OÊı·ÏÌÔÏÔÁ›· - Πανελλήνια Οφθαλμολογική Εταιρεία

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OÊı·ÏÌÔÏÔÁ›·ÂÚȯfiÌÂÓ·TfiÌÔ˜ 14 - T‡¯Ô˜ 2 - 2002¯fiÏÈÔ 145•¤ÓË ‰ËÌÔÛ›Â˘ÛË 146 £ÂÚ·apple¢ÙÈΤ˜ ÂappleÈappleÏÔΤ˜ Î·È appleÚÔÔappleÙÈΤ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛËÙˆÓ Î·ÎÔ‹ıˆÓ fiÁÎˆÓ ‚ÏÂÊ¿ÚˆÓ. ∞Ó·ÛÎfiappleËÛË ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ÙÂÎÌËÚ›ˆÛ˘B.E. Cook, G.B. BartleyAÓ·ÛÎfiappleËÛË 155 H ÂÁ¯Â›ÚËÛË ÙÔ˘ ηٷÚÚ¿ÎÙË Û ·ÛıÂÓ›˜ appleÔ˘ ¤¯Ô˘Ó ˘appleÔ‚ÏËı›Û ‚ÈÙÚÂÎÙÔÌ‹¢. ¢ÂÚÂÎÏ‹˜, N. §¿ÏÏÔ˜, A. KÔÛÎÔÛ¿˜KÏÈÓÈΤ˜ Î·È ÂÚÁ·- 161 O ÂappleÈappleÔÏ·ÛÌfi˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·appleÔÊÔÏ›‰ˆÛ˘ ÛÙÔ NÔÌfi ¤ÏÏ·˜ÛÙËÚȷΤ˜ ÌÂϤÙ˜. TÛÈÚÒÓË, A. Mapple¤ÓÔ˜, A. Z·ÊÂÈÚÈ¿‰Ë˜, . Mȯ·‹Ï, A. TÚ˘ÊˆÓ›‰Ô˘,°. TÛ·Ô‡Û˘171 ‡ÁÎÚÈÛË Ù˘ 24ˆÚ˘ ÂÓ‰ÔÊı¿ÏÌÈ·˜ apple›ÂÛ˘ Ì ϷٷÓÔappleÚfiÛÙË ‹Ì ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙÈÌÔÏfiÏ˘-ÓÙÔÚ˙ÔÏ·Ì›‰Ë˜ ˆ˜ appleÚÒÙ˘ ıÂÚ·apple¢ÙÈ΋˜ÂappleÈÏÔÁ‹˜ ÛÙÔ appleÚˆÙÔapple·ı¤˜ ÁÏ·‡ÎˆÌ·A.-°.. KÒÓÛÙ·˜, . ·apple·apple¿ÓÔ˜, . M·ÏÔ‡Ù·˜, A.X. M·ÏÙ¤˙Ô˜,I. T¤ÚÛ˘, ¢. XÔ˘ÏÈ¿Ú·, W.C. Stewart177 H ¯Ú‹ÛË Ù˘ ·ÏÏ·ÓÙÔÙÔ͛Ӣ Ù‡appleÔ˘ A ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ¤Ï͢ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ·applefi apple·Ú¿Ï˘ÛË ÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘K. MappleÔÌappleÔÚ›‰Ë˜, N. Zȿη˜, A. KÔÛÎÔÛ¿˜, N. °ÂˆÚÁÈ¿‰Ë˜184 K·ıÂÙËÚÈ·ÛÌfi˜ Ù˘ ÚÈÓÔ‰·ÎÚ˘˚΋˜ Û˘Û΢‹˜ ÛÙ· ‚Ú¤ÊË.E›Ó·È ·apple·Ú·›ÙËÙË Ë appleχÛË Ì ÔÚfi ‹ ΢·ÓÔ‡Ó ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘;B. MfiÛ¯Ô˘, N.°. Zȿη˜, K. ·Ì·Ú¿˜, I.°. °È·ÚÈÛοÓ˘,A. KÔÚ‰fiη˜, N.T. Ù¿ÁÎÔ˜187 OÊı·ÏÌÈο ÙÚ·‡Ì·Ù· ÛÙ· apple·È‰È¿: ÙÚÈÂÙ‹˜ ·Ó·ÛÎÔappleÈ΋ ÌÂϤÙËÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ appleÔ˘ appleÚÔÛ‹Ïı·Ó ÛÙȘ ÂÊËÌÂڛ˜ÙÔ˘ NÔÛÔÎÔÌ›Ԣ AXEAN.°. Zȿη˜, N. §¿ÏÏÔ˜, A. KÔÛÎÔÛ¿˜, B. MfiÛ¯Ô˘, K. MappleÔÌappleÔÚ›‰Ë˜,N. °ÂˆÚÁÈ¿‰Ë˜, N. ¢ËÌËÙÚ·ÎÔ‡ÏÈ·˜, . M·ÏÔ‡Ù·˜191 OappleÙÈ΋ Ô͇ÙËÙ·, ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È Ù‡appleÔÈ ÛÙÚ·‚ÈÛÌÔ‡Û apple·È‰È¿ Ì Ûapple·ÛÙÈ΋ ÙÂÙÚ·appleÏËÁ›· ÏfiÁˆ ÂÁÎÂÊ·ÏÈ΋˜ apple·Ú¿Ï˘Û˘N. KÔ˙¤Ë˜, X. ºˆÙÔappleÔ‡ÏÔ˘, A. M¿ÁηEӉȷʤÚÔÓÙ· 195 H ·ÈÌÔÚÚ·ÁÈ΋ ·appleÔÎfiÏÏËÛË Ù˘ ‰ÂÛÎÂÌÂÙ›Ԣ ÌÂÌ‚Ú¿Ó˘: Ì›·appleÂÚÈÛÙ·ÙÈοÂÓ ‰˘Ó¿ÌÂÈ ÂappleÈappleÏÔ΋ Ù‹˜ ÂÓ Ùˆ ‚¿ıÂÈ ÛÎÏËÚÂÎÙÔÌ‹˜E.B. XÚÈÛÙÔ‰Ô˘Ï¿Î˘, X.. ÈÁ·Ófi˜, A. °ˆÓȈٿÎË, E.A. K·ÏÔÁÈ¿ÓÓË,B.. KÔ˙ÔÌapplefiÏ˘199 KÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË ÏÂÌÊÒÌ·ÙÔ˜ ÎfiÁ¯Ô˘ Î·È ‰È·ÁÓˆÛÙÈ΋ appleÚÔÛ¤ÁÁÈÛËK. MappleÔÌappleÔÚ›‰Ë˜, N. Zȿη˜, N. ¢ËÌËÙÚ·ÎÔ‡ÏÈ·˜, N. °ÂˆÚÁÈ¿‰Ë˜203 EappleÈappleÏÂÁ̤ÓË appleÂÚ›appleÙˆÛË ‚ÏÂÊ·ÚfiappleÙˆÛ˘ ÌÂ Û˘Ó‡apple·ÚÍË ‰ÈappleÏ‹˜ apple¿ÚÂÛ˘·ÓÂÏÎÙ‹ÚˆÓ Î·È Ê·ÈÓÔ̤ÓÔ˘ Marcus Gunn jaw winking∫. ªappleÔÌappleÔÚ›‰Ë˜, ¡. ∑ȿη˜, ¡. °ÂˆÚÁÈ¿‰Ë˜206 ‡ÌÌÂÈÎÙ·213 MÂÙÂÎapple·È‰Â˘ÙÈο ı¤Ì·Ù·233 ÂÚ›ÏË„Ë ‰È‰·ÎÙÔÚÈ΋˜ ‰È·ÙÚÈ‚‹˜250 ÂÚÈÏ‹„ÂȘ ·applefi ͤӷ appleÂÚÈÔ‰Èο258 μÈ‚ÏÈÔÎÚÈÛ›·259 ÿ‰È· Î·È ÎÔÈÓ¿ Âapple·ÁÁÂÏÌ·ÙÈο261 ∞ÏÏËÏÔÁÚ·Ê›·262 ∂ȉ‹ÛÂȘ

OphthalmologiaContentsVolume 14 - No 2 - 2002Editorial 145Invited article 146 Treatment choices and prospects in the management of malignanteyelid tumours. Review of the literatureB.E. Cook, G.B. BartleyReview 155 Cataract surgery in postvitrectomised patientsD. Dereklis, N. Lallos, A, KoskosasClinical and 161 The frequency of exfoliation syndrome in the population oflaboratory studiesthe Greek Region of PellaS. Tsironi, A. Benos, A. Zafiriadis, P. Mihail, A. Trifonidou, G. Tsaousis171 24-hour comparison of latanoprost 0.005% versus the timolol/dorzolamide fixed combination as first line therapy in primaryopen-angle glaucomaA.-G.P. Konstas, P. Papapanos, S. Maloutas, A.H. Maltezos, I. Tersis,D. Houliara, W.C. Stewart177 Botulinum toxin type A application in the management of upper lidretraction secondary to facial nerve palsyK. Boboridis, N. Ziakas, A. Koskosas, N. Georgiadis184 Probing of the nasolacrimal duct in children. Is the irrigationwith saline or methylene blue necessary in confirming patency?V. Moshou, N.G. Ziakas, K. Samaras, I.G. Giariskanis,A. Kordokas, N.T. Stangos187 Ophthalmic injuries in childhood: A three years retrospective studyof eye emergencies attending the casualty department of AHEPA hospitalN.G. Ziakas, N. Lalos, A. Koskosas, V. Moshou, K. Boboridis,N. Georgiadis, N. Dimitrakoulias, S. Maloutas191 Visual acuity, refractive errors and strabismus in a group of spasticquadriplegic, school aged, cerebral palsied childrenN. Kozeis, H. Fotopoulou, A. MaggaCases reports 195 Hemorrhagic descemet’s membrane detachment: a potential complicationof deep sclerectomyE.V. Christodoulakis, C.S. Siganos, A. Goniotaki, E.A. Kalogianni,V.P. Kozombolis199 Clinical manifestation and diagnosis of orbital lymphomaK. Boboridis, N. Ziakas, N. Dimitrakoulias, N. Georgiadis203 Blepharoptosis complicated with double elevator palsy andMarcus Gun jaw winkingK. Boboridis, N. Ziakas, N. Georgiadis206 Miscellaneous213 Postgraduate lectures233 Summary of thesis250 Abstracts258 Books259 Professional issues in Ophthalmology261 Correspondence262 News items

•¤ÓË ‰ËÌÔÛ›Â˘ÛË∂appleÈ̤ÏÂÈ·: ∞.-°.. ∫ÒÓÛÙ·˜e-mail: konstas@med.auth.gr£ÂÚ·apple¢ÙÈΤ˜ ÂappleÈÏÔÁ¤˜ Î·È ÌÂÏÏÔÓÙÈΤ˜ appleÚÔÔappleÙÈΤ˜ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ÙˆÓ Î·ÎÔ‹ıˆÓ fiÁÎˆÓ ‚ÏÂÊ¿ÚˆÓ.∞Ó·ÛÎfiappleËÛË ‚È‚ÏÈÔÁÚ·ÊÈ΋˜ ÙÂÎÌËÚ›ˆÛ˘B.E. Cook, G.B. Bartley∂ÈÛ·ÁˆÁ‹O ÛÙfi¯o˜ Ù˘ ÙÂÎÌËÚȈ̤Ó˘ È·ÙÚÈ΋˜ ›ӷÈÓ· ¯ÚËÛÈÌoappleoÈ› Ù· appleÈo ¤Á΢ڷ ÂappleÈÛÙËÌoÓÈο ÙÂÎ-Ì‹ÚÈ· ÁÈ· ÙȘ ıÂÚ·apple¢ÙÈΤ˜ ÂappleÈÏoÁ¤˜. Δ¤ÙoȘ ÌÂ-ϤÙ˜ Î·È ÂÚÁ·Û›Â˜ ¯ÚÂÈ¿˙oÓÙ·È ÁÈ· ÙËÓ ‰ËÌÈo˘Ú-Á›· appleÚˆÙoÎfiÏÏˆÓ ÁÈ· oÊı·ÏÌÈ¿ÙÚo˘˜, fiappleˆ˜ Ù˘·ÌÂÚÈηÓÈ΋˜ ÂÙ·ÈÚ›·˜ oÊı·ÏÌÈ¿ÙÚˆÓ, Î·È Ó· Â-ÓËÌÂÚÒÓÂÈ ÁÈ· ÙȘ ηχÙÂÚ˜ ıÂÚ·apple¢ÙÈΤ˜ ÌÂıfi-‰o˘˜, Ì ‚¿ÛË ÙËÓ ‰È·ı¤ÛÈÌË ‚È‚ÏÈoÁÚ·Ê›·. ∂appleÂÈ-‰‹ ηӤӷ appleÚˆÙfiÎoÏÏo ‰ÂÓ ˘apple¿Ú¯ÂÈ ÁÈ· ÙËÓ ıÂÚ·-apple›· ηÎfiËıˆÓ ‚ÏÂÊ·ÚÈÎÒÓ fiÁΈÓ, oÈ oÊı·ÏÌ›·-ÙÚoÈ ‚·Û›˙oÓÙ·È ÛÙËÓ appleÚoÛˆappleÈ΋ Ùo˘˜ ÂÌappleÂÈÚ›·Î·È ÙËÓ ‰ËÌoÛÈÂ˘Ì¤ÓË ÂÌappleÂÈÚ›· ¿ÏψÓ.  appleÚfi-ÛÊ·ÙË ÂÚÁ·Û›· ·applefi Ùo˘˜ Cook Î·È Bartley 1 ‚Ú¤ıË-Πappleˆ˜ ÛÙËÓ Mayo Clinic ¯ÚËÛÈÌoappleoÈo‡Û·Ó ›ÙÂÙËÓ ÌÈÎÚoÁÚ·ÊÈ΋ ̤ıo‰o Ùo˘ Mohs ‹ ÙËÓ Ù·¯Â›·‚Èo„›· ÛÙo 98% ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ ‚ÏÂÊ·ÚÈÎÒÓηÎfiËıˆÓ fiÁÎˆÓ apple·ÚfiÙÈ ‰ÂÓ ˘apple¿Ú¯ÂÈ Û˘ÛÙËÌ·ÙÈ΋‚È‚ÏÈoÁÚ·ÊÈ΋ ˘appleoÛÙ‹ÚÈÍË Î·È ·appleo˘Û›· ÙÂÎÌËÚȈ-Ì¤ÓˆÓ appleÚˆÙoÎfiÏψÓ.ª¤ıo‰o˜Ú·ÁÌ·ÙoappleoÈ‹ıËΠ·Ó·ÛÎfiappleËÛË Ù˘ ‚È‚ÏÈoÁÚ·Ê›·˜appleo˘ ·Ó·Ê¤ÚoÓÙ·Ó Û ‚ÏÂÊ·ÚÈÎo‡˜ fiÁÎo˘˜ Î·È ·Ó·˙ËÙ‹-ıËΠÛÙo Medline Î·È PubMed ÁÈ· Ù· ¤ÙË 1966 ¤ˆ˜ 1999ηıÒ˜ Î·È ¿ÏϘ ÌoÓoÁڷʛ˜ Î·È Û˘ÁÁÚ¿ÌÌ·Ù· ·Ó·-ÊoÚ¿˜. ˘ÓoÏÈο 110 ¿ÚıÚ· ÌÂÏÂÙ‹ıËÎ·Ó Î·È fiappleˆ˜ ·Ó·-ʤÚÂÙ·È ·applefi ÙoÓ Wilkinson 2 Ù· ıÂÚ·apple¢ÙÈο Û˘ÌappleÂÚ¿-ÛÌ·Ù· ηٷٿÛÛoÓÙ·Ó Û‡Ìʈӷ Ì ‰‡o ÎÚÈÙ‹ÚÈ·. ΔoappleÚÒÙo ‹Ù·Ó Ë ÛËÌ·Û›· Ùo˘˜ ÁÈ· ÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ÙÚ¤¯o˘-Û·˜ ıÂÚ·apple¢ÙÈ΋˜ appleÚoÛ¤ÁÁÈÛ˘ Î·È ·‡ÍËÛ˘ ÙˆÓ appleoÛo-ÛÙÒÓ ÂappleÈÙ˘¯›·˜ Î·È Î·Ù·Ù¿ÛÛoÓÙ·Ó Û ÙÚ›· Âapple›apple‰·:∂apple›apple‰o ∞: appleoχ ÛËÌ·ÓÙÈο∂apple›apple‰o μ: Û¯ÂÙÈο ÛËÌ·ÓÙÈο∂apple›apple‰o °: Û¯ÂÙÈο ·ÏÏ¿ fi¯È ÛËÌ·ÓÙÈοΔo ‰Â‡ÙÂÚo ÎÚÈÙ‹ÚÈo ‹Ù·Ó Ë ‚·Ú‡ÙËÙ· Ù˘ ‚È-‚ÏÈoÁÚ·ÊÈ΋˜ ÙÂÎÌËÚ›ˆÛ˘ Î·È ¯ˆÚ›˙oÓÙ·Ó Û ÙÚÂȘ η-ÙËÁoڛ˜.∂apple›apple‰o π: ÛËÌ·ÓÙÈ΋ ÙÂÎÌËÚ›ˆÛË Ì appleÚooappleÙÈΤ˜ Ù˘-¯·ÈoappleoÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Î·È ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË∂apple›apple‰o ππ: o˘ÛÈ·ÛÙÈ΋ ÙÂÎÌËÚ›ˆÛË Ì appleÚooappleÙÈΤ˜ÌÂϤÙ˜ appleo˘ ‰ÂÓ ÙËÚo‡Û·Ó fiÏ· Ù· ÎÚÈÙ‹ÚÈ· Ùo˘ ÂappleÈapple¤‰o˘ π∂apple›apple‰o πππ: ÌÈÎÚ‹ ÙÂÎÌËÚ›ˆÛË Ì appleÂÚÈÁÚ·ÊÈΤ˜ÌÂϤÙ˜ appleo˘ ‰ÂÓ ÙËÚo‡Û·Ó Ù· apple·Ú·apple¿Óˆ ÎÚÈÙ‹ÚÈ·.∫·Ù¿Ù·ÍË Ì ‚¿ÛË Ù· apple·Ú·apple¿Óˆ ‰‡o ÎÚÈÙ‹ÚÈ··Ó·Ê¤ÚoÓÙ·Ó Û οı appleÚˆÙfiÎoÏÏo.∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ηȉȷÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·μ·ÛÈÎo΢ÙÙ·ÚÈÎfi ηÚΛӈ̷ (μ∫∫). Úoη-ÏÂ›Ù·È ·applefi ÓÂoappleÏ·ÛÌ·ÙÈ΋ ÂÍÂÚÁ·Û›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ù˘‚·ÛÈ΋˜ ÛÙÈ‚¿‰·˜ Ù˘ ÂappleȉÂÚÌ›‰·˜ appleo˘ appleoÏÏ·appleÏ·-ÛÈ¿˙oÓÙ·È Î·È ÂÈÛ‰‡o˘Ó ÛÙo ¯fiÚÈo oapplefiÙÂ Î·È apple·Ú·ÙËÚ›-Ù·È ‰ÈfiÁΈÛË Ùo˘ fiÁÎo˘. Δo ÎÂÓÙÚÈÎfi ÛËÌ›o ˘Ê›ÛٷٷÈÈÛ¯·ÈÌÈ΋ Ó¤ÎÚˆÛË Ì ·appleoÙ¤ÏÂÛÌ· ·ÈÌoÚÚ·Á›· Î·È ‰Ë-ÌÈo˘ÚÁ›· ÂÏÎÒ‰o˘˜ ÎÚ·Ù‹Ú· Ì ÂappleËṲ́ӷ ¯Â›ÏË appleo˘ ¯·-Ú·ÎÙËÚ›˙ÂÈ ÙËÓ Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË Ùo˘ fiÁÎo˘. ∞apple·-ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙo οو ‚ϤʷÚo, ¤Ûˆ ηÓıfi, ¿Óˆ‚ϤʷÚo Î·È ¤Íˆ ηÓıfi 1 . ∫·Ù·Ù¿ÛÛÂÙ·È ÛÙȘ apple·Ú·Î¿ÙˆÙ¤ÛÛÂÚȘ ηÙËÁoڛ˜: 1) ÂÓÙoappleÈṲ̂Óo (o˙҉˜, ÂÏÎ҉˜,΢ÛÙÈÎfi) 2) ‰È¿¯˘Ùo (appleÏ·Î҉˜, ÛÎÏËÚ˘ÓÙÈÎfi) 3) ÂappleÈÊ·-ÓÂÈ·Îfi, appleoÏ˘ÂÛÙÈ·Îfi Î·È 4) ÈÓoÂappleÈıËÏÈ·Îfi˜ fiÁÎo˜ Ùo˘Pinkus. ∂appleÈappleÚfiÛıÂÙ· Ù· apple·Ú·Î¿Ùˆ Û‡Ó‰ÚoÌ· Û˘Ó-√Êı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞ÚÈÛÙÔÙÂÏ›Ԣ ·ÓÂappleÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 146 - 154, 2002 146

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 147‰¤oÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË μ∫∫: 1) Ùo Û‡Ó‰ÚoÌo ‚·-ÛÈÎo΢ÙÙ·ÚÈÎo‡ ηÚÎÈÓÒÌ·Ùo˜ 2) Ùo ÂÙÂÚfiappleÏ¢ÚoÁÚ·ÌÌÈÎfi Û‡Ó‰ÚoÌo μ∫∫ Î·È 3) Ùo Û‡Ó‰ÚoÌo Bazex 3 .∏ ÂÓÙoappleÈṲ̂ÓË o˙҉˘ Î·È o˙oÂÏΈÙÈ΋ ÌoÚÊ‹·appleoÙÂÏ› ÙËÓ Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË Ùo˘ fiÁÎo˘ ÛÂappleoÛoÛÙfi 75%. ∏ o˙҉˘ ÌoÚÊ‹ ÂÌÊ·Ó›˙ÂÙ·È Û·Ó ÌÈ-ÎÚfi˜ ʈÙo‰È·appleÂÚ·Ùfi˜ fi˙o˜ Ì ÛÙÈÏappleÓ¿ fiÚÈ· Î·È ÂappleÈÊ·-ÓÂȷο ‰ÈÂÛÙ·Ï̤ӷ ·ÁÁ›·4. ªÂ ÙËÓ ‰ÈfiÁΈÛË Ùo˘fiÁÎo˘ ÂÌÊ·Ó›˙ÂÙ·È „¢‰oο„· ÌÂ Û˘Ó˘apple¿Ú¯o˘Û˜ ·-ÛÙÂȘ ÁÂÁoÓfi˜ appleo˘ ÂappleÈappleϤÎÂÈ ÙËÓ ‰È¿ÁÓˆÛË Î·È ‰ÂÓ apple·-Ú·ÙËÚÂ›Ù·È ÛÙȘ ÂÏΈÙÈΤ˜ ÌoÚʤ˜5. ∏ ¯·Ú·ÎÙËÚÈÛÙÈ΋ÂÏΈÙÈ΋ ÂÌÊ¿ÓÈÛË Ì ÎÂÓÙÚÈÎfi ÎÚ·Ù‹Ú· Î·È ÛÙÈÏappleÓ¿˘appleÂÚ˘„ˆÌ¤Ó· fiÚÈ· ÌappleoÚ› Ó· ÂÌÊ·Ó›ÛÂÈ ÌÂÏ¿Á¯ÚˆÛËappleo˘ ÂappleÈappleϤÎÂÈ ÙËÓ ‰È·ÊoÚo‰È¿ÁÓˆÛË Ì Ùo ηÎfiËı˜ÌÂϿӈ̷6.∏ ‰È¿¯˘ÙË appleÏ·Î҉˘ ‹ ÛÎÏËÚ˘ÓÙÈ΋ ÌoÚÊ‹ Û˘Ó·-ÓÙ¿Ù·È ÛÙo 15% ÙˆÓ μ∫∫ Î·È ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ Ï¢΋ ‹Ê·È¿ appleϿη Ì ‰˘Û‰È¿ÎÚÈÙ· fiÚÈ·, ¯ˆÚ›˜ ÂͤÏΈÛË Î·È·Î¤Ú·ÈË ÙËÓ ˘appleÂÚΛÌÂÓË ÂappleȉÂÚÌ›‰·, Ì ٿÛË Âapple¤ÎÙ·-Û˘ Û ‚¿ıo˜. ÙËÓ appleÂÚÈo¯‹ Ùo˘ ¤Ûˆ ηÓıo‡ ÂappleÂ-ÎÙ›ÓoÓÙ·È ÛÙoÓ ÎfiÁ¯o Î·È apple·Ú·ÚÚÈÓ›o˘˜ ÎfiÏappleo˘˜7. Δ·ÂappleÈÊ·ÓÂȷο appleoÏ˘ÂÛÙȷο μ∫∫ ÂÌÊ·Ó›˙o˘Ó appleÂÚÈÛÛfi-ÙÂÚo ·ÓÒÌ·ÏË ÂappleÈÊ¿ÓÂÈ· ·applefi ÙËÓ o˙Ò‰Ë ÌoÚÊ‹ 5 ηÈÂappleÂȉ‹ ÂÍ·appleÏÒÓÔÓÙ·È ÂappleÈÊ·ÓÂȷο ÛÙËÓ ÂappleȉÂÚÌ›‰·, ËÈÛÙoÏoÁÈ΋ ÂappleȂ‚·›ˆÛË appleÏ‹Úo˘˜ ÂÍ·›ÚÂÛ˘ Â›Ó·È ·apple·-Ú·›ÙËÙË Î·Ù¿ ÙËÓ ¯ÂÈÚo˘ÚÁÈ΋ ÂÎÙoÌ‹.Δo ÈÓoÂappleÈıËÏÈ·Îfi μ∫∫ Ùo˘ Pinkus ÂÌÊ·Ó›˙ÂÙ·È΢ڛˆ˜ ÛÙoÓ ÎoÚÌfi Î·È ÁÈ· ÙoÓ ÏfiÁo ·˘Ùfi ‰ÂÓ ı· ·Ó·-ÊÂÚı› ÛÙËÓ apple·Úo‡Û· ÂÚÁ·Û›·.Δo Û‡Ó‰ÚoÌo ‚·ÛÈÎo΢ÙÙ·ÚÈÎo‡ ηÚÎÈÓÒÌ·Ùo˜(Gorlin-Goltz) ÎÏËÚoÓoÌÂ›Ù·È Ì ÙoÓ ·˘Ùoۈ̷ÙÈÎfi ΢-Ú›·Ú¯o ¯·Ú·ÎÙ‹Ú· Î·È ¤¯ÂÈ ˘„ËÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·, ÂÌ-Ê·Ó›˙ÂÙ·È ·applefi ÙËÓ apple·È‰È΋ ËÏÈΛ·8 Î·È ÔÈ fiÁÎoÈ ÂÌÊ·-Ó›˙oÓÙ·È ÛÙ· ‚Ϥʷڷ Û ¤Ó·Ó ÛÙo˘˜ Ù¤ÛÛÂÚȘ ·ÛıÂÓ›˜ÂÓÒ ‰ÂÓ ‰È·Ê¤Úo˘Ó ÎÏÈÓÈο ·applefi ·˘Ùo‡˜ Ù˘ ÌË ÎÏËÚoÓo-ÌÈ΋˜ ÌoÚÊ‹˜9,10 . oÏÏ·appleÏo› ÌÈÎÚo› o˙Ò‰ÂȘ fiÁÎoÈ ÛÙoappleÚfiÛˆappleo ÌappleoÚ› Ó· Â›Ó·È ‰ÈÂÈÛ‰˘ÙÈÎo› Î·È Î·Ù·ÛÙÚo-ÊÈÎo› ÁÈ· Ùo˘˜ apple·Ú·Î›ÌÂÓo˘˜ ÈÛÙo‡˜.Δo Ûapple¿ÓÈo ÂÙÂÚfiappleÏ¢Úo ÁÚ·ÌÌÈÎfi Û‡Ó‰ÚoÌo μ∫∫¯·Ú·ÎÙËÚ›˙ÂÙ·È ·applefi ÂÙÂÚfiappleÏ¢ÚË ÁÚ·ÌÌÈ΋ ÂÌÊ¿ÓÈÛËo˙Ò‰o˘˜ ηÚÎÈÓÒÌ·Ùo˜, appleÂÚÈo¯¤˜ ·ÙÚoÊ›·˜ Î·È appleoÏÏ·-appleÏo‡˜ Ê·Á¤ÛoÚ˜11 . Δo Û‡Ó‰ÚoÌo Bazex ÎÏËÚoÓoÌ›ٷÈηٿ ÙoÓ Î˘Ú›·Ú¯o ¯·Ú·ÎÙ‹Ú· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·applefiappleoÏÏ·appleÏ¿ μ∫∫ ÛÙo appleÚfiÛˆappleo ηٿ ÙËÓ apple·È‰È΋ ËÏÈΛ·Î·È ÂÊ˂›· Ì ÂÌÊ¿ÓÈÛË ‚Ï·‚ÒÓ Ù‡appleo˘ ÎÚ˘oapple·Á‹Ì·Ùo˜ÛÙ· ¿ÎÚ· ÂÍ·ÈÙ›·˜ ·ÙÚoÊÈÎÒÓ ·ÏÏ·ÁÒÓ Ùo˘ ‰¤ÚÌ·Ùo˜3.Δ· μ∫∫ ÂÌÊ·Ó›˙oÓÙ·È Î˘Ú›ˆ˜ ηٿ ÙËÓ Ì¤ÛË ËÏÈ-Λ· Û ·ÓoȯÙfi¯ÚˆÌ· ‰¤ÚÌ·Ù· ·ÏÏ¿ Û˘Ó·ÓÙÒÓÙ·È ÛÂapple·È‰È¿ Î·È ¿ÙoÌ· ·ÊÚoηڷ˚‚È΋˜ appleÚo¤Ï¢Û˘12,13 .∂ÌÊ¿ÓÈÛË Û ËÏÈΛ· οو ÙˆÓ 35 ÂÙÒÓ ¤¯ÂÈ ÂappleÈıÂÙÈÎfi-ÙÂÚË appleoÚ›· Î·È Ù·¯‡ÙÂÚË ÂͤÏÈÍË ·applefi fi,ÙÈ Û ÌÂÁ·Ï‡-ÙÂÚ˜ ËÏÈ˘14 . ·ÚfiÙÈ Ù· μ∫∫ ‰ÂÓ ÌÂı›ÛÙ·ÓÙ·È, ¤¯ÂÈapple·Ú·ÙËÚËı› ·appleoÌ·ÎÚ˘Ṳ̂ÓË ÌÂÙ¿ÛÙ·ÛË Û appleoÛoÛÙfi0,02% ¤ˆ˜ 1% ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ Ì ÙËÓ ·ÈÌ·ÙÈ΋ ‹ ÏÂÌ-ÊÈ΋ o‰fi 3 .∞ηÓıo΢ÙÙ·ÚÈÎfi ηÚΛӈ̷ (∞∫∫). Δo ηÚΛӈ-Ì· ·˘Ùfi ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Î·È appleÂÚÈoÊı·ÏÌÈ΋˜ appleÂÚÈo¯‹˜ ›-Ó·È ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚo˜ fiÁÎo˜. ∂ÎʇÂÙ·È ·applefi Ù· ·Ù-Ù·Ú· Ù˘ ·Î·ÓıˆÙ‹˜ ÛÙÈ‚¿‰·˜ Ù˘ ÂappleȉÂÚÌ›‰·˜ Î·È ¯·-Ú·ÎÙËÚÈÛÙÈο ÂappleÂÎÙ›ÓÂÙ·È ÛÙo ¯fiÚÈo. ∞ÎÙÈÓÈ΋ ÎÂÚ¿Ùˆ-ÛË, ÓfiÛo˜ Ùo˘ Bowen Î·È ·ÎÙÈÓÈ΋ ‰ÂÚÌ·Ù›·ÛË Â›Ó·ÈappleÚo‰È·ıÂÛÈÎo› apple·Ú¿ÁoÓÙ˜ ÁÈ· ÙËÓ ·Ó¿appleÙ˘ÍË ∞∫∫ fiappleˆ˜Âapple›Û˘ Î·È Ùo ÎÏËÚoÓoÌo‡ÌÂÓo Ì ÙoÓ ˘appleoÏÂÈapplefiÌÂÓo ¯·-Ú·ÎÙ‹Ú· ÌÂÏ·Á¯ÚˆÛÙÈÎfi ÍËÚfi‰ÂÚÌ· ȉ›ˆ˜ ÁÈ· ÙË ÎÂÊ·Ï‹Î·È ·˘¯¤Ó·15 Ì ¤ÓÙoÓË ¤ÎıÂÛË ÛÙoÓ ‹ÏÈo. ∂ÌÊ·Ó›˙ÂÙ·ÈÛ˘¯ÓfiÙÂÚ· ÛÙo οو ‚ϤʷÚo, ¤Ûˆ ηÓıfi, ¿Óˆ ‚ϤʷÚoÎ·È ¤Íˆ ηÓıfi Ì ÂÓÙfiappleÈÛË ÛÙo ‚ÏÂÊ·ÚÈÎfi ¯Â›Ïo˜ ηȤۈ ηÓıfi 1,16 . ÙÂÚÂ›Ù·È ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ appleo˘ ı· Ùo‰È·ÊoÚoappleoÈ‹Ûo˘Ó ÎÏÈÓÈο ·applefi ¿ÏÏo˘˜ ‰ÂÚÌ·ÙÈÎo‡˜fiÁÎo˘˜ Î·È Û˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È Û·Ó ·ÓÒ‰˘ÓË o˙҉˘‹ appleÏ·Î҉˘ ‚Ï¿‚Ë, ¿ÏÏoÙ Ì ·Î·ÓfiÓÈÛÙ· fiÚÈ·, ¯ÚfiÓÈ··appleoϤappleÈÛË, ÛÙÈÏappleÓ¿ ¿ÎÚ·, ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Î·È ÎÂÓÙÚÈ-΋ ÂͤÏΈÛË 17 . ÚoÛoÌoÈ¿˙ÂÈ Û appleoÈΛϘ ηÏo‹ıÂȘ ‹Î·o‹ıÂȘ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ Î·È ·apple·ÈÙÂ›Ù·È ‚Èo„›· ÁÈ·ÙËÓ ÂappleȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘.Œ¯ÂÈ ÙËÓ Ù¿ÛË Ó· ÌÂı›ÛÙ·Ù·È Û ·appleoÌ·ÎÚ˘Ṳ̂ӷÛËÌ›· Ì ÙËÓ ·ÈÌ·ÙÈ΋ Î·È ÏÂÌÊÈ΋ o‰fi Û appleoÛoÛÙfi 2%fiÙ·Ó appleÚo¤Ú¯ÂÙ·È ·applefi ·ÎÙÈÓÈ΋ ÎÂÚ¿ÙˆÛË Î·È appleoχ appleÂ-ÚÈÛÛfiÙÂÚo fiÙ·Ó ÍÂÎÈÓ¿ÂÈ de novo16. ÂÚÈÓ¢ÚÈ΋ Âapple¤-ÎÙ·ÛË ‚ÏÂÊ·ÚÈÎo‡ ∞∫∫ ‰ËÌÈo˘ÚÁ› ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙoÓÎfiÁ¯o, ÎÚ·Óȷ΋ ÎoÈÏfiÙËÙ· ̤ۈ ÎÏ¿‰ˆÓ Ùo˘ ÙÚȉ‡Ìo˘,oÊı·ÏÌoÎÈÓËÙÈÎÒÓ Î·È appleÚoÛˆappleÈÎo‡ Ó‡Úo˘18 .Δo ∞∫∫ ÂÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Û ÁËÚ·ÈfiÙÂÚ·¿ÙoÌ· Ì ·ÓoÈÎÙfi ‰¤ÚÌ· Î·È ¯ÚfiÓÈ· ¤ÎıÂÛË ÛÙoÓ ‹ÏÈo.OÈ Vitaliano Î·È Urbach 19 ÂÍÂÙ¿˙oÓÙ·˜ Ùo˘˜ apple·Ú¿Áo-ÓÙ˜ ÎÈÓ‰‡Óo˘ ÁÈ· μ∫∫ Î·È ∞∫∫ ‚Ú‹Î·Ó fiÙÈ Ë ÌÂÙ·apple‹-‰ËÛË ·applefi ÙËÓ oÌ¿‰· ËÏÈΛ·˜ 0-59 ¤ÙË ÛÙËÓ oÌ¿‰· 60 ηÈappleÂÚÈÛÛfiÙÂÚo ¤ÙË Û¯ÂÙ›˙oÓÙ·Ó Ì ·‡ÍËÛË Î·Ù¿ 57% Ùo˘Û¯ÂÙÈÎo‡ ÎÈÓ‰‡Óo˘ ÁÈ· Ùo˘ ‰‡o fiÁÎo˘˜.∫·ÚΛӈ̷ ÛÌËÁÌ·ÙoÁfiÓˆÓ ·‰¤ÓˆÓ (∫∞).∂ÌÊ·Ó›˙oÓÙ·È Û˘Ó‹ıˆ˜ ÛÙ· ‚Ϥʷڷ Î·È ÂÁηÓı›‰· Ïfi-Áˆ Ù˘ appleÏËıÒÚ·˜ ÛÌËÁÌ·ÙoÁfiÓˆÓ ·‰¤ÓˆÓ (Meibomian,Zeis). ∂ÌÊ·Ó›˙oÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙo ¿Óˆ ‚ϤʷÚo, ΢-Ú›ˆ˜ ÛÙȘ Á˘Ó·›Î˜, Î·È ·ÓÙÈÛÙoȯo‡Ó ÛÙo 1% fiÏˆÓ ÙˆÓ‚ÏÂÊ·ÚÈÎÒÓ fiÁÎˆÓ Î·È ÛÙo 4,7% ÙˆÓ Î·ÎfiËıˆÓ ÂappleÈıË-ÏÈ·ÎÒÓ ‚ÏÂÊ·ÚÈÎÒÓ fiÁÎˆÓ 20 . ∏ ̤ÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛË˜Â›Ó·È Ù· 68 ¯ÚfiÓÈ· ·ÏÏ¿ ÌappleoÚ› Ó· ÂÌÊ·ÓÈÛÙ› Û ÓÂfi-ÙÂÚ· ¿ÙoÌ· Ì ÈÛÙoÚÈÎfi ËÏȷ΋˜ ¤ÎıÂÛ˘21,22 . Δ· ÈÛÙo-ÏoÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο appleÂÚÈÁÚ¿ÊËÎ·Ó Û ÛÂÈÚ¿ ÌÂÏÂ-ÙÒÓ 20-24 Î·È Û˘¯Ó¿ Û˘Á¯¤oÓÙ·È Ì ¿ÏÏo˘˜ ‚ÏÂÊ·ÚÈÎo‡˜fiÁÎo˘˜. ŸÙ·Ó appleÚo¤Ú¯oÓÙ·È ·applefi Ùo˘˜ ·‰¤Ó˜ Ùo˘ ZeisÛÙo ‚ÏÂÊ·ÚÈÎfi ¯Â›Ïo˜ Û˘Á¯¤oÓÙ·È Ì ¯·Ï¿˙Èo Î·È Ë Â-ÓÙfiappleÈÛ‹ Ùo˘˜ ÛÙËÓ ÂÁηÓı›‰· Û˘¯Ó¿ appleÂÚÓ¿ ·‰È¿ÁÓˆÛÙË.Δ·ÍÈÓoÌo‡ÓÙ·È Û‡Ìʈӷ Ì ÙoÓ ÙÚfiappleo ‰È‹ıËÛ˘ Î·È ÓÂoappleÏ·ÛÌ·ÙÈ΋˜ÂÍ¿appleψÛ˘ Ì appleÈo Û˘¯Ó‹ ÙËÓ o˙Ò‰Ë ÌoÚ-Ê‹ appleo˘ Â›Ó·È ÂÏ¿¯ÈÛÙ· ‰ÈËıËÙÈ΋ Î·È Û˘Á¯¤ÂÙ·È Û˘¯Ó¿Ì ‚ÏÂÊ·Ú›Ùȉ·, ¯·Ï¿˙Èo ‹ μ∫∫.O ‰Â‡ÙÂÚo˜ Ù‡appleo˜ Â›Ó·È o ÌË o˙҉˘ appleo˘ ÂÌÊ·Ó›-˙ÂÈ ˘„ËÏ‹ ‰È‹ıËÛË Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·applefi ‰ÈËıËÙÈΤ˜Î˘ÙÙ·ÚÈΤ˜ appleÚoÛÂ΂oϤ˜ ¯ˆÚ›˜ ÙËÓ ‰ËÌÈo˘ÚÁ›· fi˙ˆÓ,

148 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Ì ÂÓÙoÓfiÙÂÚË ·Î·ÓıˆÙ‹ ‰È·ÊoÚoappleo›ËÛË.¢‡o ›‰Ë ‰È‹ıËÛ˘ apple·Ú·ÙËÚo‡ÓÙ·È Î·È oÈ ÂappleÈıË-ÏȷΤ˜ ·ÏÏ·Á¤˜ Û˘Ó‰¤oÓÙ·È Ì ηÚÎÈÓÒÌ·Ù· ˘„ËÏ‹˜‰ÈËıËÙÈÎfiÙËÙ·˜. ÙËÓ apple·ÁÂÙoÂȉ‹ Âapple¤ÎÙ·ÛË appleo˘ ÂÌÊ·-Ó›˙ÂÙ·È Ùo 44%-80% ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ 23 , Ù· ÓÂoappleÏ·-ÛÌ·ÙÈο ·ÙÙ·Ú· ‹ oÌ¿‰Â˜ ΢ÙÙ¿ÚˆÓ, ¯ˆÚ›˜ ΢ÙÙ·ÚÈ-Îo‡˜ ‰ÂÛÌo‡˜, Ì ˘appleÂگڈ̷ÙÈÎfi apple˘Ú‹Ó· Î·È ÏÈappleÒ‰Ëۈ̿ÙÈ· ÛÙo ΢ÙÙ·ÚfiappleÏ·ÛÌ·, ÂÈÛ‚¿ÏÏo˘Ó ÛÙo ÂappleÈı‹ÏÈoÎ·È appleÚoηÏo‡Ó ÙËÓ ÊÏÂÁÌoÓ‹ appleo˘ ‰ËÌÈo˘ÚÁ› Ùo Û‡Ó-‰ÚoÌo ÌÂÙ·ÌÊ›ÂÛ˘ (masquerade syndrome) 25 .ÙoÓ ‰Â‡ÙÂÚo ÙÚfiappleo Âapple¤ÎÙ·Û˘ Ù· ηÚÎÈÓÈο ·Ù-Ù·Ú· ηٷϷ̂¿Óo˘Ó Ùo oÏÈÎfi apple¿¯o˜ Ùo˘ ÂappleÈıËÏ›o˘ ηÈapple·Úo˘ÛÈ¿˙oÓÙ·È ˆ˜ ηÚΛӈ̷ in situ. Δo ÂappleÈı‹ÏÈo Ùo˘ÂappleÈappleÂÊ˘ÎfiÙ·, ÎÂÚ·ÙoÂȉ‹ Î·È ÂappleȉÂÚÌ›‰·˜ apple·Úo˘ÛÈ¿˙ÂÈappleoÏ˘ÂÛÙȷ΋ ÂÓÙfiappleÈÛË Ì ÂӉȿÌÂÛ˜ ηı·Ú¤˜ appleÂ-ÚÈo¯¤˜25 .Δo ∫∞ Û˘¯Ó¿ Û˘Á¯¤ÂÙ·È Ì ¿ÏÏ· ÌoÚÊÒÌ·Ù·,Û˘ÓËı¤ÛÙÂÚ· ¯·Ï¿˙Èo, oÊı·ÏÌÈÎfi appleÂÌÊÈÁoÂȉ¤˜, ηÚΛ-ӈ̷ in situ, ·ÎfiÌ· Î·È ÂappleÈappleÂÊ˘Î›Ùȉ· Ë oappleo›· Û˘Óo-‰Â‡ÂÈ Ùo 20%-50% ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ Ì fiÁÎo 26 . ∏ ÂÓÙfiappleÈÛËÛÙo ‚ÏÂÊ·ÚÈÎfi ¯Â›Ïo˜ appleÚoηÏ› Ì·‰¿ÚˆÛË appleo˘ Ùo‰È·ÊoÚo‰È·ÁÈÁÓÒÛÎÂÈ ·applefi Ùo ¯·Ï¿˙Èo. ªappleoÚ› Ó· ›ӷÈappleoÏ˘ÂÛÙȷ΋˜ appleÚo¤Ï¢Û˘ Ì ·ÓÂÍ¿ÚÙËÙ˜ ÂÛٛ˜ Ùo˘¿Óˆ Î·È Î¿Ùˆ ‚ÏÂÊ¿Úo˘ ÛÙo 10% ÙˆÓ ·ÛıÂÓÒÓ Î·ÈappleÚoηÏ› ÌÂÙ·ÛÙ¿ÛÂȘ23,24,27 . Œ¯ÂÈ apple·Ú·ÙËÚËı› ¿ÌÂÛËÂapple¤ÎÙ·ÛË ÛÙoÓ ÎfiÁ¯o Û 19% ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ, ÛÙËÓÎÚ·Óȷ΋ ÎoÈÏfiÙËÙ· Î·È apple·Ú·ÚÚÈÓ›o˘˜ ÎfiÏappleo˘˜28,29 .ªÂÙ·ÛÙ¿ÛÂȘ ÛÙo˘˜ ÂappleȯÒÚÈo˘˜ ÏÂÌÊÈÎo‡˜ ·‰¤Ó˜ ¤¯ÂÈapple·Ú·ÙËÚËı› ÛÙo 28% ÙˆÓ ·ÛıÂÓÒÓ 29 .∫·ÎfiËı˜ ÌÂϿӈ̷. ∏ ÌÂÏ·Ó›ÓË Û˘ÓÙ›ıÂÙ·È ÛÙ·ÌÂÏ·ÓoÛÒÌ·Ù· ÙˆÓ ÂappleȉÂÚÌÈÎÒÓ ÌÂÏ·Óo΢ÙÙ¿ÚˆÓ. Δo‰¤ÚÌ· Ùo˘ appleÚoÛÒappleo˘ appleÂÚȤ¯ÂÈ appleÂÚ›appleo˘ 2000 ÌÂÏ·Óo-·ÙÙ·Ú·/mm 2 Ì ۯÂÙÈο ÏÈÁfiÙÂÚ· ·ÙÙ·Ú· ÛÙ· ‚Ϥʷ-Ú·30 . Δo ηÎfiËı˜ ÌÂϿӈ̷ appleÚo¤Ú¯ÂÙ·È ·applefi ÙËÓηÎo‹ıË ÂÍ·ÏÏ·Á‹ ÙˆÓ ÌÂÏ·Óo΢ÙÙ¿ÚˆÓ Î·È, apple·ÚfiÙÈÛ¯ÂÙÈο Ûapple¿ÓÈo, ·appleoÙÂÏ› ÙËÓ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ı·Ó¿Ùo˘·applefi appleÚˆÙoapple·ı›˜ ‰ÂÚÌ·ÙÈÎo‡˜ fiÁÎo˘˜31 . Δo ‰ÂÚÌ·ÙÈÎfiÌÂϿӈ̷ ‰È·¯ˆÚ›˙ÂÙ·È Û ٤ÛÛÂÚȘ Ù‡appleo˘˜, ·Ó¿ÏoÁ·Ì ÎÏÈÓÈο Î·È ÈÛÙoapple·ıoÏoÁÈο ÎÚÈÙ‹ÚÈ·32: 1) O˙҉˜ÌÂϿӈ̷, 2) ÂappleÈÊ·ÓÂȷο ÂÍ·appleÏo‡ÌÂÓo ÌÂϿӈ̷, 3)ÌÂϿӈ̷ lentigo maligna Î·È 4) ÌÂϿӈ̷ ÂÊËÏ›‰ˆÓÙˆÓ ¿ÎÚˆÓ Ùo oappleo›o ·ÊoÚ¿ Ù· ¯¤ÚÈ· Î·È applefi‰È·, fi¯Èfï˜ Ù· ‚Ϥʷڷ.Δo o˙҉˜ ÌÂϿӈ̷ ¤¯ÂÈ ÙËÓ ¯·Ú·ÎÙËÚÈÛÙÈ΋̷‡ÚË-ÌappleÏ ÛÊ·ÈÚÈ΋ ‰È¿Ù·ÍË Î·È ‰È·¯ˆÚ›˙ÂÙ·È ·applefi ÙoÂappleÈÊ·ÓÂȷο ÂappleÂÎÙÂÈÓfiÌÂÓo ÌÂϿӈ̷ ·applefi ÙoÓ appleÂÚÈÛ-ÛfiÙÂÚo oÌoÈoÁÂÓ‹ ¯ÚˆÌ·ÙÈÛÌfi Ùo˘31 . ∂appleÈÊ·ÓÂȷο ÂappleÂ-ÎÙÂÈÓfiÌÂÓo ÌÂϿӈ̷ ‚ÏÂÊ¿ÚˆÓ ÂÌÊ·Ó›˙ÂÈ appleoÈÎÈÏ›·¯ÚˆÌ¿ÙˆÓ fiappleˆ˜ ηʤ, Ì·‡Úo, ÁÎÚÈ Î·È ÛÎo‡Úo Úo˙.∂ÌÊ·Ó›˙ÂÙ·È ˘appleÂÚ˘„ˆÌ¤Óo ·applefi Ùo ‰¤ÚÌ· Ì ‰È·ÎÚÈÙ¿fiÚÈ·, Ù· oappleo›· ÛÙËÓ Û˘Ó¤¯ÂÈ· Ì ÙËÓ ·ÎÙÈÓˆÙ‹ Âapple¤ÎÙ·-ÛË Ùo˘ fiÁÎo˘ Á›ÓoÓÙ·È ‰˘Û‰È¿ÎÚÈÙ·. O fiÁÎo˜ ·appleoÎÙ¿o˙Ò‰Ë ÌoÚÊ‹ Î·È ÛÙo ÛËÌ›o ·˘Ùfi Û˘Ó¯›˙ÂÈ Ì ÙËÓ Î·-Ù·ÎfiÚ˘ÊË Ê¿ÛË ‰È‹ıËÛ˘ Û ‚¿ıo˜31 .Δo ÌÂϿӈ̷ lentigo maligna appleÚo¤Ú¯ÂÙ·È ·applefi ÌÈ·ÎËÏ›‰· lentigo maligna appleo˘ appleÚo¸apple‹Ú¯Â ÁÈ· ‰ÂηÂÙ›Â˜Î·È ·Ú¯›˙ÂÈ Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋ ·Ó‡„ˆÛË Ù˘ ÂappleÈÊ¿ÓÂÈ-·˜ Î·È ‰ËÌÈo˘ÚÁ›· fi˙ˆÓ, apple·ÚfiÏo appleo˘ ÛÙ· ÌÈÛ¿ ·applefi ÌÈ·ÛÂÈÚ¿ 85 appleÂÚÈÛÙ·ÙÈÎÒÓ lentigo maligna appleo˘ ˘apple¤ÛÙËÛ·Ó‚Èo„›· ¤‰ÂÈÍ·Ó ÌË ÎÏÈÓÈο ÂÌÊ·Ó‹ ‰È‹ıËÛË 33 .Δo ‚¿ıo˜ ‰È‹ıËÛ˘ Ùo˘ ηÎfiËıo˘˜ ÌÂÏ·ÓÒÌ·Ùo˜appleÂÚÈÁÚ¿ÊÂÙ·È Ì ‰‡o ΢ڛˆ˜ ÌÂıfi‰o˘˜. O Clark 34 ·Ó¤appleÙ˘ÍÂappleÚoÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ‰È·ÈÚÒÓÙ·˜ Ùo ‚¿ıo˜ Û 5·Ó·ÙoÌÈο Âapple›apple‰·:∂apple›apple‰o π: appleÂÚÈoÚ›˙ÂÙ·È ÛÙËÓ ÂappleȉÂÚÌ›‰· (in situ).∂apple›apple‰o ππ: ‰ÈËı› Ùo ¯fiÚÈo ·ÏÏ¿ ‰ÂÓ appleÚoÛ‚¿ÏÏÂÈÙËÓ ıËÏÒ‰Ë ÛÙÈ‚¿‰·.∂apple›apple‰o πππ: ‰ÈËı› ÙËÓ ıËÏÒ‰Ë ÛÙÈ‚¿‰·.∂apple›apple‰o πV: ‰ÈËı› ÙËÓ ‰ÈÎÙ˘ˆÙ‹ ÛÙÈ‚¿‰· ηÈ∂apple›apple‰o V: Ë Âapple¤ÎÙ·ÛË Êı¿ÓÂÈ ÛÙoÓ ˘appleo‰fiÚÈo È-ÛÙfi fiappleˆ˜ Ì˘˜ Î·È Ï›appleo˜.O Breslow 35 ·Ó¤appleÙ˘Í ÌÈ· appleoÛoÙÈ΋ ̤ıo‰o Áȷ̤ÙÚËÛË Ùo˘ ‚¿ıo˘˜ ‰È‹ıËÛ˘ Û mm. ∞ÛıÂÓ›˜ Ì ÏÈ-ÁfiÙÂÚo ·applefi 0,75 mm ‚¿ıo˘˜ ¤¯o˘Ó 100% ÂappleÈ‚›ˆÛË ÂÓÒη΋ appleÚfiÁÓˆÛË ¤¯o˘Ó ·˘Ùo› Ì ‰È‹ıËÛË ‚·ı‡ÙÂÚ· ·applefi3 mm.  ‰ÈËı‹ÛÂȘ ÂӉȿÌÂÛo˘ apple¿¯o˘˜ ¤¯o˘Ó ÌÈ· ÌËÁÚ·ÌÌÈ΋ Ì›ˆÛË Ùo˘ appleoÛoÛÙo‡ ÂappleÈ‚›ˆÛ˘.∞ÛıÂÓ›˜ Ì ÛÙ¿‰Èo π Î·È ππ ‰ÂÓ ¤¯o˘Ó ÛÙoȯ›· Ì·-ÎÚoÛÎoappleÈÎÒÓ ÌÂÙ·ÛÙ¿ÛÂˆÓ ‹ ÌÈÎÚoÛÎoappleÈÎÒÓ ÛÙo˘˜ÂappleȯÒÚÈo˘˜ ÏÂÌÊ·‰¤Ó˜. Ùo ÛÙ¿‰Èo πππ ¤¯o˘Ó ÌÂÙ·ÛÙ¿-ÛÂȘ ÛÙo˘˜ ÂappleȯÒÚÈo˘˜ ÏÂÌÊ·‰¤Ó˜ Î·È ÛÙo ÛÙ¿‰Èo πVÌ·ÎÚÈÓ¤˜ ÌÂÙ·ÛÙ¿ÛÂȘ. ∞Ú¯È΋ ‰ÈÂÚ‡ÓËÛË appleÚ¤appleÂÈ Ó·appleÂÚÈÏ·Ì‚¿ÓÂÈ appleÏ‹ÚË ‰ÈÂÚ‡ÓËÛË Ì ¤ÌÊ·ÛË ÛÙo Ó¢ÚÈ-Îfi Î·È Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· fiappleˆ˜ Î·È ÛÙ· oÛÙ¿. æË-Ï·ÊËÙo› ÂappleȯÒÚÈoÈ ÏÂÌÊ·‰¤Ó˜ ÂÚ¢ÓÒÓÙ·È Ì ‚Èo„›·ÏÂappleÙ‹˜ ‚ÂÏfiÓ˘ Î·È Û appleÂÚ›appleÙˆÛË ıÂÙÈÎo‡ ·appleoÙÂϤ-ÛÌ·Ùo˜ Ì ·ÓoÈÎÙ‹ ‚Èo„›·.Δ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÁÈ· ÙËÓ ‰ÈÂÓ¤ÚÁÂÈ· ‚Èo„›·˜appleÈı·Ó‹˜ ‚ÏÂÊ·ÚÈ΋˜ ηÎo‹ıÂÈ·˜ appleÂÚÈÏ·Ì‚¿Óo˘Ó‰ÈfiÁΈÛË, ·ÈÌoÚÚ·Á›· ‹ ÂͤÏΈÛË, ·ÏÏ·Á‹ ¯ÚÒÌ·Ùo˜.ªÂÙ·ÛÙ¿ÛÂȘ ÌappleoÚo‡Ó Ó· apple·Ú·ÙËÚËıo‡Ó Û oappleoÈo‰‹-appleoÙ ·applefi Ùo˘˜ apple·Ú·apple¿Óˆ fiÁÎo˘˜ Î·È ÂÏÏÈapple‹˜ ‰È¿ÁÓˆÛËÛ oappleoÈoÓ‰‹appleoÙ ÛÙ¿‰Èo ·˘Í¿Óo˘Ó ÙËÓ ÓoÛËÚfiÙËÙ· ηÈappleÈı·ÓÒ˜ ıÓËÛÈÌfiÙËÙ·.∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜¯ÂÈÚo˘ÚÁÈ΋˜ ·ÓÙÈÌÂÙÒappleÈÛ˘ŸÏ˜ oÈ Î·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ıÂÚ·apple›·˜ ıÂ-ˆÚo‡ÓÙ·È ÂappleÈapple¤‰o˘ ∞ (appleoχ ÛËÌ·ÓÙÈΤ˜ ÁÈ· ÙËÓ ÊÚoÓÙ›-‰· ÙˆÓ ·ÛıÂÓÒÓ) ÂÓÒ ·˘Ù¤˜ ÁÈ· μ∫∫ Î·È ∞∫∫ ‰È·-ʤÚo˘Ó ÛËÌ·ÓÙÈο ·applefi ·˘Ù¤˜ ÁÈ· ∫∞ Î·È Î·ÎfiËı˜ÌÂϿӈ̷.μ·ÛÈÎo΢ÙÙ·ÚÈÎfi Î·È ·Î·Óıo΢ÙÙ·ÚÈÎfi ηÚΛӈ-Ì·. ∞applefi ÙȘ 8 ηÙ¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ·˘Ùo‡˜ Ùo˘˜fiÁÎo˘˜, ηٿٷÍË ÙÂÎÌËÚ›ˆÛ˘ π (ÈÛ¯˘Ú‹ ÙÂÎÌËÚ›ˆÛË)¯·Ú·ÎÙËÚ›˙ÂÈ ÌfiÓoÓ ‰‡o, ÙËÓ ÌÈÎÚoÁÚ·ÊÈ΋ ̤ıo‰oMohs Î·È ÙËÓ ÂÍ·›ÚÂÛË Ì ٷ¯Â›· ‚Èo„›· ÂÓÒ ÛÙËÚ›¯ıË-Π۠appleÚooappleÙÈΤ˜ Î·È ·Ó·‰ÚoÌÈΤ˜ ÌÂϤÙ˜ Ì ÌÂÁ¿Ïo·ÚÈıÌfi ·ÛıÂÓÒÓ 3,36-44 . 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Intraoperativeradiolympho- scintigraphy improves sentinel lymphnode identification for patients with melanoma. AnnSurg 223: 217-24, 1996.106. Shiose S, Sakamoto T, Yoshikawa H, et al. Gene transferof a soluble receptor of VEGF inhibits the growthof experimental eyelid malignant melanoma. InvestOphthalmol Vis Sci 41: 2395-403, 2000.ªÂÙ¿ÊÚ·ÛË: ∫. ªappleÔÌappleÔÚ›‰Ë˜

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156 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Ê˘ÛÈoÏoÁÈο ·Ó·Ì¤ÓÂÙ·È ·applefi ÙË ‚·ıÌÈ·›· ·Ó¿Ú-ÚˆÛË Ùo˘ apple¿Û¯oÓÙo˜ ¯oÚÈo·ÌÊÈ‚ÏËÛÙÚoÂȉo‡˜ ÌÂ-Ù¿ ·applefi ÙËÓ ‚ÈÙÚÂÎÙoÌ‹. ∏ Ù·˘Ùfi¯ÚoÓË ·ÏÏ¿ ·ÓÙ›-ıÂÙË ·˘Ù‹ appleoÚ›· ÌappleoÚ› Ó· ‰ËÌÈo˘ÚÁ‹ÛÂÈ ÌÂÚÈΤ˜ÊoÚ¤˜ ÛËÌ·ÓÙÈÎfi ‰È·ÊoÚo‰È·ÁÓˆÛÙÈÎfi appleÚfi‚ÏËÌ·.·ıÔÊ˘ÛÈÔÏÔÁ›·O ·ÎÚÈ‚‹˜ apple·ıoÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ùo˘Î·Ù·ÚÚ¿ÎÙË appleo˘ ·Ó·appleÙ‡ÛÛÂÙ·È ÌÂÙ¿ ·applefi ‚ÈÙÚÂ-ÎÙoÌ‹ ‰ÂÓ Â›Ó·È ·ÎfiÌË ·ÚÎÂÙ¿ Û·Ê‹˜.  ÌÂÚÈΤ˜appleÂÚÈappleÙÒÛÂȘ Ë ·ÈÙ›· Â›Ó·È appleÚoÊ·Ó‹˜, fiappleˆ˜ apple.¯. o¿ÌÂÛo˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ Ùo˘ Ê·Îo‡ ·applefi ÂÚÁ·Ï›oÙ˘ ‚ÈÙÚÂÎÙoÌ‹˜ ‹ Ùo Ì·ÎÚ‡ Ú‡Á¯o˜ Ì›·˜ ¤Á¯˘Û˘ ‹·applefi ¤Ó· ͤÓo ÛÒÌ·. ¢ÂÓ ÌappleoÚ› fï˜ Ó· ÂÚÌËÓ¢ı›,apple.¯., o ÙÚfiappleo˜ Ì ÙoÓ oappleo›o ‰Ú· ÙoÍÈο Ùo ʈ˜Ùo˘ ÌÈÎÚoÛÎoapple›o˘ ‹ Ùo˘ ÂÓ‰oʈÙÈÛÌo‡ (Novak1984, Margherio 1985). To ÂÚÒÙËÌ·, ·Ó ‰Ú· ¿ÌÂ-Û· ‹ ̤ۈ Ù˘ ·‡ÍËÛ˘ Ù˘ ÂÓ‰o‚oÏ‚È΋˜ ıÂÚ-ÌoÎÚ·Û›·˜ appleo˘ appleÚoηÏ›, ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ·apple·ÓÙËı›Âapple·ÚÎÒ˜. ∞ÎfiÌË, ‰ÂÓ ¤¯ÂÈ ·apple·ÓÙËı›, Ùo ÂÚÒ-ÙËÌ· Â¿Ó Î·È Ì appleoÈÔ ÙÚfiappleo Ùo ›‰Èo Ùo ˘·ÏoÂȉ¤˜·appleoÙÂÏ› ¤Ó·Ó appleÚoÛٷ٢ÙÈÎfi ÊÚ·ÁÌfi ·apple¤Ó·ÓÙÈÛÙȘ o˘Û›Â˜ appleo˘ appleÂÚȤ¯oÓÙ·È ÛÙ· ˘ÁÚ¿ Ù˘ ¤Á¯˘ÛË˜Î·È ÂappleËÚ¿˙o˘Ó ÙËÓ oÌoÈfiÛÙ·ÛË Ùo˘ Ê·Îo‡ ‹ ¿ӷ˘Ùfi ·appleoÙÂÏ› ÊÚ·ÁÌfi appleo˘ appleÚoÛٷهÂÈ Ùo appleÚfi-ÛıÈo ÙÌ‹Ì·, ÁÂÓÈο, ·applefi ÙË ‚Ï·appleÙÈ΋ Âapple›‰Ú·ÛËÙˆÓ ÂχıÂÚˆÓ ÚÈ˙ÒÓ appleo˘ apple·Ú¿ÁoÓÙ·È ÛÙo oapple›ÛıÈoÙÌ‹Ì· Ùo˘ ‚oÏ‚o‡ Û ÊÏÂÁÌoÓÒ‰ÂȘ ‹ Û ÂÎÊ˘ÏÈ-ÛÙÈΤ˜ apple·ı‹ÛÂȘ Ùo˘ ¯oÚÈo·ÌÊÈ‚ÏËÛÙÚoÂȉo‡˜(Sneed 1984, Heiman 1984). ∏ ÙÂÏÂ˘Ù·›· ·˘Ù‹˘applefiıÂÛË, appleo˘ ¤¯ÂÈ ‰È·Ù˘appleˆı› Î·È Û˘˙ËÙ›ٷÈappleoÏÏ¿ ¯ÚfiÓÈ·, Ê·›ÓÂÙ·È ·ÚÎÂÙ¿ ÏoÁÈ΋, Â¿Ó Ï¿‚ÂÈηÓ›˜ ˘apple’ fi„Ë Ùo˘ Ù· ·Ó¿ÏoÁ· Ê·ÈÓfiÌÂÓ· appleo˘Û˘Ì‚·›Óo˘Ó ÛÙo Ê·Îfi Û apple·ı‹ÛÂȘ fiappleˆ˜ Ë ˘„ËÏ‹Ì˘ˆapple›·, Ùo Û‡Ó‰ÚoÌo Wagner-Stickler, Ë ÌÂÁ¿ÏËËÏÈΛ·, ÛÙȘ oappleo›Â˜ Â›Ó·È ‰Â‰o̤ÓË Ë Ú¢ÛÙoappleo›Ë-ÛË Ùo˘ ˘·ÏoÂȉo‡˜ ηÈ, ηٿ Û˘Ó¤appleÂÈ·, o appleÂÚÈoÚÈ-ÛÌfi˜ Ùo˘ ÚfiÏo˘ Ùo˘ ˆ˜ appleÚoÛٷ٢ÙÈÎo‡ ÊÚ·ÁÌo‡.ªÂ ÙËÓ ›‰È· ÏoÁÈ΋ ÌappleoÚ› Ó· ÂÚÌËÓ¢ı› Î·È Ë·Ó¿appleÙ˘ÍË Î·Ù·ÚÚ¿ÎÙË ÌÂÙ¿ ·applefi Û¯ÂÙÈο Û‡ÓÙoÌÂ˜Î·È ·appleϤ˜ ‚ÈÙÚÂÎÙo̤˜, fiappleˆ˜ apple.¯. Ë ‚ÈÙÚÂÎÙoÌ‹ ÁÈ·ÙË ¯ÂÈÚo˘ÚÁÈ΋ ıÂÚ·apple›· ÌÈ·˜ ÂappleȈ¯ÚÈ΋˜ ÌÂÌ-‚Ú¿Ó˘, ÛÙȘ oappleo›Â˜ o ‚Ï·appleÙÈÎfi˜ ÚfiÏo˜ ÙˆÓ ˘ÁÚÒÓÙ˘ ¤Á¯˘Û˘ ‰ÂÓ appleÚ¤appleÂÈ ÏoÁÈο Ó· ıˆÚÂ›Ù·È ÛË-Ì·ÓÙÈο ‚Ï·appleÙÈÎfi˜. ŸÏ· ·˘Ù¿ appleÈı·Ófiٷٷ ‰Â›-¯Óo˘Ó fiÙÈ Ë apple·Úo˘Û›· ÂÓfi˜ ˘ÁÈo‡˜ ˘·ÏoÂȉo‡˜·appleoÙÂÏ›, ÂÎÙfi˜ ÙˆÓ ¿ÏψÓ, Î·È ¤Ó·Ó ·apple·Ú·›ÙËÙoÊÚ·ÁÌfi appleo˘ ÂÍo˘‰ÂÙÂÚÒÓÂÈ, ‹ ÂӉ¯fiÌÂÓ· ÙÚoappleoappleoÈÂ›Î·È oÌ·ÏoappleoÈ›, ÙȘ ÙoÍÈΤ˜ ÂappleȉڿÛÂȘo˘ÛÈÒÓ appleo˘ apple·Ú¿ÁoÓÙ·È ·applefi Ùo oapple›ÛıÈo ÙÌ‹Ì· Ùo˘‚oÏ‚o‡ Û apple·ıoÏoÁÈΤ˜ ‹ Î·È Ê˘ÛÈoÏoÁÈΤ˜ η-Ù·ÛÙ¿ÛÂȘ (Chefan 1991).O ÌÂÙ¿ ÙË ‚ÈÙÚÂÎÙoÌ‹ ηٷÚÚ¿ÎÙ˘ Â›Ó·È Û˘-Ó‹ıˆ˜ apple˘ÚËÓÈÎfi˜ appleo˘ ÂappleȉÂÈÓÒÓÂÙ·È ÛÙ·ıÂÚ¿. ÂoÚÈṲ̂Ó˜ fï˜ appleÂÚÈappleÙÒÛÂȘ ÂÌÊ·Ó›˙ÂÙ·È Û·Ó oapple›-ÛıÈo˜ ÊÏoÈ҉˘, fiappleˆ˜ Û˘Ì‚·›ÓÂÈ ÌÂÙ¿ ·applefi ¤ÓÂÛË·ÂÚ›o˘ Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ‹ ‚ÈÙÚÂÎÙo̤˜ appleo˘ÎÚ·Ùo‡Ó appleoχ ¯ÚfiÓo, Î·È fiappleo˘ ηٿ ηÓfiÓ· ›ӷȷӷٿÍÈÌo˜. ¢ÂÓ Â›Ó·È ·ÎfiÌË ÁÓˆÛÙ¿ o‡Ù o ·ÎÚÈ-‚‹˜ Ì˯·ÓÈÛÌfi˜ Ù˘ Á¤ÓÂÛ‹˜ Ùo˘, ·ÏÏ¿ o‡ÙÂ Î·È oÏfiÁo˜ Ù˘ ·˘ÙfiÌ·Ù˘ ·Ó¿Ù·Í˘ Ùo˘ ÙÂÏÂ˘Ù·›o˘ (Finemberg1975, Meyers 1984).ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÌÂϤÙËÙ· Ì¿ÙÈ· ·˘Ù¿ Â›Ó·È ‰Â‰o̤Óo fiÙÈ appleÚoËÁ‹ıË-ΠÌÈ· ‚·ÚÈ¿ ηٿ ηÓfiÓ· apple¿ıËÛË (.¢., PVR,ÙÚ·‡Ì·, Î.Ï.apple.) Ì ÙËÓ oappleo›· Û¯ÂÙ›˙ÂÙ·È Ùo ÙÚ¤¯oÓ Â-apple›apple‰o Ù˘ oappleÙÈ΋˜ ÏÂÈÙo˘ÚÁ›·˜ Î·È ·applefi ÙËÓ oappleo›·ÂÍ·ÚÙ¿Ù·È ÂÓ appleoÏÏo›˜ Ë appleÚooappleÙÈ΋ Ù˘. ∂›Ó·È Âapple›Û˘‰Â‰o̤Óo, fiÙÈ ÁÈ· ÙË ıÂÚ·apple›· ·˘Ù‹˜ Ù˘ apple¿ıËÛ˘¤ÁÈÓ ÌÈ· ηٿ ηÓfiÓ· ‚·ÚÈ¿ ¯ÂÈÚo˘ÚÁÈ΋ Âapple¤Ì‚·-ÛË, fiappleˆ˜ Ë p.p. ‚ÈÙÚÂÎÙoÌ‹, appleo˘ ÂÈÛ¿ÁÂÈ Ì ÙË ÛÂÈÚ¿Ù˘ ¤Ó· ·ÚÈıÌfi ÌÈÎÚÒÓ ‹ ÌÂÁ·Ï‡ÙÂÚˆÓ ÂappleÈ‚·Ú‡ÓÛÂ-ˆÓ appleo˘ appleÈı·ÓfiÓ ı· ÂappleËÚ¿Ûo˘Ó ÙËÓ appleÚfiÁÓˆÛË, ÂÓÒapple·Ú¿ÏÏËÏ· ı· appleÚoηıoÚ›Ûo˘Ó Î·È ÙËÓ Ù¯ÓÈ΋ appleo˘ı· ·ÎoÏo˘ı‹ÛÂÈ Î·Ó›˜ ÛÙËÓ ÂÁ¯Â›ÚËÛË Ùo˘ ηٷÚ-Ú¿ÎÙË. Δ¤ÙoȘ ÂappleÈ‚·Ú‡ÓÛÂȘ ÌappleoÚo‡Ó Ó· ıˆÚËıo‡Ó,ÂÎÙfi˜ ·applefi ÙËÓ ·appleo˘Û›· Ùo˘ ˘·ÏoÂȉo‡˜, apple.¯.ÙÚ·‡Ì·Ù· Ù˘ ˙ÈÓÓ›o˘ ˙ÒÓ˘ ‰È¯ÂÈÚËÙÈο, ÙÚ·‡Ì·-Ù· Ùo˘ appleÂÚÈʷΛo˘, ‚Ï¿‚˜ ÛÙËÓ ˆ¯Ú¿-Ì˯·ÓÈΤ˜ ‹·applefi Ùo ʈ˜, o˘Ï¤˜ ÛÙËÓ appleÂÚÈo¯‹ Ùo˘ ÛÎÏËÚoÎÂÚo-ÙoÂȉÈÎo‡ oÚ›o˘, Î.Ï.apple. ∂appleo̤ӈ˜, Ë appleÚoÛo¯‹ Ùo˘ÂÍÂÙ·ÛÙ‹ ÛÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜ appleÚ¤appleÂÈ Ó· ÂÛÙÈ·-ÛÙ› appleÚˆÙ›ÛÙˆ˜ ÛÙ· ·ÎfiÏo˘ı· ÛËÌ›·:1. ΔËÓ ÂÎÙ›ÌËÛË Ù˘ oappleÙÈ΋˜ ÏÂÈÙo˘ÚÁ›·˜ ÁÈ·Ùo Âapple›apple‰o Î·È ÙËÓ appleoÚ›· Ù˘ oappleo›·˜ ı· Û˘ÏϤÍÂÈÛÙoȯ›· ·applefi Ùo ÈÛÙoÚÈÎfi ÙfiÛo ÁÈ· ÙËÓ appleÚÈÓ ·applefiÙËÓ ·Ó¿appleÙ˘ÍË Ùo˘ ηٷÚÚ¿ÎÙË appleÂÚ›o‰o, fiÛo ηÈηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁηٿÛÙ·Û˘ Î·È ÂͤÏÈÍ‹˜Ùo˘. ∂¿Ó o ‚·ıÌfi˜ ıfiψÛ˘ Ùo˘ Ê·Îo‡ Ùo ÂappleÈÙÚ¤appleÂÈ,ÌappleoÚ› Ó· appleÚoÛÙÚ¤ÍÂÈ Î·Ó›˜, Â¿Ó ¯ÚÂÈ¿˙ÂÙ·È,Î·È ÛÙË ‚o‹ıÂÈ· Ù˘ ÊÏo˘ÔÚo·ÁÁÂÈoÁÚ·Ê›·˜. Âappleoχ ıoÏo‡˜ Ê·Îo‡˜ Ë appleÚo¯ÂÈÚËÙÈ΋ ÌÂϤÙË Ùo˘oappleÈÛı›o˘ ÙÌ‹Ì·Ùo˜ Ì ˘appleÂÚ˯oÁÚ·Ê›· ı· Â›Ó·È appleÈı·ÓfiÓ¤Ó· Âapple›Û˘ appleoχ ¯Ú‹ÛÈÌo ÛÙoȯ›o.2. ΔËÓ ÂͤٷÛË ÛÙË Û¯ÈÛÌoÂȉ‹ Ï˘¯Ó›· appleo˘ ı··appleoηχ„ÂÈ appleÈı·Ó¤˜ ‚Ï¿‚˜ ÛÙo appleÂÚÈÊ¿ÎÈo, ‚Ï¿-‚˜ ÛÙË ˙›ÓÓÂÈo ˙ÒÓË Î·ıÒ˜ Î·È ÙËÓ ¤ÎÙ·ÛË ÙˆÓ

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 157·ÏÏoÈÒÛÂˆÓ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ· Î·È ÂӉ¯fiÌÂÓ· Ù˘ÎfiÚ˘ appleo˘ appleÂÚÈoÚ›˙o˘Ó ÙËÓ ‰˘Ó·ÙfiÙËÙ· ÌÈ·˜ Âapple·Ú-Îo‡˜ Ì˘‰Ú›·Û˘ appleo˘ Â›Ó·È ·ÎfiÌË appleÈo ·Ó·Áη›·ÛÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜. ∏ ÛÙÂÓ‹ ÎfiÚË Â›Ó·È appleoÏ‡Û˘¯Ófi appleÚfi‚ÏËÌ· ÛÙ· Ì¿ÙÈ· appleo˘ ¤¯o˘Ó ˘appleo‚ÏËı›Û ‚ÈÙÚÂÎÙoÌ‹. ÀappleoÏoÁ›˙ÂÙ·È fiÙÈ Ë ÎfiÚË ÌÂÁ¤ıo˘˜Î¿Ùˆ ÙˆÓ 3 mm apple·Ú·ÙËÚÂ›Ù·È ÛÙo 30,4% appleÂÚ›appleo˘ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ, οÙÈ appleo˘ ÂappleÈ‚¿ÏÏÂÈ ‰ÈÂÁ¯ÂÈ-ÚËÙÈο ÙËÓ Â˘Ú›· ¯Ú‹ÛË ‰È·ÛÙoϤˆÓ Ù˘ ÎfiÚ˘(Lacalle 1998). ∏ apple·Úo˘Û›· apple¿ÏÈ Ú‹ÍÂˆÓ ÛÙË ˙›Ó-ÓÂÈo ˙ÒÓË ÂappleÈ‚¿ÏÏÂÈ ÙËÓ ÙÚoappleoappleo›ËÛË Ù˘ Ù¯ÓÈ΋˜appleo˘ appleÚo‚ϤappleÂÈ, apple.¯., ÙoÓ ÂӉ¯fiÌÂÌÓo ·appleoÎÏÂÈÛÌfiÙ˘ Ê·ÎoıÚ˘„›·˜ Î·È ÙËÓ ÂÊ·ÚÌoÁ‹ ÌÈ·˜ Â͈appleÂÚÈ-Ê·ÎÈ΋˜ ·Ê·›ÚÂÛ˘. ∂apple›Û˘ Ë apple·Úo˘Û›· ÌÈ·˜ Û¯¿-Û˘ ÛÙo oapple›ÛıÈo appleÂÚÈÊ¿ÎÈo ·applefi appleÈı·Ófi ÙÚ·˘Ì·ÙÈ-ÛÌfi ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ appleÚoËÁËı›Û˘ ‚ÈÙÚÂÎÙo-Ì‹˜ appleÂÚÈoÚ›˙ÂÈ ÙËÓ ¤Ó‰ÂÈÍË Ê·ÎoıÚ˘„›·˜, ÂÓÒ Û˘-ÓÈÛÙ¿ apple·Ú¿ÏÏËÏ· Î·È Ûo‚·Úfi ÏfiÁo ·appleoÊ˘Á‹˜ Ùo˘Ì·Û¿˙ ÌÂÙ¿ ÙËÓ ·Ó·ÈÛıËÛ›·, ÁÈ·Ù› ˘apple¿Ú¯ÂÈ Î›Ó-‰˘Óo˜ Ù˘ ‰È·Ê˘Á‹˜ Ùo˘ apple˘Ú‹Ó· ÛÙo oapple›ÛıÈo ÙÌ‹Ì·Ùo˘ ‚oÏ‚o‡ (Hutton 1987, Wilbrandt 1994).3. ∏ ‚ÈoÌÂÙÚ›· ÛÙ· Ì¿ÙÈ· ·˘Ù¿ ·ÎoÏo˘ı› Ìȷȉȷ›ÙÂÚË Û˘ÏÏoÁÈÛÙÈ΋. ∂¿Ó appleÚfiÎÂÈÙ·È ÁÈ· Ì¿ÙÈ·appleo˘ ‰ÂÓ ¤¯o˘Ó ÛÈÏÈÎfiÓË, Ë Ì¤ÙÚËÛË ·ÎoÏo˘ı› Ùo˘˜ÎoÈÓo‡˜ ηÓfiÓ˜. Èı·ÓÒ˜ Ó· appleÚo·„o˘Ó ‰Â‰o̤-Ó· appleo˘ ¤¯o˘Ó ÂappleËÚ·Ûı›, Î·È ÂÚÌËÓ‡oÓÙ·È, ·applefiÌ›· ÂappleÈÌ‹Î˘ÓÛË Ùo˘ ‚oÏ‚o‡, ÂappleÂȉ‹ apple·Ú¿ÏÏËÏ· ¤-¯ÂÈ ÙoappleoıÂÙËı› Î·È ¤Ó·˜ appleÂÚÈ‚Úo¯ÈÛÌfi˜. ∏ apple·Úo˘-Û›· fï˜ ÂÓ‰o‚oÏ‚È΋˜ ÛÈÏÈÎfiÓ˘ ηıÈÛÙ¿ ÙË ‚Èo-ÌÂÙÚ›· ·ÛÙ·ı‹ Î·È ÂappleÈÛÊ·Ï‹, οÙÈ appleo˘ ηıÈÛÙ¿·Ó·applefiÊ¢ÎÙË ÛÙȘ appleÂÚÈÛÛfiÙÂÚ˜ ÊoÚ¤˜ ÙËÓ ¤ÌÌÂÛË̤ÙÚËÛË, ‰ËÏ·‰‹ ÙoÓ ˘appleoÏoÁÈÛÌfi Ù˘ ÈÛ¯‡o˜ Ùo˘ÂÓ‰oÊ·Îo‡ ̤ۈ Ù˘ ‚ÈoÌÂÙÚ›·˜ Ùo˘ ¿ÏÏo˘ Ì·ÙÈo‡.ÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜ appleÚ¤appleÂÈ Ó· Û˘Ó˘appleoÏoÁ›˙ÂÙ·ÈÎ·È Ó· appleÚoÛÌÂÙÚ¿Ù·È Âapple›Û˘ Î·È Ë appleÈı·Ó‹ ÌÂÙ·‚o-Ï‹ appleo˘ ÂÈÛ‹Á·Á ÛÙËÓ ‰È¿ıÏ·ÛË ·applefi ÙËÓ ÂappleÈÌ‹Î˘Ó-ÛË Ùo˘ ‚oÏ‚o‡ ¤Ó·˜ Û˘Ó˘apple¿Ú¯ˆÓ ‚Úfi¯o˜. Ú¤appleÂÈÛÙo ÛËÌ›o ·˘Ùfi Ó· Á›ÓÂÈ ÌÓ›· Ùo˘ ÁÂÁoÓfiÙo˜ fiÙÈ ËÂÓ‰o‚oÏ‚È΋ ÛÈÏÈÎfiÓË ÂÈÛ¿ÁÂÈ Ì˘ˆapple›· –7 ‰ÈoappleÙÚÈÒÓÛÙ· ¿Ê·Î· Ì¿ÙÈ·, ˘appleÂÚÌÂÙÚˆapple›· +4 ‰ÈoappleÙÚÈÒÓÛÙ· ¤Ìʷη Î·È +2 ‰ÈoappleÙÚÈÒÓ ÛÙ· „¢‰o-Ê·ÎÈο. ∂appleo̤ӈ˜, Â¿Ó ˘apple¿Ú¯ÂÈ Ë appleÚfi‚Ï„Ë, apple.¯.fiÙÈ Ë ÛÈÏÈÎfiÓË ı· apple·Ú·Ì›ÓÂÈ ÌfiÓÈÌ· ÛÙo ¯ÒÚo Ùo˘˘·ÏoÂȉo‡˜, appleÚ¤appleÂÈ o ÂÓ‰oÊ·Îfi˜ appleo˘ ı· ÙoappleoıÂÙËı›ӷ Â›Ó·È Î·Ù¿ ‰‡o ‰ÈoappleÙڛ˜ ÈÛ¯˘ÚfiÙÂÚo˜ (¢Â-ÚÂÎÏ‹˜ 1989, 1992, 1995).4. ∏ ÂappleÈÏoÁ‹ Ù˘ Ù¯ÓÈ΋˜ Î·È Ùo˘ ›‰o˘˜ Ùo˘ÂÓ‰oÊ·Îo‡ appleo˘ ı· ¯ÚËÛÈÌoappleoÈËı› ·ÎoÏo˘ıo‡ÓοappleoÈo˘˜ ÁÂÓÈο apple·Ú·‰ÂÎÙo‡˜ ηÓfiÓ˜, apple¤Ú· ·applefiÙo˘˜ oappleo›o˘˜ o οı ¯ÂÈÚo˘ÚÁfi˜ ¤¯ÂÈ ÙËÓ appleÚoÛˆappleÈ΋Ùo˘ ¿appleo„Ë. ŸÏoÈ Û˘ÌʈÓo‡Ó, apple.¯., fiÙÈ oÈ ÂÓ-‰oÊ·Îo› ÛÈÏÈÎfiÓ˘ ·appleoÙÂÏo‡Ó ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙȘappleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜. ∂›Ù ÁÈ·Ù› ˘apple¿Ú¯ÂÈ ÛÈÏÈÎfiÓË,›Ù ˘apple¿Ú¯ÂÈ Ùo ÂӉ¯fiÌÂÓo Ó· Âapple·Ó·¯ÚËÛÈÌoappleoÈ-Ëı› ·˘Ù‹. Δo ›‰Èo ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙȘ appleÂÚÈappleÙÒÛÂȘappleo˘ ˘apple¿Ú¯ÂÈ ·¤ÚÈo. °ÂÓÈÎfi˜, Âapple›Û˘, ηÓfiÓ·˜ ›-Ó·È Ë ÂÊ·ÚÌoÁ‹ ÛÎÏËÚÈ΋˜ ‹ ÛÎÏËÚoÎÂÚ·ÙÈ΋˜ Ùo-Ì‹˜ ÛÙËÓ 12 Ë ÒÚ·, ÂappleÂȉ‹ Â›Ó·È ÛÙ·ıÂÚ‹, Âappleo˘ÏÒ-ÓÂÙ·È appleÈo ÁÚ‹ÁoÚ· Î·È Â›Ó·È appleÈo ·ÛÊ·Ï‹˜ ÁÈ·Ù›appleÚoÛٷهÂÙ·È ·applefi Ùo apple¿Óˆ ‚ϤʷÚo, ÂÓÒ ·ÓÙ›ıÂ-Ù·, Ë ÎÂÚ·ÙÈ΋ ÙoÌ‹ ‹ Ë ÎÚoÙ·ÊÈ΋ ÙoÌ‹ ıˆÚo‡-ÓÙ·È ·appleoÚÚÈapple٤˜ ÛÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜ ÁÈ·Ù›·ÎÚÈ‚Ò˜ ‰ÂÓ appleÏËÚo‡Ó ÙȘ apple·Ú·apple¿Óˆ appleÚo¸appleoı¤ÛÂȘ(Mc Dermott 1997).∏ ÂappleÈÏoÁ‹ Ùo˘ ›‰o˘˜ Ùo˘ ÂÓ‰oÊ·Îo‡ ÎÏ›ÓÂÈÌ¿ÏÏoÓ appleÚo˜ ÙË ÌÂÚÈ¿ ÂÓfi˜ ƒªª∞ ÂÓ‰oÊ·Îo‡‰È·Ì¤ÙÚo˘ 7 ¯ÈÏ., ¯ˆÚ›˜ ÙÚ‡apple˜, appleo˘ ÙoappleoıÂÙ›ٷȷapplefi ÙË 12 Ë ÒÚ·. ∞˘Ùfi ÂÎÊÚ¿˙ÂÈ ÙËÓ appleÚoÙ›ÌËÛË ÙˆÓappleÂÚÈÛÛfiÙÂÚˆÓ ¯ÂÈÚo˘ÚÁÒÓ (Mc Dermott 1997, McCuen 1980). To ̤ÁÂıo˜ Î·È Ùo ›‰o˜ Ùo˘ ÂÓ‰oÊ·-Îo‡ ·˘Ùo‡ ·ÛÊ·ÏÒ˜ Ù·ÈÚÈ¿˙o˘Ó appleÂÚÈÛÛfiÙÂÚo ÌÂÙËÓ ÛÎÏËÚoÎÂÚ·ÙÈ΋ ÙoÌ‹ ÁÈ· appleÚoÊ·Ó›˜ ÏfiÁo˘˜.Ú¤appleÂÈ fï˜ Ó· appleÚoÛÙÂı› Â‰Ò fiÙÈ Î·È ·applefi Ù˯ڋÛË ·Ó·‰ÈappleÏo‡ÌÂÓˆÓ ·ÎÚ˘ÏÈÎÒÓ ÂÓ‰oÊ·ÎÒÓ ‰È-·Ì¤ÙÚo˘ 6 ¯ÈÏ., Ùo˘˜ oappleo›o˘˜ ¯ÚËÛÈÌoappleoÈ‹Û·Ì Û·ÚÎÂÙ¿ appleÂÚÈÛÙ·ÙÈο Ì·˜, ¤¯o˘Ì ‰ÂÈ appleoχ ηϿ·appleoÙÂϤÛÌ·Ù· (¢ÂÚÂÎÏ‹˜ 2000).ÃÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋∏ ‚ÈÙÚÂÎÙoÌ‹ ·Ê·ÈÚ› Ùo ˘·ÏoÂȉ¤˜ Î·È ÛÙÂ-Ú› ·applefi Ùo Ê·Îfi Î·È ÙË ˙›ÓÓÂÈo ˙ÒÓË ¤Ó· Ê˘ÛÈoÏo-ÁÈÎfi ÛÙ‹ÚÈÁÌ· Ùo˘ oappleo›o˘ Ë ÛËÌ·Û›· ·Ó·‰ÂÈÎÓ‡Â-Ù·È appleoχ ¤ÌappleÚ·ÎÙ· ÛÙËÓ ¯ÂÈÚo˘ÚÁÈ΋ Ùo˘ ηٷÚ-Ú¿ÎÙË. ∂appleÈappleϤoÓ, Û˘Ó˘apple¿Ú¯o˘Ó ÛÙȘ appleÂÚÈappleÙÒÛÂȘ·˘Ù¤˜ appleoχ Û˘¯Ó¿ Î·È ¿ÏÏoÈ apple·Ú¿ÁoÓÙ˜ appleo˘Âapple·˘Í¿Óo˘Ó ÙË ‚·ÛÈ΋ ‰˘ÛÎoÏ›· appleo˘ appleÚo·appleÙÂÈ·applefi ÙËÓ ·appleo˘Û›· Ùo˘ ˘·ÏoÂȉo‡˜, fiappleˆ˜:1. ∏ ·ÓÂapple·Ú΋˜ Û˘Ó‹ıˆ˜ Ì˘‰Ú›·ÛË.2. O˘Ï¤˜ Î·È apple·Ú·ÌoÚÊÒÛÂȘ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ·.3. ∞‰‡Ó·ÙË ‹ Ûapple·Ṳ̂ÓË ˙›ÓÓÂÈo˜ ˙ÒÓË.4. £oÏÒÛÂȘ Ùo˘ oappleÈÛı›o˘ appleÂÚÈʷΛo˘.5. ƒ‹ÍÂȘ Î·È ·˘ÍË̤ÓË ÎÈÓËÙÈÎfiÙËÙ· Ùo˘ oappleÈ-Ûı›o˘ appleÂÚÈʷΛo˘.6. ∞ÛÙ·ı¤˜ ‚¿ıo˜ Ùo˘ appleÚoÛı›o˘ ı·Ï¿Ìo˘.∏ ÂÏÏÈapple‹˜ Ì˘‰Ú›·ÛË ÌappleoÚ› ˆ˜ ¤Ó· ‚·ıÌfi Ó··ÓÙÈÌÂÙˆappleÈÛı› Ì Ùo˘˜ ‰È·ÛÙoÏ›˜ Ù˘ ›Úȉo˜. ∏apple·Ú·Û΢‹ fï˜ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ· Â›Ó·È Î·Ù¿ η-ÓfiÓ· ‰‡ÛÎoÏË. ªÈ· ηϋ χÛË ÁÈ’ ·˘Ùfi Â›Ó·È Ë ‰ÈÂ-Ó¤ÚÁÂÈ· ÌÈ·˜ ·apple¢ı›·˜ ÙoÌ‹˜ Ì ¤Ó· ÎoÊÙÂÚfi Ì·-¯·ÈÚ›‰Èo apple¿Óˆ ÛÙo Û‡ÛÙËÌ· ÂappleÈappleÂÊ˘ÎfiÙo˜- ÛÎÏË-

158 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Úo‡ ¯ˆÚ›˜ ÙË ÌÂÛoÏ¿‚ËÛË „·ÏȉÈo‡. ∏ η„o˘ÏfiÚ-ÚËÍË, appleo˘ ·ÎoÏo˘ı›, appleÚ¤appleÂÈ Ó· ÂappleȉÈÒÎÂÙ·È Ó·Â›Ó·È ·ÚÎÂÙ¿ ÌÂÁ¿ÏË, ÒÛÙ ӷ ‰È¢ÎoχÓÂÈ ÌÂÙÂÁ-¯ÂÈÚËÙÈο ÙËÓ oappleÙÈ΋ appleÚoÛapple¤Ï·ÛË Ùo˘ ‚˘ıo‡ ÁÈ·ÂͤٷÛË, ıÂÚ·apple›· ‹, Â¿Ó ˘apple¿ÚÍÂÈ ·Ó¿ÁÎË, ÌÈ·ÂappleÈappleÚfiÛıÂÙË ÂÁ¯Â›ÚËÛË (Mc Dermott 1997).∞˘Ùfi fï˜ appleo˘ ·appleoÙÂÏ› Ùo ÌfiÓÈÌo appleÚfi‚ÏË̷ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Âapple¤Ì‚·Û˘ Î·È ÙËÓ Î‡ÚÈ· ¤Ó-ÓoÈ· Ùo˘ ¯ÂÈÚo˘ÚÁo‡ Â›Ó·È Ùo ÌÂÙ·‚·ÏÏfiÌÂÓo ‚¿-ıo˜ Ùo˘ appleÚoÛı›o˘ ı·Ï¿Ìo˘ Î·È Ùo Û¯ÂÙÈο ·-ÛÙ·ı¤˜ Û‡ÛÙËÌ· appleÂÚÈʷΛo˘-˙ÈÓÓ›o˘ ˙ÒÓ˘. ∂¿Ó˘appleoı¤Ûo˘Ì fiÙÈ ‰ÂÓ Û˘ÓÙÚ¤¯o˘Ó ÂȉÈÎo› ÏfiÁoÈ, fiappleˆ˜Ú‹ÍË Ù˘ ˙ÈÓÓ›o˘ ˙ÒÓ˘, Ú‹ÍË appleÂÚÈʷΛo˘,appleoχ ÛÎÏËÚfi˜ apple˘Ú‹Ó·˜, o appleÚoÁÚ·ÌÌ·ÙÈÛÌfi˜ ÁÈ·ÌÈ· Ù˘appleÈ΋ Ê·ÎoıÚ˘„›· Â›Ó·È Ë appleÈo ÛˆÛÙ‹ χÛË.‹ÌÂÚ· Ë Ê·ÎoıÚ˘„›· ·appleoÙÂÏ› ۯ‰fiÓ ÙoÓ Î·Ófi-Ó·, ÁÈ·Ù› Ì ÙoÓ Î·ÈÚfi ·appleo‰Â›¯ıËΠfiÙÈ Ë ∂∂∫,ÛÙȘ appleÂÚÈappleÙÒÛÂȘ ·˘Ù¤˜, ¤¯ÂÈ appleÂÚÈÛÛfiÙÂÚ˜ ‰˘-ÛÎoϛ˜ Î·È ÌÂÈoÓÂÎÙ‹Ì·Ù· (Meyers 1978, Hutton1987, Ruellan 1993).∞˘Ùfi appleo˘ ˘appleoÁÚ·ÌÌ›˙ÂÙ·È ·applefi fiÏo˘˜ Ùo˘˜Û˘ÁÁÚ·Ê›˜ Â›Ó·È Ë È‰È·›ÙÂÚË appleÚoÛo¯‹ appleo˘ appleÚ¤appleÂÈÓ· ‰›ÓÂÙ·È ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÂÓfi˜ ηı·Úo‡ oappleÙÈ-Îo‡ apple‰›o˘ (fi¯È ‰Èappleψ̤Óo˜ ·applefi ÎÂÚ·ÙÈΤ˜ Ùo̤˜ÎÂÚ·ÙoÂȉ‹˜) Î·È ÙËÓ ‰È·Ù‹ÚËÛË Ù˘ ·Ó·ÚÚfiÊËÛË˜Î·È Ù˘ ¤Á¯˘Û˘ Û ۯÂÙÈο ¯·ÌËÏ¿ Âapple›apple‰·. ΔoÓ›-˙ÂÙ·È Ì ȉȷ›ÙÂÚË ¤ÌÊ·ÛË Ë ·Ó¿ÁÎË Ù˘ ÂÊ·Ú-ÌoÁ‹˜ ÌÈ·˜ Ù·ÎÙÈ΋˜ Ì ‚Ú·‰Â›˜ Î·È ‹appleÈo˘˜ ÁÂÓÈÎ¿Ú˘ıÌo‡˜. °È· Ó· ÂÓÈÛ¯˘ıo‡Ó ·ÎfiÌË appleÈo appleoχ oÈ ·-ÛÊ·Ï›˜ ·˘Ùo› ¯ÂÈÚÈÛÌo› Û˘ÛÙ‹ÓÂÙ·È Âapple› appleϤoÓ, ÌÂ-Ù¿ ÙË ‰ËÌÈo˘ÚÁ›· Ùo˘ ÛÙ·˘Úo‡, Ùo Ûapple¿ÛÈÌo Ùo˘ apple˘-Ú‹Ó· Ó· Á›ÓÂÙ·È Ì ¿ÁÎÈÛÙÚ· Î·È Î¿Ùˆ ·applefi ÛÙ·ıÂ-Ú¤˜ Û˘Óı‹Î˜, appleo˘ ÌappleoÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ appleoχappleÈo ·appleoÙÂÏÂÛÌ·ÙÈο Ë ¯Ú‹ÛË ÂÓfi˜ Û˘ÓÙËÚËÙ‹appleÚoÛı›o˘ ı·Ï¿Ìo˘. Δo ›‰Èo ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙËÓ Ê¿-ÛË Ù˘ ·Ó·ÚÚfiÊËÛ˘ ÙˆÓ «Ì·˙ÒÓ», fiappleo˘ oÈ Î·Ù¿ÙoÓ Î·Ï‡ÙÂÚo ‰˘Ó·Ùfi ÙÚfiappleo ÂÏÂÁ¯fiÌÂÓ˜ Û¯¤ÛÂȘ¤Á¯˘Û˘-·Ó·ÚÚfiÊËÛ˘ ÂÏ·¯ÈÛÙoappleoÈo‡Ó ÛÙo ̤ÁÈ-ÛÙo ‰˘Ó·Ùfi ‚·ıÌfi ÙoÓ Î›Ó‰˘Óo ÙˆÓ ÂappleÈappleÏoÎÒÓ(¢ÂÚÂÎÏ‹˜ 1989, 2000, Mc Dermott 1997).∂¿Ó ˘apple¿Ú¯ÂÈ Ú‹ÍË Ùo˘ oappleÈÛı›o˘ appleÂÚÈʷΛo˘ ‹‚Ï¿‚Ë Ù˘ ˙ÈÓÓ›o˘ ˙ÒÓ˘ Û ¤ÎÙ·ÛË apple¿Óˆ ·applefi 25-30%, o ¯ÂÈÚo˘ÚÁfi˜ appleÚ¤appleÂÈ Ó· appleÚoÛ·ÚÌfiÛÂÈ ÙËÓÙ¯ÓÈ΋ Û ·˘Ù¤˜ ÙȘ Û˘Óı‹Î˜. ÙËÓ appleÚÒÙË appleÂÚ›-appleÙˆÛË ÎÏ·ÛÈ΋ χÛË ıˆÚÂ›Ù·È ÌÈ· Ù˘appleÈ΋ ∂∂∫ ̯ڋÛË ÎÚ˘o‰›o˘ ‹ ·Á·Ï˘ ÁÈ· ÙËÓ ·Ê·›ÚÂÛË Ùo˘apple˘Ú‹Ó·. Ú¤appleÂÈ Ó· ·appleoʇÁÂÙ·È Î¿ı appleÚoÛapple¿-ıÂÈ· apple›ÂÛ˘-¤ÎıÏȄ˘, ÁÈ·Ù› ÂÁ΢ÌoÓ› ÙoÓ Î›Ó-‰˘Óo Ù˘ ÌÂÙ·ÙfiappleÈÛ˘ Ùo˘ Ê·Îo‡ ÛÙo ˘·ÏoÂȉ¤˜.·ÚfiÏ· ·˘Ù¿ fï˜, ·ÚÎÂÙo› ¯ÂÈÚo˘ÚÁo› appleÚoÙÈÌo‡ÓÙËÓ Ê·ÎoıÚ˘„›· Î·È Û’ ·˘Ù¤˜ ÙȘ appleÂÚÈappleÙÒÛÂȘ. ΔoÂappleȯ›ÚËÌ· Â›Ó·È fiÙÈ Ë ÙÂÏÂ˘Ù·›· ÂÍ·ÛÊ·Ï›˙ÂÈ ÛÙ·-ıÂÚ¤˜ Û˘Óı‹Î˜ ÙfiÓo˘, Âappleo̤ӈ˜ Î·È Î·Ïfi ¯ÂÈ-Úo˘ÚÁÈÎfi apple‰›o, Î·È ÌappleoÚ› ηÓ›˜, ÏÂÈÙo˘ÚÁÒÓÙ·˜Ì ¯·ÌËϤ˜ appleȤÛÂȘ-·Ó·ÚÚoÊ‹ÛÂȘ Î·È È‰È·›ÙÂÚËappleÚoÛo¯‹, Ó· ·appleoʇÁÂÈ ÙËÓ ·appleÒÏÂÈ· Ùo˘ apple˘Ú‹Ó· ÛÙo˘·ÏoÂȉ¤˜, ÂÓÒ apple·Ú¿ÏÏËÏ· ı· ¤¯ÂÈ Ùo Τډo˜ Ù˘ÌÈÎÚ‹˜ ÙoÌ‹˜. ΔËÓ ›‰È· ÂappleȯÂÈÚËÌ·ÙoÏoÁ›· Î·È ÙËÓ›‰È· Ù·ÎÙÈ΋ ÌappleoÚ› ηÓ›˜ Ó· ÂappleÈηÏÂÛı› Î·È Ó·ÂÊ·ÚÌfiÛÂÈ Î·È ÛÙȘ appleÂÚÈappleÙÒÛÂȘ Ì Ûapple·Ṳ̂ÓË ˙›Ó-ÓÂÈo ˙ÒÓË. ∞Ó Ë ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘ ‰ÂÓ ÍÂappleÂÚÓ¿ Ùo25-30%, ÙfiÙÂ Ë Ï‡ÛË Â›Ó·È Û¯ÂÙÈο ‡ÎoÏË. ∂¿Ó Ë‚Ï¿‚Ë Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, ÌappleoÚ› Ó· Ê·Ó› ¯Ú‹ÛÈÌo˜o ÂȉÈÎfi˜ ‰·ÎÙ‡ÏÈo˜ appleo˘ Û˘ÁÎÚ·Ù› Î·È ˘appleoÛÙËÚ›˙ÂÈÙo appleÂÚÈÊ¿ÎÈo (Cionni 2000).∏ ÂappleÈÏoÁ‹ Ùo˘ ÂÓ‰oÊ·Îo‡ ÂÍ·ÚÙ¿Ù·È ·applefi ÙÈ˜Û˘Óı‹Î˜ appleo˘ ¤¯o˘Ó ‰È·ÌoÚʈı› ηٿ Ùo Ù¤Ïo˜Ù˘ Âapple¤Ì‚·Û˘. ∏ appleÚoÙÈÌËÙ¤· χÛË Â›Ó·È ¤Ó·˜ ·-Ó·‰ÈappleÏo‡ÌÂÓo˜ ·ÎÚ˘ÏÈÎfi˜ ÂÓ‰oÊ·Îfi˜ oappleÙÈ΋˜ ˙Ò-Ó˘ ‰È·Ì¤ÙÚo˘ 6 ¯ÈÏ. ̤۷ ÛÙo Û¿ÎÎo ÂÓfi˜ ˘ÁÈo‡˜appleÂÚÈʷΛo˘. ∏ ‰Â‡ÙÂÚË Î·Ï‡ÙÂÚË Ï‡ÛË Â›Ó·È ¤Ó·˜apple·ÚfiÌoÈo˜ Ê·Îfi˜ ÌappleÚoÛÙ¿ ·applefi ¤Ó· Âapple·ÚΤ˜ ˘applefi-ÏÂÈÌÌ· oappleÈÛı›o˘ appleÂÚÈʷΛo˘ ÛÙËÚÈÁ̤Óo˜ ÛÙosulcus (Smiddy 1987). ŸÙ·Ó Ë ÙÂÏÂ˘Ù·›· χÛË ‰ÂÓÂ›Ó·È ÂÊÈÎÙ‹, ·appleo̤Óo˘Ó Û·Ó Ï‡ÛÂȘ Ë ÛÙ‹ÚÈÍËÂÓfi˜ ÂÓ‰oÊ·Îo‡ ÛÙoÓ ÛÎÏËÚfi ‹ Ë Ùoappleoı¤ÙËÛË ÂÓfi˜ÂÓ‰oÊ·Îo‡ appleÚoÛı›o˘ ı·Ï¿Ìo˘. ∏ appleÚÒÙË ¤¯ÂÈ Ù·ÌÂÈoÓÂÎÙ‹Ì·Ù· ÙˆÓ appleÈı·ÓÒÓ Ûo‚·ÚÒÓ ÂappleÈappleÏoÎÒÓÙ˘, ÂÓÒ Ë ‰Â‡ÙÂÚË ı· ‰ËÌÈo˘ÚÁ‹ÛÂÈ ‰˘ÛÎoϛ˜, Â-¿Ó ¯ÚÂÈ·Ûı› ÌÈ· Ó¤· ‚ÈÙÚÂÎÙoÌ‹ Î·È ÂÊ·ÚÌoÁ‹ÛÈÏÈÎfiÓ˘ ‹ ·ÂÚ›o˘ ÛÙ· Ì¿ÙÈ· appleo˘ ı· ÂÌÊ·Ó›Ûo˘Ó˘appleoÙÚoapple‹ Ù˘ apple·ıoÏoÁ›·˜ Ùo˘ ‚˘ıo‡. Ú¤appleÂÈ Ó·ÛËÌÂȈı›, Ù¤Ïo˜, fiÙÈ Ë ·appleo˘Û›· Ùo˘ ˘·ÏoÂȉo‡˜ÛÙÂÚ› ·applefi ·˘Ù¿ Ù· Ì¿ÙÈ· ÙoÓ Ê˘ÛÈoÏoÁÈÎfi ÊÚ·Á-Ìfi appleo˘ Ù· appleÚoÛٷهÂÈ ·applefi ÙËÓ ÙoÍÈ΋ ÁÈ· ÙoÓ ·Ì-ÊÈ‚ÏËÛÙÚoÂȉ‹ Âapple›‰Ú·ÛË o˘ÛÈÒÓ appleo˘ ÂӉ¯fiÌÂÓ·ı· ¯ÚÂÈ·˙fiÙ·Ó Ó· ¯ÚËÛÈÌoappleoÈËıo‡Ó ÛÙË ¯ÂÈÚo˘Ú-ÁÈ΋ Ùo˘ ηٷÚÚ¿ÎÙË, apple.¯. ·ÌÈÓoÁÏ˘ÎoÛȉÒÓ, ·-‰ÚÂÓ·Ï›Ó˘, Î.Ï.apple. ∏ ·appleo˘Û›· Ùo˘ ˘·ÏoÂȉo‡˜ Âappleo-̤ӈ˜ ÂappleÈ‚¿ÏÏÂÈ Î·È ÙËÓ ·appleoÊ˘Á‹ Ù˘ ¯Ú‹Û˘ ·˘-ÙÒÓ ÙˆÓ o˘ÛÈÒÓ (Grusha 1998)∞appleÔÙÂϤÛÌ·Ù·Δo ÏÂÈÙo˘ÚÁÈÎfi ·appleoÙ¤ÏÂÛÌ· ÌÂÙ¿ ÙËÓ ÂÁ¯Â›-ÚËÛË Ùo˘ ηٷÚÚ¿ÎÙË Û ̿ÙÈ· appleo˘ ¤¯o˘Ó ˘appleoÛÙ›‚ÈÙÚÂÎÙoÌ‹ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·applefi ÙËÓ Î·Ù¿ÛÙ·ÛË,·Ó·ÙoÌÈ΋ Î·È ÏÂÈÙo˘ÚÁÈ΋, Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂÈ-‰o‡˜ Î·È ÂȉÈÎfiÙÂÚ· Ù˘ ˆ¯Ú¿˜, appleo˘ ¤¯ÂÈ ‰È·ÌoÚ-ʈı› ·applefi ÙËÓ appleÚˆÙoÁÂÓ‹ apple·ıoÏoÁ›· Ùo˘˜ (·appleo-ÎfiÏÏËÛË ·ÌÊ/‰o‡˜, ‰È·‚ËÙÈ΋ ·ÌÊ/ıÂÈ·, oapple‹ Ù˘

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160 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)national Edition, Vol 7, No 6; 18-19, 1995.10. ¢ÂÚÂÎÏ‹˜ ¢, §¿Î , ΔÂÚ˙›‰o˘ Ã, ºÈÏ›‰Ë˜ ∫. ∏ ¯ÂÈÚo˘Ú-ÁÈ΋ ·ÓÙÈÌÂÙÒappleÈÛË Ùo˘ ÛÈÏÈÎoÓÔÁÂÓo‡˜ ηٷÚÚ¿ÎÙË.OÊı·ÏÌoÏoÁ›· 4, 4: 324-337, 1992.11. ¢ÂÚÂÎÏ‹˜ ¢, §¿Î , ·Úı¤Ó˘ ∞. ¢È·ıÏ·ÛÙÈΤ˜ ÌÂÙ·-‚oϤ˜ Û ̿ÙÈ· Ì ÂÓ‰o‚oÏ‚È΋ ÛÈÏÈÎfiÓË. OÊı·ÏÌo-ÏoÁ›· 1, 4: 350-352, 1989.12. ¢ÂÚÂÎÏ‹˜ ¢. ∏ Ù¯ÓÈ΋ Ù˘ Â͈appleÂÚÈÊ·ÎÈ΋˜ ÂÍ·›ÚÂÛ˘Ùo˘ ηٷÚÚ¿ÎÙË Î·È ¤ÓıÂÛ˘ ÂÓ‰oÊ·Îo‡ oappleÈÛı›o˘ı·Ï¿Ìo˘ Ì ÙË ¯Ú‹ÛË ‰È·ÙËÚËÙ‹ ı·Ï¿Ìo˘ . OÊı·Ï-ÌoÏoÁ›· 1, 1: 27-35, 1989.13. ¢ÂÚÂÎÏ‹˜ ¢, §¿Î , ∫o„·¯Â›Ï˘ ∂, ·apple·˚ˆ¿ÓÓo˘ £,°È¿ÎoÌapple . ∂ÌappleÂÈÚ›· ·applefi ÙËÓ ÂÊ·ÚÌoÁ‹ 500 ·ÎÚ˘ÏÈ-ÎÒÓ ÂÓ‰oÊ·ÎÒÓ. OÊı·ÏÌoÏoÁ›· 11,2 :162-168, 1999.14. ¢ÂÚÂÎÏ‹˜ ¢, §¿Î , ªappleÚ·˙ÈÙ›Îo˜ , °È¿ÎoÌapple ,∞Ó‰Úo‡‰Ë , ªÈÎÚfiappleo˘Ïo˜ ¢, Ù¿ÁÎo˜ ¡. ∂Á¯Â›ÚËÛËÙÚ·˘Ì·ÙÈÎo‡ ηٷÚÚ¿ÎÙË, ‚ÈÙÚÂÎÙoÌ‹, ·Ê·›ÚÂÛË ÂÓ-‰o‚oÏ‚ÈÎo‡ ͤÓo˘ ÛÒÌ·Ùo˜ Î·È ÂÊ·ÚÌoÁ‹ ÂÓ‰oÊ·Îo‡Û ¤Ó· ¯ÚfiÓo. OÊı·ÏÌoÏoÁ›· 12, 2: 158-165, 2000.15. Dohrmann KP, Atkins RE, Roth FD. Results in cataractextraction after retinal detachment Surgery. ModProbl Ophthalmol 18: 484-493, 1977.16. Faulborn J, Conway BP, Machemer R. Surgical Complicationsof pars plana vitreons Surgery. Ophthalmology95: 870-876, 1988.17. Freeman WR, Stanley PA, Kim JW. Vitrectomy for thetreatment of full-thickness stage 3 or 4 macular holes.Arch Ophthalmol 115: 11-21, 1997.18. Grusha YD, Masket S, Miller KM. Phacoemulcificationand lens implantation after pars plana vitrectomy.Ophthalmolory 105: 287-294, 1998.19. Haimann MH, Abrams GW. Prevention of lens opacificationduring diabetic vitrectomy. Ophthalmology 91:116-121, 1984.20. Hakin KN, Lavin MS, Leaver PK. Primary vitrectomy forrhegmatogenous retinal detachment. Graefes ArchClin Exp Ophthalmol 231: 344-346, 1993.21. Helbing H, Kellner V, Bornfeld N, Foerster MH. CataractSurgery and Yag Laser Capsulotomy Following Vitrectomyfor diabetic retinopathy. Ger J Ophthalmol 5:408-414, 1997.22. Hutton WL, Pesicka GA, Fuller DG. Cataract extractionin diabetic eye after vitrectomy. Am J Ophthalmol104: 1-4, 1987.23. Lacalle VD, Garate FJO, Alday NM. Phacoemulcificationcataract surgery in vitrectomized eyes. J CatarRefract Surg 24: 806-809, 1998.24. §¿Î , ¢ÂÚÂÎÏ‹˜ ¢, ∞ÏÂÍ·Ó‰Ú›‰Ë˜ ∞, º·ÓÙ¤Ï ∂, μo˘-ÓoÙÚ˘apple›‰Ë˜ ∏. ∂appleÈappleÏoΤ˜ ÂÓ‰o‚oÏ‚È΋˜ ÛÈÏÈÎfiÓ˘.OÊı·ÏÌoÏoÁ›· 1, 2: 109- 113, 1989.25. Leaver, Grey RHB, Garner A. Silicone oil injection in thetreatment of massive preretinal retraction.26. Lucke KH, Foerter MH, Laqua H. Long term results ofvitrectomy and silicone oil in 500 cases of complicatedretinal detachments. Am J Ophthalmol 104: 624-633,1987.25. Margherio RR, Cox MS Jr, Trese MT. Removal of epimacularmembranes. Ophthalmology 92: 1075-1083, 1985.26. Mc Cuen BW, Klombers L. The choice of posteriorchamber intraocular lens style in patiens with diabeticretinopathy. Arch Ophthalmol 108: 1376-1377, 1980.27. Mc Dermott ML, Puklin JE, Abrams GW, Eliot D. Phacoemulsificationfor cataract following pars plana vitrectomy.OphthalmicSurg Lasers 28: 558-564, 1997.28. Melberg MS, Thomas MA. Nuclear sclerotic cataractafter vitrectomy in patiens younger than 50 years ofage.Ophthalmology 102: 1466-1471, 1995.29. Mester V, Grewing R. Linsentrubungen nach pars planavitrectomie.Fortschr Ophthalmol 86: 429-432, 1989.30. Meyers SM, Klein R, Chandra S, Meyers FL. Unplannedextracapsular cataract extraction in postvitrectomyeyes.Am J Ophthalmol 86: 624-626, 1978.31. Michels RG. Vitrectomy for macular pucker. Ophthalmology91: 134-138, 1984.32. Nakazawa M, Kimizuka Y, Watabe T. Visual outcome aftervitrectomy for diabetic retinopathy: A five year followup. Acta Ophthalmol 97: 627-631, 1993.33. Novak MA, Rice TA, Michels RG, Aner C. The crystallinelens after vitrectomy for diabetic retinopathy. Ophthalmology91: 1480- 1484, 1984.34. Ogura Y, Takanashi T, Ishigooka H, Ogino N. Quantativeanalysis of lens change after vitrectomy. Am J Ophthalmology111: 179-183, 1991.35. Pesin SR, Oik RJ, Grand Hg. Vitrectomy for premacularfibroplasia: Prognostic Factors, long term follow upand time course of visual improvement. Ophthalmology98: 1109-1114, 1991.36. Poliner LS, Oik RJ, Grand MG. Surgical management ofpremacular fibroplasia. Arch Ophthalmol 106: 761-764, 1984.37. Ruellau YH, Hamard H, Fu WL. Cataracte et implantationsur oil vitrectomise. J Fr Ophthalmol 16: 315-319, 1993.38. Saunders DC, Brown A, Jones NP. Extracapsular cataractextraction after vitrectomy. J Cataract RefractSurg 22: 218-221, 1996.39. Smiddy WE, Stark WJ, Michels RG. Cataract extractionafter vitrectomy. Ophthalmology 94: 483-487, 1987.40. Sneed S, Parrish RK II, Mandelbanm S, Gray G. Technicalproblems of extracapsular cataract extraction aftervitrectomy. Arch Ophthalmol 102: 1077-10778, 1984.41. Thompson JT, Glaser BM, Sjaarda RN, Murphy RP. Progressionnuclear sclerosis and long term visual resultsof vitrectomy with tranforming growth factor beta 2for macular holes. Am J Ophthalmol 119: 48-54, 1995.42. Wilbrandt HR, Wilbrandt TH. Phacogenesis and managementof the lens- iris diaphragm retropulsion syndromeduring phacoemulsification. J cataract RefractiveSurg 20: 48-53, 1994.

∫ÏÈÓÈΤ˜ Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ÌÂϤÙ˜∂appleÈ̤ÏÂÈ·: ¡. °ÂˆÚÁÈ¿‰Ë˜e-mail: gnick@med.auth.grO ÂappleÈappleÔÏ·ÛÌfi˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·appleÔÊÔÏ›‰ˆÛ˘ÛÙÔ NÔÌfi ¤ÏÏ·˜. TÛÈÚÒÓË 1 , A. Mapple¤ÓÔ˜2, A. Z·ÊÂÈÚÈ¿‰Ë˜1, . Mȯ·‹Ï 1 , A. TÚ˘ÊˆÓ›‰Ô˘1, °. TÛ·Ô‡Û˘1The frequency of exfoliation syndrome in the populationof the Greek Region of PellaS. Tsironi, A. Benos, A. Zafiriadis, P. Mihail, A. Trifonidou, G. TsaousisÎÔapplefi˜: O appleÚoÛ‰ÈoÚÈÛÌfi˜ Ùo˘ ˘Ó‰ÚfiÌo˘ ∞appleoÊoÏ›‰ˆ-Û˘ (∞) ÛÙoÓ appleÏËı˘ÛÌfi Ùo˘ ÓoÌo‡ ¤ÏÏ·˜. ∞ÛıÂÓ›˜Î·È ̤ıo‰o˜: ∂Ê·ÚÌfiÛÙËΠappleÚoηıoÚÈṲ̂Óo ÂÍÂÙ·ÛÙÈ-Îfi appleÚˆÙfiÎoÏÏo Î·È ÂÍÂÙ¿ÛÙËÎ·Ó 700 ¿ÙoÌ· ·applefi 45 ÂÙÒÓÎ·È ¿Óˆ (350 ¿Ó‰Ú˜ Î·È 350 Á˘Ó·›Î˜), appleo˘ appleÚoÛ‹Ïı·ÓÌÂÙ¿ ·applefi appleÚfiÛÎÏËÛË ÁÈ· appleÚoÏËappleÙÈÎfi ¤ÏÂÁ¯o. ∏ ·Ó·ÏoÁ›·ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ ˆ˜ appleÚo˜ ÙËÓ Âapple·Ú¯›· appleÚo¤ÏÂ˘Û‹˜Ùo˘˜ Î·È ÙËÓ ÎoÈÓˆÓÈ΋ Û‡ÓıÂÛË, ÙËÚ‹ıËΠÛÙo ‰Â›ÁÌ·fiappleˆ˜ ‰È·appleÈÛÙÒıËΠ·applefi Ù· ÛÙoȯ›· Ù˘ ∂ıÓÈ΋˜ Ù·ÙÈ-ÛÙÈ΋˜ ÀappleËÚÂÛ›·˜. ∞appleoÙÂϤÛÌ·Ù·: ∞ ‰È·appleÈÛÙÒıËΠÛÂappleoÛoÛÙfi 10% ÛÙo Û‡ÓoÏo Ùo˘ ‰Â›ÁÌ·Ùo˜. Δ· appleoÛoÛÙ¿ ∞appleo˘ ‰È·appleÈÛÙÒıËÎ·Ó ·Ó¿ ËÏÈÎȷ΋ oÌ¿‰· ‹Ù·Ó 0% ÛÙËÓoÌ¿‰· ·applefi 45-54 ÂÙÒÓ, 2% ÛÙËÓ oÌ¿‰· 55-64, 21,33%ÛÙËÓ oÌ¿‰· 65-74 Î·È 34% ÛÙËÓ oÌ¿‰· Ì ËÏÈΛ· ·applefi 75ÂÙÒÓ Î·È ¿Óˆ. ¢ÂÓ ‰È·appleÈÛÙÒıËΠÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋‰È·ÊoÚ¿ ÂappleÈappleoÏ·ÛÌo‡ Ùo˘ ∞ ·Ó¿ÌÂÛ· ÛÙȘ ÙÚÂȘ Âapple·Ú-¯›Â˜ Ùo˘ ÓoÌo‡ ¤ÏÏ·˜. Ù· ‰‡o ʇϷ ∞ ÂÌÊ·Ó›ÛÙËΠÛÂappleoÛoÛÙ¿ 8,85% (¿Ó‰Ú˜) Î·È 11,14% (Á˘Ó·›Î˜), ¯ˆÚ›˜ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊoÚ¿.  appleoÛoÛÙfi 12,7% ÙˆÓ·ÙfiÌˆÓ ÂÓÙoapple›ÛÙËÎ·Ó ‡appleoappleÙ· Â˘Ú‹Ì·Ù· ÁÈ· ·Ó¿appleÙ˘ÍË ∞ÛÙo ̤ÏÏoÓ. ∏ ̤ÛË ∂O ÙˆÓ ·ÙfiÌˆÓ Ì ∞ ‹Ù·Ó 20,04mmHg, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ·applefi ÙˆÓ ˘appleo-Ïo›appleˆÓ, appleo˘ ‹Ù·Ó 15,37 mmHg.  12 ·applefi Ù· 70 ¿ÙoÌ·Ì ∞ (appleoÛoÛÙfi 17,14%) ˘apple‹Ú¯Â ÂÁηÙÂÛÙË̤Óo, ÌË ‰È·-ÁÓˆṲ̂Óo ·appleoÊoÏȉˆÙÈÎfi ÁÏ·‡ÎˆÌ· (∞°), ÂÓÒ ‰È·appleÈÛÙÒıËηÓ9 ¿ÙoÌ· Ì ÌË ‰È·ÁÓˆṲ̂Óo ¯ÚfiÓÈo ÁÏ·‡ÎˆÌ··Óoȯً˜ ÁˆÓ›·˜ (ð∞°) (appleoÛoÛÙfi 1,43%) ÛÙ· ¿ÙoÌ· ¯ˆ-Ú›˜ ∞. ˘ÌappleÂÚ¿ÛÌ·Ù·: O ÂappleÈappleoÏ·ÛÌfi˜ Ùo˘ ∞ Û¿ÙoÌ· ËÏÈΛ·˜ 45 ÂÙÒÓ Î·È ¿Óˆ Ùo˘ ÓoÌo‡ ¤ÏÏ·˜ ·Ó¤Ú-¯ÂÙ·È Û 10% Û‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘. ΔoappleoÛoÛÙfi ·˘Í¿ÓÂÙ·È ‰Ú·Ì·ÙÈο Û ۯ¤ÛË Ì ÙËÓ ¿Óo‰oÙ˘ ËÏÈΛ·˜. Δ· Â˘Ú‹Ì·Ù· appleo˘ ¤¯o˘Ó Û¯¤ÛË Ì Ùo ÁÏ·‡-Έ̷ Î·È ÙËÓ ∂O Û˘ÌʈÓo‡Ó Ì ÙËÓ ‚È‚ÏÈoÁÚ·Ê›·.Purpose: To determine the prevalence of exfoliationsyndrome in the population of Pella. Material andmethods: We studied 700 individuals (350 women and350 men), older than 45. A specified protocol was usedto record the exfoliation findings as well as the suspectclinical signs of exfoliation. Certain information from theNational Statistical Service was used in order to employa cluster, stratified sampling, representative of thepopulation of the region of Pella. Results: Evidentclinical findings were detected in the 10% of theexamined persons. The percentage of evident exfoliationsyndrome was 0% for the group of age 45-54, 2% for thegroup 55-64, 21,33% for the group 66-74 and 34% forthe group of individuals who were older than 75. Therewas no statistically significant difference between thetwo sexes concerning the prevalence of exfoliationsyndrome. Average IOP was higher (20,04 mmHg) forthe patients with exfoliation syndrome than the rest ofthe examined persons (15,37 mmHg). 12 persons fromthe ones with exfoliation syndrome had undiagnosedexfoliative glaucoma, while 9 from the persons withoutexfoliation syndrome had undiagnosed open-angleglaucoma. Conclusions: The prevalence of exfoliationsyndrome in the area of Pella was determined to 10% forpeople older than 45. The percentage of the prevalencearises dramatically for the elder. The findings of thepresent study concerning glaucoma and IOP are similarto those referred by the literature.1OÊı·ÏÌoÏoÁÈ΋ KÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡Ô̷گȷÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ Œ‰ÂÛÛ·˜2∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜, ΔÌ‹Ì· π·ÙÚÈ΋˜, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ·ÓÂappleÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 161 - 170, 2002 161

162 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)∂ÈÛ·ÁˆÁ‹Δo Û‡Ó‰ÚoÌo ·appleoÊoÏ›‰ˆÛ˘ ‹ „¢‰o·appleo-ÊoÏ›‰ˆÛ˘ (∞) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·applefi apple·Ú·ÁˆÁ‹Î·È ÂÓ·applefiıÂÛË ·appleoÊoÏȉˆÙÈÎo‡ ˘ÏÈÎo‡, appleo˘ Û˘Ó›-ÛÙ·Ù·È Û ÏÂ˘Î¿˙o˘Û˜ ÌÈÎÚoÛÎoappleÈΤ˜ ÊoÏ›‰Â˜,Û·Ó ÓÈÊ¿‰Â˜ ¯ÈoÓÈo‡ ‹ Û·Ó «appleÈÙ˘Ú›‰·», ÛÙ· appleÚfi-ÛıÈ· ΢ڛˆ˜ ÌfiÚÈ· Ùo˘ oÊı·ÏÌo‡. Δ· ÁÎÚÈ˙fiÏ¢-η «ÙÂÌ·¯›‰È·» ÂÓ·appleoÙ›ıÂÓÙ·È ÛÙo ÎoÚÈÎfi ¯Â›Ïo˜Ù˘ ›Úȉ·˜ Î·È ÛÙoÓ Ê·Îfi ·ÏÏ¿ Î·È Û ¤Ó· ÛËÌ·-ÓÙÈÎfi ·ÚÈıÌfi oÊı·ÏÌÈÎÒÓ ÈÛÙÒÓ 1 , fiappleˆ˜ ÛÙËÓ ›ÚÈ-‰·, ÛÙoÓ Ê·Îfi, ÛÙoÓ ÂappleÈappleÂÊ˘ÎfiÙ·, ÛÙo ·ÎÙÈÓˆÙfiÛÒÌ· Î·È ÛÙo appleÚfiÛıÈo ˘·ÏoÂȉ¤˜.ø˜ ÁÓˆÛÙfiÓ Ë apple¿ıËÛË apple·Úo˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏoÂӉȷʤÚoÓ Î·È ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ÎoÈÓˆÓÈÎooÈÎoÓo-ÌÈÎfi ÎfiÛÙo˜2, ηıÒ˜ appleoχ Û˘¯Ó¿ Û˘Óo‰Â‡ÂÙ·È ·applefi·‡ÍËÛË Ù˘ ÂÓ‰oÊı¿ÏÌÈ·˜ apple›ÂÛ˘, Ë oappleo›· ÌappleoÚ›ӷ o‰ËÁ‹ÛÂÈ Û ·appleoÊoÏȉˆÙÈÎfi ÁÏ·‡ÎˆÌ· (A°),Ì Âapple·ÎfiÏo˘ıË ‚Ï¿‚Ë Ùo˘ oappleÙÈÎo‡ Ó‡Úo˘ ηȷappleÒÏÂÈ· Ùo˘ oappleÙÈÎo‡ apple‰›o˘. ∂appleÈappleϤoÓ oÈ ·ÛıÂ-Ó›˜ Ì ∞ apple·Úo˘ÛÈ¿˙o˘Ó ȉȷ›ÙÂÚ˜ ‰˘ÛÎoÏ›Â˜Î·È È‰È·ÈÙÂÚfiÙËÙ˜ ηٿ ÙËÓ ¯ÂÈÚo˘ÚÁÈ΋ ·ÓÙÈÌÂ-ÙÒappleÈÛË Ùo˘ ηٷÚÚ¿ÎÙË, Ì ·appleoÙ¤ÏÂÛÌ· ·˘ÍË̤ÓoΛӉ˘Óo ÂÌÊ¿ÓÈÛ˘ ‰ÈÂÁ¯ÂÈÚËÙÈÎÒÓ ÂappleÈappleÏoÎÒÓ.Δo ∞ ıˆÚÂ›Ù·È apple¿ıËÛË ¿ÁÓˆÛÙ˘ ·ÈÙÈoÏo-Á›·˜, appleo˘ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ¿ÙoÌ· ÌÂÁ¿Ï˘ËÏÈΛ·˜3,4 . ·Úo˘ÛÈ¿˙ÂÈ ‰Â ÛËÌ·ÓÙÈΤ˜ ‰È·ÊoÚ¤˜ÛÙËÓ Î·Ù·ÓoÌ‹ Ùo˘ ÛÙȘ ‰È¿ÊoÚ˜ appleÂÚÈo¯¤˜ Ù˘°Ë˜ ·ÏÏ¿ Î·È ÂÓÙfi˜ Ù˘ ›‰È·˜ ¯ÒÚ·˜3,4 .‹ÌÂÚ· ˘apple¿Ú¯ÂÈ ·Ó·Óˆ̤Óo ÂӉȷʤÚoÓÛÙËÓ appleÚfiÛÊ·ÙË ‚È‚ÏÈoÁÚ·Ê›· ÁÈ· Ùo ∞, fi¯È ÌfiÓoÁÈ· ÙËÓ ÁÓˆÛÙ‹ Û˘Û¯¤ÙÈÛ‹ Ùo˘ Ì Ùo ÁÏ·‡ÎˆÌ· ηÈÙo˘˜ ÎÈÓ‰‡Óo˘˜ appleo˘ ÁÂÓÈÎÒ˜ ÂÓ¤¯ÂÈ ÁÈ· ÙoÓ oÊı·Ï-Ìfi ·ÏÏ¿ Î·È ÁÈ· ÙËÓ appleÚfiÛÊ·ÙË ıÂÒÚËÛ‹ Ùo˘ ˆ˜ ÁÂ-ÓÈÎÂ˘Ì¤Ó˘ ‰È·Ù·Ú·¯‹˜1,5-8 , ·Êo‡ ÂÓÙoapple›ÛÙËΠۉȿÊoÚo˘˜ ÈÛÙo‡˜ Ùo˘ ·ÓıÚÒappleÈÓo˘ ÛÒÌ·Ùo˜, fiappleˆ˜Ùo ‰¤ÚÌ·, oÈ ÓÂÊÚo›, Ùo ‹apple·Ú Î·È oÈ appleÓ‡ÌoÓ˜.ÙËÓ ∂ÏÏ¿‰· ¤¯o˘Ó ‰ÈÂÓÂÚÁËı› ¤ˆ˜ Û‹ÌÂڷοappleoȘ ÂappleȉËÌÈoÏoÁÈΤ˜ ÌÂϤÙ˜ Û ‰È¿ÊoÚ˜ appleÂ-ÚÈo¯¤˜, ΢ڛˆ˜ Û oÊı·ÏÌoÏoÁÈÎo‡˜ ·ÛıÂÓ›˜3,9-15Î·È ÏÈÁfiÙÂÚo ÛÂ Ù˘¯·›o ‰Â›ÁÌ· Ùo˘ ÁÂÓÈÎo‡ appleÏËı˘-ÛÌo‡ 16-18 .OÈ ÌÂϤÙ˜ Î·È oÈ appleÏËÚoÊoڛ˜ ÁÈ· Ùo Û‡Ó‰Úo-Ìo ·appleoÊoÏ›‰ˆÛ˘, ÙfiÛo ÛÙËÓ ‰ÈÂıÓ‹ fiÛo Î·È ÛÙËÓÂÏÏËÓÈ΋ ‚È‚ÏÈoÁÚ·Ê›·, ·ÊoÚo‡Ó ΢ڛˆ˜ ¿ÙoÌ·Ù˘ ÙÚ›Ù˘ ËÏÈΛ·˜. ∏ appleÏËÚoÊoÚ›· ÁÈ· ÙoÓ ÂappleÈappleo-Ï·ÛÌfi Ù˘ apple¿ıËÛ˘ Û ËÏÈ˘ ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 60ÂÙÒÓ Â›Ó·È Ï›Á˜. 줂·È· ·applefi Ù· fiÛ· ‹‰Ë ¤¯o˘Ó ·-Ó·ÊÂÚı› Â›Ó·È appleÚoÊ·Ó¤˜ fiÙÈ Ùo ∞ Â›Ó·È apple·ıo-ÏoÁÈ΋ ηٿÛÙ·ÛË ¿ÌÂÛ· ÂÍ·ÚÙÒÌÂÓË ·applefi ÙËÓ Ë-ÏÈΛ·3,4,19,20 .∏ Û˘Û¯¤ÙÈÛË Ùo˘ ∞ Ì Ùo ÁÏ·‡ÎˆÌ· ›ӷÈÛ·Ê‹˜ Î·È Ê·›ÓÂÙ·È fiÙÈ Ùo ∞° Â›Ó·È ÌÈ· ‰‡ÛÎoÏ··ÓÙÈÌÂÙˆappleÈ˙fiÌÂÓË ÎÏÈÓÈ΋ oÓÙfiÙËÙ·1,3,4,20 . ∏ ·˘ÍË-̤ÓË Âapple›appleÙˆÛË ÂappleÈappleÏoÎÒÓ ÙˆÓ ·appleoÊoÏȉˆÙÈÎÒÓoÊı·ÏÌÒÓ Î·Ù¿ ÙËÓ ÂÁ¯Â›ÚËÛË Ùo˘ ηٷÚÚ¿ÎÙË Â›-Ó·È Âapple›Û˘ ÌÈ· ÛËÌ·ÓÙÈ΋ apple·Ú¿ÌÂÙÚo˜3,19 .∂Í·ÈÙ›·˜ ΢ڛˆ˜ ÙˆÓ apple·Ú·apple¿Óˆ ‰Â‰o̤ӈÓ,Ùo ∞ Û˘Ó‰¤ÂÙ·È appleÈı·ÓÒ˜ Ì ·˘ÍË̤Óo ¯ÚfiÓo ηÈÎfiÛÙo˜ ÓoÛËÏ›·˜ ÙˆÓ oÊı·ÏÌoÏoÁÈÎÒÓ ·ÛıÂÓÒÓÎ·È ÌappleoÚ› Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Û˘ÌÌÂÙo¯‹ ÛÙËÓappleÚfiÎÏËÛË oappleÙÈ΋˜ ·Ó·appleËÚ›·˜. ŒÙÛÈ Â›Ó·È È‰È·›ÙÂ-Ú· ÛËÌ·ÓÙÈ΋ Ë appleÏËÚoÊfiÚËÛË ÁÈ· ÙoÓ ÂappleÈappleoÏ·ÛÌfiÙo˘ Û˘Ó‰ÚfiÌo˘ ÛÙoÓ appleÏËı˘ÛÌfi Î·È Ë Â˘·ÈÛıËÙoappleo›ËÛËÙˆÓ oÊı·ÏÌÈ¿ÙÚˆÓ ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿-ÁÓˆÛ‹ Ùo˘.∂appleÈappleϤoÓ, Ë ¿appleo„Ë fiÙÈ appleÚfiÎÂÈÙ·È ÁÈ· Û˘ÛÙË-Ì·ÙÈ΋ ‚Ï¿‚Ë 1,5-8 , Ì ÙoappleÈ΋ ¤ÎÊÚ·ÛË ÛÙoÓ oÊı·Ï-Ìfi, ηıÈÛÙ¿ ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚË ÙËÓ ÛËÌ·Û›· Ù˘‰È¿ÁÓˆÛ‹˜ Ùo˘ ·applefi ÙoÓ oÊı·ÏÌ›·ÙÚo Î·È ÙËÓ appleÈı·Ó‹Û˘ÓÂÚÁ·Û›· Ùo˘ Ì ÙȘ ¿ÏϘ ÂȉÈÎfiÙËÙ˜ appleo˘ÂÓ¤¯oÓÙ·È ÛÙo ÁÂÓÈÎfiÙÂÚo appleÚfi‚ÏËÌ·.ÀÏÈÎfi – M¤ıo‰o˜ÙËÓ ÌÂϤÙË ·˘Ù‹ ˘appleoÏoÁ›ÛÙËΠo ÂappleÈappleoÏ·ÛÌfi˜Ùo˘ ∞ ÛÙoÓ ÓoÌfi ¤ÏÏ·˜ Û’ ¤Ó· ·ÓÙÈappleÚoÛˆapple¢ÙÈÎfi‰Â›ÁÌ· Ùo˘ appleÏËı˘ÛÌo‡ Ù˘ appleÂÚÈo¯‹˜, appleo˘ ηχappleÙÂÈ ËÏÈ-˘ ·applefi 45 ÂÙÒÓ Î·È ¿Óˆ, ‰Â‰o̤Óo˘ fiÙÈ Ù· appleÚÒÈÌ· ÎÏÈ-ÓÈο ÛËÌ›· Ùo˘ ÁÏ·˘ÎÒÌ·Ùo˜ ·Ú¯›˙o˘Ó ·ÚÎÂÙ¿ appleÚÈÓÙËÓ ÙÚ›ÙË ËÏÈΛ·4,17,18 .ÚoÎÂÈ̤Óo˘ Ó· appleÚoÛÂÏ·Ûo˘Ì Ùo˘˜ ÂÍÂÙ·Ûı¤-ÓÙ˜ ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ùo˘ °¡¡ Œ‰ÂÛÛ·˜, fiappleo˘‰ÈÂÓÂÚÁ‹ıËÎÂ Ë apple·Úo‡Û· ÌÂϤÙË, ·applefi ÙoÓ Âapple٤̂ÚÈoÙo˘ 2000 ¤ˆ˜ ÙoÓ ∞appleÚ›ÏÈo Ùo˘ 2001, Û˘ÓÙ¿Í·Ì ¤Ó· ¤-ÓÙ˘appleo-appleÚfiÛÎÏËÛË appleÚoÏËappleÙÈÎo‡ ÂϤÁ¯o˘. Δo ¤ÓÙ˘appleo ·˘-Ùfi ·Ó·ÚÙ‹ıËΠ۠‰ËÌfiÛȘ ˘appleËÚÂۛ˜, ‰‹Ìo˘˜, ÎoÈÓfi-ÙËÙ˜, ÂÚÁoÛÙ¿ÛÈ·, Û¯oÏ›·, ÂÎÎÏËۛ˜, ∫∞∏ Î·È Ê˘-ÛÈο ÛÙo˘˜ ¯ÒÚo˘˜ Ùo˘ ÓoÛoÎoÌ›o˘ Î·È ÛÙ· ΤÓÙÚ· ˘-Á›·˜ Ùo˘ ÓoÌo‡. ∂appleÈappleϤoÓ ¤ÁÈÓ·Ó Âapple·ÓÂÈÏËÌ̤Ó˜ ·Ó·-ÎoÈÓÒÛÂȘ ·applefi Ùo˘˜ ÙoappleÈÎo‡˜ Ú·‰ÈoʈÓÈÎo‡˜ ÛÙ·ıÌo‡˜.Δ¤Ïo˜ Ùo ΛÌÂÓo-appleÚfiÛÎÏËÛË ‰ËÌoÛȇÙËΠηْ Âapple·Ó¿-ÏË„Ë Û fiϘ ÙȘ ÙoappleÈΤ˜ ÂÊËÌÂÚ›‰Â˜ ÙˆÓ ÙÚÈÒÓ Âapple·Ú-¯ÈÒÓ Ùo˘ ÓoÌo‡. ∂ÎÙfi˜ ·applefi Ù· ¿ÙoÌ· appleo˘ appleÚoÛ‹Ïı·Ó,·ÓÙ·appleoÎÚÈÓfiÌÂÓ· ÛÙËÓ appleÚfiÛÎÏËÛ‹ Ì·˜, ¯ÚËÛÈÌoappleoÈ‹-Û·Ì ÁÈ· ÙËÓ ÌÂϤÙË Û˘Óo‰o‡˜ ÙÒÓ Î·Ù¿ ηÈÚo‡˜ ·ÛıÂ-ÓÒÓ Ù˘ ÎÏÈÓÈ΋˜ Ì·˜, ·Êo‡ appleÚÒÙ· Ùo˘˜ ÂÓËÌÂÚÒÓ·ÌÂÁÈ· ÙËÓ ÌÂϤÙË Î·È ÙoÓ ÛÎoapplefi Ù˘.ÚoÎÂÈ̤Óo˘ Ùo ‰Â›ÁÌ· Ì·˜ Ó· Â›Ó·È fiÛo Ùo ‰˘Ó·-ÙfiÓ appleÈo ·ÓÙÈappleÚoÛˆapple¢ÙÈÎfi Ùo˘ appleÏËı˘ÛÌo‡ Ùo˘ ÓoÌo‡ÊÚoÓÙ›Û·Ì ӷ ÌÂÏÂÙ‹Ûo˘Ì ·Ú¯Èο ÙËÓ Û‡ÓıÂÛË Ùo˘appleÏËı˘ÛÌo‡ Ù˘ ¤ÏÏ·˜, ·applefi ÛÙoȯ›· appleo˘ ¢ÁÂÓÒ˜ Ì·˜apple·Ú·¯ÒÚËÛÂ Ë Ù·ÙÈÛÙÈ΋ ÀappleËÚÂÛ›· Ù˘ ¡oÌ·Ú¯›·˜

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 163›Ó·Î·˜ 1. ÂÚÈÁÚ·Ê‹ Ùo˘ appleÏËı˘ÛÌo‡ Ùo˘ ÓoÌo‡ ¤ÏÏ·˜ (·applefi 45 ÂÙÒÓ Î·È ¿Óˆ)∂apple·Ú¯›· ÏËı˘ÛÌfi˜ ∞ÛÙÈÎfi˜ ∏ÌÈ·ÛÙÈÎfi˜ ∞ÁÚÔÙÈÎfi˜∞Ï̈apple›·˜ 28949 (21%) 22% 15% 85%°È·ÓÓÈÙÛÒÓ 65988 (47%) 38% 12% 50%Œ‰ÂÛÛ·˜ 43791 (32%) 40% 21% 39%Œ‰ÂÛÛ·˜, ·applefi ÙËÓ ·appleoÁÚ·Ê‹ Ùo˘ appleÏËı˘ÛÌo‡ Ù˘ 17˘ª·ÚÙ›o˘ 1991, Ë oappleo›· ‹Ù·Ó Î·È Ë appleÈo appleÚfiÛÊ·ÙË. ¢È·appleÈ-ÛÙÒÛ·Ì ÏoÈapplefiÓ fiÙÈ Ë Î·Ù·ÓoÌ‹ ÙˆÓ ‰‡o Ê‡ÏˆÓ ÛÙoÓappleÏËı˘ÛÌfi ‹Ù·Ó 1/1, ÂÓÒ Ë Î·Ù·ÓoÌ‹ ÛÙȘ ÙÚÂȘ Âapple·Ú¯›Â˜,ˆ˜ appleÚo˜ Ùo appleoÛoÛÙfi Ùo˘ appleÏËı˘ÛÌo‡ Î·È ÙËÓ ÎoÈÓˆÓÈ΋ۇÓıÂÛË (·ÛÙÈÎfi˜, ËÌÈ·ÛÙÈÎfi˜ Î·È ·ÁÚoÙÈÎfi˜ appleÏËı˘-ÛÌfi˜) ÙˆÓ ÂÓËÏ›ÎˆÓ ¿Óˆ ÙˆÓ 45 ÂÙÒÓ appleo˘ ·appleoÊ·Û›Û·ÌÂÓ· ÌÂÏÂÙ‹Ûo˘Ì ‹Ù·Ó fiappleˆ˜ appleÂÚÈÁÚ¿ÊÂÙ·È ÛÙoÓ apple›Ó·Î· 1.Δo appleÚˆÙfiÎoÏÏo ÌÂϤÙ˘ appleo˘ ¯ÚËÛÈÌoappleoÈ‹ıËΠappleÂ-ÚÈÂÏ¿Ì‚·ÓÂ:1. ∞ÙoÌÈο ÛÙoȯ›· Ùo˘ ·ÛıÂÓo‡˜ (fiÓoÌ·, ʇÏo,ËÏÈΛ·, ÎÏapple.).2. ÚoËÁo‡ÌÂÓË oÊı·ÏÌoÏoÁÈ΋ ÂͤٷÛË (applefiÛ˜ÊoÚ¤˜ Î·È appleo‡).3. OÊı·ÏÌoÏoÁÈÎfi ÈÛÙoÚÈÎfi.4. OÈÎoÁÂÓÂÈ·Îfi oÊı·ÏÌoÏoÁÈÎfi ÈÛÙoÚÈÎfi.5. ÃÚfiÓÈ· ÓoÛ‹Ì·Ù· Î·È appleÈı·Ó‹ ¯ÚfiÓÈ· ¯Ú‹ÛËÊ·Ú̿ΈÓ.6. ŸÚ·ÛË (Ì ‹ ¯ˆÚ›˜ ‰ÈfiÚıˆÛË).7. §ÂappleÙoÌÂÚ‹ ÂͤٷÛË appleÚoÛı›ˆÓ ÌoÚ›ˆÓ Ì ‚ÈoÌÈ-ÎÚoÛÎfiappleËÛË Û ۯÈÛÌoÂȉ‹ Ï˘¯Ó›· (ÂappleÈappleÂÊ˘ÎfiÙ·˜, ÎÂ-Ú·ÙoÂȉ‹˜, ÎÏapple.), ¯ˆÚ›˜ Î·È ˘applefi Ì˘‰Ú›·ÛË (Phenylnefrine5%).8. ∂˘Ú‹Ì·Ù· ·appleoÊoÏ›‰ˆÛ˘.9. £oÏÒÛÂȘ ÛÙoÓ ÎÚ˘ÛÙ·ÏÏoÂȉ‹ Ê·Îfi (›‰o˜ ηÈÛÙ·‰Èoappleo›ËÛË).10. ⁄appleoappleÙ· Â˘Ú‹Ì·Ù· ÁÈ· ·Ó¿appleÙ˘ÍË ∞ ÌÂÏÏoÓÙÈ-ο.11. ŒÏÂÁ¯o˜ ÂÓ‰oÊı¿ÏÌÈ·˜ apple›ÂÛ˘ Ì ÙoÓfiÌÂÙÚoÂappleÈapple¤‰ˆÛ˘ Goldmann.12. °ˆÓÈoÛÎoapple›·: ηٿ ÙËÓ ÂͤٷÛË ‰fiıËΠappleÚo-Ûo¯‹ ÛÙo ‡Úo˜ Ù˘ ÁˆÓ›·˜, ÛÙËÓ ‡apple·ÚÍË ¯ÚˆÛÙÈ΋˜ ηÈÛÙoÓ ‚·ıÌfi Ù˘, ηıÒ˜ Î·È ÛÙËÓ ·Ó‡ÚÂÛË Ù˘ ÁÚ·ÌÌ‹˜Sampaolesi.13. μ˘ıoÛÎfiappleËÛË ˘applefi Ì˘‰Ú›·ÛË: ÂÎÙ›ÌËÛË Ù˘ Îo›-Ï·ÓÛ˘ Ùo˘ oappleÙÈÎo‡ ‰›ÛÎo˘ (c/d ratio), fiappleˆ˜ Î·È Î¿ıÂappleÈı·Ó‹˜ ·ÏÏo›ˆÛ˘ Ùo˘ ‚˘ıo‡ (apple.¯. ‰È·‚ËÙÈ΋ ·ÌÊÈ‚ÏË-ÛÙÚoÂȉoapple¿ıÂÈ·, ˘appleÂÚÙ·ÛÈ΋ ·ÌÊÈ‚ÏËÛÙÚoÂȉoapple¿ıÂÈ·,ˆ¯Úoapple¿ıÂÈ·, ÙoÍoappleÏ·ÛÌÈ΋ o˘Ï‹, ÎÏapple). ·ÛıÂÓ›˜ ‡appleoappleÙo˘˜ ÁÈ· ÁÏ·‡ÎˆÌ· ‰›ÓÔÓÙ·Ó o‰Ë-Á›Â˜ ÁÈ· ÂͤٷÛË oappleÙÈÎÒÓ apple‰›ˆÓ Î·È Âapple·Ó¤ÏÂÁ¯o. ·ÛıÂÓ›˜ appleo˘ Ë ‰È¿ÁÓˆÛË ÁÏ·˘ÎÒÌ·Ùo˜ Ìapple‹Î ÎÏÈÓÈοappleÚo‚ÏÂapplefiÙ·Ó ¿ÌÂÛË ¯oÚ‹ÁËÛË Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜Î·È o‰ËÁ›Â˜ ÁÈ· oappleÙÈο apple‰›·. ΔfiÛo ÛÙo˘˜ apple¿Û¯oÓÙ˜ fiÛoÎ·È ÛÙo˘˜ ˘applefiappleÙo˘˜, ÌÂÙ¿ ÙËÓ ÂͤٷÛË ·ÎoÏo˘ıo‡Û·ÓÛ·Ê›˜ o‰ËÁ›Â˜ ÁÈ· ¤ÏÂÁ¯o Î·È apple·Ú·ÎoÏo‡ıËÛË.ªÂÙ¿ ÙËÓ ‰È·apple›ÛÙˆÛË ¿ÏÏˆÓ oÊı·ÏÌoÏoÁÈÎÒÓappleÚo‚ÏËÌ¿ÙˆÓ (apple.¯. ‰È·‚ËÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚoÂȉoapple¿ıÂÈ·,˘appleÂÚÙ·ÛÈ΋ ·ÌÊÈ‚ÏËÛÙÚoÂȉoapple¿ıÂÈ·, ÎÏapple.) ‰fiıËÛ·Óo‰ËÁ›Â˜ Î·È apple·Ú·apple¤ÌÊıËÎ·Ó oÈ ·ÛıÂÓ›˜ Û ¿ÏϘ È·-ÙÚÈΤ˜ ÂȉÈÎfiÙËÙ˜.Δ· ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘ Â›Ó·È Ù· ̤¯ÚÈ Û‹ÌÂÚ· ÁÓˆ-ÛÙ¿ ·applefi ÙËÓ ‰ÈÂıÓ‹ ‚È‚ÏÈoÁÚ·Ê›· ÙfiÛo ÁÈ· Ùo ÂÁηÙÂÛÙË-̤Óo Û‡Ó‰ÚÔÌo ·appleoÊoÏ›‰ˆÛ˘21-31 fiÛo Î·È ÁÈ· Ù· «‡-appleoappleÙ·» ÛËÌ›·4,18,26,28,32-34 Ùo˘ appleÚoÎÏÈÓÈÎo‡ ∞.∏ ‰È¿ÁÓˆÛË Ùo˘ ∞ ‚·Û›ÛÙËΠÛÙËÓ ‡apple·ÚÍË ·appleo-ÊoÏȉˆÙÈÎo‡ ˘ÏÈÎo‡ ÛÙo ÎoÚÈÎfi ¯Â›Ïo˜ ‹/Î·È ÛÙo appleÚfiÛıÈoappleÂÚÈÊ¿ÎÈo, ηٿ ÙoÓ ‚ÈoÌÈÎÚoÛÎoappleÈÎfi ¤ÏÂÁ¯o ˘applefi Ì˘-‰Ú›·ÛË. ∫ÏÈÓÈο ÛËÌ›· ‡appleoappleÙ· ÁÈ· appleÈı·Ó‹ ·Ó¿appleÙ˘ÍË·appleoÊoÏ›‰ˆÛ˘ ÌÂÏÏoÓÙÈο, ıˆڋıËÎ·Ó Ù· ÂÍ‹˜: ·ÙÚo-Ê›· ÎoÚÈÎo‡ ¯Â›Ïo˘˜, ÂÓ·applefiıÂÛË ¯ÚˆÛÙÈ΋˜ ÛÙo appleÚfiÛıÈoappleÂÚÈÊ¿ÎÈo, appleÙ‡¯ˆÛË (striata) Ùo˘ appleÚoÛı›o˘ appleÂÚÈʷΛo˘.ŸÏ· Ù· ÛÙoȯ›· ÂÈÛ‹¯ıËÛ·Ó Û ËÏÂÎÙÚoÓÈÎfi ˘appleo-ÏoÁÈÛÙ‹ Î·È appleÈÓ·ÎoappleoÈ‹ıËÎ·Ó Ì ¯Ú‹ÛË Ùo˘ appleÚoÁÚ¿Ì-Ì·Ùo˜ Excell Ùo˘ Microsoft Office (Windows 98). °È·ÙËÓ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌoappleoÈ‹ıËΠÙo ÛÙ·ÙÈÛÙÈÎfiapple·Î¤Ùo SPSS (Statistical Packages for Social Sciences)Î·È appleÈo Û˘ÁÎÂÎÚÈ̤ӷ t-student test, Ë ‰oÎÈÌ·Û›· x 2 η-ıÒ˜ Î·È Ë ‰oÎÈÌ·Û›· ANOVA ‹ Kruskal-Wallis, ·Ó¿Ïo-Á· Ì ٷ ‰Â‰o̤ӷ, Î·È ˘appleoÏoÁ›ÛÙËÎ·Ó ·ÓÙ›ÛÙoȯ· oÈÛ˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ηٿ Pearson ‹ Spearman. ΔÈ-̤˜ ƒ ÌÈÎÚfiÙÂÚ˜ Ùo˘ 0,05 ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛË-Ì·ÓÙÈΤ˜. Δo appleÚfiÁÚ·ÌÌ· CIA (Confidence IntervalsAnalysis) ¯ÚËÛÈÌoappleoÈ‹ıËΠÁÈ· ÙoÓ appleÚoÛ‰ÈoÚÈÛÌfi وӉȷÛÙËÌ¿ÙˆÓ ÂÌappleÈÛÙoÛ‡Ó˘.∞appleoÙÂϤÛÌ·Ù·O Û˘ÓoÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ Î·ÈηٷÁڷʤÓÙˆÓ ÛÙo ÂÚ¢ÓËÙÈÎfi appleÚˆÙfiÎoÏÏo ·-Ó‹Ïı ÛÙ· 700 ¿ÙoÌ·. ∏ ·Ó·ÏoÁ›· ·Ó‰ÚÒÓ Î·È Á˘-Ó·ÈÎÒÓ ‹Ù·Ó 1/1 ÙfiÛo ÛÙo Û‡ÓoÏo Ùo˘ ‰Â›ÁÌ·Ùo˜(350 ¿Ó‰Ú˜ Î·È 350 Á˘Ó·›Î˜) fiÛo Î·È Î·Ù¿ ËÏÈ-Îȷ΋ oÌ¿‰· (›Ó. 2).Δ· ¿ÙoÌ· appleo˘ ÂÍÂÙ¿ÛÙËÎ·Ó ‹Ù·Ó ·applefi 45 ¤ˆ˜88 ÂÙÒÓ Î·È Î·Ù·ÓÂÌ‹ıËÎ·Ó Û ٤ÛÛÂÚȘ ËÏÈÎȷΤ˜oÌ¿‰Â˜: 1 Ë oÌ¿‰·: ·applefi 45 ¤ˆ˜ Î·È 54 ÂÙÒÓ, 2 Ë oÌ¿-‰·: ·applefi 55 ¤ˆ˜ Î·È 64 ÂÙÒÓ, 3 Ë oÌ¿‰·: ·applefi 65 ¤ˆ˜Î·È 74 ÂÙÒÓ Î·È 4 Ë oÌ¿‰·: ·applefi 75 ÂÙÒÓ Î·È ¿Óˆ.ÚoÎÂÈ̤Óo˘ Ó· Â›Ó·È ·ÓÙÈappleÚoÛˆapple¢ÙÈÎfi Ùo˘appleÏËı˘ÛÌo‡ Ùo˘ ÓoÌo‡ Ùo ÂÍÂÙ·Ûı¤Ó ‰Â›ÁÌ·, ÊÚo-ÓÙ›Û·Ì ٷ appleoÛoÛÙ¿ Ùo˘ ‰Â›ÁÌ·Ùo˜ Ó· ÂÎÊÚ¿˙o˘Ó

164 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)›Ó·Î·˜ 2. ∫·Ù·ÓoÌ‹ ηٿ ʇÏo Î·È ËÏÈΛ· ÙˆÓ ÂÍÂÙ·-Ûı¤ÓÙˆÓ∏ÏÈΛ· ÕÓ‰Ú˜ °˘Ó·›Î˜ ‡ÓoÏoÂÍÂÙ·Ûı¤ÓÙˆÓ45 - 54 125 125 25055 - 64 100 100 20065 - 74 75 75 15075+ 50 50 100‡ÓoÏo 350 350 700Ù· appleoÛoÛÙ¿ Ùo˘ appleÏËı˘ÛÌo‡ ηٿ Âapple·Ú¯›·, fiappleˆ˜‰È·appleÈÛÙÒıËÎ·Ó ·applefi Ù· ÛÙoȯ›· Ù˘ Ù·ÙÈÛÙÈ΋˜ÀappleËÚÂÛ›·˜ Ù˘ ¡oÌ·Ú¯›·˜ (›Ó. 1 Î·È 3).∞applefi Ùo˘˜ 700 ÂÍÂÙ·Ûı¤ÓÙ˜ oÈ 70 (appleoÛoÛÙfi10%) apple·Úo˘Û›·˙·Ó ∞. ∞applefi Ùo˘˜ 350 ¿Ó‰Ú˜ ÂÌÊ¿-ÓÈ˙·Ó ·appleoÊoÏ›‰ˆÛË 31 (appleoÛoÛÙfi 8.9%) Î·È ·applefi ÙȘ350 Á˘Ó·›Î˜ oÈ 39 (appleoÛoÛÙfi 11,1%). ÙoÓ apple›Ó·Î· 4appleÂÚÈÁÚ¿ÊÂÙ·È Ì ÏÂappleÙo̤ÚÂÈ· Ë Û˘¯ÓfiÙËÙ· ·appleo-ÊoÏ›‰ˆÛ˘ ÛÙo Û‡ÓoÏo ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ ·ÙfïÓ.∞applefi Ù· 70 ¿ÙoÌ· Ì ∞ ÛÙ· 22 ‰È·appleÈÛÙÒıËηappleoÊoÏ›‰ˆÛË ÂÙÂÚfiappleÏ¢ڷ ÂÓÒ ÛÙ· 48 ·ÌÊoÙÂÚfiappleÏ¢ڷ.∏ ηٷÓoÌ‹ Ù˘ ·appleoÊoÏ›‰ˆÛ˘ Û‡ÌʈӷÌ ÙËÓ ÂÓÙfiappleÈÛË ·ÏÏ¿ Î·È ÙËÓ ËÏÈΛ· Ê·›ÓÂÙ·È ÌÂÏÂappleÙo̤ÚÂÈ· ÛÙoÓ apple›Ó·Î· 5. ¿ÏÏ· 89 ¿ÙoÌ· (appleoÛoÛÙfi 12,71%) ÂÓÙoapple›-ÛÙËÎ·Ó ‡appleoappleÙ· Â˘Ú‹Ì·Ù· appleo˘ appleÈı·ÓfiÓ Û¯ÂÙ›˙oÓÙ·ÈÌ ÙËÓ ÌÂÏÏoÓÙÈ΋ ·Ó¿appleÙ˘ÍË Ùo˘ ∞. ∞˘Ù¿ Ù· ¢-Ú‹Ì·Ù· ‹Ù·Ó, fiappleˆ˜ ‹‰Ë ¤¯ÂÈ appleÂÚÈÁÚ·Ê›, ÌÂÚÈ΋ ‹appleÏ‹Ú˘ ·ÙÚoÊ›· Ùo˘ ÎoÚÈÎo‡ ¯Â›Ïo˘˜, ÂÓ·applefiıÂÛ˯ڈÛÙÈ΋˜ ‹ appleÙ‡¯ˆÛË Ùo˘ appleÚoÛı›o˘ appleÂÚÈʷΛo˘.›Ó·Î·˜ 3. ∫·Ù·ÓoÌ‹ ηٿ Âapple·Ú¯›· ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ∂apple·Ú¯›· ‡ÓoÏo oÛoÛÙfi oÛoÛÙfiÂÍÂÙ·Ûı¤ÓÙˆÓ % appleÏËı˘ÛÌo‡∞Ï̈apple›·˜ 146 20,86 21%°È·ÓÓÈÙÛÒÓ 330 47,14 47%Œ‰ÂÛÛ·˜ 224 32,00 32%‡ÓoÏo 700 100,00 100%∞applefi ÙËÓ ÛÙ·ÙÈÛÙÈ΋ ÂappleÂÍÂÚÁ·Û›· ‰È·appleÈÛÙÒıË-ΠfiÙÈ Ë ‰È·ÊoÚ¿ ÂappleÈappleoÏ·ÛÌo‡ Ùo˘ ∞ ·Ó¿ÌÂÛ·ÛÙ· ‰‡o ʇϷ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, Ùfi-Ûo ÛÙo Û‡ÓoÏo ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ, fiÛo Î·È Û οıÂÌÈ· ·applefi ÙȘ ËÏÈÎȷΤ˜ oÌ¿‰Â˜ ͯˆÚÈÛÙ¿ (‰È¿ÛÙË-Ì· ÂÌappleÈÛÙoÛ‡Ó˘ 95%).O ÂappleÈappleoÏ·ÛÌfi˜ Ùo˘ ∞ ·Ó¿ Âapple·Ú¯›· Ùo˘ Óo-Ìo‡ ‹Ù·Ó ˆ˜ ÂÍ‹˜: oÛoÛÙfi 6,8% (10 ·applefi 146 ÂÍÂ-Ù·Ûı¤ÓÙ˜, ‰È¿ÛÙËÌ· ·ÍÈoappleÈÛÙ›·˜ 95%: 3,8-12%)Ùo˘ ‰Â›ÁÌ·Ùo˜ appleÏËı˘ÛÌo‡ Ù˘ ∞Ï̈apple›·˜, appleoÛoÛÙfi11,2% (37 ·applefi 330 ÂÍÂÙ·Ûı¤ÓÙ˜, ‰È¿ÛÙËÌ· ·ÍÈoappleÈÛÙ›·˜95%: 8,2-15,1%), Ùo˘ ‰Â›ÁÌ·Ùo˜ appleÏËı˘-ÛÌo‡ ÙˆÓ °È·ÓÓÈÙÛÒÓ Î·È appleoÛoÛÙfi 10,3% (23 ·applefi224 ÂÍÂÙ·Ûı¤ÓÙ˜, ‰È¿ÛÙËÌ· ·ÍÈoappleÈÛÙ›·˜ 95%: 6,9-14,9%) Ù˘ Œ‰ÂÛÛ·˜ ÂÌÊ¿ÓÈÛ·Ó ∞ (¯. 1). ¢ÂӉȷappleÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊoÚ¿ ˆ˜appleÚo˜ ÙoÓ ÂappleÈappleoÏ·ÛÌfi Ùo˘ ∞ ·Ó¿ÌÂÛ· ÛÙȘ ÙÚÂȘÂapple·Ú¯›Â˜ Ùo˘ ÓoÌo‡ ¤ÏÏ·˜.∞applefi Ùo˘˜ 70 ·ÛıÂÓ›˜ ÌÂ Â˘Ú‹Ì·Ù· ·appleoÊoÏ›-‰ˆÛ˘ oÈ 52 (appleoÛoÛÙfi 74,28%) apple·Úo˘Û›·˙·Ó ·-appleoÊoÏ›‰ˆÛË ÎoÚÈÎo‡ ¯Â›Ïo˘˜. ŸÏoÈ oÈ ·ÛıÂÓ›˜(70) apple·Úo˘Û›·˙·Ó ·appleoÊoÏ›‰ˆÛË appleÚoÛı›o˘ appleÂÚÈ-›Ó·Î·˜4. ˘¯ÓfiÙËÙ· ˘Ó‰ÚfiÌo˘ ∞appleoÊoÏ›‰ˆÛ˘ (∞) ÛÙo Û‡ÓoÏo ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ∏ÏÈΛ· ‡ÓoÏo ÂÍÂ- ÕÙoÌ· oÛ. ÕÓ‰Ú˜ appleo˘ ÕÓ‰Ú˜ oÛ. °˘Ó·›Î˜ appleo˘ °˘Ó·›Î˜ oÛ.Ù·Ûı¤ÓÙˆÓ Ì ∞ % ÂÍÂÙ¿ÛıËÎ·Ó Ì ∞ % ÂÍÂÙ¿ÛıËÎ·Ó Ì ∞ %45 - 54 250 0 0 125 0 0 125 0 055 - 64 200 4 2 100 1 1 100 3 365 - 74 150 32 21 75 15 20 75 17 22,675+ 100 34 34 50 15 30 50 19 38‡ÓoÏo 700 70 10 350 31 8,9 350 39 11,1›Ó·Î·˜ 5. ∫·Ù·ÓoÌ‹ ÙˆÓ ·ÙfiÌˆÓ Ì ∞ ηٿ ËÏÈΛ· Î·È ÂÓÙfiappleÈÛ‹ Ùo˘∏ÏÈΛ· ÕÙoÌ· Ì ∞ ÕÙoÌ· Ì ÂÙÂÚfiappleÏ. ∞ oÛ.% ÕÙoÌ· Ì ·ÌÊoÙ. ∞ oÛ.%45 -54 0 0 0 0 0,055 - 64 4 2 50 2 50,065 - 74 32 13 40,6 19 59,475 + 34 7 20,6 27 79,4‡ÓoÏo 70 22 31,4 48 68,6

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 165ΣΑ % στις επαρχίες της Πέλλας10,30% 6,80%11,20%Aλμωπία Γιαννιτσά Έδεσσα¯‹Ì· 1ʷΛo˘, ·Êo‡ ÛÙo Û‡ÓoÏfi Ùo˘˜ ÂÓÙoapple›ÛÙËΠappleÂÚÈ-ÊÂÚÈ΋ ˙ÒÓË ·appleoÊoÏ›‰ˆÛ˘, ÂÓÒ ÛÙo˘˜ 38 (appleoÛo-ÛÙfi 54,28%) ÂÓÙoapple›ÛÙËÎÂ Î·È ÎÂÓÙÚÈÎfi˜ ‰›ÛÎo˜·appleoÊoÏ›‰ˆÛ˘. Δ· Â˘Ú‹Ì·Ù· Û˘ÌʈÓo‡Ó Ì ٷ̤¯ÚÈ Û‹ÌÂÚ· ÁÓˆÛÙ¿ ÁÈ· Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈ-ÛÙÈο Ùo˘ ∞. π‰È·›ÙÂÚ· ·Í›˙ÂÈ Ó· ˘appleoÁÚ·ÌÌÈÛÙÂ›Ë ·Ó‡ÚÂÛË Ù˘ appleÂÚÈÊÂÚÈ΋˜ «ÎoÎÎÈÒ‰o˘˜» ˙ÒÓ˘Âapple› Ùo˘ appleÚoÛı›o˘ appleÂÚÈʷΛo˘ ÛÙo Û‡ÓoÏo ÙˆÓ appleÂ-ÚÈÛÙ·ÙÈÎÒÓ 19,22 .Ùo Û‡ÓoÏo ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ Ë Ì¤ÛË ÂÓ-‰oÊı¿ÏÌÈ· apple›ÂÛË (∂O) ‚Ú¤ıËΠӷ Â›Ó·È 15,8mmHg (›Ó. 6). ∏ ÌÂÁ›ÛÙË ÙÈÌ‹ appleo˘ ÌÂÙÚ‹ıËΠۿÙoÌ· Ù˘ ÌÂϤÙ˘ ·ÊoÚo‡Û ÌÈ· Á˘Ó·›Î· ·ÛıÂÓ‹81 ÂÙÒÓ Ì ·ÌÊoÙÂÚfiappleÏ¢ÚË ·appleoÊoÏ›‰ˆÛË Î·ÈÁÏ·‡ÎˆÌ· appleo˘ ÁÈ· appleÚÒÙË ÊoÚ¿ ‰È·appleÈÛÙÒıËΠη-Ù¿ ÙËÓ ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ apple·Úo‡Û·˜ ÌÂϤÙ˘. ∏ ·ÛıÂ-Ó‹˜ apple·Úo˘Û›·˙ ·ÌÊoÙÂÚfiappleÏ¢ڷ ·appleoÊoÏ›‰ˆÛËÎoÚÈÎo‡ ¯Â›Ïo˘˜, ·appleoÊoÏ›‰ˆÛË appleÚoÛı›o˘ appleÂÚÈÊ·-Λo˘ Ì appleÂÚÈÊÂÚÈ΋ ·appleoÊoÏȉˆÙÈ΋ ˙ÒÓË Î·È ÎÂ-ÓÙÚÈÎfi ‰›ÛÎo ·appleoÊoÏ›‰ˆÛ˘. ∏ ÂÓ‰oÊı¿ÏÌÈ· apple›Â-ÛË ‹Ù·Ó 35 ÛÙoÓ ¤Ó· oÊı·ÏÌfi Î·È 43 ÛÙoÓ ¿ÏÏo. ∏Îo›Ï·ÓÛË Ùo˘ oappleÙÈÎo‡ Ó‡Úo˘ (c/d ratio) ‹Ù·Ó ‰Â-ÍÈ¿ 0,9 Î·È ·ÚÈÛÙÂÚ¿ 1 Î·È ˘apple‹Ú¯Â ·ÌÊoÙÂÚfiappleÏ¢-Ú· ÒÚÈÌo˜ apple˘ÚËÓÈÎfi˜ ηٷÚÚ¿ÎÙ˘. ∞Í›˙ÂÈ Ó· ·-Ó·ÊÂÚı› fiÙÈ Ë ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ÙoÓoÌÂÙÚËı› appleo-Ù¤ ÛÙo apple·ÚÂÏıfiÓ, ÂÓÒ ·apple¤‰È‰Â ÙËÓ appleÙÒÛË Ù˘ fiÚ·-Û‹˜ Ù˘ ÛÙoÓ Î·Ù·ÚÚ¿ÎÙË appleo˘ ›¯Â ‰È·appleÈÛÙˆı› ÛÂappleÚoËÁo‡ÌÂÓË oÊı·ÏÌoÏoÁÈ΋ ÂͤٷÛË: ∏ ÌÈÎÚfi-ÙÂÚË ÙÈÌ‹ Ê˘ÛÈoÏoÁÈ΋˜ apple›ÂÛ˘ ‹Ù·Ó 7 mmHg Û¿ÙoÌo ÌÂ Ê˘ÛÈoÏoÁÈο ÏoÈapple¿ Â˘Ú‹Ì·Ù·.›Ó·Î·˜ 6. ∂O ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ (mmHg)∂ÍÂÙ·Ûı¤ÓÙ˜ ˘ÓÔÏÈο ÕÙoÌ· ⁄appleoappleÙoÈ &Ì ∞ ª¿ÚÙ˘Ú˜Ë= 700 70 630ª¤ÛË ÙÈÌ‹ 15,83 20,04 15,37(S.D.) 4,13 6,33 3,52›Ó·Î·˜ 7. ∂O ·Ó‰ÚÒÓ vs Á˘Ó·ÈÎÒÓ (mmHg)ª¤ÛË ∂OÙ·ı. ∞apple.(S.D.)ÕÓ‰Ú˜ Û˘ÓoÏÈο 15,63 4,11°˘Ó·›Î˜ Û˘ÓoÏÈο 16,04 4,15ÕÓ‰Ú˜ Ì ∞ 20,00 6,20°˘Ó·›Î˜ Ì ∞ 20,08 6,51ÕÓ‰Ú˜ ¯ˆÚ›˜ ∞ 15,20 3,58°˘Ó·›Î˜ ¯ˆÚ›˜ ∞ 15,54 3,45∏ ̤ÛË ÂÓ‰oÊı¿ÏÌÈ· apple›ÂÛË ÛÙ· ‰‡o ʇϷ ÍÂ-¯ˆÚÈÛÙ¿ ·Ó·Ê¤ÚÂÙ·È ÛÙoÓ apple›Ó·Î· 7, ÙfiÛo ÁÈ· ÙoÛ‡ÓoÏo Ùo˘ appleÏËı˘ÛÌo‡ fiÛo Î·È ÁÈ· ÙȘ oÌ¿‰Â˜ ·-ÛıÂÓÒÓ ÌÂ Î·È ¯ˆÚ›˜ ·appleoÊoÏ›‰ˆÛË. ∏ ̤ÛË ÂÓ-‰oÊı¿ÏÌÈ· apple›ÂÛË ÙˆÓ ·Ó‰ÚÒÓ ‹Ù·Ó 15,63 mmHg(S.D. 4,11), ÂÓÒ ÙˆÓ Á˘Ó·ÈÎÒÓ ‹Ù·Ó 16,04 mmHg(S.D. 4,15). ∏ ÌÂٷ͇ Ùo˘˜ ‰È·ÊoÚ¿ ‰ÂÓ ÎÚ›ÓÂÙ·ÈÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋. Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·-ÊoÚ¿ ˆ˜ appleÚo˜ ÙËÓ Ì¤ÛË ÂÓ‰oÊı¿ÏÌÈ· apple›ÂÛË ÌÂÙ·-͇ ·Ó‰ÚÒÓ Î·È Á˘Ó·ÈÎÒÓ ‰ÂÓ ˘Ê›ÛÙ·Ù·È Î·È ÛÙȘoÌ¿‰Â˜ Ì ·appleoÊoÏ›‰ˆÛË (¿Ó‰Ú˜: 20 mmHg, Á˘-Ó·›Î˜: 20,08 mmHg) Î·È ¯ˆÚ›˜ ·appleoÊoÏ›‰ˆÛË(¿Ó‰Ú˜: 15,20 mmHg, Á˘Ó·›Î˜ 15,54 mmHg).Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (P

166 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ÌˆÓ ¯ˆÚ›˜ ·appleoÊoÏ›‰ˆÛË) 31 ¿ÙoÌ· (appleoÛoÛÙfi8,61%) apple·Úo˘Û›·Û·Ó ˘appleÂÚÙoÓ›·. Èo Û˘ÁÎÂÎÚÈ̤-Ó· 5 (appleoÛoÛÙfi 5,62%) ‹Ù·Ó ·applefi ÙËÓ oÌ¿‰· ÙˆÓ 89˘applefiappleÙˆÓ, ÂÓÒ 26 (appleoÛoÛÙfi 4,80%) ‹Ù·Ó ·applefi ÙËÓoÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ (¿ÙoÌ· ¯ˆÚ›˜ ·appleoÊoÏ›‰ˆÛËÎ·È ¯ˆÚ›˜ ‡appleoappleÙ· Â˘Ú‹Ì·Ù·) (›Ó. 8).∞applefi ÙËÓ ÛÙ·ÙÈÛÙÈ΋ ÂappleÂÍÂÚÁ·Û›· ‰È·appleÈÛÙÒıË-ΠıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ ·appleoÊoÏ›‰ˆÛËÎ·È ÛÙËÓ ÂÓ‰oÊı¿ÏÌÈ· apple›ÂÛË (ƒ

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168 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)‹‰Ë ÂÍÂÙ·Ûı¤ÓÙˆÓ ·ÙfïÓ. ŒÙÛÈ appleÚoÛ‹Ïı·ÓappleoÏÏ¿ ¿ÙoÌ· ¤Íˆ ·applefi Ùo ËÏÈÎÈ·Îfi fiÚÈo appleo˘ ›¯·-Ì ı¤ÛÂÈ, ¿ÙoÌ· ¯ˆÚ›˜ ηٷÁˆÁ‹ ·applefi ÙoÓ ÓoÌfi¤ÏÏ·˜ ‹ ¿ÙoÌ· appleo˘ ÂÓÒ ‹Ù·Ó ·applefi ÙoÓ ÓoÌfi ‰ÂÓÌappleoÚo‡Û·Ó Ó· Û˘ÌappleÂÚÈÏËÊıo‡Ó ÁÈ·Ù› appleϤoÓ Â›¯·-Ì ÛÙ·Ì·Ù‹ÛÂÈ ÙoÓ ¤ÏÂÁ¯o Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ appleÂÚÈo-¯ÒÓ, ¤¯oÓÙ·˜ ηχ„ÂÈ ÙoÓ ·ÚÈıÌfi appleo˘ ›¯Â ·applefi ÙoÓۯ‰ȷÛÌfi appleÚoηıoÚÈÛÙ› ·Ó¿ appleÂÚÈo¯‹ Î·È ËÏÈ-Λ·. ∂apple›Û˘ ¿ÓıÚˆappleoÈ appleo˘ apple·Ú·ÎoÏo˘ıo‡ÓÙ·Ó ÁÈ·ÁÏ·‡ÎˆÌ· Î·È appleÚoÛ‹Ïı·Ó ÁÈ· ÌÈ· «‰Â‡ÙÂÚË» ÁÓÒ-ÌË. Δ¤Ïo˜, Û ÌÈ· ¤Í·ÚÛË ˙‹Ïo˘, ‰È¢ı˘ÓÙ¤˜ Û¯o-Ï›ˆÓ ‹ ˘appleËÚÂÛÈÒÓ ¤ÛÙÂÏÓ·Ó fiÏo˘˜ ·ÓÂÍ·ÈÚ¤Ùˆ˜Ùo˘˜ ÂÚÁ·˙o̤Óo˘˜ Ùo˘˜, ·ÓÂÍ·ÚÙ‹Ùo˘ ËÏÈΛ·˜ ηÈηٷÁˆÁ‹˜, ÁÈ· «˘appleo¯ÚˆÙÈÎfi» ηْ ·˘Ùo‡˜ appleÚo-ÏËappleÙÈÎfi ¤ÏÂÁ¯o. º˘ÛÈο Ù· ¿ÙoÌ· appleo˘ ‰ÂÓ appleÏË-Úo‡Û·Ó ÙȘ appleÚo¸appleoı¤ÛÂȘ ‰ÂÓ Û˘ÌappleÂÚÈÏ‹ÊıËηÓÛÙoÓ ¤ÏÂÁ¯o.¿ÓÙˆ˜, Ë appleÂÚÈo¯‹ Ù˘ ¤ÏÏ·˜ ÌÂÏÂÙ¿Ù·È ÁÈ·appleÚÒÙË ÊoÚ¿ Î·È Ì¿ÏÈÛÙ· ·˘Ùfi Á›ÓÂÙ·È Ì ¤Ó·ÓÙÚfiappleo appleo˘ ηχappleÙÂÈ Ùo Û‡ÓoÏo ÙˆÓ ËÏÈÎÈ·ÎÒÓ o-Ì¿‰ˆÓ, appleo˘ ı· ÌappleoÚo‡Û·Ó Ó· apple·Úo˘ÛÈ¿˙o˘Ó ∞ ‹appleÚÒÈÌ· ÛËÌ›· ·˘Ùo‡.π‰È·›ÙÂÚ· Ë Î·Ù·ÁÚ·Ê‹ Ùo˘ ÂappleÈappleoÏ·ÛÌo‡ Ùo˘∞ ÛÙȘ ÓÂfiÙÂÚ˜ ËÏÈ˘ ¤¯ÂÈ Í¯ˆÚÈÛÙfi ÂӉȷ-ʤÚoÓ, ηıÒ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ù· ›‰È· ¿ÙoÌ· Ó· Âapple·-ÓÂÍÂÙ·ÛÙo‡Ó ÛÙo ̤ÏÏoÓ Î·È Ó· ÂappleȂ‚·Èˆı› ‹ Ó··appleoÚÚÈÊı›, ·Ó¿ÏoÁ·, Ë ˘applefiıÂÛË Ù˘ ‡apple·Ú͢appleÚÒÈÌˆÓ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ÛÙo ∞.Δ· ÛÙoȯ›· Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ ¤Ú¯oÓÙ·È Ó·appleÚoÛÙÂıo‡Ó ÛÙËÓ oÌ¿‰· ÂÚÁ·ÛÈÒÓ 3,9-18 , fiappleo˘ Â-Ú¢ӋıËΠ¤ˆ˜ Û‹ÌÂÚ· o ÂappleÈappleoÏ·ÛÌfi˜ Ùo˘ ∞ÛÙoÓ ÂÏÏ·‰ÈÎfi ¯ÒÚo Î·È ‚Ú¤ıËΠӷ Î˘Ì·›ÓÂÙ·È ÛÂappleoÛoÛÙ¿ ·applefi 6,5% ¤ˆ˜ 25%. ÚfiÎÂÈÙ·È ‰Â ÁÈ· ÌÈ··applefi ÙȘ Ï›Á˜ ÌÂϤÙ˜ appleo˘ ·Ó·Ê¤ÚoÓÙ·È ÛÙoÓ ÁÂÓÈ-Îfi appleÏËı˘ÛÌfi Î·È Û ‰È·ÛÙڈ̷و̤Óo ‰Â›ÁÌ··˘Ùo‡.˘ÌappleÂÚ¿ÛÌ·Ù·ÙËÓ ÌÂϤÙË ·˘Ù‹ ηٷÁÚ¿ÊËΠo ÂappleÈappleoÏ·-ÛÌfi˜ Ùo˘ ∞ Û ·ÓÙÈappleÚoÛˆapple¢ÙÈÎfi ‰Â›ÁÌ· Ùo˘appleÏËı˘ÛÌo‡ Ùo˘ ÓoÌo‡ ¤ÏÏ·˜, Ùo oappleo›o ·appleoÙÂÏo‡-ÓÙ·Ó ·applefi 700 ÂÓ‹ÏÈΘ ·applefi 45 ÂÙÒÓ Î·È ¿Óˆ.ŸÏ· Ù· ¿ÙoÌ· appleo˘ ÂÍÂÙ¿ÛÙËÎ·Ó Â›¯·Ó ηٷ-ÁˆÁ‹ ·applefi ÙoÓ ÓoÌfi ¤ÏÏ·˜ Î·È Î·Ó¤Ó·˜ ·applefi ¿ÏÏËappleÂÚÈo¯‹ Ù˘ ∂ÏÏ¿‰·˜. ∏ ÌÂϤÙË ‰ËÏ·‰‹ ·ÊoÚ¿·ÌÈÁÒ˜ ÙoÓ appleÏËı˘ÛÌfi Ùo˘ ÓoÌo‡ ¤ÏÏ·˜.ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ùo˘ ‰Â›Á-Ì·Ùo˜ appleÏËı˘ÛÌo‡ appleo˘ ÂÍÂÙ¿ÛÙËÎÂ, ÎÏÈÓÈο ·ÓÈ-¯Ó‡ÛÈÌo ∞ ‚Ú¤ıËÎÂ Û˘ÓoÏÈο Û appleoÛoÛÙfi 10%(70 ·ÛıÂÓ›˜ ·applefi 700 ÂÍÂÙ·Ûı¤ÓÙ˜). Δo appleoÛoÛÙfi·˘Ùfi ·Ó‚·›ÓÂÈ ‰Ú·Ì·ÙÈο Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ·.ŒÙÛÈ Â›Ó·È 0% ÛÙËÓ ‰ÂηÂÙ›· 45-54 (0 ·ÛıÂÓ›˜ ÛÂ250 ÂÍÂÙ·Ûı¤ÓÙ˜), 2% ÛÙËÓ ‰ÂηÂÙ›· 55-64 (4·ÛıÂÓ›˜ Û 200 ÂÍÂÙ·Ûı¤ÓÙ˜), 21,33% ÛÙËÓ ‰Â-ηÂÙ›· 65-74 (32 ·ÛıÂÓ›˜ ·applefi 150 ÂÍÂÙ·Ûı¤ÓÙ˜)Î·È 34% ÛÙȘ ËÏÈ˘ ·applefi 75 Î·È ¿Óˆ (34 ·ÛıÂÓ›˜·applefi 100 ÂÍÂÙ·Ûı¤ÓÙ˜).ËÌ·ÓÙÈÎfi Â›Ó·È Ó· ·Ó·Ê¤Úo˘Ì fiÙÈ ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈ΋ ‰È·ÊoÚ¿ ‰ÂÓ ‰È·appleÈÛÙÒıËΠˆ˜ appleÚo˜ÙoÓ ÂappleÈappleoÏ·ÛÌfi Ùo˘ ∞ ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ Âapple·Ú-¯ÈÒÓ Ùo˘ ÓoÌo‡ ¤ÏÏ·˜ (∞Ï̈apple›·˜, °È·ÓÓÈÙÛÒÓÎ·È Œ‰ÂÛÛ·˜).∏ apple·Úo‡Û· ÌÂϤÙË ·appleoÙÂÏ› ¤Ó· ÂappleÈappleϤoÓÛÙoȯ›o ÛÙËÓ ÁÂÓÈÎfiÙÂÚË appleÚoÛapple¿ıÂÈ· ÁÈ· ·ÎÚÈ‚‹Î·È ÏÂappleÙoÌÂÚ‹ ηٷÁÚ·Ê‹ Ùo˘ ÌÂÁ¤ıo˘˜ Âapple›appleÙˆ-Û˘ Ùo˘ ∞ ÛÙËÓ ¯ÒÚ· Ì·˜ Î·È ÛÙoÓ ÎfiÛÌo ÁÂÓÈ-ÎfiÙÂÚ·.Δ· Û˘ÌappleÂÚ¿ÛÌ·Ù· ÛÙ· oappleo›· ηٷϋͷÌ ›-Ó·È Ù· ÂÍ‹˜:• Δo ∞, ÌÈ· ÂÎÊ˘ÏÈÛÙÈ΋ ÓfiÛo˜ Û˘¯Ó‹ ÛÙËÓ∂ÏÏ¿‰·, Û˘Ó·ÓÙ¿Ù·È ÛÙo˘˜ ηÙo›Îo˘˜ Ùo˘ ÓoÌo‡¤ÏÏ·˜ ¿Óˆ ÙˆÓ 45 ÂÙÒÓ, Û appleoÛoÛÙfi 10%. ·-Úo˘ÛÈ¿˙ÂÈ ‰Â Ï›·Ó ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ ÛÙ·ÙÈÛÙÈ΋ Û˘-Û¯¤ÙÈÛË Ì ÙËÓ ËÏÈΛ· ηıÒ˜ ·˘Í¿ÓÂÙ·È ‰Ú·Ì·ÙÈοÛÙËÓ ÙÚ›ÙË ËÏÈΛ· Î·È ÛÙo˘˜ ˘appleÂÚ‹ÏÈΘ. Δo ∞ ÂÌ-Ê·Ó›˙ÂÙ·È Ùo ›‰Èo Û˘¯Ó¿ ÙfiÛo ÛÙo˘˜ ¿Ó‰Ú˜ fiÛoÎ·È ÛÙȘ Á˘Ó·›Î˜.• ËÌ·ÓÙÈÎfi ÚfiÏo ÛÙËÓ ·ÛÊ·Ï‹ ‰È¿ÁÓˆÛË Ùo˘∞ apple·›˙ÂÈ Ë Ì˘‰Ú›·ÛË, ·Êo‡ appleoÏÏ¿ ¿ÙoÌ· (ÛÙËÓapple·Úo‡Û· ÂÚÁ·Û›· 18 ·ÛıÂÓ›˜, appleoÛoÛÙfi 25,71%ÙˆÓ ·appleoÊoÏȉˆÙÈÎÒÓ ·ÙfïÓ) ¤¯o˘Ó ÛÙoȯ›· ·appleo-ÊoÏ›‰ˆÛ˘ appleÚoÛı›o˘ appleÂÚÈʷΛo˘ (Û˘¯Ó¿ ‰‡ÛÎoÏ·oÚ·Ù¿ ¯ˆÚ›˜ Ì˘‰Ú›·ÛË), ¯ˆÚ›˜ Ó· apple·Úo˘ÛÈ¿˙o˘Ó·apple·Ú·›ÙËÙ· ·appleoÊoÏ›‰ˆÛË ÎoÚÈÎo‡ ¯Â›Ïo˘˜.• Δo ∞ Û˘Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ·˘ÍË̤ÓË ÂÓ-‰oÊı¿ÏÌÈ· apple›ÂÛË (∂O), ›Ù appleÚfiÎÂÈÙ·È ÁÈ· ˘appleÂÚ-ÙoÓ›·, ›Ù ÁÈ· ÁÏ·‡ÎˆÌ·. ŒÙÛÈ Ë Ì¤ÛË ∂O ›ӷÈ15,37 mmHg (SD:3,52) ÛÙo˘˜ 630 ÌË ·appleoÊoÏȉˆ-ÙÈÎo‡˜ ÂÍÂÙ·Ûı¤ÓÙ˜ ¤Ó·ÓÙÈ 20,04 mmHg (SD:6,33) ÛÙo˘˜ ·appleoÊoÏȉˆÙÈÎo‡˜. ∂appleÈappleϤoÓ, ·applefi Ùo˘˜ÁÏ·˘ÎˆÌ·ÙÈÎo‡˜ appleo˘ ‰È·ÁÓÒÛÙËÎ·Ó ÛÙo ÂÍÂÙ·˙fi-ÌÂÓo ‰Â›ÁÌ· oÈ 12 (50%) ›¯·Ó ·appleoÊoÏȉˆÙÈÎfiÁÏ·‡ÎˆÌ· ÂÓÒ oÈ 9 (37,5%) ¯ÚfiÓÈÔ ÁÏ·‡ÎˆÌ· ·-Óoȯً˜ ÁˆÓ›·˜ Î·È oÈ 3 (12,5%) ÁÏ·‡ÎˆÌ· Ê˘-ÛÈoÏoÁÈ΋˜ apple›ÂÛ˘.• ∂ÙÂÚfiappleÏ¢ÚË ·appleoÊoÏ›‰ˆÛË ÂÌÊ·Ó›˙ÂÙ·È ÛÂ22 ¿ÙoÌ· (31,42% ÙˆÓ ·ÙfiÌˆÓ Ì ·appleoÊoÏ›‰ˆÛË),ÂÓÒ ·ÌÊoÙÂÚfiappleÏ¢ÚË Û 48 ¿ÙoÌ· (68,58% ÙˆÓ·ÙfiÌˆÓ Ì ·appleoÊoÏ›‰ˆÛË), ÛÙoȯ›o appleo˘ Û˘ÓËÁo-Ú› Ì ÙËÓ ¿appleo„Ë fiÙÈ Ë ÂÙÂÚfiappleÏ¢ÚË ·appleoÊoÏ›‰ˆÛË

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 169appleÚoo‰Â˘ÙÈο ÌÂÙ·ÙÚ¤appleÂÙ·È Û ·ÌÊoÙÂÚfiappleÏ¢ÚË.• ∏ Û˘Ó‡apple·ÚÍË ·appleoÊoÏ›‰ˆÛ˘ Î·È ˘appleÂÚÙo-Ó›·˜ Â›Ó·È Ùo ›‰Èo Û˘¯Ó‹ Û ¿Ó‰Ú˜ Î·È Á˘Ó·›Î˜.• ∏ ÁˆÓ›· Ùo˘ appleÚoÛı›o˘ ı·Ï¿Ìo˘ ‚Ú¤ıËÎÂ(¢ڤˆ˜) ·Óoȯً Î·È Ì ¿ÊıoÓË ¯ÚˆÛÙÈ΋ (¯Úˆ-ÛÙÈ΋ ππ Î·È πππ ‚·ıÌo‡ ΢ڛˆ˜) Û fiÏo˘˜ Ùo˘˜oÊı·ÏÌo‡˜ Ì ·appleoÊoÏ›‰ˆÛË.• ∏ Îo›Ï·ÓÛË Ùo˘ oappleÙÈÎo‡ Ó‡Úo˘ ‹Ù·Ó ÛÙ·ÙÈ-ÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÛÙ· ¿ÙoÌ· Ì ∞ (̤-ÛË ÙÈÌ‹: 0,36) Û ۯ¤ÛË Ì ٷ ¿ÙoÌ· ¯ˆÚ›˜ ∞ (̤-ÛË ÙÈÌ‹: 0,26). Δo ‡ÚËÌ· Û˘ÓËÁoÚ› Ì ٷ ̤¯ÚÈÛ‹ÌÂÚ· ‰Â‰o̤ӷ, Û¯ÂÙÈο Ì ÙȘ ·applefiÙo̘ ·˘ÍË-ÙÈΤ˜ ‰È·Î˘Ì¿ÓÛÂȘ (peak) Ù˘ ∂O ÙˆÓ ·appleo-ÊoÏȉˆÙÈÎÒÓ oÊı·ÏÌÒÓ Î·È ÙȘ Âapple·ÎfiÏo˘ı˜ ‰Ú·-Ì·ÙÈΤ˜ Û˘Ó¤appleÂȘ ÁÈ· Ùo oappleÙÈÎfi Ó‡Úo Î·È ÙËÓÏÂÈÙo˘ÚÁ›· Ù˘ fiÚ·Û˘.∞˘Ùfi Î·È ÌfiÓo Ùo ÁÂÁoÓfi˜ ·appleo‰ÂÈÎÓ‡ÂÈ applefiÛoÛËÌ·ÓÙÈ΋ Â›Ó·È Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ùo˘ ∞ ηÈÙ˘ appleÈı·Ó‹˜ ˘appleÂÚÙoÓ›·˜ ‹ ÁÏ·˘ÎÒÌ·Ùo˜, appleÚ¿ÁÌ·appleo˘ ÌappleoÚ› Ó· ÂappleÈÙ¢¯ı› ÌfiÓo Ì appleÚoÏËappleÙÈÎfi ¤-ÏÂÁ¯o, ·Êo‡ Ùo ∞ fiÛo Î·È Ë ˘appleÂÚÙoÓ›· Â›Ó·È ·Û˘-Ìappleو̷ÙÈο.Δ¤Ïo˜, ·Í›˙ÂÈ Ó· ÛËÌÂȈı› Ë ÛËÌ·Û›· Ùo˘appleÚoÏËappleÙÈÎo‡ ÂϤÁ¯o˘ appleo˘ ‰È·Ê·›ÓÂÙ·È Ì¤Û· ·applefi·˘Ù‹Ó ÙËÓ ÌÂϤÙË, ÌfiÓo Î·È ÌfiÓo ·Ó ·Ó·ÊÂÚı› ÙoÁÂÁoÓfi˜ fiÙÈ ·applefi Ùo˘˜ 700 Û˘ÓoÏÈο «˘ÁÈ›˜» ÂÍÂ-Ù·Ûı¤ÓÙ˜, Ìapple‹Î·Ó Û ıÂÚ·apple›· Î·È apple·Ú·ÎoÏo‡-ıËÛË ‹ apple·Ú·apple¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯o Î·È Ú‡ıÌÈÛËÛ ÂȉÈÎfi oÊı·ÏÌoÏoÁÈÎfi È·ÙÚ›o ‹ Û ¿ÏϘ È·-ÙÚÈΤ˜ ÂȉÈÎfiÙËÙ˜, 160 ¿ÙoÌ· (appleoÛoÛÙfi 22,86%Ùo˘ Û˘ÓfiÏo˘ Ùo˘ ‰Â›ÁÌ·Ùo˜).μÈ‚ÏÈoÁÚ·Ê›·1. ∫ÒÓÛÙ·˜ ∞°, Marshall GE, ∫oÏÈ¿Îo˜ °, Lee WR, ΔÚ·-η٤ÏÏ˘ ∞. ∏ ʇÛË Ùo˘ ·appleoÊoÏȉˆÙÈÎo‡ ˘ÏÈÎo‡.OÊı·ÏÌoÏoÁ›· 5: 347-360, 1993.2. ∫ÒÓÛÙ·˜ ∞°, ¢ËÌËÙÚ·Îo‡ÏÈ·˜ ¡, ∫·Ú‰·Ûfiappleo˘Ïo˜ ∞.∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ùo˘ ·appleoÊoÏȉˆÙÈÎo‡ ÁÏ·˘-ÎÒÌ·Ùo˜. ∂ÈÛËÁ‹ÛÂȘ 27o˘ ·ÓÂÏÏ‹ÓÈo˘ OÊı·ÏÌo-ÏoÁÈÎo‡ ˘Ó‰ڛo˘ 90-97, 1994.3. ª˘Ïfiappleo˘Ïo˜ ¡. ∂appleȉËÌÈoÏoÁÈ΋ ÌÂϤÙË „¢‰o·appleoÊoÏÈ-‰ˆÙÈÎo‡ ÁÏ·˘ÎÒÌ·Ùo˜ ÛÙË μfiÚÂÈo ∂ÏÏ¿‰·. OÊı·Ï-ÌoÏoÁÈο ÃÚoÓÈο 29: 181-187, 1992.4. ∫ÒÓÛÙ·˜ ∞°. ∫ÏÈÓÈ΋ ÛËÌÂÈoÏoÁ›· Ùo˘ ·appleoÊoÏȉˆ-ÙÈÎo‡ Û˘Ó‰ÚfiÌo˘. OÊı·ÏÌoÏoÁ›· 7: 126-137, 1995.5. Schlotzer-Schrehardt U, Koca MR, Naumann GOH, VolkholzH. Pseudoexfoliation syndrom. Ocular manifestationof a systemic disorder? Arch Ophthalmol 110:1752-1756, 1992.6. Streeten BW, Li ZY, Wallace RN, Eagle RC, KeshgegianAA. Pseudoexfoliative fibrillopathy in visceral organsof a patient with pseudoexfoliation syndrom. ArchOphthalmol 110: 1757-1762, 1992.7. Naumann OH, Schlötzer-Schrehardt U, Küchle M. Pseudoexfoliationsyndrome for the comprehensive ophthalmologist.Intraocular and systemic manifestations.Ophthalmology 105: 951-968, 1998.8. McCarty CA, Taylor HR. Pseudoexfoliation syndrome inAustralian adults. American Journal Ophthalmology129: 629-633, 2000.9. Trantas M. Lesions Seniles de la capsule anterieure ducristallin et du bord pupillaire. Archives d’ Ophthalmologie46: 482-491, 1929.10. Ioannides T, Katsourakis N, Velissaropoulos P. Glaucomacapsulare. Ophthalmologica 142: 160-189: 1961.11. ΔÚ·Á¿Î˘ ª, oÏÏ¿Ï˘ , °·ÚÙ·Á¿Ó˘ . 梉o·appleo-ÊoÏȉÒÛÂȘ. ¢ÂÏÙ›o Ù˘ ∂ÏÏËÓÈ΋˜ OÊı·ÏÌoÏoÁÈ΋˜ÂÙ·ÈÚ›·˜ 46: 161-169, 1978.12. ΔÚÈ·ÓٷʇÏÏo˘ °. 梉o·appleoÊoÏ›‰ˆÛË Ùo˘ appleÂÚÈÊ·-Λo˘. ¢È·ÙÚÈ‚‹ Âapple› ‰È‰·ÎÙoÚ›·, £ÂÛÛ·ÏoÓ›ÎË, 1980.13. Stefaniotou M, Petroutsos G, Psilas K. The frequency ofpseudoexfoliation in a region of Greece (Epirus). A-cta Ophthalmol 68: 307-309, 1990.14. ΔÛo‡ÙÛo˜ ∫, ¢ËÌËÙÚÈ¿‰Ë˜ μ, °·‚ÚÈ‹Ï §. ∏ Û˘¯ÓfiÙËÙ·Ù˘ „¢‰o·appleoÊoÏȉÒÛˆ˜ ÛÙoÓ ∂ÏÏËÓÈÎfi appleÏËı˘ÛÌfi.OÊı·ÏÌoÏoÁÈο ¯ÚoÓÈο 29: 303-310, 1992.15. Konstas AGP, Dimitracoulias N, Kourtzidou O, Filidis K,Bufidis T, Benos A. Frequency of exfoliation syndromein Greec cataract patients. Acta Ophthalmol 74: 478-482, 1996.16. ÙÂÊ·ÓÈÒÙo˘ ª. ∏ Û˘¯ÓfiÙËÙ· Ù˘ „¢‰o·appleoÊoÏ›‰ˆÛ˘ÛÙËÓ ◊appleÂÈÚo. ¢È‰·ÎÙoÚÈ΋ ‰È·ÙÚÈ‚‹, πˆ¿ÓÓÈÓ· 1989.17. ∫o˙oÌapplefiÏ˘ μ. ∏ „¢‰o·appleoÊoÏ›‰ˆÛË ÛÙËÓ ∫Ú‹ÙË.(ÂÚ›ÏË„Ë ¢È‰·ÎÙoÚÈ΋ ¢È·ÙÚÈ‚‹˜) OÊı·ÏÌoÏoÁ›·9: 76-88, 1997.18. ªappleo˘Ê›‰Ë˜ £. O ÂappleÈappleoÏ·ÛÌfi˜ Ùo˘ Û˘Ó‰ÚfiÌo˘ ·appleoÊo-Ï›‰ˆÛ˘ ÛÂ Ù˘¯·›o ‰Â›ÁÌ· appleÏËı˘ÛÌo‡ Ù˘ ¢ڇÙÂÚ˘appleÂÚÈo¯‹˜ £ÂÛÛ·Ïoӛ΢. ¢È‰·ÎÙoÚÈ΋ ‰È·ÙÚÈ‚‹,£ÂÛÛ·ÏoÓ›ÎË 1998.19. Konstas AGP, Lay JL, Marshall GE, Lee WR. Prevalence,diagnostic features, and response to trabeculectomyin exfoliation glaucoma. Ophthalmology 100: 619-627, 1993.20. Konstas AGP. Morphological and clinical studies on theexfoliation syndrome and open angle glaucoma. Ph DThesis Glascow 1-364, 1993.21. Gifford H. A clinical and pathological study of exfoliationof the lens capsule. Trans Am Ophthalmol Soc55: 189-216, 1957.22. Tarkkanen AH. Pseudoexfoliation of the lens capsule.Acta Ophthalmol Suppl 71: 9-98, 1962.23. Bertelsen TI. Fibrillopathia epitheliocapsularis. The socalledsenile exfoliation or pseudoexfoliation of theanterior lens capsule. Acta Ophthalmol 44: 737-750,1966.24. Hansen E, Sellevold OJ. Pseudoexfoliation of the lenscapsule. II. Development of the exfoliation syndrome.

170 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Acta Ophthalmol 47: 161-173, 1969.25. Duke-Elder S. Diseases of the lens and vitreous; glaucomaand hypotony. In: Duke-Elder S (Ed): System ofOphthalmology, Vol XI, 42, Henry Kimpton, London,1969.26. Bartholomew RS. Pseudocapsular exfoliation in the Bantuof South Africa. I. Early or pregranular clinicalstage. Br J Ophthalmol 55: 693-699, 1971.27. Aasved H. Relationship of intraocular pressure and fibrillopathiaepitheliocapsularis.Trans OphthalmolSoc UK 99: 310-311, 1979.28. Jerndal T. The initial stage of the exfoliation syndrom.Acta Ophthalmol Suppl 173: 65-66, 1985.29. Jerndal T. Open angle glaucoma and the pseudoexfoliationsyndrome. In: Gairns JE(Ed): Glaucoma, VolI, 661, Grune & Stratton, London, 1986.30. Jerndal T. Exfoliation syndrome stages I and II. Seminarsin Ophthalmology 4: 46-47, 1989.31. Slagsvold JE. The follow-up in patients with pseudoexfoliationof the lens capsule with and without glaucoma.2. The development of glaucoma in persons with pseudoexfoliation.Acta Ophthalmol 58: 188-191, 1986.32. Spearman D, Ghosh M. The conjunctiva in senile lensexfoliation. Arch Ophthalmol 94: 1757-1759, 1976.33. Prince AM, Streeten BW, Ritch R, Dark AJ, Sperling M.Preclinical diagnosis of pseudoexfoliation syndrome.Arch Ophthalmol 105: 1076-1082, 1987.34. Miyake K, Matsuda M, Inaba M. Corneal endothelialchanges in pseudoexfoliation syndrome. Am J Ophthalmol108:49-52, 1989.35. Sampaolesi R. Deux nouveaux signes qui precisent lesyndrome dit de l’ “exfoliation capsulaire du cristallin’’.Annales D’ Oculistique 192: 839-848, 1959.36. Gradle HS, Sugar HS. Conserning the chamber angle. II.Exfoliation of the zonular lamella and glaucoma capsulare.Am J Ophthalmol 23: 282-997, 1940.37. Horven I. Exfoliation syndrome. Arch Ophthalmol 76:505-511, 1966.38. Wishart PK, Spaeth GL, Poryzees EM. Anterior chamberangle in the exfoliation syndrome. Br J Ophthalmol69: 103-107, 1985.39. Prince AM, Ritch R. Clinical signs of the pseudoexfoliationsyndrom. Ophthalmology 93: 803-807, 1986.40. Sampaolesi R, Zarate J, Croxato O. The chamber anglein exfoliation glaucoma. Acta Ophthalmol Supll 184:48-53, 1988.41. Rouhiainen H, Terasvirta M. Pigmentation of the anteriorchamber angle in normal and pseudoexfoliative e-yes. Acta Ophthalmol 68: 700-702, 1990.42. Dark AJ, Streeten BW. Precapsular film on the aging humanlens: precursor of pseudoexfoliation? Br J Ophthalmol74 :717-722, 1990.43. ∫oÏÈ¿Îo˜ °, ∫ÒÓÛÙ·˜ ∞°, ¢ËÌËÙÚ·Îo‡ÏÈ·˜ ¡, ÷˝-ÙoÁÏo˘ ∫, ΔÚÈ¿ÓÙo˜ ∞. μÈo¯ËÌÈ΋ appleÚoÛ¤ÁÁÈÛË ÛÙËÓ‰ÈÂÚ‡ÓËÛË Ù˘ apple·ıoÁ¤ÓÂÈ·˜ Ùo˘ ·appleoÊoÏȉˆÙÈÎo‡Û˘Ó‰ÚfiÌo˘. OÊı·ÏÌoÏoÁ›· 6: 419-426, 1994.

‡ÁÎÚÈÛË Ù˘ 24ˆÚ˘ ÂÓ‰ÔÊı¿ÏÌÈ·˜ apple›ÂÛ˘ ÌÂÏ·Ù·ÓÔappleÚfiÛÙË ‹ Ì ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙÈÌÔÏfiÏ˘-ÓÙÔÚ˙ÔÏ·Ì›‰Ë˜ ˆ˜ appleÚÒÙ˘ ıÂÚ·apple¢ÙÈ΋˜ÂappleÈÏÔÁ‹˜ ÛÙÔ appleÚˆÙÔapple·ı¤˜ ÁÏ·‡ÎˆÌ·∞.-°.. ∫ÒÓÛÙ·˜1, . ·apple·apple¿ÓÔ˜2, . ª·ÏÔ‡Ù·˜1, ∞.Ã. ª·ÏÙ¤˙Ô˜1,π. Δ¤ÚÛ˘1, ¢. ÃÔ˘ÏÈ¿Ú·, 1 W.C. Stewart 324-hour comparison of latanorpost 0.005% versus the timolol/dorzolamide fixedcombination as first line therapy in primary open-angle glaucomaA.-G.P. Konstas, P. Papapanos, S. Maloutas, A.H. Maltezos, I. Tersis, D. Houliara, W.C. StewartÎÔapplefi˜: ˘ÁÎÚÈÙÈ΋ ÌÂϤÙË Ù˘ ·appleoÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ηȷÛÊ¿ÏÂÈ·˜ Ù˘ ¯oÚ‹ÁËÛ˘ Ï·Ù·ÓoappleÚfiÛÙ˘ 0,005% Ì›· Êo-Ú¿ ÙËÓ Ë̤ڷ Î·È Ùo˘ ÛÙ·ıÂÚo‡ Û˘Ó‰˘·ÛÌo‡ ÙÈÌoÏfiÏ˘0,5% - ÓÙoÚ˙oÏ·Ì›‰Ë˜ 2% ‰‡o ÊoÚ¤˜ ÙËÓ Ë̤ڷ, Û ·ÛıÂ-Ó›˜ Ì appleÚˆÙoapple·ı¤˜ ÁÏ·‡ÎˆÌ· ·ÓoÈÎÙ‹˜ ÁˆÓ›·˜ (°∞°) ‹oÊı·ÏÌÈ΋ ˘appleÂÚÙoÓ›·. ∞ÛıÂÓ›˜-̤ıo‰oÈ: ∏ ÌÂϤÙË ‰ÈÂÍ‹-¯ıË Û ‰‡o ΤÓÙÚ·. ∂appleÈϤ¯ıËÎ·Ó Ù˘¯·›· 34 ·ÛıÂÓ›˜ oÈ o-appleo›oÈ ˘appleo‚Ï‹ıËÎ·Ó ÂÓ·ÏÏ¿Í ÛÙË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË, ÂÊ·Ú-Ìfi˙oÓÙ·˜ ÙËÓ ·appleÏ‹ Ù˘ÊÏ‹ ̤ıo‰o. ∏ ÂÎÙ›ÌËÛË Ù˘ 24ˆÚ˘ÂÓ‰oÊı¿ÏÌÈ·˜ apple›ÂÛ˘ (∂O) ¤ÁÈÓ Ì 6 ÌÂÙÚ‹ÛÂȘ ÛÙȘ Ò-Ú˜: 02:00, 06:00, 10:00, 14:00, 18:00 Î·È 22:00. ∞appleoÙÂϤ-ÛÌ·Ù·: ΔË ÌÂϤÙË oÏoÎÏ‹ÚˆÛ·Ó 33 ·ÛıÂÓ›˜. ªÂÙ¿ ·applefi 6‚‰oÌ¿‰Â˜ ıÂÚ·apple›·˜, Ë Ì¤ÛË 24ˆÚË ∂O ‹Ù·Ó 15,9±2,3mmHg Ì ϷٷÓoappleÚfiÛÙË, Î·È 15,3±2,0 mmHg Ì ÙoÓ Û˘Ó-‰˘·ÛÌfi (p=0,05). ÃÚoÓÈο ·ÓÙ›ÛÙoȯ˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ∂O‰ÂÓ apple·Úo˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊoÚ¿ ÌÂÙ·Í‡ÙˆÓ ‰‡o oÌ¿‰ˆÓ, ÂÎÙfi˜ ·applefi ÙË Ì¤ÙÚËÛË ÙˆÓ 22:00, fiappleo˘ Ë∂O Ì ÙoÓ Û˘Ó‰˘·ÛÌfi ‹Ù·Ó 14,6±2,7 mmHg ÂÓÒ Ì ÙËÏ·Ù·ÓoappleÚfiÛÙË ‹Ù·Ó 16,6±3,1 mmHg (p0,05), ÂÎÙfi˜ ·applefi ÙËÓ appleÈÎÚ‹ Á‡-ÛË appleo˘ ‹Ù·Ó Û˘¯ÓfiÙÂÚË Ì ÙoÓ Û˘Ó‰˘·ÛÌfi (n=9) apple·Ú¿ ÌÂÙË Ï·Ù·ÓoappleÚfiÛÙË (n =0), (p=0,009). ˘ÌappleÂÚ¿ÛÌ·Ù·: ∞applefiÙË ÌÂϤÙË appleÚo·appleÙÂÈ fiÙÈ o ¤ÏÂÁ¯o˜ Ù˘ 24ˆÚ˘ ÂÓ‰oÊı¿Ï-ÌÈ·˜ apple›ÂÛ˘ ·ÛıÂÓÒÓ Ì °∞° ‹ ˘appleÂÚÙoÓ›· Â›Ó·È oÚȷο η-χÙÂÚo˜ Ì ÙoÓ ¤ÙoÈÌo Û˘Ó‰˘·ÛÌfi ÙÈÌoÏfiÏ˘-ÓÙoÚ˙oÏ·Ì›-‰Ë˜ Û ۇÁÎÚÈÛË Ì ÙË Ï·Ù·ÓoappleÚfiÛÙË.Purpose: To evaluate the efficacy and safety of latanoprost0.005% given every evening versus the timolol 0.5%/ dorzolamide2% fixed combination (Cosopt) given twice daily inprimary open-angle glaucoma (POAG) and ocular hypertensivepatients. Design: A single-masked, two center,crossover comparison with two six-week treatment periodsfollowing at least a three-week medicine free period. Diurnalcurve intraocular pressures (IOP) were taken at 02:00,06:00, 10:00, 14:00, 18:00 and 22:00 hours. Thirty-four subjectswith POAG or ocular hypertension were enrolled. Latanoprost0.005% given every evening and the fixed combinationtwice daily. Results: Thirty-three patients completedthe study. Following six weeks of treatment the diurnal IOPfor latanoprost was 15.9±2.3 mmHg and for the fixed combinationwas 15.3±2.0 mmHg (p=0.05). Individual time pointsfor IOP pressure were statistically equal between groupsexcept at the 22:00 time point when the fixed combinationwas 14.6±2.7 mmHg and latanoprost was 16.6±3.1 mmHg(p0.05) e-xcept bitter taste was found more frequently with the combination(n=9) than latanoprost (n =0); (p=0.009). Conclusion:This study indicates that the 24-hour diurnal IOP is improvedslightly with the timolol maleate/dorzolamide fixedcombination compared to latanoprost in POAG and ocularhypertensive patients.1·ÓÂappleÈÛÙËÌȷ΋ OÊı·ÏÌÔÏÔÁÈ΋ KÏÈÓÈ΋ AXEA, £ÂÛÛ·ÏÔÓ›ÎË2°.N.N. KÔÚ›ÓıÔ˘, KfiÚÈıÓÔ˜, 3 University of Shouth Carolina, Columbia, S.C., U.S.A.OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 171 - 176, 2002 171

172 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)EÈÛ·ÁˆÁ‹∏ ÌËÏÂ˚ÓÈ΋ ÙÈÌoÏfiÏË ·appleÂÙ¤ÏÂÛ ÁÈ· appleÂÚÈÛ-ÛfiÙÂÚo ·applefi 2 ‰ÂηÂٛ˜ ÙË ÌoÓoıÂÚ·apple›· appleÚÒÙ˘ÂappleÈÏoÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ùo˘ °∞° Î·È Ù˘oÊı·ÏÌÈ΋˜ ˘appleÂÚÙoÓ›·˜. ÙȘ appleÂÚÈappleÙÒÛÂȘ appleo˘ ËÚ‡ıÌÈÛË Ù˘ ∂O ‰ÂÓ Â›Ó·È Âapple·Ú΋˜ Ì ÙËÓ ÙÈÌo-ÏfiÏË ˆ˜ ÌoÓoıÂÚ·apple›·, Ë ÌÂÙ¿‚·ÛË Û ¤Ó· ·applefi Ù·ÓÂfiÙÂÚ· Ê¿Ú̷η, fiappleˆ˜ Ï·Ù·ÓoappleÚfiÛÙË (Xalatan,Pharmacia Hellas) Ì›· ÊoÚ¿ ËÌÂÚËÛ›ˆ˜ ‹ o ¤-ÙoÈÌo˜ Û˘Ó‰˘·ÛÌfi˜ ÌËÏÂ˚ÓÈ΋˜ ÙÈÌoÏfiÏ˘ 0,5% -ÓÙoÚ˙oÏ·Ì›‰Ë˜ 2% (Cosopt, MSD Vianex) ‰‡o Êo-Ú¤˜ ËÌÂÚËÛ›ˆ˜, ÌappleoÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ Î·Ï‡ÙÂÚo¤ÏÂÁ¯o Ù˘ ÂÓ‰oÊı¿ÏÌÈ·˜ apple›ÂÛ˘1-4 . ŸÌˆ˜, ‰ÂÓ ¤-¯ÂÈ ·ÎfiÌË ‰È¢ÎÚÈÓÈÛÙ› Âapple·ÚÎÒ˜ appleoÈÔ ·applefi Ù· ÓÂfiÙÂÚ·ıÂÚ·apple¢ÙÈο Û¯‹Ì·Ù· Â›Ó·È ·ÛʷϤÛÙÂÚoÎ·È ·appleoÙÂÏÂÛÌ·ÙÈÎfiÙÂÚo ˆ˜ appleÚo˜ ÙoÓ ¤ÏÂÁ¯o Ù˘ÂÓ‰oÊı¿ÏÌÈ·˜ apple›ÂÛ˘.OÈ Fechtner Î·È Û˘Ó. 5 Û˘Ó¤ÎÚÈÓ·Ó ÙËÓ ËÌÂÚ‹-ÛÈ· ∂O ˘applefi Ï·Ù·ÓoappleÚfiÛÙË ¯oÚËÁo‡ÌÂÓË Ùo ‚Ú¿-‰˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ¯oÚ‹ÁËÛË Ùo˘ Û˘Ó‰˘·ÛÌo‡‰‡o ÊoÚ¤˜ ËÌÂÚËÛ›ˆ˜, Î·È ·apple¤‰ÂÈÍ·Ó fiÙÈ o ¤ÏÂÁ-¯o˜ Ù˘ ∂O ‹Ù·Ó ۯ‰fiÓ apple·ÚfiÌoÈo˜ Î·È Ì ٷ‰‡o ·˘Ù¿ Ê¿Ú̷η. ∞applefi Ì›· appleÚoËÁËı›۷ ÌÂϤÙËÙˆÓ Konstas Î·È Û˘Ó. 6 appleÚo·appleÙÂÈ fiÙÈ Ë ‚Ú·‰˘Ó‹¯oÚ‹ÁËÛË Ï·Ù·ÓoappleÚfiÛÙ˘ ˆ˜ ÌoÓoıÂÚ·apple›·˜ ÂÍ·-ÛÊ¿ÏÈ˙ ηχÙÂÚo ¤ÏÂÁ¯o Ù˘ ∂O ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ Ë̤ڷ˜, apple·Ú¿ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡-¯Ù·˜. ∞ÓÙ›ÛÙoȯo ·appleoÙ¤ÏÂÛÌ· apple·Ú·ÙËÚ‹ıËΠηÈÛ ¿ÏÏË ÌÂϤÙË Ù˘ ›‰È·˜ oÌ¿‰·˜ Û ·ÛıÂÓ›˜ Ì·appleoÊoÏȉˆÙÈÎfi ÁÏ·‡ÎˆÌ· Ì ÙË Ï·Ù·ÓoappleÚfiÛÙË ˆ˜ÙÚ›ÙË ıÂÚ·apple¢ÙÈ΋ ÂappleÈÏoÁ‹ appleÚoÛÙÈı¤ÌÂÓË ÛÙËÓÙÈÌoÏfiÏË Î·È ÛÙË ÓÙoÚ˙oÏ·Ì›‰Ë 7 . 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OÈ ·ÛıÂÓ›˜ ¤apple·Û¯·Ó·applefi oÊı·ÏÌÈ΋ ˘appleÂÚÙoÓ›· ‹ °∞° Î·È Â›¯·Ó fiÏoÈ ·ÓoÈ-¯Ù‹ ÁˆÓ›· ÛÙoÓ ÁˆÓÈoÛÎoappleÈÎfi ¤ÏÂÁ¯o. ∏ oÌ¿‰· °∞°ÂÌÊ¿ÓÈ˙Â Ù˘appleÈΤ˜ ÁÏ·˘ÎˆÌ·ÙÈΤ˜ ‚Ï¿‚˜ ÙˆÓ oappleÙÈÎÒÓapple‰›ˆÓ ( ÚÈÓÈÎfi ‚‹Ì·, ÙoÍoÂȉ‹ ÛÎoÙÒÌ·Ù·, apple·Ú·ÎÂ-ÓÙÚÈο ÛÎoÙÒÌ·Ù· ‹ ÛÎfiو̷ Seidel) ÛÙËÓ·˘ÙoÌ·ÙoappleoÈË̤ÓË ÛÙ·ÙÈ΋ o˘‰È΋ appleÂÚÈÌÂÙÚ›· ÌÂHumphrey 30-2 Î·È ÁÏ·˘ÎˆÌ·ÙÈ΋ ·ÏÏo›ˆÛË Ùo˘oappleÙÈÎo‡ Ó‡Úo˘ (Îo›Ï·ÓÛË, ÂÓÙ‡appleˆÌ· Ùo˘ Ó¢Úo·ÌÊÈ-‚ÏËÛÙÚoÂȉÈÎo‡ ‰·ÎÙ˘Ï›o˘, Î.Ù.Ï.). ∫·Ù¿ ÙËÓ ÂappleÈÏoÁ‹ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Ï‹ÊıËΠ˘apple’ fi„ÈÓ Ë appleÚoËÁo‡ÌÂÓË·apple¿ÓÙËÛË Û ‚-·Ó·ÛÙoÏ›˜.∞applefi ÙËÓ apple·Úo‡Û· ÌÂϤÙË ·appleoÎÏ›ÛÙËÎ·Ó oÈ ·ÛıÂ-Ó›˜ Ì ÈÛÙoÚÈÎfi oÊı·ÏÌÈ΋˜ ÂÁ¯Â›ÚËÛ˘ ‹ ÙÚ·‡Ì·Ùo˜,fiÛoÈ Â›¯·Ó οÓÂÈ ¯Ú‹ÛË ÎoÚÙÈÎoÛÙÂÚoÂȉÒÓ, ·ÛıÂÓ›˜appleo˘ ¤Î·Ó·Ó ¯Ú‹ÛË Ê·ÎÒÓ Âapple·Ê‹˜, ηıÒ˜ Î·È oÈ apple¿-Û¯oÓÙ˜ ·applefi ÍËÚoÊı·ÏÌ›·, ÎÂÚ·ÙoÂȉÈΤ˜ ·ÓˆÌ·Ï›Â˜ ‹¿ÏϘ apple·ıoÏoÁÈΤ˜ ηٷÛÙ¿ÛÂȘ appleo˘ ı· ÌappleoÚo‡Û·Ó Ó·apple·ÚÂÌappleo‰›Ûo˘Ó Ì›· ·ÍÈfiappleÈÛÙË ÙoÓo̤ÙÚËÛË ÂappleÈapple‰ÒÛÂ-ˆ˜. ∂apple›Û˘ ·appleoÎÏ›ÛÙËÎ·Ó ·applefi ÙË ÌÂϤÙË ·ÛıÂÓ›˜ appleo˘¤Î·Ó·Ó ¯Ú‹ÛË Û˘ÛÙËÌ·ÙÈÎÒÓ ‚-·Ó·ÛÙoϤˆÓ, ·ÛıÂÓ›˜Ì ¤Î‰ËÏË oÊı·ÏÌÈ΋ Ïo›ÌˆÍË, appleÚo¯ˆÚË̤Óo ηٷÚÚ¿-ÎÙË, ÊÏÂÁÌoÓ¤˜ Î·È ÈÛÙoÚÈÎfi ÓÂÊÚÈ΋˜ ‹ Ëapple·ÙÈ΋˜ ‚Ï¿-‚˘. ∂appleÈϤ¯ıËÎ·Ó ÌfiÓoÓ ·ÛıÂÓ›˜ ÛÙo˘˜ oappleo›o˘˜ ‰ÂÓappleÚo¸apple‹Ú¯Â ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ¯oÚ‹ÁËÛË ÙoappleÈÎÒÓ ‚-·Ó·-ÛÙoϤˆÓ (apple.¯. ‚Ú·‰˘Î·Ú‰›·, ηډȷ΋ ·ÓÂapple¿ÚÎÂÈ·, ·-appleoÊÚ·ÎÙÈΤ˜ apple·ı‹ÛÂȘ Ùo˘ ·Ó·appleÓ¢ÛÙÈÎo‡). ∞appleoÎÏ›-ÛÙËÎ·Ó Âapple›Û˘ oÈ ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ·ÏÏÂÚÁ›· ÛÙȘÛo˘ÏÊ·Ì›‰Â˜ ‹ Û appleÚoÛÙ·ÁÏ·Ó‰›Ó˜.  ·ÛıÂÓ›˜ Ì ·Ì-ÊoÙÂÚfiappleÏ¢Úo °∞° ÂappleÈϤ¯ıËÎÂ Ù˘¯·›· o ¤Ó·˜ ÌfiÓooÊı·ÏÌfi˜ ÁÈ· Ó· Û˘ÌappleÂÚÈÏËÊı› ÛÙË ÌÂϤÙË.OÈ Ì¤ıo‰oÈ Ù˘ apple·Úo‡Û˘ ÌÂϤÙ˘ Â›Ó·È fiÌoÈoÈ ÌÂÂΛӘ appleo˘ appleÂÚÈÁÚ¿ÊËÎ·Ó Û appleÚoËÁo‡ÌÂÓ˜ ÌÂϤÙ˜̷˜9-14 . ŸÏoÈ oÈ ·ÛıÂÓ›˜ ÂÓËÌÂÚÒıËÎ·Ó Î·È ¤‰ˆÛ·Ó ÙËÓÂÓ˘applefiÁÚ·ÊË Û˘ÁηٿıÂÛ‹ Ùo˘˜ appleÚÈÓ ÍÂÎÈÓ‹ÛÂÈ Ë ÌÂϤÙË.Ùo˘˜ ·ÛıÂÓ›˜ ¯oÚËÁ‹ıËΠ·Ú¯Èο, ÌÂÙ¿ ·applefi Ù˘¯·›·ÂappleÈÏoÁ‹, Ï·Ù·ÓoappleÚfiÛÙË 0,005% (Pharmacia, Hellas) Ì›·ÊoÚ¿ ËÌÂÚËÛ›ˆ˜ οı ‚Ú¿‰˘ (20:00) ‹ Cosopt (VianexMSD), ‰‡o ÊoÚ¤˜ ËÌÂÚËÛ›ˆ˜ (08:00 Î·È 20:00) ÁÈ· Ì›·appleÚÒÙË appleÂÚ›o‰o ¤ÍÈ Â‚‰oÌ¿‰ˆÓ. ÙË Û˘Ó¤¯ÂÈ· ¤ÁÈÓ ÂÓ·Ï-Ï·Á‹ Ù˘ ıÂÚ·apple›·˜ ÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ Î·È ·ÎoÏo‡-ıËÛ ̛· ‰Â‡ÙÂÚË appleÂÚ›o‰o˜ ıÂÚ·apple›·˜ ¿ÏÏˆÓ ¤ÍÈ Â‚‰o-Ì¿‰ˆÓ. Ÿappleo˘ ¯ÚÂÈ¿ÛÙËÎÂ, appleÚoËÁ‹ıËΠ‰È·Îoapple‹ Ù˘ appleÚo-ËÁo‡ÌÂÓ˘ ·ÓÙÈÁÏ·˘ÎˆÌ·ÙÈ΋˜ ·ÁˆÁ‹˜ ÁÈ· ÙÚÂȘ ‚‰oÌ¿-‰Â˜. ªÂÙ¿ ÙËÓ Û˘ÌappleÏ‹ÚˆÛË Ùo˘Ï¿¯ÈÛÙoÓ 6 ‚‰oÌ¿‰ˆÓ

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 173ÛÙËÓ Î¿ı appleÂÚ›Ô‰o ıÂÚ·apple›·˜ oÈ ·ÛıÂÓ›˜ ˘appleo‚Ï‹ıËηÓÛ ÌÂÙÚ‹ÛÂȘ Ù˘ 24ˆÚ˘ ∂O. ∂appleÈϤ¯ıËΠÛÎfiappleÈÌ· ËappleÂÚ›o‰o˜ ıÂÚ·apple›·˜ ÙˆÓ ¤ÍÈ Â‚‰oÌ¿‰ˆÓ ÒÛÙ ӷ ‰oı›ÈηÓoappleoÈËÙÈÎfi˜ ¯ÚfiÓo˜ ‰Ú¿Û˘ Ì Ùo οı ʿÚÌ·Îo ηÈÓ· ÌËÓ ¯ÚÂÈ·ÛÙ› οı·ÚÛË ÌÂٷ͇ ÙˆÓ ıÂÚ·apple¢ÙÈÎÒÓ appleÂ-ÚÈfi‰ˆÓ Ù˘ ÌÂϤÙ˘. ∂appleo̤ӈ˜ ‰ÂÓ apple·ÚÂÌ‚Ï‹ıËΠ¯Úfi-Óo˜ ·appleoÌ¿ÎÚ˘ÓÛ˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ (wash out) ÌÂÙ·Í‡ÙˆÓ ‰‡o appleÂÚÈfi‰ˆÓ ıÂÚ·apple›·˜.∫·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ 24ˆÚ˘ ÙoÓoÌÂÙÚÈ΋˜Î·Ìapple‡Ï˘, o ÂÚ¢ÓËÙ‹˜ appleo˘ ¤Î·Ó ÙȘ ÌÂÙÚ‹ÛÂȘ Ù˘∂O ‰ÂÓ ÁÓÒÚÈ˙ Ùo ıÂÚ·apple¢ÙÈÎfi Û¯‹Ì· appleo˘ ·ÎoÏo˘ıo‡ÛÂo ·ÛıÂÓ‹˜. OÈ ÌÂÙÚ‹ÛÂȘ Ù˘ apple›ÂÛ˘ ¤ÁÈÓ·Ó Û ο-ı ΤÓÙÚo apple¿ÓÙ· ·applefi ÙoÓ ›‰Èo ÂÚ¢ÓËÙ‹ Î·È Ì Ùo ›‰ÈoÙoÓfiÌÂÙÚo ÂappleÈapple‰ÒÛˆ˜ (Goldmann). OÈ ·ÛıÂÓ›˜ ÂÈ-Û‹¯ıËÛ·Ó ÛÙo ÓoÛoÎoÌ›o Ùo appleÚˆ› Î·È oÈ ÌÂÙÚ‹ÛÂȘ ¤ÁÈ-Ó·Ó ÛÙȘ 10:00, 14:00, 18:00, 22:00, 02:00 Î·È 06:00. ∏ ̤-ÙÚËÛË ÙˆÓ 22:00 ÁÈÓfiÙ·Ó appleÚÈÓ ÙË Î·Ù¿ÎÏÈÛË, ÂÓÒ oÈ ÌÂ-ÙÚ‹ÛÂȘ Ù˘ appleÚˆÈÓ‹˜ apple›ÂÛ˘ ÙˆÓ 02:00 Î·È 06:00 ÁÈÓfiٷӷ̤ۈ˜ ÌÂÙ¿ ÙËÓ ·Ê‡appleÓÈÛË ÙˆÓ ·ÛıÂÓÒÓ. ŒÁÈÓ appleÚoÛapple¿ıÂÈ·oÈ ·ÛıÂÓ›˜ Ó· ‰È¿Áo˘Ó ηٿ Ùo ‰˘Ó·ÙfiÓ Ì›· Ê˘-ÛÈoÏoÁÈ΋ ˙ˆ‹ ÛÙo˘˜ ¯ÒÚo˘˜ Ùo˘ ÓoÛoÎoÌ›o˘.ŸÏoÈ oÈ ·ÛıÂÓ›˜ ›¯·Ó ÂÎapple·È‰Â˘Ù› appleÚÈÓ ·applefi ÙËÓÛ˘ÌÌÂÙo¯‹ ÛÙË ÌÂϤÙË ÛÙË ÛˆÛÙ‹ ÂÓÛÙ¿Ï·ÍË ÙˆÓ ÛÙ·-ÁfiÓˆÓ Î·È Â›¯Â ÂÏÂÁ¯ı› Ë Û˘ÌÌfiÚʈÛË ÛÙË Ê·ÚÌ·-΢ÙÈ΋ ·ÁˆÁ‹. ∑ËÙ‹ıËΠÂapple›Û˘ ·applefi Ùo˘˜ ·ÛıÂÓ›˜,ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘, Ó· ÂÊ·ÚÌfi˙o˘Ó ÚÈÓo‰·-ÎÚ˘˚Îfi ·appleoÎÏÂÈÛÌfi ÁÈ· ¤Ó· ÏÂappleÙfi ÌÂÙ¿ ÙËÓ ÂÓÛÙ¿Ï·ÍËÙˆÓ ÎoÏÏ˘Ú›ˆÓ. ∫·Ù·ÁÚ¿ÊËηÓ, Û οı ̤ÙÚËÛË, Ùfi-Ûo oÈ Û˘ÛÙËÌ·ÙÈΤ˜ fiÛo Î·È oÈ ÙoappleÈΤ˜ ·ÓÂappleÈı‡ÌËÙ˜ÂÓ¤ÚÁÂȘ.°È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÙÈÌÒÓ Ù˘ ∂O ÙˆÓ‰‡o oÌ¿‰ˆÓ ·ÛıÂÓÒÓ ¯ÚËÛÈÌoappleoÈ‹ıËΠÙo paired t-testÙfiÛo ÛÙȘ ÌÂÌoӈ̤Ó˜ ·ÓÙ›ÛÙoȯ˜ ÌÂÙÚ‹ÛÂȘ fiÛo ηÈÛÙËÓ 24ˆÚË Î·Ìapple‡ÏË (̤Ûo˜ fiÚo˜ ∂O). ø˜ ÛÙ¿ıÌË ·-ÍÈoappleÈÛÙ›·˜ oÚ›ÛÙËΠÙo 5% Î·È fiϘ oÈ ·Ó·Ï‡ÛÂȘ ¤ÁÈ-Ó·Ó ·ÌÊ›‰ÚoÌ·. ∏ apple·Úo‡Û· ÌÂϤÙË Â›¯Â ÛÙ·ÙÈÛÙÈο È-Û¯‡ 80% Ó· ·appleoÎÏ›ÛÂÈ Ì›· ‰È·ÊoÚ¿ 1,5 mmHg ÌÂÙ·Í‡ÙˆÓ ‰‡o oÌ¿‰ˆÓ Ì ÛÙ·ıÂÚ‹ ·applefiÎÏÈÛË 2,5 mmHg. OÈ·ÓÂappleÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÂÎÙÈÌ‹ıËÎ·Ó Ì Ùo ÙÂÛÙ Mc Nemar15 .∞appleÔÙÂϤÛÌ·Ù·∞ÛıÂÓ›˜ΔË ÌÂϤÙË oÏoÎÏ‹ÚˆÛ·Ó 33 ·ÛıÂÓ›˜, oÈ oappleo›-oÈ ˘appleo‚Ï‹ıËÎ·Ó Û ¤ÏÂÁ¯o Ù˘ 24ˆÚ˘ ÙoÓoÌÂ-ÙÚÈ΋˜ ηÌapple‡Ï˘ Î·È ÛÙȘ ‰‡o appleÂÚÈfi‰o˘˜ ıÂÚ·apple›-·˜. ∞applefi Ùo˘˜ ·ÛıÂÓ›˜ oÈ 15 ‹Ù·Ó ¿Ó‰Ú˜ Î·È oÈ 18Á˘Ó·›Î˜, Ì ̤Ûo fiÚo ËÏÈΛ·˜ 64,8 ± 8,3 ¤ÙË.∂appleÙ¿ ·ÛıÂÓ›˜ ¤apple·Û¯·Ó ·applefi oÊı·ÏÌÈ΋ ˘appleÂÚÙo-Ó›· Î·È 26 ·applefi °∞°.  11 ·ÛıÂÓ›˜ ›¯Â ¯oÚË-ÁËı› ÛÙo apple·ÚÂÏıfiÓ ÌËÏÂ˚ÓÈ΋ ÙÈÌoÏfiÏË, ÂÓÒ 23‰ÂÓ Â›¯·Ó ˘appleo‚ÏËı› appleoÙ¤ Û ·ÓÙÈÁÏ·˘ÎˆÌ·ÙÈ΋ıÂÚ·apple›·. ŒÓ·˜ ·ÛıÂÓ‹˜ ‰ÂÓ oÏoÎÏ‹ÚˆÛ ÙË ÌÂ-ϤÙË, ÁÈ·Ù› apple·Úo˘Û›·Û ·Ó·appleÓ¢ÛÙÈο appleÚo‚Ï‹Ì·-Ù· (¿ÛıÌ·) ÌÂÙ¿ ·applefi ÂÓÛÙ¿Ï·ÍË Ùo˘ Û˘Ó‰˘·ÛÌo‡,·Ó Î·È ‰ÂÓ Â›¯Â appleÚoËÁo‡ÌÂÓo ÈÛÙoÚÈÎfi.∂Ó‰oÊı¿ÏÌÈ· apple›ÂÛËO ̤Ûo˜ fiÚo˜ Ù˘ apple›ÂÛ˘ ÙˆÓ 33 ·ÛıÂÓÒÓ ¯ˆ-Ú›˜ ıÂÚ·apple›· ÛÙȘ 10:00 ‹Ù·Ó 25,8±1,4 mmHg. ∞-applefi ÙË ÌÂϤÙË Ì·˜ appleÚo¤Î˘„ fiÙÈ Ë Ì¤ÛË 24ˆÚË∂O Ì ϷٷÓoappleÚfiÛÙË ‹Ù·Ó 15,9±2,3 mmHg, ÂÓÒÌ ÙoÓ Û˘Ó‰˘·ÛÌfi ‹Ù·Ó 15,3±2,0 mmHg (P =0,05). OÈ Ì¤Û˜ ÙÈ̤˜ Ù˘ ∂O fiÏˆÓ ÙˆÓ ÂappleÈ̤-Úo˘˜ ÌÂÙÚ‹ÛÂˆÓ Ùo˘ 24ÒÚo˘ ·appleÂÈÎoÓ›˙oÓÙ·È ÛÙoÓapple›Ó·Î· 1.  ·ÓÙ›ÛÙoȯ˜ ¯ÚoÓÈο ÌÂÙÚ‹ÛÂȘ, Ë∂O ‰ÂÓ apple·Úo˘Û›·Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·-ÊoÚ¿, ÂÎÙfi˜ ·applefi ÙË Ì¤ÙÚËÛË ÙˆÓ 22:00, fiappleo˘ o ¤-ÙoÈÌo˜ Û˘Ó‰˘·ÛÌfi˜ ÂÍ·ÛÊ¿ÏÈÛ ηχÙÂÚo ¤ÏÂÁ¯oÙ˘ apple›ÂÛ˘ (p=0,006).∞ÛÊ¿ÏÂÈ·OÈ ·ÓÂappleÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ appleo˘ ηٷÁÚ¿ÊË-Î·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ·appleÂÈÎoÓ›˙oÓÙ·ÈÛÙoÓ apple›Ó·Î· 2. ¢ÂÓ apple·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜‰È·ÊoÚ¤˜ fiÛoÓ ·ÊoÚ¿ ÙȘ ·ÓÂappleÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘÌÂٷ͇ ÙˆÓ ‰‡o oÌ¿‰ˆÓ, ÂÎÙfi˜ ·applefi ÙËÓ appleÈÎÚ‹ Á‡-›Ó·Î·˜ 1. M¤ÛË 24ˆÚË EO Ì ٷ ‰‡Ô Ê¿Ú̷η (Û mmHg)flÚ· §·Ù·ÓoappleÚfiÛÙË Ù·ıÂÚfi˜ Û˘Ó‰˘·ÛÌfi˜ (Cosopt) P-value06:00 15,3 ± 2,6 15,2 ± 2,3 0,8810:00 16,7 ± 3,2 16,0 ± 3,2 0,3814:00 15,7 ± 2,7 15,2 ± 2,7 0,5318:00 16,0 ± 3,1 15,7 ± 2,7 0,7322:00 16,6 ± 3,1 14,6 ± 2,7 0,00602:00 15,0 ± 2,4 15,0 ± 2,2 0,95ª¤ÛË 24ˆÚË ∂O 15,9 ± 2,3 15,3 ± 2,0 0,05ª¤ÁÈÛÙË 18,5 ± 2,8 17,6 ± 2,5 0,20∂Ï¿¯ÈÛÙË 13,6 ± 2,1 13,0 ± 2,2 0,25∂‡Úo˜ ∂O 4,8 ± 1,8 4,6 ± 1,8 0,60

174 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)›Ó·Î·˜ 2. AÓÂappleÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ∞ÓÂappleÈı‡ÌËÙË §·Ù·ÓoappleÚfiÛÙË Ù·ıÂÚfi˜ÂÓ¤ÚÁÂÈ·Û˘Ó‰˘·ÛÌfi˜(Cosopt)ΔÛo‡ÍÈÌo/ο„ÈÌoÛÙËÓ ÂÓÛÙ¿Ï·ÍË 4 8ÀappleÂÚ·ÈÌ›· ÂappleÈappleÂÊ˘ÎfiÙ· 8 2ÈÎÚ‹ Á‡ÛË 0 9ÙÈÎÙ‹ ÂappleÈıËÏÈoapple¿ıÂÈ· 1 2∞›ÛıËÌ· ͤÓo˘ ÛÒÌ·Ùo˜ 1 1º·Áo‡Ú· 1 0∞›ÛıËÌ· ÍËÚo‡oÊı·ÏÌo‡ 0 1¢È·Îoapple‹ ÏfiÁˆ‰˘Û·ÓÂÍ›·˜ 0 1ÕÛıÌ· 0 1ÛË, appleo˘ ‹Ù·Ó ÛËÌ·ÓÙÈο Û˘¯ÓfiÙÂÚË Ì ÙoÓ Û˘Ó‰˘·-ÛÌfi (p=0,009). ËÌÂÈÒıËΠ̛· Ù¿ÛË ÁÈ· Û˘¯ÓfiÙÂ-ÚË ÂÌÊ¿ÓÈÛË ˘appleÂÚ·ÈÌ›·˜ ÌÂÙ¿ ·applefi ¯oÚ‹ÁËÛË Ï·-Ù·ÓoappleÚfiÛÙ˘, Ë oappleo›· fï˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈοÛËÌ·ÓÙÈ΋ (p=0,12).ÚoÙ›ÌËÛËÙo Ù¤Ïo˜ Ù˘ ÌÂϤÙ˘ ˙ËÙ‹ıËΠ·applefi Ùo˘˜ ·-ÛıÂÓ›˜ Ó· ‰ËÏÒÛo˘Ó ÙËÓ appleÚoÙ›ÌËÛ‹ Ùo˘˜ ÁÈ· ο-appleoÈo ·applefi Ù· ‰‡Ô ȉÈoÛ΢¿ÛÌ·Ù· Î·È Ó· ·Ó·Ê¤-Úo˘Ó, Û ÁÂÓÈΤ˜ ÁÚ·Ì̤˜, Ùo˘˜ ÏfiÁo˘˜ ·˘Ù‹˜ Ù˘appleÚoÙ›ÌËÛ˘. ŒÓ·˜ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚo˜ ·ÚÈı-Ìfi˜ ·ÛıÂÓÒÓ (n=18) appleÚoÙ›ÌËÛ ÙË Ï·Ù·ÓoappleÚfiÛÙˤӷÓÙÈ Ùo˘ ÛÙ·ıÂÚo‡ Û˘Ó‰˘·ÛÌo‡ ÙÈÌoÏfiÏ˘-ÓÙoÚ-˙oÏ·Ì›‰Ë˜ (n=2), (p

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 175Î·È Ë ·ÛÊ¿ÏÂÈ·, Ì ÙËÓ ¯oÚ‹ÁËÛË Ï·Ù·ÓoappleÚfiÛÙ˘̛· ÊoÚ¿ ËÌÂÚËÛ›ˆ˜ ¤Ó·ÓÙÈ Ùo˘ Û˘Ó‰˘·ÛÌo‡ ‰‡oÊoÚ¤˜ ËÌÂÚËÛ›ˆ˜ ˆ˜ ÌoÓoıÂÚ·apple›·˜ Û ·ÛıÂÓ›˜Ì °∞° ‹ ˘appleÂÚÙoÓ›·. ∞applefi ÙËÓ apple·Úo‡Û· ¤Ú¢ӷappleÚo¤Î˘„Â, ÛÂ Û˘Ìʈӛ· Ì ÙËÓ ÌÂϤÙË ÙˆÓ FechtnerÎ·È Û˘Ó. 5 , fiÙÈ o ¤ÏÂÁ¯o˜ Ù˘ ∂O ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ Ë̤ڷ˜ Â›Ó·È apple·ÚfiÌoÈo˜ ÙfiÛo Ì ÙË Ï·-Ù·ÓoappleÚfiÛÙË fiÛo Ì ÙoÓ Û˘Ó‰˘·ÛÌfi. ·ÚfiÏ· ·˘Ù¿,˘apple‹ÚÍ ̛· Ù¿ÛË ÁÈ· ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ ∂OÌ ÙoÓ Û˘Ó‰˘·ÛÌfi, ΢ڛˆ˜ ÛÙ· ¯ÚoÓÈο ÛËÌ›· η-χÙÂÚ˘ ‰Ú¿Û˘ Ù˘ ÙÈÌoÏfiÏ˘ ÛÙËÓ ‰È¿ÚÎÂÈ· Ù˘Ë̤ڷ˜. ∞˘Ùfi Â›Ó·È Û˘ÓÂapple¤˜ Î·È Ì ٷ Â˘Ú‹Ì·Ù·Ù˘ ÌÂϤÙ˘ ÙˆÓ Fechtner Î·È Û˘Ó. 5∂›Ó·È ·ÍÈoÛËÌ›ˆÙo Û ·˘Ù‹ ÙË Û˘ÁÎÚÈÙÈ΋ÌÂϤÙË Âapple›Û˘ fiÙÈ ÛÙË Ì¤ÙÚËÛË ÙˆÓ 22:00 o ¤ÏÂÁ¯o˜‹Ù·Ó ÛÙ·ÙÈÛÙÈο ηχÙÂÚo˜ (2,0 mmHg ‰È·ÊoÚ¿)Ì ÙoÓ ÛÙ·ıÂÚfi Û˘Ó‰˘·ÛÌfi Û ۯ¤ÛË Ì ÙËÓ Ï·-Ù·ÓoappleÚfiÛÙË. ŸÙ·Ó fiÏ· Ù· ¯ÚoÓÈο ÛËÌ›· Ù˘ 24ˆÚ˘ ̤ÙÚËÛ˘ Û˘Ó˘appleoÏoÁ›ÛÙËÎ·Ó ˘apple‹ÚÍ ÌÈ· ÌÈ-ÎÚ‹, ·ÏÏ¿ oÚȷο ÛËÌ·ÓÙÈ΋, ˘appleÂÚo¯‹ ÁÈ· ÙoÓÛ˘Ó‰˘·ÛÌfi (0,6 mmHg ‰È·ÊoÚ¿, p=0,05). ∏ ÂÏ·-ÊÚÒ˜ ˘„ËÏfiÙÂÚË apple›ÂÛË appleo˘ ‚Ú¤ıËΠηٿ ÙË Ì¤-ÙÚËÛË ÙˆÓ 22:00 ÛÙo˘˜ ·ÛıÂÓ›˜ ˘applefi Ï·Ù·ÓoappleÚfi-ÛÙË ‰ÈηÈoÏoÁÂ›Ù·È ·applefiÏ˘Ù· ·applefi ‹‰Ë ÁÓˆÛÙ¿ ÛÙoÈ-¯Â›·, Û‡Ìʈӷ Ì ٷ oappleo›· Ë ‚Ú·‰˘Ó‹ ¯oÚ‹ÁËÛËÏ·Ù·ÓoappleÚfiÛÙ˘ ÂÍ·ÛÊ·Ï›˙ÂÈ Î·Ï‡ÙÂÚo ˘appleoÙoÓÈÎfi¤ÏÂÁ¯o ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜6,12,21 . ∂›Ó·ÈÏoÁÈÎfi Âapple›Û˘ Ó· ˘appleoı¤ÛÂÈ Î·Ó›˜ fiÙÈ ÛÙȘ 10 Ùo‚Ú¿‰˘ appleÈı·ÓfiÓ ÂÓÙoapple›˙ÂÙ·È Î·È Ùo ÛËÌ›o ÂÏ¿¯È-ÛÙ˘ ‰Ú¿Û˘ Ù˘ Ï·Ù·ÓoappleÚfiÛÙ˘.ŸÛoÓ ·ÊoÚ¿ ÙËÓ ·ÛÊ¿ÏÂÈ·, Î·È Ù· ‰‡o appleÚo˚fiÓÙ·ÂÌÊ¿ÓÈÛ·Ó Û¯Â‰fiÓ apple·ÚfiÌoÈ· ¯·Ú·ÎÙËÚÈÛÙÈ-ο. ∏ appleÈÎÚ‹ Á‡ÛË ‹Ù·Ó ÛËÌ·ÓÙÈο Û˘¯ÓfiÙÂÚË ÌÂÙoÓ Û˘Ó‰˘·ÛÌfi. ÚfiÎÂÈÙ·È ÁÈ· Ì›· Û˘¯Ó‹ Î·È ÁÓˆ-ÛÙ‹ ·ÓÂappleÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· Ù˘ ÓÙoÚ˙oÏ·Ì›‰Ë˜14 .ÙËÓ ÌÂϤÙË ‚Ú¤ıËΠ̛· Ù¿ÛË ÁÈ· Û˘¯ÓfiÙÂÚË ÂÌ-Ê¿ÓÈÛË ˘appleÂÚ·ÈÌ›·˜ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ· Ì ÙË Ï·Ù·-ÓoappleÚfiÛÙË, ÁÓˆÛÙ‹ ·ÓÂappleÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· Ùo˘ Ê·Ú-Ì¿Îo˘22,25 .∂›Ó·È ÂӉȷʤÚoÓ fiÙÈ oÈ ·ÛıÂÓ›˜ Ì·˜, fiÙ·ÓÙo˘˜ ˙ËÙ‹ıËÎÂ, ¤‰ÂÈÍ·Ó Ó· appleÚoÙÈÌo‡Ó ÛËÌ·ÓÙÈÎ¿Û˘¯ÓfiÙÂÚ· ÙË Ï·Ù·ÓoappleÚfiÛÙË apple·Ú¿ ÙoÓ Û˘Ó‰˘·ÛÌfi.∂apple¤ÏÂÍ·Ó ÙË Ï·Ù·ÓoappleÚfiÛÙË Î˘Ú›ˆ˜ ÁÈ· ÙËÓ ‚oÏÈ΋¯oÚ‹ÁËÛË Ì›· ÊoÚ¿ ËÌÂÚËÛ›ˆ˜. ∏ apple·Úo‡Û· ÌÂϤ-ÙË ÂÓÈÛ¯‡ÂÈ ÙËÓ ÂÓÙ‡appleˆÛË fiÙÈ Ë Û˘¯ÓfiÙËÙ· ‰oÛoÏfi-ÁËÛ˘ ÂappleËÚ¿˙ÂÈ ÙËÓ appleoÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ÁÏ·˘Îˆ-Ì·ÙÈÎÒÓ ·ÛıÂÓÒÓ Î·È appleÈı·ÓÒ˜ Î·È ÙËÓ Û˘ÌÌfiÚʈ-ÛË. ÂÚÈÛÛfiÙÂÚ· ÛÙoȯ›· ·apple·ÈÙo‡ÓÙ·È ÛÙo ̤Ï-ÏoÓ Û ·˘Ùfi Ùo ı¤Ì·.∏ apple·Úo‡Û· 24ˆÚË ÌÂϤÙË ÁÈ· appleÚÒÙË ÊoÚ¿ Û˘-Ó¤ÎÚÈÓ ‰‡o ‰ËÌoÊÈÏ‹ Ê¿Ú̷η ÛÙËÓ ıÂÚ·apple›· Ùo˘ÁÏ·˘ÎÒÌ·Ùo˜ ˆ˜ ÌoÓoıÂÚ·apple›·˜. ∞applefi Ù· ·appleoÙÂ-ϤÛÌ·Ù· appleÚo·appleÙÂÈ fiÙÈ Ë 24ˆÚË Î·Ìapple‡ÏË Ù˘ ∂OÙˆÓ ·ÛıÂÓÒÓ Ì °∞° ‹ oÊı·ÏÌÈ΋ ˘appleÂÚÙoÓ›· appleo˘ıÂÚ·apple‡oÓÙ·È Ì ÙoÓ Û˘Ó‰˘·ÛÌfi Â›Ó·È ÂÏ·ÊÚÒ˜ η-χÙÂÚË Û˘ÁÎÚÈÓfiÌÂÓË Ì ÙËÓ 24ˆÚË Î·Ìapple‡ÏË ˘applefiÏ·Ù·ÓoappleÚfiÛÙË Î·È ·˘Ùfi ΢ڛˆ˜ oÊ›ÏÂÙ·È ÛÙËÓ‚Ú·‰˘Ó‹ ̤ÙÚËÛË ÛÙȘ 22:00. ÙËÓ ÌÂϤÙË Ì·˜ ‰ÂÓ¤ÁÈÓ appleÚoÛapple¿ıÂÈ· Û‡ÁÎÚÈÛ˘ Ùo˘ Û˘Ó‰˘·ÛÌo‡ ηÈÙ˘ Ï·Ù·ÓoappleÚfiÛÙ˘ Ì appleÚˆÈÓ‹ ¯oÚ‹ÁËÛË. ∂›Ó·È appleÈı·ÓfiË appleÚˆÈÓ‹ ¯oÚ‹ÁËÛË Ù˘ Ï·Ù·ÓoappleÚfiÛÙ˘ Ó· ¿Ï-Ï·˙ ٷ ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ 24ˆÚ˘ ηÌapple‡Ï˘. ∂›-Ó·È Âapple›Û˘ appleÈı·Ófi Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ 24ˆÚ˘ηÌapple‡Ï˘ Ó· ‹Ù·Ó ‰È·ÊoÚÂÙÈο Û ¿ÏÏ· ÁÏ·˘ÎÒÌ·-Ù· (fiappleˆ˜ Ùo ·appleoÊoÏȉˆÙÈÎfi ÁÏ·‡ÎˆÌ·) Î·È Û ‰È·-ÊoÚÂÙÈÎo‡˜ ÂıÓÈο appleÏËı˘ÛÌo‡˜.BÈ‚ÏÈÔÁÚ·Ê›·1. Smith SL, Pruitt CA, Sine CS, Hudgins AC, Stewart WC.The use of latanoprost 0.005% once daily to simplifymedical therapy in patients with primary open-angleglaucoma or ocular hypertension. Acta Opthalmologica77: 189-192, 1999.2. Clineshmidt CM, Williams RD, Snyder E, Adamsons IA. Arandomized trial in patients inadequately controlledon timolol alone comparing the dorzolamide-timololcombination to monotherapy with timolol or dorzolamide.Ophthalmology 106: 17-24, 1999.3. Hutzelmann J, Owens S, Sedden A, Adamsons I, Vargas E.Comparison of the safety and efficacy of the fixedcombination of dorzolamide/timolol and the concomitantadministration of dorzolamide and timolol: Aclinical equivalence study. International Clinical EquivalenceStudy Group. Br J Ophthalmol 82: 1249-1253, 1998.4. Boyle JE, Ghosh K, Gieser DK, Adamsons IA. A randomizedtrial comparing the dorzolamide-timolol combinationgiven twice daily to monotherapy with timololor dorzolamide. Ophthlamology 106: 10-16, 1999.5. Fechtner R, Clineschmidt C, Getson A, Adamson I, CosoptStudy Group. A three month parallel randomized, observer-masked,multicenter study comparing Cosoptto Xalatan in patients with elevated IOP. Invest OphthalmolVis Sci 40: S665, 1999.6. Konstas AGP, Maltezos AC, Gandi S, Hudgins AC, StewartWC. Comparison of the 24 hour intraocular pressurereduction with two dosing regimes of latanoprost andtimolol in patients with open-angle glaucoma. Am JOphthalmol 128: 15-20, 1999.7. Konstas AGP, Lake S, Maltezos AC, Holmes KT, StewartWC. 24 hour intraocular pressure reduction with latanoprostcompared to pilocarpine as third line therapyin exfoliation glaucoma. Eye 15: 59-63, 2001.8. Orzalesi N, Rossetti L, Invernizzi T, Bottoli A, Autelitano A.

176 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Effect of timolol, latanoprost, and dorzolamide on circadianIOP in glaucoma or ocular hypertension. InvestOphthalmol Vis Sci 41: 2566-2573. 2000.9. Konstas AGP, Mantziris DA, Cate EA, Stewart WC. Effectof timolol on the diurnal intraocular in exfoliation andprimary open-angle glaucoma. Arch Ophthalmol 115:975-979, 1997.10. Konstas AGP, Maltezos A, Mantziris DA, Sine CS, StewartWC. The comparative ocular hypotensive effect of a-praclonidine with timolol maleate in exfoliation versusprimary open-angle glaucoma patients. Eye 13:314-318, 1999.11. Konstas AGP, Maltezos T, Bufidis T, Hudgins AC, StewartWC. 24 hour control of IOP with dorzolamide and timololmaleate in exfoliation and primary open-angleglaucoma. Eye 14: 73-77, 2000.12. Konstas AGP, Stewart WC, Topouzis F, Tersis I, HolmesKT, Stangos N. Brimonidine 0,2% given two or threetimes daily versus timolol maleate 0,5% in primaryopen-angle glaucoma. Am J Ophthalmol 131: 729-733, 2001.13. Konstas AGP, Nakos E, Tersis I, Lallos N, Leech JN,Stewart WC. A comparison of once-daily morning vsevening dosing of concomitant latanoprost/timolol.Am J Ophthalmol 133: 753-757, 2002.14. Konstas AGP, Kozobolis VP, Tersis I, Leech J, StewartWC. The efficacy and safety of the timolol/dorzolamidefixed combination versus latanoprost in exfoliationglaucoma. Eye 2002 (in press).15. Siegel S. Non Parametric Statistics. Series in Psychology.New York: McGraw Hill, 1956: 63-67.16. Stjernschantz J, Resul B. Phenyl substituted prostaglandinanalogs for glaucoma treatment. Drugs of the Future17: 691, 1999.17. Nilsson SFE, Samuelsson M, Bill A, Stjernschantz J. Increaseduveoscleral outflow as a possible mechanismof ocular hypotension caused by prostaglandin F2a-1-isopropylester in the cynomolgus monkey. Exp EyeRes 48: 707, 1989.18. Gabelt BT, Kaufman PL. Prostaglandin F2a increasesuveoscleral outflow in the cynomolgus monkey. ExpEye Res 49: 389, 1989.19. Kerstetter JR, Brubaker RF, Wilson SE, Kullerstrand LJ.Prostaglandin F2a-1-isopropylester lowers intraocularpressure without decreasing aqueous humor flow. AmJ Ophthalmol 105: 30, 1988.20. Toris CB, Camras CD, Yablonski ME. Effects of PhXA41, a new prostaglandin F2a analog, on aqueous humordynamics in human eyes. Ophthalmology 100:1297, 1993.21. Alm A, Stjernschantz J, the Scandinavian LatanoprostStudy Group. Effects on intraocular pressure and sideeffects of 0.005% latanoprost applied once dai˙ly,evening or morning: a comparison with timolol.Ophthalmology 102: 1743-1752, 1995.22. Camras CB, United States Latanoprost Study Group.Comparison of latanoprost and timolol in patientswith ocular hypertension and glaucoma: A six-month,masked, multicenter trial in the United States. Ophthalmology103: 138-147, 1996.23. Watson P, Stjernschantz J, Scandanavian LatanoprostStudy Group. A six-month, randomized, double-maskedstudy comparing latanoprost with timolol in o-pen-angle glaucoma and ocular hypertension. Ophthalmology103: 126-137, 1996.24. Camras CB, Wax MB, Ritch R, Weinreb R, Robin AL,Higginbotham EJ, Lustgarten J, Stewart WC, SherwoodM, Krupin T, Wilensky J, Cioffi GA, Katz LJ, SchumerRA, Kaufman PL, Minckler D, Zimmerman T, StjernschantzJ, United States Latanoprost Study Group.Latanoprost treatment for glaucoma: effects of treatingfor 1 year and of switching from timolol. Am JOphthalmol 126: 390-399, 1998.25. Stewart WC. Current and future glaucoma therapy. CibaVision Ophthalmics, Duluth, Georgia, 1-43, 1997.26. Smith SL, Pruitt CA, Sine CS, Hudgins AC, Stewart WC.Latanoprost 0.005% and anterior segment uveitis.Acta Ophthalmol Scand 77: 668-672, 1999.27. Moroi SE, Gottfredsdottir MS, Schteingart MT, Elner SG,Lee CM, Schertzer RM, Abrams GW, Johnson MW.Cystoid macular edema associated with latanoprosttherapy in a case series of patients with glaucoma andocular hypertension. Ophthalmology 106: 1024-1029,1999.28. Kaufman HE, Varnell ED, Thompson HW. Latanoprostincreases the severity and recurrence of herpetic keratitisin the rabbit. Am J Ophthalmol 127: 531-536,1999.29. Stewart WC. New perspectives in the medical treatmentof glaucoma. Current Opinion 127: 142-147, 1999.30. Strahlman E, Tipping R, Vogel R, and the InternationalDorzolamide Study Group. A double masked, randomized1-year study comparing dorzolamide (Trusopt),timolol, and betaxolol. Arch Ophthalmol 113: 1009-1016, 1995.

∏ ¯Ú‹ÛË Ù˘ ·ÏÏ·ÓÙÔÙÔ͛Ӣ Ù‡appleÔ˘ ∞ ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛˤÏ͢ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ·applefi apple·Ú¿Ï˘ÛËÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘∫. MappleÔÌappleÔÚ›‰Ë˜, ¡. Zȿη˜ ∞. ∫ÔÛÎÔÛ¿˜, ¡. °ÂˆÚÁÈ¿‰Ë˜Botulinum toxin type A application in the management of upper lid retractionsecondary to facial nerve palsyK. Boboridis, N. Ziakas, A. Koskosas, N. Georgiadis∂ÈÛ·ÁˆÁ‹: ∏ ¤ÏÍË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ·applefi apple·Ú¿Ï˘ÛËÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘ ¤¯ÂÈ Û·Ó Û˘Ó¤appleÂÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÏ·ÁfiÊı·ÏÌÔ˘, ÙËÓ appleÏËÌÌÂÏ‹ Î¿Ï˘„Ë ÙÔ˘ ÎÂÚ·ÙÔÂȉ‹ ηȉËÌÈÔ˘ÚÁ›· ÎÂÚ·Ù›Ùȉ·˜ ·applefi ¤ÎıÂÛË. ·ÚÔ˘ÛÈ¿˙Ô˘Ì ÙËÓÂÌappleÂÈÚ›· Ì·˜ ·applefi ÙËÓ ¯Ú‹ÛË Ù˘ ·ÏÏ·ÓÙÔÙÔ͛Ӣ Ù‡appleÔ˘ ∞ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ù˘ ¤Ï͢ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ Ì ÙËÓ¯ËÌÈ΋ ·appleÔÓ‡ڈÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜. ∞ÛıÂÓ›˜ –ª¤ıÔ‰Ô˜: ∏ ̤ıÔ‰Ô˜ ÂÊ·ÚÌfiÛıËΠ۠18 ·ÛıÂÓ›˜ ÌÂappleÚfiÛÊ·ÙË apple·Ú¿Ï˘ÛË ÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘, Û˘ÌappleÙˆ-Ì·ÙÈÎfi Ï·ÁfiÊı·ÏÌÔ Î·È ÎÂÚ·Ù›Ùȉ· ÂÍ ÂÎı¤Ûˆ˜ appleÔ˘ ‰ÂÓ·ÓÙ·appleÔÎÚ›ıËΠÛÙËÓ Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Ù¯ÓËÙÒÓ ‰·-ÎÚ‡ˆÓ. ªÂ ÙËÓ ¯Ú‹ÛË ‚ÂÏfiÓ·˜ ÈÓÛÔ˘Ï›Ó˘ appleÚ·ÁÌ·ÙÔappleÔÈ-‹ıËΠ¤Á¯˘ÛË 7,5-15 IU Botox ÛÙËÓ ÌÂÛfiÙËÙ· ÙÔ˘ ¿Óˆ‚ÏÂÊ¿ÚÔ˘, ·ÓÒÙÂÚ· ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘ ÙÔ˘ Whitnall, apple·Ú¿Ï-ÏËÏ· Î·È ¿Óˆ ·applefi ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘. ∫·Ù·ÁÚ¿ÊËÎ·Ó ÙÔ¿ÓÔÈÁÌ· Ù˘ ‚ÏÂÊ·ÚÈ΋˜ Û¯ÈÛÌ‹˜, ÙÔ Â‡ÚÔ˜ ÏÂÈÙÔ˘ÚÁ›·˜ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Î·È ÙÔ ¿ÓÔÈÁÌ· ÙÔ˘ Ï·ÁfiÊı·ÏÌÔ˘ appleÚÈÓ Î·ÈÌÂÙ¿ ÙËÓ ¤Á¯˘ÛË ·Ó¿ Ù·ÎÙ¿ ‰È·ÛÙ‹Ì·Ù· ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜apple·Ú·ÎÔÏÔ‡ıËÛ˘. ∞appleÔÙÂϤÛÌ·Ù·: μÂÏÙ›ˆÛË ÙÔ˘ Ï·Áfi-Êı·ÏÌÔ˘ Î·È appleÚÔÛÙ·Û›· ÙÔ˘ ÎÂÚ·ÙÔÂȉ‹ ÂappleÈÙ‡¯ıËΠÛÂfiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∏ ¤ÏÍË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ‰ÈÔÚıÒıËÎÂÌ ı¤ÛË ÙÔ˘ ‚ÏÂÊ·ÚÈÎÔ‡ ¯Â›ÏÔ˘˜ ηÙÒÙÂÚ· ·applefiÙÔ ¿Óˆ ∫O, ÂÓÒ Û ‰‡Ô ÌfiÓÔÓ ·ÛıÂÓ›˜ Î¿Ï˘appleÙ ÙÔÓ Ô-appleÙÈÎfi ¿ÍÔÓ·. ∏ ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ ÙÔ͛Ӣ ‹Ù·Ó ηٿ̤ÛÔ fiÚÔ 10 ‚‰ÔÌ¿‰Â˜ Î·È ‰ÂÓ apple·ÚÔ˘ÛÈ¿ÛıËÎ·Ó ÂappleÈappleÏÔΤ˜‹ ÔÊı·ÏÌÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û ηӤӷ appleÂÚÈ-ÛÙ·ÙÈÎfi. ˘ÌappleÂÚ¿ÛÌ·Ù·: ∏ ¯Ú‹ÛË Ù˘ ·ÏÏ·ÓÙÔÙÔ͛Ӣ·appleÔÙÂÏ› Ì›· ·ÛÊ·Ï‹ Î·È ·appleÔÙÂÏÂÛÌ·ÙÈ΋ ̤ıÔ‰Ô appleÚfi-ÛηÈÚ˘ ·ÓÙÈÌÂÙÒappleÈÛ˘ ÙÔ˘ Û˘Ìappleو̷ÙÈÎÔ‡ Ï·ÁfiÊı·Ï-ÌÔ˘ ·applefi apple·Ú¿Ï˘ÛË ÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘.Introduction: Upper lid retraction secondary to seventhnerve palsy may result in lagophthalmos, incomplete corneaprotection and exposure keratopathy. We present ourexperience from the use of Botulinum toxin type A in themanagement of upper lid retraction by inducing chemicaldenervation of the levator muscle. Patients – Methods:Eighteen patients with recent onset of seventh nerve palsyand symptomatic lagophthalmos with exposure keratopathynot responding to artificial tear topical medicationswere included. With an insulin syringe 7,5-15 IU of Botulinumtoxin were infused through the middle of the upper liddeep, towards the orbital apex, above Whitnall’s ligamentand levator muscle. Palpebral aperture, levator functionand lagophthalmos before and after infusion were recordedon regular post treatment intervals. Results: Lagophthalmosimprovement and corneal protection was a-chieved in all patients. Upper lid retraction was reducedwith lid covering the upper limbus whereas in only twocases the visual axis was obstructed. Chemical denervationlasted for a mean period of 10 weeks. No complicationsor extraocular muscle involvement was recorded inany of the patients during the post treatment period.Conclusions: Botulinum toxin application is a safe andeffective alternative in the temporary management of symptomaticlagophthalmos due to seventh nerve palsy.OÊı·ÏÌÔÏÔÁÈ΋ KÏÈÓÈ΋ AÚÈÛÙÔÙÂÏ›Ԣ ·ÓÂappleÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 177 - 183, 2002 177

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OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 179∂ÈÎ. 2. £¤ÛË ¤Á¯˘ÛË Ù˘ ·ÏÏ·ÓÙoÙo͛Ӣ ÛÙo ¿Óˆ ‚ϤʷÚo.(0-4 mm). Δ· ·›ÙÈ· Ù˘ apple·Ú¿Ï˘Û˘ Ùo˘ appleÚoÛˆappleÈÎo‡Ó‡Úo˘ ·Ó¿ appleÂÚÈÛÙ·ÙÈÎfi ‹Ù·Ó: ȉÈoapple·ı‹˜ apple·Ú¿Ï˘ÛËBell (7), ·Îo˘ÛÙÈÎfi ÓÂ˘Ú›ÓˆÌ· (4), ·Ê·›ÚÂÛË fiÁÎo˘ apple·-ÚˆÙ›‰·˜ (2), οٷÁÌ· ÏÈıoÂȉo‡˜ oÛÙo‡ (2) Î·È ÌÂÙÂÁ-¯ÂÈÚËÙÈο (3).º·ÚÌ·ÎoÏoÁ›·: ∏ ∞ÏÏ·ÓÙoÙoÍ›ÓË Ù‡appleo˘ ∞ apple·Ú¿-ÁÂÙ·È ·applefi Ùo Clostridium Botulinum Ù‡appleo˘ ∞ Î·È appleÚo-ηÏ› ·appleoÎÏÂÈÛÌfi Ù˘ appleÂÚÈÊÂÚÈ΋˜ ·appleÂÏ¢ı¤ÚˆÛ˘ ·-ÎÂÙ˘Ïo¯oÏ›Ó˘ ·applefi ÙȘ appleÚoÛ˘Ó·appleÙÈΤ˜ ¯oÏÈÓÂÚÁÈΤ˜Ó¢ÚÈΤ˜ ·appleoÏ‹ÍÂȘ. ∞˘Ùfi ÂappleÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·appleo‰fi-ÌËÛË Ù˘ SNAP-25, appleÚˆÙ½Ó˘ ·apple·Ú·›ÙËÙ˘ ÁÈ· ÙËÓappleÚoÛÎfiÏÏËÛË Î·È ·appleÂÏ¢ı¤ÚˆÛË Ù˘ ·ÎÂÙ˘Ïo¯oÏ›Ó˘·applefi Ù· ÌÂÙ·Û˘Ó·appleÙÈο ΢ÛÙ›‰È·. O ¯ËÌÈÎfi˜ Ó¢ÚoÌ˘˚-Îfi˜ ·appleoÎÏÂÈÛÌfi˜ ·Ó·ÛÙÚ¤ÊÂÙ·È ˘applefi Ê˘ÛÈoÏoÁÈΤ˜ Û˘Óı‹Î˜Û appleÂÚ›appleo˘ 12 ‚‰oÌ¿‰Â˜. Δ· ‰‡o ‰È·ı¤ÛÈÌ· Â-ÌappleoÚÈο Û΢¿ÛÌ·Ù· Â›Ó·È Ùo Botox ® Î·È Ùo Dysport ®Ì 4 ÊoÚ¤˜ ·ÛıÂÓ¤ÛÙÂÚË ‰Ú¿ÛË ÛÙȘ ›‰È˜ ‰ÈÂıÓ›˜ Ìo-Ó¿‰Â˜41-46 . ÙËÓ ÂÚÁ·Û›· Ì·˜ ¯ÚËÛÈÌoappleoÈ‹Û·Ì Ùo Â-ÌappleoÚÈÎfi ÂÓ¤ÛÈÌo Û··ÛÌ· Botox ® Ùo oappleo›o ‰È·Ù›ıÂÙ·ÈÛ ÊÈ·Ï›‰È· appleÂÚÈÂÎÙÈÎfiÙËÙ·˜ 100 IU Û ÌoÚÊ‹ ÛÎfiÓ˘.∞Ó·Û˘ÛÙ¿Ù·È Ì 4 ml ÂÓ¤ÛÈÌo˘ ‰È·Ï‡Ì·Ùo˜ ¯ÏˆÚÈo‡¯o˘Ó·ÙÚ›o˘ 0,9% ¤ÙÛÈ ÒÛÙ 0,1 ml Ùo˘ ‰È·Ï‡Ì·Ùo˜ Ó· appleÂ-ÚȤ¯ÂÈ 2,5 IU Ùo͛Ӣ.ΔÚfiappleo˜ ¤Á¯˘Û˘: ∏ ¯oÚ‹ÁËÛË Ù˘ Ùo͛Ӣ ¤ÁÈÓ Ì‚ÂÏfiÓ· ÈÓÛo˘Ï›Ó˘ 27 G ÛÙËÓ ÌÂÛfiÙËÙ· Ùo˘ ‰¤ÚÌ·Ùo˜Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ Ì ÊoÚ¿ appleÚo˜ ÙËÓ ÎoÚ˘Ê‹ Ùo˘ ÎfiÁ-¯o˘ Î·È apple·Ú¿ÏÏËÏ· appleÚo˜ Ùo ¿Óˆ Ùo›¯ˆÌ¿ Ùo˘. ∏ ‚ÂÏfi-Ó· ÂÈÛ¿ÁÂÙ·È ÛÙo ÎoÁ¯ÈÎfi Ï›appleo˜ ·ÓÒÙÂÚ· ·applefi ÙoÓ Û‡Ó-‰ÂÛÌo Ùo˘ Whitnall Î·È ÙËÓ Á·ÛÙ¤Ú· Ùo˘ ·ÓÂÏÎÙ‹Ú·Ì˘fi˜ Ì ÙoÓ ·ÛıÂÓ‹ Ó· appleÚoÛËÏÒÓÂÙ·È ÛÙËÓ appleÚˆÙ‡o˘Û·‚ÏÂÌÌ·ÙÈ΋ ı¤ÛË. ªÂ ÙËÓ Â›Ûo‰o ÛÙoÓ oappleÈÛıo‰È·ÊÚ·Á-Ì·ÙÈÎfi ¯ÒÚo Î·È ·Êo‡ Ì ·Ó·ÚÚfiÊËÛË ‚‚·Èˆıo‡ÌÂfiÙÈ ‰ÂÓ ¤¯o˘Ì ÂÈÛ¤ÏıÂÈ Û οappleoÈo ·ÁÁ›o (¿Óˆ oÊı·Ï-ÌÈ΋ ÊϤ‚·), Ë ‚ÂÏfiÓË ÛÙÚ¤ÊÂÙ·È appleÚo˜ Ù· οو ÒÛÙ ӷ¤ÚıÂÈ Û Âapple·Ê‹ Ì ÙËÓ Á·ÛÙ¤Ú· Ùo˘ ·ÓÂÏÎÙ‹Ú· ¯ˆÚ›˜ Ó·ÙoÓ ‰È·appleÂÚ¿ÛÂÈ. °›ÓÂÙ·È ¤Á¯˘ÛË appleoÛfiÙËÙ·˜ ·ÏÏ·ÓÙo-Ùo͛Ӣ 7,5-15 IU ·Ó¿ÏoÁ· Ì ÙoÓ ·ÛıÂÓ‹ Î·È Ë Âapple›‰Ú·-ÛË ÛÙoÓ ÙfiÓo Ùo˘ ·ÓÂÏÎÙ‹Ú· Î·È ÙËÓ ı¤ÛË Ùo˘ ‚ÏÂÊ¿Úo˘ÂÎÙÈÌ¿Ù·È ÌÂÙ¿ ·applefi Ì›· ‚‰oÌ¿‰· (∂ÈÎ. 2).∏ ̤ıo‰o˜ ÛÙo¯Â‡ÂÈ ÛÙËÓ Ì›ˆÛË Ùo˘ ÙfiÓo˘ Ùo˘·ÓÂÏÎÙ‹Ú· Ì˘fi˜, ·ÏÏ·Á‹ Ù˘ ‰˘Ó·ÌÈ΋˜ ÈÛoÚÚoapple›·˜ ·-Ó¿ÌÂÛ· ÛÙoÓ ·ÓÂÏÎÙ‹Ú· Î·È ÛÊÈÁÎÙ‹Ú· Ì˘ Î·È ÙËÓ ÂÍ¿-ÏÂÈ„Ë Ù˘ ˘ÛÙ¤ÚËÛ˘ Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ Û ۯ¤ÛË ÌÂ∂ÈÎ. 3. ∞ÚÈÛÙÂÚ‹ apple¿ÚÂÛË appleÚoÛˆappleÈÎo‡ Ó‡Úo˘: ˘ÛÙ¤ÚË-ÛË ¯·Ï¿ÚˆÛ˘ Ùo˘ Û‡ÛÙoȯo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ ˆ˜appleÚo˜ ÙËÓ ˘ÁÈ‹ appleÏÂ˘Ú¿.ÙËÓ ˘ÁÈ‹ appleÏÂ˘Ú¿ ÛÙËÓ Î¿Ùˆ ‚ÏÂÌÌ·ÙÈ΋ Ì ‰È·Ù‹ÚËÛËÂχıÂÚo˘ Ùo˘ oappleÙÈÎo‡ ¿ÍoÓ· (∂ÈÎ. 3). OÈ apple·Ú¿ÌÂÙÚoÈappleo˘ ηٷÁÚ¿ÊoÓÙ·Ó Â›Ó·È Ùo ‡„o˜ Ù˘ ‚ÏÂÊ·ÚÈ΋˜ Û¯È-ÛÌ‹˜, Ë ·applefiÛÙ·ÛË Ùo˘ ‚ÏÂÊ·ÚÈÎo‡ ¯Â›Ïo˘˜ (¿Óˆ Î·È Î¿-Ùˆ) ·applefi ÙËÓ ·ÓÙ·Ó¿ÎÏ·ÛË ÊˆÙÂÈÓ‹˜ appleËÁ‹˜ ÛÙoÓ ÎÂÚ·-ÙoÂȉ‹, Ùo ‡Úo˜ ÏÂÈÙo˘ÚÁ›·˜ Ùo˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜, Ùo‡Úo˜ Ùo˘ Ï·ÁfiÊı·ÏÌo˘, Ùo Ê·ÈÓfiÌÂÓo Bell, Ë Î·Ù¿ÛÙ·-ÛË Ùo˘ ÂappleÈıËÏ›o˘ Ùo˘ ÎÂÚ·ÙoÂȉ‹ Î·È Ù· ˘appleoÎÂÈÌÂÓÈÎ¿Û˘ÌappleÙÒÌ·Ù· Ùo˘ ·ÛıÂÓ‹ appleÚÈÓ Î·È ·Ó¿ Ù·ÎÙ¿ ‰È·ÛÙ‹Ì·-Ù· ÌÂÙ¿ ÙËÓ ¤Á¯˘ÛË.ŸÙ·Ó ˘apple‹Ú¯Â ¤ÎıÂÛË ÛÎÏËÚo‡ ÌÂÁ·Ï‡ÙÂÚË ·applefi 2mm ·Ó¿ÌÂÛ· ÛÙo οو ‚ϤʷÚo Î·È Ùo ∫O ÁÈÓfiÙ·Ó‰ÈfiÚıˆÛË Ùo˘ apple·Ú·Ï˘ÙÈÎo‡ ÂÎÙÚfiappleÈo˘ Ì ÙËÓ Ì¤ıo‰oÙ˘ ¤Íˆ Ù·ÚÛÈ΋˜ Ù·ÈÓ›·˜47 48 .  ·ÛıÂÓ›˜ appleo˘ Ë appleÙÒÛËÊÚ˘‰Èo‡ ‰ËÌÈo˘ÚÁo‡Û ÏÂÈÙo˘ÚÁÈο appleÚo‚Ï‹Ì·Ù· ÛÙËÓΛÓËÛË Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ ÂappleȯÂÈÚo‡ÓÙ·Ó ¿ÌÂÛË ·Ó¿Ú-ÙËÛË Ì ˘appleÂÚfiÊÚ˘· ÂÍ·›ÚÂÛË ¤ÏÏÂȄ˘ ‰¤ÚÌ·Ùo˜.∞appleoÙÂϤÛÌ·Ù·∏ ̤ıo‰o˜ ‹Ù·Ó ηϿ ·ÓÂÎÙ‹ ·applefi fiÏo˘˜ Ùo˘˜·ÛıÂÓ›˜. ∂appleÈÙ‡¯ıËΠ̛ˆÛË Ùo˘ ‡Úo˘˜ Ù˘ÌÂÛo‚ÏÂÊ¿ÚÈ·˜, Ì›ˆÛË Ùo˘ ÙfiÓo˘ Ùo˘ ·ÓÂÏÎÙ‹Ú·Ì˘fi˜, ηÙÒÙÂÚË ı¤ÛË Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ ηٿ ̤ÛofiÚo 3,1 mm (2-6 mm) Î·È ÌÈÎÚ‹ ‰È·ÊoÚ¿ ÛÙËÓÏÂÈÙo˘ÚÁ›· Ùo˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜. ∏ ÛËÌ·ÓÙÈ΋ Ì›ˆ-ÛË Ùo˘ Ï·ÁfiÊı·ÏÌo˘ ηٿ ̤Ûo fiÚo 3,2 mm (1-4mm) ‚ÂÏÙ›ˆÛ ٷ ÏÂÈÙo˘ÚÁÈο appleÚo‚Ï‹Ì·Ù· ÙˆÓ·ÛıÂÓÒÓ Ì appleÏ‹ÚË ›·ÛË Ùo˘ ÎÂÚ·ÙoÂȉÈÎo‡ ÂappleÈıË-Ï›o˘ ·ÎfiÌ· Î·È ¯ˆÚ›˜ ÂappleÈÎo˘ÚÈ΋ ÙoappleÈ΋ ÏÈapple·ÓÙÈ΋·ÁˆÁ‹ Î·È Ì›ˆÛË Ù˘ ÂappleÈÊoÚ¿˜, ȉ›ˆ˜ ÛÙ· appleÂÚÈÛÙ·-ÙÈο appleo˘ ·ÎoÏo‡ıËÛ ‰ÈfiÚıˆÛË Î·È Ùo˘ apple·Ú·Ï˘-ÙÈÎo‡ ÂÎÙÚfiappleÈo˘ (∂ÈÎ. 4, 5). O oappleÙÈÎfi˜ ¿ÍoÓ·˜ apple·-Ú¤ÌÂÈÓ ÂχıÂÚo˜ ÛÙËÓ appleÚˆÙ‡o˘Û· ‚ÏÂÌÌ·ÙÈ΋ı¤ÛË Û fiÏ· Ù· appleÂÚÈÛÙ·ÙÈο ÂÎÙfi˜ ·applefi ‰‡o ÛÙ·oappleo›· ¤ÁÈÓ ¤Á¯˘ÛË ÌÂÁ·Ï‡ÙÂÚ˘ appleoÛfiÙËÙ·˜ Ùo͛ӢÏfiÁˆ ·Ú¯È΋˜ ÂÓÙoÓfiÙÂÚ˘ ÍËÚoÊı·ÏÌ›·˜ Î·È˘appleoÎÂÈÌÂÓÈÎÒÓ ÂÓo¯ÏËÌ¿ÙˆÓ. ∏ ̤ÁÈÛÙË ‰Ú¿ÛË Ùo˘·ÏÏ·ÓÙoÙo͛Ӣ apple·Ú·ÙËÚ‹ıËΠ̤۷ ÛÙȘ appleÚÒÙ˜

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182 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)‰‹ ÙËÓ ¤ÏÍË Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ Î·È ‰ÂÓ ·apple·ÈÙ› η-ıËÌÂÚÈÓ‹ Û˘ÌÌÂÙo¯‹ Î·È ÊÚoÓÙ›‰· Ùo˘ ·ÛıÂÓ‹ fiappleˆ˜Ì ÙËÓ ·ÁˆÁ‹ Ù¯ÓËÙÒÓ ‰·ÎÚ‡ˆÓ. ∂›Ó·È ÂÏ¿¯È-ÛÙ· ÂappleÂÌ‚·ÙÈ΋, Ì ÂÏ¿¯ÈÛÙ˜ appleÈı·Ó¤˜ ÂappleÈappleÏoΤ˜Î·È appleÚoÛʤÚÂÈ ¿ÚÈÛÙË appleÚoÛÙ·Û›· Ùo˘ ÎÂÚ·ÙoÂȉ‹Ì¤¯ÚÈ Ùo ‰È¿ÛÙËÌ· ÙˆÓ 8 Ùo˘Ï¿¯ÈÛÙoÓ ÌËÓÒÓ, oapplefiÙÂË ‚Ï¿‚Ë Ùo˘ appleÚoÛˆappleÈÎo‡ Ó‡Úo˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·ÈÌË ·Ó·ÛÙÚ¤„ÈÌË Î·È ÂÊ·ÚÌfi˙ÂÙ·È ÌÈ· ·applefi ÙȘ ÌfiÓÈ-̘ ¯ÂÈÚo˘ÚÁÈΤ˜ ÌÂıfi‰o˘˜ ·ÓÙÈÌÂÙÒappleÈÛ˘. ∂appleÈ-Ù˘Á¯¿ÓÂÙ·È ˘appleoÎÂÈÌÂÓÈ΋ ÈηÓoappleo›ËÛË Ùo˘ ·ÛıÂÓ‹Î·È ‚ÂÏÙ›ˆÛË Ù˘ ·ÈÛıËÙÈ΋˜ ÂÈÎfiÓ·˜ ·applefi ÙȘ ‰È·-Ù·Ú·¯¤˜ ÛÙËÓ ÏÂÈÙo˘ÚÁ›· Ùo˘ ÛÊÈÁÎÙ‹Ú· Ì˘fi˜ ηÈÛ˘ÓÂapple·ÎfiÏo˘ıË ¤ÏÍË Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘. Δo ÌoÓ·-‰ÈÎfi ÌÂÈoÓ¤ÎÙËÌ· Ù˘ ÌÂıfi‰o˘ apple·Ú·Ì¤ÓÂÈ Ùo ˘„Ë-Ïfi ÎfiÛÙo˜ ÁÈ· ÙËÓ appleÚoÌ‹ıÂÈ· Ù˘ Ùo͛Ӣ Î·È Ë‚Ú·¯Â›· Û˘ÓÈÛÙÒÌÂÓË ‰È¿ÚÎÂÈ· Û˘ÓÙ‹ÚËÛ‹˜ Ù˘ Û„‡ÍË. 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The tarsal strip procedure. Archivesof Ophthalmology 97(11): 2192-6, 1979.48. Anderson Rl. The tarsal strip. Transactions New OrleansAcademy of Ophthalmology 30: 352-63, 1982.49. Patrinely JR, Whiting AS, Anderson RL. Local side effectsof botulinum toxin injections. Advances in Neurology49: 493-500, 1988.50. Biglan AW, Gonnering R, Lockhart LB, Rabin B, FuersteFH. Absence of antibody production in patients treatedwith botulinum A toxin. American Journal ofOphthalmology 101(2): 232-5, 1986.51. Lingua RW. Sequelae of botulinum toxin injection. AmericanJournal of Ophthalmology 100(2): 305-7, 1985.52. Balkan RJ, Poole T. A five-year analysis of botulinumtoxin type A injections: some unusual features. Annalsof Ophthalmology 23(9): 326-33, 1991.53. Harris CP, Alderson K, Nebeker J, Holds JB, AndersonRL. Histologic features of human orbicularis oculi treatedwith botulinum A toxin. Archives of Ophthalmology109(3): 393-5, 1991.54. Price J, O’Day J. 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∫·ıÂÙËÚÈ·ÛÌfi˜ Ù˘ ÚÈÓÔ‰·ÎÚ˘˚΋˜ Û˘Û΢‹˜ ÛÙ· ‚Ú¤ÊË.∂›Ó·È ·apple·Ú·›ÙËÙË Ë appleχÛË Ì ÔÚfi‹ ΢·ÓÔ‡Ó ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘;μ. ªfiÛ¯Ô˘1, ¡.°. ∑ȿη˜1, ∫. ·Ì·Ú¿˜2, π.°. °È·ÚÈÛοÓ˘1,∞. ∫ÔÚ‰fiη˜1, ¡.Δ. Ù¿ÁÎÔ˜1Probing of the nasolacrimal duct in children. Is the irrigation with salineor methylene blue necessary in confirming patency?V. Moshou, N.G. Ziakas, K. Samaras, I.G. Giariskanis, A. Kordokas, N.T. StangosÎoapplefi˜: ∏ apple·Úo˘Û›·ÛË Ù˘ ÂÌappleÂÈÚ›·˜ Ì·˜ ·applefi ÙoÓ Î·-ıÂÙËÚÈ·ÛÌfi Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ ÛÙ· ‚Ú¤ÊË Î·È ÙËÓÂÊ·ÚÌoÁ‹ ‹ fi¯È appleχÛ˘ Ì oÚfi ‹ ΢·Óo‡Ó Ùo˘ ÌÂı˘ÏÂ-Ó›o˘. ª¤ıo‰o˜: ªÂٷ͇ 1982 Î·È 2001, 214 ‚Ú¤ÊË Ì·applefiÊÚ·ÍË Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ ˘appleo‚Ï‹ıËÎ·Ó Û η-ıÂÙËÚÈ·ÛÌfi ˘applefi ̤ıË. ∏ ËÏÈΛ· ÙˆÓ apple·È‰ÈÒÓ ÂÎ˘Ì·›ÓÂÙo·applefi 8 ÌËÓÒÓ Ì¤¯ÚÈ 2,5 ¯ÚoÓÒÓ. ªÂÙ¿ ÙoÓ Î·ıÂÙËÚÈ·ÛÌfi·ÎoÏo˘ıo‡Û appleχÛË Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ Ì oÚfi ‹Î˘·Óo‡Ó Ùo˘ ÌÂı˘ÏÂÓ›o˘ ÁÈ· ÙËÓ ÂappleȂ‚·›ˆÛË Ù˘ ‰È¿ÓoÈ-͢ applefiÚo˘. ∏ appleχÛË ‰ÂÓ ¤ÁÈÓ Û 45 appleÂÚÈÛÙ·ÙÈο. ∞appleoÙÂ-ϤÛÌ·Ù·: ∏ ÂappleÈÙ˘¯›· Ù˘ Âapple¤Ì‚·Û˘ ·Ó‹Ïı Û appleoÛoÛÙfi80-90% ÙfiÛo Âapple› ÙˆÓ 169 appleÂÚÈÛÙ·ÙÈÎÒÓ appleo˘ ¤ÁÈÓ appleχÛËfiÛo Î·È Âapple› ÙˆÓ 45 appleo˘ ·˘Ù‹ ‰ÂÓ ÂÊ·ÚÌfiÛıËÎÂ. ˘Ìapple¤-Ú·ÛÌ·: ∏ appleχÛË Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ Û˘Û΢‹˜ ÌÂÙ¿ ÙoÓηıÂÙËÚÈ·ÛÌfi ÁÈ· Û˘ÁÁÂÓ‹ ·applefiÊÚ·Í‹ Ù˘ ‰ÂÓ Â›Ó·È ·apple·-Ú·›ÙËÙË ÁÈ· ÙËÓ ÂappleÈÙ˘¯›· Ùo˘ ·appleoÙÂϤÛÌ·Ùo˜.Purpose: To present our experience with probing of thenasolacrimal duct in children and the use of saline or methyleneblue for irrigation to confirm patency. Methods:Between 1982 and 2001, 214 children with congenital nasolacrimalduct obstruction underwent probing under generalanesthesia. At the end of the procedure, in all but 45cases irrigation with saline or methylene blue was done toconfirm patency of the duct. Results: Success rate of theprobing was the same, 80-90%, both in the 169 caseswhere irrigation was carried out and in the 45 cases wherethis was not done. Conclusion: Irrigation of the nasolacrimalduct following probing for congenital nasolacrimalduct obstruction doesn’t affect the success rate of theprocedure.∂ÈÛ·ÁˆÁ‹∏ appleÈo Û˘¯Ó‹ ·ÓˆÌ·Ï›· Ùo˘ ·appleo¯ÂÙ¢ÙÈÎo‡‰·ÎÚ˘˚Îo‡ Û˘ÛÙ‹Ì·Ùo˜ ÛÙ· apple·È‰È¿ Â›Ó·È Ë Û˘ÁÁÂ-Ó‹˜ ·applefiÊÚ·ÍË Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡. ‡ÌʈӷÌ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ apple¿Û¯ÂÈ Ùo 15-20% ÙˆÓ ÓÂo-ÁÓÒÓ 1 , ÂÓÒ ¿ÏϘ ·Ó·ÙoÌÈΤ˜ ÌÂϤÙ˜ ·Ó·Ê¤Úo˘ÓÛ˘¯ÓfiÙËÙ· ·applefiÊڷ͢ 35-73% 2 . ∞ÌÊoÙÂÚfiappleÏ¢-ÚË ÂÌÊ¿ÓÈÛË apple·Úo˘ÛÈ¿˙ÂÈ Ùo 30% ÙˆÓ appleÂÚÈappleÙÒÛÂ-ˆÓ.˘Ó‹ıˆ˜ Ë ·applefiÊÚ·ÍË ‚Ú›ÛÎÂÙ·È ÛÙo ÚÈÓÈÎfi ¿-ÎÚo Ùo˘ ÚÈÓo‰·ÎÚ˘˚Îo‡ applefiÚo˘, ·ÎÚÈ‚Ò˜ appleÚÈÓ ÙËÓ›Ûo‰fi Ùo˘ ÛÙË Ì‡ÙË, ÛÙË ‚·Ï‚›‰· Ùo˘ Hasner.apple·ÓÈfiÙÂÚ·, ÌappleoÚ› Ó· ˘apple¿Ú¯ÂÈ ·ÙÂÏ‹˜ ‰È¿appleÏ·ÛËÙˆÓ oÛÙÒÓ Á‡Úˆ ·applefi Ùo ‰·ÎÚ˘˚Îfi Û‡ÛÙËÌ· ‹ apple·-Ú·ÏÏ·Á‹ Ù˘ Ê˘ÛÈoÏoÁÈ΋˜ ·Ó·ÙoÌ›·˜ Ùo˘ ÚÈÓo‰·-ÎÚ˘˚Îo‡ applefiÚo˘. Ù· appleÂÚÈÛÛfiÙÂÚ· ·applefi Ù· ÓÂoÁÓ¿·˘Ù¿ Á›ÓÂÙ·È ·˘ÙfiÌ·ÙË ‰È¿ÓoÈÍË Ùo˘ applefiÚo˘ ηȷappleoηٿÛÙ·ÛË Ù˘ Ê˘ÛÈoÏoÁÈ΋˜ appleoÚ›·˜ ÙˆÓ ‰·-ÎÚ‡ˆÓ. ŒÙÛÈ Ùo appleoÛoÛÙfi ÙˆÓ apple·È‰ÈÒÓ appleo˘ ¯ÚÂÈ-¿˙oÓÙ·È oÊı·ÏÌoÏoÁÈ΋ ÊÚoÓÙ›‰· Êı¿ÓÂÈ Ùo 6% 3 .∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· appleÂÚÈÏ·Ì‚¿ÓÂÈ ÂappleÈÊoÚ¿ ·applefi1. OÊı·ÏÌoÏoÁÈ΋ KÏÈÓÈ΋ ∞..£.2. ∞′ ·È‰È·ÙÚÈ΋ KÏÈÓÈ΋ ∞..£.OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 184 - 186, 2002 184

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 185ÙȘ appleÚÒÙ˜ ‚‰oÌ¿‰Â˜ Ù˘ ˙ˆ‹˜, Ì ÂÎÎÚ›ÛÂȘ ‚ÏÂÓ-ÓÒ‰ÂȘ ‹ ‚ÏÂÓÓoapple˘Ò‰ÂȘ. ∏ ‰È¿ÁÓˆÛË Â›Ó·È Â‡ÎoÏË,‚·ÛÈṲ̂ÓË ÛÙo ÈÛÙoÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË. ∏‰È·ÊoÚÈ΋ ‰È¿ÁÓˆÛË ı· Á›ÓÂÈ ·applefi ÙËÓ ÂappleÈappleÂÊ˘Î›ÙÈ-‰·, ÙËÓ ·appleo˘Û›· ‹ ·ÙÚËÛ›· ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ ÛËÌ›-ˆÓ, Ùo Û˘Ú›ÁÁÈo Ùo˘ ÚÈÓo‰·ÎÚ˘˚Îo‡ applefiÚo˘, Ùo Û˘Á-ÁÂÓ¤˜ ÁÏ·‡ÎˆÌ· Î·È ÙË ‰·ÎÚ˘o΢ÛÙ›Ùȉ·3.∏ Û˘¯Ó‹ ·˘ÙfiÌ·ÙË ‰È¿ÓoÈÍË Ùo˘ ÚÈÓo‰·ÎÚ˘˚Îo‡applefiÚo˘, ÂappleÈ‚¿ÏÏÂÈ ÙËÓ ·Ó·ÌoÓ‹ ηٿ Ùo˘˜ appleÚÒÙo˘˜Ì‹Ó˜ Ù˘ ˙ˆ‹˜ (̤¯ÚÈ ÙoÓ 8o-12o Ì‹Ó·) Ì ÙoappleÈ΋·ÓÙÈ‚ÈoÙÈ΋ ·ÁˆÁ‹ Î·È ˘‰ÚoÛÙ·ÙÈÎfi Ì·Û¿˙ Ùo˘ÚÈÓo‰·ÎÚ˘˚Îo‡ applefiÚo˘. ªÂ ÙËÓ Ù·ÎÙÈ΋ ·˘Ù‹ ·appleoη-ı›ÛÙ·Ù·È Ë ‚·ÙfiÙËÙ· Ùo˘ applefiÚo˘ ηٿ ÙoÓ appleÚÒÙo¯ÚfiÓo Ù˘ ˙ˆ‹˜ ÛÙo 88-96% ÙˆÓ apple·È‰ÈÒÓ. ∞ÏÏ¿ ηÈÙ· ÌÈÛ¿ apple·È‰È¿ ·applefi ÂΛӷ appleo˘ Û˘Ó¯›˙o˘Ó Ó· ‰·-ÎÚ‡˙o˘Ó ÌÂÙ¿ ÙoÓ appleÚÒÙo ¯ÚfiÓo, ‚ÂÏÙÈÒÓoÓÙ·È ÛËÌ·-ÓÙÈο ̤¯ÚÈ ÙoÓ 18o Ì‹Ó·4. °È· Ù· ˘applefiÏoÈapple· apple·È‰È¿Ë ÎÏ·ÛÛÈ΋ ·ÓÙÈÌÂÙÒappleÈÛË Â›Ó·È o ηıÂÙËÚÈ·ÛÌfi˜Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ Î·È Ë appleχÛË Ì oÚfi ‹Î˘·Óo‡Ó Ùo˘ ÌÂı˘ÏÂÓ›o˘ ÁÈ· ÙËÓ ÂappleȂ‚·›ˆÛË Ù˘‰È¿ÓoÈ͢ Ùo˘ applefiÚo˘ ˘applefi ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›· ‹ ̤ıË.∞ÛıÂÓ›˜ Î·È Ì¤ıo‰o˜∞applefi Ùo 1982 ̤¯ÚÈ Ùo 2001, 214 ‚Ú¤ÊË ˘appleo‚Ï‹ıË-Î·Ó Û ηıÂÙËÚÈ·ÛÌfi Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ ˘applefi ̤ıË.∏ ËÏÈΛ· ÙˆÓ apple·È‰ÈÒÓ ÂÎ˘Ì·›ÓÂÙo ·applefi 8 ÌËÓÒÓ Ì¤-¯ÚÈ 2,5 ¯ÚoÓÒÓ, Ì ̤Ûo fiÚo Ùo˘˜ 11 Ì‹Ó˜. 61 apple·È‰È¿ ›-¯·Ó ·ÌÊoÙÂÚfiappleÏ¢ÚË ·applefiÊÚ·ÍË Î·È ¤ÙÛÈ o Û˘ÓoÏÈÎfi˜·ÚÈıÌfi˜ ÙˆÓ oÊı·ÏÌÒÓ ‹Ù·Ó 275. Ù· 215 Ì¿ÙÈ· ÌÂÙ¿ÙoÓ Î·ıÂÙËÚÈ·ÛÌfi ¤ÁÈÓ appleχÛË Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡Ì oÚfi ‹ ΢·Óo‡Ó Ùo˘ ÌÂı˘ÏÂÓ›o˘, Û ÌÂÁ¿ÏË ·Ú·›ˆÛË.Ù· 60 Ì¿ÙÈ· Ë appleχÛË ‰ÂÓ ÂÊ·ÚÌfiÛıËÎÂ. fiÏ· Ù· appleÂÚÈÛÙ·ÙÈο ÁÈ· 4-5 Ë̤Ú˜ appleÚÈÓ ·applefi ÙoÓηıÂÙËÚÈ·ÛÌfi ‰ÈÓfiÙ·Ó ÙoappleÈ΋ ·ÓÙÈ‚ÈoÙÈ΋ ·ÁˆÁ‹ ηÈÁÈ· 5 Ë̤Ú˜ ÌÂÙ¿ ÙoÓ Î·ıÂÙËÚÈ·ÛÌfi ‰ÈÓfiÙ·Ó ÌÈÎÙfiÎoÏχÚÈo (·ÓÙÈ‚ÈoÙÈÎfi Î·È ÎoÚÙÈ˙fiÓË).∞appleoÙÂϤÛÌ·Ù·∏ ‰È¿ÓoÈÍË Ùo˘ ÚÈÓo‰·ÎÚ˘˚Îo‡ applefiÚo˘ Î·È Ë·apple·ÏÏ·Á‹ Ùo˘ ÌÈÎÚo‡ ·ÛıÂÓ‹ ·applefi ÙËÓ ÂappleÈÊoÚ¿Î·È ÙȘ ‚ÏÂÓÓoapple˘Ò‰ÂȘ ÂÎÎÚ›ÛÂȘ appleÚ·ÁÌ·ÙoappleoÈ‹-ıËΠ۠appleoÛoÛÙfi 88-90% Î·È ÛÙȘ ‰‡o oÌ¿‰Â˜ (189Ì¿ÙÈ· ·applefi Ù· 215 Ì appleχÛË ÌÂÙ¿ ÙoÓ Î·ıÂÙËÚÈ·ÛÌfiÎ·È 55 Ì¿ÙÈ· ·applefi Ù· 61 ¯ˆÚ›˜ appleχÛË ÌÂÙ¿ ÙoÓ Î·-ıÂÙËÚÈ·ÛÌfi).Δ· ˘applefiÏoÈapple· apple·È‰È¿ ›¯·Ó ·appleoηٿÛÙ·ÛË Ù˘·applefiÊڷ͢ ‹ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌappleÙˆÌ¿ÙˆÓ ÌÂÙ¿·applefi ıÂÙÈÎfi ηıÂÙËÚÈ·ÛÌfi appleo˘ appleÚ·ÁÌ·ÙoappleoÈ‹ıËÎÂ3-5 Ì‹Ó˜ ÌÂÙ¿ ·applefi ÙoÓ appleÚÒÙo.˘˙‹ÙËÛËO ηıÂÙËÚÈ·ÛÌfi˜ Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ ›-Ó·È ·appleoÙÂÏÂÛÌ·ÙÈ΋ ̤ıo‰o˜ ‰È¿ÓoÈ͢ Ù˘ Û˘Á-ÁÂÓo‡˜ ·applefiÊڷ͢ Ùo˘ ÚÈÓo‰·ÎÚ˘˚Îo‡ applefiÚo˘, ÁÈ·Ùo˘˜ ·ÛıÂÓ›˜ ÂΛÓo˘˜ appleo˘ Ë ‰È¿ÓoÈÍË ‰ÂÓ ¤ÁÈÓ·˘ÙfiÌ·Ù· ̤¯ÚÈ ÙoÓ 8o-12o Ì‹Ó· Ù˘ ˙ˆ‹˜. ∏ ·Ó·-ÌoÓ‹ ÁÈ· Ù˘¯fiÓ ·˘ÙfiÌ·ÙË ‰È¿ÓoÈÍË Ùo˘ applefiÚo˘ ÎÚ›-ÓÂÙ·È ·apple·Ú·›ÙËÙË, ‰Â‰o̤Óo˘ Ùo˘ ˘„ËÏo‡ appleoÛo-ÛÙo‡ ÙˆÓ apple·È‰ÈÒÓ appleo˘ ·apple·ÏÏ¿ÛÛoÓÙ·È ÙˆÓ Û˘-ÌappleÙˆÌ¿ÙˆÓ Ù˘ ·applefiÊڷ͢ ̤۷ ÛÙoÓ appleÚÒÙo ¯Úfi-Óo Ù˘ ˙ˆ‹˜ Ùo˘˜, Ì ÙËÓ ‚o‹ıÂÈ· Ù˘ Û˘ÓÙËÚËÙÈ΋˜·ÁˆÁ‹˜5. ∏ Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Û˘Ó›ÛÙ·Ù·È ·Ê’ÂÓfi˜ ÛÙËÓ ÙoappleÈ΋ ·ÓÙÈ‚ÈoÙÈ΋ ·ÁˆÁ‹, ·Ê’ ÂÙ¤Úo˘ÛÙo ηıËÌÂÚÈÓfi Ì·Û¿˙ Ùo˘ applefiÚo˘. ∂ÎÙfi˜ Ù˘ Û˘-¯Ó‹˜ ÂÓÛÙ¿Ï·Í˘ ÙˆÓ ·ÓÙÈ‚ÈoÙÈÎÒÓ ÛÙ·ÁfiÓˆÓ Î·Ù¿ÙȘ appleÂÚÈfi‰o˘˜ ‚ÏÂÓÓoapple˘ˆ‰ÒÓ ÂÎÎÚ›ÛÂˆÓ (ÊÏÂÁÌo-Ó‹˜), Â›Ó·È ÛÎfiappleÈÌo Ó· ÂÓÛÙ·Ï¿ÛÛoÓÙ·È Î·È ÌÈ·ÊoÚ¿ ÙËÓ Ë̤ڷ ηٿ ÙȘ appleÂÚÈfi‰o˘˜ ËÚÂÌ›·˜, ÁÈ·Ó· ·appleoÙÚ¤appleÂÙ·È Ë appleÈı·ÓfiÙËÙ· Ó¤·˜ appleÚoÛ‚oÏ‹˜.Δo Ì·Û¿˙ appleÚ¤appleÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Î·ıËÌÂÚÈ-Ó¿ Ì apple›ÂÛË Ùo˘ ‰·ÎÚ˘˚Îo‡ ·ÛÎo‡ Î·È Û˘Ó¤¯ÈÛËÙ˘ apple›ÂÛ˘ appleÚo˜ Ù· οو Û‡Ìʈӷ Ì ÙËÓ appleoÚ›·Ùo˘ ÚÈÓo‰·ÎÚ˘˚Îo‡ applefiÚo˘, fiappleˆ˜ appleÚÒÙo˜ appleÂÚȤ-ÁÚ·„ o Creiger (1923) 3 . ª’ ·˘ÙfiÓ ÙoÓ ÙÚfiappleo ·-ÛÎÂ›Ù·È ˘‰ÚoÛÙ·ÙÈ΋ apple›ÂÛË appleÚo˜ Ùo ÛËÌ›o ·applefi-Êڷ͢ Î·È ÌappleoÚ› Ó· ‰ËÌÈo˘ÚÁËı› ¿ÓoÈÁÌ· ÛÙËÓÌÂÌ‚Ú¿ÓË appleo˘ ÊÚ¿ÛÛÂÈ ÙoÓ applefiÚo. ∏ Ù·ÎÙÈ΋ ·˘Ù‹o‰ËÁ› ÛÂ Â˘Ù˘¯¤˜ ·appleoÙ¤ÏÂÛÌ· ÛÙo 90% ÙˆÓ appleÂÚÈappleÙÒÛˆÓ̤۷ ÛÙoÓ appleÚÒÙo ¯ÚfiÓo Ù˘ ˙ˆ‹˜. ÙȘ˘applefiÏoÈapple˜ appleÂÚÈappleÙÒÛÂȘ ÂӉ›ÎÓ˘Ù·È o ηıÂÙËÚÈ·-ÛÌfi˜ Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ 6,7 . Àapple¿Ú¯o˘Ó Û˘Á-ÁÚ·Ê›˜ appleo˘ ·Ó·Ê¤Úo˘Ó ÙËÓ ‰ÈÂÓ¤ÚÁÂÈ· Ùo˘ ηıÂ-ÙËÚÈ·ÛÌo‡ ÛÙo Â͈ÙÂÚÈÎfi È·ÙÚ›o, ÂÓÒ oÈ appleÂÚÈÛÛfi-ÙÂÚoÈ appleÚoÙÈÌo‡Ó ÙËÓ ¯ÂÈÚo˘ÚÁÈ΋ ·›ıo˘Û· Ì ÙËÓÛ˘ÓÂÚÁ·Û›· Ùo˘ ·Ó·ÈÛıËÛÈoÏfiÁo˘8-10 .ŸÏ· Ù· appleÂÚÈÛÙ·ÙÈο Ì·˜ ¤ÁÈÓ·Ó ÛÙo ¯ÂÈÚo˘Ú-Á›o Ì Ùo˘˜ ÌÈÎÚo‡˜ ·ÛıÂÓ›˜ ˘applefi ̤ıË. Ùo ÌÂ-Á·Ï‡ÙÂÚo ·ÚÈıÌfi ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ ÌÂÙ¿ ÙoÓ Î·-ıÂÙËÚÈ·ÛÌfi ¤ÁÈÓ appleχÛË Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡Î·È ÂappleȂ‚·›ˆÛË Ù˘ ‰È¿ÓoÈ͢ Ùo˘ applefiÚo˘.Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰oÎÈÌ¿Û·ÌÂ Î·È ‰È·appleÈ-ÛÙÒÛ·Ì Ùo ›‰Èo ηϿ ·appleoÙÂϤÛÌ·Ù· ¯ˆÚ›˜ ÙËÓappleχÛË, ÛÙȘ appleÂÚÈappleÙÒÛÂȘ appleo˘ Ë ·›ÛıËÛË Ù˘ ‰È¿ÓoÈ-͢ Ùo˘ applefiÚo˘ ηٿ ÙËÓ ÒÚ· Ùo˘ ηıÂÙËÚÈ·ÛÌo‡‹Ù·Ó ‚¤‚·ÈË.˘Ìapple¤Ú·ÛÌ·∏ appleχÛË Ù˘ ÚÈÓo‰·ÎÚ˘˚΋˜ o‰o‡ ÌÂÙ¿ ÙoÓηıÂÙËÚÈ·ÛÌfi ÁÈ· ÙËÓ Û˘ÁÁÂÓ‹ ·applefiÊÚ·Í‹ Ù˘ ‰ÂÓ

186 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Â›Ó·È apple¿ÓÙoÙ ·apple·Ú·›ÙËÙË. ÈÛÙ‡o˘Ì fiÙÈ Ë appleχ-ÛË ¯ÚÂÈ¿˙ÂÙ·È ÌfiÓoÓ ÛÙȘ appleÂÚÈappleÙÒÛÂȘ appleo˘ ηٿÙËÓ ‰ÈÂÓ¤ÚÁÂÈ· Ùo˘ ηıÂÙËÚÈ·ÛÌo‡ ·ÌÊÈ‚¿ÏÏo˘ÌÂÁÈ· ÙËÓ ‰È¿ÓoÈÍË Ùo˘ applefiÚo˘.∏ ÌË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ appleχÛ˘ ¤¯ÂÈ ‰‡o ÛËÌ·-ÓÙÈο appleÏÂoÓÂÎÙ‹Ì·Ù·:1. ÂÏ¿ÙÙˆÛË Ùo˘ ¯ÚfiÓo˘ Ù˘ ·Ó·ÈÛıËÛ›·˜2. ·appleoÊ˘Á‹ Ùo˘ ÎÈÓ‰‡Óo˘ Ùo˘ Ï·Ú˘ÁÁfiÛapple·-ÛÌo˘ ·applefi ÂÚÂıÈÛÌfi Ùo˘ Ï¿Ú˘ÁÁ· ·applefi ÙoÓ oÚfi Ù˘appleχÛ˘.μÈ‚ÏÈoÁÚ·Ê›·1. ªacEwen CJ, Young JDH. Epiphora during the first yearof life. Eye, 5: 596-600, 1991.2. Cassady TC. Developmental anatomy of the nasolacrimalduct. Arch. Ophthalmol 47: 141-148, 1952.3. Nelson L.B. Harley”s Pediatric Ophthalmology. Congenitalblocked nasolacrimal duct.W.B. Saunders company1998: 349-352.4. Kushner BJ. Congenital nasolacrimal system obstruction.Arch. Ophthalmol. 100: 597-600, 1982.5. Nelson L.B, MD, Granet DB, MD, Olitsky S, MD, Burke MJ,MD. Nasolacrimal duct obstruction. Journal of PediatricOphthalmology & Strabismus 37: 103-106, 2000.6. Katowitz JA, Welsh MG. Timing of initial probing andirrigation in congenital nasolacrimal duct obstruction.Ophthalmology 94: 698-705, 1987.7. Robb RM. Probing and irrigation for congenital nasolacrimalduct obstruction. Arch. Ophthalmology 104:378-379, 1986.8. Paul TO, Shepherd R. Congenital nasolacrimal duct obstruction:natural history and the timing of optimal intervention.Journal of Pediatric Ophthalmology &Strabismus 31: 362-367, 1994.9. Migliori ME, MD, Putterman AM, MD. Silicone intubationfor the treatment of congenital lacrimal duct obstruction:Succesfull results removing the tubes after sixweeks. Ophthalmology, 95: 792-795, 1988.10. Burns SJ ,Kipioti A. Follow up after probing for congenitalnasolacrimal duct obstruction. Journal of PediatricOphthalmology & Strabismus 38: 163-165, 2001.

OÊı·ÏÌÈο ÙÚ·‡Ì·Ù· ÛÙ· apple·È‰È¿: ÙÚÈÂÙ‹˜ ·Ó·ÛÎÔappleÈ΋ÌÂϤÙË ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ appleÔ˘ appleÚÔÛ‹Ïı·Ó ÛÙȘ ÂÊËÌÂڛ˜ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∞Ã∂∞¡.°. ∑ȿη˜, ¡. §¿ÏÏo˜, ∞. ∫oÛÎoÛ¿˜, μ. ªfiÛ¯o˘, ∫. ªappleoÌappleoÚ›‰Ë˜,¡. °ÂˆÚÁÈ¿‰Ë˜, ¡. ¢ËÌËÙÚ·Îo‡ÏÈ·˜, . ª·Ïo‡Ù·˜Ophthalmic injuries in childhood: A three years retrospective study of eye emergenciesattending the casualty department of AHEPA hospitalN.G. Ziakas, N. Lalos, A. Koskosas, V. Moshou, K. Boboridis, N. Georgiadis,N. Dimitrakoulias, S. MaloutasÎoapplefi˜: ∏ ηٷÁÚ·Ê‹, Ë ·ÈÙÈoÏoÁÈ΋ Ù·ÍÈÓfiÌËÛË Î·È Ë·ÓÙÈÌÂÙÒappleÈÛË/¤Î‚·ÛË ÙˆÓ oÊı·ÏÌoÏoÁÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓÙˆÓ apple·È‰ÈÒÓ appleo˘ appleÚoÛ‹Ïı·Ó Û Ë̤Ú˜ ÁÂÓÈ΋˜ ÂÊËÌÂ-Ú›·˜ ÛÙo ÙÌ‹Ì· ÙˆÓ ÂappleÂÈÁfiÓÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ Ùo˘ ÓoÛoÎo-Ì›o˘ ∞Ã∂∞. ÀÏÈÎfi-ª¤ıo‰o˜: ∏ ÌÂϤÙË ‹Ù·Ó ·Ó·ÛÎoappleÈ-΋ Î·È ·ÊoÚo‡Û fiÏ· Ù· apple·È‰È¿ ËÏÈΛ·˜ 0-16 ÂÙÒÓ appleo˘appleÚoÛ‹Ïı·Ó Ì ÙÚ·‡Ì· ÛÙȘ ÂÊËÌÂڛ˜ Ù˘ oÊı·ÏÌoÏoÁÈ-΋˜ ÎÏÈÓÈ΋˜ Ùo˘ ÓoÛoÎoÌ›o˘ ∞Ã∂∞ ÛÙo ∞ÚÈÛÙoÙ¤ÏÂÈo·ÓÂappleÈÛÙ‹ÌÈo ηٿ ÙËÓ ÙÚÈÂÙ›· 1998-2000. π‰È·›ÙÂÚË ÛËÌ·-Û›· ‰fiıËΠÛÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Û ۯ¤ÛË Ì Ùo Û‡ÓoÏoÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ, ÙËÓ ËÏÈÎȷ΋ ηٷÓoÌ‹ Ùo˘˜ Î·È ÙËÓ ·È-ÙÈoÏoÁ›· Ùo˘˜. ∂apple›Û˘, ÌÂÏÂÙ‹ıËΠo ·ÚÈıÌfi˜, oÈ ·Èٛ˜ ηÈË ‚·Ú‡ÙËÙ· ÙˆÓ ÙÚ·˘Ì¿ÙˆÓ ÛÙ· apple·È‰È¿ appleo˘ ·apple·ÈÙ‹ıËÎÂÓoÛËÏ›· ÁÈ· appleÂÚ·ÈÙ¤Úˆ ıÂÚ·apple¢ÙÈ΋ ·ÓÙÈÌÂÙÒappleÈÛË.∞appleoÙÂϤÛÌ·Ù·: ∂apple› Û˘ÓfiÏo˘ 17149 ÂÍÂÙ·Ûı¤ÓÙˆÓ ·Ùfi-ÌˆÓ ÛÙȘ ÂÊËÌÂڛ˜ Ù˘ oÊı·ÏÌoÏoÁÈ΋˜ ÎÏÈÓÈ΋˜ Ùo˘ÓoÛoÎoÌ›o˘ ∞Ã∂∞ ÛÙËÓ ÙÚÈÂÙ›· 1998-2000 o Û˘ÓoÏÈÎfi˜·ÚÈıÌfi˜ ÙˆÓ ÙÚ·˘Ì¿ÙˆÓ ‹Ù·Ó 6213 appleÂÚÈÛÙ·ÙÈο Î·È ÂÍ ·˘-ÙÒÓ Ù· 444 (7%) ‹Ù·Ó apple·È‰È¿. ∏ ËÏÈÎȷ΋ ηٷÓoÌ‹ ¤‰ÂÈÍÂfiÙÈ Ùo ÌÂÁ·Ï‡ÙÂÚo appleoÛoÛÙfi (31%) ·ÊoÚo‡Û apple·È‰È¿ ËÏÈ-Λ·˜ 5-8 ÂÙÒÓ Î·È Ùo ÌÈÎÚfiÙÂÚo (20%) apple·È‰È¿ ËÏÈΛ·˜ 13-16ÂÙÒÓ ÂÓÒ Ë Û¯¤ÛË ·ÁfiÚÈ· appleÚo˜ ÎoÚ›ÙÛÈ· ‹Ù·Ó 55% appleÚo˜45% ·ÓÙ›ÛÙoȯ·. Δ· Û˘¯ÓfiÙÂÚ· ›‰Ë ÙÚ·˘Ì¿ÙˆÓ ·ÊoÚo‡-Û·Ó ·applefiappleÙˆÛË ÂappleÈıËÏ›o˘ ÎÂÚ·ÙoÂȉo‡˜ (54%), ıÏ·ÛÙÈÎfiÙÚ·‡Ì· (20%), ˘appleoÙ·ÚÛÈÎfi ͤÓo ÛÒÌ· (10%), ͤÓo ÛÒÌ·ÎÂÚ·ÙoÂȉo‡˜ (11%), ‰È·ÌappleÂÚ¤˜ ÙÚ·‡Ì· ‚oÏ‚o‡ (3%) ηȯËÌÈÎfi ¤Áη˘Ì· (2%). ∏ ÂÈÛ·ÁˆÁ‹ ÁÈ· ÓoÛËÏ›· ÎÚ›ıËηapple·Ú·›ÙËÙË Û appleoÛoÛÙfi 7% ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ apple·È‰ÈÒÓ ÌÂÙÚ·‡Ì· ÂÓÒ Ùo ·ÓÙ›ÛÙoȯo appleoÛoÛÙfi Âapple› ÙˆÓ ÂÓËÏ›ÎˆÓ ‹Ù·Ó2%. Δ· Û˘¯ÓfiÙÂÚ· ›‰Ë ÙÚ·˘Ì¿ÙˆÓ ÛÙo Û‡ÓoÏo ÙˆÓ 32 apple·È-Purpose: To record the patterns, the aetiologies andthe treatment/outcome of paediatric eyes injuriesattending the eye casualty department of AHEPAhospital. Material/Methods: A retrospective study ofall children 0-16 years of age with eye injuries,attending the casualty department of the AristoteleanUniversity Eye Clinic at the AHEPA General Hospitalduring the period 1998-2000. Analysis of the cases wasdone according to age and aetiology. Further review ofall cases requiring admission was carried out. Results:A total of 17149 patients were examined at the eyecasualty department of the Aristotelean University EyeClinic at the AHEPA General Hospital during the 1998-2000 period of which 6213 were eye injuries and 444 ofthem (7%) involved children. Age distribution of thepaediatric cases revealed the highest percentage(31%) in children 5–8 years of age and the lowest (20%)in children 13–16 years of age, while male to femaleratio was 55% to 45% respectively. The main categoriesof eye injuries in children were traumaticepithelial abrasion (54%), blunt trauma (20%), subtarsalforeign bo-dy (10%), corneal foreign body (11%),penetrating ocular trauma (3%) and chemical injury(2%). Admission for inpa-tient management wasnecessary in 7% of all paedriatic cases with oculartrauma, whereas in adult patients this was 2%. Themain types of injury in the 32 children requi-ringhospitalisation were penetrating trauma (44%), blunttrauma (28%) and traumatic epithelial abrasion (22%).Conclusion: The incidence of eye injuries in childrenOÊı·ÏÌoÏoÁÈ΋ ∫ÏÈÓÈ΋, ¡oÛoÎoÌ›o ∞Ã∂∞, ∞ÚÈÛÙoÙ¤ÏÂÈo ·ÓÂappleÈÛÙ‹ÌÈo £ÂÛÛ·ÏÔӛ΢OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 187 - 190, 2002 187

188 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)‰ÈÒÓ appleo‡ ÓoÛËχıËÎ·Ó ‹Ù·Ó ‰È·ÌappleÂÚ‹ (44%), ıÏ·ÛÙÈο(28%) Î·È ·applefiappleÙˆÛË ÂappleÈıËÏ›o˘ ÎÂÚ·ÙoÂȉo‡˜ (22%). ˘-ÌappleÂÚ¿ÛÌ·Ù·: Δo appleoÛoÛÙfi ÙˆÓ oÊı·ÏÌÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓÛÙ· apple·È‰È¿ Â›Ó·È ÌÈÎÚfi Û ۯ¤ÛË Ì Ùo ·ÓÙ›ÛÙoȯo ÛÙo˘˜ÂÓ‹ÏÈΘ, ·ÏÏ¿ Ë ·Ó¿ÁÎË ÁÈ· ÓoÛËÏ›· Â›Ó·È Û˘¯ÓfiÙÂÚËÛÙ· apple·È‰È¿. ∏ appleÏÂÈo„ËÊ›· ÙˆÓ apple·È‰ÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓ ‰ÂÓÂ›Ó·È ·ÓËÛ˘¯ÈÙÈ΋˜ ʇÛ˘ Î·È ÌappleoÚ› Ó· appleÚoÏËÊı› ÌÂÙËÓ ·Ó¿ÏoÁË ÂÓË̤ڈÛË. Δ· appleÂÚÈÛÙ·ÙÈο appleo˘ ¯Ú‹˙o˘ÓÓoÛËÏ›·˜ Û ÌÈÎÚfi appleoÛoÛÙfi ¤¯o˘Ó η΋ appleÚfiÁÓˆÛËfiÛoÓ ·ÊoÚ¿ ÙËÓ ÙÂÏÈ΋ Ùo˘˜ fiÚ·ÛË.was significantly lower than in adults, but admissionfor inpatient management was necessary more frequentlyin children. The vast majority of paediatric eyetrauma cases are not severe and better education canprevent such ocular hazards.∂ÈÛ·ÁˆÁ‹Δ· ÙÚ·‡Ì·Ù· Ùo˘ ‚oÏ‚o‡ ·appleoÙÂÏo‡Ó ÙËÓ Î˘-ÚÈfiÙÂÚË ·ÈÙ›· ÌoÓfiÊı·ÏÌ˘ ·appleÒÏÂÈ·˜ fiÚ·Û˘ ÛÙ·apple·È‰È¿, ÂÓÒ Û˘¯Ó¿ ¤¯o˘Ó ˆ˜ ·appleoÙ¤ÏÂÛÌ· ÛËÌ·ÓÙÈ΋oÊı·ÏÌÈ΋ ÓoÛËÚfiÙËÙ· ÏÈÁfiÙÂÚo Ûo‚·Ú‹ ·applefi ÙËÓÙ˘ÊÏfiÙËÙ·1. ªÂϤÙ˜ ¤¯o˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· apple·È‰È¿ ›-Ó·È ‰˘Û·Ó¿ÏoÁ· ÂappleÈÚÚÂapple‹ Û Ûo‚·Ú¿ oÊı·ÏÌÈοÙÚ·‡Ì·Ù·2,3 , appleoÏÏ¿ ·applefi Ù· oappleo›· Û˘Ó‹ıˆ˜ Û˘Ì-‚·›Óo˘Ó ηٿ ÙËÓ Û¯oÏÈ΋ ËÏÈΛ·4,5 Î·È ı· ÌappleoÚo‡-Û·Ó Ó· ¤¯o˘Ó appleÚoÏËÊı› 5,6 . ∂apple›Û˘, Â›Ó·È ÁÓˆÛÙfi fi-ÙÈ appleoÏÏ¿ ·applefi ·˘Ù¿ Â›Ó·È ·appleoÙ¤ÏÂÛÌ· ÙÚ·˘Ì·ÙÈÛÌo‡ÙˆÓ apple·È‰ÈÒÓ ·applefi ÂappleÈΛӉ˘Ó· apple·È¯Ó›‰È·3,6-9 .  ̛·ÌÂϤÙË ·applefi ÙȘ ∏∞, Ë ·ÌÂÚÈηÓÈ΋ ‰È‡ı˘ÓÛˢÁ›·˜ ·Ó·Ê¤ÚÂÈ fiÙÈ Ù· apple·È¯Ó›‰È· Â›Ó·È ˘apple‡ı˘Ó·ÁÈ· 600.000 oÊı·ÏÌÈο ÙÚ·‡Ì·Ù· οı ¯ÚfiÓo 10 .Îoapplefi˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·-Ê‹, Ë ·ÈÙÈoÏoÁÈ΋ Ù·ÍÈÓfiÌËÛË Î·È Ë ·ÓÙÈÌÂÙÒappleÈÛË/¤Î‚·ÛË ÙˆÓ oÊı·ÏÌoÏoÁÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓ ÙˆÓ apple·È-‰ÈÒÓ appleo˘ appleÚoÛ‹Ïı·Ó Û Ë̤Ú˜ ÁÂÓÈ΋˜ ÂÊËÌÂÚ›·˜ÛÙo ÙÌ‹Ì· ÙˆÓ ÂappleÂÈÁfiÓÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ Ùo˘ÓoÛoÎoÌ›o˘ ∞Ã∂∞ ηٿ ÙËÓ ÙÚÈÂÙ›· 1998-2000.ÀÏÈÎfi – ª¤ıÔ‰Ô˜∏ ÌÂϤÙË ‹Ù·Ó ·Ó·ÛÎoappleÈ΋ Î·È ·ÊoÚo‡Û fiÏ· Ù·apple·È‰È¿ ËÏÈΛ·˜ 0-16 ÂÙÒÓ appleo˘ appleÚoÛ‹Ïı·Ó Ì ÈÛÙoÚÈÎfiÙÚ·‡Ì·Ùo˜ ÛÙȘ ÂÊËÌÂڛ˜ Ù˘ oÊı·ÏÌoÏoÁÈ΋˜ ÎÏÈÓÈ΋˜Ùo˘ ÓoÛoÎoÌ›o˘ ∞Ã∂∞ ÛÙo ∞ÚÈÛÙoÙ¤ÏÂÈo ·ÓÂappleÈÛÙ‹-ÌÈo ηٿ ÙËÓ ÙÚÈÂÙ›· 1998-2000. ŒÁÈÓ Ì ٷ ‰Â‰o̤ӷappleo˘ ‚Ú¤ıËÎ·Ó ÛÙ· Âapple›ÛËÌ· ‚È‚Ï›· ηٷÁÚ·Ê‹˜ Ùo˘ ÙÌ‹-Ì·Ùo˜ ÙˆÓ ÂappleÂÈÁfiÓÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ Ù˘ ·ÓÂappleÈÛÙËÌÈ·-΋˜ OÊı·ÏÌoÏoÁÈ΋˜ ∫ÏÈÓÈ΋˜ Ùo˘ ÓoÛoÎoÌ›o˘∞Ã∂∞. Ù· ‚È‚Ï›· ·˘Ù¿ ηٷÁÚ¿ÊoÓÙ·È Ë ËÌÂÚoÌËÓ›·ÂͤٷÛ˘, Ù· appleÏ‹ÚË ÛÙoȯ›· Ùo˘ οı ·ÛıÂÓ‹, ¤Ó· Û‡-ÓÙoÌo ÈÛÙoÚÈÎfi, Ù· ·ÓÙÈÎÂÈÌÂÓÈο Â˘Ú‹Ì·Ù·, Ë appleÈı·Ó‹‰È¿ÁÓˆÛË Î·È Ë ıÂÚ·apple¢ÙÈ΋ ·ÓÙÈÌÂÙÒappleÈÛË. ∂apple›Û˘, ·Ó·-ʤÚoÓÙ·È ·Ó·Ï˘ÙÈο Ù· appleÂÚÈÛÙ·ÙÈο Ù· oappleo›· ÂÈÛ‹¯ıË-Û·Ó ÛÙËÓ ÎÏÈÓÈ΋ Î·È Ë ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛ‹ Ùo˘˜.°È· Ùo ÛÎoapplefi Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ ÌÂÏÂÙ‹ıËηÓfiÏoÈ oÈ ÌÈÎÚo› ·ÛıÂÓ›˜ ËÏÈΛ·˜ 0-16 ÂÙÒÓ. ËÌÂÈÒıËÎÂË ËÏÈΛ· Ùo˘˜, Ë ËÌÂÚoÌËÓ›· ÂͤٷÛ˘, Ë ·ÈÙ›· appleÚoÛ¤-Ï¢Û˘, Ë appleÈı·Ó‹ ‰È¿ÁÓˆÛË Î·È Ë ·ÓÙÈÌÂÙÒappleÈÛË. π‰È·›-ÙÂÚo ‚¿Úo˜ ‰fiıËΠÛÙȘ appleÂÚÈappleÙÒÛÂȘ ÙˆÓ apple·È‰ÈÒÓ appleo˘¯ÚÂÈ¿ÛÙËÎ·Ó ÂÈÛ·ÁˆÁ‹ ηıÒ˜ Î·È Ù· ·›ÙÈ· appleo˘ o‰‹ÁË-Û·Ó Û ·˘Ù‹. Δ¤Ïo˜, ¤ÁÈÓ ÌÈ· ·‰Ú‹ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛËÙˆÓ Â˘ÚËÌ¿ÙˆÓ Û ۯ¤ÛË Ì Ùo ·ÓÙ›ÛÙoȯo Û˘ÓoÏÈÎfi·ÚÈıÌfi ÙˆÓ oÊı·ÏÌoÏoÁÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓ ÛÙËÓ ÙÚÈÂÙ›··˘Ù‹ ηÈ, ΢ڛˆ˜, ÙËÓ ËÏÈÎȷ΋ Î·È ·ÈÙÈoÏoÁÈ΋ ηٷ-ÓoÌ‹ Ùo˘˜.∞appleÔÙÂϤÛÌ·Ù·Ùo ¯ÚoÓÈÎfi ‰È¿ÛÙËÌ· 1998-2000 appleÚoÛ‹Ïı·ÓÛÙȘ Ë̤Ú˜ ÁÂÓÈ΋˜ ÂÊËÌÂÚ›·˜ Ù˘ OÊı·Ï-ÌoÏoÁÈ΋˜ ∫ÏÈÓÈ΋˜ Ùo˘ ÓoÛoÎoÌ›o˘ ∞Ã∂∞Û˘ÓoÏÈο 17149 ¿ÙoÌ·. ∂apple› Ùo˘ Û˘ÓfiÏo˘ ÙˆÓ17149 ÂÍÂÙ·Ûı¤ÓÙˆÓ o Û˘ÓoÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓÙÚ·˘Ì¿ÙˆÓ ‹Ù·Ó 6213 appleÂÚÈÛÙ·ÙÈο Î·È ÂÍ ·˘ÙÒÓÙ· 444 (7%) ‹Ù·Ó apple·È‰È¿. ∏ ËÏÈÎȷ΋ ηٷÓoÌ‹(›Ó. 1) ¤‰ÂÈÍ fiÙÈ Ùo ÌÂÁ·Ï‡ÙÂÚo appleoÛoÛÙfi (31%)·ÊoÚo‡Û apple·È‰È¿ ËÏÈΛ·˜ 5-8 ÂÙÒÓ Î·È Ùo ÌÈÎÚfi-ÙÂÚo (20%) apple·È‰È¿ ËÏÈΛ·˜ 13-16 ÂÙÒÓ ÂÓÒ Ë Û¯¤-ÛË ·ÁfiÚÈ· appleÚo˜ ÎoÚ›ÙÛÈ· ‹Ù·Ó 55% appleÚo˜ 45%·ÓÙ›ÛÙoȯ·. Δ· Û˘¯ÓfiÙÂÚ· ›‰Ë ÙÚ·˘Ì¿ÙˆÓ (›Ó.2) ·ÊoÚo‡Û·Ó ÙÚ·˘Ì·ÙÈ΋ ·applefiappleÙˆÛË ÂappleÈıËÏ›o˘ÎÂÚ·ÙoÂȉo‡˜ (54%), ıÏ·ÛÙÈÎfi ÙÚ·‡Ì· (20%),˘appleoÙ·ÚÛÈÎfi ͤÓo ÛÒÌ· (10%), ͤÓo ÛÒÌ· ÎÂ-Ú·ÙoÂȉo‡˜ (11%), ‰È·ÌappleÂÚ¤˜ ÙÚ·‡Ì· ‚oÏ‚o‡(3%) Î·È ¯ËÌÈÎfi ¤Áη˘Ì· (2%). ∏ ÂÈÛ·ÁˆÁ‹ ÁÈ·ÓoÛËÏ›· ÎÚ›ıËΠ·apple·Ú·›ÙËÙË Û 32 apple·È‰È¿ ÌÂÙÚ·‡Ì·, appleoÛoÛÙfi 7%, ÂÓÒ Ùo ·ÓÙ›ÛÙoȯo appleoÛoÛÙfiÂapple› ÙˆÓ ÂÓËÏ›ÎˆÓ ‹Ù·Ó 2%. Δ· Û˘¯ÓfiÙÂÚ· ›‰ËÙÚ·˘Ì¿ÙˆÓ ÛÙo Û‡ÓoÏo ÙˆÓ 32 apple·È‰ÈÒÓ appleo˘ ÓoÛË-χıËÎ·Ó (›Ó. 3) ‹Ù·Ó ‰È·ÌappleÂÚ‹ (44%), ıÏ·ÛÙÈ-ο (28%) Î·È ÙÚ·˘Ì·ÙÈ΋ ·applefiappleÙˆÛË ÂappleÈıËÏ›o˘

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190 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)appleoÛoÛÙfi ÙˆÓ apple·È‰ÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓ appleo˘ ¯ÚÂÈ¿ÛÙËÎÂÓoÛËÏ›· ›¯Â ηϋ ÙÂÏÈ΋ ¤Î‚·ÛË appleÏËÓ ÙˆÓ ‰È·-ÌappleÂÚÒÓ ÙÚ·˘Ì¿ÙˆÓ ÌÂ Û˘ÌÌÂÙo¯‹ ÙˆÓ oappleÈÛı›ˆÓÌoÚ›ˆÓ.˘ÌappleÂÚ¿ÛÌ·Ù·Δ· Âapple›ÁoÓÙ· oÊı·ÏÌoÏoÁÈο appleÚo‚Ï‹Ì·Ù·ÙˆÓ apple·È‰ÈÒÓ Î·È appleÈo Û˘ÁÎÂÎÚÈ̤ӷ Ù· ÙÚ·‡Ì·Ù·Â›Ó·È ¤Ó·˜ ȉȷ›ÙÂÚ· Ó¢ڷÏÁÈÎfi˜ Ùo̤·˜ Ù˘OÊı·ÏÌoÏoÁ›·˜. ∏ ‰˘Û¯¤ÚÂÈ· ÛÙË Ï‹„Ë Î·È ÙËÓÂÎÙ›ÌËÛË Ùo˘ ÈÛÙoÚÈÎo‡, Ù· appleÚo‚Ï‹Ì·Ù· ÛÙËÓ ÎÏÈ-ÓÈ΋ ÂͤٷÛË Î·È Ë „˘¯È΋ ÊfiÚÙÈÛË Ù˘ oÈÎoÁ¤ÓÂÈ-·˜ Ùo˘ apple·È‰Èo‡ ·apple·ÈÙo‡Ó ȉȷ›ÙÂÚË appleÚoÛo¯‹ ·ÏÏ¿Î·È ÂÌappleÂÈÚ›· ·applefi ÙËÓ appleÏÂ˘Ú¿ ÙˆÓ oÊı·ÏÌÈ¿ÙÚˆÓ.Δo appleoÛoÛÙfi ÙˆÓ oÊı·ÏÌÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓ ÛÙ· apple·È-‰È¿ Â›Ó·È ÌÈÎÚfi Û ۯ¤ÛË Ì Ùo ·ÓÙ›ÛÙoȯo ÛÙo˘˜ÂÓ‹ÏÈΘ, ·ÏÏ¿ Ë ·Ó¿ÁÎË ÁÈ· ÓoÛËÏ›· Â›Ó·È Û˘-¯ÓfiÙÂÚË ÛÙ· apple·È‰È¿. ∏ appleÏÂÈo„ËÊ›· ÙˆÓ apple·È‰ÈÎÒÓÙÚ·˘Ì¿ÙˆÓ ‰ÂÓ Â›Ó·È ·ÓËÛ˘¯ÈÙÈ΋˜ ʇÛ˘ ηÈÌappleoÚ› Ó· appleÚoÏËÊı› Ì ÙËÓ ·Ó¿ÏoÁË ÂÓË̤ڈÛË.Δ· appleÂÚÈÛÙ·ÙÈο appleo˘ ¯Ú‹˙o˘Ó ÓoÛËÏ›·˜ Û ÌÈÎÚfiappleoÛoÛÙfi ¤¯o˘Ó η΋ appleÚfiÁÓˆÛË fiÛoÓ ·ÊoÚ¿ ÙËÓÙÂÏÈ΋ Ùo˘˜ fiÚ·ÛË.μÈ‚ÏÈoÁÚ·Ê›·1. National Society to Prevent Blindness. Fact Sheet. NewYork : National Society to Prevent Blindness, 1980.2. Schein OD, Hibberd PL, Shingleton BJ, Kunzweiler T, FrambachDA, Seddon JM, et al. Spectrum and burden ofocular injury. Ophthalmology 95: 300-5, 1986.3. Macewen CJ. Eye injuries: a prospective survey of 5671cases. Br J Ophthalmol 73:888-94, 1989.4. Grin TR, Nelson LB, Jeffers JB. Eye injuries in childhood.Pediatrics 80: 13-7, 1987.5. LaRoche GR, McIntyre L, Schertzer RM. Epidemiology ofsevere eye injuries in childhood. Ophthalmology 95:1603-7, 1988.6. Nelson LB, Wilson TW, Jeffers JB. Eye injuries in childhood:demography, etiology, and prevention. Pediatrics84: 438-41, 1989.7. Strahlam E, Elman M, Daud E,Baker S. Causes of pediatriceye injuries: a populationbased study. Arch Ophthlmol108: 603-6, 1990.8. Maltzaman BA, Pruzon H, Mund ML. A survey of oculartrauma. Surv Ophthalmol 21: 285-90, 1976.9. Charteris DG. Ocular injuries caused by suction toy. J RColl Surg Edinb 34: 338-9, 1989.10. Centres for Disease Control. Toy safety United States1983. MMWR 33: 697-8, 1984.11. Nash EA, Margo CE. Patterns of emergency departmentvisits for disorders of the eye and ocular andexa. ArchOphthalmol 116(9): 1222-6, 1998.12. Garcia GE. Management of ocular emergencies and urgenteye problems. Am Fam Physician 53(2): 565-74,1996.13. Cascairo MA, Mazow ML, Prager TC. Pediatric oculartrauma: a retrospective survey. J Pediatr OphthalmolStrabismus 31(5): 312-7, 1994.14. Ziakas NG, Ramsay AS, Clarke MP, Stannard K. ‘Pogsand slammers’: ocular injury caused by a new game.Br J Ophthalmol 81(4): 331-2, 1997.15. Rychwalski PJ, O’Halloran HS, Cooper HM, Baker RS,Stevens JL. Evaluation and classification of pediatricocular trauma. Pediatr Emerg Care 15(4): 277-9,1999.16. ª·Ïo‡Ù·˜ , ¢ËÌËÙÚ·Îo‡ÏÈ·˜ ¡, ª·ÏÙ¤˙o˜ ∞. ¢È·ÌappleÂ-Ú‹ ÙÚ·‡Ì·Ù· Ùo˘ ‚oÏ‚o‡ ÛÙËÓ apple·È‰È΋ ËÏÈΛ· (ÂappleȉË-ÌÈoÏoÁÈο ÛÙoȯ›· Î·È appleÚfiÏË„Ë). OÊı·ÏÌoÏoÁ›·8(2): 172-6, 1996.17. ¢ËÌËÙÚ·Îo‡ÏÈ·˜ ¡. ∏ ÌÈÎÚo¯ÂÈÚo˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒappleÈÛËÙˆÓ ‰È·ÌappleÂÚÒÓ ÎÂÚ·ÙoÛÎÏËÚÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓ Ùo˘‚oÏ‚o‡. ¢È‰·ÎÙoÚÈ΋ ‰È·ÙÚÈ‚‹, £ÂÛÛ·ÏoÓ›ÎË 1981.18. ª·Ïo‡Ù·˜ , ¢ËÌËÙÚ·Îo‡ÏÈ·˜ ¡, ª·ÏÙ¤˙o˜ ∞, Ù¿Ìo˘-ΔÛÈ·appleÚ¿˙Ë ª. ∂appleȉËÌÈoÏoÁÈΤ˜ apple·Ú·ÙËÚ‹ÛÂȘ ηÈappleÚfiÏË„Ë ÙˆÓ ÙÚ·˘Ì¿ÙˆÓ Ùo˘ oÊı·ÏÌo‡ ÛÙ· apple·È‰È¿.·È‰È·ÙÚÈ΋ μoÚ›o˘ ∂ÏÏ¿‰o˜ 8: 280-4, 1996.19. ¢ËÌËÙÚ·Îo‡ÏÈ·˜ ¡. ¢È·ÌappleÂÚ‹ ÙÚ·‡Ì·Ù· ‚oÏ‚o‡.OÊı·ÏÌoÏoÁ›· 3(2): 111-20, 1991.20. Lai JC, Fecrat S, Barron Y, Goldberg MF. Traumatic hyphemain children: risk factors for complications.Arch Ophthalmol 119(1): 64-70, 2001.21. Lueder GT. Air bag-associated ocular trauma in children.Ophthalmology 107(8): 1472-5, 2000.22. Dana MR, Schaumberg DA, Moyes AL, Gomes JA, LaibsonPR, Holland EJ, Sugar A, Sugar J. Outcome of penetratingkeratoplasty after ocular trauma in children.Arch Ophthalmol 113(12): 1503-7, 1995.23. ∑ȿη˜ ¡°, ÷ς·Ù˙‹˜ ¡£, ªÈÎÚfiappleo˘Ïo˜ ¢, ªfiÛ¯o˘ μ,¢o‡‰o˘ ∞, °ÂˆÚÁÈ¿‰Ë˜ ¡, Ù¿ÁÎo˜ ¡Δ. ªÂϤÙË ÙˆÓ¤ÎÙ·ÎÙˆÓ oÊı·ÏÌoÏoÁÈÎÒÓ appleÚo‚ÏËÌ¿ÙˆÓ Û apple·È‰È¿appleo˘ appleÚoÛ¤Ú¯oÓÙ·È Û ÂÊËÌÂڛ˜ ÂÓfi˜ ÁÂÓÈÎo‡ ÓoÛo-ÎoÌ›o˘. OÊı·ÏÌoÏoÁ›· 13(3): 291-94, 2001.24. ¢ËÌËÙÚ·Îo‡ÏÈ·˜ ¡, ª·Ïo‡Ù·˜ , ∫o„·¯Â›Ï˘ ∂, ª·Ó-Ù˙›Ú˘ ¢. ¢È·ÌappleÂÚ‹ ÙÚ·‡Ì·Ù· ‚oÏ‚o‡ – apple·Ú·ÙËÚ‹-ÛÂȘ ·applefi ÙËÓ ÂÌappleÂÈÚ›· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ 10 ÂÙÒÓ. O-Êı·ÏÌoÏoÁ›· 7(2): 144-50, 1995.

OappleÙÈ΋ o͇ÙËÙ·, ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È Ù‡appleoÈÛÙÚ·‚ÈÛÌo‡ Û apple·È‰È¿ Ì Ûapple·ÛÙÈ΋ ÙÂÙÚ·appleÏËÁ›·ÏfiÁˆ ÂÁÎÂÊ·ÏÈ΋˜ apple·Ú¿Ï˘Û˘¡. ∫o˙¤Ë˜1, Ã. ºˆÙoappleo‡Ïo˘2, ∞. ª¿Áη1Visual acuity , refractive errors and strabismus in a group of spastic quadriplegic,school aged, cerebral palsied childrenN. Kozeis, H. Fotopoulou, A. MaggaÎoapplefi˜: ∏ appleÚooappleÙÈ΋ ·˘Ù‹ ÌÂϤÙË Û¯Â‰È¿ÛÙËΠÁÈ· Ó·ÌÂÏÂÙ‹ÛÂÈ ‚·ÛÈÎo‡˜ apple·Ú¿ÁoÓÙ˜ Ù˘ oappleÙÈ΋˜ ÏÂÈÙo˘Ú-Á›·˜, Û ÌÈ· oÌ¿‰· apple·È‰ÈÒÓ Ì Ûapple·ÛÙÈ΋ ÙÂÙÚ·appleÏËÁ›·,ÛÙ· appleÏ·›ÛÈ· ‰ÈÂÚ‡ÓËÛ˘ appleÈı·ÓÒÓ ·ÈÙÈÒÓ appleÚfiÎÏËÛ˘ Ì·-ıËÛÈ·ÎÒÓ ‰˘ÛÎoÏÈÒÓ. ÀÏÈο – ª¤ıo‰oÈ: ÙË ÌÂϤÙË ·˘-Ù‹ Û˘ÌÌÂÙ›¯·Ó 20 apple·È‰È¿ (ËÏÈΛ·˜ 6-15 ÂÙÒÓ) Ì Ûapple·ÛÙÈ-΋ ÙÂÙÚ·appleÏËÁ›· ÏfiÁˆ ÂÁÎÂÊ·ÏÈ΋˜ apple·Ú¿Ï˘Û˘. ŸÏ· Ù·apple·È‰È¿ apple·Úo˘Û›·˙·Ó ÈηÓoappleoÈËÙÈ΋ ÓoËÙÈ΋ ÏÂÈÙo˘ÚÁ›· ,ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙oÓÙ·È ·ÍÈfiappleÈÛÙ· ·appleoÙÂϤÛÌ·Ù·. ∂ÎÙÈ-Ì‹ıËΠÙo Âapple›apple‰o Ù˘ ηχÙÂÚ· ‰ÈoÚıˆÌ¤Ó˘ oappleÙÈ΋˜o͇ÙËÙ·˜ Û οı oÊı·ÏÌfi ͯˆÚÈÛÙ¿, Ùo ‡Úo˜ ÙˆÓ ‰È·-ıÏ·ÛÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È Ù¤Ïo˜ Ùo appleoÛoÛÙfi Î·È oÈ Ù‡appleoÈÛÙÚ·‚ÈÛÌo‡. ∞appleoÙÂϤÛÌ·Ù·: ∏ ‰ÈoÚıˆÌ¤ÓË oappleÙÈ΋ o͇-ÙËÙ· ÛÙo 54,6% ÙˆÓ ‰ÂÍÈÒÓ oÊı·ÏÌÒÓ Î·È ÛÙo 65,3% ÌÈ-ÎÚfiÙÂÚË ·applefi 3/3 ( 10/10). OÈ ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ΢-Ì·›ÓÔÓÙ·Ó ·applefi +4,50 ̤¯ÚÈ –3,00 D ÛÊ·›ÚˆÌ· Î·È +3,50̤¯ÚÈ –1,00 D ·ÏÈÓ‰Úo (·ÚÈo˜ ¿ÍoÓ·˜ ÛÙȘ 90 Ìo›Ú˜).Δo 60 % ÙˆÓ apple·È‰ÈÒÓ ÂÌÊ¿ÓÈ˙·Ó ÛÙÚ·‚ÈÛÌfi, ÂÓÒ ÛÙo 98%·appleo˘Û›·˙Â Ë ÛÙÂÚÂoÛÎoappleÈ΋ fiÚ·ÛË. ˘Ìapple¤Ú·ÛÌ·: ΔoÂapple›apple‰o Ù˘ ‰ÈoÚıˆÌ¤Ó˘ oappleÙÈ΋˜ o͇ÙËÙ·˜ Â›Ó·È Û ÌÂ-Á¿Ïo appleoÛoÛÙfi ÌÂȈ̤Óo, ÂÓÒ Ùo ‡Úo˜ ÙˆÓ ‰È·ıÏ·ÛÙÈÎÒӷӈ̷ÏÈÒÓ Î·È Ùo appleoÛoÛÙfi ÂÌÊ¿ÓÈÛ˘ ÛÙÚ·‚ÈÛÌo‡ Â›Ó·È˘„ËÏfi. ¢Â‰o̤Óo˘ fiÙÈ oÈ apple·Ú·apple¿Óˆ apple·Ú¿ÌÂÙÚoÈ Ù˘oappleÙÈ΋˜ ÏÂÈÙo˘ÚÁ›·˜ Â›Ó·È ·applefi Ùo˘˜ appleÈo ÛËÌ·ÓÙÈÎo‡˜ (ȉÈ-·›ÙÂÚ· Û fi,ÙÈ ·ÊoÚ¿ ÙËÓ ÂÎapple·›‰Â˘ÛË), Ë oÌ¿‰· ·˘Ù‹ ÙˆÓapple·È‰ÈÒÓ ¯Ú‹˙ÂÈ Û˘ÛÙËÌ·ÙÈ΋˜ Î·È Ù·ÎÙÈ΋˜ ·ÍÈoÏfiÁËÛ˘,fiappleˆ˜ Î·È ·ÓÙÈÌÂÙÒappleÈÛ˘ ÙˆÓ oappleÙÈÎÒÓ Ùo˘˜ appleÚo‚ÏËÌ¿ÙˆÓ̤۷ ·applefi appleÚoÁÚ¿ÌÌ·Ù· ·appleoηٿÛÙ·Û˘.Purpose: This prospective study was set up to investigatesome important components of visual function relatedto reading, for educational purposes in a group ofspastic quadriplegic. Materials and methods: The studygroup was consisted of 20 spastic quadriplegic schoolaged children due to cerebral palsy. All of them appearedto have a good enough mental level. The corrected visualacuity, the refractive errors and the type of strabismuswere studied by using well known tests. Results: Morethan 50% of the eyes appeared with corrected visual acuityless than 1.0, the refractive errors ranged between+4,50 and –3,00 sphere and +3,50 to –1,00 cylinder.60% of the children with strabismus, while 98% withoutstereoscopic vision. Conclusion: In a high incidence, thestudied components of visual function related to reading,were disturbed, interfering with the learning process.Thus, they should be evaluated in any spastic quadriplegicchild of school age.1OÊı·ÏÌoÏoÁÈÎfi ÙÌ‹Ì·,2ΔÌ‹Ì· Ê˘ÛÈoıÂÚ·apple›·˜ π‰Ú‡Ì·Ùo˜ ·appleoηٿÛÙ·Û˘ ·Ó·apple‹ÚˆÓ apple·›‰ˆÓ (∂§∂∞ £ÂÛÛ·Ïoӛ΢)OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 191 - 194, 2002 191

192 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)∂ÈÛ·ÁˆÁ‹·Ó ÂÁÎÂÊ·ÏÈ΋ apple·Ú¿Ï˘ÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÌÈ·ÌfiÓÈÌË, ÌË ÂÍÂÏÈÛÛfiÌÂÓË, ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, appleo˘ÌappleoÚ› Ó· Ï¿‚ÂÈ ¯ÒÚ· appleÚÈÓ, ηٿ ‹ ÌÂÙ¿ ÙoÓ ÙoÎÂÙfi.∫¿ı ‚Ï¿‚Ë appleo˘ appleÏ‹ÙÙÂÈ ÙoÓ ¿ˆÚo ·ÎfiÌË apple·È-‰ÈÎfi ÂÁΤʷÏo, Û˘Ó‹ıˆ˜ o‰ËÁ› ÛÙËÓ ÂÌÊ¿ÓÈÛËappleoÈÎ›ÏˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‰˘ÛÏÂÈÙo˘ÚÁÈÒÓ 1,2 .∞Ó Î·È Ë appleÚoÂÍ¿Ú¯o˘Û· ÛËÌÂÈoÏoÁ›· ·ÊoÚ¿ÛÙo ÎÈÓËÙÈÎfi Û‡ÛÙËÌ·, ˆÛÙfiÛo ¤Ó· ÌÂÁ¿Ïo appleoÛo-ÛÙfi ÙˆÓ apple·È‰ÈÒÓ ·˘ÙÒÓ ÂÌÊ·Ó›˙o˘Ó Û˘Óo‰¤˜ ‰˘-ÛÏÂÈÙo˘ÚÁ›Â˜ Î·È ·applefi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·, fiappleˆ˜ Ù··ÈÛıËÙËÚȷο 3,4 .∏ fiÚ·ÛË ·appleoÙÂÏ› ¤Ó·Ó ·applefi Ùo˘˜ ÛËÌ·ÓÙÈÎfi-ÙÂÚo˘˜ apple·Ú¿ÁoÓÙ˜ appleo˘ ÂappleËÚ¿˙o˘Ó ÙË Ê˘ÛÈoÏoÁÈ΋·Ó¿appleÙ˘ÍË Î·È ÙËÓ ÈηÓfiÙËÙ· Ì¿ıËÛ˘ ÂÓfi˜ apple·È‰Èo‡.∏ ÂÌÊ¿ÓÈÛË oappleÙÈÎÒÓ ‚Ï·‚ÒÓ, Û appleÂÚ›appleÙˆÛËÂÁÎÂÊ·ÏÈ΋˜ apple·Ú¿Ï˘Û˘, Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó‹. 3§›Á˜ ÌÂϤÙ˜ fï˜ ¤¯o˘Ó ‰ÈÂÚ¢ӋÛÂÈ oÏo-ÎÏËڈ̤ӷ Ù· ‚·ÛÈο Û˘ÓıÂÙÈο Ù˘ oappleÙÈ΋˜ ÏÂÈ-Ùo˘ÚÁ›·˜ appleo˘ ÂÌappleϤÎoÓÙ·È ÛÙË ‰È·‰Èηۛ· Ù˘ Ì¿-ıËÛ˘ ÛÙ· apple·È‰È¿ ·˘Ù¿.∏ appleÚooappleÙÈ΋ ·˘Ù‹ ÌÂϤÙË Û¯Â‰È¿ÛÙËΠÁÈ· Ó·ÌÂÏÂÙ‹ÛÂÈ oÚÈṲ̂ӷ ·applefi ·˘Ù¿ Ù· Û˘ÓıÂÙÈο Ù˘oappleÙÈ΋˜ ÏÂÈÙo˘ÚÁ›·˜ (oappleÙÈ΋ o͇ÙËÙ·, ‰È·ıÏ·ÛÙÈ-Τ˜ ·ÓˆÌ·Ï›Â˜, ›‰Ë ÛÙÚ·‚ÈÛÌo‡), appleo˘ ¿ÌÂÛ· Û¯Â-Ù›˙oÓÙ·È Ì ÙË Û¯oÏÈ΋ ÂÎapple·›‰Â˘ÛË (·ÚÈ· Ì ÙËÓÈηÓfiÙËÙ· Ù˘ ·Ó¿ÁÓˆÛ˘), ˘appleoı¤ÙoÓÙ·˜ fiÙÈ Ìappleo-Úo‡Ó Ó· ÙËÓ ÂappleËÚ¿Ûo˘Ó ÛËÌ·ÓÙÈο. ∏ ÌÂϤÙË ·-ÊoÚo‡Û ÌÈ· oÌ¿‰· apple·È‰ÈÒÓ Ì Ûapple·ÛÙÈ΋ ÙÂÙÚ·-appleÏËÁ›· ÏfiÁˆ ÂÁÎÂÊ·ÏÈ΋˜ apple·Ú¿Ï˘Û˘.ÀÏÈο – ª¤ıo‰oÈÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯Â ÌÈ· oÌ¿‰· 20 apple·È‰ÈÒÓ ÌÂÛapple·ÛÙÈ΋ ÙÂÙÚ·appleÏËÁ›· ÏfiÁˆ ÂÁÎÂÊ·ÏÈ΋˜ apple·Ú¿Ï˘Û˘.∏ ËÏÈΛ· ÙˆÓ apple·È‰ÈÒÓ Î˘Ì·ÈÓfiÙ·Ó ·applefi ¤ÍÈ Ì¤¯ÚÈ ‰Â-ηapple¤ÓÙ ÂÙÒÓ Î·È ÊoÈÙo‡Û·Ó Û ۯoÏ›· ÂȉÈ΋˜ ·ÁˆÁ‹˜.Δ· ÎÚÈÙ‹ÚÈ· ¤ÓÙ·Í˘ ÛÙË ÌÂϤÙË ‹Ù·Ó Ù· ÂÍ‹˜:• Δ· apple·È‰È¿ ¤appleÚÂapple ӷ Â›Ó·È ËÏÈΛ·˜ ÌÂٷ͇ 6 ηÈ15 ÂÙÒÓ• ∏ ·ÈÙ›· Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ Ó· ‹Ù·Ó Û˘ÁÁÂ-Ó‹˜, ÌË ÂÍÂÏ›ÍÈÌË• O ‰Â›ÎÙ˘ ÓoËÌoÛ‡Ó˘ ÙˆÓ apple·È‰ÈÒÓ Ó· Â›Ó·È Î·-χÙÂÚo˜ ‹ ›Ûo˜ Ì 70• ¡· ˘apple‹Ú¯Â ηϋ Û˘ÓÂÚÁ·Û›· Ùo˘ apple·È‰Èo‡ ÛÙ· ÙÂÛÙ• ¡· ˘apple‹Ú¯Â ηÏfi˜ ¤ÏÂÁ¯o˜ Ù˘ ÎÂÊ·Ï‹˜ Ùo˘ apple·È‰Èo‡• ¡· ÌËÓ ˘apple‹Ú¯Â ÈÛÙoÚÈÎfi ÂappleÈÏË„›·˜ ‹ ıÂÚ·apple›·˜Ì ·ÓÙÈÂappleÈÏËappleÙÈο Ê¿Ú̷η• ¡· ÌËÓ Â›¯Â appleÚoËÁËı› oÊı·ÏÌÈ΋ Âapple¤Ì‚·ÛË• ¡· ÌËÓ ˘apple‹Ú¯·Ó Ûo‚·Ú¿ appleÚo‚Ï‹Ì·Ù· oÌÈÏ›·˜• ¡· ÌËÓ ¯ÚËÛÈÌoappleoÈo‡Û·Ó Ù· apple·È‰È¿ ‚oËı‹Ì·Ù·¯·ÌËÏ‹˜ fiÚ·Û˘.Δo appleÚˆÙfiÎoÏÏo appleo˘ ·ÎoÏo˘ı‹ıËΠappleÂÚÈÂÏ¿Ì‚·ÓÂ:• ∂ÎÙ›ÌËÛË Ùo˘ ‰Â›ÎÙË ÓoËÌoÛ‡Ó˘ Î·È „˘¯oÏoÁÈ-΋ ·ÍÈoÏfiÁËÛË• ∫ÏÈÓÈ΋ ÂÎÙ›ÌËÛË:– oappleÙÈ΋˜ o͇ÙËÙ·˜ (Ì·ÎÚÈ¿)– ‰È·ıÏ·ÛÙÈ΋˜ ÈηÓfiÙËÙ·˜ ÙˆÓ oÊı·ÏÌÒÓ– Ù˘ ı¤Û˘ ÙˆÓ Ì·ÙÈÒÓ (Ù‡appleoÈ ÛÙÚ·‚ÈÛÌo‡).ÚÈÓ ÙËÓ ÂÎÙ¤ÏÂÛË ÙˆÓ ÙÂÛÙ ÂÍ·ÛÊ·ÏÈ˙fiÙ·Ó Ë ¿ÓÂ-ÙË ı¤ÛË Ùo˘ ÛÒÌ·Ùo˜ ÙˆÓ apple·È‰ÈÒÓ (ηٷӿψÛË ÌÂȈ-Ì¤ÓˆÓ appleoÛÒÓ ÂÓ¤ÚÁÂÈ·˜), ηıÒ˜ Î·È Ë Û¯ÂÙÈ΋ ËÛ˘¯›·Ùo˘ ¯ÒÚo˘ ÒÛÙ Ùo apple·È‰› Ó· Û˘ÁÎÂÓÙÚÒÓÂÈ ÙËÓ appleÚoÛo¯‹Ùo˘ ‡ÎoÏ· ÛÙËÓ ÂÎÙ¤ÏÂÛË Ùo˘ Û˘ÁÎÂÎÚÈ̤Óo˘ ÙÂÛÙ.∞ÎfiÌË, ÂÍ·ÛÊ·ÏÈ˙fiÙ·Ó Î·Ïfi˜ ʈÙÈÛÌfi˜ Ùo˘ ¯ÒÚo˘, ÂÓÒË ÂÎÙ¤ÏÂÛË ÙˆÓ ÙÂÛÙ ÁÈÓfiÙ·Ó Û ηıÈÛÙÈ΋ ı¤ÛË (ÛÂηÓoÓÈÎfi ıÚ·Ó›o ‹ Û ηڤÎÏ· ÂȉÈο ‰È·ÌoÚʈ̤ÓËÁÈ· ÎÈÓËÙÈΤ˜ ·Ó·appleËڛ˜).Δ· ÙÂÛÙ Ù· oappleo›· ¯ÚËÛÈÌoappleoÈ‹ıËÎ·Ó ‹Ù·Ó Ù· ·Îfi-Ïo˘ı·:• ΔÂÛÙ ÂÎÙ›ÌËÛ˘ Ùo˘ ‰Â›ÎÙË ÓoËÌoÛ‡Ó˘ (¯ÚËÛÈÌoappleoÈ‹ıËΤӷ˜ Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ÙÂÛÙ wisc, wppsi ηÈppvt).‡Ìʈӷ Ì ٷ ÙÂÛÙ ·˘Ù¿ Û˘Ó‹ıˆ˜ appleÚo·appleÙÂÈ Ëapple·Ú·Î¿Ùˆ Ù·ÍÈÓfiÌËÛË:¯>130 appleoχ ˘„ËÏ‹ ÓfiËÛË120

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194 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)‚ÈÛÌo‡ 7 .∏ ÌÂϤÙË ·ÊoÚo‡Û ̛· oÌ¿‰· apple·È‰ÈÒÓ ÌÂÛapple·ÛÙÈ΋ ÙÂÙÚ·appleÏËÁ›· Ì ÈηÓoappleoÈËÙÈ΋ ÓfiËÛË(‰Â›ÎÙ˘ ÓoËÌoÛ‡Ó˘ appleo˘ Î˘Ì·ÈÓfiÙ·Ó ·applefi 70-90),ÁÂÁoÓfi˜ appleo˘ ÂÍ·ÛÊ¿ÏÈ˙ ÙfiÛo ÙË Û˘ÓÂÚÁ·Û›·Ùo˘˜, fiÛo Î·È ÙËÓ ·ÍÈoappleÈÛÙ›· ÙˆÓ ·appleoÙÂÏÂÛÌ¿ÙˆÓ. fi,ÙÈ ·ÊoÚ¿ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‰ÈoÚıˆÌ¤Ó˘oappleÙÈ΋˜ o͇ÙËÙ·˜, Ë appleÏÂÈo„ËÊ›· ÙˆÓ Ì·ÙÈÒÓ ÂÌÊ¿-ÓÈ˙ ÌÂȈ̤ÓË oappleÙÈ΋ o͇ÙËÙ· ·ÎfiÌË Î·È ÌÂÙ¿ ·applefiÙË ‰ÈfiÚıˆÛË. OÈ ‰È·ÊoÚ¤˜ ·Ó¿ÌÂÛ· ÛÙ· ‰‡o Ì¿ÙÈ·‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈΤ˜. Δo ˘„ËÏfi appleoÛoÛÙfi ÌË Ê˘-ÛÈoÏoÁÈ΋˜ ‰ÈoÚıˆÌ¤Ó˘ oappleÙÈ΋˜ o͇ÙËÙ·˜ ÌappleoÚ›ӷ ÂÍËÁËı›, ÙfiÛo ÏfiÁˆ Ù˘ ηı˘ÛÙÂÚË̤Ó˘ ÛÂappleoÏϤ˜ appleÂÚÈappleÙÒÛÂȘ ‰È¿ÁÓˆÛ˘ Î·È ·ÓÙÈÌÂÙÒappleÈÛË˜ÙˆÓ ·ÓˆÌ·ÏÈÒÓ (apple¯. ÏfiÁˆ appleÚoÙÂÚ·ÈfiÙËÙ·˜ ·ÓÙÈÌÂ-ÙÒappleÈÛ˘ ¿ÏÏˆÓ ·Ó·appleËÚÈÒÓ), fiÛo Î·È ÛÙËÓ ‡apple·ÚÍˢ„ËÏo‡ appleoÛoÛÙo‡ ÛÙÚ·‚ÈÛÌo‡.∂apple›Û˘ ˘„ËÏfi, Û ۯ¤ÛË Ì Ùo ÁÂÓÈÎfi apple·È‰ÈÎfiappleÏËı˘ÛÌfi, Â›Ó·È Ùo appleoÛoÛÙfi ÂÌÊ¿ÓÈÛ˘ ‰È·ıÏ·ÛÙÈ-ÎÒÓ ·ÓˆÌ·ÏÈÒÓ. ∞Ó Î·È Ë ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ fiÏoÈ oÈÙ‡appleoÈ ‰È·ıÏ·ÛÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Â›Ó·È appleÈı·Óo›, ˢappleÂÚÌÂÙÚˆapple›· Â›Ó·È Ë appleÈo Û˘¯Ó‹ ‰È·ıÏ·ÛÙÈ΋ ·Óˆ-Ì·Ï›·, Û˘Ó‰˘·Ṳ̂ÓË ÙȘ appleÂÚÈÛÛfiÙÂÚ˜ ÊoÚ¤˜ ηÈÌ ·ÛÙÈÁÌ·ÙÈÛÌfi. Δo ‡Úo˜ ÙˆÓ ‰È·ıÏ·ÛÙÈÎÒÓ ·-ӈ̷ÏÈÒÓ Î˘Ì·ÈÓfiÙ·Ó Û ̤ÙÚÈ· Âapple›apple‰·.Δo ˘„ËÏfiÙÂÚo appleoÛoÛÙfi ÂÌÊ¿ÓÈÛ˘ ‰È·ıÏ·ÛÙÈ-ÎÒÓ ·ÓˆÌ·ÏÈÒÓ Û ·˘Ù‹ ÙËÓ oÌ¿‰· apple·È‰ÈÒÓ ı·ÌappleoÚo‡Û ӷ ·appleo‰oı› ÛÙË ‰˘ÛÏÂÈÙo˘ÚÁ›· Ùo˘ ÌË-¯·ÓÈÛÌo‡ ÂÛÙÈ·ÛÌo‡ ηٿ ÙËÓ ÎÚ›ÛÈÌË appleÂÚ›o‰o ·-Ó¿appleÙ˘Í˘ Ù˘ fiÚ·Û˘. Ÿappleˆ˜ ÁÓˆÚ›˙o˘ÌÂ, o Ì˯·-ÓÈÛÌfi˜ ·˘Ùfi˜ ÂϤÁ¯ÂÙ·È ·applefi Ùo ∫¡. ∞Ó Î·È appleÈ-ÛÙ‡o˘Ì fiÙÈ oÈ ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ı· appleÚ¤appleÂÈÓ· ÂÓÙoapple›˙oÓÙ·È Î·È Ó· ·ÓÙÈÌÂÙˆapple›˙oÓÙ·È ¤Á-ηÈÚ·, ‰ÂÓ appleÚ¤appleÂÈ Ó· apple·Ú·‚ϤappleoÓÙ·È oÈ appleÚ·ÎÙÈΤ˜‰˘ÛÎoϛ˜ appleo˘ Û˘¯Ó¿ Û˘Ó·ÓÙÒÓÙ·È Û ·˘Ù¤˜ ÙȘ appleÂ-ÚÈappleÙÒÛÂȘ7-9 . fi,ÙÈ ·ÊoÚ¿ ÙËÓ apple·Úo˘Û›· ÛÙÚ·‚ÈÛÌo‡, ·˘-Ùfi˜ ˘apple‹Ú¯Â ÛÙËÓ appleÏÂÈo„ËÊ›· ÙˆÓ apple·È‰ÈÒÓ. ªÂ ÌÈ-ÎÚ‹ ‰È·ÊoÚ¿ Ù· appleÂÚÈÛÛfiÙÂÚ· ÂÌÊ¿ÓÈ˙·Ó Â͈ÙÚoapple›·.Δ· ·›ÙÈ· ÙˆÓ ˘„ËÏÒÓ appleoÛoÛÙÒÓ Û˘ÓÂÎÙÈÎo‡ÛÙÚ·‚ÈÛÌo‡ ı· appleÚ¤appleÂÈ Ó· ·Ó·˙ËÙËıo‡Ó Û ‰È·Ù·-Ú·Á̤Óo˘˜ ÎÂÓÙÚÈÎo‡˜ Ì˯·ÓÈÛÌo‡˜ ‰ÈfiÊı·ÏÌ˘fiÚ·Û˘, ‰È·ÊoÚoappleoÈË̤Óo˘ Ì˘˚Îo‡ ÙfiÓo˘, ÎÏapple. 10˘ÌappleÂÚ·ÛÌ·ÙÈο ·Ó·Ê¤Úo˘Ì fiÙÈ fiÏ· Ù· apple·È-‰È¿ apple·Úo˘Û›·˙·Ó Û ˘„ËÏ¿ appleoÛoÛÙ¿ ÛËÌ·ÓÙÈοappleÚo‚Ï‹Ì·Ù· ÛÙ· ˘applefi ÌÂϤÙË Û˘ÓıÂÙÈο Ù˘ oappleÙÈ-΋˜ ÏÂÈÙo˘ÚÁ›·˜. ∂appleÂȉ‹ Ù· Û˘ÓıÂÙÈο ·˘Ù¿ ›ӷÈÛËÌ·ÓÙÈο ÁÈ· ÙËÓ ÈηÓfiÙËÙ· Ùo˘ ‰È·‚¿ÛÌ·Ùo˜, ı·appleÚ¤appleÂÈ Ó· ÂϤÁ¯oÓÙ·È Û οı apple·È‰› Ì Ûapple·ÛÙÈ΋ÙÂÙÚ·appleÏËÁ›· ÏfiÁˆ ÂÁÎÂÊ·ÏÈ΋˜ apple·Ú¿Ï˘Û˘ appleo˘‚Ú›ÛÎÂÙ·È ÛÙË Û¯oÏÈ΋ ËÏÈΛ·.øÛÙfiÛo, ı· ‹Ù·Ó ¯Ú‹ÛÈÌË Ë ÌÂϤÙË ÙˆÓ oappleÙÈ-ÎÒÓ ·˘ÙÒÓ apple·Ú·ÁfiÓÙˆÓ Û ÌÂÁ·Ï‡ÙÂÚo ·ÚÈıÌfi apple·È-‰ÈÒÓ ÁÈ· ÙËÓ ÂappleȂ‚·›ˆÛË ÙˆÓ Û˘ÌappleÂÚ·ÛÌ¿ÙˆÓ.BÈ‚ÏÈÔÁÚ·Ê›·1. Crothers B, Paine RS. The natural history of cerebral palsy.Harvard University press Cambridge, Mass, Oxforduniversity Press, London 1989.2. Blair E, Stanley FJ. Aetiological pathways to spastic cerebralpalsy. Paediatric perinat Epidemiol 7: 302-317,1993.3. ¡. ∫o˙¤Ë˜. μϤappleˆ - ª·ı·›Óˆ - ∫ÈÓo‡Ì·È, £ÂÛÛ·ÏoÓ›ÎË2000.4. ¡. ∫o˙¤Ë˜. ·È‰È¿ Ì ȉȷÈÙÂÚfiÙËÙ˜ ÛÙËÓ ÂÎapple·›‰Â˘ÛË,£ÂÛÛ·ÏoÓ›ÎË 2001.5. Sheridan MD. Visual screening procedures for very youngor handicapped children. In: Gardiner et al : Aspectsof developmental and paediatrics ophthalmology HeinemannMedical books,London, 1969: 39.6. Foley J. Central visual disturbances. Dev Med Child Neurol29: 110-120, 1987.7. Troilo D. Neonatal eye growth and emmetropisation – aliterature review. Eye 6: 154-160, 1992.8. Booth RG et al. Postnatal development of vision in humanand non-human premates. Annual review of Neurosciences8: 495, 1985.9. Slataper FJ. Age norms of refraction and vision. Archivesof Ophthalmol 43: 466, 1950.10. Flynn JT. Strabismus. A neurodevelopmental approach.Springer – Verlag, New York 1991.

∂ӉȷʤÚÔÓÙ· appleÂÚÈÛÙ·ÙÈο∂appleÈ̤ÏÂÈ·: ¡. ¢ËÌËÙÚ·ÎÔ‡ÏÈ·˜e-mail: Ôkebe@otenet.grH ·ÈÌÔÚÚ·ÁÈ΋ ·appleÔÎfiÏÏËÛË Ù˘ ‰ÂÛÎÂÌÂÙ›Ԣ ÌÂÌ‚Ú¿Ó˘:Ì›· ÂÓ ‰˘Ó¿ÌÂÈ ÂappleÈappleÏÔ΋ Ù‹˜ ÂÓ Ùˆ ‚¿ıÂÈ ÛÎÏËÚÂÎÙÔÌ‹˜∂.μ. ÃÚÈÛÙÔ‰Ô˘Ï¿Î˘1,2 , Ã.. ÈÁ·Ófi˜1,2 , ∞. °ˆÓȈٿÎË 1,2 ,∂.∞. ∫·ÏÔÁÈ¿ÓÓË 1,2 , μ.. ∫Ô˙ÔÌapplefiÏ˘1,2Hemorrhagic descemet’s membrane detachment: e potentialcomplication of deep sclerectomyE.V. Christodoulakis, Ch.S. Siganos, A. Goniotaki, E.A. Kalogianni, V.P. KozombolisÎÔapplefi˜: ∏ ·Ó·ÊÔÚ¿ ÂÓfi˜ appleÂÚÈÛÙ·ÙÈÎÔ‡ appleÔ˘ ÂÌÊ¿ÓÈÛ ·È-ÌÔÚÚ·ÁÈ΋ ·appleÔÎfiÏÏËÛË Ù˘ ‰ÂÛÎÂÌÂÙ›Ԣ ÌÂÌ‚Ú¿Ó˘ ÌÂÙ¿·applefi ÂÓ Ùˆ ‚¿ıÂÈ ÛÎÏËÚÂÎÙÔÌ‹. ∞ÛıÂÓ›˜ Î·È ª¤ıÔ‰ÔÈ: ¢È·-‚ËÙÈÎfi˜ ·ÛıÂÓ‹˜ 63 ÂÙÒÓ appleÔ˘ ¤apple·Û¯Â ·applefi ·ÚÚ‡ıÌÈÛÙÔ ¯Úfi-ÓÈÔ ÁÏ·‡ÎˆÌ· ·ÓÔÈÎÙ‹˜ ÁˆÓ›·˜ Ì appleÏ‹ÚË Ê·Ú̷΢ÙÈ΋ ·Áˆ-Á‹ ˘appleÔ‚Ï‹ıËΠ۠ÂÁ¯Â›ÚËÛË ÂÓ Ùˆ ‚¿ıÂÈ ÛÎÏËÚÂÎÙÔÌ‹˜ ¯ˆ-Ú›˜ ÂappleÈappleÏÔΤ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¯Ú‹ÛË ÌÈÙÔÌ˘Î›Ó˘ C. AappleÔ-ÙÂϤÛÌ·Ù·: TË 2Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ apple·Ú·ÙËÚ‹ıËΠ·È-ÌÔÚÚ·ÁÈ΋ ·appleÔÎfiÏlËÛË Ù˘ ‰ÂÛÎÂÌÂÙ›Ԣ. H ·ÈÌÔÚÚ·Á›· apple·-ÚÔ˘Û›·Û ٷ¯Â›· ·appleÔÚÚfiÊËÛË ÙȘ ‰‡Ô appleÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ ÌÂÛ˘ÓÔ‰fi Ì›ˆÛË Ù˘ ·appleÔÎfiÏÏËÛ˘ ÌÂÙ¿ ÙËn appleÂÚ›Ô‰Ô ·˘Ù‹ ηÈÔ Ú˘ıÌfi˜ ·appleÔÚÚfiÊËÛ˘ ÙÔ˘ ·›Ì·ÙÔ˜ ÌÂÈÒıËÎÂ. H ‰ÂÛÎÂ̤-ÙÂÈÔ˜ Âapple·Ó·Û˘ÁÎÔÏÏ‹ıËΠappleÏ‹Úˆ˜ 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›-ÚËÛË ¯ˆÚ›˜ η̛· Âapple¤Ì‚·ÛË ·ÏÏ¿ ‰ËÌÈÔ˘ÚÁ‹ıËΠÌÈ· apple·Ú·-ÎÂÓÙÚÈ΋ ÎÂÚ·ÙÈ΋ Ô˘ÏÔappleÔ›ËÛË. H Ê˘Û·Ï›‰· ‰ÂÓ ÂappleËÚ¿ÛÙË-ΠÏÂÈÙÔ˘ÚÁÈο ηٿ ÙËÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ appleÂÚ›Ô‰Ô Î·È Ë EOapple·Ú¤ÌÂÈÓ ÛÙ·ıÂÚ‹ ÛÙÔ Âapple›appleÂ‰Ô ÌÂٷ͇ 12 Î·È 15 mmHg ¯ˆ-Ú›˜ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ˘Ìapple¤Ú·ÛÌ·: H ·ÈÌÔÚÚ·ÁÈ΋·appleÔÎfiÏÏËÛË Ù˘ ‰ÂÛÎÂÌÂÙ›Ԣ appleÚ¤appleÂÈ Ó· ÂÎÏ·Ì‚¿ÓÂÙ·È ˆ˜ÌÈ· appleÈı·Ó‹ ÂappleÈappleÏÔ΋ Ù‹˜ ÂÓ Ùˆ ‚¿ıÂÈ ÛÎÏËÚÂÎÙÔÌ‹˜.Purpose: To report a case that developed hemorrhagicDescemet’s membrane detachment after deep sclerectomy.Patient and Methods: Case report. A 63-year-old diabeticpatient suffering from uncontrolled chronic open-angleglaucoma with full medication, underwent an uneventfuldeep sclerectomy operation combined with intraoperativeMitomycin-C. Results: On the second postoperative day, ahemorrhagic Descemet’s membrane detachment (HDDM)was observed. The hemorrhage showed rapid absorptionrate during the first two weeks along with reduction of theHDDM. After this period of time the rate of blood absorptionwas decreased. The Descemet’s membrane reattachedcompletely six months after surgery without any interventionbut a paracentral corneal scar was present. The blebwas not functionally impaired during the whole postoperativeperiod, and intraocular pressure remained stable atthe level between 12 and 15 mmHg without medication.Conclusion: Hemorrhagic Descemet’s membrane detachmentshould be considered as a potential complicationof deep sclerectomy.EÈÛ·ÁˆÁ‹∏ ÂÓ Ùˆ μ¿ıÂÈ ÎÏËÚÂÎÙoÌ‹ (μ) Â›Ó·È ÌÈ·Ó¤· ¯ÂÈÚo˘ÚÁÈ΋ appleÚoÛ¤ÁÁÈÛË ÁÈ· ÙoÓ ¤ÏÂÁ¯o Ùo˘ÌË Ú˘ıÌÈ˙fiÌÂÓo˘ Ê·Ú̷΢ÙÈο ÁÏ·˘ÎÒÌ·Ùo˜,appleo˘ appleÂÚÈÁÚ¿ÊËΠappleÚÒÙË ÊoÚ¿ ·applefi Ùo˘˜ FyodorofÎ·È Kozlov 1-4 . ∞˘Ù‹ Ë ÌË ‰È·ÙÈÙÚ·›Óo˘Û· ‰ÈËıËÙÈ-΋ Ù¯ÓÈ΋ ·appleoÙÂÏ› ÌÈ· ÂÓ·ÏÏ·ÎÙÈ΋ Ù¯ÓÈ΋ ÛÙËÓ1·ÓÂappleÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ¯ÔÏ‹ ∂appleÈÛÙËÌÒÓ ÀÁ›·˜, ΔÔ̤·˜ ¡Â˘ÚÔÏÔÁ›·˜ Î·È ∞ÈÛıËÙËÚ›ˆÓ √ÚÁ¿ÓˆÓ, √Êı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋,∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘.2μ·Ú‰ÈÓÔÁÈ¿ÓÓÂÈÔ ∂ÚÁ·ÛÙ‹ÚÈÔ ªÂÙ·ÌÔۯ‡ÛÂˆÓ Î·È ªÈÎÚÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ √Êı·ÏÌÔ‡, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 195 - 198, 2002 195

196 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ÙÚ·ÌappleÂÎo˘ÏÂÎÙoÌ‹. Δo ·ÚÈo appleÏÂoÓ¤ÎÙËÌ· Ù˘ μÛ ۯ¤ÛË Ì ÙËÓ ÎÏ·ÛÛÈ΋ ÙÚ·ÌappleÂÎo˘ÏÂÎÙoÌ‹ Ê·›-ÓÂÙ·È Ó· Â›Ó·È Ë ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ÂappleÈappleÏoÎÒÓ 3-5 . OÊ›ÏÂÙ·È ‰Â ÛÙËÓ ‰È·Ù‹ÚËÛË ÌÈ·˜ ÏÂappleÙ‹˜ ÌÂÌ-‚Ú¿Ó˘ ̤ۈ Ù˘ oappleo›·˜ Ùo ˘‰·ÙoÂȉ¤˜ ‰ÈËı›ٷÈÌ ¤Ó· ·ÚÁfi Ú˘ıÌfi, ·ÓÙ›ıÂÙ· Ì ÙËÓ ÙÚ·ÌappleÂÎo˘ÏÂ-ÎÙoÌ‹ 6,7 . Àapple¿Ú¯o˘Ó Ï›Á˜ ·Ó·ÊoÚ¤˜ ÂappleÈappleÏoÎÒÓÙ˘ μ ÛÙËÓ ‚È‚ÏÈoÁÚ·Ê›·2-5 . ∂‰Ò apple·Úo˘ÛÈ¿˙o˘ÌÂÌÈ· Ó¤· ÂappleÈappleÏo΋, ÙËÓ ·ÈÌoÚÚ·ÁÈ΋ ·appleoÎfiÏÏËÛËÙ˘ ‰ÂÛÎÂÌÂÙ›o˘ ÌÂÌ‚Ú¿Ó˘ (∞∞¢ª) appleo˘ apple·Ú·-ÙËÚÂ›Ù·È ÁÈ· appleÚÒÙË ÊoÚ¿, ÌÂÙ¿ appleÚoËÁËı›۷ μÛ ‰È·‚ËÙÈÎfi ÁÏ·˘ÎˆÌ·ÙÈÎfi ·ÛıÂÓ‹.·ÚÔ˘Û›·ÛË appleÂÚÈÛÙ·ÙÈÎÔ‡ÕÓ‰Ú·˜ 63 ÂÙÒÓ apple·Úo˘ÛÈ¿ÛÙËΠÙo Âapple٤̂ÚÈoÙo˘ 2000 Ì ¯ÚfiÓÈo ÁÏ·‡ÎˆÌ· ·ÓoÈÎÙ‹˜ ÁˆÓ›·˜ ηÈÛÙo˘˜ ‰‡o oÊı·ÏÌo‡˜, ÁÓˆÛÙfi ·applefi ÂÓÓ¤· ¤ÙË. O ·ÛıÂ-Ó‹˜ ¤apple·Û¯Â ·applefi ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ·applefi Ùo 1978, ooappleo›o˜ ‹Ù·Ó ÈÓÛo˘ÏÈÓoÂÍ·ÚÙÒÌÂÓo˜ ·applefi Ùo 1984, ÂÓÒ‰ÂÓ ·Ó·Ê¤ÚıËΠÈÛÙoÚÈÎfi ˘apple¤ÚÙ·Û˘. O ‰ÂÍÈfi˜ oÊı·Ï-Ìfi˜ ‹Ù·Ó ¤ÌÊ·Îo˜ (̤ÙÚÈo˜ apple˘ÚËÓÈÎfi˜ ηٷÚÚ¿ÎÙ˘),Ì ηχÙÂÚË ‰˘Ó·Ù‹ fiÚ·ÛË Ì ‰ÈfiÚıˆÛË 20/32 (-0.25sph -0,75 cyl x 60 o ) Î·È ÂÓ‰oÊı¿ÏÌÈ· apple›ÂÛË (∂O) 23mmHg ˘applefi ·ÁˆÁ‹ Ì ÛÙ·ÁfiÓ˜ ÙÈÌoÏfiÏ˘, ÓÙoÚ˙oÏ·Ì›-‰Ë˜ Î·È Ï·Ù·ÓoappleÚfiÛÙ˘. ∏ ÂͤٷÛË ÛÙËÓ Û¯ÈÛÌoÂȉ‹ Ï˘-¯Ó›· ¤‰ÂÈÍ ‰È·˘Á‹ ÎÂÚ·ÙoÂȉ‹, ‚·ı‡ Î·È ‹ÚÂÌo appleÚfi-ÛıÈo ı¿Ï·Ìo, Ê˘ÛÈoÏoÁÈ΋ ›Úȉ· Û ¯ÚÒÌ· Î·È Û‡ÛÙ·ÛË(˘Ê‹) Î·È ÎfiÚË ÛÙÚoÁÁ˘Ï‹ Î·È oÌ·Ï¿ ·ÓÙȉÚÒÛ· ÛÙoʈ˜. ∫·Ù¿ ÙËÓ ÁˆÓÈoÛÎoapple›· ‚Ú¤ıËΠ¢Ú›· ·ÓoÈÎÙ‹ÁˆÓ›· ¯ˆÚ›˜ ÂÌÊ·Ó‹ ›¯ÓË ÓÂo·ÁÁ›ˆÛ˘. ∏ ‚˘ıoÛÎfiappleË-ÛË ·appleoÎ¿Ï˘„ ۯ¤ÛË Îo›Ï·ÓÛ˘ appleÚo˜ ‰›ÛÎo (cup/discratio) 0,6 Î·È o˘Ï¤˜ laser ÛÙoÓ oapple›ÛıÈo applefiÏo ÏfiÁˆ appleÚoË-Áo‡ÌÂÓ˘ ıÂÚ·apple›·˜ Ì laser ÁÈ· ‰È·‚ËÙÈ΋ ˆ¯Úoapple¿ıÂÈ·Î·È ÌË apple·Ú·ÁˆÁÈ΋ ‰È·‚ËÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚoÂȉoapple¿ıÂÈ·.O ·ÚÈÛÙÂÚfi˜ oÊı·ÏÌfi˜ ‹Ù·Ó Âapple›Û˘ ¤ÌÊ·Îo˜ (̤-ÙÚÈo˜ apple˘ÚËÓÈÎfi˜ ηٷÚÚ¿ÎÙ˘), Ì ηχÙÂÚË ‰˘Ó·Ù‹ fi-Ú·ÛË Ì ‰ÈfiÚıˆÛË 20/50 (-0.75 sph -0.75 cyl x 150 o ) ηÈ∂O 14 mmHg ˘applefi ÙËÓ ›‰È· ·ÁˆÁ‹. ¢ÂÓ ˘apple‹Ú¯·Ó ‰È·-ÊoÚ¤˜ ·Ó¿ÌÂÛ· ÛÙo˘˜ ‰‡o oÊı·ÏÌo‡˜ ÂÎÙfi˜ ·applefi ÙËÓ‚˘ıoÛÎfiappleËÛË: ÛÙoÓ ·ÚÈÛÙÂÚfi oÊı·ÏÌfi Ë Û¯¤ÛË Îo›Ï·Ó-Û˘ appleÚo˜ ‰›ÛÎo ‹Ù·Ó appleÂÚ›appleo˘ 0,5 Î·È Â›¯Â appleÂÚÈÛÛfiÙÂÚ˜o˘Ï¤˜ laser ÏfiÁˆ appleÚoËÁËı›Û˘ apple·Ó·ÌÊÈ‚ÏËÛÙÚoÂȉÈ-΋˜ ʈÙoappleËÍ›·˜.O ·ÛıÂÓ‹˜ ÙËÓ 4Ë ÂappleÙÂÌ‚Ú›o˘ 2000 ˘appleo‚Ï‹ıËÎÂÛ μ ÛÙoÓ ‰ÂÍÈfi oÊı·ÏÌfi: ·Ú¯Èο ¤Ó·˜ ÎÚËÌÓfi˜ ÂappleÈappleÂÊ˘ÎfiÙ·Ì ‚¿ÛË Ùo ÎfiÏappleˆÌ· apple·Ú·Û΢¿ÛÙËΠÛÙo¿Óˆ ÚÈÓÈÎfi ÙÂÙ·ÚÙËÌfiÚÈo Î·È ¤Ó·˜ ÛapplefiÁÁo˜ ÂÌ‚·appleÙÈ-Ṳ̂Óo˜ Û ‰È¿Ï˘Ì· ÌÈÙoÌ˘Î›Ó˘ (Û˘ÁΤÓÙÚˆÛË 0.2 mg/ml) ÙoappleoıÂÙ‹ıËΠοو ·applefi ·˘ÙfiÓ ÁÈ· ¯ÚfiÓo 2,5 ÏÂappleÙÒÓ.∞ÎoÏo‡ıËÛ appleÚoÛÂÎÙÈ΋ appleχÛË Ù˘ appleÂÚÈo¯‹˜ ÌÂ20 cc BSS. ÙË Û˘Ó¤¯ÂÈ· apple·Ú·Û΢¿ÛÙËΠ¤Ó· ÂappleÈÊ·-ÓÂÈ·Îfi, ÌÈÛo‡ apple¿¯o˘˜, ÙÚ·appleÂ˙oÂȉ¤˜ ÛÎÏËÚÈÎfi apple¤Ù·ÏoÌ ‚¿ÛË Ùo ÛÎÏËÚoÎÂÚ·ÙoÂȉÈÎfi fiÚÈo Î·È ‰È·ÛÙ¿ÛÂȘ5,0×5,0 mm Î·È Âapple¤ÎÙ·ÛË Ì¤¯ÚÈ ÙȘ ÎÂÚ·ÙoÂȉÈΤ˜ ÛÙÈ-‚¿‰Â˜ ηٿ 1,5 mm. ∞̤ۈ˜ ÌÂÙ¿ apple·Ú·Û΢¿ÛÙËΠ¤Ó·‚·ı‡ÙÂÚo ÙÚÈÁˆÓÈÎfi ÛÎÏËÚÈÎfi apple¤Ù·Ïo ̤¯ÚÈ ÙËÓ ·appleoο-Ï˘„Ë Ùo˘ Â͈ÙÂÚÈÎo‡ ÙoȯÒÌ·Ùo˜ Ùo˘ ۈϋӷ Ùo˘Schlemm, Ùo oappleo›o ÂappleÂÎÙ¿ıËΠappleÚo˜ Ù· οو Î·È Â-ÌappleÚfi˜ ̤¯ÚÈ ÙËÓ appleÚo-‰ÂÛÎÂ̤ÙÂÈo ÎÂÚ·ÙoÂȉÈ΋ ÛÙÈ‚¿-‰·. ∞ÎoÏo‡ıËÛ appleÚoÛÂÎÙÈ΋ ÂÎÙoÌ‹ Ùo˘ ‚·ı‡ÙÂÚo˘ÛÎÏËÚoÎÂÚ·ÙoÂȉÈÎo‡ appleÂÙ¿Ïo˘ Î·È Ë ·appleoÌ¿ÎÚ˘ÓÛË Ùo˘Â͈ÙÂÚÈÎo‡ ÙoȯÒÌ·Ùo˜ Ùo˘ ۈϋӷ Ùo˘ Schlemm. ÙËÛ˘Ó¤¯ÂÈ· ·Û΋ıËΠ¯ÂÈÚo˘ÚÁÈÎfi˜ ¯ÂÈÚÈÛÌfi˜ Ì ÛapplefiÁÁo,Ì ÛÎoapplefi ÙËÓ appleÂÚÈoÚÈṲ̂ÓË ·appleoÎfiÏÏËÛË Ù˘ ‰ÂÛÎÂÌÂ-Ù›o˘ ÌÂÌ‚Ú¿Ó˘ ÁÈ· Ó· ·˘ÍËı› Ë ÂÎÚo‹ Ùo˘ ˘‰·ÙoÂÈ-‰o‡˜ ˘ÁÚo‡. Δo ˘‰·ÙoÂȉ¤˜ ˘ÁÚfi ¿Ú¯ÈÛ ӷ ‰È·¯¤ÂÙ·È·˘ÙfiÌ·Ù· ·applefi ÙËÓ ‰ËÌÈo˘ÚÁËı›۷ ÂappleÈÊ¿ÓÂÈ· Ù˘ Âappleo-ÓoÌ·˙fiÌÂÓ˘ ÙÚ·ÌappleÂÎo˘Ïo-‰ÂÛÎÂÌÂÙ›o˘ ÌÂÌ‚Ú¿Ó˘.∞ÎoÏo‡ıËÛÂ Û˘ÚÚ·Ê‹ Ùo˘ ÂappleÈappleoÏ‹˜ ÛÎÏËÚÈÎo‡ appleÂÙ¿-Ïo˘ Û ‰‡o ÛËÌ›· ÛÙȘ ·ÓÒÙÂÚ˜ ÁˆÓ›Â˜ Ùo˘ Ì ¯Ú‹ÛËÚ¿ÌÌ·Ùo˜ Ó¿˘ÏoÓ 10-0 Î·È ¤Á¯˘ÛË apple·¯‡ÚÚ¢ÛÙo˘ È͈-‰oÂÏ·ÛÙÈÎo‡ (Healon GV, Pharmacia & Upjohn, O˘-„¿Ï·, o˘Ë‰›·) οو ·applefi ·˘Ùfi. Δo ÙÚ·‡Ì· Ùo˘ ÂappleÈappleÂ-Ê˘ÎfiÙ· ¤ÎÏÂÈÛ Ì ¯Ú‹ÛË ‰‡o Ú·ÌÌ¿ÙˆÓ appleoÏ˘ÁÏ·ÎÙ›Ó˘9-0 (Vicryl), ÂÓÒ Healon GV ÙoappleoıÂÙ‹ıËΠÂapple›Û˘ ο-Ùˆ ·applefi Ùo apple¤Ù·Ïo Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ·.∏ Âapple¤Ì‚·ÛË ÙÂÏ›ˆÛ Ì ¤ÓÂÛË ‰ÂÍ·ÌÂı·˙fiÓ˘0,4%-ÁÂÓÙ·Ì˘Î›Ó˘ ÛÙo οو ÎfiÏappleˆÌ· Ùo˘ ÂappleÈappleÂÊ˘Îfi-Ù·, Ì ¯Ú‹ÛË ÌÈÎÙ‹˜ ·ÏoÈÊ‹˜ ‰ÂÍ·ÌÂı·˙fiÓ˘ 0,1%-ÙoÌappleÚ·Ì˘Î›Ó˘ Î·È Ù¤Ïo˜ Ì Âapple›‰ÂÛË Ùo˘ oÊı·ÏÌo‡.ªÂÙÂÁ¯ÂÈÚËÙÈο ‰fiıËΠÎoÏχÚÈo ‰ÂÍ·ÌÂı·˙fiÓ˘0,1%-ÙoÌappleÚ·Ì˘Î›Ó˘ ÁÈ· ÙÚÂȘ Ì‹Ó˜ Û ۯ‹Ì· ÛÙ·‰È·-΋˜ Ì›ˆÛ˘.O ·ÛıÂÓ‹˜ ÂÍÂÙ¿ÛÙËΠÙËÓ appleÚÒÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋Ë̤ڷ Î·È Â›¯Â ÛÙ·ıÂÚ‹ oappleÙÈ΋ o͇ÙËÙ· (20/32), ∂O12 mm Hg, ‰ÈËıËÙÈ΋ Ê˘Û·Ï›‰· Ì ηϋ ÏÂÈÙo˘ÚÁÈÎfiÙË-Ù· Î·È ¯ˆÚ›˜ ‰È·ÚÚo‹, ‰È·˘Á‹ ÎÂÚ·ÙoÂȉ‹ Î·È appleÚfiÛıÈoı¿Ï·Ìo Ì ‹appleÈ· ·ÓÙ›‰Ú·ÛË (+1 ·ÙÙ·Ú·). ΔËÓ ‰Â‡ÙÂÚËÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ ÂÌÊ¿ÓÈÛ ÌÈ· ‰Ú·Ì·ÙÈ΋ Ì›ˆÛËÙ˘ oappleÙÈ΋˜ o͇ÙËÙ·˜ Û ·ÓÙ›ÏË„Ë ÎÈÓo‡ÌÂÓ˘ ¯ÂÈÚfi˜,∂O 12 mmHg Î·È ÌÈ· ·ÈÌoÚÚ·ÁÈ΋ ·appleoÎfiÏÏËÛË Ù˘‰ÂÛÎÂÌÂÙ›o˘ ÌÂÌ‚Ú¿Ó˘. ·Ú·ÙËÚ‹ıËΠÌÈ· Ù·¯Â›· ·-appleoÚÚfiÊËÛË Ù˘ ·ÈÌoÚÚ·Á›·˜ ηٿ ÙȘ appleÚÒÙ˜ ‰‡o ‚‰o-Ì¿‰Â˜, Ì ·ÊÂÙËÚ›· ÙËÓ appleÂÚÈʤÚÂÈ·. ÙȘ ‰‡o ‚‰oÌ¿-‰Â˜ ›¯Â oappleÙÈ΋ o͇ÙËÙ· 20/800 Î·È ∂O 14 mmHg ¯ˆ-Ú›˜ ·ÓÙÈÁÏ·˘ÎˆÌ·ÙÈ΋ ·ÁˆÁ‹ Î·È ÏÈÁfiÙÂÚË ·ÈÌoÚÚ·Á›·ÛÙo ÛËÌ›o Ù˘ ·appleoÎfiÏÏËÛ˘, ÂÓÒ Ì¤¯ÚÈ Ùo Ù¤Ïo˜ Ùo˘appleÚÒÙo˘ Ì‹Ó· Ë oappleÙÈ΋ o͇ÙËÙ· apple·Ú¤ÌÂÈÓ ·ÌÂÙ¿‚ÏËÙË.ÙË Û˘Ó¤¯ÂÈ· o ·ÛıÂÓ‹˜ ÂÍÂÙ·˙fiÙ·Ó Î¿ıÂ Ì‹Ó·Î·È Ë oappleÙÈ΋ o͇ÙËÙ· ‹Ù·Ó: ÙoÓ 2o Ì‹Ó· (ÛÙo Ù¤Ïo˜ Ùo˘)20/400, ÙoÓ 3o Ì‹Ó· 20/300, ÙoÓ 4o Ì‹Ó· 20/200, ÙoÓ 5oÌ‹Ó· 20/160, ÂÓÒ ÛÙo Ù¤Ïo˜ Ùo˘ 6o˘ Ì‹Ó· ·˘Í‹ıËΠÛË-Ì·ÓÙÈο Û 20/50.Ùo Ù¤Ïo˜ Ùo˘ 5o˘ Ì‹Ó· ˘apple‹Ú¯Â ˘appleoÏÂÈapplefiÌÂÓË ·È-ÌoÚÚ·Á›· (EÈÎ. 1), ÂÓÒ ÛÙo Ù¤Ïo˜ Ùo˘ 6o˘ Ì‹Ó· Ë ‰Â-ÛÎÂ̤ÙÂÈo˜ ÌÂÌ‚Ú¿ÓË Â›¯Â Âapple·Ó·Û˘ÁÎoÏÏËı› Î·È ˘apple‹Ú-¯Â ÌÈ· ‹appleÈ· apple·Ú·ÎÂÓÙÚÈ΋ ÎÂÚ·ÙoÂȉÈ΋ o˘Ï‹ (EÈÎ. 2).

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200 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Ì·ÙÈ΋ Âapple¤ÎÙ·ÛË 9-14 . ·Úo˘ÛÈ¿˙o˘Ì ‰‡o ÂӉȷʤ-ÚoÓÙ· appleÂÚÈÛÙ·ÙÈο Ì ·ÚÈ· appleÚˆÙoapple·ı‹ ÂÓÙfiappleÈÛËÛÙoÓ ·ÓÒÙÂÚo ÎfiÁ¯o Î·È ‰·ÎÚ˘˚Îfi ·‰¤Ó· ·ÓÙ›ÛÙoÈ-¯· Î·È ÙËÓ ‰È·ÁÓˆÛÙÈ΋ appleÚoÛ¤ÁÁÈÛ‹ Ùo˘˜.·Úo˘Û›·ÛË appleÚÒÙo˘ appleÂÚÈÛÙ·ÙÈÎo‡°˘Ó·›Î· ËÏÈΛ·˜ 76 ÂÙÒÓ apple·Úo˘ÛÈ¿ÛıËΠÛÙËÓÎÏÈÓÈ΋ Ì·˜ Ì appleÚoo‰Â˘ÙÈ΋ ·ÌÊoÙÂÚfiappleÏ¢ÚË ‰ÈfiÁΈ-ÛË ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Î·È ¤ÓÙoÓË ¯‡ÌˆÛË Ùo˘ ÂappleÈappleÂÊ˘Îfi-Ù· ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÈÂÙ›·. ∏ ‰ÈfiÁΈÛË ‹Ù·Ó ·ÓÒ‰˘ÓË ÌÂÂÏ·ÛÙÈ΋ ˘Ê‹, appleÂÚÈfiÚÈ˙ ÙȘ ÎÈÓ‹ÛÂȘ ÙˆÓ ‚ÏÂÊ¿ÚˆÓÎ·È ‚oÏ‚o‡ Î·È ÎÏÈÓÈο ÂappleÂÎÙ›ÓoÓÙ·Ó ÛÙoÓ ·ÓÒÙÂÚoÎfiÁ¯o (∂ÈÎ. 1, 2). ÚoËÁo‡ÌÂÓË ·ÓÙÈ‚ÈoÙÈ΋ ıÂÚ·apple›·ÁÈ· Ïo›ÌˆÍË ‹ appleÈı·Ó‹ ‚ÏÂÊ·Ú›Ùȉ· ‰ÂÓ Â›¯Â ηӤӷ·appleoÙ¤ÏÂÛÌ·. ∏ Ì·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›· ·appleoÎ¿Ï˘„ ÌÈ·‰È¿¯˘ÙË ÂÏ·ÊÚ¿ ÂÙÂÚoÁÂÓ‹ Ì¿˙· appleo˘ ηٷϿ̂·ÓÂÙËÓ appleÂÚÈo¯‹ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Î·È Ùo˘ ·ÓÒÙÂÚo˘ ÎfiÁ¯o˘,¯ˆÚ›˜ oÛÙÈΤ˜ ‰È·‚ÚÒÛÂȘ ‹ ‰ÈËı‹ÛÂȘ ‚oÏ‚o‡ ηÈÂÍoÊı¿ÏÌÈˆÓ Ì˘ÒÓ, Ì ·Î·ÓfiÓÈÛÙ· fiÚÈ·, ¯ˆÚ›˜ ÂÌÊ·-Ó‹ ο„· (∂ÈÎ. 3, 4). ∞applefi ÙËÓ ÎÏÈÓÈ΋ Î·È ·appleÂÈÎoÓÈÛÙÈ΋ÌÂϤÙË Ù¤ıËÎÂ Ë ˘appleo„›· ÏÂÌÊÒÌ·Ùo˜ Î·È ·ÎoÏo‡ıËÛ‚Èo„›· ̤ۈ ‰ÂÚÌ·ÙÈ΋˜ ÙoÌ‹˜ ÛÙËÓ ·‡Ï·Î· Ùo˘ ¿Óˆ‚ÏÂÊ¿Úo˘. ∞appleoηχÊıËΠ‰È¿¯˘Ùo˜ fiÁÎo˜ Ê·È‹˜¯ÚoÈ¿˜, ÂÏ·ÛÙÈ΋˜ Û‡ÛÙ·Û˘ Î·È Ì ·Î·ÓfiÓÈÛÙË ‰È‹ıË-ÛË fiÏˆÓ ÙˆÓ apple·Ú·Î›ÌÂÓˆÓ ‰oÌÒÓ Ùo˘ ‚ÏÂÊ¿Úo˘(ÎoÁ¯ÈÎfi ‰È¿ÊÚ·ÁÌ·, Ï›appleo˜, ·ÓÂÏÎÙ‹Ú·˜ Ì˘˜, Ù·ÚÛfi˜Î·È ÂappleÈappleÂÊ˘ÎfiÙ·˜). ∏ ‚Èo„›· ·appleoÎ¿Ï˘„ ÂÎÙÂٷ̤ÓˉȋıËÛË Ì ̤Ûo˘ ÌÂÁ¤ıo˘˜ ÓÂoappleÏ·ÛÌ·ÙÈο ÏÂÌÊoÂÈ-‰‹ ·ÙÙ·Ú· ıÂÙÈο ÛÙo˘˜ μ-΢ÙÙ·ÚÈÎo‡˜ ‰Â›ÎÙ˜ L-26/CD-20 Î·È PAN B/CD-45RA Î·È ·ÚÓËÙÈο ÛÙoÓ Δ·Î˘ÙÙ·ÚÈÎfi ‰Â›ÎÙË UCHL-1/CD-45RO Î·È ÛÙo CD-5·ÓÙÈÁfiÓo. ∏ ‰È¿ÁÓˆÛË ‹Ù·Ó ‰È¿¯˘Ùo, ¯·ÌËÏ‹˜ ηÎo‹-ıÂÈ·˜ ÌË Hodgkin ϤÌʈ̷ μ-΢ÙÙ·ÚÈ΋˜ ·Ú¯‹˜ ·applefi‚ÏÂÓÓoÁoÓoÛ¯ÂÙÈ˙fiÌÂÓo ÏÂÌÊÈÎfi ÈÛÙfi (Maltoma) ÌÂappleÏ·ÛÌ·Ùo΢ÙÙ·ÚÈ΋ ‰È·ÊoÚoappleo›ËÛË. ∏ ·ÛıÂÓ‹˜ apple·-Ú·apple¤ÌÊıËΠ۠oÁÎoÏoÁÈÎfi-·ÈÌ·ÙoÏoÁÈÎfi ΤÓÙÚo ÁÈ·Û˘ÛÙËÌ·ÙÈ΋ ‰ÈÂÚ‡ÓËÛË Î·È ıÂÚ·apple›·. Δo ÂÓÙoappleÈṲ̂-Óo ÎoÁ¯ÈÎfi ϤÌʈ̷ ¯ˆÚ›˜ Û˘ÛÙËÌ·ÙÈΤ˜ ÂappleÂÎÙ¿ÛÂȘ·ÓÙÈÌÂÙˆapple›ÛıËΠÌÂ Û˘ÛÙËÌ·ÙÈ΋ ¯oÚ‹ÁËÛË ¯ÏˆÚ·Ì-‚o˘Î›Ï˘. ΔÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·apple›·˜˘apple‹Ú¯Â ı·̷ÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ·applefiÙ· ‚Ϥʷڷ Î·È ÎfiÁ¯o, ÂÓÒ apple·Ú¤ÌÂÓÂ Ë ·appleo˘Û›· Û˘-ÛÙËÌ·ÙÈ΋˜ ÓfiÛo˘ ÌÂ Ê˘ÛÈoÏoÁÈÎo‡˜ Ùo˘˜ ÂÚÁ·ÛÙËÚÈ·-Îo‡˜ ‰Â›ÎÙ˜ (∂ÈÎ. 5).∂ÈÎ. 1. ∂ÌÊ¿ÓÈÛË appleÚÒÙo˘ ·ÛıÂÓo‡˜ Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋‰ÈfiÁΈÛË ¿Óˆ ‚ÏÂÊ¿ÚˆÓ.∂ÈÎ. 2. ¢ÈfiÁΈÛË Ùo˘ ·ÚÈÛÙÂÚo‡ ¿Óˆ ‚ÏÂÊ¿Úo˘.∂ÈÎ. 3,4. ª·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›· appleÚÒÙo˘ appleÂÚÈÛÙ·ÙÈÎo‡ Ì ÂÓÙfiappleÈÛË Ùo˘ fiÁÎo˘ ÛÙo ·ÓÒÙÂÚo ÙÌ‹Ì· Ùo˘ ÎfiÁ¯o˘ ηÈÙËÓ ‚ÏÂÊ·ÚÈ΋ appleÂÚÈo¯‹.

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 201∂ÈÎ.5. ∂ÌÊ¿ÓÈÛË Ù˘ ·ÛıÂÓo‡˜ ÙÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ıÂ-Ú·apple›· Ì ÛËÌ·ÓÙÈ΋ ˘appleo¯ÒÚËÛË Ùo˘ oȉ‹Ì·Ùo˜.∂ÈÎ. 7. ∂ÌÊ¿ÓÈÛË Ù˘ ‚ÏÂÊ·ÚÈ΋˜ Ìo›Ú·˜ Ùo˘ ‰·ÎÚ˘-˚Îo‡ ·‰¤Ó· ηٿ ÙËÓ ‰ÈÂÓ¤ÚÁÂÈ· ‚Èo„›·˜.·Úo˘Û›·ÛË ‰Â‡ÙÂÚo˘ appleÂÚÈÛÙ·ÙÈÎo‡ÕÓ‰Ú·˜ ËÏÈΛ·˜ 78 ÂÙÒÓ apple·Úo˘ÛÈ¿ÛıËΠ̠appleÚoo‰Â˘ÙÈ΋·ÓÒ‰˘ÓË ‰ÈfiÁΈÛË ÛÙËÓ ÎÚoÙ·ÊÈ΋ appleÂÚÈo¯‹Ùo˘ ‰ÂÍÈo‡ ¿Óˆ ‚ÏÂÊ¿Úo˘ Î·È ‰·ÎÚ˘˚Îo‡ ·‰¤Ó· ‰È¿ÚÎÂÈ-·˜ ÙÚÈÒÓ ÌËÓÒÓ. Àapple‹Ú¯Â appleÙÒÛË Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ ηÈÊ·ÈÓoÌÂÓÈο ·appleo˘Û›· Û˘ÌÌÂÙo¯‹˜ Ùo˘ ˘applefiÏoÈappleo˘ ÎfiÁ¯o˘Î·È ÂappleÈappleÂÊ˘ÎfiÙ· (∂ÈÎ. 6). ∏ ·ÍoÓÈ΋ ÙoÌoÁÚ·Ê›··appleoÎ¿Ï˘„Â Û˘Ìapple·Á‹ ‰ÈfiÁΈÛË Ùo˘ ‰·ÎÚ˘˚Îo‡ ·‰¤Ó·¯ˆÚ›˜ ‰È¿‚ÚˆÛË oÛÙo‡, Ì ۷ʋ fiÚÈ·. Ú·ÁÌ·ÙoappleoÈ-‹ıËΠ‚Èo„›· ̤ۈ ‰ÂÚÌ·ÙÈ΋˜ ÙoÌ‹˜ Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘Î·È ·Êo‡ ·appleoÎÏ›ÛıËΠ̷ÎÚoÛÎoappleÈο Ë appleÈı·ÓfiÙËÙ·Ùo˘ appleÏÂÈfiÌoÚÊo˘ ·‰ÂÓÒÌ·Ùo˜ Ùo˘ ‰·ÎÚ˘˚Îo‡ ·‰¤Ó·,·Ê·ÈÚ¤ıËÎÂ Ë ‚ÏÂÊ·ÚÈ΋ Ìo›Ú· Ùo˘ ·‰¤Ó· (∂ÈÎ. 7). ∏apple·ıoÏoÁo·Ó·ÙoÌÈ΋ ÂͤٷÛË ·appleoÎ¿Ï˘„Â, fiappleˆ˜ Î·È ÛÙoappleÚoËÁo‡ÌÂÓo appleÂÚÈÛÙ·ÙÈÎfi, ‰È‹ıËÛË Ì ̤Ûo˘ ÌÂÁ¤ıo˘˜ÓÂoappleÏ·ÛÌ·ÙÈο ÏÂÌÊoÂȉ‹ ·ÙÙ·Ú· ıÂÙÈο ÛÙo L-26/CD-20, Û ÛËÌ·ÓÙÈÎo‡˜ ·ÚÈıÌo‡˜ ÛÙo PAN B/ CD-45RA, ÛÙo·ÓÙÈÁfiÓo CD-5 Î·È Û ̤ÙÚÈo˘˜ ·ÚÈıÌo‡˜ ÛÙËÓ Î˘ÎÏ›ÓËD1. ∏ ‰È¿ÁÓˆÛË ‹Ù·Ó ϤÌʈ̷ ·applefi ·ÙÙ·Ú· Ùo˘ Ì·Ó-‰‡·. O ·ÛıÂÓ‹˜ apple·Ú·apple¤ÌÊıËΠ۠·ÈÌ·ÙoÏoÁÈÎfioÁÎoÏoÁÈÎfiΤÓÙÚo. Àapple‹ÚÍ ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋∂ÈÎ. 6. ∂ÌÊ¿ÓÈÛË Ùo˘ ‰Â‡ÙÂÚo˘ ·ÛıÂÓo‡˜ Ì ‰ÈfiÁΈÛËÙo˘ ‰ÂÍÈo‡ ‰·ÎÚ˘˚Îo‡ ·‰¤Ó· Î·È appleÙÒÛË Ùo˘ ‚ÏÂ-Ê¿Úo˘.˘appleo„›· Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛo˘ Î·È ·ÎoÏo‡ıËÛ ¯ËÌÂÈoıÂ-Ú·apple›· Ì ¿ÌÂÛË ˘appleo¯ÒÚËÛË Ù˘ ‰ÈfiÁΈÛ˘ Ùo˘ ‰·ÎÚ˘-˚Îo‡ ·‰¤Ó· Î·È ¤ÏÂÁ¯o Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛo˘.˘˙‹ÙËÛË∏ oÊı·ÏÌoÏoÁÈ΋ ÂͤٷÛË ÌappleoÚ› Ó· Â›Ó·È ÙoappleÚÒÙo ‚‹Ì· ‰È¿ÁÓˆÛ˘ ÎoÁ¯ÈÎo‡ Î·È ‰˘ÓËÙÈο Û˘-ÛÙËÌ·ÙÈÎo‡ ÏÂÌÊÒÌ·Ùo˜. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È‰ÈÂÚ‡ÓËÛË ÌappleoÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙoappleÚoÛ‰fiÎÈÌo ÂappleÈ‚›ˆÛ˘ Ì appleÏ‹ÚË ›·ÛË Ù˘ ηÎo‹-ıo˘˜ ·˘Ù‹˜ ÓÂoappleÏ·Û›·˜7. ∏ ·appleÂÈÎoÓÈÛÙÈ΋ ‰ÈÂÚ‡-ÓËÛË Ì ·ÍoÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›· Î·È Ë·apple·Ú·›ÙËÙË ‚Èo„›· Ù˘ Ì¿˙·˜ ı¤ÙÂÈ ÙËÓ ¤ÁηÈÚËÎ·È ·ÎÚÈ‚‹ ‰È¿ÁÓˆÛË Ì o˘ÛÈ·ÛÙÈ΋ ÛËÌ·Û›· ÁÈ·ÙËÓ ÂappleÈ‚›ˆÛË Ùo˘ ·ÛıÂÓ‹ 15 16 . ∏ o˘ÛÈ·ÛÙÈ΋ ‰È¿-ÎÚÈÛË ÙˆÓ ÏÂÌÊˆÌ¿ÙˆÓ ÎfiÁ¯o˘ appleÚ¤appleÂÈ Ó· Â›Ó·È ÛÂηÏo‹ıË ÏÂÌÊÈ΋ ˘appleÂÚappleÏ·Û›· Î·È Î·ÎfiËı˜ ϤÌ-ʈ̷ Ì ÂӉȿÌÂÛo ÛÙ¿‰Èo ·Î·ıfiÚÈÛÙ˘ ηÎo‹-ıÂÈ·˜ ÙËÓ ¿Ù˘appleË ÏÂÌÊÈ΋ ˘appleÂÚappleÏ·Û›·. ·ÚfiÏo fiÙÈÙ· ÏÂÌÊÒÌ·Ù· Hodgkin’s ·appleoÙÂÏo‡Ó Ùo 30% ÙˆÓÛ˘ÛÙËÌ·ÙÈÎÒÓ ÏÂÌʈ̿وÓ, Ë ÂÓÙfiappleÈÛË ÛÙoÓ ÎfiÁ-¯o Â›Ó·È Û¯Â‰fiÓ ·appleoÎÏÂÈÛÙÈο ÌË Hodgkin’s. ∏ Û˘-ÛÙËÌ·ÙÈ΋ ‰ÈÂÚ‡ÓËÛË appleÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Ê˘ÛÈ΋ÂͤٷÛË, ·ÎÙÈÓoÁÚ·Ê›· ıÒڷη, ·ÍoÓÈ΋ ÙoÌo-ÁÚ·Ê›·, ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·Ùo˜ Î·È ·Ó¿Ï˘ÛË ÌÂÌoÓoÎψÓÈο ·ÓÙÈÛÒÌ·Ù·, ËÏÂÎÙÚoÊfiÚËÛË appleÚˆ-ÙÂ˚ÓÒÓ oÚo‡, ‚Èo„›· Ì˘ÂÏo‡ oÛÙÒÓ Î·È ÂͤٷÛËÛappleÏËÓfi˜ Î·È ‹apple·Ùo˜. ∞ÓÙÂӉ›ÎÓ˘Ù·È Ë ¯ÂÈÚo˘ÚÁÈ-΋ ÂÍ·›ÚÂÛË ÎoÁ¯ÈÎÒÓ fiÁΈÓ, ÂÓÒ Ë ·ÎÙÈÓo‚oÏ›··appleoÙÂÏ› ÙËÓ Î·Ï‡ÙÂÚË Ì¤ıo‰o ıÂÚ·apple›·˜ ÏÂÌʈ-Ì¿ÙˆÓ ÂÓÙoappleÈÛÌ¤ÓˆÓ ÛÙoÓ ÎfiÁ¯o, Ì ÙËÓ appleÚoÛı‹ÎËÙ˘ ¯ËÌÂÈoıÂÚ·apple›·˜ ÛÂ Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛo 17-21 .∫·Ù·Ï‹ÁoÓÙ·˜, ÙoÓ›˙o˘Ì ÙËÓ ·Í›· Ù˘ oÚı‹˜ o-Êı·ÏÌoÏoÁÈ΋˜ ‰È¿ÁÓˆÛ˘ Û ÌÈ· ‰˘ÓËÙÈο ηÎo-‹ıË ı·Ó·ÙËÊfiÚo Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛo.

202 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)μÈ‚ÏÈoÁÚ·Ê›·1. Astarita RW, Minckler D, Taylor CR, Levine A, Lukes RJ.Orbital and adnexal lymphomas. A multiparameterapproach. American Journal of Clinical Pathology73(5): 615-21, 1980.2. Au_Eong KG, Choo CT. Burkitt lymphoma manifestingas acute proptosis. American Journal of Ophthalmology123(6): 856-8, 1997.3. Bairey O, Kremer I, Rakowsky E, Hadar H, Shaklai M. Orbitaland adnexal involvement in systemic non-Hodgkin’slymphoma. Cancer 73(9): 2395-9, 1994.4. Demirci H, Shields CL, Shields JA, Honavar SG, MercadoGJ, Tovilla JC. Orbital tumors in the older adult population.Ophthalmology 109(2): 243-8, 2000.5. Fitzpatrick PJ, Macko S. Lymphoreticular tumors of theorbit. International Journal of Radiation Oncology,Biology, Physics 10(3): 333-40, 1984.6. Johnson TE, Tse DT, Byrne GE, Restrepo A, WhitcombCC, Voigt W, et al. Ocular-adnexal lymphoid tumors: aclinicopathologic and molecular genetic study of 77patients. Ophthalmic Plastic and Reconstructive Surgery15(3): 171-9, 1999.7. Jenkins C, Rose GE, Bunce C, Wright JE, Cree IA, PlowmanN, et al. Histological features of ocular adnexallymphoma (REAL classification) and their associationwith patient morbidity and survival. The BritishJournal of Ophthalmology 84(8): 907-13, 2000.8. Ko YH, Kim CW, Park CS, Jang HK, Lee SS, Kim SH, etal. REAL classification of malignant lymphomas inthe Republic of Korea: incidence of recently recognizedentities and changes in clinicopathologic features.Hematolymphoreticular Study Group of the KoreanSociety of Pathologists. Revised European-Americanlymphoma. Cancer 83(4): 806-12, 1998.9. Coupland SE, Krause L, Delecluse HJ, Anagnostopoulos I,Foss HD, Hummel M, et al. Lymphoproliferative lesionsof the ocular adnexa. Analysis of 112 cases. Ophthalmology105(8): 1430-41, 1998.10. Cheij G, Cooper JL, Wesley RE. Orbital histiocytic lymphomaarising from the ethmoid sinus. OphthalmicSurgery 18(2): 95-6, 1987.11. Coupland SE, Foss HD, Hummel M, Stein H. Extranodalmarginal zone B-cell lymphoma of the lacrimal glandassociated with crystal-storing histiocytosis. Ophthalmology109(1): 105-10, 2002.12. Knowles DM, Jakobiec FA. Ocular adnexal lymphoidneoplasms: clinical, histopathologic, electron microscopic,and immunologic characteristics. Human Pathology13(2): 148-62, 1982.13. Knowles DM, Jakobiec FA, McNally L, Burke JS. Lymphoidhyperplasia and malignant lymphoma occurring in theocular adnexa (orbit, conjunctiva, and eyelids): a prospectivemultiparametric analysis of 108 cases during1977 to 1987. Human Pathology 21(9): 959-73, 1990.14. Medeiros LJ, Harris NL. Lymphoid infiltrates of the orbitand conjunctiva. A morphologic and immunophenotypicstudy of 99 cases. The American Journal ofSurgical Pathology 13(6): 459-71, 1989.15. Flanders AE, Mafee MF, Rao VM, Choi KH. CT characteristicsof orbital pseudotumors and other orbital inflammatoryprocesses. Journal of Computer AssistedTomography; 13(1): 40-7.16. Rowe LD, Tsiaras W, Nichols C, Myers AR. Computerizedaxial tomography in inflammatory pseudotumorof the orbit. Otolaryngology and Head and NeckSurgery; 88(4): 378-83.17. Barthold HJ, Harvey A, Markoe AM, Brady LW, AugsburgerJJ, Shields JA. Treatment of orbital pseudotumorsand lymphoma. American Journal of ClinicalOncology: the Official Publication of the AmericanRadium Society 9(6): 527-32, 1986.18. Bolek TW, Moyses HM, Marcus RB, Gorden L, Maiese RL,Almasri NM, et al. Radiotherapy in the management oforbital lymphoma. International Journal of RadiationOncology, Biology, Physics 44(1): 31-6, 1999.19. Chao CK, Lin HS, Devineni VR, Smith M. Radiationtherapy for primary orbital lymphoma. InternationalJournal of Radiation Oncology, Biology, Physics31(4): 929-34, 1995.20. Le QT, Eulau SM, George TI, Hildebrand R, Warnke RA,Donaldson SS, et al. Primary radiotherapy for localizedorbital MALT lymphoma. International Journalof Radiation Oncology, Biology, Physics 52(3): 657-63, 2002.21. Smitt MC, Donaldson SS. Radiotherapy is successfultreatment for orbital lymphoma. International Journalof Radiation Oncology, Biology, Physics 26(1): 59-66, 1993.

∂appleÈappleÏÂÁ̤ÓË appleÂÚ›appleÙˆÛË ‚ÏÂÊ·ÚfiappleÙˆÛ˘ ÌÂ Û˘Ó‡apple·ÚÍˉÈappleÏ‹˜ apple¿ÚÂÛ˘ ·ÓÂÏÎÙ‹ÚˆÓ Î·ÈÊ·ÈÓÔ̤ÓÔ˘ Marcus Gunn jaw winking∫. ªappleÔÌappleÔÚ›‰Ë˜, ¡. ∑ȿη˜, ¡. °ÂˆÚÁÈ¿‰Ë˜Blepharoptosis complicated with double elevator palsy and Marcus Gunn jaw winkingK. Boboridis, N. Ziakas, N. Georgiadis∏ appleÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ Û˘¯Ó¿ ÂappleÈappleϤÎÂÙ·È Ì ‰È·Ù·-Ú·¯¤˜ ÂÓÓ‡ڈÛ˘ ·applefi ÙÔ ÎÔÈÓfi ÎÈÓËÙÈÎfi Î·È apple·Ú¿‰ÔÍËÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜.  ¿ÏϘ appleÂÚÈappleÙÒÛÂÈ˜Û˘Ó˘apple¿Ú¯Ô˘Ó ‰È·Ù·Ú·¯¤˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ¿Óˆ ÔÚıÔ‡Î·È Ù˘ ı¤Û˘ ÙÔ˘ ‚ÔÏ‚Ô‡. ·ÚÔ˘ÛÈ¿˙Ô˘Ì ¤Ó· ÂappleÈappleÏÂÁ-̤ÓÔ appleÂÚÈÛÙ·ÙÈÎfi Û˘ÁÁÂÓÔ‡˜ ‚ÏÂÊ·ÚfiappleÙˆÛ˘ fiappleÔ˘ Û˘-Ó˘apple¿Ú¯Ô˘Ó Ë apple·Ú¿‰ÔÍË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ·ÓÂÏÎÙ‹Ú· ÌÂÙËÓ ÌÔÚÊ‹ ÙÔ˘ Marcus Gunn jaw winking Ì ÙËÓ apple¿ÚÂÛËÙÔ˘ ·ÓÂÏÎÙ‹Ú· Î·È ÙÔ˘ ¿Óˆ ÔÚıÔ‡, ÌÂ Û˘ÓÂapple·ÎfiÏÔ˘ıˢappleÔÙÚÔapple›·. ∞ӷχÔÓÙ·È ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ ‰˘ÛÎÔϛ˜ Î·È ËÂӉ‰ÂÈÁ̤ÓË ıÂÚ·apple¢ÙÈ΋ appleÚÔÛ¤ÁÁÈÛË.Upper lid ptosis can often be complicated with III nerveenervation abnormalities and levator muscle aberrant movement.In other cases superior rectus weakness can affectthe lid height and globe position. We present a complicatedptosis case where aberrant levator enervation inthe form of Marcus Gunn jaw winking coexists with doubleelevator palsy and hypotropia. The diagnostic challengesand surgical indications are being highlighted.∂ÈÛ·ÁˆÁ‹∏ appleÙÒÛË Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ ÌappleoÚ› Ó· ›ӷÈÛ˘ÁÁÂÓ‹˜ ‹ Âapple›ÎÙËÙË Î·È ·ÈÙÈoÏoÁÈο ηٷٿÛÛÂ-Ù·È Û ·appleoÓÂ˘ÚˆÙÈ΋, Ì˘oÁÂÓ‹, Ó¢ÚoÁÂÓ‹ ηÈÙ¤Ïo˜ Ì˯·ÓÈ΋. ∏ Ó¢ÚoÁÂÓ‹˜ appleÙÒÛË oÊ›ÏÂÙ·ÈÛ ‰È·Ù·Ú·¯¤˜ ÂÓÓ‡ڈÛ˘ Ùo˘ ·ÓÂÏÎÙ‹Ú· ·applefi ÙoÎoÈÓfi ÎÈÓËÙÈÎfi Ó‡Úo Î·È ÛÙËÓ Û˘ÁÁÂÓ‹ ÌoÚÊ‹ ÙË˜Û˘¯Ó¿ ÂÌÊ·Ó›˙ÂÙ·È Ì Ùo Ê·ÈÓfiÌÂÓo Marcus Gunnjaw winking 1 . ∂ÌÊ·Ó›˙ÂÙ·È ÛÙo 5% ÙˆÓ appleÂÚÈÛÙ·ÙÈ-ÎÒÓ Û˘ÁÁÂÓo‡˜ appleÙÒÛ˘ Î·È Û˘ÓËı¤ÛÙÂÚ· oÊ›ÏÂ-Ù·È Û ·ÓÒÌ·ÏË ÎoÈÓ‹ ÂÓÓ‡ڈÛË Ùo˘ ·ÓÂÏÎÙ‹Ú·Î·È ÙˆÓ ¤Íˆ appleÙÂÚ˘ÁoÂȉÒÓ Ì˘ÒÓ Ù˘ οو ÁÓ¿ıo˘Ì ·appleoÙ¤ÏÂÛÌ· Ùo ¿Óˆ ‚ϤʷÚo Ó· Û˘Ûapple¿Ù·È fiÙ·ÓË ÁÓ¿ıo˜ ÎÈÓÂ›Ù·È appleÚo˜ ÙËÓ ·ÓÙ›ıÂÙË appleÏÂ˘Ú¿ ηȷÓÙ›ÛÙÚÔÊ· Ó· ¯·Ï·ÚÒÓÂÈ fiÙ·Ó Ë ÁÓ¿ıo˜ ÎÈÓ›ٷÈappleÚo˜ ÙËÓ ›‰È· appleÏÂ˘Ú¿ 2 . ∏ apple·Ú¿‰oÍË Î›ÓËÛË Ùo˘‚ÏÂÊ¿Úo˘ appleÚoηÏÂ›Ù·È Û¯Â‰fiÓ ·applefi οı ΛÓËÛËÙ˘ οو ÁÓ¿ıo˘ fiappleˆ˜ ¿ÓoÈÁÌ· Ùo˘ ÛÙfiÌ·Ùo˜, Ì¿-ÛËÛË, ·Ó·ÚÚfiÊËÛË Î·È Î·Ù¿appleoÛË 3 . ÙȘ Âapple›ÎÙËÙ˜ÌoÚʤ˜ Ë apple·Ú¿‰oÍË ÂÓÓ‡ڈÛË Â›Ó·È ·appleoÙ¤ÏÂÛÌ··ÓÒÌ·Ï˘ ·Ó·Á¤ÓÓËÛ˘ Ùo˘ ÎoÈÓo‡ ÎÈÓËÙÈÎo‡ Ó‡-Úo˘ ηÙfiappleÈÓ ÙÚ·˘Ì·ÙÈÛÌo‡, apple¿ÚÂÛ˘ ‹ apple·Ú¿Ï˘Û˘Ì apple·ÚfiÌoÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ë oappleo›· fï˜ ÌappleoÚ›ӷ appleÂÚÈÏ·Ì‚¿ÓÂÈ appleÂÚÈÛÛfiÙÂÚo˘˜ Ì˘˜4.∏ ÏÂÈÙo˘ÚÁ›· Ùo˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ Î·È Ë ı¤ÛËÙo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÎÈÓËÙÈÎfiÙËÙ·Ùo˘ ¿Óˆ oÚıo‡ Ì˘fi˜, appleo˘ Ì ÙËÓ ÎoÈÓ‹ ο„· Ùo˘ÛÙo ÛËÌ›o appleÚfiÛÊ˘Û˘ Ùo˘ oÚıo‡ ÛÙoÓ ‚oÏ‚fi ‰Ë-ÌÈo˘ÚÁo‡Ó ¤Ó· ÏÂÈÙo˘ÚÁÈÎfi Û‡ÓoÏo ·ÓÂÏÎÙ‹ÚˆÓÙo˘ ‚ÏÂÊ¿Úo˘ Î·È ‚oÏ‚o‡. ÙËÓ Û˘ÁÁÂÓ‹ ηٿ-ÛÙ·ÛË Ù˘ ‰ÈappleÏ‹˜ apple¿ÚÂÛ˘ ÙˆÓ ·ÓÂÏÎÙ‹ÚˆÓ apple·Ú·-ÙËÚÂ›Ù·È appleÙÒÛË ·applefi ÌÂȈ̤ÓË ÏÂÈÙo˘ÚÁ›· Ùo˘·ÓÂÏÎÙ‹Ú· Î·È ÂappleÈappleÚfiÛıÂÙ· ÌÂȈ̤ÓË ÏÂÈÙo˘ÚÁ›·Ùo˘ ¿Óˆ oÚıo‡ ÌÂ Û˘ÓÂapple·ÎfiÏo˘ıË ˘appleoÙÚoapple›· ηȷ‰˘Ó·Ì›· ÛÙÚoÊ‹˜ Ùo˘ ‚oÏ‚o‡ ·ÓÒÙÂÚ· ·applefi ÙËÓappleÚˆÙ‡o˘Û· ı¤ÛË 5 6 . ˘¯Ó¿ Û˘Ó˘apple¿Ú¯ÂÈ Î·È ÌÂȈ-OÊı·ÏÌÔÏÔÁÈ΋ KÏÈÓÈ΋ AÚÈÛÙÔÙÂÏ›Ԣ ·ÓÂappleÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢.OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 203 - 205, 2002 203

204 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)̤ÓË ÏÂÈÙo˘ÚÁ›· Ùo˘ οو ÏoÍo‡.∏ ‰ÈÂÚ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒappleÈÛË Ù˘ ‚ÏÂÊ·ÚfiappleÙˆÛ˘ÂappleÈappleϤÎÂÙ·È fiÙ·Ó Û˘Ó˘apple¿Ú¯ÂÈ Î¿appleoÈ· ·applefi ÙȘapple·Ú·apple¿Óˆ ‰È·Ù·Ú·¯¤˜. ·Úo˘ÛÈ¿˙o˘Ì ÌÈ· Ûapple¿ÓÈ·appleÂÚ›appleÙˆÛË Û˘ÁÁÂÓo‡˜ appleÙÒÛ˘ Ì ٷ˘Ùfi¯ÚoÓË Û˘Ó‡-apple·ÚÍË Ùo˘ Ê·ÈÓo̤Óo˘ Marcus Gunn jaw winking, ‰ÈappleÏ‹˜apple¿ÚÂÛ˘ ÙˆÓ ·ÓÂÏÎÙ‹ÚˆÓ Î·È ˘appleoÙÚoapple›·˜.·Úo˘Û›·ÛË appleÂÚÈÛÙ·ÙÈÎo‡ÕÓ‰Ú·˜ ËÏÈΛ·˜ 47 ÂÙÒÓ apple·Úo˘ÛÈ¿ÛıËΠÛÙËÓ ÎÏÈ-ÓÈ΋ Ì·˜ Ì appleÙÒÛË Ùo˘ ·ÚÈÛÙÂÚo‡ ¿Óˆ ‚ÏÂÊ¿Úo˘ ·applefiÁÂÓÓ‹Ûˆ˜. O Û‡ÛÙoȯo˜ oÊı·ÏÌfi˜ ‹Ù·Ó ·Ì‚Ï˘ˆappleË̤-Óo˜ Ì fiÚ·ÛË 4/10 Î·È Ë ı¤ÛË Ùo˘ ‚ÏÂÊ¿Úo˘ ‹Ù·Ó 6 mmηÙÒÙÂÚ· ·applefi ÙËÓ ˘ÁÈ‹ ‰ÂÍÈ¿ appleÏÂ˘Ú¿. Δo ¿ÓoÈÁÌ· Ù˘‚ÏÂÊ·ÚÈ΋˜ Û¯ÈÛÌ‹˜ ‹Ù·Ó 9 mm ‰ÂÍÈ¿ Î·È 3 mm ·ÚÈÛÙÂ-Ú¿ ÂÓÒ Ë ÏÂÈÙo˘ÚÁ›· Ùo˘ ·ÓÂÏÎÙ‹Ú· ‹Ù·Ó 15 mm ‰ÂÍÈ¿Î·È 6 mm ÛÙo appleÙˆÙÈÎfi ·ÚÈÛÙÂÚfi ‚ϤʷÚo (∂ÈÎ. 1).∏ ‰ÈÂÚ‡ÓËÛË Ù˘ appleÙÒÛ˘ Î·È ÙˆÓ ÂÍoÊı¿ÏÌȈÓÌ˘ÒÓ ·appleoÎ¿Ï˘„ ÙËÓ Û˘Ó‡apple·ÚÍË ÙˆÓ apple·Ú·Î¿Ùˆ ηٷ-ÛÙ¿ÛÂˆÓ appleo˘ ÂappleÈappleϤÎo˘Ó ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ·ÓÙÈ-ÌÂÙÒappleÈÛË Ùo˘ ·ÛıÂÓ‹.1. ∏ oÊı·ÏÌoÎÈÓËÙÈ΋ ÂͤٷÛË ÂÌÊ¿ÓÈÛ ÌÈÎÚo‡‚·ıÌo‡ ˘appleoÙÚoapple›· Ùo˘ ·ÚÈÛÙÂÚo‡ oÊı·ÏÌo‡ (ÌÈÎÚo¸appleoÙÚoapple›·)Ë oappleo›· ˘appleoÛÙÚ¤ÊoÓÙ·Ó fiÙ·Ó o ·ÚÈÛÙÂÚfi˜ o-Êı·ÏÌfi˜ appleÚoۋψÓÂ, Ì apple·Ú¿ÏÏËÏË ‚ÂÏÙ›ˆÛË Ù˘ ı¤Û˘Ùo˘ ‚ÏÂÊ¿Úo˘ Î·È Ì›ˆÛË Ù˘ appleÙÒÛ˘ ÛÙo 1 mm (∂ÈÎ. 2,3). Àapple‹Ú¯Â ·‰˘Ó·Ì›· ÛÙÚoÊ‹˜ Ùo˘ ‚oÏ‚o‡ ·ÓÒÙÂÚ· ·-applefi ÙËÓ appleÚˆÙ‡o˘Û· ı¤ÛË ÙfiÛo ηٷÎfiÚ˘Ê· fiÛo ηȿӈ appleÏ¿ÁÈ·, ÂÓÒ Ë ‰oÎÈÌ·Û›· ‰˘Ó·ÌÈ΋˜ ¤Ï͢ (tractiontest) Ùo˘ ‚oÏ‚o‡ ‰ÂÓ ¤‰ÂÈÍ ›ÓˆÛË ‹ apple·Á›‰Â˘ÛË Ùo˘ ο-Ùˆ oÚıo‡. Δ· Â˘Ú‹Ì·Ù· Û˘ÓËÁoÚo‡Ó ÛÙËÓ ‰È¿ÁÓˆÛË Ù˘‰ÈappleÏ‹˜ apple¿ÚÂÛ˘ ÙˆÓ ·ÓÂÏÎÙ‹ÚˆÓ (double elevator palsy)ÌÂ Û˘ÌÌÂÙo¯‹ Î·È Ùo˘ οو ÏoÍo‡.2. ∂appleÈappleÚfiÛıÂÙ·, Û ÂÎo‡ÛÈ· appleÏ¿ÁÈ· ΛÓËÛË Ù˘ ο-Ùˆ ÁÓ¿ıo˘ apple·Ú·ÙËÚ‹ıËΠÙo Ê·ÈÓfiÌÂÓo Marcus Gunnjaw winking, ‰ËÏ·‰‹ ÂÓ·ÏÏ·ÛÛfiÌÂÓË ¤ÏÍË Î·È appleÙÒÛËÙo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘, ÌÂÙ·‚¿ÏÏoÓÙ·˜ Ùo ¿ÓoÈÁÌ· Ù˘ ‚ÏÂ-Ê·ÚÈ΋˜ Û¯ÈÛÌ‹˜ ·applefi 5 ÛÙ· 13 mm, ‰ËÏ·‰‹ 4 mm ·ÓÒ-ÙÂÚ· ·applefi ÙËÓ ˘ÁÈ‹ appleÏÂ˘Ú¿ (∂ÈÎ. 4, 5). ∞ÎfiÌ·, ÛÙoÈÛÙoÚÈÎfi Ùo˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ appleÚÈÓ ·applefi Ù¤ÛÛÂÚ· Î·È ‰‡o¯ÚfiÓÈ· ·ÓÙ›ÛÙoȯ· ›¯Â ˘appleo‚ÏËı› Û ‰‡o ‰È·‰o¯ÈΤ˜¯ÂÈÚo˘ÚÁÈΤ˜ ÂappleÂÌ‚¿ÛÂȘ Ù‡appleo˘ Fasanella-Servat Ì η-Ì›· ‚ÂÏÙ›ˆÛË Ù˘ ı¤Û˘ Ùo˘ ‚ÏÂÊ¿Úo˘ (∂ÈÎ. 6).˘˙‹ÙËÛË∏ Ûapple¿ÓÈ· Û˘Ó‡apple·ÚÍË ÛÙo appleÂÚÈÛÙ·ÙÈÎfi ·˘ÙfiÙ˘ appleÙÒÛ˘ Ùo˘ ¿Óˆ ‚ÏÂÊ¿Úo˘, Ù˘ ˘appleoÙÚoapple›·˜∂ÈÎ. 1. ∂ÌÊ¿ÓÈÛË Ùo˘ ·ÛıÂÓ‹ Ì Ùo ‚ϤÌÌ· ÛÙËÓ appleÚˆ-Ù‡o˘Û· ı¤ÛË Î·È ÙËÓ ¤ÓÙoÓË appleÙÒÛË Ùo˘ ·ÚÈÛÙÂÚo‡¿Óˆ ‚ÏÂÊ¿Úo˘.∂ÈÎ. 3. ¢ÈfiÚıˆÛË Ù˘ ı¤Û˘ Ùo˘ ‚oÏ‚o‡ Î·È Ùo˘ ‚ÏÂ-Ê¿Úo˘ Ì ÙËÓ Î¿Ï˘„Ë Ùo˘ ‰ÂÍÈo‡ (˘ÁÈo‡˜) Ì·ÙÈo‡Î·È appleÚoۋψÛË Ì Ùo ·ÚÈÛÙÂÚfi (appleÙˆÙÈÎfi).∂ÈÎ. 2. ∞‰˘Ó·Ì›· ·Ó‡„ˆÛ˘ Ùo˘ ‚ÏÂÊ¿Úo˘ ·ÓÒÙÂÚ··applefi ÙËÓ oÚÈ˙fiÓÙÈ· ı¤ÛË.∂ÈÎ. 4. ∏ ·Ó·ÛÙÚoÊ‹ Ùo˘ ‚ÏÂÊ¿Úo˘ Ê·ÓÂÚÒÓÂÈ Ùo ‚Ú·-¯‡ apple¤Ù·Ïo Ùo˘ Ù·ÚÛo‡ ·applefi ÙȘ Âapple·ÓÂÈÏËÌ̤Ó˜ ÂappleÂÌ-‚¿ÛÂȘ ÁÈ· ÙËÓ ·ÓfiÚıˆÛË Ùo˘ ‚ÏÂÊ¿Úo˘.

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 205∂ÈÎ. 5, 6. ∂Ó·ÏÏ·Á‹ Ù˘ ı¤Û˘ Ùo˘ ·ÚÈÛÙÂÚo‡ ¿Óˆ ‚ÏÂÊ¿Úo˘ ·applefi appleÙÒÛË ÛÙËÓ ËÚÂÌ›· Û ¤ÏÍË Ì ÙËÓ Î›ÓËÛË Ù˘ οوÁÓ¿ıo˘ (Marcus Gunn jaw winking).Î·È ‰ÈappleÏ‹˜ apple¿ÚÂÛ˘ ÙˆÓ ·ÓÂÏÎÙ‹ÚˆÓ Î·È Û˘Á¯Úfi-Óˆ˜ Ùo˘ Ê·ÈÓo̤Óo˘ Marcus Gunn jaw winking ‰Ë-ÌÈo˘ÚÁ› Ûo‚·Úfi ‰È·ÁÓˆÛÙÈÎfi appleÚfi‚ÏËÌ· Ùo oappleo›oo‰‹ÁËÛ apple·Ï·ÈfiÙÂÚ· Û ‰‡o Âapple·ÓÂÈÏËÌ̤Ó˜ Ï·Óı·Ṳ̂Ó˜ÂappleÂÌ‚¿ÛÂȘ ¯ˆÚ›˜ o˘ÛÈ·ÛÙÈ΋ ‚ÂÏÙ›ˆ-ÛË 7 . Δo Û‡ÌappleÏÂÁÌ· ÙˆÓ ‰ÈappleÏÒÓ ·ÓÂÏÎÙ‹ÚˆÓ Î·È Ëapple·Ú¿‰oÍË ÎÈÓËÙÈÎfiÙËÙ· Ùo˘ ‚ÏÂÊ¿Úo˘ ÌappleoÚo‡Ó‡ÎoÏ· Ó· apple·Ú·‚ÏÂÊıo‡Ó Î·È Ó· ÂappleÈappleϤÍo˘Ó Ùo·appleoÙ¤ÏÂÛÌ· οı ¯ÂÈÚo˘ÚÁÈ΋˜ appleÚoÛ¤ÁÁÈÛ˘ ‚Ú¿-¯˘ÓÛ˘ Ù˘ ·appleoÓ‡ڈÛ˘ ‹ Ùo˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜. ∏ÂӉ‰ÂÈÁ̤ÓË appleÚoÛ¤ÁÁÈÛË appleÚ¤appleÂÈ Ó· ÛÙo¯Â‡ÂÈ ·Ú-¯Èο ÛÙËÓ ‰ÈfiÚıˆÛË Ù˘ ˘appleoÙÚoapple›·˜ Î·È ÂÓ›Û¯˘ÛËÙo˘ ¿Óˆ oÚıo‡ Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ¿Óˆ ÌÂÙ¿ıÂÛË˜ÙˆÓ appleÏ¿ÁÈˆÓ oÚıÒÓ, fiappleˆ˜ appleÂÚÈÁÚ¿ÊËΠ·applefi ÙoÓKnapp 8-10 .  ‰Â‡ÙÂÚo ¯ÚfiÓo, ÂӉ›ÎÓ˘Ù·È Ë ‰È·-ÙoÌ‹ Ùo˘ ·ÓÂÏÎÙ‹Ú· ÁÈ· ‰ÈfiÚıˆÛË Ùo˘ Ê·ÈÓo̤Óo˘Marcus Gunn Î·È ·Ó¿ÚÙËÛË Ùo˘ appleÙˆÙÈÎo‡ ‚ÏÂ-Ê¿Úo˘ ·applefi Ùo ÊÚ‡‰È Î·È ÙoÓ ÌÂÙˆappleÈ·›o Ì˘ Ì ٷÈ-Ó›· appleÏ·Ù›·˜ appleÂÚÈÙoÓ›·˜11-13 . °È· ·applefiÏ˘ÙË Û˘ÌÌÂ-ÙÚ›· ÂappleÈ‚¿ÏÏÂÙ·È Ë ·ÌÊoÙÂÚfiappleÏ¢ÚË ‰È·ÙoÌ‹ ηȷӿÚÙËÛË, Ù¯ÓÈ΋ appleo˘ Ûapple¿ÓÈ· Á›ÓÂÙ·È ‰ÂÎÙ‹ ·applefiÙoÓ ·ÛıÂÓ‹ 14 . O Û˘ÁÎÂÎÚÈ̤Óo˜ ·ÛıÂÓ‹˜ ·Ó¤‚·ÏÂÙËÓ ·applefiÊ·ÛË ÁÈ· ¯ÂÈÚo˘ÚÁÈ΋ ‰ÈfiÚıˆÛË Û ÌÂÙ·-ÁÂÓ¤ÛÙÂÚo ¯ÚfiÓo. Δo apple·Ú·apple¿Óˆ appleÂÚÈÛÙ·ÙÈÎfi η-Ù·‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· appleÚoÛÂÎÙÈ΋ Î·È Û˘ÛÙË-Ì·ÙÈ΋ ‰ÈÂÚ‡ÓËÛË fiÏˆÓ ÙˆÓ apple·Ú·Ì¤ÙÚˆÓ Ù˘ ‚ÏÂ-Ê·ÚfiappleÙˆÛ˘ Î·È ÎÈÓËÙÈÎfiÙËÙ·˜ Ùo˘ ‚oÏ‚o‡ ¤appleÂÈÙ··applefi ÏÂappleÙoÌÂÚ‹ oÊı·ÏÌoÏoÁÈ΋ ÂͤٷÛË, ·ÎfiÌ·Î·È ÛÙ· Ê·ÈÓoÌÂÓÈο ·appleÏ¿ appleÂÚÈÛÙ·ÙÈο. ÙËÓ ·ÓÙÈ-ÌÂÙÒappleÈÛË appleÚ¤appleÂÈ Ó· ÙËÚo‡ÓÙ·È oÈ ÂӉ›ÍÂȘ وӉȷÊfiÚˆÓ ¯ÂÈÚo˘ÚÁÈÎÒÓ Ù¯ÓÈÎÒÓ, oÈ oappleo›Â˜ Û˘-¯Ó¿ ·apple·ÈÙo‡Ó ‰‡o ‹ appleÂÚÈÛÛfiÙÂÚ· ÛÙ¿‰È·, ȉ›ˆ˜ ÛÂÂappleÈappleÏÂÁ̤ӷ appleÂÚÈÛÙ·ÙÈο.μÈ‚ÏÈoÁÚ·Ê›·1. Collin JR. New concepts in the management of ptosis.Eye 2(Pt 2): 185-8, 1988.2. Goodisson D, Snape L. The jaw-winking syndrome. TheNew Zealand Dental Journal 96(424): 58-9, 2000.3. Eve FR. Pterygoid-levator synkinesis. The Marcus Gunnjaw-winking phenomenon. Journal of Clinical Neuro-Ophthalmology 7(1): 61-2, 1987.4. Bullock JD. Marcus-Gunn jaw-winking ptosis: classificationand surgical management. Journal of PediatricOphthalmology and Strabismus; 17(6): 375-9.5. Lee JP, Collin JR, Timms C. Elevating the hypotropic globe.British Journal of Ophthalmology 70(1): 26-32, 1986.6. Collin JR, Beard C, Wood I. Experimental and clinical dataon the insertion of the levator palpebrae superiorismuscle. American Journal of Ophthalmology 85(6):792-801, 1978.7. Callahan MA. Surgically mismanaged ptosis associatedwith double elevator palsy. Archives of Ophthalmology99(1): 108-12, 1981.8. Kocak-Altintas AG, Kocakkkk-Midillioglu I, Dabil H, DumanS. Selective management of double elevator palsyby either inferior rectus recession and/or knapp typetransposition surgery. Binocul Vis Strabismus Q15(1): 39-46, 2000.9. Singh D, Singh M. Total transplantation of the superiorrectus muscle for ptosis. A new surgical approach.Transactions of the Ophthalmological Societies of theUnited Kingdom 98(1): 71-4, 1978.10. Khwarg SI, Tarbet KJ, Dortzbach RK, Lucarelli MJ. Managementof moderate-to-severe Marcus-Gunn jawwinkingptosis. Ophthalmology 106(6): 1191-6, 1999.11. Neuhaus RW. Eyelid suspension with a transposed levatorpalpebrae superioris muscle. American Journal ofOphthalmology 100(2): 308-11, 1985.12. Betharia SM, Kumar S. Levator sling for Marcus Gunnptosis. The British Journal of Ophthalmology 71(9):685-9, 1987.13. Dryden RM, Fleming JC, Quickert MH. Levator transpositionand frontalis sling procedure in severe unilateralptosis and the paradoxically innervated levator.Archives of Ophthalmology 100(3): 462-4, 1982.14. Dillman DB, Anderson RL. Levator myectomy in synkineticptosis. Archives of Ophthalmology 102(3): 422-3, 1984.

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OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 2071925, ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ ÙÌËÌ¿ÙˆÓ, appleÂÚÈÏ·Ì‚¿ÓÂÈappleϤÔÓ Î·È ·˘ÙfiÓÔÌÔ OÊı·ÏÌÔÏÔÁÈÎfi TÌ‹Ì· ‰˘Ó·-ÌÈÎfiÙËÙ·˜ apple¤ÓÙ ÎÏÈÓÒÓ, ÂÓÒ Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÍÂÙ·-Ûı¤ÓÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ TÌ‹Ì· ·˘Ùfi ·Ó¤Ú¯ÂÙ·È ÛÂ947 7 .EÎÙfi˜ ÙˆÓ ˘appleËÚÂÛÈÒÓ appleÔ˘ appleÚÔÛʤÚÂÈ ÙÔ NÔ-ÛÔÎÔÌÂ›Ô Ù˘ X›Ô˘, ÛËÌ·ÓÙÈΤ˜ ˘appleËÚÂۛ˜ appleÚÔ-ÛʤÚÔ˘Ó Î·È ÔÈ È‰ÈÒÙ˜ ÔÊı·ÏÌ›·ÙÚÔÈ. I·ÙÚÔ› Ì·ӷÁÓˆÚÈṲ̂ÓË ·applefi ÙÔÓ I·ÙÚÈÎfi ‡ÏÏÔÁÔ X›Ô˘ÙËÓ ÂȉÈÎfiÙËÙ· ÙÔ˘ ÔÊı·ÏÌÈ¿ÙÚÔ˘ ‹Ù·Ó appleÚÔappleÔÏÂ-ÌÈο ÔÈ apple·Ú·Î¿Ùˆ: M·˘ÚÔÎÔÚ‰¿ÙÔ˜ ¢ËÌÔÛı¤Ó˘(1886-1977), M˘Ù·Ú¿Î˘ °ÂÒÚÁÈÔ˜ (1875-1945),ˆÙËÚfiappleÔ˘ÏÔ˜ ˆÙ‹ÚÈÔ˜ (1910-1949) Î·È ˆÙËÚfiappleÔ˘ÏÔ˜AϤͷӉÚÔ˜ (1876-1956) 8 . EÎ ÙˆÓ apple·Ï·ÈÔ-Ù¤ÚˆÓ ÔÊı·ÏÌÈ¿ÙÚˆÓ, Ô ÌÂÓ MÈÏÙÈ¿‰Ë˜ T˙ËÚ¿˜(1860-1931) ›¯Â appleÂı¿ÓÂÈ Ù˘ÊÏfi˜ ÙÔ 1931, Ô ‰ÂAapplefiÛÙÔÏÔ˜ IÛȉˆÚ›‰Ë˜ (1870-1942) ·ÛÎÔ‡Û ÙËÓ·ıÔÏÔÁ›· (°ÂÓ. I·ÙÚÈ΋) ̤¯ÚÈ ÙÔ 1937, ÔapplefiÙÂÎ·È Û˘ÓÙ·ÍÈÔ‰ÔÙ‹ıËÎÂ.Ù· ÌÂÙ·appleÂÏ¢ıÂÚˆÙÈο ¯ÚfiÓÈ· ÛÙËÓ X›Ô ÏÂÈ-ÙÔ‡ÚÁËÛ ·ÎfiÌË OÊı·ÏÌÔÏÔÁÈÎfi TÌ‹Ì· ÛÙËÓ Ô-Ï˘ÎÏÈÓÈ΋ °.º. AÓ‰Ú¿‰Ô˘, ηıÒ˜ Î·È Ë OÊı·Ï-ÌÔÏÔÁÈ΋ KÏÈÓÈ΋ ÙÔ˘ ¢. M·˘ÚÔÎÔÚ‰¿ÙÔ˘9.ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜ ı· appleÚ¤appleÂÈÓ· ·Ó·Ê¤ÚÔ˘ÌÂ Î·È ÙËÓ Û˘Ì‚ÔÏ‹ ÙˆÓ appleÚ·ÎÙÈ-ÎÒÓ ıÂÚ·apple¢ÙÒÓ, appleÔ˘ appleÚÔÛ¤ÊÂÚ·Ó ¯Ú‹ÛÈ̘ ÁÂÓÈ-ο ˘appleËÚÂۛ˜. XÚËÛÌÔappleÔÈÔ‡Û·Ó Û·Ó ıÂÚ·apple¢ÙÈ΋̤ıÔ‰Ô ÙËÓ Âapple›ÙÚÈ„Ë ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Ì ‰È¿ÊÔÚ·˘ÏÈο (Á·Ï·˙fiappleÂÙÚ·, ˙¿¯·ÚË, Ê˘Ù¿, Î.¿.), appleÚ·ÎÙÈ-΋ appleÔ˘ appleÂÚÈÁÚ¿ÊËΠηٿ appleÚÒÙÔÓ ·applefi ÙÔÓ IappleappleÔ-ÎÚ¿ÙË. XÚËÛÈÌÔappleÔÈÔ‡Û·Ó Âapple›Û˘ ‰È¿ÊÔÚ· ÂappleÈı¤-Ì·Ù· Ì ·ÓÙÈÊÏÔÁÈÛÙÈ΋ Î·È ‹appleÈ· ·ÓÙÈÛËappleÙÈ΋ ‰Ú¿-ÛË 10 . AÓ¿ÏÔÁ· ̤۷ ¯ÚËÛÈÌÔappleÔÈÔ‡ÛÂ Î·È Ô ·appleÏfi˜Ï·fi˜ Û·Ó ÚÂ̤ÓÙÈ·, Û ·appleÔÌ·ÎÚ˘Ṳ̂ӷ ¯ˆÚÈ¿ ÙÔ˘ÓËÛÈÔ‡ 11 .OÈ ˘appleÔ‰Ô̤˜ fï˜ ·˘Ù¤˜ ·ÓÂapple·ÚÎÔ‡Ó ÛËÌ·-ÓÙÈο ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜. OÈÛ˘Óı‹Î˜ appleÔ˘ appleÚԷӷʤڷÌÂ, ·ÏÏ¿ Î·È Ë appleÏËı˘-ÛÌȷ΋ ¤ÎÚËÍË appleÔ˘ appleÚÔοÏÂÛ ÛÙÔ ÓËÛ› Ë MÈÎÚ·-ÛÈ·ÙÈ΋ ÂıÓÈ΋ ÙÚ·Áˆ‰›·, appleÚÔÛ‰›‰Ô˘Ó ÛÙÔ appleÚfi-‚ÏËÌ· ÛÔ‚·Ú¤˜ ‰È·ÛÙ¿ÛÂȘ.O B›ÎÙˆÚ KÔ˘ÎÔ˘Ú›‰Ë˜, È·ÙÚfi˜ Î·È ÛappleÔ˘‰·›Ô˜ÎÔÈÓˆÓÈÎfi˜ Î·È appleÔÏÈÙÈÎfi˜ apple·Ú¿ÁˆÓ ÙÔ˘ ÌÂÛÔappleÔϤ-ÌÔ˘, Û ¤ÎıÂÛ‹ ÙÔ˘ Û¯ÂÙÈο Ì ÙËÓ ˘ÁÂÈÔÓÔÌÈ΋ η-Ù¿ÛÙ·ÛË ÙˆÓ M·ÛÙȯԯˆÚ›ˆÓ, ·Ó·Ê¤ÚÂÙ·È ÛÙÔ ÙÚ¿-¯ˆÌ·, appleÔ˘ Ì·ÛÙ›˙ÂÈ ÙËÓ ‡apple·ÈıÚÔ, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓÊ˘Ì·Ù›ˆÛË. YappleÔ‰ÂÈÎÓ‡ÂÈ Ì¿ÏÈÛÙ· ˆ˜ ıÂÚ·apple›· ÙÔ˘appleÚÔ‚Ï‹Ì·ÙÔ˜ ÙËÓ ‰ËÌÈÔ˘ÚÁ›· appleÂÚÈԉ¢fiÓÙˆÓ ·ÓÙÈ-ÙÚ·¯ˆÌ·ÙÈÎÒÓ È·ÙÚ›ˆÓ 12 .EÎÙfi˜ ÙˆÓ ·ÙfiÌˆÓ appleÔ˘ ÙÔappleÔıÂÙÔ‡ÓÙ·È ·apple¤Ó·-ÓÙÈ ÛÙÔ appleÚfi‚ÏËÌ· Î·È ˙ËÙÔ‡Ó ¿ÌÂÛË Ï‡ÛË, ›ӷÈÎ·È ÔÈ ›‰È˜ ÔÈ KÔÈÓfiÙËÙ˜ Ù˘ ˘apple·›ıÚÔ˘. O ÚfiÂ-‰ÚÔ˜ Ù˘ KÔÈÓfiÙËÙ·˜ K·Ú‰·Ì‡ÏˆÓ ٤ʷÓÔ˜ KÔ˘-ÏÔ˘ÌÔ‡ÓÙÚ·˜ ·appleÔÛÙ¤ÏÏÂÈ ·Ó·ÊÔÚ¿ appleÚÔ˜ ÙÔYappleÔ˘ÚÁÂ›Ô YÁÈÂÈÓ‹˜ Î·È ÚfiÓÔÈ·˜ Ì ı¤Ì· “TÔÙÚ¿¯ˆÌ· ÙÔ˘ BÔÚÂÈÔ·Ó·Ó·ÙÔÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘N‹ÛÔ˘”. ÙËÓ ·Ó·ÊÔÚ¿ ·˘Ù‹ ·Ó·Ê¤ÚÂÙ·È Ë ‰ÂÈӋηٿÛÙ·ÛË ÙÔ˘ appleÏËı˘ÛÌÔ‡, ηıÒ˜ Î·È ÔÈ ÛÔ‚·Ú¤˜ÎÔÈÓˆÓÈΤ˜ Î·È ÔÈÎÔÓÔÌÈΤ˜ ÂappleÈappleÙÒÛÂȘ Ù˘ ÓfiÛÔ˘.AӷʤÚÂÙ·È ¯·Ú·ÎÙËÚÈÛÙÈο appleˆ˜ Ù· 8/10 ÙˆÓÛÙÚ·ÙÂ˘Û›ÌˆÓ Ó¤ˆÓ Ù˘ appleÂÚÈÔ¯‹˜ Ù˘Á¯¿ÓÔ˘Ó Û˘ÓÂ-¯ÒÓ ·Ó·‚ÔÏÒÓ ˆ˜ ÙÚ·¯ˆÌ·Ù›Â˜. H ÙÚ·ÁÈ΋ ηٿ-ÛÙ·ÛË appleÂÚÈÁÚ¿ÊÂÙ·È Ó· appleÏ‹ÙÙÂÈ Î·È Ù· Á‡Úˆ ¯ˆ-ÚÈ¿: AÌ¿‰Â˜, B›ÎÈ, K·ÌappleÈ¿, º˘Ù¿, ˘ÎÈ¿‰·, ˘-ÙÈfi˜, ÎÏapple. AÏÏ¿ ÂÍ·ÈÚÂÙÈÎfi ÂӉȷʤÚÔÓ apple·ÚÔ˘ÛÈ¿-˙ÂÈ ÛÙËÓ ·Ó·ÊÔÚ¿ ·˘Ù‹ Î·È Ë appleÂÚÈÁÚ·Ê‹ ÙˆÓ Ì¤-ÙÚˆÓ appleÔ˘ ›¯·Ó ÏËÊı› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ÙÔ˘ÙÚ·¯ÒÌ·ÙÔ˜ Î·È Ù˘ ·Ó·appleÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ ÙˆÓ:“... TÔ Û˘ÓÂÚÁ›ÔÓ Û˘Ó‰Ú·ÌÔ‡ÌÂÓÔÓ ·applefi ¯ˆÚÔʇ-ϷΘ ÂÓ¤ÛÎËappleÙ ÂȘ Ù· ¯ˆÚÈ¿ ‰È· Ó· appleÚԂ› ÂȘÙËÓ ‰È· η˘ÙËÚÈ¿Ûˆ˜ ıÂÚ·apple›·Ó... H ÌË ÂȉÈÎfiÙ˘ÙÔ˘ È·ÙÚÔ‡, ÙÔ ·Î·Ù¿ÏÏËÏÔÓ ÙˆÓ ËÌÂÚÒÓ Î·È ˆÚÒÓÂÚÁ·Û›·˜, Ë Û˘Óԉ›· ÙÔ˘ ¯ˆÚÔʇϷÎÔ˜14 , Âapple¤ÊÂ-ÚÔÓ ÙÔÓ ·ÓÙ›appleÔ‰· ÙÔ˘ ‰ÈˆÎÔ̤ÓÔ˘ ·appleÔÙÂϤÛÌ·ÙÔ˜.OÈ ¯ˆÚÈÎÔ› Âapple› Ùˆ ·ÎÔ‡ÛÌ·ÙÈ fiÙÈ ÙÔ Û˘ÓÂÚÁ›ÔÓ‹ÙÔ ÂÓ fi„ÂÈ ÙÔ˘ ¯ˆÚ›Ô˘ ÙˆÓ ÂÙÚ¤appleÔÓÙÔ ÂȘ Ê˘Á‹ÓÎ·È ‰È·ÛÎÔÚapple›˙ÔÓÙÔ ÂȘ ÙÔ˘˜ ·ÁÚÔ‡˜, Ô˘‰ÂÓfi˜ ÙÚ·-¯ˆÌ·ÙÈÎÔ‡ ·Ó¢ÚÈÛÎÔ̤ÓÔ˘ appleϤÔÓ ˘applefi ÙÔ˘ Û˘ÓÂÚ-Á›Ԣ appleÚÔ˜ ıÂÚ·apple›·Ó” 14 .TÔÓ ·ÓÙÈÙÚ·¯ˆÌ·ÙÈÎfi fï˜ ·ÁÒÓ· ÛÙ‹ÚÈÍ·ÓÛÙÔ ÓËÛ›, ÂÎÙfi˜ ÙˆÓ È·ÙÚÒÓ, Î·È ¿ÏÏÔÈ apple·Ú¿ÁÔÓÙ˜.H EÏÏËÓÈ΋ ÔÏÈÙ›·, Ë ÙÔappleÈ΋ EÎÎÏËÛ›·, Ë XÈ·-΋ ¢appleÔÈ˝·, Î.¿.AÚ¯Èο Ô ÙfiÙ °ÂÓ. ¢ÈÔÈÎËÙ‹˜ N‹ÛˆÓ AÚ¯ÈappleÂ-Ï¿ÁÔ˘˜ °ÂÒÚÁÈÔ˜ ·apple·Ó‰Ú¤Ô˘ ‰ÈfiÚÈÛ Ì ‰ËÌfi-ÛÈ· ‰·apple¿ÓË ÂȉÈÎÔ‡˜ È·ÙÚÔ‡˜, ÔÈ ÔappleÔ›ÔÈ ·ÊÔ‡ ÂÎapple·È‰Â‡ÙËηÓÛÙÔ OÊı·ÏÌÈ·ÙÚ›Ô, ·Û¯ÔÏ‹ıËηÓÌ ÙËÓ ‰ˆÚÂ¿Ó ıÂÚ·apple›· ÙˆÓ ÙÚ·¯ˆÌ·ÙÈÎÒÓ 15 .ÙÔÓ ·ÁÒÓ· ·˘Ùfi appleÚÔÛʤÚÂÈ ÌÂÁ¿Ï˜ ˘appleËÚÂۛ˜ ÔÔÊı·ÏÌ›·ÙÚÔ˜ ˆÙ‹ÚÈÔ˜ ˆÙËÚfiappleÔ˘ÏÔ˜. AÓÙÈÙÚ·-¯ˆÌ·ÙÈÎÔ› Ù·ıÌÔ› ȉڇÔÓÙ·È ·ÚÁfiÙÂÚ· ÛÙÔ ¯ˆÚÈ¿˘ÚÁ›, K·Ú‰¿Ì˘Ï· Î·È KÔ˘ÚÔ‡ÓÈ·. H ‰·apple¿ÓË ÁÈ·ÙËÓ ÏÂÈÙÔ˘ÚÁ›· ÌÔÓ›ÌˆÓ Ù·ıÌÒÓ ÛÙ· ¯ˆÚÈ¿ ·˘Ù¿Á›ÓÂÙ·È ·applefi ÙÔ YappleÔ˘ÚÁÂ›Ô KÚ·ÙÈ΋˜ YÁÈÂÈÓ‹˜ ηÈAÓÙÈÏ‹„ˆ˜, appleÂÚ› ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1937. H ‰·apple¿ÓË appleÂ-ÚÈÂÏ¿Ì‚·Ó ÌÈÛıÔ‡˜ ÙÚÈÒÓ ÔÊı·ÏÌÈ¿ÙÚˆÓ, ¤ÍÈ ÓÔ-ÛÔÎfiÌˆÓ Î·È ÙËÓ ‰È¿ıÂÛË ÙÔ˘ ·apple·ÈÙÔ‡ÌÂÓÔ˘ Ê·Ú-̷΢ÙÈÎÔ‡ ˘ÏÈÎÔ‡ 16 . H ηٷÓÔÌ‹ ÙˆÓ Ù·ıÌÒÓ·˘ÙÒÓ Á›ÓÂÙ·È appleÚÔÊ·ÓÒ˜ Ì ¯ˆÚÔÙ·ÍÈο - appleÏËı˘-ÛÌȷο ÎÚÈÙ‹ÚÈ· (NfiÙÈ·, BÔÚÂÈÔ‰˘ÙÈ΋ Î·È BÔÚÂÈ-Ô·Ó·ÙÔÏÈ΋ X›Ô˜) 17 .M ÓÔÌÔıÂÙÈÎfi ‰È¿Ù·ÁÌ· ÛÙȘ 26 IÔ˘Ï›Ô˘ ÙÔ˘

208 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)1929 ȉڇÂÙ·È ÙÔ ¢ËÌfiÛÈÔ OÊı·ÏÌÈ·ÙÚÂ›Ô Ù˘ X›-Ô˘, Ì ·Ú¯È΋ ‰˘Ó·ÌÈÎfiÙËÙ· 25 ÎÏÈÓÒÓ, Ì ÛÎÔapplefiÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜. ÙËÓ ›‰Ú˘ÛËÙÔ˘ OÊı·ÏÌÈ·ÙÚ›Ԣ appleÚˆÙÔÛÙ·Ù› Ô ÔÊı·ÏÌ›·-ÙÚÔ˜ ¢ËÌÔÛı¤Ó˘ M·˘ÚÔÎÔÚ‰¿ÙÔ˜, Ô ÔappleÔ›Ô˜ ηÈÙÔ ‰È¢ı‡ÓÂÈ Ì¤¯ÚÈ ÙÔ 1953 18 .M ·applefiÊ·ÛË ÙÔ˘ YÊ˘appleÔ˘ÚÁÔ‡ YÁÈÂÈÓ‹˜ ÛÙȘ16 IÔ˘Ó›Ô˘ 1937 Û˘ÓÈÛÙ¿Ù·È ÛÙÔ ÓËÛ› ÂappleÈÙÚÔapple‹ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜, Ì ÙËÓ Û˘ÌÌÂ-ÙÔ¯‹ ÙÔ˘ NÔÌ¿Ú¯Ë X›Ô˘ ˆ˜ ÚÔ¤‰ÚÔ˘, ÙÔ˘ ÚÔ˚-Ûٷ̤ÓÔ˘ ÙÔ˘ YÁÂÈÔÓÔÌÈÎÔ‡ K¤ÓÙÚÔ˘, ÙÔ˘ ¢È¢ı˘-ÓÙ‹ ÙÔ˘ ˘appleÔηٷÛÙ‹Ì·ÙÔ˜ Ù˘ EıÓÈ΋˜ TÚ¿appleÂ˙·˜,ÙÔ˘ ¢ËÌ¿Ú¯Ô˘ X›Ô˘ Î·È ÙÔ˘ È·ÙÚÔ‡ KˆÓÛÙ. M·-‰È¿. AÚÁfiÙÂÚ· Ë ÂappleÈÙÚÔapple‹ ·˘Ù‹ ‰È¢ڇÓÂÙ·È Ì ÙËÓÛ˘ÌÌÂÙÔ¯‹ ÙÔ˘ MËÙÚÔappleÔÏ›ÙË X›Ô˘, ÙÔ˘ ÚÔ¤‰ÚÔ˘ÚˆÙÔ‰ÈÎÒÓ, ÙÔ˘ ÚÔ¤‰ÚÔ˘ ÙÔ˘ I·ÙÚÈÎÔ‡ ˘ÏÏfi-ÁÔ˘ X›Ô˘, ÙÔ˘ ¢ËÌ¿Ú¯Ô˘ K·Ú‰·Ì‡ÏˆÓ Î·È ÙÔ˘ÚÔ¤‰ÚÔ˘ Ù˘ KÔÈÓfiÙËÙ·˜ K·Ï·ÌˆÙ‹˜19 . TÔ ¤ÚÁÔfï˜ Ù˘ ÂappleÈÙÚÔapple‹˜ ·˘Ù‹˜ ˘apple‹ÚÍ ̿ÏÏÔÓ ‰È·¯ÂÈ-ÚÈÛÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·.ËÌ·ÓÙÈΤ˜ fï˜ ˘appleËÚÂۛ˜ ÛÙÔÓ ·ÁÒÓ· ηٿÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜ appleÚÔÛ¤ÊÂÚÂ Î·È Ô ÙfiÙ MËÙÚÔappleÔ-Ï›Ù˘ X›Ô˘ Iˆ·ÎÂ›Ì ÙÚÔ˘Ìapple‹˜ (1881-1950). H Ï·-ÌappleÚ‹ ·˘Ù‹ appleÚÔÛˆappleÈÎfiÙËÙ· Ù˘ Xȷ΋˜ EÎÎÏËÛ›·˜,·Ó¿ÌÂÛ· ÛÙÔ ÛappleÔ˘‰·›Ô ÎÔÈÓˆÓÈÎfi ¤ÚÁÔ appleÔ˘ appleÚÔ-Û¤ÊÂÚ ÛÙÔÓ Ï·fi ÙÔ˘, ȉȷ›ÙÂÚ· ÊÚfiÓÙÈÛÂ Î·È ÙÔÓ·ÁÒÓ· ηٿ ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜. ·Ó MËÙÚÔappleÔÏ›Ù˘BÔÏÈÛÛÔ‡ Î·È K·Ú‰·Ì‡ÏˆÓ apple·Ï·ÈfiÙÂÚ·, ÁÓÒÚÈ˙ÂηϿ ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ appleÏËı˘ÛÌÔ‡ ÛÙËÓ Xȷ΋‡apple·ÈıÚÔ. O Iˆ·Î›Ì, ·applefi Ù· appleÚÒÙ· ¯ÚfiÓÈ· Ù˘ ·Ú-¯ÈÂÚ·Ù›·˜ ÙÔ˘ ÛÙËÓ MËÙÚfiappleÔÏË Ù˘ X›Ô˘ (1933),·Û¯ÔÏÂ›Ù·È ÛÔ‚·Ú¿ Ì ÙÔ appleÚfi‚ÏËÌ· Î·È ÙËÓ ıÂÚ·-apple›· ÙÔ˘. ŒÙÛÈ ÙÔ 1937 Ì ‰·apple¿ÓË Ù˘, ˘applefi ÙËÓappleÚÔ‰Ú›· ÙÔ˘ EappleÈÙÚfiappleÔ˘ KÔÈÓˆÊÂÏÒÓ ÎÔappleÒÓ,ÛÙ¤ÏÓÂÈ ÛÙËÓ Aı‹Ó· ÁÈ· ÂȉÈ΋ ÂÎapple·›‰Â˘ÛË ÙÚÂȘÓÔÛÔÎfi̘, Ì ÙȘ Ôappleԛ˜ ÛÙÂϯÒÓÂÈ ÛÙË Û˘Ó¤¯ÂÈ·Ù· AÓÙÈÙÚ·¯ˆÌ·ÙÈο I·ÙÚ›· ÙÔ˘ NËÛÈÔ‡. H ÂÎapple·›‰Â˘ÛËÙˆÓ ÓÔÛÔÎfiÌˆÓ ‰È·ÚΛ ¤Ó· ÂÍ¿ÌËÓÔÎ·È ÁÈ· ÙÔÓ ÛÎÔapplefi ·˘Ùfi ‰·apple·ÓÒÓÙ·È 30.000 ‰Ú¯. 20 .H ÂÍ·ÛÊ¿ÏÈÛË ¿ÏψÛÙ Ù˘ ÎÚ·ÙÈ΋˜ ‰·apple¿Ó˘ ÁÈ·ÙËÓ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ appleÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ ÌÔӛ̈ÓAÓÙÈÙÚ·¯ˆÌ·ÙÈÎÒÓ Ù·ıÌÒÓ ¤ÁÈÓ ‰˘Ó·Ù‹ Ì ÙȘ¿ÔÎÓ˜ appleȤÛÂȘ ÙÔ˘ Iˆ·ÎÂ›Ì ÙÚÔ˘Ìapple‹ appleÚÔ˜ ÙÔÓ·ÚÌfi‰ÈÔ YappleÔ˘ÚÁfi KÔÚ˘˙‹ Î·È ÌÂÙ¿ ·applefi ·ÏÏÂapple¿Ï-ÏËÏ· Ù·Í›‰È· ÛÙËÓ Aı‹Ó·.·Ú¿ÏÏËÏ·, Ì appleÏÔ‡ÛÈ· ·ÚıÚÔÁÚ·Ê›· ÛÙÔÓÙÔappleÈÎfi Ù‡appleÔ, Ì ÂappleÈÛÙÔϤ˜ ÙÔ˘ appleÚÔ˜ ÙÔ˘˜ ÔÌÔÁÂÓ›˜ÙÔ˘ Â͈ÙÂÚÈÎÔ‡, Ì ÂȉÈΤ˜ ÂÁ΢ÎÏ›Ô˘˜ ÙÔ˘ appleÚÔ˜ÙÔÓ appleÏËı˘ÛÌfi, appleÚÔÛapple·ı› Ó· ‰È·ÊˆÙ›ÛÂÈ ÙÔÓ Ï·fiÎ·È Ó· ·Ó·˙ËÙ‹ÛÂÈ Î¿ı ‰˘Ó·Ù‹ ‚Ô‹ıÂÈ· ÁÈ· ÙÔÓ·ÁÒÓ·. ŒÓ· ¯·Ú·ÎÙËÚÈÛÙÈÎfi ·applefiÛapple·ÛÌ· ÌÈ·˜ÂÁ΢ÎÏ›Ô˘ ÙÔ˘ appleÚÔ˜ ÙÔ˘˜ ÔÌÔÁÂÓ›˜ Ù˘ N. YfiÚÎË˜Â›Ó·È ‰ËψÙÈÎfi ÙˆÓ ÛΤ„ÂÒÓ ÙÔ˘: ... “Aӷ̤ÓÔÌÂÓÙËÓ Û˘Ó‰ÚÔÌ‹Ó Î·È ÂÓ›Û¯˘ÛÈÓ Î·È ÙˆÓ ÂÓ AÌÂÚÈ΋X›ˆÓ. ¢ÂÓ Ì·˜ ‰È·Ê‡ÁÂÈ fiÙÈ ˙‹Ù ÂȘ ÙËÓ ˘appleÂÚapplefi-ÓÙÈÔÓ XÒÚ·Ó ‚ÈÔapple·Ï·ÈÛÙ·›. AÏÏ¿ Û˘Á¯ÚfiÓˆ˜ ÁÓˆ-Ú›˙ÔÌÂÓ fiÙÈ ‰ÂÓ Û·˜ ·apple¤ÏÈappleÂÓ Ô˘‰¤: Ë Â˘Û¤‚ÂÈ·,Ô˘‰¤ Ë ÊÈÏÔapple·ÙÚ›·, Ô˘‰¤ Ë appleÔÏ˘ıÚ‡ÏËÙÔ˜ Xȷ΋ÊÈÏÔÙÈÌ›·”... (12 OÎÙˆ‚Ú›Ô˘ 1937) 21 .O ÛappleÔ˘‰·›Ô˜ ÓÔÌÈÎfi˜ Î·È ÏfiÁÈÔ˜ Ù˘ ÂappleÔ¯‹˜AϤͷӉÚÔ˜ ·¯Ófi˜ appleÂÚÈÁÚ¿ÊÂÈ Ì ÙÚfiappleÔ appleÂÚÈÂ-ÎÙÈÎfi ÙËÓ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÙÔappleÈ΋˜ EÎÎÏËÛ›·˜...“H EÎÎÏËÛ›· ·ÓÂÌ›¯ıÂÈ ÂÓÂÚÁÒ˜ Î·È fiψ˜ ÂappleÈÙ˘-¯Ò˜ ÂȘ Ù· ηı‹ÎÔÓÙ· Ù˘ ˘Á›·˜ Î·È Ù˘ ÎÔÈÓˆÓÈ-΋˜ appleÚfiÓÔÈ·˜...”T¤ÏÔ˜, ı· appleÚ¤appleÂÈ Ó· ˘appleÔÁÚ·ÌÌ›ÛÔ˘ÌÂ Î·È ÙËÓÛ˘Ì‚ÔÏ‹ ÙˆÓ Â˘applefiÚˆÓ X›ˆÓ, ΢ڛˆ˜ Ù˘ ‰È·ÛappleÔ-Ú¿˜, ÛÙËÓ ÛÙ‹ÚÈÍË ÙˆÓ Â˘·ÁÒÓ È‰Ú˘Ì¿ÙˆÓ ÙÔ˘ ÓË-ÛÈÔ‡, ·ÏÏ¿ Î·È Ù˘ ˘ÁÂÈÔÓÔÌÈ΋˜ ÊÚÔÓÙ›‰·˜ ÙÔ˘appleÏËı˘ÛÌÔ‡. H §ÔÓ‰›ÓÂÈÔ˜ EappleÈÙÚÔapple‹, ÁÈ· apple·Ú¿-‰ÂÈÁÌ·, appleÚÔÛ¤ÊÂÚ ÛËÌ·ÓÙÈο appleÔÛ¿ ÁÈ· ÙÔ˘˜ ÛÎÔappleÔ‡˜·˘ÙÔ‡˜.H Û‡ÛÙ·ÛË ¿ÏψÛÙ Ù˘ EappleÈÙÚÔapple‹˜ AÓÙÈÙÚ·-¯ˆÌ·ÙÈÎÔ‡ AÁÒÓ·, fiappleˆ˜ appleÚԷӷʤڷÌÂ, Î·È Ë ÌÂ-Ù¤appleÂÈÙ· ‰È‡ڢÓÛ‹ Ù˘, Ì ÙËÓ Û˘ÌÌÂÙÔ¯‹ Ì¿ÏÈÛÙ··ÓÒÙÂÚÔ˘ ‰ÈηÛÙÈÎÔ‡, appleÚÔ˚‰Â¿˙ÂÈ Ì¿ÏÏÔÓ ÛÙËӉȷ¯Â›ÚÈÛË ÌÂÁ¿ÏˆÓ appleÔÛÒÓ.¢˘ÛÙ˘¯Ò˜, Ô applefiÏÂÌÔ˜ appleÔ˘ ·ÎÔÏÔ‡ıËÛ ‰È¤ÎÔ-„ fiϘ ·˘Ù¤˜ ÙȘ ÛappleÔ˘‰·›Â˜ appleÚˆÙÔ‚Ô˘Ï›Â˜. ŒıÂ-Û ı¤Ì·Ù· ÂappleÈ‚›ˆÛ˘ ÙÔ˘ appleÏËı˘ÛÌÔ‡ Î·È ¤ÛÙÚ„ÂÙȘ ÊÚÔÓÙ›‰Â˜ fiÏˆÓ ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ‚·ÛÈÎÒÓ·Ó·ÁÎÒÓ. H fiÏË appleÚÔÛapple¿ıÂÈ· ÙÔ˘ ·ÓÙÈÙÚ·¯ˆÌ·ÙÈ-ÎÔ‡ ·ÁÒÓ· ÂÍ·Ûı¤ÓËÛÂ Î·È Î¿appleÔÈ· ÛÙÈÁÌ‹ ۯ‰fiÓÂÎÌˉÂÓ›ÛÙËÎÂ.T· appleÚÒÙ· ÌÂÙ·appleÂÏ¢ıÂÚˆÙÈο ¯ÚfiÓÈ· Ë appleÚÔ-Ûapple¿ıÂÈ· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜ Û˘Ó¯›-ÛÙËÎÂ Î·È ÂÓÙ¿ıËÎÂ. AÓÙÈÙÚ·¯ˆÌ·ÙÈο I·ÙÚ›·ÏÂÈÙÔ‡ÚÁËÛ·Ó ÂappleÈappleϤÔÓ ÛÙ· ¯ˆÚÈ¿ B›ÎÈ, AÌ¿‰Â˜,ÕÁ. °ÂÒÚÁÈÔ˜, K·Ï·ÌˆÙ‹, MÂÛÙ¿, ¢È‰‡Ì·, K·ÏÏÈ-Ì·ÛÈ¿ Î·È ÛÙËÓ applefiÏË Ù˘ X›Ô˘ (ÛÙÔ YÁÂÈÔÓÔÌÈÎfiK¤ÓÙÚÔ) 22 . ÚˆÙÔapplefiÚÔÈ Î·È apple¿ÏÈ ÔÈ ÔÊı·ÏÌ›·ÙÚÔÈÙÔ˘ ÓËÛÈÔ‡ (I. §·ÙÔ˘Û¿Î˘, XÚ. Mapple›ÙÛ·˜), ηıÒ˜Î·È ÙÔ apple·Ú·˚·ÙÚÈÎfi appleÚÔÛˆappleÈÎfi, ηٿÊÂÚ·Ó ÒÛÙÂÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’70 ÙÔ ÙÚ¿¯ˆÌ· ˆ˜ ÂÓ-‰ËÌÈÎfi ÓfiÛËÌ· Ó· ÂÍ·ÏÂÈÊı› ·applefi ÙËÓ X›Ô.BÈ‚ÏÈÔÁÚ·Ê›·1. KÔ˘ÎÔ˘Ú›‰Ë B. §fiÁÔÈ Î·È ¿ÚıÚ·. Aı‹Ó· 1986, Û. 181.2. ·˚‰Ô‡ÛË M. H I·ÙÚÈ΋ ÛÙËÓ X›Ô ηٿ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜·ÈÒÓ˜. X›Ô˜ 2001, Û. 64.

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 2093. ·˚‰Ô‡ÛË M. fiapple. apple. Û. 63-64.4. BÏ. ÂappleÚ·Á̤ӷ ÙˆÓ ºÈÏ·ÓıÚˆappleÈÎÒÓ I‰Ú˘Ì¿ÙˆÓ X›Ô˘Î·Ù¿ ÙÔ ¤ÙÔ˜ 1933, X›Ô˜ 1934.5. BÏ. ºÈÏ·ÓıÚˆappleÈο I‰Ú‡Ì·Ù· applefiψ˜ X›Ô˘, X›Ô˜ 1935.6. Î˘Ï›ÙÛÂÈÔÓ NÔÛÔÎÔÌ›ÔÓ - π·ÙÚÈ΋ ΛÓËÛȘ ÙˆÓ ÂÙÒÓ1908, 1909, 1910 Î·È 1911 Î·È ¤ÎıÂÛȘ appleÂappleÚ·Á̤ӈÓ,ÛԘ 1912, Û. 9, 42-43.7. ÂÚ. ∂ıÓÔÌ¿ÚÙ˘˜ Ï¿ÙˆÓ Ô Ã›Ô˘, ÛԘ 1939, Û. 45.8. ªËÙÚÒÔÓ π·ÙÚÒÓ, O‰ÔÓÙÈ·ÙÚÒÓ Î·È M·ÈÒÓ ¤ÙÔ˜ 1939.AÚ¯. A. Mȯ·ËÏ›‰Ë.9. Mȯ·ËÏ›‰Ë A. Cum Deo, X›Ô˜ 2000, Û. 20.10. X·‚È¿Ú·-K·Ú·¯¿ÏÈÔ˘ . H Ï·˚΋ I·ÙÚÈ΋ Ù˘ X›Ô˘.Aı‹Ó· 1993, Û. 89-90.11. °Ú·appleÙ¤˜ appleÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ appleÚ·ÎÙÈ΋ ·ÓÙÈÌÂÙÒappleÈÛËÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜ ¤¯Ô˘Ì ÁÈ· Ù· ¯ˆÚÈ¿ º˘Ù¿, BÔÏÈÛÛfi,˘ÚÁ›, OχÌappleÔÈ, MÂÛÙ¿, §Èı›, ÕÁ. °ÂÒÚÁÈÔ, ÔÙ·-ÌÈ¿, ÈÛappleÈÏÔ‡ÓÙ·, K·Ù·ÚÚ¿ÎÙË, Î.¿.12. ÂÚ. AÈÁ·›ÔÓ. TÔÌ. A′, Ù‡¯Ô˜ 4, Û. 246-50.13. A˜ ÛËÌÂȈı› appleˆ˜ Ì ÓÔÌÔıÂÙÈ΋ Ú‡ıÌÈÛË ÙÔ˘ 1937, ÔÈÙÚ·¯ˆÌ·Ù›Â˜ appleÔ˘ ‰ÂÓ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÙËÓ Ù·ÎÙÈ΋ ıÂ-Ú·apple›· ÙÔ˘˜ ‹ ÔÈ ÁÔÓ›˜ appleÔ˘ ‰ÂÓ ÂappleÈÌÂÏÔ‡ÓÙÔ Ù˘ ıÂ-Ú·apple›·˜ ÙˆÓ apple·È‰ÈÒÓ ÙÔ˘˜ ‰ÈÒÎÔÓÙÔ appleÔÈÓÈο (N.651/37 “appleÂÚ› ηٷappleÔÏÂÌ‹Ûˆ˜ ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜”).14. ÂÚ. EıÓÔÌ¿ÚÙ˘˜, Î.Ïapple., X›Ô˜ 1936, Û. 200.15. ·˚‰Ô‡ÛË M. fiapple. apple., Û. 44.16. ÂÚ. EıÓÔÌ¿ÚÙ˘˜ Î.Ïapple. X›Ô˜ 1937, Û. 58.17. AÓ·ÌÓËÛÙÈÎfi §Â‡ÎˆÌ· ÙÔ˘ ·Á¯È·ÎÔ‡ ·ÏÏËÏÔ‚ÔËıËÙÈ-ÎÔ‡ Û˘ÏÏfiÁÔ˘ “O KÔÚ·‹˜”. N. YfiÚÎË 1937, Û. 18.18. X·‚È¿Ú·-K·Ú·¯¿ÏÈÔ˘ . XÈÒÙ˜ OÊı·ÏÌ›·ÙÚÔÈ ÛÙÔ ·′ÌÈÛfi ÙÔ˘ ·ÈÒÓ· Ì·˜. ÂÚ. Xȷ΋ EappleÈıÂÒÚËÛË Ù‡¯. 2(1986), ÛÂÏ. 92-96.19. AÚ¯Â›Ô ¢È‡ı˘ÓÛ˘ YÁÈÂÈÓ‹˜ Î·È ¢ËÌ. YÁ›·˜ NÔÌÔ‡ X›-Ô˘ (Ê·Î. “EappleÈÙÚÔapple‹ AÓÙÈÙÚ·¯ˆÌ·ÙÈÎÔ‡ AÁÒÓ·”).20. ÂappleÚ·Á̤ӷ Ù˘ EappleÈÙÚÔapple‹˜ KÔÈÓˆÊÂÏÒÓ ÎÔappleÒÓ ÂÓ ÙËN‹Ûˆ X›ˆ - ÂÙÒÓ 1936-1939. X›Ô˜ 1940, Û. 13.21. AÓ·ÌÓËÛÙÈÎfi §Â‡ÎˆÌ·, fiapple. apple., Û. 10.22. AÚ¯Â›Ô ¢È‡ı˘ÓÛ˘ YÁÈÂÈÓ‹˜ ÎÏapple. (Ê·Î. “Ù¤Á·ÛË AÓÙÈ-ÙÚ·¯ˆÌ·ÙÈÎÒÓ I·ÙÚ›ˆÓ”).

O ÔÊı·ÏÌfi˜ οÙÔappleÙÚÔÓ Ù˘ „˘¯‹˜*. X·Ú·Ì‹˜OÈ ÔÊı·ÏÌÔ›, ȉԇ Ô Î˘ÚÈÒÙÂÚÔ˜ ÙˆÓ ‰ÂÛÌÒÓ,‰È’ ˆÓ Ô ¿ÓıÚˆappleÔ˜ Û˘Ó‰¤ÂÙ·È ÌÂÙ¿ Ù˘ ʇÛˆ˜. TÔappleÚÒÙÈÛÙÔÓ Ù˘ ·ÓÙÈÏ‹„ˆ˜ fiÚÁ·ÓÔÓ, ÙÔ appleÔÏ˘ÙÈÌfi-Ù·ÙÔÓ Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ‰ÒÚÔÓ, Ë ÎÔÚˆÓ›˜ ÙˆÓ ·È-Ûı‹ÛˆÓ.AÍÈÔı·‡Ì·ÛÙÔÓ Ù˘ ‰Ú¿Ûˆ˜ ÙÔ ·ÈÛıËÙ‹ÚÈÔÓ!AÏËıÒ˜ Â›Ó·È ı·˘Ì·ÛÌÔ‡ ·Í›· Ë appleÚfiÓÔÈ· Ù˘º‡Ûˆ˜, ‹ÙȘ fiÚÁ·ÓÔÓ ÙfiÛÔÓ ÏÂappleÙÔÊ˘¤˜ Î·È ÙËÏÈ-η‡Ù˘ ¯ÚËÛÈÌfiÙËÙÔ˜ ÂÙÔappleÔı¤ÙËÛÂÓ ÂÓÙfi˜ ÙÔ˘ Ô-ÛÙ½ÓÔ˘ ÎfiÁ¯Ô˘, ˆ˜ ÂÓ appleÚÔÊ˘Ï·ÎÙÈ΋ apple˘Í›‰È. Oapplefi-Û·˜ Î·È ÔappleÔ›·˜ ηÎÒÛÂȘ ·appleÔʇÁÂÈ Ô ÔÊı·ÏÌfi˜Ô‡Ùˆ appleÚÔ·ÛappleÈ˙fiÌÂÓÔ˜ ÂÓ Ùˆ ÎfiÁ¯ˆ, apple·˜ ÙȘ ÂÓÓÔ›,·Ó Ì¿ÏÈÛÙ· Ï¿‚Ë ˘apple’ fi„ÈÓ, fiÙÈ ÙÔ appleÚfiÛˆappleÔÓ, ·Î¿-Ï˘appleÙÔÓ ÙËÚÔ‡ÌÂÓÔÓ, ‰È·ÙÂÏ› ÂÎÙÂıÂÈ̤ÓÔÓ ‰ÈËÓÂ-ÎÒ˜ ÂȘ Ù·˜ ¤ÍˆıÂÓ apple·ÓÙÔ›·˜ ÂappleÈ‚Ï·‚›˜ Âappleȉڿ-ÛÂȘ.¢ÂÓ ËÚΤÛıË ‰Â ÂȘ ÙÔ‡ÙÔ Î·È ÌfiÓÔÓ Ë º‡ÛȘ,·ÏÏ¿ Î·È Ù· ‚Ϥʷڷ ÌÂÙ¿ ÙˆÓ ‚ÏÂÊ·Ú›‰ˆÓ appleÚÔ˜ÙÂÏÂÈÔÙ¤Ú·Ó appleÚÔ¿ÛappleÈÛÈÓ ÙˆÓ ÔÊı·ÏÌÒÓ ¤ıËÎÂ,Î·È Ù·˜ ÔÊÚ‡˜ ‡appleÂÚıÂÓ ·˘ÙÒÓ ¤Ù·Í appleÚÔ˜ ÙÔÓ ·˘-ÙfiÓ ÛÎÔapplefiÓ. K·È Ë ÏÂappleÙÔÌÂÚÂÛÙ¤Ú· ÙÔ˘ ÔÊı·ÏÌԇηٷÛ΢‹ apple·ÚÈÛÙ¿ ÙÈ ÙÔ Ù¤ÏÂÈÔÓ, fiappleÂÚ Î·È Ô ‰Â-ÍÈÒÙ·ÙÔ˜ ÙˆÓ ·ÚÈÛÙÔÙ¯ÓÒÓ ‰ÂÓ ı· ˉ‡Ó·ÙÔ ÙÂ-¯ÓËÙÒ˜ Ó· ηٷÛ΢¿ÛË.H fiÚ·ÛȘ ÂΛÓËÛ ÙÔÓ ı·˘Ì·ÛÌfiÓ ÙÔ˘ ·ÓıÚÒappleÔ˘·applefi Ù˘ ·appleˆÙ¿Ù˘ ·Ú¯·ÈfiÙËÙÔ˜, Î·È Û‹ÌÂÚÔÓ,fiÙÂ Ë ÂappleÈÛÙ‹ÌË ÂÓ fiÏË ·˘Ù‹˜ ÙË ÌÂÁ·ÏÔappleÚ¤appleÂÈ· ÂÚ-ÌËÓ‡ÂÈ Ù· apple¿ÓÙ· ÌÂÙ’ ·appleԉ›ÍˆÓ, Ë ÏÂÈÙÔ˘ÚÁ›·Ù˘ ÔÚ¿Ûˆ˜ ‹Á·Á ÙÔ˘˜ ÂappleÈÛÙ‹ÌÔÓ·˜ ÂȘ ÙËÓ ‰È·-Ù‡appleˆÛÈÓ ÙˆÓ Î·ÓfiÓˆÓ Ù˘ ÔappleÙÈ΋˜ Î·È ÙËÓ ‰ËÌÈ-Ô˘ÚÁ›·Ó ÔÏÔÎÏ‹ÚÔ˘ ÂappleÈÛÙ‹Ì˘.◊ıÂÏÔÓ apple¤Ú·Ó ÙÔ˘ ‰¤ÔÓÙÔ˜ ÂÎÙ·ı‹, ·Ó ÂappleÂÈ-¯Â›ÚÔ˘Ó Ó· appleÚ·ÁÌ·Ù¢ıÒ Ò‰Â Ù· ηٿ ÙËÓ ÏÂÈ-ÙÔ˘ÚÁ›·Ó Ù˘ ÔÚ¿Ûˆ˜. ¢È· ÙÔ‡ÙÔ Î·È apple·Ú·ÙÚ¤-¯ˆÓ, ÙÔ ÁÂ Ó˘Ó ¤¯ÔÓ, Ù· ηْ ·˘Ù‹Ó, appleÚÔ‚·›Óˆ ÂȘfi,ÙÈ Û¯ÂÙÈÎÒ˜ appleÚÔ˜ ÙËÓ fiÚ·ÛÈÓ Â›Ó و ·Ó·ÁÓÒÛÙËappleÚÔÛÈÙfiÓ Î·È Â˘ÓfiËÙÔÓ. Yapplefi ·ÈÛıËÙÈÎ‹Ó ¤appleÔ„ÈÓ˘apple¿Ú¯ÂÈ fiÚÁ·ÓÔÓ ÙÔ˘ ·ÓıÚˆapple›ÓÔ˘ ÛÒÌ·ÙÔ˜ ˆÚ·ÈfiÙÂÚÔÓÙˆÓ ÔÊı·ÏÌÒÓ; ¢È·ÎÚ›ÓÔ˘ÛÈ ÙÔ˘˜ ÔÊı·Ï-ÌÔ‡˜ ÂȘ ˆÚ·›Ô˘˜ Î·È ÌË ˆÚ·›Ô˘˜. AÏÏ¿ Î·È ÔÈ Ìˈڷ›ÔÈ ÔÊı·ÏÌÔ›, ÔÈ ˘ÁÈ›˜ ÂÓÓÔ›ٷÈ, ÎÚ·ÙÔ‡ÛÈ Ù·Û΋appleÙÚ· Ù˘ ηÏÏÔÓ‹˜ ÂÓ ÙË fiÏË ÙÔ˘ appleÚÔÛÒappleÔ˘‰È·ÌÔÚÊÒÛÂÈ.K·È Ô˘ ÌfiÓÔÓ ˆÚ·›ÔÈ Â›Ó ÔÈ ÔÊı·ÏÌÔ›, ·ÏÏ¿Ù· Ì¿Ï· Û˘Ì‚¿ÏÏÔÓÙ·È Î·È ÂȘ ÙËÓ Î·ÏÏÔÓ‹Ó Î·È¢ڢıÌ›·Ó ÙÔ˘ appleÚÔÛÒappleÔ˘. º·ÓÙ·Ûı‹Ù ÙÔ ˆÚ·Èfi-ÙÂÚÔÓ appleÚfiÛˆappleÔÓ ÌÂÙ¿ Ù˘ ÂÏÏËÓÈ΋˜ ȉ·ÓÈ΋˜ η-Ù·ÙÔÌ‹˜ Î·È Û¯‹Ì·ÙÔ˜ ÚÈÓfi˜ Î·È ÛÙfiÌ·ÙÔ˜ Û˘ÌÌÂ-ÙÚÈÎÔ‡ Î·È Â˘ÁÚ¿ÌÌˆÓ apple·ÚÂÈÒÓ, ÙÔ˘ appleÚÔÛÒappleÔ˘ ‰ÂÙÔ‡ÙÔ˘ ηχ„·Ù ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, Î·È ı· ›‰ËÙÂÙËÓ Î·ÏÏÔÓ‹Ó ÂÍ·Ê·ÓÈ˙Ô̤ÓËÓ. TˆÓ ÔÊı·ÏÌÒÓ ‰ÂÙÔ Î¿ÏÏÔ˜ ÔÊ›ÏÂÙ·È Ô˘ ÌfiÓÔÓ ÂȘ ÙÔ Û¯‹Ì· ·˘ÙÒÓÎ·È ÙËÓ ı¤ÛÈÓ Î·È ÙËÓ Â˘ÁÚ·ÌÌ›·Ó, ·ÏÏ¿ Î·È Ì¿ÏÈ-ÛÙ· ÂȘ ÙËÓ ¤ÎÊÚ·ÛÈÓ. TÈ ‰’ ÂÛÙ› ¤ÎÊÚ·ÛȘ ÔÊı·Ï-ÌÒÓ;OÈ appleÔÈËÙ·› Î·È ÔÈ ÚˆÌ·ÓÙÈÎÔ› appleÔÏÏ·¯Ò˜ ÙËÓ¤ÎÊÚ·ÛÈÓ Ù·‡ÙËÓ ÂÈÎÔÓ›˙Ô˘ÛÈÓ, ¤Î·ÛÙÔ˜ ηٿ ÙÔ‰ÔÎÔ‡Ó, ·Ê’ Ô‡ ¿Ïψ˜ ‰È¿ÊÔÚÔ˜ ›ÓÂ ÙˆÓ ÔÊı·Ï-ÌÒÓ Ë ¤ÎÊÚ·ÛȘ ηٿ Ù·˜ „˘¯Èο˜ ηٷÛÙ¿ÛÂȘ.ŸÙÈ ÔÈ ÔÊı·ÏÌÔ› ›Ó ÙÔ Î¿ÙÔappleÚÔÓ Ù˘ „˘¯‹˜,ÙÔ‡ÙÔ ·appleÂÈÚ¿ÎȘ ÂÚÚ‹ıË.H ÔÚÁ‹ ÂȘ ÙÔ ‚ϤÌÌ· ·appleÂÈÎÔÓ›˙ÂÙ·È, Î·È ÙÔÌ›ÛÔ˜ ÂÓ ·˘ÙÒ ˙ˆÁÚ·Ê›ٷÈ. H ¯·Ú¿ Î·È Ë ıÏ›„Ș,Ë ÙfiÏÌË Î·È ÙÔ ‰¤Ô˜, Ë ·Á·Ó¿ÎÙËÛȘ Î·È Ë appleÚ·fiÙ˘,Ë ·Ó˘appleÔÌÔÓËÛ›· Î·È Ë ÂÁηÚÙ¤ÚËÛȘ, ÙˆÓ ·ÈÛıË-Ì¿ÙˆÓ Ë ·ÁÓfiÙ˘ Î·È Ù· ηÎÔ‡ÚÁ· ¤ÓÛÙÈÎÙ·, ‰È’ȉ›·˜ ÙˆÓ ÔÊı·ÏÌÒÓ ÂÎÊÚ¿Ûˆ˜ ‰È·Ê·›ÓÔÓÙ·È.M‹appleˆ˜ ‰Â ÙˆÓ ÔÊı·ÏÌÒÓ Ë ¤ÎÊÚ·ÛȘ ‰ÂÓappleÚÔ‰›‰ÂÈ Î·È ÙËÓ Â˘Ê˘˝·Ó, Î·È Ù˘ ‰È·ÓÔ›·˜ ÙËÓ·Ó¿appleÙ˘ÍÈÓ Î·È ÙËÓ ÌÈÎÚfiÓÔÈ·Ó Î·È ÙËÓ appleÔÓËÚ›·Ó;AÊ’ ÂÙ¤ÚÔ˘ ‰Â Î·È ÙˆÓ ·ÈÛıËÌ¿ÙˆÓ Ë ·ÁÓfiÙ˘ʷÂÈÓfiٷٷ Âapple› ÙˆÓ ÔÊı·ÏÌÒÓ ·appleÔÙ˘appleÔ‡Ù·È. ŒÓ‚ϤÌÌ· appleÔÏÏ¿ÎȘ apple·ÚËÁÔÚ› appleÏÂÈfiÙÂÚÔÓ apple¿Û˘ÂÎÊÚ¿Ûˆ˜, Î·È Ë Û˘Ìapple¿ıÂÈ·, Ë appleÚ·ÁÌ·ÙÈ΋ ηÈÌË appleÚÔÛappleÔÈËÙ‹, ÂΉËÏÔ‡Ù·È Î·È Î·Ù·Ê·›ÓÂÙ·È ‰È·ÙˆÓ ÔÌÌ¿ÙˆÓ Ì¿ÏÏÔÓ ‹ ‰È· ÙˆÓ ÏfiÁˆÓ. T· ¯Â›ÏË* Αναδημοσίευση από το περιοδικό “Επιστημονική Ηχώ”, Έτος 11ον, Ιούνιος 1924, Τεύχος 6, σελ. 90-92.Το περιοδικό βρέθηκε στο αρχείο του θεσσαλονικιού ποιητή Τάκη Βαρβιτσιώτη και παραχωρήθηκε ευγενικά στην Συντακτική Επιτροπήτης Π.Ο.Ε.OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 210 - 212, 2002 210

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 211‰‡Ó·ÓÙ·È Ó· „¢ÛıÒÛÈÓ, ÔÈ ÔÊı·ÏÌÔ› fï˜ Ô˘‰¤appleÔÙÂ.TȘ ÂÍ ËÌÒÓ ÏËÛÌÔÓ› ÙÔ appleÏ‹Ú˜ ÁÏ˘Î‡ÙËÙÔ˜‚ϤÌÌ· Ù˘ ÌËÙÚfi˜ ·˘ÙÔ‡; AÏÏ¿ Î·È ËÌ›˜ ÔÈ È·ÙÚÔ›appleÔÏÏ¿ÎȘ ‰ÂÓ appleÚԉȉfiÌÂı· ÂÎ Ù˘ ÂÎÊÚ¿Ûˆ˜ ÙˆÓÔÊı·ÏÌÒÓ ‰È· ÙËÓ „˘¯ÈÎ‹Ó ÛÙÂÓÔ¯ˆÚ›·Ó Ì·˜ ÂÎÙ˘ η΋˜ appleÔÚ›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜;E˘ÏfiÁˆ˜ Ô B›ÎÙˆÚ O˘ÁÎÒ ÂοÏÂÈ ÙÔÓ ÔÊı·Ï-ÌfiÓ ı˘Ú›‰· ·ÓˆÁ̤ÓËÓ, ‰È’ ˘ ‚ϤappleÂÈ ÙȘ Ù·˜ ÛΤ-„ÂȘ Ù˘ „˘¯‹˜ Î·È ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. E›Ó ‰Â ¿˘ÏÔ˜ÙˆÓ ÔÊı·ÏÌÒÓ Ë ¤ÎÊÚ·ÛȘ, Î·È ·ÓÂapple›‰ÂÎÙÔ˜ appleÂÚÈ-ÁÚ·Ê‹˜ Î·È apple·Ú·ÛÙ¿Ûˆ˜. K·È fï˜ Â›Ó·È ÙfiÛÔÓÂÌÊ·Ó‹˜ ÂοÛÙÔÙÂ!O‡Î ÔÏ›ÁÔÓ ‰Â Û˘Ì‚¿ÏÏÂÙ·È ÂȘ ÙËÓ ÙÔÈ·‡ÙËÓ ‹ÙÔÈ·‡ÙËÓ ¤ÎÊÚ·ÛÈÓ ÙˆÓ ÔÊı·ÏÌÒÓ Î·È ÙˆÓ ‚ÏÂÊ¿-ÚˆÓ Î·È ÔÊÚ‡ˆÓ ·È ÎÈÓ‹ÛÂȘ, ÂÓÙ‡ıÂÓ ‰Â Î·È ·applefiÙˆÓ ·Ú¯·ÈÔÙ¿ÙˆÓ ¯ÚfiÓˆÓ ‰ÈÂÙ˘appleÒıËÛ·Ó Ê˘ÛÈÔ-ÁÓˆÌÈη› apple·Ú·ÙËÚ‹ÛÂȘ.Yapplefi ÙËÓ ¤appleÔ„ÈÓ Ù·‡ÙËÓ ·ÏËı¤˜ ÂÓÙÚ‡ÊËÌ··appleÔÙÂÏ› Ë ÌÂϤÙË ÙˆÓ ·Ú¯·›ˆÓ EÏÏ‹ÓˆÓ Û˘ÁÁÚ·-ʤˆÓ, ÂÍ ˆÓ ÂappleÈÙÚ·apple‹Ùˆ ËÌ›Ó Ó· ·Ó·Ê¤ÚˆÌÂÓ Â-ÓÙ·‡ı· ÔÏ›Á· ÙÈÓ¿, Û¯ÂÙÈο appleÚÔ˜ ÙÔ ˙‹ÙËÌ· ÙÔ‡ÙÔ.K·È ‰Ë apple·Ú’ OÌ‹Úˆ ÙÔ appleÚÔ˜ Ù· Ôapple›Ûˆ ÙÚ¤appleÂÈÓÙ· fiÌÌ·Ù· ‰ËÏÔ› ÔÙ¤ ÌÂÓ ·‰È·ÊÔÚ›·Ó, ÔÙ¤ ‰Â appleÂÚÈ-ÊÚfiÓËÛÈÓ Î·È ¯·ÈÚÂηΛ·Ó. O‡Ùˆ˜ Ô ÓÂÊÂÏËÁÂÚ¤-Ù˘ Z‡˜ ·‰È·ÊÔÚÒÓ appleÂÚ› ÙˆÓ TÚÒˆÓ “¿ÏÈÓ ÙÚ¤appleÂÈfiÛÛ ʷÂÈÓÒ”. H ‰Â AıËÓ¿ ‰È· Ï›ıÔ˘ ηْ ·˘-¯¤Ó· appleÏ‹Í·Û· ÙÔÓ ÕÚËÓ ÁÂÏ¿ ¯·ÈÚÂηÎÔ‡Û· ηÈappleÚÔ˜ Ù· Ôapple›Ûˆ ÛÙÚ¤ÊÂÈ Ù· fiÌÌ·Ù·.AÈ Âapple› Ù· appleÏ¿ÁÈ· ÎÈÓ‹ÛÂȘ ÙˆÓ ÔÌÌ¿ÙˆÓ ‰¤Ô˜ÛËÌ·›ÓÔ˘ÛÈÓ. O‡Ùˆ Ô TËϤ̷¯Ô˜, ȉÒÓ ÙÔÓ apple·Ù¤Ú··˘ÙÔ‡ O‰˘ÛÛ¤·, ÔÓ Ë AıËÓ¿ fiÌÔÈÔÓ appleÚÔ˜ Ó¤ÔÓ ¿Ó-‰Ú· η٤ÛÙËÛÂÓ, “ÂÙ¤ÚˆÛ ‚¿Ï’ fiÌÌ·Ù· ÊÔ‚Ëı›˜ÌË ıÂfi˜ ›˔.TÔ appleÚÔ˜ ÙÔ Î¿Ùˆ Ó‡ÂÈÓ ‰ËÏÔ› ·È‰Ò Î·È Û¤-‚·˜.TÔ ˘applefi‰Ú· ÔÚ¿Ó ÔÚÁ‹Ó ÂΉËÏÔ›. K·È ‰Ë ÔZ¢˜ ˘applefi‰Ú· ›‰Â ÙÔÓ ÕÚËÓ appleÏËÁ¤ÓÙ· ˘applefi ÙÔ˘¢ÈÔÌ‹‰Ô˘˜.K·È ÙˆÓ ‚ÏÂÊ¿ÚˆÓ ‰Â Î·È ÙˆÓ ÔÊÚ‡ˆÓ ·È ÎÈ-Ó‹ÛÂȘ ‰È¿ÊÔÚ· ‰ËÏÔ‡ÛÈ Û˘Ó·ÈÛı‹Ì·Ù·, ÌÂȉ›·Ì·,χappleËÓ Î·È ¿ÏÏ·.O AÈÛ¯‡ÏÔ˜ ÙËÓ apple·ÚıÂÓÈÎ‹Ó ·È‰Ò apple·Ú¤ÛÙËÛÂϤÁˆÓ: “οو ‚ÏÂÌÌ¿ÙˆÓ Ú¤appleÂÈ ‚ÔÏ‹”. O ‰Â E˘ÚÈapple›‰Ë˜:“·È‰Ò˜ ÂÓ ÔÊı·ÏÌÔ›˜ Á›ÁÓÂÙ·È”.¢È· Ù· ¿ÁÚÈ· ‰Â ÙˆÓ Á˘Ó·ÈÎÒÓ fiÌÌ·Ù· Ô AÈÛ¯‡-ÏÔ˜ ϤÁÂÈ: “ÔÌÌ¿ÙˆÓ ÛÙ¿˙Ô˘ÛÈÓ ·›Ì· ‰ÈÔÊÈϤ˜”.E›appleÔÓ, fiÙÈ ÙˆÓ ÔÊı·ÏÌÒÓ Ë ¤ÎÊÚ·ÛȘ ›Ó·ÓÂapple›‰ÂÎÙÔ˜ appleÂÚÈÁÚ·Ê‹˜ Î·È apple·Ú·ÛÙ¿Ûˆ˜. AÏÏ¿Î·È Ë Ù¤¯ÓË ÂȘ ÙÔ‡ÙÔ Û˘Ó·ÓÙ¿ ÛÎfiappleÂÏÔÓ. H ÁÏ˘appleÙÈ΋ԇÙ ηٿ appleÚÔÛ¤ÁÁÈÛÈÓ Ë‰˘Ó‹ıË appleÔÙ¤ Ó· apple·-Ú·ÛÙ‹ÛË ÙËÓ ¿˘ÏÔÓ ¤ÎÊÚ·ÛÈÓ. Ò˜ ‰Â Ó· apple·Ú·-ÛÙ‹ÛË ·˘Ù‹Ó, ·ÊÔ‡ ¤ÎÊÚ·ÛȘ ÔÊı·ÏÌÒÓ ‰ËÏÔ› ˙ˆ-‹Ó Î·È „˘¯‹˜ ‡apple·ÚÍÈÓ;H ˙ˆÁÚ·ÊÈ΋ ÂÓ ÙÔ‡ÙÔȘ ηÙÒÚıˆÛ ÙË ‚ÔËı›·ÙˆÓ ¯ÚˆÌ¿ÙˆÓ Ó· ˘appleÂÚ‚‹ ÂÓ Ì¤ÚÂÈ ÙÔÓ ÛÎfiappleÂÏÔÓ.AÏÏ’ ÔÈ ÌÂÁ¿ÏÔÈ ˙ˆÁÚ¿ÊÔÈ, ÔÈ ‰˘ÓËı¤ÓÙ˜ Ó’·appleÂÈÎÔÓ›ÛˆÛÈÓ Âapple› ÙˆÓ ÔÊı·ÏÌÒÓ Ù·‡ÙËÓ ‹ ÂΛ-ÓËÓ ÙËÓ ¤ÎÊÚ·ÛÈÓ, ηÙÒÚıˆÛ·Ó ÙÔ‡ÙÔ ¤¯ÔÓÙ˜ Â-ÓÒappleÈÔÓ ·˘ÙÒÓ appleÚˆÙfiÙ˘appleÔÓ ˙ˆÓ Î·È ‰È·ÙÂÏÔ‡Ó ˘applefiÙÔ ÎÚ¿ÙÔ˜ ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ fiappleÂÚ ‹ıÂÏÔÓ Ó· ÂÈ-ÎÔÓ›ÛˆÛÈÓ.O M¤Á·˜ TÈÙÛÈ·Ófi˜, ı¤ÏˆÓ Ó· ˙ˆÁÚ·Ê‹ÛËÙËÓ M·Á‰·ÏËÓ‹Ó ÌÂÙ·ÓÔÔ‡Û·Ó, Ì¿ÙËÓ appleÚÔÛÂapple¿ıÂÈÓ’ ·Ó·Ù˘appleÒÛË Âapple› ÙˆÓ ÔÊı·ÏÌÒÓ Ù˘ ÂÈÎfiÓÔ˜ Ù˘ÌÂÙ·ÓÔ›·˜ ÙÔ ·›ÛıËÌ·Ø ÌfiÓÔÓ ‰Â fiÙ appleÚÔÛ‹ÏıÂÓ·˘ÙÒ Ë ·appleÈÛÙ‹Û·Û· Âڈ̤ÓË ÙÔ˘, ‰ڿͷÙÔ ÙË˜Â˘Î·ÈÚ›·˜ Î·È Â˙ˆÁÚ¿ÊËÛ ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ ÂΛ-Ó˘ ÂȘ ÙÔ appleÚfiÛˆappleÔÓ Ù˘ M·Á‰·ÏËÓ‹˜.K·È Ë ÂÈÎÒÓ ÂΛÓË ÙÔ˘ TÈÙÛÈ·ÓÔ‡ appleÚÔηÏ›ÂÓ IÙ·Ï›· ÙÔÓ ÁÂÓÈÎfiÓ ı·˘Ì·ÛÌfiÓ ‰È· ÙˆÓ ÔÊı·Ï-ÌÒÓ appleÚÔ apple¿ÓÙˆÓ ÙËÓ ¤ÎÊÚ·ÛÈÓ.TÔ ·ÈÛıËÙ‹ÚÈÔÓ Ù˘ ÔÚ¿Ûˆ˜ ›Ó ٤ÏÔ˜ ÙfiÛÔÓappleÔχÙÈÌÔÓ, ÒÛÙ apple¿ÓÙ˜ ۯ‰fiÓ ÔÌÔÏÔÁÔ‡ÛÈÓ, fiÙÈÙ˘ Ù˘ÊÏÒÛˆ˜ ›Ó appleÚÔÙÈÌfiÙÂÚÔ˜ Ô ı¿Ó·ÙÔ˜.“TÔ Á·Ú ÔÚ¿Ó ÙÔ Êˆ˜ ÙÔ˘ HÏ›Ô˘ ˙ËÓ ¤ÛÙÈ”, Ϥ-ÁÂÈ Ô ŸÌËÚÔ˜.¿ÓÙ· ‚‚·›ˆ˜ Ù· ·ÈÛıËÙ‹ÚÈ· ¯Ú‹ÛÈÌ· Ù˘Á-¯¿ÓÔ˘ÛÈ ÙË ˙ˆ‹, ÙÔ Ù˘ ÔÚ¿Ûˆ˜ fï˜ apple¿ÓÙˆÓ˘appleÂÚÙÂÚ› ˆ˜ ¢ÓfiËÙÔÓ.EÓ ÙË ÂÓ Á¤ÓÂÈ ‰Â apple·ıÔÏÔÁ›· ·Û¯¤Ùˆ˜ appleÚÔ˜ÙËÓ ÔÊı·ÏÌÔÏÔÁ›·Ó, ÙÔ Ù˘ ÔÚ¿Ûˆ˜ ·ÈÛıËÙ‹ÚÈÔÓ·appleÔ‚·›ÓÂÈ ¯ÚËÛÈÌÒÙ·ÙÔÓ ÂÓ ÙË ‰È·ÁÓˆÛÙÈ΋. O›·ÓÛËÌ·Û›·Ó ¤¯ÂÈ Ù˘ ›ÚȉԘ ÙÔ ÙÚ‹Ì·, Ë ÎfiÚË, ÂÓ ÙˉȷÁÓÒÛÂÈ appleÏ›ÛÙˆÓ fiÛˆÓ ÓÔÛËÌ¿ÙˆÓ ÙÔ˘ Ó¢ÚÈ-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ‰ÂÓ Â›Ó ·Ó¿ÁÎË Ó· ÙÔÓ›ÛˆÌÂÓ.M‹appleˆ˜ ‰Â ÙÔ˘ ‚˘ıÔ‡ ÙÔ˘ ÔÊı·ÏÌÔ‡ Ë ÔÊı·ÏÌÔ-ÛÎÔappleÈ΋ ÂͤٷÛȘ ›Ó ÔÏÈÁÒÙÂÚÔÓ ÛËÌ·ÓÙÈ΋ ÂÓÙË ‰È·ÁÓÒÛÂÈ ÙÔÛÔ‡ÙˆÓ ÓfiÛˆÓ ÙÔ˘ Ó¢ÚÈÎÔ‡ ηÈÙˆÓ ¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ, ÙÔ˘ ÓÂÊÚÔ‡, fiÁÎˆÓ ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘, ‰È·‚‹ÙÔ˘ Î·È ÏÔÈappleÒÓ;AÏÏ¿ Î·È ÙÔ˘ ‚ϤÌÌ·ÙÔ˜ Ë ¤ÎÊÚ·ÛȘ ‰ÂÓ Â›Ó‰ȷÁÓˆÛÙÈÎÒ˜ ‚·Ú˘Û‹Ì·ÓÙÔ˜; K·È ÙˆÓ ‚ÏÂÊ¿ÚˆÓË Ì‡ÛȘ Î·È Ë ˘apple¤ÚÌÂÙÚÔ˜ ·˘ÙÒÓ ‰È·ÛÙÔÏ‹ Ô˘ ÛÌÈ-ÎÚ¿Ó Î¤ÎÙËÙ·È ÛËÌ·Û›·Ó. K·È Ù˘ ¯ÚÔÈ¿˜ ‰Â ÙÔ˘‚ÔÏ‚Ô‡ Ë ·ÏÏÔ›ˆÛȘ Î·È Ë appleÚÔapple¤ÙÂÈ· ·˘ÙÔ‡, ›ÓÂÛ˘ÌappleÙÒÌ·Ù· Ù· Ì¿Ï· ‚·Ú‡ÓÔÓÙ· ÂÓ ÙË ‰È·ÁÓˆÛÙÈ-΋ appleÏ¿ÛÙÈÁÁÈ.ΔÔ˘ ÔÊı·ÏÌÔ‡ ‰Â Ë apple·ıÔÏÔÁ›· ·appleÔÙÂÏ› ÙÔÓÎÏ¿‰ÔÓ Ù˘ OÊı·ÏÌÔÏÔÁ›·˜, ÎÏ¿‰ÔÓ ¯ÚÔÓÔÏÔÁÔ‡-ÌÂÓÔÓ ·apple’ ·˘Ù‹˜ Ù˘ ·Ú¯‹˜ Ù˘ I·ÙÚÈ΋˜ Î·È XÂÈ-ÚÔ˘ÚÁÈ΋˜, ÂȘ ı·˘Ì·ÛÙ‹Ó ·Ó·¯ı¤ÓÙ· ÙÂÏÂÈfiÙËÙ·

212 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ηٿ ÙÔ˘˜ Óˆ٤ÚÔ˘˜ ¯ÚfiÓÔ˘˜.OÈ È·ÙÚÔ›, ÔÈ Ù˘ ÂappleÈÛÙ‹Ì˘ ¢ÁÂÓ›˜ Ô‡ÙÔÈÛηapple·Ó›˜, ÂÈÚÁ¿ÛıËÛ·Ó Î·È ÂÌfi¯ıËÛ·Ó ÙÂÏÂÛÊfi-Úˆ˜ appleÚÔ˜ appleÚÔ·ÁˆÁ‹Ó ÙÔ˘ ÛappleÔ˘‰·ÈÔÙ¿ÙÔ˘ ÙÔ‡ÙÔ˘ÎÏ¿‰Ô˘, ÙÔ˘ ÔappleÔ›Ô˘ ÛÎÔapplefi˜ ›ÓÂ Ë Û˘ÓÙ‹ÚËÛȘ ÙÔ˘appleÔÏ˘ÙÈÌÔÙ¿ÙÔ˘ ÙˆÓ ‰ÒÚˆÓ Ù˘ ·ÓÛfiÊÔ˘ ¢ËÌÈ-Ô˘ÚÁ›·˜, Ù˘ ÔÚ¿Ûˆ˜. K·È ·applefi Ù˘ ·appleˆÙ¿Ù˘ ·Ú-¯·ÈfiÙËÙÔ˜, Ë ÙˆÓ ÔÊı·ÏÌÒÓ È·ÙÚÈ΋ ÂıˆڋıËÛappleÔ˘‰·ÈÔÙ¿ÙË, Ê·›ÓÂÙ·È ‰Â fiÙÈ Î·È ÁÂÓÓ·ÈfiٷٷËÌ›‚ÔÓÙÔ ÔÈ ıÂÚ·apple‡ÔÓÙ˜ ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜. O‡-Ùˆ ÂÎ ÙÔ˘ ·˘Û·Ó›Ô˘ Ì·Óı¿ÓÔÌÂÓ, fiÙÈ Ô º·Ï‡-ÛÈÔ˜, apple¿Û¯ˆÓ ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ Î·È È·ı›˜ ˘applefi ÙˆÓÈÂÚ¤ˆÓ ÙÔ˘ AÛÎÏËappleÈÔ‡, ÂappleÏ‹ÚˆÛÂÓ ›·ÙÚ· ‰ÈÛ¯ÈÏ›-Ô˘˜ Ûٷًڷ˜ ¯Ú˘ÛÔ‡ ‰È· Ù˘ appleÔÈËÙÚ›·˜ AÓ‡ÙÙË˜Î·È ÈÂÚfiÓ ‰Â Ùˆ AÛÎÏËappleÈÒ ›‰Ú˘ÛÂÓ ÂÓ N·˘apple¿ÎÙˆ.N˘Ó ‰ÂÓ appleÂÚ·ÙÒÓ Ù· ÔÏ›Á· Ù·‡Ù·, ÙÔ‡ÙÔ ı·ÂappleÂı‡ÌÔ˘Ó Ó· ÙÔÓ›Ûˆ ȉȷÈÙ¤Úˆ˜: fiÙÈ Ë OÊı·ÏÌÔ-ÏÔÁ›· ˘appleËÚÂÙ› Î·È Ì¤Á·Ó EıÓÈÎfiÓ ÛÎÔapplefiÓ, ԛԘ›ÓÂ Ë ¿ÛÎËÛȘ ÙÔ˘ ÔÊı·ÏÌÔ‡ Î·È appleÚÔÂÙÔÈÌ·Û›··˘ÙÔ‡ ‰È· apple¿Û·˜ Ù·˜ ·ÓÙÈÍfiÔ˘˜ appleÂÚÈÛÙ¿ÛÂȘ Ù˘·ÙÚ›‰Ô˜.O˘¯› ‚‚·›ˆ˜ ̇ˆapple·˜ Î·È ·Ì‚χˆapple·˜ ηÈÙÚ·¯ˆÌ·ÙÈÎÔ‡˜ ¤¯ÂÈ ·Ó¿ÁÎËÓ Ó· apple·ÚÔ˘ÛÈ¿ÛË Ë·ÙÚ›˜ ηٿ ÙËÓ ÒÚ·Ó Ù˘ ˘appleÂÚ·Ûapple›Ûˆ˜ Ù˘ ÙÈÌ‹˜·˘Ù‹˜, ·ÏÏ¿ §˘ÁÁ›˜ appleÔÏ˘ÔÌÌ¿ÙÔ˘˜. ¢È· ÙÔ‡ÙÔ Ìfi-ÓÔÓ ÂÓ‰Âϯ‹˜ ˘apple¤Ú Ù˘ ÔÚ¿Ûˆ˜ ̤ÚÈÌÓ· ı· ˉ‡-Ó·ÙÔ Ó· ˘appleËÚÂÙ‹ÛÂÈ Ô˘ ÌfiÓÔÓ ÙËÓ EÏÏËÓÈÎ‹Ó EappleÈ-ÛÙ‹ÌËÓ ·ÏÏ¿ Î·È ÙËÓ EÏÏËÓÈÎ‹Ó ·ÙÚ›‰·.

MÂÙÂÎapple·È‰Â˘ÙÈο ı¤Ì·Ù·∂appleÈ̤ÏÂÈ·: ¡. ¢ËÌËÙÚ·ÎÔ‡ÏÈ·˜e-mail: Ôkebe@otenet.gr∏ ¯ÚˆÛÙÈ΋ Trypan blue ÛÙËÓ ÂÁ¯Â›ÚËÛË Ùo˘ ηٷÚÚ¿ÎÙË. ∫. OÈÎoÓoÌ›‰Ë˜∏ ÌÂÁ·Ï‡ÙÂÚË appleÚfiÎÏËÛË ÛÙËÓ ·Ê·›ÚÂÛË ÂÓfi˜Ï¢Îo‡ ηٷÚÚ¿ÎÙË Â›Ó·È Ë ·appleo˘Û›· Ù˘ Úfi‰ÈÓ˘·ÓÙ·‡ÁÂÈ·˜ Ùo˘ ‚˘ıo‡. ∞Ó o ¯ÂÈÚo˘ÚÁfi˜ ÛÎoapple‡ÂÈÓ· appleÚo‚› Û ʷÎoıÚ˘„›· Î·È Ùoappleoı¤ÙËÛË ÂÓ‰o-Ê·Îo‡ ̤۷ ÛÙo Û¿ÎÎo, ÌÈ· ·Î¤Ú·È· η„o˘ÏfiÚ-ÚËÍË Â›Ó·È ·apple·Ú·›ÙËÙË ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ùo˘ Û¿Î-Îo˘. ∞Ó o ¯ÂÈÚo˘ÚÁfi˜ ÛÎoapple‡ÂÈ Ó· appleÚo¯ˆÚ‹ÛÂÈ ÛÂÂ͈appleÂÚÈÊ·ÎÈ΋ ·Ê·›ÚÂÛË Ùo˘ ηٷÚÚ¿ÎÙË ÙfiÙÂÌÈ· can opener η„o˘ÏoÙoÌ‹ Â›Ó·È ·appleo‰ÂÎÙ‹.∏ η„o˘ÏfiÚÚËÍË Û·Ó ¯ÚfiÓo˜ Ù˘ Ê·ÎoıÚ˘-„›·˜ ·appleoÙÂÏ› ÙȘ appleÂÚÈÛÛfiÙÂÚ˜ ÊoÚ¤˜ ÙË ÛËÌ·ÓÙÈ-ÎfiÙÂÚË ¯ÂÈÚo˘ÚÁÈ΋ ‰È·‰Èηۛ·. Δ· ΢ÚÈfiÙÂÚ·appleÏÂoÓÂÎÙ‹Ì·Ù· appleo˘ appleÚo·appleÙo˘Ó ·applefi ÌÈ· ÛˆÛًη„o˘ÏfiÚÚËÍË Â›Ó·È:1. OÈ ¯ÂÈÚÈÛÌo› ÁÈ· ÙËÓ ÂÎÙ¤ÏÂÛ‹ Ù˘, ÂÍ·-ÛÎo‡Ó ÂÏ¿¯ÈÛÙË ‰Ú¿ÛË apple¿Óˆ ÛÙËÓ ˙›ÓÓÂÈo ˙ÒÓË.2. ∂appleÂȉ‹ ‰ÂÓ ˘apple¿Ú¯o˘Ó Ú¿ÎË Ùo˘ appleÚoÛı›o˘appleÂÚÈʷΛo˘ appleo˘ Ó· appleÚoÂͤ¯o˘Ó, ηıfiÛoÓ Ùo ¯Â›Ïo˜Ù˘ η„o˘ÏfiÚÚË͢ Â›Ó·È oÌ·Ïfi, ‰ÂÓ appleÚo·appleÙo˘Ó¯ÂÈÚo˘ÚÁÈο appleÚo‚Ï‹Ì·Ù· ·applefi ·˘Ù¿, ΢ڛˆ˜ ηٿÙËÓ ·Ó·ÚÚfiÊËÛË (appleχÛË) ÙˆÓ Ê·Î·›ˆÓ Ì·˙ÒÓ.3. ∫·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Âapple¤Ì‚·Û˘, o Û¿Î-Îo˜ Ùo˘ appleÂÚÈʷΛo˘ Â›Ó·È Û¯ËÌ·ÙÈṲ̂Óo˜ Î·È Â˘-Ú‡˜. Δo oapple›ÛıÈo appleÂÚÈÊ¿ÎÈo appleÚo‚¿ÏÏÂÈ appleÚo˜ Ù· apple›-Ûˆ, Ì·ÎÚÈ¿ ·applefi Ùo appleÚfiÛıÈo. ∞˘Ùfi ηıÈÛÙ¿ ÙËÓ Â-apple¤Ì‚·ÛË Â˘ÎoÏfiÙÂÚË ÂÓÒ Ù·˘Ùfi¯ÚoÓ· ÌÂÈÒÓÂÈ ÙoÓΛӉ˘Óo ڋ͢ Ùo˘ oappleÈÛı›o˘ appleÂÚÈʷΛo˘.4. OÈ ¯ÂÈÚo˘ÚÁÈÎo› ¯ÂÈÚÈÛÌo› ̤۷ ÛÙo Û¿ÎÎoÙo˘ appleÂÚÈʷΛo˘ Â›Ó·È ·ÛʷϤÛÙÂÚoÈ, ‰ÈfiÙÈ ‰ÂÓ ˘-apple¿Ú¯o˘Ó Û¯›ÛÌ·Ù· ÛÙo appleÚfiÛıÈo appleÂÚÈÊ¿ÎÈo appleo˘ ı·ÌappleoÚo‡Û·Ó Ó· ÂappleÂÎÙ·ıo‡Ó ÛÙo oapple›ÛıÈo.5. ¢È·ÛÊ·Ï›˙ÂÈ ÙËÓ ¤ÓıÂÛË Ùo˘ ÂÓ‰oÊ·Îo‡ÛÙo Û¿ÎÎo Ùo˘ appleÂÚÈʷΛo˘.6.  appleÂÚ›appleÙˆÛË Ú‹Í˘, ¤ÛÙˆ Î·È ÌÂÁ¿Ï˘, Ùo˘oappleÈÛı›o˘ appleÂÚÈʷΛo˘ Ë Ùoappleoı¤ÙËÛË Ùo˘ ÂÓ‰oÊ·-Îo‡ ÛÙoÓ oapple›ÛıÈo ı¿Ï·Ìo (sulcus) ÌappleÚoÛÙ¿ ·applefiÙËÓ Î·„o˘ÏfiÚÚËÍË Â›Ó·È ·ÛÊ·Ï‹˜, ¯ˆÚ›˜ ÙoÓ Î›Ó-‰˘Óo Ó· apple·ÚÂÎÙoappleÈÛı› o Ê·Îfi˜ ÛÙo ˘·ÏoÂȉ¤˜.OÈ ¯ÂÈÚo˘ÚÁo› ¯ÚËÛÈÌoappleo›ËÛ·Ó ‰È¿ÊoÚ˜ ÙÂ-¯ÓÈΤ˜ ÁÈ· Ó· ‚ÂÏÙÈÒÛo˘Ó ÙËÓ Â˘ÎÚ›ÓÂÈ· Ùo˘ appleÚfi-ÛıÈo˘ appleÂÚÈʷΛo˘ Û ·appleo˘Û›· Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜fiappleˆ˜:·) ∏ ¯Ú‹ÛË appleÏ¿ÁÈo˘ ʈÙÈÛÌo‡ ·applefi ¤Ó· ‰Â‡-ÙÂÚo fiÚÁ·Óo, apple.¯. ¤Ó· ۈϋӷ Ì oappleÙÈΤ˜ ›Ó˜.‚) ªÂÁ¿ÏË ÌÂÁ¤ı˘ÓÛË.Á)  appleÂÚÈappleÙÒÛÂȘ appleo˘ ‰È·Óoȯı› Ùo appleÚfiÛıÈoappleÂÚÈÊ¿ÎÈo Î·È o Ï¢Îfi˜ ÊÏoÈfi˜ ÂÌappleo‰›˙ÂÈ ÙËÓ oÚ·-ÙfiÙËÙ·, ÙfiÙ appleÚ¤appleÂÈ Ó· ÛÙ·Ì·Ù‹ÛÂÈ Ë Î·„o˘ÏoÙoÌ‹Î·È Ó· ηı·ÚÈÛÙ› Ùo apple‰›o ›Ù Ì ¯Ú‹ÛË È͈‰oÂ-Ï·ÛÙÈÎo‡ ‹ ÌÂ Û˘Û΢‹ appleχÛ˘-·Ó·ÚÚfiÊËÛ˘ ÁÈ·Ó· ·appleoÌ·ÎÚ˘Óı› o ÊÏoÈfi˜, appleÚoÛ¤¯oÓÙ·˜ Ù·˘Ùfi-¯ÚoÓ· Ó· ÌË ·Ó·ÚÚoÊËı› Ùo appleÚfiÛıÈo appleÂÚÈÊ¿ÎÈo.‰) Δo appleÈo ÌÂÁ¿Ïo ‚‹Ì· appleo˘ ¤ÁÈÓ ÛÙo ¯ÂÈÚÈ-ÛÌfi Ùo˘ appleÚfiÛıÈo˘ appleÂÚÈʷΛo˘, Û ·appleo˘Û›· Úfi‰È-Ó˘ ·ÓÙ·‡ÁÂÈ·˜, Â›Ó·È Ë ¯Ú‹ÛË ¯ÚˆÛÙÈÎÒÓ Ùo˘ appleÂ-ÚÈʷΛo˘. °È· ·˘Ùfi Ùo ÛÎoapplefi ¯ÚËÛÈÌoappleoÈ‹ıËηӉȿÊoÚ˜ o˘Û›Â˜. ∏ ÊÏo˘oÚÂÛνÓË 2% ¯ÚˆÌ·Ù›-˙ÂÈ ·ÛıÂÓÒ˜ ÙËÓ appleÚfiÛıÈ· ÂappleÈÊ¿ÓÂÈ· Ùo˘ appleÂÚÈÊ·-Λo˘ Î·È ¤¯ÂÈ ÈÛ¯˘ÚfiÙÂÚË Û‡Ó‰ÂÛË Ì ÙËÓ ¤Ûˆ ÂappleÈ-Ê¿ÓÂÈ¿ Ùo˘ (ÂappleÈıËÏȷ΋), ·Êo‡ ÂÓÂı› ÌÂÙ¿ ·applefiÌÈÎÚ‹ Ó‡ÍË Ùo˘ appleÚoÛı›o˘ appleÂÚÈʷΛo˘. ∂›Ó·È ·apple·-Ú·›ÙËÙo˜ o ʈÙÈÛÌfi˜ Ì ÌappleÏ Ùo˘ Îo‚·ÏÙ›o˘ ÁÈ· Ó·Á›ÓÂÈ oÚ·Ù‹ Ë ¯ÚˆÛÙÈ΋. Δo ›‰o˜ ·˘Ùfi Ùo˘ ʈÙÈ-ÛÌo‡ Ï›appleÂÈ ·applefi Ù· appleÂÚÈÛÛfiÙÂÚ· ÌÈÎÚoÛÎfiappleÈ·.ÕÏϘ ¯ÚˆÛÙÈΤ˜ fiappleˆ˜ Ùo methylene blue ηÈÙo gentian violet ·appleo‰Â›¯ıËÎ·Ó ÙoÍÈΤ˜ ÁÈ· Ùo ÂÓ-‰oı‹ÏÈo. Δo ·›Ì· Ùo˘ ·ÛıÂÓo‡˜ ¯ÚËÛÈÌoappleoÈ‹ıËÎÂÂapple›Û˘ ÁÈ’ ·˘Ùfi Ùo ÛÎoapplefi (ˆ˜ ¯ÚˆÛÙÈ΋- ·ÈÌo¯Úˆ-Ì·ÙÈÛÌfi˜).oÏϤ˜ ·applefi ÙȘ Ù¯ÓÈΤ˜ ·˘Ù¤˜ Â›Ó·È Û¯ÂÙÈο¯ÚoÓo‚fiÚ˜ Î·È ¿ÏϘ ·appleo‰Â›¯ıËÎ·Ó ÙoÍÈΤ˜ ÁÈ·Ùo ÂÓ‰oı‹ÏÈo Ùo˘ ÎÂÚ·ÙoÂȉo‡˜.ŒÙÛÈ ÙÂÏÂ˘Ù·›· ¯ÚËÛÈÌoappleoÈo‡ÓÙ·È ‰‡o Ӥ˜¯ÚˆÛÙÈΤ˜ Ì ·appleo‰Â‰ÂÈÁ̤ÓË ·ÛÊ¿ÏÂÈ· Î·È ·appleo-OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 213 - 215, 2002 213

214 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÁÈ· ¯ÚÒÛË Ùo˘ appleÚoÛı›o˘ appleÂÚÈÊ·-Λo˘. O Horiguchi Î·È oÈ Û˘ÓÂÚÁ¿Ù˜ Ùo˘ ¤‰ÂÈÍ·ÓfiÙÈ ˘apple¿Ú¯ÂÈ ·ÛÊ¿ÏÂÈ· Ùo˘ ÂÓ‰oıËÏ›o˘ Î·È ·ÛÊ·-Ï‹˜ Ù¯ÓÈ΋ ÁÈ· ÙË ‰È¿Ï˘ÛË, apple·Ú·Û΢‹ Î·È ÂÓ·applefiıÂÛËÙo˘ appleÚ¿ÛÈÓo˘ Ù˘ ÈÓ‰o΢·Ó›Ó˘ (ICG) ÛÙoappleÚfiÛıÈo appleÂÚÈÊ¿ÎÈo. ∏ ¯ÚˆÛÙÈ΋ ·˘Ù‹ ¯ÚËÛÈÌoappleoÈ-‹ıËΠÛÙËÓ Î·Ú‰ÈoÏoÁ›· Î·È ÙËÓ ·ÁÁÂÈoÁÚ·Ê›·Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂȉ‹.O Melles Î·È oÈ Û˘ÓÂÚÁ¿Ù˜ Ùo˘ ÂÊ¿ÚÌoÛ·Ó¤Ó· ¿ÏÏo Û··ÛÌ·, Ùo Trypan blue, appleo˘ Â›Ó·È Âapple›-Û˘ ·ÛʷϤ˜ Î·È ·appleoÙÂÏÂÛÌ·ÙÈÎfi.∏ Ù¯ÓÈ΋ Ùo˘ Melles Î·È ÙˆÓ Û˘ÓÂÚÁ·ÙÒÓ Ùo˘ÁÈ· ÙË ¯Ú‹ÛË Ùo˘ Trypan- blue Â›Ó·È Ë ÂÍ‹˜:– ÙoÌ‹ ÎÂÚ·ÙoÂȉo‡˜ ÛÙo ∫O– ·Ó·ÚÚfiÊËÛË Ùo˘ ˘‰·ÙoÂȉo‡˜ ˘ÁÚo‡– ÂÈÛ·ÁˆÁ‹ ·¤Ú· ÛÙoÓ appleÚfiÛıÈo ı¿Ï·Ìo– ¤Á¯˘ÛË 0,1 ml Trypan- blue (0,1%) Û ڢı-ÌÈÛÙÈÎfi ‰È¿Ï˘Ì· Ì ·apple¢ı›·˜ Âapple·Ê‹ Ì Ùo appleÚfi-ÛıÈo appleÂÚÈÊ¿ÎÈo– appleχÛË Ùo˘ .£. Ì BSS ÁÈ· Ó· ·appleoÌ·ÎÚ˘ÓıÂ›Ë appleÏÂoÓ¿˙o˘Û· ¯ÚˆÛÙÈ΋– ¤Á¯˘ÛË È͈‰oÂÏ·ÛÙÈ΋˜ o˘Û›·˜ ˘„ËÏo‡ ªμ– η„o˘ÏoÙoÌ‹ Ì Ϸ‚›‰· Ë Î·„o˘ÏfiÙoÌo.∏ Ù¯ÓÈ΋ Ùo˘ Horiguchi Î·È ÙˆÓ Û˘ÓÂÚÁ·ÙÒÓÙo˘ ÁÈ· ¯Ú‹ÛË Ùo˘ appleÚ¿ÛÈÓo˘ Ù˘ ÈÓ‰o΢·Ó›Ó˘(πCG) Â›Ó·È Ë ÂÍ‹˜:– appleÚoÂÙoÈÌ·Û›· Ùo˘ ‰È·Ï‡Ì·Ùo˜ Ì 25mg ‰˘o-ÊÈÏoappleoÈË̤Ó˘ ÛÎfiÓ˘ ICG Î·È ¤Ó· ÊÈ·Ï›‰Èo ‰È·-χÙË. ÚoÛı¤Ùo˘Â 0,5 cc ‰È·Ï‡ÙË ÛÙË ÛÎfiÓË Î·È Ùˉȷχo˘ÌÂ. ÚoÛı¤Ùo˘Ì 4,5 cc μSS Plus.ŒÙÛÈÊÙÈ¿¯Óo˘Ì ¤Ó· ‰È¿Ï˘Ì· ÌÂ Û˘ÁΤÓÙÚˆÛË 0,5%Î·È ÔÛ̈ÙÈÎfiÙËÙ· 270 milOsm.– ∂Ó›o˘Ì ÌÈ· ÌÂÁ¿ÏË Ê˘Û·Ï›‰· ·¤Ú· ÛÙoÓ.£. Ì ‰ÈappleÏfi ÛÎoapplefi: appleÚÒÙoÓ Ó· ·appleoʇÁo˘Ì ÙËÓÂapple·Ê‹ Ù˘ ¯ÚˆÛÙÈ΋˜ Ì Ùo ÂÓ‰oı‹ÏÈo Î·È ‰Â‡-ÙÂÚoÓ Ó· ·‰ÂÈ¿Ûo˘Ì ÙÔÓ £ ·applefi Ùo ˘‰·ÙoÂȉ¤˜˘ÁÚfi ÁÈ· Ó· ÂappleÈÙ‡¯o˘Ì ηχÙÂÚË Âapple·Ê‹ Ù˘ ¯Úˆ-ÛÙÈ΋˜ Ì ÙËÓ Î¿„·.– ªÂ Û‡ÚÈÁÁ· appleo˘ ¤¯ÂÈ ‚ÂÏfiÓË 30 G ÂÓ›o˘ÌÂ0,5 cc ¯ÚˆÛÙÈ΋˜ ÁÈ· Ó· ¯ÚˆÌ·Ù›Ûo˘Ì Ùo appleÚfiÛıÈoappleÂÚÈÊ¿ÎÈo.– ∂Ó›o˘Ì È͈‰oÂÏ·ÛÙÈÎfi Î·È oÏoÎÏËÚÒÓo˘-Ì ÙËÓ Î·„o˘ÏoÙoÌ‹.∏ Ù¯ÓÈ΋ ÌappleoÚ› Ó· ‚ÂÏÙȈı› Ì ÙËÓ ¤Á¯˘ÛËÈ͈‰oÂÏ·ÛÙÈÎo‡ ˘„ËÏo‡ ÌoÚÈ·Îo‡ ‚¿Úo˘˜ ÛÙËÓÙoÌ‹ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ·Êo‡ ÂÓÂı› o ·¤Ú·˜. ªÂ·˘Ùfi ÙoÓ ÙÚfiappleo ‰È·ÙËÚÂ›Ù·È o ·¤Ú·˜ Î·È Ë ¯ÚˆÛÙÈ-΋ ÛÙoÓ £.OÈ appleÂÚÈÛÛfiÙÂÚoÈ ¯ÂÈÚo˘ÚÁÔ› ¯ÚËÛÈÌoappleoÈo‡ÓÙo Tryban-blue ÁÈ·Ù› Â›Ó·È ÊıËÓfiÙÂÚo Î·È ÏÈÁfiÙÂÚoÙoÍÈÎfi ·applefi ÙË ¯ÚˆÛÙÈ΋ I.C.G.∞applefi ÌÂϤÙ˜ appleo˘ ¤ÁÈÓ·Ó Î·È ·ÊoÚo‡Û·Ó ÙËÓÙoÍÈÎfiÙËÙ· Ù˘ ¯ÚˆÛÙÈ΋˜ ÛÙo˘˜ ÈÛÙo‡˜ ‰ÂÓ apple·Ú·-ÙËÚ‹ıËΠηÌÈ¿ ÂappleÈappleÏo΋. Δo Δrypan blue 0,1%¤¯ÂÈ ¯ÚËÛÈÌoappleoÈËı› ÎÏÈÓÈο ÁÈ·:1) ΔËÓ ÂͤٷÛË Î·Ù·ÛÙÚoÊ‹˜ ÙˆÓ ÂÓ‰oıËÏÈ·-ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿ ·applefi ·Ê·›ÚÂÛË Î·Ù·ÚÚ¿ÎÙË,¯ˆÚ›˜ Ó· apple·Ú·ÙËÚËıo‡Ó apple·ÚÂÓ¤ÚÁÂȘ Ì apple·-Ú·ÎoÏo‡ıËÛË apple¿Óˆ ·applefi 8 ¤ÙË.2) ∂apple›Û˘ Ë ¯ÚˆÛÙÈ΋ ·˘Ù‹ ¯ÚËÛÈÌoappleoÈ›ٷÈÛ·Ó Úo˘Ù›Ó· ÛÙËÓ ÂͤٷÛË ÂÓ‰oıËÏÈ·ÎÒÓ Î˘ÙÙ¿-ÚˆÓ ÛÙËÓ ÎÂÚ·ÙoappleÏ·ÛÙÈ΋.ÙËÓ oÏÏ·Ó‰È΋ ÙÚ¿appleÂ˙· oÊı·ÏÌÒÓ ¯ÚË-ÛÈÌoappleoÈÂ›Ù·È Ùo Trypan blue ÛÂ Û˘ÁΤÓÙÚˆÛË 0,3%ÁÈ· appleÂÚÈÛÛfiÙÂÚo ·applefi 15 ¯ÚfiÓÈ· Û 32.000 ÎÂÚ·-ÙoÂȉ›˜, ¯ˆÚ›˜ Ó· ·appleo‰Âȯı› ηӤӷ ÛÙoȯ›o ÂÓ-‰oıËÏȷ΋˜ ÙoÍÈÎfiÙËÙ·˜.3) ∏ ‰fiÛË appleo˘ ¯ÚËÛÈÌoappleoÈÂ›Ù·È Â›Ó·È Î·Ù¿10.000 ÊoÚ¤˜ ÌÈÎÚfiÙÂÚË ·applefi ÙË ‰fiÛË appleo˘ ÌappleoÚ›ӷ appleÚoηϤÛÂÈ ÓÂoappleÏ¿ÛÌ·Ù· Û appleÂÈÚ·Ì·Ùfi˙ˆ·Î·È ıˆÚÂ›Ù·È ·applefiÏ˘Ù· ·ÛÊ·Ï‹˜.ŒÙÛÈ Ùo Trypan blue ÛÂ Û˘ÁΤÓÙÚˆÛË 0,1%‰ÂÓ apple·Úo˘ÛÈ¿˙ÂÈ ÙoÍÈ΋ ‰Ú¿ÛË ÛÙo ÂÓ‰oı‹ÏÈo ‹¿ÏÏo˘˜ ÈÛÙo‡˜, ȉȷ›ÙÂÚ· ÂappleÂȉ‹ Ë appleÏÂoÓ¿˙o˘Û·¯ÚˆÛÙÈ΋ ÂÎappleχÓÂÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌoÁ‹ÛÙo appleÂÚÈÊ¿ÎÈo.Δ· appleÏÂoÓÂÎÙ‹Ì·Ù· appleo˘ appleÚo·appleÙo˘Ó ·applefi Ù˯ÚËÛÈÌoappleo›ËÛË Ù˘ ¯ÚˆÛÙÈ΋˜ Δrypan blue ›ӷÈ:·. ∏ ¯ÚÒÛË Ùo˘ appleÂÚÈʷΛo˘ Ì Ùo Trypan blue‚oËı¿ ÙoÓ oÊı·ÏÌo¯ÂÈÚo˘ÚÁfi Ó· ‰ÂÈ Î·Ï‡ÙÂÚ·Ù· fiÚÈ· Ù˘ η„o˘ÏfiÚÚË͢ Û appleÂÚÈappleÙÒÛÂȘ Ï¢-ÎÒÓ Î·Ù·ÚÚ·ÎÙÒÓ, ÌÂÈÒÓoÓÙ·˜ ÙËÓ appleÈı·ÓfiÙËÙ·Âapple¤ÎÙ·Û‹˜ Ù˘ appleÚo˜ ÙËÓ appleÂÚÈʤÚÂÈ· ‹ Ù˘ Ú‹Í˘Ù˘ Ì ÙoÓ ÛÙ˘ÏÂfi Ù˘ Ê·ÎoıÚ˘„›·˜. ŒÙÛÈ o Ìappleω·ÎÙ‡ÏÈo˜ Ùo˘ appleÂÚÈʷΛo˘ Î·È Ùo appleÂÚÈÊÂÚÈÎfi ÙÌ‹-Ì· ÙÔ˘ appleÂÚÈÊ·Î›Ô˘ appleo˘ ‰ÂÓ ¤¯ÂÈ ÂÎÙ·Ì›, ‰È·ÎÚ›-ÓoÓÙ·È Î·ı·Ú¿ ·applefi ÙËÓ ÁÎÚ›˙· ʷη›· Ì¿˙· Ëoappleo›· ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·applefi Ùo ÎÂÓÙÚÈÎfi ÙÌ‹Ì· Ùo˘appleÂÚÈʷΛo˘ appleo˘ ¤¯ÂÈ ÂÎÙ·Ì›.‚. ∂›Ó·È ‡ÎoÏË Î·È ÁÚ‹ÁoÚË ‰È·‰Èηۛ·.Á. ¢ÂÓ ˘apple¿Ú¯ÂÈ ÙoÍÈÎfiÙËÙ· ÛÙo˘˜ ÈÛÙo‡˜ fiappleˆ˜·Ó·Ê¤Ú·Ì apple·Ú·apple¿Óˆ.‰. ŒÓ· ÂappleÈappleÚfiÛıÂÙo appleÏÂoÓ¤ÎÙËÌ· Â›Ó·È Ë Â˘-ÎÚÈÓ‹˜ oÚ·ÙfiÙËÙ· Ùo˘ appleÂÚÈÊÂÚÈÎo‡ ‰·ÎÙ˘Ï›o˘ Ùo˘appleÚfiÛıÈo˘ appleÂÚÈʷΛo˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ê·ÎoıÚ˘„›·˜.μÈ‚ÏÈoÁÚ·Ê›·1. Steinert F.R. The intumescent Cataract. In: L.Buratto R.Oshez, S. Masket. Cataract: Surgery in ComplicatedCases. Slack Thorofare NJ 29-30, 2000.

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 2152. Findl O, Amon ª. Anterior capsulotomy created by radiofrequencyendodiathermy and continuous curvilinearposterior capsu1orhexis in a patient with intumescentcataract and primary capsu1ar fibrosis. Journalof Cataract & Refractive Surgery 24(6): 870-1, 1998.3. Vestavia ∞, Singh R, Desai J. Phacoemulsification of whitemature cataract. Journal of C·t·ract ·nd Refractivesurgery 24(2): 270-7, 1998.4. Agarwala N, Parikh S. Intumescent Cataract Management.In; L. Buratto, R. Oshez ,S. Masket,Cataract incomplicated cases.Slack Thorofare N.J. 32-33, 2000.5. Horiguchi ª, Miyake ∫, Ohta π, Ito À. Straining of the lenscapsule for circular continuous capsulorrhexis in eyeswith white cataract. Archives Oπ Ophthalmology.116(4): 535-7, 1998.6. Bhattacharjee ∫, Bhattacharjee ∏, Goswami BJ, Sarma ƒ.Capsu1orhexis in intumescent Cataract. Journal ofCataract ·nd Refractive Surgery 25(8): 1045-7, 1999.7. Melles R.G, et al. Trypan blue capsule staining to visualizethe capsulorhexis in cataract surgery. J. Cataract RefractSurg 25(1) 7-9, 19998. Gimbel HV, Neuhann Δ. Development, advantages, andmethods of the continuous circular capsulorhexis techinique.J Cataract Refract Surg 16: 31-37, 1990.9. Hoffer KJ, McFarland JE. Intracameral subcapsular fluoresceinstaining for improved visualization during capsulorhexisin hypermature cataracts (letter). J Cataract.Refract Surg 19: 566, 1993.10. Cimetta DJ, Gatti ª, Lobianco G. Haemocoloration ofthe anterior capsule in white cataract CCC.Eur J. ImplantRefract Surg 7: 184-185, 1995.11. Fritz WL. Fluorescein blue, light-assisted capsulorhexisfor mature or hypermature cataract. J Cataract RefractSurg 24: 19-20, 1998.12. Norn MS. Per operative trypan blue Óital staining ofcorneal endothelium; eight years’ follow up. ActaOphthalmol 58: 550-555, 1980.13. Pels ∂, Schuchard À. Organ culture and endothelial evaluationas a preservative method for human corneas.πn: Brightbill FS, ed, Corneal Surgery; Theory,Technique, and Tissue. St Louis, ªO, CV Mosby Co,93-102, 1986.14. Serbel B. Capsulorhexis Enlagement. In: L.Buratto R.Oshez, S. Masket. Cataract Surgery in ComplicatedCases. Slack Thorofare NJ34, 2000.15. Gimbel HV, Willerscheidt AB. What to do with limitedview: The intumescent cataract. J. Cataract RefractSurg 19: 657-661, 1993.

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OÈ Î‡ÚÈoÈ ·˘ÍËÙÈÎo› apple·Ú¿ÁoÓÙ˜ appleo˘ÂÓ¤¯oÓÙ·È ÛÙËÓ apple·ıoÏoÁ›· Ù˘ PVROÈ Î‡ÚȘ Ê¿ÛÂȘ Ùo˘ ΢ÙÙ·ÚÈÎo‡ ÌÂÙ·‚oÏÈ-ÛÌo‡, Ë ‰È·ÊoÚoappleo›ËÛË, Ë ÌÂÙ·Ó¿ÛÙ¢ÛË, o appleoÏ-Ï·appleÏ·ÛÈ·ÛÌfi˜, Ë ·Ó·Á¤ÓÓËÛË fiappleˆ˜ Î·È oÈ ·ÏÏËÏÂappleȉڿÛÂȘÙo˘ ΢ÙÙ¿Úo˘ Ì ÙËÓ ÂÍˆÎ˘ÙÙ¿ÚÈ· ıÂ̤-ÏÈ· o˘Û›· Ú˘ıÌ›˙oÓÙ·È ·applefi ÌÈ· ÌÂÁ¿ÏË oÈÎoÁ¤ÓÂÈ·appleÚˆÙÂ˚ÓÈÎÒÓ ÌoÚ›ˆÓ appleo˘ oÓoÌ¿˙oÓÙ·È ·˘ÍËÙÈÎo›apple·Ú¿ÁoÓÙ˜. oÏÏo› ·applefi ·˘Ùo‡˜ ˘apple¿Ú¯o˘Ó ÛÂ Ê˘-ÛÈoÏoÁÈ΋ ηٿÛÙ·ÛË ÂÓÙfi˜ ‰È·ÊfiÚˆÓ oÊı·ÏÌÈ-ÎÒÓ ÈÛÙÒÓ Î·È appleÈı·ÓÒ˜ Ó· ‰È·‰Ú·Ì·Ù›˙o˘Ó οappleoÈoÚfiÏo ÛÙËÓ apple·ıoÁ¤ÓÂÈ· Ù˘ PVR, ›Ù Ì ÙÚfiappleoÌÂÌoӈ̤Óo ‹ appleÈo appleÈı·ÓfiÓ Ì ÙËÓ ÌoÚÊ‹ Û‡ÓıÂ-ÙˆÓ ‚ÈoÏoÁÈÎÒÓ Û˘Ó‰˘·ÛÌÒÓ Ì ¿ÏÏ· ÌfiÚÈ·.– ∂appleȉÂÚÌÈÎfi˜ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁoÓÙ·˜ (epidermalgrowth factor-EGF).O EGF ÂÓÂÚÁoappleoÈ› ÙoÓ appleoÏÏ·appleÏ·ÛÈ·ÛÌfiappleoÏÏÒÓ ÂappleÈıËÏÈ·ÎÒÓ Î·È ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ. ∂›Ó·È ȉȷ›ÙÂÚ· ‰Ú·ÛÙÈÎfi˜ Âapple› Ùo˘ appleoÏÏ·appleÏ·-ÛÈ·ÛÌo‡ Î·È Ù˘ ÌÂÙ·Ó¿ÛÙ¢Û˘ ÙˆÓ ÌÂÏ·Á¯ÚˆÛÙÈ-ÎÒÓ Î˘ÙÙ¿ÚˆÓ 7 . O EGF ¤¯ÂÈ ‚ÚÂı› ·ÎfiÌË fiÙÈ ¤¯ÂÈ·ÁÁÂÈoÁÂÓÂÙÈΤ˜ ȉÈfiÙËÙ˜, ‰ÈÂÁ›ÚoÓÙ·˜ ÙoÓ appleoÏÏ·-appleÏ·ÛÈ·ÛÌfi ÙˆÓ ÂÓ‰oıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. OÈ ‰Ú¿-ÛÂȘ Ùo˘ apple·Ú¿ÁoÓÙ· ·˘Ùo‡ ÂÓÈÛ¯‡oÓÙ·È ·applefi ÙËÓapple·Úo˘Û›· Ù˘ ıÚoÌ‚›Ó˘ Ùo˘ oÚo‡ ·ÏÏ¿ Î·È ·applefi ÙËÓapple·Úo˘Û›· ¿ÏÏˆÓ ·˘ÍËÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ 8 .– ∞˘ÍËÙÈÎfi˜ apple·Ú¿ÁoÓÙ·˜ ÙˆÓ ·ÈÌoappleÂÙ·Ï›ˆÓ(Platelet-Derived Growth Factor, PDGF]∞˘Ùfi˜ o apple·Ú¿ÁoÓÙ·˜ Â›Ó·È o ΢ÚÈfiÙÂÚo˜ apple·-Ú¿ÁoÓÙ·˜ appleo˘ ˘apple¿Ú¯ÂÈ Ì¤Û· ÛÙoÓ oÚfi Ùo˘ ·›Ì·-Ùo˜9. ÙȘ appleÂÚÈappleÙÒÛÂȘ ·ÈÌoÚÚ·Á›·˜ ÛÙo ˘·Ï҉˜ÛÒÌ· o PDGF ·appleÂÏ¢ıÂÚÒÓÂÙ·È Û ÌÂÁ¿Ï˜ appleo-ÛfiÙËÙ˜, appleÚoÂÚ¯fiÌÂÓo˜ ·applefi Ù· ·ÈÌoappleÂÙ¿ÏÈ·. ∫·Ù’·˘ÙfiÓ ÙoÓ ÙÚfiappleo ÌappleoÚ› Ó· ÂÓÈÛ¯‡ÛÂÈ ÙËÓ ·Ó¿-appleÙ˘ÍË ÈÓoÁÏoÈ·Îo‡ ÈÛÙo‡ ̤۷ ÛÙo ˘·Ï҉˜. ∏ ¤-ÓÂÛË Ùo˘ apple·Ú¿ÁoÓÙ· ·˘Ùo‡ Î·È Ù˘ ÊÈÌappleÚoÓÂÎÙ›-Ó˘ ÛÙo ˘·Ï҉˜ appleÚoÛʤÚÂÙ·È ¿ÏψÛÙÂ Û·Ó ¤Ó·appleoχ ηÏfi appleÂÈÚ·Ì·ÙÈÎfi ÌoÓÙ¤Ïo ÁÈ· ÙoÓ Û¯ËÌ·ÙÈ-ÛÌfi Âapple·ÌÊ/ÎÒÓ ÌÂÌ‚Ú·ÓÒÓ ÙˆÓ oappleo›ˆÓ Ë Û‡Ûapple·-ÛË o‰ËÁ› Û ·appleoÎfiÏÏËÛË Ùo˘ ·ÌÊ/‰o‡˜10 . ∂ÎÙfi˜·applefi Ù· ÈÛ¯˘Ú¿ ÌÈÙoÁÂÓ‹ ÂÚÂı›ÛÌ·Ù· Âapple¿Óˆ ÛÙo˘˜ÈÓo‚Ï¿ÛÙ˜, ÛÙ· Ï›· Ì˘˝Î¿ ·ÙÙ·Ú·, ÛÙ· ·ÙÙ·Ú·Ù˘ ÁÏo›·˜, ÛÙ· ÂappleÈıËÏȷο ·ÙÙ·Ú· Ùo˘ Ê·Îo‡Î·È ÛÙ· ·ÙÙ·Ú· Ùo˘ ÌÂÏ·Á¯Úfio˘ ÂappleÈıËÏ›o˘7-11 , oPDGF Âapple›Û˘ appleÚo¿ÁÂÈ ÙËÓ apple·Ú·ÁˆÁ‹ Ù˘ ÎoÏÏ·-ÁÂÓ¿Û˘12 ·ÏÏ¿ Î·È oÚÈÛÌ¤ÓˆÓ Ù‡appleˆÓ appleÚoÛÙ·-ÁÏ·Ó‰ÈÓÒÓ fiappleˆ˜ Ù˘ PGI2 (appleÚoÛÙ·Î˘ÎÏ›ÓË) ηÈ

218 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Ù˘ PGE2. Œ¯ÂÈ ‰È·appleÈÛÙˆı› fiÙÈ ·ÛΛ Âapple›Û˘ ÛË-Ì·ÓÙÈ΋ ¯ËÌÂÈoÙ·ÎÙÈ΋ ‰Ú¿ÛË Âapple¿Óˆ ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯o˘˜ Î·È È‰È·›ÙÂÚ· ÛÙ· Ì·ÎÚoÊ¿Á·9, ¢ÓoÒ-ÓÙ·˜ apple·Ú¿ÏÏËÏ· ÙËÓ ·appleÂÏ¢ı¤ÚˆÛË ÂÓfi˜ ¿ÏÏo˘ÌÈÙoÁÂÓÔ‡˜ Î·È ·ÁÁÂÈoÁÂÓÂÙÈÎo‡ apple·Ú¿ÁoÓÙ·, Ùo˘·˘ÍËÙÈÎo‡ apple·Ú¿ÁoÓÙ· fiÌoÈo˘ Ì ÙËÓ ÈÓÛo˘Ï›ÓË(insulin-like growth factor) 13-16 . Δo ÌÂÁ·Ï‡ÙÂÚoappleoÛoÛÙfi Ùo˘ apple·Ú¿ÁoÓÙ· ·˘Ùo‡ appleÚo¤Ú¯ÂÙ·È ·applefi ÙoappleÏ¿ÛÌ· ·ÏÏ¿ ˘apple¿Ú¯ÂÈ Âapple›Û˘ Î·È apple·Ú·ÁˆÁ‹ Ù˘o˘Û›·˜ ·˘Ù‹˜ ·applefi ¤ÎÙoapple· ·ÙÙ·Ú·.– O ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁoÓÙ·˜ fiÌoÈo˜ Ì ÙËÓ ÈÓ-Ûo˘Ï›ÓË Ù‡appleo˘ π (insulin-like growth factor type I).O IGF-I Û˘Ó‰¤ÂÙ·È Ì ÂȉÈÎo‡˜ ˘appleo‰o¯Â›˜ appleo˘˘apple¿Ú¯o˘Ó ȉ›ˆ˜ ÛÙ· ÂÓ‰oıËÏȷο ·ÁÁÂȷο ·ÙÙ·-Ú·, ÛÙ· appleÂÚÈ·ÙÙ·Ú· ÙˆÓ ·ÁÁ›ˆÓ Ùo˘ ·ÌÊ/‰o‡˜16·ÏÏ¿ Î·È ÛÙȘ ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ÙˆÓ ÌÂÏ·Á-¯ÚˆÛÙÈÎÒÓ ÂappleÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ 17 . ∂appleȉÚÒÓÙ·˜ÛÙo˘˜ ˘appleo‰o¯Â›˜ ·˘Ùo‡˜ ÂÌÊ·Ó›˙ÂÈ ‰Ú¿ÛË ÌÈÙoÁÂ-ÓÂÙÈ΋ Î·È ¯ËÌÂÈoÙ·ÎÙÈ΋.– OÈ ÈÓo‚Ï·ÛÙÈÎo› ·˘ÍËÙÈÎo› apple·Ú¿ÁoÓÙ˜(FGF).OÈ ‰Ú¿ÛÂȘ ÙˆÓ apple·Ú·ÁfiÓÙˆÓ FGF Âapple› ÙˆÓ΢ÙÙ¿ÚˆÓ-ÛÙfi¯ˆÓ Â›Ó·È appleoÏ˘¿ÚÈı̘: ‰ÈÂÁ›Úo˘ÓÙoÓ appleoÏÏ·appleÏ·ÛÈ·ÛÌfi appleoÏÏÒÓ Î˘ÙÙ¿ÚˆÓ ÌÂÛo‰ÂÚ-Ì·ÙÈ΋˜ ‹ Ó¢ÚoÂÎÙo‰ÂÚÌ·ÙÈ΋˜ appleÚo¤Ï¢Û˘, ÂappleÈ-Ù·¯‡Óo˘Ó ÙËÓ ÈÛÙÈ΋ o˘Ïoappleo›ËÛË, ȉȷ›ÙÂÚ· ÙËÓ ÎÂ-Ú·ÙoÂȉÈ΋, ÂÓÈÛ¯‡o˘Ó ÙËÓ ÎÂÚ·ÙoÂȉÈ΋ ·ÏÏ¿ ηÈÙËÓ ·ÌÊ/‰È΋ ÓÂo·ÁÁÂÈoÁ¤ÓÂÛË Î·È ‰ÈÂÁ›Úo˘Ó Âapple›-Û˘ appleoÏϤ˜ ÂȉÈΤ˜ ΢ÙÙ·ÚÈΤ˜ ÏÂÈÙo˘ÚÁ›Â˜ fiappleˆ˜ ÙoÊ·ÈÓfiÌÂÓo Ù˘ ʈÙoÌÂÙ·ÙÚoapple‹˜ ηıÒ˜ Î·È Ùo ÌÂ-Ù·‚oÏÈÛÌfi ÙˆÓ ÊˆÙÔ¸appleo‰o¯¤ˆÓ. Δ¤Ïo˜, ¤¯o˘Ó ÙËÓÈηÓfiÙËÙ· Ó· ÂappleÈÙ›Óo˘Ó ÙËÓ Û‡ÓıÂÛË ·ÏÏ¿ Î·È Ó·ÙÚoappleoappleoÈo‡Ó ÙËÓ Î·Ù·ÓoÌ‹ ‰È·ÊfiÚˆÓ Û˘ÛÙ·ÙÈÎÒÓÙ˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ ıÂ̤ÏÈ·˜ o˘Û›·˜ fiappleˆ˜ Ù˘ ÂÏ·-ÛÙ›Ó˘, Ùo˘ ÎoÏÏ·ÁfiÓo˘, ÙˆÓ ‚ÏÂÓÓoappleoÏ˘Û·Î¯·ÚÈ-ÙÒÓ, Ù˘ ÊÈÌappleÚoÓÂÎÙ›Ó˘, Ù˘ Ï·ÌÈÓ›Ó˘, ‰ËÏ·‰‹fiÏˆÓ ÂÎÂ›ÓˆÓ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ appleo˘ ‰ËÌÈo˘ÚÁo‡Ó Ùo˘applefiÛÙڈ̷ ÁÈ· ÙoÓ appleoÏÏ·appleÏ·ÛÈ·ÛÌfi Ùo˘ ÈÓoÁÏoÈ-·Îo‡ ÈÛÙo‡ ηٿ ÙËÓ ·Ó¿appleÙ˘ÍË Ù˘ PVR 22-23 .– O apple·Ú¿ÁoÓÙ·˜ TGF-b (Transforming GrowthFactor Beta).O apple·Ú¿ÁoÓÙ·˜ TGF-b Â›Ó·È ·applefi Ùo˘˜ appleϤoÓÂӉȷʤÚoÓÙ˜ apple·Ú¿ÁoÓÙ˜ appleo˘ Ú˘ıÌ›˙o˘Ó ÙËÓ È-ÛÙÈ΋ ·Ó¿appleÙ˘ÍË ‰ÈfiÙÈ ¤¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Û˘Á¯Úfi-Óˆ˜ Î·È Ó· ‰ÈÂÁ›ÚÂÈ Î·È Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙoÓ Î˘ÙÙ·-ÚÈÎfi appleoÏÏ·appleÏ·ÛÈ·ÛÌfi, ·Ó¿ÏoÁ· Ì ÙËÓ Ê‡ÛË Ùo˘Î˘ÙÙ¿Úo˘-ÛÙfi¯o˘ Î·È ÙˆÓ ÂȉÈÎÒÓ Û˘ÓıËÎÒÓ appleo˘ÂappleÈÎÚ·Ùo‡Ó ÛÙoÓ ÂÍˆÎ˘ÙÙ¿ÚÈo ¯ÒÚo, oÈ oappleo›Â˜ ΢-Ú›ˆ˜ ηıoÚ›˙oÓÙ·È ·applefi ÙËÓ Û˘ÁΤÓÙÚˆÛË appleo˘ ¤-¯o˘Ó oÈ ¿ÏÏoÈ ·˘ÍËÙÈÎo› apple·Ú¿ÁoÓÙ˜ ̤۷ Û ·˘ÙfiÓ.O ÌÂÌoӈ̤Óo˜ TGF-b Â›Ó·È ˆ˜ Âapple› Ùo appleÏ›-ÛÙoÓ ÌÈÙoÁÂÓÂÙÈÎfi˜ ÂÓÒ fiÙ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ¿Ï-Ïo˘˜ ·˘ÍËÙÈÎo‡˜ apple·Ú¿ÁoÓÙ˜ ¤¯ÂÈ ÙËÓ ÈηÓfiÙËÙ·Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙoÓ Î˘ÙÙ·ÚÈÎfi appleoÏÏ·appleÏ·ÛÈ·ÛÌfi. OTGF-b Âapple›Û˘ ÂÍ·ÛΛ ÌÈ· ÈÛ¯˘Ú‹ Âapple›‰Ú·ÛË Âapple¿-Óˆ ÛÙËÓ Û‡ÓıÂÛË ÙˆÓ ˘ÏÈÎÒÓ Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ ıÂ-̤ÏÈ·˜ o˘Û›·˜, ‰ÈÂÁ›ÚoÓÙ·˜ ÙËÓ apple·Ú·ÁˆÁ‹ Ùo˘ÎoÏÏ·ÁfiÓo˘, Ù˘ ÊÈÌappleÚoÓÂÎÙ›Ó˘, Ù˘ ÂÏ·ÛÙ›ÓË˜Î·È ÙˆÓ ÁÏ˘Îo˙·ÌÈÓoÁÏ˘Î·ÓÒÓ 25,26 . Δ¤Ïo˜, ¤¯ÂÈ ¯Ë-ÌÂÈoÙ·ÎÙÈΤ˜ ȉÈfiÙËÙ˜ ÛÙ· Ì·ÎÚoÊ¿Á· Î·È Ùo˘˜ÈÓo‚Ï¿ÛÙ˜. ŸÙ·Ó ·˘Ùfi˜ o apple·Ú¿ÁoÓÙ·˜ ¯oÚËÁËı›ÂÓ‰o¸·ÏoÂȉÈο Ì·˙› Ì ÙËÓ ÊÈÌappleÚoÓÂÎÙ›ÓË Û appleÂÈ-Ú·Ì·ÙÈÎfi Âapple›apple‰o o‰ËÁ› Û ÂÏÎÙÈ΋ ·appleoÎfiÏÏËÛËÙo˘ ·ÌÊ/‰o‡˜.2.1. O ÚfiÏo˜ ÙˆÓ ·˘ÍËÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ ÛÙËÓ‰ËÌÈo˘ÚÁ›· Ù˘ PVR∏ ·Ó¿appleÙ˘ÍË Ù˘ PVR appleÂÚÓ¿ÂÈ ·applefi 3 ‰È·‰o¯È-Τ˜ Ê¿ÛÂȘ oÈ oappleo›Â˜ ›ӷÈ: Ë ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ΢ÙÙ¿ÚˆÓ-ÛÙfi¯ˆÓ, o appleoÏÏ·appleÏ·ÛÈ·ÛÌfi˜ Ùo˘˜ ηȷÎoÏo‡ıˆ˜ Ë Û‡Ûapple·ÛË ÙˆÓ ÓÂoÛ¯ËÌ·ÙÈ˙oÌ¤ÓˆÓ È-ÛÙÒÓ appleo˘ o‰ËÁ› ÛÙËÓ ·appleoÎfiÏÏËÛË Ùo˘ ·ÌÊ/‰o‡˜.OÈ ‰È·ÊoÚÂÙÈÎo› ·˘ÍËÙÈÎo› apple·Ú¿ÁoÓÙ˜ appleo˘ appleÚo-¤Ú¯oÓÙ·È ·applefi ÙoÓ ·ÌÊ/‰‹ ‹ ÙoÓ oÚfi Ùo˘ ·›Ì·Ùo˜‰È·‰Ú·Ì·Ù›˙o˘Ó ‰È·ÊoÚÂÙÈÎfi ÚfiÏo Û οı ̛··applefi ÙȘ Ê¿ÛÂȘ ·˘Ù¤˜.∞) º¿ÛË Ù˘ ÌÂÙ·Ó¿ÛÙ¢Û˘.∏ ¤Ó·ÚÍË Ù˘ PVR ÍÂÎÈÓ¿ Ì ÙËÓ ÌÂÙ·Ó¿-ÛÙ¢ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ª.∂ Ùo˘ ·ÌÊ/‰o‡˜ Ù·oappleo›· Û ÌÈ· ·appleoÎfiÏÏËÛË Ùo˘ ·ÌÊ/‰o‡˜ ·appleoÛappleÒ-ÓÙ·È ·applefi ÙËÓ ‚·ÛÈ΋ Ùo˘˜ ÌÂÌ‚Ú¿ÓË Î·È ·Êo‡ Â-χıÂÚ· ÎÈÓËıo‡Ó ÛÙoÓ ˘appleo·ÌÊ/‰ÈÎfi ¯ÒÚo ‰È·Ì¤-Ûo˘ Ù˘ ÚˆÁÌ‹˜ ÂÈÛ¤Ú¯oÓÙ·È ÛÙËÓ ˘·ÏoÂȉÈ΋ ÎoÈ-ÏfiÙËÙ·. ∏ ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ª.∂ÍÂÎÈÓ¿ ·applefi ÙoÓ ·appleo¯ˆÚÈÛÌfi Ùo˘˜ ·applefi ÙËÓ ‚·ÛÈ΋ÌÂÌ‚Ú¿ÓË Ùo˘ ÂappleÈıËÏ›o˘ ÏfiÁˆ Ù˘ ÂÓÂÚÁoappleo›ËÛ˘ÂÓfi˜ ÂÓ˙‡Ìo˘ Ùo oappleo›o ˘apple¿Ú¯ÂÈ ÛÙoÓ ·ÌÊ/‰‹ Ùo˘ È-ÛÙÈÎo‡ ÂÓÂÚÁoappleoÈËÙ‹ Ùo˘ appleÏ·ÛÌÈÓoÁfiÓo˘ (Δissue-Plasminogen Activator, tPA). A˘Ù‹ Ë appleÚˆÙ½ÓË ‰È-·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏo ÛÙËÓ ·ÈÌfiÛÙ·ÛË Î·Èȉȷ›ÙÂÚ· ÛÙËÓ ÈÓˆ‰oÁÔÓfiÏ˘ÛË ÂÓÒ apple·Ú¿ÏÏËÏ· ¤-¯ÂÈ Î·È ÌÈ· appleÚˆÙÂoÏ˘ÙÈ΋ ‰Ú¿ÛË ÛÙo˘˜ ÈÛÙo‡˜ appleo˘appleÂÚÈ‚¿ÏÏo˘Ó Ùo ·ÙÙ·Úo, ¢ÓoÒÓÙ·˜ ¤ÙÛÈ ÙËÓ Î˘Ù-Ù·ÚÈ΋ ÌÂÙ·Ó¿ÛÙ¢ÛË. ªÂÙ·ÙÚ¤appleÂÈ appleÚ¿ÁÌ·ÙÈ ÙoappleÏ·ÛÌÈÓoÁfiÓo Ùo˘ oÚo‡ Û appleÏ·ÛÌ›ÓË, Ë oappleo›· ÌÂÙËÓ ÛÂÈÚ¿ Ù˘ ÂÓÂÚÁoappleoÈ› ÙȘ ÎoÏÏ·ÁÂÓ¿Û˜27 . Oapple·Ú¿ÁoÓÙ·˜ tPA apple·Ú¿ÁÂÙ·È ·applefi Ù· ·ÁÁÂȷο ÙoÈ-¯ÒÌ·Ù· ÂÓÒ Ë ¤ÎÎÚÈÛ‹ Ùo˘ ÂÓÈÛ¯‡ÂÙ·È ·applefi ÙËÓapple·Úo˘Û›· oÚÈÛÌ¤ÓˆÓ ·˘ÍËÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ fiappleˆ˜o EGF ‹ o IGF-I. O apple·Ú¿ÁoÓÙ·˜ tPA ÂÓÙfi˜Ùo˘ ˘·ÏoÂȉo‡˜ Û ·ÛıÂÓ›˜ Ì PVR ˘apple¿Ú¯ÂÈ ÛÂÛ˘ÁΤÓÙÚˆÛË 3 ÊoÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·applefi ·˘Ù‹ ÛÙoÓoÚfi Ùo˘ ·›Ì·Ùo˜, ÁÂÁoÓfi˜ appleo˘ ÛËÌ·›ÓÂÈ fiÙÈ ÂÎÙfi˜·applefi ÙËÓ ·appleÏ‹ apple·ıËÙÈ΋ ‰›o‰o ÏfiÁˆ ‰È¿Ûapple·Û˘ Ùo˘·ÈÌ·Ùo·ÌÊÈ‚ÏËÛÙÚoÂȉÈÎo‡ ÊÚ·ÁÌo‡ ˘apple¿Ú¯ÂÈ Î·ÈÂÓÂÚÁfi˜ apple·Ú·ÁˆÁ‹ Ùo˘ apple·Ú¿ÁoÓÙ· ·˘Ùo‡ Û ÙoappleÈ-Îfi Âapple›apple‰o. H ÂÓ˙˘Ì·ÙÈ΋ χÛË ÙˆÓ ‰È·ÊfiÚˆÓ Û˘-

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 219ÛÙ·ÙÈÎÒÓ Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ ıÂ̤ÏÈ·˜ o˘Û›·˜ ÂappleÈ-ÙÚ¤appleÂÈ ÙËÓ ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·ÏÏ¿fï˜ ÂÏ¢ıÂÚÒÓÂÈ Î·È ·˘ÍËÙÈÎo‡˜ apple·Ú¿ÁoÓÙ˜ fiappleˆ˜Î˘Ú›ˆ˜ ÙoÓ FGF, oÈ oappleo›oÈ ÌappleoÚo‡Ó Ó· ‰Ú¿-Ûo˘Ó Î·È ÌÈÙoÁÂÓÂÙÈο ·ÏÏ¿ Î·È ¯ËÌÂÈoÙ·ÎÙÈο 28 .ŸÙ·Ó Ù· ·ÙÙ·Ú· Ùo˘ ª.∂ Ùo˘ ·ÌÊ/‰o‡˜ ·appleÂ-Ï¢ıÂÚˆıo‡Ó ·applefi ÙËÓ ‚·ÛÈ΋ Ùo˘˜ ÌÂÌ‚Ú¿ÓË, ÌÂÙËÓ ¯ËÌÂÈoÙ·ÎÙÈ΋ ‰Ú¿ÛË oÚÈÛÌ¤ÓˆÓ ‚ÈoÏoÁÈÎÒÓapple·Ú·ÁfiÓÙˆÓ ÌÂÙ·Ó·ÛÙ‡o˘Ó ÛÙo ˘appleo·ÌÊ/‰ÈÎfi ˘-ÁÚfi. OÚÈṲ̂ÓoÈ ·applefi ·˘Ùo‡˜ Ùo˘˜ ‚ÈoÏoÁÈÎo‡˜ apple·-Ú¿ÁoÓÙ˜ Â›Ó·È appleÈı·ÓÒ˜ appleÂÚÈÛÛfiÙÂÚo ηıoÚÈÛÙÈÎo›·apple’ fi,ÙÈ ¿ÏÏoÈ Î·È ·˘Ùfi ÈÛ¯‡ÂÈ È‰È·›ÙÂÚ· ÁÈ· ÙoÓPDGF Î·È ÙËÓ ÊÈÌappleÚoÓÂÎÙ›ÓË appleo˘ ·Ó¢ڛÛÎoÓÙ·ÈÛ ÌÂÁ¿Ï˜ appleoÛfiÙËÙ˜ ÂÓÙfi˜ Ùo˘ ˘·ÏoÂȉo‡˜ ·ÛıÂ-ÓÒÓ Ì PVR 8, 3-35 . O apple·Ú¿ÁoÓÙ·˜ Âapple›Û˘ IGF-I ¤¯ÂÈÂapple›Û˘ ÈÛ¯˘Ú‹ ¯ËÌÂÈoÙ·ÎÙÈ΋ ‰Ú¿ÛË Âapple¿Óˆ Ûٷ·ÙÙ·Ú· Ùo˘ ª.∂ Î·È ÂÓÂÚÁoappleoÈ› Û’ ·˘Ù¿ Ù· ·ÙÙ·-Ú· ÙoÓ ÈÛÙÈÎfi ÂÓÂÚÁoappleoÈËÙ‹ Ùo˘ appleÏ·ÛÌÈÓoÁfiÓo˘29 .OÈ apple·Ú¿ÁoÓÙ˜ PDGF Î·È IGF-I η٤¯o˘Ó Âapple›ÛË˜Î·È ¯ËÌÂÈoÙ·ÎÙÈΤ˜ ȉÈfiÙËÙ˜ Î·È ÁÈ· ¿ÏÏ· ·ÙÙ·Ú·appleo˘ ÂÌappleϤÎoÓÙ·È ÛÙËÓ apple·ıoÁ¤ÓÂÈ· Ù˘ PVR, fiappleˆ˜Ù· ·ÛÙÚo·ÙÙ·Ú·9,29-31 Î·È Ùo˘˜ ÈÓo‚Ï¿ÛÙ˜9,33 .μ) º¿ÛË Ùo˘ appleoÏÏ·appleÏ·ÛÈ·ÛÌo‡.∏ Ê¿ÛË Ùo˘ appleoÏÏ·appleÏ·ÛÈ·ÛÌo‡ Û ۯ¤ÛË Ì ÙËÓÊ¿ÛË Ù˘ ÌÂÙ·Ó¿ÛÙ¢Û˘ ‰ÈÂÁ›ÚÂÙ·È ·applefi appleÂÚÈÛÛfi-ÙÂÚo˘˜ ·˘ÍËÙÈÎo‡˜ apple·Ú¿ÁoÓÙ˜. ŸÙ·Ó oÈ apple·Ú¿ÁoÓÙ˜FGF ·ÏÏ¿ Î·È o EGF ¯ÚËÛÈÌoappleoÈo‡ÓÙ·È ÌÂÌoӈ̤ӷÁ›ÓÂÙ·È Ê·ÓÂÚ‹ Ë ¤ÓÙoÓË ‰Ú¿ÛË Ùo˘˜ ÛÙoÓ appleoÏÏ·appleÏ·-ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ª.∂ ÂÓÒ o PDGF Î·È oIGF-I fiappleˆ˜ Î·È Ë ÈÓÛo˘Ï›ÓË Ê·›ÓÂÙ·È fiÙÈ ÂÍ·ÛÎo‡ÓÏÈÁfiÙÂÚË Âapple·ÁˆÁ‹ Û’ ·˘Ù‹ ÙË Ê¿ÛË 34-56 . O Û˘Ó‰˘·-ÛÌfi˜ appleoÏÏÒÓ ·applefi ·˘Ùo‡˜ Ùo˘˜ apple·Ú¿ÁoÓÙ˜ ·ÚÎÂÙ¿Û˘¯Ó¿ o‰ËÁ› Û ÌÈ· ηı·Ú‹ Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË Âapple¿-Óˆ ÛÙoÓ appleoÏÏ·appleÏ·ÛÈ·ÛÌfi ÙˆÓ ÂappleÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿-ÚˆÓ, ‰›ÓoÓÙ·˜ ¤Ó· appleÂÚÈÛÛfiÙÂÚo ¤ÓÙoÓo ÂÚ¤ıÈÛÌ· ÁÈ·appleoÏÏ·appleÏ·ÛÈ·ÛÌfi 35 . ∏ ıÚoÌ‚›ÓË Ë oappleo›· ˘apple¿Ú¯ÂÈÛÙoÓ oÚfi ˘applefi ÙËÓ ÌoÚÊ‹ Ù˘ appleÚoıÚoÌ‚›Ó˘ ›ӷÈoÌo›ˆ˜ ¤ÓÙoÓ· ÌÈÙoÁÂÓ‹˜ o˘Û›· ÁÈ· Ù· ·ÙÙ·Ú· Ùo˘ª.∂, Ùo˘˜ ÈÓo‚Ï¿ÛÙ˜ Î·È Ù· ÁÏoȷο ·ÌÊ/‰Èο ·Ù-Ù·Ú·, ȉȷ›ÙÂÚ· fiÙ·Ó ·˘Ù‹ Û˘Ó‰˘¿˙ÂÙ·È Ì‰ȿÊoÚo˘˜ ·˘ÍËÙÈÎo‡˜ apple·Ú¿ÁoÓÙ˜37,38 . ∞ÓÙÈı¤Ùˆ˜, oTGF-b ‰ÂÓ ¤¯ÂÈ ‰Ú¿ÛË Âapple¿Óˆ ÛÙoÓ appleoÏÏ·appleÏ·ÛÈ·ÛÌfiÙˆÓ Î˘ÙÙ¿ÚˆÓ, ·Ó·ÛÙ¤ÏÏÂÈ fï˜ ÙËÓ ‰Ú¿ÛË ÙˆÓ ¿Ï-ÏˆÓ ·˘ÍËÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ 37 . Δo appleoÈo˜ Â›Ó·È oappleÚ·ÁÌ·ÙÈÎfi˜ ÚfiÏo˜ ·˘Ùo‡ Ùo˘ apple·Ú¿ÁoÓÙ· Â›Ó·È ı¤Ì·appleoÏÏÒÓ Û˘ÍËÙ‹ÛˆÓ.°) ‡Ûapple·ÛË ÙˆÓ appleÚo·ÌÊ/‰ÈÎÒÓ ÈÛÙÒÓ.Δ· ·ÙÙ·Ú· Ùo˘ ª.∂ fiÙ·Ó ¤Ú¯oÓÙ·È Û Âapple·Ê‹Ì Ùo ÎoÏÏ·ÁfiÓo ÁÚ‹ÁoÚ· ·Ó·appleÙ‡ÛÛo˘Ó ¤Ó· Ì˯·-ÓÈÛÌfi Û‡Ûapple·Û˘ ÙˆÓ ÈÓȉ›ˆÓ Ùo˘˜. Δ· ·ÙÙ·Ú·,appleÚ¿ÁÌ·ÙÈ, Ì ÙËÓ ‚o‹ıÂÈ· „¢‰oappleo‰›ˆÓ Î·È ÙËӉȷÌÂÛoÏ¿‚ËÛË Ù˘ ÊÈÌappleÚoÓÂÎÙ›Ó˘, Û˘Ó‰¤oÓÙ·ÈÌ Ùo ÎoÏÏ·ÁfiÓo Î·È appleÚoo‰Â˘ÙÈο ¤ÏÎÔ˘Ó Ù· ÈÓ›-‰È¿ Ùo˘ Ì ÌÈ· Ù·¯‡ÙËÙ· ¤ˆ˜ Ù· 2,5 Ìm/min, ‰ËÏ·-‰‹ ÎoÓÙ¿ ÛÙ· 4 mm/24h .2.2. Úo¤Ï¢ÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·˘ÍËÙÈÎÒÓ apple·-Ú·ÁfiÓÙˆÓ.OÈ ‰È¿ÊoÚoÈ ‚ÈoÏoÁÈÎo› ÌÂÛoÏ·‚ËÙ¤˜ ˘apple‡ı˘-ÓoÈ ÁÈ· ÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÙ·Ó¿ÛÙ¢ÛË Î·È ÙoÓ appleoÏ-Ï·appleÏ·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ (ª.∂, ÁÏoȷο ·Ù-Ù·Ú·, Î.¿) appleÚo¤Ú¯oÓÙ·È ·applefi ‰È¿ÊoÚ˜ appleËÁ¤˜ oÈ o-appleo›Â˜ ÌappleoÚ› Ó· Â›Ó·È Î·È Û˘ÌappleÏËڈ̷ÙÈΤ˜ ÌÂÙ·-͇ Ùo˘˜.1) O ·ÌÊÈ‚ÏËÛÙÚoÂȉ‹˜ Â›Ó·È ·ÚÎÂÙ¿ appleÏo‡-ÛÈo˜ Û ·˘ÍËÙÈÎo‡˜ apple·Ú¿ÁoÓÙ˜, ȉȷ›ÙÂÚ· ÛÙo˘˜FGF & TGF-b, oÈ oappleo›oÈ ÁÂÓÈÎfiÙÂÚ· ¤¯o˘Ó ÌÈ· ¤-ÓÙoÓË ÌÈÙoÁÂÓ‹ ‰Ú¿ÛË Âapple¿Óˆ ÛÙ· ·ÙÙ·Ú· Ùo˘ª.∂ Î·È ÛÙ· ·ÌÊ/ο ·ÛÙÚo·ÙÙ·Ú·18,19,21,32 . ∂apple›-Û˘ o ·ÌÊ/‰‹˜ appleÂÚȤ¯ÂÈ ‰È¿ÊoÚo˘˜ Ó¢Úo‰È·‚È‚·-ÛÙ¤˜ oÈ oappleo›oÈ Â›Ó·È ÈηÓo› Ó· ‰ÈÂÁ›Úo˘Ó ÙoÓ appleoÏ-Ï·appleÏ·ÛÈ·ÛÌfi ÙˆÓ ÁÏoÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ·ÌÊ/‰o‡˜39 , fiappleˆ˜ Î·È ÙËÓ ÂÓÂÚÁoappleo›ËÛË appleÚˆÙÂoÏ˘ÙÈ-ÎÒÓ ÂÓ˙‡ÌˆÓ fiappleˆ˜ Ùo tPA 26 .2) O oÚfi˜ Ùo˘ ·›Ì·Ùo˜ Î·È Ù· ¤ÌÌoÚÊ· ÛÙoȯ›·Ùo˘ ·›Ì·Ùo˜ ·appleoÙÂÏo‡Ó ÌÈ· ‰Â‡ÙÂÚË appleËÁ‹. ∏ appleËÁ‹·˘Ù‹ Â›Ó·È appleÏo‡ÛÈ· Û PDGF, EGF, TGF-b ηÈıÚoÌ‚›ÓË Î·ıÒ˜ Î·È Û appleÚˆÙ½Ó˜ Ùo˘ oÚo‡ fiappleˆ˜ ÙËÊÈÌappleÚoÓÂÎÙ›ÓË ‹ Ùo tƒ∞, oÈ oappleo›Â˜ ¢Óoo‡Ó ÙËÓ Î˘Ù-Ù·ÚÈ΋ ÌÂÙ·Ó¿ÛÙ¢ÛË Î·È ÙËÓ Âapple·ÁˆÁ‹ ÊÏÂÁÌoÓˆ-‰ÒÓ ·ÓÙȉڿÛˆÓ. ŸÏ· ·˘Ù¿ Ù· ‰È·ÊoÚÂÙÈο ÛÙoÈ-¯Â›· ÌappleoÚo‡Ó Ó· ‰ÈÂÈÛ‰‡Ûo˘Ó ÂÓÙfi˜ Ùo˘ oÊı·ÏÌo‡Û ÌÈ· appleÂÚ›appleÙˆÛË ÂÓ‰o¸·ÏoÂȉÈ΋˜ ·ÈÌoÚÚ·Á›·˜.∞ÎfiÌ· Î·È ÌÂÙ¿ ·applefi ÌÈ· ÂappleÈÙ˘¯‹ Âapple¤Ì‚·ÛË ·appleoÎfiÏ-ÏËÛ˘ Ùo˘ ·ÌÊ/‰o‡˜ o ·ÈÌ·Ùo·ÌÊ/ÈÎfi˜ ÊÚ·ÁÌfi˜Âapple·Ó¤Ú¯ÂÙ·È ÛÙo Ê˘ÛÈoÏoÁÈÎfi ÌÂÙ¿ ·applefi 2 Ì‹Ó˜ appleÂ-Ú›appleo˘. ∞applefi ÌÂÙÚ‹ÛÂȘ appleo˘ ¤¯o˘Ó Á›ÓÂÈ ÛÙo ˘·Ï҉˜¤¯ÂÈ ‚ÚÂı› ·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ·1-·ÓÙÈıÚ˘„›Ó˘,Ù˘ ·1-fiÍÈÓ˘ ÁÏ˘ÎoappleÚˆÙ½Ó˘, Ù˘ ·Ï-‚o˘Ì›Ó˘, Ù˘ ÙÚ·ÓÛÊÂÚ›Ó˘ Î·È ÙˆÓ ·ÓÙÈۈ̿وÓπgG. ∏ ÙÚ·ÓÛÊÂÚ›ÓË appleÈı·ÓfiÓ Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙoÓappleoÏÏ·appleÏ·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ apple·Ú¤¯oÓÙ·˜ ÈfiÓÙ·Ûȉ‹Úo˘ ÁÈ· ÙËÓ ‰ÈÂÚÁ·Û›· Ù˘ ̛وÛ˘. ∞applefi appleÂÈÚ·-Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤¯ÂÈ ·appleo‰Âȯı› fiÙÈ Ù· ·ÙÙ·Ú· Ùo˘ª.∂ ÌÂÙ·Ó·ÛÙ‡o˘Ó Û ηÏÏȤÚÁÂȘ ÂÎÏÂÎÙÈο ·applefiÙ· ¯·ÌËÏfiÙÂÚ· Âapple›apple‰· Û˘ÁΤÓÙÚˆÛ˘ Ùo˘ oÚo‡appleÚo˜ Ù· ˘„ËÏfiÙÂÚ· Âapple›apple‰·.oÈo Â›Ó·È fï˜ ÂΛÓo Ùo Û˘ÛÙ·ÙÈÎfi Ùo˘ o-Úo‡ appleo˘ apple·›˙ÂÈ ÙoÓ ÛËÌ·ÓÙÈÎfiÙÂÚo ÚfiÏo ÛÙËÓ ¯Ë-ÌÂÈoÙ·Í›· Î·È ÛÙËÓ ‰È¤ÁÂÚÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÁÈ· ÌÂ-Ù·Ó¿ÛÙ¢ÛË; Δo appleÚÒÙo ÛÙoȯ›o Ùo˘ oÚo‡ appleo˘ ¤¯ÂÈÌÂÏÂÙËı› Â›Ó·È Ë ÊÈÌappleÚoÓÂÎÙ›ÓË. ∏ ÊÈÌappleÚoÓÂÎÙ›-ÓË Â›Ó·È ¤Ó· ÁÏ˘ÎoappleÚˆÙÂ˚ÓÈÎfi ÌfiÚÈo Ùo˘ oÚo‡ Û¢„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ¤ˆ˜ Î·È 300 Ìg/ml Ùo oappleo›oÌÂÛoÏ·‚› ÁÈ· ÙȘ ·ÏÏËÏÂappleȉڿÛÂȘ ÙˆÓ Î˘ÙÙ¿ÚˆÓÌ Ùo ÎoÏÏ·ÁfiÓo Î·È ¤¯ÂÈ ÁÂÓÈο appleoÏÏ·appleϤ˜ ı¤ÛÂȘ‰¤ÛÌ¢Û˘. ∏ ·ÏÏËÏÂapple›‰Ú·ÛË Ù˘ ÊÈÌappleÚoÓÂÎÙ›Ó˘

220 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Ì ٷ ·ÙÙ·Ú· Ùo˘ ª.∂ Á›ÓÂÙ·È Ì ÂȉÈΤ˜ appleÚˆ-Ù½Ó˜ appleo˘ oÓoÌ¿˙oÓÙ·È ÈÓÙÂÁÎÚ›Ó˜. ∂ÎÙfi˜ ·applefiÙËÓ ı¤ÛË ·ÏÏËÏÂapple›‰Ú·Û˘ Ì Ùo ·ÙÙ·Úo ˘apple¿Ú¯o˘ÓÎ·È ı¤ÛÂȘ appleÚfiÛÊ˘Û˘ ÁÈ· Ùo ÎoÏÏ·ÁfiÓo ·ÏÏ¿ ηÈÁÈ· Ùo ˘·Ïo˘ÚoÓÈÎfi o͇. ªÂ Ùo˘˜ Ì˯·ÓÈÛÌo‡˜·˘Ùo‡˜ Ë ÊÈÌappleÚoÓÂÎÙ›ÓË ‰Ú· Û·Ó ÌÈ· Á¤Ê˘Ú· ÌÂ-ٷ͇ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ ıÂ̤ÏÈ·˜o˘Û›·˜ Î·È Î·Ù’ ·˘ÙfiÓ ÙoÓ ÙÚfiappleo Â›Ó·È ÈηӋ Ó·‰ÈÂÁ›ÚÂÈ ÙfiÛo ÙËÓ ÌÂÙ·Ó¿ÛÙ¢ÛË fiÛo Î·È ÙËÓ ¯Ë-ÌÂÈoÙ·Í›·.3) Δo ÌÂÏ¿Á¯Úo˘Ó ÂappleÈı‹ÏÈo Ùo˘ ·ÌÊ/‰o‡˜ ›-Ó·È oÌo›ˆ˜ Î·È ·˘Ùfi ÌÈ· ‰˘ÓËÙÈ΋ appleËÁ‹ ÙˆÓ ·˘ÍË-ÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ. Δ· ·ÙÙ·Ú· Ùo˘ ª.∂ ¤¯o˘ÓÌÈ· ÈÛ¯˘Ú‹ ÌÈÙoÁÂÓÂÙÈ΋ Âapple›‰Ú·ÛË Âapple¿Óˆ Û ·Ù-Ù·Ú· fiappleˆ˜ Ù· ÁÏoȷο ·ÙÙ·Ú· Î·È Ùo˘˜ ÈÓo‚Ï¿-ÛÙ˜40 . ∂apple›Û˘ Ù· ·ÙÙ·Ú· ·˘Ù¿ ÂÎÎÚ›Óo˘Ó ¯Ë-ÌÂÈoÙ·ÎÙÈÎo‡˜ apple·Ú¿ÁoÓÙ˜ ÁÈ· Ù· ·ÛÙÚo·ÙÙ·Ú·41 .OÚÈṲ̂ÓoÈ ·˘ÍËÙÈÎo› apple·Ú¿ÁoÓÙ˜ appleo˘ apple·Ú¿ÁoÓÙ·È·applefi Ù· ·ÙÙ·Ú· Ùo˘ ª.∂ ÌappleoÚo‡Ó Ó· ·ÓȯÓ¢ıo‡ÓÎ·È Ó· Ù·˘ÙoappleoÈËıo‡Ó fiappleˆ˜ o PDGF, o FGF Î·È oTGF-b 24,55-57 .4) Èı·ÓfiÓ Î·È Ùo ·ÎÙÈÓˆÙfi ÛÒÌ· Ó· ÂÓ¤¯ÂÙ·ÈÛÙoÓ Û¯ËÌ·ÙÈÛÌfi Ù˘ PVR. OÈ ‰o̤˜ Ù˘ appleÚfiÛıÈ·˜Ìo›Ú·˜ Ùo˘ Ú·ÁoÂȉo‡˜ appleÂÚȤ¯o˘Ó appleÏËıÒÚ· ·applefi·˘ÍËÙÈÎo‡˜ apple·Ú¿ÁoÓÙ˜ Î·È È‰È·›ÙÂÚ· FGF 21,36 oÈoappleo›oÈ ÌappleoÚo‡Ó Ó· ·appleÂÏ¢ıÂÚˆıo‡Ó ÛÙËÓ ˘·ÏoÂÈ-‰È΋ ÎoÈÏfiÙËÙ· Î·È Ó· Û˘ÌÌÂÙ¿Û¯o˘Ó ¤ÙÛÈ ÛÙoÓÛ¯ËÌ·ÙÈÛÌfi ˘·Ïo·ÌÊ/ÎÒÓ ÌÂÌ‚Ú¿ÓˆÓ 47 .∞applefi ÙËÓ apple·Ú·apple¿Óˆ Û˘˙‹ÙËÛË Á›ÓÂÙ·È Ê·ÓÂÚfifiÙÈ fiÙ·Ó ÌÈ· ÊoÚ¿ ÂÓÂÚÁoappleoÈËı› ·applefi ÙËÓ ·appleoÎfiÏ-ÏËÛË Ùo˘ ·ÌÊ/‰o‡˜ o Ì˯·ÓÈÛÌfi˜ Ù˘ ÌÂÙ·Ó¿ÛÙ¢-Û˘ Î·È Ùo˘ appleoÏÏ·appleÏ·ÛÈ·ÛÌo‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ª.∂ ÌappleoÚ› Ó· ·˘Ùo‰ÈÂÁÂÚı› Ì ¤Ó·Ó Ì˯·ÓÈÛÌfi·˘ÙoÎÚÈÓo‡˜ ‰Ú¿Û˘.3. ÚˆÙ½Ó˜ appleÚoÛÎfiÏÏËÛ˘ Î·È ÂÍˆÎ˘ÙÙ¿ÚÈ·ıÂ̤ÏÈ· o˘Û›· (∂xtracellular Matrix, ECM).ƒ‡ıÌÈÛË Ù˘ ÌoÚÊoÏoÁ›·˜ Ù˘ Û˘ÌappleÂÚÈÊoÚ¿˜ÙˆÓ ΢ÙÙ¿ÚˆÓ ·applefi ÙËÓ ECMŒÚ¢Ó˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ‚ÈoÏoÁ›·˜ ¤¯o˘Ó ‰Â›-ÍÂÈ fiÙÈ Ë ÂÍˆÎ˘ÙÙ¿ÚÈ· ıÂ̤ÏÈ· o˘Û›· apple·›˙ÂÈ ÛËÌ·-ÓÙÈÎfi ÚfiÏo ÛÙËÓ ‰È·ÌfiÚʈÛË ÙfiÛo Ù˘ ÌoÚÊoÏoÁ›-·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ fiÛo Î·È ÛÙËÓ ‚ÈoÏoÁÈ΋ Ùo˘˜ Û˘-ÌappleÂÚÈÊoÚ¿ 19 .Δ· ·ÙÙ·Ú· Ùo˘ ª.∂ Ï·Ì‚¿Óo˘Ó ÌÈ· ‰È·ÊoÚÂ-ÙÈ΋ ÌoÚÊoÏoÁ›· fiÙ·Ó Ê‡Áo˘Ó ·applefi ÙËÓ Ê˘ÛÈo-ÏoÁÈ΋ ı¤ÛË Ùo˘˜. ∏ ηÏÏȤÚÁÂÈ· ΢ÙÙ¿ÚˆÓ Ùo˘ª.∂ Û ÙÚ˘‚Ï›· Ì ˘·ÏoÂȉ¤˜ o‰ËÁ› ÛÙoÓ ÌÂÙ·-Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ÂappleÈıËÏÈfiÌoÚÊˆÓ ·˘ÙÒÓ Î˘ÙÙ¿ÚˆÓÛ ·ÙÙ·Ú· appleo˘ ÌoÈ¿˙o˘Ó Ì Ùo˘˜ ÈÓo‚Ï¿ÛÙ˜ ‹ Ì·ÙÙ·Ú· ÌÂÛÂÁ¯˘Ì·ÙoÁÂÓo‡˜ appleÚo¤Ï¢Û˘20 . ∞ÚÎÂ-Ù¤˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ª.∂ÛÙo ˘·ÏoÂȉ¤˜ ·ÏÏ¿˙ÂÈ Ë ‰oÌ‹ Ùo˘˜ ·applefi ÙËÓ ÂÈÎfi-Ó· Ùo˘ appleÏ·ÎfiÛÙÚˆÙo˘ ÂappleÈıËÏÈoÂȉo‡˜ Û¯ËÌ·ÙÈ-ÛÌo‡ Û ·ÙÚ·ÎÙoÂȉ‹ ÌoÚÊoÏoÁ›·. ÕÚ·, οappleoÈoÛÙoȯ›o Ùo˘ ·ÓıÚÒappleÈÓo˘ ˘·ÏoÂȉo‡˜ o‰ËÁ› ÛÙoÓÌÂÙ·Û¯ËÌ·ÙÈÛÌfi ·˘Ùfi.ŸÙ·Ó Ù· ·ÙÙ·Ú· Ùo˘ ª.∂ ηÏÏÈÂÚÁËıo‡Ó Û¢ÏÈÎfi Ì ·appleo˘Û›· ÎoÏÏ·ÁfiÓo˘, ÙfiÙ ·˘Ù¿ ‰È·ÙË-Úo‡Ó ÙËÓ ÂappleÈıËÏÈoÂȉ‹ ÌoÚÊoÏoÁ›· Ùo˘˜. ŸÙ·Ó fi-̈˜ appleÚoÛÙ›ıÂÙ·È ÎoÏÏ·ÁfiÓo ÙfiÙ ·appleoÎÙo‡Ó ÌoÚ-ÊoÏoÁ›· fiappleˆ˜ oÈ ÈÓo‚Ï¿ÛÙ˜ Ì ·Ó¿appleÙ˘ÍË Î˘ÙoappleÏ·ÛÌ·ÙÈÎÒӄ¢‰oappleo‰›ˆÓ appleo˘ ·ÁηÏÈ¿˙o˘Ó ÙȘ›Ó˜ ÎoÏÏ·ÁfiÓo˘. OÈ appleÂÚÈo¯¤˜ ÙˆÓ „¢‰oappleo‰›ˆÓappleo˘ ¤Ú¯oÓÙ·È Û Âapple·Ê‹ Ì Ùo ÎoÏÏ·ÁfiÓo ›ӷÈÂÍÂȉÈÎÂ˘Ì¤Ó˜ appleÂÚÈo¯¤˜ Ù˘ ΢ÙÙ·ÚoappleÏ·ÛÌ·ÙÈ΋˜ÌÂÌ‚Ú¿Ó˘ appleo˘ ηÏo‡ÓÙ·È coated pits. OÈ appleÂÚÈo¯¤˜·˘Ù¤˜ Â›Ó·È appleÂÚÈo¯¤˜ oÈ oappleo›Â˜ ¤¯o˘Ó ÂÍÂȉÈ΢-̤Óo˘˜ ˘appleo‰o¯Â›˜ ÁÈ· Ó· ÌappleoÚ› Ó· Á›ÓÂÈ Ë ·Ó·-ÁÓÒÚÈÛË Î·È Ë Âapple·Ê‹ ÌÂٷ͇ ΢ÙÙ¿ÚˆÓ ª.∂ ηÈÎoÏÏ·ÁfiÓo˘ (Ì ÙËÓ ‚o‹ıÂÈ· Ù˘ ÊÈÌappleÚoÓÂÎÙ›ÓË˜Î·È ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ).∞ÓÙ›ıÂÙ· ·applefi ÙËÓ Âapple›‰Ú·ÛË Ùo˘ ÎoÏÏ·ÁfiÓo˘ÛÙËÓ ÌoÚÊoÏoÁ›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ª.∂, oÈ ÌÂϤ-Ù˜ Ì Ùo ˘·Ïo˘ÚoÓÈÎfi o͇ ÂÓfi˜ ¿ÏÏo˘ ÛËÌ·ÓÙÈÎo‡ÛÙoȯ›o˘ Ùo˘ ˘·ÏÒ‰o˘˜ ‰ÂÓ ¤¯o˘Ó ‰Â›ÍÂÈ fiÙÈ ·˘ÙfiÂappleËÚ¿˙ÂÈ Ù· ·ÙÙ·Ú· Ùo˘ ª.∂. OÈ ¤Ú¢Ó˜ ÛÙoÓÙo̤· ·˘Ùfi Û˘Ó¯›˙oÓÙ·È ‰ÈfiÙÈ Î·È ¿ÏÏ· ÛÙoȯ›·Ù· oappleo›· ˘apple¿Ú¯o˘Ó ÂÓÙfi˜ Ùo˘ ˘·ÏÒ‰o˘˜ appleÈı·ÓfiÓÓ· ¤¯o˘Ó Âapple›‰Ú·ÛË ÛÙ· ·ÙÙ·Ú· Ùo˘ ª.∂.∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë apple·Ú·ÙÂٷ̤ÓË Î·È Âapple·ÓÂÈ-ÏËÌ̤ÓË ÂÊ·ÚÌoÁ‹ ÎÚ˘oappleËÍ›·˜ o‰ËÁ› ÛÙËÓ apple·Ú·-ÁˆÁ‹ ÈÓÈ΋˜ ÛÙo ˘·Ï҉˜. ∂appleÈappleÚfiÛıÂÙ· ÁÓˆÚ›˙o˘-Ì fiÙÈ Ë apple·Úo˘Û›· ·›Ì·Ùo˜ ÛÙo ˘·Ï҉˜ ÛÒÌ· ·˘-Í¿ÓÂÈ ÙËÓ Âapple›appleÙˆÛË Ù˘ PVR 23 . ŸÏ˜ ·˘Ù¤˜ oÈ apple·-Ú·ÙËÚ‹ÛÂȘ ‰Â›¯Óo˘Ó Âapple›Û˘ fiÙÈ Ë apple·Úo˘Û›· ÈÓÈ΋˜ÌappleoÚ› Ó· ¤¯ÂÈ Âapple›‰Ú·ÛË ÛÙËÓ ÌoÚÊoÏoÁ›· ·ÏÏ¿Î·È ÛÙËÓ Û˘ÌappleÂÚÈÊoÚ¿ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ª.∂.∞applefi ·Ó¿ÏoÁ˜ ÌÂϤÙ˜ Û ηÏÏȤÚÁÂȘ ¤¯ÂÈ ‚ÚÂı›fiÙÈ Ë ÈÓÈ΋ ¤¯ÂÈ apple·ÚfiÌoȘ ÂappleȉڿÛÂȘ ÛÙ· ·Ù-Ù·Ú· Ùo˘ ª.∂ fiappleˆ˜ Î·È Ùo ÎoÏÏ·ÁfiÓo 24 .Δ· ÁÏoȷο ·ÙÙ·Ú· Ùo˘ ·ÌÊ/‰o‡˜, Âapple›Û˘fiÙ·Ó Î·ÏÏÈÂÚÁËıo‡Ó ÛÙȘ ›‰È˜ Û˘Óı‹Î˜, o‰ËÁo‡ÓÛ ۇÛapple·ÛË Ùo˘ ˘·ÏoÂȉo‡˜, ·Ó Î·È ÏÈÁfiÙÂÚ˘ ¤ÓÙ·-Û˘ ·applefi ·˘Ù‹Ó appleo˘ ‰ËÌÈo˘ÚÁo‡Ó Ù· ·ÙÙ·Ú· Ùo˘ª.∂.4. ∂appleÈappleÚfiÛıÂÙoÈ apple·Ú¿ÁoÓÙ˜ oÈ oappleo›oÈ Ú˘ı-Ì›˙o˘Ó ÙËÓ Û˘ÌappleÂÚÈÊoÚ¿ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ª.∂. H ÛËÌ·Û›· Ùo˘ ·ÓoÛoÏoÁÈÎo‡ Û˘ÛÙ‹Ì·Ùo˜∏ apple·Úo˘Û›· ÂÓÙfi˜ ÙˆÓ Âapple·ÌÊ/‰ÈÎÒÓ ÌÂÌ‚Ú·-ÓÒÓ ÏÂÌÊo΢ÙÙ¿ÚˆÓ Î·È Ì·ÎÚoÊ¿ÁˆÓ ·applefi ·ÛıÂ-Ó›˜ Ì PVR Â›Ó·È ÌÈ· ¤ÌÌÂÛË ·applefi‰ÂÈÍË fiÙÈ ÊÏÂÁ-ÌoÓÒ‰Ë ·ÏÏ¿ Î·È appleÈı·ÓÒ˜ ·ÓoÛoÏoÁÈο Ê·ÈÓfiÌÂÓ·›Ûˆ˜ Ó· Ï·Ì‚¿Óo˘Ó ̤Úo˜ ÛÙËÓ ‰È·‰ÚoÌ‹ Ù˘ ÓfiÛo˘

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OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 225È·ÙÚo› Ó· Û˘Ì‚o˘Ï‡o˘Ó ÛˆÛÙ¿ Ùo˘˜ ¯ÂÈÚo˘ÚÁË-̤Óo˘˜ ·ÛıÂÓ›˜.Ùoȯ›· ·ÂÚoappleoÚÈ΋˜ Ê˘ÛÈoÏoÁ›·˜∏ ·ÙÌfiÛÊ·ÈÚ· Â›Ó·È Ì›ÁÌ· ·ÂÚ›ˆÓ (΢ڛˆ˜80% ¡ 2, 20% O 2). Δo ·ÓıÚÒappleÈÓo ÛÒÌ· Â›Ó·È Îo-ÚÂṲ̂Óo Ì ¡ 2, ‰ËÏ·‰‹ Ë ›‰È· appleoÛfiÙËÙ· ¡ 2ÂÈ-ÛappleÓ¤ÂÙ·È Î·È ÂÎappleÓ¤ÂÙ·È Î·È Ùo 21% Ù˘ ·Ó·appleÓo‹˜Ì·˜ Â›Ó·È O 2. ŸÙ·Ó Ë ·ÙÌoÛÊ·ÈÚÈ΋ apple›ÂÛË ÂÏ·Ù-ÙÒÓÂÙ·È Û ÌÂÁ¿Ï· ‡„Ë ·˘Í¿ÓÂÙ·È o fiÁÎo˜ ÙˆÓ ·Â-Ú›ˆÓ appleo˘ Â›Ó·È apple·ÁÈ‰Â˘Ì¤Ó· Û ÎoÈÏfiÙËÙ˜ Ùo˘ ÛÒ-Ì·Ùo˜. ∫·Ù¿ ÙËÓ ¿Óo‰o Ùo˘ ·ÂÚoÛοÊo˘˜ Ù· ·¤ÚÈ··˘Ù¿ ‰È·ÛÙ¤ÏÏoÓÙ·È, ÂÓÒ Î·Ù¿ ÙËÓ Î¿ıo‰o Û˘ÌappleȤ˙oÓÙ·È.∫·Ù¿ ÙËÓ ¿Óo‰o Ù· ·¤ÚÈ· appleo˘ Â›Ó·È ‰È·-Ï˘Ì¤Ó· ÛÙo ·›Ì· Î·È ÛÙo˘˜ ÈÛÙo‡˜ ·appleÂÏ¢ıÂÚÒÓo-ÓÙ·È Î·È ÂÈÛ¤Ú¯oÓÙ·È ÛÙËÓ Î˘ÎÏoÊoÚ›· ˘applefi ÌoÚÊ‹Ê˘Û·Ï›‰ˆÓ (ÓfiÛo˜ ·appleoÛ˘Ìapple›ÂÛ˘ Â›Ó·È Ë ·appleÂÏ¢ı¤ÚˆÛË΢ڛˆ˜ Ê˘Û·Ï›‰ˆÓ ¡ 2). ∞˘Ù‹ Ë Î·Ù¿-ÛÙ·ÛË ‰ËÌÈo˘ÚÁÂ›Ù·È Û ˘„fiÌÂÙÚ· ÌÂÁ·Ï‡ÙÂÚ· ·-applefi 30.000 applefi‰È·. Δo Û‡ÓoÏo ÙˆÓ appleÙ‹ÛÂˆÓ Á›ÓÂÙ·È·applefi 12.000-50.000 applefi‰È·, fiappleo˘ Ë ·ÙÌoÛÊ·ÈÚÈ΋ apple›-ÂÛË apple¤ÊÙÂÈ ·applefi 483 mmHg Û 87 mmHg ·ÓÙ›ÛÙoÈ-¯·. ¿Óˆ ·applefi Ù· 63.000 applefi‰È· Ë ˙ÒÓË Â›Ó·È appleϤoÓÈÛfiÙÈÌË Ì Ùo ‰È¿ÛÙËÌ·.∏ apple›ÂÛË Ù˘ ηÌapple›Ó·˜Ùo˘ ·ÂÚoÛοÊo˘˜∏ Û˘Ìapple›ÂÛË Ù˘ ηÌapple›Ó·˜ Ùo˘ ·ÂÚoÛοÊo˘˜Á›ÓÂÙ·È ÁÈ· Ó· ·appleoÊ¢¯ıo‡Ó fiÏ· Ù· appleÚo‚Ï‹Ì·Ù··Ê’ ÂÓfi˜ ÌÂÓ ÙˆÓ ‰oÌÈÎÒÓ ÛÙoȯ›ˆÓ Ùo˘ ·ÂÚoappleÏ¿Óo˘·applefi ÙȘ ÌÂÁ¿Ï˜ ‰È·ÊoÚ¤˜ appleȤÛˆ˜ Ì¤Û·Î·È ¤Íˆ ·applefi ·˘Ùfi, ·Ê’ ÂÙ¤Úo˘ ÁÈ· ÙËÓ ·ÎÂÚ·ÈfiÙË-Ù· ÙˆÓ ÂappleÈ‚·ÙÒÓ. ∏ Û˘Ìapple›ÂÛË Á›ÓÂÙ·È Ì apple·Úo¯‹appleÂappleÈÂṲ̂Óo˘ ·¤Ú· Î·È ¤ÙÛÈ appleÂÚÈoÚ›˙oÓÙ·È Ù· appleÚo-‚Ï‹Ì·Ù· appleo˘ ‰ËÌÈo˘ÚÁ› Ë ÌÂÁ¿ÏË ˘„oÌÂÙÚÈ΋‰È·ÊoÚ¿, ‰È·ÙËÚÒÓÙ·˜ ÙËÓ apple›ÂÛË Û Âapple›apple‰o ı·-Ï¿ÛÛ˘, ̤¯ÚÈ ‡„Ë fiappleo˘ appleϤoÓ ˘Ê›ÛÙ·ÓÙ·È ‰oÌÈÎo›appleÂÚÈoÚÈÛÌo› ÁÈ· Ùo ÛοÊo˜. ∏ ‰È·ÊoÚ¿ apple›ÂÛ˘·Ó¿ÌÂÛ· ÛÙËÓ ·applefiÏ˘ÙË apple›ÂÛË Ù˘ ηÌapple›Ó·˜ ηÈÛÙËÓ apple›ÂÛË Ù˘ ·ÙÌfiÛÊ·ÈÚ·˜, ÛÙo ‡„o˜ Ù˘ appleÙ‹Û˘,oÓoÌ¿˙ÂÙ·È ‰È·ÊoÚÈ΋ apple›ÂÛË. ŒÙÛÈ Û ‡„o˜ 25.000appleo‰ÈÒÓ (7.700 ̤ÙÚ·) Ë ·ÙÌoÛÊ·ÈÚÈ΋ apple›ÂÛË Â›Ó·È287 mmHg, Ë ‰È·ÊoÚÈ΋ apple›ÂÛË 231 mmHg Î·È Ë·applefiÏ˘ÙË apple›ÂÛË Ì¤Û· ÛÙo ·ÂÚoappleÏ¿Óo 518 mmHg,appleo˘ ÈÛo‰˘Ó·Ì› Û ‡„o˜ 3.000 ̤ÙÚˆÓ. Ù· Û‡Á-¯ÚoÓ· ·ÂÚoÛοÊË Ï·Ì‚¿ÓÂÙ·È Ì¤ÚÈÌÓ· Ì ÙË ¯Ú‹-ÛË Û˘ÌappleÈÂṲ̂Óo˘ ·¤Ú·, Ùo˘ ηχÙÂÚo˘ ‰˘Ó·Ùo‡appleÂÚÈ‚¿ÏÏoÓÙo˜, ¯ˆÚ›˜ Ó· ÎÈÓ‰˘Ó‡ÂÈ Ùo ÛοÊo˜·applefi ÙËÓ appleoχ ÌÂÁ¿ÏË ‰È·ÊoÚ¿ apple›ÂÛ˘ appleo˘ ·ÛΛ-Ù·È ÛÙ· ÙoȯÒÌ·Ù· Ùo˘ ·ÂÚoappleÏ¿Óo˘. Àapple¿Ú¯o˘Ó‰È¿ÊoÚoÈ Ì¤ıo‰oÈ ÁÈ· Ó· ‰È·ÙËÚËı› Ë apple›ÂÛË Ù˘ηÌapple›Ó·˜ apple¿Óˆ ·applefi Ùo ¿ÌÂÛo appleÂÚÈ‚¿ÏÏoÓ. º¤ÚÂ-Ù·È ·¤Ú·˜ ·apple’ ¤Íˆ, Û˘ÌappleȤ˙ÂÙ·È Î·È apple·Ú¤¯ÂÙ·ÈÛÙËÓ Î·Ìapple›Ó·. ∂ϤÁ¯ÂÙ·È Ë ¤Ío‰o˜ Ùo˘ Û˘ÌappleÈÂṲ̂-Óo˘ ·¤Ú· appleÚo˜ ÙËÓ ·ÙÌfiÛÊ·ÈÚ·. ˘Á¯ÚfiÓˆ˜ ÂϤÁ-¯ÂÙ·È Î·È Ë ıÂÚÌoÎÚ·Û›·.  ÌÂÁ¿Ï· ‡„Ë ¯ÚÂÈ¿˙Â-Ù·È ˘appleÂÚ‚oÏÈ΋ ÂÓ¤ÚÁÂÈ· ÁÈ· Ó· Û˘ÌappleÈÂÛÙ› o ¯·-ÌËÏ‹˜ apple˘ÎÓfiÙËÙ·˜ ·¤Ú·˜. ŒÙÛÈ Û appleÙ‹ÛÂȘ apple¿Óˆ·applefi 80.000 applefi‰È· (‰È¿ÛÙËÌ·) ¯ÚËÛÈÌoappleoÈÂ›Ù·È ·¤-Ú·˜ appleo˘ ·Ó·Î˘ÎÏÒÓÂÙ·È (ÛÊÚ·ÁÈṲ̂Ó˜ ηÌapple›-Ó˜). Δ· fiÚÈ· ÙˆÓ ÌÂÙ·‚oÏÒÓ Ù˘ apple›ÂÛ˘ ηٿ ÙˉȿÚÎÂÈ· Ù˘ appleÙ‹Û˘ ‰ÂÓ appleÚ¤appleÂÈ Ó· ˘appleÂÚ‚·›ÓÔ˘ÓÙ· 300-500 applefi‰È·/ÏÂappleÙfi (94-156 ̤ÙÚ·) Û appleÙ‹ÛÂȘapple¿Óˆ ·applefi 5.000-8.000 applefi‰È·.À„fiÌÂÙÚo Î·È ÂÓ‰oÊı¿ÏÌÈ· apple›ÂÛËÙo Âapple›apple‰o Ù˘ ı¿Ï·ÛÛ·˜ Ë ·applefiÏ˘ÙË ÂÓ‰o-Êı¿ÏÌÈ· apple›ÂÛË Â›Ó·È 777 mmHg Î·È Ë ·ÙÌoÛÊ·È-ÚÈ΋ apple›ÂÛË 760 mmHg. ∏ ‰È·ÊoÚ¿ ÙˆÓ ‰‡o appleȤÛÂ-ˆÓ Â›Ó·È 17 mmHg Î·È ·appleoÙÂÏ› ÙËÓ ∂O appleo˘ ÌÂ-ÙÚo‡Ì Ì Ùo ÙoÓfiÌÂÙÚo. ∫·Ù¿ ÙËÓ ·appleoÁ›ˆÛË Â-Ï·ÙÙÒÓÂÙ·È Ë apple›ÂÛË ÛÙËÓ Î·Ìapple›Ó·. Ù· 8.000 applefi‰È·Á›ÓÂÙ·È 565 mmHg, ÛÙ· 12.000 applefi‰È· Á›ÓÂÙ·È 483mmHg Î·È ÛÙ· 50.000 applefi‰È· apple¤ÊÙÂÈ ÛÙ· 67 mmHg.˘Á¯ÚfiÓˆ˜ Ë ·applefiÏ˘ÙË ÂÓ‰oÊı¿ÏÌÈ· apple›ÂÛË(∞∂O) apple¤ÊÙÂÈ, fi¯È fï˜ ÙfiÛo Ù·¯¤ˆ˜ fiÛo Ë ·-ÙÌoÛÊ·ÈÚÈ΋ apple›ÂÛË (∞) Ì ·appleoÙ¤ÏÂÛÌ· Ó· ·˘Í¿-ÓÂÈ Ë ∂O, Â¿Ó ‰ÂÓ Á›ÓÂÙ·È Î·Ï‹ ÂÎÚo‹ Ùo˘ ˘‰·Ùo-Âȉo‡˜. ∂appleÈappleϤoÓ Ë ÂÓ‰oÊı¿ÏÌÈ· Ê˘Û·Ï›‰· ·˘Í¿-ÓÂÙ·È Û fiÁÎo Û‡Ìʈӷ Ì Ùo ÎÏ¿ÛÌ· 777/565 ÁÈ·Ó· ‰È·ÙËÚ‹ÛÂÈ ÙËÓ ∂O ÙˆÓ 17 mmHg (∂ÈÎ. 1).ŒÙÛÈ ·˘Í¿ÓÂÙ·È Û fiÁÎo ηٿ Ùo 1/3. ∂¿Ó ËÂÓ‰oÊı¿ÏÌÈ· Ê˘Û·Ï›‰· ‰ÂÓ Â›Ó·È ÙfiÛo ÌÂÁ¿ÏË ÙoÌ¿ÙÈ ÌappleoÚ› Ó· ·ÓÙÈÛÙ·ıÌ›ÛÂÈ ÙË ‰È·ÛÙoÏ‹ Ì Ùo˘˜ÂÍ‹˜ Ì˯·ÓÈÛÌo‡˜:·) ÛÎÏËÚÈ΋ ‰È·ÛÙ·ÏÙÈÎfiÙËÙ·‚) ¯oÚÈoÂȉÈ΋ Û˘ÌappleÈÂÛÙÈÎfiÙËÙ· appleo˘ ·ÎoÏo˘ı›ٷȷapplefiÁ) ÂappleÈÙ·¯˘ÓfiÌÂÓË ÂÎÚo‹ ˘‰·ÙoÂȉo‡˜.Àapple¿Ú¯o˘Ó Û¯ÂÙÈÎo› apple›Ó·Î˜ appleo˘ ‰Â›¯Óo˘Ó ÙoÓfiÁÎo Ù˘ Ê˘Û·Ï›‰·˜ Û mL Î·È Ùo Âapple› ÙÔȘ ÂηÙfiappleoÛoÛÙfi Ùo˘ Û˘ÓoÏÈÎo‡ fiÁÎo˘, ÌÂÙÚo‡ÌÂÓo Û ıË-Ï·›Â˜ ‰È·Ì¤ÙÚo˘˜ oÊı·ÏÌoÛÎoappleÈο, Ùo˘ ÌËÓ›ÛÎo˘appleo˘ Â›Ó·È apple¿Óˆ ·applefi Ùo ¿Óˆ fiÚÈo Ù˘ ıËÏ‹˜.ŒÙÛÈ Î·ıoÚ›˙ÂÙ·È fiÙÈ o ̤ÁÈÛÙo˜ fiÁÎo˜ ·Â-Ú›o˘ appleo˘ ÌappleoÚ› Ó· ¤¯ÂÈ ÂÓ‰oÊı¿ÏÌÈ· o ·ÛıÂÓ‹˜

226 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)Aέριο560 mmHgEπίπεδο θαλάσσης 760 mmHgEOΠ = 17 mmHgAΠAEOΠ8.000 πόδια (ft)AέριοAEPIO543210-1-2-3-4-541525375063758592Όγκος %Θηλαίες διάμετροι απο τηνκορυφή του οπτικού δίσκου∂ÈÎ. 2. º˘Û·Ï›‰· 4 dd apple¿Óˆ ·applefi ÙËÓ ÎÔÚ˘Ê‹ ÙÔ˘ ÔappleÙÈ-ÎÔ‡ ‰›ÛÎÔ˘ ·ÓÙÈÛÙÔȯ› Û ÏÈÁfiÙÂÚÔ ·applefi 10%.8∂ÈÎ. 1. ¢È·ÛÙÔÏ‹ Ê˘Û·Ï›‰·˜ ηٿ ÙËÓ ·appleÔÁ›ˆÛË.ÒÛÙ ӷ Ù·Íȉ¤„ÂÈ Ì ·ÛÊ¿ÏÂÈ· Û ÂappleÈ‚·ÙÈÎfi ·Â-ÚoappleÏ¿Óo (¤ˆ˜ 30.000 applefi‰È·), Â›Ó·È appleÂÚ›appleo˘ Ùo10% Ùo˘ Û˘ÓoÏÈÎo‡ oÊı·ÏÌÈÎo‡ fiÁÎo˘, ‰ËÏ·‰‹0,6 mL. OÚ›˙ÂÙ·È ‰Â oÊı·ÏÌoÛÎoappleÈο Û 4 ıËÏ·›-˜ ‰È·Ì¤ÙÚo˘˜(4 dd) ·applefi Ùo ¿Óˆ fiÚÈo Ù˘ oappleÙÈ΋˜ıËÏ‹˜ Û ۯ¤ÛË Ì Ùo Âapple›apple‰o Ùo˘ ·ÂÚ›o˘ ÌËÓ›-ÛÎo˘ Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂȉ‹ (∂ÈÎ. 2). Ú¤appleÂÈ Ó· ÏË-Êı› ˘apple’ fi„ÈÓ fiÙÈ ·Ó o ÌËÓ›ÛÎo˜ Â›Ó·È ÛÙËÓ ÎoÚ˘Ê‹Ù˘ oappleÙÈ΋˜ ıËÏ‹˜, Ë Ê˘Û·Ï›‰· ·appleoÙÂÏ› Ùo 50%Ùo˘ fiÁÎo˘ Ùo˘ ‚oÏ‚o‡. ÕÏÏo˜ ÙÚfiappleo˜ ̤ÙÚËÛ˘Ùo˘ fiÁÎo˘ Ù˘ Ê˘Û·Ï›‰·˜ ·ÏÏ¿ fi¯È ÙfiÛo ·ÎÚÈ‚‹˜Â›Ó·È Ùo Âapple›apple‰o Ùo˘ ·ÂÚ›o˘ ÌËÓ›ÛÎo˘ appleo˘ Ê·›ÓÂ-Ù·È ·applefi ÙËÓ ÎfiÚË. ∂¿Ó ÌfiÏȘ Ê·›ÓÂÙ·È ÙfiÙÂ Ë Ê˘-Û·Ï›‰· Â›Ó·È Ùo˘Ï¿¯ÈÛÙoÓ Ùo 25% Ùo˘ oÊı·ÏÌÈÎo‡fiÁÎo˘ Î·È Â¿Ó Â›Ó·È ÛÙo ΤÓÙÚo Ù˘ ÎfiÚ˘ ÙfiÙ ›-Ó·È Ùo 50%.˘ÌappleÂÚ·ÛÌ·ÙÈο Ë ÂÎÙ¿Ó˘ÛË ÙˆÓ 0,6 mL(10%) ·ÂÚ›Ô˘ ·ÓÙÈÛÙ·ıÌ›˙ÂÙ·È ·applefi ÙËÓ ÂÎÚÔ‹ ÙÔ˘˘‰·ÙÔÂȉԇ˜ Î·È ‰Â ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ‰˘Û¿ÚÂÛÙ· Â-apple·ÎfiÏÔ˘ı· Û ÌÈ· appleÙ‹ÛË ÂappleÈ‚·ÙÈÎÔ‡ ·ÂÚÔÛοÊÔ˘˜.BÈ‚ÏÈÔÁÚ·Ê›·1. Aerospace Medical Association. Medical lines for AirTravel. Aviation Space and Environmental Medicin,V.67, n.10,II(B1-B15), October 1996.2. AMA Commission on Emergency Medical Services.Medical aspects of transportation aboard commercialaircraft. JAMA 247: 1007-11, 1982.3. Chawla K. Flying after surgery. Aviation Space and EnvironmentalMedicin. Journ. Suppl. October 1996, V.67,n.10, section II.4. Cottrell J. Altitude exposures during aircraft flight. Flyinghigher. Chest, 93: 81-4. 1988.5. Denison D.M, Ledwith F. Complex reaction time at simulatedaltitudes of 5000 and 8.000 feet. AerospaceMedicine 37: 1010-1013, 1996.6. ¢ËÌËÙÚ¿Îo˜ ., ÙÂÚÁ›o˘ . ∞Ú¯¤˜ ¯ÂÈÚo˘ÚÁÈ΋˜ ·appleo-ÎfiÏÏËÛ˘ Ùo˘ ·ÌÊ/‰o˘˜. ∫ÂÊ.10 (173-197)UniversityStudio Press £Â·ÛÛ·ÏoÓ›ÎË ¤Î‰oÛË 1Ë.7. Hilton G.F. Grizzard. Pneumatic retinopexy a two stepout patient operation without conjunctival incision.Ophthalmology 93: 626-641, 1986.8. Hilton G.F, Kelly N.E. Pneumatic retinopexy. Ophthalmology94: 307-314, 1987.9). Hordinsky JR, Georg MH. Response capability during civilair carrier in flight medical emergencies. OklahomaCity. FAA Civil Aeromedical Institute, 1991,DOT/FAA report, AM-91/3.10. Kreissig I, Lincoff H. The treatment of giant tear detachmentsusing retroyaloidal perfluorocarbon gasseswithout drainage or vitrectomy. Graefes Arch ClinExp Ophthalmol 225: 94-8, 1987.11. Kreissig I. Minimal surgery for retinal detachment V.2Application of expanding gasses (167-268). Thieme,Stuttgart, New York 2000.12. Lincoff H, Halt D. Intravitreal expansion of perfluorocarbonbubbles Arch Ophthalmol 98: 1646, 1980.13. Lincoff H, Coleman J. The perfluorocarbon gasses in thetreatment of retinal detachment Ophthalmology 90:546-51, 1983.14. Lincoff H, Weinberger D, Stergiou P. Air travel with intraoculargas. Clinical considerations. Arch Ophth107: 907-10, 1989.15. Mc Farland. Human factors in relation to the developmentof pressurized cabins, aerospace Medicine 42:1303-18, 1971.16. Norton E.W.D. Intraocular gas in the management ofselected retinal detachments Trans Am Acad OphthalOtolarygol 77: 85-98, 1973.17. Tornable PE, Hilton GF. Pneumatic retinpexy. A two yearfollow up study, Ophthalmology 1991, 98: 1115-23.

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232 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)μÈ‚ÏÈÔÁÚ·Ê›·1. Simcock PR, Kelleher S, Dunne JR. Neurofhthalmic findingsin botulism type B Eye 8: 646-648, 1994.2. Caya JC. Clostridium botulinum and the ophthalmologist:a review of botulism, including biological warfareramifications of botulinum toxin Survey of Ophthalmology46 (1): 25-34, 2001.3. Levinson W, Jawetz E. Examination and Board ReviewMedical Microbiology and Immunology 5th ed. Stamford:Appleton & Lange, 93-94,120-122, 141-143, 236-237, 257-258, 1998.4. Lyon M. Infectious diseases fellow. Massachusetts GeneralHospital. Lecture Synopsis from 11/6, 2001.5. Terrenova W, Palunbo JN, Breman JG. Ocular findings inbotulism type B. JAMA 241 (5): 475-477, 1979.6. Parssinen O, Rummukainen M. Acute glaucoma and acutecorneal edema in association with botulism ActaOphthalmol Scand 75: 732-734, 1997.7. Duke – Elder. System of Ophthalmology. 2nd ed. Vol. 8,London: 106, 204-209, 227, 247, 359-360, 1033, 1991.8. NOVA Bioterrorism website www.pbs.org.9. Albert & Jakobiec. Principles & Practice of Ophthalmology.2nd ed., Vol. 1,2 Philadelphia: Harcourt Brace &Co, 155-156, 883-884, 1238, 2000.10. Ruiz-Moreno J. Choroidal neovascularization in the courseof Q- fever. Retina 17(6): 553-555, 1997.11. Schuil J, Richardus JH, Baarsma GS, Schaap GJP. Qfever as a possible of bilateral optic neuritis. Br JOphthalmol 69 (8): 580-583, 1985.12. Shaked Y, Samra Y. Q –fever meningoencefalitis associatedwith bilateral abduscens nerve paralysis, bilateraloptic neuritis and abnormal cerebrospinal fluidfindings. Infection 17(6): 394-395, 1989.13. Pepose Holland & wilhelmus. Ocular Infection and Immunity.St. Louis: CV Mosby, 1249-1251, 1996.14. Al-Kaff AS. Ocular brucellosis. Int. Ophthalmol. Clin(3): 139-145, 1995.15. Elrazak MA. Brucella optic neuritis. Arch.Intern Med151 (4): 776-8, 1991.16. Akduman L, Or M, Hasanreisoglou B, Kurtar K. A caseof ocular brucellosis: importance of vitreous specimen.Acta Ophthalmologica 71(1): 130-132, 1993.17. Franz DR, Jahrling PB, et al. Clinical recognition andmanagement of patents exposed to biological warfareagents. JAMA 278: 399-411, 1997.18. Cieslak TJ, Eitzen EM. Clinical and epidemiological principlesof anthrax. Emerging Infectious Diseases. 5 (4):552-555, 1999.19. Dixon TC, Meselson M, et al. Anthrax. NEJM 341 (11):815-826, 1999.20. Irkec M. Correspondence to Review of Ophthalmology.vol 9: 58-59, 2002.21. Barnard NAS. Anthrax of the eyelid. Ophthalmic PhysiolOpt 10 (3): 300-301, 1990.22. Researchers discover how anthrax toxin destroys cells.Infectious Disease News 14 (11): 14, 200123. CDC website: www.cdc.gov.24. Kibadi K, Mupapa K, et al. Late ophthalmologic manifestationsin survivors of the 1995 Ebola virus epidemicin Kilwrit, Democratic Republic of the Congo. J.Infect. Dis Ebola Virus Suppl 179: S13-14, 1999.25. Bwaka MA, Bonnet MJ et al. Ebola hemorrhagic fever inKilwit, Democratic Republic of the Congo: Clinicalobservations in 103 patients. J Infect Dis Ebola VirusSuppl 179: S1-7, 1999.

ÂÚ›ÏË„Ë ‰È‰·ÎÙÔÚÈ΋˜ ‰È·ÙÚÈ‚‹˜∂appleÈ̤ÏÂÈ·: ∞. ª¿ÓıÔ˜e-mail: amanthos@med.auth.grTÔ Ê·ÈÓfiÌÂÓÔ Bell ÛÙÔÓ ÎˆÌ·ÙÒ‰Ë ·ÛıÂÓ‹ ηÈÛ ·ÛıÂÓ›˜ Ì ÓfiÛÔ Alzheimer ηÈÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (M.S.)A. P¤appleÙÛ˘°ÂÓÈÎfi ª¤ÚÔ˜π. EÈÛ·ÁˆÁ‹Δo Ê·ÈÓfiÌÂÓo Ùo˘ Bell (º.μ.) Â›Ó·È ÌÈ· ·applefiÙȘ appleÚˆÙfiÁoÓ˜ Ê˘ÛÈoÏoÁÈΤ˜ «Û˘Ó-ÎÈÓ‹ÛÂȘ» ηÈappleÂÚÈÁÚ¿ÊÂÙ·È Û·Ó ¤Ó· apple·Ú¿‰ÂÈÁÌ· ÙˆÓ appleoÏÏÒÓappleÚoÛˆappleo-oÊı·ÏÌÈÎÒÓ Ù·˘Ùfi¯ÚoÓˆÓ ÎÈÓ‹ÛˆÓ.∞˘Ùfi Û˘Ó‹ıˆ˜ Û˘Ó›ÛÙ·Ù·È ÛÙËÓ appleÚo˜ Ù· ¤Íˆ ηȿӈ ΛÓËÛË ÙˆÓ ‚oÏ‚ÒÓ, ÂÓÒ o ÂÍÂÙ·˙fiÌÂÓo˜ η-Ù·‚¿ÏÏÂÈ appleÚoÛapple¿ıÂÈ· ÁÈ· ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓÎ·È o ÂÍÂÙ·ÛÙ‹˜ appleÚoÛapple·ı› Ó· ÙoÓ ÂÌappleo‰›ÛÂÈ Û˘-ÁÎÚ·ÙÒÓÙ·˜ Ù· ‚Ϥʷڿ Ùo˘. Δo Ê·ÈÓfiÌÂÓo ·˘Ùfiapple·Ú¿ÁÂÙ·È Âapple›Û˘ ηٿ ÙoÓ ÂÚÂıÈÛÌfi Ùo˘ ÎÂÚ·Ùo-Âȉo‡˜ (Miller: Walsh and Hoyt).OÈ oÏoÎÏËڈ̤Ó˜ Î·È Û˘Ó‰˘·Ṳ̂Ó˜ ÎÈÓ‹-ÛÂȘ ÙˆÓ oÊı·ÏÌÒÓ Î·È ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, ÙˆÓ Ì˘ÒÓÙo˘ appleÚoÛÒappleo˘, Ù˘ ÁÏÒÛÛ·˜, Ù˘ ˘appleÂÚÒ·˜, Ùo˘ Ê¿-Ú˘ÁÁ· Î·È ÙˆÓ ·Ó·appleÓ¢ÛÙÈÎÒÓ Ì˘ÒÓ Û¯ÂÙ›˙oÓÙ·ÈÌ Ó¢ÚÈΤ˜ Û˘Ó‰¤ÛÂȘ ÛÙo Û٤ϯo˜ (brainstem).∏ ·ÎÚÈ‚‹˜ ·Ó·ÙoÌ›· ·˘ÙÒÓ ÙˆÓ ‰È·apple˘ÚËÓÈÎÒÓÛ˘Ó‰¤ÛÂˆÓ Â›Ó·È ¿ÁÓˆÛÙË.∂apple›Û˘, oÏoÎÏËڈ̤Ó˜ appleÚoÛˆappleÈΤ˜ ÎÈÓ‹ÛÂÈ˜Â›Ó·È Ùo ¯¿ÛÌËÌ·, o ıËÏ·ÛÌfi˜, Ë Î·Ù¿appleoÛË, Ùo Á¤-ÏÈo Î·È Ùo ÎÏ¿Ì·.ππ. ΔÔ Ê·ÈÓfiÌÂÓÔ BELLΔo 1823 o Sir Charles Bell ·Ó¤ÊÂÚ ¤Ó· Ê·È-ÓfiÌÂÓo ÛÙÚoÊ‹˜ ÙˆÓ oÊı·ÏÌÒÓ (oculogyric), appleo˘¤ÎÙoÙ ʤÚÂÈ Ùo fiÓoÌ¿ Ùo˘ Î·È Ùo oappleo›o appleÚÒÙo˜appleÂÚȤÁÚ·„ Û ·ÛıÂÓ‹ Ì appleÂÚÈÊÂÚÈ΋ apple·Ú¿Ï˘ÛËÙo˘ appleÚoÛˆappleÈÎo‡ Ó‡Úo˘ (·Ó·ÊÂÚfiÌÂÓË ˆ˜ apple·Ú¿-Ï˘ÛË Ùo˘ Bell), ˆ˜ ÌÈ· appleÚo˜ Ù· ¿Óˆ ÛÙÚoÊ‹ Ùo˘‚oÏ‚o‡ ηٿ ÙËÓ appleÚoÛapple¿ıÂÈ· Ùo˘ ·ÛıÂÓo‡˜ Ó·ÎÏ›ÛÂÈ Ù· ‚Ϥʷڷ (∂ÈÎ. 1).Δo 1913 o Prezzolini Î·È o Barany appleÂÚȤÁÚ·-„·Ó ÙË ÛÙÚoÊ‹ ÙˆÓ ‚oÏ‚ÒÓ appleÚo˜ Ù· ¤Íˆ ÌÂÙ¿ ·applefi¤ÓÙoÓo ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Û ·ÛıÂÓ‹ Ì ÂÓ-‰oÎÚ·Óȷ΋ apple¿ıËÛË, Ë oappleo›· ÌappleoÚ› Ó· ıˆÚËıÂ›Û·Ó apple·Ú·ÏÏ·Á‹ Ùo˘ Ê·ÈÓo̤Óo˘ Bell (Walsh ηÈHoyt).·Ú·ÏÏ·Á¤˜ Ùo˘ Ê·ÈÓo̤Óo˘ Bell1) apple·ÛÙÈÎfiÙËÙ· Ùo˘ Û˘˙˘Áo‡˜ ‚ϤÌÌ·Ùo˜(..μ., Spasticity of conjugate gaze)·Ó Ûapple·ÛÙÈÎfiÙËÙ· Ùo˘ Û˘˙˘Áo‡˜ ‚ϤÌÌ·Ùo˜(..μ.) oÚ›˙ÂÙ·È Ë oÚÈ˙fiÓÙÈ· apple·Ú¤ÎÎÏÈÛË ÙˆÓ o-Êı·ÏÌÒÓ appleÚo˜ ÙËÓ ·apple¤Ó·ÓÙÈ appleÏÂ˘Ú¿ ·applefi ÙËÓ ÂÁÎÂ-Ê·ÏÈ΋ ‚Ï¿‚Ë (∂ÈÎ. 2), fiÙ·Ó ˙ËÙ‹Ûo˘Ì ·applefi ÙoÓ·ÛıÂÓ‹ Ó· ÎÏ›ÛÂÈ Ù· ‚Ϥʷڿ Ùo˘, ÂÓÒ o ÂÍÂÙ·-ÛÙ‹˜ Ù· ÎÚ·Ù¿ÂÈ ·Óoȯٿ.ÚÒÙo˜ o Cogan Ùo 1948 ¤‰ˆÛ ¤ÌÊ·ÛË ÛÙËÓ·Í›· ·˘Ùo‡ Ùo˘ ÛËÌ›o˘ ÁÈ· ÙËÓ appleÚÒÈÌË ÂΉ‹ÏˆÛËÂÁÎÂÊ·ÏÈÎÒÓ ‚Ï·‚ÒÓ Î·È Ùo oÓfiÌ·Û Ûapple·ÛÙÈÎfiÙË-Ù· Ùo˘ Û˘˙˘Áo‡˜ ‚ϤÌÌ·Ùo˜ (..μ., Spasticity ofconjugate gaze), Ùo oappleo›o ıˆÚÂ›Ù·È apple·Ú·ÏÏ·Á‹ Ùo˘Ê·ÈÓo̤Óo˘ Ùo˘ Bell.OÈ Smith, Gay Î·È Cogan (1959) Û˘ÌappleÂ-Ú·›Óo˘Ó fiÙÈ Ë Ûapple·ÛÙÈÎfiÙËÙ· Ùo˘ Û˘˙˘Áo‡˜ ‚ϤÌ-Ì·Ùo˜ Â›Ó·È Ì›· Ù·¯Â›· ‰oÎÈÌ·Û›· (test) ÁÈ· ÂÎÙ›-ÌËÛË ÌÈ·˜ ÌoÓfiappleÏ¢Ú˘ ÂÓ‰oÎÚ·Óȷ΋˜ apple¿ıËÛ˘.∞˘Ùfi Û˘¯Ó¿ ‰Â›¯ÓÂÈ ÌÈ· ‚Ï¿‚Ë Ùo˘ ̤Ûo˘ ÂÁÎÂ-Ê¿Ïo˘ (‚ÚÂÁÌ·ÙÈÎfi˜ Î·È ÎÚoÙ·ÊÈÎfi˜ Ïo‚fi˜) ηÈÛ˘Óo‰Â‡ÂÙ·È Û˘¯Ó¿ ·applefi ·ÓÒÌ·Ïo oappleÙoÎÈÓËÙÈÎfiÓ˘ÛÙ·ÁÌfi (34%).OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 233 - 249, 2002 233

234 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)EÈÎ. 1. º·ÈÓfiÌÂÓÔ Bell. ÚÔ˜ Ù· ¤Íˆ Î·È ¿Óˆ ΛÓËÛË ÙˆÓ‚ÔÏ‚ÒÓ, ÂÓÒ Ô ÂÍÂÙ·˙fiÌÂÓÔ˜ ηٷ‚¿ÏÏÂÈ appleÚÔÛapple¿ıÂÈ·ÁÈ· ÎÏ›ÛÈÌÔ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Î·È Ô ÂÍÂÙ·ÛÙ‹˜ appleÚÔ-Ûapple·ı› Ó· ÙÔÓ ÂÌappleÔ‰›ÛÂÈ Û˘ÁÎÚ·ÙÒÓÙ·˜ Ù· ‚Ϥʷڷ.˘ÌÌÂÙÚÈÎfi Ê·ÈÓfiÌÂÓÔ Bell, ‰È·‚¿ıÌÈÛË (score) ¢.O.Î·È A.O. = 3/3 (‰ÂÓ Ê·›ÓÂÙ·È Ô ÎÂÚ·ÙÔÂȉ‹˜).2) ËÌ›o Ù˘ oÚÈ˙fiÓÙÈ·˜ Û˘˙˘Áo‡˜ oÊı·ÏÌÈ-΋˜ apple·Ú¤ÎÎÏÈÛ˘Δo 1970 o Lozano-Elizondo appleÂÚȤÁÚ·„ Ùo«ÛËÌ›o Ù˘ Û˘˙˘Áo‡˜ oÚÈ˙fiÓÙÈ·˜ oÊı·ÏÌÈ΋˜ apple·-Ú¤ÎÎÏÈÛ˘», Ùo oappleo›o ÌappleoÚ› Ó· ıˆÚËı› apple·Ú·Ï-Ï·Á‹ Ùo˘ ÛËÌ›o˘ Ù˘ Ûapple·ÛÙÈÎfiÙËÙ·˜ Ùo˘ Û˘˙˘Áo‡˜‚ϤÌÌ·Ùo˜.O Lozano-Elizondo ¯ÚËÛÈÌoappleo›ËÛ ‰‡o ‰oÎÈ-̷ۛ˜ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Ùo˘ ÛËÌ›o˘ Û˘˙˘Áo‡˜oÚÈ˙fiÓÙÈ·˜ apple·Ú¤ÎÎÏÈÛ˘ ·) ÙË ‰ÈfiÊı·ÏÌË (·ÌÊo-ÙÂÚfiappleÏ¢ÚË) ‰oÎÈÌ·Û›· Î¿Ï˘„˘ (cover test) ηȂ) ÙË ‰oÎÈÌ·Û›· ·Ú·ÈˆÌ¤Óo˘ ‚ÏÂÊ·ÚÈÛÌo‡ (spacedblinking test).·) ¢ÈfiÊı·ÏÌË (·ÌÊoÙÂÚfiappleÏ¢ÚË) ‰oÎÈÌ·Û›·Î¿Ï˘„˘ (cover test).O ÂÍÂÙ·ÛÙ‹˜ οıÂÙ·È ÂÌappleÚfi˜ ·applefi ÙoÓ ·ÛıÂÓ‹,·applefi ÙoÓ oappleo›o ˙ËÙ¿ÂÈ Ó· ÎÚ·Ù¿ÂÈ Ùo˘˜ oÊı·ÏÌo‡˜·ÓoȯÙo‡˜, ÂÓÒ o ·ÛıÂÓ‹˜ appleÚoÛËÏÒÓÂÈ ÛÙ·ıÂڿηْ ¢ı›·Ó ÂÌappleÚfi˜ Û’ ¤Ó· ·ÓÙÈΛÌÂÓo, apple.¯. Ùo ‰È-Îfi Ùo˘ ·ÓÙ›¯ÂÈÚ· Ì ÙÂٷ̤Óo Ùo ‚Ú·¯›oÓ· ‹ ¤Ó·Ìoχ‚È, appleo˘ ÎÚ·Ù¿ÂÈ o ›‰Èo˜ Û ·applefiÛÙ·ÛË 40-50 cmηٿ Ì‹Îo˜ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜ Î·È ÛÙo Âapple›apple‰oÙˆÓ oÊı·ÏÌÒÓ.ªÂ ·ÌÊoÙÂÚfiappleÏ¢Úo Î¿Ï˘ÌÌ· oÈ oÊı·ÏÌo›Ùo˘ ·ÛıÂÓo‡˜ ηχappleÙoÓÙ·È Î·È ·appleoηχappleÙoÓÙ·È Û‰ȿÛÙËÌ· 4 ‹ 5 sec. ŸÙ·Ó ·appleoÛ‡ÚÂÙ·È Ë ‰ÈfiÊı·Ï-ÌË Î¿Ï˘„Ë oÈ oÊı·ÏÌo› apple·ÚÂÎÎÏ›Óo˘Ó oÚÈ˙fiÓÙÈ·appleÚo˜ Ù· ‰ÂÍÈ¿ ‹ ·ÚÈÛÙÂÚ¿ Î·È apple·Ú·ÙËÚÂ›Ù·È Ù·-¯Â›· ‰ÈoÚıˆÙÈ΋ oÊı·ÏÌÈ΋ ΛÓËÛË appleÚo˜ Ùo Τ-ÓÙÚo Ùo˘ ·ÓÙÈÎÂÈ̤Óo˘ appleÚoۋψÛ˘ (∂ÈÎ. 3).‚) ¢oÎÈÌ·Û›· ·Ú·ÈˆÌ¤Óo˘ ‚ÏÂÊ·ÚÈÛÌo‡ (spacedblinking test).EÈÎ. 2. apple·ÛÙÈÎfiÙËÙ· ÙÔ˘ Û˘˙˘ÁÔ‡˜ ‚ϤÌÌ·ÙÔ˜ (Spasticityof conjugate gaze). ÚÔηÏÂ›Ù·È ·Ó ˙ËÙ‹ÛÔ˘Ì ·applefiÙÔÓ ·ÛıÂÓ‹ Ó· ÎÏ›ÛÂÈ Ù· ‚Ϥʷڿ ÙÔ˘, ÂÓÒ Ô ÂÍÂÙ·-ÛÙ‹˜ ÎÚ·Ù¿ÂÈ ‰˘Ó·Ù¿ Ù· ‚Ϥʷڷ ·ÓÔȯٿ. ∏ apple·Ú¤Î-ÎÏÈÛË Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ appleÚÔ˜ ÙËÓ ·apple¤Ó·ÓÙÈ appleÏ¢-Ú¿ Ù˘ ‚Ï¿‚˘ (Cogan).∑ËÙ¿Ì ·applefi ÙoÓ ·ÛıÂÓ‹ Ó· ·Óo›ÁÂÈ Î·È Ó·ÎÏ›ÓÂÈ Ùo˘˜ oÊı·ÏÌo‡˜ Ùo˘, ¯ˆÚ›˜ Ó· appleȤÛÂÈ Ù·‚Ϥʷڿ Ùo˘, Û ηÓoÓÈο ‰È·ÛÙ‹Ì·Ù· 4 ‹ 5 sec,ÂÓÒ Ù·˘Ùfi¯ÚoÓ· ÎoÈÙ¿ÂÈ ÛÙ·ıÂÚ¿ Î·È Û˘Ó¤¯ÂÈ·ÙoÓ ·ÓÙ›¯ÂÈÚ¿ Ùo˘ ‹ ÙË Ì‡ÙË ÂÓfi˜ ÌoÏ˘‚Èo‡ ÂÌappleÚfi˜·applefi Ùo˘˜ oÊı·ÏÌo‡˜ Ùo˘.ÙȘ apple·Ú·apple¿Óˆ ‰oÎÈ̷ۛ˜ o ÂÍÂÙ·ÛÙ‹˜ appleÚ¤appleÂÈÓ· apple·Ú·ÙËÚ› ÙË ı¤ÛË Î·È ÙˆÓ ‰‡o oÊı·ÏÌÒÓ ÙËÛÙÈÁÌ‹ ηٿ ÙËÓ oappleo›· ·appleoÛ‡ÚÂÙ·È Ë ‰ÈfiÊı·ÏÌËÎ¿Ï˘„Ë ‹ fiÙ·Ó o ·ÛıÂÓ‹˜ ·Óo›ÁÂÈ Ù· ‚Ϥʷڿ Ùo˘.∂¿Ó oÈ oÊı·ÏÌo› apple·ÚÂÎÎÏ›Óo˘Ó appleÚo˜ Ù· ¿Óˆ ‹Î¿Ùˆ ‹ apple·Ú·Ì¤Óo˘Ó ÛÙ·ıÂÚ¿ ÛÙËÓ ÎÂÓÙÚÈ΋ ı¤ÛË, Ë·apple¿ÓÙËÛË ıˆÚÂ›Ù·È Ê˘ÛÈoÏoÁÈ΋ ‹ ·ÚÓËÙÈ΋.OÚÈ˙fiÓÙÈ· Û˘˙˘Á‹˜ apple·Ú¤ÎÎÏÈÛË ÙˆÓ oÊı·Ï-ÌÒÓ appleÚo˜ Ù· ‰ÂÍÈ¿ ‹ ·ÚÈÛÙÂÚ¿ Ì ·Ó·appleˉËÌ·ÙÈ΋appleÚo˜ Ù· apple›Ûˆ ‰ÈoÚıˆÙÈ΋ ΛÓËÛË appleÚo˜ Ùo ΤÓÙÚo ‹Ùo ÛËÌ›o appleÚoۋψÛ˘ ıˆÚÂ›Ù·È ıÂÙÈ΋ ‹ ·ÓÒÌ·-ÏË (∂ÈÎ. 4). O ·apple·ÁˆÁfi˜ oÊı·ÏÌfi˜ Û˘Ó‹ıˆ˜ ¤¯ÂÈÌÂÁ·Ï‡ÙÂÚo ‡Úo˜ ΛÓËÛ˘ ·applefi ÙoÓ appleÚoÛ·ÁˆÁfi.∫·Ù¿ ÙoÓ Lozano-Elizondo Ùo ÛËÌ›o ¤¯ÂÈÎÏÈÓÈ΋ ·Í›· Û Ó¢ÚoÏoÁÈÎo‡˜ ·ÛıÂÓ›˜.O D. Lozano-Elizondo apple·Ú·ÎoÏo‡ıËÛ 24 ·-ÛıÂÓ›˜ Û ‰È¿ÛÙËÌ· 18 ÌËÓÒÓ.  13 ·ÛıÂÓ›˜ ˘-apple‹Ú¯Â ÂÓÙfiappleÈÛË Ù˘ ‚Ï¿‚˘ Ì ¯ÂÈÚo˘ÚÁÈ΋ ‹ apple·-ıoÏoÁo·Ó·ÙoÌÈ΋ ÂappleȂ‚·›ˆÛË. ∞applefi Ùo˘˜ 24 ·-ÛıÂÓ›˜, appleo˘ Ùo ÛËÌ›o ‹Ù·Ó ıÂÙÈÎfi, ÌfiÓoÓ 3 ‰ÂÓapple·Úo˘Û›·Û·Ó Ó¢ÚoÏoÁÈο ÛËÌ›· ÂÙÂÚfiappleÏ¢Ú˘ÂÓÙfiappleÈÛ˘ Ù˘ ÓfiÛo˘, ÂÎÙfi˜ ·applefi Ùo ıÂÙÈÎfi oappleÙoÎÈ-ÓËÙÈÎfi Ó˘ÛÙ·ÁÌfi appleÚo˜ ÙËÓ ›‰È· appleÏÂ˘Ú¿.OÚÈ˙fiÓÙÈ· Û˘˙˘Á‹˜ apple·Ú¤ÎÎÏÈÛË ÙˆÓ oÊı·Ï-ÌÒÓ Â›Ó·È ·Û˘Ó‹ı˘ Û ˘ÁÈ‹ ¿ÙoÌ·.  ÌÈ· oÌ¿‰·250 Ê˘ÛÈoÏoÁÈÎÒÓ ·ÙfiÌˆÓ Ùo ÛËÌ›o ‹Ù·Ó ıÂÙÈÎfiÌfiÓo Û 4 ¿ÙoÌ·.

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 235EÈÎ. 3. ¢ÈfiÊı·ÏÌË ‰ÔÎÈÌ·Û›· Î¿Ï˘„˘ (cover test). A) Ô ·ÛıÂÓ‹˜ appleÚÔÛËÏÒÓÂÈ Î·Ù’ ¢ı›·Ó ÂÌappleÚfi˜ Û’ ¤Ó· ·ÓÙÈΛÌÂÓÔ,B) ηχappleÙÔÓÙ·È Î·È ÔÈ ‰‡Ô ÔÊı·ÏÌÔ›, °) ·appleÔÛ‡ÚÂÙ·È Ë ‰ÈfiÊı·ÏÌË Î¿Ï˘„Ë Î·È ÔÈ ÔÊı·ÏÌÔ› apple·ÚÂÎÎÏ›ÓÔ˘Ó ÔÚÈ˙fiÓÙÈ·appleÚÔ˜ Ù· ‰ÂÍÈ¿, ¢) apple·Ú·ÙËÚÂ›Ù·È Ù·¯Â›· ‰ÈÔÚıˆÙÈ΋ ÔÊı·ÏÌÈ΋ ΛÓËÛË appleÚÔ˜ ÙÔ Î¤ÓÙÚÔ ÙÔ˘ ·ÓÙÈÎÂÈ̤ÓÔ˘ appleÚÔۋψ-Û˘ (Lozano-Elizondo).EÈÎ. 4. ¢ÔÎÈÌ·Û›· ·Ú·ÈˆÌ¤ÓÔ˘ ‚ÏÂÊ·ÚÈÛÌÔ‡ (spaced blinking test). ∞) Ô ·ÛıÂÓ‹˜ appleÚÔÛËÏÒÓÂÈ Î·Ù’ ¢ı›·Ó ÂÌappleÚfi˜ Û’ ¤Ó··ÓÙÈΛÌÂÓÔ, μ) Ô ·ÛıÂÓ‹˜ ÎÏ›ÓÂÈ Ù· ‚Ϥʷڿ ÙÔ˘ ÔÌ·Ï¿, ÂÓÒ appleÚÔÛapple·ı› Ó· ‰È·ÙËÚ‹ÛÂÈ ÙËÓ appleÚÔۋψۋ ÙÔ˘, °) ÔÈÔÊı·ÏÌÔ› apple·ÚÂÎÎÏ›ÓÔ˘Ó ÔÚÈ˙fiÓÙÈ· appleÚÔ˜ Ù· ‰ÂÍÈ¿ ÙË ÛÙÈÁÌ‹ appleÔ˘ ·ÓÔ›ÁÔ˘Ó Ù· ‚Ϥʷڷ, ¢) Ù·¯Â›· ÂappleÈΤÓÙÚˆÛË ÙˆÓÔÊı·ÏÌÒÓ ÛÙÔ ·ÓÙÈΛÌÂÓÔ appleÚÔۋψÛ˘ (Lozano-Elizondo).

236 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)∞Ó·ÛÙÚoÊ‹ Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ Bell∏ ·Ó·ÛÙÚoÊ‹ Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ Bell, ‰ËÏ·-‰‹ Ë appleÚo˜ Ù· οو ΛÓËÛË ÙˆÓ ‚oÏ‚ÒÓ, appleÂÚÈÁÚ¿-ÊËΠappleÏ‹Úˆ˜ ·applefi ÙoÓ Hall ¯ˆÚ›˜ Ó· ·Ó·Ê¤ÚÂÈappleoÛoÛÙ¿, o Bender (1966) ·Ó·Ê¤ÚÂÈ 3% ÛÙ· Ê˘-ÛÈoÏoÁÈο ¿ÙoÌ· Î·È o Alvarez ÛÙË ÛÂÈÚ¿ Ùo˘ ·Ó·-ʤÚÂÈ 0,9% ÛÙ· Ê˘ÛÈoÏoÁÈο ¿ÙoÌ·. ∂apple›Û˘, Ë Û˘-¯ÓfiÙËÙ· Ù˘ appleÚo˜ Ù· οو ·apple¿ÓÙËÛ˘ Â›Ó·È 8% ÛÙËÛÂÈÚ¿ ÙˆÓ Francis Î·È Loughhead Î·È ÛÙË ÛÂÈÚ¿Ùo˘ Ferrer 3,7%.∫·Ù¿ Ùo˘˜ Jambel Î·È Haidt Â›Ó·È appleÈı·ÓfiÓ ÛÂÌÂÚÈο ¿ÙoÌ· Ë ÈηÓfiÙËÙ¿ Ùo˘˜ Ó· ÂÓ·ÓÙȈıo‡ÓÂÓÂÚÁËÙÈο ÛÙËÓ apple·Ú·ÁˆÁ‹ Ùo˘ º.μ. Ó· Â›Ó·È ÛË-Ì·ÓÙÈÎfi˜ apple·Ú¿ÁˆÓ ÁÈ· ÙËÓ apple·Ú·ÁˆÁ‹ Ùo˘ ·appleoη-Ïo‡ÌÂÓo˘ ·Ó¿ÛÙÚoÊo˘ º.μ., ηٿ Ùo oappleo›o oÈ ‚oÏ-‚o› ÎÈÓo‡ÓÙ·È appleÚo˜ Ù· οو ·ÓÙ› appleÚo˜ Ù· ¿Óˆ.º·ÈÓfiÌÂÓo Bell Î·È ËÏÈΛ·Δo Ê·ÈÓfiÌÂÓo Ùo˘ Bell apple·Ú¿ÁÂÙ·È ‰˘ÛÎoÏfiÙÂ-Ú· Ì ÙËÓ apple¿Úo‰o Ù˘ ËÏÈΛ·˜, fiappleˆ˜ appleÚÒÙo˜ oChamberlain (1971) ·Ó·Ê¤ÚÂÈ Î·È Û˘¯Ó¿ ‰ÂÓ ˘-apple¿Ú¯ÂÈ Û oÚÈṲ̂Óo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Ùo˘ Parkinson(Alvarez 1980).∫·Ù¿ ÙoÓ Ferrer ÛÙ· ÓÂoÁÓ¿ Ùo Ê·ÈÓfiÌÂÓoBell Û˘Ó‹ıˆ˜ ‰ÂÓ apple·Ú¿ÁÂÙ·È, ‰ÈfiÙÈ ·apple·ÈÙÂ›Ù·È Î¿-appleoÈ· ˆÚÈÌfiÙËÙ· Ùo˘ ÛÙÂϤ¯o˘˜ ÁÈ· ÙË Ê˘ÛÈoÏoÁÈ΋apple·Ú·ÁˆÁ‹ Ùo˘.∫·Ù¿ Ùo˘˜ Snir Î·È Û˘Ó. (1996) ÛÙ· Ê˘-ÛÈoÏoÁÈο ÓÂoÁÓ¿ apple·Úo˘ÛÈ¿˙ÂÙ·È appleÏ‹Ú˜ º.μ. ÛÙo35,5% ÙËÓ 3Ë Ë̤ڷ Î·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 16‚‰oÌ¿‰ˆÓ Ù˘ ˙ˆ‹˜ ÛÙo 97,3%.∞Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ BellÚÒÙo˜ o Hall ‚ڋΠ·Û˘ÌÌÂÙÚ›· Ùo˘ º.μ. ÛÂ21 ¿ÙoÌ· Û ۇÓoÏo 800 ˘ÁÈÒÓ appleÂÚÈappleÙÒÛˆÓ, ‰Ë-Ï·‰‹ 2,6%, ÛÙ· oappleo›· Ë ·Ó‡„ˆÛË Ùo˘ ÂÓfi˜ oÊı·Ï-Ìo‡ ‹Ù·Ó ·ÍÈoÛËÌ›ˆÙ· ÌÈÎÚfiÙÂÚË Û¯ÂÙÈο Ì ÙoÓ¿ÏÏo, ‰ÂÓ ·Ó·Ê¤ÚÂÈ fï˜ appleoÈo˜ oÊı·ÏÌfi˜ (·Ó·-ʤÚÂÙ·È ·applefi ÙoÓ Alvarez).OÈ Corin et al (1972) Û ۇÓoÏo 70 ·ÛıÂÓÒÓ,ËÏÈΛ·˜ 52-79 ÂÙÒÓ, Ì ÓfiÛo Ùo˘ Parkinson apple·Ú·-Ù‹ÚËÛ·Ó Ì¤ÙÚÈ· ‹ Ûo‚·Ú‹ appleÚoÛ‚oÏ‹ Ùo˘ º.μ. ÛÂ23 ·ÛıÂÓ›˜ (33%) Î·È ‰ÂÓ ·Ó·Ê¤Úo˘Ó Â¿Ó ˘apple‹Ú-¯Â ·Û˘ÌÌÂÙÚ›· Ùo˘ º.μ.O Alvarez ·ÍÈoÏfiÁËÛ Ùo º.μ. ÌÂٷ͇ appleÏ‹Úˆ˜Ê˘ÛÈoÏoÁÈÎo‡ Î·È appleÏ‹Úˆ˜ ηٷÚÁË̤Óo˘ Î·È ÙoÙ·ÍÈÓfiÌËÛÂ Û·Ó Ê˘ÛÈoÏoÁÈÎfi Î·È ÂÙÂÚfiappleÏ¢ڷ ‹·ÌÊoÙÂÚfiappleÏ¢ڷ ·ÓÒÌ·Ïo. ø˜ ·ÓÒÌ·Ïo ıÂÒÚËÛÂÙo ÂÏ·Ùو̤Óo ‹ ÌË apple·Ú·ÁfiÌÂÓo º.μ. ∂ͤٷÛ Â-Ó‹ÏÈΘ Ì ۇӉÚoÌo Parkinson Î·È Ê˘ÛÈoÏoÁÈ-Îo‡˜ ÂÓ‹ÏÈΘ (control group). Ù· ·appleoÙÂϤÛÌ·Ù¿Ùo˘ o Alvarez ·Ó·Ê¤ÚÂÈ Î·È ÛÙȘ ‰‡o oÌ¿‰Â˜ ·Û‡Ì-ÌÂÙÚo º.μ., appleÈo Û˘¯Ó¿ Ì ÙËÓ ¿Óo‰o Ù˘ ËÏÈΛ·˜,·ÏÏ¿ appleÈo Ûo‚·Úfi ÛÙË ÓfiÛo Ùo˘ Parkinson. ∂apple›ÛË˜Ë ·Û˘ÌÌÂÙÚ›· ‹Ù·Ó appleÈo Û˘¯Ó‹ ˘apple¤Ú Ùo˘ ∞.O., ‰Ë-Ï·‰‹ Ë Î›ÓËÛË appleÚo˜ Ù· ¿Óˆ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙoÓ∞.O. Î·È ‹Ù·Ó appleÂÚÈÛÛfiÙÂÚo ÂappleËÚ·Ṳ̂ÓË ÛÙË Ófi-Ûo Ùo˘ Parkinson. O appleÈo Û˘¯Ófi˜ Û˘Ó‰˘·ÛÌfi˜ ‹Ù·ÓË Î·Ù¿ÚÁËÛË Ùo˘ º.μ. ÛÙoÓ ¢.O. Î·È Ë ÂÏ¿ÙÙˆÛËÛÙoÓ ∞.O. ÙËÓ oÌ¿‰· ÙˆÓ Ê˘ÛÈoÏoÁÈÎÒÓ o ¢.O.‹Ù·Ó appleÂÚÈÛÛfiÙÂÚo ÂappleËÚ·Ṳ̂Óo˜ Û’ fiϘ ÙȘ appleÂÚÈappleÙÒÛÂȘ·Û˘ÌÌÂÙÚ›·˜.III. ¡Â˘ÚÈ΋ Ô‰fi˜ - ·Ú·ÁˆÁ‹ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ BELL∞Ó Î·È Ë ·ÎÚÈ‚‹˜ Ó¢ÚÈ΋ o‰fi˜ Â›Ó·È ¿ÁÓˆ-ÛÙË, Û˘Ó‰¤ÛÂȘ ÌÂٷ͇ Ùo˘ appleÚoÛˆappleÈÎo‡ Î·È Ùo˘ÎoÈÓo‡ ÎÈÓËÙÈÎo‡ ÂÌappleϤÎoÓÙ·È Û’ ·˘Ùfi Ùo Ê·ÈÓfi-ÌÂÓo (Duane).∏ apple·Úo˘Û›· Ùo˘ Û ·ÛıÂÓ›˜ appleo˘ ‰ÂÓ Ìappleo-Úo‡Ó ÂÎo‡ÛÈ· Ó· ·Ó˘„ÒÛo˘Ó Ùo˘˜ oÊı·ÏÌo‡˜ Ùo˘˜ÂappleȂ‚·ÈÒÓÂÈ fiÙÈ oÈ Ó¢ÚÈΤ˜ o‰o› ÛÙo Û٤ϯo˜ÌÂٷ͇ Ùo˘ apple˘Ú‹Ó· Ùo˘ appleÚoÛˆappleÈÎo‡ Î·È Ùo˘ ÙÌ‹-Ì·Ùo˜ Ùo˘ apple˘Ú‹Ó· Ùo˘ ÎoÈÓo‡ ÎÈÓËÙÈÎo‡, appleo˘ Â›Ó·È˘apple‡ı˘Ó˜ ÁÈ· ÙËÓ ·Ó‡„ˆÛË ÙˆÓ ‚oÏ‚ÒÓ, ›ӷȷΤڷȘ (Jambell and Haidt, 1972).OÈ Jambel Î·È Haidt (1972) ·Ó·Ê¤Úo˘Ó fiÙÈÛÙo ÂÚÁ·ÛÙ‹ÚÈfi Ùo˘˜ appleÚoοÏÂÛ·Ó ¤ÓÙoÓo ÂÚÂıÈ-ÛÌfi ÛÙËÓ appleÂÚÈo¯‹ Ù˘ ¤Ûˆ ÂappleÈÌ‹Îo˘˜ ‰ÂÛÌ›‰·˜,Ùo˘˜ apple˘Ú‹Ó˜ Ùo˘ ÎoÈÓo‡ ÎÈÓËÙÈÎo‡ (πππ) Î·È appleÚo-ÛˆappleÈÎo‡ (VIπ) Ó‡Úo˘ Î·È appleoÙ¤ ‰ÂÓ apple·Ú‹Á·Á·ÓÙ·˘Ùfi¯ÚoÓ· Ù· ÛÙoȯ›· Ùo˘ º.μ. Î·È Î·Ù·Ï‹Áo˘ÓÛÙo Û˘Ìapple¤Ú·ÛÌ· fiÙÈ oÈ ‰o̤˜ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜Î·È oÈ apple˘Ú‹Ó˜ ‰ÂÓ Â›Ó·È Ùo ΤÓÙÚo Û˘Á¯ÚoÓÈÛÌo‡‹ oÏoÎÏ‹ÚˆÛ˘ Ùo˘ º.μ.∫·Ù’ ·˘Ùo‡˜ Ùo Ê·ÈÓfiÌÂÓo Ùo˘ Bell ‰ÂÓ apple·Ú¿-ÁÂÙ·È Û ÌoÓfiappleÏ¢Úo ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ ‹Î·Ù¿ Ùo ‚ÏÂÊ·ÚÈÛÌfi (blinking). ∏ ΛÓËÛË Â›Ó·ÈÛ·Îη‰È΋ Î·È Û˘ÌappleÏËÚÒÓÂÙ·È Û 400 msec. ΔoÊ·ÈÓfiÌÂÓo Ùo˘ Bell Û˘Á¯ÚoÓ›˙ÂÙ·È Î·È oÏoÎÏËÚÒ-ÓÂÙ·È ÛÙË ÁÂÊ˘ÚÈ΋ ‰ÈÎÙ˘ˆÙ‹ o˘Û›· (pontine reticularsubstance).∫·Ù¿ Ùo˘˜ Jambel Î·È Haidt Ù· ·ÈÛıËÙÈο ÂÚÂı›ÛÌ·Ù·Êı¿Óo˘Ó ÛÙËÓ appleÂÚÈo¯‹ Ù˘ ηχappleÙÚ·˜(tegmentum area) ·applefi ÙoÓ ÂÁÎÂÊ·ÏÈÎfi ÊÏoÈfi, ÙoÓÎÂÚ·ÙoÂȉ‹, ÙoÓ ·ÌÊÈ‚ÏËÛÙÚoÂȉ‹ Î·È ›Ûˆ˜ ·applefi ¿Ï-Ϙ appleÂÚÈo¯¤˜ Ùo˘ ‰ÈÎÙ˘ˆÙo‡ Û¯ËÌ·ÙÈÛÌo‡ Ùo˘ ÛÙÂ-Ϥ¯o˘˜ (∂ÈÎ. 5). ∞applefi ÙËÓ appleÂÚÈo¯‹ ·˘Ù‹ ÒÛÂȘ ÛÙ¤Ï-ÓoÓÙ·È Î·È ÛÙo˘˜ ‰‡o apple˘Ú‹Ó˜ Ùo˘ appleÚoÛˆappleÈÎo‡ ηÈÙo˘ ÎoÈÓo‡ ÎÈÓËÙÈÎo‡ Ó‡Úo˘ ÁÈ· Ùo Û˘Á¯ÚoÓÈÛÌfiÙ˘ ·apple¿ÓÙËÛ˘. ∞applefi ÙoÓ ÂÁÎÂÊ·ÏÈÎfi ÊÏoÈfi (ÌÂÙˆappleÈ·›o˜Ïo‚fi˜) Êı¿Óo˘Ó ÂÚÂı›ÛÌ·Ù· appleo˘ appleÚoηÏo‡Ó

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 237EÈÎ. 5. To Ê·ÈÓfiÌÂÓÔ ÙÔ˘ Bell ηٿ ÙÔ˘˜ Jampel Î·È Haidt(1972) ÔÏÔÎÏËÚÒÓÂÙ·È Û ÌÈ· ÎÔÈÏȷ΋ appleÂÚÈÔ¯‹ ÙÔ˘‰ÈÎÙ˘ˆÙÔ‡ Û¯ËÌ·ÙÈÛÌÔ‡, appleÔ˘ Â›Ó·È appleÂÚÈÁÁÚ·Ì̤ÓËÛÙÔ Û¯‹Ì·. H appleÂÚÈÔ¯‹ ·˘Ù‹ ‰¤¯ÂÙ·È ÒÛÂȘ ·applefi 1) ÙÔÊÏÔÈfi ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, 2) ÙÔ ÙÚ›‰˘ÌÔ Ó‡ÚÔ, 3) appleÈı·ÓÒ˜·applefi ÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹, 4) ÙÔ ÂÓÂÚÁÔappleÔÈfi ‰ÈÎÙ˘ˆÙfiÛ‡ÛÙËÌ· Î·È ÛÙ¤ÏÓÂÈ ÒÛÂȘ appleÚÔ˜ ÙÔÓ appleÚÔÙÂÙÚ·‰˘ÌÈÎfiapple˘Ú‹Ó· ÁÈ· ÙË Û‡Ûapple·ÛË Ù˘ ÎfiÚ˘, appleÚÔ˜ ÙÔ˘˜ ˘appleÔapple˘-Ú‹Ó˜ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ ÁÈ· ÙÔÓ ¿Óˆ ÔÚıfi Î·È ÙÔÓοو ÏÔÍfi, appleÔ˘ apple·Ú¿ÁÔ˘Ó ÙËÓ appleÚÔ˜ Ù· ¿Óˆ ÔÊı·ÏÌÈ-΋ ΛÓËÛË Î·È appleÚÔ˜ ÙÔ˘˜ apple˘Ú‹Ó˜ ÙÔ˘ appleÚÔÛˆappleÈÎÔ‡appleÔ˘ appleÚÔηÏÔ‡Ó ÙÔ ÎÏ›ÛÈÌÔ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ. IO = ˘appleÔapple˘Ú‹Ó·˜ÙÔ˘ οو ÏÔÍÔ‡, IR = ˘appleÔapple˘Ú‹Ó·˜ ÙÔ˘ ο-Ùˆ ÔÚıÔ‡, ML = ̤ÛË ÁÚ·ÌÌ‹, MR = ˘appleÔapple˘Ú‹Ó·˜ÙÔ˘ ¤Ûˆ ÔÚıÔ‡, SR = ˘appleÔapple˘Ú‹Ó·˜ ÙÔ˘ ¿Óˆ ÔÚıÔ‡(Jampel Î·È Haidt).Îfi, ˘apple‹Ú¯·Ó Û˘Óo‰¤˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ¯ÂÈϤˆÓ, ÙˆÓÛÈ·ÁfiÓˆÓ Î·È apple·‡ÛË Ù˘ ·Ó·appleÓo‹˜.‡Ìʈӷ Ì ÙȘ ÌÂϤÙ˜ ÙˆÓ Weinstein ηÈBender fiϘ oÈ appleÚoÛˆappleo-oÊı·ÏÌÈΤ˜ Î·È appleÚoÛˆappleo-·Ó·appleÓ¢ÛÙÈΤ˜«Û˘Ó-ÎÈÓ‹ÛÂȘ» oÏoÎÏËÚÒÓo-ÓÙ·È ÛÙo ‰ÈÎÙ˘ˆÙfi Û¯ËÌ·ÙÈÛÌfi Ùo˘ ÛÙÂϤ¯o˘˜.Ùo Ê·ÈÓfiÌÂÓo Ùo˘ Bell ˘apple¿Ú¯o˘Ó ·Û˘Ó›‰Ë-Ù˜ Ù·¯Â›Â˜ oÊı·ÏÌÈΤ˜ ÎÈÓ‹ÛÂȘ ηٿ Ùo Û˘ÓÂȉË-Ùfi ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, oÈ oappleo›Â˜ ıˆÚo‡ÓÙ·ÈÙ·¯Â›Â˜ ÎÈÓ‹ÛÂȘ Î·È Âappleo̤ӈ˜ Â›Ó·È Û·Îο‰Â˜.OÈ o‰o› Ù˘ oÊı·ÏÌoΛÓËÛ˘ ÁÈ· Ùo Ê·ÈÓfi-ÌÂÓo Bell ‰ÂÓ Â›Ó·È ÁÓˆÛÙo› ̤¯ÚÈ Û‹ÌÂÚ·. OÈ∂steban Î·È Û˘Ó. appleÚoÙ›Óo˘Ó ÙËÓ ÂÍ‹˜ ˘applefiıÂÛË:∞applefi ÙoÓ oÊı·ÏÌoÎÈÓËÙÈÎfi ÌÂÙˆappleÈ·›o ÊÏoÈfi Ùo˘ÂÁÎÂÊ¿Ïo˘ ›Ó˜ ‰È· Ùo˘ appleÚoÛı›o˘ ÛΤÏo˘˜ Ù‹˜ ¤ÛˆÎ¿„·˜ appleoÚ‡oÓÙ·È ÎoÓÙ¿ ÛÙo ÁfiÓ˘ Î·È Û ÛÙÂÓ‹Û¯¤ÛË Ì ˘appleÂÚapple˘ÚËÓÈΤ˜ ›Ó˜ Ùo˘ appleÚoÛˆappleÈÎo‡ Ó‡-Úo˘. ÿÓ˜ ÁÈ· Ùo ‚ϤÌÌ· appleÚo˜ Ù· ¿Óˆ appleoÚ‡oÓٷȉȷ Ùo˘ appleÚoÙÂÙÚ·‰‡Ìo˘ (pretectum) Î·È oappleÈÛı›o˘Û˘Ó‰¤ÛÌo˘ (posterior commissure). ÿÓ˜ oÈ oappleo›Â˜Í¯ˆÚ›˙o˘Ó ·applefi ÙËÓ Î‡ÚÈ· oÊı·ÏÌoÎÈÓËÙÈ΋ o‰fiappleÈı·ÓfiÓ ÂÓÒÓoÓÙ·È Ì ÙoÓ apple˘Ú‹Ó· Ùo˘ ¿Óˆ oÚıo‡,·ÌÊoÙÂÚfiappleÏ¢Úo ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ. ∞applefi ÙoÓÎÂÚ·ÙoÂȉ‹ Êı¿Óo˘Ó ÂÚÂı›ÛÌ·Ù·, appleo˘ ÌÂÚÈΤ˜ÊoÚ¤˜ ÌappleoÚ› Ó· Â›Ó·È ÂappleÒ‰˘Ó· Î·È appleÚoηÏo‡Ó,Âapple›Û˘, ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ. Δo ı¿Ì‚o˜ appleÚoη-Ï› ·ÓÙ·Ó·ÎÏ·ÛÙÈÎfi ÎÏ›ÛÈÌo ÏfiÁˆ ¤ÓÙoÓo˘ ÂÚÂıÈ-ÛÌo‡ Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂȉo‡˜.OÈ Weinstein Î·È Bender (1943) ÂÚ¤ıÈÛ·Ó appleÂ-ÚÈo¯‹ ÛÙË ÁÂÊ˘ÚÈ΋ ηχappleÙÚ· (pontine tegmentum)1,5-2,5 mm ·applefi Ùo ÌÂÛo-o‚ÂÏÈ·›o Âapple›apple‰o(Ùo ‰ÈÎÙ˘ˆÙfi Û¯ËÌ·ÙÈÛÌfi ÛÙo ÙÌ‹Ì· Ù˘ Á¤Ê˘Ú·˜)ÌÂٷ͇ Ùo˘ apple˘Ú‹Ó· Ùo˘ ÎoÈÓo‡ ÎÈÓËÙÈÎo‡ (πππ) ηÈÙo˘ apple˘Ú‹Ó· Ùo˘ appleÚoÛˆappleÈÎo‡ (VII) Ó‡Úo˘ Î·È apple¤-Ù˘¯·Ó ·ÌÊoÙÂÚfiappleÏ¢Úo ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ,ΛÓËÛË ÙˆÓ ‚oÏ‚ÒÓ appleÚo˜ Ù· ¿Óˆ Î·È Û‡Ûapple·ÛË Ù˘ÎfiÚ˘. ∂¿Ó ¯ÚËÛÈÌoappleoÈo‡Û·Ó ˘„ËÏfiÙÂÚo ‰˘Ó·ÌÈ-EÈÎ. 6. ˘ÓÔappleÙÈÎfi Û¯‹Ì· ÙÔ˘ ÂϤÁ¯Ô˘ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ ÎÈ-Ó‹ÛˆÓ. ∞applefi Ù· ÌÂÙˆappleÈ·›· ÔÊı·ÏÌÈο apple‰›· (FEF)Î·È ÙË ‚ÚÂÁÌ·ÙÔ-ÎÚÔÙ·ÊÔ-ÈÓȷ΋ Û˘Ì‚ÔÏ‹ (POT)˘appleÂÚapple˘ÚËÓÈΤ˜ Û˘Ó‰¤ÛÂȘ appleÔÚ‡ÔÓÙ·È appleÚÔ˜ Ù· appleÚfi-ÛıÈ· ‰È‰‡ÌÈ· (SC), ÙÔÓ ÎÔÈÏÈ·Îfi ‰È¿ÌÂÛÔ apple˘Ú‹Ó· Ù˘¤Ûˆ ÂappleÈÌ‹ÎÔ˘˜ ‰ÂÛÌ›‰·˜ (riMLF) Î·È ÙÔÓ apple·Ú¿ÌÂÛÔÁÂÊ˘ÚÈÎfi ‰ÈÎÙ˘ˆÙfi Û¯ËÌ·ÙÈÛÌfi (PPRF). T· ÌÂÙˆappleÈ·›·ÔÊı·ÏÌÈο apple‰›· (FEF) Î·È Ù· appleÚfiÛıÈ· ‰È‰‡ÌÈ· (SC)¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ apple·Ú·ÁˆÁ‹ ÙˆÓ Û·Îο‰ˆÓ, ÂÓÒ Ë‚ÏÂÁÌ·ÙÔ-ÎÚÔÙ·ÊÔ-ÈÓȷ΋ Û˘Ì‚ÔÏ‹ (POT) ¤¯ÂÈ Û¯¤ÛËÌ ÙȘ ÎÈÓ‹ÛÂȘ apple·Ú·ÎÔÏÔ‡ıËÛ˘ (persuit), (Miller).

238 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ÂÓÒ ‰È·ÙËÚo‡Ó Ù·˘Ùfi¯ÚoÓ· Û‡Ó‰ÂÛË Ì Ùo appleÚoÛˆappleÈÎfiÓ‡Úo, ‰È·ÙËÚÒÓÙ·˜ ÙËÓ ·Ó·ÙoÌÈ΋ ‚¿ÛË ÁÈ·Û˘ÓÂÚÁÈ΋ appleÚo˜ Ù· ¿Óˆ ΛÓËÛË ÙˆÓ oÊı·ÏÌÒÓ, Ëoappleo›· Û˘Óo‰Â‡ÂÈ Ùo ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ.Δ· ÌÂÙˆappleÈ·›· oÊı·ÏÌÈο apple‰›· ÛÙ¤ÏÓo˘ÓappleÚo‚oϤ˜ ηْ ¢ı›·Ó ÛÙ· ΤÓÙÚ· Ùo˘ ÛÙÂϤ¯o˘˜ÁÈ· ÙȘ oÚÈ˙fiÓÙȘ Î·È Î¿ıÂÙ˜ ÎÈÓ‹ÛÂȘ Ùo˘ ‚ϤÌ-Ì·Ùo˜ (∂ÈÎ. 6), ‰ËÏ·‰‹ ÛÙoÓ apple˘Ú‹Ó· Ùo˘ apple·Ú¿-ÌÂÛo˘ ÁÂÊ˘ÚÈÎo‡ ‰ÈÎÙ˘ˆÙo‡ Û¯ËÌ·ÙÈÛÌo‡ (PPRF)Î·È ÛÙoÓ ÎoÈÏÈ·Îfi ‰È¿ÌÂÛo apple˘Ú‹Ó· Ù˘ ¤Ûˆ ÂappleÈ-Ì‹Îo˘˜ ‰ÂÛÌ›‰·˜ (riMLF).OÈ oÚÈ˙fiÓÙȘ Û·Îο‰Â˜ ÌappleoÚ› Ó· apple·Ú¿ÁoÓٷț٠·applefi Ùo ·ÓÙ›ÛÙoȯo ÌÂÙˆappleÈ·›o oÊı·ÏÌÈÎfi apple‰›o(FEF) ‹ ·ÓÙ›ÛÙoȯo ¿Óˆ ‰È‰‡ÌÈo. OÈ Î¿ıÂÙ˜ o-Êı·ÏÌÈΤ˜ ÎÈÓ‹ÛÂȘ ·apple·ÈÙo‡Ó Ù·˘Ùfi¯ÚoÓË ‰Ú·ÛÙË-ÚÈfiÙËÙ· ›Ù ·ÌÊoÙ¤ÚˆÓ ÙˆÓ ÌÂÙˆappleÈ·›ˆÓ oÊı·Ï-ÌÈÎÒÓ apple‰›ˆÓ ‹ ·ÌÊoÙ¤ÚˆÓ ÙˆÓ ¿Óˆ ‰È‰˘Ì›ˆÓ.∫ÏÈÓÈΤ˜ Î·È appleÂÈÚ·Ì·ÙÈΤ˜ ÂӉ›ÍÂȘ ÂÓÈÛ¯‡-o˘Ó ÙËÓ ¿appleo„Ë, fiÙÈ o Û‡ÛÙoȯo˜ ÌÂÙˆappleÈ·›o˜ ÊÏoÈfi˜ÌappleoÚ› Ó· appleÚoηϤÛÂÈ Û‡ÛÙoȯ˜ Û·Îο‰Â˜, fiÙ·ÓÙo ·ÓÙ›ÛÙoȯo ËÌÈÛÊ·›ÚÈo ¤¯ÂÈ Î·Ù·ÛÙÚ·Ê›. ø˜ ÂÎÙo‡Ùo˘, ‰‡o ‹ appleÂÚÈÛÛfiÙÂÚ˜ o‰o› appleo˘ ÌappleoÚ› Ó·appleÚoηϤÛo˘Ó Û·Îο‰Â˜ ÌappleoÚ› Ó· ˘apple¿Ú¯o˘Ó.IV. ∫ÒÌ· - ¡fiÛÔ˜ Alzheimer -ÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS)∞applefi ÙËÓ ˘apple¿Ú¯o˘Û· appleÏËıÒÚ· ÁÓÒÛÂˆÓ Î·ÈappleÏËÚoÊoÚÈÒÓ ÁÈ· Ùo ÎÒÌ·, ÙË ÓfiÛo Ùo˘ Alzheimer(AD) Î·È ÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS), oÈ o-appleo›Â˜ Ì·˜ ‚oÌ‚·Ú‰›˙o˘Ó Û‹ÌÂÚ·, apple·Ú·Î¿Ùˆ ·Ó·-ʤÚoÓÙ·È ÌfiÓo ‚·ÛÈΤ˜ Î·È ·apple·Ú·›ÙËÙ˜ appleÏËÚo-Êoڛ˜, oÈ oappleo›Â˜ ›Ûˆ˜ ÌappleoÚ› Ó· ‚oËı‹Ûo˘Ó ÛÙËÓηٷÓfiËÛË Ù˘ ÌÂϤÙ˘ Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ BellÛÙo˘˜ ·ÛıÂÓ›˜ ·˘Ùo‡˜, Ùo oappleo›o ·appleoÙÂÏ› Î·È Ùo·ÓÙÈΛÌÂÓo Ù˘ apple·Úo‡Û˘ ÂÚÁ·Û›·˜.∫ÒÌ·OÚÈÛÌfi˜ ÎÒÌ·Ùo˜: ¤Ó·˜ ·ÛıÂÓ‹˜ o oappleo›o˜‰ÂÓ ·apple·ÓÙ¿ ÏÂÎÙÈο, ‰ÂÓ ˘apple·Îo‡ÂÈ Û ÂÓÙoϤ˜ ηȉÂÓ ·Óo›ÁÂÈ Ùo˘˜ oÊı·ÏÌo‡˜ Ùo˘ ›Ù ·˘ÙfiÌ·Ù· ›-Ù Û oappleoÈo‰‹appleoÙ ÂÚ¤ıÈÛÌ· ıˆÚÂ›Ù·È fiÙÈ ‚Ú›-ÛÎÂÙ·È Û ÎÒÌ· (Jennett B Î·È Teasdale G).OÈ Levy D.E. Î·È Û˘Ó. ¯ÚËÛÈÌoappleoÈo‡Ó Ùo˘˜apple·Ú·Î¿Ùˆ oÚÈÛÌo‡˜:∫ÒÌ·: ‰ÂÓ ·Óo›ÁÂÈ Ùo˘˜ oÊı·ÏÌo‡˜ ·ÓÂÍ¿Ú-ÙËÙ· ·applefi ÙË Ê‡ÛË Ùo˘ ÂÚÂı›ÛÌ·Ùo˜, ‰›ÓÂÈ ÌË Î·-Ù·ÓoËÙ¤˜ ÏÂÎÙÈΤ˜ ·apple·ÓÙ‹ÛÂȘ Î·È ‰ÂÓ ˘apple·Îo‡ÂÈÛ ÂÓÙoϤ˜.º˘ÙÈ΋ ηٿÛÙ·ÛË (vegetative state): ·Óo›ÁÂÈÙo˘˜ oÊı·ÏÌo‡˜ ·˘ÙfiÌ·Ù·, Û ıfiÚ˘‚o ‹ Û applefiÓo,·ÏÏ¿ ‰›ÓÂÈ ÌË Î·Ù·ÓoËÙ¤˜ ÏÂÎÙÈΤ˜ ·apple·ÓÙ‹ÛÂȘ ηȉÂÓ ˘apple·Îo‡ÂÈ Û ÂÓÙoϤ˜. ηٿÛÙ·ÛË Û˘Ó›‰ËÛ˘ ‰›ÓÂÈ Î·Ù·ÓoËÙ¤˜·apple·ÓÙ‹ÛÂȘ ‹ ˘apple·Îo‡ÂÈ Û ÂÓÙoϤ˜.ËÌ·Û›· ¤¯ÂÈ o ‰È·¯ˆÚÈÛÌfi˜ ÌÂٷ͇ Ê˘ÙÈ΋˜Î·Ù¿ÛÙ·Û˘ Î·È ÎÒÌ·Ùo˜.∫ϛ̷η ÎÒÌ·ÙÔ˜ °Ï·ÛÎfi‚˘∏ Îϛ̷η ÎÒÌ·Ùo˜ °Ï·ÛÎfi‚˘ (Teasdale ηÈJennett, 1974) ˘ÈoıÂÙ‹ıËΠÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Â-ÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ ·applefi ‰È¿ÊoÚ˜ ·Èٛ˜, ¯ÚËÛÈÌoappleoÈ›ٷÈ¢ڤˆ˜ Î·È ıˆÚÂ›Ù·È Â‡ÎoÏ· ÂÊ·ÚÌfiÛÈ-ÌË ·apple’ fiÏo Ùo È·ÙÚÈÎfi Î·È ÓoÛËÏ¢ÙÈÎfi appleÚoÛˆappleÈÎfi.∫ϛ̷η ÎÒÌ·ÙÔ˜ °Ï·ÛÎfi‚˘ÕÓoÈÁÌ· ÙˆÓ oÊı·ÏÌÒÓ: - ·˘ÙfiÌ·Ù· ∂ 4- Û ÏÂÎÙÈο ÂÚÂı›ÛÌ·Ù· 3- Û ÂappleÒ‰˘Ó· ÂÚÂı›ÛÌ·Ù· 2- ηıfiÏo˘ 1∫·Ï‡ÙÂÚË ÎÈÓËÙÈ΋·apple¿ÓÙËÛË: - ˘apple·Îo‡ÂÈ Û ÂÓÙoϤ˜ ª 5- ÂÓÙoapple›˙ÂÈ ÙoÓ applefiÓo 4- ÎÈÓ‹ÛÂȘ ·ÓÒÌ·Ï˘ ο̄˘Û applefiÓo 3- ÎÈÓ‹ÛÂȘ ¤ÎÙ·Û˘ Û applefiÓo 2- η̛· ΛÓËÛË 1§ÂÎÙÈΤ˜ ·apple·ÓÙ‹ÛÂȘ: - appleÚoÛ·Ó·ÙoÏÈṲ̂Óo˜ V 5- Û˘Á¯˘ÙÈÎfi˜ ÛÙË Û˘˙‹ÙËÛË 4- ·apple·ÓÙ¿ Ì fi¯È ÛˆÛÙ¤˜ ϤÍÂȘ 3- ·apple·ÓÙ¿ Ì ·Î·Ù·ÓfiËÙo˘˜ ‹¯o˘˜ 2- η̛· ·apple¿ÓÙËÛË 1E M V ·appleoÙ¤ÏÂÛÌ· (score) 3 - 14.§fiÁˆ Ù˘ appleÚ·ÎÙÈÎfiÙËÙ¿˜ Ùo˘ Ùo Û‡ÛÙËÌ· ·˘-Ùfi ¤¯ÂÈ Â˘Ú¤ˆ˜ ÂÊ·ÚÌoÛı›.ªÂÚÈΤ˜ apple·Ú·ÙËÚ‹ÛÂȘ ÌappleoÚ› Ó· Ï›appleo˘Ó,ÂappleÂȉ‹ ¤Ó· ÛÙoȯ›o ‰ÂÓ ÌappleoÚ› Ó· ÂÏÂÁ¯ı›, apple.¯. ËoÌÈÏ›· Û ·ÛıÂÓ›˜ Ì ÙÚ·¯ÂÈoÙoÌ›· ‹ Ùo ¿ÓoÈÁÌ·ÙˆÓ oÊı·ÏÌÒÓ fiÙ·Ó Ì˯·ÓÈο Â›Ó·È ·‰‡Ó·Ùo. ŒÓ··applefi Ù· appleÏÂoÓÂÎÙ‹Ì·Ù· Ù˘ ÌÂıfi‰o˘ apple¿ÓÙˆ˜ ›ӷÈfiÙÈ ‰›ÓÂÈ appleÏËÚoÊoڛ˜ ·ÎfiÌË Î·È fiÙ·Ó ¤Ó· ÙÌ‹Ì·Ù˘ Ï›appleÂÈ.¡fiÛÔ˜ AlzheimerO Alvarez ·Ó·Ê¤ÚÂÈ ·Û‡ÌÌÂÙÚo Ê·ÈÓfiÌÂÓoμell, appleÈo Û˘¯Ó¿ Ì ÙËÓ ¿Óo‰o Ù˘ ËÏÈΛ·˜, ·ÏÏ¿ appleÈoÛo‚·Ú¿ ÂappleËÚ·Ṳ̂Óo ÛÙË ÓfiÛo Ùo˘ Parkinson.ÙË ‚È‚ÏÈoÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È Âapple›Û˘ fiÙÈ Ùo25% ÙˆÓ ·ÛıÂÓÒÓ Ì ÓfiÛo Alzheimer ›¯·Ó Ù· apple·-ıoÏoÁo·Ó·ÙoÌÈο Î·È ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ù˘ ÓfiÛo˘

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 239Ùo˘ Parkinson (Leverenz Î·È Sumi). ∞˘Ùfi˜ ›ӷÈÎ·È o ÏfiÁo˜ appleo˘ Ì·˜ apple·Ú·Î›ÓËÛ ӷ ÌÂÏÂÙ‹Ûo˘ÌÂÙo Ê·ÈÓfiÌÂÓo μell ÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Ùo˘Alzheimer Î·È fiÛo ÁÓˆÚ›˙o˘Ì ‰ÂÓ ˘apple¿Ú¯ÂÈ ‰ÈÂıÓ‹˜‚È‚ÏÈoÁÚ·Ê›· ÁÈ· Ùo Ê·ÈÓfiÌÂÓo ·˘Ùfi ÛÙo˘˜·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer.∂›Ó·È ÁÓˆÛÙfi fiÙÈ 1 ÛÙo˘˜ 10 ·ÓıÚÒappleo˘˜ appleÂ-Ú›appleo˘ apple·ÁÎoÛÌ›ˆ˜ Â›Ó·È ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 65 ÂÙÒÓ.∞applefi ÙË ÓfiÛo Ùo˘ Alzheimer (AD) apple¿Û¯ÂÈ Ùo 19%Ùo˘ appleÏËı˘ÛÌo‡ ËÏÈΛ·˜ 75-84 ÂÙÒÓ Î·È 45% ¿ÓˆÙˆÓ 85 ÂÙÒÓ.  ̛· appleÚfiÛÊ·ÙË ÂappleȉËÌÈoÏoÁÈ΋ ÌÂ-ϤÙË ÛÙËÓ ∂ÏÏ¿‰· ·applefi ÙË ÓfiÛo Ùo˘ Alzheimer apple¿-Û¯ÂÈ Ùo 10% ÙˆÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 70 ÂÙÒÓÎ·È Ùo 57% ¿Óˆ ÙˆÓ 90 ÂÙÒÓ (Tsolaki et al).∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·ÚÈ· apple·ıoÏoÁo·Ó·ÙoÌÈ-ο Â˘Ú‹Ì·Ù· ÛÙË ÓfiÛo Ùo˘ Alzheimer Â›Ó·È o ·ÚÈı-Ìfi˜ ÙˆÓ ÁÂÚoÓÙÈÎÒÓ appleÏ·ÎÒÓ Î·È Ó¢Úo˚ÓȉÈÎÒÓ‚oÛÙÚ‡¯ˆÓ, Ë ÂÏ¿ÙÙˆÛË ÛÙoÓ ·ÚÈıÌfi ÙˆÓ Û˘Ó¿„Â-ˆÓ (Â›Ó·È o˘ÛÈ·ÛÙÈο ÓfiÛo˜ ÙˆÓ Û˘Ó¿„ˆÓ) Î·È ËÌÂÁ¿ÏË ·appleÒÏÂÈ· ÙˆÓ Ó¢ÚÒÓˆÓ.Œ¯ÂÈ È‰È·›ÙÂÚo ÂӉȷʤÚoÓ Ë apple·Ú·Ù‹ÚËÛËÙˆÓ Joachim et al fiÙÈ Ùo 18% ÙˆÓ ·ÛıÂÓÒÓ Ùo˘˜ ÌÂÓfiÛo Alzheimer ›¯Â Âapple·Ú΋ ·appleÒÏÂÈ· Ó¢ÚÒÓˆÓÎ·È ÛˆÌ¿ÙÈ· Ùo˘ Lewy ÛÙË Ì¤Ï·ÈÓ· o˘Û›·, ¤ÙÛÈ Ò-ÛÙ ӷ ÙÂı› Î·È Ë ‰È¿ÁÓˆÛË Ù˘ ÓfiÛo˘ Ùo˘ Parkinson.OÈ Leverenz Î·È Sumi ‚Ú‹Î·Ó fiÙÈ Ùo 25% ÙˆÓ·ÛıÂÓÒÓ Ùo˘˜ Ì ÓfiÛo Alzheimer ›¯·Ó Ù· apple·ıo-ÏoÁo·Ó·ÙoÌÈο Î·È ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ù˘ ÓfiÛo˘Ùo˘ Parkinson.ÙË ÓfiÛo Ùo˘ Alzheimer o ÂÁΤʷÏo˜ ›ӷÈηıoÏÈο ·ÙÚoÊÈÎfi˜ Ì ̛· ˘appleÂÚo¯‹ Ù˘ ·ÙÚoÊ›·˜ÛÙo Âapple›apple‰o Ùo˘ ÎÚoÙ·ÊÈÎo‡, ÌÂÙˆappleÈ·›o˘ ‹ ‚ÚÂÁ-Ì·ÙÈÎo‡ Ïo‚o‡ Î·È Û ÌÂÚÈΤ˜ appleÂÚÈappleÙÒÛÂȘ Ùo˘ÈÓÈ·Îo‡ Ïo‚o‡ (∫ˆÓÛÙ·ÓÙÈÓ›‰Ë˜).∏ ÂÁÎÂÊ·ÏÈ΋ ·ÙÚoÊ›· Â›Ó·È ÁÂÓÈο Û˘ÌÌÂÙÚÈ-΋, ·ÏÏ¿ apple·Ú·ÙËÚo‡ÓÙ·È Î·È appleÂÚÈappleÙÒÛÂȘ ·Û˘Ì-ÌÂÙÚ›·˜ (Bugiani et al 1986, Bouras et al 1988).ª·ÁÓËÙÈ΋ ÙoÌoÁÚ·Ê›· (MRI). ¢È·Ù·Ú·¯¤˜ÛÙË Ï¢΋ o˘Û›· (white matter hyperdensities) ‚Ú›-ÛÎÂÙ·È ÛÙo 30% Ì ÓfiÛo Ùo˘ Alzheimer. ∂apple›Û˘ ˘-apple¿Ú¯ÂÈ ·ÙÚoÊ›·, ȉȷ›ÙÂÚ· appleÂÚÈo¯È΋ ·ÙÚoÊ›· Ùo˘ÂÓ‰oÚÈÓÈÎo‡ ÊÏoÈo‡, Ùo˘ ÎÚoÙ·ÊÈÎo‡ ÓÂoÊÏoÈo‡Î·È Ùo˘ ÈappleappleoοÌappleÈo˘ Û¯ËÌ·ÙÈÛÌo‡ (ΔÛoÏ¿ÎË ª.).ªoÓoʈÙoÓȷ΋ ·ÍoÓÈ΋ ÙoÌoÁÚ·Ê›·(SPECT). ∞Ó¢ڛÛÎÂÙ·È ÂÏ¿ÙÙˆÛË Ù˘ ÂÁÎÂÊ·ÏÈ-΋˜ ·ÈÌ·ÙÈ΋˜ Úo‹˜ ÛÙo ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈo, appleo˘Û¯ÂÙ›˙ÂÙ·È Ì ‰È·Ù·Ú·¯¤˜ Ùo˘ ÏfiÁo˘ Î·È ÂÏ¿ÙÙˆÛËÙ˘ Úo‹˜ ÛÙoÓ ·ÚÈÛÙÂÚfi ‚ÚÂÁÌ·ÙÈÎfi Ïo‚fi, appleo˘ Û¯Â-Ù›˙ÂÙ·È Ì ÙËÓ ·appleÚ·Í›· (Osimani A and al, 1994).ÙËÓ appleÚoÁÂÚoÓÙÈ΋ ÌoÚÊ‹ Ê·›ÓÂÙ·È fiÙÈ apple¿Û¯ÂÈ Î˘-Ú›ˆ˜ Ùo ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈo (Jugust Î·È Û˘Ó.).o˙ÈÙÚoÓȷ΋ ÙoÌoÁÚ·Ê›· (PET). ÙË ÓfiÛoÙo˘ Alzheimer ÛÙËÓ PET apple·Ú·ÙËÚÂ›Ù·È ‰È·Ù·Ú·¯‹Ùo˘ ÌÂÙ·‚oÏÈÛÌo‡ ΢ڛˆ˜ ÛÙo˘˜ ÎÚoÙ·ÊÈÎo‡˜ ηȂÚÂÁÌ·ÙÈÎo‡˜ Ïo‚o‡˜ (Kumar A, 1993).O ˘appleoÌÂÙ·‚oÏÈÛÌfi˜ Ùo˘ ‚ÚÂÁÌ·ÙÈÎo‡ Ïo‚o‡apple·Ú·Ì¤ÓÂÈ apple¿ÓÙ· appleÈo Ûo‚·Úfi˜ Ì ÙËÓ apple¿Úo‰o Ùo˘¯ÚfiÓo˘ ·applefi ÙoÓ ˘appleoÌÂÙ·‚oÏÈÛÌfi ÛÙo ÌÂÙˆappleÈ·›oÏo‚fi ÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Ùo˘ Alzheimer (JugustÎ·È Û˘Ó.).º·ÛÌ·ÙoÛÎoapple›·. ∂›Ó·È ÌÈ· Ó¤· Ù¯ÓÈ΋, Ë o-appleo›· ÂappleÈÙÚ¤appleÂÈ ÙËÓ apple·Ú·ÎoÏo‡ıËÛË Ù˘ o͢ÁfiÓˆ-Û˘ Ùo˘ ÂÁÎÂÊ·ÏÈÎo‡ ·›Ì·Ùo˜ Î·È Ùo˘ ÂÁÎÂÊ·ÏÈ-Îo‡ ÈÛÙo‡. OÈ ·ÛıÂÓ›˜ Ì ÓfiÛo Ùo˘ Alzheimer,ηٿ ÙËÓ ÂͤٷÛË Ì Ó¢Úo„˘¯oÏoÁÈΤ˜ ‰oÎÈÌ·Û›-˜, ›¯·Ó ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË Î·È ÛÙËÓ o͢ÁoÓˆ-̤ÓË ·ÈÌoÛÊ·ÈÚ›ÓË Î·È ÛÙËÓ oÏÈ΋ ·ÈÌoÛÊ·ÈÚ›ÓË,Ë oappleo›· ‹Ù·Ó appleÈo ÂÎÛÂÛËÌ·Ṳ̂ÓË ÛÙo˘˜ ‚ÚÂÁÌ·ÙÈ-Îo‡˜ Ïo‚o‡˜ (Hock C Î·È Û˘Ó.).ÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS)Àapple‹Ú¯Â Û ̷˜ Ë ÎÏÈÓÈ΋ ÂÓÙ‡appleˆÛË fiÙÈ Ùo Ê·È-ÓfiÌÂÓo Ùo˘ Bell ÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÛÎÏ‹Ú˘ÓÛË Î·-Ù¿ appleϿη˜ ˘appleÂÚapple·Ú¿ÁÂÙ·È Î·È fiÛo ÁÓˆÚ›˙o˘Ì‰ÂÓ ˘apple¿Ú¯ÂÈ ‰ÈÂıÓ‹˜ ‚È‚ÏÈoÁÚ·Ê›· ÁÈ· Ùo Ê·ÈÓfi-ÌÂÓo Ùo˘ Bell ÛÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜. O Ïfi-Áo˜ ·˘Ùfi˜ Î·È ÂappleÂȉ‹ Ë ÓfiÛo˜ ·˘Ù‹ appleÚoÛ‚¿ÏÏÂÈ ÓÂfiÙÂÚ˜ËÏÈ˘ Û ۯ¤ÛË Ì ÙË ÓfiÛo Ùo˘ Alzheimer,appleo˘ appleÚoÛ‚¿ÏÏÂÈ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, Ì·˜ apple·Ú·Î›-ÓËÛ ӷ ÌÂÏÂÙ‹Ûo˘Ì Ùo Ê·ÈÓfiÌÂÓo Ùo˘ Bell ηÈÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜.∏ ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ Â›Ó·È Ûo‚·Ú‹ Ó¢-ÚoÏoÁÈ΋ ÓfiÛo˜, ÏfiÁˆ Ù˘ Û˘¯ÓfiÙËÙ·˜, Ù˘ ¯ÚoÓÈfi-ÙËÙ¿˜ Ù˘ Î·È Ù˘ Ù¿Û˘ Ù˘ Ó· appleÚoÛ‚¿ÏÏÂÈ Ó·ڿ¿ÙoÌ·. ÷ڷÎÙËÚ›˙ÂÙ·È ÎÏÈÓÈο ·applefi ÂappleÂÈÛfi‰È· Â-ÛÙȷ΋˜ appleÚoÛ‚oÏ‹˜ ÙˆÓ oappleÙÈÎÒÓ Ó‡ڈÓ, Ù˘ ÛappleoÓ-‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È Ùo˘ ÂÁÎÂÊ¿Ïo˘, Ù· oappleo›· ˘appleo-¯ˆÚo‡Ó Û appleoÈΛÏË ¤ÎÙ·ÛË Î·È ˘appleoÙÚoappleÈ¿˙o˘Ó Û¯ÚoÓÈÎfi ‰È¿ÛÙËÌ· appleoÏÏÒÓ ÂÙÒÓ. Δ· ÎÏÈÓÈο Û˘ÌappleÙÒÌ·Ù·apple·Úo˘ÛÈ¿˙o˘Ó ÌÂÁ¿ÏË appleoÈÎÈÏ›·, ÏfiÁˆ ÙˆÓappleoÈÎ›ÏˆÓ ÂÓÙoapple›ÛÂˆÓ Î·È Ù˘ ¤ÎÙ·Û˘ ÙˆÓ ·appleoÌ˘Â-ÏÈÓˆÙÈÎÒÓ ‚Ï·‚ÒÓ.∏ Û˘¯ÓfiÙËÙ· Ù˘ ÛÎÏ‹Ú˘ÓÛ˘ ηٿ appleϿη˜(MS) appleoÈΛÏÏÂÈ ·Ó¿ÏoÁ· Ì ÙË ÁˆÁÚ·ÊÈ΋ appleÂÚÈo-¯‹, ·˘Í·ÓfiÌÂÓË fiÛo appleÚo¯ˆÚ¿Ì ‚fiÚÂÈ· Î·È ÓfiÙÈ·Ùo˘ ÈÛËÌÂÚÈÓo‡. ÙȘ ∏∞ Â›Ó·È 6-80 appleÂÚÈÛÙ·ÙÈο·Ó¿ 100.000. ∂›Ó·È Û¯ÂÙÈο Ûapple¿ÓÈ· ÛÙËÓ ∞Û›· ηÈÙËÓ ∞ÊÚÈ΋. ÚoÛ‚¿ÏÏÂÈ Á˘Ó·›Î˜ appleÂÚÈÛÛfiÙÂÚo ·-applefi Ùo˘˜ ¿Ó‰Ú˜ Û ·Ó·ÏoÁ›· 2:1. ∂›Ó·È ·Û˘Ó‹ı˘

240 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ÛÙ· apple·È‰È¿ οو ÙˆÓ 10 ÂÙÒÓ Î·È Ë ÌÂÁ·Ï‡ÙÂÚË Û˘-¯ÓfiÙËÙ· apple·Ú·ÙËÚÂ›Ù·È Û Ӥo˘˜ ÂÓ‹ÏÈΘ 25-40 Â-ÙÒÓ. ¿ÓÙˆ˜ appleÚoÛ‚oÏ‹ Ù˘ ÓfiÛo˘ Û ¿ÙoÌ· ¿ÓˆÙˆÓ 50 ÂÙÒÓ ‰ÂÓ Â›Ó·È Ûapple¿ÓÈ· (Kurtzke, Matthews·Ó·Ê¤ÚoÓÙ·È ÛÙo ∞merican Academy of Ophthalmology).Δo̤˜ Ùo˘ ÂÁÎÂÊ¿Ïo˘ Î·È Ù˘ ÛappleoÓ‰˘ÏÈ΋˜ÛÙ‹Ï˘ ·appleoηχappleÙo˘Ó ‰È·ÛÎoÚappleÈṲ̂Ó˜ ‚Ï¿‚˜,oÈ oappleo›Â˜ ͯˆÚ›˙o˘Ó ·applefi ÙËÓ appleÂÚÈ‚¿ÏÏo˘Û· Ï¢-΋ o˘Û›· ·applefi Ùo Úfi‰ÈÓo-ÁÎÚÈ ¯ÚÒÌ·, ÏfiÁˆ Ù˘ ·-appleÒÏÂÈ·˜ Ù˘ Ì˘ÂÏ›Ó˘ o˘Û›·˜ Î·È appleo˘ Ë ‰È¿ÌÂÙÚfi˜Ùo˘˜ appleoÈΛÏÏÂÈ ·applefi ÌÈÎÚfiÙÂÚË Ùo˘ ÂÓfi˜ ¯ÈÏÈoÛÙo‡Ì¤¯ÚÈ Ï›Á· ÂηÙoÛÙ¿. ∞Ó¢ڛÛÎoÓÙ·È Î˘Ú›ˆ˜ ÛÙËÏ¢΋ o˘Û›· Ùo˘ ÂÁÎÂÊ¿Ïo˘ Î·È Ù˘ ÛappleoÓ‰˘ÏÈ΋˜ÛÙ‹Ï˘ Î·È ‰ÂÓ ÂappleÂÎÙ›ÓoÓÙ·È apple¤Ú·Ó Ù˘ ˙ÒÓ˘ ÂÈ-Ûfi‰o˘ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ Î·È ÛappleoÓ‰˘ÏÈÎÒÓ Ó‡ڈÓ.∏ ÙoappleoÁÚ·Ê›· ÙˆÓ ‚Ï·‚ÒÓ Â›Ó·È ·ÍÈoÛËÌ›ˆ-ÙË. ÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ÂÓÙfiappleÈÛË apple¤ÚÈÍ ÙˆÓappleÏ·Á›ˆÓ ÎoÈÏÈÒÓ. ∂apple›Û˘ ÂÓÙoapple›˙oÓÙ·È ÛÙ· oappleÙÈοÓ‡ڷ Î·È ÛÙo ¯›·ÛÌ· (·ÏÏ¿ Ûapple¿ÓÈ· ÛÙȘ oappleÙÈΤ˜Ù·Èӛ˜) Î·È ÙË ÛappleoÓ‰˘ÏÈ΋ ÛÙ‹ÏË. OÈ ‚Ï¿‚˜ ‰È·-ÛÎoÚapple›˙oÓÙ·È Ù˘¯·›· ÛÙo Û٤ϯo˜, ÛÙË ÛappleoÓ‰˘ÏÈ-΋ ÛÙ‹ÏË Î·È ÛÙ· ÂÁÎÂÊ·ÏÈο ÛΤÏË, ¯ˆÚ›˜ οappleoÈ·appleÚoÙ›ÌËÛË Û oÌ¿‰· ÈÓÒÓ. ÙoÓ ÂÁÎÂÊ·ÏÈÎfi ÊÏoÈfiηٷÛÙÚ¤ÊÂÙ·È Ë Ì˘ÂÏ›ÓË ·ÏÏ¿ Ù· Ó¢ÚÈο ·ÙÙ·-Ú· o˘ÛÈ·ÛÙÈο apple·Ú·Ì¤Óo˘Ó ¿ıÈÎÙ·.OÈ Lublin Î·È Reingold (1996) ¯ÚËÛÈÌoappleoÈo‡ÓÙËÓ apple·Ú·Î¿Ùˆ Ù·ÍÈÓfiÌËÛË ÁÈ· ÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿appleϿη˜ ÁÈ· ÏoÁ·ÚÈ·ÛÌfi Ù˘ National MultipleSclerosis Society (USA) Advisory Committee onClinical Trials of New Agents in Multiple Sclerosis:1) ÀappleoÙÚoappleÈ¿˙o˘Û· ˘Ê¤ÛÈÌË (relapsing-remitting,RR) ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS).2) ÚˆÙoapple·ı‹˜ appleÚo˚o‡Û· (primary-progressive,PP) ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS).3) ¢Â˘ÙÂÚoapple·ı‹˜ appleÚo˚o‡Û· (secondary-progressive,SP) ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS).4) Úo˚o‡Û· ˘appleoÙÚoappleÈ¿˙o˘Û· (progressiverelapsing,PR)ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS).OÈ ·ÓˆÙ¤Úˆ oÚÈÛÌo› ·Ó·Ê¤ÚoÓÙ·È ÛÙËÓ ÎÏÈÓÈ-΋ appleoÚ›· ÙˆÓ ·ÛıÂÓÒÓ Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleÏ¿-η˜ (MS). OÈ apple·Ú¿ÌÂÙÚoÈ Ù˘ MRI ‰ÂÓ Ï‹ÊıËηӢapplefi„Ë ÛÙËÓ apple·Ú·apple¿Óˆ Ù·ÍÈÓfiÌËÛË, apple·Ú¿ ÙȘ ·Ó·-ÊÂÚfiÌÂÓ˜ ‰È·ÊoÚ¤˜ ÛÙË MRI Û oÚÈṲ̂Ó˜ ÌoÚ-ʤ˜ ÛÎÏ‹Ú˘ÓÛ˘ ηٿ appleϿη˜ (MS) (‰ËÏ·‰‹ PP¤Ó·ÓÙÈ Ù˘ SP-MS), ‰ÈfiÙÈ Ì¤ÏË Ù˘ ÂappleÈÙÚoapple‹˜ ÌÂȉȷ›ÙÂÚË apple›ڷ ÛÙË MRI appleÈÛÙ‡o˘Ó fiÙÈ Ë ÙÚ¤¯o˘-Û· ÂÌappleÂÈÚ›· ‰ÂÓ ÂappleÈÙÚ¤appleÂÈ Âapple·Ú΋ Û˘Û¯¤ÙÈÛË Ù˘ÎÏÈÓÈ΋˜ appleoÚ›·˜ Ù˘ ÛÎÏ‹Ú˘ÓÛ˘ ηٿ appleϿη˜(MS) Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ MRI.∂ȉÈÎfi ̤ÚÔ˜π. ÎÔapplefi˜ŒÓ·˜ ·applefi Ùo˘˜ ÛÎoappleo‡˜ Ù˘ apple·Úo‡Û˘ ¤Ú¢-Ó·˜ Â›Ó·È Ó· Û˘ÁÎÂÓÙÚÒÛo˘Ì ÙËÓ ˘apple¿Ú¯o˘Û· Ï›ÁˉÈÂıÓ‹ ‚È‚ÏÈoÁÚ·Ê›· ÁÈ· Ùo Ê·ÈÓfiÌÂÓo Ùo˘ Bell.°ÓˆÚ›˙oÓÙ·˜ fiÙÈ ‰ÂÓ ˘apple¿Ú¯ÂÈ ‚È‚ÏÈoÁÚ·Ê›· Û¯ÂÙÈ-΋ Ì Ùo Ê·ÈÓfiÌÂÓo Ùo˘ Bell ÛÙo˘˜ ·ÛıÂÓ›˜ Û ÎÒ-Ì·, ÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer Î·È ÛÎÏ‹-Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS), ÛÙËÓ ¤ÚÂ˘Ó¿ Ì·˜ Û˘ÌappleÂÚÈÏ·Ì‚¿Óo˘ÌÂÙË ÌÂϤÙË Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘Bell Î·È Û’ ·˘Ù¤˜ ÙȘ oÌ¿‰Â˜ ·ÛıÂÓÒÓ.O ·ÚÈo˜ ÛÎoapplefi˜ Ì·˜ Â›Ó·È Ó· appleÚoÛapple·ı‹Ûo˘-Ì ӷ οÓo˘Ì ÌÈ· appleÚÒÙË appleÚoÛ¤ÁÁÈÛË Ùo˘ Ê·ÈÓo-̤Óo˘ Ùo˘ Bell ÛÙo˘˜ ·ÛıÂÓ›˜ ·˘Ùo‡˜, Ó· ı¤Ûo˘ÌÂÂÚˆÙ‹Ì·Ù· ·ÏÏ¿ Î·È Ó· appleÚoÛapple·ı‹Ûo˘Ì ӷ ‰Ò-Ûo˘Ì ·apple·ÓÙ‹ÛÂȘ.∂Ïapple›˙o˘Ì fiÙÈ Ë appleÚÒÙË appleÚoÛ¤ÁÁÈÛË Ùo˘ Ê·È-Óo̤Óo˘ Bell Û’ ·˘Ù¤˜ ÙȘ oÌ¿‰Â˜ ·ÛıÂÓÒÓ ›Ûˆ˜Ê·Ó› ¯Ú‹ÛÈÌË Û’ ·˘ÙfiÓ appleo˘ ÌÂÏÏoÓÙÈο ı· ‹ıÂÏÂÓ· ÂÌ‚·ı‡ÓÂÈ appleÂÚÈÛÛfiÙÂÚo ÛÙo ı¤Ì·.ππ. AÛıÂÓ›˜ Î·È Ì¤ıÔ‰Ô˜·Ú·ÎoÏo˘ı‹Û·Ì 35 ·ÛıÂÓ›˜ Û ÎÒÌ· Ù˘-¯·›·, ¯ˆÚ›˜ ȉȷ›ÙÂÚ· ÎÚÈÙ‹ÚÈ· ÂappleÈÏoÁ‹˜ (6 ·ÛıÂ-Ó›˜ ÛÙË MoÓ¿‰· EÓÙ·ÙÈ΋˜ £ÂÚ·apple›·˜ Ùo˘ ¡Â˘-Úo¯ÂÈÚo˘ÚÁÈÎo‡ ∫¤ÓÙÚo˘ Beaumont, Dublin ηÈÙo˘˜ ˘applefiÏoÈappleo˘˜ 29 ÛÙË MoÓ¿‰· EÓÙ·ÙÈ΋˜ £ÂÚ·-apple›·˜ Ùo˘ °. . ¡oÛoÎoÌ›o˘ «°. ·apple·ÓÈÎoÏ¿o˘»).Δ· ·›ÙÈ· Ùo˘ ÎÒÌ·Ùo˜ ‹Ù·Ó:1) appleÙÒÛË ·applefi ‡„o˜ Ì ∫.∂.∫. Û 6 ·ÛıÂÓ›˜2) ÙÚo¯·›o Ì ∫.∂.∫. Û 173) Ú‹ÍË ·Ó¢ڇÛÌ·Ùo˜ Î·È ·ÈÌoÚÚ·Á›· Û 64) ÌÂÁ¿ÏË ÂÓ‰oÂÁÎÂÊ·ÏÈ΋ ·ÈÌoÚÚ·Á›· Û 35) ˘‰ÚoΤʷÏo˜ Û 16) ·Ê·›ÚÂÛË ÌËÓÈÁÁÈÒÌ·Ùo˜ Û 17) ·Û·Ê¤˜ ÈÛÙoÚÈÎfi (ı˘ÚÂoÙo͛ΈÛË;) Û 1∞applefi Û‡ÓoÏo 35 ·ÛıÂÓÒÓ Û ÎÒÌ· ¤¯o˘ÌÂ:·) ∞Ó·Ó‹„·ÓÙ˜ = 18‚) Â Ê˘ÙÈ΋ ηٿÛÙ·ÛË = 5Á) ∫·Ù·Ï‹Í·ÓÙ˜ = 12∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Û ÎÒÌ· Î˘Ì·›ÓÂÙ·È·applefi 5 ¤ˆ˜ 73 ¤ÙË, Ì ̤Ûo fiÚo ËÏÈΛ·˜ 40,2 ¤ÙË(S.D. 19,23), 21 ¿Ó‰Ú˜ Î·È 14 Á˘Ó·›Î˜. O ̤Ûo˜¯ÚfiÓo˜ apple·Ú·ÎoÏo‡ıËÛ˘ ‹Ù·Ó 27,5 Ë̤Ú˜, ·applefi 3¤ˆ˜ 107 Ë̤Ú˜.Ùo˘˜ ·ÛıÂÓ›˜ appleo˘ ·Ó¤ÓË„·Ó, o ̤Ûo˜ ¯Úfi-Óo˜ apple·Ú·ÎoÏo‡ıËÛ˘ ‹Ù·Ó 25,5 Ë̤Ú˜, ·applefi 4 ¤ˆ˜

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 24171 Ë̤Ú˜.Ùo˘˜ ·ÛıÂÓ›˜ ÛÂ Ê˘ÙÈ΋ ηٿÛÙ·ÛË, o ̤-Ûo˜ ¯ÚfiÓo˜ apple·Ú·ÎoÏo‡ıËÛ˘ ‹Ù·Ó 66,8 Ë̤Ú˜, ·-applefi 28 ¤ˆ˜ 107 Ë̤Ú˜.Ùo˘˜ ·ÛıÂÓ›˜ appleo˘ η٤ÏËÍ·Ó, o ̤Ûo˜ ¯Úfi-Óo˜ apple·Ú·ÎoÏo‡ıËÛ˘ ‹Ù·Ó 14,25 Ë̤Ú˜, ·applefi 3¤ˆ˜ 41 Ë̤Ú˜. 69 Ù˘¯·›o˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer,appleo˘ apple·Ú·ÎoÏo˘ıo‡ÓÙ·È ÛÙo È·ÙÚ›o Alzheimer Ù˘°′ ·ÓÂappleÈÛÙËÌȷ΋˜ ¡Â˘ÚoÏoÁÈ΋˜ ∫ÏÈÓÈ΋˜ Ùo˘°. . ¡oÛoÎoÌ›o˘ «°. ·apple·ÓÈÎoÏ¿o˘» ηٷÁÚ¿-„·Ì Ùo Ê·ÈÓfiÌÂÓo Ùo˘ Bell.  3 ·ÛıÂÓ›˜ ‰ÂÓ‹Ù·Ó ‰˘Ó·Ù‹ Ë ÂͤٷÛË Ùo˘ Ê·ÈÓo̤Óo˘, ÏfiÁˆ ÌËÛ˘ÓÂÚÁ·Û›·˜ ÏfiÁˆ Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÓfiÛo˘ Alzheimer.∞appleoÎÏ›ÛÙËÎ·Ó ·ÛıÂÓ›˜ appleo˘ ›¯·Ó o-Êı·ÏÌoÏoÁÈ΋ ÓfiÛo ‹ ›¯·Ó ˘appleo‚ÏËı› Û oÊı·Ï-ÌoÏoÁÈ΋ ¯ÂÈÚo˘ÚÁÈ΋ Âapple¤Ì‚·ÛË.∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ì ÓfiÛo Alzheimer ΢-Ì·›ÓÂÙ·È ·applefi 53 ¤ˆ˜ 89 ¤ÙË, Ì ̤Ûo fiÚo ËÏÈΛ·˜67,85 ¤ÙË (S.D. 8,27). OÈ ¿Ó‰Ú˜ ‹Ù·Ó 25 Î·È oÈ Á˘-Ó·›Î˜ 41.∂apple›Û˘ ·applefi Ùo È·ÙÚ›o Ù˘ ÛÎÏ‹Ú˘ÓÛ˘ ηٿappleϿη˜ (M.S.) Ù˘ ›‰È·˜ ÎÏÈÓÈ΋˜ ¤ÁÈÓ ηٷÁÚ·Ê‹Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ μell Û 75 Ù˘¯·›o˘˜ ·ÛıÂÓ›˜Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS). ∞appleoÎÏ›ÛÙËηӷÛıÂÓ›˜ appleo˘ ›¯·Ó oÊı·ÏÌoÏoÁÈ΋ ÓfiÛo ‹ ›¯·Ó˘appleo‚ÏËı› Û oÊı·ÏÌoÏoÁÈ΋ ¯ÂÈÚo˘ÚÁÈ΋ Âapple¤Ì-‚·ÛË.∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿appleϿη˜ (M.S.) Î˘Ì·›ÓÂÙ·È ·applefi 20 ¤ˆ˜ 64 ¤ÙË, ÌÂ̤Ûo fiÚo ËÏÈΛ·˜ 38,89 ¤ÙË (S.D. 9,19). OÈ ¿Ó‰Ú˜‹Ù·Ó 31 Î·È oÈ Á˘Ó·›Î˜ 44.∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ì appleÚˆÙoapple·ı‹ appleÚo˚o‡-Û· ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (11 ·ÛıÂÓ›˜, 14,66%Ùo˘ Û˘ÓfiÏo˘) Î˘Ì·›ÓÂÙ·È ·applefi 31 ¤ˆ˜ 51 ¤ÙË, ÌÂ̤Ûo fiÚo ËÏÈΛ·˜ 42,18 ¤ÙË (S.D. 5,62). OÈ ¿Ó‰Ú˜‹Ù·Ó 4 Î·È oÈ Á˘Ó·›Î˜ 7.∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ì ‰Â˘ÙÂÚoapple·ı‹ appleÚo˚o‡Û·ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (31 ·ÛıÂÓ›˜,41,33% Ùo˘ Û˘ÓfiÏo˘) Î˘Ì·›ÓÂÙ·È ·applefi 24 ¤ˆ˜ 59 ¤ÙË,Ì ̤Ûo fiÚo ËÏÈΛ·˜ 40,19 ¤ÙË (S.D. 8,91). OÈ ¿Ó-‰Ú˜ ‹Ù·Ó 11 Î·È oÈ Á˘Ó·›Î˜ 20.∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ì ˘appleoÙÚoappleÈ¿˙o˘Û·˘Ê¤ÛÈÌË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (32 ·ÛıÂÓ›˜,42,66% Ùo˘ Û˘ÓfiÏo˘) Î˘Ì·›ÓÂÙ·È ·applefi 20 ¤ˆ˜ 64¤ÙË, Ì ̤Ûo fiÚo ËÏÈΛ·˜ 36,47 ¤ÙË (S.D. 10,17). OÈ¿Ó‰Ú˜ ‹Ù·Ó 15 Î·È oÈ Á˘Ó·›Î˜ 17.ŒÓ·˜ ¿Ó‰Ú·˜ ·ÛıÂÓ‹˜ (1,29% Ùo˘ Û˘ÓfiÏo˘),ËÏÈΛ·˜ 40 ÂÙÒÓ, ›¯Â appleÚo˚o‡Û· ˘appleoÙÚoappleÈ¿˙o˘Û·ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜, Ë oappleo›· ·appleoÙÂÏ› appleoχÛapple¿ÓÈ· ÌoÚÊ‹ Ù˘ ÓfiÛo˘.·Ó ‰Â›ÁÌ· ˘ÁÈÒÓ ·ÙfiÌˆÓ ¯ÚËÛÈÌoappleoÈ‹Û·ÌÂ106 ¿ÙoÌ· Ù˘¯·›·, ·applefi Ùo˘˜ appleÚoÛÂÚ¯fiÌÂÓo˘˜ ÛÙoÂ͈ÙÂÚÈÎfi È·ÙÚ›o Ù˘ OÊı·ÏÌoÏoÁÈ΋˜ ∫ÏÈÓÈ΋˜Ùo˘ ¡oÛoÎoÌ›o˘ ÁÈ· ¤ÏÂÁ¯o ‹ ÁÈ· ‰È·ıÏ·ÛÙÈÎfiappleÚfi‚ÏËÌ· Î·È ·applefi Ùo˘˜ Û˘Óo‰o‡˜ ÙˆÓ ÓoÛËÏ¢o-Ì¤ÓˆÓ ÛÙËÓ OÊı·ÏÌoÏoÁÈ΋ ∫ÏÈÓÈ΋. ∞appleoÎÏ›ÛÙË-Î·Ó ·ÛıÂÓ›˜ appleo˘ ›¯·Ó ÈÛÙoÚÈÎfi Ó¢ÚoÏoÁÈ΋˜ÓfiÛo˘, ÛÙÚ·‚ÈÛÌfi ‹ ÂÁ¯Â›ÚËÛË ÛÙÚ·‚ÈÛÌo‡, ¿ÏÏËoÊı·ÏÌoÏoÁÈ΋ Âapple¤Ì‚·ÛË ‹ ‹Ù·Ó Û oÊı·ÏÌoÏo-ÁÈ΋ ·ÁˆÁ‹.∏ ËÏÈΛ· ÙˆÓ ˘ÁÈÒÓ ·ÙfiÌˆÓ Î˘Ì·›ÓÂÙ·È ·applefi17 ¤ˆ˜ 90 ¤ÙË, Ì ̤Ûo fiÚo ËÏÈΛ·˜ 51,81 ¤ÙË (S.D.20,25). OÈ ¿Ó‰Ú˜ ‹Ù·Ó 56 Î·È oÈ Á˘Ó·›Î˜ 50.ª¤ıÔ‰Ô˜ŸÛoÓ ·ÊoÚ¿ ÙËÓ Ù¯ÓÈ΋ appleo˘ ¯ÚËÛÈÌoappleoÈo‡-Ì ÁÈ· ÙËÓ ÂͤٷÛË Ùo˘ Ê·ÈÓo̤Óo˘ Bell ¯ˆÚ›˙o˘-Ì Ùo˘˜ ·ÛıÂÓ›˜ Ì·˜ Û ‰‡o ÌÂÁ¿Ï˜ oÌ¿‰Â˜:·) Ùo˘˜ ·ÛıÂÓ›˜ Û ÎÒÌ·, ÛÙo˘˜ oappleo›o˘˜ Ïfi-Áˆ Ùo˘ ÂappleÈapple¤‰o˘ Û˘Ó›‰ËÛ˘ ¤¯o˘Ì ‰˘ÛÎoÏ›· Â-ÎÙ›ÌËÛ˘ Ùo˘ Ê·ÈÓo̤Óo˘ Bell. ’ ·˘Ùo‡˜ ¯ÚËÛÈ-ÌoappleoÈo‡Ì ÌÈ· apple·Ú·ÏÏ·Á‹ Ù˘ Ù¯ÓÈ΋˜ Ùo˘ Lozano-Elizondo,ÙËÓ oappleo›· ·Ó·Ê¤Úo˘Ì ÏÂappleÙoÌÂÚÒ˜apple·Ú·Î¿Ùˆ ηȂ) ÙËÓ oÌ¿‰· appleo˘ ¤¯ÂÈ appleÏ‹ÚË Âapple·Ê‹, ‰ËÏ·‰‹Ùo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer, Ùo˘˜ ·ÛıÂÓ›˜Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS), ·˘Ùo‡˜ appleo˘ ·Ó¤-ÓË„·Ó ·applefi Ùo ÎÒÌ· Î·È Ùo˘˜ ˘ÁÈ›˜. ’ ·˘Ùo‡˜ Â-Ì›˜ ¯ÚËÛÈÌoappleoÈo‡Ì ÙËÓ ÂÍ‹˜ Ù¯ÓÈ΋ ÁÈ· ÙËÓ Âͤ-Ù·ÛË Ùo˘ Ê·ÈÓo̤Óo˘ Bell (ÙÚoappleoappleo›ËÛË Ù˘ ÌÂıfi‰o˘ÙˆÓ Jambel Î·È Haidt):¢›Óo˘Ì ÂÓÙoÏ‹ ÛÙoÓ ÂÍÂÙ·˙fiÌÂÓo Ó· ÎoÈÙ¿ÂÈηْ ¢ı›·Ó ÂÌappleÚfi˜ Î·È Ì ÙoÓ ·ÓÙ›¯ÂÈÚ· Î·È Ùo‰Â›ÎÙË Ùo˘ ÂÓfi˜ ¯ÂÚÈo‡ ¤ÏÎo˘Ì appleÚo˜ Ù· ¿Óˆ Ù·¿Óˆ ‚Ϥʷڷ, Ì Ùo ‰Â›ÎÙË Î·È ·ÓÙ›¯ÂÈÚ· Ùo˘ ¿Ï-Ïo˘ ¯ÂÚÈo‡ ¤ÏÎo˘Ì ٷ οو ‚Ϥʷڷ appleÚo˜ Ù· ο-Ùˆ ÁÈ· Ó· ÎÚ·Ù‹Ûo˘Ì ٷ ‚Ϥʷڷ ·Óoȯٿ apple·Ú¿ÙË ı¤ÏËÛË Ùo˘ ÂÍÂÙ·˙o̤Óo˘. ·Ú·ÁÁ¤ÏÏo˘ÌÂÛÙoÓ ÂÍÂÙ·˙fiÌÂÓo Ó· appleÚoÛapple·ı‹ÛÂÈ Ó· ÎÏ›ÛÂÈ Ù·‚Ϥʷڿ Ùo˘ ‰˘Ó·Ù¿ Î·È ÂÌ›˜ apple·Ú·ÙËÚo‡Ì ÙȘoÊı·ÏÌÈΤ˜ ÎÈÓ‹ÛÂȘ. ¿ÓÙ· Âapple·Ó·Ï·Ì‚¿Óo˘ÌÂÙËÓ ÂͤٷÛË Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ Bell Û’ fiÏo˘˜ Ùo˘˜ÂÍÂÙ·˙fiÌÂÓo˘˜ ÙÚÂȘ ÊoÚ¤˜ Î·È Ï·Ì‚¿Óo˘Ì ۷ÓoÚÈÛÙÈ΋ ·apple¿ÓÙËÛË, fiÙ·Ó ¤¯o˘Ì Âapple·Ó·Ï·Ì‚·Ófi-ÌÂÓ˜ ÙÚÂȘ ›‰È˜ ·apple·ÓÙ‹ÛÂȘ.∫ϛ̷η Ù·ÍÈÓfiÌËÛ˘ Ùo˘ Ê·ÈÓo̤Óo˘ BellŸÛoÓ ·ÊoÚ¿ ÙË ‰È·‚¿ıÌÈÛË (score) Ùo˘ Ê·È-Óo̤Óo˘ Bell, ·Ó¿ÏoÁ· Ì ÙËÓ Î›ÓËÛË Ùo˘ ‚oÏ‚o‡appleÚo˜ Ù· ¿Óˆ, ¯ÚËÛÈÌoappleoÈo‡Ì ÙÚoappleoappleo›ËÛË Ù˘Îϛ̷η˜ Snir fiappleˆ˜ Ê·›ÓÂÙ·È apple·Ú·Î¿Ùˆ:

242 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)EÈÎ. 7. AÛ‡ÌÌÂÙÚÔ Ê·ÈÓfiÌÂÓÔ Bell, ‰È·‚¿ıÌÈÛË (score) 0/1¢.O. = (η̛· ΛÓËÛË) Î·È A.O. = 1 (ÌÈÎÚ‹ ΛÓËÛËappleÚÔ˜ Ù· ¿Óˆ).0 = η̛· ·apple¿ÓÙËÛË Ùo˘ oÊı·ÏÌo‡1 = ÌÈÎÚ‹ ΛÓËÛË (ÂÏ¿¯ÈÛÙË Î›ÓËÛË appleÚo˜ Ù·¿Óˆ)2 = ΛÓËÛË appleÚo˜ Ù· ¿Óˆ Ì oÚ·Ùfi ÙoÓ ÎÂÚ·-ÙoÂȉ‹3 = appleÏ‹Ú˘ ·apple¿ÓÙËÛË, o ‚oÏ‚fi˜ ÛÙÚ¤ÊÂÙ·ÈappleÚo˜ Ù· ¿Óˆ Î·È ¤Íˆ ‹ ¿Óˆ ÌfiÓo, ÂÓÒ ‰ÂÓ Â›Ó·ÈoÚ·Ùfi˜ o ÎÂÚ·ÙoÂȉ‹˜ (∂ÈÎ. 1 Î·È 7).∂appleÈappleϤoÓ ¯·Ú·ÎÙËÚ›˙o˘Ì Ùo Ê·ÈÓfiÌÂÓo BellÛ·Ó Û˘ÌÌÂÙÚÈÎfi (∂ÈÎ. 1), fiÙ·Ó oÈ ‚oÏ‚o› ÛÙÚ¤-ÊoÓÙ·È appleÚo˜ Ù· ¿Óˆ Î·È ¤Íˆ ÛÙoÓ ›‰Èo ‚·ıÌfi ηȷۇÌÌÂÙÚo (∂ÈÎ. 7) fiÙ·Ó o ¤Ó·˜ ‚oÏ‚fi˜ ˘appleÂÚÙÂÚ›Ùo˘ ¿ÏÏo˘ ÛÙËÓ Î›ÓËÛË appleÚo˜ Ù· ¿Óˆ, apple.¯. ·Û‡ÌÌÂ-ÙÚo ˘apple¤Ú Ùo˘ ·ÚÈÛÙÂÚo‡ oÊı·ÏÌo‡, fiÙ·Ó o ·ÚÈÛÙÂ-Úfi˜ ‚oÏ‚fi˜ ˘appleÂÚÙÂÚ› Ùo˘ ‰ÂÍÈo‡ ÛÙËÓ Î›ÓËÛËappleÚo˜ Ù· ¿Óˆ Î·È ¤Íˆ.Δ¯ÓÈ΋ ÂͤٷÛ˘ Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ BellÛÙo˘˜ ·ÛıÂÓ›˜ Û ÎÒÌ·∂Ê·ÚÌfi˙o˘Ì ̛· apple·Ú·ÏÏ·Á‹ Ù˘ Ù¯ÓÈ΋˜Ùo˘ Lozano-Elizondo.1) ∂¿Ó o ·ÛıÂÓ‹˜ ¤¯ÂÈ ÎÏÂÈÛÙo‡˜ Ùo˘ oÊı·Ï-Ìo‡˜ Ùo˘, o ÂÍÂÙ·ÛÙ‹˜ ·Óo›ÁÂÈ Ù·˘Ùfi¯ÚoÓ· Î·È Ù·‰‡o ‚Ϥʷڷ Î·È apple·Ú·ÙËÚ› ÙȘ ÎÈÓ‹ÛÂȘ Î·È ÙˆÓ‰‡o oÊı·ÏÌÒÓ ÛÙoÓ ÎˆÌ·ÙÒ‰Ë ·ÛıÂÓ‹.2) ∂¿Ó o ·ÛıÂÓ‹˜ ¤¯ÂÈ ·ÓoÈÎÙo‡˜ Ùo˘˜ oÊı·Ï-Ìo‡˜, o ÂÍÂÙ·ÛÙ‹˜ ÎÏ›ÓÂÈ Î·È ·Óo›ÁÂÈ o ›‰Èo˜ Ù·˘-Ùfi¯ÚoÓ· Î·È Ù· ‰‡o ‚Ϥʷڷ Î·È apple·Ú·ÙËÚ› ÙȘ ÎÈ-Ó‹ÛÂȘ Î·È ÙˆÓ ‰‡o oÊı·ÏÌÒÓ.ŸÙ·Ó Ùo Âapple›apple‰o Û˘Ó›‰ËÛ˘ Ùo˘ ·ÛıÂÓo‡˜¤¯ÂÈ ‚ÂÏÙȈı› ˙ËÙo‡Ì ·applefi ÙoÓ ›‰Èo Ó· ÎÏ›ÛÂÈ Ù·‚Ϥʷڿ Ùo˘ Ù·˘Ùfi¯ÚoÓ·, ÂÓÒ ÂÌ›˜ ÎÚ·Ù¿Ì ٷ‚Ϥʷڷ ·Óoȯٿ Ì ÙË Ì¤ıo‰o appleo˘ appleÚo·Ó·Ê¤Ú·-ÌÂ Î·È Î·Ù·ÁÚ¿Êo˘Ì Ùo Ê·ÈÓfiÌÂÓo Ùo˘ Bell.ΔȘ ÎÈÓ‹ÛÂȘ ·˘Ù¤˜ ÙȘ ηٷÁÚ¿Êo˘Ì Û ۯ¤ÛËÌ Ùo Âapple›apple‰o Û˘Ó›‰ËÛ˘ Ùo˘ ·ÛıÂÓo‡˜ ‚¿ÛÂÈ Ù˘Îϛ̷η˜ Ù˘ °Ï·ÛÎfi‚˘ (GCS), fiappleo˘ ̤ÁÈÛÙo ıÂ-ˆÚÂ›Ù·È Ùo 14 (appleÏ‹Ú˘ Âapple·Ê‹) Î·È Î·ÙÒÙÂÚo Ùo 3.ÙËÓ Îϛ̷η °Ï·ÛÎfi‚˘ fiÚÈo ÙoappleoıÂÙo‡ÌÂÙo 8, ‰ÈfiÙÈ Ùo ÛËÌ›o ·˘Ùfi ıˆÚÂ›Ù·È Î·ıoÚÈÛÙÈÎfiÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÚ·¯ÂÈoÙoÌ›·˜, Ë oappleo›· Á›ÓÂÙ·ÈfiÙ·Ó Ùo Âapple›apple‰o Û˘Ó›‰ËÛ˘ Ùo˘ ·ÛıÂÓo‡˜ ‚¿ÛÂÈÙ˘ GCS Â›Ó·È < ‹ = 8 (R.J. Moulton).·Ó º.μ. ıˆÚo‡Ì ÙËÓ Î›ÓËÛË ÙˆÓ ‚oÏ‚ÒÓ ÛÂÛ˘ÓÂȉËÙfi ÎÏ›ÛÈÌo ÙˆÓ ‚ÏÂÊ¿ÚˆÓ. Δo Ù·˘Ùfi¯ÚoÓo¿ÓoÈÁÌ· ‹ Ùo Ù·˘Ùfi¯ÚoÓo ÎÏ›ÛÈÌo-¿ÓoÈÁÌ· ÙˆÓ‚ÏÂÊ¿ÚˆÓ ·applefi ÙoÓ ÂÍÂÙ·ÛÙ‹ ÛÙoÓ ·ÛıÂÓ‹ Û ÎÒÌ·Ùo ıˆÚo‡ÌÂ Û·Ó apple·Ú·ÏÏ·Á‹ Ù˘ Ù¯ÓÈ΋˜ Ùo˘ Lozano-Elizondo,Ë oappleo›· ¯ÚËÛÈÌoappleoÈÂ›Ù·È ÛÙËÓ Âͤ-Ù·ÛË Ùo˘ ÛËÌ›o˘ Ù˘ oÚÈ˙fiÓÙÈ·˜ Û˘˙˘Áo‡˜ oÊı·Ï-ÌÈ΋˜ apple·Ú¤ÎÎÏÈÛ˘. Àapple¿Ú¯ÂÈ fï˜ ‚·ÛÈ΋ ‰È·Êo-Ú¿, ‰ÈfiÙÈ ÛÙoÓ ÎˆÌ·ÙÒ‰Ë ·ÛıÂÓ‹ ‰ÂÓ ˘apple¿Ú¯ÂÈ appleÚo-ۋψÛË, ÂÓÒ Ë Ù¯ÓÈ΋ Ùo˘ Lozano-Elizondo ¯ÚË-ÛÈÌoappleoÈ› ÙË ‰È·Îoapple‹ Ù˘ appleÚoۋψÛ˘ Ùo˘ ÂÍÂ-Ù·˙o̤Óo˘.Ùo˘˜ ·ÛıÂÓ›˜ Û ÎÒÌ· ηٷÁÚ¿Êo˘ÌÂ:1) Ùo Ù·˘Ùfi¯ÚoÓo ¿ÓoÈÁÌ· (Ù.∞.) ÙˆÓ ‚ÏÂ-Ê¿ÚˆÓ, ·Ó apple·Ú¿ÁÂÙ·È Î›ÓËÛË ¿Óˆ ‹ οو, fiÙ·Ó ËGCS < ‹ = 8.2) ŸÙ·Ó Ë GCS < ‹ = 8 ÙÈ Î›ÓËÛË ÙˆÓ ‚oÏ-‚ÒÓ apple·Ú¿ÁÂÙ·È ÛÙo Ù·˘Ùfi¯ÚoÓo ÎÏ›ÛÈÌo-¿ÓoÈÁÌ·ÙˆÓ ‚ÏÂÊ¿ÚˆÓ (Ù.∫/∞) ‹ Ù·˘Ùfi¯ÚoÓo ¿ÓoÈÁÌ· ÙˆÓ‚ÏÂÊ¿ÚˆÓ (Ù. ∞), (oÚÈ˙fiÓÙÈ·, οıÂÙË ‹ η̛·);3)  appleoÈo Âapple›apple‰o GCS ·Ú¯›˙ÂÈ Ó· ˘apple¿Ú¯ÂȺ.μ. (appleÚo˜ Ù· apple¿Óˆ ‹ οو);4)  appleoÈo ·Ú¯ÈÎfi Âapple›apple‰o GCS ˘apple¿Ú¯ÂÈ ÛÙoÙ·˘Ùfi¯ÚoÓo ÎÏ›ÛÈÌo-¿ÓoÈÁÌ· (Ù. ∫/∞) ÙˆÓ ‚ÏÂÊ¿-ÚˆÓ Î›ÓËÛË ‰ÂÍÈ¿ ‹ ·ÚÈÛÙÂÚ¿ (‹ appleÚo˜ Ù· apple¿Óˆ ‹Î¿Ùˆ); Àapple¿Ú¯ÂÈ ËÌÈappleÏËÁ›·;5) ΔÂÏÈο ÙÈ º.μ. apple·Ú¿ÁÂÙ·È;6) Δo ÙÂÏÈÎfi º.μ. Î·È Ë Î›ÓËÛË Î·Ù¿ Ùo Ù. ∫/∞‹ Ù.∞ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, appleo˘ apple·Ú¿ÁÂÙ·È, Û˘ÌʈÓo‡ÓÌÂٷ͇ Ùo˘˜;Δ¯ÓÈ΋ ÂͤٷÛ˘ Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘ BellÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer, Ì ÛÎÏ‹Ú˘ÓÛËηٿ appleϿη˜ (MS) Î·È ÛÙo˘˜ ˘ÁÈ›˜:ÃÚËÛÈÌoappleoÈo‡Ì ÙËÓ Ù¯ÓÈ΋ appleo˘ appleÚo·Ó·Ê¤-Ú·Ì apple·Ú·apple¿Óˆ. ¢›Óo˘Ì ÂÓÙoÏ‹ ÛÙoÓ ÂÍÂÙ·˙fi-ÌÂÓo Ó· ÎoÈÙ¿ÂÈ Î·Ù’ ¢ı›·Ó ÂÌappleÚfi˜ Î·È Ì ÙoÓ·ÓÙ›¯ÂÈÚ· Î·È Ùo ‰Â›ÎÙË Ùo˘ ÂÓfi˜ ¯ÂÚÈo‡ ¤ÏÎo˘ÌÂÛÙ·ıÂÚ¿ Ù· ¿Óˆ ‚Ϥʷڷ appleÚo˜ Ù· ¿Óˆ Î·È Ì Ùo‰Â›ÎÙË Î·È ·ÓÙ›¯ÂÈÚ· Ùo˘ ¿ÏÏo˘ ¯ÂÚÈo‡ ¤ÏÎo˘Ì ٷοو ‚Ϥʷڷ appleÚo˜ Ù· οو. ∂ÓÒ ÎÚ·Ù¿Ì ٷ‚Ϥʷڷ ·Óoȯٿ, apple·Ú¿ ÙË ı¤ÏËÛË Ùo˘ ÂÍÂÙ·˙o̤-Óo˘, ϤÌ ӷ ÎÏ›ÛÂÈ ÛÙ·ıÂÚ¿ Ù· ‚Ϥʷڿ Ùo˘ ηÈÓ· ÌËÓ ·Ê‹ÛÂÈ Ó· Ù· ·Óo›Ío˘ÌÂ Î·È apple·Ú·ÙËÚo‡ÌÂÙȘ oÊı·ÏÌÈΤ˜ ÎÈÓ‹ÛÂȘ. ∂Ó Û˘Ó¯›· ‚¿ÛÂÈ Ù˘

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 243ÙÚoappleoappleo›ËÛ˘ Ù˘ Îϛ̷η˜ Snir ηٷÁÚ¿Êo˘ÌÂÙË ı¤ÛË ÙˆÓ ‚oÏ‚ÒÓ Î·È ÙËÓ ˘apple¿Ú¯o˘Û· Û˘ÌÌÂÙÚ›·‹ ·Û˘ÌÌÂÙÚ›· Ù˘ ΛÓËÛ˘ ÙˆÓ ‚oÏ‚ÒÓ.πππ. ∞OΔ∂§∂ª∞Δ∞∫ÒÌ·ŸÙ·Ó Ùo Âapple›apple‰o Ù˘ GCS Â›Ó·È < ‹ = 8 .Ùo˘˜ 35 ·ÛıÂÓ›˜ Ì·˜ Û ÎÒÌ· (18 appleo˘ ·Ó¤-ÓË„·Ó, 5 ÛÂ Ê˘ÙÈ΋ ηٿÛÙ·ÛË Î·È 12 appleo˘ η٤ÏË-Í·Ó ÙÂÏÈο) fiÙ·Ó Ùo Âapple›apple‰o Ù˘ GCS Â›Ó·È < ‹ =8 (‹ ‚Ú›ÛÎoÓÙ·È Î·È Û ηٷÛÙoÏ‹) ηӤӷ˜ ‰ÂÓapple·Úo˘Û›·Û ΛÓËÛË ÙˆÓ ‚oÏ‚ÒÓ, Ù‡appleo˘ Ê·ÈÓÔ-̤Óo˘ Ùo˘ Bell, ‰ËÏ·‰‹ ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ùfi Ó· ˘apple·-Îo‡ÛÂÈ o ·ÛıÂÓ‹˜ Û ÂÓÙoÏ‹, ÒÛÙ ӷ ÎÏ›ÛÂÈ Ù·‚Ϥʷڿ Ùo˘ ÁÈ· Ó· appleÚoÎÏËı› Ê·ÈÓfiÌÂÓo Bell.ŸÙ·Ó Ùo Âapple›apple‰o Ù˘ GCS Â›Ó·È < ‹ = 8 ÛÙoÙ·˘Ùfi¯ÚoÓo ÎÏ›ÛÈÌo Î·È ¿ÓoÈÁÌ· ÙˆÓ ‚ÏÂÊ¿ÚˆÓ,fiÙ·Ó ·˘Ù¿ Â›Ó·È ·Óoȯٿ, (Ù.∫/∞) ‹ Ù·˘Ùfi¯ÚoÓo¿ÓoÈÁÌ· ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, fiÙ·Ó ·˘Ù¿ Â›Ó·È ÎÏÂÈÛÙ¿(Ù. ∞) ¤¯o˘Ì ٷ apple·Ú·Î¿Ùˆ ·appleoÙÂϤÛÌ·Ù·:1) ∞applefi Ùo˘˜ 18 ·ÛıÂÓ›˜ appleo˘ ·Ó¤ÓË„·Ó:·) 12 ·ÛıÂÓ›˜ ‰ÂÓ apple·Úo˘Û›·Û·Ó η̛· ΛÓË-ÛË.‚) 2 ·ÛıÂÓ›˜ apple·Úo˘Û›·Û·Ó oÚÈ˙fiÓÙÈ· ΛÓËÛË·ÓÙ›ıÂÙ· appleÚo˜ ÙËÓ appleÏÂ˘Ú¿ Ù˘ ËÌÈappleÏËÁ›·˜.Á) ŒÓ·˜ ·ÛıÂÓ‹˜ Ì ˘apple·Ú·¯ÓoÂȉ‹ ·ÈÌoÚÚ·-Á›· Î·È ‰È¿¯˘Ùo o›‰ËÌ· ÂÁÎÂÊ¿Ïo˘ apple·Úo˘Û›·ÛÂΛÓËÛË appleÚo˜ Ù· ‰ÂÍÈ¿ ÙˆÓ ‰‡o oÊı·ÏÌÒÓ Î·È Âapple·-Ó·ÊoÚ¿ ·ÚÁ¿ ÛÙË Ì¤ÛË ÁÚ·ÌÌ‹.‰) ŒÓ·˜ ·ÛıÂÓ‹˜ apple·Úo˘Û›·Û oÚÈ˙fiÓÙÈ· Λ-ÓËÛË ·ÚÈÛÙÂÚ¿ appleÚo˜ ÙËÓ appleÏÂ˘Ú¿ Ù˘ ‚Ï¿‚˘ (ÎÚo-Ù·Êo‚ÚÂÁÌ·ÙÈο ·ÚÈÛÙÂÚ¿).Â) ŒÓ·˜ ·ÛıÂÓ‹˜ apple·Úo˘Û›·Û oÚÈ˙fiÓÙÈ· ΛÓË-ÛË ‰ÂÍÈ¿ Î·È ·ÚÈÛÙÂÚ¿ Ì apple·Úo‰È΋ ËÌÈappleÏËÁ›··ÚÈÛÙÂÚ¿.ÛÙ) ŒÓ·˜ ·ÛıÂÓ‹˜ apple·Úo˘Û›·Û oÚÈ˙fiÓÙȘ Ó˘-ÛÙ·ÁÌoÂȉ›˜ ÎÈÓ‹ÛÂȘ appleÚo˜ Ù· ‰ÂÍÈ¿ Ì ¤ÌÊÚ·ÎÙ·ÛÙo ‚ÚÂÁÌ·ÙÈÎfi Î·È ÈÓÈ·Îfi Ïo‚fi ·ÚÈÛÙÂÚ¿, ·ÓÙ›ıÂ-Ù· appleÚo˜ ÙËÓ appleÏÂ˘Ú¿ Ù˘ ‚Ï¿‚˘, ¯ˆÚ›˜ ËÌÈappleÏËÁ›·.2) ∞applefi Ùo˘˜ 5 ·ÛıÂÓ›˜ ÛÂ Ê˘ÙÈ΋ ηٿÛÙ·ÛË·) 2 ·ÛıÂÓ›˜ apple·Úo˘Û›·Û·Ó ΛÓËÛË appleÚo˜ ٷοو.O ¤Ó·˜ ›¯Â ‚Ï¿‚Ë ÛÙo ı¿Ï·Ìo ·ÚÈÛÙÂÚ¿ ηÈËÌÈappleÏËÁ›· ‰ÂÍÈ¿ Î·È o ¿ÏÏo˜ ·ÛıÂÓ‹˜ ›¯Â apple‡ÎÓˆ-ÛË ÛÙo ·ÚÈÛÙÂÚfi ¿Óˆ apple·ÚÂÁÎÂÊ·ÏȉÈÎfi ÛΤÏo˜.‚) 2 ·ÛıÂÓ›˜ apple·Úo˘Û›·Û·Ó ¿ÏÏoÙ ¿ÏÏË Î›-ÓËÛË Ùo˘ ÂÓfi˜ ‚oÏ‚o‡ (¢.O. ‹ ∞.O.) ‰ÂÍÈ¿, ·ÚÈ-ÛÙÂÚ¿ ‹ οو. O ¤Ó·˜ ›¯Â ˘apple·Ú·¯ÓoÂȉ‹ ·ÈÌoÚ-Ú·Á›· ÏfiÁˆ ڋ͢ ·Ó¢ڇÛÌ·Ùo˜ Ù˘ oapple›ÛıÈ·˜ ·-Ó·ÛÙöÙÈ΋˜ ·ÚÙËÚ›·˜ ·ÚÈÛÙÂÚ¿ Î·È ËÌÈappleÏËÁ›·‰ÂÍÈ¿ Î·È o ¿ÏÏo˜ ›¯Â ˘appleoÛÎÏËÚ›‰Èo ·È̿و̷ÌÂÙˆappleo‚ÚÂÁÌ·ÙÈο ·ÚÈÛÙÂÚ¿, o›‰ËÌ· Ùo˘ ·ÚÈ-ÛÙÂÚo‡ Ïo‚o‡ Ì apple·ÚÂÎÙfiappleÈÛË Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜Î·È ËÌÈappleÏËÁ›· ‰ÂÍÈ¿.Á) ŒÓ·˜ ·ÛıÂÓ‹˜ apple·Úo˘Û›·Û oÚÈ˙fiÓÙÈ· ΛÓË-ÛË appleÚo˜ ÙËÓ appleÏÂ˘Ú¿ Ù˘ ËÌÈappleÏËÁ›·˜ (oÚÈ˙fiÓÙÈ· Λ-ÓËÛË appleÚo˜ Ù· ‰ÂÍÈ¿, ËÌÈappleÏËÁ›· ‰ÂÍÈ¿) Ì ÂÓ‰oÂ-ÁÎÂÊ·ÏÈ΋ Î·È ÂÓ‰oÎoÈÏȷ΋ ·ÈÌoÚÚ·Á›· ÏfiÁˆ Ú‹-͢ ·Ó¢ڇÛÌ·Ùo˜ Ù˘ appleÚfiÛıÈ·˜ ·Ó·ÛÙöÙÈ΋˜Î·È ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ ·ÚÈÛÙÂÚ¿.3) ∞applefi Ùo˘˜ 12 ·ÛıÂÓ›˜ appleo˘ η٤ÏËÍ·ÓÛÙo Ù·˘Ùfi¯ÚoÓo ÎÏ›ÛÈÌo Î·È ¿ÓoÈÁÌ· ÙˆÓ‚ÏÂÊ¿ÚˆÓ, fiÙ·Ó ·˘Ù¿ Â›Ó·È ·Óoȯٿ (Ù.∫/∞), ‹Ù·˘Ùfi¯ÚoÓo ¿ÓoÈÁÌ· ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, fiÙ·Ó ·˘Ù¿ ›-Ó·È ÎÏÂÈÛÙ¿ (Ù. ∞), ηӤӷ˜ ‰ÂÓ apple·Úo˘Û›·Û η̛·Î›ÓËÛË.·Ú·Î¿Ùˆ (apple›Ó·Î·˜ 1) Ê·›ÓÂÙ·È Û appleoÈo Âapple›-apple‰o GCS ·Ú¯›˙ÂÈ Ó· ˘apple¿Ú¯ÂÈ º.μ. (appleÚo˜ Ù· apple¿Óˆ‹ οو) Î·È Ùo ÙÂÏÈο apple·Ú·ÁfiÌÂÓo º.μ.II) ∞applefi Ùo˘˜ 5 ·ÛıÂÓ›˜ ÛÂ Ê˘ÙÈ΋ ηٿÛÙ·-ÛË1) GCS = 9(T), Ù. ∞. = ÛÙÚoÊ‹ ÙˆÓ ‚oÏ‚ÒÓ ·Ú-¯Èο Ï›Áo appleÚo˜ Ù· ¿Óˆ Î·È Ï›Áo ‰ÂÍÈ¿ Î·È ÛÙË Û˘-Ó¤¯ÂÈ· appleÚo˜ Ù· οو Î·È Ï›Áo ‰ÂÍÈ¿ (‚Ï¿‚Ë ÛÙoı¿Ï·Ìo ·ÚÈÛÙÂÚ¿ Î·È ËÌÈappleÏËÁ›· ‰ÂÍÈ¿). ΔÂÏÈÎfiº.μ = ·Ú¯Èο Ï›Áo appleÚo˜ Ù· ¿Óˆ Î·È Ï›Áo ‰ÂÍÈ¿ ηÈÛÙË Û˘Ó¤¯ÂÈ· appleÚo˜ Ù· οو Î·È Ï›Áo ‰ÂÍÈ¿ (›‰Èo).2) GCS >8 º.μ.= 0/0 ΔÂÏÈÎfi º.μ.= 0/03) GCS >8 º.μ.= 0/0 ΔÂÏÈÎfi º.μ.= 0/04) GCS >8 º.μ.= 0/0 ΔÂÏÈÎfi º.μ.= 0/05) GCS > 8(Δ), Ù. ∞ = ÌÈÎÚ‹ ΛÓËÛË appleÚo˜ Ù· Î¿ÙˆÎ·È ¤Íˆ ·ÚÈÛÙÂÚ¿ ¿Ìʈ (apple‡ÎÓˆÛË ÛÙo ·ÚÈÛÙÂÚfi¿Óˆ apple·ÚÂÁÎÂÊ·ÏȉÈÎfi ÛΤÏo˜). ΔÂÏÈÎfi º.μ. =1/1.Ÿappleˆ˜ Ê·›ÓÂÙ·È ·applefi Ù· apple·Ú·apple¿Óˆ ‰‡o ·ÛıÂ-Ó›˜ apple·Úo˘Û›·Û·Ó ΛÓËÛË appleÚo˜ Ù· οو, ¤Ó·˜ Ì‚Ͽ‚Ë ÛÙo ı¿Ï·Ìo ·ÚÈÛÙÂÚ¿ Î·È ËÌÈappleÏËÁ›· ‰ÂÍÈ¿Î·È ¤Ó·˜ ·ÛıÂÓ‹˜ Ì apple‡ÎÓˆÛË ÛÙo ·ÚÈÛÙÂÚfi ¿Óˆapple·ÚÂÁÎÂÊ·ÏȉÈÎfi ÛΤÏo˜.III) ∞applefi Ùo˘˜ 12 ·ÛıÂÓ›˜ appleo˘ η٤ÏËÍ·Ó¢‡o ·ÛıÂÓ›˜ appleo˘ ÂÌÊ¿ÓÈÛ·Ó ·Ú¯Èο οappleoÈ·‚ÂÏÙ›ˆÛË apple·Úo˘Û›·Û·Ó Ê·ÈÓfiÌÂÓo Bell (1/1 Î·È oȉ‡o), fiÙ·Ó Ùo Âapple›apple‰o Ù˘ GCS ‹Ù·Ó > 8, fï˜ ÂÓÛ˘Ó¯›· ÏfiÁˆ Âappleȉ›ӈÛ˘ Ùo Ê·ÈÓfiÌÂÓo Bell¤apple·˘Û ӷ apple·Ú¿ÁÂÙ·È.Ùo˘˜ ·ÛıÂÓ›˜ appleo˘ η٤ÏËÍ·Ó ·Ú¯ÈÎfi Î·È ÙÂ-ÏÈÎfi º.μ. ‰ÂÓ apple·Ú¿ÁÂÙ·È (0/0) Î·È Âappleo̤ӈ˜ ‰ÂÓÌappleoÚ› Ó· Á›ÓÂÈ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÁÈ· Û‡ÁÎÚÈÛËÌÂٷ͇ ·ÛıÂÓÒÓ appleo˘ ·Ó¤ÓË„·Ó Î·È ·ÛıÂÓÒÓ appleo˘Î·Ù¤ÏËÍ·Ó, ·Êo‡ oÈ 12 (12/35) appleo˘ η٤ÏËÍ·Ó ‰ÂÓ

244 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)›Ó·Î·˜ 1I) ∞applefi Ùo˘˜ 18 ·ÛıÂÓ›˜ appleo˘ ·Ó¤ÓË„·ÓI. GCS = 12 º.μ.= 2/1 ÙÂÏÈÎfi º.μ.= 2/2II. GCS = 12 º.μ.= 1/1 ÙÂÏÈÎfi º.μ.= 1/3III. GCS = 9 (·Ê·Û›·) º.μ.= oÚÈ˙fiÓÙÈ· ΛÓËÛË ·Ú.( ->,->), ÙÂÏÈÎfi º.μ.= 0/0,ËÌÈappleÏËÁ›· ∞Ú.IV. GCS = 9 º.μ.= 2/2 ÙÂÏÈÎfi º.μ.= 2/2V. GCS = 14 º.μ.= 3/2 ÙÂÏÈÎfi º.μ.= 3/3VI. GCS = 12 º.μ.= 1/1 ÙÂÏÈÎfi º.μ.= 2/2VII. GCS = 14 º.μ.= 2/2 ÙÂÏÈÎfi º.μ.= 2/2VIII. GCS = 14 º.μ.= 3/3 ÙÂÏÈÎfi º.μ.= 3/3IX. GCS = 14 º.μ.= ¢.O. appleÚo˜ Ù· ·ÚÈÛÙÂÚ¿ appleÏ¿ÁÈ· ‡. ∞.O. appleÚo˜ Ù· ¿ÓˆÎ·È Ï›Áo ¤Íˆ, 0/1(apple·Ú¿‰oÍ· ·Û‡ÌÌÂÙÚo) !ÙÂÏÈÎfi º.μ.=2/3X. GCS = 14 º.μ.= 2/2 ÙÂÏÈÎfi º.μ.=3/3XI. GCS = 9 º.μ.= 0/1 ÙÂÏÈÎfi º.μ.=0/1XII. GCS = 9 º.μ.= 1/3 ÙÂÏÈÎfi º.μ.=1/3XIII. GCS = 14 º.μ.= 3/3 ÙÂÏÈÎfi º.μ.=3/3XIV. GCS = 11 º.μ.= oÚÈ˙fiÓÙȘ ‰ÂÍÈ¿-·ÚÈÛÙÂÚ¿ ÎÈÓ‹ÛÂȘ, ÙÂÏÈÎfi º.μ.=oÚÈ˙fiÓÙȘ ‰ÂÍÈ¿-·ÚÈÛÙÂÚ¿ ÎÈÓ‹ÛÂȘXV. GCS = 11 º.μ.= 1/1 ÙÂÏÈÎfi º.μ.=2/2XVI. GCS = 12 º.μ.= 1/1 ÙÂÏÈÎfi º.μ.=1/1XVII. GCS = 13 º.μ.= 1/1 ÙÂÏÈÎfi º.μ.=3/3XVIII. GCS = 8 º.μ.= 0/0 ÙÂÏÈÎfi º.μ.= 0/0apple·Úo˘Û›·˙·Ó η̛· ΛÓËÛË ÙˆÓ ‚oÏ‚ÒÓ.Δo ÙÂÏÈÎfi º.μ. Î·È Ë Î›ÓËÛË Î·Ù¿ Ùo Ù. ∫/∞ ‹Ù.∞ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, appleo˘ apple·Ú¿ÁÂÙ·È Û˘ÌʈÓo‡Ó ÌÂ-ٷ͇ Ùo˘˜;I) Ùo˘˜ 16 ·applefi 18 ·ÛıÂÓ›˜ appleo˘ ·Ó¤ÓË„·Ó‰ÂÓ ˘apple¿Ú¯ÂÈ Û˘Ìʈӛ· ÌÂٷ͇ Ùo˘ ÙÂÏÈο apple·Ú·Áfi-ÌÂÓo˘ º.μ. Î·È Ù˘ ΛÓËÛ˘ ηٿ Ùo Ù. ∫/∞ ‹ Ù.∞ÙˆÓ ‚ÏÂÊ¿ÚˆÓ.II) ∞applefi Ùo˘˜ 5 ·ÛıÂÓ›˜ ÛÂ Ê˘ÙÈ΋ ηٿÛÙ·-ÛË Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓ ÌappleoÚo‡Ó Ó· ·Ó·Ï˘ıo‡ÓÛÙ·ÙÈÛÙÈο.πππ) Ùo˘˜ 12 ·ÛıÂÓ›˜ appleo˘ η٤ÏËÍ·Ó ‰ÂÓ apple·-Ú¿ÁÂÙ·È Î·Ì›· ΛÓËÛË Î·Ù¿ Ùo Ù. ∫/∞ ‹ Ù.∞ ÙˆÓ‚ÏÂÊ¿ÚˆÓ, o‡ÙÂ Î·È º.μ. Î·È Âappleo̤ӈ˜ Ë Û‡ÁÎÚÈ-ÛË ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹.AÛıÂÓ›˜ Ì ÓfiÛÔ Alzheimer∂apple› Û˘ÓfiÏo˘ 66 ·ÛıÂÓÒÓ (3 ·appleoÎÏ›ÛÙËηӷapplefi Ùo˘˜ 69, ÏfiÁˆ ÌË Û˘ÓÂÚÁ·Û›·˜) ¤¯o˘Ì ÙËÓapple·Ú·Î¿Ùˆ ‰È·‚¿ıÌÈÛË (score) Ùo˘ º.μ. ÁÈ· Ùo¢.O. Î·È ∞.O.ŸÛÔÓ ·ÊÔÚ¿ ÙË Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘Bell ÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer ¤¯o˘ÌÂ:˘ÌÌÂÙÚÈÎfi Ê·ÈÓfiÌÂÓo Bell apple·Úo˘Û›·˙·Ó 29·ÛıÂÓ›˜, ‰ËÏ·‰‹ appleoÛoÛÙfi 43,93%.∞Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ Bell ˘apple¤Ú Ùo˘¢.O. apple·Úo˘Û›·˙·Ó 5 ·ÛıÂÓ›˜, ‰ËÏ·‰‹ appleoÛoÛÙfi‰È·‚¿ıÌÈÛË (score) ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡appleÏ‹ıÔ˜ (%)0 1 2 3AÛıÂÓ›˜ ÌÂAlzheimer (66) 1 (1,5) 7 (10,6) 37 (56,1) 21 (31,8)‰È·‚¿ıÌÈÛË (score) ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡appleÏ‹ıÔ˜ (%)1 2 3AÛıÂÓ›˜ ÌÂAlzheimer (66) 3 (4,5) 21 (31,8) 42 (63,6)7,57% Î·È ·Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ Bell ˘apple¤ÚÙo˘ ∞O apple·Úo˘Û›·˙·Ó 32 ·ÛıÂÓ›˜, ‰ËÏ·‰‹ appleo-ÛoÛÙfi 48,48%.∞ÛıÂÓ›˜ Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS)∂apple› Û˘ÓfiÏo˘ 75 ·ÛıÂÓÒÓ Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿appleϿη˜ ¤¯o˘Ì ÙËÓ apple·Ú·Î¿Ùˆ ‰È·‚¿ıÌÈÛË (score)Ùo˘ º.μ. ÁÈ· Ùo ¢.O. Î·È ∞.O.∂apple›Û˘ fiÛÔÓ ·ÊÔÚ¿ ÙË Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo-̤Óo˘ Bell ÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿appleϿη˜ ¤¯o˘ÌÂ:˘ÌÌÂÙÚÈÎfi Ê·ÈÓfiÌÂÓo Bell apple·Úo˘Û›·˙·Ó 58·ÛıÂÓ›˜, ‰ËÏ·‰‹ appleoÛoÛÙfi 77,3%.

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 245‰È·‚¿ıÌÈÛË (score) ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡appleÏ‹ıÔ˜ (%)0 1 2 3AÛıÂÓ›˜ ÌÂÛÎÏ‹Ú˘ÓÛË Î·Ù¿appleϿη˜ (75) 5 (6,7) 13 (17,3) 57 (76,0)‰È·‚¿ıÌÈÛË (score) ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡appleÏ‹ıÔ˜ (%)1 2 3AÛıÂÓ›˜ ÌÂÛÎÏ‹Ú˘ÓÛË Î·Ù¿appleϿη˜ (75) 10 (13,3) 65 (86,7)∞Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ Bell ˘apple¤Ú Ùo˘¢.O., apple·Úo˘Û›·˙·Ó 3 ·ÛıÂÓ›˜, ‰ËÏ·‰‹ 4% Î·È·Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ Bell ˘apple¤Ú Ùo˘∞O, apple·Úo˘Û›·˙·Ó 14 ·ÛıÂÓ›˜, ‰ËÏ·‰‹ appleoÛoÛÙfi18,66%.¢Â›ÁÌ· ˘ÁÈÒÓ ·ÙfïÓ ۇÓoÏo 106 Ù˘¯·›ˆÓ ·ÙfiÌˆÓ ¤¯o˘Ì ÙËÓapple·Ú·Î¿Ùˆ ‰È·‚¿ıÌÈÛË (score) Ùo˘ º.μ. ÁÈ· Ùo¢.O. Î·È ∞.O.‰È·‚¿ıÌÈÛË (score) ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡appleÏ‹ıÔ˜ (%)0 1 2 3ÀÁÈ›˜ (106) 1 (0,9) 5 (4,7) 16 (15,1) 87 (79,2)‰È·‚¿ıÌÈÛË (score) ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡appleÏ‹ıÔ˜ (%)1 2 3ÀÁÈ›˜ (106) 3 (2,8) 10 (9,4) 93 (87,7)¯ÂÙÈο Ì ÙË Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ BellÛÙo˘˜ ˘ÁÈ›˜ ¤¯o˘ÌÂ:˘ÌÌÂÙÚÈÎfi Ê·ÈÓfiÌÂÓo Bell apple·Úo˘Û›·˙·Ó 83,‰ËÏ. appleoÛoÛÙfi 78,30%.∞Û˘ÌÌÂÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ Bell ˘apple¤Ú Ùo˘¢.O., apple·Úo˘Û›·˙·Ó 5, ‰ËÏ·‰‹ 4,71% Î·È ·Û˘ÌÌÂ-ÙÚ›· Ùo˘ Ê·ÈÓo̤Óo˘ Bell ˘apple¤Ú Ùo˘ ∞O, apple·Úo˘-Û›·˙·Ó 18, ‰ËÏ·‰‹ appleoÛoÛÙfi 16,98%.IV. Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË°È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰o̤ӈӯÚËÛÈÌoappleoÈ‹ıËÎ·Ó apple·Ú·ÌÂÙÚÈΤ˜ ‰oÎÈ̷ۛ˜fiappleˆ˜ Ùo Student’s t test, Ùo x 2 test Î·È Ë ·Ó¿Ï˘Ûˉȷ·̷ÓÛ˘ (analysis of variance). ÃÚËÛÈÌoappleoÈ‹-ıËÎ·Ó fï˜ Î·È ÌË apple·Ú·ÌÂÙÚÈΤ˜ ‰oÎÈ̷ۛ˜fiappleˆ˜ Ùo Jonckheere-Terpstra Test, Ùo MarginalHomogeneity Test, Ùo Mann-Whitney U test Î·È ÙoWilcoxon Signed Ranks Test ηıÒ˜ Ù· ‰Â‰oÌ¤Ó·Â›Ó·È Î·Ù¿ ‚¿ÛË Î·ÙËÁoÚÈο. fiϘ ÙȘ appleÂÚÈappleÙÒÛÂȘ ıˆÚo‡Ì fiÙÈ Ù··appleoÙÂϤÛÌ·Ù· Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο fiÙ·Óp

246 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 3 ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer, Û ۇÓoÏo69, ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÏÂÁ¯ı› Ùo º.μ., ‰ÈfiÙȉÂÓ Û˘ÓÂÚÁ¿˙oÓÙ·È, ÏfiÁˆ Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ÓfiÛo˘.∏ Û˘¯ÓfiÙ˘ Ù‹˜ appleÚo˜ Ù· οو ·apple¿ÓÙËÛ˘ ›-Ó·È 8% ÛÙË ÛÂÈÚ¿ ÙˆÓ Francis Î·È Loughhead ηÈÛÙË ÛÂÈÚ¿ Ùo˘ Ferrer 3,7%, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· Ù˘oÚÈ˙fiÓÙÈ·˜ apple·Ú¤ÎÎÏÈÛ˘ (..μ.) 1% ‹Ù·Ó ›‰È· ÌÂÙo˘ Ferrer. ∫·Ó¤Ó· ·applefi Ù· appleÂÚÈÛÙ·ÙÈο Ì oÚÈ˙fi-ÓÙÈ· ·apple¿ÓÙËÛË (..μ.) ÙˆÓ Francis Î·È Loughhead‰ÂÓ Â›¯Â ‚Ï¿‚Ë ‚ÚÂÁÌ·ÙoÎÚoÙ·ÊÈο.ÙË ÌÂϤÙË Ì·˜ ˘apple¿Ú¯ÂÈ ¤Ó·˜ apple·Ú·ÙËÚËÙ‹˜,˘apple¿Ú¯o˘Ó ÎÚÈÙ‹ÚÈ· ¯·Ú·ÎÙËÚÈÛÌo‡ ÙˆÓ ·apple·ÓÙ‹-ÛÂˆÓ (‰È·‚¿ıÌÈÛË 0, 1, 2, 3 - Û˘ÌÌÂÙÚÈÎfi, ·Û‡ÌÌÂ-ÙÚo) Î·È Ë ÂappleÈÏoÁ‹ ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ Â›Ó·È Ù˘¯·›·.ÙË ‰È΋ Ì·˜ ÛÂÈÚ¿ ‰ÂÓ ˘apple¿Ú¯ÂÈ Î·Ó¤Ó· Ù˘appleÈ-Îfi appleÂÚÈÛÙ·ÙÈÎfi oÚÈ˙fiÓÙÈ·˜ ·apple¿ÓÙËÛ˘ (..μ.) Ùo˘Ê·ÈÓo̤Óo˘ Ùo˘ Bell .∞Ó Ë appleÂÚÈo¯‹ Ùo˘ ‰ÈÎÙ˘ˆÙo‡ Û¯ËÌ·ÙÈÛÌo‡ ÁÈ·Ùo Û˘Á¯ÚoÓÈÛÌfi Ùo˘ º.μ. ¤¯ÂÈ ÂȉÈ΋ ÏÂÈÙo˘ÚÁ›· ÂÎÁÂÓÂÙ‹˜ ‹ ÂÍÂÏ›ÛÛÂÙ·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË Â›Ó·È¿ÁÓˆÛÙo ηٿ Ùo˘˜ Jambel Î·È Haidt.O Ferrer ·Ó·Ê¤ÚÂÈ fiÙÈ Ùo º.μ. Â›Ó·È Ûapple¿ÓÈoÛÙ· ‚Ú¤ÊË Î¿Ùˆ ÙˆÓ 8 ÌËÓÒÓ.OÈ Snir Î·È Û˘Ó. (1996) ÛÙËÓ ÂÚÁ·Û›· Ùo˘˜ ÁÈ·Ùo Ê·ÈÓfiÌÂÓo Bell ÛÙ· ÓÂoÁÓ¿ Î·È appleÚfiˆÚ· ·Ó·-ʤÚo˘Ó fiÙÈ Ù· appleÚfiˆÚ· ‰ÂÓ apple·Úo˘Û›·˙·Ó º.μ. η-Ù¿ ÙËÓ appleÚÒÙË Â‚‰oÌ¿‰· Ù˘ ˙ˆ‹˜, ÂÓÒ Ùo 29,6%apple·Úo˘Û›·˙ ·ÛıÂÓ¤˜ ˆ˜ appleÏ‹Ú˜ º.μ. ÙËÓ 8Ë‚‰oÌ¿‰· Ù˘ ˙ˆ‹˜. OÈ ›‰ÈoÈ ·Ó·Ê¤Úo˘Ó ÛÙË ÌÂϤ-ÙË Ùo˘˜ ÁÈ· Ù· ÙÂÏÂÈfiÌËÓ· ÓÂoÁÓ¿ fiÙÈ Ùo 35,7%apple·Úo˘Û›·˙ ıÂÙÈÎfi º.μ. ÙËÓ 3Ë Ë̤ڷ Ù˘ ˙ˆ‹˜,50% ÛÙËÓ ËÏÈΛ· 4-8 ‚‰oÌ¿‰ˆÓ Î·È 97,3% ÙoÓ 4oÌ‹Ó· Ù˘ ˙ˆ‹˜. ∞apple’ ·˘Ù¿ Ù· ·appleoÙÂϤÛÌ·Ù· Û˘ÌappleÂ-Ú·›Óo˘Ó fiÙÈ Ùo º.μ. ¤¯ÂÈ Ì·ÎÚ¿ Ó¢ÚoÏoÁÈ΋ ÂͤÏÈ-ÍË Î·È ·appleoÙÂÏ› ÙÌ‹Ì· Ù˘ ‰È·‰Èηۛ·˜ Ù˘ Ê˘-ÛÈoÏoÁÈ΋˜ Ó¢ÚoÏoÁÈ΋˜ ˆÚ›Ì·ÓÛ˘ ÛÙ· ÙÂÏÂÈfiÌË-Ó· Î·È ÛÙ· appleÚfiˆÚ· ÓÂoÁÓ¿. Δ· ‰Â‰o̤ӷ Ùo˘˜ Û˘Ì-ʈÓo‡Ó Ì appleÚoËÁo‡ÌÂÓ· Â˘Ú‹Ì·Ù· Ùo˘ Ferrer fiÙÈÙo º.μ. ‰ÂÓ Â›Ó·È ÎoÈÓfi ‡ÚËÌ· ÛÙ· ÓÂoÁÓ¿ ÙËÓappleÚÒÙË Â‚‰oÌ¿‰· Ù˘ ˙ˆ‹˜. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ‚·ı-ÌÈ·›·˜ ·‡ÍËÛ˘ Ùo˘ º.μ. ·applefi Ù· appleÚfiˆÚ· ÓÂoÁÓ¿ÛÙ· ÙÂÏÂÈfiÌËÓ· ÂÓÈÛ¯‡ÂÈ ÙËÓ ¿appleo„Ë fiÙÈ Ë ˆÚ›Ì·ÓÛËÙo˘ ÛÙÂϤ¯o˘˜ (brainstem) Â›Ó·È ·Ó·Áη›· appleÚo¸applefiıÂÛËÁÈ· ÙË Ê˘ÛÈoÏoÁÈ΋ ÂÌÊ¿ÓÈÛË Ùo˘ º.μ.Ù· appleÂÚÈÛÙ·ÙÈο Ì·˜ Û ÎÒÌ· appleo˘ ·Ó¤ÓË„·Ó,fiÛo ·˘Í¿ÓÂÈ Ùo Âapple›apple‰o Îϛ̷η˜ ÎÒÌ·Ùo˜ °Ï·-ÛÎfi‚˘ (GCS), ‰ËÏ·‰‹ Ùo Âapple›apple‰o ÂÁÚ‹ÁoÚÛ˘appleo˘ Û¯ÂÙ›˙ÂÙ·È Ì Ùo ‰ÈÎÙ˘ˆÙfi Û¯ËÌ·ÙÈÛÌfi, ÙfiÛo·Ó‚·›ÓÂÈ Ë ‰È·‚¿ıÌÈÛË (score) Ùo˘ º.μ.∞ÓÙ›ıÂÙ·, Û Âapple›apple‰o GCS οو Ùo˘ 8 Î·È Û’·˘Ùo‡˜ appleo˘ η٤ÏËÍ·Ó ‰ÂÓ apple·Ú¿ÁÂÙ·È Î·Ì›· ΛÓËÛË.Àapple¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ùo˘ ÂappleÈapple¤‰o˘GCS appleo˘ ·Ú¯›˙ÂÈ Ó· ÂÌÊ·Ó›˙ÂÙ·È Ùo Ê·ÈÓfiÌÂÓoBell Î·È Ù˘ ‰È·‚¿ıÌÈÛ˘ (score) Î·È ÁÈ· Ùo˘˜ ‰‡ooÊı·ÏÌo‡˜ (p=0,008 ÁÈ· Ùo ‰ÂÍÈfi oÊı·ÏÌfi ηÈp=0,031 ÁÈ· ÙoÓ ·ÚÈÛÙÂÚfi oÊı·ÏÌfi, Jonckheere -Terpstra Test), ‰ËÏ·‰‹ ¤¯o˘Ì ηχÙÂÚË ‰È·‚¿ı-ÌÈÛË (score) ÁÈ· ·˘Ùo‡˜ appleo˘ ¤¯o˘Ó appleÈo ˘„ËÏfi Âapple›-apple‰o GCS.∏ ÌË Û˘Ìʈӛ· Ùo˘ ÙÂÏÈο apple·Ú·ÁfiÌÂÓo˘ º.μ.ÛÙo˘˜ ·Ó·Ó‹„·ÓÙ˜ ·applefi ÎÒÌ· ·ÛıÂÓ›˜ Ì ÙȘ apple·-Ú·ÙËÚo‡ÌÂÓ˜ ÎÈÓ‹ÛÂȘ ηٿ Ùo Ù·˘Ùfi¯ÚoÓo ¿ÓoÈÁ-Ì· ‹ ÎÏ›ÛÈÌo Î·È ¿ÓoÈÁÌ· ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, fiÙ·Ó·˘Ùo› ‚Ú›ÛÎÔÓÙ·Ó Û ÎÒÌ·, ı· ÌappleoÚo‡Û ӷ ÂÚÌË-Ó¢ı› Ì ÙËÓ ¿appleo„Ë fiÙÈ Ùo º.μ. ÂϤÁ¯ÂÙ·È ·applefi·ÓÒÙÂÚ· ΤÓÙÚ·, ÂÓÒ oÈ ¿ÏϘ ÎÈÓ‹ÛÂȘ ·applefi ηÙÒ-ÙÂÚ· ΤÓÙÚ·.ŸÛoÓ ·ÊoÚ¿ ÙËÓ ·Ó·ÛÙÚoÊ‹ Ùo˘ º.μ., Ë o-appleo›· appleÂÚÈÁÚ¿ÊËΠappleÏ‹Úˆ˜ ·applefi ÙoÓ Hall ¯ˆÚ›˜ Ó··Ó·Ê¤ÚÂÈ appleoÛoÛÙ¿, o Bender (1966) ·Ó·Ê¤ÚÂÈ 3%ÛÙ· Ê˘ÛÈoÏoÁÈο ¿ÙoÌ· Î·È o Alvarez ÛÙË ÛÂÈÚ¿Ùo˘ ·Ó·Ê¤ÚÂÈ 0,9% ÛÙ· Ê˘ÛÈoÏoÁÈο ¿ÙoÌ·. ∏ Û˘-¯ÓfiÙËÙ· Ù˘ appleÚo˜ Ù· οو ·apple¿ÓÙËÛ˘ Â›Ó·È 8% ÛÙËÛÂÈÚ¿ ÙˆÓ Francis Î·È Loughhead Î·È ÛÙo˘ Ferrer3,7%.∞applefi Ùo˘˜ 42 ·ÛıÂÓ›˜ ÙˆÓ Francis Î·È LoughheadÌ ·apple¿ÓÙËÛË appleÚo˜ Ù· οو ÛÙo º.μ. 17%›¯Â ·ÓˆÌ·Ï›· ÛÙËÓ oÊı·ÏÌÈ΋ ÂappleÈÊ¿ÓÂÈ· (ÙoÓ ÎÂ-Ú·ÙoÂȉ‹;) Î·È Î·Ó¤Ó·˜ ·applefi ·˘Ùo‡˜ ‰ÂÓ Â›¯Â Ï·Áfi-Êı·ÏÌo. OÈ apple·Ú·apple¿Óˆ ÈÛ¯˘Ú›˙oÓÙ·È fiÙÈ Ë appleÚo˜ ٷοو ·apple¿ÓÙËÛË ı· ÌappleoÚo‡Û ӷ ıˆÚËı› Û·ÓappleÚoÛٷ٢ÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜, fiÙ·Ó Ë appleÚo˜ Ù· ¿Óˆ·apple¿ÓÙËÛË Â›¯Â ·appleoÙ‡¯ÂÈ Ó· appleÚoÛٷهÛÂÈ Ùo‚oÏ‚fi, appleÈı·ÓfiÓ ÂÌappleϤÎoÓÙ·˜ ÙË Ó¢ÚoÊ˘ÛÈoÏoÁÈ-΋ oÏoÎÏ‹ÚˆÛË ÙˆÓ ÈÓÒÓ Ùo˘ ÙÚȉ‡Ìo˘ ÁÈ· ÙoÓapplefiÓo Ì Ùo Ì˯·ÓÈÛÌfi Ùo˘ º.μ.∫·Ù¿ Ùo˘˜ Jambel Î·È Haidt Â›Ó·È appleÈı·ÓfiÓ ÛÂÌÂÚÈο ¿ÙoÌ· Ë ÈηÓfiÙËÙ¿ Ùo˘˜ Ó· ÂÓ·ÓÙȈıo‡ÓÂÓÂÚÁËÙÈο ÛÙËÓ apple·Ú·ÁˆÁ‹ Ùo˘ º.μ. Ó· Â›Ó·È ÛË-Ì·ÓÙÈÎfi˜ apple·Ú¿ÁˆÓ ÁÈ· ÙËÓ apple·Ú·ÁˆÁ‹ Ùo˘ ·appleoη-Ïo‡ÌÂÓo˘ ·Ó¿ÛÙÚoÊo˘ º.μ., ηٿ Ùo oappleo›o oÈ ‚oÏ-‚o› ÎÈÓo‡ÓÙ·È appleÚo˜ Ù· οو ·ÓÙ› appleÚo˜ Ù· ¿Óˆ.Ÿappleˆ˜ appleÚo·Ó·Ê¤ÚıËΠÛÙ· appleÂÚÈÛÙ·ÙÈο Ì·˜3 ˘ÁÈ›˜ apple·Úo˘Û›·Û·Ó „¢‰¤˜ º.μ. ·Ú¯Èο appleÚo˜ ٷοو.ÚÒÙo˜ o Hall (1936) ‚ڋΠ·Û˘ÌÌÂÙÚ›· Ùo˘º.μ. Û 21 ¿ÙoÌ· Û ۇÓoÏo 800 ˘ÁÈÒÓ appleÂÚÈappleÙÒÛÂ-ˆÓ, ‰ËÏ·‰‹ 2,6%, ÛÙ· oappleo›· Ë ·Ó‡„ˆÛË Ùo˘ ÂÓfi˜oÊı·ÏÌo‡ ‹Ù·Ó ·ÍÈoÛËÌ›ˆÙ· ÌÈÎÚfiÙÂÚË Û¯ÂÙÈοÌ ÙoÓ ¿ÏÏo, ‰ÂÓ ·Ó·Ê¤ÚÂÈ fï˜ appleoÈo˜ oÊı·ÏÌfi˜.OÈ Corin et al (1972) Û 70 ·ÛıÂÓ›˜ ËÏÈΛ·˜52-79 ÂÙÒÓ Ì ÓfiÛo Ùo˘ Parkinson ›¯·Ó ̤ÙÚÈ· ‹Ûo‚·Ú‹ appleÚoÛ‚oÏ‹ Ùo˘ º.μ. Û 23 ·ÛıÂÓ›˜ (33%)Î·È ‰ÂÓ ·Ó·Ê¤Úo˘Ó ·Ó ˘apple‹Ú¯Â ·Û˘ÌÌÂÙÚ›· Ùo˘ º.μ.O Alvarez ·ÍÈoÏfiÁËÛ Ùo º.μ. ÌÂٷ͇ appleÏ‹Úˆ˜

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 247Ê˘ÛÈoÏoÁÈÎo‡ Î·È appleÏ‹Úˆ˜ ηٷÚÁË̤Óo˘ Î·È ÙoÙ·ÍÈÓfiÌËÛÂ Û·Ó Ê˘ÛÈoÏoÁÈÎfi Î·È ÂÙÂÚfiappleÏ¢ڷ ‹·ÌÊoÙÂÚfiappleÏ¢ڷ ·ÓÒÌ·Ïo. ø˜ ·ÓÒÌ·Ïo ıÂÒÚËÛÂÙo ÂÏ·Ùو̤Óo ‹ ÌË apple·Ú·ÁfiÌÂÓo º.μ.∫·Ù¿ ÙoÓ Alvarez ·applefi ÙËÓ ËÏÈΛ· ÙˆÓ 50 ÂÙÒÓ¤¯o˘Ì ¤Ó·ÚÍË ·ÌÊoÙÂÚfiappleÏ¢Ú˘ ÂÏ¿ÙÙˆÛ˘ Ùo˘º.μ., ÏfiÁˆ ËÏÈΛ·˜ Û oÚÈṲ̂ӷ ¿ÙoÌ·. ∞˘Ù‹ ηٿappleÏÂÈo„ËÊ›· ÙˆÓ appleÂÚÈappleÙÒÛÂˆÓ ÍÂÎÈÓ¿ÂÈ ·applefi Ùo ‰Â-ÍÈfi oÊı·ÏÌfi Î·È ÌappleoÚ› Ó· ıˆÚËı› ̤Úo˜ Ù˘ÁÂÓÈÎfiÙÂÚ˘ ‰È·‰Èηۛ·˜ Ù˘ Á‹Ú·ÓÛ˘ Ùo˘ Ó¢-ÚÈÎo‡ Û˘ÛÙ‹Ì·Ùo˜. ∂apple›Û˘, ·Ó·Ê¤ÚÂÈ fiÙÈ Ë ËÏÈΛ·ÂappleËÚ¤·Û Ùo Ê·ÈÓfiÌÂÓo μell, ·ÏÏ¿ ıˆÚ› ÙË ÓfiÛoÙo˘ Parkinson appleÂÚÈÛÛfiÙÂÚo ηٷÛÙ·ÏÙÈ΋ ÛÙË Ê˘-ÛÈoÏoÁÈ΋ ·apple¿ÓÙËÛË Ùo˘ º.μ. Î·È ·˘Ùfi ·ÓÙ·Ó·ÎÏ¿ÛÙË Û˘¯ÓfiÙËÙ· Ù˘ ·Û˘ÌÌÂÙÚ›·˜, Ë oappleo›· ‹Ù·Ó appleÈoÌÂÁ¿ÏË ·apple’ fi,ÙÈ ÛÙ· Ê˘ÛÈoÏoÁÈο ¿ÙoÌ·.∞ӷʤÚÂÙ·È Âapple›Û˘ fiÙÈ Ë ÓfiÛo˜ Ùo˘ ÎÈÓËÙÈÎo‡Ó¢ÚÒÓ· (motor neuron disease) ηٷÛÙ¤ÏÏÂÈ ÙËÊ˘ÛÈoÏoÁÈ΋ appleÚo˜ Ù· ¿Óˆ ·apple¿ÓÙËÛË ( Alvarez1977, Esteban et al 1978).∫·Ù¿ ÙoÓ Alvarez appleÚ¤appleÂÈ Ó· ÏËÊı› ˘applefi„Ë fiÙÈoÈ ‰È¿ÊoÚ˜ ıˆڛ˜ ‰ÂÓ Û˘ÌʈÓo‡Ó Û¯ÂÙÈο ÌÂÙË ı¤ÛË Ù˘ ‰oÌÈ΋˜ ‚Ï¿‚˘ ηٿ ÙËÓ appleÚfio‰o Ù˘ËÏÈΛ·˜ (Á‹Ú·˜), ÙË ÓfiÛo Ùo˘ Parkinson Î·È ÙËÓfiÛo Ùo˘ ÎÈÓËÙÈÎo‡ Ó¢ÚÒÓ·, oÈ oappleo›Â˜ ÌappleoÚ› ӷηٷÛÙ¤ÏÏo˘Ó ÙË Ê˘ÛÈoÏoÁÈ΋ ·apple¿ÓÙËÛË Û ÌÂÚÈ-ο ¿ÙoÌ·, ·ÏÏ¿ ‚‚·›ˆ˜ fi¯È Û’ fiÏ·. O ›‰Èo˜ ıˆ-Ú› appleÈo Û˘ÓÂÙ‹ ÙËÓ ¿appleo„Ë fiÙÈ ‚Ï¿‚˜ Û appleÂÚÈÛÛfi-ÙÂÚ˜ ·applefi Ì›· ı¤ÛÂȘ ηٿ Ì‹Îo˜ ·˘Ù‹˜ Ù˘ appleÂÚ›-appleÏo΢ o‰o‡ ÌappleoÚ› Ó· ηٷÚÁ‹Ûo˘Ó Ùo º.μ.Δ· ‰Èο Ì·˜ Â˘Ú‹Ì·Ù· Û˘ÌʈÓo‡Ó Ì ٷ ¢-Ú‹Ì·Ù· Ùo˘ Alvarez.Ùo˘˜ ˘ÁÈ›˜, fiÛo ·˘Í¿ÓÂÈ Ë ËÏÈΛ·, ÂÏ·ÙÙÒÓÂ-Ù·È Ë ‰È·‚¿ıÌÈÛË (score) Ùo˘ º.μ.∂apple›Û˘, fiÛo ·˘Í¿ÓÂÈ Ë ËÏÈΛ·, ·˘Í¿ÓÂÈ Ë ·-Û˘ÌÌÂÙÚ›· ˘apple¤Ú Ùo˘ ∞.O, ‰ËÏ·‰‹ ÂÏ·ÙÙÒÓÂÙ·È Ë‰È·‚¿ıÌÈÛË (score) Ùo˘ º.μ. ÛÙo ¢.O. Î·È ·˘Í¿ÓÂÈË ‰È·‚¿ıÌÈÛË (score) ˘apple¤Ú Ùo˘ ∞.O., fiappleˆ˜ appleÚo·-appleÙÂÈ ·applefi ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓÌ·˜.Ù· appleÂÚÈÛÙ·ÙÈο Ì·˜ Î·È ÛÙȘ ÙÚÂȘ oÌ¿‰Â˜ ˉȷ‚¿ıÌÈÛË (score) ÂÏ·ÙÙÒÓÂÙ·È Ì ÙËÓ ËÏÈΛ·(ÓfiÛo˜ Alzheimer, ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ Î·È ˘-ÁÈ›˜) Î·È ˘apple¿Ú¯ÂÈ ·Û˘ÌÌÂÙÚ›· ˘apple¤Ú Ùo˘ ∞.O., Ëoappleo›· ·˘Í¿ÓÂÈ Ì ÙËÓ ËÏÈΛ· ÙˆÓ ÂÍÂÙ·˙o̤ӈÓ, Ëoappleo›· Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, ·ÏÏ¿ ‰ÂÓ ˘apple¿Ú-¯ÂÈ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊoÚ¿ ÌÂٷ͇ ÙˆÓ oÌ¿‰ˆÓ.∂apple›Û˘, Ù· Â˘Ú‹Ì·Ù· Ùo˘ Alvarez ÁÈ· ÙËÓ Ófi-Ûo Ùo˘ Parkinson ÌoÈ¿˙o˘Ó Ì ٷ ‰Èο Ì·˜ ÁÈ· ÙËÓfiÛo Alzheimer.Ùo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer Ë ‰È·‚¿ı-ÌÈÛË (score) ˘apple¤Ú Ùo˘ ∞.O. Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, ¯ˆ-Ú›˜ fï˜ Ó· appleÚo·appleÙÂÈ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊoÚ¿.ŸÌˆ˜ ÛÙo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer˘apple¿Ú¯ÂÈ ·Û˘ÌÌÂÙÚ›· ˘apple¤Ú Ùo˘ ∞.O. ÛËÌ·ÓÙÈ΋ Û·ӷÏoÁ›· Û appleoÛoÛÙfi 48,48%, ÂÓÒ ÛÙo˘˜ ·ÛıÂÓ›˜Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ ˘apple¿Ú¯ÂÈ Û appleoÛoÛÙfi18,66% Î·È ÛÙo Û‡ÓoÏo ÙˆÓ ˘ÁÈÒÓ Û 16,9 %.ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ Ì ¯Ú‹ÛË·) ÌoÓoʈÙoÓȷ΋˜ ·ÍoÓÈ΋˜ ÙoÌoÁÚ·Ê›·˜(SPECT)‚) Ù˘ appleo˙ÈÙÚoÓȷ΋˜ ÙoÌoÁÚ·Ê›·˜ (PET) ηÈÁ) Ù˘ Ê·ÛÌ·ÙoÛÎoapple›·˜appleÈı·ÓfiÓ Ó· Ì·˜ ‰ÒÛÂÈ ·apple¿ÓÙËÛË ÛÙËÓ ·Û˘Ì-ÌÂÙÚ›· Ùo˘ º.μ. ˘apple¤Ú Ùo˘ ∞.O.VI. Àª∂ƒ∞ª∞Δ∞ÙË ÌÂϤÙË Ì·˜ ·Û¯oÏËı‹Î·Ì Ì Ùo Ê·ÈÓfi-ÌÂÓo Ùo˘ Bell (º.μ.) ÛÙoÓ ·ÛıÂÓ‹ Û ÎÒÌ·, ÌÂÓfiÛo Alzheimer, Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ (MS)Î·È Û ‰Â›ÁÌ· ˘ÁÈÒÓ ·ÙfïÓ.ÃÚËÛÈÌoappleoÈÂ›Ù·È Ì˯·ÓÈ΋ apple·ÚÂÌ‚oÏ‹ ÛÙ·‚Ϥʷڷ, ·Êo‡ Ù·˘Ùfi¯ÚoÓ· Ùo ¿Óˆ Î·È Ùo οو‚ϤʷÚo Û˘ÁÎÚ·Ùo‡ÓÙ·È ·applefi ÙoÓ ÂÍÂÙ·ÛÙ‹ Î·È Á›-ÓÂÙ·È Î·Ù·ÁÚ·Ê‹ Ùo˘ º.μ.Àapple¿Ú¯ÂÈ ¤Ó·˜ apple·Ú·ÙËÚËÙ‹˜, ˘apple¿Ú¯o˘Ó ÎÚÈÙ‹-ÚÈ· ¯·Ú·ÎÙËÚÈÛÌo‡ ÙˆÓ ·apple·ÓÙ‹ÛÂˆÓ (‰È·‚¿ıÌÈÛË0, 1, 2, 3 - Û˘ÌÌÂÙÚÈÎfi, ·Û‡ÌÌÂÙÚo) Î·È Ë ÂappleÈÏoÁ‹ÙˆÓ appleÂÚÈÛÙ·ÙÈÎÒÓ Â›Ó·È Ù˘¯·›·. 3 ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer ‰ÂÓ Â›Ó·È‰˘Ó·Ùfi Ó· ÂÏÂÁ¯ı› Ùo º.μ. ‰ÈfiÙÈ ‰ÂÓ Û˘ÓÂÚÁ¿˙o-ÓÙ·È, ÏfiÁˆ Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÓfiÛo˘.ÙË ÛÂÈÚ¿ Ì·˜ ‰ÂÓ ˘apple¿Ú¯ÂÈ Î·Ó¤Ó·, Ù˘appleÈÎfiappleÂÚÈÛÙ·ÙÈÎfi oÚÈ˙fiÓÙÈ·˜ ·apple¿ÓÙËÛ˘, ‰ËÏ·‰‹ Ûapple·-ÛÙÈÎfiÙËÙ·˜ Ùo˘ Û˘˙˘Áo‡˜ ‚ϤÌÌ·Ùo˜.Ùo˘˜ ·ÛıÂÓ›˜ Ì·˜ Û ÎÒÌ· Ì Âapple›apple‰o ÎÏ›-̷η˜ ÎÒÌ·Ùo˜ °Ï·ÛÎfi‚˘ (GCS) οو Ùo˘ 8 ηÈÛ’ ·˘Ùo‡˜ appleo˘ ÙÂÏÈο η٤ÏËÍ·Ó ‰ÂÓ apple·Ú¿ÁÂٷȺ.μ.∞ÓÙ›ıÂÙ·, ÛÙo˘˜ ·ÛıÂÓ›˜ Ì·˜ Û ÎÒÌ·, appleo˘·Ó¤ÓË„·Ó, fiÛo ·˘Í¿ÓÂÈ Ùo Âapple›apple‰o GCS (‰ËÏ·‰‹Ùo Âapple›apple‰o ÂÁÚ‹ÁoÚÛ˘, appleo˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙoÓ ‰È-ÎÙ˘ˆÙfi Û¯ËÌ·ÙÈÛÌfi), ÙfiÛo ·Ó‚·›ÓÂÈ Ë ‰È·‚¿ıÌÈ-ÛË (score) Ùo˘ º.μ.∂appleo̤ӈ˜, Ë apple·Ú·ÁˆÁ‹ Ùo˘ Ê·ÈÓo̤Óo˘ Ùo˘μell, fiÙ·Ó Ë Îϛ̷η ÎÒÌ·Ùo˜ °Ï·ÛÎfi‚˘ (GCS)Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·applefi 8, ı· ÌappleoÚo‡Û ӷ ıˆÚËı›appleÚoÁÓˆÛÙÈÎfi ÛËÌ›o, ÛÂ Û˘Û¯ÂÙÈÛÌfi apple¿ÓÙ· ‚Â-‚·›ˆ˜ Ì ÙË ÁÂÓÈ΋ ÂÈÎfiÓ· Ùo˘ ·ÛıÂÓo‡˜, Û ·ÓÙ›-ıÂÛË Ì Ùo˘˜ ·ÛıÂÓ›˜ appleo˘ ηٿÏËÍ·Ó (GCS ÌÈ-ÎÚfiÙÂÚË ·applefi 8), ÛÙo˘˜ oappleo›o˘˜ ‰ÂÓ apple·Ú¿ÁÂÙ·È Î·-Ì›· ΛÓËÛË.°È· Ùo˘˜ ·ÛıÂÓ›˜ Û ÎÒÌ·, appleo˘ ÌÂÙ¤appleÂÛ·Ó ÛÂÊ˘ÙÈ΋ ηٿÛÙ·ÛË, ‰ÂÓ ÌappleoÚo‡Ó Ó· ÂÍ·¯ıo‡Ó

248 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)·ÛÊ·Ï‹ Û˘ÌappleÂÚ¿ÛÌ·Ù·.∞applefi ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË (student’s t test,x 2 , analysis of variance) Âapple›Û˘ appleÚo·appleÙÂÈ fiÙÈ1) ¢ÂÓ ˘apple¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊoÚ¿ ÛÙËÓ apple·-Ú·ÁˆÁ‹ Ùo˘ º.μ. ÌÂٷ͇ ÓfiÛo˘ Alzheimer ηȉ›ÁÌ·Ùo˜ ˘ÁÈÒÓ ·ÙfïÓ.2) ¢ÂÓ ˘apple¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊoÚ¿ ÛÙËÓ apple·-Ú·ÁˆÁ‹ Ùo˘ º.μ. ÌÂٷ͇ ·ÛıÂÓÒÓ Ì ÛÎÏ‹Ú˘ÓÛËηٿ appleϿη˜ Î·È ‰Â›ÁÌ·Ùo˜ ˘ÁÈÒÓ ·ÙfïÓ.3) ŸÛo ·˘Í¿ÓÂÈ Ë ËÏÈΛ· Î·È ÛÙȘ ÙÚÂȘ oÌ¿-‰Â˜ (ÓfiÛo˜ Alzheimer, ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜Î·È ˘ÁÈ›˜) ÂappleËÚ¿˙ÂÙ·È Ë apple·Ú·ÁˆÁ‹ Ùo˘ º.μ., ‰Ë-Ï·‰‹ ÂÏ·ÙÙÒÓÂÙ·È Ë ‰È·‚¿ıÌÈÛË (score). ªfiÓo Û’¤Ó·Ó ˘ÁÈ‹ (62 ÂÙÒÓ) ‰ÂÓ apple·Ú¿ÁÂÙ·È Î·Ì›· ΛÓËÛËÛÙo ¢.O. (0,9%) Î·È Û’ ¤Ó·Ó ·ÛıÂÓ‹ Ì ÓfiÛo AlzheimerÛÙo ¢.O. (1,5%).4) ∫·È ÛÙȘ ÙÚÂȘ oÌ¿‰Â˜ (ÓfiÛo˜ Alzheimer,ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ Î·È ˘ÁÈ›˜) ˘apple¿Ú¯ÂÈ·Û˘ÌÌÂÙÚ›· ˘apple¤Ú Ùo˘ ∞.O., Ë oappleo›· ·˘Í¿ÓÂÈ Ì ÙËÓËÏÈΛ· ÙˆÓ ÂÍÂÙ·˙o̤ӈÓ. Ùo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛoAlzheimer Û ·Ó·ÏoÁ›· ˘apple¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË·Û˘ÌÌÂÙÚ›· ˘apple¤Ú Ùo˘ ∞.O., ¯ˆÚ›˜ fï˜ Ó· appleÚo·-appleÙÂÈ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊoÚ¿.∂appleo̤ӈ˜, ÛÙ· appleÂÚÈÛÙ·ÙÈο Ì·˜ Î·È ÛÙȘ ÙÚÂȘoÌ¿‰Â˜ (ÓfiÛo˜ Alzheimer, ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleÏ¿-η˜ Î·È ˘ÁÈ›˜) Ë ‰È·‚¿ıÌÈÛË (score) ÂÏ·ÙÙÒÓÂÙ·ÈÌ ÙËÓ ËÏÈΛ· Î·È ˘apple¿Ú¯ÂÈ ·Û˘ÌÌÂÙÚ›· ˘apple¤Ú Ùo˘∞.O., Ë oappleo›· ·˘Í¿ÓÂÈ Ì ÙËÓ ËÏÈΛ· ÙˆÓ ÂÍÂ-Ù·˙o̤ӈÓ, Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, ·ÏÏ¿ ‰ÂÓ˘apple¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈ΋ ‰È·ÊoÚ¿ ÌÂٷ͇ ÙˆÓ oÌ¿‰ˆÓ.Ùo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer ˘apple¿Ú¯ÂÈÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Û ÂηÙoÛÙÈ·›· ·Ó·ÏoÁ›··Û˘ÌÌÂÙÚ›· ‰È·‚¿ıÌÈÛ˘ ˘apple¤Ú Ùo˘ ∞.O., ·Ó ηȉÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈ΋ ‰È·ÊoÚ¿ ÛÙËÓ ·Û˘ÌÌÂÙÚ›·‰È·‚¿ıÌÈÛ˘ ˘apple¤Ú Ùo˘ ∞.O. ÛÙȘ ÙÚÂȘ oÌ¿‰Â˜ (Ófi-Ûo Alzheimer, ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ Î·È ˘ÁÈ›˜).Ùo˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛo Alzheimer Û ÂηÙo-ÛÙÈ·›· ·Ó·ÏoÁ›· Ë ·Û˘ÌÌÂÙÚ›· ‰È·‚¿ıÌÈÛ˘ ˘apple¤ÚÙo˘ ∞.O. Â›Ó·È Û appleoÛoÛÙfi 48,48%, ÂÓÒ ÛÙo˘˜ ·-ÛıÂÓ›˜ Ì ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ appleϿη˜ Ùo appleoÛoÛÙfiÊı¿ÓÂÈ 18,66% Î·È ÛÙo Û‡ÓoÏo ÙˆÓ ˘ÁÈÒÓ Êı¿ÓÂÈÛÙo 16,9%.BÈ‚ÏÈÔÁÚ·Ê›·1. Adams D. Raymond, Victor Maurice. Principles of Neurology,5th ed., McGraw-Hill, Inc., 1993.2. Allik J, Rauk M, Luuk A. Control and sense of eye movementbehind closed eyelids. Perception, 10: 39-51, 1981.3. Alvarez G. Bell’s phenomenon in normal adults and inParkinson’s disease. Acta Neurol Scandinav 62: 127-131, 1980.4. American Academy of Ophthalmology (1993-94), Basicand Clinical Science Course, Neuro- Ophthalmology,Section 5.5. American Academy of Ophthalmology. ¡∂ÀƒOOº£∞§-ªO§O°π∞, ΔfiÌo˜ 5. ªÂÙ¿ÊÚ·ÛË ·applefi ÙoÓ ∫·ıËÁËÙ‹¡. Ù¿ÁÎo Ì ÙË Û˘ÓÂÚÁ·Û›· Ùo˘ Û˘Ó·‰¤ÏÊo˘ ∂. μ.°ÎoÙ˙·Ú›‰Ë. ∂appleÈ̤ÏÂÈ· ¤Î‰oÛ˘: °. ¢. ·ÏË̤Ú˘.π∞Δƒπ∫∂ ∂∫¢O∂π « . Ã. ∞Ã∞§π¢∏»,1997.6. Bach-Y-Rita P, Collins CC. The control of Eye Movements,p 183. Academic Press, New York and London,1971.7. Bell C. On the motions of the eye in illustration of theuses of the muscles and nerves of the orbit. PhilosTrans R. Soc. Lon. 113. 166-86, 1823.8. Burde RM, Savino PJ, Trobe JD. Clinical Decisions inNeuro-Ophthalmology, ed. 2. St. Louis, CV MosbyCo, 1992.9. Buttner U, Brandt Th. Baillier’s Clinical Neurology. Volume1/ Number 2, Bailiere Tindall, London, 1992.10. Chamberlain W. Restriction in upward gaze with advancingage. Am J Ophthal. 1971, Vol. 71, No. 1, pp. 341-346.11. Chu FC, Reingold DB, Cogan DB. Lid triggered synkineses.Ophthalmology; 88, 1019-23, 1981 Oct.12. Clark VA, Detels R, Visscher BR et al. Factors associatedwith a malignant or benign course of multiple sclerosis.JAMA 248: 856-860, 1982.13. Cogan D. Hemianopia and associated symptoms due toparietotemporal lobe lesions. Am J Ophthalmol, 50:1056-1066, 1960.14. Cogan DG. Neurology of the Ocular Muscles, ed. Springfield,III, Charles C. Thomas, 1956.15. Cogan DG. Neurologic significance of lateral conjugatedeviation of the eyes on forced closure of the lids.Arch Ophthalmol 39: 37, 1948.16. Cohen SW, Banko W, Zerykier A. Testing of Bell’s phenomenonby transocular transcutaneoustransillumination.Am J Ophthalmol 84: 734-735, 1977.17. Corin MS, Elizan TS, Bender MB. Oculomotor Functionin Patients with Parkinson’s Disease. J Neurol Sci. 15:251-265, 1972.18. Davis PC, Gearing M, Gray L, Mirra SS, Morris JC,Edland SD, Lin T and Heyman A. The CERADexperience, part VIII. Neuroimaging-neuropathologycorrelates of temporal lobe changes in Alzheimer’sdisease. Neurology 45: 178-179, 1995.19. Duane’s Ophthalmology on CD-Rom. Supranucleardisorders of eye movements Vol 2 / Chap 10 -15. J. B.Lippincott Company. Ed. 1995.20. Duke-Elder S, Cook C. Normal development. Part I.Embryology. In Duke-Elder S (ed): System of Ophthalmology,Vol 3, p 29. St. Louis, CV Mosby, 1963.21. Duke-Elder, Anatomy. In Duke-Elder S (ed): System ofOphthalmology, Vol. VI, pp 770, 1973.22. Esteban A, Andre C, Gimenez-Roldan S. Abnormalitiesof Bell’s phenomenon in amyotrophic lateral sclerosis.

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ÂÚÈÏ‹„ÂȘ ·applefi ͤӷ appleÂÚÈÔ‰Èο∂appleÈ̤ÏÂÈ·: A. M¿ÓıÔ˜e-mail: amanthos@med.auth.grBritish Journal ofOphthalmologyμÈoÌÂÙÚÈ΋ ÁˆÓÈoÛÎoapple›· Î·È oÈ ÂappleȉڿÛÂȘ Ù˘ËÏÈΛ·˜, Ù˘ Ê˘Ï‹˜ Î·È Ùo˘ ʇÏo˘ apple¿Óˆ ÛÙË Áˆ-Ó›· Ùo˘ appleÚoÛı›o˘ ı·Ï¿Ìo˘N.G. Congdon, P.J. Foster, S. Wamsley, J. Gutmark,W. Nolan, S.K. Seah, G.J. Johnson, A.T.BromanBr J Ophthalmol 86: 18-22, 2002 ·˘Ùfi Ùo ¿ÚıÚo oÈ Û˘ÁÁÚ·Ê›˜ ¯ÚËÛÈÌoappleoÈo‡ÓÌÈ· appleÚˆÙfiÙ˘appleË Ì¤ıo‰o ÁÈ· Ó· ÌÂÙÚ‹Ûo˘ÓÙoÓ appleÚfiÛıÈo ı¿Ï·Ìo Ì ÛÎoapplefi ÙË Û‡ÁÎÚÈÛË Ù˘ Áˆ-Ó›·˜ Ùo˘ appleÚoÛı›o˘ ı·Ï¿Ìo˘ ÌÂٷ͇ ·ÙfiÌˆÓ appleo˘Î·Ù¿ÁoÓÙ·È ·applefi ÙËÓ ∂˘ÚÒappleË, ÙËÓ ∞ÊÚÈ΋ Î·È ÙËÓ∞Û›· Î·È ¤¯o˘Ó ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ·applefi 40 ¤ÙË.ªÂÏÂÙ‹ıËÎ·Ó 15 ¿ÙoÌ· ·applefi οı ʇÏo, ·applefi ο-ı ‰ÂηÂÙ›· ÌÂٷ͇ ÙˆÓ 40 Î·È 70 ÂÙÒÓ Î·È ·applefiοı ̛· ·applefi ÙȘ ÙÚÂȘ Ê˘ÏÂÙÈΤ˜ oÌ¿‰Â˜, ¤Á¯Úˆ-ÌoÈ, Ï¢Îo› Î·È ∞ÛÈ¿Ù˜. °È· ÙË ‚ÈoÌÂÙÚÈ΋ Áˆ-ÓÈoÛÎoapple›· ¯ÚËÛÈÌoappleoÈ‹ıËΠ̛· Û¯ÈÛÌoÂȉ‹˜ Ï˘-¯Ó›· Î·È ¤Ó·˜ ÁˆÓÈoÊ·Îfi˜ ÁÈ· Ó· Á›Óo˘Ó ÌÂÙÚ‹ÛÂȘ·applefi ÙËÓ Ê·ÓÂÚ‹ ›Ûo‰o Ù˘ ›Úȉ·˜ Û ۯ¤ÛË Ì ÙËÁÚ·ÌÌ‹ Ùo˘ Schwalbe. ·˘Ù‹ ÙË ÌÂϤÙË ‰ÂÓ ·Ó‚ڤıËΠÛËÌ·ÓÙÈ΋‰È·ÊoÚ¿ ÛÙȘ ÌÂÙÚ‹ÛÂȘ Ù˘ ÁˆÓ›·˜ ÌÂٷ͇ ÙˆÓ ¤Á-¯ÚˆÌˆÓ, ÙˆÓ Ï¢ÎÒÓ Î·È ÙˆÓ ∞ÛÈ·ÙÒÓ. øÛÙfiÛo oÈÓ·Úo› ∞ÛÈ¿Ù˜ ÂÌÊ·Ó›˙oÓÙ·È Ó· ¤¯o˘Ó ‚·ı‡ÙÂÚËÁˆÓ›· Û ۯ¤ÛË Ì Ùo˘˜ ¤Á¯ÚˆÌo˘˜ Î·È Ùo˘˜Ï¢Îo‡˜, ·Ó Î·È Ë ÁˆÓ›· Û ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜∞ÛÈ¿Ù˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ÛÙÂÓfiÙÂÚË (p=0,004) ÛÂÛ¯¤ÛË Ì ÙË ÁˆÓ›· ›‰È·˜ ËÏÈΛ·˜ Ï¢ÎÒÓ, ¤Á¯Úˆ-ÌˆÓ ·ÙfïÓ.∏ ·appleoÙ˘¯›· Ó· ηٷ‰Âȯı› ‰È·ÊoÚ¿ ÛÙȘ ÌÂ-ÙÚ‹ÛÂȘ Ù˘ ÁˆÓ›·˜ ÌÂٷ͇ ·˘ÙÒÓ ÙˆÓ Ê˘ÏÂÙÈÎÒÓoÌ¿‰ˆÓ appleÚoηÏ› ¤ÎappleÏËÍË, ‰oı¤ÓÙo˜ Ù˘ ÌÂÁ·Ï‡-ÙÂÚ˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ ÌÂ-ٷ͇ ÙˆÓ ∞ÛÈ·ÙÒÓ. º·›ÓÂÙ·È fiÙÈ Ë oÌoÈfiÙËÙ· ÛÙȘÌÂÙÚ‹ÛÂȘ ÌÂٷ͇ ÙˆÓ ∞ÛÈ·ÙÒÓ Î·È ÙˆÓ ‰˘ÙÈÎo¢-Úˆapple·›ˆÓ ÌappleoÚ› Ó· ηχappleÙÂÈ appleoχ ‰È·ÊoÚÂÙÈΤ˜Ù¿ÛÂȘ Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ·. ∏ Ê·ÈÓoÌÂÓÈο appleÈoÁÚ‹ÁoÚË ÂÏ¿ÙÙˆÛË Ùo˘ ‚¿ıo˘˜ Ù˘ ÁˆÓ›·˜ Û ۯ¤-ÛË Ì ÙËÓ ËÏÈΛ· appleo˘ apple·Ú·ÙËÚÂ›Ù·È ÛÙ˘ ∞ÛÈ·ÙÈ΋˜Î·Ù·ÁˆÁ‹˜ ¿ÙoÌ·, ÌappleoÚ› Ó· oÊ›ÏÂÙ·È ÛÙË ÌÂÁ·-χÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ηٷÚÚ¿ÎÙË. øÛÙfi-Ûo Ù· ÛÙ·ÙÈÛÙÈο ‰Â‰o̤ӷ ·applefi Ì·ÎÚ¿˜ ‰È·ÚΛ·˜ÌÂϤÙ˜ Â›Ó·È ·ÓÂapple·Ú΋ Î·È ·˘Ùfi ÌappleoÚ› Ó· ÂÍË-ÁÂ›È Ùo ÛÙÂÓ¿ Û˘Ó‰Â‰Â̤Óo Ê·ÈÓfiÌÂÓo Ù˘ ·˘ÍË̤-Ó˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ Ì˘ˆapple›·˜ Û Ó·Úo‡˜∞ÛÈ¿Ù˜ (¡.∞. §¿ÏÏo˜).˘Û¯¤ÙÈÛË Ùo˘ oÊı·ÏÌÈÎo‡ ÙÚ·‡Ì·Ùo˜ Ì ÙoÊÏoÈÒ‰Ë, Ùo apple˘ÚËÓÈÎfi Î·È ÙoÓ oapple›ÛıÈo ˘apple·Î·„È-Îfi ηٷÚÚ¿ÎÙË: Beaver Dam Eye StudyT.Y. Wong, B.E.K. Klein, R. Klein, S.C. TomanyBr J Ophthalmol 86: 152-155, 2002OÈ Û˘Ó¤appleÂȘ ÌÈÎÚÒÓ oÊı·ÏÌÈÎÒÓ ÙÚ·˘Ì¿ÙˆÓÛÙo ÁÂÓÈÎfi appleÏËı˘ÛÌfi Â›Ó·È ·Û·Ê›˜. ∏ Û¯¤ÛË ÌÂ-ٷ͇ ·Ó·ÊÂÚfiÌÂÓo˘ oÊı·ÏÌÈÎo‡ ÙÚ·˘Ì·ÙÈÛÌo‡Î·È Ùo˘ ÊÏoÈÒ‰Ë, Ùo˘ apple˘ÚËÓÈÎo‡ Î·È Ùo˘ oappleÈÛı›o˘˘appleoη„ÈÎo‡ ηٷÚÚ¿ÎÙË Û ÌÈ· ηıoÚÈṲ̂ÓËoÌ¿‰· appleÏËı˘ÛÌo‡ ÌÂÏÂÙ¿Ù·È Û ·˘Ù‹ ÙËÓ ÂÚÁ·Û›·.ÙË ÌÂϤÙË ·˘Ù‹ appleÂÚÈÏ‹ÊıËÎÂ Ù˘¯·›o ‰Â›ÁÌ·appleÏËı˘ÛÌo‡ ËÏÈΛ·˜ 43 Ì 86 ÂÙÒÓ appleo˘ ‰È¤ÌÂÓ ÛÙoBeaver Dam Wisconsin. (n=4926). ∏ ÂappleȂ‚·›ˆ-ÛË Ùo˘ oÊı·ÏÌÈÎo‡ ÙÚ·˘Ì·ÙÈÛÌo‡ ÁÈÓfiÙ·Ó Ì ÙËÏ‹„Ë ÏÂappleÙoÌÂÚo‡˜ ÈÛÙoÚÈÎo‡ Î·È Ë ıfiψÛË Ùo˘Ê·Îo‡ ÛÙ·‰ÈoappleoÈ‹ıËΠ̠ÙË Ï‹„Ë ÊˆÙoÁÚ·ÊÈÒÓ.ÙË Û˘Ó¤¯ÂÈ· ÌÂÏÂÙ‹ıËÎÂ Ë Û¯¤ÛË ÌÂٷ͇ oÊı·Ï-ÌÈÎo‡ ÙÚ·‡Ì·Ùo˜ Î·È ÊÏoÈÒ‰o˘˜, apple˘ÚËÓÈÎo‡ ηÈoappleÈÛı›o˘ ˘appleoη„ÈÎo‡ ηٷÚÚ¿ÎÙË.ÕÙoÌ· Ì ÈÛÙoÚÈÎfi oÊı·ÏÌÈÎo‡ ÙÚ·‡Ì·Ùo˜ ›-Ó·È appleÈı·ÓfiÙÂÚo Ó· ¤¯o˘Ó ÊÏoÈÒ‰Ë Î·Ù·ÚÚ¿ÎÙË(appleÈı·ÓfiÙËÙ· 1,5; 95% Ì ̤ÛË ·applefiÎÏÈÛË 1,0 Ì 2,2)Î·È oapple›ÛıÈo ˘appleoη„ÈÎfi (appleÈı·ÓfiÙËÙ· 1,7; 95% ÌÂ̤ÛË ·applefiÎÏÈÛË 1,0 Ì 3,1) Û ۯ¤ÛË Ì ¿ÙoÌ· Ù·oappleo›· ‰ÂÓ ·Ó·Ê¤Úo˘Ó ÈÛÙoÚÈÎfi ÙÚ·‡Ì·Ùo˜. ∞˘Ù‹ ËÛ˘Û¯¤ÙÈÛË Â›Ó·È ÈÛ¯˘ÚfiÙÂÚË ÌÂٷ͇ ·ÙfiÌˆÓ appleo˘¤¯o˘Ó ÈÛÙoÚÈÎfi oÊı·ÏÌÈÎo‡ ÙÚ·‡Ì·Ùo˜ ·applefi ·Ì‚χfiÚÁ·Óo (appleÈı·ÓfiÙËÙ· 3,3; 95% Ì ̤ÛË ·applefiÎÏÈÛË1,6 Ì 6,9 ÁÈ· ÊÏoÈÒ‰Ë Î·Ù·ÚÚ¿ÎÙË Î·È appleÈı·ÓfiÙË-Ù· 4,1; 95% Ì ̤ÛË ·applefiÎÏÈÛË 1,5 Ì 10,8 ÁÈ· oapple›-ÛıÈo ˘appleoη„ÈÎfi ηٷÚÚ¿ÎÙË). øÛÙfiÛo Û˘ÁÎÚ›-ÓoÓÙ·˜ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ηٷÚÚ¿ÎÙË ÌÂÙ·-͇ ÙÚ·˘Ì·ÙÈÛÌ¤ÓˆÓ Î·È ÌË ÙÚ·˘Ì·ÙÈṲ̂ӈÓoÊı·ÏÌÒÓ ÌÂٷ͇ ·ÙfiÌˆÓ Ì ÂÙÂÚfiappleÏ¢Úo oÊı·Ï-ÌÈÎfi ÙÚ·‡Ì·, Ë Û˘Û¯¤ÙÈÛË oÊı·ÏÌÈÎo‡ ÙÚ·‡Ì·Ùo˜Î·È ÊÏoÈÒ‰Ë Î·Ù·ÚÚ¿ÎÙË ‰ÂÓ ˘Ê›ÛÙ·Ù·È appleϤoÓ ·ÓOÊı·ÏÌoÏoÁ›·, 14, 2 : 250 - 257, 2002 250

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 251Î·È ˘apple¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÚ·‡Ì·Ùo˜ Î·È oapple›-ÛıÈo˘ ˘appleoη„ÈÎo‡ ηٷÚÚ¿ÎÙË (appleÈı·ÓfiÙËÙ· 2,4;95% Ì ̤ÛË ·applefiÎÏÈÛË 0,8 Ì 7,8).OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁo˘Ó ÛÙo Û˘Ìapple¤Ú·ÛÌ·fiÙÈ Ê·›ÓÂÙ·È Ó· ˘apple¿Ú¯ÂÈ Û·Ê‹˜ Û¯¤ÛË ÌÂٷ͇oÊı·ÏÌÈÎo‡ ÙÚ·‡Ì·Ùo˜ Î·È oapple›ÛıÈo˘ ˘appleoη„ÈÎo‡Î·Ù·ÚÚ¿ÎÙË. ( ¡. ∞. §¿ÏÏo˜ )ºÏÂÁÌ¤ÓˆÓ Ó·ÓÈÎfi˜ Ûapple›Ïo˜ ÂappleÈappleÂÊ˘ÎfiÙ·: ∫ÏÈ-ÓÈÎoapple·ıoÏoÁÈο ¯·Ú·ÎÙËÚÈÛÙÈοE. Zamir, H. Mechoulam, A. Mieeza, F. Levi-Schaffer, J. Pe’erBr J Ophthalmol 86: 28-30, 2002O ÊÏÂÁÌ¤ÓˆÓ Ó·ÓÈÎfi˜ Ûapple›Ïo˜ Ùo˘ ÂappleÈappleÂÊ˘-ÎfiÙ·, appleoÏϤ˜ ÊoÚ¤˜, Ï·Óı·Ṳ̂ӷ ‰›ÓÂÈ ÙËÓ ÂÓÙ‡-appleˆÛË fiÙÈ Â›Ó·È Î·Îo‹ı˘ ÏfiÁˆ Ù˘ Ù·¯Â›·˜ ·Ó¿-appleÙ˘Í‹˜ Ùo˘. Δ· ÎÏÈÓÈο Î·È Ù· ÈÛÙoapple·ıoÏoÁÈο ¯·-Ú·ÎÙËÚÈÛÙÈο Ùo˘ ‰ÂÓ ¤¯o˘Ó ·ÎfiÌË appleÂÚÈÁÚ·Ê› ÛÂÛÂÈÚ¤˜ ·ÛıÂÓÒÓ. OÈ Û˘ÁÁÚ·Ê›˜ ÛÙo ¿ÚıÚo ·˘ÙfiappleÚoÛapple·ıo‡Ó Ó· appleÂÚÈÁÚ¿„o˘Ó Ù· ÎÏÈÓÈο Î·È ÈÛÙoapple·ıoÏoÁÈο¯·Ú·ÎÙËÚÈÛÙÈο∏ ÂÚÁ·Û›· ·˘Ù‹ Â›Ó·È Ì›· ·Ó·ÛÎoappleÈ΋ ÌË Ù˘-¯·ÈoappleoÈË̤ÓË ÎÏÈÓÈÎoapple·ıoÏoÁÈ΋ ÌÂϤÙË. ŸÏoÈ oÈ·ÛıÂÓ›˜ ÌÈÎÚfiÙÂÚoÈ ·applefi 20 ÂÙÒÓ Ì Ûapple›Ïo ÂappleÈappleÂ-Ê˘ÎfiÙ·, appleo˘ ·Ê·ÈÚ¤ıËΠ¯ÂÈÚo˘ÚÁÈο ÌÂٷ͇1990 Î·È 2000 appleÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË. ∂‰Ò appleÂ-ÚÈÁÚ¿ÊoÓÙ·È Ù· ÎÏÈÓÈο ÛËÌ›· ηıÒ˜ Î·È Ù· ÈÛÙoapple·ıoÏoÁÈÎ¿Â˘Ú‹Ì·Ù· ÙˆÓ ÂÍ·ÈÚÂı¤ÓÙˆÓ ‚Ï·‚ÒÓ.˘ÓoÏÈο 63 Ûapple›ÏoÈ ÂappleÈappleÂÊ˘ÎfiÙ· ·Ê·ÈÚ¤ıË-ηÓ. 25% ÙˆÓ ·ÛıÂÓÒÓ Â›¯·Ó ·appleÏfi Ûapple›Ïo ÂappleÈappleÂ-Ê˘ÎfiÙ· Î·È 75% ›¯·Ó Ûapple›Ïo ÂappleÈappleÂÊ˘ÎfiÙ· ÌÂappleÚo¤¯oÓÙ· ÊÏÂÁÌoÓÒ‰Ë ¯·Ú·ÎÙËÚÈÛÙÈο (¢‰È¿-ÎÚÈÙË Û˘ÁΤÓÙÚˆÛË ÏÂÌÊo΢ÙÙ¿ÚˆÓ, appleÏ·-ÛÌ·Ùo΢ÙÙ¿ÚˆÓ Î·È ËˆÛÈÓoʛψÓ). ∂appleÈıËÏȷΤ˜Î‡ÛÙ˜ ‹Ù·Ó Û˘¯Ófi ‡ÚËÌ·. ŸÏoÈ oÈ Ûapple›ÏoÈ ‚ÚÈ-ÛÎfiÙ·Ó ÛÙo ∫O ‹ ÎoÓÙ¿ Û ·˘Ùfi Î·È ¯·Ú·ÎÙËÚÈ-˙fiÙ·Ó ·applefi appleÂÚÈfi‰o˘˜ ˘appleoÙÚoapple‹˜ Î·È ‡ÊÂÛ˘.75% ÙˆÓ ·ÛıÂÓÒÓ apple·Úo˘Û›·˙·Ó ÈÛÙoÚÈÎfi ·ÏÏÂÚ-ÁÈ΋˜ ÓfiÛo˘. ËÌ·ÓÙÈ΋ ıËÏ҉˘ ·ÓÙ›‰Ú·ÛË ·applefiÙoÓ ÂappleÈappleÂÊ˘ÎfiÙ· ‹Ù·Ó apple·Úo‡Û· Û fiÏo˘˜ Ùo˘˜·ÛıÂÓ›˜ Î·È ˘appleo‰ËÏÒÓÂÈ appleÈı·Ó‹ ·ÏÏÂÚÁ›· Ùo˘ÂappleÈappleÂÊ˘ÎfiÙ·.OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁo˘Ó ÛÙo Û˘Ìapple¤Ú·ÛÌ·fiÙÈ o ÊÏÂÁÌ¤ÓˆÓ Ó·ÓÈÎfi˜ Ûapple›Ïo˜ Ùo˘ ÂappleÈappleÂÊ˘Îfi-Ù· Â›Ó·È ÌÈ· ÌoÓ·‰È΋ ÂÓfiÙËÙ·, ‰È·ÊoÚÂÙÈ΋ ·applefiÙoÓ ·appleÏfi Ûapple›Ïo Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ·. ∏ Û¯¤ÛË Ùo˘ ÌÂÙËÓ ·ÏÏÂÚÁÈ΋ ÂappleÈappleÂÊ˘Î›Ùȉ· ¤¯ÂÈ ·appleo‰Âȯı› ηÈapple·Ú¿ ÙËÓ Î·Ù¿ appleÂÚÈfi‰o˘˜ Ù·¯Â›· ·‡ÍËÛ‹ Ùo˘, È-ÛÙoapple·ıoÏoÁÈο appleÚfiÎÂÈÙ·È ÁÈ· ηÏo‹ı˘ ‚Ï¿‚Ë(¡.∞. §¿ÏÏo˜).ª·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ·appleoÙÂϤÛÌ·Ù· ÌÂÙ¿ ·applefi η-Ù·ÛÙÚoÊ‹ Ùo˘ ΢ÎÏÈÎo‡ ÛÒÌ·Ùo˜ Ì diode laserÛ appleÂÚÈÛÙ·ÙÈο Û‡ÓıÂÙo˘ ÁÏ·˘ÎÒÌ·Ùo˜ Ì Ù˯ڋÛË Ùo˘ Zeiss Visual II systemS. Ataullah, S. Biswas, P.H. Artes, E. O’Donoghue,A.E.A. Ridway, A.F. SpencerBr J Ophthalmol 86: 39-42, 2002Îoapplefi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛËÙ˘ ·appleoÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È Ù˘ ·ÛÊ¿ÏÂÈ·˜ Ùo˘Zeiss Visual II diode laser system ÛÙËÓ ÂÏ¿ÙÙˆÛËÙ˘ ÂÓ‰oÊı¿ÏÌÈ·˜ apple›ÂÛ˘ Û ·ÛıÂÓ›˜ Ì ۇÓıÂÙoÁÏ·‡ÎˆÌ·.OÈ Û˘ÁÁÚ·Ê›˜ ·Ó·Ï‡o˘Ó Ù· È·ÙÚÈο ÈÛÙoÚÈο·ÛıÂÓÒÓ appleo˘ ˘appleo‚Ï‹ıËÎ·Ó Û ‰È·-ÛÎÏËÚÈ΋ ΢-ÎÏoηٷÛÙÚoÊÈ΋ Âapple¤Ì‚·ÛË Ì ÙË ¯Ú‹ÛË Ùo˘ diodelaser ÛÙo Manchester Royal Eye Hospital ηٿÙË ‰È¿ÚÎÂÈ· 34 ÌËÓÒÓ. 55 oÊı·ÏÌo› ·applefi 53 ·ÛıÂ-Ó›˜ Ì ۇÓıÂÙo ÁÏ·‡ÎˆÌ· apple·Ú·ÎoÏo˘ı‹ıËηÓÁÈ· 12-52 Ì‹Ó˜ (Ì.o. 23,1 Ì‹Ó˜) ÌÂÙ¿ ·applefi ÙËÓÂÊ·ÚÌoÁ‹ Ùo˘ Laser.∏ ̤ÛË ÂÓ‰oÊı¿ÏÌÈ· apple›ÂÛË appleÚÈÓ ÙËÓ ÂÊ·Ú-ÌoÁ‹ Ùo˘ laser ‹Ù·Ó 35,8 mmHg (Ì ‡Úo˜ 22-26mmHg). ÙËÓ ÙÂÏÂ˘Ù·›· Âapple›ÛÎÂ„Ë Ë Ì¤ÛË ∂.O..‹Ù·Ó 17,3 mmHg (Ì ‡Úo˜ 0-40 mmHg). ªÂÙ¿ ÙËıÂÚ·apple›·, 45 oÊı·ÏÌo› (82%) ›¯·Ó ÂÓ‰oÊı¿ÏÌÈ·apple›ÂÛË ÌÂٷ͇ 5 mmHg Î·È 22 mmHg Î·È Û 46oÊı·ÏÌo‡˜ (84%) Ë appleÚo¯ÂÈÚËÙÈ΋ ∂.O.. ÂÏ·Ù-ÙÒıËΠηٿ 30% ‹ Î·È appleÂÚÈÛÛfiÙÂÚo. ∫·Ù¿ ÙËÓ ÙÂ-ÏÂ˘Ù·›· ÂͤٷÛË, o ̤Ûo˜ ·ÚÈıÌfi˜ ÙˆÓ Ê·Ú̿ΈÓappleo˘ ¯ÚËÛÈÌoappleoÈo‡ÓÙ·Ó ÂÏ·ÙÙÒıËΠ·applefi 2,1 Û 1,6(p

252 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ÙÚoapple‹˜ Ù˘ ÓfiÛo˘ Î·È Ù˘ ıÓËÙfiÙËÙ·˜ appleo˘ Û¯ÂÙ›˙Â-Ù·È Ì ÙoÓ fiÁÎo Û ·ÛıÂÓ›˜ Ì ÌÂϿӈ̷ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ·.ÚfiÎÂÈÙ·È ÁÈ· Ì›· ·Ó·‰ÚoÌÈ΋ ÌÂϤÙË ÙˆÓÎÏÈÓÈÎÒÓ Î·È ÈÛÙoapple·ıoÏoÁÈÎÒÓ ‰Â‰oÌ¤ÓˆÓ 69 ·-ÛıÂÓÒÓ Ì ÌÂϿӈ̷ Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ· ‰È·ÊfiÚˆÓÈÛÙoÏoÁÈÎÒÓ Ù‡appleˆÓ.Ÿappleˆ˜ ¤‰ÂÈÍÂ Ë ÌÂϤÙË ·˘Ù‹ ÛËÌ·ÓÙÈÎo› apple·-Ú¿ÁoÓÙ˜ ÎÈÓ‰‡Óo˘ ÁÈ· ÙËÓ ˘appleoÙÚoapple‹ Ù˘ ÓfiÛo˘ ‹-Ù·Ó Î‡ÙÙ·Ú· Ì ·Î·ÓfiÓÈÛÙË ¯ÚˆÛÙÈ΋ (RR=2,0,p=0,0007), ·ÙÂÏ‹˜ ¯ÂÈÚo˘ÚÁÈ΋ ·Ê·›ÚÂÛË (RR=3,5, p=0,008), ‰È‹ıËÛË Ùo˘ fiÁÎo˘ ‚·ı‡ÙÂÚ· ·applefiÙËÓ È‰›ˆ˜ o˘Û›· Ùo˘ ÂappleÈappleÂÊ˘ÎfiÙ· (RR=3,9, p=0,008), Î·È apple·Úo˘Û›· ÂappleÈıËÏÈ·ÎÒÓ oÁÎo΢ÙÙ¿ÚˆÓ(RR=2,9, p=0,05). ŒÓ·˜ ÛËÌ·ÓÙÈÎfi˜ apple·Ú¿ÁoÓÙ·˜ÎÈÓ‰‡Óo˘ ÁÈ· ÙËÓ ıÓËÙfiÙËÙ· appleo˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙoÓfiÁÎo, ‹Ù·Ó Î·È Ë ÂÓÙfiappleÈÛË Ùo˘ fiÁÎo˘ ÛÙo ‚ÏÂÊ·ÚÈ-Îfi ÂappleÈappleÂÊ˘ÎfiÙ·, ÛÙËÓ ÂÁηÓı›‰·, ÛÙË ÌËÓoÂȉ‹appleÙ˘¯‹ Î·È ÛÙ· ÎoÏappleÒÌ·Ù· (RR=5,9, p=0,001), ˉȋıËÛË Ùo˘ fiÁÎo˘ ‚·ı‡ÙÂÚ· ·applefi Ù· ÛÙÚÒÌ· Ùo˘ÂappleÈappleÂÊ˘ÎfiÙ· (RR=5,5, p=0,001), Ë ·ÙÂÏ‹˜ ¯ÂÈ-Úo˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ùo˘ fiÁÎo˘ (RR=4,4, p=0,05)Î·È Ë o˙҉˘ ‹ ÌÈÎÙ‹ (o˙҉˘ Î·È ÂappleÈıËÏȷ΋) ·‡-ÍËÛË Ùo˘ fiÁÎo˘ (RR=1,2, p=0,002). ∏ ¯Ú‹ÛË Û˘-ÌappleÏËڈ̷ÙÈ΋˜ ıÂÚ·apple›·˜ ‰ÂÓ ÂappleËÚ¤·Û ÛËÌ·ÓÙÈ-ο Ùo appleoÛoÛÙfi ˘appleoÙÚoapple‹˜ Ù˘ ÓfiÛo˘ ‹ ÙË ıÓËÙfiÙË-Ù· appleo˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙoÓ fiÁÎo.∏ apple·Úo‡Û· ÌÂϤÙË ÂappleȉÂÈÎÓ‡ÂÈ ÙËÓ ·appleoÙ˘¯›·ÙˆÓ ·Ó·‰ÚoÌÈÎÒÓ ÌÂÏÂÙÒÓ ÁÈ· Ùo ÌÂϿӈ̷ Ùo˘ÂappleÈappleÂÊ˘ÎfiÙ· ÁÈ· ÙËÓ ·appleoÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ‹ fi¯ÈÙ˘ Û˘ÌappleÏËڈ̷ÙÈ΋˜ ıÂÚ·apple›·˜ Û ۯ¤ÛË Ì Ù˯ÂÈÚo˘ÚÁÈ΋ ·Ê·›ÚÂÛË (¡. ∞. §¿ÏÏo˜).∏ ıÂÚ·apple›· Ù˘ ‰Â˘ÙÂÚoapple·ıo‡˜ ˘appleÂÚ¤ÎÎÚÈÛ˘‰·ÎÚ‡ˆÓ Ì Botulinum toxin, appleo˘ oÊ›ÏÂÙ·È ÛÙËÓ¤ÎÙoappleË ·Ó·Á¤ÓÓËÛË Ó¢ÚÈÎÒÓ ÈÓÒÓ ÌÂÙ¿ ·applefi apple·-Ú¿Ï˘ÛË Ù˘ 7 ˘ Û˘˙˘Á›·˜ ‹ ÌÂÙ¿ ·applefi ÌÂÙ·Ìfi-Û¯Â˘ÛË ÛÈÂÏoÁfiÓo˘ ·‰¤Ó·David L Keegan, Gerd Geerling, John P Lee, GlenBlake, J Richard Collin, Gordon T PlantBr J Ophthalmol ;86: 43-46, 2002OÈ Û˘ÁÁÚ·Ê›˜ ÛÙo ¿ÚıÚo ·˘Ùfi ÌÂÏÂÙo‡Ó ÙËÓ·appleoÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ Botulinum toxin A ÛÙËÓıÂÚ·apple›· Ù˘ ‰Â˘ÙÂÚoapple·ıo‡˜ ˘appleÂÚ¤ÎÎÚÈÛ˘ ‰·-ÎÚ‡ˆÓ.ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÌÂÏÂÙo‡ÓÙ·È 3 ·ÛıÂÓ›˜ ÌÂÌoÓfiappleÏ¢ÚË ˘appleÂÚ¤ÎÎÚÈÛË ‰·ÎÚ‡ˆÓ (‰È·ÁÓÒÛÙË-Î·Ó ˆ˜ ÎoÚÎo‰Â›ÏÂÈ· ‰·ÎÚ‡ÚÚoÈ·) Î·È ¤Ó·˜ ·ÛıÂ-Ó‹˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ˘appleoÁÓ¿ıÈo˘ ÛÈÂÏoÁfiÓo˘·‰¤Ó·. ∏ apple·Ú·ÁˆÁ‹ ÙˆÓ ‰·ÎÚ‡ˆÓ appleoÛoÙÈÎoappleoÈ‹-ıËΠÙfiÛo ÁÈ· ÙË ‚·ÛÈ΋ ¤ÎÎÚÈÛË, fiÛo Î·È ÁÈ· ÙËÓ¤ÎÎÚÈÛË ÌÂÙ¿ ·applefi ÂÚÂıÈÛÌfi Ì ÙË ¯Ú‹ÛË Ùo˘Schirmer test. appleÈÓıËÚoÁÚ¿ÊËÌ· ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ·‰¤ÓˆÓ ¯ÚËÛÈÌoappleoÈ‹ıËΠÁÈ· ÙË ÌÂϤÙË Ù˘ÂÎÚo‹˜ ÙˆÓ ‰·ÎÚ‡ˆÓ. Δo ÛappleÈÓıËÚoÁÚ¿ÊËÌ· appleÚ·Á-Ì·ÙoappleoÈ‹ıËΠ̠¤ÓÂÛË Dysport ÂÓÙfi˜ Ùo˘ ‰·ÎÚ˘-˚Îo‡ ·‰¤Ó· ÛÙ· ¿ÙoÌ· Ì ÎoÚÎo‰Â›ÏÂÈ· ‰·ÎÚ‡Ú-ÚoÈ· Î·È appleÂÚ› Ùo˘ ‰·ÎÚ˘˚Îo‡ ·‰¤Ó· ÛÙo ¿ÙoÌo ÌÂÌÂÙ·ÌfiÛ¯Â˘ÛË.2 ·applefi Ùo˘˜ 3 oÊı·ÏÌo‡˜, Ì ÁÓˆÛÙ‹ ˘appleÂÚ¤Î-ÎÚÈÛË ‰·ÎÚ‡ˆÓ ÌÂÙ¿ ·applefi ¤ÎÙoappleË ·Ó·Á¤ÓÓÂÛË ÙˆÓÓ¢ÚÈÎÒÓ ÈÓÒÓ, ›¯·Ó ÌÂÁ·Ï‡ÙÂÚo Schirmer test ÛÂÛ¯¤ÛË Ì Ùo ¿ÏÏo oÊı·ÏÌfi. Δo ÛappleÈÓıËÚoÁÚ¿ÊËÌ··appleoÎ¿Ï˘„ fiÙÈ Ùo Û‡ÛÙËÌ· ·appleo¯¤Ù¢Û˘ ÙˆÓ ‰·-ÎÚ‡ˆÓ ‹Ù·Ó ·ÓoȯÙfi. O ÙÚ›Ùo˜ ·ÛıÂÓ‹ Ì ¤ÎÙoappleË·Ó·Á¤ÓÓÂÛË Ó¢ÚÈÎÒÓ ÈÓÒÓ Î·È ‰·ÎÚ‡ÚÚoÈ· ›¯Â·applefiÊÚ·ÍË ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ o‰ÒÓ. ªÂÙ¿ ·applefi ıÂÚ·-apple›· Ì Botulinum toxin A oÈ ‰‡o appleÚÒÙoÈ ·ÛıÂÓ›˜Î·ıÒ˜ Î·È ·˘Ùfi˜ Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË Ùo˘ ÛÈÂÏoÁfiÓo˘·‰¤Ó· apple·Úo˘Û›·Û·Ó ÂÏ¿ÙÙˆÛË Ù˘ ‰·ÎÚ‡ÚÚoÈ·˜ÁÈ· appleÂÚ›o‰o 3 Ì 4 ÌËÓÒÓ. O ·ÛıÂÓ‹˜ Ì ·applefiÊÚ·-ÍË ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ o‰ÒÓ ‰ÂÓ apple·Úo˘Û›·Û η̛·‚ÂÏÙ›ˆÛË. ¢‡o ·ÛıÂÓ›˜ ÂÌÊ¿ÓÈÛ·Ó appleÙÒÛË Ùo˘¿Óˆ ‚ÏÂÊ¿Úo˘ ÌÂÙ¿ ·applefi ÙËÓ ¤ÓÂÛË Ì Dysport, ·Ï-Ï¿ ˘appleo¯ÒÚËÛ ·˘ÙfiÌ·Ù·.OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁo˘Ó ÛÙo Û˘Ìapple¤Ú·ÛÌ·fiÙÈ Ë ‰È¿ÁÓˆÛË Ù˘ ‰Â˘ÙÂÚoapple·ıo‡˜ ˘appleÂÚ¤ÎÎÚÈÛ˘‰·ÎÚ‡ˆÓ Â›Ó·È ‰‡ÛÎoÏË.  ·˘Ù¿ Ù· appleÂÚÈÛÙ·ÙÈο ËıÂÚ·apple›· Ì Botulinum toxin A ÌappleoÚ› Ó· ·appleo‚›¯Ú‹ÛÈÌË, ·ÏÏ¿ ‰ÂÓ appleÚ¤appleÂÈ Ó· apple·Ú·‚Ϥappleo˘Ì ηÈÙȘ ·ÓÂappleÈı‡ÌËÙ˜ apple·ÚÂÓ¤ÚÁÂȤ˜ Ùo˘ Ê·ÚÌ¿Îo˘(¡.∞. §¿ÏÏo˜).Archives of Ophthalmology∞Ó·ÙoÌÈο ·appleoÙÂϤÛÌ·Ù· ÌÂÙ¿ ·applefi ÂÁ¯Â›ÚËÛËÁÈ· ȉÈoapple·ı‹ oapple‹ Ù˘ ˆ¯Ú¿˜ Ì ÙË ‚o‹ıÂÈ· Ù˘Optical Coherence TomographyM.S. Ip, b J. Baker, J.S. Duker, E. Reichel, C.R.Baumal, R. Gangon, C.A. PuliafitoArch Ophthalmol. 120: 29-35, 2002Ùo ¿ÚıÚo ·˘Ùfi ÌÂÏÂÙÒÓÙ·È Ù· ·appleoÙÂϤÛÌ·Ù·Ù˘ ·Ó·ÙoÌÈ΋˜ ·appleoηٿÛÙ·Û˘ Ù˘ ȉÈoapple·ı‹˜oapple‹˜ Ù˘ ˆ¯Ú¿˜, ÌÂÙ¿ ·applefi ‚ÈÙÚÂÎÙoÌ‹ Ì ȉȷ›ÙÂÚˤÌÊ·ÛË ÛÙËÓ appleÚo¯ÂÈÚËÙÈ΋ oÚÈ˙fiÓÙÈ· ‰È¿ÌÂÙÚoÙ˘ oapple‹˜, fiappleˆ˜ ·˘Ù‹ ηıoÚ›˙ÂÙ·È Ì ÙË ‚o‹ıÂÈ·Ù˘ Optical Coherence Tomography Î·È ÛÙË Û˘-Û¯¤ÙÈÛË Ù˘ Ì ÙËÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ oappleÙÈ΋ o͇ÙËÙ·Î·È ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Û˘Ìappleو̿وÓ.

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 25340 oÊı·ÏÌo› Ì ȉÈoapple·ı‹ oapple‹ Ù˘ ˆ¯Ú¿˜ ÂÍÂ-Ù¿ÛÙËÎ·Ó appleÚo¯ÂÈÚËÙÈο Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈο ÌÂOCT. ŸÏoÈ oÈ ·ÛıÂÓ›˜ ·ÓÙÈÌÂÙˆapple›ÛıËÎ·Ó Ì ‚È-ÙÚÂÎÙoÌ‹, ·Ê·›ÚÂÛË Ùo˘ oappleÈÛı›o˘ ÊÏoÈo‡ Ùo˘ ˘·-ÏoÂȉo‡˜, Î·È Ì ¤Á¯˘ÛË perfluoropropane ‹ sulfurhexafluoride. ªÂÙÂÁ¯ÂÈÚËÙÈο oÈ ·ÛıÂÓ›˜ ÙoappleoıÂ-Ù‹ıËÎ·Ó Ì Ùo appleÚfiÛˆappleo appleÚo˜ Ù· οو ÁÈ· 7 Ì 14Ë̤Ú˜. 22 (92%) ·applefi Ùo˘˜ 24 oÊı·ÏÌo‡˜ Ì appleÚoÂ-¯ÂÈÙËÙÈ΋ ȉÈoapple·ı‹˜ oapple‹ Ù˘ ˆ¯Ú¿˜ ÌÈÎÚfiÙÂÚË ·applefi400Ìm ÂappleÈÙ‡¯ıËΠ·Ó·ÙoÌÈ΋ ·appleoηٿÛÙ·ÛË. Â9 (56%) ·applefi 16 oÊı·ÏÌo‡˜ Ì oapple‹ ˆ¯Ú¿˜ 400Ìm ‹ÌÂÁ·Ï‡ÙÂÚË apple·Ú·ÙËÚ‹ıËΠ·Ó·ÙoÌÈ΋ ·appleoηٿ-ÛÙ·ÛË. (P=0,2). ∏ ̤ÛË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ oappleÙÈ΋ o-͇ÙËÙ· ‚ÂÏÙÈÒıËΠηٿ 4 ÁÚ·Ì̤˜ ÛÙo˘˜ 31 o-Êı·ÏÌo‡˜ Ì ·Ó·ÙoÌÈ΋ ·appleoηٿÛÙ·ÛË Ù˘ oapple‹˜Ù˘ ˆ¯Ú¿˜, ÂÓÒ Î·Ì›· ·ÏÏ·Á‹ ‰ÂÓ apple·Ú·ÙËÚ‹ıËÎÂÛÙo˘˜ 9 oÊı·ÏÌo‡˜, fiappleo˘ Ë ·Ó·ÙoÌÈ΋ ·appleoηٿ-ÛÙ·ÛË Ù˘ oapple‹˜ Ù˘ ˆ¯Ú¿˜, ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ù‹.(P

254 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)ÏoÓÙ¤˜ (17 ¿Ó‰Ú˜ Î·È 16 Á˘Ó·›Î˜), ËÏÈΛ·˜ ÌÂÙ·-͇ 23 Ì 51 ¯ÚoÓÒÓ, oÈ oappleo›oÈ ‹Ù·Ó ÓËÛÙÈÎo› ÁÈ· 12ÒÚ˜ ‹ ›¯·Ó Ê¿ÂÈ 1 Ì 2 ÒÚ˜ appleÚÈÓ ÙË Û˘ÏÏoÁ‹ ÙˆÓ‰·ÎÚ‡ˆÓ. Δ· ‰¿ÎÚ˘· ·Ó·Ï‡ıËÎ·Ó ÁÈ· ÙoÓ ˘appleo-ÏoÁÈÛÌfi Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ oÏÈ΋˜ appleÚˆÙ½ÓË˜Î·È Ù˘ ÈÓÛo˘Ï›Ó˘ ·ÁˆÌ¤Ó· ÙÂÌ¿¯È· ÎÂÚ·Ùo-Âȉo‡˜ Î·È ÂappleÈappleÂÊ˘ÎfiÙ·, Âappleˆ¿ÛÙËÎ·Ó Ì ˘appleo-‰o¯Â›˜ ·ÓÙ› - ÈÓÛo˘Ï›Ó˘ Î·È ·ÓÙ›- IGF-I.πÓÛo˘Ï›ÓË ·Ó‚ڤıËΠ۠fiÏ· Ù· ‰Â›ÁÌ·Ù·‰·ÎÚ‡ˆÓ Î·È Ë Ì¤ÛË Û˘ÁΤÓÙÚˆÛ‹ Ù˘ ‹Ù·Ó0,404+0,129 ng/mL. ¢ÂÓ apple·Ú·ÙËÚ‹ıËΠη̛·‰È·ÊoÚ¿ ·Ó¿ÌÂÛ· ÛÙ· ‰‡o ʇÏÏ·. Δ· ¿ÙoÌ· Ù·oappleo›· ›¯·Ó Ê¿ÂÈ appleÚÈÓ ÙË Û˘ÏÏoÁ‹ ÙˆÓ ‰·ÎÚ‡ˆÓ ›-¯·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘ÁΤÓÙÚˆÛË ÈÓÛo˘Ï›Ó˘ ÛÙ· ‰¿-ÎÚ˘· Û ۯ¤ÛË Ì ٷ ÓËÛÙÈο ¿ÙoÌ·. ¢ÂÓ ˘apple‹Ú¯ÂÁÚ·ÌÌÈ΋ Û¯¤ÛË ÌÂٷ͇ Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ oÏÈ-΋˜ appleÚˆÙ½Ó˘ ( 4,61+0,79mg/mL) Î·È Ù˘ ÈÓÛo˘-Ï›Ó˘. Àappleo‰o¯Â›˜ ÈÓÛo˘Ï›Ó˘ Î·È IGF-I ·Ó‚ڤıË-Î·Ó ÛÙË ÌÂÌ‚Ú¿ÓË Î·È ÛÙo ΢ÙfiappleÏ·ÛÌ· ÙˆÓ ÂappleÈıË-ÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ Î·È Ùo˘ ÂappleÈappleÂ-Ê˘ÎfiÙ·.OÈ Û˘ÁÁÚ·Ê›˜ Ì ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ηٿÊÂ-Ú·Ó Ó· ηٷ‰Â›Ío˘Ó ÙËÓ ‡apple·ÚÍË ÈÓÛo˘Ï›Ó˘ ÛÙo‰·ÎÚ˘˚Îfi ÊÈÏÌ Î·ıÒ˜ Î·È ÙËÓ ‡apple·ÚÍË ˘appleo‰o¯¤ˆÓÈÓÛo˘Ï›Ó˘ Î·È IGF-I ÛÙËÓ oÊı·ÏÌÈ΋ ÂappleÈÊ¿ÓÂÈ·.∞applefi Ù· ·appleoÙÂϤÛÌ·Ù· ·˘Ù¿ Á›ÓÂÙ·È Ê·ÓÂÚfi fiÙÈ ËÈÓÛo˘Ï›ÓË appleÚ¤appleÂÈ Ó· apple·›˙ÂÈ Î¿appleoÈo ÚfiÏo ÛÙo ÌÂ-Ù·‚oÏÈÛÌfi Ù˘ oÊı·ÏÌÈ΋˜ ÂappleÈÊ¿ÓÂÈ·˜ (¡.∞. §¿Ï-Ïo˜).ª›· ÌÂϤÙË Ù˘ ÌoÚȷ΋˜ ¤ÎÊÚ·Û˘ ÙˆÓ Êˆ-Ùo¸appleo‰o¯¤ˆÓ ÌÂÙ¿ ·applefi appleÂÈÚ·Ì·ÙÈ΋ ·appleoÎfiÏÏËÛËÙo˘ ·ÌÊÈ‚ÏËÛÙÚoÂȉo‡˜T.S. Rex, R.N. Fariss, G.P. Lewis, K.A. Linberg, I.Sokal, S.K. FisherInvest Ophthalmol Vis Sci 43: 1234-1247, 2002ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ appleÂÚÈÁÚ¿ÊoÓÙ·È oÈ ·ÏÏ·Á¤˜ÛÙ· appleÚfiÙ˘apple· ÂÓÙfiappleÈÛ˘ Î·È ÛÙ· Âapple›apple‰· ÙˆÓ Ú·-‚‰›ˆÓ Î·È ÙˆÓ ÎˆÓ›ˆÓ ÌÂÙ¿ ·applefi appleÂÈÚ·Ì·ÙÈ΋ ·appleo-ÎfiÏÏËÛË Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂȉo‡˜.∞appleoÎoÏÏ‹ıËÎ·Ó oÈ ·ÌÊÈ‚ÏËÛÙÚoÂȉ›˜ Á·ÙÒÓÁÈ· 1,3,7 ‹ 28 Ë̤Ú˜. Ùo ‰È¿ÛÙËÌ· ·˘Ùfi oÈ ‚oÏ‚o›ÙoappleoıÂÙ‹ıËÎ·Ó Û ÌoÓÈÌoappleoÈËÙÈÎfi ˘ÁÚfi ÁÈ· ·Óo-Ûo΢ÙÙ·Úo¯ËÌÈ΋ ·Ó¿Ï˘ÛË ‹ oÌoÁÂÓoappleoÈ‹ıËηÓÁÈ· ‚Èo¯ËÌÈ΋ ·Ó¿Ï˘ÛË. ∏ ·ÓoÛo΢ÙÙ·Úo¯ËÌÈ΋·Ó¿Ï˘ÛË appleÚ·ÁÌ·ÙoappleoÈ‹ıËΠ¯ÚËÛÈÌoappleoÈÒÓÙ·˜ 19ÛËÌ·ÓÙ¤˜ ÁÈ· ÌfiÚÈ· appleo˘ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Û¯Â-Ù›˙oÓÙ·È Ì Ùo˘˜ ʈÙo˘appleo‰o¯Â›˜. OÈ Û˘ÁÎÂÓÙÚÒ-ÛÂȘ ÙˆÓ appleÚˆÙÂ˚ÓÒÓ Î·ıoÚ›ÛÙËÎ·Ó Ì ÙË ¯Ú‹ÛË ˘-ÁÚÒÓ Ì ·ÓoÛoηıËψ٤˜ appleo˘ Û˘Ó‰¤oÓÙ·È Ì appleÚˆ-Ù½Ó˜ ‹ ÙËÓ ·Ó¿Ï˘ÛË Western ÎËÏ›‰·˜. O ΢ÙÙ·ÚÈ-Îfi˜ ı¿Ó·Ùo˜ ÙˆÓ ÎˆÓ›ˆÓ ·Ó·Ï‡ıËΠ̠‰ÈappleÏ‹ Û‹-Ì·ÓÛË Ì TdT-dUTP Û ÙÂÏÈ΋ Û‹Ì·ÓÛË ÂÁÎoapple‹˜Î·È ÂȉÈο ÁÈ· Ù· Έӛ· ·ÓÙÈÛÒÌ·Ù·.∞Ó Î·È Î¿appleoÈ· Έӛ· apple¤ı·Ó·Ó ·ÚÎÂÙ¿ ÂappleÈ-‚›ˆÛ·Ó ÌÂÙ¿ ·applefi Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ·appleoÎfiÏÏËÛ˘Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂȉo‡˜. ∞Ó Î·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈ-ο Ùo˘˜ ÌappleoÚ› Ó· ›¯·Ó ·ÏÏ¿ÍÂÈ Ù· Ú·‚‰›· ˆ˜ÊˆÙo˘appleo‰o¯Â›˜ Û˘Ó¤¯ÈÛ·Ó Ó· ÂÎÊÚ¿˙o˘Ó Ù· appleÂ-ÚÈÛÛfiÙÂÚ· ·applefi Ù· ÌfiÚÈ· appleo˘ ÌÂÏÂÙ‹Û·Ì ÁÈ· fiÛo‰È¿ÛÙËÌ· ‹Ù·Ó ˙ˆÓÙ·Ó¿.  ·ÓÙ›ıÂÛË Ù· Έӛ··apple¤Ù˘¯·Ó Ó· Ù·ÍÈÓoÌËıo‡Ó Ì ۯ‰fiÓ fiÏo˘˜ Ùo˘ÛËÌ·ÓÙ¤˜ ÂȉÈÎo‡˜ ÁÈ· ·˘Ù¿ 3 Ì 7 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ·appleoÎfiÏÏËÛË. ∏ ÂÍ·›ÚÂÛË ‹Ù·Ó Ë ÊˆÛÊo‰o˘Û›ÓËappleo˘ ‚Ú¤ıËΠÙfiÛo ÛÙ· Ú·‚‰›· fiÛo Î·È ÛÙ· Έӛ·Î·È Û ·appleoÎoÏÏ‹ÛÂȘ 28 ËÌÂÚÒÓ ·˘Í‹ıËΠηٿ180% Ùo˘ appleoÛo‡ appleo˘ ˘apple¿Ú¯ÂÈ ÛÂ Ê˘ÛÈoÏoÁÈÎfi ·Ì-ÊÈ‚ÏËÛÙÚoÂȉ‹.OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁo˘Ó ÛÙo Û˘Ìapple¤Ú·ÛÌ·fiÙÈ Ù· Έӛ· Î·È Ù· Ú·‚‰›· Û˘ÌappleÂÚÈʤÚoÓÙ·È ‰È·-ÊoÚÂÙÈο ÛÙËÓ ·appleoÎfiÏÏËÛË Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂÈ-‰o‡˜. ∞˘Ù‹ Ë ‰È·ÊoÚ¿ ÌappleoÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ Ù·-¯‡ÙÂÚË Âapple¿Óo‰o Ù˘ fiÚ·Û˘ Ì ٷ Ú·‚‰›· Î·È ÙȘ·ÏÏ·Á¤˜ appleo˘ ÂÌÊ·Ó›˙oÓÙ·È ÌÂÙ¿ ·applefi οappleoÈo¯ÚfiÓo ÛÙË ¤Á¯ÚˆÌË fiÚ·ÛË Î·È ÙËÓ oappleÙÈ΋ o͇ÙËÙ·Î·È appleo˘ ·Ó·Ê¤ÚoÓÙ·È Û˘¯Ó¿ ÌÂÙ¿ ·applefi ÂappleÈÙ˘¯Â›˜ÂÁ¯ÂÈÚ‹ÛÂȘ Âapple·Ó·ÎfiÏÏËÛ˘ Ùo˘ ·ÌÊÈ‚ÏËÛÙÚoÂÈ-‰o‡˜ (¡.∞. §¿ÏÏo˜).Ophthalmologyªoۯ‡̷ٷ ·ÌÓÈoÓÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ ÁÈ· ·ÙÚ·˘-Ì·ÙÈΤ˜ ‰È·ÙÚ‹ÛÂȘ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜, ‰ÂÛÎÂÌÂ-Ùo΋Ϙ Î·È ‚·ıÈ¿ ¤ÏÎËA. Solomon, D. Meller, P. Prabhasawat, T. John,E. Espana, K.P. Steuhl, S.C.G. TsengOphthlmology 109: 694-703, 2002ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ appleÂÚÈÁÚ¿ÊÂÙ·È Ùo ÎÏÈÓÈÎfi·appleoÙ¤ÏÂÛÌ· Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ·ÌÓÈoÓÈÎÒÓ ÌÂÌ-‚Ú·ÓÒÓ ÁÈ· ·ÙÚ·˘Ì·ÙÈΤ˜ ‰È·ÙÚ‹ÛÂȘ Ùo˘ ÎÂÚ·-ÙoÂȉo‡˜, ‰ÂÛÎÂÌÂÙo΋Ϙ Î·È ‚·ıÈ¿ ¤ÏÎË.ÚfiÎÂÈÙ·È ÁÈ· Ì›· appleÚooappleÙÈ΋, ÌË Û˘ÁÎÚÈÙÈ΋,apple·ÚÂÌ‚·ÙÈ΋ ÛÂÈÚ¿ appleÂÚÈappleÙÒÛˆÓ. ΔÚÈ¿ÓÙ· Ù¤ÛÛÂ-ÚȘ oÊı·ÏÌo› 33 Û˘Ó¯fiÌÂÓˆÓ ·ÛıÂÓÒÓ appleo˘ ¯ÂÈ-Úo˘ÚÁ‹ıËÎ·Ó ÁÈ· ·ÙÚ·˘Ì·ÙÈ΋ ‰È¿ÙÚËÛË Ùo˘ ÎÂ-Ú·ÙoÂȉo‡˜, ‹ ‰ÂÛÎÂÌÂÙo΋ÏË Û 4 apple·ÓÂappleÈÛÙËÌÈ·-Τ˜ oÊı·ÏÌoÏoÁÈΤ˜ ÎÏÈÓÈΤ˜. ¯ÂÙÈΤ˜ ·˘Ùo¿Óo-Û˜ apple·ı‹ÛÂȘ appleo˘ Û˘ÌappleÂÚÈÂÏ‹ÊıËÛ·Ó ‹Ù·Ó Ú¢-Ì·ÙoÂȉ‹˜ ·ÚıÚ›Ùȉ· (6 appleÂÚÈÛÙ·ÙÈο ), Ùo Û‡Ó‰Úo-

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 255Ìo Stevens – Johnson (3 appleÂÚÈÛÙ·ÙÈο), Ùo oÊı·Ï-ÌÈÎfi o˘Ï҉˜ appleÂÌÊ˘ÁoÂȉ¤˜ (1 appleÂÚÈÛÙ·ÙÈÎfi), Û˘-ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎo˜ (1 appleÂÚÈÛÙ·ÙÈÎfi)Î·È ¤Ó·˜ oÊı·ÏÌfi˜ Ì ¤ÏÎo˜ Mooren, ηıÒ˜ ηÈÓ¢ÚoÙÚoÊÈΤ˜ ÎÂÚ·Ùoapple¿ıÂȘ ‹ ÎÂÚ·Ùoapple¿ıÂȘ·applefi ¤ÎıÂÛË (10 appleÂÚÈÛÙ·ÙÈο), ÌÂÙ·ÏoÈÌÒ‰Ë ÌË ıÂ-Ú·apple‡ÛÈÌ· ¤ÏÎË (6 appleÂÚÈÛÙ·ÙÈο)Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈ-ο (5 appleÂÚÈÛÙ·ÙÈο).∏ ¯ÂÈÚo˘ÚÁÈ΋ Ù¯ÓÈ΋ appleo˘ ¯ÚËÛÈÌoappleoÈ‹ıË΋ٷÓ, 3 Ì 4 ÛÙÚÒÌ·Ù· ·ÌÓÈoÙÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Â-Ê·ÚÌfiÛıËÎ·Ó apple¿Óˆ ÛÙo apple˘ı̤ӷ Ùo˘ ¤ÏÎo˘˜ ηÈηıËÏÒıËÎ·Ó ÌÂ Û˘Ó¯fiÌÂÓ˜ ‹ ‰È·ÎÂÎoÌ̤Ó˜ڷʤ˜ Ì ӿÈÏoÓ 10-0. Ùo Ù¤Ïo˜ ¤Ó· ÌÂÁ¿ÏoÎoÌÌ¿ÙÈ ·ÌÓÈoÓÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ¯ÚËÛÈÌoappleoÈ‹ıËÎÂÁÈ· Ó· ηχ„ÂÈ ÙËÓ appleÚfiÛıÈ· ÂappleÈÊ¿ÓÂÈ· Ùo˘ ÎÂ-Ú·ÙoÂȉo‡˜.π‰È·›ÙÂÚË ¤ÌÊ·ÛË ‰fiıËΠÛÙË ÌÂϤÙË Ùo˘‚¿ıo˘˜ Ùo˘ appleÚoÛı›o˘ ı·Ï¿Ìo˘, ÛÙËÓ ÂappleÈıËÏÈoappleo›ËÛËÙo˘ Ìoۯ‡̷Ùo˜ Ù˘ ·ÌÓÈoÓÈ΋˜ ÌÂÌ‚Ú¿-Ó˘ Î·È Ù˘ ÛÙ·ıÂÚfiÙËÙ·˜ Ùo˘ apple¿¯o˘˜ Ùo˘ ÛÙÚÒ-Ì·Ùo˜ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜. O ̤Ûo˜ fiÚo˜ apple·Ú·Îo-Ïo‡ıËÛ˘ ‹Ù·Ó 8,1+5,7 Ì‹Ó˜. ∂appleÈÙ˘¯‹ ·appleoÙÂϤ-ÛÌ·Ù· apple·Ú·ÙËÚ‹ıËÎ·Ó Û 28 ·applefi Ù· 33 appleÂÚÈÛÙ·ÙÈ-ο, appleoÛoÛÙfi 82.3%. ∞applefi ÙȘ ÂappleÈÙ˘¯‹˜ appleÂÚÈappleÙÒÛÂȘ23 oÊı·ÏÌo› ¯ÚÂÈ¿ÛÙËÎ·Ó Ì›· ÌÂÙ·ÌfiÛ¯Â˘ÛË ·-ÌÓÈoÓÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È 5 oÊı·ÏÌo› ¯ÚÂÈ¿ÛıË-Î·Ó 2 ÂappleÂÌ‚¿ÛÂȘ.  5 oÊı·ÏÌo‡˜ ·apple·ÈÙ‹ıËΠӷ·ÎoÏo˘ı‹ÛÂÈ ÌÈ· oÚÈÛÙÈ΋ Âapple¤Ì‚·ÛË, fiappleˆ˜ ‰È·-ÌappleÂÚ‹˜ ÎÂÚ·ÙoappleÏ·ÛÙÈ΋ ‹ Âapple¤Ì‚·ÛË ÛÙ· ‚Ϥʷ-Ú·. ∞appleoÙ˘¯›· apple·Ú·ÙËÚ‹ıËΠ۠6 oÊı·ÏÌo‡˜ ÌÂÚÂ˘Ì·ÙoÂȉ‹ ·ÚıÚ›Ùȉ·, Ó¢ÚoÙÚoÊÈ΋ ÎÂÚ·Ùoapple¿-ıÂÈ· ‹ Ù‹ÍË Ùo˘ ÎÂÚ·ÙoÂȉo‡˜.Δo Û˘Ìapple¤Ú·ÛÌ· ·applefi ·˘Ù‹ ÙËÓ ÂÚÁ·Û›· ›ӷÈfiÙÈ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÌÓÈoÓÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÌappleoÚ›ӷ ‚oËı‹ÛÂÈ ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ·ÙÚ·˘Ì·ÙÈÎÒӉȷÙÚ‹ÛÂˆÓ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ηıÒ˜ Î·È Û ‰Â-ÛÎÂÌÂÙo΋Ϙ. ªappleoÚ› Ó· ¯ÚËÛÈÌoappleoÈËı› ›Ù ˆ˜oÚÈÛÙÈ΋ ıÂÚ·apple›·, ›Ù ‚oËıËÙÈο ̤¯ÚÈ Ó· ˘appleo-¯ˆÚ‹ÛÂÈ o ÂÚÂıÈÛÌfi˜ Ùo˘ oÊı·ÏÌo‡ Î·È Ó· appleÚo¯ˆ-Ú‹Ûo˘Ì Û appleÈo ÚÈ˙È΋ ıÂÚ·apple›·, fiappleˆ˜ ÎÂÚ·ÙoappleÏ·ÛÙÈ΋.∂apple›Û˘ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÌÓÈoÓÈ΋˜ÌÂÌ‚Ú¿Ó˘ ÌappleoÚ› Ó· ·appleoÙÂϤÛÂÈ ıÂÚ·apple›· ÂÎÏo-Á‹˜ Û ¯ÒÚ˜ fiappleo˘ Ë appleÚoÛÊoÚ¿ ÌoÛ¯Â˘Ì¿ÙˆÓ ÁÈ·ÎÂÚ·ÙoappleÏ·ÛÙÈ΋ Â›Ó·È ÌÈÎÚ‹ (¡. ∞. §¿ÏÏo˜).∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ıÂÚ·apple›· ÂÓ‰oÎo¯È-ÎÒÓ Í¤ÓˆÓ ÛˆÌ¿ÙˆÓT. Fulcher, A. McNab, T. SullivanOphthalmology 109: 494-500, 2002ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ Á›ÓÂÙ·È ·Ó·ÛÎfiappleËÛË ÙˆÓÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È Ù˘ ·ÓÙÈÌÂÙÒappleÈÛ˘·ÛıÂÓÒÓ Ì ÂÓ‰oÎo¯ÈÎfi ͤÓo ÛÒÌ·. ÂÚÈÂÏ‹ÊıË-Û·Ó 40 ·ÛıÂÓ›˜ appleo˘ ·ÓÙÈÌÂÙˆapple›ÛÙËÎ¿Ó Û 2 Τ-ÓÙÚ· ÂÍÂȉÈÎÂ˘Ì¤Ó· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ù¤ÙoȈÓappleÂÚÈÛÙ·ÙÈÎÒÓ. ªÂÏÂÙ‹ıËÎ·Ó È‰È·›ÙÂÚ· Ë oappleÙÈ΋o͇ÙËÙ·, Ë ¯ÂÈÚo˘ÚÁÈ΋ Ù¯ÓÈ΋ Î·È oÈ ÂappleÈappleÏoΤ˜.43% ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ÌÈÎÚfiÙÂÚoÈ ·applefi 30ÂÙÒÓ.  ·˘Ù‹ ÙË ÛÂÈÚ¿ ÙˆÓ ·ÛıÂÓÒÓ ˘apple‹Ú¯·Ó 22ÌÂÙ·ÏÏÈο ÌË oÚÁ·ÓÈο ˘ÏÈο, 5 ÌË ÌÂÙ·ÏÏÈο ÌËoÚÁ·ÓÈο ˘ÏÈο Î·È 13 oÚÁ·ÓÈο ˘ÏÈο, appleo˘ÂÓÙoapple›ÛÙËÎ·Ó ÂÓ‰oÎo¯Èο. 30 ·ÛıÂÓ›˜ ·ÓÙÈÌÂÙˆapple›ÛıËηÓÏ›Áo ÌÂÙ¿ Ùo ·Ù‡¯ËÌ· Î·È 10 ·ÛıÂÓ›˜·ÚÁfiÙÂÚ· fiÙ·Ó ¿Ú¯ÈÛ·Ó Ó· ÂÌÊ·Ó›˙o˘Ó ÂappleÈappleÏoΤ˜. 34 ·ÛıÂÓ›˜ appleÚ·ÁÌ·ÙoappleoÈ‹ıËΠ¯ÂÈÚo˘ÚÁÈ΋·Ê·›ÚÂÛË Ùo˘ ͤÓo˘ ÛÒÌ·Ùo˜ ›Ù ÏfiÁˆ ÂÌÊ¿ÓÈ-Û˘ ÂappleÈappleÏoÎÒÓ, ›Ù ÏfiÁˆ ‡ÎoÏ˘ appleÚfiÛ‚·Û˘. Â6 ·ÛıÂÓ›˜ ‰ÂÓ appleÚ·ÁÌ·ÙoappleoÈ‹ıËΠ¯ÂÈÚo˘ÚÁÈ΋·Ê·›ÚÂÛË, ÏfiÁˆ Ù˘ ÂÓÙfiappleÈÛ˘ Ùo˘ ÌË oÚÁ·ÓÈÎo‡Í¤Óo˘ ÛÒÌ·Ùo˜ ÛÙo oapple›ÛıÈo ÙÌ‹Ì· Ùo˘ ÎfiÁ¯o˘. 13·ÛıÂÓ›˜ η٤ÏËÍ·Ó Û ·appleÒÏÂÈ· Ù˘ fiÚ·Û‹˜ Ùo˘˜,12 ·applefi Ùo˘˜ oappleo›o˘˜ Ë ·appleÒÏÂÈ· ·˘Ù‹ oÊÂÈÏfiÙ·ÓÛÙo ·Ú¯ÈÎfi ÙÚ·‡Ì·.OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁo˘Ó ÛÙo Û˘Ìapple¤Ú·ÛÌ·fiÙÈ Ù· ÂÓ‰oÎo¯Èο ͤӷ ÛÒÌ·Ù· appleoχ Û˘¯Ó¿ Û˘Óo-‰Â‡oÓÙ·È ·applefi ·appleÒÏÂÈ· Ù˘ fiÚ·Û˘ Î·È ·˘Ù‹ oÊ›-ÏÂÙ·È ÛÙoÓ ·Ú¯ÈÎfi ÙÚ·˘Ì·ÙÈÛÌo‡ Ùo˘ oÊı·ÏÌo‡. ∏·ÍoÓÈ΋ ÙoÌoÁÚ·Ê›· ·appleoÙÂÏ› ÙË Ì¤ıo‰o ÂÎÏoÁ‹˜ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Ùo˘ ÙÚ·‡Ì·Ùo˜. ∏ ¯ÂÈÚo˘ÚÁÈ΋·Ê·›ÚÂÛË ÂӉ›ÎÓ˘Ù·È ÁÈ· fiÏ· Ù· oÚÁ·ÓÈο ͤӷÛÒÌ·Ù·. Δ· ÌË oÚÁ·ÓÈο ͤӷ ÛÒÌ·Ù· appleÚ¤appleÂÈ Ó··Ê·ÈÚo‡ÓÙ·È Û appleÂÚ›appleÙˆÛË appleo˘ ‚Ú›ÛÎoÓÙ·È ÛÙoappleÚfiÛıÈo ÙÌ‹Ì· Ùo˘ ÎfiÁ¯o˘ Î·È Û οı appleÂÚ›appleÙˆÛËappleo˘ appleÚoηÏo‡Ó ÂappleÈappleÏoΤ˜. ∞ÓfiÚÁ·Ó· ͤӷ ÛÒÌ·-Ù·, ÂÓÙoappleÈṲ̂ӷ ÛÙË ÎoÚ˘Ê‹ Ùo˘ ÎfiÁ¯o˘ Î·È Ù·oappleo›· ‰ÂÓ Û˘Óo‰Â‡oÓÙ·È ·applefi ÂappleÈappleÏoΤ˜ ‰Â ı· appleÚ¤appleÂÈÓ· ¯ÂÈÚo˘ÚÁo‡ÓÙ·È (¡.∞. §¿ÏÏo˜).American Journalof OphthalmologyªÂϤÙË Ù˘ apple˘ÎÓfiÙËÙ·˜ ÙˆÓ ÎÂÚ·Ùo΢ÙÙ¿ÚˆÓÛÙo ΤÓÙÚo Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ·ÙfiÌˆÓ ÌÂÙ¿ ·applefiLasikK. Mitooka, M. Ramirez, L. Maguire, J. Erie, S.Patel, J. McLaren, D. Hodge, W. BourneAm J Ophthalmol 133: 307-3174, 2002ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÌÂÏÂÙÒÓÙ·È oÈ ·ÏÏ·Á¤˜ÛÙËÓ apple˘ÎÓfiÙËÙ· ÙˆÓ ÎÂÚ·Ùo΢ÙÙ¿ÚˆÓ, Ùo appleÚÒÙo¯ÚfiÓo ÌÂÙ¿ ·applefi lasik.

256 OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002)˘ÌappleÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË ·˘Ù‹ 17oÊı·ÏÌo› ·applefi 11 ·ÛıÂÓ›˜ oÈ oappleo›oÈ ˘appleo‚Ï‹ıËηÓÛ ‰ÈfiÚıˆÛË Ù˘ ·ÌÂÙÚˆapple›·˜ Ùo˘˜ Ì Lasik. ΔoÎÚËÌÓfi˜ appleo˘ apple·Ú·Û΢¿ÛÙËΠ̠ÙoÓ ÌÈÎÚoÎÂ-Ú·ÙoÙfiÌo ‹Ù·Ó 180 Ìm Î·È Ë ‰È·ıÏ·ÛÙÈ΋ ·ÓˆÌ·-Ï›· Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ –2,0dpt Î·È –11,0 dpt. OÎÂÚ·ÙoÂȉ‹˜ ʈÙoÁÚ·Ê‹ıËΠÌÂ Û˘ÓÂÛÙÈ·Îfi ÌÈ-ÎÚoÛÎfiappleÈo appleÚÈÓ ÙËÓ Âapple¤Ì‚·ÛË, ηıÒ˜ Î·È Ì›·Â‚‰oÌ¿‰·, 1 ,3,6 Î·È 12 Ì‹Ó˜ ÌÂÙÂÁ¯ÂÈÚËÙÈο. Δ·ÎÂÚoÙo·ÙÙ·Ú· ÌÂÙÚ‹ıËÎ·Ó ·applefi ¤Ó· ÌfiÓo apple·Ú·-ÙËÚËÙ‹ Û fiϘ ÙȘ appleÂÚÈappleÙÒÛÂȘ. ∏ apple˘ÎÓfiÙËÙ· ÙˆÓ΢ÙÙ¿ÚˆÓ ˘appleoÏoÁ›ÛÙËΠÛÙo appleÚfiÛıÈo Î·È ÛÙo oapple›-ÛıÈo ÙÌ‹Ì· Ùo˘ ÎÚËÌÓo‡, ÛÙo appleÚfiÛıÈo Î·È ÛÙo oapple›-ÛıÈo ÙÌ‹Ì· Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ apple¿¯o˘˜ 100Ìm appleo˘oÚÈoıÂÙ‹ıËΠ·Ì¤Ûˆ˜ οو ·applefi Ùo ·Ê·ÈÚÂı¤ÓÙÌ‹Ì· Ùo˘ ÛÙÚÒÌ·Ùo˜, Î·È ÛÙo oapple›ÛıÈo ÙÚÈÙËÌfiÚÈoÙo˘ ÛÙÚÒÌ·Ùo˜. Δo ÙÌ‹Ì· Ùo˘ ÛÙÚÒÌ·Ùo˜ appleo˘·Ê·ÈÚ¤ıËΠapple·Ú·Ï‹ÊıËΠ·applefi ÙË ÌÂϤÙË.∏ apple˘ÎÓfiÙËÙ· ÙˆÓ ÎÂÚ·Ùo΢ÙÙ¿ÚˆÓ ÛÙo appleÚfi-ÛıÈo ÙÌ‹Ì· Ùo˘ ÎÚËÌÓo‡ ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó28,978+5849 ·ÙÙ·Ú·/mm 3 appleÚÈÓ ÙËÓ Âapple¤Ì‚·ÛË Î·Èo ·ÚÈıÌfi˜ ·˘Ùfi˜ ÂÏ·ÙÙÒıËΠ۠fiϘ ÙȘ ÌÂÙÂÁ¯ÂÈ-ÚËÙÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ·ÏÏ¿ Ë Ì›ˆÛË ·˘Ù‹ ‰ÂÓ ‹Ù·ÓÛËÌ·ÓÙÈ΋, 22% ÂÏ¿ÙÙˆÛË Ùo˘ ·ÚÈıÌo‡ ÙˆÓ ÎÂ-Ú·Ùo΢ÙÙ¿ÚˆÓ. ∏ apple˘ÎÓfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙooapple›ÛıÈo ÙÌ‹Ì· Ùo˘ ÎÚËÌÓo‡ ‹Ù·Ó appleÚo¯ÂÈÚËÙÈο20,397+4215 ·ÙÙ·Ú· / mm 3 Î·È o ·ÚÈıÌfi˜ ·˘Ùfi˜ÂÏ·ÙÙÒıËΠ20% Î·È 40% ÌÂÙÂÁ¯ÂÈÚËÙÈο, Ì›·Â‚‰oÌ¿‰· Î·È ¤Ó· ¯ÚfiÓo ·ÓÙ›ÛÙoȯ·, ÌÂÙ¿ ÙËÓ Â-apple¤Ì‚·ÛË. O ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙo appleÚfiÛıÈoÙÌ‹Ì· Ùo˘ ÎÂÚ·ÙoÂȉo‡˜, appleo˘ ‚Ú›ÛÎÂÙ·È ·Ì¤Ûˆ˜Î¿Ùˆ ·applefi Ùo ·Ê·ÈÚÂı¤Ó ÙÌ‹Ì· appleÚo¯ÂÈÚËÙÈο ‹-Ù·Ó 16,605+3595 ·ÙÙ·Ú·/mm 3 Î·È ÂÏ·ÙÙÒıËΠÛÂappleoÛoÛÙfi 16% Î·È 30%, 3 Î·È 12 Ì‹Ó˜ ÌÂÙ¿ ÙËÓÂapple¤Ì‚·ÛË. Ùo ·ÓÙ›ÛÙoȯo oapple›ÛıÈo ÙÌ‹Ì· Ùo˘ ÎÂ-Ú·ÙoÂȉo‡˜ η̛· ·ÏÏ·Á‹ ÛÙË apple˘ÎÓfiÙËÙ· ÙˆÓ Î˘Ù-Ù¿ÚˆÓ ‰ÂÓ apple·Ú·ÙËÚ‹ıËÎÂ∏ apple˘ÎÓfiÙËÙ· ÙˆÓ ÎÂÚ·Ùo΢ÙÙ¿ÚˆÓ ÛÙo oapple›-ÛıÈo ÙÌ‹Ì· Ùo˘ ÎÚËÌÓo‡ Î·È ÛÙo appleÚfiÛıÈo ÙÌ‹Ì·Ùo˘ ÎÂÚ·ÙoÂȉo‡˜, appleo˘ ‚Ú›ÛÎÂÙ·È ·Ì¤Ûˆ˜ οو·applefi Ù· ·Ê·ÈÚÂı¤Ó, ÂÏ·ÙÙÒÓÂÙ·È 1 ‚‰oÌ¿‰· Î·È 3Ì‹Ó˜, ·ÓÙ›ÛÙoȯ· ÌÂÙ¿ ·applefi ÙËÓ Âapple¤Ì‚·ÛË. ∏ apple˘-ÎÓfiÙËÙ· ÙˆÓ ÎÂÚ·Ùo΢ÙÙ¿ÚˆÓ ÛÙo appleÚfiÛıÈo ÙÌ‹Ì·Ùo˘ ÎÚËÌÓo‡ ÂÏ·ÙÙÒÓÂÙ·È ¤Ó· ¯ÚfiÓo ÌÂÙ¿ ÙËÓ Â-apple¤Ì‚·ÛË. Δ· Ì·ÎÚo¯ÚfiÓÈ· ·appleoÙÂϤÛÌ·Ù· ·˘Ù‹˜Ù˘ ÂÏ¿ÙÙˆÛ˘ Ù˘ apple˘ÎÓfiÙËÙ·˜ ÙˆÓ ÎÂÚ·Ùo΢ÙÙ¿-ÚˆÓ ı· appleÚ¤appleÂÈ Ó· ÌÂÏÂÙËıo‡Ó (¡.∞. §¿ÏÏo˜).ª¤ÙÚËÛË Ùo˘ apple¿¯o˘˜ Ùo˘ ÂappleÈıËÏ›o˘ Ùo˘ ÎÂÚ·Ùo-Âȉo‡˜ ÛÂ Û˘Óı‹Î˜ ˘appleoÍ›·˜ Ì ÙË ‚o‹ıÂÈ· Ùo˘Optical Coherence TomographyJ. Wang, D. Fonn, Mopton, T. Simpson, L. JonesAm J Ophthlmol 133: 315-319, 2002ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÌÂÏÂÙ¿Ù·È ·Ó Ùo apple¿¯o˜ Ùo˘ÂappleÈıËÏ›o˘ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ·˘Í¿ÓÂÈ Û ۯ¤ÛË ÌÂÙo o›‰ËÌ· Ùo˘ ÎÂÚ·ÙoÂȉo‡˜, Ùo oappleo›o appleÚoηÏ›ٷȷapplefi ÙË ¯Ú‹ÛË Ì·Ï·ÎÒÓ Ê·ÎÒÓ Âapple·Ê‹˜.O ¤Ó·˜ oÊı·ÏÌfi˜ 20 ÂıÂÏoÓÙÒÓ, ËÏÈΛ·˜35,6+9,6 ÂÙÒÓ, (10 ¿Ó‰Ú˜, 10 Á˘Ó·›Î˜), appleo˘ ‰ÂÊoÚo‡Û·Ó Ê·Îo‡˜ Âapple·Ê‹˜, ηχÊıËΤ Ì ̷ϷÎfiÊ·Îfi Âapple·Ê‹˜ ÁÈ· ‰È¿ÚÎÂÈ· 3 ˆÚÒÓ Î·È o ¿ÏÏo˜oÊı·ÏÌfi˜ ¯ÚËÛÈÌoappleoÈ‹ıËΠˆ˜ Ì¿ÚÙ˘Ú·˜. Δo apple¿-¯o˜ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ Î·È Ùo˘ ÂappleÈıËÏ›o˘ Ùo˘ ÌÂ-ÙÚ‹ıËÎ·Ó appleÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌoÁ‹ Ùo˘ Ê·Îo‡Âapple·Ê‹˜ Ì ÙË ‚o‹ıÂÈ· Ùo˘ Optical Coherence Tomography.∞̤ۈ˜ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË Ùo˘ Ê·Îo‡ Âapple·-Ê‹˜ Ùo oÏÈÎfi apple¿¯o˜ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ‹Ù·Ó ÛËÌ·-ÓÙÈο ·˘ÍË̤Óo 13,8+2,3% Û ۯ¤ÛË Ì Ùo ̤ÛofiÚo Î·È 100 ÏÂappleÙ¿ ·ÚÁfiÙÂÚ· apple·Ú¿ÌÂÈÓ ·ÎfiÌË ·˘-ÍË̤Óo 4,5+2,3%. O oÊı·ÏÌfi˜ appleo˘ ¯ÚËÛÈÌoappleoÈ‹-ıËΠˆ˜ Ì¿ÚÙ˘Ú·˜ ‰ÂÓ apple·Ú·ÙËÚ‹ıËΠη̛· ·ÏÏ·-Á‹ ÛÙo oÏÈÎfi apple¿¯o˜ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜. ∞̤ۈ˜ ÌÂ-Ù¿ ÙËÓ ·Ê·›ÚÂÛË Ùo˘ Ê·Îo‡ Âapple·Ê‹˜ Ùo apple¿¯o˜ Ùo˘ÂappleÈıËÏ›o˘ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ‹Ù·Ó ·˘ÍË̤Óo ηٿ1,7+4,8%, ·ÏÏ¿ ·˘Ù‹ Ë ·‡ÍËÛË ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈ΋. ∞ÎoÏo˘ıÒÓÙ·˜ ÙËÓ ·Ê·›ÚÂÛË Ùo˘Ê·Îo‡ Âapple·Ê‹˜, Ùo apple¿¯o˜ Ùo˘ ÂappleÈıËÏ›o˘ Ùo˘ ÎÂÚ·-ÙoÂȉo‡˜ ¿ÏÏ·Í ÛËÌ·ÓÙÈο ÛÙ· ÂapplefiÌÂÓ· 100 ÏÂappleÙ¿,Ì ÂappleÈ̤Úo˘˜ ÌÂÙÚ‹ÛÂȘ ÛÙ· 60, 80 Î·È ÛÙ·100 ÏÂappleÙ¿.∏ ÂÚÁ·Û›· ·˘Ù‹ ηٷϋÁÂÈ ÛÙo Û˘Ìapple¤Ú·ÛÌ·,fiÙÈ ÂÓÒ Ùo oÏÈÎfi apple¿¯o˜ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ·˘Í¿ÓÂÈÛËÌ·ÓÙÈο ηٿ ÙË ‰È¿ÚÎÂÈ· ˘appleoÍ›·˜ appleo˘ oÊ›ÏÂ-Ù·È ÛÙË ¯Ú‹ÛË Ê·ÎÒÓ Âapple·Ê‹˜, Ùo apple¿¯o˜ Ùo˘ ÂappleÈıË-Ï›o˘ Ùo˘ ÎÂÚ·ÙoÂȉo‡˜ ‰ÂÓ apple·Úo˘ÛÈ¿˙ÂÈ ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË (¡.∞. §¿ÏÏo˜).ÃÂÈÚo˘ÚÁÈ΋ ıÂÚ·apple›· Ù˘ Âapple·ÌÊÈ‚ÏËÛÙÚoÂȉÈ-΋˜ ÌÂÌ‚Ú¿Ó˘ Û Ó·Úo‡˜ ·ÛıÂÓ›˜N. Benhamou, P. Massin, R. Spolaore, M. Paques,A. GaudricAm J Ophthlmol 133: 358-364, 2002ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ Á›ÓÂÙ·È ·Ó·ÊoÚ¿ ÛÙ· ·-appleoÙÂϤÛÌ·Ù· Ù˘ ¯ÂÈÚo˘ÚÁÈ΋˜ ·Ê·›ÚÂÛ˘ Âapple·Ì-ÊÈ‚ÏËÛÙÚoÂȉÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Û Ó·Úo‡˜ ·ÛıÂ-Ó›˜.ÚfiÎÂÈÙ·È ÁÈ· Ì›· ·Ó·ÛÎoappleÈ΋ ÌÂϤÙË 20 ÓÂ-·ÚÒÓ ·ÛıÂÓÒÓ appleo˘ ˘appleo‚Ï‹ıËÎ·Ó Û ‚ÈÙÚÂÎÙoÌ‹ÁÈ· ÙËÓ ·Ê·›ÚÂÛË Âapple·ÌÊÈ‚ÏËÛÙÚoÂȉÈ΋˜ ÌÂÌ‚Ú¿-

OÊı·ÏÌÔÏÔÁ›·, 14, 2 (2002) 257Ó˘. ŸÏoÈ oÈ ·ÛıÂÓ›˜ ›¯·Ó ˘appleo‚ÏËı› Û appleÚoÂ-¯ÂÈÚËÙÈ΋ ÂͤٷÛË, appleo˘ appleÂÚÈÂÏ¿Ì‚·Ó ‚ÈoÌÈÎÚo-ÛÎfiappleÈÛË Ùo˘ ‚˘ıo‡, ʈÙoÁÚ¿ÊËÛË Î·È ÊÏo˘o·Á-ÁÂÈoÁÚ·Ê›·.9 ·ÛıÂÓ›˜ ‹Ù·Ó ·ÁfiÚÈ· Î·È 11 ‹Ù·Ó ÎoÚ›ÙÛÈ·(ËÏÈΛ·˜ 7-26 ÂÙÒÓ, ̤ÛË ËÏÈΛ· 16,3 ¯ÚfiÓÈ· ). ∏ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ apple·Ú·ÎoÏo‡ıËÛË Î˘Ì·ÈÓfiÙ·Ó ÌÂÙ·-͇ 4-96 Ì‹Ó˜ ( 21,2 Ì‹Ó˜).  13 ·ÛıÂÓ›˜ ‰È·appleÈ-ÛÙÒıËΠȉÈoapple·ı‹˜ Âapple·ÌÊÈ‚ÏËÛÙÚoÂȉÈ΋ ÌÂÌ-‚Ú¿ÓË, Û 6 appleÂÚÈÛÙ·ÙÈο Ë ÌÂÌ‚Ú¿ÓË Û˘Ó‰ÂfiÙ·Ó ÌÂÛ˘Ó˘apple¿Ú¯o˘Û· ÂÓ‰oÊı¿ÏÌÈ· ÊÏÂÁÌoÓ‹ Î·È Û ¤Ó·appleÂÚÈÛÙ·ÙÈÎfi Û˘Ó˘apple‹Ú¯Â ·Ì¿Úو̷ Ùo˘ ·ÌÊÈ‚ÏË-ÛÙÚoÂȉo‡˜ Î·È Ùo˘ ÌÂÏ¿Á¯Úo˘ ÂappleÈıËÏ›o˘.  13appleÂÚÈÛÙ·ÙÈο Ë Âapple·ÌÊÈ‚ÏËÛÙÚoÂȉÈ΋ ÌÂÌ‚Ú¿ÓË ‹-Ù·Ó Ï¢΋, apple·¯È¿, ·‰È·Ê·Ó‹˜ Ì ÂÓÙoappleÈṲ̂ÓË Ú˘Ù›-‰ˆÛË Î·È Ûo‚·Ú‹ ‰È·Ù·Ú·¯‹ Ùo˘ ·ÌÊÈ‚ÏË-ÛÙÚoÂȉo‡˜. ∏ ÙÂÏÈ΋ ηχÙÂÚ· ‰ÈoÚıo‡ÌÂÓË oappleÙÈ-΋ o͇ÙËÙ· ‹Ù·Ó ÛËÌ·ÓÙÈο ηχÙÂÚË Û ۯ¤ÛË ÌÂÙËÓ appleÚo¯ÂÈÚËÙÈ΋ oappleÙÈ΋ o͇ÙËÙ·. ∏ ̤ÛË ‚ÂÏ-Ù›ˆÛË Ù˘ oappleÙÈ΋˜ o͇ÙËÙ·˜ ‹Ù·Ó 4,25 ÁÚ·Ì̤˜ ηÈ17 ·ÛıÂÓ›˜ ΤډÈÛ·Ó ‰‡o ‹ appleÂÚÈÛÛfiÙÂÚ˜ ÁÚ·Ì-̤˜. ∞˘Ù‹ Ë ‚ÂÏÙ›ˆÛË ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙ· appleÂÚÈ-ÛÙ·ÙÈο Ì ‰Â˘ÙÂÚoapple·ı‹ Âapple·ÌÊÈ‚ÏËÛÙÚoÂȉÈ΋ÌÂÌ‚Ú¿ÓË apple·Ú¿ Û ·˘Ù¿ Ì ȉÈoapple·ı‹˜. ∫·Ù¿ ÙËӉȿÚÎÂÈ· Ù˘ Âapple·ÓÂͤٷÛ˘ ˘appleoÙÚoapple‹ apple·Ú·ÙËÚ‹-ıËΤ Û 5 (25%) appleÂÚÈÛÙ·ÙÈο.  ̛· appleÂÚ›appleÙˆÛËÌÂÙÂÁ¯ÂÈÚËÙÈ΋ oÊı·ÏÌÈ΋ ˘appleÂÚÙoÓ›· ·apple·›ÙËÛ‰ÈËıËÙÈ΋ Âapple¤Ì‚·ÛË.OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁo˘Ó ÛÙo Û˘Ìapple¤Ú·ÛÌ·fiÙÈ oÈ Âapple·ÌÊÈ‚ÏËÛÙÚoÂȉÈΤ˜ ÌÂÌ‚Ú¿Ó˜ Û Ó·ڿ¿ÙoÌ· ¤¯o˘Ó ‰È·ÊoÚÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο, fiÛo·ÊoÚ¿ Ùo apple¿¯o˜ Ùo˘˜ Î·È ÙË ‰‡Ó·ÌË Û˘ÁÎfiÏÏËÛ˘Ì ÙoÓ ˘appleoΛÌÂÓo ·ÌÊÈ‚ÏËÛÙÚoÂȉ‹, Û ۯ¤ÛË Ì·˘Ù¤˜ ÙˆÓ ÂÓËϛΈÓ. ∏ ¯ÂÈÚo˘ÚÁÈ΋ Ùo˘˜ ·Ê·›ÚÂ-ÛË Â›Ó·È ·appleoÙÂÏÂÛÌ·ÙÈ΋ Î·È ·ÛÊ·Ï‹˜. ∏ oappleÙÈ΋o͇ÙËÙ· ‚ÂÏÙÈÒÓÂÙ·È Û fiÏ· ۯ‰fiÓ Ù· appleÂÚÈÛÙ·ÙÈ-ο, ·ÏÏ¿ Ë ˘appleoÙÚoapple‹ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙ· Ó·ڿ¿ÙoÌ· Û ۯ¤ÛË Ì Ùo˘˜ ÂÓ‹ÏÈΘ (¡.∞. §¿ÏÏo˜).

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Eȉ‹ÛÂȘ∂appleÈ̤ÏÂÈ·: .OÈÎÔÓÔÌ›‰Ë˜e-mail: panomile@otenet.gr1. ∂appleÈÛÙËÌoÓÈ΋ ÂÓË̤ڈÛË∞. ∂øΔ∂ƒπ∫O·ÓÂÏÏ‹ÓÈ· OÊı·ÏÌoÏoÁÈ΋ ∂Ù·ÈÚ›· (.O.∂.)∂·ÚÈÓfi ˘ÌapplefiÛÈo OÊı·ÏÌoÏoÁ›·˜ 2002M ÂappleÈÙ˘¯›· appleÚ·ÁÌ·ÙÔappleÔÈ‹ıËΠÙËÓ 10-12M·˝Ô˘ 2002 ÛÙÔ apple·ÓÂappleÈÛÙËÌÈ·Îfi ·ÌÊÈı¤·ÙÚÔ ÙÔ˘BfiÏÔ˘ Ë ÂÙ‹ÛÈ· ηıÈÂڈ̤ÓË ÂΉ‹ÏˆÛË Ù˘ OE“E·ÚÈÓfi ˘ÌapplefiÛÈÔ” 2002. ÙȘ “AÓÙÈapple·Ú·ı¤ÛÂȘÛÙËÓ Û‡Á¯ÚÔÓË OÊı·ÏÌÔÏÔÁ›·” apple·ÚÔ˘ÛÈ¿ÛıËηӷapplefi„ÂȘ Û ·ÌÊÈÏÂÁfiÌÂÓ· ı¤Ì·Ù· ¢ڇÙÂÚÔ˘ ÂӉȷ-ʤÚÔÓÙÔ˜ ˘applefi ÌÔÚÊ‹ “·ÓÙÈapple·Ú·ı¤ÛˆӔ (Debates)·applefi ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙÔÓ ÙÔ̤· ÙÔ˘˜ ÔÌÈÏÈÙ¤˜. ÕÏÏ·ı¤Ì·Ù· ‹Ù·Ó: “•ËÚÔÊı·ÏÌ›· – NÂfiÙÂÚ˜ ÂÍÂÏ›ÍÂȘ”,“XÂÈÚÔ˘ÚÁÈ΋ ÙÔ˘ KÂÚ·ÙÔÂȉԇ˜” ηÈ, fiappleˆ˜ ¤¯ÂÈ Î·-ıÈÂÚˆı› ·applefi ÙËÓ OE, “I·ÙÚÈ΋ Ú¿ÍË – OÚÁ¿Óˆ-ÛË – AÍÈÔÏfiÁËÛË – AÌÔÈ‚‹ Û·Ó ı¤Ì· Âapple·ÁÁÂÏÌ·ÙÈ-ÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. TËÓ ÙÂÏÂ˘Ù·›· Ë̤ڷ appleÚ·ÁÌ·ÙÔappleÔÈ‹ıËΉÂÍ›ˆÛË appleÚÔ˜ ÙÈÌ‹Ó ÙˆÓ Û˘Ó¤‰ÚˆÓ.ÕÏϘ ÂΉËÏÒÛÂȘM ÂappleÈÙ˘¯›· appleÚ·ÁÌ·ÙÔappleÔÈ‹ıËΠÛÙȘ ÂÁηٷ-ÛÙ¿ÛÂȘ ÙÔ˘ “Sani Beach Hotel” ÛÙËÓ X·ÏÎȉÈ΋,ÙËÓ 5-9 IÔ˘Ó›Ô˘ 2002, ÙÔ 35 Ô ·ÓÂÏÏ‹ÓÈÔ OÊı/Îfi˘Ó¤‰ÚÈÔ. ŒÏ·‚·Ó ̤ÚÔ˜ appleÏ‹ıÔ˜ ÂÏÏ‹ÓˆÓ Î·È Í¤-ÓˆÓ ÔÌÈÏËÙÒÓ Î·È ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ Û˘Ó¤‰ÚˆÓ.ÙËÓ ‰ÂÍ›ˆÛË Ù˘ Ï‹Í˘ ÙÔ˘ ˘Ó‰ڛԢ, appleÔ˘ ¤ÁÈÓÂÛÙËÓ appleÈÛ›Ó· ÙÔ˘ ÍÂÓÔ‰Ô¯Â›Ô˘ Ì ÙËÓ Û˘ÌÌÂÙÔ¯‹ÁÓˆÛÙÒÓ BÔÚÂÈÔÂÏÏ·‰›ÙÈÎˆÓ ÌÔ˘ÛÈÎÔ¯ÔÚ¢ÙÈÎÒÓÛ˘ÁÎÚÔÙËÌ¿ÙˆÓ, ÔÈ Û‡Ó‰ÚÔÈ ¤‰ˆÛ·Ó Ú·ÓÙ‚ԇÛÙËÓ KÚ‹ÙË ÁÈ· ÙÔ 36 Ô ·ÓÂÏÏ‹ÓÈÔ OÊı/Îfi ˘Ó¤-‰ÚÈÔ ÙÔÓ IÔ‡ÓÈÔ 2003.ÚoÛ¯›˜ ÂΉËÏÒÛÂȘ·ÓÂÏÏ‹ÓÈ· OÊı·ÏÌoÏoÁÈ΋ ∂Ù·ÈÚ›·ºÚÔÓÙÈÛÙ‹ÚÈÔ °Ï·˘ÎÒÌ·ÙÔ˜ NԤ̂ÚÈÔ˜ 2002Ú·ÁÌ·ÙÔappleÔÈÂ›Ù·È ÙÔÓ NԤ̂ÚÈÔ ÙÔ Î·ıÈÂÚˆ-̤ÓÔ ÂÙ‹ÛÈÔ ÊÚÔÓÙÈÛÙ‹ÚÈÔ °Ï·˘ÎÒÌ·ÙÔ˜. O ·ÎÚÈ-‚‹˜ ¯ÚfiÓÔ˜ Î·È ÙfiappleÔ˜ Ù˘ Û˘Ó¿ÓÙËÛ˘ ı· ÔÚÈÛı›ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ.ÕÏϘ appleÚoÛ¯›˜ ÂΉËÏÒÛÂȘ1-4 IÔ˘Ó›Ô˘, 2002X·ÏÎȉÈ΋ڷÁÌ·ÙÔappleÔÈÂ›Ù·È ÙÔ 36o ·ÓÂÏÏ‹ÓÈÔ OÊı·Ï-ÌÔÏÔÁÈÎfi ˘Ó¤‰ÚÈÔ ÛÙȘ 4-8 IÔ˘Ó›Ô˘ 2002, ÛÙÔ ˘ÓÂ-‰ÚÈ·Îfi K¤ÓÙÚÔ Creta Maris ÛÙËÓ XÂÚÛfiÓËÛÔ Ù˘KÚ‹Ù˘.ÏËÚoÊoڛ˜:AKTINA-CITY CONGRESS§. ˘ÁÁÚÔ‡ 314-316176 73 ∫·ÏÏÈı¤·, ∞ı‹Ó·ΔËÏ. 010 9524 888Fax: 010 9524 088E-mail: info@citycongress.grwww.eoe2003.gr4-6 OÎÙˆ‚Ú›Ô˘, 2002Iˆ¿ÓÓÈÓ·Ú·ÁÌ·ÙÔappleÔÈÂ›Ù·È ÙÔ 2Ô ·ÓÂÏÏ‹ÓÈÔ ˘Ó¤‰ÚÈÔOÊı·ÏÌÈÎÒÓ ÊÏÂÁÌÔÓÒÓ Î·È ÏÔÈÌÒÍÂˆÓ ÛÙȘ 4-6OÎÙˆ‚Ú›Ô˘ ÛÙÔ ˘Ó‰ÚÈ·Îfi K¤ÓÙÚÔ Hotel “Du Lac”,˘applefi ÙËÓ ·ÈÁ›‰· Ù˘ I·ÙÚÈ΋˜ ¯ÔÏ‹˜ ÙÔ˘ ·ÓÂappleÈÛÙËÌ›Ô˘Iˆ·ÓÓ›ÓˆÓ Î·È ÙˆÓ OÊı·ÏÌÔÏÔÁÈÎÒÓ EÙ·ÈÚÂÈÒÓ.ÏËÚoÊoڛ˜: K· ZÔ‡Ìapple· K·ÏÏÈfiappleËK. ºÚfiÓÙ˙Ô˘ 745444 Iˆ¿ÓÓÈÓ·μ. ∂•øΔ∂ƒπ∫O20-23 Âapple٤̂ÚÈÔ˜ 2002Orlando, Florida, USATÔ American Academy of OphthalmologyappleÚ·ÁÌ·ÙÔappleÔÈÂ›Ù·È ÛÙȘ 20-23 ÂappleÙÂÌ‚Ú›Ô˘ ÛÙÔOÚÏ¿Ó‰Ô, ºÏÒÚÈÓÙ·, USA.ÏËÚÔÊÔڛ˜: Δel. +1 415 561 8500 ext. 304Fax: +1 415 561 8576OÊı·ÏÌoÏoÁ›·, 14, 2 : 262, 2002 1