age 2 years the follow-up was made every three months and after that every 6 months.
The contact lens fitting was possible only in the last months but they are a lot of questions
which raise for the future.The girl has an exotropia and the parents refused until now the
surgical correction. The iridectomy done during the surgery imposes some limits regarding the
RGP fitting and the main question is if the allingment and the ideal correction with contact
lens will be well tolerated in binocular vision. She will suppress ? She will be diplopic ?
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13. Standardul de ngrijire al nou-nscutului prematur

i retinopatia de prematuritate sever
C. Niulescu, C. Nascutzy,
IOMCAlfred RusescuBucureti
Scop: Analiza factorilor de risc asociai prematuritii la copiii care au dezvoltat forme severe
de retinopatie de prematuritate.
Metoda: Au fost incluse dou loturi de copii provenii din dou materniti din Bucureti care
au necesitat tratament, nscui n perioada 01.01.2010-31.12.2012, cu vrsta de gestaie (VG)
34s i/sau greutatea la natere (GN) 2000 gr: 59 de copii de la maternitatea (M) nr. 1
(reprezint 12,4% din totalul de 476 de copii examinai) i 57 de copii de la M. nr.2 (38,2% din
totalul de 149 de copii examinai). Au fost urmrite VG, GN, modul de resuscitare imediat
postnatal, administrarea de oxigen i de mas eritrocitar, prezena infeciei neonatale.
Rezultate: La grupa cu VG 33-34 s, la M nr.1 niciun copil nu a fost tratat, pe cnd la M nr.2,
17 copii (29,8%) au avut nevoie de tratament; toi copiii au primit oxigen suplimentar, iar cei
cu VG 33-34 s de la M. nr.2 au fost reanimai la natere cu oxigen 100% pe masc cu balon; 7
(11,9%) copii de la M. nr. 1 au primit surfactant i 4 copii (7%) de la M. nr.2; 39 de copii (66%)
de la M. nr.1 au primit mas eritrocitar i 35 (61%) de la M. nr. 2; 7 copii (11,9%) au avut
stare septic de la M. nr. 1 i 29 (51%) de la M. nr. 2; dopamin au primit 18 copii (30,5%) de
la M. nr. 1 i 39 copii (68,4%) de la M. nr.2; la 41% dintre copii am gsit o corelaie ntre starea
septic a nou-nascutului si o patologie infecioas matern.
Concluzii: ngrijirea-nou nscutului prematur are cea mai mare importan pentru evoluia
retinopatiei de prematuritate; este obligatoriu ca administrarea suplimentar de oxigen s fie
monitorizat cel puin n funcie de Sa O2 periferic, dup valori standardizate; este necesar
elucidarea cauzei sepsisului neonatal, mai ales n absena patologiei infecioase materne.
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13. The standard of neonatal premature care

and severe retinopathy of prematurity
C. Niulescu, C. Nascutzy,
IOMCAlfred RusescuBucharest
Purpose: analysis of prematurity related risk factors at children who developed severe
retinopathy of prematurity (ROP).
Method: in the study were included two groups of infants from two maternities from Bucharest
who needed treatment, born between 01.01.2010-31.12.2012, with gestational age (GA) 34
s and/or birth weight (BW) 2000 gm: 59 infants from maternity (M.) No. 1 (12,4% out of
476 infants tested for ROP) and 57 infants from M. No. 2 (38,2% out of 149 infants tested).
GA, BW, neonatal resuscitation immediately after birth, oxygen administration and blood
transfusions, neonatal sepsis were analyzed.
Results: from 33-34s GA group, no one needed treatment from M. No.1, but 17 children (29,8%
out of 59 infants treated) were treated from M. No. 2; oxygen was administered to all of the
babies, and the infants with 33-34s GA from M. No. 2 were resuscitated with unmonitored
unblended oxygen immediately after birth; 11 (18,6%) infants from M. No. 1 were given
surfactant and 4 infants (7%) from M. No. 2; 39 infants (66%) from. No. 1 were given blood
transfusions and 35 (61%) from M. No.2; 7 infants (11,9%) from M. no.1 were diagnosed with
neonatal sepsis and 29 (51%) from M. no. 2; 18 infants (30,5%) from M. No. 1 were given
dopamine and 39 infants (68,4%) from M. No.2; there were a correlation between neonatal
sepsis and maternal infectious pathology for 41% infants.
Conclusions: the standard of neonatal care have the greatest importance for ROP evolution; it
is mandatory that the supplemental oxygen administration to be monitored at least by peripheral
oxygen saturation, using standardized values; it is of great importance to know the causes of
neonatal sepsis in the absence of maternal infectious pathology.
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14. Adaptarea lentilelor de ortokeratologie

la un caz de miopie rapid progresiv
A.M. Pop,
Clinica Optilens, Cluj-Napoca
Scop: se prezinta cazul unei fetite de 9 ani, cu miopie medie cu evolutie rapida, cu antecedente
heredo-colaterale de miopie forte(mama), respectiv miopie mare(tata), adaptata cu lentile de
ortokeratologie.
Metoda: s-au evaluat: acuitatea vizuala cu cea mai buna corectie optica, lungimea axului
anteroposterior, topografiile corneene, biomicroscopia polului anterior- inainte si pe
parcursul tratamentului.
Rezultate: -au fost necesare doua reevaluari ale tratamentului si inlocuiri ale lentilelor de
ortokeratologie pe parcursul a 2 ani de tratament pentru obtinerea si mentinerea unei acuitati
vizuale optime
Concluzii: -conform masurarii axului anteroposterior, evolutia miopiei a fost mai lenta in 2 ani
(pe parcursul tratamentului), fata de anul precedent instituirii acestuia
-nu au existat complicatii legate portul lentilelor de contact
-acuitatea vizuala oferita pe parcursul zilei a fost optima
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14. Adapting orthokeratology lenses in rapidly progressive myopia

A.M. Pop,
Optilens Clinic, Cluj-Napoca
Goal: presenting the case of a 9-year old girl, suffering from medium myopia with rapid
progression, with heredo-collateral antecedents of myopia forte(mother) and high myopia
(father), adapted with ortho-k lenses.
Method: we have assessed the following: visual acuity with best optical correction, length of
the anteroposterior axis, corneal topography results, biomicroscopic exams of the anterior pole
- before and during treatment.
Results: the patient needed two treatment reevaluations and replacements of the ortho-k lenses
during a 2-years treatment period to obtain and maintain optimal visual acuity
Conclusions: according to the anteroposterior axis measurements , the progression of her
myopia was slower in 2 years(during treatment) compared to the year before treatment was
initiated
-no complications associated with wearing contact lenses were reported
-visual acuity during the day was optimal
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15. Corecia i controlul progresiei miopiei la copii

L. Constantin, D. E. Popa
Clinica de Oftalmologie, SCJU Sibiu
Spitalul "Polisano" Sibiu
Ortokeratologia este o metod modern reversibil i noninvaziv de corecie i control a

progresiei miopiei prin remodelarea corneei pe timpul nopii.
Prezentm cteva cazuri de miopie mic i medie corectat prin aceast metod, dificultiile
ntlnite i modalitile de rezolvare ale acestora.
Concluzii:
Ortokeratologia este o opiune eficient de tratament n cazul miopiei la copii de pn la 4.00
D, ncetinete progresia miopiei, ofer libertate deplin unor activiti sociale, recreaionale i
sportive, mbuntete calitatea vederii pe timpul zilei fr purtarea lentilei de corecie
aerian sau de contact moi.
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15. Correction and control of myopia progression in children

L. Constantin, D. E. Popa
Ophthalmology Clinic , SCJU Sibiu
Polisano Hospital Sibiu
Ortokeratology is a modern reversible and noninvasive method of correction and control of

myopia progression using overnight corneal reshaping.
We are presenting a number of cases with mild and medium myopia treated with this method,
difficulties in treatment and methods of dealing with them.
Conclusion: Ortokeratology represents a safe and effective treatment for progression of
myopia in children not more than 4.00 D, offering freedom for social and recreational
activities , sports , improving quality of vision during day without the use of a correction
lenses or soft lenses.
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16. Cataract traumatic operat la copil

I. Iosub, L. ram,
Spitalul Clinic de Urgene Oftalmologice Bucureti
Lucrarea prezint cazul unui copil in vrst de 8 ani, ce se prezint la SCUOB in data de
12.08.2013 pentru care mama acuz la OD scderea acuitii vizuale posttraumatism, survenit
n data de 7.08.2013, declarativ n context domestic.
La internare: VOD=Numr degetele la 30 cm, VOS=1 fc, TOD=18 mmHg, TOS=16 mmHg.
Examinarea polului anterior obiectiveaz: OD: plag cornean paracentral coaptat, mase
cristaliniene in camera anterioar, cristalin opacifiat n toate straturile.
Examinarea polului posterior al OD este inexplorabil .
Ecografia ocular a OD ilustreaz retina atasat.
Diagnosticul este de OD Status posttraumatism forte, Plag cornean, Cataract traumatic.
Intervenia chirurgical s-a realizat pe data de 13.08.2013 sub anestezie general, practicanduse la nivelul OD: aspirarea maselor cristaliniene din camera anterioar, extracia extracapsular
a cristalinului prin aspirare, implantare de pseudofak de camer posterioar.
Evoluia postoperatorie este favorabil.
La externare prezint VOD=1 fc, TOD=17 mmHg
Prognosticul funcional ocular este foarte bun.
Particularitatea cazului const n recuperarea excelent postintervenie, cu toate c operaia sa realizat dup mai multe zile posttraumatism.
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16. Traumatic cataract

I. Iosub, L. ram,
This paper presents the case of an 8 years old pacient, came to the Emergency Eye Hospital in
12.08.2013 accompanied by his mother, accusing post-traumatic RE decreased visual acuity
occurring on 07.08.2013.
On admission : RVA = counts fingers at 30 cm , LVA = 6/6
Examination of the RE anterior pole = paracentral corneal wound ripe, lens opacified in all
layers .
Examination of the RE posterior pole is inexplorable .
RE ocular ultrasound illustrates attached retina.
Positive diagnosis is RE corneal wound , traumatic cataract .
The surgery was performed on 13.08.2013 under general anesthesia, practicing the RE lens
masses suction from the anterior chamber, extracapsular extraction of lens through aspiration,
posterior chamber IOL implantation .
The postoperative evolution is favorable.
Discharge presents RVA = 6/6
The ocular functional prognosis is very good, if postoperative recommendations are respected.
The particularity of the case lies in the excellent post-intervention recovery, despite the fact the
surgery was performed several days after the traumatism.
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17. Administrarea intravitreean de Bevacizumab

pentru tratamentul membranei neovasculare coroidiene
asociate distrofiei maculare viteliforme Best
C.Taban, A. Merticariu, L. Melcioiu, A. Oprescu, R. Ionescu, A. Iacob, F. Balt,
Spitalul Clinic de Urgene Oftalmologice Bucureti
Prezentm cazul unui pacient n vrst de 11 ani cu antecedente heredocolaterale de boal Best
si diagnosticat cu distrofie macular viteliform complicat cu membran neovascular
coroidian (MNVC) subfoveolar. Pacientului i s-a adminstrat o serie de 3 injecii cu
bevacizumab (1,25 mg/0.05 ml) la interval de o lun intre injecii i a fost urmrit timp de 6
luni.
La o lun dup prima injecie, acuitatea vizual s-a mbuntit cu 8 rnduri ( de la 0.1 ps la
0.9 ps). Tomografia n coeren optic a retinei a artat resorbia lichidului subretinian,
normalizarea profilului foveal i micorarea MNVC.
La controlul de 6 luni acuitatea vizul i aspectul fundului de ochi au rmas stabile. Nu au fost
observate efecte adverse oculare sau sistemice asociate terapiei.
Concluzii: Tratamentul intravitreean cu Bevacizumab poate fi o soluie eficient in cazul
membranei neovasculare asociate distrofiei maculare viteliforme Best, dar, n continuare, sunt
necesare studii mai ample.
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17. Intravitreal bevacizumab in the treatment of choroidal

neovascular membranes associated with
Bests vitelliform dystrophy
C.Taban, A. Merticariu, L. Melcioiu, A. Oprescu, R. Ionescu, A. Iacob, F. Balt,
We present the case of an 11-year-old boy with a positive family history of Best disease and
confirmed Best vitelliform macular dystrophy. The macular lesion was complicated by
subfoveal choroidal neovascularization (CNV) for which three monthly intravitreal injections
with Bevacizumab(1.25 mg/0.05 ml) were administered.
One month after the first injection, visual acuity improved by 8 lines (from 0,1 to 0,9) , and a
regression of the neovascular lesion with resolution of the exudative manifestations was
observed. Optical coherence tomography of the retina revealed resorbtion of the subretinal
fluid, restoration of normal macular architecture and contraction of the CNV.
Six months following the first injection with Bevacizumab, the best corrected visual acuity was
maintained and fundus appeared stable. No drug-related ocular or systemic side effects were
encountered.
Conclusions: Intravitreal injections with bevacizumab may be an effective treatment for
subfoveal neovascular lesions in Best vitelliform macular dystrophy, but more extensive
studies are required.
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18. Ectropion uveal congenital cu multiple chiste

la nivelul marginii pupilare - rezolvare chirurgical
A. Ciubotaru, L.Popescu, D. Cerceanu
Clinica Oftalmologic Infosan
Departamentul de Oftalmologie, Spitalul Judeean de UrgenTrgovite
Lucrarea prezint cazul unei fetie de 4 ani, care s-a prezentat n clinica noastr cu multiple
chiste iriene la nivelul marginii pupilare a ambilor ochi. Deoarece aceste chiste iriene epiteliale
obstruau axul vizual, acoperind total pupila n mioz, am decis si am practicat excizia lor
chirurgicala, cu un rezultat postoperator favorabil.
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18. Congenital ectropion uveae with multiple epithelial cysts at pupillary

margin surgical management
A. Ciubotaru, L.Popescu, D. Cerceanu
Infosan Eye Clinic, Bucharest
Ophthalmology Clinic, SJUTrgovite
This paper presents the case of a four-year-old girl, who presented in our clinic with multiple
epithelial iris cysts at the pupillary margin of both eyes. As these epithelial iris cysts obstructed
visual axis, covering total pupillary aperture in miosis, we decided and performed their surgical
excision with a favourable postoperative result.
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19. Hipoplazie foveolar izolat-caz clinic

S.Sevan, C. Vlduiu1, 2
Clinica Iris, Cluj-Napoca
Clinica Oftalmologic, Cluj-Napoca
Introducere: Hipoplazia foveolar este o afeciune relativ rar, clasic bilateral, cu alterarea
variabil a acuitii vizuale, caracterizat histopatologic prin absena depresiunii foveolare i
persistena straturilor retiniene interne la acest nivel ( modificri confirmate prin tomografia n
coeren optic).
Material i metode: Raportm cazul unei paciente cu hipoplazie foveolar izolat monocular,
diagnosticat la vrsta de 4 ani, care a urmat tratament pleioptic , cu o complian excelent.
Pacienta a fost monitorizat sistematic, n ultimii 4 ani, intervenindu-se activ pentru corecia
altor factori ambliopigeni aprui n evoluie ( corecia chirurgical a esotropiei instalate
secundar ocluziei full-time) i pentru meninerea nivelului acuitii vizuale (filtre Bangerter).
Rezultate: In urma tratamentului pacienta a prezentat o ameliorare semnificativ a acuitii
vizuale n ochiul afectat.
Discuii i concluzii: Exist autori care sugereaz utilizarea termenului de disgenezie foveolar
sau foveea plana n locul celui de hipoplazie foveolar, subliniind faptul c supraspecializarea
conurilor la nivel foveolar poate fi prezervat chiar i n prezena modificrilor anatomice
patologice. Astfel, n cazuri selectate, tratamentul ambliopiei n hipoplazia foveolar poate fi
unul de success.
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19. Isolated foveal hypoplasia-clinical case report

S.Sevan, C. Vlduiu1, 2
Iris Pediatric and General Ophthalmology Clinic, Cluj-Napoca
Ophthalmology Clinic, Cluj-Napoca
Introduction: Foveolar hypoplasia is a relative rare disease, classically bilateral, with variable
visual acuity levels, histopathologically characterized by the absence of the foveal pit and the
persistence of the internal retinal layers at this level ( also confirmed by optical coherence
tomography).
Material and methods: We report the clinical case of a female patient with monocular isolated
foveal hypoplasia, diagnosed at the age of 4 years old, who has followed pleioptic treatment,
with an excellent compliance . Systematic follow-up of the patient was performed, during the
last 4 years, with active intervention for the correction of other ambliopigenic factors ( surgical
correction of esotropia secondary to full time occlusion ) and visual acuity mainteinance
therapy ( Bangerter filters).
Results: Following treatment there was significant recovery of the visual function in the
affected eye.
Discussions and conclusions: There are papers that suggest using the term of foveal disgenezia
or foveea plana, underlining the fact that overspecialization of the fovel cones can be preserved,
even there are pathological anatomical changes in the foveea. Thus, in selected cases,the
treatment of amblyopia in foveal hypoplasia can be a success.
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20. Uveita anterioar la copil: o provocare diagnostic i terapeutic

A. Grigorescu,
Introducere: Artrita juvenil idiopatic reprezint cea mai frecvent afeciune sistemic
asociat cu uveita anterioar cronic la copii.
Material i metod: Pacientul C.A., 5 ani, s-a prezentat pentru suspiciune de conjunctivit
datorit unui ochi rou intermitent de cteva luni. n urma examenului oftalmologic s-a stabilit
diagnosticul de uveit anterioar cronic. Consulturile interdisciplinare (pediatric i
reumatologic) i analizele specifice au ridicat suspiciunea de artrit juvenil idiopatic.
Rezultate: Fenomenele de uveit s-au ameliorat sub tratament intensiv imunosupresor, dar au
aprut complicaiile specifice bolii: keratopatie n bandelet i cataract.
Concluzii: n marea majoritate a cazurilor, manifestrile articulare apar naintea diagnosticrii
uveitei. Dar atunci cnd investigaiile nu deceleaz o cauz etiologic evident, datorit
aspectului clinic i rspunsului favorabil la tratamentul specific, se poate considera uveita ca
fiind prima manifestare a bolii.
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20. Childhood anterior uveitis: diagnose and therapeutic challenge

A. Grigorescu,
Juvenile idiopathic arthritis is the most common systemic disease associated with childhood
anterior uveitis.
Material and Method: A five year old boy presented with suspicion of conjunctivitis because
of a several months history of intermittent red eye. Ophthalmic examination, pediatric and
rheumatologic consult, specific investigations, oriented the diagnosis towards chronic anterior
uveitis with suspicion of juvenile idiopathic arthritis.
Results: Under immunosuppression treatment decreased the inflammation, but developed
specific complications (cataracts and band keratopathy).
Conclusions: In the greater majority of cases, arthritis antedates the diagnosis of uveitis. But
when there is no evident etiology of uveitis, because of clinical aspect and favorable response
to specific therapy, we might consider uveitis as the primary manifestation of the disease.
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21. Tratamentul cu propranolol sistemic pentru hemangiomul

capilar periocular
I.D. Boricean,
Spitalul Clinic de Copii, Braov
Scop: Aprecierea eficacitii i siguranei administrrii sistemice a propranololului n

tratamentul hemangiomului capilar periocular.
Material i metoda: Prezentm cazul unei fetie de 3 luni cu hemangiom capilar la nivelul
pleoapei superioare i orbitei anterioare drepte, cu factori de risc pentru dezvoltarea ambliopiei,
care a fost tratat cu propranolol administrat per os. S-a nceput cu o doz de 0,5mg/kgc/zi 1
sptmn, 1mg/kgc/zi a doua sptmn si apoi 2mg/kgc/zi mprite n dou doze cu
monitorizarea tensiunii arteriale i a pulsului. Mrimea hemangiomului a fost documentat
iniial prin examenul clinic cu fotografiere i examenul prin tomografie computerizat, ulterior
pe perioada tratamentului i la finalul studiului s-a examinat clinic cu fotografiere periodic i
s-a efectuat ecografie orbitar. Tratamentul a fost oprit dupa 8 luni, n momentul n care
leziunea devenise abia vizibil i examenul oftalmologic nu a mai decelat factori de risc ai
ambliopiei.
Rezultate: Tratamentul cu propranolol per os a redus treptat n 8 luni mrimea hemangiomului.
Medicaia a fost bine tolerat i nu s-au constatat efecte adverse. La vrsta de 7 luni precum i
la sfritul studiului (la vrsta de 11 luni) copilul a fost capabil s coopereze i s rspund la
testul Lang pentru stereopsis ceea ce nseamn c nu a dezvoltat ambliopie.
Concluzii: Tratamentul cu propranolol oral pentru hemangiomul capilar al pleoapei i orbitei
la copii determin regresia aproape complet dup cteva luni de administrare, fr efecte
secundare majore. Propranololul oral ar putea deveni tratamentul de prim intenie al
hemangiomului capilar.
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21. Treatment with systemic propranolol for periocular capillary

hemangioma
I.D. Boricean,
Childrens Hospital, Brasov
Purpose: To assesss the efficacity and safety of systemic propranolol for periocular capillary
hemangioma
Methods: A 3-months old girl with infantile capillary hemangioma of the right upper eyelid
and anterior orbit, at risk of developing amblyopia was treated with oral propranolol. The
starting dose was 0,5mg/kg/day for 1 week, 1mg/kg/day for the following week, then 2
mg/kg/day divided in 2 doses with monitoring of blood pressure and heart rate. Size of
hemangioma was initially documented by clinical examination, CT-scan and by photography,
then by clinical examination, photography and B-scan echography throughout treatment and at
the conclusion of follow-up. The treatment was stoped after 8 months, when the lesion was
barely visible and no risk factors for amblyopia were detected.
Results: Treatment with oral propranolol reduced gradually the size of hemangioma over the 8
months treatment period. Medication was well tolerated and no adverse effects were noted. At
7 months old and at the end of the study (11-months old), the child was able to cooperate and
respond at Lang test for stereopsis which means that amblyopia has not been developed.
Conclusions: The treatment with oral propranolol for eyelid and orbital infantile capillary
hemangioma led to almost complete regression of the lesion after few months of administration
with no major collateral effects. Oral propranolol could become the first line therapy for
capillary hemangioma.
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22. Toxoplasmoza congenital sistemic

C. Niulescu,
Va fi prezentat cazul unui nou-nscut prematur diagnosticat imediat postnatal cu o form sever
de toxoplasmoz congenital sistemic, provenit din mediul rural, dintr-o sarcin
nemonitorizat. A prezentat hidrocefalie cu atrofie cortical marcat, calcificri cerebrale i
afectare ocular: uveit bilateral, dezlipire de retin i microftalmie, avnd un prognostic pe
termen lung rezervat, att ocular, ct i neurologic. Un alt nou-nscut, provenit din mediul
urban, din sarcin monitorizat (dar fr testarea Ac pentru Toxoplasma gondii), a prezentat la
natere hidrocefalie, microcalcificri cerebrale, convulsii neonatale, meningit, uveit i
corioretinit bilateral.
Investigarea i tratamentul corect al infeciilor materne care pot afecta sntatea nou-nscutului
trebuie s fie incluse ntr-un program naional, ntruct cei mai muli copii n Romnia se nasc
n familiile din medii sociale defavorizate, iar efectele acestora asupra copilului pot fi
devastatoare.
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22. Congenital systemic toxoplasmosis

C. Niulescu,
This paper present the case of a premature new-borne from rural origin, unmonitored
pregnancy, diagnosed immediately after birth with a severe form of systemic congenital
toxoplasmosis. He presented hydrocephalus with marked cortical atrophy, intracranial
calcifications and ocular manifestations: bilateral uveitis, retinal detachment and
microphthalmos, with bad ocular and neurological prognosis. Another new-borne, from urban
origin, monitored pregnancy (no Toxoplasma gondii Ac tested), presented at birth
hydrocephalus, abnormal cerebral spinal fluid, neonatal convulsions, intracranial
calcifications, bilateral uveitis and retinochoroiditis.
Diagnosis and treatment of maternal infections who could affect the baby`s health (TORCHS)
must be included in a national programme, because in Romania the most babies are born in
families with very low income and on the other hand, their effects about the baby could be
devastating.
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23. Retinopatie pigmentar X-linkat form sever

n cazul a 2 frai n prima decad de via
G. Birlea1, D. Grigoriu2,
1
2
Clinica Pro Visual, Cluj Napoca

Clinica Oftapro, Bucuresti
Retinopatia pigmentar X-linkat este o distrofie de tip bastonae conuri, cea mai rar intlnit
n cadrul retinopatiilor pigmentare, dar cu prognosticul cel mai rezervat.
Scop: Lucrarea prezint cazul a doi frai diagnosticai cu retinopatie pigmentar cu debut
precoce i afectare vizual important, avnd ca istoric familial doar rude de grad 3-4 cu
aceeai afeciune.
Metoda: Pacienii, 2 frai cu vrste de 12 respectiv 6 ani, s-au prezentat pentru scderea lentprogresiv a vederii centrale nsoit de nictalopie. Pacienii au fost evaluai clinic prin
msurarea acuitii vizuale, refracie cu cicloplegie, biomicroscopia pol anterior si posterior i
paraclinic prin perimetrie Goldman, electroretinograma, PEV si OCT n decursul evoluiei.
Ambii frai au prezentat miopie medie, acuitate vizual sub 20/70, cu afectare asimetric ntre
cei doi ochi. La modificrile retiniene cu patern pentru degenerescena miopic s-au adugat
n evoluie apariia de rari spiculi de pigment n periferia medie n cazul fratelui mai mare.
Diagnosticul s-a stabilit pe baza ngustrilor specifice ale cmpului vizual, precum i
modificri ERG rspunsul slab al conurilor n fotopic i mai ales afectarea rspunsului
bastonaelor n scotopic. Screening-ul molecular a confirmat mutaii ale genei RP2, specifice
formei x-linkate. Deoarece opiunile terpeutice sunt limitate, s-a urmrit maximizarea vederii
prin corecia optic a miopiei iar ca adjuvant s-au administrat trofice retiniene i cure scurte cu
vitamina A in doze medii.
Rezultate. Evoluia a fost lent progresiv, cu deteriorarea acuittii vizuale, modificrile
importante nregistrate fiind ngustrile cmpului vizual i aspectul ERG.
Concluzii: Degenerescena fotoreceptorilor face parte din afeciunile vizuale debilitante,
pentru care se ncearc terapii genice sau implantri de microcipuri retiniene (Argus II - aprobat
de FDA in 2013) cu scopul de a mbunti calitatea vieii acestor pacieni
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23. Severe form of X-linked pigmentary retinopathy

in the first decade in 2 siblings
G. Birlea1, D. Grigoriu2,
1
Pro Visual Clinic, Cluj Napoca, 2Ophthalmology Clinic Oftapro, Bucharest
X-linked Pigmentary Retinopathy is a rod-cone dystrophy which constitutes only

approximately 10% of all cases of Retinitis Pigmentosa, yet tends to have the most severe
prognostic of all forms.
Purpose: We present the case of two siblings which have been diagnosed with Pigmentary
Retinopathy manifested in the first decade of life, with severe visual impairment.The family
history revealed only some 3rd and 4th grade relatives with the same disease.
Method: Two siblings, 6 and 12 years old, presented with progressive visual loss and
nyctalopia. They were clinically evaluated by measuring visual acuity, cycloplegic refraction,
slit lamp exam and fundus exam, and paraclinically investigated by means of Goldmann
perimetry, electroretinography, visual evoked potential and OCT. Both brothers had myopic
astigmatism with medium myopia with BCVA less than 20/70. During follow-up
examinations, we noticed the appearance of a few bone spicules in mid -periphery of the retina
of the older brother.
Based on findings in Goldmann perimetry (progressive narrowing of visual field) and an almost
flat scotopic and fotopic ERG and also genetic tests wich revealed mutations in RP2 gene, we
were able to establish the diagnosis of X linked Pigmentary Retinopathy.
While therapies are limited, it is essential to help patients maximize the vision they do have
with refraction and low-vision evaluation. In addition, we prescribed medium doses of vitamin
A and tablets with Lutein/zeaxanthin.
Results: The evolution was slowly progressive, with visual acuity deterioration, narrowing of
the visual field and worsening of ERG response.
Conclusions: Pigmentary Retinopathy is one of the debilitating ophthalmologic disorders; gene
therapies or phototransducing chips (Argus II - FDA approved in 2013) represent the hope for
an improved quality of life for these patients.
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24. Tumor versus inflamaie

n patologia esuturilor moi extraoculare ale copilului
D. Cioplean, D. Georgescu,
Patologia inflamatorie orbitar i tumorile inflamate ale esuturilor moi extraoculare pot fi
adesea confundate, diagnosticul diferenial fiind dificil.
Obiectiv: Identificarea etapelor de diagnostic precum i a investigaiilor necesare n tranarea
diagnosticului n asemenea situaii
Material i metod: Vor fi prezentate dou cazuri cu aspect aparent de celulit orbitara,
modficari ale motilitii oculare, exoftalmie i modificri morfologice imagistice ale
muchiului drept superior de aspect tumoral n care ntregul tablou clinic, imagistica i
investigatiile de laborator nu au reuit s elimine suspiciunea de rabomiosarcom a muchiului
Drept Superior. De asemenea, va fi prezentat un caz de inflamaie conjunctival localizat
insoit de modificari morfologice ale conjunctivei n care a fost suspectata prezena unui
limfom conjunctival.
Rezultate: n primul caz, diagnosticul final a fost stabilit anatomopatologic dup extirparea
formaiunii tumorale, un chist dermoid orbitar n contact cu muchiul drept superior, perforat
spontan i care a generat fenomenele inflamatorii de vecintate.
n al doilea caz, raspunsul la tratamentul agresiv antiinflamator si antinfectios a dus la
eliminarea suspiciunii de rabdomiosarcom prin dipariia semnelor clinice i a modificrilor
imagistice ale muchiului drept superior fr ns a gsi o explicaie originii procesului
inflamator pn n prezent i necesitnd o urmrire atent in continuare.
n ultimul caz, diagnosticul a fost stabilit dupa prelevarea biopsiei care a identificat un
lipodermoid cojunctival superior, care insa fusese traumatizat iniial mecanic i ulterior chimic
de tratamentul topic agresiv administrat repetat.
Concluzie: Cazurile de acest tip necesit o abordare atent, responsabil, colaborarea cu ali
specialiti iar daca dignosticul nu poate fi tranat clinic i imagistic, biopsia corect efectuat
devine obligatorie.
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24. Tumour versus inflammation in extraocular soft tissues clinical

manifestations in children
D. Cioplean, D. Georgescu,
Very often, extraocular soft tissue inflamations can mimic tumors and viceversa, differential
diagnosis being difficult.
Objective: To identify diagnosis stages and necessary investigations in order to to find the real
diagnosis in such cases.
Material and method: We will present two cases with apparent aspect of orbital celulitis
accompanied by changes in ocular motility, proptosis and imagistic tumoral aspects of the
Superior Rectus Muscle. In both cases, the clinical aspect, the imaging and lab testes were not
able to eliminate the suspicion of rabdomyosarcoma of the Superior Rectus Muscle. Another
case of localised conjunctival inflammation miming a conjunctival lymphoma will be also
presented.
Results: In the first case, the final diagnosis was pointed after surgical removal by the
histopathological examination which identified an orbital dermoid cyst in contact with the
Superior Rectus Muscle, spontaneously perforated and generating the satellite inflammatory
manifestations.
In the second case, the suspicion of rabdomyosarcoma was eliminated only after the promptly
positive response to agressive antiinflammatory and antibacterial general treatment The
Superior Muscle Rectus imagistic changes and the clinical signs dissappeared but
unfortunatelly we still dont know which was the origin of this manifestation. The child needs
follow-up and probably more investigations.
In the last case a conjunctival lipodermoid was identified after biopsy. The clinical
manifestations were connected with a previous mecanic trauma followed by chemical trauma
induced by agressive and repetead topical treatment with steroids.
In conclusion, such cases need a very careful and responsable approach, the coopertation with
otther specialists. When the diagnosis is not relevant by clinical, lab tests and imaging, the
biopsy is mandatory.
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25. Intubaia de canal lacrimo-nazal cu tub de siliconic

sub supraveghere endoscopic nazal
L.Teodorescu, A. Agache, I. Velcea
Spitalul de pediatrie MEDLIFE, Bucureti
Intubaia cu tub siliconic a canalului lacrimo-nazal este un tratament eficient n obstrucia

recurent de canal lacrimo-nazal.
Intubaia monocanalicular (Masterka) const n sondajul canalului lacrimo-nazal prin punctul
lacrimal superior cu sonda exploratoare i apoi introducerea tubului siliconic cu ajutorul sondei
metalice pe care este ataat.
Succesul procedurii depinde de deschiderea adecvat a valvei Hasner, de evitarea inseriei
tubului ntr-o cale fals i de alegerea lungimii adecvate a tubului.
Prin examinare endoscopic nazal, se poate vizualiza captul sondei exploratoare i apoi
captul tubului siliconic dup ce a trecut prin valva Hasner. De asemenea, se poate vizualiza
dac tulbul ramne pe loc i nu se retract n timpul manevrei de scoatere a mandrenului
metalic.
Intubaia bi-canalicular (Ritleng) const n inseria probei Ritleng n canalul lacrimo-nazal i
apoi introducerea captului subire al tubului Ritleng pe incizura probei. Apoi proba se extrage
din canalul lacrimo-nazal i captul tubului Rileng se extrage din cavitatea nazal. Sub
vizualizare endoscopic captul tubului este extras uor, fr a traumatiza mucoasa cavitii
nazale.
Supravegherea endoscopic nazal face ca procedura de intubaie cu tub siliconic a canalului
lacrimo-nazal s fie mai rapid i reduce rata complicaiilor.
51

THE VITH EDITION
8-10 MAI 2014

25. Silicon intubation of the nasolacrimal duct

under nasal endoscopic survey
L.Teodorescu, A. Agache, I. Velcea
MEDLIFE Childrens Hospital, Bucharest
Silicon intubation of the naso-lacrimal duct is an effective treatment of the recurrent nasolacrimal obstruction.
Monocanalicular silicon intubation (Masterka) consists in probing the naso-lacrimal duct
through the superior lacrimal punctum and than advancing the silicon stent through the
nasolacrimal duct by pulling on the guide probe and by anchoring at the punctum by a pluglike fixation head.
The good outcome of the procedure depends on the effective opening of the valve of Hasner,
on avoiding stent insertion in a false passage and on appropriate selection of the stent length.
Under direct endoscopic visualization of the inferior turbinate the tip of the probe and then the
tip of the stent can be seen after passing through the valve of Hasner. Also, while removing the
metal guide, it may be observed if the silicon tubing stays in place and does no retract.
When using a bicanalicular stent (Ritleng), the procedure involved inserting a Ritleng probe
into the nasolacrimal duct and feeding a thread guide through it. The probe is then withdrawn
and the thread guide should be retrieved from the nose. Under direct endoscopic visualization
the thread guide is easily retrieved with no trauma of the nasal mucosa.
Nasal endoscopy survey makes the silicon intubation of the naso-lacrimal duct procedure
shorter and reduces the rate of complications.
52
A VI-A EDIIE
8-10 MAI 2014

26. Poster: Uveit anterioar hipertensiv la o pacient de 15 ani

C. Du,
Spitalul de Pediatrie Piteti
Inflamatia ocular la copii prezint o important epidemiologic deosebit , uveita fiind mai
frecvent o cauz a scderii de vedere in populatia pediatric decat in cea adult . Uveita cronic
anterioar la copii este asociat cu variate complicatii ce amenint vederea si care pot apare
precoce in evolutia bolii . Pacientii cu o afectiune mai sever la prezentare au un risc crescut
de efecte adverse aditionale . Prezentam un caz de uveit anterioar unilateral asociat cu
hipertensiune intraocular la o pacient de 15 ani cu un istoric de meningit si tuberculoz in
primii ani de viat . Tinand cont de rezultatele investigatiilor si de raspunsul la terapie, sinuzita
frontal si maxilar homolateral cronic asociat a fost identificat drept cauz .
53

THE VITH EDITION
8-10 MAI 2014

26. Poster : Hypertensive anterior uveitis in a 15 year-old girl

Claudia Duta,
Paediatric Hospital of Piteti
Ocular inflammation in children is of substantial epidemiologic importance , particularly

since uveitis in children produces more vision loss than it does in adults . Chronic anterior
uveitis in children is associated with various vision threatening complications which can
develop early in the disease course . Patients with more severe disease at presentation are at
increased risk of additional adverse effects . A case of unilateral anterior uveitis associated
with ocular hypertension in a 15 year-old girl with a history of meningitis and tuberculosis in
early childhood is presented . Judging by the results of the systemic workup and the response
to therapy , the associated homolateral chronic frontal and maxillary sinusitis was identified
as beeing the cause.
54
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SPONSORI DE ARGINT / SILVER SPONSORS
SPONSORI / SPONSORS
PARTENERI MEDIA / MEDIA PARTNERS
OPERATOR EVENIMENT / EVENT OPERATOR
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A VI-A EDIIE A CONGRESULUI

8-10 MAI 2014

Cuprins / Table of Contents

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

17. Administrarea intravitreean de Bevacizumab pentru tratamentul membranei neovasculare coroidiene

8-10 MAI 2014

1. Exotropia intermitent- rezultate postoperatorii

Scopul lucrrii: De a descrie rezultatele postoperatorii n exotropia intermitent i de a le

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

1. Surgical results in intermittent exotropia

Purpose: To describe surgical outcomes in intermittent exotropia and to relate these to

8-10 MAI 2014

2. Hipotropia restrictiv dup anestezia parabulbar

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

2. Restrictive hypotropia after parabulbar anesthesia

8-10 MAI 2014

3. Strabismul din oftalmopatia tiroidian

Orbitopatia Graves necesit o abordare clinic i terapeutic multidisciplinar.

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

3. Strabimus related to thyroid ophthalmopathy

Graves orbitopathy requires a multidisciplinary approach.

8-10 MAI 2014

4. Acurateea msurtorilor efectuate cu dispozitivul PlusoptiX

Clinica Oftalmologic, Cluj-Napoca

Scop: Compararea valorilor refractive obinute cu ajutorul autorefractometrului pediatric

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

4. The accuracy of objective refraction measurements obtained

Ophthalmology Clinic, Cluj-Napoca

Purpose: To evaluate the objective refraction measurements obtained using PlusoptiX

8-10 MAI 2014

5. Eficiena programului HTS Amblyopia iNet

Spitalul Judeean Clinic de Urgen Sibiu

Introducere: Ambliopia reprezint tulburarea sistemului visual caracterizat printr-o acuitate

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

5. HTS Amblyopia iNet software efficiency

Emergency Clinical Hospital Sibiu, Ophthalmology Clinic

8-10 MAI 2014

6. Pareza congenital a oblicului superior

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

6. Congenital superior oblique paresis

8-10 MAI 2014

7. Myokymia muchiului oblic superior

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

7. Superior oblique myokymia- a rare form of strabismus

Superior oblique myokymia is a rare monocular rotator nystagmus, characterized by short

8-10 MAI 2014

8. Esotropie i retinoschisis juvenil

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014

8. Esotropia and juvenile retinoschisis

8-10 MAI 2014

9. Reintervenie pentru exotropie recidivat

Clinica Oftalmologic Infosan, Bucureti

THE CONGRESS OF THE ROMANIAN SOCIETY

8-10 MAI 2014