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					Contents                                3

SEEOS                              4
Word Of Welcome                    5
Welcome To Tirana                  6
Committees                         8
Our Sponsors                       9
Invited Speakers                   18
Congress Accreditation             19
Place Of Venue                     20
Final Program & Events Timetable   21
General Information                28
Our Website                        31
Oral Abstracts                     32
Poster Abstracts                   98
               4   South-East European
                   Ophthalmological Society
                   The South-East European Ophthalmological Society (SEEOS) was found in 2004,
                   as an international regional association to collect ophthalmologists from South-East
                   European region. Now, 16 countries - Moldova, Ukraine, Slovakia, Cyprus, Croatia,
                   Slovenia, Turkey, Serbia, Albania, Hungary, Greece, Italy, Bosnia-Hercegovina,
                   Romania, Bulgaria, Macedonia - are registrated under this Society.

                   Every year one of the member states organizes the Congress of SEEOS. After five
                   successfull congresses in Sarajevo (2004), Sofia (2005), Tessaloniki (2006), Novi
                   Sad (2007), Dubrovnik (2008), and last year in Budapest (2009), the 7th Congress
                   of SEEOS will be organized in our country, Albania, in Tirana this summer, during the
                   18th and the 20th of June 2010. We are waiting for participations of more than 200
                   ophthalmologist from all European Countries.

                   The main topics will be: Refraction and oculomotor disorders; Cornea; Cataract and
                   refractive surgery; Glaucoma; New treatment in retinal pathologies; Management
                   of ocular and orbital tumors; Neuroophthalmology. The Congress of SEEOS always
                   pays special attention to VISION 2020 program and prevention of blindness.

                   The SEEOS has also an international Journal called South-East European Journal of
                   Ophthalmology, with an editorial center in Sofia.





                                                         CROATRIA                            RUMANIA

                                                              BOSNJA &

                                     ITALY                          MONTENEGRO
                                                                               KOSOVO           BULGARIA

                                                                                 MACEDONIA                   TURKEY



Word of Welcome                                                                           5

Dear Colleagues and Friends,

We are proudly honored to invite you all at the 7th Congress of the South-East
European Ophthalmology Society, that will take place in the capital of Albania, Tirana
between the 18th and the 20th of June 2010 at the National Historical Museum.
This will be the first International Congress of its kind in the field of ophthalmology
that is taking part in this city.

In this Congress there will be present around one hundred professors from all
around the globe with a high level of scientific knowledge that will present the new
achievements and trends in different fields of ophthalmology.

This Congress will also be of special interest for young devoted ophthalmologists
from south-east European region, providing them a unique chance to learn from
several experts around the world. The structure of this scientific congress will be of
interests for both anterior and posterior segment specialists alike.

We are honored to have as special invited speakers of our Congress;
Prof. Gilles Renard; New corneal surgeries with femtosecond laser
Prof. Leonidas Zografos; Modern diagnostic and treatment moethods of intraocular tumors
Prof. Murat Karacorlu; Current concepts and new trends in vitreo-retinal diseases
Invited speakers of the Congress will present and speak for different ophthalmologic
fields, including diagnostic and therapeutical problems in ophthalmology. We
have planned many sessions in which are included seminars on: Refraction
and oculomotor disorders; Cornea; Cataract and refractive surgery; Glaucoma;
New treatment in retinal pathologies; Management of orbital tumors;
Neuroophthalmology; separated sessions will be organized by the representative of
SEE-ARVO and Vision 2020.

Located in the heart of Albania, Tirana is the fastest growing city of Europe. With
a dynamic full of energy lifestyle the City never sleeps. The relaxing atmosphere
among colleagues and friends, as well as the social programs will offer you an
unforgettable experience.

We warmly welcome you to join us in Tirana!
               6   Welcome to Tirana

                   On behalf of the South-East European Society’s Foundation Board and the
                   Organizing Committee of the 7th Congress of SEEOS it is my greatest pleasure to
                   welcome you to Tirana during the 18th and the 20th of June 2010.

                   This Congress will be the first International event of this size in the field of
                   Ophthalmology in my country. This scientific meeting is filed with original data and
                   overviews presented by clinical as well as basic researchers.

                   The Congress timetable will provide upper opportunities to meet and talk with most
                   Nationalities worldwide colleagues and to exchange scientific ideas in a relaxing
                   atmosphere. At this time of the year Tirana is at its best, it is a spring time with
                   usually a mild climate and daylight lasting until late at night. In addition an attractive
                   social program will be organized. We are convinced that all delegates will contribute
                   to the success of this meeting, thus making it possible to enhance future discussion
                   and collaboration and to combat the eye diseases.

                   Again a warm welcome to Tirana and to the 7th Congress of SEEOS.

                   Sincerely Yours
                   Pajtim Lutaj MD; PhD
                   Professor of Ophthalmology
                   University Hospital Center of “Mother Theresa”, Tirana - ALBANIA
                   President of the Organizing Committee for the 7th Congress of SEEOS
               8   Committees

                   SEEOS Foundation Board:
                   Mustafa SEFIC Prof. / Bosnja & Herzegovina
                   Athanasios NIKOLAKOPOULOS Prof. / Greece
                   Petja VASSILEVA Prof. / Bulgaria
                   Slobodanka LATINOVIC Prof. / Serbia
                   Nikica GABRIC Prof. / Croatia
                   Janos NEMETH Prof. / Hungaria
                   Marko HAWLINA Prof. / Slovenia
                   Cesare FORLINI Prof. / Italy
                   Nadiya F. BOBROVA Prof. / Ukraine
                   Mahmut KASKALOGLU Prof. / Turkey
                   Andrej CERNAK Prof. / Slovakia
                   Pajtim LUTAJ Prof. / Albania
                   Daniela SELARU Prof. / Rumania
                   Mircea FILIP Prof. / Rumania
                   Titos CHRISTOFORIDIS Prof. / Cyprus
                   Eugeniu BENDELIC Prof. / Moldova
                   Magdalena A. VELEVSKA Prof. / Macedonia

                   President of Honor:
                   Prof. Gilles Renard

                   Organizing Committee:
                   Pajtim LUTAJ / President
                   Bledar KRUJA / Secretary
                   Julinda JAHO / Member
                   Jonid BILBILI / Member
                   Veli TAGANI / Member
                   Gazmend KAÇANIKU / Member

                   Prevention of Blindness:
                   Volker KLAUS
                   Ivo KOCUR

                   Under the auspices of:
                   University of Tirana in Albania
                   The Albanian Academy of Science

                   Congress Secretariat:
                   THEVISUALVOICE - Advertising Agency
                   Drevish Hima str. P2, Sh2, No: 1/1
                   Tirana - ALBANIA
                   Tel/Fax: +355 4 245 249 0
                   Contact Person: Migailed Delija / Mobile: +355 68 20 80 126
Grateful Thanks to                                                           9

Our Sponsors
The Organizing Committee and the SEEOS Foundation Board, gratefully
acknowledges the participation and the support of the following companies:

Bul. AVNOJ 64-3/10 1000 SKOPJE
Tel.++3892 2454 516
Fax.++3892 2455051

Celopecka 3, Beograd, Srbija
Tel. ++381 112421 561
Fax.++381 112402 070

We are collaborating
with many companies
and for some we have
exclusive rights for

                                 Seling medical ophthalmic equipment,
                                 intraocular lenses, surgical covers, gloves, sterile cloth, sets, frames,
                                 sunglasses and equipment for optics.
Clinia Vision
               18   Special invited &
                    Invited Speakers
                    Special Invited Speakers of the Congress
                    Gilles RENARD / France
                    Leonidas ZOGRAFOS / Switzerland
                    Murat KARACORLU / Turkey

                    Invited Speakers of the Congress
                    Andrej CERNAK / Slovakia
                    Athanasios NIKOLAKOPOULOS / Greece
                    Baha TOYGAR / Turkey
                    Cesare FORLINI / Italy
                    Christina GRUPCHEVA / Bulgaria
                    Daniela SELARU / Rumania
                    Gabor MARK / Hungary
                    George CRANIAS / Grecce
                    Hakan OZDEMIR / Turkey
                    Janos NEMETH / Hungary
                    Jordan POULAS / Greece
                    Kelmend SPAHIU / Kosovo
                    Lucia SCOROLLI / Italy
                    Magdalena A. VELESKA / Macedonia
                    Mahmut KASKALOGLU / Turkey
                    Marko HAWLINA / Slovenia
                    Martine JAGER / Netherland
                    Matteo PIOVELLA / Italy
                    Mustafa SEFIC / Bosnja & Herzegovina
                    Nadiya BOBROVA / Ukraine
                    Nikica GABRIC / Croatia
                    Petia VASSILEVA / Bulgaria
                    Sergio SCALINCI / Italy
                    Slobodanka LATINOVIC / Serbia
                    Vladimir PFIEFER / Slovenia
                    Vesna DIMOVSKA / Macedonia
                    Volker KLAUS / Germany
                    Zoltan NAGY / Hungary
Congress        19

               20   Place of Venue

                    On Friday, 18th of June 2010, on site registration will be available at the National
                    Historical Museum - Conference Place, at the reception in the main hall.

                    The scientific meetings will start on the 18th of June at 10 o’clock to continue
                    during the 19th and the 20th of June 2010 at the biggest Congress Hall of National
                    Historical Museum. The venue place is located at the center of Tirana, having close
                    access from all directions. This is certainly one of the most busy and popular area of
                    the city, located on the north side of Skanderbeg Square you would never pass by
                    without noticing the big building and its most attractive mosaic which is considered
                    to be the biggest in the Balcans.
                    The venue is very easily reachable from all directions, may that be from your hotel
                    or from the “Mother Theresa” airport. Being close to the venue place you might find
                    it attractive to have a short few minutes walk from your hotel, though there are bus
                    services that might get you there in just few seconds.

                    Below are the distances in m or min walk from your Hotel to the Venue Place:
                    - Tirana International Hotel    50 m         0 min walk
                    - Mondial Hotel              1100 m         20 min walk
                    - Arber Hotel                 300 m          2 min walk
                    - Nirvana Hotel               500 m         10 min walk

                    Pick up every morning from the congress organizers will be available for all
                    foreigners upon request, you might need to specify it on the arrivals registration

Final Program                                                                       21

& Events Timetable
                        Thursday / 17th of June 2010
19:00 Welcome Reception of SEEOS Foundation Board at the Academy of
      Sciences by the President, Academician Gudar Beqiraj.

                           Friday / 18th of June 2010
08:00 Registration and information
09:00 Opening Ceremony
09:30 Coffee break & Commercial Exhibition

         Chairperson: G. Renard, Co-chairpersons: N. Gabric & V. Pfeifer

10:00 New corneal surgeries with femtosecond laser:
      G. Renard / France • 001
10:30 Topography Guided ex. laser ablations for the treatment of highly aberrated
      corneas: J. Poulas / Greece • 002
10:37 Moria one use – plus sbk vs ldv femtolaser - clinical evaluation:
      N. Gabric, M. Bohac, I. Dekaris / Croatia • 003
10:45 Deep Anterior Lamellar Keratoplasty:
      V. Pfeifer / Slovenia • 004
10:52 Monovision: An option for presbyopia?:
      M. Kaskaloglu / Turkey • 005
11:00 Advances in hyperopic LASIK:
      M. Anticic, M. Bohac, N. Gabric / Croatia • 006
11:07 Comparison of different types of phakic intraocular lenses:
      N. Gabric, I. Dekaris, M. Bohac / Croatia • 007
11:15 Overview on the features and benefits of AcrySof ® Cachét Phakic IOL:
      B. Toygar / Turkey • 008
11:22 Correcting Presbyopia and Astigmatism Implementing COMICS through
      1.8 mm Incision with Stellaris and MICS IOL’s:
      V. Pfeifer, M. Schwarzbartl / Slovenia • 009
11:30 Phototherapeutic Keratectomy (PTK) in the Treatement of Corneal
      Granular Dystrophy GROENOW I:
      P. Lutaj, J. Jaho, B. Kruja / Albania • 010
11:37 Treatment of severe corneal ulcer - our experience:
      M. Antova-Velevska / Macedonia • 011
11:45 Corneal Cross-Linking:
      M. Meço, D. Uzer / Albania • 012
11:52 The AcrySof ® IQ ReSTOR ® lens:
      M. Vukosavljevic / Serbia • 013

12.30 - 14.00 Lunch & Commercial Exhibition

                               • CATARACT AND REFRACTIVE SURGERY SESSION •
                             Chairperson: P. Lutaj, Co-chairpersons: M. Kaskaloglu & Z. Nagy

                    14:00 Management of Advanced Cataracts:
                           M. Kaskaloglu / Turkey • 014
                    14:07 Use of Femtosecond Laser System in Cataract Surgery:
                           Z. Nagy / Hungary • 015
                    14:14 The gold standard of secondary IOL implantation in the transconjunctival era:
                           C. Forlini, M. Forlini, A. Bratu, P. Rossini / Italy • 016
                    14:24 Cataract and floppy iris syndrome (case report):
                           Arjeta Grezda, Julinda Jaho, Anila Gambeta / Albania • 017
                    14:30 Comparisons of different presbyopia treatments: Refractive lens exchange
                           with multifocal intraocular lens implantation VS. LASIK Monovision: A.Barišic,
                           N.Gabric, I.Dekaris, I.Romac, M.Bohac, B.Juric, V.Glavota / Croatia • 018
                    14:37 Age Related Cataract Surgical Coverage and Contribution to Visual
                           Impairment Reduction in Population of Vojvodina:
                           S. Latinovic, S. Bariši, M. Maleševic / Serbia • 019
                    14:45 How, why, when mix and match:
                           B. Juric, N. Gabric, A. Barišic, M. Bohac / Croatia • 020
                    14:52 Maximizing torsional phaco efficiency and introduction to OZil IP:
                           B. Toygar / Turkey • 021
                    15:00 Cataract extraction with Diffractive Multifocal IOLs:
                           Pajtim Lutaj / Albania • 022
                     15:07 Accommodative Intraocular Lens Implants:
                           Z. Tunc / Turkey • 023
                    15:15 Uses of multifocal intraocular lenses – Restor Acrysoft:
                           M. Asani / Kosovo • 024
                    15:30 Anterior Chamber phakic intraocular lens ACPIOL– Cache
                           M. Asani / Kosovo • 025
                    15:45 Dynamic aphakia corrections (IOL+glasses) of infants at congenital cataracts
                           phacoaspiration: N. Bobrova, O. Zhekov, A. Dembovetska / Ukraine • 026
                    15:52 Posterior chamber Iris-claw lenses as way to correct postoperative
                           aphakia in critical cases: N. Ianopol, K. Bardhi, J. Bilbili / Rumania • 027

                    16:00 Coffee break & Commercial Exhibition

                                               • GLAUCOMA SESSION •
                             Chairperson: M. Sefic, Co-chairpersons: S. Latinovic & E. Goranci

                    16:30 Selective laser trabeculoplasty as a new approach to glaucoma treatment:
                          M. Sefic, S. Sefic-Kasumovic / Bosnia&Hercegovina • 028
                    16:37 Selective laser trabeculoplasty in the treatment of glaucoma simplex in the
                          patient who is allergic to all medications for curing glaucoma:
                          M. Lukic, M. Gavric, N. Gabric / Croatia • 029
                    16:45 Management of bleb overfiltration in a patient 4 years after Trabeculectomy
                          with MMC: J. Jaho, J. Dai, B. Kruja, P. Lutaj / Albania • 030

16:52 Vasoactivity changes correlating to intraocular pressure – Experimental
       study. S. Latinovic / Serbia • 031
17:00 New congenital glaucoma surgical treatment method. Bobrova Nadiia,
       Tatjyana Sorochinskaya, Natalia Kuzmina / Ukraine • 032
17:07 Is cataract surgery an alternative treatment for glaucoma?
       A. Cernak, K. Kakoulidis, M.Cernak / Slovakia • 033
17:15 Dilemmas in primary chronic glaucoma treatment:
       I. Goranci, A. Goranci, D. Goranci, H. Ajvazi, D. Goranci / Kosovo • 034
17:22 Correlations of the changes between the iridocorneal angle and other
       parametres at the neovascular glaucoma: H. Ajvazi, I. Goranci, A. Goranci,
       D. Goranci, B. Kastrati, M. Ismaili / Kosovo • 035
17:30 Our first experience with Ex-Press mini glaucoma shunt:
       M. Gavric, N. Gabric, K. Matkovic / Croatia • 036
17:37 Complications related to bleb formation following trabeculectomy:
       V. Dimovska / Macedonia • 037
17:45 How much are informed patients in Tetovo and Skopje on the importance
       of glaucoma disease: F. Xhaferi, B. Tateshi / Macedonia • 038
 17:52 The benefit of neuroprotective adjunctive nicergoline therapy in the
       treatment of primary open glaucoma:
       J. Bilbili, D. Costin, K. Bardhi, C.F. Costea, MP Bucatariu / Rumania • 039
18:00 Free radicals hypothesis in glaucoma pathogenesis and comments
       on an experimental model of acute glaucoma on a rabbit:
       K. Bardhi, J. Bilbili, N. Ianopol, Shala’ta Walid / Rumania • 040
18:07 Glaucoma World Day Screening: S. Ljaljevic, M. Ahmedbegovic, M. Pranjic,
       E. Alimanovic, V. Jurišic / Bosnia and Herzegovina • 041
18:15 Vascular risc factors at patients with trabeculectomy: K. Blazevska
       Buzarovska, V. Dimovska Jordanova; M. Golubovic / Macedonia • 042
18:22 Secondary glaucoma post vitreoretinal surgery:
       A.Tonuzi, I. Arapi / Albania • 043

                          Saturday / 19th of June 2010

                        • MEDICAL RETINA SESSION •
       Chairperson: L. Zografos, Co-chairpersons: A. Cernak & H. Ozdemir

08:30 The interpretation of OCT images of the retina. Refining imaging for retinal
      disease: H. Ozdemir / Turkey • 044
08:50 Modern diagnostic and treatment methods of intraocular tumors:
      L. Zografos / Switzerland • 045
09:15 Local chemotherapy of retinoblastoma by melphalan intravitreal injection
      (the preliminary report): N. Bobrova, T. Sorochinskaya / Ukraine • 046
09:26 Central Serous Retinopathy treatment with acetazolamide per os and diclofenac
      eye drops: M. Vlašic, N. Gabric, R. Lazic, I. Boras, N. Draca / Croatia • 047
09:32 Bilateral CRAO in patient with giant cell arteritis:
      B. Zhuri, M. Kubati-Ajeti, O. Kubati / Kosovo • 048

                    09:38 Effect of Bevacizumab on Pathologic Proliferative Tissues Developed in Proliferative
                          Diabetic Retinopathy: N. Ianopol, K. Bardhi, J. Bilbili, B. Kirchhov / Rumania • 049
                    09:44 Effect of Bevacizumab (Avastin) on the Diabetic Macular Edema:
                          S. Lationovic, Lala Ceklic / Serbia • 050
                    09:50 Bilateral serous retinal detachment:
                          V. Mema, E. Leci, A. Hibraj, N. Taneja / Albania • 051
                    19:56 Intravitreal Avastine and Triamcinolone combination for CME post CRVO:
                          J. Dai, J. Jaho, B. Kruja, P. Lutaj / Albania • 052
                    10:02 Central Serous Retinopathy:
                          J. Jaho, J. Dai, B. Kruja, P. Lutaj / Albania • 053
                    10:08 Ocular hypertension in active toxoplasmosis retinitis – a case report:
                          A. Monka, E. Muço, E. Leci / Albania • 054
                    10:14 Application of bevacizumab injection for neovascularisation of the anterior
                          segment: A. Shabani, M. Asani, V. Ajazaj, E. Dida / Kosovo • 055
                    10:21 Screening of Retinopathy of Prematurity in Republic of Macedonia/1year result:
                          B. Tateshi, M. Ivanovska, A. Oros, G. Zlateva, V. Nikolovska-Buckovska,
                          H. Duma / Macedonia • 056

                    10:30 Coffee break & Commercial Exhibition

                                           • RETINAL SURGERY SESSION •
                        Chairperson: A. Nikolakopoulos, Co-chairpersons: M. Karacorlu & C. Forlini

                    11:00 Current concepts and new trends in vitreo-retinal diseases:
                          M. Karacorlu / Turkey • 057
                    11:30 Current small incision 25G plus constellation vitrectomy. Safety and
                          efficiency for the new surgeon: A. Nikolakopoulos / Greece • 058
                    11:45 Vitreoretinal surgery challenge.
                          B. Dabov, S. Mavrodieva / Bulgaria • 059
                    11:50 Heavy silicone oil as first choice in complicated retinal detachment:
                          Checkmate in two moves!:
                          C. Forlini, M. Forlini, A. Bratu, P. Rossini / Italy • 060
                    12:00 Functional and anatomical outcome after severe ocular trauma managed
                          with combined keratoplasty and pars plana vitrectomy:
                          V. Pfeifer, S. Stunf, M. Globocnik-Petrovic / Slovenija • 061
                    12:06 Toxoplasmic retinochoroiditis:
                          J. Dai, J. Jaho, B. Kruja, P. Lutaj / Albania • 062
                    12:12 Steven-Johnson Syndrome after administration of Tegretol:
                          E. Leci, A. Tandili, A. Monka / Albania • 063
                    12:18 Uveitis - case report:
                          S. Fileva, V. Fileva / Macedonia • 064
                    12:24 Carotid Cavernous Shunt:
                          B. Kruja, E. Veliu, K. Karafili, J. Jaho, P. Lutaj / Albania • 065

                    12:30 Lunch & Commercial Exhibition

 Chairperson: Nadiya Bobrova, Co-chairpersons: K. Spahiu & M. Antova-Velevska

14:00 Treatment of complex ocular trauma with mini-invasive systems: trauma festival:
      C. Forlini, M. Forlini, A. Bratu, P. Rossini / Italy • 066
14:10 Etiological classification of ptosis:
      K. Spahiu / Kosovo • 067
14:15 Frontalis muscle suspension with heterologous materials for ptosis correction:
      K. Spahiu / Kosovo • 068
14:20 Treatment of blepharophimosis syndrome:
      G. Hoxha / Kosovo • 069
14:25 Metastasis orbitae - appropriate diagnosis: B. Kostovska,
      M. Antova-Velevska, Z. Arnaudovski, V. Nikolovska / Macedonia • 070
14:30 Orbital Cavernous hemangioma:
      N. Salihu, M. Kubati-Ajeti, O. Kubati, B. Zhuri. / Kosovo • 071
14:35 Pediatric orbit tumor and tumorlike lesions: Z. Arnaudovski,
      M. Antova-Velevska, V. Nikolovska, B. Kostovska / Macedonia • 072
14:40 Floppy Eyelid Syndrome:
      B. Kruja, P. Lutaj / Albania • 073
14:45 Factors affecting visual function in benign intracranial hypertension:
      V. Tagani; A. Daizi; E. Balliu. P. Lutaj / Albania • 074
14:50 Treatment of the pterygium relapses after 6th recidivism, with the use of a
      egg membrane: O. Kubati, M. Kubati-Ajeti, N. Salihu / Kosovo • 075
14:55 Monocular Hyperfunction of Inferior Oblique Muscle:
      S. Boshnjakovska, M. Boshnjakovski / Macedonia • 076
15:00 Hallerman-Streiff Syndrome – A case Report: M. Çapuni-Brestovci,
      A. Miftari, A. Vuçitërna, L. Shiroka, S. Buqinca / Kosovo • 077
15:05 Comparision of the cycloplegic effect of atropine and cyclopentolate in children
      with hyperopia: M. Ilazi, G. Kaçaniku, M. Kubati, S. Gashi / Kosovo • 078
15:10 The impact of refractive anomalies in strabismus appearance and functional
      ambliopy: M. Kubati, O. Kubati, M. Ilazi, S. Gashi, B. Zhuri / Kosovo • 079
15:15 How to avoid via false (path) during probing in dacryocystitis neonatoria:
      O. Kubati, B. Zhuri, M. Kubati-Ajeti / Kosovo • 080
15:20 Ocular Manifestation in Down (21+) Syndrome:
      M. Boshnjakovski, K. Buzarevska / Macedonia • 081
15:25 Cyanoacrylate glue for the treatment of corneal perforations:
      B. Kruja, E. Veliu, J.Jaho, K. Karafili, P. Lutaj / Albania • 082
15:30 A case of sympathetique ophthalmia in a sixty year-old patient:
      E. Molosiu / Albania • 083
15:35 Complication of Neurofibromatosis, Type 1 presented at the outpatient visit
      at the Health Center of Specialities Nr 2, Tirane-Albania:
      Nora Burda, Blerta Gjoni / Albania • 084
15:40 Recession of Inferior Oblique Muscle, a new experience of weakness surgery
      of Inferior Oblique Muscle, applying in UHC “Mother Theresa”-case report:
      A. Tandili, A. Tonuzi, E. Leci / Albania • 085

                    15:45 The different strategy of anesthesia on cataract surgery under local anesthesia:
                          L. Agolli / Albania • 086
                    15:50 Trichophyton Spp. Fungal Keratitis in 22 Y-Old Female Contact Lenses Wearer:
                          V. Glavota, N. Gabric, I. Dekaris, I. Mravicic / Croatia • 087
                    15:55 Rehabilitation in low vision patients: state of art:
                          S. Scalinci / Italy • 088
                    16:00 Beginners difficulties of phacoemulsification method based on scientific
                          studies of some South – East and West European countries:
                          N. Bardhi, E. Balliu, S. Kavaja / Albania • 089
                    16:05 Treatment of decompensated compressive glaucoma with collagen implants
                          (case report): J. Bilbili; D. Costin, K. Bardhi, Costea, Claudia-Florida;
                          Bucatariu, M.P. / Rumania • 090
                    16:10 Management of traumatic hyphema: Retrospective Evaluation of
                          hospitalized patient, Eye Clinic, UHC “Mother Theresa”:
                          A. Tandili, Sh.Dajti, S. Xinxo, S. Zhugli, V. Mema, L. Agolli, A. Grezda,
                          A. Monka, J. Jaho, A. Hibraj, I. Zhonga, N. Burda, S. Zhuka / Albania • 091
                    16:15 Complicated cases in cataract surgery:
                          L. Scorolli / Italy • 092
                    16:20 Success rate of external dacryocystorhinostomy. Does silicone intubation affect
                          outcome?: G. Kaçaniku, K. Spahiu, M. Ilazi, G. Hoxha, M. Ismaili / Kosovo • 093
                    16:25 Fitting keratoconus. Choose the good design with standart or custom
                          contact lenses: Patrice MONGEOT / France • 094
                    16:30 Differents fitting prothesis eyes, four painted to sléral prosthesis:
                          Gerard Fournier / France • 095

                    16:30 Coffee break & Commercial Exhibition

                                 • SEE-ARVO (South-East European - ARVO) Session •
                         Chairperson: C. Grupcheva, Co-chairpersons: M. Jager & G. Mark Somfai

                    17:00 Welcome, Opening remarks:
                          Gábor Mark Somfai / Hungary
                    17:02 Welcome from the International Chapter Affiliate Council of ARVO:
                          Martine Jager / Netherlands
                    17:05 Angiogenesis and uveal melanoma:
                          Martine J. Jager, M. El Filali, L.V. Ly, P. A. van der Velden / Netherlands • 096
                    17:15 New diagnostic method in dry eye:
                          János Németh / Hungary • 097
                    17:25 Tear film stability test cover version of the TBUT single…
                          Christina Grupcheva / Bulgaria • 098
                    17:35 Allergic Granulomatosis of the Conjunctiva in Asthmatic Patients:
                          A Limited Form of the Churg-Strauss Syndrome:
                          Altin Pani, Martin Mayers, Pearl S Rosenbaum / USA • 99
                    17:45 Transplantation of amniotic membrane – indications and results:
                          T. Hergeldzhieva, P. Vassileva, N. Surchev, Y. Kirilova / Bulgaria • 100

17:52 HSV confirmations in surface disease – piece of cake, is it?:
      G. Yordanov, Zl. Trifonov. Y. Yordanov / Bulgaria • 101
17:59 Closing remarks:
      Christina Grupcheva / Bulgaria
      Gabor Mark Somfai / Hungary • WORKSHOP

                          Sunday / 20th of June 2010

                            • VISION 2020 Session •
           Chairperson: I. Kocur, Co-chairpersons: J. Nemeth & P. Lutaj

08:30 Prevention of blindness and Vision 2020 in Europe:
      I. Kocur (WHO) / Switzerland • 102
08:45 Prevention of blindness and visual rehabilitation in Hungary:
      J. Nemeth, G. Barcsay / Hungary • 103
09:00 Establishing National Vision 2020 Programmes in Ukraine:
      N. Bobrova / Ukraine • 104
09:15 Ophthalmology and Healthcare in Turkey:
      Mahmut Kaskaloglu / Turkey • 105
09:30 Prevention of avoidable blindness and visual impairment in Albania:
      P. Lutaj, J. Jaho, B. Kruja / Albania • 106
09:45 National vision program 2020 in Slovakia:
      A. Cernak / Slovakia • 107
10:00 Challenges for decreasing and prevention of the blindness in Macedonia:
      M. Antova Velevska, B. Tateshi, I. Bogdanova & F. Dzaferi / Macedonia • 108
10:15 Closing of the 7th Congress of SEEOS

10:30 Lunch & Commercial Exhibition
               28   General Information

                    Tirana is the capital of Albania. It is also the largest city in the Republic of Albania.
                    The Congress of Lushnja selected the city as the temporary national capital in 1920.
                    Later in 1925, the city acquired this status permanently. Tirana was founded in 1614
                    by Sulejman Pasha. Nowadays the city is home to more than one million people, it
                    has enlarged 6 times itself only during the last 2 decades and it is considered the
                    fastest growing city of Europe.
                    Having a Mediterranean climate, Tirana’s temperatures during June vary from
                    20 – 26 C degrees. Being in the beginning of the summer the whether is quite hot,
                    days are long and full of sun.
                    You may follow the forecast for Tirana online at

                    Passport & Visa
                    Passport and visas requirements may differ according to the country and place
                    of origin. Please, contact your travel agent or the nearest Albanian Consulate /
                    Embassy in your country of further advices.

                    Official Letter of Invitation
                    An official invitation letter will be send upon request. This letter can be used as an
                    attendance confirmation document and it can be appended to your visa application,
                    however it does not constitute any commitments by the Congress organizers to
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                    to participation in the Congress. Please send an email to the congress secretariat
                    at: with subject: invitation letter for visa (full name,
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                    properly and adequately insured. The Congress organizers and the Organizing
                    Committee accept no responsibility for any loss of money or other goods incurred
                    by the participants.

                    English and Albanian are the official languages of the Congress. During the
                    international symposium the official language will be English.

                    Congress Badges
                    All participants and guests should wear their congress badges for the entrance
                    to the Congress area, during the scientific sessions, at the exhibition area, during
                    poster session and all other social activities.

                    Certificate of Attendance
                    A certificate of attendance will be provided to all registered participants after the final
                    session on Sunday 20th of June 2010.

Currency and Credit cards
The currency used in Albania is LEK (1EUR = 135 LEK). Credit cards are excepted
at both congress, hotels, as well as on the majority of shops. Tirana has plenty of
ATMs connected to international networks. The main chains are Tirana Bank, Pro
Credit Bank, Raiffeisen Bank and American Bank of Albania. We advice the use of
cash in local currency (LEK), money exchange shops or banks can easily be found
in any corner near by.

Electricity is 220 V and there are no 110 V plugs in hotels or at Congress Venue.
Please do not forget to bring with you the chargers of your own equipments; laptop,
mobile phone, etc.

Tirana’s Airport “Mother Theresa” is the main and the most important gate for
travelers to Albania and it is only 15 km distance from the City center. The usual rate
for taxis from Airport to the Tirana City center, Venue place or hotel is 3.000 LEK or
20 EUR.

Mother Theresa International Airport – Venue place or hotel, transportation from
the organizing committee upon request. Please send an email to the congress
secretariat at: with subject: Airport Pick up (full name,
arrivals date & time)

Taxis are availiable at taxi stands or hailed on the street. Other ways are phone call
taxies, you may call from your cel phone and book a taxi at 22 55 555 or 22 77 777.
All taxies are yellow and should have yellow plates and rate meters.

Dress Code
Casual during the Congress and social events, formal for the Gala Dinner.

Important Deadlines
Deadline for earlier registration 15th of April
Deadline for late registration 15th of May
Deadline for abstract submission 1st of May
Deadline for poster submission 1st of May

Social Program
17 June 2010 / 19.00 – 20.00      Welcome Reception of SEEOS Foundation Board
18 June 2010 / 09.00 – 10.00      Opening Ceremony
18 June 2010 / 19.00 – 20.00      Visit at the National Historical Museum
19 June 2010 / 20.30 – 24.00      Gala Dinner (not included in the registration fee)
20 June 2010 / 16.00 – 20.00      Tirana sight seeing

                    Registration Information
                    Registration Fee                               before 1st of May                                    after 1st of May

                    Participant                                           150     EUR                                         200 EUR
                    Resident*                                              50     EUR                                         100 EUR
                    Accompanying Person                                   100     EUR                                         100 EUR
                    Gala Dinner                                            40     EUR                                          40 EUR

                    Registration fee includes access to all Scientific Sessions and Exhibition Area,
                    Conference bag, Badge, one copy of the Final Program and Book of Abstracts,
                    Welcome Cocktail, Coffee and Tea breaks and Lunches also, during the Congress
                    (18-20 June 2010).
                    You are welcomed to download and fill in the application form of SEEOS 2010 at
                    our website: or requested by email at

                       *Please be aware that all applicants applying under the Resident status must attach
                        a letter from their University confirming the Resident status.

                    Hotel Reservation
                    Hotel Tirana International ****                              85 EUR/single                        95 EUR/double
                    Hotel Mondial ****                                           76 EUR/single                        88 EUR/double
                    Hotel Nirvana, Arber, City, ***                              53 EUR/single                        70 EUR/double
                    Student Accommodation Solutions                              20 EUR/student

                       *Booking must be made together with your application form.

                    Abstract Submission Guideline
                    - Invited Speakers of the Congress will have 10 min for their presentations.
                    - Special Invited Speakers will have 30 min for their lectures and discussions.
                    - Other speakers will have 5 to 10 min for their presentations and discussions.
                    You are welcome to send a proposal of your abstract with in 500 symbols at our
                    email addresses or
                    Deadline by 1st of May.

                    Project equipments
                    A double multimedia projection screen connected to a laptop will be provided from
                    the Congress organizers to play all presentations during the Congress.

                    Personal Notes
Our Website                                                                               31

Our new designed website offers a variety of information related to South-East
Ophthalmological Society, its past, present as well as the upcoming Congresses.

In order to be registered on the website you may need to create your own account
filling in your personal datas. All subscribed users will than receive e-mails with news
and other important information and activities related to SEEOS.

  *The website is bilingual, offering a good opportunity for all English speakers as
   well as for the Albanian native speakers to explore and read all published articles.
               34   Corneal & Refractive
                    Surgery Session
                                    Chairperson: G. Renard, Co-chairpersons: N. Gabric & V. Pfeifer
                            New corneal surgeries with femtosecond laser:
                            G. Renard
                            Paris, France
                    Oral lecture.

                            Topography Guided ex. laser ablations for the treatment of highly
                            aberrated corneas:
                            Jordan Poulas
                            iLaser Refractive Surgery Institute, Thessaloniki, Greece
                    The purpose of this study is to present the usefulness of topography guided
                    laser corrections in specific cases of refractive surgery such us: post traumatic
                    cornea scars, keratoconus, high asymmetric astigmatism and retreatment for the
                    enlargement of decentred laser ablations.
                    Using the Allegretto 400 Hz laser T-CAT platform and the Pentacam Scheimflug
                    imager we treated 8 patients (10 eyes) in 12 months.
                    In all patients we performed surface laser ablation and MMC application at the end
                    of the surgery for 20 sec.
                    The BCDVA increased at least two lines postoperatively in all patients comparing to
                    the preop values of BCDVA.
                    Although the patient population is not large we think that topography guided laser
                    ablations is a helpful tool to reduce the HOA of the cornea and to help the patients
                    to achieve better vision acuity and quality.

                            Moria one use - plus SBK vs. LDV Femtolaser - Clinical Evaluation:
                            N. Gabric, M. Bohac, I. Dekaris
                            Eye clinic Svjetlost, Croatia
                    Aims: To compare flap thickness, flap and stromal bed quality, visual and refractive
                    outcomes and patient satisfaction beetwen LASIK procedures using either MORIA
                    one use-plus SBK mechanical microkeratome or Ziemer FEMTO LDV laser.
                    Patients and methods: Prospective study on 60 patients, divided into two groups,
                    who underwent LASIK procedure with flap creation either with Moria SBK one
                    use-plus mechanical microkeratome or Ziemer FEMTO LDV laser. Mean age in
                    both groups was 35 ± 15 years, spherical equivalent -6.00 D (ranging from -9.00
                    to +3.00 D), corneal thickness 540±40μm and keratometry values were 44±4D. All
                    curvature and elevation maps were normal.
                    We evaluated flap thickness and profile with OCT and Pentacam in several axis,

complication rate, time of procedure, quality of resection, flap and stromal bed,
visual outcome, patients discomfort during the surgery and postoperative dry eye.
Results: Mean flap thickness for SBK was 93±11μm and for femtolaser 95±5μm,
all flaps aligned perfectly to corneal bed. Intraoperative and postoperative
complications were unremarkable in both groups. Flap, corneal bed and resection
quality were slightly better in SBK group.
Patients discomfort was greater in femtolaser group due to longer blackout
phenomena. There was no diffrence in discomfort in early postoperative period.
Visual acuity and postoperative dry eye were the same in both groups measured at
Day1, Week1 and Month1. At month 3 hyperopic patients from femtolaser had less
regression rate while there was no difference in myopic group.
Conclusions: Both methods have excellent results in myopic cases. One use-plus
SBK showed slightly better results in flap and stromal bed quality, provides easier
handling and less patients discomfort during the surgery. Femtolaser gives better
results in hyperopic cases due to wider corneal bed and ablation zone independent
on K values.

        Deep Anterior Lamellar Keratoplasty:
        V. Pfeifer
        University Eye Clinic Ljubljana, Slovenija
To demonstrate that deep anterior lamellar keratoplasty (DLAK) can give similar or
even better results regarding high contrast (90%) visual acuity, low contrast (10%)
visual acuity (LogMar), higher-order aberrations and corneal transparency than
penetrating keratoplasty (PKP) in keratoconus patient. To present the structure of
interface between lamellar graft and Descemets membrane observed by confocal
Using big bubble technique DALK was performed keratoconus patients who were
contact lens intolerant. The surgical technique will be briefly shown. Two years after
surgery the best spectacle corrected visual acuity (BSCVA) high and low contrast
(at 90% and 10%) was taken. Also the amount of higher-order aberrations using a
Hartmann-Shack-style wavefront sensor were measured. The interface quality was
observed by confocal microscopy and compared to best scenario PKP patient.
Two years after surgery the transplant is clear, no interface is detected on slit lamp in
DALK patient. The 90% contrast BSCVA is +0.02 LogMar, 10% contrast BSCVA is
+0.26 LogMar, confocal microscopy shows no major differences between PKP and
DALK, there are less higher-order aberrations in DALK patient.
DALK can give good VA results and good quality of vision. The results are
comparable and can be even better than those of best scenario PKP patient in my
hands. The surgical technique in DALK is more demanding, takes longer time but
there can be no endothelial rejection. In contrary to PKP the lifespan of transplant
is longer and seems to be same as lifespan of the patient. So only one surgery is
needed in young DALK throughout his life. In PKP patient the lifespan of transplant
is shorter and grafting has to be repeated ones ore more times.

                            Monovision: An option for presbyopia?:
                            Mahmut Kaskaloglu
                            Kaskaloglu Eye Hospital, Izmir, Turkey
                    With the popularization of multifocal and accommodative lenses more patients are
                    requesting presbyopia correction after cataract surgery. Monovision is a method
                    of presbyopic correction where one eye is corrected for distance and other for
                    near. Typically if monovision is attempted during cataract surgery one eye should
                    be emmetropic and the other eye should be -2.0D. However this maybe difficult to
                    adapt for many patients and jeopardizes the success of the operation. This is why
                    I attempt what I call minimonovision that is attempt to make one eye emmetropic
                    and the other eye around -0.75. This provides the patient sufficient near vision
                    acuity for most of the daily routine activities. In this presentation I will talk about the
                    monovision techniques and discuss my personal approach.

                            Advances in hyperopic Lasik:
                            M. Anticic, M. Bohac, N. Gabric
                            Eye clinic Svjetlost, Croatia
                    Aims: To evaluate outcomes of LASIK for Hyperopia
                    Patients and methods: Prospective study included 100 eyes of 60 hyperopic
                    patients with mean preoperative SE +3.3±1.16 dpt, which were randomly assigned
                    into three groups. Every patient underwent protocol preoperative ophthalmic
                    test that included a thorough slit lamp biomicroscopy, corneal topography using
                    Wavelight Oculyzer, specular microscopy, and recorded uncorected, bestcorected
                    and cycloplegic refraction. All treatments were performed using Moria M2
                    microkeratome and Wavelight Allegretto 400Hz excimer laser. 18 eyes underwent
                    standard ablation procedure, on 35 eyes we did topoguided treatement, and on 47
                    eyes we manualy decentred ablation zone. We evaluated visual acuity, regression
                    rate, complications and patient satisfaction over 6-12 months.
                    Results: All patients did well and achieved UCVA >20/40, binoculary 95% of
                    patients achieved ≥20/20. Patients in group with manual decentration of half
                    distance between visual and pupilary axis did the best. 92% of patients were in
                    ± 0.50 dtp range (80% achieved 20/20 vision), while only 85% of patients from
                    topoguided group achieved that result (72% achieved 20/20). The weakest results
                    were in patients who unerwent standard procedure only 72% of patients were
                    in ±0.50 dpth range (66% achieved 20/20). There were few complications that
                    included severe dry eye, mild epithelial ingrowth not requiring removal, irregular
                    astigmatism, and decentration.
                    Conclusions: Manual decentration that includes half distance between visual and
                    pupilary axis is predictable and safe. It shows low regression rate and does not have
                    a problem of severe decentration that sometimes can happen using topoquided
                    treatement. Large decentrations cause night vision problems (double vision, glare)
                    and influence on patients satisfaction.

        Comparison of different types of phakic intraocular lenses:
        N. Gabric, I. Dekaris, M. Bohac
        Eye clinic Svjetlost, Croatia
Aims: To compare visual outcome, complication rate, endothelial cell loss and
patient satisfaction after implantation of Verisyse, Veriflex and Cachet intraocular
lenses (IOL).
Patients and methods: Retrospective assessment of 390 eyes who underwent
phakic IOL implantation in the past 36 months. Uncorrected and best corrected
distance visual acuity (BCDVA), postoperative cylinder, complication rate
(intraoperative and postoperative), intraocular pressure (IOP), endotheliall cell loss
(ECL) and patient satisfaction were investigated.
Results: 90% of patients achieved their preoperative BCVA. 17% of patients in
Cachet group gained on or more lines of BCDVA compared to 12% for Verisyse
and 10% for Veriflex. 15% of patients in Verisyse group had one or more cylinder
of postoperative astigmatism compared to less than 5% in Veriflex/Cachet
group. Intraoperative endothelial cell loss was 4%, slightly higher in Veriflex group
(mechanism of implantation?). Yearly ECL for Verisyse/Veriflex was around 2,5%
and 1% in 6 month for Cachet. 1% of patients showed transitory postoperative
increase of IOP probably caused by residual viscoelastic. 95% of all patients are
higly satisfied.
Conclusions: All lenses show satisfying results.Dissadvanages of Verisyse/Veriflex
are need for more anesthesia than just topical, also for Verisyse is the incision
size and postoperative astigmatism. Veriflex shows slight matherial problems and
gathering of pigment precipitats on silicone/acrylate border. Cachet has too small
diopter range, high price and too short follow up.

        Overview on the features and benefits of Acrysof Cachet Phacic IOL:
        Baha Toygar
No abstract.

        Correcting Presbyopia and Astigmatism Implementing COMICS
        through 1.8 mm Incision with Stellaris and MICS IOL’s:
        V. Pfeifer, M. Schwarzbartl
        Eye Surgery Center Dr. Pfeifer
To demonstrate safety and effectiveness of COMICS (coaxial micro incision cataract
surgery) using ultra small incision IOLs in correcting refractive error and presbyopia.
COMICS was used to remove cataract or clean lens. Ultra small incision Acri.LISA
Toric 466 TD IOLs were used to correct refractive error and presbyopia. Cataract

                    extraction was performed through 1.8mm incision using coaxial Quick Chop
                    phacoemulsification technique. Acri.LISA Toric 466 TD aspheric diffractive bifocal
                    IOLs were implanted through 1.8mm incisions.
                    Surgical technique is safe, postoperative induced astigmatism is minimal or zero.
                    Patients implanted with Acri.LISA Toric 466 TD do not need glasses for most daily
                    COMICS can be safely performed through 1.8mm incision and Acri.LISA Toric 466
                    TD can be implanted through 1.8mm incision inducing no change in astigmatism
                    or Q value of the cornea. Toric diffractive bifocal IOL’s give good far and near visual
                    acuity, correct myopia, hyperopia, presbyopia and astigmatism. Refractive lens
                    exchange (RLE) is a good method to cure refractive error and presbyopia. New
                    design toric diffractive IOLs with aspheric optic like Acri.LISA Toric 466 TD make it
                    even better.

                            Phototherapeutic Keratectomy (PTK) in the Treatment of Corneal
                            Granular Dystrophy GROENOUW I:
                            Pajtim Lutaj1, Julinda Jaho2, Bledar Kruja3
                             UHC “Mother Theresa” of Tirana and Vision Eye Clinic; 2Universal Hospital
                            Tirana, 3National Traumatology Center, Military Hospital, Tirana, Albania
                    Aims: Corneal granular dystrophy Groenouw type I is a rare autosomal dominant
                    disease caused by allelic mutations of the BIGH3 gene. The specific phenotype is
                    characterized by granular opacities (white, sharply demarcated spots resembling
                    snowflakes or bread crumbs) in the anterior corneal stroma, sparing the periphery
                    and causing corneal erosions and blurred vision. Phototherapeutic keratectomy
                    (PTK) constitutes an effective procedure that improves visual acuity, but recurrences
                    occur. We are presenting a case, succesfully treated with PTK, with no signs of
                    recurrence in 5 years.
                    Patients and methods: Case report of patient K.H., born in 1988, male,
                    diagnosed in 2004 with Groenouw I corneal dystrophy, BCVA of 2/10 in both
                    eyes. PTK was performed using Keratechnology - isobeam D200 Excimer Laser.
                    Treatment was applied at the optic zone of 6.5 mm, depth 2 x 10μm. This was
                    followed by correction of the induced hyperopia. A soft contact lens was applied at
                    the end of the procedure.
                    Results: BCVA of 8/10 even 5 years after the procedure, in both eyes, compared to
                    2/10 before treatment. No signs of recurrence of the corneal dystrophy 5years after
                    Conclusions: Corneal grafting has been the standard treatment for visually
                    disabling granular dystrophy, but as literature shows, PTK has significant
                    advantages over this procedure and must be the first choice in the management of
                    corneal granular dystrophy when intervention is required.

       Treatment of severe corneal ulcer - Our Experience:
       Magdalena Antova Velevska
       University Eye Clinic Skopje
Aim: The treatment of immunological corneal disease and melting is still a challenge
of ophthalmologist.
Purpose: To present experience with topical cyclosporine in treatment in case of
severe ulcerative and marginal forms.
Patient and methods: We report for 15 patients suffering from rheumatic ulcer
treated with cyclosporine A. Follow up range between 6 and 24 months.
The study was performed in 20 eyes with R. disease. SLE, primary Sjogren Sy. and
melting after cataract surgery.
Results: In all cases corneal perforation could be prevented with adequate
systemic and topical treatment on time. One case was treated with penetration
keratoplasty a chaud and conjunctive flap. Corneal melting as a serious diagnosis
requires exhaustive examination and prompt but continuous treatment. Definitive
management often cannot be achieved by local therapy alone and requires
institution or escalation of systemic treatment, including immunosuppressive therapy
using cytotoxic agents such as cyclophosphamide or immunomodulatory agents
such as methotrexate or cyclosporine.
The effect of the 3-6 months long treatment with either medication was significant of
corneal and lacrimal status.

       Corneal Cross - Linking:
       Mimoza Meco, Dilek Uzer
       American Hospital, Tirana, Albania
Aim: To report first results of corneal cross-linking treatment(CCL) in progresiv
keratoconic(KC) patient in Albania.
Patients and methods: Retrospective reviewof 15 patients treated in our center.
Preoperative assessment and postoperative follow-up were documented as follow
at each visit: uncorrected and corrected visual aquity, keratometry, refraction,
corneal thickness and Pentacam measurements were documented.
Results: Mean follow-up 4 months (range 2 to7). Mean BVCA and mean refraction
improved slightly. Mean average upillary power (APP) and apical Keratomerty
(AK) changed from 47.50D to 45.00D and from 59.50D to57.70D (p<0.05). Mean
baseline PCP (pupl center pachymetry) decreased (p<0.05).
Conclusions: CCL appears to be un effective technique to stop progressing of
keratoconus. Further follow-up of our patients is required to assess its long-term

                            The AcrySof ® IQ ReSTOR ® lens:
                            Miroslav Vukosavljevic
                            Military Medical Academy, Serbia
                    AcrySof IQ intraocular lens implant are designed to give the majority of cataract
                    surgery patients without astigmatism the best potential for high quality single-
                    distance vision.

                    The IQ lens is ideal for patients who wish to be corrected for distance vision and
                    are comfortable wearing glasses. Also, the AcrySof IQ intraocular lens is designed
                    to have the lens capsule “shrink wrap” around it. This helps the lens remain stable
                    and centered within the eye. The patented yellow color of the AcrySof IQ intraocular
                    lens is biocompatible and bonded to the structure of the acrylic material. The yellow
                    color of the AcrySof IQ intraocular lens, approximates the natural discoloration
                    (i.e., natural yellowing) of a healthy adult crystalline lens, without a negative
                    impact on color perception. Contrast sensitivity and night driving are improved
                    after implantation of the yellow-tinted AcrySof IQ intraocular lens. The AcrySof
                    IQ intraocular lens is compatible with secondary cataract treatment, known as a
                    Nd:YAG laser posterior capsulotomy, if required.
Cataract & Refractive                                                                    41

Surgery Session
              Chairperson: P. Lutaj, Co-chairpersons: M. Kaskaloglu & Z. Nagy
        Management of Advanced Cataracts:
        Mahmut Kaskaloglu
        Kaskaloglu Eye Hospital, Izmir, Turkey
Cataract operation with phacoemulsification is a standard procedure universally
however since cataracts present in various stages it is imperative for the surgeons
to utilize the proper techniques for each type of cataract. While in the western
countries most of the cataracts are in the early stage, many patients present at
advanced stages. A high percentage of these cases are patients with a single eye or
had complicated surgeries on the other eye and present for their second eye at later
stages. So it is very important to do safe phacoemulsification in these advanced
cataracts. Surgeons who are operating these cases should utilize the proper
instruments abd the techniques for safe surgery in these cases. In this presentation I
will present my approach in advanced cataracts and how tips to do safe surgery in

        Use of Femtosecond Laser System in Cataract Surgery:
        Zoltan Nagy
        Department of Ophthalmology, Semmelweis University, Budapest, Hungary
Aims: To evaluate the use of a new femtosecond laser system to liquefy the
cataractous lens, perform a refractive capsulotomy, and create optically aligned
corneal incisions for refractive cataract surgery.
Patiens and methods: Following IRB review and approval, patients undergoing
standard cataract surgery or refractive cataract surgery were initially treated with
a novel intraocular femtosecond laser (LenSx Lasers, Aliso Viejo CA) to liquefy
the cataractous lens, perform the capsulotomy, and exit the eye with the creation
of corneal incisions. Following laser treatment, patients underwent irrigation and
aspiration of the liquefied lens material and subsequent intraocular lens implantation.
Results: The laser successfully liquefied the lens nucleus so that it was aspirated
with the use of an I/A tip. Laser capsulotomy diameter was accurate to within 0.25
mm of intended, and centration was accurate and highly reproducible. Multiplanar
corneal incisions were self-sealing.
Conclusions: The LenSx femtosecond laser has the potential to improve cataract
and refractive lens procedures by eliminating the need for complex surgical
maneuvers, increasing surgical precision and reducing variability of traditional
manual phaco surgery.

                            The gold standard of secondary IOL implantation in the
                            transconjunctival era:
                            Cesare Forlini1, Matteo Forlini2, Adriana Bratu1, Paolo Rossini1
                             Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy.
                             Department of Ophthalmology, Policlinico di Modena, Modena, Italy.
                    Aims: The aim of this study was to report our long term evaluation of the use of
                    retropupillary implantation of the iris claw intraocular lens (RPICIOL) in many aphakia
                    conditions without capsular support in the era of transition to the transconjunctival
                    mini-invasive sutureless vitrectomy techniques.
                    Patients and methods: A retrospective analysis of 320 eyes which underwent
                    RPICIOL implantation in post traumatic aphakia, post cataract surgery aphakia and
                    in cases of penetrating keratoplasy associated with vitrectomy for post traumatic
                    and post cataract surgery aphakia. All procedures were performed with 20 gauge
                    or 23 or 25 gauge vitrectomy techniques. For these eyes we reviewed the refractive
                    outcome, anatomical outcome, the long term stability of the implants and the
                    possible long term complications.
                    Results: In our series the mean age for the included patients was 61.7. The mean
                    follow up time was 5.3 years. The post operative residual spherical equivalent error
                    was -1.34 ± 1.24 SD. In all cases the RPICIOL was stable without disenclavation
                    except 3 cases with subluxation due to slippage of one of the iris claw haptics and 1
                    spontaneous complete posterior dislocation. We had also one case of
                    retinal detachment. No cases of uveitis were observed. Eight cases complaint of
                    chronic dull pain. Iridodonesis was seen in 5 cases. One case of postoperative
                    macular oedema was observed. No postoperative increase in the mean intraocular
                    Conclusions: RPICIOL for secondary implantations in combination with
                    transconjunctival mini invasive vitrectomy surgery is not only a valid alternative
                    strategy to the classic scleral-fixed or angle supported IOL implantation but also a
                    gold standard technique.

                            Cataract and floppy iris syndrome - Case Report:
                            Arjeta Grezda1, Julinda Jaho2, Anila Gambeta3
                             Universitary Hospital Center of “Mother Theresa” in Tirana;
                             Universal Hospital Tirana; 3Regional Hospital of Lushnja
                    Aims: As Flomax (tamsulosin hydrochloride) is known to be associated with floppy
                    iris syndrome and has been introduced and used since 2 years in Albania, we are
                    we are trying to point out the importance of taking a detailed history for tamsulosin
                    use in order to diagnose floppy iris syndrome in patients scheduled for cataract
                    Patients and methods: A 67 year old man was presented to the ophthalmology
                    clinic with cataract. He suffered from systemic hypertension and also benign
                    prostatic hypertrophy. He was on tamsulosin treatment from 1.5 years. We
                    concluded that the patient was at great risk for intraoperative floppy iris syndrome,

so our procedure of choice for the prevention of any intraoperative complication was
iris retractors use since the initiation of the procedure.
Results: The presence of floppy iris syndrome was confirmed during the surgical
procedure. The use of iris retractors helped the phacoemulsification procedure and
the intervention was completed without any intraoperative complication. The BCVA
was 9/10 two weeks later.
Conclusions: As it is well known that tamsulosin can be associated with IFIS, it is
cardinal to take detailed medical history of patients having cataract surgery, paying
attention to a history of benign prostate hypertrophy and its treatment. These cases
need special care and also a careful planning to choose the appropriate technique
for prevention of any intraoperative complication.

        Comparison of different presbyopia treatments: Refractive lens exchange
        with multifocal intraocular lens implantation Vs. LASIK Monovision:
        A. Barišic, N. Gabric, I. Dekaris, I. Romac, M. Bohac, B. Juric, V. Glavota
        Eye clinic Svjetlost, Croatia
Aims: There are several methods for presbyopia treatment. Refractive lens
exchange followed by multifocal intraocular lens implantation enables high rate
of spectacle independance but have some visual disturbances. Principle of
monovision, achived by LASIK or of monofocal intraocular lens implantation, gives
patient ability to have good distant vision with dominant eye and and good near
vision with nondominant eye. In this prospective randomized study we wanted
to compare clinical outcome in patients who underwent either of the mentioned
Patients and methods: In this prospective randomized study we divided patients
into two groups. In the first group were 50 patients (N=100 eyes) who underwent
refractive lens exchange with multifocal intraocular lens implantation and in second
group 50 patients (N=100 eyes) who underwent LASIK monovision as presbyopia
treatment. Uncorrected distant, near and intermediate visual acuity, patient’s
subjective satisfaction and visual disturbances were measured. Follow up was 12
Results: Patients in both groups achieved distant UCVA ≥0.8 and near UCVA
≥J2. Patients in RLE+MFIOL group had better near UCVA and patients in LASIK
monovision group had better distant vision. Patients in RLE+MFIOL group reported
visual disturbances (haloes, glare). Patients satisfaction and spectacle independance
was high in both groups.
Conclusions: Refractive lens exchange with multifocal intraocular lens implantation
and LASIK monovision are effective methods for presbyopia treatment. LASIK
monovision with -0.50D – 1.00D of residual dioptry at nondominant eye in patients
under 50 years enables good near vision without affecting stereovision. In patients
over 50 years, multifocal IOLs are preferable.

                            Age Related Cataract Surgery Coverage and Contribution to Vision
                            Impairment Reduction in Population of Vojvodina:
                            Slobodanka Latinovic, Sava Barišic and Marijana Maleševic
                            University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
                    Aims: To estimate the age related cataract surgical coverage according to
                    preoperative VA and visual impairment in Vojvodina and its contribution to reducing
                    visual disabilty.
                    Methods: A cross-sectional biphasic population based study of 50 + years citizens
                    in Vojvodina was performed in 2007/08. By telephone interviewing a sample
                    with reading problems was selected -11% (819), and 502 (61.3%) came for the
                    ophthalmic examination focused on age related cataractand preoperative visual
                    acuity. Annual surgical coverage was estimated in all 7 regional eye centers.
                    Results: The cataract was present in 1.57%(12.800 citizans) of holl population 50 +
                    years. Visual acuity bether then 0.3 was in 55.3% (monocular or incipien cataract),
                    34.7% (4.192) with low vison and with legal blind was 10%( 1.232 ). Predicted
                    number of cataract surgery for reducing visual disabilitywas 5424. The 7 surgical
                    services in the year 2009 covered 4.852 operations of senile cataract with mean age
                    of 70,5 years, more women (55,5%). According to preoperative visual acuity only
                    27,5% was operated from the visual impaired group and 72,5% was pacient with
                    monocular or incipient cataract. High comorbidity (66.2%) was associated, mostly
                    cardiovascular disease (44.6%) and diabetes mellitus (21.7%).
                    Conclusions: The difference between the needs of cataract surgery and the
                    surgeries performed is low, but the distribution of surgical coverage according to
                    preoperative VA does not meet the requirements for reducing visual disabilty caused
                    by senile cataract. To overcome this, we need tocreate the central cataract register
                    with the priority of surgery in patients with low vision andblindness. Operations in
                    patients with monocular and incipient cataract should be maintained by increasing
                    the overall number of procedures.

                            How, why, when mix and match:
                            B. Juric, N. Gabric, A. Barišic, M. Bohac
                            Eye clinic Svjetlost, Croatia
                    Aims: To achieve binocular visual results in patients with cataract or candidates
                    for refractive lens excange with different kinds of multifocal IOLs using a “mix and
                    match“ method.
                    Patients and methods: A prospective study enrolled 120 patients, aged between
                    45 and 75 years (median age=60 years): 60 patients with mix and match approach-
                    implantation of refractive multifocal IOL(ReZoom) in their dominant eye and a
                    diffractive multifocal IOL (Tecnis, ReStor) in their non dominant eye; 60 patient with
                    the same type of multifocal IOL. Subjective satisfaction, spectacle dependency,
                    near, intermediate and distant UCVA and visual disturbances were measured and
                    compared in both groups during 3 months after procedure.
                    Results: In first group the mean binocular distance decimal visual acuity was

0.75+/-0.55 D, the mean binocular intermediate decimal visual acuity was 0.75
+/- 0.50 D, the mean binocular near decimal visual acuity was +0.25 +/- 0.30 D. In
other group the mean binocular distance decimal visual acuity was +0.25 +/- 0.75
D, the mean binocular near decimal visual acuity was 0.30 +/- 0.55.
Conclusions: Mix and match is an excellent compromise of vision-good results at
all distances. Patients are either highly satisfied or highly unsatisfied. Main problems
of unsatisfied patients are night glares and halos and different image quality from
each eye. Only good patient selection will give good results.

        Maximizing torsional phaco efficiency and introduction to OZil IP:
        Baha Toygar
No abstract.

        Cataract extraction with Diffractive Multifocal IOLs:
        Pajtim Lutaj
        UHC “Mother Theresa” of Tirana; Vision Eye Clinic, Albania
Aims: Comparison of visual results and quality of vision of two multifocal Intraocular
Lens: AcriLisa and Diffractiva.
Material: 46 eyes were operated on for cataract. Phakoemulsification technique.
24 eyes are implanted with AcriLisa mIOL (group 1) and 22 eyes with Diffractiva
mIOL (group 2).
Patiens and methods: Evaluation of visual results was performed between the
first and third week post operatively. The quantity and quality of vision was explored
in both groups by using the evaluation of BAVA and BCVA for far, intermediary and
near distance, and a questionnaire dealing with patient’s satisfaction and presence
of halos and glare.
Results: The predictability was good in both groups (mean refractive error <1.00 Dp).
Mean corrected distance visual acuity was similar in groups 1 and 2 (0.8). Mean
corrected intermediary visual acuity was the same in both groups. Mean corrected
near visual acuity was better in group 2.
Halos and glare were noted in 8% (group 1) and 9 % (group 2)
Conclusions: The Implantation of diffractive IOL is increasing in practice of cataract
surgery because of high level of patient satisfaction to be spectacles free. However,
the occurrence of halos and glare suggest a limitation of these indication of
multifocal IOL, particularly for night driving patients.

                            Accomodative Intraocular lens implants:
                            Zeki Tunc
                    No abstract.

                            Use of multifocal intraocular lenses - Restor Acrysoft:
                            Minir Asani
                            Pristina, Kosovo
                    A multifocal IOL has the advantage of providing the patient with functional vision at
                    near, intermediate, and remote distances. Careful patient selection and counseling
                    along with preoperative measurement are critically important for achieving patient
                    satisfaction postoperatively.
                    The AcrySof ReSTORE lens (Alcon) recently received FDA approval. The ReSTORE
                    is a foldable diffractive lens a 6.0 mm optic, 13 mm diameter approved for use to
                    correct presbyopia can be placed through a microincision. It is an aspheric design.

                            Anterior Chamber phakic intraocular lens ACPIOL - Cache (Alcon):
                            Minir Asani
                            Pristina, Kosovo
                    Phakic IOLs (PIOLs) Cache represent a new category of IOL that expands the range
                    of keratorefractive surgery, offering surgeons and their patients new options for
                    vision correction (high myopia -6.00 to -16.5.oo dpt.). Cache is a foldable Acrysof
                    lens a 6.0 mm optic can be placed through a 2,6 mm incision.
                    Topical anesthesia with intracameral supplement is suitable if the patient can
                    cooperate and the PIOL can be inserted through a small incision. A peripheral
                    iridotomy is not recommended for Cache.

        Dynamic aphakia correction (IOL+glasses) of infants at congenital
        cataracts phacoaspiration:
        Bobrova Nadiia, Zhekov Oleksii, Dembovetska Anna
        SI “The Filatov Institute of Eye Diseases and Tissue Therapy, AMS of Ukraine”
        Odessa, Ukraine
Aims: to develop infants (1-24 months) aphakia dynamic correction (IOL+ glasses)
at congenital cataract phacoaspiration
Patiens and methods: 19 children (25 eyes) aged 6 - 23 month (ave 17mo±
1,5SD) with different types of congenital cataracts were operated by standard
microincision technique-phacoaspiration and primary IOL implantation. Optical IOL
power was calculated on hypermetropia (2,0-5,0 D).
An offered method consists in realisation of one-stage baggal IOL implantation at
congenital cataracts phacoaspiration in combination with dynamic glass correction
in the postoperative period («+», then «-»). Remote supervision under sedation were
in 2, 4 and 6 months after operation. Observation was performed under sedation.
Results: Pseudophakic eyes refraction in all cases after operation was
hypermetropic from +1,5 to +4,5 D. Additional glasses correction was appointed
to 11 children with Hm+3 - Hm+4,5 D to reach emmetropia. Three children
refused glasses correction. In 4 months of supervision hypermetropic refraction
decreased in all cases to +2,0 D. In 6 months of supervision weak miopia (-0,5-1,0
D) was revealed in 2 cases, in 3 were emmetropia, in 10 cases – remained weak
hypermetropia +1,0 to +2,0 D. The main advantage of developed method consists
in possibility of primary baggal IOL implantation, that practically it is not possible at
the delayed secondary implantation.
Conclusions: The exploited method allows to receive emmetropic refraction of
pseudophakic infants eye after operation and in the remote terms of the supervision
despite of dynamic refraction changes owing to eye growth and corneal refraction.

        Posterior Chamber Iris-claw Lenses as a Way to Correct
        Postoperative Aphakia in Critical Cases:
        Narcisa Ianopol, Jonid Bilbili, Klajda Bardhi
        Ophthalmologic Department, Railway Clinic Hospital, Lasi, Romania
Aims: To analyze the implantation of the iris claw lenses back to the iris diaphragm,
as a surgical method for correction of postoperative aphakia in critical cases.
Patients and methods: Eyes with different constellations of anterior segment
and posterior segment pathologies including postoperative aphakia are presented,
as consecutive steps during the surgical sessions. Together with other anterior
segment and vitreo-retinal procedures required by each special condition, the
implantation of the iris-claw lenses back to the iris is demonstrated, as a step to
correct the refractive status of the eye. The advantages and disadvantages of
this surgical method to correct postoperative aphakia in the absence of posterior
capsule support are analyzed.

                    Results: The implantation of the iris-claw lenses in the posterior chamber has
                    important advantages over the other techniques of aphakia correction in the
                    absence of the posterior capsule support: simplicity of the surgical technique, less
                    traumatism of the eye and a good restauration of the anterior chamber anatomy
                    while sparing the anterior chamber angle, corneal endothelium and the ciliary
                    body region. However, there is still a degree of postoperative astigmatism and the
                    necessity of a new formula for the calculation of the intraocular lens power.
                    Conclusions: The implantation of the iris-claw lenses in the posterior chamber
                    of the eye is one of the best surgical method to correct postoperative aphakia in
                    numerous critical cases, when there is no capsular support back to the iris.
Glaucoma                                                                                49

              Chairperson: M. Sefic, Co-chairpersons: S. Latinovic & E. Goranci
        Selective laser trabeculoplasty as a new approach to glaucoma
        Mustafa Sefic, Sanja Sefic-Kasumovic
        Eye Clinic “Dr. Sefic”. Sarajevo, Bosnia & Herzegovina
It is a simple, highly effective laser procedure (SLT) that reduces intraocular
pressure. It has selective targets and irradiates only pigmented cells in the
trabecular meshwork (TM) with no collateral damage to its understanding structure.
Macrophage recruitment takes place to remove damages cells and TM cells divide
to replace the lost cells. New cells and more normal TM restore balanced aqueous
outflow function. We presented a group od 67 eyes with intraocular pressure (IOP)
25.7 mm Hg with 6-month follow up. SLT was performed to all of them. After 3
months in 67% of our patients IOP was 18.3mm Hg. Rest of 33% tested patients
had repeated SLT and after one month 12% had reduced IOP of 5.2 mm Hg. 21%
of our patients had no reaction to repeated SLT.
Conclusions: SLT offers an effective IOP lowering in patients with open angle
glaucoma on medical therapy. It is safe, effective, simple, fast and repeatable
procedure with no side effects. It does not affect any future surgery. It makes
possible a better quality of live (cancelling or reducing medicament therapy). SLT is
an effective alternative to medication as first line therapy.

        Selective laser trabeculoplasty in the treatment of glaucoma simplex
        in the patient who is allergic to all medications for curing glaucoma:
        M. Lukic, M. Gavric, N. Gabric
        Eye clinic Svjetlost, Croatia
Aims: The aim of this study is to present our experience in the efficency of the
Selective Laser Trabeculoplasty (SLT) in the patient who is allergic to all types of
medications for treating glaucoma, especially those which in their composition
contain bensalconium chloridum as preservative. The patient is also allergic to all
types of local anesthetic drops with the same preservative.
Patients and methods: This is a prospective study which follows SLT effects applied
in the patient with glaucoma simplex to both eyes during the last 20 months. Except
the measuring of intraocluar pressure, the whole time the changes in the visual field
and optic nerve are being monitored. We used SLT-Ellex, computerized visual field-
OCTOPUS and OCT-Zeiss.
Results: Pre-operative ocular pressure in the patient was in the right eye 29,00
mmHg and 26,00 mm Hg in the left eye. First day after the Selective Laser
Trabeculoplasty IOP in the right eye was 21,00 mm Hg and in the left eye 16,00 mm
Hg. One month after the SLT treatment, IOP was 19,00 mm Hg in the right eye and
15,00 mmHg in the left one. In the following 16 months IOP was between 16-19

                    mm Hg in the right eye and 15-17 mm Hg in the left eye. After 16 months IOP is still
                    correct in the left eye but in the right eye it has increased to 25,00 mmHg. SLT re-
                    treatment was carried out on the right eye and the IOP has been again stabilized up
                    to now on the values of 16-18 mmHg.
                    Conclusions: SLT has shown as very effective in the patient with glaucoma
                    simplex and for now the only method for maintaining regular IOP in the patient with
                    glaucoma simplex who is allergic to all types of medications.

                            Management of bleb overfiltration in a patient 4 years after
                            trabeculectomy with MMC:
                            Julinda Jaho1, Jonida Dai2, Bledar Kruja3, Pajtim Lutaj4
                             Universal Hospital Tirana, Albania; 2“Optika Trevi”; 3National
                            Traumatology Center, Military Hospital; 4UHC “Mother Theresa”, Tirana and
                            Albanian Vision Eye Clinic, Albania
                    Aims: Overfiltration may follow months to years after filtering surgery especially
                    with the use of antimetabolites. Complications related to overfiltration may lead to
                    a decrease in visual acuity through complicated hypotony or ocular infection. Our
                    presentation reports the management of a case with late overfiltration involving
                    the resection of the bleb associated with covering of the trabeculectomy site with
                    healthy conjunctival flap rotation.
                    Patients and methods: Case report of a patient, born in 1952, who had
                    undergone Trabeculectomy with MMC in both eyes (OD in 2004 and OS in 2005).
                    Encapsulated cist had been present in the right eye, associated with stabilized IOP
                    and BCVA of 8/10. He presents to our clinic in February 2009 complaining for acute
                    reduced visual acuity. The examination showed BCVA of 3/10, flat anterior chamber.
                    Atropine and pressure patch were administered for 24 h. The next day examination
                    showed presence of the anterior chamber, Seidel ++, hypotony. Atropine and
                    pressure patch administration was continued for other two days, at the end of which
                    the examination still showed BCVA of 4/10, Seidel ++. Surgical reconstruction of
                    the bleb was performed then, consisting in 2 cross sutures at the site of the leakage
                    and reconstruction of the conjunctival bleb with healthy conjunctival flap rotation.
                    Results: TIO of 14 mm Hg in the third postoperative day. BCVA of 4/10 and faint
                    CN opacification one month later. Normal function of the conjunctival bleb, BCVA of
                    8/10 cc + 2 X 1750, 4 months after the reconstruction surgery of the bleb.
                    Conclusions: Bleb resection associated with covering of the trabeculectomy site
                    rotating a healthy conjunctival flap is a safe and effective procedure for the treatment
                    of a late overfiltration and its complications. Patients must be aware of the possibility
                    of a recurring Seidel; however, according to the literature, the incidence of this
                    complication remains low.

        Vasoactivity Changes Corelating to Intraocular Pressure -
        Experimental Study:
        Slobodanka Latinovic
        University of Novi Sad, Faculty of Medicine of Novi Sad, Serbia
Aims: To evaluate the effects of intraocular pressure changes and vasoactive drugs
effects on the uvea vascular structure.
Methods: In the experimental changes of intraocular pressure we evaluated the
status of intraocular circulation with Neopren Latex technique and iris fluorescein
angiography. The effects of adrenergic drugs (Adrenalin) in various intraocular
pressure conditions were analyzed.
Results: At the normal intraocular pressure of 16 mmHg the intraocular circulation
and blood Perfusion was regular. When intraocular pressure raises, exceding the
value of the prefusion pressure in the intraocular vascular network, mechanicle
passive vasocompression will ocure as well as reduction of blood flow and
prefusion of the neopren-latex marker and Na-flouresceinat. The visible vascular
network reduces in proportion with the raising of IOP. Vasoconstrictive effect of
adrenalin manifests it self intresing activity in conditions of normal IOP. In loew
IOP passive vazodilatation will ocur togeder with increased vesculare permeability
caused the ruprute of hematoocular barier.
Conclusion: IOP, blood flow, homodinamics and hidrodinamics in the eye are in
direct correlation with extracirculatory pressure around the blood vessels in to the
eye. The activity and effects of the adrenergic and hooll vasoactive drugs is also
influenced by the conditions of the extracirculatory pressure or intraocular pressure.

        New congenital glaucoma surgical treatment method:
        Bobrova Nadiia, Tatjyana Sorochinskaya, Natalia Kuzmina
        SI “The Filatov Institute of Eye Diseases and Tissue Therapy, AMS of Ukraine”
        Odessa, Ukraine
Aims: New congenital glaucoma surgical treatment development.
Patients and methods: At Pediatric Ophthalmology department was elaborated
viscosurgery technique which was performed on 42 eyes with congenital glaucoma
(CG). The medical investigation of 26 children (52 eyes) were reviewed. Mean
patient age was 14,4 + 10,9 mo (range 3 mo/o – 6 y/o). Corneal edema and
diffuse corneal opacities were observed on 38 eyes. Corneal diameter on 42 eyes
exceeded age norm and varied from 12,5 to 16,5mm. Mean initial measures of
IOP, anterior chamber deep and axial length were 30,95+3,7 (range 21,0 – 45,0)
mmHg, 3,83+ 0,34 (range 3,0 – 4,7) mm and 24,3+2,15 (range 21,0 – 29,9) mm
accordingly. Gonioscopy detected goniodisgenesis II-III with anterior iris attachment
and goniosynechias. In this case was diagnosed unilateral CG at 10 patients,
bilateral – 16, with Sturge-Weber syndrome – 2. Original viscosurgery technique
include superficial and deep scleral flats formation with dispersive viscoelastic
injection through lateral preliminary paracentesis into the anterior chamber, mainly in
operative zone, with its additional injection between superficial and deep scleral flats
and between sclera and Tennon capsule.

                    Results. In early postoperative period anterior chamber shallowing was revealed
                    in 6 cases and small hyphema – in 3 eyes, which passed on after medicamentous
                    treatment. IOP compensation (mean 20,5+2,7 mm Hg) was observed in all cases
                    during 3 mo postoperative investigation, flat filtration pillow without cicatricial
                    changes was formed in operative zone, the anterior chamber depth and eye axial
                    length have decreased up to 3,67 (+ 0,33) mm and 23,9 (+ 2,0) mm accordingly, a
                    pupil was round without deformations and synechias.
                    Conclusions. Viscosurgery technique is the main way in the management of
                    congenital glaucoma treatment which allowed to perform operation without severe
                    complications, create new ways of anterior chamber fluid outflow and achieve stable
                    IOP compensation.

                           Is cataract surgery an alternative treatment for glaucoma?:
                           A. Cernak, K. Kakoulidis, M. Cernak
                    Aims: To evaluate morphologic changes in the anterior chamber after cataract
                    extraction in glaucomatic and in non glaucomatic patients.
                    Patients and methods: Patients are divided into 2 main groups:
                    1st group (60 eyes) were patients operated for cataract without glaucoma.
                    2nd group (22 eyes) were patients operated for cataract with glaucoma (under anti
                    glaucomatic treatment).
                    In both groups the IOP, anterior chamber depth (ACD) and angle of anterior
                    chamber of 90 degrees and of 180 degrees measured before surgery and 6 weeks
                    after surgery.
                    Results: In non glaucomatic patients ACD before operation was 3,1mm and after
                    operation was 4,5 mm iridocorneal angle of anterior chamber before operation was
                    23,2 degrees and after was 35,5 degrees. IOP were decreased from 14,8 mmHg to
                    13,3 mmHg.
                    In glaucomatic patients ACD was 2,9mm before cataract extraction and 4,4mm
                    Iridocorneal angle of AC was 18,5 degrees before and 31,7 degrees after surgery
                    IOP were decreased from 17,9 mmHg to 15,9 mmHg.
                    Conclusions: There are significant morphologic changes in the anterior chamber
                    (ACD, IOP, IRIDOCORNEAL ANGLES) after cataract extraction and implantation of
                    post. IOL. {P (0,01)}

        Dilemmas in primary chronic glaucoma treatment:
        Ilhami Goranci, Ardiana Goranci Baruti, Dafina Goranci Rexhebeqaj,
        Halil Ajvazi, Dardan Goranci
        Oculooptica” clinic in Prishtina
        Regional Hospital in Prizren, Kosovo.
Aims: The main goal of this work is to determine the most appropriate way of
primary chronic glaucoma treatment, without harmful organic (and excavation,
papilla’s deflection of the optical nerve) and functional damage (damage to the field).
Material and methods: This is a retrospective study from ophthalmology clinic
“Okulooptika” in Pristina and department of ophthalmology in regional Hospital of
Prizren. We reviewed the clinical records of 146 primary chronic glaucoma patients
Analysis were done in 2006-2009 year. Patients were followed up with visual acuity
testing, ophthalmoscopic examination, perimetry testing.
Results: From total number of patients 15,362, with glaucoma were 489(3,2%),
and 146(29.8%) with primary chronic glaucoma. From 146 patients with primary
chronic glaucoma 136(93.2%) were treated with medical treatment, and 10(6.8%)
with surgical treatment.
Conclusions: Based on our study continuing with medical treatment, at chronic
glaucoma patients, with compensated ocular tension is the best option because of
the surgical risks.
We achieve best results when we apply surgical treatment as early as we could in
uncompensated primary glaucoma patients, in order to avoid glaucomatous damage.

        Correlation of the changes between the iridocorneal angle and other
        parametres at the neovascular glaucoma:
        Halil Ajvazi1, Ilhami Goranci1, Ardiana Goranci1, Dafina Goranci3,
        Bekim Kastrati2, Mimoza Ismaili1.
        ¹Eye Clinic in Prishtina, University Clinical Centar-Kosovo,
        ²Regional Hospital Center in Gjilan-Kosovo,
        ³Regional Hospital Center in Prizeren-Kosovo.
Introduction: Neovascular glaucoma-NVG is an atrophic optic neuropathy
resulting from the neovascularization of the iridocorneal angle-ICA by increasing the
intraocular pressure-IOP, associated with the changes in the retina and papillae nervi
Aims: To analyze the findings in the iridocorneal angle at the NVG and corelation
between IOP, PNO and visual acuity.
Material and methods: In this study were included 116 patints with NVG, of whom
75 or (64,7%) male and 41 or (35,3%) female, treated at the Eye Clinic in Prishtina,
University Clinical Center-Kosovo, during the period of time from January 2000
until February 2010. We have performed relevant biomicroscopic, gonioscopic,
tonometric and ophtalmoscopic examination as well as visual acuty test. We have
also used the statistcal methods of the processing and analyzis according to the
protocol of the WHO.

                    Results and discussion: The mean age of the patients with the changes in
                    the ICA was 61.1 years and varied from 17-77 years. Our study found that most
                    affected age was from 60-69 years.
                    At the ICA, we have clasified four stages from I till IV and ascertained that there is
                    a high and positive corelation between stage of the ICA and IOP which was varied
                    from 25 mmHg till 59 mmHg. Reuslts of the IOP have also determined the ocular
                    clinical state of compensation, subcompensation and decompensation. Visual
                    acuity damages at the NVG, have been clasified as the big damages with 84.7%
                    of cases and minor damages with 15.3% of cases. Cases with the heavy damages
                    were the cases with blindness, L+P± up to V=0.3 and cases with slightly damages
                    with V=0.4-1.0. Visual acuity damages were in corelation with the changes in the
                    PNO from initial stage to absolute stage.
                    Conclusions: All necessary measurements should be taken in order to prevent
                    neovascular appearence, spread and development in the ICA of etiology whatever,
                    because such a monitoring will enable us to prevent the elevation of the IOP with
                    direct influence at PNO and visual acuity and to be successfully in managing of the
                    NVG which, otherwise will be with irreversible and heavy consequences.

                            Our first expirience with Ex-Press Mini Glaucoma Shunt
                            Implantation in Eye:
                            M. Gavric, N. Gabric, K. Matkovic
                            Clinic «Svjetlost», Zagreb, Croatia:
                    Aims: To evaluate the outcome and complications of the Ex-Press glaucoma
                    implant under a scleral flap for the treatment of medicaly uncontrolled glaucoma.
                    Patients and methods: A retrospective, non- randomised study was done. Thirty-
                    one subject age 38-82 with uncontrolled OAG and one patient with congenital
                    glaucoma and transplanted cornea, implanted with Ex-PRESS Mini Glaucoma shunt
                    under scleral flap, were reviewed. The follow up period was 12 months. The primary
                    outcome included IOP control, postoperative medications and early post-operative
                    Results: Thirty-four eyes of 31 patient with open angle glaucoma were implanted
                    under a scleral flap with the Ex PRESS mini glaucoma shunt. Seven eyes
                    (22,58%) had the surgery combined with cataract extraction and intra-ocular lens
                    implantation. The mean IOP was reduced from 29,04 +/-8,00 to 15,02 +/- 6,02
                    mmHg. Mean number of medications was reduced from 3,1+/- 1,2 preoperatively
                    to 0,8 +/- 1,02 after 12 months of follow up. A review of the postoperative
                    complications related to Ex PRESS shunt placement revealed one case of
                    excesive intraocular haemorrhage (24 h postoperatively) and 2 cases of hypotony
                    andchoroidal detachment.
                    Conclusions: The Ex PRESS Mini Glaucoma Implant under a scleral flap provides
                    satisfactory IOP control, medication reduction and low rate of device-related

        Complications related to bleb formation following trabeculectomy:
        Vesna Dimovska
        Public Health Institution University Eye Clinic, Skopje, Macedonia
Trabeculectomy as filtering procedure is the standard and still superior surgical
method for glaucoma patients with indications for surgical treatment.
The success of trabeculectomy mainly depends on the development of
filtering bleb. Failure of the filtering bleb could occur at various period following
trabeculectomy. Scarring of the filtering bleb is mostly due to the proliferation of
subconjunctival fibroblasts and biosynthesis of extracellular materials, like collagen.
Trabeculectomy with intraoperative application of antifibrotic agents, as MMC or
5-Fu, is proven to reduce the proliferation of fibrous tissue and subsequent scarring
of the fistula.
Accurate assessment of the morphologic and functional status of the filtering bleb
is crucial in the short and long-term follow up period to recognize potential signs of
failure and development of complications.
Most frequent bleb-related complications are manifested as the occurrence of:
bleb leak and excessive filtration leading to hypotony; flat anterior chamber; bleb
encapsulation, development of cystic bleb and bleb infection.
Filtering bleb complications mostly are determined by: the placement of filtering flap
(limbus-based or fornix-based flap), the area covered with antifibrotic agent, as well
with the concentration and dosage of antifibrotic agent.
Ophthalmologists, especially glaucoma surgeons, should be aware and take into
account the importance of monitoring the filtering bleb and its morphologic changes
in order to predict surgery outcome and avoid, as much as it is possible, filtering
failure. This, of course, should be combined with continued improvement of one’s
surgical technique.

        How much are informed patients in Tetovo and Skopje on the
        importance of glaucoma disease:
        Fatmir Xhaferi1, Bekim Tateshi2
          Department of Ophthalmology Clinical Hospital Tetove, Macedonia
          Univesity Eye Clinic, Skopje, Macedonia
Aims: Is the level of population health education and how are they informed about
Material and methods: It is designed questionnaire that contains general
information: age, sex, place of living, level of education and whether the person
suffers from glaucoma, and 7 questions regarding glaucoma such as:

1. Do you know what disease is glaucoma?
   Yes        No
 2. Do you know that most often appears after age 45-50 years?
   Yes        No
 3. Are you informed with the symptoms of glaucoma ?
   Yes        No

                    4. Are you informed with the fact that if not detected and treated early, glaucoma
                    can end with blinding?
                       Yes       No
                    5. Are you informed that the treatment of glaucoma is longterm and should be used
                    during the rest of life?
                       Yes       No
                    6. Have you ever been to an ophthalmologist to measure eye pressure?
                       Yes       No
                    7. Do you know that glaucoma may be related to family inheritance?
                       Yes       No
                    Were interviewed 470 patients who came to visit the ophthalmology services in
                    Clinical Hospital Tetovo and Skopje University eye Clinic .
                    The data were analyzed according to parameters specified in the questionnaire.
                    Results: Only 7 % of respondents indicated a solid level of information for
                    glaucoma disease, responding positively to all questions.
                    Conclusions: The level of information for glaucoma disease is very low in the
                    analized population sample, it s indicate lower health education of population.
                    This fact requires greater commitment to primary health services generaly and
                    ophthalmology services in particulary, because the visual impairment and blindness
                    due to glaucoma disease pose seriose public heath problem.

                           The benefit of neuroprotective adjunctive nicergoline therapy in the
                           treatment of primary open glaucoma:
                           J. Bilbili2, D. Costin1, K. Bardhi2, Costea C. Florida1, M.P. Bucatariu2
                            Medicine and Farmacy University “Gr. T. Popa”, Ophtalmology, Iasi, Romania
                            Clinical Neurosurgery Hospital “Prof. dr. N. Oblu”, Ophtalmology, Iasi, Romania
                    Aims: The purpose of our study was to evaluate the benefit of neuroprotective
                    adjunctive therapy in the treatment of primary open glaucoma.
                    Patients and methods: Our study was a prospective longitudinal study. We
                    compared two groups of diagnosed glaucomatous patients. Group 1 was formed of
                    newly diagnosed glaucoma patients, with early glaucomatous changes and without
                    other pathologies. Group 2 was formes of diagnosed glaucoma patients, with
                    moderate glaucomatous changes and with or without other pathologies (systemic
                    hypertension, artheriosclerosis, diabetus mellitus, smokers). Group 1 received only
                    antiglaucomatous topical therapy (containing dorzolamidum). Group 2 received
                    topical hypotensive therapy and treatment with nicergolin in doses of 30 mg per day.
                    We compared the results at three months of treatment regarding the lowering effect
                    on intraocular pressure and the evolution of visual field status.
                    Results: Medium IOP before treatment in Group 1 was 23,3 mmHg ± 1.453 and
                    in Group 2 was 25,076 mmHg ± 2.540. Medium IOP at three months of treatment
                    was in Group 1 16,857 mmHg ± 2.356 and in Group 2 16.5 mmHg ± 2.533. In both
                    groups topical hypotensive medication was effective and IOP was reduced statistic
                    significantly (IOP was below target pressure) (p<0.05 ). Regarding the evolution of
                    visual field, MS improves in both groups, significantly statistically. MS in group 1
                    before was 18.67±2.218 dB and after was 20.33±1.72. In group 2 the MS shows a

slightly better improvement from 15.07±3.441 dB to 17.30±3.53 dB. Both groups
had a statistically significant improvement (p<0.01).
Conclusions: We consider that adjunctive neuroprotective treatment with nicergolin
in patients with compensated primary open angle glaucoma offers a certain benefit
to the preservation and improvement of the visual field.

        Free radicals hypothesis in glaucoma pathogenesis and comments
        on an experimental model of acute glaucoma on a rabbit:
        K. Bardhi, J. Bilbili, W. Shala’ta, N. Ianopol,V. Sarbu, F. Gradinaru
        Ophthalmology, Railway Clinic Hospital, Iasi, Romania
The study was conducted on an experimental model of acute glaucoma on
rabbit and investigates the biochemical and morphopathological modifications
determined by the sudden increase of the intraocular pressure at the level of the
retina and the head of the optic nerve.
The biochemical results were statistically interpreted and they showed for the
glaucomatous group an increased level of malonic dialdehide, a decrease of the
reduced glutathione and an increased level of oxidized glutathione, the differences
being statistically significant.
The morphopathological analysis on the optic and electronic microscopy shows that
under the conditions of the experiment there are discrete alterations at the level of all
the retinal layers, without a general modification of the retinal architecture.
Conclusions: The sudden increase of intraocular pressure on rabbit induces
certain biochemical and morphological modifications, which correlated among them,
could suggest the free radicals intervention.

        Glaucoma World Day - Screening:
        Ljaljevic Sanida, Ahmedbegovic Melisa, Pranjic Merita,
        Alimanovic Emina, Jurišic Vesna
        Eye Clinic KCU, Sarajevo, Bosnia & Herzegovina
Aims: Glaucoma is usually symptomless and vision loss is irreversible. With early
detection, medications and surgeries can be used to prevent further vision loss.
World Glaucoma Day aims to educate people about how to assess their risk for
glaucoma and to be aware of the importance of regular eye exams and disease
Material and methods: During glaucoma screening programme 108 patients were
included. We took database from patients and payed attention on all glaucoma risk
factors (age, race, family history, diabetes, high myopia, hypertension, migraine,
headache...). We measured IOP with aplanation tonometry and checked head of
optic nerv by ophtalmoscopy.

                    Results: 21 of patients were suspicious on glaucoma and they were invited on
                    complete glaucoma test on Eye Clinic. After all glaucoma diagnostics, we detected
                    3 patients with open angle glaucoma and one with ocular hypertension.
                    Conclusions: Finding people with the early stages of glaucoma, and then treating
                    them before they lose their sight becouse early detection is the key to preventing

                            Vascular risc factors at patients with trabeculectomy:
                            K. Blazevska Buzarovska, V. Dimovska Jordanova, M. Golubovic
                            University Eye Clinic. Skopje. Makedonija
                    We have analised 200 patients at the glaucoma department operated for
                    glaucoma and trabeculectomy with and withouth using of 5-Fu was performed.
                    All of the patients were followed up before the surgery with chacking the internal
                    specialist investigations and a randomized prospective-retorspective study was
                    followed up.The results showed that the most important risc factor after the
                    normalisation of IOP (after trabeculectomy with 5-fu) in the progression of glaucoma
                    was genetic predisposition, (OR=12,28,95%), 4,91-3072) than hypertension
                    OR+5,63/95%CI2,39-13,26), heard desease ORr=4.01,95%Ci 1.78-9.03),
                    pseudoexpholiation OR=2.79 95%1.20-6.46) and myopia OR=2,75 95%0, 86-8-84.
                    Conclusions: Trabeculectomy has benefit on the IOP level in 97% of our patients
                    but other risc factors favorised the damage of the optic. In our group visual field
                    examination five years after successful trabeculectomy showed progression of the
                    damage in 45% of the patients with present risc factorts.

                            Secondary glaucoma post vitreoretinal surgery:
                            Ali Tonuzi, Ilir Arapi
                            Universitary Center of Hospital “Mother Teresa”, Faculty of Medicine,
                            ORL-Ophthalmology Department, Tirana, Albania
                    Aims: The treatment of patients with secondary glaucoma post vitreoretinal surgery.
                    Secondary glaucoma leading vitreoretinal surgery is almost a common
                    concomitance, and knowledges on it are of a particular importance for the
                    ophthalmologist,this is linked to the growing number of surgical interventions
                    undertaken by our patients in our clinic.
                    Patients and Methods: We have reported specific patients with secondary
                    glaucoma post vitreoretinal surgery, and for each case we have used different
                    treatment illustrating it with the corresponding examples.
                    Secondary glaucoma in this type of surgery is acceptable as a complication
                    following these interventions because the vitreoretinal surgeon finds himself in front
                    of a dilemma during this type of surgery. The insufficient injection of Air, balancing
                    solution, SF6, C3F8, or insufficient silicon oil in the filling of the vitreal cavity after
                    TPPV risks a total failure of vitreoretinal surgery. Also the sorrunding band used for

such surgery (tractional retinal detachments) raises the chance of glaucoma, this
is linked to the bulb deformations by the band shifting the tissues forward into the
anterior segment. This shifting closes the angle of the “camera anterior” from the
iris radix. This angle can be also closed by blood or inflammatory cells leading these
interventions or even as a result of the ciliary body effusion, an event connected to
an exudative or hemorrhagic choroidal detachment. These concomitances happen
even in closed or opened ocular traumas.
Results: In all the referred patients we achieved the main objective to decrease the
IOL pressure and to stabilize it.
Conclusions: Knowing this complication ,notably the cause that leads to this type
of complication, helps us in treating the patient without consequences in the visual
acuity, which is the final goal which the patient and the surgeon must achieve.
               60   Medical retina
                                  Chairperson: L. Zografos, Co-chairpersons: A. Cernak & H. Ozdemir
                            The interpretation of OCT images of the retina. Refining imaging for
                            retinal disease:
                            Hakan Ozdemir
                    Oral Lecture.

                            Modern diagnostic and treatment methods of intraocular tumors:
                            L. Zografos
                    Oral Lecture.

                            Local chemotherapy of retinoblastoma by melphalan intravitreal
                            injection - The Preliminary Report:
                            Bobrova Nadiia, Tatjyana Sorochinskaya
                            SI “The Filatov Institute of Eye Diseases and Tissue Therapy, AMS of
                            Ukraine” Odessa, Ukraine
                    Aims: To study efficacy of intravitreal melphalan chemotherapy at retinoblastoma (RB).
                    Patients and methods: Intravitreal pars plana Alkeran (active drug Melphalan)
                    injection was performed to 22 children (24 eyes) at age 5mo/o - 6 y/o (mean
                    26+12mo) with unilateral (12 eyes) and bilateral (12 eyes) retinoblastoma in stages
                    T1-T3: majority of eyes had T3 stage - 15, T1 was at 3 eyes and T2 - at 6. From
                    1 to 4 injections per eye were administered depending on indications. Children
                    also received simultaneously chemoreduction according to C. Shields et al. (1996)
                    protocol (Carboplatin, Etoiposid, Vincristin). Endovitreal melphalan was used after
                    primary chemoreduction therapy and focal tumour destruction on 15 eyes with
                    remnant lesions and vitreal seeds and in 9 cases - as primary procedure with the
                    further systemic chemoreduction therapy appointment. Dynamic supervision within
                    2-10 months (mean 4.6+2.1mo) is spent at 12 children (13 eyes)
                    Results: No complications during and after endovitreal procedure were occurred.
                    No systemic toxicity and negative melphalan influence on eye tissues were noted.
                    The positive tumour response on local chemotherapy manifested by vitreal seeds
                    and small retinal lesions resorbtion, large lesions reduction and calcination was
                    achieved on 10 of 13 eyes, with final tumor calcination and resorbtion in 2 cases.
                    3 eyes in T3 stage were enucleated, no continued tumour growth in the injections
                    area and in the eye covers was revealed in any case.

Conclusions: Intravitreal Melphalan injection is a perspective approach in
retinoblastoma treatment, allowing to affect directly on a tumour and vitreal seeds,
and can be applied in complex RB treatment at children.

        Central serous retinopathy (CSR) treatment with acetazolamide per
        os and diclofenac eye drops:
        M. Vlašic, N. Gabric, R. Lazic, I. Boras, N. Draca
        Eye clinic Svjetlost, Croatia
Aims: Central serous retinopathy (CSR) is characterized by an accumulation of
transparent fluid at the posterior pole of the fundus involving macula with RPE
leakage and choroidal hyperpermeability. Acetazolamide (Diamox®), a carbonic
anhydrase inhibitor diuretic used in ophthalmology to treat glaucoma, was used
along with diclofenac eye drops (Naclof®) in this retrospective study.
Patients and methods: 25 patients were followed from August 2009 to August
2010. The diagnosis of CSR was confirmed by Optic Coherence Tomography
–OCT and fluorescein angiography. Visual acuity (VA), biomicroscopy and central
retinal thickness (CRT) were measured at each visit. The follow up period was 12
months. All patients were innitialy treated with 250 mg of acetazolamide per os and
diclofenac eye drops 3 times a day.
Results: BCVA improved more than ≥ 3 lines of Snellen in 20 patients, and ≤ 1 lines
of Snellen in 2 patients. The BCVA was unchanged in 2 patients , and moderate
vision loss ( ≥3 lines of BCVA) was reported only in 1 patient. The improvement
of VA was in correlation with a decrease in CRT. In 15 patients therapy was
stopped after 2 months, in 5 after 6 months and in 5 patients treatment continued
throughout whole follow up period.
Conclusions: Acetazolamide and diclofenac treatment was successful in VA and
reducing CRT. This treatment proved to be effective, with good compliance, and
without any serious systemic and ocular side effects.

        Bilateral CRAO in patient with giant cell arteritis:
        B. Zhuri, M. Kubati-Ajeti, O. Kubati
        Laser Eye Center Kubati, Prishtina, Kosova
Aims:To present that delay treatment with steroids in giant cell arteritis can cause
bilateral CRAO.
Patient and methods(case report): Female patient 61 year old came in our clinic
with no light perception in both eyes. Her visual acuity was first decreased in the left
eye and was diagnosed as CRAO. Two week latter she have had another attack in
the right eye. CRAO was diagnosed again but no steroid therapy was administered.
She suffered from headache, neck pain and jaw pain also and is diabetic too.ESR
and CRP wasn’t done till she came to our clinic.

                    Indirect ophthalmoscopy was performed and fundus image also was done.
                    Laboratory tests, Se(68) and CRP(46) was done also.
                    Results: After steroid administration Se and CRP decreased to normal level.
                    Headache, neck and jaw pain have stopped also.
                    Conclusions: Delay administration of steroids in giant cell arteritis can cause
                    bilateral CRAO.

                            Effect of Bevacizumab on Pathologic Proliferative Tissues
                            Developed in Proliferative Diabetic Retinopathy:
                            N. Ianopol1, K. Bardhi1, J. Bilbili1, B. Kirchhof2
                             Ophthalmology, Railway Clinic Hospital, Iasi, Romania, 2Vitreo-retinal
                            Surgery Department, Center of Ophthalmology, University of Köln, Germany
                    Aims: To analyze, from the macroscopic point of view, the evolution of the vitreo-
                    retinal fibrosis and neovascularization in proliferative diabetic retinopathy (PDR) after
                    anti-VEGF blockade realized by intravitreally injected Bevacizumab (Avastin).
                    Materials and methods: Eyes with PDR received one or several consecutive doses
                    of 1.25 mg or 2.5 mg Bevacizumab, as intravitreal injections (ivit B). The evolution
                    of the vitreo-retinal fibrosis and neovascularization was assessed macroscopically,
                    in dynamics, qualitatively (on colored CI, red free RFI and fluorescein angiography
                    FAI images) and quantitatively, by following up the processes inside of the same
                    previously established retinal area (red-blue circles method on black white images).
                    Results: The qualitative analysis of the fundus images revealed that after 1st ivit B,
                    even from the first week, the vitreo-retinal neovascularization regresses continuously.
                    The quantitative interpretation of the black white images could suggest first a false
                    impression of increase of fibrosis if it was not taken into account that, before ivit
                    B, when the neovascularization is active, the fibrotic tissue of the new vessels
                    walls is masked by the blood flow. After further ivit B, the qualitative as well as
                    the quantitative analysis of the ocular fundus images revealed a regression of both
                    pathologic tissues – fibrotic and neovascular. The continuous decrease of the fibrotic
                    tissue volume as well as of the retinal area covered by it suggests that ivit B does
                    not lead to fibrogenesis. The degeneration of the fibrotic tissue, macroscopically
                    observed as contraction, creates tractions on the retina and blood vessels, leading
                    finally to retinal detachment and vitreous hemorrhage.
                    Conclusions: Ivit B leads to the correlated regression of fibrosis and angiogenesis,
                    probably by stimulating similar processes like the ones included in the wound
                    healing. Further research is necessary to analyze these phenomena in dynamics, “in
                    vivo, on the human eye, also from microscopic point of view and on a longer period
                    of time after anti-VEGF therapy.

        Effect of Bevacizumab (Avastin) on the Diabetic Macular Edema:
        Slobodanka Latinovic1, Lala Ceklic2
          University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
          Eye Clinic Kasin Do, Sarajevo, BiH*
Aims: To evaluate the effect of intravitreal unselective anti-VEGF antibody
bevacuzimab (Avastin, La Rosh) on visual acuity in eyes with proliferative diabetic
retinopathy and clinically evident macular edema.
Methods: The case series of consecutive 20 eyes of 16 patients with proliferative
diabetic retinopathy and persistent diabetic macular edema who were treated with
intravitreal dose of 2.5 mg bevacuzimab in 0,05mL (Avastin). All the patients were
peviously treated with argon laser photocoagulation. Main outcome measures were
Snellen visual acuity and fundus clinical findings and patients self estimated quality
of vision evaluated on the visual analogue scale (VAS). The follow up was 6 months.
Results: Diabetic macular edema in PDR was mild in 50% of patients, moderate
in 35% and in 15% it was severe. After one dose of intravitreal bevacuzimab and
in three eyes after two doses, we obtained the stabilization of retina and macular
edema in 25% (5 eyes), improvement was present in 65% (13 eyes) and the state
was worse in 10% (2 eyes). Visual acuity was improved by 2 or more lines in 13
eyes, no changes were found in 5 eyes and in 2 eyes with severe macular edema,
the VA was worse by 2 lines than before the intravitreal application of bevacuzimab.
Subjective patient assessment of visual function on the visual analogue scale (VAS)
showed an improvement from 60.2 +/- 17.5 to 76.0 +/- 15.6 (p<0.001) 6 months
after bevacizumab.
Conclusions: After intravitreal bevacuzimab (Avastin), visual acuity was stabilized
and improved by 90% in eyes with proliferative diabetic retinopathy with mild
and moderate macular edema as well Self-assessed visual acuity and patient
satisfaction were significantly improved.

        Bilateral serous retinal detachment:
        Vilma Mema1, Eralda Leci1, Artan Hibraj1, Nishant Taneja2
          Universitary Hospital Center “Mother Theresa”, Tirana, Albania
          Internacional Clinic, Tirana, Albania
Aims: To describe systematic diagnostic protocol and management in a 29 year old
male patient presenting with sudden onset serous elevation of retina in both eyes.
Patients and methods: A 29 year old male patient presented to us with 1 week
history of painless diminution of both eyes. On examination he was found to have
bilateral serous retinal elevation with optic nerve head swelling.
On detailed systemic and ocular examination patient was found to be HIV positive
with Non Hodgkins Lymphoma involving the gastrointestinal tract. The ocular
manifestations were supposed to secondary to lymphoma.
Conclusions: Secondary intraocular lymphoma can masquerade as serous
elevation of retina. Thorough systemic work up is required in such cases.

                            Intravitreal Bevacizumab and Triamcinolone combination for CME
                            post CRVO:
                            Jonida Dai1, Julinda Jaho2, Bledar Kruja3, Pajtim Lutaj1,4
                             Albanian Vision Clinic; 2Universal Hospital Tirana; 3National Traumatology
                            Center, Military Hospital; 4UHG “Mother Theresa” of Tirana, Albania
                    Aims: Central retinal vein occlusion (CRVO) is a common retinal vascular disorder
                    that can lead to significant visual disability. Persistent macular edema is one of the
                    major complications associated with CRVO. The purpose of this interventional case
                    report is to describe the clinical course of a case with macular edema secondary
                    to CRVO, treated with intravitreal injection of Bevacizumab, followed by intravitreal
                    injection of Triamcinolone.
                    Patients and methods: Case report of patient A.B., born in1957, male, presented
                    with acute reduction of VA on the right eye, BCVA of 2/10. No history of diabetes
                    or systemic hypertension present. Sistemic examination was unremarkable. FFA
                    and OCT were performed. Diagnose of CRVO was established. Intravitreal injection
                    of Bevacizumab was applied. By the time following the third injection, resorption
                    of the hemorrhage in the peripheral retina was seen, but presence of CME was
                    confirmed from OCT. In these circumstances, intravitreal triamcinolone injection was
                    Results: The patient reported improvement of vision in 3 weeks after Triamcinolone
                    administration, with BCVA of 5 – 6/10 on examination, which remained the same
                    during one year of follow-up.
                    Conclusions: There is currently no proven guideline for macular edema in the
                    setting of CRVO. However, in patients with macular edema, the injection of both
                    bevacizumab or triamcinolone into the vitreous cavity has been shown to be
                    effective not only in resolving the edema, but also in the corresponding improvement
                    of vision. Further studies are now underway to evaluate long term effects of these
                    intravitreal injections.

                            Central serous retinopathy:
                            Julinda Jaho1, Jonida Dai2, Bledar Kruja3, Pajtim Lutaj2,4
                             Universal Hospital Tirana, Albania; 2Albanian Vision Clinic;
                             National Traumatology Center, Military Hospital;
                             UHC “Mother Theresa”, Tirana, Albania
                    Aims: Central serous chorioretinopathy remains an idiopathic condition, occurring
                    primarily in healthy men between 25 and 55 years of age. It is often associated
                    with certain personality types, elevated levels of corticosteroids and stress. We are
                    presenting two different clinical courses of two patients with CSCR.
                    Patients and methods: Case #1, B.H., 1972, male, presents with reduced VA
                    of the right eye, on 12/10/2009. BCVA of 1/10 (RE), 10/10 (LE). The examination
                    showed elevation of the retina of the posterior pole. FFA and OCT were performed.
                    The diagnose of central serous chorioretinopathy was established. Acetazolamide
                    125 bid was prescribed.

Case# 2, A.H., 1977, male, presents with reduced VA of 5/10 on the left eye.
Examination showed elevation of the central retina, more extended superiorly. OCT
confirms the diagnosis of CSCR. Other systemic examinations were unremarkable.
Acetazolamide 125 mg tid was prescribed.
Results: Case #1: the patient presents one month later with BCVA of 8/10.
Acetazolamide was interrupted then. Case #2: The patient was evaluated once a
month. It was only at the third control visit that he reported a better VA. BCVA was
7/10 at this time.
Conclusions: Most eyes with CSCR (80 – 90%) undergo spontaneous resorption
of subretinal fluid within 3-4 months; recovery of visual acuity usually follows, but
can take up to a year. Current treatment guidelines suggest that patients may be
observed for at least 3-4 months in most first episodes of unilateral CSCR. Laser
photocoagulation may be considered in other cases.

        Ocular hypertension in active toxoplasmosis retinitis - Case Report:
        Anila Monka1, Ermira Muço2, Eralda Leci1
          Ophthalmology Service, UHC, Tirana
          Infective Diseases Service, UHC, Tirana
Aims: To report a case of ocular hypertension in a 57-year-old woman during
recurrent attacks of the toxoplasmosis retinitis.
Patients and methods: A 57-year-old woman, one eye patient presented in
emergency room after treatment of an acute attack of angle-closure glaucoma. VA
0,1; IOP 48mmHg; FO examination – active lesion of 1 disc diameter superiorly
O.N.; Moderate vitritis; Normal anterior segment.
She was treated:-systemic steroids; - sulphonamide therapy.
Results: Six weeks after therapy: VA 20/20; IOP 17.3 mmHg; Normal visual field;
Normal optic disc. Since then, the patient has had 2 other recurrent attacks of
ocular toxoplasmosis. In both attacks IOP was 30 mmHg and after administration of
steroid and sulfonamide therapy IOP came back to normal.
Conclusions: Retinal Toxoplasmosis may cause ocular hypertension. FO
examination is important in detecting of ocular features of this systemic disease.

        Application of bevacizumab injection for neovascularisation of the
        anterior segment:
        A. Shabani, M. Asani, V. Ajazaj, E. Dida
        Klinika Gjermane e Syrit, Prishtina, Kosovo
Objective: To report the efficacy of subconjunctival bevacizumab injection in
patients with corneal neovascularisation, and intracameral injection in patients with
Methods: In this study were included three eyes of three different patients with
corneal neovascularisation, One eye had neovascularisation because of herpetic

                    keratitis and the other two eyes of two different patients with neovascular leucoma.
                    In this study we have also included three eyes with rubeosis from patients suffering
                    from neovascular glaucoma at which 0.1ml subconjunctival was applied, and in the
                    cases with a iris neovascularisation 0.04ml bevacizumab was applied. Morphologic
                    changes were investigated by slit-lamp biomicroscopy and anterior segment
                    Results: Corneal and iris neovascularisation regressed dramatically a week after the
                    injection in all of the cases. In one case, iris NV reappeared after 4 months, therefore
                    in this case for the second time intracameral injection of bevacizumab was applied.
                    In the other cases no relapse was seen within the follow-up of four to six months.
                    No infection, no bleeding and no inflammation were observed.
                    Conclusions: Subconjunctival and intracameral injection of bevacizumab may offer
                    an additional treatment for corneal neovascularization and rubeosis.

                            Screening of Retinopathy of Prematurity in Republic of Macedonia -
                            one year results:
                            B. Tateshi, M. Ivanovska, A. Oros, G. Zlateva, V. Nikolovska-Buckovska, H.Duma
                            University Eye Clinic, Skopje, Macedonia.
                    Aims: Retinopathy of prematurity (ROP) is a retinal disorder of low birth weight
                    premature infants potentially leading to blindness in a small but significant
                    percentage of those infants. Examination of eye fundus presented selective
                    screening wich is conducted by an ophthalmologist for early detection of ROP.
                    Patients and methods: In this cross-sectional research we included all infants
                    with birth weight of 1500 grams or less and/or were born at 28 gestational weeks
                    or less, admitted to the intensive care unit at the department of neonatology at
                    University Clinic for Ginecology and Obstetrics. Examination of the fundus of the
                    child should do an ophthalmologist with an indirect ophthalmoscope and aspheric
                    lens of 20 D. Children with indication for laser therapy were treated at the Institute of
                    neonatology in Belgrade, by Professor Ana Oros.
                    Results: The study included a cohort of 769 prematurity infants who were treated in
                    the intensive care unit at the department of neonatology at University Clinic for
                    Ginecology and Obstetrics in Skopje. Invegistated infants were with body weight
                    ranged from 760 - 2650 grams, with a gestational age 25-33 weeks. With laser
                    therapy were treated 43 prematurity infants.
                    Conclusions: This statement outlines the principles on which a screening program
                    to detect ROP in infants at risk might be based. The goal of an effective screening
                    program must be to identify the relatively few preterm infants who require treatment
                    for ROP from among the much larger number born each year while minimizing the
                    number of stressful examinations required for these sick infants.
Retinal surgery                                                                             67

               Chairperson: A. Nikolakopoulos, Co-chairpersons: M. Karacorlu & C. Forlini
        Current concepts and new trends in vitreo-retinal diseases:
        M. Karacorlu
Oral Lecture.

        Current small incision 25G plus constellation vitrectomy. Safety and
        efficiency for the new surgeon:
        A. Nikolakopoulos
No abstract.

        Vitreoretinal surgery challenge:
        B. Dabov, S. Mavrodieva
No abstract.

        Heavy silicone oil as first choice in complicated retinal detachment:
        Checkmate in two moves!:
        Cesare Forlini1, Matteo Forlini2, Adriana Bratu1, Paolo Rossini1
         Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy.
          Department of Ophthalmology. Policlinico di Modena. Modena, Italy.
Aims: To show our strategy in complicated retinal detachment (RD) cases with high
possibility of development of post opertaive PVR and R.D. recurrence.
Patients and methods: 24 selceted patients, with high risk of PVR recurrence
(>C3) were trated with heavy silicon oil (Densiron 68, Fluoron).For all patients,
routinely we perform an ILM peeling, prior staining (in fluid or PFCL) with ICG or
Brilliant Peel; use of endolaser on present break(s) and at 360°; direct PFCL-HSO
exchange or prior air exchange. HSO is maintained within a period among 60 and
90 days.
Results: Recurrence at the superior retina was present in 7 cases (30%) between
9 and 3 o’clock, at the moment of the second procedure performed among 60-90
days from the first operation. In 3 cases it was used 1000 cs oil, in 4 cases gas

                    mix (C2F6 15%). Of the 3 cases were tamponade with 1000cs oil 2 cases had to
                    be reoperated with the use of 1000 cs oil.4 cases are highlighted of essudation in
                    anterior chamber over the anterior and posterior surface of the IOL, associated to
                    increase of intraocular pressure, all well controlled with medical therapy.
                    Conclusions: The choice of HSO Densiron 68, associated with the ILM routine
                    peeling, has avoided R.D. recurrence episodes or PVR at inferior sectors and at the
                    posterior pole (in any case, no macular secondary pucker was encountered). HSO
                    does not oblige the patient to uncomfortable positioning.

                           Functional and anatomical outcome after severe ocular trauma
                           managed with combined keratoplasty and pars plana vitrectomy:
                           Vladimir Pfeifer, Spela Stunf, Mojca Globocnik Petrovic
                           Eye Hospital, University Clinical Centre Ljubljana Slovenia
                    Aims: To evaluate the outcome of combined penetrating keratoplasty and pars
                    plana vitrectomy with the use of temporary keratoprosthesis (PKP+PPV/TK)
                    performed in eyes with severe injury of anterior and posterior segment.
                    Patients and methods: A retrospective study of 7 patients (7 eyes), who
                    underwent PKP+PPV/TK in 2002-2007.
                    Results: Mean length of follow-up was 3.3 years. Delay of PKP+PPV/TK after
                    occurrence of posterior segment pathology was 1-2 days (two eyes), 10-15 days
                    (three eyes) and more than 1 month (two eyes). The BCVA at the final follow-up in
                    2008 was 0.8–1.0 in two eyes, 0.1 in one, and LP in three eyes. One painful blind
                    eye was enucleated. Five globes attained anatomical restitution: clear corneal and
                    attached retina (three eyes), permanent silicone tamponade and PVR (one eye) and
                    opaque cornea with detached retina (one eye). One eye underwent phthyisis.
                    Conclusions: Three eyes (42.85%) attained at least ambulatory vision and
                    two (28,6%) attained excellent vision. Eye salvage, which can be sole realistic
                    expectation in severe trauma, succeeded in five eyes (71.4%). PKP+PPV/TK is a
                    useful method for severe trauma. The outcome depends on severity of injury, timing
                    and multiplicity of surgery(ies).
                    Financial disclosure: authors have no financial interest.

        Toxoplasmic retinochoroiditis:
        Jonida Dai1, Julinda Jaho2, Bledar Kruja3 Pajtim Lutaj1,4
          Albanian Vision Clinic; 2Universal Hospital Tirana; 3National Traumatology
        Center, Military Hospital; 4UHG “Mother Theresa” of Tirana, Albania
Aims: Toxoplasmic retinochoroiditis is probably the most common cause of
posterior segment infection worldwide. Recurrences occur in many patients. We are
presenting a case of recurrent posterior uveitis, that was resolved only after specific
treatment for Toxoplasma Gondi.
Patients and methods: Case report of patient V.B., 1962, with a history of episodic
reduced VA from 2 years. Recently treated with oral and topical corticosteroids
for the diagnosis of Posterior Uveitis. Last episode in January 2010. The patients
presents with BCVA of 2/10 on mars 2010. Examination showed and a new
toxoplasmic lesion above the macula and an old toxoplasmic lesion located in the
superotemporal retina. Immediate controlled interruption of corticosteroids intake
was recommended and was performed in consultation with the endocrinologist.
Pirimethamine and sulfadiazine combined with folinic acid was prescribed.
Results: Immediate improvement of vision was observed, with BCVA of 9/10 in a
Conclusions: The first goal of toxoplasmic retinochoroiditis treatment is to control
the infection and then limit the resulting scarring. Corticosteroids should not be used
without concurrent antibiotic treatment or in immunocompromised patients due to
the risk of exacerbation of the disease.

        Steven - Johnson Syndrome after administration of Tegretol:
        Eralda Leci, Alketa Tandili, Anila Monka
        “Mother Theresa” University Hospital Center
Aims: To identify early the first symptoms of this syndrome
Patients and methods: Female, 18 years old, treated for 1 month with tegretol, for
continous headache and seizures.
Observation and follow-up of the patient in infective diseases and dermatologic
clinics, and intensive care unit.
Results: Patient suffered a generalized erythema multiforme affecting her systemic
condition. She was treated with intravenous corticosteroids, rehydrating therapy for
2 weeks and after 1 month had total recovery. Ocular complications were trichiasis,
Conclusions: Steven-Johson is a type III hypersensibility reaction, caused by
administration of certain drugs, infections, radiotherapy in malignancies, etc. Ocular
features might be the first signs of this disease. Taking a good medical history of
the patient is very helpful in correlating the possible trigger factors with the first
symptoms, the proper diagnose, and administering the right therapy.

                            Uveitis - Case Report:
                            S. Fileva, V. Fileva
                            General Hospital-Ohrid
                    Aims: Uveitis, by strict definition is an inflammation of the uveal
                    tract. However, the term is now used to describe many forms of intraocular
                    inflammation which may involve not only the uvea, but also adjacent
                    Classification: The four main classifications are:
                    Anatomical-anterior, intermediate, posterior and panuveitis
                    Clinical-Acute, chronic
                    Aetiological-exogenous and endogenous wich may be associated with systemic
                    disease, infection with bacteria, viruses, protozoans, idiopathic specific
                    uveitis entities and idiopathic non-specific uveitis entities.
                    Pathological-granulomatous or non granulomatous.
                    Patients and methods: A case report: A 21years old woman is presented. She
                    complains about red eye, ocular pain, floaters and impaired vision of right eye. She
                    was self-treating about one week with ocular drops (sol.dexamethason)
                    VOD-0,5,VOS-1,0. Biomikroskop examination OD-ciliar conjuctival injection,
                    corneal oedema with small KP, posterior synechiae. Ophtalmoscopia-big
                    floaters. Fundus-cystoid macular oedema. OS examination-normal. TOU-
                    FFA-cystoid macular oedema, OCT-parafofeolar RP defect. All internistic
                    and rheumatologic tests were negative. After intensive systemic and local
                    steroid therapy uveitis almost completely retreat: VOD-1.0. Couple of months she
                    took steroids in minimal doses with aim the possibility of recidive to minimalize.
                    After almost one year it comes to almost identical disease on the other
                    (left) eye. She did the same internistic and reumatologish tests but they
                    were negative again. The only difference was that this disease on the left
                    eye appears after a long trip and climate change. The same therapy was
                    given and uveitis completely retreats. In period of three years from the
                    beginning till today we noticed couple of mild recidives on the both eyes.
                    Last examination of the patient: VOD-1,0 VOS- 0,8. Macular angiography and
                    Conclusions: This case is very serious because of the age of the patient and
                    because of the length of the uveitis (3 years). And after all internistic
                    and rheumatologic tests taken, the reason of the disease is still unknown.
                    The only thing that we can notice is the appearance of recidives it comes
                    along after climate change, long trip, small or bigger cold. We can
                    conclude that it is likely possible that this disease it comes out from
                    some kind of immunodeficiency.

        Carotid cavernous shunt - Case Report:
        Bledar Kruja1, Elvis Veliu1, Julinda Jaho1, Kujtim Karafili1, Pajtim Lutaj2
          National Center of Traumatology, Military Hospital of Albania
          Albanian Vision Clinic
Aims: To report a case of a young patient 30 years old who suffer of carotid
cavernous shunt, after a head trauma.
Patients and methods: Male 30 years old,was involved in a car accident and hit
his head very hard. He was in comma after the accident,and during the first days he
developed a pulsative proptosis of his left eye, conjuctival chemosis, proptosis, total
internal opthalmoplegia and behavour disorders.
An MRA was performed,which showed a carotid carvenous shunt. He was treated
properly and the symptoms disappeared, but he has partial opthalmoplegia left, and
very low vision in his left eye.
Conclusions: CCFs can either result from trauma or develop spontaneously.
Traumatic CCFs may occur after head injuries in which the intracavernous carotid
artery is torn. Causes of these head injuries range from minor falls to severe
penetrating trauma. A relatively high incidence of traumatic CCF has been reported
in patients with middle fossa basilar skull fractures. 3 In addition, iatrogenic injury
from endovascular therapy may contribute to traumatic CCFs. Spontaneous CCFs
usually result from a ruptured carotid aneurysm; however, some authors have
hypothesized that these fistulas may be congenital arteriovenous connections that
open spontaneously in the setting of collagen vascular disease, atherosclerotic
disease, hypertension, or childbirth.
CCFs can result in transmission of arterial pressure to the ophthalmic veins, which
communicate directly with the cavernous sinus, and decreased arterial perfusion of
the globe. Both events lead to orbital manifestations. In addition, mass effect in the
cavernous sinu from CCFs can result in palsies involving cranial nerves III, VI, and/or
VII may result from.
               72   Strabismus and external
                    Eye diseases session
                                  Chairperson: N. Bobrova, Co-chairpersons: K. Spahiu & M. A. Velevska
                            Treatment of complex ocular trauma with mini-invasive systems:
                            trauma festival (video presentation):
                            Cesare Forlini1, Matteo Forlini2, Adriana Bratu1, Paolo Rossini1
                             Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy.
                             Department of Ophthalmology, Policlinico di Modena, Modena, Italy.
                    Synopsis: The video shows the use of the mini-invasive 25,23 gauge systems in
                    the treatment of complex cases of ocular traumatology. The possibility to combine
                    the surgical techniques 25,23,20 gauges allows the surgeon to customize the
                    surgical strategy, according to the difficulty of the case, with the purpose to get the
                    best anatomical and functional result. The mini-invasive surgery systems open a
                    new era in the field of complex trauma cases.

                            Etiological classification of ptosis:
                            Kelmend Spahiu
                            University Eye Clinic in Prishtina, Kosovo
                    Aims: the aim of this paper is to present classification of ptosis based on the
                    Patients and methods: review and comprehensive analysis of more than 500
                    cases of ptosis was done.
                    Results: ptosis is classified in: myogenic, neurogenic, traumatic, mechanical and
                    Myogenic ptosis as a major group is divided in: dysgenetic ptosis (simple
                    dysgenetic, with superior rectus weakness and blepharophimosis syndrome),
                    aponeurotic ptosis, and ptosis in progressive external ophthalmoplegia.
                    Neurogenic ptosis is divided in: ptosis in third nerve palsy, ptosis in Horner`s
                    syndrome, ptosis in myasthenia gravis, ptosis in Marcus-Gunn syndrome and ptosis
                    in aberrant regeneration of third nerve.
                    Traumatic ptosis is divided in: ptosis following eyelid lacerations and ptosis
                    following orbital injuries.
                    Mechanical ptosis is divided in: ptosis due to eyelid tumors and ptosis due to
                    cicatricial conditions.
                    Pseudoptosis is divided in: pseudoptosis due to hypotropia, pseudoptosis due
                    to enophthalmos and anophthalmos, pseudoptosis due to dermatochalasis and
                    pseudoptosis due to blepharochalasis.
                    Conclusions: the presented classification of ptosis includes the majority of ptosis
                    types. It is based exclusively on ethiology of ptosis and it is a matter of further

        Frontalis muscle suspension with heterologous materials for ptosis
        Kelmend Spahiu, Gazmend Kaçaniku, Suzana Bucinca
        Eye Clinic, Universitary Clinical Center of Kosova
Purpose: the aim of this paper is to present results of frontalis muscle suspension
with heterologous materials for ptosis correction.
Material: nine cases of frontalis muscle suspension with heterologous materials
are analysed. In five cases polypropylene 4-0 sutture was used and in four cases
Zenoderm strip was used.
Results: ptosis was corrected to cosmetically acceptable degree (difference in
primary position between operated and unoperated eyelid ≤ 1-2 mm) in all of the
In one case were polypropylene 4-0 sutture was used exteriorisation of sutture with
reccurence of ptosis was noticed, and in the second case granuloma formation.
In one case were Zenoderm strip was used reccurence of ptosis was noticed.
Conclusions: frontalis muscle suspension with heterologous materials can be
preferred as one of the solutions for correction of severe ptosis with poor levator
muscle function, especially in cases were temporary correction of ptosis is needful.

        Treatment of blepharophimosis syndrome:
        Gentian Hoxha
        Eye Clinic, University Clinical Center of Kosovo
Aims: the aim of this paper is to present the complexity and difficulties in the
surgical treatment of blepharophimosis syndrome.
Patients and methods: treatment of blepharophimosis is carried out in two
stages. In the first act lateral canthoplasty (sec. Agnew) and epicanthus correction
(sec. Mustarde) were done. In the second act ptosis correction by frontalis muscle
suspension with autogenous fascia lata (sec. Fox) was done.
Results: in the first act horizontal diameter of interpalpebral aperture is widened
for 3-4 mm, epicanthal folds are reduced and intercanthal distance shortened for
6-7 mm. In the second act ptosis is corrected, eyelid is elevated 3-4 mm, thus
interpalpebral aperture is widened in vertical diameter.
Conclusions: blepharophimosis syndrome must be corrected in at least two acts.
In the first act lateral canthoplasty and epicanthus correction are done and in the
second ptosis correction is done.
This approach in treatment of blepharophimosis gives the best results.

                            Metastasis orbitae - appropriate diagnosis:
                            B. Kostovska, M. Antova-Velevska, Z. Arnaudovski, V. Nikolovska
                            University eye Clinic-Skopje, Macedonia
                    Aims: To evaluate orbital metastases as symptom of malignant disease and looking
                    for the primary tumor location. What are the appropriate diagnostic methods for
                    approaching exact diagnosis in these cases?
                    Material and Methods: We check up female patient with anamnesis of
                    thyreothoxicosis. Subjective symptoms as pain (retrobulbar), reduced visual acuity,
                    edema palpebrae, exophtalmus, chemosis, exposure defects of the cornea and
                    cilliary hyperemia we found on anterior segment of the eye.
                    We requested blood control, hormonal status, and KTM, MR of the orbit and head.
                    We recommended hospitalization for benefit of appropriate diagnosis.
                    After consulting neurosurgeon we proceed orbital biopsy.
                    Results: MR of the orbit diagnosis expansive tumor, anterior- super lateral segment
                    which dislocate eye in front and slightly down.
                    Orbital biopsy showed retrobulbar tumor with fibrosis and positive
                    imunohistochemically dye 80 % for estrogen hormone. It is probably metastatic
                    tumor grow from lobular carcinoma of the breasts.
                    Conclusions: Orbital metastases are very difficult to diagnose. Systemic diseases
                    usually misdiagnosis and complicate appropriate treatment from the beginning.
                    Management is based on location and extent of both orbital and systemic disease.

                            Orbital Cavernous hemangioma:
                            Naser Salihu1, Mirlinda Kubati-Ajeti1, Orhan Kubati2, Burim Zhuri2
                             University Eye Clinic, Prishtina, Kosova
                             Laser Eye Center Kubati, Prishtina, Kosova
                    Cavernous hemangiomas are the most common intraorbital tumors found in adults.
                    It is most commonly seen in middle-aged women. Most of are found within the
                    muscle cone, but can be found anywhere in the orbit.
                    Aims: The aim of this study was to report our experiences in patients with orbital
                    cavernous hemangiomas after surgical treatment using lateral orbitotomy.
                    Material and methods: This retrospective study include cases with intraconal
                    cavernous hemangiomas seen at our centers between 1999 to 2009. Our study
                    have had 18 patients of which 11 were females. All patients underwent complete
                    ophthalmic examinations included visual acuity, external eye examination, ocular
                    motility, pupillary reflexes, anterior segment evaluation, dilated fundus examination,
                    visual field, ultrasound and CT scan examination of the affected eye and orbit. Most
                    common complaint was axial painless proptosis seen in all patients followed by local
                    pain. No case showed bilateral involvement.
                    Results: All patients underwent surgical treatment in general anestesia using lateral
                    orbitotomy. The excised tissue was subjected to histopathological examination
                    that confirmed diagnosis. Postoperative results were good including visual acuity,
                    visual field defects and afferent pupillary reflex, while in one remained transitory

disturbance in extraocular muscle function with self limited diplopia.
Conclusions: We think the surgical excision of symptomatic tumors with intraconal
localisation using lateral orbitotomy is one of the best choices because it can give
good access to the deep lateral portion of the muscle con.

        Pediatric orbit tumor and tumorlike lesions:
        Z. Arnaudovski, M.Antova-Velevska, V. Nikolovska, B. Kostovska
        University eye Clinic – Skopje, Macedonia
Aims: Describe the clinical and histopathology characteristics of eye and orbit
tumors in children and tumorlike lesions from 2008-2010 in University eye Clinic,
Patients and Methods: Patients younger than 17 years old with histological
confirmed eye and orbital tumors treated at University eye Clinic during 2008 -2010
were subjected to a retrospective analysis. Patients with granulation, hordeolum,
and chalazion were excluded.
Results: Totally, 35 patients (23 boys and 12 girls) with eyelid tumors were included.
The 4 most common tumors, in order of frequency, were cellulites, dermoid cysts
(17.9%), squamous cell papillomas, and compound nevi, than rarely retrobulbar
tumor – Haemangioma capillary, rhabdomiosarkoma.
Conclusions: dermoid cysts are the most common eye tumors of children. Surgical
excision produced good results. Malignant tumors of the eye and orbit are rare in
children and require appropriate diagnosis and prompt therapy.

        Floppy eyelid syndrome:
        Bledar Kruja1, Pajtim Lutaj2
          National Traumatology Center, Military Hospital; 2UHC “Mother Theresa” of
        Tirana and Vision Eye Clinic
Aims: To report a case of floppy eyelid syndrome, which was diagnosed and
treated in our hospital.
Patients and methods: Our patient is 36 years old, male. We complained of
chronic conjucvtivitis for the last 2 years. He was on local and systematic antibiotics
every time his situations deteriorates .He suffers also from obesity and sleeping
After a careful examination we noticed loose upper lid with redundant lid skin. His
symptoms were worse in the morning and better in the evening. The patient was
diagnosed with floppy eyelid syndrome.
We suggest the patient to use an eye shield during sleep.
Results: The patient improved rapidly and had no more chronic conjunctivitis.
This syndrome is frequently misdiagnosed, unilateral or bilateral, it typically affects
very obese men who may also suffer from sleep disorders and snoring.
Redundant upper lid skin and loose tarsal plates that easily evert.

                    Chronic, intense micro papillary conjunctivitis of the superior tarsal conjunctiva.
                    Punctuate keratopathy, filamentary keratitis and superior vascularization may be
                    Eye shield during sleep
                    Horizontal lid shortening.
                    Conclusions: Floppy eyelid syndrome is rare and often misdiagnosed. The patient
                    usually suffers from chronic conjunctivitis for several years, which is caused by the
                    contact of the eye with the pillow during sleep.

                            Factors affecting Visual Funcion in Benign Intracranial Hypertension:
                            Veli Tagani, Adelina Daizi, Eneda Balliu, Pajtim Lutaj
                            U.H.C. Mother Tereza, Dept of Ophthalmology, Tirana
                    Aims: To evoluete the factors affecting visual function in 46 patient with Benign
                    Intracranial Hypertension (BIH) in Albania.
                    Material and methods: 46 patients with BIH was evaluated at UHC Mother Tereza
                    in Tirana.Age of patients ranged from 8-50 years.(medium 38), of 46 patients, 9
                    were male and 37 female. The M:F ratio was 1:10. Obesity was found in 24 (52%)
                    patients. There were 8 patients with venous sinus trombosis. Two patients were
                    with anemia and one with high myopia. Four patients under 18 years werw with viral
                    infection and otitis media. MRI demostrated an empty sella in 16 patients.
                    Results: Two patients had early papilledema;10 moderate,14 severity and 9 chronic
                    Visual acuity was disturbed in 2 eyes (40%;41%) of the patients had visual acuities
                    betwen 0,2-0,7; only 10%of the patients had visual acuity less 0,05.
                    Automated perimetry revealed enlargement of blind spot, inferior nasal defects and
                    periferial constriction.
                    Lumbo peritoneal shunting became necessary in 10 patients.
                    Patients with high myopia ,anemia with severy and chronic papilledema ,emty sela,
                    obesity, has the high risk for visual loss.
                    Conclusions: BIH is not always a bening condition; fundal changes and visual
                    function should be carefully monitored.

                            Treatment of the pterygium relapses after 6th recidivism, with the
                            use of a egg membrane:
                            O. Kubati, M. Kubati-Ajeti, N. Salihu
                            Laser Eye Center Kubati, Prishtina, Kosova
                    Aims: Amnion membrane replacement with an egg membrane to cover sclera after
                    excision of relapse pterygium.
                    Case prasented: 43 yr. Female was examined in our Clinic with history of several
                    previous excision of pterygium with simple method. The 6th relapse of pterygium

has provoked massive cell proliferation, monolateral esotropia, while her neck was
found to be in violent torticolis position.
Methods: The excision of the pterygium and fiber tissue around it, release of the
eye lids, the upper and the lower fornix as well as the caruncula of the conjunctiva
and musculus rectus internus. Placement of conjuctivo-limbal autograph and
coverage of the surface of sclera after the injected s/c triamcinolone with an egg
membrane instead of the amnion membrane.
Results: The normal bulbus movement has been achieved, improving in the same
time the torticolis position. Also the fornix conjunctiva gets created in the nasal part
which was blocked with the connective tissue.
Conclusions: The primary wide excision of the pterygium and of the Tenon
membrane is mostly followed with around 50% of recidivism, therefore even after
first surgical procedure a conjunctive autograph should be used to fill the sclera,
since we believe that each re-operation provokes fibrotic proliferation.

        Monocular Hyper Function of Inferior Oblique Muscle:
        S. Boshnjakovska, M. Boshnjakovski
        University Clinic for Eye Diseases, Skopje, Macedonia

The hyper function of the inferior is frequently present in infantile esotropia.
According some of the authors, it can be present as much as in 60% of infantile
esotropia (Von Noorden). Most frequently is bilateral, but mono lateral presentation is
not excluded.
Aims: To analysed the frequency and particularities of patients having one side
hyper function of MOI.
Patients and methods: We have examined and analysed 60 patients, with hyper
function of MOI, aged between 4 and 8 years. In all the patient standard strabologic
examination woos performed. Treatment woos consisted of total optical correction,
and after treatment of underling ambliopia and establishing of equal acuity on booth
eyes, surgical treatment woos performed. Surgery consisted of ante position of MOI
by Gobin.
Results: In 58 we have find infantile esotropia, associated with hyper function of
M.O.I. Monocular hyper function of MOI woos noted in 6 patients. In 2 patients
there woos present hyper function of MOI without presence of strabismus in primary
position of the eyes. Results of the surgical treatment were successful.
Conclusions: The monocular hyper function of IOM is not very frequent. It is very
important to perform careful and comprehensive clinical evaluation of congenital
esotropia in order to establish precise and accurate surgical indication.

                            Hallerman-Streiff Syndrome - Case Report:
                            Çapuni-Brestovci Meshqyre, A. Miftari, A. Vuçitërna, L. Shiroka, S. Buqinca
                            University Clinical Centre - Eye Clinic, Prishtinë
                    Aims: To present a forme fruste of the Haller4mann-Streiff syndrome with juvenile
                    glaucoma, having all the main features of the syndrome but congenital cataracts.
                    Patients and Methods: A 16 year old schoolboy was admitted with untreated
                    juvenile glaucoma. The intraocular pressure was 70 mm. Hg in the left eye and
                    62 mm. Hg in the right eye (Goldmann applanation tonometer). There was no
                    light perception in the right eye and 1/60 in the left improving to 0.1 with +7.0 D
                    sph. There was microphthalamos, enophthalamos, the upper lid was short and
                    the conjunctiva was thin. The cornea was oedematous with fine epithelial bullae.
                    The anterior chamber was of normal depth with no signs of inflammation. The
                    gonioscopic examination revealed that the drainage angle was open. The left iris
                    was atrophic-colobomatous. The pupils were slightly dilated. A red reflex was
                    present. The lenses were clear. The right optic disc was pale and cupped (0.9 – 1).
                    The left optic disc was pale.
                    Antiglaucomatous therapy failed to reduce the pressure and a left trabeculecthomy
                    was carried out.
                    Results: In the left eye the intraocular pressure has fallen to within normal limits
                    and the vision has improved to 0.3 – 0.4 with 7.0 D sph. The medical therapy was
                    continued in the right eye but the pressure still remains high (40 mm. Hg).
                    Conclusions: A case of the Hallermann-Streiff syndrome with juvenile glaucoma
                    and no cataracts is presented. Topical therapy failed to reduce intraocular pressure.
                    Trabeculecthomy in the left eye was carried out with success.

                            Comparision of the cycloplegic effect of atropine and cyclopentolate
                            in children with hyperopia:
                            M. Ilazi, G. Kaçaniku, M. Kubati, S. Gashi
                            University Clinical Center, Eye Clinic, Pristina Kosovo
                    Aims: This study aimed to evaluate the safety and efficacy of two cycloplegic
                    regimens in hyperopic children under 10 years of age.
                    Patients and methods: Three hundred-thirty eight children aged 1 to 10 years
                    were treatet with two different cycloplegigs and regimens.
                    Cyclopentolate drops 0.5% or 1% was instilled 2 times after 5-min interval, and the
                    refractions with retinoscope were evaluated after 45 min.
                    Atropine drops 0.5% or 1% was instilled 3 times a day for three days and once on
                    the day of examination. Objective rerefraction with retinoscope was evaluated. The
                    responses to cycloplegia in different age groups, the degree of hyperopia, presence
                    of strabismus, and side effects were also compared.
                    Results: there was significantly more (p<0.01) hyperopia discovered with atropine
                    cycloplegia than with cyclopentolate cycloplegia, averaging approximately +0.6 D
                    per subject in the group receiving atropine. On 132 of 318 children, or 42% of them
                    cyclopentolate cycloplegia gave the same hyperopia as atropine. On patients with

very high hyperopias of more than +8.00 D, atropine and cyclopentolate cycloplegic
refractions were the same.
Conclusions: Children under the 6 years of age with esotropia, should receive
atropine for objective refracrion, because they need full hyperopic correction to
prevent accommodative convergence. After 6 years of age, children do not need
atropine cycloplegia, because they should receive optical correction only for
manifest hyperopia (the highest + sphere that does not blurr the distant vision).

        The impact of refractive anomalies in strabismus apearance and
        functional ambliopy:
        M. Kubati, O. Kubati, M. Ilazi, S. Gashi, B. Zhuri
        University Clinical Center, Eye Clinic, Pristina Kosovo
Aims: is to analise the impact of refractive anomalies in strabism appearance and
amblyopy, as well as to determine the impact of the type of refractive anomaly in
appearance of strabismus and functional ambliopia.
Patients and methods: In this study are involved 320 children of age 0-11,
examined in the specialized Eye Clinic “Kubati” in Prizren. The patients have been
analyzed according to the gender, living place, the age of being visited by the
ophthalmologist, the type of refractive anomalies, their impact in appearance of the
strabismus (its types) and of amblyopy.
Results: From 320 examined, 306 had refractive anomalies and14 had no refractive
anomaly. By refractive anomalies dominates hypermetropy with 134 cases and
hipermetropic astigmatism with 93cases that impact appearance of strabismus.
From 255 cases with strabismus, 71 happened to have strabismus.
Conclusions: In order to prevent strabism and amblyopy it is necceserry to
diagnose in time and correct afterwards the refractive anomalies.

        How to avoid via false (path) during probing in dacryocystitis
        O. Kubati, B. Zhuri, M. Kubati-Ajeti,
        Laser Eye Center Kubati, Prishtina, Kosova
Aims: We have found that a number of our patients have undergone unsuccessful
probing. Aim of this study is to find what was the cause of failure.
Patients: We have analyzed 40 cases with dacryocystitits neonatoria in 2009. 19 of
them female and 21 male. In 21 cases we have intervened only once (our cases).19
cases are from other clinics which have undergone unsuccessful probing. From them
10 cases have had probing once,4 cases twice, thrice 3 cases and fourthly 2 cases.
Method: Probing was done in the third month of life under general anesthesia
(ketalar). We have used Bowman “OO” or “O” probe. After probing the lachrymal
system is irrigated with saline, through point of upper and lower punctum to prove
the canalization. If saline passé in to the pharynx or through the nostril the probing

                    was done successfully.
                    Results: All cases have undergone successful probing. No epiphora and purulent
                    inflammation was found in further examinations.
                    Conclusions: We have proven that the failure of probing in 19 cases was because
                    of via falsa(false path). We have not identified any abnormalities in nasolacrimal canal
                    The general anesthesia where reflexes of nasal mucous membranes, larynx and
                    pharynx are preserved enables us to make the irrigation after probing.

                            Ocular Manifestation in Down (21+) Syndrome:
                            M. Boshnjakovski, K. Buzarevska
                            University Clinic for Eye Dieses, Skopje, Macedonia
                    The Down syndrome in its clinical appearance is characterised with mental
                    retardation, typical facial and body constitution, heart anomalies, anomalies of
                    the bones, hydrocephalus etc. Although not rare, the ocular manifestations in this
                    syndrome are rarely analysed in systemised way.
                    Aims: To research and analyse ocular manifestations in Down syndrome
                    Patients and methods: We have analysed the ocular affections in 35 patients
                    with Down syndrome with prospective study. The age of the patients is between 8
                    and 18 years. Every patient had undergone trough standardised ophthalmologic
                    examination: visual acuity, refraction, slit lamp, measures of intra ocular tension ,
                    examination of the retina as well as strabologic status.
                    Results: Visual acuity woos not measurable in 8 patients. We have observed visual
                    acuity less than 20/50 in 11 patients. The best measured visual acuity woos 20/30.
                    Concerning the refraction, the hypermetropia is dominant, although the myopia is
                    not excluded. We have observed cataract in 1 patient and keratocone in 2 patients.
                    Concerning the strabologic status, we have 9 strabismus-7 esotropia, 2 exotropia,
                    in 8 nystagmus and functional ambliopia in 5.
                    Conclusions: In Down syndrome there is in general decreased visual acuity
                    comparing to the general population. The prevalence of refraction anomalies,
                    cataract, keratocone, strabismus, nystagmus and functional lambliopia is also
                    higher than in general population.

                            Cyanoacrylate glue for the treatment of corneal perforation:
                            Bledar Kruja1, Elvis Veliu1, Julinda Jaho1, Kujtim Karafili1, Pajtim Lutaj2
                             National Center of Traumatology, Military Hospital of Albania
                             Albanian Vision Clinic
                    Aims: To report 2 cases with corneal perforation, which was treated with the
                    application of cyanoacrylate glue on wound leak.
                    Patients and methods: the 2 patient suffered by corneal abscess caused by an
                    agricultural trauma. After a about 1,5 month they developed corneal perforation at
                    the center of the abscess and shallowing of the anterior chamber. On both patient

we used cyanoacrylicate glue on the perforation and contact lens upon it.
Results: The next day both patient had formed anterior chamber and no leakage at
all. We continue the therapy for the corneal abscess for a long time.
The effective early application of a cyanoacrylate glue corneal patch can aid in the
management of small corneal perforations, corneal melts and wound leaks. Their
use gives improved visual outcomes with reduced enucleation rates (6% vs 19%).
It may also avoid the need for tectonic penetrating keratoplasty. Cyanoacrylate
glue prevents re-epithelialization into the zone of damaged and naked stroma and
prevents the development of the critical setting for collagenase production that
leads to stromal melting. Cyanoacrylates also have significant bacteriostatic activity
against gram-positive organisms. We describe a simple and easily reproducible
method of cyanoacrylate corneal patch application, with neglible risk of inadvertent
glue complications. It has the further advantage of a smooth corneal surface
rather than an irregular surface as often occurs with direct application methods.
With corneal application, the major concern is toxicity of cyanoacrylates through
direct contact with the corneal endothelium and lens. Fibrin glues may be less
toxic; however, they are not as readily available. The longer alkyl chains of currently
available cyanoacrylate glues (e.g. Histoacryl) slows degradation significantly, limiting
accumulation of histotoxic by-products to amounts that can be effectively eliminated
by tissues. Vigilance in monitoring for infection/corneal infiltrate is necessary at all
times, especially when the glue has been present for more than 6 weeks.
Conclusions: Corneal patching with cyanoacrylate glue is a temporizing procedure
only, buying time to allow healing secondary to medical treatment of the underlying
condition, or allowing surgery to be elective and under more optimal conditions
once inflammation has been reduced and the integrity of the globe restored.

        A case of sympathetique ophthalmia in a sixty year-old patient:
        Eglantina Molosiu
        Regional Hospital of Fier
Aims: To report a case of sympathetique ophthalmia in a sixty year-old patient and
to provide a review of the literature on this topic.
Patients and methods: Case report
Results: A sixty year-old man with a history of right eye injury presented at
our department after two months from trauma complaining of pain, redness,
photophobia and decreased vision in the left eye. The ophthalmic examination
revealed a phtisis bulbi in the right eye with no vision at all and severe inflammation
of the left eye with visual acuity reduced to 5/10. The inflammation was spread
through the anterior and posterior segment. The patient was hospitalized and
treated with cycloplegic,topical and systemic steroids. After recovery the patient
underwent to periodic checkups.
Conclusions: It is very important to treat properly every severe trauma of the eye,
specialy those with great risk of sympathetique ophthalmia. Even if the patient is
old,it should aways kept on mind the risk of sympathetique ophthalmia. Periodic
checkups of the patients in risk of sympathetique ophthalmia and of those who
develop the disease.

                            Complication of Neurofribromatosis, Type 1 presented at the out
                            patient visit at the Health Center of Specialties No 2:
                            Nora Burda1, Blerta Gjoni2
                             Ophthalmologist, Health Center of Specialities No 2, Tirana, Albania
                             Dermatologist, Health Center of Specialities No 2, Tirana, Albania
                    Introduction: Neurofibromatosis NF is a genetic autosomal dominant, and
                    multidimensional disorder, witch is characterized by changes in skin coloring,
                    neurological and orthopedic changes. NF is the most frequent of the so-called
                    hamartoses. This disorder is the featured with various phenotypes. Among most
                    frequent complications are the lost of sight due to optic nerve glioma, tumors of
                    vertebral column, scoliosis, vascular lesions and changes is the long bones.
                    Patients and methods: This study was designed as a case report assey. The
                    objective of this study was the patient with initial N.C
                    Case presentation: A female patient 36 years old was present at the ophtlmologist
                    office. She complain constant headache on the parieto occipital region, periorbital
                    pain around the left eye, and slight decrease of vision on this eye. Somatic signs
                    and symptoms, fatigue, weakness, joint ,spinal and bone pains. During objective
                    examination of the eyes she present: Right eye: VA 6-7/10, BCVA 10/10, IOP
                    17.3mmHg, anterior segment unremarkable, fundus examination, ONH, normal,
                    macula normal, C/D ratio 0.3, normal color test. Left eye: VA: 6/10, BCVA 9/10,
                    IOP 23 mmHg, slight proptosis, slight ptosis of upper eyelid, two iris Lisch nodules,
                    posterior segment ONH normal, macula normal, C/D ratio 03- 0.4, normal color
                    test. On visual field examination she had decreased of light sensitivity LE, RE.
                    normal. She is follow up for OHT, and prophylactic treatment with sol. timololi
                    LE. Dermatological status: Onset of the first changes in the skin date since the
                    early childhood, café-au-lait macules, with the various shape and size from 2-4 cm,
                    6 in the number, as well several pale spots in the skin of the limbs. Subcutaneos
                    neurofribormas and the multiple cutaneous neurofibromas. The evaluation of
                    the patient and the diagnosis were done relying on the physical, laboratory and
                    imagery examinations,and consulting with different specialities at our clinic. ORL
                    examination: bilateral neurosensorial hypoacussia, spontan nistagmus, provoked
                    horizontal nistagmus, vertical nistagmus.
                    Imagery examination: Radiography of spinal column showed cervical
                    spondelyarthrosis. Radiography of long bones presented a slight frontal prominence
                    of tibia bilateral. Neurological examination no signs of neurological deficiencies.
                    Internist /cardiologist didn’t found signs of arterial hypertension, signs of anxiety
                    were observed, as well intentional tremor, gingival hemorrhage few times.
                    Conclusions: According to criteria and the examination’results we diagnosed the
                    patient with Neurofribomatosis-1.We recommended routine examinations optic
                    nerve check up, changes in sight, Lisch iris nodules, progressive changes in visual
                    field, annual examination of the eye is essential in detections of optical nerve lesions.

        Recession of Inferior Oblique Muscle, a new experience of
        weakness surgery of Inferior Oblique Muscle, applying in UHC
        “Mother Theresa”- Case Report:
        Alketa Tandili, Ali Tonuzi, Eralda Leci
        University Hospital Centre “Mother Theresa”, Tirana, Albania
Aims: To report a new surgical technique of inferior Oblique Muscle weakness
applying in Eye Clinic, UHC “Mother Theresa”.
Patients and methods: The patient is a female child 12 years old. The general
ophthalmologist referred him to Pediatric Ophthalmology and Squint Department in
Eye Clinic, UHC “Mother Theresa”, we performed ophthalmologic examination and
sensory and motor evaluation.
Results: The patient was examed and we identified abnormal head posture, good
stereopsis and good vision in both eyes.
There was a right hypertropia when the head was straight, which increases on left
gaze, and on right tilt (Bielschowsky +). There was an overaction of inferior oblique
in the right eye and an excyclotortion in fundus examination. There was diagnosed:
RE- Superior oblique palsy, and we performed surgical treatment:
RE –Recession of Inferior Oblique Muscle.
Conclusions: A superior oblique palsy is the most common cause of a vertical
Surgical management of inferior oblique muscle overaction is based on changing
the function of inferior oblique muscle. Recession of inferior muscle is the most
commonly used technique, followed by myectomy and anteriorization. Inferior
oblique myotomy is not effective, because the cut ends of the muscle inevitably
reunite or scar to sclera, causing residual inferior oblique overaction.
The basis of graded recession of Inferior oblique muscle is that the more anterior
inferior oblique insertion, the greater weakening effect. Applying this technique help
us for better post-op results.

        The different strategy of anesthesia on cataract surgery under local
        D.SH.M (MD) Lindita Agolli
        Anesthesia & intesif care on Hospital of Speciality “Mother Theresa”, Tirana,
Background and aims: The cataract surgery includes on the most of cases the
third generation patients which olso manifest other companion diseases. Stress
sometimes is a reason for intraoperative complications.
The study is dedicated to the effects of the different strategy of anesthesia on
cataract surgery under local anesthesia.
Material and methods: The investigation is done on 100 patients ASA II-III
undergone cataract surgery under local anestesia.There are chosen four different
strategies on 25 patients each group:
• Retrobulbar block and premedication and anesthesist on call

                    • Retrobulbar block and premedication and anesthesist assistance
                    • Retrobulbar block and sedacion and anesthesist assistance
                    • Retrobulbar block and sedacion and premedication and anesthesist asistence
                    It is studied:-Perioperative haemodinamic instability:
                    - Complictions (intraoperative hemorragia, postoperation nausea and vomiting)
                    - Patient satisfaction
                    - Surgeon comfort
                    According the stress and haemodinamic conditions it was given nifedipine,atenolol
                    diazepam ecet.
                    Sedation was realised with: fentanyl-midazolam i.v on subanesthetic doses before
                    retrobulbar block was aplied.
                    RESULTS: The hemodinamic instability for each group was:
                     1-140 ± 50—90 ± 30    2-140 ± 40—90 ± 20    3-110 ± 20 — 85 ± 20   4-115 ± 25—80 ± 20
                     FC 80 ± 20            FC 75 ± 25            FC 80 ± 20             FC 70 ± 15
                    p < 0,05
                    Complications were: two cases hipertension on group one, hipertension one case
                    on group two, hypotension one case on group three. Other complications: vomiting
                    one patient on gr.three, nousea one case on gr. four.
                    The patient satisfation about anestezist asistence was: 42 patients not nesesery, 48
                    patients avalieble, 10 patients necessary.
                    The anestesist asistence (surgeon comfort) was: not necessary 10 patients,
                    avalieble 53 and necessary 47 patients.
                    Conclusions: There are different strategies on cataract surgery under general
                    anestezia. The probability of surgical and haemodinamic complications are not
                    indicatet from the anestetic manipulations, but it is groun up the patients satisfaction
                    and the surgen comfort on the presence of sedation and the anesthesist.

                            Trichophyton Spp. Fungal Keratitis in 22 Years Old Female Contact
                            Lenses Wearer:
                            V. Glavota, N. Gabric, I. Dekaris, I. Mravicic
                            Eye clinic Svjetlost, Croatia
                    Aims: Fungal keratitis represents one of the most difficult forms of microbial keratitis
                    to diagnose and treat successfully. We present a case report of Trichophyton Spp.
                    Fungal keratitis in 22 years old female contact lens wearer.
                    Patients and methods: CASE REPORT. A 22 years old female developed corneal
                    melting syndrome, spontaneous corneal perforation and complicated cataract of
                    the left eye. Conjunctival swab, first sample of corneal tissue and from the anterior
                    chamber were sterile. Urgent therapeutic perforating keratoplasty (PK), was
                    performed together with extracapsular cataract extraction and the implantation
                    of the intraocular lens in the posterior chamber. The patient was systematicaly
                    treated with ciprofloxacin and diflucan, subconjunctivaly with dexamethason and
                    atropin and topicaly with chlorhexidine, brolene, levofloxacin, polimyxin B, and
                    dexamethason/neomycin). Microbiology evaluation was performed also following
                    excisional biopsy of the intracameral portion of the lesion. The presence of

Trichophyton spp. was finally confirmed. Itraconazole and garamycin were included
in the systemic therapy.
Results: After treatment corneal graft was clear for 17 days but decompesated
28 days after the PK. After 2 weeks microorganisms invaded the vitreous and
caused endophthalmitis. Despite urgent pars plana vitrectomy patient developed
endophthalmitis, lost light sensation and developed phthysis. Evisceration and the
implantation of silicon prosthesis was done.
Conclusions: PK is a method of choice in treating severe infectious
keratitis unresponsive to conservative tretment but without the eradication of
microorganisms it cannot restore the vision or save the eye. Prompt diagnosis and
treatment of Trichophyton spp. keratitis are essential for a good visual outcome.

        Rehabilitation in low vision patients: state of art:
        S. Scalinci
No abstract.

        Beginners difficulties of phacoemulsification method, based on
        scientific studies of some South – East and West European countries:
        Ndue Bardhi1, Eneda Balliu2, Silvana Kavaja3
          Central Military University Hospital, Tirana, Albania
          Universiy Hospitality Center Mother Teresa, Tirana, Albania
          Civil Hospital, Durres, Albania
Aims: Study and appropriation of these knowledge and different experiences
on Beginning difficulties transition period, in order to prevent errors and to avoid
the enthusiasm of the surgeons after their first experiences in phaco-technique
method to compare and to analyze different surgical techniques and performance
of cataract surgery with new method of phacoemulsification at South-Eastern
European countries, based on studies of others authors during last years.
Introduction: The study on survey of cataract surgery, on purpose to present
distribution of cataract surgery and the certain characteristics of the cataract
surgery results: A disproportion between the limited use of cataract surgery
(methods ECCE+IOL and phaco surgery) and slow transition from ECCE to phaco
“There has been a wide variation between clinics in technique and performances”.
“Any sight-threatening complication during surgery has varied between 2.5%
and 4.5%“.
1-The frequency of complications does not show any tendency of change during
   this period.

                    2-To question the enthusiasm of the surgeons after the their first experiences in the
                      phaco technique is still the big problem. We should continually work on improving
                      surgical skills and raising the level of technical support.

                           Treatment of decompensated compressive glaucoma with collagen
                           implant - Case Report:
                           J. Bilbili2, D. Costin1, K. Bardhi2, Costea, C. Florida1, M.P. Bucatariu2
                            Medicine and Farmacy University “Gr. T. Popa”, Ophtalmology, Iasi, Romania
                            Clinical Neurosurgery Hospital “Prof. dr. N. Oblu”, Ophtalmology, Iasi, Romania
                    Aims: A 69 year old woman appeared with visual loss in both eyes, pain and
                    photophobia. Standard ophtalmological assessment diagnosed a primary open angle
                    glaucoma and compressive glaucoma because of Graves ophtalmopathy, left eye
                    total optic atrophy. The patient`s history shows a decompensated glaucoma, treated
                    for several years with three ocular hypotensors. The trabeculectomy with collagen
                    implant was attempted and postoperative visual acuity and visual field improve.
                    Neuroprotective therapy leads to recovery of optical function (from 0.04 to 0.12)
                    The assessment of all pathogenic mechanisms is very important. We have to
                    see all target areas where different mechanisms act and the areas where several
                    mechanisms act in the same time with more damage. Probably the glaucoma
                    surgery must have been accomplished earlier and the results would have been
                    better. The neuroprotective therapy should be established for all glaucoma patients,
                    preserving the visual function.

                           Management of traumatic hyphema : Retrospective Evaluation of
                           hospitalized patient, Eye Clinic, UHC “Mother Theresa”:
                           A. Tandili1, Sh. Dajti1, S. Xinxo2, S. Zhugli1, V. Mema1, L. Agolli1,
                           A. Grezda1, A. Monka1, J. Jaho1, A. Hibraj1, I. Zhonga1, N. Burda3, S. Zhuka4
                            University Hospital Centre “Mother Theresa” Tirana, Albania; 2Institute of
                           Public Health, Tirana, Albania; 3Health Center of Specialities Nr. 2, Tirana,
                           Albania; 4Health Center of Specialities Nr. 3, Tirana, Albania
                    Aims: To evaluate the clinical outcome of patient with traumatic hyphema
                    hospitalized and treated in Eye Clinic, UHC “Mother Theresa”. Tirana, Albania.
                    Patients and methods: A retrospective cases series. Ninety-two patient with
                    traumatic hyphema were hospitalized for ocular injury from January 2008 to January
                    2010. Data regarding initial and final VA, slit lamp biomicroscopy, hyphema size,
                    ophthalmoscopy, intraocular pressure, rebleeding, medical and surgical intervention
                    were record.
                    Results: Seventy(76%) patients were male and fifteen(16.3%) patients were
                    children. Major causes of traumatic hyphema were piece of wood, tools and toys.
                    All patients (100%) were presented in the emergency room within 2 hours from the

time of the trauma.
Thirteen(14%) patients presented total hyphema, thirteen (14 %) patients presented
hyphema-more than half AC, eighteen (20%) patients presented hyphema in half of
AC, forty-eight (52%)patients presented hyphema in third of AC or less.
Visual Acuity was better than 20/200 in 60 (64.2%) patients; thirty-seven (40.2%)
patients had high intraocular pressure.
The most common lesions associated with traumatic hyphema were corneal injuries
(41cases, 44.5%). The median final visual acuity was 20/30; unsatisfactory final
VA (worse than 20/40) was statistically associated with ocular posterior segment
lesions and grade of hyphema. Grade of hyphema was also related to intraocular
surgical intervention, which was performed in 5 cases 5.4%. Rebleeding occurred in
9 (9.7%) patients.
Conclusions: Hospitalization is absolutely recommended for all patient present in
emergency room with hyphema. Rebleeding could happen even in hospitalized
conditions. Associated posterior ocular segment injuries and hyphema of greater
magnitude were related to the worst final visual acuities.

        Complicated cases in cataract surgery:
        L. Scorolli
No abstract.

        Success rate of external dacryocystorhinostomy: does silicone
        intubation affect outcome?:
        G. Kaçaniku, K. Spahiu, M. Ilazi, G. Hoxha, M. Ismaili
        Eye Clinic, University Clinical Center of Kosova, Prishtina
Aims: To compare the success rate of external dacryocystorhinostomy with and
without silicone intubation.
Methods: This study included 129 patients with lacrimal drainage system disorders
who underwent the external dacryocystorhinostomy and divided in two groups
depending on whether silicone intubation was used during the surgery or not. 41
DCR’s were performed with intubation and 88 without. The data was analyzed using
the average, standard deviation, variation coefficient, and the statistical significance
was determined by t-test.
Results: The mean age of the patients was 38.0±14.6SD years, including 97
females and 32 males. Intraoperative complications were present more frequently in
the group without intubation 19.3% compared to 12.2% in the group with intubation
(p>0.05). The postoperative complication was closure of the anastomosis, less
frequent in the group with intubation 4.9% compared to 12.5% in the group without
intubation (p>0.05). The success rate was evaluated by lacrimal patency to irrigation
and relief of epiphora. By groups, patency in the group with intubation was higher

                    95.1% compared to 87.5% in the group without intubation (p>0.05).
                    Conclusions: Our findings suggest that success rate was higher in
                    ocystorhinostomy with silicone intubation, although results were not statistically
                    significant. Prospective studies involving larger patient numbers are required to
                    confirm this beneficial effect of silicone intubation.

                            Fitting keratoconus. Choose the good design with standart or
                            custom contact lenses:
                            Patrice MONGEOT
                    No abstract.

                            Differents fitting prothesis eyes, four painted to sléral prosthesis:
                            Gerard Fournier.
                    No abstract.
SEE - ARVO                                                                            89

               Chairperson: C. Grupcheva, Co-chairpersons: M. Jager & G. M. Somfai
       Welcome, Opening remarks:
       Gábor Mark Somfai
       Budapest, Hungary
Welcome from the International Chapter Affiliate Council of ARVO. Martine Jager
(Leiden, The Netherlands)

       Angiogenesis and uveal melanoma:
       Martine J. Jager, M. El Filali, L.V. Ly, P.A. van der Velden
       Leiden, The Netherlands
No abstract.

       New diagnostic method in dry eye:
       J. Németh1, E. Fodor1, A. Berta2, T. Komár2, P. Nemec3, M. Higazy4,
       I. Petricek5, M. Prost6, G. Semak7, H. Grupcheva8, O. Evren9,
       P. Schollmayer10, A. Samaha11, K. Hlavackova12
         Budapest, Hungary, 2Debrecen, Hungary, 3Czech Republic, 4Egypt,
         Croatia, 6Poland, 7Belarus, 8Bulgaria, 9Turkey, 10Slovenia, 11Lebanon,
Aim: Based on population studies, the prevalence of dry eye is between 10-30 %
in adults however a large portion of the patients is not diagnosed and a widespread
underdiagnosis seems to be reality. The lecture details a new diagnostic method,
the lid parallel conjunctival folds (LIPCOF).
Patients and methods: In 12 centers in 11 countries altogether 272 eyes of
272 dry eye patients (75 male and 197 female) were examined. Their age was on
average 52.7 +/- 16.2 years (min: 17, max: 89 years). The LIPCOF was examined
and graded according to the method of Höh. Tear film break up time (BUT),
fluorescein staining and Schirmer test without anesthesia were measured. The
subjective symptoms were detected using16 standard written questions.
Results: The LIPCOF score showed significant positive correlations with the
following parameters: age, severity, fluorescein staining (r>0.2; p<0.001), and
inverse correlations with BUT, Schirmer test (r>0.2; p<0.000). The LIPCOF score
exhibited significant correlations with subjective symptoms (r=0.250, p<0.001).
Conclusions: For the diagnosis of dry eye disease, the LIPCOF test showed
a medium sensitivity and specificity with good positive and medium negative
predictive value. These results support the use of LIPCOF as a screening test. It

                    is a simple, quick and non-invasive method, which might be part of the routine
                    ophthalmological examination protocol.

                            Tear film stability test-cover version of the TBUT single... :
                            Christina Grupcheva
                            Medical University-Varna, Specialised Eye Hospital Varna
                    The correlation between the tear break up time(TBUT) and inter-blink intervals is
                    well known as ocular protection index (OPI). However, the new technology provides
                    us with more options… Tear film stability test is quick, effective, objective and
                    repeatable new approach. It involves a calculation of the mean inter-blink time
                    in different activities such as reading, working on a computer resting etc. When
                    the mean interval for given activity has been calculated, a movie of the tear film
                    “behavior” is taken at least 3 times for the individual maximal period of non-blinking.
                    All shots for the inter-blink intervals (in milliseconds) are identified and analysed using
                    a newly developed grading system – position and extent of the tear film defects. If
                    for example mean inter-blink interval of “drinking coffee” is 10 seconds, and all 3
                    shots demonstrate intact tear film at that time point, the patient is “safe” to drink
                    coffee from dry eye point of view. However, if the inter-blink interval of computer
                    work is 17 seconds and at that time point patient has medium of 1/3 central tear
                    film defect – the patient needs proper management of their dry eye when working
                    on a computer.
                    The tear film stability test
                    Could be done in action and rest
                    Is objective and quiet advanced
                    In your practice it has a chance

                            Allergic Granulomatosis of Conjunctiva in Asthmatic Patients:
                            Limited Form of Churg-Strauss Syndrome:
                            Altin Pani, Pearl S. Rosenbaum, Martin Mayers
                            Albert Einstein College of Medicine/Bronx-Lebanon Hospital Center, NYC, USA
                    Aims: To describe the clinical and pathological entity of allergic granulomatosis
                    (hypersensitivity granuloma, eosinophilic granuloma with flame figures) of the
                    conjunctiva which, in a patient with bronchial asthma, may represent a limited form
                    of the potentially life-threatening Churg-Strauss syndrome (allergic granulomatosis
                    and angiitis).
                    Patients and methods: Clinicopathological case reports of a 56-year-old Hispanic
                    man (Case#1) and a 40-year-old African-American woman (Case#2) who underwent
                    biopsies of superior limbal conjunctival nodules. Both patients had a past medical
                    history of bronchial asthma; the patient in Case#1 had exacerbation of his asthma
                    at presentation and required hospitalization one week later. Histopathology of the

excised conjunctival nodules was performed in both cases and electron microscopy
was performed in Case#1.
Results: Histopathology of the conjunctival nodules in both cases revealed
eosinophilic infiltration with scattered lymphocytes and plasma cells. Several “flame
figures,” amorphous basophilic and eosinophilic material surrounded by palisading
histiocytes and giant cells, were present. Leder esterase staining was positive
centrally in the flame figures. Electron microscopy (Case # 1) of the flame figures
demonstrated intact bundles of collagen encrusted with numerous degranulated
eosinophils and free lysozyme granules. No vasculitis was observed in the
Conclusions: These cases may represent a limited form of Churg-Strauss
syndrome, as previously described in prostate. While these conjunctival granulomas
may result from transient eosinophilic activity in response to inciting agents, its
presence in a patient with asthma warrants close observation for the development
of life-threatening multisystem vasculitis.

        Transplantation of amniotic membrane-indications and results:
        T. Hergeldzhieva, P. Vassileva, N. Surchev, Y. Kirilova
        University Eye Hospital “Prof. Pashev”, Sofia, Bulgaria
Aims: To present the indications and results for amniotic membrane transplantation
(AMT) at our hospital.
Patients and methods: Retrospective review of medical files of patients operated
between February 2008 and February 2010 was done. Demographic data,
operative indications and postoperative results were gathered and analyzed.
Results: Fifty patients, 26 male (52%) and 24 female (48%), underwent AMT.
Persistent corneal epithelial defects after PKP were the most common indication
for AMT – 23 patients (46%). In 15 of them this led to full recovery of the defects
and preservation of corneal transparency, in the other 8 grafts the effect was only
temporary. Other frequent indications for AMT included chemical burn (8pts -16%),
painful bullous keratopathy with erosions (7pts – 14%), pterygium excision (3pts
– 6%), corneal ulcer (3pts – 6%), considerable epithelial erosions, unresponsive
to bandage lens and/or conservative treatment (3pts – 6%), corneal perforation
(2pts – 4%) and VZV ulcerative keratitis (1pt – 2%). In 5 cases with chemical burn
AMT succeeded in maintaining corneal transparency and integrity of conjunctival
epithelium. All patients with painful bullous keratopathy had reduction of pain and
improved quality of life after the procedure. In cases with other indications AMT also
had beneficial therapeutic effect.
Conclusions: AMT is an appropriate treatment option for patients with persistent
corneal epithelial defects, ocular surface burns, and for alleviating pain, caused by
bullous keratopathy.

                            HSV confirmation in surface disease-piece of cake, is it?:
                            G. Yordanov, Zl. Trifonov. Y. Yordanov
                            University Eye clinic, Trakia University-Stara Zagora
                    Background: In real life the diagnosis of herpetic keratitis is based on medical
                    history and clinical findings. Since majority of the cases show typical clinical
                    appearance most of the time we don’t really need additional laboratory confirmation.
                    Though there are some marginal cases in which diagnosis should be supported with
                    laboratory tests.
                    Aims: To apply polymerase chain reaction (PCR) in diagnosis of herpetic keratitis
                    with typical and atypical clinical presentations and analyze it’s efficacy and
                    indications for clinical application.
                    Patients and methods: Prospective randomized study enrolled 32 patients (32
                    eyes), of which 24 eyes presented with typical herpetic disease clinical presentation
                    (epithelial, stromal, disciform) and 8 eyes presented with an atypical form analyzed
                    with PCR and real time PCR techniques. The control group consisted of 10 healthy
                    individuals, age and sex matched. To generate the specific HSV DNA amplicons
                    we collected epithelial cells samples from the lesions and tears using two different
                    Results: In the epithelial keratitis group - positive PCR results for HSV DNA were
                    proved in 15 out of 20 epithelial cells samples (75%), compared to 10-50 % in tear
                    samples. In cases with disciform and stromal forms the tear samples were positive
                    for no more then 50%. None of the control group had a positive reaction for HSV
                    Conclusions: Up to date there is no general agreement about the “golden
                    standard” in HSV DNA confirmation in ophthalmology. In the peer reviewed literature
                    PCR appears to be the most useful test, but it is also the most expensive one for
                    everyday use. The results are sample collection modality dependent. Our study
                    proves that epithelial cell samples are most reliable for the final decision and shows
                    method’s role in the ‘trick” diagnosis of atypical keratitis.
Vision 2020                                                                             93

              Chairperson: I. Kocur, Co-chairpersons: J. Nemeth & P. Lutaj
        Action Plan for the Prevention of Avoidable Blindness and Visual
        Ivo Kocur
        World Health Organization, Prevention of Blindness and
        Deafness, CH-1211, Geneva 27, Switzerland
The Action plan for the prevention of avoidable blindness and visual impairment
was drawn up at the request of 61st World Health Assembly (WHA). WHO drafted
the Action plan in consultation with Member States and international partners.
Subsequently the Action plan was endorsed by 62nd WHA in 2009. The Action
plan has been developed to provide guidance with the aim to scale up efforts for
strengthening eye health. The Action plan for the prevention of avoidable blindness
and visual impairment is designed to: (1) increase political and financial commitment
to eliminating avoidable blindness; (2) facilitate the preparation of evidence-based
standards and guidelines for cost-effective interventions; (3) review international
experience and share lessons learnt and best practices in implementing policies,
plans and programmes for the prevention of blindness and visual impairment; (4)
strengthen partnerships, collaboration and coordination between stakeholders
involved in preventing avoidable blindness; (5) collect, analyse and disseminate
information systematically on trends and progress made in preventing avoidable
blindness globally, regionally and nationally. Throughout the Action plan, each
objective requires separate actions by Member States, the Secretariat and
international partners. Proposed action at national level will be discussed including
suggested roles and activities for national societies of ophthalmology and individual
eye health care professionals.

        Prevention of blindness and visual rehabilitation:
        J. Németh, Gy. Barcsay
        Department of Ophthalmology, Semmelweis University, Budapest, Hungary
Blindness is a great social-economic problem in East-European countries as both
the visual rehabilitation and the eye health care segment is seriously underfinanced.
Prevention possibilities: However the screening of age related macular degeneration
(AMD) is not difficult, the treatment possibilities are strongly limited due to fact
that anti-VEGF therapy is extremely expensive. The use of alternative off-label
compounds is legally restricted to scientific studies. For diabetic retinopathy and
retinopathy of prematurity, telemedical screening seems to be a cost-effective way
however it would need large start-up investment and constant financial support
to run a nationwide program. Besides, good quality fundus lasers and trained
experts in panretinal and macular photocoagulation are needed. For early glaucoma
detection and therapy, also a nationwide network of trained ophthalmologists would
be needed.

                    Vision rehabilitation: Nationwide networking of different parties might be
                    successful, based on widespread cooperation between health care professionals
                    and their organizations, rehabilitation institutes, government, insurance companies,
                    and NGOs (patient’s club and interests groups). A new protocol will be presented
                    for opththalmologists, which is being prepared with the purpose of providing timely
                    access to vision rehabilitation for low vision patients, while adding the least possible
                    workload for ophthalmic practicioners. The protocol also specifies the levels and
                    type of vision impairment, when offering the possibility of vision rehabilitation is either
                    obligatory or optional.

                            Establishing National Vision 2020 Programmes in Ukraine:
                            Nadiya. F. Bobrova
                    Disability in children is one of the most pressing medical and social problems
                    of modern society. In Ukraine, the problem of pediatric disability is very severe,
                    because it has a steady tendency to increase on the background of fertility
                    reduction. Congenital and hereditary eye diseases have also tended to increase in
                    the structure of total disability since childhood - in the 2005 they amounted to 5,5%
                    in 2007 - 9,4% of all nosoforms.
                    The main causes of disability eye “since childhood” are diseases – in 81,9%,
                    outcomes of trauma - in 18,1%. Eye diseases are include the following: severe
                    pathology, in particular syndromic eye damage (combined anatomical birth defects
                    - microphthalmia, mikrokornea, iris colobomas) - 18,6%, the pathology of the lens
                    (cataract and aphakia) - 16,2%, degenerative myopia - 13, 4%, refractive errors -
                    19,1%, retinal pathology - 14,3%, glaucoma - 7,5%, optic nerve atrophy - 7,6%,
                    tumors of eye and orbit - 0,7%.
                    The mentioned rates of disability in childhood in Ukraine indicate areas that
                    require the most attention and increasing of efficacy of medical, preventive and
                    organizational measures for improvement of the treatment outcomes of these
                    children and prevent the disabling complications development.

                            Ophthalmology and Healthcare in Turkey:
                            Mahmut Kaskaloglu
                            Kaskaloglu Eye Hospital, Izmir, Turkey
                    Major developments have taken place in the field of health care in Turkey during
                    the past 6 years. Government social security agency increased the coverage of
                    health care and started paying for health services from private providers. This has
                    increased the investment in private healthcare. Ophthalmology has been the first
                    branch to take advantage of the new situation and a large number of eye modern
                    eye centers are built all over the country. These centers are easily accessible and
                    provide eye care at no or low cost to the patient. There are no waiting lists for
                    operations except for corneal transplantation. Socials security provides all necessary

medicine without cost to the patient. In my presentation I will present the current
situation in detail.

        Prevention of avoidable blindness and visual impairement in Albania:
        P. Lutaj1; J. Jaho2; B. Kruja3
          UHC “Mother Theresa” Tirana and Albanian Vision Clinic; 2Universal
        Hospital Tirana; 3National Traumatology Center, Universitary Military Hospital
Two Health Assembly Resolutions (WHA56.26 and WHA59.25) focused on
avoidable blindness and visual impairment; Urging Member States: -to commit
and support the Global Initiative for the Elimination of Avoidable Blindness and
visual impairment; -to establish a national coordinating committee for Vision
2020. The Albanian Ministry of Health (AMH) has approved these resolutions. The
ophthalmology community has prepared the National Blindness Prevention Plan and
sent to AMH. Various NGOs like IAPB; lions club Albania; United States Agency for
International Development (USAID), Albania’s Contribution to Blindness Prevention
are invited into partnership with AMH to assist the work of blindness prevention
in Albania.The aim is: - to demonstrate an effective model for blindness prevention
Including the subject in national health plans and programs; -to find out the major
cause of blindness: cataracts, glaucoma, AMD and visual impairment
Cataracts: UHC+ Private Eye Clinics providing 80 % phaco; Districts mainly
ECCE. Needed: operating microscopes; phaco machines for districts and Trainings
Glaucoma: There is no national glaucoma screening up to date. Examination;
medical and surgical treatment provided.
Diabetic retinopathy: Screening only for patients referred from endocrinologists.
Angiography & Laser treatment provided only privately due to lack of equipment in
UHC “Mother Teresa” Vitreo-retinal surgery not provided in the UHC. Urgent need
for: Angiography and argon / diode laser machines
AMD & Visual Impairment. No national screening up to date. Treatment with anti
VGF provided only privately.
The first LOW VISION CENTRE was created in Albania one year ago.

        National Vision Program 2020 - Slovakia:
        Andrej Cernak
The health care in Slovakia is fully covered by State National Insurance.All people in
slovakia have to be insured by law.
Waiting list for ophathalmologic surgeries or any examinations is from 0 to 3 months.
(We have 500 ophthalmologists for 5 Milion inhabitans).

                    For children - we perform immediatelly after born credeisation (identification) with
                    2% povidin iodine.
                    All newborns are checked during 1st week for cataract.
                    All children in age of 3 years old are checked by ophthalmologists or paediatric
                    doctors for amblyopia.
                    For adults - all patients with diabetes mellitus are sent once per year for
                    ophthalmological examination.
                    - 10 centers are established for diagnosis and treatment of macular degeneration.
                    The centers have OCT, FAG, and the treatment is done with LUCENTIS or
                    Treatment is fully covered by incurance comapnies.

                            Challenges for decreasing and prevention of the blindness in
                            Republic of Macedonia:
                            Magdalena Antova Velevska, B. Tateshi, I. Bogdanova and F. Dzaferi
                            Universitary Eye Clinic - Scopje
                    Aims: To establish and implementation of the Program Vision 2020 in Republic Of
                    We will present the first experience in the laser treatment of the ROP pilot project for
                    screening of the children’s refraction anomalies
                    Also we would like to promote platform for new partnership cooperation between
                    Southern Eastern European countries in respect of twining projects and joint

                             “Beg-in-the-lens” IOL implantation in the pediatric congenital
                             cataracts phacoaspiration:
                             N. Bobrova1, M.-J. Tassignon2, T. Romanova1
                              SI Filatov Institute of Eye Diseases and Tissue Therapy, AMS of Ukraine»
                             Odessa, Ukraine; 2Ophthalmologic Department of University Clinic Antwerp,
                     Aims: to study “bag-in-the-lens” (BIL) IOL implantation with new fastening type
                     during congenital cataracts phacoaspiration.
                     Patients and methods: BIL implantation was made to 11 children 2.5 -18 y/o
                     (ave 8 y/o) with congenital cataracts. Complexity of operation consists in «twins»
                     capsulorhexises performing without opening of anterior hyaloid membrane as
                     fastening of original BIL IOL model is carried out on two identical in the sizes
                     (anterior and posterior) capsulorhexises.
                     Conclusions: The new technology of cataract surgery with IOL “bag-in-the- lens”
                     (BIL) implantation differs by raised delicacy manipulations complexity which consists
                     in two identical capsulorhexises performance. The greatest difficulties take place
                     in posterior «twins» capsulorhexises formation and anterior hyaloid membrane
                     preservation. Thus paramount value gets to the isolated Bergerovsky space opening
                     with the subsequent cautious anterior hyaloid membrane viscodissection from
                     posterior capsule.

                             Outcomes of refractive lens exchange in high myopic eyes:
                             Ismail Halili, Fatih Mehmet Mutlu
                             Gata Hospital, Ankara, Turkey
                     Aims: To report results of clear lens extraction (CLE) or cataract extraction in high
                     myopic eyes.
                     Methods: 58 patients had undergone sequential bilateral clear lens extraction (CLE)
                     or cataract extraction aiming correction of high myopia.
                     Results: The follow up time ranged from 24 months to 5 years (mean 38.6 months).
                     The male: female ratio was 7:51, and the mean age was 53.3 years. Preoperative
                     axial length ranged from 25.64 mm to 33.88 mm (mean 28.9 mm)
                     Preoperative refractive error ranged from -9.50 dioptres to -23.60 dioptres (median
                     -14.30 D), and postoperative mean refractive error was -1.90 dioptres.
                     Mean best corrected visual acuity was 0.7 logmar before surgery and 0.238 logmar
                     after surgery.
                     Two cases of rhegmatogenous retinal detachment occurred 4 years after surgery
                     one of which bilateral detachment.
                     Conclusions: Refractive lens exchange despite its potential complications is one of
                     the most applicated forms for correcting high myopia in elder people.

        Lidocaina 4%, VersusTetracaina 0.5 %, versus Lidocaina 4% combined
        with. Tetracaina 0,5 % in topical anesthesia in cataract surgery:
        Saimir Kuçi1, Pajtim Lutaj2
          UHC of Tirana; 2Albanian”Vision” eye Clinic in Tirana.
Cataract surgery is the most frequent surgical procedure requiring anesthesia.
Modern technique of Phacoemulsification has developed the cataract surgery.
This one consists in a small incision of cornea tissue, suture free technique and a
short period of time in operating room. These advantages of Phacoemulsification
technique require anesthesia too, being a non invasive procedure. Topical
anesthesia is the most used technique.
Aims: To evaluate the patients comfort and cooperation in the phacoemulsification
and its relation with an earlier recovery of the patients in the postoperative period.
Patients and Methods: We have studied 420 patients during the period of time
2006-2010. The age of patients was from 35 to 83 years. We excluded patients
with language problems, dementia, deafness, ocular pathology, surgeries converted
to extra capsular technique and patients that refused this type of anesthesia. The
patient was separated in three groups of about 140 patients:
All the patients were pre-medicated with lorazepam 0,25 mg and antihypertensive
therapy per os 30 min before the surgery.
In the first group we have used topical anesthesia with lidocaina 4% (four times
every five minutes, one drop before surgery)
In the second group we have used topical anesthesia with tetracaina 0,5 % ( four
times every five minutes, one drop of tetracaina 0,5 % before surgery)
In the third group we have used topical anesthesia with lidocaina 4 % and tetracaina
0,5 % ( two times every five minutes, one drop of tetracaina 0,5% and two times
every five minutes, one drop of lidocaina 4%, before surgery)
We have asked every patient if they feel pain, at the start the operation, at the
moment of the introduction of phaco probe and at the moment of the implantation
of the lens with injector. We have evaluated the hemodynamic parameters (blood
pressure, cardiac frequence and respiratory frequence)
Results: In the third group of the patients we had the best hemodynamic
parameters, less pain when we started the operation, at the moment of crystallin
aspiration with phago and at the moment of the implantation of the lent according to
the classification of pain scale (mild, moderate and severe).
22% of the patients in first group, 30% of the patients in second group and 15%
of the patients in third group needed sedation with 2,5 mg midasolam 250 mcg
Endo venous anesthesia with 5 mg midasolam 500 mcg Fentanyl was necessary
in 4 patients from the first group, 6 patients in second group and 2 patients in third
group needed.
Conclusions: Combined topical anesthesia with lidocaine and tetracaine resulted
more beneficial in cataract phaco surgery. Most of the patients in the third group
had excellent cooperation and no pain. The patients were more comfortable during
the development of the surgery and 4 hours after surgery.

                             Topical anesthesia vs. parabulbar anaesthesia in the cataract
                             exctraction surgery with phacoemulsification:
                             Muhamed Troplini, Eno Qerimi
                             Department of Ophthalmology-Regional Hospital Durres
                     Aims: To compare two methods of anesthesia in the extraction of cataract with the
                     technique of phacoemulsification and posterior chamber lens implant during 3 years
                     period of 2006-2009.
                     Patients and methods: 400 cataract surgeries were performed during 3 years
                     period (2006-2009); 200 were performed under topical anesthesia and 200
                     hundred were performed under parabulbar anesthesia (retrobulbar, peribulbar,
                     Results: All patient underwent phacoemulsification with posterior chamber lens
                     implant. All surgery was done using a temporal clear corneal approach. In order
                     to compare the two techniques intraoperative and postoperative complications
                     were checked. Intraoperative complications checked were pain and corneal haze.
                     Postoperative complications checked were echimosis and conjuctival injection. In
                     the group with parabulbar anesthesia pain was present in 3 % of cases, corneal
                     haze in 1 % of cases, echimosis and conjuctival injection in 3-5% of cases. In the
                     group with topical anesthesia pain was present in 4 % of cases, corneal haze in
                     0.5% of cases, echimosis and conjuctival injection in 0.5% of cases.
                     Conclusions: Topical anesthesia is not suitable for a young surgeon, but an expert
                     surgeon sees no difference in both techniques. Despite the increased technical
                     difficulty, topical anesthesia has proven to be an effective alternative to parabulbar
                     anesthesia for cataract surgery that avoids the risks of periocular injection and its
                     complications; the patient also profits from rapid visual rehabilitation.

                             Pseudo myopia (Accommodative spasm) - Case Report:
                             Nora Burda (Dhales)1, Alketa Tandili2, Jonida Dai3
                              Polyclinic of Specialties No 2 Tirane, Albania; 2UHC “Mother Theresa”,
                             Eye Clinic, Tirane, Albania; 3UHC “Mother Theresa”, Eye Clinic, Tirane, Albania
                     Aims: To report a case of pseudo myopia diagnosed and followed up in Eye Clinic,
                     UHC “Mother Theresa”.
                     Patients and methods: The patient is a female child. The general ophthalmologist
                     referred her to Pediatric Ophthalmology and Squint Department, UHC “Mother
                     Theresa” and we performed ophthalmologic examination.
                     Results: The patient complained about headache, discomfort and blurred vision
                     even she put on glasses, sph -2.0D in both eyes. She was exam by general
                     ophthalmologist and was referred to pediatric neurologist, since the headache
                     persisted, but general examination resulted as a normal child.
                     In Ophthalmologist examination we check carefully VA( with and without her glasses)
                     in both eyes: 20/200, Manifest refraction in both eyes: sph -8.0D and Cycloplegic
                     Refraction using a strong cycloplegic like atropine, resulted in both eyes: sph
                     +2.0D, color test and slit lamp examination resulted normal.

Conclusions: Pseudo myopia (Accommodative spasm) refers to an intermittent
and temporary shift in refraction of the eye towards myopia, in which the focusing
of light in front of the retina is due to a transient spasm of the ciliary muscle causing
an increase in the refractive power of the eye. It may be either organic, through
stimulation of the parasympathetic nervous system, or functional in origin, through
eye strain or fatigue of ocular systems. It is common in young adults who have
active accommodation, and classically occurs after a change in visual requirements,
such as students preparing for an exam, or a change in occupation.

        Case report-Myopia alta degenerativa and POAG:
        J. Ristova1, V. Dimovska-Jordanova2
          Private health organization OKULUS-A, Stip, Republic of Macedonia
          Public Health Institution University Eye Clinic, Skopje, Republic of Macedonia
Aims: Presentation of a female patient born 1975 with malignant myopia
(myopia alta degenerativa) corrected with GP contact lenses –21. Dsph.
During a routine control, patient had increased IOP measured with Schiotz
tonometer control measurements were performed during one month for two
times a week, which confirmed the presence of intraocular hypertension.
Patients and methods: The patient was routinely examined for: visual acuity
fundus, aplanation and Schiotz tonometry, slit lamp and Goldmann exploration of
retinal periphery, gonioscopy, visual field and ultrasound examination.
Results: VOD: 0,1cc; VOS: 0,1-0,2cc TOD: 28 mm Hg; TOS: 24 mm Hg
(aplanation tonometry) Fundus OU: myopicus (conus myopicus on temporal edge
of ONH), followed by peripapillary atrophy, isolated preretinal hemorrhage with
parapillar localisation in the temporal sector of the left eye, disseminated retinal
and choroidal atrophy layers with predominant affection of macular area. Vitreous
body with opalescence and numerous floating opacities with different shape and
size. Slit lamp examination of the anterior segment without pathologic findings.
Gonioscopy with open ICA. Visual field: peripheral damage in the temporal half with
central and paracentral scotoma on both sides. Ultrasound assessment: Vitreous
body opacities. Antiglaucomatous treatment was started with selective beta-
blockers (Betoptic S 0,25% two times daily), that maintained IOP decrease (first
line treatment, especially regarding the neuroprotective feature of the drug). Routine
follow up controls on regular basic have shown stabilisation of IOP, with no further
visual field damage and visual acuity deterioration.
Conclusions: This case report have shown the close association of high myopia
and primary open angle glaucoma, confirming the significance of myopia as
glaucoma risk factor. This fact emphasises the necessity of regular monitoring of
intraocular pressure, visual field examination and exploration of retinal periphery in
order to avoide further sight-threatening complications, such as retinal detachment.

                             Intravitreal bevacizumab (Avastin) and PRP in the treatment of
                             neovascular glaucoma:
                             Gentiana Bunguri
                             Regional Hospital Durres, Albania
                     Aims: To describe a case series of neovascular glaucoma (NVG) caused by central
                     retinal vein occlusion (CRVO) that was treated with intravitreal bevacizumab (IVB;
                     Avastin) as the first choice followed by PRP when necessary.
                     Patients and methods: Retrospective interventional case series. A group of 7
                     patients (7 eyes) with NVG with neovas¬cularization of the iris of different grades
                     and symptomatic elevation of intraocular pressure (IOP) received IVB (1.25 mg/0.05
                     ml). Diode laser PRP was carried out in 4 patients, 5 weeks after injection of
                     bevacizumab. Follow-up examinations occurred every 2 days for the 1st week than
                     in a weekly basis for 4 months.
                     Results: IVB resulted in a marked regression of anterior segment neovascularization
                     and relief of symptoms within 48 hours. IOP decreased substantially in three eyes; in
                     the other four eyes adjuvant PRP was necessary to keep under control the IOP and
                     the iris neovascularization. No side effects were observed.
                     Conclusion: IVB leads to a rapid regression of iris and angle neovascularization
                     and should be investigated more thoroughly in the management of NVG. The cases
                     we followed demonstrates that intravitreal bevacizumab injection can successfully
                     produce regression of iris neovascularization with subsequent decrease in IOP in
                     cases of neovascular glaucoma
                     Bevacizumab as a pharmacological treatment has the advantage of being rapid in
                     effect but has the disadvantage of limited duration of action. Combining intravitreal
                     bevacizumab injection with panretinal photocoagulation can offer both rapid and
                     long-lasting effect.
                     Another advantage of bevacizumab is the ability to use this modality to treat eyes
                     with opaque media. Lastly, intravitreal bevacizumab injection may be the first choice,
                     but not the only option in the treatment of neovascular glaucoma.

                             Glaucoma in Sturge Weber Syndrome:
                             Flamur Marku
                             Hospital of Rreshen, Mirdite, Albania
                     Sturge Weber Syndrome belongs to a group of disorders collectively known as
                     the phacomatoses. It consists of congenital hamartomatous malformations that
                     may affect the eye, skin and CNS at different times. The glaucoma associated with
                     Sturge Weber syndrome is a significant cause of morbidity because of its early onset
                     and resistance to conventional forms of treatment. A 12 years old boy presented to
                     our clinic one year ago with a history of: Painless blurred vision on the right eye, mild
                     headache, redness and tearing. No other ophthalmic complain.
                     Systemic complains: presence of right facial hemangioma, no neurologic

Pacient underwent ocular and systemic evaluation to confirm the diagnosis.
On ophthalmic exam the BCVA was 9/10 and the IOP 38mmHg. The anterrio
segment of the right eye shows increased conjuctival vascularity and abnormal
plexus of episceral vessels. Clear lens and vitreous. C/d ratio 0.4-0.5
Her Physical exam unremarkable. Her pressure is controlled with b-blocker and
followed up every 3 months. Comments: Patients with cutaneous involvements
appears to have ocular manifestations of Sturge Weber Syndrome. Glaucoma
have been estimated to occur in 30-70 % of patients with this syndrome.This case
demonstrates the importance of diagnosis and follow up in glaucoma cases of
Sturge Weber Syndrome with no neurologic manifestation.

        Influence of sufentanil vs fentanyl on the intraocular pressure during
        the tracheal intubation:
        Hektor Sula, Rudin Domi, Ilir Ohri
        Department of Anesthesiology
        University Hospital Center Mother Theresa, Tirane, Albania
Aims: Laryngoscopy and tracheal intubation can raise transitory intraocular
pressure (IOP), especially during difficult intubations. Our goal was to study the
sufentanil’ and fentanyl’s effects on intraocular pressure during normal and difficult
Patients and methods: During January 2006- January 2008 there were included
120 patients, with normal IOP (tonometer XL.USA), undergoing general anesthesia.
The patients were divided in two groups, 60 patients each receiving 2 minutes
before the intubation 0.3 mcg./kg Sufentanil (S) or 3.0 mcg/kg Fentanyl (F). 14
patients have been founded to have difficult laryngoscopy as ASA definition and
tracheal intubations, 8 regarding sufentanil group and 6 regarding fentanyl group
in which several attempts to intubate were made. We compared the intraocular
pressure value before and 2 minutes after the intubations between two groups and
also between two subgroups resulted as difficult intubations.
Results: Mean intraocular pressure measured 2 min after intubation in group
receiving sufentanil was lower than in the fentanyl group. Mean intraocular
pressure changes in the two groups were – 1, 67 in sufentanil group and
-1, 77 in fentanyl group. In the subgroups composed by patients having
difficult intubation mean intraocular pressure changes were + 1, 93 mmHg
and +3, 7 mmHg, respectively in them receiving sufentanil and fentanyl.
Conclusions: Both drugs blunt the increased intraocular pressure during
laryngoscopy and tracheal intubations but in difficult intubation sufentanil presented
better protection than fentanyl.

                             Uveitis and masquerade syndrome:
                             Golubovic-Arsovska Milena
                             Clinic for eye disease, Medical faculty-Skopje
                     Diagnostics of intraocular inflammation poses a great challenge, not only to general
                     ophthalmologists, but also those who have a specialty in uveitis.
                     It is a matter of fact that this affliction of the uveal tract may be caused by a number
                     of infectious agents, but it may also be a manifestation of a plethora of systematic
                     disease and immunologic disorders in the organism, which in turn have a qoud
                     ad vitam meaning, which accentuates the importance of resolving the diagnostic
                     dilemmas in these cases.
                     The aim of this paper is to point out the frequency of a set of symptoms qualified
                     with the attribute ‘masquerade syndrome’ in a clinical case, its diagnostic dilemmas,
                     as well as its treatment.
                     In conclusion, a rather limited number of clinical manifestations of uveitis point out
                     the significance of determining the spatial situation and the type of ocular clinical
                     signs, and even more significantly, the meaning of the correct anamnestic data
                     collection. The diagnostic procedures should be lead by clinically tested and proven

                             The outcome of TPPV in patients with retinal detachment with ILM
                             peeling compared to patients with no membrane peeling:
                             M. Pietras-Trzpiel1, T. Choragiewicz1, M. Latalska1, T. Zarnowski1,
                             C. Forlini3, A. Junemann1,2, R. Rejdak1
                              Department of Ophthalmology in Lublin; 2Department of Ophthalmology in
                             Erlangen; 3St. Maria Croci Hospital in Ravenna
                     Aims: The aim of the study was to evaluate visual acuity and changes in retinal
                     layers in patients with retinal detachment following TPPV, on whom ICG-assisted
                     ILM peeling was performed, in comparison with the patients without ILM peeling.
                     Patients and methods: The first group consisted of 18 patients with retinal
                     detachment, on whom ILM peeling was performed. The second group consisted
                     of 21 patients on whom we did not perform ILM peeling. In all patients the macula
                     was detached before the operation. In all patients, an ophthalmologic examination
                     was carried out 6 weeks after the operation. It comprised functional parameters
                     such as visual acuity, fundus examination, intraocular pressure testing and OCT
                     examination - including assessment of the eventual presence of persistent small
                     retinal detachment, swelling of the retina, retinal pigment epithelium disorders and
                     the possible presence of an epiretinal membrane.
                     Results: We did not observe statistically-significant differences in VA between the
                     two groups. In the first group we did not observe any retinal detachment; in the
                     second group in 14% of patients small retinal detachment was present. The OCT
                     examination also showed the presence of swelling of the retina in 5% of patients in
                     the first group, compared with 30% in the second group. An ERM was present in
                     36.36% of the group without peeling while in the first group only one patient- 5.16%

developed an ERM. Retinal pigment epithelium disorders were observed in all
patients in both groups.
Conclusions: We consider that ILM peeling allowed us to restore the normal
anatomy of the eye.

        Avastine (Bevacizumab) treatment for branch retinal vein occlusion -
        Case Report:
        Silvana Kavaja1, Teuta Haveri2
         Regional Hospital, Durres, Albania; 2American Hospital, Tirana, Albania
Introduction: Branch retinal vein occlusion is one of the frequent cause of vision
loss over the 40 years of age. Reduced blood perfusion and subsequent retinal
hypoxia lead to sudden loss of vision. Also retinal hypoxia is the stimulating factor
for secreting VEGF factor. High levels of vascular endothelial VEGF- factor results in
corpus vitreum after BRVO. This causes loosening of tight junctions of the wall of
blood vessels which results in vascular leakage and macular edema.
The persistent macular edema is the cause of long-term loss of vision. Intravitreal
avastine (Bevacizumab) injection result in significant improvement for visual acuity.
Aims: To report one case showing significant visual acuity improvement after
avastine injection
Patients and Methods: Patient N. K 67 years old, from Durres presented
at 05/11/2009 complaining for sudden loss of vision from 1 week. Hystory of
hypertension treatment.In ophthalmic examination Visual acuity OD = 2/10 OS =
0,04. Quiet anterior segment and in retinal examination in OD BRVO in seen. In
FFA macular edema of the right eye and normal aspect of retina in the left eye. A
brain MR was performed which revealed an ischemic cerebral zone, following AVC,
explaining the low visual acuity of the left eye. Than an 0,05 ml intravitreal injection
of Avastine (Bevacizumab) 100 mg/ 4 ml was injected in the right eye, in surgery
room under sterile conditions. Patient was treated with local antibiotics ( Tobradex 3
x) for one week and his intraocular tension was followed. After one week his visual
acuity improved in 4/10 and after 2 week reach the maximum of 8/10. In control
examination after 4 months patient present visual acuity = 7/10 and in FFA retinal
haemorrhage absorption but small diffusion in the macula. The same procedure of
Avastine injection was recommended and repeated and 1 week later visual acuity
reached = 8/10
Conclusion: Intravitreal avastine injection efficacy method for macular edema
treatment and visual acuity improving, after BRVO.

                             Case report: Eye and Munchausen syndrome:
                             Gjoni Blerta, Burda Nora
                             Dermatologist, Policlinic of Specialities No 2 Tirane, Albania.
                     Introduction: Munchausen Syndrome is a rare psychiatric disorder in which
                     patients inflict on themselves an illness or injury for the primary purpose of assuming
                     the sick role. Because these patients can present with many different complaints
                     and clinical symptoms, diagnosis is often made at a later stage of consulting visit
                     with other specialists. In Munchausen’s Syndrome, a particular form of factitious
                     disorders, symptoms of illness or injury are intentionally produced for psychological
                     reasons in order to be hospitalized and even to submit her to invasive interventions.
                     Case report: We are presenting a case report of 45 –year old women present at
                     the ophthalmologist doctor at our policlinic of Specialilities Nr 2. The first diagnosed
                     was made by dermatologist with “Suspect Cellulites at the infraorbital region at
                     buccal sinister”. Consultation with Ophthalmologist: Moderated ekimosis in dark
                     color at periorbital sinister region spread down to the lower mandibles region.
                     Objective examination: VA 9/10 OU, BCVA 10/10 OU ,eyelid swelling, discharge,
                     eyelid sticking (worse in morning), red eye, foreign body sensation, corneal epithelial
                     erosions (fluo, positive), ACH,normal, iris normal, good pupillary reaction.
                     Fundus: Details are clearly noticed but the examination is difficult seens tha patient
                     doesn’t collaborate. We didn’t see any retinal pathology. We didn’t observe any
                     damage of contusive nature at the sinister bulb. Consult with dermatologist:during
                     the objective examination the patient presented an erythematosis cianotic areas,
                     infiltrated edematosis and painful. It’s localized manly in the periorbital sinister
                     region. Even the patient didn’t communicate enough she presented subjective
                     complaints such as severe pain in this region. The lab tests: Normal results,
                     anticorps anti borrhelia IgM 4.1U/ml, anti borrhelia IgG 2.7 U/ml. Consults with
                     Psychiatrist: The patient present light mental disorders. Actually doesn’t present
                     any acute psychiatric problem.X/ray of sinusis:Sinusis normal CT of the head.
                     Consult with the neurologist: Present only peripheral hypocausi sinister. Actually has
                     a light mental disorder. The patient was treat with topical AB, cycloplegy, natural
                     tears for a period of 2 weeks, and was not yet healling, she damage her sellf very
                     often. Also with systemic antibiotic therapy, tranculisant and cortisone and antibiotic
                     local treatment. Patient doesn’t present any improvement at local status even was
                     under medical treatment.
                     Conclusion: Munchausen’s syndrome is a rare psychiatric diagnosis. The patient
                     was treat with topical AB, cycloplegy,natural tears for a period of 2 weeks, and was
                     not yet healling, she damage her sellf very often. The common clues to diagnosis
                     are: a no healing wound in the absence of risk factors for wound failure; a history of
                     psychiatric illness; repeated bleeding from the wound site, and a desire to continue
                     the sick role. Early detection will allow proper psychiatric referral to prevent injuries
                     to the patient, abuses to the medical system.

        Surgical metods for treatment of eyelid tumors with different
        S. Gashi, M. Kubati; M. Ilazi, A. Miftari, A. Vuçiterna
        University Clinical Center, Eye Clinic, Pristina, Kosovo
Aims: To present surgical methods for the treatment of eyelid tumours based on the
localisation factor
Patients and methods: Based on the localisation of the tumour, we have applied:
1. direct closure with cantotomy as well as cantolize; 2. temporal flap; 3. glabelar
flap of the forehead; and 4. free transplant
Results: After the 1-2mm tumour excidation within the healthy tissue as well as
the reconstruction of the eyelid, satisfactorily results have been obtained in terms of
functionality as well as aesthetic;
Conclusions: The investigation shows that the best operational methods for eyelid
tumours are as follows: for the treatment of the internal angle tumours is the glabelar
flap of the forehead; for the upper eyelid the best method is the free transplant; the
treatment of the lower eyelid can be performed with the temporal flap as well as the
direct closure with cantotomi and cantolize, in cases when the defect allows us to
apply this method.

        Pulsatile exophthalmus. Transmitted intracranial pulsation due to a
        defect in the orbital roof - Case Report:
        E. Musabelliu1, P. Hodo1, B. Kruja1, E. Veliu1, L. Binjaku1, A. Teliti1,
        A. Dhima2, P. Lutaj3
          National Trauma Center. Central University Military Hospital, Tirana
          American Hospital, Tirana; 3Albanian Vision Clinic, Tirana
Introduction: A 26-years-old girl was admitted in to the intensive care unit of this
hospital after a penetrated head gun injury. Her medical history is unremarkable. The
patient is reported with right frontal injury, massive left facial musculo – cutaneous
defect and with right intermittent pulsating eye (caused by the combination of
an orbital encephalocele immediately after a head injury). With clinical signs and
complains of massive cranio – facial hemorrhage, retro orbital pain, chemosis,
pulsatil exophthalmus, ocular and cranial bruit, left lower motor neuron palsy, right
frontal and massive left facial damages in the way of bullet. Computed tomography
of the brain diagnosed right frontal damages, right orbital roof damages and
encephalocele, anterior skull base fracture with massive left zygomatic and maxillary
destructions. Computed tomography angiography, magnetic resonance imaging,
and magnetic resonance angiography of the brain the day after show a right A1 post
traumatic aneurismtic dissection without evidence of hemorrhage. Uneventful until
day 10, complicate with right frontal post traumatic cerebrospinal fistula. On day 18
a massive rhinorrhagia, intracranialy originating was managed after blood transfusion
and nasal posterior tampons. Computed tomography of the brain after this severe
complication diagnosed a massive right frontal intracerebral hematoma, suggesting
an A1 aneurysm rupture and clinically turning exophthalmus in to non pulsatile.

                     Patients and methods: The clinical, radiological, and medico - surgical findings
                     of this case of traumatic encephalocele treated at our institution is presented. This
                     case is also compared with previously published series.
                     Conclusions: This is a case related to a gun accident following unpredicted
                     complications. Orbital roof fractures after blunt injury are rare. Traumatic
                     encephalocele in the orbital cavity are even rarer, with only few cases published to
                     date. How should her case be further evaluated and managed?

                             Orbital cellulitis at a 5 month-old baby - Case Report:
                             Sanja Borovic, Lejla Rovcanin, Ognjen Jovicevic, Haris Kujundzic
                             Institute for Children Disease, Clinical Center of Montenegro, Podgorica
                     Introduction: Sinus-related bacterial orbital cellulitis is the most common , and is
                     most frequently secondary to ethmoidal sinusitis. It tipically affect children, but is
                     very rear under 6 months of age. The authors present this unusual case of orbital
                     cellulitis and its complication - orbital abscess. Boy aged 5 months was admitted
                     because of swelling of the eyelids on the left eye, fever for two days and elevated
                     inflammatory parameters.
                     Methods: Clinical examinations showed a proptosis of the left bulbus as well as
                     restricted ocular movements- especially adduction. Pupillary reactions was correct,
                     and re-evaluated at frequent intervals. FOU was without pathological findings. The
                     patient was evaluated by otrinolaryngologist olso.
                     CT PNS and orbit: indicates the presence of inflammatory changes in the ethmoid
                     cells region and left maxillary sinus, with noticeable soft-tissue inflammatory mass in
                     the medial orbital segment and consecutively bulbus protrusion.
                     Intensive antibiotic therapy and displacement treatment several times a day were
                     conducted. On the third day of antibiotic treatment we noticed lateral proptosis and
                     conjunctival chemosis, without other pathological findings.
                     MR PNS and orbit: indicates the presence of inflammatory content of 9mm diameter
                     in the medial segment of the left orbit with impression of the bulbus anteromedially.
                     External ethmoidectomy and intraorbital incision with drainage of purulent
                     collections performed under general endotracheal anesthesia. Staphyloccocus
                     pyogenes was isolated by microbiological analysis of the purulent content.
                     Opthalmologycal exam was correct.
                     Conclusions: Orbital abscess is relatively rare in sinus-related orbital cellulitis,
                     and extremely rare in this earliest age. But with carefuly and frequently re-
                     evaluation,good cooperation, and intervention in the nick of time, it is possible to
                     prevent other serios complications and to come to successfully healing.

        Gunshot Eye Injuries from bullets and projectiles:
        Ndue Bardhi, Kujtim Karafili, Violeta Ristani, Elvis Veli.
        Central Military University Hospital (C.M.U.H), Tirane, Albania
Aims: To study and analyze cases (patients) with Gunshot Eye Injuries from bullets
and projectiles attended in C.M.U.H during 12 years (1995-2006).
Patients and methods: This is retrospective analyzing and clinical study of all the
cases with Gunshot Eye Injuries from bullets and projectiles, attended in our hospital
during this period. In this study are taken into consideration and are analyzed
57-cases (patients) with these upper kind injuries. The study is realized analyzing in
details the incidence of these injuries in proportion to total number of Gunshot and
Explosion Eye Injuries attended, in reference to period of time (years), aged groups,
kind or type of gunshot, residence, profession, occupation, the step (degree), kind
of injuries and the combination with injuries of other organs and systems of body
(organism), injuries in one or both eyes, significance (seriousness) of injuries, etc..
Results: There are 57 cases (patients) with Gunshot Eye Injuries from bullets and
projectiles attended in C.M.U.H during 12 years (1995-2006). (tab nr 1,2). Those
constitute respectively 33% of total number with Gunshot and Explosion Eye
Injuries, attended during this period. (tab nr 2). Mostly of them 34 cases (60%)
haves occurred only during two years (1997-1999). (tab nr 1). The sex incidence is
weighted on the male side (93%) and female only 7%.(tab nr 3). The highest aged
group incidence is (11-20 years) group - 38.5%. (tab nr 4). The frequency of injuries
e civil persons was 42 cases (74%).While military persons was only 15 cases (26%).
(tab nr 5). They are most usually caused by the blast of shells, (projectiles) and
bullets, -40 cases (70%), from bursting of explosions (projectiles), -4 cases (7%),
and from blast of bombs, grenades, mines (projectiles), only -13 cases (23%). (tab
nr6). Bilateral ) injuries (in both eyes) are more rare -18 cases (32%) than unilateral
injuries (in one eye) -39 cases (68%). (tab nr 7). All the cases in according to the
degree (step) of injury are divided in three important groups. Eyes very hard injuries
constitute -48 cases (84%). (tab nr 8,9). From total number of hard eye injuries -48
cases (100%) result that there are -43 cases (90%), damaged very hard in one eye,
while 3 of them are dead, and to others have ended in bilateral (both eyes) blinded
-5 cases (10%). (tab nr 9,10). Eyes injuries combined with other organs (systems)
injuries found at 50 cases (88%). (tab nr 11), and all -57 cases (100%) result with
intraocular or intra-orbit foreign bodies (tab nr 12).
Conclusions: The frequency of injuries Gunshot Eye Injuries from bullets and
projectiles is relatively high -57cases (33% of total Eye Gunshot and Explosions
Injuries) attended during these years (1995-2006)(tab nr 1,2). The great majority
is made up of lacerations end perforating wounds of the globe, lids and orbit
contusions, concussion due to blast, intraocular foreign bodies and burns of varying
severity. Our experience pointed that kind injuries of the eyes are like war typical
injuries and have multiple traumas. (tab nr 9,10,11,12 and photos). Such injuries
usually occur sporadically in civilian life, but they are essentially typical of war. It
is noteworthy that this injuries are not directly enemy action, but rather to type of
accidents that occur in civil and industrial circumstance (tab nr 5,6). In our country
have occurred from innumerable causes, in a very circumstances of difficult life,
political crisis (year 1997) and of Kosovo war (year 1999)
Need for treatment and attended in a hospital specialized in field of trauma as it’s
our hospital in Tirana (C.M.U.H)

                             Chronic Progressive External Ophthalmoplegia:
                             A. Szigeti, Z. Szepessy, Z. Hargitai, J. Hargitai, A. Szamosi, M. Fodor,
                             R. Vámos, J. Németh
                             Department of Ophthalmology, Semmelweis University, Budapest
                     Aims: Chronic progressive external ophthalmoplegia (CPEO) is a rare mitochondrial
                     myopathy characterized by slowly progressive paralysis of the extraocular muscles
                     with onset around the age of 20 patients usually experience bilateral, symmetrical,
                     progressive ptosis before the phthalmoplegia.
                     Patients and methods: Case report: 31-year-old woman with 10 year history of
                     slowly progressive paralysis of the extraocular muscles was referred to our institute.
                     Every action of extraocular muscles was reduced in both eyes. She could not
                     adduct and elevate, there was only a slight abduction and depression function in
                     both eyes.
                     Patient had no ptosis or exophthalmus. BCVA was 20/20 in both eyes. Slit lamp
                     examination was normal.
                     Dilated funduscopic examination revealed slight pigment disturbance in the
                     periphery. Visual field and color vision tests were normal. Electroretinography
                     showed lower borderline scotopic b-wave amplitudes. Laboratory tests showed
                     increased lactic acid and creatine phosphokinase values. The results of liver and
                     kidney function, autoimmun and serologic tests were normal. All thyroid function
                     tests yielded negative results. Urinalysis, chest x-ray, heart ultrasound, brain and
                     orbital magnetic resonance, nasal sinus CT scans were normal. Tensilon test
                     excluded myasthenia gravis.
                     We considered the case as CPEO clinically; mitochondrial DNA analysis is in
                     Conclusions: In CPEO, slowly progressive paralysis of the extraocular muscles
                     may develop without ptosis. A careful differential diagnosis is very important.

                             The effect of amblyopia therapy on ocular alignment:
                             Eno Qerimi
                             Department of Ophthalmology-Regional Hospital Durres, Albania
                     Aims: We have tried to describe the change in ocular alignment at 2 years after
                     treatment of amblyopia in children younger than 7 years of age at enrollment.
                     Patients and methods: A randomized clinical trial of patching versus atropine for
                     6 months followed by standard clinical care for 18 months was conducted in 357
                     children with anisometropic, strabismic, or combined amblyopia (20/40-20/100)
                     whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment
                     was evaluated at enrollment and after 2 years of follow-up.
                     Results: At enrollment when tested at distance fixation, 161 (45%) children were
                     orthotropic, 91 (25%) had a microtropia (1-8 PD), and 105 (29%) had a heterotropia
                     up to 8 PD. Of the 161 patients with no presence of strabismus, similar proportions
                     of patients initially assigned to the patching and atropine groups developed new
                     strabismus by 2 years (18% vs. 16%, P - 0.84). Of these cases of new strabismus,

only 2 patients in the patching group and 3 patients in the atropine group developed
a deviation that was greater than 8 PD. Microtropia at enrollment progressed to a
deviation greater than 8 PD with similar frequency in both treatment groups (13%
vs. 15%, P _ 1.00). Of the 105 patients with strabismus greater than 8 PD at
enrollment, 13% of those in the patching group and 16% of those in the atropine
group improved to orthotropia without strabismus surgery. Strabismus surgery was
performed in 32 patients during the 2-year study period.
Conclusions: Patients who had amblyopia treatment with patching or atropine
for 6 months followed by standard clinical care were found to have similar rates of
deterioration and improvement of ocular alignment. When parents begin amblyopia
treatment for children without strabismus, they should be warned of the remote
possibility of development of strabismus, although it is most often a small angle
deviation. Strabismus resolved after amblyopia therapy in some cases.

        Treatment of V pattern esotropia with overreaction of the inferior
        oblique muscles, in a single surgical procedure - Case Report:
        M. Ilazi, M. Kubati,
        University Clinical Center, Eye Clinic, Pristina, Kosovo
Purpose: Apprasial of the impact of the inferior oblique myectomy in collapsing of
the V pattern, during the surgical treatment of the V esotropia with inferior oblique
Methods: Medial rectus muscle recession and muscle myectomy in both eyes.
Results: Inferior oblique myectomy collapsed V pattern for 15 prism diopters.
Conclusions: Inferior oblique myectomy made collapsed half of the V pattern, and
makes us think for additional vertical transposition of the horizontal muscles.

        Alternant Esotropia and surgical correction in both eyes:
        Mire Shoshi, Avdyl Shoshi, Aferdita Bakalli
        University Clinical Centre of Kosova, Eye Clinic, Pristina, Kosovo
Aims: The aim of this presentation is to introduce our experience in treatment of
patients with alternant esotropy, by surgical procedure in weakening the function of
medial rectus muscle in both eyes.
Patients and methods: In this work are included 77 patients. With surgical
method under general anesthesia, we weakened function of medial rectus muscle
in both eyes with retro position of muscle, depending of deviation angle. Surgical
procedure is applied in patients with alternant esotropy where deviation angle is
remained after application of standard methods of treatment like correction of
refractory anomalies, occlusion and orthopeloptic trainings.
Results: All of the operated patients are evaluated pre and postoperatively
regarding angle deviation in 6m, 1m and Sinoptofor. Up to day the results have
shoved to be positive, which means that deviation angle was improved for all of our

                     patients. During period of time 2005–2006 we treated 77 patients with alternant
                     esotropy, where deviation angle in distance of 6m was 37.8 prism diopter before
                     and 6.5 prism diopter after the intervention. In distance of 1m deviation angle was
                     39.5 prism diopter before and 7.2 prism diopter after intervention.
                     Conclusions: Alternant Esotropy appears in about 2% of children under age of 3y.,
                     or in 3% of all children. Alternant Esotropy with wide deviation angle seeks a number
                     of surgical procedures. It is important measurement of deviation angle before and
                     after surgical operation in order to achieve and keep binocular function after the
                     surgical intervention.

                             Treatment of exotropia associated with unilateral primary inferior:
                             oblique overaction
                             M. Kubati, M. Ilazi, S. Gashi, A. Vuçiterna, A. Miftari
                             University Clinical Center, Eye Clinic, Pristina, Kosovo
                     Aims: To evaluate the efect of IO – myectomy in horizontal deviation
                     Case presented:18 year-old boy with exotropia and unilateral inferior oblique
                     overaction (IOOA).
                     Methods: Recess – resect procedure for exotropia and IO myectomy of left eye
                     Results: Cover test in primary position is ortho. No inferior oblique overaction in
                     primary position on side gaze. V pattern is significantly reduced.
                     Conclusions: Either primary, or secondary IOOA should be treated with weakening
                     procedures of the overacting IO. When performing simultaneous horizontal and
                     inferior oblique surgery, the amount of horizontal surgery should be based on the
                     horizontal measurements in the primary position and be independent of the IO

                             A case of trichinella spiralis located in the rectus externus muscle:
                             Silvana Kavaja
                             Regional Hospital, Durres, Albania
                     Background: Trichinella spiralis is classified in the group of nematodes whose
                     presence in human muscles is known from a long time but was specified by
                     Zenker in 1860. Nowdays in Europe it is rare, but once upon a time the cases have
                     been described as epidemics. Trichinella spiralis is observed in two forms: as a
                     parasite, developed in the intestines and the larvae placed in the striate muscles
                     of the same person. Muscular Trichinelas worms are in the form of thin 0.7-1 nm
                     fibres enrolled in a capsule with a hyalinised form. The cause of infection in man
                     is usually from eating uncooked meat, soft or wild pork, smoked meat, or ham.
                     When alive muscular Trichinella reaches the stomach, the capsule is destroyed,
                     allowing free pass into the intestine. In 2-3 days they grow and mature. Embryons
                     develop from eggs, seven days after passing the stomach. Thus a single Trichinella
                     produces 1000 others. Passing through the intestinal mucous membrane they arrive

in the stream of capillary blood from which they come out and stay in the union of
Patients and methods: On 15/10/2009 the patient N.H. 50 years presented
to the oculist. He is a teacher and he was initially treated for conjunctivitis of
the left eye, then developed episcleritis, and scleritis, but that situation was not
improved with therapy. The complaints were: eye redness, excessive lacrimation,
photophobia, chemosis in the temporal side and the formation of a nodule in
the area where the tendon of the rectus externus muscle is situated. Later on
the patient complained the pain during eye movement. The examinations done
to evaluate the view were normal, with a view performance 10/10. Therefore a
diagnostic question was raised: Could it be a neoplasm in the tendon of the rectus
externus muscle? The surgical intervention was done on the 22.10.2009 with
subconjunctival anaesthesia with lidocaine 2%. There was performed an intervent
same as that done in strabismus in which the limbus of conjunctiva was released.
With the release of the area there was a thin worm that was moving to the area
emerged out of inflammed muscle. The muscle was caught with cleme vertically in
the healthy part of it and was extirpated up to the insertion of the scleral tendon.
Two other worms were removed. Their appearance was like piesces of thread. They
were placed altogether with the muscle in formaline 10%. The remainder of the
rectus externus muscle was mended with two sutures 1 mm in front of the equator.
The same thing was done for the conjunctiva wound closure.
Results: Histopathologic examination was performed and the result was Trichinella
spiralis in muscles.The eye problems were treated with Tobramycini ointment.
Patient came two months later and he had no eye complaints and the view was
normal and binocular. This is the first case of this pathology established in my city.

        Presentation of a case with Cogan syndrom:
        Tatjana Ziu1, Silvana Kavaja2
          Department of Ophthalmology, Hospital Center of Elbasan;
          Department of ophthalmology, Hospital Center of Durres
Background: Cogan Syndrome, first described by David Cogan in 1945,is an
autoimmune disease, It is a disorder that causes eye inflammation, including
conditions such as keratitis, iritis, scleritis, or conjunctivitis, associated with balance
problems, ringing(tinnitus), nausea,vertigo,vomiting,weight loss and other symptoms
that resemble Meniere’s disease. These vestibuloauditory symptoms can progress
to rapid bilateral deafness due to inflammation affecting the 8th cranial nerve. .
Patients and methods: The patient S.A, male, born on April 18th 1986 from
Elbasan, presented on Oct 2009 sore throat,diarrhea, jaw pains, earaches and
headache.On November 30th he felt stuffed, disconnected, vertigo, vomiting
and diarrhea. His hearing was decreasing. He developed fever with night sweats,
headache, left ear pain, jaw pain and tinnitus. On 5th of December he woke
up with pain in his ears and hearing decreased dramatically.His eyes became
red,tearing,very sensitive to light and the vision was lowing to 5/10. He went through
many examinations like: CT Scan of the head, chest and abdomen which they only
found inflammation in lymph nodes in the right lower quadrant of his abdomen.

                     They did MRI of the head which showed inner ear inflammation.The blood tests,
                     Haematology and Biochemistry resulted normal.Lumbar punct.and tests for syphilis,
                     HIV, fungus, meningitis etc. resulted normal.In vestibular laboratory was checked
                     up for balance mechanism which resulted very damaged.He immediately was
                     seen by an ophthalmologist and was diagnosed for iritis.It was prescribed locally,
                     prednisolone 4 times a day in drops,ointment in evening and homatropine 2 times
                     a day. The ophthalmologist suggested for Cogan’s disease and consulted with ENT
                     doctor and Rheumatologist. They agreed for Cogan’s syndrome. They prescribed 60
                     mg prednisone per day for 10 days, tapering 10 mg every 3 day and Methotrexate
                     10 mg for the first week, following by 20 mg per week from that moment. He began
                     vestibular rehab (exercises for his eyes to help regain his balance). During this four
                     months he had no recidives of Iritis but sensory neural hearing loss still remained.
                     Results: This is the first albanian case diagnosed with Cogan Syndrome. Treatment
                     with steroids and imunosupresors improves the symptoms of the desease but
                     hearing loss is not reversing.

                             Avoidance of nitrous oxide during vitrectomy operations decreases
                             the incidence of postoperative nausea and vomiting:
                             K. Martinovska, M. Gavrilovska, Z. Martinovska
                             University Eye Clinic, Skopje, Macedonia
                     Aims: Postoperative nausea and vomiting are the most common and undesirable
                     complaints after ophthalmic surgery and they can compromise the results of it.
                     It has been reported that fentanyl combined with N2O increase the incidence of
                     postoperative nausea and vomiting. Installing SF6 during vitrectomy operations
                     demands avoiding N2O during general anesthesia. Increasing isoflurane combined
                     with small doses of fentanyl and esmerone decreases the incidence of these
                     Patients and methods: 68 patients undergoing elective surgery (p.p.vitrectomy)
                     in the Eye Clinic in Skopje in the period between 01.01.2009 and 01.01.2010, age
                     23-78, ASA classification I-III. Diazepam was used as premedication (5mg per os).
                     Introuduction of anesthesia was performed with propofol intravenously (2,5mg/
                     kg). Isoflurane was administrated in concentrations (06 – 1 - 1, 2 -1, 5 - 2 vol%) .
                     36 patients received N2O + O2 ( 50:50 ) mixture. 32 patients received O2 + room
                     air (50 : 50) mixture. Fentanyl and esmerone were administrated in small doses
                     according to the anesthetic needs.
                     Results: Nausea and vomiting were observed: N2O group – 36 patients; 16
                     patients (44%) had nausea; 11 (30%) vomited. O2 + room air group – 32 patients; 9
                     patients (28%) had nausea; 5 patients (16%) vomited.
                     Conclusions: Nausea and vomiting remain common sequels after ophthalmic
                     surgery performed in general anesthesia. Having on mind the factors which could
                     confound the results (age, gender, weight, pain, preveious history of nausea and
                     vomiting, length of surgery), we got significantly lower incidence of postoperative
                     nausea and vomiting when nitrous oxide was eliminated from propofol – isoflurane
                     – fentanyl anesthesia during vitrectomy operations. Also the interference of SF6 and
                     nitrous oxide is eliminated.

       Children and anaesthesia in ophthalmology (propfol + isoflurane +
       esmerone vs. ketalar):
       K. Martinovska, D. Zaev, A. Gavrilovski
       University Eye Clinic, Skopje, Macedonia
Aims: The number of children demanding eye surgery grows up every day.
They receive general anesthesia. The aim of this work is to show the advantage
of combined propofol + isoflurane + esmerone anesthesia vs. ketalar as only
Patients and methods: 112 patients, age 2-14, ASA I-II, operated in the period
01.01.2009 – 01.01.2010 in the Eye Clinic in Skopje. Premedication: supp.
diazepam. Intraoperative monitoring: EKG, pulse, AT, SaO2. 46 patients received
ketalar (2mg/kg); 66 received combined propofol + isoflurane + esmerone
anesthesia and were intubated. Intraoperative conditions were observed;
awakening; postoperative restlessness; pain; nausea and vomiting.
Results: Ketalar group: 33 patients (30%) intraoperativly had tremor, undesired
movements and increased secretion of saliva. Spontaneous awakening and late
verbal contact are characteristics of the anesthetic. Postoperative restlessness
had 45 patients (40%). 29 patients (26%) had pain. 11 patients (9%) had nausea
and vomiting. Propofol + isoflurane + esmerone group: excellent intraoperative
conditions; fast awakening and verbal contact; 8 patients (7%) had postoperative
restlessness; 22 patients (20%) had pain; 27 patients (24%) had nausea and
Conclusions: There is no an ideal anesthetic and anesthesia. However, both
administrated types are satisfactory. Ketalar is cheap, easy to administrate, acts
quickly and is suitable for short diagnostic and short extrabulbar procedures.
Combined endotracheal anesthesia (propofol + isoflurane + esmerone) is practiced
more frequently. The muscle relaxant enables bulbus without undesirable
movements and variations in IOP. The volatile anesthetic enables easy control of
the depth of anesthesia aside from the length of surgery. Intubation enables safe
airway when the head is covered for the needs of surgery. The second type is to be
practiced whenever it’s possible.
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