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Radiotherapy is one of the cornerstones for treatment of patients with intracranial metastases. Whole brain radiotherapy (WBRT) as well as stereotactic radiosurgery are part of the non-surgical treatment for brain metastases. The toxicities associated with the treatment, among which we cannot neglect cognitive impairment, represent a current topic in an era marked by advances in oncological treatments with implications for the long-term survival of these patients. The mechanisms that involve the onset of cognitive decline are multiple and are still the subject of research. We propose to highlight the pathophysiological elements involved in cognitive impairment as well as strategies including hippocampal avoidance (HA) WBRT for different histological cancer type candidates for target therapies that cross the blood-brain barrier. Even if the implementation of HA-WBRT plus memantine as standard is still a subject for debate, for cases with multiple brain metastases or metastases unsuitable for targeted radiotherapy and a life expectancy > 4 months, it is necessary to apply a preventive strategy for the impairment of cognitive function. New studies to evaluate cognitive function for long term survivals, but also an evaluation of other factors including the number and volume of brain metastases, their intracranial and extracranial localization and the effect of modern oncological therapies must be included in future analyzes and studies. [ABSTRACT FROM AUTHOR]

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Bevacizumab is a recombinant humanized monoclonal antibody directed against vascular endothelial growth factor (VEGF). Though other VEGF inhibitors are being approved for the treatment of ophthalmological conditions, bevacizumab found its way into ophthalmology and clinical practice all around the world. The objective of this review is to present the ophthalmic dosage and administration pathways of bevacizumab in treating refractory glaucoma patients. [ABSTRACT FROM AUTHOR]

Rationale (hypothesis). Although cataract and glaucoma represent an increasingly common situation encountered concomitantly, the management of this association is still debatable. Objective (aim). We aimed to assess intraocular pressure dynamics after phacoemulsification in patients with uncontrolled primary open angle glaucoma (POAG). Methods and Results. The present study was designed as a prospective, non-randomized, cohort study. The study population comprised of 38 patients with medically uncontrolled POAG who underwent cataract surgery by phacoemulsification between 2011 and 2012. Most of the patients (32/38, 84.2%) needed glaucoma surgery after a variable time (mean time between surgeries was 11.6 +/- 4.18 months). Mean preoperative IOP decreased with 2,1 +/- 3,7 mmHg at 6 months (CI 95% 1.96 to 3.56) and with 1,9 +/-3,9 mmHg at 12 months compared with the baseline IOP. Postoperative IOP was statistically significant lower compared with its preoperative value at 6 months (p=9.11 × 10-8) and at one year (p=9.2 × 10-5. The difference between mean IOP at 6 months and 1 year after cataract surgery was not statistically significant (p>0.05). Preoperatively, all the patients received topical antiglaucoma therapy. After phacoemulsification, their number did not change statistically significant, but it showed a slight increase. Average number of topical glaucoma medications used preoperatively was 2.66 + / -0.66, while at 6 months after surgery it was 2.71 + / - 0,75 and at 12 months postoperatively, 2.9 +/- 0.53. Discussion. IOP decreased statistically significant after phacoemulsification in patients with uncontrolled POAG, but the decrease was not sufficient for optimal glaucoma management; therefore, many patients needed subsequent glaucoma surgery. [ABSTRACT FROM AUTHOR]

Rationale: The pathogenesis of diabetic retinopathy is multifactorial, and a range of hyperglycemia-linked pathways has been implicated in the initiation and progression of this condition. All the cells in the retina are affected by the diabetic milieu, and in view of such disease and tissue complexity, it is unlikely that any single process is solely responsible for the retinal pathophysiology. Dyslipidemia is considered a trigger to rapid worsening of the condition and its treatment is becoming a part of normal diabetes treatment. Nevertheless, as establishing causal mechanisms and related conditions remain an important research goal, also the means to follow up the impact on the retina and other ocular tissues are as important. Objective: this retrospective study shows the progression of diabetic macular edema (DME) in patients with dyslipidemia related to poor glycemic and blood control in subjects with existing DME by measuring the total macular volume (TMV) and thickness through the spectral domain optical coherence tomography (SD- OCT). Methods and results: 30 uncontrolled cases of type 2 diabetes that were measured monthly by SD- OCT through a period of 3 months with correlation to the degree of dyslipidemia and hyperglycemia, were analyzed. Conclusion: The role of OCT in monitoring the progression of DME in patients with uncontrolled type 2 diabetes is essential and the collaboration between the ophthalmologist and endocrinologist is essential to monitor the course of disease in uncontrolled patients. [ABSTRACT FROM AUTHOR]

Introduction: This study reports our results relating to palpebral eyelid fissure and orbital measurements following evisceration with orbital implantation of hydroxyapatite integrated implant and PMMA implant. Materials and Methods: This study is a prospective study of 43 patients that underwent evisceration for different ocular affections at University Emergency Hospital Bucharest, Ophthalmology department between January 2009 and September 2010 (Group A comprising of twenty patients had the coralline hydroxyapatite implant –Integrated Ocular Implants, USA and Group B comprising of twenty-three received non-integrated PMMA ocular implants) .The outcomes measured were the degree of exo /enophthalmos, horizontal eyelid fissure and palpebral fissure height at 4 years after surgical intervention related to measurement to the contralateral eye. Results: Horizontal eyelid fissure (HEF) was suffering a shortening of 7.4% in the group B versus the contralateral eye, and only 1.9% in the group A related to the contralateral eye. Eyelid fissure height was greater in the group B with 5.2% regarding the contralateral eye, and 1.2% in group A. The degree of enophthalmia was higher in the group B of 4 mm versus the contralateral eye and lower in group A 1.5 mm regarding the contralateral eye. Conclusions:. Although a hydroxyapatite implant may be not as economic as a PMMA implant, a patient must be warned about the effect on its ocular structures in time and that cosmetic appearance over years will change more dramatically than in the fellow normal eye. Therefore preoperative counseling of the patient is crucial in long term patient satisfaction. [ABSTRACT FROM AUTHOR]

Glaucoma is a group of optic neuropathies characterized by the degeneration of retinal ganglion cells and the loss of their axons in the optic nerve. The only approved therapies for the treatment of glaucoma are topical medications and surgical procedures aimed at lowering intraocular pressure. Gene therapy involves the insertion, removal, or modification of genetic material within cells to repair or compensate for the loss of a gene's function. It describes a process or technology that enables the genetic modification of cells to produce a therapeutic effect. However, changing the genetic material alone does not extend the duration of overexpression of proteins that combat disease, nor does it facilitate the production of new proteins for this purpose. We reviewed the literature concerning the use of gene therapy in the treatment of glaucoma and explored the future directions that this innovation may offer. Three genes associated with glaucoma have been identified within these loci: myocilin/trabecular meshwork glucocorticoid response (TIGR) (GLC1A), optineurin (GLC1E), and WDR36 (GLC1G). Among these, the most extensively studied glaucoma gene is myocilin (a TM-inducible glucocorticoid response gene). Building on previous successes, researchers have begun to apply genetic therapeutic approaches to alleviate or reduce symptoms associated with ocular hypertension (OHT) and glaucoma-like optic neuropathy (GON). It is evident that several therapeutic strategies exist that modulate aqueous humor production and flow, thereby regulating intraocular pressure (IOP) and protecting retinal ganglion cells (RGCs) from apoptosis. With the emergence of gene therapy as a potentially viable approach to preserving vision, new methods for managing glaucoma may soon become available. Genomic therapy is a promising treatment option for glaucoma patients and has significant potential for widespread clinical application.

Background and Objectives: This research investigated the morphometric dimensions of the optic foramen (OF), superior orbital fissure (SOF) and inferior orbital fissure (IOF), using indirect measurement techniques such as laser scanning, making it likely the first study of its kind. This study aimed to identify the morphometric variability of the main orbit communications and to highlight the differences between genders., Materials and Methods: The anthropometric study was conducted on sixty dry skulls (120 orbits) of adults aged between 20 and 70 years. Measurements of orbital communications were made using the RS6 laser scanner. The orbital parameters that were investigated are as follows: length and width of the SOF and IOF, and height and width of the OF., Results: In males, the average height of the OF was 8.27 mm and 8.13 mm in females, while the average width of the OF was 6.34 mm in males and 5.83 mm in females. The SOF average length was 21.09 mm in males and 17.58 mm in females. The widths of the SOF in the three thirds (anterior, middle and posterior) in males were 5.14/4.77/7.11 mm and 2.28/3.48/5.80 mm in females. The average length of the IOF was 33.05 mm in males and 32.30 mm in females. The widths of the IOF in the three thirds (anterior, middle and posterior) were 5.61/3.92/4.70 mm in males and 7.24/4.68/4.08 mm in females., Conclusions: The OF height and width were higher in males compared to females. The SOF length and width were higher in males compared to females. The IOF length was higher in males for the right orbit and higher in females for the left orbit. The IOF width for both orbits was higher in females in the anterior and middle third, and higher for males in the posterior third. Evaluation of dry skulls using laser scanning is reliable and recommended for data accuracy. Laser scanning can become a usable method for all indented and hard-to-reach regions of the cranial skeleton.

Background: The goal of the present study was to identify differences in retinal microvasculature between healthy Caucasians and healthy Asians in order to provide a better understanding of the variability between different ethnic groups., Methods: In this cross-sectional study, 191 healthy Chinese and Caucasian participants were enrolled. They underwent optical coherence tomography angiography (OCTA) scans with Zeiss Cirrus HD-5000 Spectral-Domain with AngioPlex. Linear regression models were used to investigate the association of OCTA metrics with potential risk factors., Results: Whereas participants in both groups are comparable in age and sex, Chinese participants had a longer axial length, higher spherical equivalent, higher intraocular pressure ( p < 0.001), and a significantly higher perfusion density of large vessels in the superficial capillary plexus ( p < 0.001). Regarding the foveolar avascular area (FAZ), Chinese participants had a larger superficial FAZ, a wider superficial FAZ perimeter, and a more circular deep FAZ shape ( p < 0.001)., Conclusions: There are significant differences in the retinal vasculature between Caucasian and Asian eyes as measured using OCTA. This needs to be considered when developing normative databases. Whether such findings relate to inter-racial differences in the incidence of retinal vascular disease remains to be shown.

Background: In vivo confocal microscopy (IVCM) is a vital tool in studying dry eye disease (DED), providing insights into morphological changes at ocular surface unit levels. This review presents the main differences in corneal structure between aqueous-deficient dry eye disease (AD-DED) and normal eyes., Methods: A comprehensive search of PubMed, Web of Science, Embase, and MEDLINE databases from January 2000 to December 2023 was conducted. The study selection process, as well as data selection and examination, were independently performed by two members of the review team., Results: The review reveals a consistent decrease in corneal surface epithelial cell density in AD-DED cases compared to a control group, but conflicting data on basal epithelial cell density. Notably, the abnormal hyperreflectivity of keratocytes in patients with Sjogren's syndrome was recorded, and there was a significant keratocyte density in AD-DED subjects compared to evaporative DED and control groups. Studies also found a decrease in sub-basal nerve density, increased tortuosity, and the fragmentation of nerve fibers. Dendritic cell density and dendritic cell dendrites increase in AD-DED patients compared to healthy subjects., Conclusions: IVCM is a powerful tool for enhancing our understanding of the pathophysiological mechanisms underlying DED. However, the review underscores the urgent need to standardize the terminology, analysis, and units used for accurate interpretation, a crucial step in advancing our knowledge of DED.

Background and Objective: Hydroxychloroquine sulfate (HCQ) is a lysosomotropic agent administered in systemic lupus erythematosus and rheumatoid arthritis that has fewer toxic effects than chloroquine. However, HCQ may still be responsible for retinal toxicity. In this study, we observed structural changes in the retinas of experimental rats after prolonged exposure to HCQ. Matherials and Methods: We investigated several aspects regarding retinal changes, at both the histopathological and ultrastructural levels. We used 96 male albino Wistar rats distributed into four equal groups (n = 24 per group): the first three groups were treated with different doses of HCQ (50, 100, and 200 mg/kg HCQ, injected intraperitoneally in a single dose daily), and the last group (the control group, n = 24) was treated with saline solution administered in the same way (0.4 mL of saline solution). The treated groups received HCQ daily for 4 months, and every month, six animals from each group were sacrificed to assess retinal changes. The eyes were examined via optical (OM) and electronic microscopy (EM). Statistical analysis was deployed, and results regarding retinal morpho-photometry were acquired. Results: We observed structural retinal changes in both high and low doses of HCQ; while high doses determined a significant thinning of the retina, lower doses caused retinal thickening. Morphological retinal changes upon exposure to HCQ are believed to be caused by accumulated HCQ in lysosomes found in retinal ganglion cells and in the inner nuclear and photoreceptor cell layers. Such changes were most evident in the group receiving HCQ intraperitoneally in doses of 100 mg/kg for a longer period (4 months). Conclusions: The present study highlights histopathological and ultrastructural retinal changes induced by chronic HCQ administration, which were strongly connected to the dosage and period of exposure.

Objective: Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorder (NMOSD) are autoimmune-mediated central nervous system disorders distinguished by the presence of serum aquaporine-4 IgG antibody (AQP4-Ab). The clinical panel comprises severe optic neuritis (ON) and transverse myelitis, which can result in incomplete recovery and a high risk of recurrence., Methods: This study aimed to evaluate the visual outcomes of three patients with severe acute ON in NMOSD that was non-responsive to intravenous methylprednisolone (IVMP), who received plasma exchange therapy (PLEX). We included three patients (P1, P2 and P3) with severe acute ON who had no improvement after IVMP treatment and were admitted to the ophthalmology department at the Emergency University Hospital Bucharest from January 2022 to September 2023. All three patients with ON were diagnosed in accordance with the criteria described by the Optic Neuritis Treatment Trial. All the subjects were experiencing their first attack., Results: The mean recruitment age was 35.3 ± 7.71. All patients were seropositive for the AQP4 antibody. All patients were tested for serum myelin oligodendrocyte glycoprotein (MOG) antibody but only one showed a positive test (P3). Lesions visible in orbital MRI indicated the involvement of retrobulbar, canalicular and/or intracranial segments. All three subjects had no response or incomplete remission after an IVMP protocol (5 days of 1000 mg intravenous methylprednisolone in sodium chloride 0.9%). The mean time from onset of optic neuritis to PLEX was 37.6 days. The PLEX treatment protocol comprised five cycles of plasma exchange treatment over 10 days, with a plasma exchange session every other day. An amount of 1 to 1.5 volumes of circulating plasma were dialyzed for 2-4 h. At 1 month after the completion of PLEX therapy, BCVA and VF parameters were improved in all three patients., Conclusion: The treatment of ON remains subject to debate and is somewhat controversial. Plasma exchange must be considered as a rescue therapy when IVMP is insufficient for AQP4-ON patients. This study revealed that PLEX treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. This study suggests that PLEX may be associated with improved visual outcomes in NMOSD acute optic neuritis.

Ehlers-Danlos syndromes (EDS) represent a group of rare inherited disorders that affect connective tissues. There are 13 types of disease, most of them affecting joints or skin; symptoms usually include loose joints, joint pain, stretchy velvety skin, abnormal scar formation. However, the most serious type of disease is vascular EDS (vEDS), or EDS type 4 because patients may suffer vessels dissections or internal organs lesions, followed by bleeding, which endangers patient's life, but also thromboembolic events. We present two clinical cases of vEDS managed in our clinic in 1 year distance. In both cases, patients were active young persons (in their thirties, and respectively, twenties), both with multiple non-traumatic vascular dissections, and severe ocular complications: arterio-venous fistula with massive exophthalmia, and central retinal artery occlusion, respectively. Both cases were challenging since the life of the patients were threatened by their condition. However, in both cases, prompt treatment and finding the right trigger of the ocular pathology and vascular injuries helped doctors to provide proper and prompt medical care, in order to prevent future similar events to happen and to preserve a good quality of life for these patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Cherecheanu, Romanitan, Pirvulescu, Iancu, Garhöfer, Iancu, Cherecheanu, Zemba, Vasile, Simonov and Branisteanu.)

The present paper explores genetic polymorphism and its association with thromboembolic retinal venous disorders, such as central/hemi-retinal vein occlusion, as well as possible correlations with other ocular findings, such as closed angle glaucoma, but also with autoimmune general disorders. In this review, we are highlighting the importance of establishing a correspondence between all of the above, since they all have complex etiopathogeneses; sometimes, when all coexist together, they could generate effects that may be very difficult to manage. There are studies supporting that genetic polymorphism, such as the variant MTHFR A1298C, may increase the risk for developing glaucoma, especially in the heterozygote model. Being aware of all these aspects may prove to be useful in patients with several associated diseases, as a combined effort between several medical specialties may prove to the benefit of these patients. Our review, completed with an exemplifying clinical case, shows that it is necessary to raise awareness of all aspects of a complex medical situation, including the genetic one, of a patient being at risk for thromboembolic episodes, for preventing them or managing them promptly and properly in the future.

Anti-epidermal growth factor receptor (EGFR)-targeted therapy has been intensely researched in the last years, motivated by the favorable results obtained with monoclonal antibodies in HER2-enriched breast cancer (BC) patients. Most researched alternatives of anti-EGFR agents were tyrosine kinase inhibitors (TKIs) and monoclonal antibodies. However, excluding monoclonal antibodies trastuzumab and pertuzumab, the remaining anti-EGFR molecules have exhibited disappointing results, due to the lack of specificity and frequent adverse side effects. TKIs have several advantages, including reduced cardiotoxicity, oral administration and favorable penetration of blood-brain barrier for brain metastatic BC. Lapatinib and neratinib and recently pyrotinib (approved only in China) are the only TKIs from dozens of molecules researched over the years that were approved to be used in clinical practice with limited indications, in a subset of BC patients, single or in combination with other chemotherapy or hormonal therapeutic agents. Improved identification of BC subtypes and improved characterization of aggressive forms (triple negative BC or inflammatory BC) should lead to advancements in shaping of targeted agents to improve the outcome of patients., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020, Spandidos Publications.)

Visual evoked potentials (VEP) are a significant visual electrophysiological diagnostic exam, which can be used as a suitable objective measure of optic nerve function. The topic was greatly debated and many correlations between the magnitude of the VEP latency parameters and parameters of Humphrey static perimetry suggested that the abnormal cortex responses in patients with glaucomatous changes could be tested by both electrophysiological and physical methods. Moreover, the optic nerve glaucomatous damage observed by reduction in ganglion cell layer and retinal fibre layer thickness through SD-OCT tests, which are known to precede Humphrey visual field defects, correlates with VEP latency parameters, thus consolidating the position of the VEP testing in glaucoma progression., (©Romanian Society of Ophthalmology.)

Introduction: The iris vascular supply originates in the anterior and long posterior ciliary arteries. The endothelium influences local blood flow by releasing endothelium relaxing and contracting substances. From a functional perspective, the ocular vascular tonus adjustment is humoral and neural dependent. Objectives: The present article aims to evaluate the possible implications of topical administration of selective COX2 and nonselective COX inhibitors generically named nonsteroidal anti-inflammatory drugs (NSAIDs) and their possible interactions with the endocannabinoid system and the way they could interfere with the vascular tone at the level of ocular iris territory in Wistar rats. Materials and methods: Experimental protocol on Wistar rats was performed in accordance with present laws regarding animal welfare and ethics in animal experiments (Directive 86/ 609EEC/ 1986; Romanian Law 205/ 2004; Romanian Laws 206/ 2004, 471/ 2002 and 9/ 2008; Romanian Order 143/ 400). The studied substances were instilled topically under general anesthesia, and images of the rat iris vessels were captured over a period of 10 minutes. The obtained images were further analyzed using an appropriate hardware and software program. Results: The nonselective NSAIDs induced vascular dilation in the iris vessels, while the selective COX2 inhibitors determined a variable degree of vasoconstriction. Conclusion: In view of the results of this experiment and the added evidence found in literature, we consider that further research will show the potential benefits for the additional use of NSAIDs in ocular pathology, otherwise unaffected by this medication until the present time (for example, glaucoma treatment).

Rare ocular pathology has an important impact on the quality of life of patients because often the damage is bilateral and, although asymmetric, causes a significant decrease in visual acuity. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmological examination and for a more active involvement in their care. Moreover, a significant percentage of these orphan diseases do not have treatment approved by the FDA. The examination and monitoring of patients with rare ophthalmological disorders represents a key component of an ongoing project at the University Emergency Hospital, Bucharest, Romania - Ophthalmology Clinic. Rare disease registries are leading tools for the development of clinical research for rare diseases, improvement of patient access to new diagnostic methods, follow-up and new emerging therapies. As of this moment, the European list of rare diseases includes 53 ophthalmological diseases, which are classified as rare diseases and another 103 systemic diseases with ophthalmological involvement, out of a total of 7000 rare diseases.

The focus of this review is the role of endocannabinoid system in ocular and systemic circulation. By critically examining preclinical and clinical research, we explore the cannabinoid receptors localization and vascular implications as well as their interaction with other anti-inflammatory drugs. The objective is to transfer knowledge on the use of cannabinoids, specifically their effect on ocular circulation and intraocular pressure, and provide a better understanding of the endocannabinoid system complexity in modulating local and systemic circulations in order to identify potential uses and limitations of cannabinoid-based therapeutics., (© NEPjOPH.)

Introduction. We present the case of a 73-year-old woman with osteoporosis, who presented to the emergency room with a sudden vision loss and ocular pain in the right eye, which appeared two days before. The patient mentioned loss of appetite, weight loss for three months and low fever for two weeks. Materials and methods. Among the ophthalmological findings, the most important were panuveitis, and large confluent necrotic areas in the peripheral retina. The patient was diagnosed with RE Panuveitis and acute necrotizing retinitis. Results. Blood exams showed leukocytosis and monocytosis, thrombocytosis and anemia. Further investigations showed high levels of Cytomegalovirus (CMV) anti IgG and Herpes Simplex (HS) type 1 virus anti IgM, urinary infection, and secondary hepatic cytolysis. The CT and MRI of the thorax and abdomen showed no sign of neoplastic disease, and no explanation for the CMV infection was found. The patient received general corticotherapy and antiviral therapy, and, after one month, RE BCVA was 20/ 30. Particularity of the case. Acute necrotizing retinitis in an old patient with CMV and HSV type 1, associated with secondary hepatic cytolysis, without any other immunosuppressive disease and very good outcome.

Purpose: to familiarize the public with the role of corneal biomechanics in glaucoma patient management. Methods: Ocular Response Analyzer (ORA) is the only device that measures in vivo corneal biomechanics. Recent studies regarding "corneal biomechanics and glaucoma" were reviewed and the obtained data were compared in order to present a better understanding of the corneal biomechanical properties involvement in glaucoma care. Results: According to the studies reviewed, in primary open angle glaucoma (POAG) the mean corneal hysteresis (CH) and the corneal resistance factor (CRF) were approximately 2 mmHg lower than in normal eyes. In ocular hypertension (OH), the mean CH was about 1mmHg higher than in POAG patients and 1mmHg lower than in the control group, while the mean CRF was about 2mmHg higher than in POAG and 1mmHg higher than in the control group. Regarding the normal tension glaucoma (NTG), there were studies that showed that the mean CH and CRF were approximately 1mmHg lower than in POAG and studies that showed similar values between the POAG and NTG groups. The mean CH did not differ much between POAG and angle closure glaucoma (ACG), being lower than in normal individuals, while CRF appeared to be higher in the ACG than in normal individuals. Concerning congenital glaucoma (CG), both CH and CRF were about 2mmHg lower than in normal eyes. Conclusions: Corneal biomechanics influenced the IOP measurement and have been proven to be of a great significance in glaucoma patients regardless of the central corneal thickness (CCT). Lower values of CH and CRF could suggest an alteration in the corneal response associated to glaucoma.

Unlabelled: Abstract, Purpose: We present the clinical, paraclinical and therapeutic features in a patient with secondary congenital aphakia., Methods: A 2-year-old patient, diagnosed with congenital rubella syndrome including sensorineural deafness, congenital heart disease, intellectual disability, microcephaly, microphthalmia, and congenital cataract, presented to our clinic for the surgical treatment of cataract., Results: During the surgery, the absence of the lens' cortex was observed, hence, the final diagnose was of secondary congenital aphakia. Surgery was then continued with a posterior capsulorhexis and an anterior vitrectomy, deciding to postpone the implantation of the posterior chamber intraocular lens.

Glaucoma is a progressive optic neuropathy, characterized by loss of retinal ganglion cells and retinal nerve fiber layer as well as visual field loss. Therefore, in glaucoma, the correlation between structure and function is important, since it can be useful for tracking glaucomatous changes and for following the progression of the disease.

We present the case of a patient who was operated for cerulean cataract one year ago and who developed light-blue posterior capsule opacifications similar to that of the initial cataract. This case suggests that the mechanism of the light-blue color formation in the cerulean cataract was also present in the lens epithelial cells, forming the posterior capsule opacity.

Despite the high prevalence of panic disorders in patients in primary-care settings, this condition is frequently under-recognised and under-treated. After the description of DSM-IV diagnosis criteria of panic disorders, this paper underline the importance of an adequate somatic and psychiatric differential diagnosis. Even if cognitive-behavioural therapy is the best studied psychotherapeutical approach, several efficacious psychodynamic psychotherapies were also described. High-potency benzodiazepines provide a rapid efficacy with beneficial effects during the first days of treatment. However, benzodiazepines should be avoided in the long term, because of the development of tolerance and dependence. Antidepressants (SSRI, venlafaxine) are effective in preventing panic attacks, especially in improving anticipatory anxiety and avoidance behaviour.

It is well known that nicotine that is a major toxic component of cigarette smoke induces oxidative stress which is responsible for the lung damages in COPD and cancer. There have been reported some cases of COPD in never smoking patients exposed to air pollutants. The aim of our study is to evaluate the morphological pulmonary changes in rats exposed to cigarette smoke respectively to solid combustible smoke and to establish the relationship between the exposure and the level of oxidative stress measured through serum (s) and pulmonary tissue (l) MDA in rats (TBARS method). Thirty Wistar rats were divided into three groups (n = 10): (1) the control group (C), (2) the cigarette smoke group (CS), and (3) the solid combustible smoke group (SC). Apart from the control group, these were treated with solid combustibles smoke or cigarette smoke for six months. We collected blood for serum determination of MDA and the lungs were removed for histopathological analysis and to determine the levels of malondialdehyde (MDA). The levels of serum and lung MDA were significantly higher in CS and SC groups compared with C group, but not significantly differences between CS and SC group were detected. These findings are positively correlated with histopathological changes (squamous metaplasia and clear cell hyperplasia in the bronchium epithelium, emphysema) found in pulmonary tissue. Preliminary data of our study confirms that not only the cigarette smoke but also the environmental pollutants are involved in the major pathways of COPD.

Parkinson's disease (PD) is one of the most common neurodegenerative disorders. Several toxin-induced animals models simulate the motor deficits occurring in PD. Among them, the unilateral 6-hydroxydopamine (6-OHDA) model is frequently used in rats and has the advantage of presenting side-biased motor impairments. However, the behavioral consequences of a unilateral 6-OHDA-lesion have, so far, not been described in detail in mice. The aim of this study was to characterize mice with unilateral 6-OHDA-lesions placed in the median forebrain bundle using several motor behavioral tests in order to identify the most suitable predictor of nigral cell loss. Mice underwent various drug-induced (amphetamine- and apomorphine-induced rotation) and spontaneous motor tests (cylinder, rotarod, elevated body swing, and stride length test). The amphetamine-induced rotation test, the cylinder and the rotarod test were most sensitive and reliable in detecting loss of tyrosine hydroxylase-immunoreactive cells in the substantia nigra. This study demonstrates that substantial and stable unilateral 6-OHDA-induced lesions can be established in mice, and that these lesions can be functionally assessed using several different side-bias-based behavioral tests. This mouse model offers the opportunity to use transgenic mouse strains and study the interactions between genes of interest and toxins in relation to Parkinson's disease etiology in the future.

The application of 3-D computer radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT) for head and neck cancer requires a standardization of the procedures for the delineation of the target volumes. Over the past few years, some proposals emerged from the literature for the delineation of the neck node levels. Detailed examination of these proposals however revealed some important discrepancies. The objective of the present article is to present the consensus guidelines for the delineation of the node levels in the node-negative neck.