O p h t h a l m o l o g i a - Πανελλήνια Οφθαλμολογική Εταιρεία

Ophthalmologia OÊı·ÏÌÔÏÔÁ›·Organon of the PanhellenicOphthalmological SocietyŸÚÁ·ÓÔ Ù˘ ·ÓÂÏÏ‹ÓÈ·˜OÊı·ÏÌÔÏÔÁÈ΋˜ EÙ·ÈÚ›·˜Co-EditorsMembersQuarterly publicationFounderP.A. Konstas (Thessaloniki)Editor in chiefN. Dimitrakoulias (Thessaloniki)Editorial BoardN. Georgiadis (Thessaloniki)D. Dereklis (Thessaloniki)S.A. Dimitrakos (Thessaloniki)A.K. Manthos(Thessaloniki)P. Economidis (Thessaloniki)I. Tsatsos (Thessaloniki)A.P. Vorkas (Larnaka)N. Ziakas (Thessaloniki)N. Kozeis (Thessaloniki)I. Koliopoulos (Patra)E. Kopsachilis (Thessaloniki)A-G.P. Konstas (Thessaloniki)S. Maloutas (Thessaloniki)D. Mikropoulos (Thessaloniki)E. Bechrakis (Athens)K. Boboridis (Thessaloniki)Th. Bufidis (Thessaloniki)P. Prazitikos (Thessaloniki)N. Papadopoulos (Thessaloniki)Ch. Terzidou (Athens)K. Psilas (Ioannina)TÚÈÌËÓÈ·›· ¤Î‰ÔÛËI‰Ú˘Ù‹˜.A. KÒÓÛÙ·˜ (£ÂÛÛ·ÏÔÓ›ÎË)EΉfiÙ˘N. ¢ËÌËÙÚ·ÎÔ‡ÏÈ·˜ (£ÂÛÛ·ÏÔÓ›ÎË)˘ÓÙ·ÎÙÈ΋ EappleÈÙÚÔapple‹˘ÓÂΉfiÙ˜ N. °ÂˆÚÁÈ¿‰Ë˜ (£ÂÛÛ·ÏÔÓ›ÎË)¢. ¢ÂÚÂÎÏ‹˜ (£ÂÛÛ·ÏÔÓ›ÎË).A. ¢ËÌËÙÚ¿ÎÔ˜ (£ÂÛÛ·ÏÔÓ›ÎË)A.K. M¿ÓıÔ˜ (£ÂÛÛ·ÏÔÓ›ÎË). OÈÎÔÓÔÌ›‰Ë˜ (£ÂÛÛ·ÏÔÓ›ÎË)I. TÛ¿ÙÛÔ˜ (£ÂÛÛ·ÏÔÓ›ÎË)M¤ÏËA.. BÔÚο˜ (§¿Úӷη)N. Zȿη˜ (£ÂÛÛ·ÏÔÓ›ÎË)N. KÔ˙¤Ë˜ (£ÂÛÛ·ÏÔÓ›ÎË)I. KÔÏÈfiappleÔ˘ÏÔ˜ (¿ÙÚ·)E. KÔ„·¯Â›Ï˘ (£ÂÛÛ·ÏÔÓ›ÎË)A-°.. KÒÓÛÙ·˜ (£ÂÛÛ·ÏÔÓ›ÎË). M·ÏÔ‡Ù·˜ (£ÂÛÛ·ÏÔÓ›ÎË)¢. ªÈÎÚfiappleÔ˘ÏÔ˜ (£ÂÛÛ·ÏÔÓ›ÎË)E. Mapple¯ڿ΢ (Aı‹Ó·)∫. ªappleÔÌappleÔÚ›‰Ë˜ (£ÂÛÛ·ÏÔÓ›ÎË)£. MappleÔ˘Ê›‰Ë˜ (£ÂÛÛ·ÏÔÓ›ÎË). ªappleÚ·˙ÈÙ›ÎÔ˜ (£ÂÛÛ·ÏÔÓ›ÎË)N. ·apple·‰fiappleÔ˘ÏÔ˜ (£ÂÛÛ·ÏÔÓ›ÎË)X. TÂÚ˙›‰Ô˘ (Aı‹Ó·)K. æ‡ÏÏ·˜ (Iˆ¿ÓÓÈÓ·)International Editorial BoardEvangelos Alexandridis (Germany)Jorge Alio (Spain)Francesco Bandello (Italy)Francesco Carones (Italy)David Charteris (U.K.)Richard Collin (U.K.)Ahment Cucukoglou (Turkey)Donald D’ Amico (U.S.A.)Sheraz Daya (U.K.)Thomas Friberg (U.S.A.)Evangelos Gragoudas (U.S.A.)Ian Grierson (U.K.)Gabor Hollo (Hungary)Mercado Hugo-Quiroz (Mexico)Stephen D. Klyce (U.S.A.)Marguerite B. McDonald (U.S.A)Shlomo Melamed (Israel)Maarten Mourits (Netherlands)Murat Irkec (Turkey)Constantin Pournaras (Switzerland)Alan Robin (U.S.A.)Theo Seiler (Switzerland)William C. Stewart (U.S.A.)Miguel Teus (Spain)John Thygesen (Denmark)Petja Vassileva (Bulgaria)George Williams (U.S.A.)Leonidas Zografos (Switzerland)Mailing Address(Subscriptions – Checks – Advertising)Panhellenic Ophthalmological SocietyP.O. Box 1585, 540 06 – Thessaloniki, GreeceSecretariat: M.-E. Pouliou, Tel. & Fax: +30 2310 245499e-mail: info@poe.gr & p-o-e@otenet.grweb-site: http://www.poe.grAnnual Subscriptionfor foreign countries: 60 €PublisherUniversity Studio PressLeonidas Michalis, 32 Armenopoulou Str.546 35 – Thessaloniki, GreeceTel. +30 2310 209637 & +30 2310 209837T·¯˘‰ÚÔÌÈ΋ ¢È‡ı˘ÓÛË(EÁÁڷʤ˜ – EÌ‚¿ÛÌ·Ù· – ¢È·ÊËÌ›ÛÂȘ)·ÓÂÏÏ‹ÓÈ· OÊı·ÏÌÔÏÔÁÈ΋ EÙ·ÈÚ›·T.£. 1585, 540 06 – £ÂÛÛ·ÏÔÓ›ÎË°Ú·ÌÌ·Ù›·: M.-∂. Ô‡ÏÈÔ˘, ΔËÏ. & º·Í: 2310 245499e-mail: info@poe.gr & p-o-e@otenet.grweb-site: http://www.poe.grEÙ‹ÛÈ· ˘Ó‰ÚÔÌ‹: 30 €EȉÈ΢fiÌÂÓÔÈ – ºÔÈÙËÙ¤˜: 15 €(¢È·Ó¤ÌÂÙ·È ‰ˆÚÂ¿Ó ÛÙ· ̤ÏË Ù˘ OE)Yapple‡ı˘ÓÔ˜ T˘appleÔÁÚ·Ê›ԢUniversity Studio Press§ÂˆÓ›‰·˜ Mȯ¿Ï˘, AÚÌÂÓÔappleÔ‡ÏÔ˘ 32546 35 – £ÂÛÛ·ÏÔÓ›ÎËTËÏ. 2310 209637 & 2310 209837¢ÈÔÈÎËÙÈÎfi ˘Ì‚Ô‡ÏÈÔ: ¡. °ÂˆÚÁÈ¿‰Ë˜, . ¢ËÌËÙÚ¿ÎÔ˜, μ. ∫Ô˙ÔÌapplefiÏ˘, . §¿ÎÂ, ∫. ªappleÔÌappleÔÚ›‰Ë˜

OÊı·ÏÌÔÏÔÁ›·TfiÌÔ˜ 18 - T‡¯Ô˜ 2 - 2006ÂÚȯfiÌÂÓ·∞ÓÙ› Û¯ÔÏ›Ô˘ 115AÓ·ÛÎfiappleËÛË 117 ∞appleÔÊÔÏȉˆÙÈÎfi ÁÏ·‡ÎˆÌ·: ÚfiÛÊ·Ù˜ ÂÍÂÏ›ÍÂȘ ÛÙËÓ Î·Ù·ÓfiËÛËÙ˘ apple¿ıËÛ˘¡.∞. §¿ÏÏÔ˜, . ΔÛÈÚÒÓË, ∞.-°.. ∫ÒÓÛÙ·˜, μ.. ∫Ô˙ÔÌapplefiÏ˘, °. ∫ÔÏÈ¿ÎÔ˜KÏÈÓÈΤ˜ Î·È ÂÚÁ·- 133 ˘ÁÎÚÈÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·applefiÊڷ͢ ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›ԢÛÙËÚȷΤ˜ ÌÂϤÙÂ˜Î·È ·ÎÚ˘ÏÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·applefiÊڷ͢ Ù˘ ÏË·ıÔ˘ ÁÈ· ÙËÓ·ÓÙÌÂÙÒappleÈÛË Ù˘ Û˘Ìappleو̷ÙÈ΋˜ ÍËÚÔÊı·ÏÌ›·˜K. MappleÔÌappleÔÚ›‰Ë˜, ¢. ªÈÎÚfiappleÔ˘ÏÔ˜, E. °ÂˆÚÁÈ¿‰Ô˘, ¡. ∑ȿη˜, ¡. °ÂˆÚÁÈ¿‰Ë˜139 ¢È·‚ËÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔapple¿ıÂÈ· Î·È ÁÏ˘ÎÔ˙˘ÏȈ̤ÓË ·ÈÌÔÛÊ·ÈÚ›ÓË. æ·ÚÚ¿, π. μ·ÁÁÂÏfiappleÔ˘ÏÔ˜, μ. ƒÔ‡ÓÙÔ˘, . πÛ··Î›‰Ë˜,¢. §‡ÎÔ˜, ∞. Δ·Ïapple›‰Ë˜144 ªappleÔÚ› ¤Ó· ·ÍÈfiappleÈÛÙÔ ÔappleÙÈÎfi apple‰›Ô Ó· ÌËÓ Â›Ó·È appleÚ·ÁÌ·ÙÈο ·ÍÈfiappleÈÛÙÔ;¡. ª˘ÏfiappleÔ˘ÏÔ˜, £. ·appleapple¿˜, ∞. μ·˚ÔappleÔ‡ÏÔ˘, ∞. ∫ÔÛÎÔÛ¿˜, º. ΔÔappleÔ‡˙˘148 The use of diode laser cyclophotocoagulation in the treatment ofrefractory glaucomaA. Mandalos, M. Tsatsos, T. RichardsonEӉȷʤÚÔÓÙ· 152 O ÚfiÏÔ˜ ÙÔ˘ ÎÚ˘ÛÙ·ÏÏÔÂȉԇ˜ Ê·ÎÔ‡ Î·È ÙÔ˘ ˘·ÏÔÂȉԇ˜ ÛÙÔ ·ÓıÂÎÙÈÎfiappleÂÚÈÛÙ·ÙÈοÁÏ·‡ÎˆÌ· ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ (ÙÚÂȘ appleÂÚÈappleÙÒÛÂȘ)Δ. ∞ÚÁ˘ÚfiappleÔ˘ÏÔ˜, ∫. ªapple·Úapple¿Î˘156 ∞ÁÁÂÈ˝Ùȉ· ÎÏ¿‰Ô˘ ·ÌÊ‚ÏËÛÙÚÔÂȉÈ΋˜ ÊϤ‚·˜ ÛÂ Ó¤Ô ¿ÙÔÌÔ∂. ·apple·‚·ÛÈÏ›Ԣ §. ƒ·˙‹˜, ∫. æ‡ÏÏ·˜, ∞. °Ú·ÙÛˆÓ›‰Ë˜, ∞. ·apple·appleÔÛÙfiÏÔ˘‡ÌÌÂÈÎÙ· 161 °ÂÒÚÁÔ˜ ∫ˆÛÙÔÌÔ›Ú˘ ‹ ∫ˆÛÙÔ̇Ú˘. ÷‚È¿Ú·-∫·Ú·¯¿ÏÈÔ˘164 °ÂÒÚÁÔ˜ ªËÙ·Ú¿Î˘. ÷‚È¿Ú·-∫·Ú·¯¿ÏÈÔ˘165 O James Ware (1756-1815) Î·È Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙËÓ ÔÊı·ÏÌÔÏÔÁÈ΋‚È‚ÏÈÔÁÚ·Ê›· Ì ٷ ¤ÚÁ· ÙÔ˘ “Extracting the Cataract”, “Remarks onthe Fistula Lachrymalis” “Opthalmy” Î.¿.°. ªapple·Ï·Ó›Î·˜MÂÙÂÎapple·È‰Â˘ÙÈο 173 Laser pointers, ÊÔÚËÙ¿ ËÏÂÎÙÚÔÓÈο apple·È¯Ó›‰È·: fiÛÔ ·ÛÊ·Ï‹ı¤Ì·Ù·Â›Ó·È ÁÈ· ÙËÓ fiÚ·ÛË ÙˆÓ apple·È‰ÈÒÓ;∞. ∫·Î·‚Ô‡ÙË-¢Ô‡‰Ô˘, ¢. Δ˙¤Ù˙Ë, ∞. OÈÎÔÓfiÌÔ˘, ø. §ÂÏÈÔappleÔ‡ÏÔ˘176 Degenerative eye diseases184 ¡Â˘ÚÔÔÊı·ÏÌÔÏÔÁÈ΋ appleÚÔÛ¤ÁÁÈÛË ÙˆÓ Ó¢ÚÔ˚ӈ̷ÙÒÛˆӡ. ∫Ô˙¤Ë˜, ∞. μ·Ú‰·ÚÈÓfi˜, . §¿ÎÂμÈ‚ÏÈÔÎÚÈۛ˜ 189ÂÚÈÏ‹„ÂȘ ·applefi 193ͤӷ appleÂÚÈÔ‰Èο∂ȉ‹ÛÂȘ 196∂ÈÎfiÓ· Â͈ʇÏÏÔ˘: º›ÌˆÛË ‰ÂÍÈÔ‡ ‚ÔÏ‚Ô‡ Û ·ÛıÂÓ‹ Ì ı˘ÚÂÔÂȉÈ΋ ÔÊı·Ï-ÌÔapple¿ıÂÈ·

OphthalmologiaVolume 18 - No 2 - 2006ContentsEditÔrial 115Review 117 Recent advances in understading exfoliative glaucomaN.A. Lallos, S. Tsironi, A.G.-P. Konstas, V.P. Kozombolis, G. KoliakosClinical and 133 Comparative application of punctum plugs and acrylic lacrimal plugslaboratory studiesfor the management of symptomatic dry eyesK. Boboridis, D. Mikropoulos, ∂. Georgiadou, N. Ziakas, N. Georgiadis139 Diabetic retinopathy and glycosylated hemoglobinP. Psarra, I. Vaggelopoulos, V. Roundou, P. Isaakidis, D. Lykos, A. Talpidis144 Could a reliable visual field be not truly reliable?N. Mylopoulos, T. Pappas, A. Vaiopoulou, A. Koskosas, F. Topouzis148 H ÂÊ·ÚÌÔÊ‹ ΢ÎÏÔʈÙÔappleËÍ›·˜ Ì diode Laser ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË·ÓıÂÎÙÈÎÔ‡ ÁÏ·˘ÎÒÌ·ÙÔ˜∞. ª¿Ó‰·ÏÔ˜, ª. ΔÛ¿ÙÛÔ˜, Δ. RichardsonCases reports 152 The important role of the crystalline lens and the vitreous body in thepathogenesis and management of the persistent angle closure glaucomaT. Argyropoulos, K. Barpakis156 Interesting case report of vasculitis in branch retinal vein in a young personE. Papavasiliou, L. Razis, K. Psillas, A. Gratsonidis, A. PapapostolouMiscellaneous 161 Georgios Kostomiris or KostomyrisS. Chaviara-Karachaliou164 Georgios MitarakisS. Chaviara-Karachaliou165 O James Ware (1756-1815) and his contribution to the ophthamologicbiobliography with the literaure of “Extracting the Cataract”, “Remarkson the Fistula Lachrymalis” “Ophthalmy” etcG. BalanikasPostgraduate 173 Laser pointers mobile electronic games. How safe are theylecturesfor children’s visionA. Kakavouti-Doudou, D. Tzetzi, A. Oikonomou, O. Leliopoulou176 Degenerative bye diseases184 Neuroopthalmological approach in reuro inoutatosesN. Kozeis, A. Vardarinos, S. LakeBook reviews 189∞bstracts 193News items 196Cover picture: Right oculear phimonia in a patient with thyroid ophthalmopathy

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 119∂ÈÎ 3. ∂Ó·applefiıÂÛË ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙÔ ÎÔÚÈÎfi¯Â›ÏÔ˜. O ÎÂÓÙÚÈÎfi˜ ‰›ÛÎÔ˜, Ë ÂӉȿÌÂÛË ˙ÒÓË Î·È ËappleÂÚÈÊÂÚÈ΋ ˙ÒÓË Â›Ó·È ÔÚ·Ù¿ Û ·˘Ùfi ÙÔ appleÂÚÈÛÙ·ÙÈÎfi.∂ÈÎ 4. ŒÓÙÔÓË ÂÓ·applefiıÂÛË ¯ÚˆÛÙÈ΋˜ Û ·ÛıÂÓ‹ Ì °∞.º·›ÓÂÙ·È Ë ÁÚ·ÌÌ‹ Sampaolesi.ʤÚÂÈ· ÙÔ˘ appleÂÚÈÊ·Î›Ô˘ apple·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì›· Ï¢΋,ÎÔÎÎÈ҉˘ ΢ÎÏÈ΋ ˙ÒÓË ÌÂÙ·‚ÏËÙÔ‡ ‡ÚÔ˘˜, appleÔ˘ÔÓÔÌ¿˙ÂÙ·È ÎÔÎÎÈ҉˘ ˙ÒÓË. ÕÏÏÔÙ ÂÌÊ·Ó›˙ÂٷȈ˜ ÏÂappleÙ‹ ÌÂÌ‚Ú¿ÓË Ì appleÚÈÔÓˆÙ‹ appleÂÚÈʤÚÂÈ· ηȿÏÏÔÙ ˆ˜ Ì›· appleÈÔ ¤ÓÙÔÓË ˙ÒÓË, ‰›ÎËÓ ÎÚ˘ÛÙ·ÏÏÈ-΋˜ ˙¿¯·Ú˘. ˘¯Ó¿ ÂÌÊ·Ó›˙ÂÈ Ôapple¤˜ Î·È ÂappleÈÎÔÈÓˆ-Ó› Ì ÙÔÓ ÎÂÓÙÚÈÎfi ‰›ÛÎÔ Ì Á¤Ê˘Ú˜ ·appleÔÊÔÏȉˆ-ÙÈÎÔ‡ ˘ÏÈÎÔ‡ (Tarkkanen 1962). Δ¤ÏÔ˜, Ì›· ‰È·˘-Á‹˜ ÂӉȿÌÂÛË ˙ÒÓË Ê˘ÛÈÔÏÔÁÈÎÔ‡ appleÂÚÈÊ·Î›Ô˘¯ˆÚ›˙ÂÈ ÙÔÓ ÎÂÓÙÚÈÎfi ‰›ÛÎÔ ·applefi ÙËÓ appleÂÚÈÊÂÚÈ΋ÎÔÎÎÒ‰Ë ˙ÒÓË (∂ÈÎ 3). ÈÛÙ‡ÂÙ·È fiÙÈ Ë ‰È·˘Á‹˜˙ÒÓË Û¯ËÌ·Ù›˙ÂÙ·È ·applefi ÙË Û˘Ó¯‹ ΛÓËÛË Î·ı·ÚÈ-ÛÌÔ‡ Ù˘ ›Úȉ·˜, appleÔ˘ ·Î·Ù¿apple·˘ÛÙ· ÎÈÓÂ›Ù·È ÌÂÙ·-͇ ̇Û˘ Î·È Ì˘‰Ú›·Û˘ (Konstas & Allan 1989,Ritch et al 2003).∫ÔÎΛ· ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ ·Ó¢ڛ-ÛÎÔÓÙ·È ÛÙÔ ÎÔÚÈÎfi ¯Â›ÏÔ˜, ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙÔ˘ ÎÂ-Ú·ÙÔÂȉԇ˜, ÛÙË ÁˆÓ›· ÙÔ˘ appleÚÔÛı›Ô˘ ı·Ï¿ÌÔ˘, ÛÙË˙›ÓÓÂÈÔ ˙ÒÓË Î·È ÛÙÔ ·ÎÙÈÓˆÙfi ÛÒÌ· (∂ÈÎ 4-12).Δ· ·ÁÁ›· Ù˘ ›Úȉ·˜ Û˘¯Ó¿ apple·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·-ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜. Δ· ·ÁÁÂȷο ÂÓ‰ÔıËÏȷο ·Ù-Ù·Ú· Î·È Ù· appleÂÚÈ·ÙÙ·Ú· ÂÎÊ˘Ï›˙ÔÓÙ·È, Ô ·˘Ïfi˜88ÙˆÓ ·ÁÁ›ˆÓ Â›Ó·È Û˘¯Ó¿ ÛÙÂӈ̤ÓÔ˜ Î·È ÌappleÔ-Ú› Ó· ·appleÔÊÚ·¯ı›, ÌÂ Û˘ÓÔ‰fi ·appleÒÏÂÈ· Ù˘ Ê˘-ÛÈÔÏÔÁÈ΋˜ ·ÎÙÈÓˆÙ‹˜ ·ÁÁÂȷ΋˜ ‰È·ÌfiÚʈÛ˘ÛÙËÓ ›Úȉ· Î·È Û˘ÓÔ‰fi ‰ËÌÈÔ˘ÚÁ›· ÂÛÙÈÒÓ ÓÂÔ·Á-Á›ˆÛ˘ (∂ÈÎ 11-12). ∏ ÁˆÓÈÔÛÎÔapple›· ‰Â›¯ÓÂÈ ·˘-ÍË̤ÓË ÂÓ·applefiıÂÛË ¯ÚˆÛÙÈ΋˜ ÛÙÔÓ ËıÌfi, Ë ÔappleÔ›·Â›Ó·È ÂÓÙÔÓfiÙÂÚË appleÚÔ˜ Ù· οو (∫ÒÓÛÙ·˜ 1995).ΔÔ ˘ÏÈÎfi ·appleÔÊÔÏ›‰ˆÛ˘ ÛÙË ÁˆÓ›· apple·Ú·ÙËÚ‹ıËÎÂÁÈ· appleÚÒÙË ÊÔÚ¿ ·applefi ÙÔÓ Barkan ÙÔ 1936. ∏ Áˆ-ÓÈÔÛÎÔappleÈ΋ ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·applefi ηʤ-Ì·‡ÚË ¯ÚÒÛË ÂÙÂÚÔÁÂÓÔ‡˜ ηٷÓÔÌ‹˜ (∂ÈÎ 4).ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·ÛıÂÓÒÓ Ì ∞ ¤‰ÂÈÍ·ÓÂÏ·Ùو̤ÓÔ Schirmer test Î·È ÂÏ·Ùو̤ÓÔ ¯ÚfiÓԉȿÛapple·Û˘ Ù˘ ‰·ÎÚ˘˚΋˜ ÛÙÈ‚¿‰·˜ (Kozobolis∂ÈÎ 5. ª·ÎÚÔÛÎÔappleÈ΋ ÂÈÎfiÓ· ÔÊı·ÏÌÔ‡ Ì °∞ ÙÂÏÈÎÔ‡ÛÙ·‰›Ô˘.∂ÈÎ 6. ∂Ó·applefiıÂÛË ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙÔ ·ÎÙÈÓˆ-Ùfi ÛÒÌ·.1999), ÂÏ·Ùو̤ÓË apple˘ÎÓfiÙËÙ· ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘Ù-Ù¿ÚˆÓ ÙÔ˘ ÎÂÚ·ÙÔÂȉԇ˜ Ì ÌÔÚÊÔÏÔÁÈΤ˜ ‰È·Ù·-Ú·¯¤˜ ˆ˜ appleÚÔ˜ ÙÔ Û¯‹Ì· Î·È ÙÔ Ì¤ÁÂıÔ˜ (Stefaniotouet al 1999) Î·È ‰È·appleÈÛÙÒıËΠÌÈ· Ûapple¿ÓÈ·

120 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)∂ÈÎ 7. ΔÔ ·appleÔ¯ÂÙ¢ÙÈÎfi ‰›ÎÙ˘Ô Û ·ÛıÂÓ‹ Ì °∞. ˘Û-ÛˆÚ‡ÛÂȘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î·È ¯ÚˆÛÙÈ΋ÛÙÔ ËıÌÔÂȉ¤˜ apple¤Ù·ÏÔ.∂ÈÎ 10. ˘ÛÛÒÚ¢ÛË ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ (‚¤ÏÔ˜)‰›appleÏ· Û ‰ÔΛ‰· ÙÔ˘ ËıÌÔÂȉԇ˜ appleÂÙ¿ÏÔ˘ (Δª).∂ÈÎ 8. ∞appleÔÊÔÏȉˆÙÈÎfi ˘ÏÈÎfi ÛÙÔ appleÚfiÛıÈÔ appleÂÚÈÊ¿ÎÈÔ.∂ÈÎ 11. ∏ ›Úȉ· Û ·ÛıÂÓ‹ Ì °∞. ¢È·ÎÚ›ÓÔÓÙ·È «·ÁÁ›·-Ê·ÓÙ¿ÛÌ·Ù·».∂ÈÎ 9. ∞appleÔÊÔÏȉˆÙÈÎfi ˘ÏÈÎfi ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔ-ÛÎfiappleÈÔ.∂ÈÎ 12. ∞ÁÁ›Ô-Ê¿ÓÙ·ÛÌ· Û ÌÂÁ¤ı˘ÓÛË ÛÙËÓ ›Úȉ· (‚¤ÏÔ˜).

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 121ÌÔÚÊ‹ ÎÂÚ·ÙÔapple¿ıÂÈ·˜, appleÔ˘ ›Ûˆ˜ ÂÓÔ¯ÔappleÔÈ›ٷÈÁÈ· ÔÚÈṲ̂Ó˜ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÂappleÈappleÏÔΤ˜, appleÔ˘ Û˘-ÓÔ‰Â‡Ô˘Ó ÙËÓ apple¿ıËÛË (Naumman et al 2000).μ˘ıÔÛÎÔappleÈο ¤¯ÂÈ apple·Ú·ÙËÚËı› fiÙÈ ÔÈ ·ÛıÂ-Ó›˜ Ì ∞ apple·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈÎÚfiÙÂÚË Ì¤ÛË ÂappleÈÊ¿-ÓÂÈ· ÔappleÙÈ΋˜ ıËÏ‹˜ ηÈ, ÛÙȘ appleÂÚÈappleÙÒÛÂȘ appleÔ˘ Û˘Ó˘apple¿Ú¯ÂÈÁÏ·‡ÎˆÌ·, ÂÎÛÂÛËÌ·Ṳ̂ÓË ÎԛϷÓÛË ÙÔ˘ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘, Û ۇÁÎÚÈÛË Ì ·ÛıÂÓ›˜ apple¿Û¯Ô-ÓÙ˜ ·applefi °∞° (Jonas 1997), apple·ÚfiÏÔ appleÔ˘ ·˘Ù¿ Ù·Û˘ÌappleÂÚ¿ÛÌ·Ù· ‰ÂÓ ÂappleȂ‚·ÈÒÓÔÓÙ·È Û fiϘ ÙȘ ÌÂ-ϤÙ˜. ∂appleÈappleϤÔÓ, ˘apple¿Ú¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇∞ Î·È ÁÂÚÔÓÙÈ΋˜ ÂÎʇÏÈÛË Ù˘ ˆ¯Ú¿˜, Ë ÔappleÔ›·Î·Ù¿ ηÓfiÓ· ‚·Û›˙ÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË Âapple›appleÙˆÛËÙˆÓ ‰‡Ô apple·ı‹ÛÂˆÓ Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜.OÈ ·ÛıÂÓ›˜ Ì A Û˘¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó ÎÏÈÓÈοÔÚ·Ùfi Û‡Ó‰ÚÔÌÔ ÂÙÂÚfiappleÏ¢ڷ (Ritch et al 2003).ÙËÓ appleÏÂÈÔ„ËÊ›· ÙˆÓ appleÂÚÈappleÙÒÛÂˆÓ ·˘ÙÒÓ fï˜˘apple¿Ú¯ÂÈ ÈÛÙÔapple·ıÔÏÔÁÈο ·ÓȯÓ‡ÛÈÌÔ ˘ÏÈÎfi ·appleÔ-ÊÔÏ›‰ˆÛ˘ Î·È ÛÙÔ˘˜ ‰‡Ô ÔÊı·ÏÌÔ‡˜. ∂appleÔ̤ӈ˜,ÙÔ ∞ Â›Ó·È Û˘¯ÓfiÙÂÚ· ·Û‡ÌÌÂÙÚÔ ÛÙËÓ ÂÌÊ¿ÓÈÛËÎ·È Ûapple¿ÓÈ· ·ÏËıÈÓ¿ ÂÙÂÚfiappleÏ¢ÚÔ (Mitchell et al1999). ∏ ·ÌÊÔÙÂÚfiappleÏ¢ÚË ÂÌÊ¿ÓÈÛË apple¿ÓÙˆ˜ ›ӷȷÚÎÂÙ¿ Û˘¯Ó‹ Û ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ (Moreno-Montaoes et al 1989, Krause et al 1988, Kozoboliset al 1997, Stefaniotou et al 1990).  ¿ÏϘ ‰ËÌÔ-ÛȇÛÂȘ, ·ÓÙ›ıÂÙ·, ·Ó·Ê¤ÚÂÙ·È ˆ˜ ÂappleÈÎÚ·ÙÔ‡Û· ËÂÙÂÚfiappleÏ¢ÚË ÂÌÊ¿ÓÈÛË ÙÔ˘ ∞, ÌÂ Û˘¯ÓfiÙËÙ· ¤ˆ˜Î·È 3:1 (Aasved 1971d, Layden & Shaffer 1974,Brooks & Gillies 1988, Futa et al 1992, Henry et al1987). OÈ ·ÛıÂÓ›˜ appleÔ˘ apple·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÌÊÔÙÂÚfiappleÏ¢ڷ∞ Ù›ÓÔ˘Ó Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔÈ Û ËÏÈ-Λ· ·applefi ÂΛÓÔ˘˜ Ì ÂÙÂÚfiappleÏ¢ÚÔ, ·ÏÏ¿ Ë ‰È·ÊÔ-Ú¿ Ù˘ ËÏÈΛ·˜ Â›Ó·È Û˘¯Ó¿ ÌÈÎÚ‹ (Tarkkanen1962, Aasved 1971d, Gifford 1957, Hiller et al1982, Kozart & Yanoff 1982,).  ·ÛıÂÓ›˜ Ì ÎÏÈ-ÓÈο ÂÙÂÚfiappleÏ¢ÚÔ ∞ Î·È ·ÌÊÔÙÂÚfiappleÏ¢ÚÔ ÁÏ·‡-Έ̷, Ë ∂O Â›Ó·È ˘„ËÏfiÙÂÚË ÛÙÔÓ ÔÊı·ÏÌfi ÌÂÙËÓ ·appleÔÊÔÏ›‰ˆÛË (Aasved 1971c).∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ °∞ Â›Ó·È ˘„ËÏ‹ ÂȉÈο ÛÂÔÚÈṲ̂ÓÔ˘˜ appleÏËı˘ÛÌÔ‡˜ (Ritch et al 2003). H ·˘-ÍË̤ÓË ∂O Ì ‹ ¯ˆÚ›˜ ÁÏ·˘ÎˆÌ·ÙÈ΋ ‚Ï¿‚Ë ÂÌ-Ê·Ó›˙ÂÙ·È Û appleÔÛÔÛÙfi appleÂÚ›appleÔ˘ 25% ÙˆÓ ·ÙfïÓÌ ∞, appleÂÚ›appleÔ˘ 6-10 ÊÔÚ¤˜ appleÂÚÈÛÛfiÙÂÚÔ ·applefi fi,ÙÈÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ ¯ˆÚ›˜ ∞ (Aasved 1971c, Kozart& Yannof 1982, Kozobolis et al 1997, Ringvold etal 1991). Δ· ¿ÙÔÌ· Ì ÔÊı·ÏÌÈ΋ ˘appleÂÚÙÔÓ›· ηÈ∞ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË appleÈı·ÓfiÙËÙ· Ó· ·Ó·appleÙ‡ÍÔ˘ÓÁÏ·˘ÎˆÌ·ÙÈ΋ ‚Ï¿‚Ë ·applefi fi,ÙÈ ÂΛÓÔÈ ¯ˆÚ›˜ ·appleÔ-ÊÔÏ›‰ˆÛË (Henry et al 1987, Pohnanpelto 1986,Thorburn 1988).ΔÔ °∞ Û˘¯Ó¿ ¤¯ÂÈ appleÈÔ ÛÔ‚·Ú‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ·Î·È ¯ÂÈÚfiÙÂÚË appleÚfiÁÓˆÛË ·applefi ÙÔ °∞° (¢ËÌËÙÚ·-ÎÔ‡ÏÈ·˜ Î·È Û˘Ó 1995, Ritch et al 2003, Konstas etal 2004). ∫·Ù¿ ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘ Ë ∂O ›-Ó·È ˘„ËÏfiÙÂÚË ·applefi fi,ÙÈ ÛÙÔ °∞°, Ì ˘„ËÏfiÙÂÚ˜·È¯Ì¤˜ apple›ÂÛ˘ ÂÓÒ ˘apple¿Ú¯ÂÈ Âapple›Û˘ Û˘¯ÓfiÙÂÚË Î·ÈÛÔ‚·ÚfiÙÂÚË ÔappleÙÈ΋ Ó¢ÚÔapple¿ıÂÈ·, ¯ÂÈÚfiÙÂÚË ‚Ï¿-‚Ë ÔappleÙÈÎÒÓ apple‰›ˆÓ, ›Ûˆ˜ ·ÓÂapple·Ú΋˜ ·apple¿ÓÙËÛËÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ÛÔ‚·ÚfiÙÂÚË ÎÏÈÓÈ΋ ÂÈ-ÎfiÓ· Î·È Û˘¯ÓfiÙÂÚË ·Ó¿ÁÎË ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ apple·-ڤ̂·ÛË (Aasved 1971a, Futa et al 1992, Konstaset al 1993a; 1997a; 1998, Moreno-Montanes et al1990, Tarkkanen 1965). ∏ 24ˆÚË ‰È·Î‡Ì·ÓÛË Ù˘∂O Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ Ì °∞·applefi fi,ÙÈ Û Î›ÓÔ˘˜ Ì °∞° (Konstas et al1997b). ∂appleÈappleϤÔÓ ÔÈ ·ÛıÂÓ›˜ Ì °∞ Ê·›ÓÂÙ·È fiÙȤ¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ Ì¤ÛÔ Â‡-ÚÔ˜ ∂O, ˘„ËÏfiÙÂÚË Ì¤ÁÈÛÙË ∂O Î·È ˘„ËÏfiÙÂ-ÚË ÂÏ¿¯ÈÛÙË ∂O ·ÏÏ¿ Î·È ÛËÌ·ÓÙÈο ¯ÂÈÚfiÙÂÚˉȷ·̷ÓÛË Ù˘ 24ˆÚ˘ ∂O ÁÂÓÈο Û ۯ¤ÛË Ì·ÛıÂÓ›˜ Ì °∞° (Konstas et al 2004a; 2004b).∞ÛıÂÓ›˜ Ì °∞ η٤‰ÂÈÍ·Ó Û˘¯ÓfiÙÂÚ· ‡ÚÔ˜∂O ÌÂÁ·Ï‡ÙÂÚÔ ·applefi 15 mmHg (Konstas et al1997b). ∂apple›Û˘ ÛËÌ·ÓÙÈÎfi Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙÔ45% ÙˆÓ ·ÛıÂÓÒÓ Ì °∞ Î·È ÛÙÔ 22.5% ·ÛıÂÓÒÓÌ °∞°, ÙÔ Ì¤ÁÈÛÙÔ Âapple›appleÂ‰Ô Ù˘ ∂O apple·Ú·ÙË-Ú‹ıËΠ¤Íˆ ·applefi ÙȘ Û˘Ó‹ıÂȘ ÒÚ˜ ÏÂÈÙÔ˘ÚÁ›·˜ÂÓfi˜ È·ÙÚ›Ԣ (Konstas et al 1997b).ΔÔ °∞ ÌappleÔÚ› Ó· apple·Ú·Ì›ÓÂÈ ·Û˘Ìappleو̷ÙÈÎfi̤¯ÚÈ Ó· appleÚÔ·„ÂÈ ÛÔ‚·Ú‹ ÔappleÙÈ΋ ‚Ï¿‚Ë Î·È ·Ó·-appleËÚ›·. ∂appleÂȉ‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·applefi ¤ÏÏÂÈ„Ë Û˘-ÌappleÙˆÌ¿ÙˆÓ ¤¯ÂÈ Â‡ÛÙÔ¯· ¯·Ú·ÎÙËÚÈÛÙ› ˆ˜ «ÎÏÈÓÈ-ο ÛȈappleËÏ‹ ÔÓÙfiÙËÙ· Ì ̷ÎÚÈ¿ Î·È ‡appleÔ˘ÏË ‰È·-‰ÚÔÌ‹». øÛÙfiÛÔ Ë apple¿ıËÛË appleÚÔηÏ› ·ÓÙÈÏËappleÙ¿Û˘ÌappleÙÒÌ·Ù· Û˘¯ÓfiÙÂÚ· ·applefi ÙÔ °∞° (∫ÒÓÛÙ·˜1995). ŒÙÛÈ, Û ÔÚÈṲ̂Ó˜ appleÂÚÈappleÙÒÛÂȘ ÌappleÔÚ› Ó·appleÚÔηϤÛÂÈ ÌÈ· ÛÂÈÚ¿ ·applefi ˘appleÔÎÂÈÌÂÓÈο Û˘ÌappleÙÒ-Ì·Ù· fiappleˆ˜ ‹appleÈÔ ÔÊı·ÏÌÈÎfi applefiÓÔ ‹ ·›ÛıËÌ· «Ù¿-Û˘» ÏfiÁˆ ˘„ËÏ‹˜ ∂O, ‰˘ÛÎÔÏ›· ÛÙÔ ‰È¿‚·ÛÌ·,ÌÂȈ̤ÓË appleÂÚÈÊÂÚÈ΋ ‹ Ó˘ÎÙÂÚÈÓ‹ fiÚ·ÛË Î·È ÙÂÏÈ-ο ·appleÒÏÂÈ· Ù˘ fiÚ·Û˘, ÂÍ·ÈÙ›·˜ appleÚÔ¯ˆÚË̤Ó˘ÁÏ·˘ÎˆÌ·ÙÈ΋˜ Ó¢ÚÔapple¿ıÂÈ·˜ (Ritch et al 2003).∏ ˘„ËÏ‹ ∂O appleÔ˘ ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ °∞ ¤¯ÂÈ Âapple›-Û˘ ˆ˜ Âapple·ÎfiÏÔ˘ıÔ appleÈÔ Û˘¯Ó‹ ÂΉ‹ÏˆÛË ·ÁÁÂÈ·-ÎÒÓ ÂappleÂÈÛÔ‰›ˆÓ (apple.¯. ·applefiÊÚ·ÍË ÎÂÓÙÚÈ΋˜ ÊϤ‚·˜·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜), Ù· ÔappleÔ›· ‚Ï¿appleÙÔ˘Ó ÛÔ‚·Ú¿ÙËÓ fiÚ·ÛË.  ¤Ó· ÌÈÎÚfi appleÔÛÔÛÙfi, ÔÈ ·ÛıÂÓ›˜ ›Ûˆ˜apple·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ· appleÔ˘ ÌÈÌÂ›Ù·È ‰Ú·-Ì·ÙÈο ÙÔ Ô͇ ÁÏ·‡ÎˆÌ· ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜, Ì ÎfiÎ-ÎÈÓÔ Ì¿ÙÈ, Ô›‰ËÌ· ÎÂÚ·ÙÔÂȉԇ˜, ÎÂÊ·Ï·ÏÁ›· ηÈÔÊı·ÏÌÈÎfi applefiÓÔ (Gillies and Brooks 1988) ∏ ÂÈÎfi-Ó· ·˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ó¿appleÙ˘ÍË «Ôͤo˜ ÁÏ·˘ÎÒ-

122 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)Ì·ÙÔ˜ ·ÓÔȯً˜ ÁˆÓ›·˜», Ì ÌÈ· ∂O appleÔ˘ ÍÂappleÂÚÓ¿Ù· 50 mmHg (Brooks & Gillies 1988, Gillies andBrooks 1988, Jerndal 1986).  ·˘Ù¤˜ Ù˘ appleÂÚÈappleÙÒ-ÛÂȘ ÌappleÔÚ› Ó· Û˘Ó˘apple¿Ú¯ÂÈ ‹appleÈ· ˘appleÔÂappleÈıËÏȷ΋ ıfi-ψÛË ÙÔ˘ ÎÂÚ·ÙÔÂȉԇ˜, ·Ó Î·È ÛÙȘ appleÂÚÈÛÛfiÙÂÚ˜appleÂÚÈappleÙÒÛÂȘ Ô ÎÂÚ·ÙÔÂȉ‹˜ Â›Ó·È ‰È·Ê·Ó‹˜.∞applefi ÌÈ· ÛÂÈÚ¿ ÂÚÁ·ÛÈÒÓ ¤¯Ô˘Ó appleÚÔ·„ÂÈ·ÓÙÈÌ·¯fiÌÂÓ˜ ·applefi„ÂȘ ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÌÂٷ͇·appleÔÊÔÏ›‰ˆÛ˘ Î·È ÁÏ·˘ÎÒÌ·ÙÔ˜ ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜(Layden & Shaffer 1974, Wishart et al 1985, Ritch1994b, Gross et al 1994, Kasner et al 1997). OÈÔÊı·ÏÌÔ› Ì ∞ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ¤¯Ô˘Ó ¯·Ú·ÎÙË-ÚÈÛÙÈο appleÔ˘ appleÚԉȷı¤ÙÔ˘Ó Û ·Ó¿appleÙ˘ÍË ÁÏ·˘ÎÒ-Ì·ÙÔ˜ ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ (Ritch et al 2003). ˘ÁÎÂ-ÎÚÈ̤ӷ, ÎÔÚÈÎfi˜ ·appleÔÎÏÂÈÛÌfi˜ ÌappleÔÚ› Ó· appleÚÔ·-„ÂÈ ·applefi ÙÔÓ Û˘Ó‰˘·ÛÌfi ÔappleÈÛı›ˆÓ Û˘Ó¯ÂÈÒÓ, ·˘-ÍË̤ÓÔ˘ apple¿¯Ô˘˜ ‹ ‰˘Ûη̄›·˜ Ù˘ ›Úȉ·˜ ·ÏÏ¿Î·È appleÚfiÛıÈ·˜ ÌÂٷΛÓËÛ˘ ÙÔ˘ Ê·ÎÔ‡ ÏfiÁˆ ÂÍ·-Ûı¤ÓÈÛ˘ Ù˘ ˙ÈÓÓ›Ԣ ˙ÒÓ˘ (Ritch et al 2003).ΔÔ °∞ ÁÂÓÈο ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÁÏ·‡ÎˆÌ·appleÔ˘ ‰ÂÓ ÂϤÁ¯ÂÙ·È Â‡ÎÔÏ· Ì ÙË Ê·Ú̷΢ÙÈ΋ ıÂ-Ú·apple›· (Konstas et al 2005). ∞˘Ùfi appleÈı·ÓfiÓ Ó· Û¯Â-Ù›˙ÂÙ·È Ì ٷ ¯ÂÈÚfiÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ∂O.∂ÎÙfi˜ ·applefi ÙËÓ ˘„ËÏfiÙÂÚË Ì¤ÛË ÙÈÌ‹ ∂O ·appleԉ›-¯ıËΠfiÙÈ Î·È ÙÔ Â‡ÚÔ˜ Ù˘ 24ˆÚ˘ ‰È·Î‡Ì·ÓÛ˘ηıÒ˜ Î·È Ë Ì¤ÁÈÛÙË ÙÈÌ‹ Ù˘ ∂O ηٿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ 24ÒÚÔ˘ Â›Ó·È ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ÛÂÛ‡ÁÎÚÈÛË Ì ٷ ·ÓÙ›ÛÙÔȯ· ÌÂÁ¤ıË ÙÔ˘ °∞°.º·›ÓÂÙ·È apple¿ÓÙˆ˜ fiÙÈ Ë ÂÏ¿ÙÙˆÛË Ù˘ ∂O ¤¯ÂÈ¿ÌÂÛË Âapple›‰Ú·ÛË ÛÙËÓ ·appleÔÙÚÔapple‹ Ù˘ ¯ÂÈÚÔÙ¤Ú¢-Û˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì °∞, ·Ó Î·È ‰ÂÓ ÂÁÁ˘¿Ù·Èapple¿ÓÙ· ÙËÓ ÛÙ·ıÂÚÔappleÔ›ËÛË Ù˘ ‚Ï¿‚˘ Û fiÏÔ˘˜ÙÔ˘˜ ·ÛıÂÓ›˜ (Konstas 2004a).EappleÈappleÔÏ·ÛÌfi˜ Î·È ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ÛËÌ·Û›· ÙÔ˘ ∞Ù· ¿ÙÔÌ· Ì ∞ Ô Î›Ó‰˘ÓÔ˜ ·Ó¿appleÙ˘Í˘ ÁÏ·˘-ÎÒÌ·ÙÔ˜ Â›Ó·È ·ıÚÔÈÛÙÈÎfi˜ Ì ÙËÓ apple¿ÚÔ‰Ô ÙÔ˘¯ÚfiÓÔ˘. OÈ ·Ó·ÊÂÚfiÌÂÓ˜ ·Ó·ÏÔÁ›Â˜ ÂappleÈappleÔÏ·-ÛÌÔ‡ ÙÔ˘ ∞ appleÔÈΛÏÏÔ˘Ó Â˘Ú¤ˆ˜ (Aasved 1971a,Bartholomew 1973, Colin et al 1988, Kozobolis etal 1997; 2000, Stefaniotou et al 1990, Teshome &Regassa 2004). ΔÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÌappleÔÚ› Ó· ÔÊ›-ÏÂÙ·È ÙfiÛÔ Û appleÚ·ÁÌ·ÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ ÂappleÈappleÔÏ·ÛÌfiÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÌÂٷ͇ ÙˆÓ appleÏËı˘ÛÌÈ·-ÎÒÓ ÔÌ¿‰ˆÓ, fiÛÔ Î·È Û ‰È·ÊÔÚ¤˜ ÛÙ· ¯ÚËÛÈÌÔappleÔÈÔ‡ÌÂÓ·‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Î·È ÌÂıfi‰Ô˘˜.Œ¯ÂÈ apple·Ú·ÙËÚËı› fiÙÈ Ô ÂappleÈappleÔÏ·ÛÌfi˜ Ù˘ apple¿ıË-Û˘ ÂappleËÚ¿˙ÂÙ·È Î·ıÔÚÈÛÙÈο ·applefi ÙÔÓ ÙfiappleÔ ‰È·-‚›ˆÛ˘, ÙË Ê˘ÏÂÙÈ΋ appleÚԤϢÛË, ÙËÓ ËÏÈÎȷ΋ η-Ù·ÓÔÌ‹ ÙÔ‡ ˘applefi ÌÂϤÙË appleÏËı˘ÛÌÔ‡ Î·È ÙËÓ ‡apple·ÚÍËÛ˘ÓÔ‰ÒÓ ÔÊı·ÏÌÈÎÒÓ apple·ı‹ÛÂˆÓ Ì ΢ÚÈfiÙÂÚË ÙÔÁÏ·‡ÎˆÌ· (ºÔ˘ÓÙÔ˘Ï¿Î˘ 2005). ÙËÓ ∂˘ÚÒappleË ÔÈÌÂÁ·Ï‡ÙÂÚ˜ ·Ó·ÏÔÁ›Â˜ ∞ Î·È °∞ ÁÏ·˘ÎÒÌ·ÙÔ˜·Ó·Ê¤ÚÔÓÙ·È ÛÙË Î·Ó‰ÈÓ·‚›·, ÙË ƒˆÛ›·, ÙËÓπÛapple·Ó›· ÙËÓ πÚÏ·Ó‰›· Î·È ÙËÓ ∂ÏÏ¿‰·. ∞ÓÙÈappleÚÔ-Ûˆapple¢ÙÈΤ˜ ·Ó·ÏÔÁ›Â˜ ÂappleÈappleÔÏ·ÛÌÔ‡ ÙÔ˘ °∞ ÛÙÔÓÂÏÏËÓÈÎfi ÁÏ·˘ÎˆÌ·ÙÈÎfi appleÏËı˘ÛÌfi appleÔÈΛÏÏÔ˘Ó ÌÂ-ٷ͇ 25-54% (Konstas 1989, Konstas 1993, Kozoboliset al 1997, Stefaniotou et al 1990).Œ¯ÂÈ ÂÎÙÈÌËı› fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÙfiÌˆÓ ÌÂ∞ Î·È °∞ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 63Î·È 75 ÂηÙÔÌÌ˘Ú›ˆÓ (Ritch & Schlotzer-Schrehardt2001), ÔapplefiÙÂ Ë ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ ÛËÌ·-Û›· ÙÔ˘ °∞ ¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ· (Konstas et al 2003). ∂appleÈappleϤÔÓ, Û fiϘ ÙȘ·Ó·ÊÂÚfiÌÂÓ˜ ÛÂÈÚ¤˜ Ô ÂappleÈappleÔÏ·ÛÌfi˜ ÙÔ˘ °∞ ·˘-Í¿ÓÂÙ·È ÛÙ·ıÂÚ¿ Ì ÙËÓ ËÏÈΛ· Î·È ÁÈ’ ·˘Ùfi ÙÔ Ïfi-ÁÔ Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ appleÚԂϤappleÂÙ·È Ó· ·˘ÍËı›‰Ú·Ì·ÙÈο ̤۷ ÛÙȘ ÂapplefiÌÂÓ˜ ‰‡Ô ‰ÂηÂٛ˜,ÏfiÁˆ Ù˘ Á‹Ú·ÓÛ˘ ÙÔ˘ Â˘Úˆapple·˚ÎÔ‡ appleÏËı˘ÛÌÔ‡(Perasalo & Raitta 1992, Ringvold 1999, Ritch1994). Œ¯ÂÈ ˘appleÔÏÔÁÈÛÙ› fiÙÈ Ì¤Û· Û 10 ¯ÚfiÓÈ· ı·˘apple¿Ú¯ÂÈ ÌÈ· ·Ó¿ÁÎË ÁÈ· ·‡ÍËÛË ÙˆÓ ÔÈÎÔÓÔÌÈÎÒÓapplefiÚˆÓ appleÔ˘ appleÚÔÔÚ›˙ÔÓÙ·È ÁÈ· ÙË ÊÚÔÓÙ›‰· ÙÔ˘ÁÏ·˘ÎÒÌ·ÙÔ˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 30%, appleÚÔÎÂÈ̤-ÓÔ˘ ·appleÏ¿ Ó· ‰È·ÙËÚËıÔ‡Ó Ù· ÛËÌÂÚÈÓ¿ Âapple›apple‰·apple·ÚÔ¯ÒÓ (Raivio 1987). ∞˘Ù‹ Ë ·‡ÍËÛË ·appleÔ‰fiıË-Π۠ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÛÙËÓ ·˘Í·ÓfiÌÂÓË apple·ÚÔ˘-Û›· ÙÔ˘ °∞ ÛÙÔÓ ˘applefi ÌÂϤÙË appleÏËı˘ÛÌfi.∂ÍÂÏ›ÍÂȘ ÛÙËÓ apple·ıÔÁ¤ÓÂÈ· Ù˘ apple¿ıËÛ˘‹ÌÂÚ· ıˆÚÂ›Ù·È fiÙÈ ÙÔ ∞ Â›Ó·È ÌÈ· Û¯ÂÙÈ-˙fiÌÂÓË Ì ÙËÓ ËÏÈΛ·, ÁÂÓÈÎÂ˘Ì¤ÓË ‰È·Ù·Ú·¯‹ Ù˘ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜ (Ritch et al 2003, Koliakos etal 2003, Koliakos & Konstas 2005, ºÔ˘ÓÙÔ˘Ï¿Î˘2005), appleÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·applefi appleÔÏ˘ÂÛÙȷ΋ Û‡ÓıÂÛËÎ·È appleÚÔԉ¢ÙÈ΋ ¿ıÚÔÈÛË ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ ˘ÏÈ-ÎÔ‡, ÙÔ ÔappleÔ›Ô ‰ÂÓ ·appleÔÛ˘ÓÙ›ıÂÙ·È, ·ÏÏ¿ appleÚÔԉ¢ÙÈ-ο Û˘ÛÛˆÚ‡ÂÙ·È Û ‰È¿ÊÔÚÔ˘˜ ÂÓ‰ÔÊı¿ÏÌÈÔ˘˜Î·È ÂÍÔÊı¿ÏÌÈÔ˘˜ ÈÛÙÔ‡˜ (Ritch & Schlotzer-Schrehardt 2001, Ritch et al 2003). ΔÔ ˘ÏÈÎfi ·˘ÙfiÈÛÙÔÏÔÁÈο ¤¯ÂÈ ·Ó¢ÚÂı› ÛÙÔ Ê·Îfi, ÛÙËÓ ›Úȉ·,ÛÙÔ ·ÎÙÈÓˆÙfi ÛÒÌ·, ÛÙË ˙›ÓÓÂÈÔ ˙ÒÓË ÛÙÔ˘˜ ÂÛˆÙÂ-ÚÈÎÔ‡˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ ÙÔ˘ trabeculum Î·È ÙÔ˘ apple·Ú·-ηӷÏÈÎÔ‡ ‰ÈÎÙ˘ˆÙÔ‡. ΔÔ ˘ÏÈÎfi ÈÛÙÔÏÔÁÈο Î·È ÌÈ-ÎÚÔÛÎÔappleÈο Â›Ó·È Û¯Â‰fiÓ fiÌÔÈÔ Ì ÙÔ ·Ì˘ÏÔÂȉ¤˜,·ÏÏ¿ ‰È·Ê¤ÚÂÈ ÈÛÙÔ¯ËÌÈο. OÈ ÔÊı·ÏÌÈΤ˜ ÂΉËÏÒ-

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 123ÛÂȘ ÙÔ˘ ∞ ÂappleËÚ¿˙Ô˘Ó fiϘ ÙȘ ‰Ô̤˜ ÙÔ˘ appleÚfi-ÛıÈÔ˘ ı·Ï¿ÌÔ˘, ηıÒ˜ Âapple›Û˘ Î·È ÙÔ˘ ÂappleÈappleÂÊ˘ÎfiÙ·Î·È ÙˆÓ ÈÛÙÒÓ ÙÔ˘ ÎfiÁ¯Ô˘ (Ritch & Schlotzer-Schrehardt 2001, Koliakos & Konstas 2005). ∏ ·È-ÙÈÔÏÔÁ›· ·˘Ù‹˜ Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ‰È·Ù·Ú·¯‹˜ Ù˘ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜ apple·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË.∏ ÙÚ¤¯Ô˘Û· ·ÓÙ›ÏË„Ë ÁÈ· ÙÔ ∞ appleÚÔÙ›ÓÂÈÌÈ· ˘appleÂÚ‚ÔÏÈ΋ Û‡ÓıÂÛË ‹ ·ÓÂapple·Ú΋ ·appleÔ‰fiÌËÛËÛ˘ÛÙ·ÙÈÎÒÓ Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜ (apple.¯. ÙˆÓÂÏ·ÛÙÈÎÒÓ ÌÈÎÚÔ˚Óȉ›ˆÓ Î.¿.), appleÔ˘ ‰ÈÂÁ›ÚÂÙ·È ·applefiÙÔÓ TGF-‚1 Î·È Ô‰ËÁ› Û ¿ıÚÔÈÛ‹ ÙÔ˘˜ ÛÙȘ ¯·-Ú·ÎÙËÚÈÛÙÈΤ˜ ·appleÔÊÔÏȉˆÙÈΤ˜ ›Ó˜ (Koliakos et al2003, Ritch et al 2003). ÿÛˆ˜, Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ·apple·ıÔÏÔÁÈΤ˜ ‰È·‰Èηۛ˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ Î·È ÔÚÈ-Ṳ̂ӷ Û˘ÛÙ·ÙÈο Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ appleÚÔÂÚ-¯fiÌÂÓ· ·applefi ÌÂÚÈÎÒ˜ ·appleÔ‰ÔÌË̤Ó˜ appleÚˆÙ½Ó˜ Ù˘‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘, ·ÏÏËÏÂappleȉÚÔ‡Ó Ì ΢ÙÙ·ÚÈ-ÎÔ‡˜ ˘appleԉԯ›˜, Ô‰ËÁÒÓÙ·˜ Û ¤Ó·Ó Ê·‡ÏÔ Î‡ÎÏÔÛ‡ÓıÂÛ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ ˘ÏÈÎÔ‡ Î·È ÂappleÈappleÚfiÛıÂÙËÂÓۈ̿وÛË ÛÙȘ ·appleÔÊÔÏȉˆÙÈΤ˜ ›Ó˜ (Ritch et al2003). ∏ apple·ÚÔ˘Û›· appleÚˆÙÂÔÁÏ˘Î·ÓÒÓ Î·È Ë ‚ÈÔ¯Ë-ÌÈ΋ Û˘ÁÁ¤ÓÂÈ· Ì ÙȘ ÂÏ·ÛÙÈΤ˜ ›Ó˜ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈÛÙËÓ ˘applefiıÂÛË fiÙÈ ÙÔ ∞ Â›Ó·È ‰È·Ù·Ú·¯‹ ÛÙË Û‡ÓıÂÛËÙˆÓ ‚·ÛÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ. Èı·Ó¤˜ ı¤ÛÂȘapple·Ú·ÁˆÁ‹˜ ÙÔ˘ ˘ÏÈÎÔ‡ ·˘ÙÔ‡ Â›Ó·È Ù· ÂappleÈıËÏȷο·ÙÙ·Ú· ÙÔ˘ appleÚÔÛı›Ô˘ appleÂÚÈÊ·Î›Ô˘, Ù· ¯ÚˆÛÙÈÎÔ-ÊfiÚ· ·ÙÙ·Ú· Ù˘ ›Úȉ·˜ Î·È ÙÔ˘ ·ÎÙÈÓˆÙÔ‡ ÛÒÌ·-ÙÔ˜, Î·È Ù· appleÂÚÈ·ÙÙ·Ú· Ù˘ ›Úȉ·˜ Î·È ÙÔ˘ ·ÎÙÈ-ÓˆÙÔ‡ ÛÒÌ·ÙÔ˜.∞ÓÔÛÔ˚ÛÙÔ¯ËÌÈΤ˜ ÌÂϤÙ˜ apple·ÚÔ˘ÛÈ¿˙Ô˘Ó Â˘-Ú‹Ì·Ù· appleÔ˘ Û˘ÓËÁÔÚÔ‡Ó ÛÙË Û‡ÓıÂÛË ‰È·ÊfiÚˆÓ·˘ÍËÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ fiappleˆ˜ IGF-1, TGF-‚1 ηȂ2 ·applefi Ù· ÂappleÈıËÏȷο ·ÙÙ·Ú· ÙÔ˘ ·ÎÙÈÓˆÙÔ‡ ÛÒ-Ì·ÙÔ˜. Δ· ·ÙÙ·Ú· ÙÔ˘ ‰ÈÎÙ˘ˆÙÔ‡ Û¯ËÌ·ÙÈÛÌÔ‡ ‰È·-ı¤ÙÔ˘Ó ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ ˘appleԉԯ›˜ ÁÈ· ÙÔ˘˜ ›‰ÈÔ˘˜ ·˘-ÍËÙÈÎÔ‡˜ apple·Ú¿ÁÔÓÙ˜. ∏ ·ÁÁÂÈÔapple¿ıÂÈ· Ù˘ ›Úȉ·˜Î·È Ë ·˘ÍË̤ÓË ‰È·appleÂÚ·ÙfiÙËÙ· ÙÔ˘ ·ÈÌ·ÙÔ-˘‰·ÙÔÂÈ-‰ÈÎÔ‡ ÊÚ·ÁÌÔ‡ ·appleÔÙÂÏÔ‡Ó ÂappleȂ‚·ÈˆÌ¤Ó· ¯·Ú·-ÎÙËÚÈÛÙÈο ÙÔ˘ ∞. ø˜ ¿ÌÂÛË Û˘Ó¤appleÂÈ· appleÚÔ·appleÙÂÈË ·˘ÍË̤ÓË ‰È·appleÂÚ·ÙfiÙËÙ· appleÚˆÙÂ˚ÓÒÓ ·applefi ÙÔ appleÏ¿-ÛÌ· ÛÙÔÓ appleÚfiÛıÈÔ ı¿Ï·ÌÔ. (Schlotzer-Schrehardt etal 2003). ∂Í·ÈÙ›·˜ Ù˘ ·ÓÈÛÔÚÚÔapple›·˜ ÙˆÓ ÂÓ˙‡ÌˆÓ·appleÔ‰fiÌËÛ˘ Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜ (ÌÂÙ·ÏÏÔappleÚˆÙ¿Û˜,MMP) Î·È ÙˆÓ ·Ó·ÛÙÔϤˆÓ ÙÔ˘˜(TIMP), ÙÔ apple·ıÔÏÔÁÈÎfi ·appleÔÊÔÏȉˆÙÈÎfi ˘ÏÈÎfi ‰ÂÓ·appleÔ‰ÔÌÂ›Ù·È ·ÏÏ¿ Ì ÙËÓ apple¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘·ıÚÔ›˙ÂÙ·È appleÚÔԉ¢ÙÈο ÂÓÙfi˜ ÙˆÓ ÈÛÙÒÓ. ∞˘Ù‹ Ëapple·ıÔÏÔÁÈ΋ ¿ıÚÔÈÛË ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎԇ̷˙› Ì ÙËÓ apple·Ú¿ÏÏËÏË ·appleÂÏ¢ı¤ÚˆÛË Î·È ·applefiıÂ-ÛË Ù˘ ¯ÚˆÛÙÈ΋˜ ÛÙÔ ‰›ÎÙ˘Ô ·appleÔ¯¤Ù¢Û˘ ηٷϋ-ÁÔ˘Ó Ì ÙËÓ apple¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Û ÌÈ· apple·ıÔÏÔÁÈ΋·ÏÏËÏÔ˘¯›· ÁÂÁÔÓfiÙˆÓ ÛÙÔ Û‡ÛÙËÌ· ÂÎÚÔ‹˜, appleÔ˘Ô‰ËÁÔ‡Ó ·Ú¯Èο Û ·˘ÍË̤ÓË ∂O (ÔÊı·ÏÌÈ΋˘appleÂÚÙÔÓ›·) Î·È ÙÂÏÈο ÛÙËÓ ·Ó¿appleÙ˘ÍË ÙÔ˘ °∞.ŒÓ·˜ ·ÚÈıÌfi˜ ‚ÈÔ¯ËÌÈÎÒÓ Î·È ÌË apple·Ú·Áfi-ÓÙˆÓ, ›Ûˆ˜ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ °∞(Koliakos & Konstas 2005). ∏ ·Ó·ÁÓÒÚÈÛË Ù¤ÙÔÈ-ˆÓ apple·Ú·ÁfiÓÙˆÓ ÛÙÔ °∞ ı· ÌappleÔÚÔ‡Û ӷ ¤¯ÂÈ ÛË-Ì·ÓÙÈ΋ ·Í›· ÛÙÔ Ì¤ÏÏÔÓ (Orr et al 2001). Èı·Ó¿ÁÂÓÂÙÈο appleÚfiÙ˘apple· appleÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÈÙÔ¯ÔÓ‰Úȷ΋,·˘ÙÔۈ̷ÙÈ΋ ‹ Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ·(Damji et al 1998) ÂÓÒ ÛÙÔ˘˜ appleÈı·ÓÔ‡˜ ÌË ÁÂÓÂÙÈ-ÎÔ‡˜ apple·Ú¿ÁÔÓÙ˜ Û˘ÌappleÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ˘appleÂÚÈÒ-‰Ë˜ ·ÎÙÈÓÔ‚ÔÏ›· (UVA), ÙÚ·‡Ì·Ù·, ·ÓÔÛÔÏÔÁÈÎÔ›apple·Ú¿ÁÔÓÙ˜ ‹ È˚΋ ÌfiÏ˘ÓÛË (Damji et al 1998,Kozobolis et al 1999, Orr et al 2001). ·Ú¿ ÙÔ fiÙȉÂÓ ÌappleÔÚ› Ó· ·appleÔÎÏÂÈÛÙ› ¤Ó·˜ appleÔÏ˘apple·Ú·ÁÔÓÙÈ-Îfi˜ ÙÚfiappleÔ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, appleÚfiÛÊ·Ù˜ appleÏËÚÔ-ÊÔڛ˜ ·applefi ÌÂϤÙ˜ Î·È ÌÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÈ-‰ÈÎÒÓ Ù‡appleˆÓ HLA appleÚÔÙ›ÓÔ˘Ó fiÙÈ ÙÔ °∞ ›Ûˆ˜ ÎÏË-ÚÔÓÔÌÂ›Ù·È ˆ˜ ¤Ó· ·˘ÙÔÛˆÌÈÎfi ΢ڛ·Ú¯Ô ¯·Ú·-ÎÙËÚÈÛÙÈÎfi Ì ηı˘ÛÙÂÚË̤ÓË ¤Ó·ÚÍË Î·È ·ÙÂÏ‹‰È›ۉ˘ÛË (FitzSimon et al 1996). ·ÚfiÏ· ·˘Ù¿,Ù· ‰Â‰Ô̤ӷ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Â›Ó·È ·ÓÂapple·Ú΋,·Ó·ÊÔÚÈο Ì ÂȉÈο ÁÔÓ›‰È· appleÔ˘ ÂÌappleϤÎÔÓÙ·ÈÛÙËÓ ·Ó¿appleÙ˘ÍË ÙÔ˘ °∞.ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ Û˘Ó‰¤Ô˘Ó ÙËÓ apple·ÚÔ˘Û›·ÙÔ˘ DNA ÙÔ˘ ÈÔ‡ ÙÔ˘ ÎÔÈÓÔ‡ ¤ÚappleËÙ· (HSV) ÛÙËÓ›Úȉ· Î·È ÛÙËÓ ·Ó¿appleÙ˘ÍË ÙÔ˘ °∞ (Detorakis et al2002). Œ¯ÂÈ appleÈÛÙÔappleÔÈËı› Âapple·ÚÎÒ˜ fiÙÈ Ô HSV ›-Ó·È ÌÈ· ÁÓˆÛÙ‹ ·ÈÙ›· ÁÂÓÂÙÈ΋˜ ‚Ï¿‚˘, appleÔ˘ ÂÓÂÚ-ÁÔappleÔÈÂ›Ù·È Û˘¯Ó¿ ·applefi appleÂÚÈ‚·ÏÏÔÓÙÈο ÂÚÂı›ÛÌ·-Ù·. T· ‰Â‰Ô̤ӷ ·˘Ù¿ ˘appleÔ‰˘ÎÓÂ›Ô˘Ó fiÙÈ Ë apple·ıÔ-Á¤ÓÂÛË ÙÔ˘ °∞ ›Ûˆ˜ ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÏÏËÏÂapple›‰Ú·-ÛË ÌÂٷ͇ ÁÂÓÂÙÈÎÒÓ Î·È appleÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ apple·Ú·Áfi-ÓÙˆÓ. ªÈ· ¿ÏÏË Û¯ÂÙÈ΋ ÌÂϤÙË ˘apple¤‰ÂÈÍ ·appleÒÏÂÈ·Ù˘ ÂÙÂÚÔ˙˘ÁˆÙ›·˜ (LOH) ÛÙȘ ¯ÚˆÌÔÛˆÌÈΤ˜ appleÂ-ÚÈÔ¯¤˜ 1q, 7p, 7q, 9p, 9q Î·È 13q, Û ‰Â›ÁÌ·Ù· ›Úȉ·˜Î·È appleÚfiÛıÈ·˜ ο„·˜ ·applefi ·ÛıÂÓ›˜ Ì °∞, ÂappleÈÛË-Ì·›ÓÔÓÙ·˜ fiÙÈ ·˘Ù¤˜ ÔÈ ¯ÚˆÌÔÛˆÌÈΤ˜ appleÂÚÈÔ¯¤˜›Ûˆ˜ appleÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÁÔÓ›‰È· appleÔ˘ ÂÌappleϤÎÔÓÙ·È ÛÙËÓapple·ıÔÁ¤ÓÂÛË ÙÔ˘ °∞ (Kozobolis et al 1999). ∏ LOHÛ˘Û¯ÂÙ›ÛÙËΠ̠ÙÔ ˘„fiÌÂÙÚÔ Ù˘ ηÙÔÈΛ·˜, ÙÔÔappleÔ›Ô Ì ÙË ÛÂÈÚ¿ ÙÔ˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ¤ÎıÂÛËÛÙËÓ ˘appleÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›·. ΔÔ Â‡ÚËÌ· ·˘Ùfi ˘appleÔ-‰ËÏÒÓÂÈ ÌÈ· ·˘ÍË̤ÓË ‰ÂÎÙÈÎfiÙËÙ· ÙˆÓ ÁÂÓÂÙÈÎÒÓappleÂÚÈÔ¯ÒÓ appleÔ˘ ÂÍÂÙ¿ÛÙËÎ·Ó Û UV∞.∏ appleÔÈΛÏË ‰È¿‰ÔÛË ÙÔ˘ °∞ Û ‰È¿ÊÔÚ˜ Áˆ-ÁÚ·ÊÈΤ˜ ÙÔappleÔıÂۛ˜ Î·È appleÏËı˘ÛÌÔ‡˜ ¤¯ÂÈ ·appleÔ‰Ôı›ÛÙÔ apple·ÚÂÏıfiÓ Î·È ÛÙËÓ UVA, ÌÈ· ‚·ÛÈ΋ ·ÈÙ›·apple·Ú·ÁˆÁ‹˜ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ (Taylor 1979). Úfi-ÛÊ·Ù· ·Ó·Ê¤ÚıËÎ·Ó ÌÂȈ̤ӷ Âapple›apple‰· ·ÛÎÔÚ‚È-

124 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)ÎÔ‡ ÔͤԘ, ·ÚÈÔ˘ ·Ó·ÛÙÔϤ· ÙˆÓ ÂÏ¢ı¤ÚˆÓ ÚÈ-˙ÒÓ ÛÙÔÓ ÔÊı·ÏÌfi, ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ÙˆÓ·ÛıÂÓÒÓ Ì °∞ ( Koliakos et al 2002b). ∏ ̤-Û˱SD Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ ÛÙÔ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ·ÙfiÌˆÓ Ì ∞ (0.86±0.43 mM)‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ٷ ˘ÁÈ‹¿ÙÔÌ· Ù˘ ›‰È·˜ ËÏÈΛ·˜ Δ· ·appleÔÙÂϤÛÌ·Ù· ·˘Ù¿˘appleÔÛÙËÚ›˙Ô˘Ó ¤Ó· ÂÏ·Ùو̷ÙÈÎfi ·ÓÙÈÔÍÂȉˆÙÈÎfi·Ì˘ÓÙÈÎfi Û‡ÛÙËÌ·. ∂appleÈappleÚfiÛıÂÙ·, appleÚfiÛÊ·Ù· ‰È·-appleÈÛÙÒıËΠÌÈ· ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓÛ˘ÁÎÂÓÙÚÒÛÂˆÓ ÙÔ˘ ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ ÛÙÔ ˘‰·ÙÔ-Âȉ¤˜ ˘ÁÚfi Î·È ÙÔ˘ 8-ÈÛÔappleÚÔÛÙ·Ó›Ô˘ ÛÙÔ ›‰ÈÔ ˘ÁÚfi(Koliakos et al 2003b).¢ÔÌ‹ ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ΔÔ ·ÓÒÌ·Ï· apple·Ú·¯ı¤Ó ˘ÏÈÎfi ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙÔ ÌÈÎÚÔÛÎfiappleÈÔ ˆ˜ periodic acid–Schiff (PAS) ıÂÙÈ-Îfi, ˈÛËÓÔÊÈÏÈÎfi Î·È Ô˙҉˜. EÓÙÔapple›˙ÂÙ·È ÛÙ·appleÚfiÛıÈ· ÌfiÚÈ· ÙÔ˘ ‚ÔÏ‚Ô‡, fiappleˆ˜ ÙÔ appleÚfiÛıÈÔ appleÂÚÈ-Ê¿ÎÈÔ, ÙËÓ appleÚfiÛıÈ· Î·È Ôapple›ÛıÈ· ÂappleÈÊ¿ÓÂÈ· Ù˘ ›ÚÈ-‰·˜, ÙȘ ·ÎÙÈÓˆÙ¤˜ appleÚÔÛÂ΂ÔϤ˜, ÙË ˙›ÓÓÂÈÔ ˙ÒÓË, ÙËÁˆÓ›· ÙÔ˘ appleÚÔÛı›Ô˘ ı·Ï¿ÌÔ˘, ÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙÔ˘ ÎÂ-Ú·ÙÔÂȉԇ˜ Î·È ÙËÓ appleÚfiÛıÈ· ˘·ÏÔÂȉÈ΋ ÂappleÈÊ¿ÓÂÈ·(Garner & Alexander 1984, Ritch et al 2003).ªÂ ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ËÏÂÎÙÚÔÓÈÎÔ‡ ÌÈÎÚÔÛÎÔapple›-Ô˘ Á›ÓÂÙ·È ÂÌÊ·Ó¤˜ fiÙÈ ÔÈ Ô˙Ò‰ÂȘ Û˘ÛÛˆÚ‡ÛÂȘ·appleÔÙÂÏÔ‡ÓÙ·È ·applefi ·ÓÒÌ·Ï· ÈÓ›‰È·. ΔÔ ËÏÂÎÙÚÔÓÈ-Îfi ÌÈÎÚÔÛÎfiappleÈÔ ·appleÔηχappleÙÂÈ fiÙÈ ÔÈ Û˘ÛÛˆÚ‡ÛÂȘ·appleÔÙÂÏÔ‡ÓÙ·È ·applefi ›Ó˜ Ù˘¯·›· ‰È·ÙÂÙ·Á̤Ó˜, ËÏÂ-ÎÙÚÔÓÈο apple˘ÎÓ¤˜, Ì ÌÔÚÊ‹ ¢ı›· ‹ ηÌapple‡ÏË, ÌÂappleÂÚÈÛÙ·ÛȷΤ˜ appleÚÔÛÂ΂ÔϤ˜ (Naumann et al1998). °ÂÓÈο, ‰‡Ô Ù‡appleÔÈ ·applefi ·appleÔÊÔÏȉˆÙÈο ÈÓ›-‰È· ÌappleÔÚÔ‡Ó Ó· ‰È·ÊÔÚo‰È·ÁÓˆÛıÔ‡Ó. Δ· Δ‡appleÔ˘∞ ÈÓ›‰È· ¤¯Ô˘Ó ‰È¿ÌÂÙÚÔ 18-25 nm, Î·È Ì›· appleÂÚÈÔ-‰È΋ ÂappleÈÎÚ·ÙÔ‡Û· ˙ÒÓË Û‡Ó‰ÂÛ˘ ÙˆÓ 50 nm, ‹ ÏÈ-ÁfiÙÂÚÔ Û˘¯Ó¿ ÙˆÓ 25 nm. Δ· Ù‡appleÔ˘ μ ÈÓ›‰È· ›ӷÈÎÔÓÙ‡ÙÂÚ· (0.3-0.5 nm), apple·¯‡ÙÂÚ· (30-45 nm), appleÂ-ÚÈÛÛfiÙÂÚÔ ËÏÂÎÙÚÔÓÈο apple˘ÎÓ¿, Ì ÏÈÁfiÙÂÚÔ ÂÌÊ·-Ó‹ ˙ÒÓË Û‡Ó‰ÂÛ˘. ∞˘Ù¿ Ù· ȉȷÈÙ¤Úˆ˜ ¯·Ú·ÎÙËÚÈ-ÛÙÈο ·appleÔÊÔÏȉˆÙÈο ÈÓ›‰È· ·ÏÏËÏÔÛ˘ÌappleϤÎÔÓÙ·ÈÎ·È ·appleÔÙÂÏÔ‡ÓÙ·È ·applefi ÌÈÎÚÔ˚Ó›‰È· Ù· ÔappleÔ›· ¤¯Ô˘Ó3-7 nm ‹ 8-10 nm ‰È¿ÌÂÙÚÔ, Â›Ó·È ÛˆÏËÓÔÂȉ‹ ÛÂÂÁοÚÛȘ ÙÔ̤˜ Î·È ¤¯Ô˘Ó ÌÈÎÚÔappleÂÚÈÔ‰ÈÎfiÙËÙ·10-12 nm (Ritch & Schlotzer-Schrehardt 2001). OÈÌÈÎÚÔ˚Óȉ҉ÂȘ ˘appleÔÌÔÓ¿‰Â˜ Ê·›ÓÔÓÙ·È Ó· ‰È·ÌÔÚ-ÊÒÓÔ˘Ó ¤Ó·Ó apple˘Ú‹Ó· ·applefi ÙËÓ appleÏ¢ÚÈ΋ Û˘Ó¿ıÚÔÈ-ÛË, Ô ÔappleÔ›Ô˜ Â›Ó·È Î·Ï˘Ì̤ÓÔ˜ ·applefi ¤Ó· ËÏÂÎÙÚÔÓÈ-ο apple˘ÎÓfi Û˘Áί˘Ì¤ÓÔ ˘ÏÈÎfi Ì appleÏ¢ÚÈΤ˜ Â΂Ϸ-ÛÙ‹ÛÂȘ Û ٷÎÙ¿ ‰È·ÛÙ‹Ì·Ù·, appleÔ˘ ·ÓÙÈÛÙÔȯԇÓÛÙȘ ÛÙ·˘ÚÔÂȉ›˜ Û˘Ó‰¤ÛÂȘ ÙˆÓ ·appleÔÊÔÏȉˆÙÈÎÒÓÈÓÒÓ. OÈ ·appleÔÊÔÏȉˆÙÈΤ˜ ›Ó˜ ‰È·appleϤÎÔÓÙ·È Û¿ÌÔÚÊË Ô˘Û›·. Èı·Ófiٷٷ, ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î¿-Ó˜ Â›Ó·È apple·ÚÔ‡Û˜ ÛÙËÓ ÂappleÈÊ¿ÓÂÈ· ÙˆÓ ·appleÔÊÔÏÈ-‰ˆÙÈÎÒÓ ÈÓȉ›ˆÓ Î·È ·ÓÙÈappleÚÔÛˆappleÂ‡Ô˘Ó ÙÔ ÌÂÛÔ˚ÓÈ-‰È·Îfi ˘ÏÈÎfi (Koliakos & Konstas 2005).·Ú¿ ÙËÓ ÂÎÙÂÓ‹ ¤Ú¢ӷ, Ë ·ÎÚÈ‚‹˜ ¯ËÌÈ΋ۇÓıÂÛË ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ apple·Ú·Ì¤ÓÂÈ¿ÁÓˆÛÙË. OÈ ‚ÈÔ¯ËÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ÂÌappleÔ‰›˙ÔÓÙ·È·applefi Ù· ·ÓÂapple·Ú΋ appleÔÛ¿ ÙÔ˘ ‰È·ı¤ÛÈÌÔ˘ ˘ÏÈÎÔ‡,·applefi ÙËÓ ·‰È·Ï˘ÙfiÙËÙ· ÙÔ˘ ˘ÏÈÎÔ‡ Î·È ·applefi ÙËÓ ¤Ï-ÏÂÈ„Ë appleÂÈÚ·Ì·ÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘. ŒÌÌÂÛ· ÈÛÙÔ¯ËÌÈ-ο Î·È ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈο ÛÙÔȯ›· appleÚÔÙ›ÓÔ˘Ó ¤Ó·Û‡ÌappleÏÂÁÌ· ·applefi ÁÏ˘ÎÔappleÚˆÙ½ÓË / appleÚˆÙÂÔÁÏ˘Î¿ÓË·appleÔÙÂÏÔ‡ÌÂÓÔ ·applefi ¤Ó·Ó appleÚˆÙÂ˚ÓÈÎfi apple˘Ú‹Ó· appleÔ˘appleÂÚÈ‚¿ÏÏÂÙ·È ·applefi ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î¿Ó˜. ΔÔ ·appleÔ-ÊÔÏȉˆÙÈÎfi ˘ÏÈÎfi ·Óı›ÛÙ·Ù·È ÛÙËÓ ·appleÔ‰fiÌËÛË·applefi Ù· appleÂÚÈÛÛfiÙÂÚ· ¤Ó˙˘Ì·, Û˘ÌappleÂÚÈÏ·Ì‚·ÓÔ̤-ÓˆÓ Ù˘ ÎÔÏÏ·ÁÂÓ¿Û˘, ÙÚ˘„›Ó˘, apple„›Ó˘ Î·È apple·-apple·˝Ó˘.ªÂ ‚¿ÛË Ù· ‚ÈÔ¯ËÌÈο Î·È ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈο‰Â‰Ô̤ӷ ‰È·ÌÔÚÊÒÓÔÓÙ·È ÙÚÂȘ ·ÚȘ ıˆڛ˜ۯÂÙÈο Ì ÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡˘ÏÈÎÔ‡. ∏ appleÚÒÙË ÔÓÔÌ¿˙ÂÙ·È «ıˆڛ· ÙÔ˘ ·Ì˘ÏÔ-Âȉԇ˜» Î·È ‚·Û›ÛÙËΠÛÙËÓ Â‡ÚÂÛË appleÚˆÙÂ˚ÓÈÎÒÓÛ˘ÛÙ·ÙÈÎÒÓ ÛÙÔ ·appleÔÊÔÏȉˆÙÈÎfi ˘ÏÈÎfi, fiappleˆ˜ ÙÔ·Ì˘ÏÔÂȉ¤˜ ƒ, ηıÒ˜ Î·È ÛÙË ıÂÙÈ΋ Ù·˘ÙÔappleÔ›ËÛËÙÔ˘ ·Ì˘ÏÔÂȉԇ˜ ∞ Ì ÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÛÙÔapple·Ú·apple¿Óˆ ˘ÏÈÎfi (Ringvold et al 1973). øÛÙfiÛÔ,appleÂÚÈÛÛfiÙÂÚÔ ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÂÍÂÙ¿ÛÂȘ, fiappleˆ˜ ÔappleÚÔÛ‰ÈÔÚÈÛÌfi˜ appleÚˆÙÂ˚ÓÈÎÒÓ ‰ÔÌÒÓ Ì ÌÔÓÔÎψÓÈ-ο ·ÓÙÈÛÒÌ·Ù· Î·È Ì ¯ÚÒÛÂȘ ÂÚ˘ıÚÔ‡ ÙÔ˘Congo, ¤‰ˆÛ·Ó ·ÚÓËÙÈο ·appleÔÙÂϤÛÌ·Ù· ˆ˜ appleÚÔ˜ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ‚-·Ì˘ÏÔÂȉԇ˜, ÙÔ˘ ·Ì˘ÏÔÂÈ-‰Ô‡˜ ∞, Ù˘ appleÚfi‰ÚÔÌ˘ appleÚˆÙ½Ó˘ ÙÔ˘ ·Ì˘ÏÔÂÈ-‰Ô‡˜, Ù˘ ÙÚ·ÓÛı˘ÚÂÙ›Ó˘ Î·È ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈ-ÓÒÓ ÙˆÓ ÂÏ·ÊÚÒÓ ·Ï‡ÛˆÓ (Ringvold et al 1993)˘ÓÂappleÒ˜, apple·ÚfiÏÔ appleÔ˘ οappleÔȘ appleÂÚÈappleÙÒÛÂȘ ∞Û˘Ó˘apple¿Ú¯Ô˘Ó Ì appleÚˆÙÔapple·ı‹ ·Ì˘ÏÔ›‰ˆÛË, Ë Û˘-ÁÎÂÎÚÈ̤ÓË ıˆڛ· ‰ÂÓ ÌappleÔÚ› Ó· ÂappleȂ‚·Èˆı›.∏ ‰Â‡ÙÂÚË ıˆڛ· ·Ó·Ê¤ÚÂÙ·È ˆ˜ «ıˆڛ·Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘». ÙËÚ›˙ÂÙ·È ÛÙËÓ ˘applefiıÂ-ÛË fiÙÈ Ë apple·Ú·ÁˆÁ‹ ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ ›-Ó·È ·appleÔÙ¤ÏÂÛÌ· ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘. ∞˘Ùfi ˘appleÔÛÙËÚ›˙ÂÙ·È ·applefiÙË Û˘¯Ó‹ Û˘Û¯¤ÙÈÛË ‡apple·Ú͢ ÙÔ˘ ˘ÏÈÎÔ‡, Ì ·Óˆ-̷ϛ˜ Ù˘ ÂappleÈÊ¿ÓÂÈ·˜ ÙˆÓ ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÈÎÒÓÙ‡appleˆÓ, appleÔ˘ ÂÓÔ¯ÔappleÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ú¯È΋ ÙÔ˘ apple·-Ú·ÁˆÁ‹ Î·È ·applefi ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈΤ˜ ·appleԉ›ÍÂȘ‡apple·Ú͢ ·ÓÙÈÁÔÓÈÎÒÓ Î·ıÔÚÈÛÙÒÓ (ÂappleÈÙfiappleˆÓ) Ù˘‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ (Konstas et al 1990, Schlotzer-

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 125Schrechardt et al 1992), fiappleˆ˜ Ë Ï·ÌÈÓ›ÓË, ÙÔ ÈÓˆ-‰ÔÁfiÓÔ Î·È Ë appleÚˆÙÂÔÁÏ˘Î¿ÓË ıÂÈ˚΋ Ëapple·Ú¿ÓË. H˘applefiıÂÛË ·˘Ù‹ ˘appleÔÛÙËÚ›˙ÂÙ·È Î·È ·applefi ÙÔ ÁÂÁÔÓfi˜Ù˘ ·Ó‡ÚÂÛ˘ ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ·ÛıÂÓÒÓ ÌÂA Î·È °A ·˘ÍËÌ¤ÓˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÌÂÙ·Û¯Ë-Ì·Ù›˙ÔÓÙÔ˜ ·˘ÍËÙÈÎÔ‡ apple·Ú¿ÁÔÓÙ· ‚‹Ù· 1 (TGFbeta 1) (Schlotzer-Schrechardt et al 2001, Koliakoset al 2001). Ÿappleˆ˜ ·Ó·Ê¤ÚÂÙ·È apple·Ú·Î¿Ùˆ, Ô apple·Ú¿-ÁÔÓÙ·˜ ·˘Ùfi˜ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ apple·ıÔÏÔÁÈ΋ apple·Ú·-ÁˆÁ‹ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜ Î·È ÙËÓ ›ÓˆÛË Û appleÔÏ-Ϥ˜ apple·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ.Δ¤ÏÔ˜, Ë ÙÚ›ÙË ıˆڛ· Â›Ó·È ·˘Ù‹ «ÙˆÓ ÂÏ·-ÛÙÈÎÒÓ ÌÈÎÚÔ˚Óȉ›ˆÓ». μ·Û›˙ÂÙ·È ÛÙË ‰ÔÌÈ΋ Û˘-Û¯¤ÙÈÛË ÙˆÓ ·appleÔÊÔÏȉˆÙÈÎÒÓ ÈÓÒÓ Ì ÙȘ ›Ó˜ ÙÔ˘ÂÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, appleÔ˘ ˘appleÔÛÙËÚ›˙ÂÙ·ÈÌ ÈÛÙÔ¯ËÌÈΤ˜ ¯ÚÒÛÂȘ, Î·È ÛÙȘ ÌÔÚÊÔÏÔÁÈΤ˜ÂӉ›ÍÂȘ fiÙÈ Ë ·Ó¿appleÙ˘ÍË ÙˆÓ appleÚÒÙˆÓ ÛÙËÚ›˙ÂÙ·ÈÛÙËÓ ÂÎʇÏÈÛË ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÈÓÒÓ (Garner et al1984). ΔË ıˆڛ· ·˘Ù‹ ÙÔÓ›˙ÂÈ ·ÎfiÌË appleÂÚÈÛÛfiÙÂÚÔË Î˘Ú›·Ú¯Ë ‡apple·ÚÍË ‰È·ÊfiÚˆÓ ÂappleÈÙfiappleˆÓ ÂÏ·ÛÙÈ-ÎÔ‡ ÈÛÙÔ‡, fiappleˆ˜ Ë ÂÏ·ÛÙ›ÓË, Ë ÊÈÌappleÚÈÏ›ÓË, ÙÔ ·Ì˘-ÏÔÂȉ¤˜-ƒ Î·È Ë ‚ÈÙÚÔÓÂÎÙ›ÓË, ̤۷ ÛÙÔ apple·ıÔÏÔÁÈ-Îfi ˘ÏÈÎfi. ˘ÁÎÂÎÚÈ̤ӷ, Ë appleÚÔÂÍ¿Ú¯Ô˘Û· Ù·˘ÙÔappleÔ›ËÛË,ÙfiÛÔ Û ÂÓ‰Ô‚ÔÏ‚ÈΤ˜ fiÛÔ Î·È Û Â͈‚ÔÏ-‚ÈΤ˜ appleÂÚÈÔ¯¤˜, ÙˆÓ apple·Ú·ÁfiÓÙˆÓ LΔμƒ, Ù˘ ÊÈ-ÌappleÚÈÏ›Ó˘ ·ÏÏ¿ Î·È ·˘ÍËÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ (TGF-‚1), ‰›ÓÂÈ ÙËÓ ¤Ó‰ÂÈÍË fiÙÈ ›Ûˆ˜ ÙÔ ∞ ·appleÔÙÂÏ› ¤Ó·Ù‡appleÔ ÂÏ¿ÛÙˆÛ˘ Ì ·˘ÍË̤ÓË apple·Ú·ÁˆÁ‹ Î·È Û˘Û-ÛÒÚ¢ÛË ÂÏ·ÛÙÈÎÒÓ ÌÈÎÚÔ˚Óȉ›ˆÓ (Schlotzer-Schrechardt et al 1997). ∏ ‡ÚÂÛË Ù¤ÙÔÈˆÓ ÛËÌ›-ˆÓ ÂÏ¿ÛÙˆÛ˘ ÛÙÔ ËıÌÔÂȉ¤˜ apple¤Ù·ÏÔ ÙÔ˘ ÔappleÙÈÎÔ‡Ó‡ÚÔ˘ ·ÛıÂÓÒÓ Ì ∞ ÂÓÈÛ¯‡ÂÈ ÙËÓ apple·Ú·apple¿Óˆ¿appleÔ„Ë. ∫·È Û ·˘Ù‹ ÙËÓ appleÂÚ›appleÙˆÛË fï˜ ˘apple¿Ú-¯Ô˘Ó ·ÌÊÈ‚Ôϛ˜ ηٿ applefiÛÔ ÙÔ ∞ ·appleÔÙÂÏ› ·apple¿-ÓÙËÛË Û ÌÈ· ‚Ï¿‚Ë Î·È ˘appleÂÚ¤ÎÊÚ·ÛË ÙˆÓ ÁÔÓÈ-‰›ˆÓ appleÔ˘ ÂϤÁ¯Ô˘Ó ÙË Û˘ÌappleÂÚÈÊÔÚ¿ ÙˆÓ ÂÏ·ÛÙÈ-ÎÒÓ ‚ÈÔÌÔÚ›ˆÓ ‹ Û ¤Ó· apple·ıÔÏÔÁÈÎfi ÂÚ¤ıÈÛÌ·appleÔ˘ appleÚÔηÏ› ÙËÓ apple·ıÔÏÔÁÈ΋ Û‡ÓıÂÛË Î·È Û˘Û-ÛÒÚ¢ÛË ÂÏ·ÛÙÈÎÒÓ ÈÓÒÓ, ÙË ÛÙÈÁÌ‹ Ì¿ÏÈÛÙ· appleÔ˘ ËÙÂÏÂ˘Ù·›· ·apple·ÓÙ¿Ù·È ÌfiÓÔ Û ÂȉÈΤ˜ ‰ÈÂÚÁ·Û›Â˜fiappleˆ˜ Ë ÂappleԇψÛË.˘ÌappleÂÚ·ÛÌ·ÙÈο, ÔÈ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ıˆڛ˜ÂÍËÁÔ‡Ó ÂÓ Ì¤ÚÂÈ ÙËÓ apple·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ apple¿ıË-Û˘. ¢ÂÓ ·Ó·ÈÚÔ‡Ó Ë Ì›· ÙËÓ ¿ÏÏË ‰ÈfiÙÈ Ô ÌÂÙ·‚Ô-ÏÈÛÌfi˜ Î·È Ë ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ÂÏ·ÛÙÈÎÒÓ ÈÓÒÓÎ·È Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· η-ıÒ˜ ·appleÔÙÂÏÔ‡Ó Ì›· ÂÓÈ·›· ‰ÔÌÈ΋ ÌÔÓ¿‰·(Koliakos & Konstas 2005). ∞ÎfiÌË fï˜ ·appleÔ̤ÓÂÈÓ· ηıÔÚÈÛÙ› Ë ·ÏÏËÏÔ˘¯›· ÙˆÓ ‰È¿ÊÔÚˆÓ apple·ıÔ-ÁÂÓÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÁÈ· Ó· ‰È¢ÎÚÈÓÈÛÙ› appleÏ‹-Úˆ˜ Ë ·ÈÙ›· ¤Ó·Ú͢ ÙÔ˘ ∞.A˘ÍËÙÈÎÔ› apple·Ú¿ÁÔÓÙ˜ΔÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi Â›Ó·È ‰È·˘Á¤˜ ÂÍˆÎ˘ÙÙ¿-ÚÈÔ ˘ÁÚfi, ÙÔ ÔappleÔ›Ô ÂÎÎÚ›ÓÂÙ·È ·applefi ÙÔ ÌË ¯ÚˆÛÙÈÎÔ-ÊfiÚÔ ÂappleÈı‹ÏÈÔ ÙÔ˘ ·ÎÙÈÓˆÙÔ‡ ÛÒÌ·ÙÔ˜ ÙÔ˘ ÔÊı·Ï-ÌÔ‡. ÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ‚Ú¤ıËΠfiÙÈ ˘apple¿Ú¯ÂȤӷ˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·applefi ·˘ÍËÙÈÎÔ‡˜ apple·Ú¿ÁÔ-ÓÙ˜, fiappleˆ˜ Ô ÈÓÔ‚Ï·ÛÙÈÎfi˜ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜,Ô ÂappleȉÂÚÌÈÎfi˜ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜, Ô ÌÂÙ·Û¯Ë-Ì·Ù›˙ˆÓ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ ‚‹Ù·, Ô ÈÓÛÔ˘ÏÈÓÔ-Âȉ‹˜ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ Î.¿. (KÔÏÈ¿ÎÔ˜ ηÈÛ˘Ó 1999). ∏ Û‡ÓıÂÛË ÙˆÓ appleÚˆÙÂ˚ÓÒÓ ·˘ÙÒÓ ÛÙÔ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ·ÏÏÔÈÒÓÂÙ·È Ì ‰Ú·Ì·ÙÈÎfi ÙÚfiappleÔÛ ‰È¿ÊÔÚ˜ apple·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ÙÔ˘ÔÊı·ÏÌÔ‡, ÌÂٷ͇ ÙˆÓ ÔappleÔ›ˆÓ Â›Ó·È Î·È ÙÔ °∞.ΔÔ 8-ÈÛÔappleÚÔÛÙ¿ÓÈÔ, ¤Ó· ÁˆÌÂÙÚÈÎfi ÈÛÔÌÂÚ¤˜Ù˘ appleÚÔÛÙ·ÁÏ·Ó‰›Ó˘ F 2a(PGF 2a), Â›Ó·È ¤Ó· appleÚÔ˚fiÓÙ˘ ‰Ú¿Û˘ ÙˆÓ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Ì appleÈÛÙÔappleÔÈ-Ë̤ÓË ÂÓÂÚÁfiÙËÙ· ·˘ÍËÙÈÎÔ‡ apple·Ú¿ÁÔÓÙ· (Yura etal 1999). ∂appleÈappleÚfiÛıÂÙ·, Ù· Âapple›apple‰· ÛÙÔ ˘‰·ÙÔÂȉ¤˜ÙÔ˘ ‚·ÛÈÎÔ‡ ÈÓÔ‚Ï·ÛÙÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ apple·Ú¿ÁÔÓÙ·(bFGF), (Gartaganis et al 2001) Î·È ÙÔ˘ Ëapple·ÙÔ΢Ù-Ù·ÚÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ apple·Ú¿ÁÔÓÙ· (HGF), (Hu et al2001) ¤¯Ô˘Ó ‚ÚÂı› ·˘ÍË̤ӷ Û ÔÊı·ÏÌÔ‡˜ Ì °∞. ·˘Ù¿ Ù· ¿ÙÔÌ· Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ HGF ‚Ú¤ıË-ΠÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË (1,425.5±586.7 pg/mL),Û ۯ¤ÛË Ì ¿ÙÔÌ· Ì °∞° (855.0± 341.5 pg/mL).∏ ˘„ËÏfiÙÂÚË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ HGF, Û ¿ÙÔÌ· Ì°∞ ‰Â›¯ÓÂÈ fiÙÈ apple·›˙ÂÈ Î¿appleÔÈÔ ÚfiÏÔ ÛÙËÓ apple¿ıËÛË(Hu et al 2001). ∂apple›Û˘ Ô ÂÓ‰ÔıËÏÈ·Îfi˜ ·˘ÍËÙÈÎfi˜apple·Ú¿ÁÔÓÙ·˜ (VEGF) Ê·›ÓÂÙ·È fiÙÈ ÂÓ¤¯ÂÙ·È ÛÙËÓÂÌÊ¿ÓÈÛË ÙÔ˘ °∞.  appleÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‚Ú¤ıËÎÂfiÙÈ Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ÂÓ‰ÔıËÏÈ·ÎÔ‡ ·˘ÍËÙÈÎÔ‡apple·Ú¿ÁÔÓÙ· (VEGF) apple·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ ‰È·-ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ Ì °∞° (140.4±51.0pg/mL), ÁÏ·‡ÎˆÌ· ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ 142.8±40.2pg/mL) Î·È °∞ (158.6±58.9 pg/mL).∂›Ó·È ·ÓÙÈÏËappleÙfi fiÙÈ ·˘ÙÔ› ÔÈ ·˘ÍËÙÈÎÔ› apple·Ú¿-ÁÔÓÙ˜ ›Ûˆ˜ ÂappleËÚ¿˙Ô˘Ó ÙË Û‡ÓıÂÛË Ù˘ ÂÍˆÎ˘Ù-Ù¿ÚÈ·˜ Ô˘Û›·˜ ÛÙÔ ∞ Î·È °∞. ∂appleÈappleϤÔÓ, Ô ÌÂÙ·-Û¯ËÌ·Ù›˙ˆÓ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ (TGF-‚1), ¤-Ó·˜ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ appleÔ˘ ÂÌappleϤÎÂÙ·È Û apple·-ıÔÏÔÁÈΤ˜ ‰È·‰Èηۛ˜ appleÚÔηÏÔ‡ÌÂÓ˜ ·applefi ˘appleÂÚ-‚ÔÏÈ΋ ¿ıÚÔÈÛË ÈÓÒ‰Ô˘˜ ˘ÏÈÎÔ‡, ‚Ú¤ıËΠÛËÌ·ÓÙÈ-ο ·˘ÍË̤ÓÔ˜ ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ÙˆÓ ·ÛıÂÓÒÓÌ ∞ (Schlotzer-Schrechardt et al 2001, Koliakoset al 2001). Àapple¿Ú¯Ô˘Ó ‰Â‰Ô̤ӷ ÁÈ· ÂÓÈÛ¯˘Ì¤ÓËÙÔappleÈ΋ Û‡ÓıÂÛË ÙÔ˘ TGF-‚1 Û ÈÛÙÔ‡˜ ÙÔ˘ appleÚfi-ÛıÈÔ˘ ÙÌ‹Ì·ÙÔ˜, appleÚÔÙ›ÓÔÓÙ·˜ ¤ÙÛÈ ¤Ó· ÛËÌ·ÓÙÈÎfiÚfiÏÔ ÁÈ· ÙÔÓ TGF-‚1 ÛÙËÓ appleÚÔÒıËÛË ·˘Ù‹ Ù˘ apple·-ıÔÏÔÁÈ΋˜ ‰È·‰Èηۛ·˜ Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜

126 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)(Schlotzer-Schrehardt et al 2001). ∏ ‰Ú¿ÛË ÙÔ˘TGF-‚1 Û ÈÓˆÙÈΤ˜ ‰È·‰Èηۛ˜ appleÂÚÈÏ·Ì‚¿ÓÂÈÙËÓ Âapple›‰Ú·Û‹ ÙÔ˘ ÛÙËÓ apple·Ú·ÁˆÁ‹ Î·È ÙËÓ ÂÓÂÚÁÔappleÔ›ËÛËÂȉÈÎÒÓ ·appleÔ‰ÔÌËÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Ù˘ Â͈-΢ÙÙ¿ÚÈ·˜ Ô˘Û›·˜, ÙȘ ÌÂÙ·ÏÏÔappleÚˆÙ¿Û˜ (MMP). ÌÈ· appleÚfiÛÊ·ÙË ÌÂϤÙË, ·ÓȯÓ‡ÙËÎ·Ó ÛËÌ·ÓÙÈο·˘ÍË̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ MMP-2, MMP-3,TIMP-1 Î·È TIªP-2 Û ‰Â›ÁÌ·Ù· ˘‰·ÙÔÂȉԇ˜ ·applefi·ÛıÂÓ›˜ Ì °∞. ·Ú’ fiÏ· ·˘Ù¿, Ù· Âapple›apple‰· Ù˘ÂÓ‰ÔÁÂÓÔ‡˜ ÂÓÂÚÁo‡ MMP-2 ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÈ-ˆÌ¤Ó· Î·È Ô ÏfiÁÔ˜ Ù˘ MMP-2 Î·È ÙÔ˘ ‚·ÛÈÎÔ‡Ù˘ ·Ó·ÛÙÔϤ· Δπªƒ-2 ‹Ù·Ó ÌÂȈ̤ÓÔ˜, ηٷϋ-ÁÔÓÙ·˜ Û ÌÈ· ˘appleÂÚÔ¯‹ ÙÔ˘ Δπªƒ-2 Âapple› Ù˘ ªªƒ-2 ÛÙ· ‰Â›ÁÌ·Ù· Ì °∞ (Schlotzer-Schrehardt et al2003). ∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ˘appleÔ‰ÂÈÎÓ‡Ô˘Ó ÌÈ· Û‡ÓıÂÙËÙÚÔappleÔappleÔ›ËÛË Î·È ·ÏÏËÏÂapple›‰Ú·ÛË ÛÙËÓ ÙÔappleÈ΋ÈÛÔÚÚÔapple›· ªªƒ/Δπªƒ Î·È ÌÂȈ̤ÓË ÂÓÂÚÁfiÙËÙ·ªªƒ ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi, appleÔ˘ ›Ûˆ˜ appleÚÔ¿ÁÂÈ ÙËÓ·ÓÒÌ·ÏË ¿ıÚÔÈÛË ÛÙÚÒÌ·ÙÔ˜ ÛÙÔ °∞ (Schlotzer-Schrehardt et al 2003).∞Ó Î·È Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ ·˘-ÍËÙÈÎÔ› apple·Ú¿ÁÔÓÙ˜ apple·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓÂÌÊ¿ÓÈÛË ÙÔ˘ ∞ Î·È °∞, Ë ÛËÌ·Û›·, Ë Û‡ÓıÂÛËÎ·È Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘˜ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÎÙÂÓ‹ appleÂÚ·ÈÙ¤-Úˆ ÌÂϤÙË. ∂ÎÙfi˜ ·applefi ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ apple·Ú¿ÁÔ-ÓÙ˜ appleÔ˘ ·Ó·Ê¤ÚıËÎ·Ó appleÈÔ apple¿Óˆ ı· appleÚ¤appleÂÈ Ó·ÂÍÂÙ·ÛıÔ‡Ó Û ۯ¤ÛË Ì ÙÔ °∞ Î·È ¿ÏÏÔÈ apple·Ú¿ÁÔ-ÓÙ˜ appleÔ˘ ¤¯Ô˘Ó ÂÓÙÔappleÈÛı› ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi.∂appleÈÛËÌ·›ÓÂÙ·È Ë appleÈı·Ó‹ ÛËÌ·Û›· ÙˆÓ ·˘ÍËÙÈÎÒÓapple·Ú·ÁfiÓÙˆÓ ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ appleÔ˘ apple·›˙Ô˘Ó ÛËÌ·-ÓÙÈÎfi ÚfiÏÔ ÛÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ÂappleԇψÛ˘. ∂apple›Û˘ÚfiÏÔ ·˘ÍËÙÈÎÔ‡ apple·Ú¿ÁÔÓÙ· ÌappleÔÚ› Ó· apple·›˙ÂÈ Î·È ËÙÚ·ÓÛÊÂÚ›ÓË. ∏ ÙÚ·ÓÛÊÂÚ›ÓË ‚Ú›ÛÎÂÙ·È ÛÙÔ ˘‰·-ÙÔÂȉ¤˜ ˘ÁÚfi ÛÂ Û˘ÁΤÓÙÚˆÛË ÌÂÁ·Ï‡ÙÂÚË ·applefi ·˘-Ù‹ appleÔ˘ ı· ‰ÈηÈÔÏÔÁÔ‡Û ˘appleÂډȋıËÛË ·applefi ÙÔappleÏ¿ÛÌ·. ÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ·ÛıÂÓÒÓ Ì °∞¤¯Ô˘Ó ÂÓÙÔappleÈÛı› ‰È·ÊÔÚÂÙÈΤ˜ ÈÛÔÌÔÚʤ˜ ÙÔ˘ ÌÔ-Ú›Ô˘ ·˘ÙÔ‡. ∂appleÈappleϤÔÓ ÛÙËÓ ÂÓÂÚÁfiÙËÙ· ·˘ÍËÙÈÎÔ‡apple·Ú¿ÁÔÓÙ· appleÔ˘ ‰È·appleÈÛÙÒÓÂÙ·È ÛÙÔ ˘‰·ÙÔÂȉ¤˜˘ÁÚfi ÛÙÔ °∞ Â›Ó·È appleÈı·Ófi Ó· Û˘Ì‚¿ÏÏÔ˘Ó Î·ÈıÚ·‡ÛÌ·Ù· appleÚˆÙÂ˚ÓÒÓ Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜,fiappleˆ˜ Ë Ï·ÌÈÓ›ÓË (Koliakos et al 2000).O ÈÓÛÔ˘ÏÈÓÔÂȉ‹˜ ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ 1(IGF-1) appleÚÔ¿ÁÂÈ ÙÔÓ appleÔÏÏ·appleÏ·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿-ÚˆÓ ÙÔ˘ ‰ÈÎÙ˘ˆÙÔ‡ Û¯ËÌ·ÙÈÛÌÔ‡. ΔÔ 80% ÙÔ˘IGF-1 ÙÔ˘ ÔÚÔ‡ ·Ó¢ڛÛÎÂÙ·È ÛÙËÓ ·ÓÂÓÂÚÁfi ÙÔ˘ÌÔÚÊ‹ Û˘Ó‰Â̤ÓÔ˜ Ì ÙËÓ IGF appleÚˆÙ½ÓË 3(IGFBP-3) ·ÏÏ¿ Î·È Ì ¿ÏϘ appleÚˆÙ½Ó˜. ÙÔ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi Ô IGF-1 ‚Ú›ÛÎÂÙ·È Ì ÙËÓ ÂÓÂÚÁfiÌË Û˘Ó‰Â‰Â̤ÓË ÙÔ˘ ÌÔÚÊ‹ Î·È Ë ‰Ú·ÛÙÈÎfiÙËÙ¿ÙÔ˘ Ú˘ıÌ›˙ÂÙ·È ·applefi ÙËÓ ‰Ú¿ÛË ÂȉÈÎÒÓ appleÚˆÙ·-ÛÒÓ. Èı·Ó‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÈÌ·ÙÔ–˘‰·ÙÔÂȉÈÎÔ‡ÊÚ·ÁÌÔ‡ ÌappleÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ‰È·Ù·Ú·¯‹ Ù˘ڇıÌÈÛ˘ ÙÔ˘ IGF-1. ·Ú’ fiÏ· ·˘Ù¿, ¤ˆ˜ ÙÒÚ·‰ÂÓ ¤¯ÂÈ ‚ÚÂı› ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ apple·-Ú¿ÁÔÓÙÔ˜ ·˘ÙÔ‡ ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ·ÛıÂÓÒÓ Ì°∞ (Koliakos et al 2001, Koliakos & Konstas2005).À‰·Ù¿ÓıڷΘOÚÈṲ̂Ó˜ ÌÂϤÙ˜ η٤‰ÂÈÍ·Ó ÙË ¯ÚÒÛË ÙÔ˘·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ Ì ¯ÚˆÛÙÈΤ˜ appleÔ˘ ·ÓÈ-¯ÓÂ‡Ô˘Ó ÙȘ ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î¿Ó˜, Î·È Û˘ÁÎÂÎÚÈ-̤ӷ ÙÔ PAS, ÙÔ Alcian blue Î·È ÙÔ ÂÚ˘ıÚfi ÙÔ˘ƒÔ˘ıËÓ›Ô˘ (Baba 1983). ∏ apple·ÚÔ˘Û›· ÙˆÓ ÁÏ˘ÎÔ-˙·ÌÈÓÔÁÏ˘Î·ÓÒÓ ÌappleÔÚ› Ó· ηٷ‰Âȯı› Î·È Ì·ÓÔÛÔ˚ÛÙÔ¯ËÌÈΤ˜ ÌÂıfi‰Ô˘˜, ÔÈ Ôappleԛ˜ ·ÓȯÓ‡-Ô˘Ó ÙËÓ apple·ÚÔ˘Û›· ıÂÈ˚΋˜ Ëapple·Ú›Ó˘, ıÂÈ˚΋˜ ¯ÔÓ-‰ÚÔ˚Ù›Ó˘, ıÂÈ˚΋˜ ‰ÂÚÌ·Ù¿Ó˘ Î·È ˘·ÏÔ˘ÚÔÓÈÎÔ‡ÔͤԘ (Fitzsimmons et al 1997). EappleÔ̤ӈ˜, ˢappleÂÚapple·Ú·ÁˆÁ‹ Î·È Ô ·ÓÒÌ·ÏÔ˜ ÌÂÙ·‚ÔÏÈÛÌfi˜ ÙˆÓÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î·ÓÒÓ, ¤¯ÂÈ appleÚÔÙ·ı› ˆ˜ Ì›· ·applefiÙȘ ‚·ÛÈΤ˜ ·ÏÏ·Á¤˜ ÙÔ˘ ∞. ˘ÁÎÂÎÚÈ̤ӷ, Ë apple·-ÚÔ˘Û›· ˘·ÏÔ˘ÚÔÓÈÎÔ‡ ÔͤԘ ÛÙÔÓ appleÚfiÛıÈÔ ı¿Ï·ÌÔÙÔ˘ ÔÊı·ÏÌÔ‡ ¤¯ÂÈ ¿ÌÂÛ· Û˘Ó‰Âı› Ì ÙËÓ ‡apple·ÚÍË·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ (Fitzsimmons et al 1997).ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó Î·È ·˘ÍË̤ÓË Û˘-ÁΤÓÙÚˆÛË ÙÔ˘ ÌÔÚ›Ô˘ ·˘ÙÔ‡ ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi·ÛıÂÓÒÓ Ì A Î·È ÂappleÈÛËÌ·›ÓÔ˘Ó fiÙÈ Ë apple·ÚÔ˘Û›·ÙÔ˘ ÌÔÚ›Ô˘ ·˘ÙÔ‡ ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ÌappleÔÚ› Ó· Û˘-ÓÙÂÏ› ÛÙËÓ apple·ıÔÏÔÁÈ΋ apple·Ú·ÁˆÁ‹ Î·È ¿ÏÏˆÓ ÌÔ-Ú›ˆÓ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ (Lamari et al 1998,Gartaganis et al 2001)AÏÏË appleÈÔ appleÚfiÛÊ·ÙË ÌÂϤÙË ·Ó·Ê¤ÚÂÈ fiÙÈ Ù·ÌfiÚÈ· ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡appleÔ˘ IX Î·È Ù· ÌfiÚÈ· Ù˘‰ÈÁÏ˘Î¿Ó˘ appleÔ˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi·ÛıÂÓÒÓ Ì A appleÂÚȤ¯Ô˘Ó appleÂÚÈÛÛfiÙÂÚË ıÂÈ˚΋‰ÂÚÌ·Ù¿ÓË Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜Ì¿ÚÙ˘Ú˜. ÙËÓ ›‰È· ÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÛÙÔA ·ÓȯÓ‡ÂÙ·È appleÂÚÈÛÛfiÙÂÚÔ Ô Âapple›ÙÔappleÔ˜ HNK-1,Ô ÔappleÔ›Ô˜ ‚Ú¤ıËΠӷ ÂÓÙÔapple›˙ÂÙ·È Î˘Ú›ˆ˜ Û ·ÏÏË-ÏÔ˘¯›Â˜ ıÂÈ˚΋˜ ‰ÂÚÌ·Ù¿Ó˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Ù‡-appleÔ˘ IX (Gartaganis et al 2004). H ÁÏ˘ÎÔÛȉÈ΋ ·Ï-ÏËÏÔ˘¯›· 3-ÛÔ˘ÏÊÔ ÁÏ˘ÎÔ˘ÚÔÓÈÎfi Ô͇- Á·Ï·ÎÙfi-˙Ë-N ·Î¤Ù˘ÏÔÁÏ˘ÎÔ˙·Ì›ÓË ÁÓˆÛÙ‹ Î·È ˆ˜ Âapple›ÙÔappleÔ˜HNK-1 ·appleÔÙÂÏ› Û˘ÛÙ·ÙÈÎfi ÌÈ·˜ ÛÂÈÚ¿˜ ÌÔ-Ú›ˆÓ Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜ Î·È Ù˘ ΢ÙÙ·ÚÈ΋˜ÌÂÌ‚Ú¿Ó˘, appleÔ˘ ηٿ ηÓfiÓ· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ΢ÙÙ·ÚÈ΋ appleÚÔÛÎfiÏÏËÛË. H Ï·ÌÈÓ›ÓË, appleÔ˘ fiappleˆ˜·Ó·Ê¤ÚıËΠappleÈÔ apple¿Óˆ ÂÌappleϤÎÂÙ·È Î·È ·˘Ù‹ ÛÙËÓ

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 127apple·ıÔÊ˘ÛÈÔÏÔÊ›· ÙÔ˘ A, ·appleÔÙÂÏ› apple·Ú¿‰ÂÈÁÌ·Ù¤ÙÔÈÔ˘ ›‰Ô˘˜ ÌÔÚ›Ô˘ (Pesheva et al 1987).ÙÔÓ ·ÓıÚÒappleÈÓÔ ÔÊı·ÏÌfi Ô Âapple›ÙÔappleÔ˜ HNK-1ÂÓÙÔapple›˙ÂÙ·È Ê˘ÛÈÔÏÔÁÈο ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹,ÛÙÔ ÔappleÙÈÎfi Ó‡ÚÔ, Ù· Ó‡ڷ ÙÔ˘ ·ÎÙÈÓˆÙÔ‡ ÛÒÌ·-ÙÔ˜, ÙÔ ·ÎÙÈÓˆÙfi ÛÒÌ· Î·È ÙÔ ÂappleÈı‹ÏÈÔ Ù˘ ›Úȉ·˜,ÙË ˙›ÓÓÂÈÔ ˙ÒÓË Î·È ÙÔÓ ÛÎÏËÚfi. O Âapple›ÙÔappleÔ˜ ·˘Ùfi˜Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈο ¿ÊıÔÓÔ˜ ÛÙ· ˘appleÂÓ‰ÔıËÏÈ·-ο ·ÙÙ·Ú· ÙÔ˘ ·ÎÙÈÓˆÙÔ‡ ÛÒÌ·ÙÔ˜. T· ·ÙÙ·Ú··˘Ù¿ ıˆÚÂ›Ù·È fiÙÈ Û˘ÌÌÂÙ¤¯Ô˘Ó ÂÓÂÚÁ¿ ÛÙËÓ apple·-Ú·ÁˆÁ‹ Î·È ·Ó·Ó¤ˆÛË Ù˘ ÂÏ·ÛÙÈ΋˜ ÂÍˆÎ˘ÙÙ¿-ÚÈ·˜ Ô˘Û›·˜ ÙÔ˘ ·ÎÙÈÓˆÙÔ‡ ÛÒÌ·ÙÔ˜. AÍ›˙ÂÈ Âapple›-Û˘ Ó· ÛËÌÂȈı› fiÙÈ Ô Âapple›ÙÔappleÔ˜ HNK-1 Û¯ÂÙ›˙Â-Ù·È Î·È Ì ÙÔ Û‡ÛÙËÌ· ÙˆÓ ÂÏ·ÛÙÈÎÒÓ ÈÓȉ›ˆÓ Ù‹˜ÂÓ ÏfiÁˆ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜. ∏ apple·ÚÔ˘Û›· ·˘Ù‹˜Ù˘ ¿ÏÏËÏÔ˘¯›·˜ ÁÏ˘Î·ÓÒÓ appleÔ˘, fiappleˆ˜ appleÚԷӷʤÚıËΤ¯ÂÈ «Û˘ÁÎÔÏÏËÙÈΤ˜» ȉÈfiÙËÙ˜, appleÔχ appleÈı·-ÓfiÓ Û˘Ì‚¿ÏÏÂÈ ÛÙË ÛÙ·ıÂÚÔappleÔ›ËÛË ÙˆÓ ÈÛÙÒÓ ÙÔ˘·ÎÙÈÓˆÙÔ‡ ÛÒÌ·ÙÔ˜ Î·È Ù˘ ›Úȉ·˜. Ú¤appleÂÈ Âapple›Û˘ӷ ·Ó·ÊÂÚı› fiÙÈ Ù· ˘appleÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ÙÔ˘·ÎÙÈÓˆÙÔ‡ ÛÒÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È È‰È·›ÙÂڷ¢·›ÛıËÙ· ÛÙËÓ ·˘ÍË̤ÓË ∂O, Ë ÔappleÔ›· ÙÂÏÈοÌappleÔÚ› Ó· Ù· Ô‰ËÁ‹ÛÂÈ Û ·applefiappleÙˆÛË (Uusitalo &Kivela 1997, Uusitalo & Kivela 2001). EÙÛÈ, Ù· ·Ù-Ù·Ú· ·˘Ù¿ Â›Ó·È appleÔχ appleÈı·Ófi Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÂ¤Ó·Ó «Ê·‡ÏÔ Î‡ÎÏÔ» appleÚÔÛapple¿ıÂÈ·˜ ·Ó·‰fiÌËÛ˘Ù˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Ô˘Û›·˜ ÛÂ Û˘Óı‹Î˜ Î˘Ì·ÈÓfiÌÂ-Ó˘ ∂O ‹ Î·È ÔÍÂȉˆÙÈÎÔ‡ ÛÙÚ˜, Ô‰ËÁÒÓÙ·˜ ÙÂ-ÏÈο ÛÙËÓ apple·Ú·ÁˆÁ‹ ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡Î·È ÙËÓ apple·Ú¿ÏÏËÏË ·‡ÍËÛË Ù˘ ∂O. ÙÔ ÛËÌ›Է˘Ùfi appleÚ¤appleÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ô Âapple›ÙÔappleÔ˜ HNK-1·appleÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÁÓÒÚÈÛÌ· ÙÔ˘ ·appleÔÊÔÏÈ-‰ˆÙÈÎÔ‡ ˘ÏÈÎÔ‡, appleÔ˘ ÌappleÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙÔÓÂÓÙÔappleÈÛÌfi ÙÔ˘. ŒÙÛÈ Ì ÙË ¯Ú‹ÛË ·ÓÙÈۈ̿وӤӷÓÙÈ ÙÔ˘ ÂappleÈÙfiappleÔ˘ ·˘ÙÔ‡ ηıÒ˜ Î·È Ù˘ LTBP¤¯ÂÈ ‚ÚÂı› fiÙÈ ÙÔ A Â›Ó·È apple¿ÓÙ· ·ÌÊÔÙÂÚfiappleÏ¢-ÚÔ Ì ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ¤ÎÊÚ·Û˘ ÛÙÔÓ ˘appleÔÙÈı¤ÌÂ-ÓÔ ˘ÁÈ‹ ÔÊı·ÏÌfi (Hammer et al 2001).·appleÔÊÔÏȉˆÙÈÎÒÓ ÈÓÒÓ Î·È ÔÈ ÌÈÎÚÔ˚ÓȉÈΤ˜ ˘appleÔÔ-Ì¿‰Â˜ ÙÔ˘s, ‰Â›¯ÓÔ˘Ó ÌÈ· ˘appleÂÚ‚ÔÏÈ΋ apple·Ú·ÁˆÁ‹·ÓÒÌ·ÏˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÌÈÎÚÔ˚Óȉ›ˆÓ ÛÙÔ Â͈-΢ÙÙ¿ÚÈÔ ˘ÏÈÎfi ÙÔ˘ ∞ (Ritch et al 2003). ∂apple›Û˘¿ÏÏ· Û˘ÛÙ·ÙÈο ÙÔ˘ ÂÏ·ÛÙÈÎÔ‡ ÈÓÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜fiappleˆ˜ ÔÈ Ï·Óı¿ÓÔ˘Û˜ ÌÔÚʤ˜ ÙˆÓ appleÚˆÙÂ˚ÓÒÓLTBP-1 Î·È LTBP-2 appleÔ˘ ‰ÂÛÌÂ‡Ô˘Ó ÙÔÓ apple·Ú¿ÁÔ-ÓÙ· TGF-‚1, ‚Ú¤ıËÎ·Ó Û ÂÓ‰Ô- Î·È Â͈‚ÔÏ‚ÈΤ˜ÂÓÙÔapple›ÛÂȘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î·È ¤¯Ô˘Ó ÙËÓȉÈfiÙËÙ· ‰ÔÌÈÎÔ‡ ˘ÏÈÎÔ‡ ÙˆÓ ·appleÔÊÔÏȉˆÙÈÎÒÓ ˘ÏÈ-ÎÒÓ Î·È Û˘Ó‰ÂÙÈÎÔ‡ ÎÚ›ÎÔ˘, ·Ó¿ÌÂÛ· Û ·˘Ù¤˜ ηÈÙÔÓ apple·Ú¿ÁÔÓÙ· TGF-‚1 (Schlotzer-Schrehardt etal 2000).÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ·appleÔ˘Û›· ÙÔ˘ ÎÔÏÏ·-ÁfiÓÔ˘ Ù‡appleÔ˘ I, II, III, IV, VIII, ÙÔ˘ ·Ì˘ÏÔÂȉԇ˜–∞ ÙÔ˘ ‚-·Ì˘ÏÔÂȉԇ˜, Ù˘ appleÚfi‰ÚÔÌ˘ appleÚˆÙ½Ó˘·Ì˘ÏÔÂȉԇ˜ Î·È Ù˘ ÙÚ·ÓÛı˘ÚÂÙ›Ó˘ (Schlotzer-Schrehardt et al 1992), ÂÓÒ ·ÓÙ›ıÂÙ· ¤¯ÂÈ ‰È·appleÈ-ÛÙˆı› Ë apple·ÚÔ˘Û›· ÙˆÓ ·appleÔÏÈappleÔappleÚˆÙÂ˚ÓÒÓ ∞-1, μ,∂ Î·È LP. ∏ ‚ÈÔ¯ËÌÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ·appleÔÊÔÏȉˆÙÈ-ÎÔ‡ ˘ÏÈÎÔ‡ Ì appleÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ·ÌÈÓÔͤˆÓ ηÈËÏÂÎÙÚÔÊfiÚËÛË ¤‰ÂÈÍÂ Û˘ÛÙ·ÙÈο appleÔ˘ ·apple·ÓÙÒ-ÓÙ·È Û ‰Ô̤˜ ·Ì˘ÏÔÂȉԇ˜, ‚·ÛÈ΋˜ ΢ÙÙ·ÚÈ΋˜ÌÂÌ‚Ú¿Ó˘ Î·È ÂÏ·ÛÙÈÎÒÓ ÈÓÒÓ Î·È fi¯È Û ‰Ô̤˜ÎÔÏÏ·ÁfiÓÔ˘ ηıÒ˜ Î·È ÙËÓ ‡apple·ÚÍË ‰‡Ô appleÔÏ˘appleÂappleÙȉ›ˆÓÌ ªμ 14,4 Î·È 16,3 Kd (Ringvold et al1989). ∏ ÛÙÔȯÂȷ΋ ·Ó¿Ï˘ÛË Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈ-ÎÚÔÛÎfiappleÈÔ ·Ó·Î¿Ï˘„ ÙËÓ ‡apple·ÚÍË ·˙ÒÙÔ˘, ı›Ԣ¯ÏˆÚ›Ô˘ Î·È „¢‰·ÚÁ‡ÚÔ˘ ̤۷ ÛÙÔ˘˜ ·appleÔÊÔÏÈ-‰ˆÙÈÎÔ‡˜ apple˘Ú‹Ó˜ ηıÒ˜ Î·È ·Û‚ÂÛÙ›Ô˘ ÛÙËÓ appleÂ-ÚÈʤÚÂÈ· ÙˆÓ ÈÓȉ›ˆÓ (Kortje 1996). Δ¤ÏÔ˜, apple·Ú¿ÙȘ ÌÈÎÚ¤˜ ‰È·ÊÔÚÔappleÔÈ‹ÛÂȘ ÛÙÔ˘˜ ‚ÈÔÌÔÚÈ·ÎÔ‡˜‰ÂÛÌÔ‡˜ Î·È ÙËÓ appleÔÛfiÙËÙ· Ù˘ ‰È¿ÌÂÛ˘ Ô˘Û›·˜ Ùfi-ÛÔ ÙÔ ÂÓ‰Ô‚ÔÏ‚ÈÎfi fiÛÔ Î·È ÙÔ Â͈‚ÔÏ‚ÈÎfi ·appleÔÊÔ-ÏȉˆÙÈÎfi ˘ÏÈÎfi, apple·ÚÔ˘ÛÈ¿˙Ô˘Ó Û¯Â‰fiÓ Ù·˘ÙfiÛËÌËappleÚˆÙÂ˚ÓÈ΋ Û‡ÓıÂÛË, Ë ÔappleÔ›· Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ-΋ Î·È Í¯ˆÚ›˙ÂÈ ·applefi ÔappleÔÈ·‰‹appleÔÙ ¿ÏÏË ÌÔÚÊ‹ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ ıÂ̤ÏÈ·˜ Ô˘Û›·˜.ÚˆÙÂ˚ÓÈο Û˘ÛÙ·ÙÈÎ¿Δ· appleÚˆÙÂ˚ÓÈο Û˘ÛÙ·ÙÈο ÙÔ˘ ·appleÔÊÔÏȉˆÙÈ-ÎÔ‡ ˘ÏÈÎÔ‡, Û˘ÌappleÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ ÙË ÌË-ÎÔÏÏ·-ÁfiÓÔ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘, Â›Ó·È Ë Ï·ÌÈÓ›ÓË, Ë ÓÈÙÔ-Á¤ÓË/ÂÓ·ÎÙ›ÓË Î·È Ë ÊÈÌappleÚÔÓÂÎÙ›ÓË ( Konstas et al1990; 1991) Î·È ÂappleÈÙfiappleÈ· fiappleˆ˜ Â›Ó·È Ë ¿ÏÊ·-ÂÏ·-ÛÙ›ÓË, Ë ÙÚÔappleÔÂÏ·ÛÙ›ÓË, Ë ÊÈÌappleÚÈÏ›ÓË, ÙÔ ·Ì˘ÏÔÂÈ-‰¤˜ P Î·È Ë ‚ÈÙÚÔÓÂÎÙ›ÓË. ªÂϤÙ˜ Ì ÙÔ ËÏÂÎÙÚÔ-ÓÈÎfi ÌÈÎÚÔÛÎfiappleÈÔ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÊÈÌappleÚÈÏ›ÓË –1, ÙÔ·ÚÈÔ Û˘ÛÙ·ÙÈÎfi ÙˆÓ ÂÏ·ÛÙÈÎÒÓ ÌÈÎÚÔ˚Óȉ›ˆÓ ÙˆÓªÂÏÏÔÓÙÈ΋ ¤Ú¢ӷΔÔ ∞ ·appleÔÙÂÏ› Û‹ÌÂÚ· ¤Ó· ·ÓÔÈÎÙfi apple‰›Ô¤Ú¢ӷ˜ Î·È ÎÏÈÓÈ΋˜ ÌÂϤÙ˘ (Koliakos & Konstas2005). Àapple¿Ú¯Ô˘Ó appleÔÏÏ¿ ÛËÌ›· appleÔ˘ appleÚ¤appleÂÈ Ó··appleÔÛ·ÊËÓÈÛÙÔ‡Ó ÁÈ· Ó· ηıÔÚÈÛÙÔ‡Ó Ì ·ÎÚ›‚ÂÈ·Ù· ÂappleÈ̤ÚÔ˘˜ ÛÙÔȯ›· Ù˘ apple¿ıËÛ˘. ø˜ appleÚÔ˜ ÙËÓapple·ıÔÁ¤ÓÂÈ·, appleÚ¤appleÂÈ Ó· ‰È¢ÎÚÈÓÈÛÙ› Ë ·ÎÚÈ‚‹˜ ·È-ÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘, Ô ÚfiÏÔ˜ ÙˆÓ ‰È·ÊfiÚˆÓ Â͈ÁÂ-ÓÒÓ (appleÂÚÈ‚¿ÏÏÔÓ, ÙÔÍÈΤ˜ Ô˘Û›Â˜, ‰È·ÙÚÔÊ‹, ÙÚ·‡-Ì·, ÏÔÈÌÒÍÂȘ) Î·È ÂÓ‰ÔÁÂÓÒÓ (ÁÔÓ›‰È·) apple·Ú·Áfi-

128 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)ÓÙˆÓ ÛÙȘ apple·ıÔÏÔÁÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ Î·È Ë Û˘ÌappleÂÚÈ-ÊÔÚ¿ ÙˆÓ ÈÛÙÒÓ appleÔ˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂΉ‹ÏˆÛËÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÙfiÛÔ Û ÌÔÚÈ·Îfi Âapple›appleÂ‰Ô fiÛÔ Î·ÈÛ Âapple›appleÂ‰Ô ÔÌÔÈÔÛÙ·ÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ (Ritch2005). ∞apple·ÈÙÂ›Ù·È Âapple›Û˘ appleÂÚ·ÈÙ¤Úˆ ÌÂϤÙË ÁÈ·ÙÔÓ ·ÎÚÈ‚‹ appleÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ‚ÈÔ¯ËÌÈ΋˜ Û‡ÛÙ·-Û˘ Î·È ‰ÔÌ‹˜ ÙÔ˘ ·appleÔÊÔÏȉˆÙÈÎÔ‡ ˘ÏÈÎÔ‡, ÙˆÓÛÙ·‰›ˆÓ apple·Ú·ÁˆÁ‹˜ Î·È ¤ÎÎÚÈÛ‹˜ ÙÔ˘ ·applefi ÙÔ Î‡Ù-Ù·ÚÔ Î·È ÙÔ˘ ÙÚfiappleÔ˘ ÔÚÁ¿ÓˆÛ‹˜ ÙÔ˘ Û ÈÓ҉˜ ‰›-ÎÙ˘Ô (Konstas et al 2005). ∞ÏÏ¿ Î·È ÛÙÔÓ ÎÏÈÓÈÎfiÙÔ̤· ˘apple¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈο ÂÚˆÙ‹Ì·Ù· appleÔ˘ appleÚ¤appleÂÈÓ· ·apple·ÓÙËıÔ‡Ó, fiappleˆ˜ appleÔÈÔÈ apple·Ú¿ÁÔÓÙ˜ ηıÔ-Ú›˙Ô˘Ó ÙËÓ ÂÙÂÚfiappleÏ¢ÚË ‹ ÙËÓ ·ÌÊÔÙÂÚfiappleÏ¢ÚËÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘, ÁÈ·Ù› Ë ÙÂÏÂ˘Ù·›· ÂΉËÏÒÓÂ-Ù·È Ì ‰È·ÊÔÚÂÙÈ΋ ‚·Ú‡ÙËÙ· Û οı ·ÛıÂÓ‹,ÁÈ·Ù› ÔÚÈṲ̂ӷ appleÂÚÈÛÙ·ÙÈο ÂÌÊ·Ó›˙Ô˘Ó ÁÏ·‡Îˆ-Ì· Î·È ¿ÏÏ· fi¯È, appleÔȘ Â›Ó·È ÔÈ ÎÏÈÓÈΤ˜ ÂappleÈappleÙÒÛÂȘÙ˘ Û˘ÛÙËÌ·ÙÈ΋˜ ‰È¿ÛÙ·Û˘ Ù˘ apple¿ıËÛ˘ Î·È ÌÂappleÔÈÔ˘˜ ÙÚfiappleÔ˘˜ ı· ÌappleÔÚÔ‡Û ӷ ·Ó·appleÙ˘¯ı› Ìȷ̤ıÔ‰Ô˜ ·Ó›¯Ó¢Û˘ appleÔχ appleÚÒÈÌˆÓ Î·È ÌË ÂÌÊ·-ÓÒÓ ·ÏÏ·ÁÒÓ ÛÙÔ appleÚfiÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ÔÊı·ÏÌÔ‡,¤ÙÛÈ ÒÛÙ ӷ ÂÍ·ÛÊ·ÏÈÛÙ› Ë Ù·¯‡ÙÂÚË ‰˘Ó·Ù‹ ‰È¿-ÁÓˆÛË. Δ¤ÏÔ˜, ¯ÚÂÈ¿˙ÔÓÙ·È appleÂÚÈÛÛfiÙÂÚ· ÂappleȉËÌÈÔ-ÏÔÁÈο ‰Â‰Ô̤ӷ ÁÈ· Ó· appleÚÔÛ‰ÈÔÚÈÛÙ› Ë ·ÈÙ›· وӉȷÊÔÚÒÓ ÛÙËÓ Âapple›appleÙˆÛË Ù˘ ÓfiÛÔ˘ ÌÂٷ͇ Ê˘-ÏÒÓ, ÂıÓÈÎÒÓ ÔÌ¿‰ˆÓ Î·È ÙÔappleÈÎÒÓ ÎÔÈÓˆÓÈÒÓ Î·ÈÁÈ· Ó· appleÚÔ·„ÂÈ ÌÈ· appleÈÔ ¤Á΢ÚË Î·È ÂÓÈ·›· ÌÂıÔ-‰ÔÏÔÁ›· ηٷÁÚ·Ê‹˜ ÙˆÓ ·appleÔÙÂÏÂÛÌ¿ÙˆÓ. ∏ Û‚¿ıÔ˜ ·Ó¿Ï˘ÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ∞ ı·‚ÔËı‹ÛÂÈ fi¯È ÌfiÓÔ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓÔÊı·ÏÌÈÎÒÓ apple·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ì ÙȘÔappleԛ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Û¯ÂÙ›˙ÂÙ·È ·ÏÏ¿ ÂӉ¯Ô̤ӈ˜Î·È ÛÙË ‰È¢ÎÚ›ÓÈÛË Ù˘ apple·ıÔÊ˘ÛÈÔÏÔÁ›·˜ ÛÔ‚·-ÚÒÓ Û˘ÛÙËÌ·ÙÈÎÒÓ apple·ı‹ÛˆÓ.∂Óı·ÚÚ˘ÓÙÈο Â›Ó·È Ù· appleÚfiÛÊ·Ù· Â˘Ú‹Ì·Ù·ÙˆÓ Konstas et al (2006), fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÛËÌ·-ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙˆÓ ÂappleÈapple¤‰ˆÓ ÙÔ˘ TGF beta 1 ηÈÙˆÓ ˙ÂÏ·ÙÈÓ·ÛÒÓ appleÔ˘ ÂappleÈʤÚÂÈ Ë ÌÔÓÔıÂÚ·apple›· ÌÂÏ·Ù·ÓÔappleÚfiÛÙË Û ·ÛıÂÓ›˜ Ì °∞. ÈÔ Û˘ÁÎÂÎÚÈ-̤ӷ ÌÂÙÚ‹ıËÎ·Ó ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ TGFbeta1,MMP-2, TIMP-2, MMP-9 Ì ·ÓÔÛÔ¯ËÌÈΤ˜ÌÂıfi‰Ô˘˜. μÚ¤ıËΠfiÙÈ Ë Ì¤ÛË ÂÓÂÚÁ‹ Û˘ÁΤÓÙÚˆ-ÛË ÙÔ˘ TGF-beta1 ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ‹Ù·Ó ÛË-Ì·ÓÙÈο ¯·ÌËÏfiÙÂÚË Û ·ÛıÂÓ›˜ Ì °∞ appleÔ˘ ÂÏ¿Ì-‚·Ó·Ó ˆ˜ ¯ÚfiÓÈ· ıÂÚ·apple›· Ï·Ù·ÓÔappleÚfiÛÙË (3.1+/-0.65 pg). ∂apple›Û˘ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ MMP-2Î·È TIMP-2 ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ ÛÙËÓ›‰È· ÔÌ¿‰· ·ÛıÂÓÒÓ. ∏ ıÂÚ·apple›· Ì ϷٷÓÔappleÚfi-ÛÙË ‰Â›¯ÓÂÈ fiÙÈ ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Âapple›‰Ú·ÛË ÛÙË Û˘-ÁΤÓÙÚˆÛË ÛÙÔ ˘‰·ÙÔÂȉ¤˜ ˘ÁÚfi ÙˆÓ TGF-beta1,MMP-2 Î·È TIMP-2 Û ·ÛıÂÓ›˜ Ì °∞. ªÂÏÏÔ-ÓÙÈο ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ÌappleÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂappleÚÒÈÌË ¯Ú‹ÛË Ù˘ Ï·Ù·ÓÔappleÚfiÛÙ˘ ‹ ¿ÏÏˆÓ apple·Úfi-ÌÔÈˆÓ Ê·ÚÌ¿ÎˆÓ Û ·ÛıÂÓ›˜ Ì ∞ appleÚÈÓ ÂÌÊ·Ó›-ÛÔ˘Ó ¿ÓÔ‰Ô Ù˘ ∂O, ˆ˜ appleÚÔÏËappleÙÈ΋ ·ÁˆÁ‹ (Konstas et al 2006).∞˘Ù¤˜ ÔÈ appleÚfiÛÊ·Ù˜ ÂÚ¢ÓËÙÈΤ˜ appleÚfiÔ‰ÔÈ,appleÔ˘ appleÂÚÈÁÚ¿ÊËÎ·Ó ·ÓˆÙ¤Úˆ, apple·Ú¤¯Ô˘Ó ˘appleÔÛ¯fi-ÌÂÓ· ‰Â‰Ô̤ӷ, Ù· ÔappleÔ›· ·Ó ·ÎÔÏÔ˘ıËıÔ‡Ó ·applefiÌÈ· ‰ÔÌË̤ÓË ÎÏÈÓÈÎÔ-‚ÈÔ¯ËÌÈ΋ appleÚfiÙ·ÛË, ›Ûˆ˜Ô‰ËÁ‹ÛÔ˘Ó ÛÙË ‰È·Û·Ê‹ÓÈÛË ÙˆÓ apple·ıÔÁÂÓÂÙÈÎÒÓÔ‰ÒÓ Î·È ÌÔÚÈ·ÎÒÓ ÛËÌ¿ÙˆÓ, appleÔ˘ Û˘ÓÂapple¿ÁÔÓÙ·ÈÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ °∞.μÈ‚ÏÈÔÁÚ·Ê›·Aasved H. The frequency of fibrillopathia epitheliocapsularis(so-called senile exfoliation or pseudoexfoliaton)in patients with open angle glaucoma. Acta Ophthalmol49: 194-10, 1971a.Aasved H. Mass screening for fibrillopathia epitheliocapsularis.Acta Ophthalmol 49: 334-43, 1971b.Aasved H. Intraocular pressure in eyes with and withoutfibrillopathia epitheliocapsularis. Acta Ophthalmol49: 601-10, 1971c.Aasved H. Mass screening for fibrillopathia epitheliocapsularis.Acta Ophthalmol 49: 334-43, 1971d.Aasved H. Prevalence of fibrillopathia epitheliocapsularis(pseudoexfoliation) and capsular glaucoma. TransOphthalmol Soc U K 99: 293-5, 1975.Amari F, Nagata S, Umihira J. Lectin electron microscopichistochemistry of the pseudoexfoliative material inthe skin. Invest Ophthalmol Vis Sci 35 3962–66, 1994.Arvind H, Raju P, Paul PG, et al. Pseudoexfoliation in SouthIndia. Br J Ophthalmol 87: 1321-23, 2003.Awan KJ. Acute angle-closure glaucoma in pseudoexfoliationsyndrome. Glaucoma 6: 226-7, 1984.Ayed S, Ghorbel M, Nacef L, et al. The exfoliation syndromein Tunisia. Tunis Med 68: 19-22, 1990.Baba ∏. Histochemical and polarization optical investigationfor glycosaminoglycans in exfoliation syndrome.Graefes Arch Clin Exp Ophthalmol 221: 106-9,1983.Bartholomew RS. Pseudocapsular exfoliation in the Bantuof South Africa. II Occurrence and prevalence. Br JOphthalmol 57: 41-5, 1973.Bartholomew RS. Incidence of pseudoexfoliation in SouthAfrican Negroes and Scots. Trans Ophthalmol Soc UK 99: 299-01, 1979.Bartholomew RS. Pseudoexfoliation and angle-colsureglaucoma. Glaucoma 3: 213-16, 1981.Bedri A, Alemu B. Pseudoexfoliation syndrome in Ethipianglaucoma patients. East Afr Med J 76: 278-80, 1999.Brooks AMV, GilliesWE. The presentation and prognosis of

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∫ÏÈÓÈΤ˜ Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ÌÂϤÙ˜∂appleÈ̤ÏÂÈ·: ¡. °ÂˆÚÁÈ¿‰Ë˜e-mail: gnick@med.auth.gr˘ÁÎÚÈÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·applefiÊڷ͢ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ Î·È ·ÎÚ˘ÏÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ·applefiÊڷ͢ Ù˘ ÏË·ıÔ˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛËÙ˘ Û˘Ìappleو̷ÙÈ΋˜ ÍËÚÔÊı·ÏÌ›·˜∫. ªappleÔÌappleÔÚ›‰Ë˜, ¢. ªÈÎÚfiappleÔ˘ÏÔ˜, ∂. °ÂˆÚÁÈ¿‰Ô˘, ¡. ∑ȿη˜, ¡. °ÂˆÚÁÈ¿‰Ë˜Comparative application of punctum plugs and acrylic lacrimal plugsfor the management of symptomatic dry eyesK. Boboridis, D. Mikropoulos, ∂. Georgiadou, N. Ziakas, N. Georgiadis∂ÈÛ·ÁˆÁ‹: ∏ ·applefiÊÚ·ÍË ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ ÛˆÏËÓ·Ú›ˆÓ¤¯ÂÈ ÂÊ·ÚÌÔÛı› Ì ÂappleÈÙ˘¯›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ù˘ÍËÚÔÊı·ÏÌ›·˜. ·ÚÔ˘ÛÈ¿˙Ô˘Ì ٷ ·appleÔÙÂϤÛÌ·Ù· ·applefiÙËÓ Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·applefiÊڷ͢ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ Ì ·˘Ù¿ appleÔ˘ ·appleÔÊÚ¿ÛÛÔ˘Ó ÙËÓ‰·ÎÚ˘˚΋ Ï‹Î˘ıÔ Î·È ‰·ÎÚ˘˚Îfi ÛˆÏËÓ¿ÚÈÔ. ª¤ıÔ‰Ô˜:∞Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 32 ·ÛıÂÓÒÓ Ì ÍËÚÔÊı·ÏÌ›· fiÁÎÔ˘appleÔ˘ ·ÓÙÈÌÂÙˆapple›ÛıËÎ·Ó Û ‰È¿ÛÙËÌ· 4 ÂÙÒÓ (2001-2005)Ì ÌÔۯ‡̷ٷ ·applefiÊڷ͢ ÙˆÓ Î¿Ùˆ ‰·ÎÚ˘˚ÎÒÓ ÛˆÏË-Ó·Ú›ˆÓ.  11 ·ÛıÂÓ›˜ (ÔÌ¿‰· ∞) ÙÔappleÔıÂÙ‹ıËÎ·Ó ÌÔ-ۯ‡̷ٷ ÛÈÏÈÎfiÓ˘ ÛÙÔ ‰·ÎÚ˘˚Îfi ÛËÌÂ›Ô Î·È Û 15·ÛıÂÓ›˜ (ÔÌ¿‰· μ) ·ÎÚ˘ÏÈο ÌÔۯ‡̷ٷ ·applefiÊÚ·Í˘Ù˘ ‰·ÎÚ˘˚΋˜ ÏË·ıÔ˘, ÂÓÒ Û 6 ·ÛıÂÓ›˜ (ÔÌ¿‰· °)ÌÔۯ‡̷ٷ ·applefiÊڷ͢ ‰·ÎÚ˘˚ÎÔ‡ ÛˆÏËÓ·Ú›Ô˘. ÙËÓÂÏ¿¯ÈÛÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ apple·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ 12 ÌËÓÒÓηٷÁÚ¿ÊËÎ·Ó Ù· Û˘ÌappleÙÒÌ·Ù· Î·È ÛËÌ›· ÍËÚÔÊı·Ï-Ì›·˜, Ë ·appleÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·applefiÊڷ͢ Î·È ÔÈ appleÈı·Ó¤˜ÂappleÈappleÏÔΤ˜. ∞appleÔÙÂϤÛÌ·Ù·: ÙËÓ ÔÌ¿‰· ∞ ¯ÚËÛÈ-ÌÔappleÔÈ‹ıËÎ·Ó ÌÔۯ‡̷ٷ 0,6 Î·È 0,8 mm ÌÂÙ¿ ·applefi ‰È·-ÛÙÔÏ‹ ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ. ∏ ‰ÔÎÈÌ·Û›· Schirmer’s·˘Í‹ıËΠηٿ ̤ÛÔ fiÚÔ 9 mm, ÂÓÒ 8/11 (73%) ·ÛıÂÓ›˜·Ó¤ÊÂÚ·Ó ˘appleÔÎÂÈÌÂÓÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌappleÙˆÌ¿ÙˆÓ ÌÂÙ¿ÙËÓ ‰Â‡ÙÂÚË Â‚‰ÔÌ¿‰·.  7/11 (63%) appleÂÚÈÛÙ·ÙÈο ‰È·appleÈ-ÛÙÒıËÎÂ Ù˘¯·›· ·appleÒÏÂÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓfi˜ ÌÔۯ‡̷ÙÔ˜ÂÓÙfi˜ ÙÔ˘ ÙÚ›ÙÔ˘ Ì‹Ó·.  2 appleÂÚÈÛÙ·ÙÈο ÂÌÊ·Ó›ÛıËÎÂIntroduction: Lacrimal occlusion has become an establishedmethod of dry eye management. We present theresults from a comparative study of punctum plugs versusacrylic lacrimal plugs. Methods: Retrospective studyof 32 patients with aqueous tear deficiency managedwith lower lacrimal occlusion over a 4 year period (2001-2005). Eleven patients (group A) had silicon punctumplugs whereas 15 patients (group B) had acrylic lacrimalplugs and 6 patients (group C) had canalicular plugs. Inthe minimum follow up period of 12 months we recordedthe symptoms and signs of dry eyes, the effectiveness ofocclusion and possible complications. Results: In groupA were used plugs of 0,6 and 0,8 mm diameter after punctumdilatation. Mean increase of Schirmer’s test was 9mm and 8/11 (73%) patients reported subjective improvementafter the second week. In 7/11 (63%) casesspontaneous loss of at least one plug was recordedwithin the first three months. Pyogenic granuloma of thepunctum developed in 2 cases whereas further 3 had conjunctivalirritation. In group μ no punctum dilatation wasrequired, mean increase of Schirmer’s test was 5 mmand 13/15 (86%) patients reported subjective improvementof symptoms. In group C the plug was inserted followingpunctum dilatation, mean increase of Schirmer’stest was 7 mm and one case developed canalicular in-A′ OÊı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ·ÓÂappleÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢OÊı·ÏÌÔÏÔÁ›·, 18, 2 : 133 - 138, 2006

134 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)apple˘ÔÁfiÓÔ ÎÔÎΛˆÌ· ÛÙËÓ appleÂÚÈÔ¯‹ ÙÔ˘ ‰·ÎÚ˘˝ÎÔ‡ ÛËÌ›ԢÂÓÒ Û 3 ÂÚÂıÈÛÌfi˜ ÙÔ˘ ÂappleÈappleÂÊ˘ÎfiÙ·. ÙËÓ ÔÌ¿‰· μ ÙÔÌfiÛ¯Â˘Ì· ÙÔappleÔıÂÙ‹ıËΠ¯ˆÚ›˜ ‰È·ÛÙÔÏ‹ ÙÔ˘ ÛËÌ›Ԣ, ˉÔÎÈÌ·Û›· Schirmer’s ·˘Í‹ıËΠηٿ ̤ÛÔ fiÚÔ 5 mm ηÈ13/15 (86%) ·ÛıÂÓ›˜ apple·ÚÔ˘Û›·Û·Ó ˘appleÔÎÂÈÌÂÓÈ΋ ‚ÂÏÙ›ˆ-ÛË ÙˆÓ Û˘ÌappleÙˆÌ¿ÙˆÓ ¯ˆÚ›˜ ÂappleÈappleÏÔΤ˜. ÙËÓ ÔÌ¿‰· ° ÙÔÌfiÛ¯Â˘Ì· ÙÔappleÔıÂÙ‹ıËΠÌÂÙ¿ ·applefi ‰È·ÛÙÔÏ‹ ÙÔ˘ ÛËÌ›Ԣ,Ë ‰ÔÎÈÌ·Û›· Schirmer’s ·˘Í‹ıËΠηٿ 7 mm Î·È fiÏÔÈ ÔÈ·ÛıÂÓ›˜ (100%) apple·ÚÔ˘Û›·Û·Ó ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìappleو̿-ÙˆÓ.  ¤Ó· appleÂÚÈÛÙ·ÙÈÎfi apple·ÚÔ˘ÛÈ¿ÛıËΠÊÏÂÁÌÔÓ‹ ÙÔ˘‰·ÎÚ˘˚ÎÔ‡ ÛˆÏËÓ·Ú›Ô˘ appleÔ˘ ·ÓÙÈÌÂÙˆapple›ÛıËÎÂ Û˘ÓÙËÚËÙÈ-ο. ¢ÂÓ apple·ÚÔ˘ÛÈ¿ÛıËÎ·Ó ¿ÏϘ ÂappleÈappleÏÔΤ˜. ˘ÌappleÂÚ¿-ÛÌ·Ù·: Δ· ÌÔۯ‡̷ٷ ·applefiÊڷ͢ ÙÔ˘ ‰·ÎÚ˘˝ÎÔ‡ ÛËÌ›-Ô˘ ·apple·ÈÙÔ‡Ó ÙËÓ ÂappleÈÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ÌÂÁ¤ıÔ˘˜, appleÚÔ-ÛʤÚÔ˘Ó appleÏ‹ÚË ·applefiÊÚ·ÍË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Ì ÌÈÎÚ‹fï˜ ˘appleÔÎÂÈÌÂÓÈ΋ ‚ÂÏÙ›ˆÛË ÏfiÁˆ ÂÚÂıÈÛÌÔ‡ ÙÔ˘ ÂappleÈappleÂ-Ê˘ÎfiÙ· Î·È Ù˘¯·›·˜ ·appleÒÏÂÈ·˜. ∞ÓÙ›ıÂÙ·, Ù· ·ÎÚ˘ÏÈο ÌÔ-ۯ‡̷ٷ ‰·ÎÚ˘˚΋˜ ÏË·ıÔ˘ ‰ÂÓ ·apple·ÈÙÔ‡Ó ‰È·ÛÙÔÏ‹ ÙÔ˘ÛËÌ›Ԣ, appleÚÔÛʤÚÔ˘Ó ˘„ËÏfi appleÔÛÔÛÙfi ˘appleÔÎÂÈÌÂÓÈ΋˜‚ÂÏÙ›ˆÛ˘ ÙˆÓ Û˘Ìappleو̿وÓ, ‰ÂÓ Û˘Ó‰¤ÔÓÙ·È Ì ¿ÏϘÂappleÈappleÏÔΤ˜, apple·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ¤ÙÛÈ Ì›· ·appleÔÙÂÏÂÛÌ·ÙÈ΋ ̤ıÔ‰Ô·ÓÙÈÌÂÙÒappleÈÛ˘ Ù˘ ÍËÚÔÊı·ÏÌ›·˜ fiÁÎÔ˘. Δ¤ÏÔ˜, Ù·ÌÔۯ‡̷ٷ ‰·ÎÚ˘˚ÎÔ‡ ÛˆÏËÓ·Ú›Ô˘ apple·Ú¤¯Ô˘Ó appleÏ‹ÚË ·-applefiÊÚ·ÍË Ì ˘appleÔÎÂÈÌÂÓÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìappleو̿وÓ.flammation which was treated conservatively. No furthercomplications were recorded. Conclusions: Punctumplugs require size selection and offer complete occlusionof the lower system with low subjective improvement dueto conjunctival irritation and spontaneous loss. On thecontrary, the acrylic lacrimal plugs do not require punctumdilatation and achieve a high subjective improvement ratewith minimal discomfort. Finally, the canalicular plugs offerthe maximum occlusion with high patient satisfaction butare related to minor transient complications.∂ÈÛ·ÁˆÁ‹ÔÏϤ˜ ıÂÚ·apple¢ÙÈΤ˜ ̤ıÔ‰ÔÈ ¤¯Ô˘Ó ÂÊ·ÚÌÔ-Ûı› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË ÙˆÓ ÛËÌ›ˆÓ Î·È Û˘-ÌappleÙˆÌ¿ÙˆÓ Ù˘ ·appleÏ‹˜ ÍËÚÔÊı·ÏÌ›·˜ ·applefi ÌÂȈ̤-ÓË ¤ÎÎÚÈÛË Ù˘ ˘‰¿ÙÈÓ˘ Ê¿Û˘ ÙˆÓ ‰·ÎÚ‡ˆÓ ÌÂ-ٷ͇ ÙˆÓ ÔappleÔ›ˆÓ, ÔÈ appleÈÔ Û˘ÓËıÈṲ̂Ó˜, Â›Ó·È Ë ÙÔappleÈ΋·ÁˆÁ‹ Ì Û΢¿ÛÌ·Ù· Ù¯ÓËÙÒÓ ‰·ÎÚ‡ˆÓ ηÈË ·applefiÊÚ·ÍË ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Ì ÌÔ-ۯ‡̷ٷ ÛÈÏÈÎfiÓ˘. ∏ ÙÂÏÂ˘Ù·›· ̤ıÔ‰Ô˜ appleÂÚÈ-Ï·Ì‚¿ÓÂÈ ÌÔۯ‡̷ٷ ·applefiÊڷ͢ ÙˆÓ ‰·ÎÚ˘˚ÎÒÓÛËÌ›ˆÓ appleÔ˘ apple·Ú·Ì¤ÓÔ˘Ó ÔÚ·Ù¿ ÛÙËÓ ÂappleÈÛÎfiappleËÛËÎ·È Ù˘ ‰·ÎÚ˘˚΋˜ ÏË·ıÔ˘ Î·È ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ Ûˆ-ÏËÓ·Ú›Ô˘ appleÔ˘ ÂÊ·ÚÌfi˙ÔÓÙ·È ÂÓÙfi˜ ÙˆÓ ÛˆÏËÓ·Ú›ˆÓÎ·È ¿Ú· ‰ÂÓ Â›Ó·È ÔÚ·Ù¿ ηٿ ÙËÓ ÂͤٷÛË 1-4 . ∏·applefiÊÚ·ÍË Ù˘ ·appleÔ¯ÂÙ¢ÙÈ΋˜ ÌÔ›Ú·˜ ÙÔ˘ ‰·ÎÚ˘˚-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì Âapple·ÎfiÏÔ˘ıÔ ÙËÓ ÂÍ·ÛÊ¿ÏÈÛËÌÂÁ·Ï‡ÙÂÚÔ˘ fiÁÎÔ˘ ‰·ÎÚ‡ˆÓ ÛÙËÓ ‚ÏÂÊ·ÚÈ΋ Û¯È-ÛÌ‹ Î·È ÔÊı·ÏÌÈ΋ ÂappleÈÊ¿ÓÂÈ· ¤¯ÂÈ ÂÊ·ÚÌÔÛı› ÌÂÛ¯ÂÙÈ΋ ÂappleÈÙ˘¯›· appleÔ˘ appleÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙÔÓ Ù‡-appleÔ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ù˘ Û˘-Ìappleو̷ÙÈ΋˜ ·appleÏ‹˜ ÍËÚÔÊı·ÏÌ›·˜5. ∞ÎfiÌ·, appleÔÈΛ-Ϙ ÂappleÈappleÏÔΤ˜ ¤¯Ô˘Ó ηٷÁÚ·Ê›, Û¯ÂÙÈ˙fiÌÂÓ˜ ÌÂÙÔ Â›‰Ô˜ Î·È ÙÔ ˘ÏÈÎfi ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ Î·ıÒ˜ ηÈÙÔ ÛËÌÂ›Ô Ù˘ ·applefiÊڷ͢.ÎÔapplefi˜ Ù˘ apple·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ¤Ú¢ӷÙ˘ Û˘ÁÎÚÈÙÈ΋˜ ·appleÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ÙÚÈÒÓ‚·ÛÈÎÒÓ Ù‡appleˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·applefiÊڷ͢ ÙˆÓ ÙÚÈ-ÒÓ ‰È·‰Ô¯ÈÎÒÓ ÛËÌ›ˆÓ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·appleÔ¯ÂÙ¢-ÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ηٷÁÚ¿ÊÔÓÙ·˜ ÙËÓ ·ÏÏ·Á‹ÙˆÓ ÛËÌ›ˆÓ Î·È Û˘ÌappleÙˆÌ¿ÙˆÓ Ù˘ ·appleÏ‹˜ ÍËÚÔ-Êı·ÏÌ›·˜, ÙËÓ Â˘ÎÔÏ›· ¯ÂÈÚÈÛÌÔ‡ ÙÔ˘ οı ÌÔ-ۯ‡̷ÙÔ˜ Î·È ÙȘ appleÈı·Ó¤˜ ÂappleÈappleÏÔΤ˜ appleÔ˘ Û¯ÂÙ›˙Ô-ÓÙ·È Ì ÙËÓ ¯Ú‹ÛË ÙÔ˘˜.ª¤ıÔ‰Ô˜∏ ÂÚÁ·Û›· ·˘Ù‹ ·ÊÔÚ¿ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ÙˆÓ·Ú¯Â›ˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘Ìappleو̷ÙÈ΋ ÍËÚÔÊı·ÏÌ›·fiÁÎÔ˘ appleÔ˘ ·ÓÙÈÌÂÙˆapple›ÛıËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Î·È ÛÂȉȈÙÈÎfi ΤÓÙÚÔ Û ‰È¿ÛÙËÌ· 4 ÂÙÒÓ (∞appleÚ›ÏÈÔ˜ 2001-ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2005) Ì ٷ ÙÚ›· ‚·ÛÈο ›‰Ë ÌÔÛ¯Â˘Ì¿-ÙˆÓ ·applefiÊڷ͢ ÙˆÓ ÙÚÈÒÓ ‰È·‰Ô¯ÈÎÒÓ ÛËÌ›ˆÓ ÙˆÓ Î¿-Ùˆ ‰·ÎÚ˘˚ÎÒÓ ÛˆÏËÓ·Ú›ˆÓ.ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Û˘ÌappleÂÚÈÏ‹ÊıËηÓfiÛÔÈ apple·ÚÔ˘Û›·˙·Ó Û˘ÌappleÙÒÌ·Ù· ·applefi ·appleÏ‹ ÍËÚ¿ ÎÂÚ·ÙÔ-ÂappleÈappleÂÊ˘Î›Ùȉ· (KC sicca), Û‡Ìʈӷ Ì ٷ apple·Ú·Î¿ÙˆÎÚÈÙ‹ÚÈ·6:1) ˘ÌappleÙÒÌ·Ù· η‡ÛÔ˘ ‹ ͤÓÔ˘ ÛÒÌ·ÙÔ˜ Û¯ÂÙÈ˙fi-ÌÂÓ· Ì ÍËÚfi ÔÊı·ÏÌfi2) £ÂÙÈ΋ ¯ÚÒÛË Ù˘ ÔÊı·ÏÌÈ΋˜ ÂappleÈÊ¿ÓÂÈ·˜ ÌÂÊÏÔ˘ÔÚÂÛνÓË (fluorescein) ‹ ÂÚ˘ıÚfi Ù˘ μÂÁÁ¿Ï˘(rose μengal) ηÈ

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 1353) ÃÚfiÓÔ ‰È¿Ûapple·Û˘ ¯ÚˆÛÙÈ΋˜ ÏÈÁfiÙÂÚÔ ·applefi 5 sec‹ ‰ÔÎÈÌ·Û›· Schirmer ÌÈÎÚfiÙÂÚË ·applefi 5 mm.∏ ¯ÚÒÛË Ù˘ ÔÊı·ÏÌÈ΋˜ ÂappleÈÊ¿ÓÂÈ·˜ Ì fluoresceinÎ·È rose μengal ÁÈÓfiÙ·Ó Ì ÙËÓ ·ÎfiÏÔ˘ıË Ì¤ıÔ‰Ô,fiappleˆ˜ appleÂÚÈÁÚ¿ÊËΠ·applefi ÙÔ˘˜ Shimmura 7 Î·È Toda 8 . ∏¯ÚÒÛË Ì fluorescein ·ÊÔÚÔ‡Û ÙÔ ÂappleÈı‹ÏÈÔ ÙÔ˘ ÎÂÚ·-ÙÔÂȉ‹ ¯ˆÚÈṲ̂ÓÔ Û ÙÚÂȘ ÔÚÈ˙fiÓÙȘ ˙ÒÓ˜, ÙËÓ ¿Óˆ,̤ÛË Î·È Î¿Ùˆ, ηٷÁÚ¿ÊÔÓÙ·˜ ÁÈ· ÙËÓ Î¿ı ˙ÒÓË ‚·ı-ÌÔÏÔÁ›· ·applefi 0 ¤ˆ˜ 3, ·Ó¿ÏÔÁ· Ì ÙËÓ ¤ÓÙ·ÛË Ù˘ ηٷ-ÎÚ¿ÙËÛ˘ ¯ÚˆÛÙÈ΋˜, ‰›ÓÔÓÙ·˜ ¤ÙÛÈ Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔ-Á›· ·applefi 0 ¤ˆ˜ 9. ∞ÓÙ›ÛÙÔȯ· Ë ¯ÚÒÛË Ì rose μengal·ÊÔÚÔ‡Û fiÏË ÙËÓ ÔÊı·ÏÌÈ΋ ÂappleÈÊ¿ÓÂÈ·, Ë ÔappleÔ›· ¯ˆÚ›-˙ÔÓÙ·Ó Û ÙÚÂȘ ηٷÎfiÚ˘Ê˜ ˙ÒÓ˜, ÙÔ ÙÚ›ÁˆÓÔ ÙÔ˘ ÚÈ-ÓÈÎÔ‡ ÂappleÈappleÂÊ˘ÎfiÙ·, ÙËÓ ÂappleÈÊ¿ÓÂÈ· ÙÔ˘ ÎÂÚ·ÙÔÂȉ‹ ηÈÙÔ ÙÚ›ÁˆÓÔ ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÂappleÈappleÂÊ˘ÎfiÙ·, Ì ·ÓÙ›ÛÙÔȯ˂·ıÌÔÓfiÌËÛË ·applefi 0 ¤ˆ˜ 3 ÁÈ· οı ˙ÒÓË, ·Ó¿ÏÔÁ· ÌÂÙËÓ ¤ÓÙ·ÛË ¯ÚÒÛ˘ Î·È Û˘ÓÔÏÈο ·applefi 0 ¤ˆ˜ 9.∞ÎfiÌ·, ÛÙËÓ ÌÂϤÙË Û˘ÌappleÂÚÈÏ‹ÊıËÎ·Ó fiÛÔÈ ·ÛıÂ-Ó›˜ apple·ÚÔ˘Û›·˙·Ó apple·ÚfiÌÔÈ· Û˘Ìappleو̷ÙÈ΋ ÍËÚÔÊı·Ï-Ì›· fiÁÎÔ˘ ·applefi Ì›ˆÛË apple·Ú·ÁˆÁ‹˜ ‰·ÎÚ‡ˆÓ ÏfiÁˆ ·˘-ÙÔ¿ÓÔÛ˘ ‰È·Ù·Ú·¯‹˜, fiappleˆ˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ Sjogren’s, ˉȿÁÓˆÛË ÙÔ˘ ÔappleÔ›Ô˘ ÂappleȂ‚·ÈÒÓÔÓÙ·Ó Ì ÙËÓ apple·ÚÔ˘-Û›· ÙÚÈÒÓ ·applefi Ù· Ù¤ÛÛÂÚ· apple·Ú·Î¿Ùˆ ÎÚÈÙ‹ÚÈ· ηٿFox 9 :1) •ËÚÔÊı·ÏÌ›· fiappleˆ˜ ηıÔÚ›ÛıËΠapple·Ú·apple¿Óˆ2) •ËÚÔÛÙÔÌ›·3) £ÂÙÈ΋ ‚ÈÔ„›· ÂappleÈÎÔ˘ÚÈÎÔ‡ ÛÈÂÏÔÁfiÓÔ˘ ·‰¤Ó··applefi ÙÔÓ ÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ ÁÈ· ÏÂÌÊÔ΢ÙÙ·ÚÈ΋‰È‹ıËÛË Î·È4) £ÂÙÈΤ˜ ÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· ÚÂ˘Ì·ÙÔÂȉ‹apple·Ú¿ÁÔÓÙ· ‹ ·ÓÙÈapple˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù· ‹ ·ÓÙÈÛÒÌ·Ù·SS-A ‹ SS-B.¢ÂÓ Û˘ÌappleÂÚÈÏ‹ÊıËÎ·Ó appleÂÚÈÛÙ·ÙÈο Ì ‚·Ú‡ÙÂÚÂ˜Ô˘ÏÔappleÔÈËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÊı·ÏÌÈ΋˜ ÂappleÈÊ¿ÓÂÈ·˜ÏfiÁˆ ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ fiappleˆ˜ ÛÙÔ ÔÊı·ÏÌÈÎfiappleÂÌÊÈÁÔÂȉ¤˜ ‹ ·Ú¯fiÌÂÓË Ù‹ÍË Ù˘ appleÂÚÈʤÚÂÈ·˜ ÙÔ˘ ÎÂ-Ú·ÙÔÂȉԇ˜, fiappleˆ˜ ÛÙËÓ ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ·. Δ¤ÏÔ˜,·appleÔÎÏ›ÛıËÎ·Ó fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÌappleÙÒÌ·Ù· ÍËÚÔ-Êı·ÏÌ›·˜ ·applefi ÂÍ¿ÙÌÈÛË ‰·ÎÚ‡ˆÓ ÏfiÁˆ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ÙˆÓ Ù·ÚÛÈ·›ˆÓ ·‰¤ÓˆÓ ‹ ‚ÏÂÊ·Ú›Ùȉ·˜ ηıÒ˜ Î·È fiÛÔÈapple·ÚÔ˘Û›·˙·Ó ‰È·Ù·Ú·¯¤˜ ı¤Û˘ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ fiappleˆ˜ÂÎÙÚfiappleÈÔ, ÂÓÙÚfiappleÈÔ Î·È Î˘Ú›ˆ˜ Ô˘Ï҉˜, ÙÚȯ›·ÛË ‹ Ô˘-ÏÔappleÔ›ËÛË ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ.∂ÈÎ. 1. ¯ËÌ·ÙÈ΋ apple·Ú¿ÛÙ·ÛË ÙÔ˘ ÌÔÛ¯Â˘Ì¿ÙˆÓ ÛÈÏÈÎfi-Ó˘ ÁÈ· ÙËÓ ·applefiÊÚ·ÍË ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ.∂ÈÎ. 2. ∞applefiÊÚ·ÍË ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ Ì ÌfiÛ¯Â˘Ì·ÛÈÏÈÎfiÓ˘ Î·È Ë ·ÓÙȉڷÛÙÈ΋ ˘appleÂÚ·ÈÌ›· Ù˘ appleÂÚÈÔ¯‹˜.∂ÈÎ. 3. ∞. ΔÔappleÔı¤ÙËÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ‰·ÎÚ˘˚΋˜ ÏË·ıÔ˘ (Smart plug) Ì ÙÔ 1/3 ÙÔ˘ Ì‹ÎÔ˘˜ ÙÔ˘ ÂÎÙfi˜ ÙÔ˘ ÛËÌ›Ԣ. μ.μÚ¿¯˘ÓÛË Î·È ‰È‡ڢÓÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ·applefi ÙËÓ ıÂÚÌÔÎÚ·Û›· ÙÔ˘ ÛÒÌ·ÙÔ˜ 5-10″ ·ÚÁfiÙÂÚ·.

136 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)∂ÈÎ. 4. ΔÔappleÔı¤ÙËÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ‰·ÎÚ˘˚ÎÔ‡ ÛˆÏË-Ó·Ú›Ô˘ (Herrick plug).OÈ 32 ·ÛıÂÓ›˜ appleÔ˘ Û˘ÌappleÂÚÈÏ‹ÊıËÎ·Ó ÛÙËÓ ÌÂϤÙËηٷٿ¯ıËÎ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜.  11 ·ÛıÂÓ›˜ (ÔÌ¿‰·∞) ÙÔappleÔıÂÙ‹ıËÎ·Ó ÌÔۯ‡̷ٷ ÛÈÏÈÎfiÓ˘ (punctumplugs) ·applefiÊڷ͢ ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ (∂ÈÎ. 1,2) ηÈÛ 15 ·ÛıÂÓ›˜ (ÔÌ¿‰· μ) ıÂÚÌÔ·ÓÙȉÚÒÓÙ· ·ÎÚ˘ÏÈοÌÔۯ‡̷ٷ (smart plugs) ·applefiÊڷ͢ Ù˘ ‰·ÎÚ˘˚΋˜ÏË·ıÔ˘ (∂ÈÎ. 3∞, μ), ÂÓÒ Û 6 ·ÛıÂÓ›˜ (ÔÌ¿‰· °)¯ÚËÛÈÌÔappleÔÈ‹ıËÎ·Ó ÌÔۯ‡̷ٷ ·applefiÊڷ͢ ‰·ÎÚ˘˚ÎÔ‡ÛˆÏËÓ·Ú›Ô˘ (Herrick plugs) (∂ÈÎ. 4). ÙËÓ ÂÏ¿¯ÈÛÙË ÌÂ-ÙÂÁ¯ÂÈÚËÙÈ΋ apple·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ 12 ÌËÓÒÓ Î·Ù·ÁÚ¿-ÊËÎ·Ó ÔÈ ·ÏÏ·Á¤˜ ÛÙ· ˘appleÔÎÂÈÌÂÓÈο Û˘ÌappleÙÒÌ·Ù· ηȷÓÙÈÎÂÈÌÂÓÈο ÛËÌ›· Ù˘ ÍËÚÔÊı·ÏÌ›·˜, Ë Â˘ÎÔÏ›· ¯ÂÈ-ÚÈÛÌÔ‡ Î·È ÙÔappleÔı¤ÙËÛ˘ ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ·applefiÊڷ͢,ÔÈ appleÈı·Ó¤˜ ÂappleÈappleÏÔΤ˜ Î·È Ù¤ÏÔ˜ Ë ‰˘Ó·ÙfiÙËÙ· ·Ó·ÛÙÚÔ-Ê‹˜ Ù˘ ·applefiÊڷ͢.∞appleÔÙÂϤÛÌ·Ù·∞applefi ÙȘ Ù¤ÛÛÂÚÂȘ ‰È·Ì¤ÙÚÔ˘˜ appleÔ˘ appleÚÔÛʤÚÔ-ÓÙ·È Ù· ÌÔۯ‡̷ٷ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ, ·Ó¿ÏÔÁ·Ì ÙËÓ ÂÙ·ÈÚ›·, ¯ÚËÛÈÌÔappleÔÈ‹ıËÎ·Ó ÌfiÓÔÓ ·˘Ù¿ÙˆÓ 0,6 Î·È 0,8 mm, ‰ËÏ·‰‹ ÔÈ ÌÂÁ·Ï‡ÙÂÚ˜ ‰È¿ÌÂ-ÙÚÔÈ, ÛÙ· appleÂÚÈÛÙ·ÙÈο Ù˘ ÔÌ¿‰·˜ ∞.  fiÏÔ˘˜ ·˘-ÙÔ‡˜ ÙÔ˘ ·ÛıÂÓ›˜ Ù· ÌÔۯ‡̷ٷ ÙÔappleÔıÂÙ‹ıËηÓÌÂÙ¿ ·applefi ‰È·ÛÙÔÏ‹ ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ ¤appleÂÈÙ··applefi ÂÓÛÙ¿Ï·ÍË ÙÔappleÈÎÔ‡ ·Ó·ÈÛıËÙÈÎÔ‡ ÂÓÒ Û 4·ÛıÂÓ›˜ ¯ÚÂÈ¿ÛıËÎÂ Ë ÙÔappleÈ΋ ‰È‹ıËÛË Ì ͢ÏÔ-η˝ÓË ÏfiÁˆ Ù˘ Û¯ÂÙÈ΋˜ apple›ÂÛ˘ appleÔ˘ ·apple·ÈÙÔ‡ÓÙ·ÓÁÈ· ÙËÓ ·ÛÊ·Ï‹ ÙÔappleÔı¤ÙËÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ̤ۈÙÔ˘ ÈÓÒ‰Ô˘˜ ‰·ÎÙ˘Ï›Ô˘ ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ.∏ ‰ÔÎÈÌ·Û›· Schirmer’s ‚ÂÏÙÈÒıËΠ̠̤ÛË·‡ÍËÛË 9 mm, ÂÓÒ 8/11 (73%) ·ÛıÂÓ›˜ ·Ó¤ÊÂÚ·ÓfiÙÈ ‰È·apple›ÛÙˆÛ·Ó ˘appleÔÎÂÈÌÂÓÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘-ÌappleÙˆÌ¿ÙˆÓ ÍËÚÔÊı·ÏÌ›·˜ ÌÂÙ¿ ÙËÓ ‰Â‡ÙÂÚË Â‚‰Ô-Ì¿‰·.  fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ apple·Ú·ÙËÚ‹ıËΠ‹appleÈ·˘appleÂÚ·ÈÌ›· Ù˘ appleÂÚÈÔ¯‹˜ ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›ԢÁ‡Úˆ ·applefi ÙÔ ÌfiÛ¯Â˘Ì· ÂÓÒ ÛÙÔ˘˜ ÌÈÛÔ‡˜ appleÂÚ›appleÔ˘∂ÈÎ. 5. ˘ÔÁfiÓÔ ÎÔÎΛˆÌ· ·applefi ÌÔۯ‡̷ٷ ‰·ÎÚ˘˚ÎÔ‡ÛËÌ›Ԣ.(6/11) ÂÌÊ·Ó›ÛıËΠ‹appleÈ· ˘appleÂÚ·ÈÌ›· ÛÙËÓ ·ÓÙ›ÛÙÔÈ-¯Ë appleÂÚÈÔ¯‹ ÙÔ˘ ‚ÔÏ‚ÈÎÔ‡ ÂappleÈappleÂÊ˘ÎfiÙ·. Δ· apple·Ú·-apple¿Óˆ Â˘Ú‹Ì·Ù· Û˘ÓËÁÔÚÔ‡Ó ˘apple¤Ú ÙÔ˘ ¯ÚfiÓÈÔ˘ÂÚÂıÈÛÌÔ‡ ·applefi ÙÔ ÌfiÛ¯Â˘Ì· Î·È Û˘ÓÂappleÒ˜ Ù˘ ·Ó·-ÎÏ·ÛÙÈ΋˜ ‰·ÎÚ‡ÚÚÔÈ·˜, Ë ÔappleÔ›· Â›Ó·È ˘apple‡ı˘ÓËÁÈ· ÙËÓ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ Schirmer’s test Û·˘Ù¿ Ù· appleÂÚÈÛÙ·ÙÈο.ËÌ·ÓÙÈ΋ apple·Ú·Ù‹ÚËÛË ·appleÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜fiÙÈ Û 7/11 (63%) ·ÛıÂÓ›˜ ‰È·appleÈÛÙÒıËÎÂ Ù˘¯·›··appleÒÏÂÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓfi˜ ÌÔۯ‡̷ÙÔ˜ ÂÓÙfi˜ ÙÔ˘ÙÚ›ÙÔ˘ Ì‹Ó· ·applefi ÙËÓ ÙÔappleÔı¤ÙËÛË.  2 ·ÎfiÌ· appleÂ-ÚÈÛÙ·ÙÈο ÂÌÊ·Ó›ÛıËΠapple˘ÔÁfiÓÔ ÎÔÎΛˆÌ· ÛÙËÓappleÂÚÈÔ¯‹ ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÛËÌ›Ԣ ·applefi ÙÔÓ ¯ÚfiÓÈÔÂÚÂıÈÛÌfi ÙÔ˘ ÂappleÈappleÂÊ˘ÎfiÙ· (∂ÈÎ. 5). fiÏ· Ù· appleÂÚÈÛÙ·ÙÈο Ù˘ ÔÌ¿‰·˜ μ ÙÔ Ìfi-Û¯Â˘Ì· ÙÔappleÔıÂÙ‹ıËΠÛÙËÓ ‰·ÎÚ˘˚΋ Ï‹Î˘ıÔ ¯ˆ-Ú›˜ ‰È·ÛÙÔÏ‹ ÙÔ˘ ÛËÌ›Ԣ ‹ Ì ‹appleÈ· ÌfiÓÔÓ ‰È¿ÓÔÈ-ÍË, Ë ÔappleÔ›· ‹Ù·Ó appleÔχ ηϿ ·ÓÂÎÙ‹ Ì ÙËÓ ÙÔappleÈ΋ÂÓÛÙ¿Ï·ÍË ·Ó·ÈÛıËÙÈÎÔ‡. ∏ ‰ÔÎÈÌ·Û›· Schirmer’s·˘Í‹ıËΠηٿ ̤ÛÔ fiÚÔ 5 mm Î·È 13/15 (86%)·ÛıÂÓ›˜ apple·ÚÔ˘Û›·Û·Ó ˘appleÔÎÂÈÌÂÓÈ΋ ‚ÂÏÙ›ˆÛËÙˆÓ Û˘ÌappleÙˆÌ¿ÙˆÓ ÂÓÙfi˜ Ù˘ ‰Â‡ÙÂÚ˘ ‚‰ÔÌ¿‰·˜·applefi ÙËÓ ·applefiÊÚ·ÍË ¯ˆÚ›˜ ÙËÓ ÂÌÊ¿ÓÈÛË ÂappleÈappleÏÔ-ÎÒÓ. Δ· ÌfiÓ· Ù¯ÓÈο appleÚÔ‚Ï‹Ì·Ù· Ù˘ ÙÔappleÔı¤ÙË-Û˘ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ ÛÙ· appleÚÒÙ· ‰‡Ô appleÂÚÈÛÙ·ÙÈοappleÔ˘ ÂÊ·ÚÌfiÛıËΠ‹Ù·Ó ‹ ıÚ·‡ÛË ÙÔ˘ ÌÔۯ‡̷-ÙÔ˜ ·applefi ÌË Î·Ù¿ÏÏËÏË Ï·‚›‰· ¯ÂÈÚÈÛÌÔ‡ Î·È Ë ‰È·-ÛÙÔÏ‹ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ appleÚÈÓ ÙËÓ ÙÔappleÔı¤ÙËÛË ÏfiÁˆappleÏËÌÌÂÏÔ‡˜ „‡Í˘ Î·È Î·ı˘ÛÙÂÚË̤Ó˘ ÙÔappleÔı¤ÙË-Û˘. ∫·È ÛÙȘ ‰‡Ô appleÂÚÈappleÙÒÛÂȘ ·apple·ÈÙ‹ıËΠ·ÓÙÈη-Ù¿ÛÙ·ÛË ÙÔ˘ ÌÔۯ‡̷ÙÔ˜.∞applefi ÙȘ ÙÚÂȘ ‰È·ı¤ÛÈ̘ ‰È·Ì¤ÙÚÔ˘˜ ÙˆÓ ÌÔ-Û¯Â˘Ì¿ÙˆÓ Herrick ¯ÚËÛÈÌÔappleÔÈ‹ıËÎ·Ó ·˘Ù¿ ÙˆÓ0,5 Î·È 0,7 mm, ‰ËÏ·‰‹ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ‰È·ÙÔ-ÌÒÓ ÛÙ· appleÂÚÈÛÙ·ÙÈο Ù˘ ÔÌ¿‰·˜ °. °È· ÙËÓ ÙÔappleÔ-

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138 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)appleÚÔÛʤÚÔ˘Ó Â˘ÎÔÏ›· ÙÔappleÔı¤ÙËÛ˘ Î·È ˘appleÔÎÂÈÌÂ-ÓÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌappleÙˆÌ¿ÙˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂÛ·Ê‹ ‰˘Ó·ÙfiÙËÙ· Û˘Ó‰˘·ÛÌÔ‡ ÙÔ˘˜ Ì ·applefiÊÚ·ÍËÎ·È ÙÔ˘ ¿Óˆ ÛˆÏËÓ·Ú›Ô˘, fiÙ·Ó ·apple·ÈÙÂ›Ù·È appleÂÚ·È-Ù¤Úˆ ‚ÂÏÙ›ˆÛË Ù˘ ÍËÚÔÊı·ÏÌ›·˜19 .μÈ‚ÏÈÔÁÚ·Ê›·1. Hamano T. Lacrimal duct occlusion for the treatment ofdry eye. Semin Ophthalmol 20(2): 71-4, 2005.2. Jones CE, Anklesaria M, Gordon AD, Prouty RE, RashidR, Singla RK, et al. Retrospective safety study of theherrick lacrimal plug: a device used to occlude the lacrimalcanaliculus. Clao J 28(4): 206-10, 2002.3. Tai MC, Cosar CB, Cohen EJ, Rapuano CJ, Laibson PR.The clinical efficacy of silicone punctal plug therapy.Cornea 21(2): 135-9, 2002.4. Gordonson LC. Efficacy and tolerability outcomes afterpunctal occlusion with silicone plugs in dry eye syndrome.Am J Ophthalmol 132(4): 600-1, 2001.5. Dohlman CH. Punctal occlusion in keratoconjunctivitissicca. Ophthalmology 85(12): 1277-81, 1978.6. Toda I, Fujishima H, Tsubota K. Ocular fatigue is the majorsymptom of dry eye. Acta Ophthalmol (Copenh)71(3): 347-52, 1993.7. Shimmura S, Ono M, Shinozaki K, Toda I, Takamura E,Mashima Y, et al. Sodium hyaluronate eyedrops in thetreatment of dry eyes. Br J Ophthalmol 79(11): 1007-11, 1995.8. Toda I, Tsubota K. Practical double vital staining for ocularsurface evaluation. Cornea 12(4): 366-7, 1993.9. Fox R, Robinson C, Curd J, Kozin F, Howell F. Sjogren’ssyndrome: proposed criteria for classification. ArthritisRheum 45: 577-83, 1896.10. Linberg JV, Moore CA. Symptoms of canalicular obstruction.Ophthalmology 95(8): 1077-9, 1988.11. Rumelt S, Remulla H, Rubin PA. Silicone punctal plugmigration resulting in dacryocystitis and canaliculitis.Cornea 16(3): 377-9, 1997.12. Yuen KS, Cheng AC, Chan WM. Pyogenic granulomasafter silicone punctal plugs: a clinical and histopathologicstudy. Am J Ophthalmol 140(5): 963; author reply963-4, 2005.13. Musadiq M, Mukherji S, Sandramouli S. Pyogenic granulomafollowing silicone punctal plugs: report of twocases. Orbit 24(2):149-51, 2005.14. Obata H, Ibaraki N, Tsuru T. A technique for preventingspontaneous loss of lacrimal punctal plugs. Am J Ophthalmol141(3): 567-9, 2006.15. White WL, Glover AT. Difficulty in removal of siliconepunctum plugs. Ophthalmic Surg 20(7): 523, 1989.16. White WL, Bartley GB, Hawes MJ, Linberg JV, LeventerDB. Iatrogenic complications related to the use ofHerrick Lacrimal Plugs. Ophthalmology 108(10):1835-7, 2001.17. Hunt L. Complications of punctal plugs. Insight 25(3):96, 2000.18. Hurwitz JJ, Pavlin CJ, Rhemtulla K. Identification of retainedintracanalicular plugs with ultrasound biomicroscopy.Can J Ophthalmol 39(5): 533-7, 2004.19. Murgatroyd H, Craig JP, Sloan B. Determination of relativecontribution of the superior and inferior canaliculito the lacrimal drainage system in health using thedrop test. Clin Experiment Ophthalmol 32(4): 404-10,2004.

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140 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)EÈÛ·ÁˆÁ‹ÙÔ ‰˘ÙÈÎfi ÎfiÛÌÔ ÙÔ 5-7% ÙÔ˘ ÁÂÓÈÎÔ‡ appleÏËı˘ÛÌÔ‡apple¿Û¯ÂÈ ·applefi ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ªÂÙ·Í‡ÙˆÓ ÂappleÈappleÏÔÎÒÓ ÙÔ˘ ‰È·‚‹ÙË È‰È·›ÙÂÚË ÛËÌ·Û›·¤¯Ô˘Ó ÔÈ ÔÊı·ÏÌÈΤ˜1.OÊı·ÏÌÈΤ˜ ÂappleÈappleÏÔΤ˜ /¢1. ¿ÚÂÛË Â͈‚ÔÏ‚ÈÎÒÓ Ì˘ÒÓ – ¢Èappleψapple›· –ÙÒÛË ‚ÏÂÊ¿ÚˆÓ2. πÛ¯·ÈÌÈ΋ ÔappleÙÈ΋ Ó¢ÚÔapple¿ıÂÈ· (π.O.¡.)3. ∫·Ù·ÚÚ¿ÎÙ˘ – ¢È·ıÏ·ÛÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ –°Ï·‡ÎˆÌ·4. ¢È·‚ËÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔapple¿ıÂÈ· (¢.∞.)Î·È ÓÂÔ·ÁÁÂÈ·Îfi (N/A) ÁÏ·‡ÎˆÌ·.∏ ¢.∞. Â›Ó·È Ì›· ·applefi ÙȘ ÛÔ‚·ÚfiÙÂÚ˜ ÂappleÈappleÏÔΤ˜Ë ÔappleÔ›·, ·Ó ‰ÂÓ ‰È·ÁÓˆÛı› Î·È ·ÓÙÈÌÂÙˆappleÈÛı›¤ÁηÈÚ·, ηٷϋÁÂÈ Û هÊψÛË.·Ú¿ÁÔÓÙ˜ appleÔ˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛËÎ·È ÂͤÏÈÍË Ù˘ ¢.∞.1. ¢È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ ÙÔ˘ ‰È·‚‹ÙË2. ªÂÙ·‚ÔÏÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÓfiÛÔ˘3. Δ‡appleÔ˜ ÙÔ˘ ‰È·‚‹ÙË4. ˘Ó˘apple¿Ú¯Ô˘Û˜ apple·ı‹ÛÂȘ – ∫·Ù·ÛÙ¿ÛÂȘfiappleˆ˜:·. ¡ÂÊÚÔapple¿ıÂÈ· Ì ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·‚. ∞ÚÙËÚȷ΋ ˘apple¤ÚÙ·ÛËÁ. ∞Ó·ÈÌ›·‰. ∫‡ËÛËÂ. ∂Ê˂›·ÛÙ. ∫·Ù·Ó¿ÏˆÛË ÔÈÓÔappleÓ‡̷ÙÔ˜ – ∫¿appleÓÈÛÌ·˙. ÀappleÂÚÏÈappleȉ·ÈÌ›· Ì ·˘ÍËÛË ÙˆÓ LDL.·ıÔÁ¤ÓÂÈ· Ù˘ ‰È·‚ËÙÈ΋˜·ÌÊÈ‚ÏËÛÙÚÔÂȉÔapple¿ıÂÈ·˜O ΢ÚÈfiÙÂÚÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ ÁÈ·ÙËÓ ·Ó¿appleÙ˘ÍË ¢.∞. Â›Ó·È Ë ˘appleÔÍ›· ÙÔ˘ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉԇ˜. OÈ Ì˯·ÓÈÛÌÔ› Î·È apple·Ú¿ÁÔÓÙ˜ appleÔ˘Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ˘appleÔÍ›·˜ ›ӷÈ:1. H ·‡ÍËÛË Ù˘ ÂÓ‰Ô΢ÙÙ·ÚÈ΋˜ ÛÔÚ‚ÈÙfiÏ˘ÛÙ· appleÂÚÈ·ÙÙ·Ú· appleÔ˘ Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ÂÓ‰Ô-΢ÙÙ¿ÚÈ·˜ ÔÛ̈ÙÈ΋˜ apple›ÂÛ˘-ÂÓ‰Ô΢ÙÙ¿ÚÈÔ Ô›‰ËÌ·Î·È apple·ÚÂÌapplefi‰ÈÛË Ù˘ ‰È¿¯˘Û˘ ÙÔ˘ Ô͢ÁfiÓÔ˘.∞ÓÙ›ÛÙÔÈ¯Ô Ô›‰ËÌ· ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· appleÚÔ-ηÏ› Ú‹ÍË ÙÔ˘ ¤Ûˆ ·ÈÌ·ÙÔ·ÌÊÈ‚ÏËÛÙÚÔÂȉÈÎÔ‡ÊÚ·ÁÌÔ‡ Ì ·appleÔÙ¤ÏÂÛÌ· ‰È·ÚÚÔ‹ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓÙÔ˘ ·›Ì·ÙÔ˜.2. ¿¯˘ÓÛË Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÙÚȯÔ-ÂȉÒÓ Î·È ˘·ÏÔÂȉ‹˜ ÂÎʇÏÈÛË ÙˆÓ ·ÚÙËÚÈÔÏ›ˆÓÎ·È ÙˆÓ ÙÚȯÔÂȉÒÓ appleÔ˘ Ô‰ËÁ› Û ‚·ıÌÈ·›· ÛÙ¤-ÓˆÛË Î·È ·applefiÊÚ·ÍË ÙˆÓ ·ÁÁ›ˆÓ Î·È Î·Ù¿ Û˘Ó¤appleÂÈ·Û Ì›ˆÛË Ù˘ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ , Û ˘appleÔÍ›· ηÈÈÛ¯·ÈÌ›· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜. ∂apple›Û˘ Ë ·appleÒ-ÏÂÈ· ÙˆÓ appleÂÚÈ΢ÙÙ¿ÚˆÓ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›·ÌÈÎÚÔ·Ó¢ڢÛÌ¿ÙˆÓ ÏfiÁˆ Ì›ˆÛ˘ Ù˘ ˘appleÔÛÙ‹ÚË-͢ ÙˆÓ ·ÁÁ›ˆÓ.3. ªÂÙ·‚ÔϤ˜ ÙˆÓ ¿ÌÔÚÊˆÓ Î·È ¤ÌÌÔÚÊˆÓ Û˘-ÛÙ·ÙÈÎÒÓ ÙÔ˘ ·›Ì·ÙÔ˜:·. ∞‡ÍËÛË Ù˘ apple·Ú·ÁˆÁ‹˜ ·applefi ÙÔ ‹apple·Ú ÈÓˆ‰Ô-ÁfiÓÔ˘ Î·È ·2 Ì·ÎÚÔÛÊ·ÈÚÈÓÒÓ appleÔ˘ ·˘Í¿ÓÔ˘Ó ÙËÁÏÔÈfiÙËÙ· ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÙËÓ ÈηÓfiÙËÙ· Û˘Ó¿ıÚÔÈ-Û˘ Î·È Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ.‚. ªÂ›ˆÛË Ù˘ ÂÏ·ÛÙÈÎfiÙËÙ·˜ Î·È Ù˘ ÈηÓfiÙË-Ù·˜ apple·Ú·ÌfiÚʈÛ˘ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ.Á. ªÂÙ·‚ÔϤ˜ ÙˆÓ apple·Ú·ÁfiÓÙˆÓ apple‹Í˘ appleÔ˘ ¢-ÓÔÔ‡Ó ÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚ˆÓ.4. ∏ apple·Ú·ÁˆÁ‹ ·ÁÁÂÈÔÁÂÓÂÙÈÎÒÓ apple·Ú·ÁfiÓÙˆÓ·applefi ÙÔÓ ÈÛ¯·ÈÌÈÎfi ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹, Û·Ó ‡ÛÙ·ÙËappleÚÔÛapple¿ıÂÈ· ·˘ÙÔ‡ ·ÓÙÈÚÚfiappleËÛ˘ Ù˘ ˘appleÔÍ›·˜, appleÔ˘Ô‰ËÁÔ‡Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ·Ó·-ÛÙÔÌÒÛÂˆÓ Î·È ÓÂfiappleÏ·ÛÙˆÓ ·ÁÁ›ˆÓ. Œ¯Ô˘Ó ÌÂ-ÏÂÙËı› ÙÚÂȘ apple·Ú¿ÁÔÓÙ˜. O IGF-1 (insulin likegrowth factor-1), o PDGF (·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ÙˆÓ ·ÈÌÔappleÂÙ·Ï›ˆÓ) Î·È Ô ·˘ÍËÙÈÎfi˜ apple·Ú¿ÁÔÓÙ·˜ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ FGF. Œ¯Ô˘Ó apple·Ú·ÙËÚËı› ·˘ÍË-̤ӷ Âapple›apple‰· ÙÔ˘ IGF-1 ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜.5. ∏ ·˘ÍËÙÈ΋ ¯ËÌÈ΋ Û˘ÁÁ¤ÓÂÈ· Ù˘ ÁÏ˘ÎÔ˙˘-ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ [HbA1c] Ì ÙÔ Ô͢ÁfiÓÔÏfiÁˆ ÙÔ˘ ‰ÂÛÌÔ‡ Ù˘ ÁÏ˘Îfi˙˘ Ì ÙËÓ ÙÂÏÈ΋ ‚·Ï›-ÓË ÙˆÓ ‚-appleÔÏ˘appleÂappleÙȉÈÎÒÓ ·Ï‡ÛˆÓ Ù˘ HbA1c appleÔ˘appleÚÔηÏ› Ì›ˆÛË Ù˘ ÈηÓfiÙËÙ·˜ ·appleÔ‰¤ÛÌ¢Û˘ÙÔ˘ Ô͢ÁfiÓÔ˘ Î·È ÂappleÔ̤ӈ˜ ˘appleÔÍ›· ÏfiÁˆ ÌÂȈ̤-Ó˘ ‰È¿ıÂÛ‹˜ ÙÔ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜. ΔÈ̤˜ HbA1c ¤ˆ˜6% Ù˘ ÔÏÈ΋˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘ ıˆÚÔ‡ÓÙ·È Ê˘ÛÈÔ-ÏÔÁÈΤ˜. ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ apple·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛËÙÔ˘ appleÔÛÔÛÙÔ‡ Ù˘ HbA1c, Ë ÔappleÔ›· ÂÎÊÚ¿˙ÂÈ ¤ÌÌÂ-Û· ÙÔ Ì¤ÛÔ fiÚÔ ÁÏ˘Î·ÈÌ›·˜ ÙÔ˘ appleÚÔËÁÔ‡ÌÂÓÔ˘ ‰È-Ì‹ÓÔ˘1-9 .Ù·‰ÈÔappleÔ›ËÛË Ù˘ ‰È·‚ËÙÈ΋˜·ÌÊÈ‚ÏËÛÙÚÔÂȉÔapple¿ıÂÈ·˜1. ◊appleÈ· ÌË apple·Ú·ÁˆÁÈ΋ ‰È·‚ËÙÈ΋ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉÔapple¿ıÂÈ· [‹appleÈ· ª¢∞]⁄apple·ÚÍË Î·È ÂÓfi˜ ÌfiÓÔ ÌÈÎÚÔ·Ó¢ڇÛÌ·ÙÔ˜ ‹ÌÈÎÚÔ·ÈÌÔÚÚ·Á›·˜ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹2. ªÂÙÚÈ· ÌË apple·Ú·ÁˆÁÈ΋ ‰È·‚ËÙÈ΋ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉÔapple¿ıÂÈ· [̤ÙÚÈ· ª¢∞]ªÈÎÚÔ·ÈÌÔÚÚ·Á›Â˜ ‹ ÌÈÎÚÔ·Ó¢ڇÛÌ·Ù· ‹·ÌÊfiÙÂÚ· Î·È ÂappleÈappleϤÔÓ Ì·Ï·Î¿ ÂÍȉÚÒÌ·Ù· –

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 141ÎÔÌ‚ÔÏÔÁÂÈÔÂȉ›˜ ÊϤ‚˜ ‹ ‹appleȘ ÌÈÎÚÔ·ÁÁÂÈ·-Τ˜ ·ÓˆÌ·Ï›Â˜.3. Ô‚·Ú‹ ÌË apple·Ú·ÁˆÁÈ΋ ‰È·‚ËÙÈ΋ ·ÌÊÈ-‚ÏËÛÙÚÔÂȉÔapple¿ıÂÈ· [ÛÔ‚·Ú‹ ª¢∞]ªÈÎÚÔ·ÈÌÔÚÚ·Á›Â˜ ‹ Î·È ÌÈÎÚÔ·Ó¢ڇÛÌ·Ù·ÛÙ· Ù¤ÛÛÂÚ· ÙÂÙ·ÚÙËÌfiÚÈ· ‹ ÎÔÌ‚ÔÏÔÁÈÔÂȉ›˜ÊϤ‚˜ Û appleÂÚÈÛÛfiÙÂÚ· ·applefi ‰‡Ô ÙÂÙ·ÚÙËÌfiÚÈ· ‹ÌÈÎÚÔ·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜ Û ¤Ó· ÙÂÙ·ÚÙËÌfiÚÈÔ.4. Ôχ ÛÔ‚·Ú‹ ÌË apple·Ú·ÁˆÁÈ΋ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉÔapple¿ıÂÈ· [appleÔχ ÛÔ‚·Ú‹ ª¢∞]¢‡Ô ‹ appleÂÚÈÛÛfiÙÂÚ˜ ·ÏÏÔÈÒÛÂȘ Ù˘ ÛÔ‚·Ú‹˜¯ˆÚ›˜ ·ÏËı‹ ÓÂÔ·ÁÁ›ˆÛË [¡/∞]5. ÚÒÈÌË apple·Ú·ÁˆÁÈ΋ ‰È·‚ËÙÈ΋ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉÔapple¿ıÂÈ·¡/∞ ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘ < ·applefi ÙÔ 1/4 Ù˘ ‰È·-̤ÙÚÔ˘ ÙÔ˘ ‹ ¡/∞ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ < ·applefi ÙÔ óÙ˘ ‰È·Ì¤ÙÚÔ˘ ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘6. À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ apple·Ú·ÁˆÁÈ΋ ‰È·‚ËÙÈ΋·ÌÊÈ‚ÏËÛÙÚÔÂȉÔapple¿ıÂÈ·¡/∞ ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘ > 1/4 Ù˘ ‰È·Ì¤ÙÚÔ˘ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘ Î·È ÂÓ‰Ô¸·ÏÔÂȉÈ΋ ‹ appleÚÔ·ÌÊÈ-‚ÏËÛÙÚÔÂȉÈ΋ ·ÈÌÔÚÚ·Á›· ‹ ¡/∞ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ-‰Ô‡˜ > ·applefi ÙÔ ó Ù˘ ‰È·Ì¤ÙÚÔ˘ ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘.ΔÔ Ô›‰ËÌ· Ù˘ ˆ¯Ú¿˜ ÌappleÔÚ› Ó· ÂÌÊ·Ó›˙ÂÙ·ÈÛ fiÏ· Ù· ÛÙ¿‰È· Ù˘ ¢.∞ 1 .ϤÙË Ì·˜ ·appleÔÎÏ›ÛıËÎ·Ó ·ÛıÂÓ›˜ Ì ÌË Ú˘ıÌÈṲ̂ÓË·ÚÙËÚȷ΋ apple›ÂÛË Î·È ·ÛıÂÓ›˜ Ì ԢڷÈÌ›·.OÈ ·ÛıÂÓ›˜ ¯ˆÚ›ÛÙËηÓ, ·Ó¿ÏÔÁ· Ì ÙËÓ ÙÈÌ‹ Ù˘HbA1c, Ë ÔappleÔ›· ÌÂÙÚ‹ıËΠÛÙÔ ‰È·‚ËÙÔÏÔÁÈÎfi È·ÙÚ›ÔÌ ÙË Ì¤ıÔ‰Ô DCA 2000 Ù˘ Bayer, Û ÙÚÂȘ ÔÌ¿‰Â˜.ÙËÓ appleÚÒÙË ÔÌ¿‰· [Oª∞¢∞ 1] Û˘ÌappleÂÚÈÏ¿‚·Ì·˘ÙÔ‡˜ Ì ÙÈ̤˜ HbA1c 10%.OÈ ·ÛıÂÓ›˜ appleÔ˘ appleÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ÔÌ¿-‰·˜ 1 ‹Ù·Ó 34 (appleÔÛÔÛÙfi 21,4%), Ù˘ ÔÌ¿‰·˜ 2 ‹Ù·Ó 111(appleÔÛÔÛÙfi 69,8%) Î·È Ù˘ ÔÌ¿‰·˜ 3 ‹Ù·Ó 14 (appleÔÛÔÛÙfi8,7%) (¯. 1).ÙË Û˘Ó¤¯ÂÈ· ÌÂÏÂÙ‹Û·Ì ٷ ·appleÔÙÂϤÛÌ·Ù· Ù˘‚˘ıÔÛÎfiappleËÛ˘ Î·È ·Ó¿ÏÔÁ· Ì ٷ Â˘Ú‹Ì·Ù· ¤ÁÈÓ ËÛÙ·‰ÈÔappleÔ›ËÛË ÛÂ:1. Èڛ˜ apple·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·2. ◊appleÈ· ª¢∞3. ª¤ÙÚÈ· ª¢∞4. Ô‚·Ú‹ ª¢∞5. Ôχ ÛÔ‚·Ú‹ ª¢∞6. ·Ú·ÁˆÁÈ΋ ¢∞∫·ÙfiappleÈÓ ¤ÁÈÓ ÂappleÂÍÂÚÁ·Û›· ÙˆÓ ·appleÔÙÂÏÂÛÌ¿ÙˆÓÌ ۇÁÎÚÈÛË ÙˆÓ appleÔÛÔÛÙÒÓ ÙˆÓ ‰È·ÊfiÚˆÓ ÛÙ·‰›ˆÓ ¢.∞.ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ.ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜∫·Ù¿ ÙË ‰ÈÂÙ›· OÎÙÒ‚ÚÈÔ˜ 2002 – Âapple٤̂ÚÈÔ˜2004 ÂÍÂÙ¿ÛıËÎ·Ó ÛÙÔ ÔÊı·ÏÌÔÏÔÁÈÎfi Î·È ‰È·‚ËÙÔÏÔ-ÁÈÎfi È·ÙÚ›Ô, apple·Ú¿ÏÏËÏ·, 159 ·ÛıÂÓ›˜ Ì ۷ί·Ú҉ˉȷ‚‹ÙË ( 68 ¿ÓÙÚ˜, appleÔÛÔÛÙfi 42,8% Î·È 91 Á˘Ó·›Î˜,appleÔÛÔÛÙfi 57,2%) ËÏÈΛ·˜ ÌÂٷ͇ 33 ¤ˆ˜ 87 ÂÙÒÓ (Ì.fi.67.3) Î·È Ì.fi. ‰È¿ÚÎÂÈ·˜ Ù˘ ÓfiÛÔ˘ 9,9 ¤ÙË. ∞applefi ÙË ÌÂ-120100111∞appleÔÙÂϤÛÌ·Ù·ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ (159) ‚Ú¤ıËηÓ:›Ó·Î·˜ 1Èڛ˜ ·ÏÏÔÈÒÛÂȘ ¢.∞ 109 ÔÛÔÛÙfi·ÛıÂÓ›˜ 68,5%◊appleÈ· ª¢∞ 28 17,6%ª¤ÙÚÈ· ª¢∞ 11 6,9%Ô‚·Ú‹ ª¢∞ 8 5%Ôχ ÛÔ‚·Ú‹ ª¢∞ 2 1,2%·Ú·ÁˆÁÈ΋ ¢∞ 1 0,6%80604020034141 2 31 2 3¯‹Ì· 1ÙËÓ Oª∞¢∞ 1 (Û‡ÓÔÏÔ ·ÛıÂÓÒÓ 34)›Ó·Î·˜ 2Èڛ˜ ·ÏÏÔÈÒÛÂȘ ¢.∞ 26 ÔÛÔÛÙfi·ÛıÂÓ›˜ 76,4%◊appleÈ· ª¢∞ 6 17,9%ª¤ÙÚÈ· ª¢∞ 2 5,8%Ô‚·Ú‹ ª¢∞ 0 0%Ôχ ÛÔ‚·Ú‹ ª¢∞ 0 0%·Ú·ÁˆÁÈ΋ ¢∞ 0 0%

142 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)ÙËÓ Oª∞¢∞ 2 (Û‡ÓÔÏÔ ·ÛıÂÓÒÓ 111)›Ó·Î·˜ 3Èڛ˜ ·ÏÏÔÈÒÛÂȘ ¢.∞ 78 ÔÛÔÛÙfi·ÛıÂÓ›˜ 72,7%◊appleÈ· ª¢∞ 19 17,1%ª¤ÙÚÈ· ª¢∞ 7 6,3%Ô‚·Ú‹ ª¢∞ 6 5,4%Ôχ ÛÔ‚·Ú‹ ª¢∞ 1 0,9%·Ú·ÁˆÁÈ΋ ¢∞ 0 0%ÙËÓ Oª∞¢∞ 3 (Û‡ÓÔÏÔ ·ÛıÂÓÒÓ 14)›Ó·Î·˜ 4Èڛ˜ ·ÏÏÔÈÒÛÂȘ ¢.∞ 5 ÔÛÔÛÙfi·ÛıÂÓ›˜ 31,4%◊appleÈ· ª¢∞ 3 21,4%ª¤ÙÚÈ· ª¢∞ 2 14,2%Ô‚·Ú‹ ª¢∞ 2 14,2%Ôχ ÛÔ‚·Ú‹ ª¢∞ 1 7,1%·Ú·ÁˆÁÈ΋ ¢∞ 1 7,1%Ÿappleˆ˜ Ê·›ÓÂÙ·È ·applefi ÙÔ˘˜ apple·Ú·apple¿Óˆ apple›Ó·Î˜,ÛÙȘ ÔÌ¿‰Â˜ 2 Î·È 3 apple·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓÔ appleÔÛÔ-ÛÙfi ÂÌÊ¿ÓÈÛ˘ ÛÔ‚·ÚfiÙÂÚˆÓ ÌÔÚÊÒÓ ¢.∞. (ÛÔ‚·-Ú‹ ª¢∞, appleÔχ ÛÔ‚·Ú‹ ª¢∞ Î·È apple·Ú·ÁˆÁÈ΋¢.∞.), ÂÓÒ ÛÙËÓ ÔÌ¿‰· 1 Ù· appleÔÛÔÛÙ¿ ÙˆÓ ·ÓÙ›ÛÙÔÈ-¯ˆÓ ÌÔÚÊÒÓ ‹Ù·Ó ÌˉÂÓÈο. ∂apple›Û˘ ÛÙËÓ ÔÌ¿‰· 1apple·Ú·ÙËÚÂ›Ù·È ÙÔ ˘„ËÏfiÙÂÚÔ appleÔÛÔÛÙfi ·ÛıÂÓÒÓ ¯ˆ-Ú›˜ ·ÏÏÔÈÒÛÂȘ ¢.∞. (›Ó. 5).˘ÌappleÂÚ¿ÛÌ·Ù·Ÿappleˆ˜ ‚ϤappleÔ˘Ì ÛÙÔÓ apple›Ó·Î· 1 ÙÔ appleÔÛÔÛÙfiÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ appleÔ˘ ‚Ú¤ıËΠ¯ˆÚ›˜ ·Ï-ÏÔÈÒÛÂȘ ¢∞ ·Ó¤Ú¯ÂÙ·È Û 68,5%, ÂÓÒ Ì appleÔχ ÛÔ-‚·Ú‹ ª¢∞ Î·È apple·Ú·ÁˆÁÈ΋ ¢∞ ‹Ù·Ó 1,2% ηÈ0,6% ·ÓÙ›ÛÙÔȯ·.ÙÔÓ apple›Ó·Î· 2, Ô ÔappleÔ›Ô˜ appleÂÚÈÏ·Ì‚¿ÓÂÈ ·ÛıÂ-Ó›˜ Ì ÙÈ̤˜ HbA1c ¤ˆ˜ 7,5% apple·Ú·ÙËÚԇ̠fiÙÈ Ù··ÓÙ›ÛÙÔȯ· appleÔÛÔÛÙ¿ ÌˉÂÓ›˙ÔÓÙ·È ÂÓÒ ÛÙÔÓ apple›Ó·-η 3, Ô ÔappleÔ›Ô˜ appleÂÚÈÏ·Ì‚¿ÓÂÈ ·ÛıÂÓ›˜ Ì ÙÈ̤˜HbA1c ·applefi 7,5% ¤ˆ˜ 10% Ù· appleÔÛÔÛÙ¿ Â›Ó·È 0,9%Î·È 0% ·ÓÙ›ÛÙÔȯ·.ÙÔÓ apple›Ó·Î· 4 appleÔ˘ ·appleÂÈÎÔÓ›˙ÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ÙˆÓ ÔappleÔ›ˆÓ Ë HbA1c ‹Ù·Ó ·applefi 10% Î·È ¿Óˆ ÔÈ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜ ·Ó¤Ú¯ÔÓÙ·È Û 7,1% Î·È ÁÈ· Ù·‰‡Ô ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘. ∂‰Ò ı· appleÚ¤appleÂÈ Ó· ÛËÌÂȈı›fiÙÈ ÙÔ appleÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi‚˘ıfi ‹Ù·Ó 31,4%.ΔÂÏÈÎÒ˜ Û˘ÌappleÂÚ·›ÓÔ˘Ì fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ÙÈ-̤˜ HbA1c ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ ‚Ú¤ıËηÓÛ ÌÂÁ·Ï‡ÙÂÚÔ appleÔÛÔÛÙfi ¯ˆÚ›˜ apple·ıÔÏÔÁÈο ¢ڋ-Ì·Ù· Î·È ÂÌÊ¿ÓÈÛ·Ó ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú¤˜ ÌÔÚʤ˜¢∞, ·ÓÙ›ıÂÙ· Ì ÂΛÓÔ˘˜ appleÔ˘ ÔÈ ÙÈ̤˜ HbA1c‹Ù·Ó ˘„ËϤ˜.›Ó·Î·˜ 5‡ÓÔÏÔ OÌ¿‰· 1 OÌ¿‰· 2 OÌ¿‰· 3Èڛ˜ ·ÏÏÔÈÒÛÂȘ ¢.∞ 68,5% 76,4% 72,7% 31,4%◊appleÈ· ª¢∞ 17,6% 17,9% 17,1% 21,4%ª¤ÙÚÈ· ª¢∞ 6,9% 5,8% 6,3% 14,2%Ô‚·Ú‹ ª¢∞ 5% 0 5,4% 14,2%Ôχ ÛÔ‚·Ú‹ ª¢∞ 1,2% 0 0,9% 7,1%·Ú·ÁˆÁÈ΋ ¢∞ 0,6% 0 0 7,1%μÈ‚ÏÈÔÁÚ·Ê›·1. §¿Î , ª·ÏÙ¤˙Ô˜ ∞, ¢È¿Ê·˜ . ¢È·‚ËÙÈ΋ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉÔapple¿ıÂÈ· .ÙÔ ¡. Ù¿ÁÎÔ˘ Î·È ¢ËÌËÙÚ¿ÎÔ˘‡Á¯ÚÔÓ˜ Ù¿ÛÂȘ ÛÙË ıÂÚ·apple›· ÙˆÓ apple·ı‹ÛÂˆÓ ÙÔ˘·ÌÊ/‰Ô‡˜, ÂΉfiÛÂȘ University studio press £ÂÛÛ·ÏÔ-Ó›ÎË 143-173: 1999.2. ∫·Ú·Ì‹ÙÛÔ˜ ¢. ÃÚfiÓȘ ‰È·‚ËÙÈΤ˜ ÂappleÈappleÏÔΤ˜,ÛÙÔ ∫·-Ú·Ì‹ÙÛÔ˜ ¢ ¢È·‚ËÙÔÏÔÁ›· ıˆڛ· Î·È appleÚ·ÎÙÈ΋ ·ÓÙÈ-ÌÂÙÒappleÈÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ÂΉfiÛÂȘ ÈÒ-΢,£ÂÛÛ·ÏÔÓ›ÎË 217-229: 2000.3. American Academy of Ophthalmology. Retina and VitreousSection 12.4. Jerneld B, Algvere P. Proteinouria and blood glucoselevels in a population with diabetic retinopathy.Am.jOphthalmol 104: 283, 1987.5. æ‡ÏÏ·˜∫. ∂ÈÛ·ÁˆÁ‹ ÛÙËÓ ÔÊı·ÏÌÔÏÔÁ›· Î·È ÛÙË Ó¢ÚÔ-ÔÊı·ÏÌÔÏÔÁ›·, ÂΉfiÛÂȘUniversity studio press £ÂÛ-Û·ÏÔÓ›ÎË 221-260: 1994.6. Kanski JJ. Retinal Vascular Disorders in Kanski J, Clini-

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 143cal ophalmology,A Systemic Approach, London 334-379, 1994.7. Little HL, Sachs AH. Role of abnormal blood rheology inthe pathogenesis of diabetic retinopathy.Trans AmAcad Ophthalmol Otolaryngol 83: 522, 1977.8. Grant M, Ryssel B, Fitzgerald C, Merimee TJ. Insulin –likegrowth factors in vitreous studies in control anddiabetic subjects with neovascularization. Diabets 35:416-420, 1986.9. Henricsson M, Nilsson A, Groop L, Heijl A, Janzon L.Prevalence of diabetic retinopathy in relation to age atonset of the diabetes , treatment,duration and glycemiccontrol.Acta Opthalmol Scand 74: 523-527, 1996.10. Diabetes Control and Complications Trial (DCCT)Research Group. The relationship of glycemic exposure(HbA1c) and the risk of development and progressionof retinopathy in the diabetes control and complicationstrial. Diabetes 44(8): 968-983, 1995.11. Diabetes Control and Complications Trial (DCCT)Research Group. Progression of retinopathy with intensiveversus conventional treatment in the DiabetesControl and Complications Trial. Diabetes Controland Complications Trial (DCCT) Research Group.Opthalmology 102(4): 647-661, 1995.12. Diabetes Control and Complications Trial (DCCT) ResearchGroup. Early worsening of diabetic retinopathyin the Diabetes Control and Complications Trial.Arch Opthalmol 116(7): 874-76, 1998. Erratum in:Arch Opthalmol 116(11): 1469, 1998.13. Diabetes Control and Complications Trial (DCCT)Research Group. Retinopathy and nephropathy in patientswith type I diabetes four years after a trial of intensivetherapy. The Diabetes Control and ComplicationsTrial/Epidemiology of Diabetes Interventionsand Complications Research Group. N Engl JMed 342(6): 381-389, 2000. Erratum in N Engl J Med342(18): 1376, 2000.14. Diabetes Control and Complications Trial (DCCT) ResearchGroup. The effect of intensive diabetes treatmenton the progression of diabetic retinopathy ininsulin-dependent diabetes mellitus. Diabetes Controland Complications Trial. Arch Opthalmol 113(1): 36-51, 1995.15. Zhang I, Krzentowski G, Albert A, Lefebvre PJ. Risk ofdeveloping retinopathy in Diabetes Control and ComplicationsTrial type I diabetic patients with good orpoor metabolic control. Diabetes Care 24(7): 1275-1279, 2000.

ªappleÔÚ› ¤Ó· ·ÍÈfiappleÈÛÙÔ ÔappleÙÈÎfi apple‰›Ô Ó·ÌËÓ Â›Ó·È appleÚ·ÁÌ·ÙÈο ·ÍÈfiappleÈÛÙÔ;¡. ª˘ÏfiappleÔ˘ÏÔ˜1, £. ·appleapple¿˜2, ∞. μ·˚ÔappleÔ‡ÏÔ˘1, ∞. ∫ÔÛÎÔÛ¿˜2, º. ΔÔappleÔ‡˙˘2Could a reliable visual field be not truly reliable?N. Mylopoulos, T. Pappas, A. Vaiopoulou, A. Koskosas, F. TopouzisÎÔapplefi˜: ·ÚÔ˘Û›·ÛË ÂӉȷʤÚÔÓÙÔ˜ appleÂÚÈÛÙ·ÙÈÎÔ‡ ÌÂÛËÌ·ÓÙÈ΋ ·applefiÎÏÈÛË ÌÂٷ͇ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙÔ˘ ÔappleÙÈÎÔ‡Ó‡ÚÔ˘ Î·È ÙˆÓ ÔappleÙÈÎÒÓ apple‰›ˆÓ. ª¤ıÔ‰ÔÈ-ÀÏÈÎfi: ∫·Ù·-ÁÚ·Ê‹ ÙˆÓ ‚ÈÔÌÔÚÊÔÌÂÙÚÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÛÙÈ-‚¿‰·˜ ÙˆÓ Ó¢ÚÈÎÒÓ ÈÓÒÓ Î·È Ù˘ ÎÂÊ·Ï‹˜ ÙÔ˘ ÔappleÙÈÎÔ‡Ó‡ÚÔ˘ Ì ÙȘ ÓÂfiÙÂÚ˜ laser ·appleÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜Î·ıÒ˜ Î·È ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ ÎÏ·ÛÈ΋˜ “white on white”(WOW) ·˘ÙfiÌ·Ù˘ appleÂÚÈÌÂÙÚ›·˜. ∞appleÔÙÂϤÛÌ·Ù·:  ·ÓÙ›-ıÂÛË Ì ÙËÓ ÌÈÎÚ‹ ‚Ï¿‚Ë ÙˆÓ ÔappleÙÈÎÒÓ apple‰›ˆÓ Ë ‚Ï¿‚ËÛÙËÓ ÛÙÈ‚¿‰· ÙˆÓ Ó¢ÚÈÎÒÓ ÈÓÒÓ Î·È ÛÙÔ ÔappleÙÈÎfi Ó‡ÚÔ‹Ù·Ó ÂÎÙÂٷ̤ÓË Û‡Ìʈӷ Ì ÙȘ ηٷÁڷʤ˜ ÙˆÓ Ó¤ˆÓlaser ·appleÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ. ˘ÌappleÂÚ¿ÛÌ·Ù·: OÈ Ó¤Â˜laser ·appleÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ, ÂÎÙfi˜ ·applefi ÙËÓ appleÚÒÈÌËappleÚÔÛ˘Ìappleو̷ÙÈ΋‰È¿ÁÓˆÛË ÙÔ˘ ÁÏ·˘ÎÒÌ·ÙÔ˜, appleÚÔÛʤ-ÚÔ˘Ó ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· Û ÔÚȷΤ˜ ηٷÛÙ¿ÛÂȘ, fiappleÔ˘Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ÔappleÙÈÎÒÓ apple‰›ˆÓ apple·ÚÔ˘ÛÈ¿˙Ô˘Ó ·applefiÎÏÈ-ÛË ·applefi Ù· Â˘Ú‹Ì·Ù· Ù˘ ‚ÈÔÌÈÎÚÔÛÎfiappleËÛ˘.Purpose: To present a case report with significant inconsistencybetween optic disc and visual fields findings.Methods: Biomorphometric characteristics of optic nervefiber layer and optic nerve head were recorded using newlaser imaging instruments. Classic “white on white” (WOW)automatic perimetry was also carried out. Results: Incontrast with the mild damage found in visual field, opticnerve fiber layer and optic disc damage were advancedbased on new laser imaging instruments measurements.Conclusions: New laser imaging instruments are veryhelpful not only in early diagnosis of glaucoma but also insituations where there is inconsistency between biomicroscopyand visual field findings.∂ÈÛ·ÁˆÁ‹ΔÔ ÁÏ·‡ÎˆÌ·, Û‡Ìʈӷ Ì ÙÔÓ ÈÛ¯‡ÔÓÙ· ÔÚÈ-ÛÌfi, ·appleÔÙÂÏ› ÌÈ· ÔappleÙÈ΋ Ó¢ÚÔapple¿ıÂÈ·, appleÔ˘ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·applefi ·appleÒÏÂÈ· ÙˆÓ Á·ÁÁÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓÎ·È ÙˆÓ Ó¢ڷÍfiÓˆÓ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹, Ì ·appleÔ-Ù¤ÏÂÛÌ· ÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ¤ÎappleÙˆÛË ÙÔ˘ ÔappleÙÈÎÔ‡ appleÂ-‰›Ô˘1,2 . ∏ ·appleÒÏÂÈ· ·˘Ù‹ ÌappleÔÚ› Ó· ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ÙÔappleÈ΋ ‹ ÁÂÓÈÎÂ˘Ì¤ÓË Ï¤appleÙ˘ÓÛË ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ ÙˆÓÓ¢ÚÈÎÒÓ ÈÓÒÓ Î·È ÙÔ˘ Ó¢ÚÈÎÔ‡ ÈÛÙÔ‡ Ù˘ ÔappleÙÈ΋˜ıËÏ‹˜3.ΔÔ ÁÏ·‡ÎˆÌ· ·appleÔÙÂÏ› ÙËÓ ‰Â‡ÙÂÚË ·ÈÙ›· ÌË·Ó·ÛÙÚ¤„ÈÌ˘ Ù‡ÊψÛ˘ apple·ÁÎÔÛÌ›ˆ˜4. ŒÓ· ·applefiÙ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë Î·ı˘ÛÙ¤ÚËÛËÛÙË ‰È¿ÁÓˆÛË, ÁÂÁÔÓfi˜ appleÔ˘ ¤¯ÂÈ Û·Ó ·appleÔÙ¤ÏÂÛÌ·ÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ Ì ÁÏ·‡ÎˆÌ· Ó· ÌËÓ ÁÓˆÚ›-˙Ô˘Ó fiÙÈ apple¿Û¯Ô˘Ó ·apple’ ÙË ÓfiÛÔ 5 . ∂apple›Û˘ ÌÂϤÙ˜¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ·appleÒÏÂÈ· ÙˆÓ Ó¢ÚÈÎÒÓ ÈÓÒÓ ÛÙÔÁÏ·‡ÎˆÌ· appleÚÔËÁÂ›Ù·È Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ¤ÎappleÙˆÛ˘̤¯ÚÈ Î·È 5 ¤ÙË 3,6-9 . °È· ÙË ‰È¿ÁÓˆÛË, ·ÏÏ¿ Î·È ÙËÓapple·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘, Ù· ·Úȷ̤۷ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÔappleÙÈÎÒÓ apple‰›ˆÓ Î·È ËÂͤٷÛË ÙÔ˘ ÔappleÙÈÎÔ‡ Ó‡ÚÔ˘ Î·È Ù˘ ÛÙÈ‚¿‰·˜ ÙˆÓÓ¢ÚÈÎÒÓ ÈÓÒÓ. Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ӥ˜ laser ÙÂ-¯ÓÔÏÔÁ›Â˜ appleÚÔÛÙ¤ıËÎ·Ó ÛÙȘ ÎÏ·ÛÈΤ˜ ÌÂıfi‰Ô˘˜ÂͤٷÛ˘, Ì ÛÎÔapplefi ÙËÓ appleÚˆÈÌfiÙÂÚË ‰È¿ÁÓˆÛË, ·Ï-Ï¿ Î·È ÙËÓ Î·Ï‡ÙÂÚË apple·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÁÏ·˘Îˆ-Ì·ÙÈÎÔ‡ ·ÛıÂÓ‹.1 π·ÙÚÈÎfi ¢È·‚·ÏηÓÈÎfi ∫¤ÓÙÚÔ2 ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ·ÓÂappleÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢. μ′ OÊı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋. ¡ÔÛÔÎÔÌÂ›Ô “·apple·ÁˆÚÁ›Ô˘”OÊı·ÏÌÔÏÔÁ›·, 18, 2 : 144 - 147, 2006

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146 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)∂ÈÎ. 3. OappleÙÈο apple‰›·. ∂appleÈÛËÌ·›ÓÂÙ·È Ë ÌÈÎÚ‹ Û¯ÂÙÈο ‚Ï¿‚Ë.Δ· ÔappleÙÈο ÙÔ˘ apple‰›· ÂÌÊ¿ÓÈ˙·Ó ¤Ó· ÎÂÓÙÚÈÎfi ÛÎfi-و̷ ‰ÂÍÈ¿ Ì ·Ú¯fiÌÂÓÔ ÚÈÓÈÎfi ‚‹Ì· Î·È ¤Ó· ÂÁηÙÂ-ÛÙË̤ÓÔ ÚÈÓÈÎfi ‚‹Ì· ·ÚÈÛÙÂÚ¿ (∂ÈÎ. 2).ΔÔ AGIS Score ÙˆÓ apple‰›ˆÓ ‹Ù·Ó 4 ÁÈ· ÙÔÓ ¢.O ηÈ3 ÁÈ· ÙÔÓ ∞.O 10 . ∞apple’ ÙËÓ ·Ó·ÛÎfiappleËÛË Ù˘ ÛÂÈÚ¿˜ ÙˆÓÔappleÙÈÎÒÓ apple‰›ˆÓ appleÔ˘ ›¯Â appleÚ·ÁÌ·ÙÔappleÔÈ‹ÛÂÈ Ô ·ÛıÂÓ‹˜ÛÙÔ ‰È¿ÛÙËÌ· ·applefi ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÁÏ·˘ÎÒÌ·ÙÔ˜ ̤¯ÚÈÛ‹ÌÂÚ· ‰ÂÓ apple·Ú·ÙËÚ‹ıËΠȉȷ›ÙÂÚË ÌÂÙ·‚ÔÏ‹ Ù˘‚Ï¿‚˘.∏ ÌÂÁ¿ÏË ·applefiÎÏÈÛË ÌÂٷ͇ Ù˘ ·Ó·ÙÔÌÈ΋˜ ‚Ï¿-‚˘, fiappleˆ˜ ·˘Ù‹ appleÚÔ·appleÙÂÈ ·applefi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Î·ÈÙȘ ʈÙÔÁڷʛ˜ ‚˘ıÔ‡, Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ¤ÎappleÙˆÛ˘appleÔ˘ ·appleÔÙ˘appleÒÓÂÙ·È ÛÙ· ÔappleÙÈο apple‰›·, η٤ÛÙËÛ ÂappleÈÙ·-ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË ·Ó·˙‹ÙËÛ˘ appleÂÚ·ÈÙ¤Úˆ appleÏËÚÔÊÔÚÈÒÓÁÈ· ÙËÓ ·ÎÚÈ‚‹ ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘. OÈ appleÏËÚÔÊÔڛ˜ ·˘-Ù¤˜ ·Ó·˙ËÙ‹ıËÎ·Ó ÛÙȘ ÓÂfiÙÂÚ˜ laser ·appleÂÈÎÔÓÈÛÙÈΤ˜ÌÂıfi‰Ô˘˜: Confocal Scanning Laser OphthalmoscopyHeidelberg Retina Tomograph (HRT), Optical CoherenceTomography (OCT), Scanning Laser Polarimeter,Nerve Fiber Layer Analyser (GDx), Retinal ThicknessAnalyzer (RTA).∏ ·appleÂÈÎfiÓÈÛË ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘ Ì ÙÔ HRT,OCT, RTA ÂappleȂ‚·›ˆÛ (Ì ‰È·ÊÔÚÔappleÔÈ‹ÛÂȘ appleÔ˘ÔÊ›ÏÔÓÙ·È ÛÙÔÓ ‰È·ÊÔÚÂÙÈÎfi ÙÚfiappleÔ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘Î¿ı ̤ÛÔ˘) ÙÔ ÌÂÁ¿ÏÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘,ÛÙÔ ÔappleÔ›Ô ı· ÌappleÔÚÔ‡Û ӷ ·appleÔ‰Ôı› Î·È ÙÔ ÌÂÁ¿ÏÔ Ì¤-ÁÂıÔ˜ Ù˘ ÎԛϷÓÛ˘ (›Ó. 1).øÛÙfiÛÔ, Ë Î·Ù·ÁÚ·Ê‹ ÙÔ˘ apple¿¯Ô˘˜ Ù˘ ÛÙÈ‚¿‰·˜ÙˆÓ Ó¢ÚÈÎÒÓ ÈÓÒÓ ÙfiÛÔ ·applefi ÙÔ OCT, fiÛÔ Î·È ·applefi ÙÔGDx, ¤‰ÂÈÍ ÌÈ· ÁÂÓÈÎÂ˘Ì¤ÓË Ï¤appleÙ˘ÓÛË ÙÔ˘ apple¿¯Ô˘˜ Ù˘ÛÙÈ‚¿‰·˜ ÙˆÓ Ó¢ÚÈÎÒÓ ÈÓÒÓ Î·È ÛÙ· Ù¤ÛÛÂÚ· ÙÂÙ·ÚÙË-ÌfiÚÈ· (¿Óˆ-ÚÈÓÈÎfi-οو-ÎÚÔÙ·ÊÈÎfi). ∏ ¤ÎappleÙˆÛË ·˘Ù‹›Ó·Î·˜ 1. BÈÔÌÔÚÊÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÔappleÙÈÎÔ‡ Ó‡-ÚÔ˘·Ú¿ÌÂÙÚÔÈ OCT HRT RTAOD OS OS OS OD OSDisc Area mm 2 3.48 3.84 2.94 3.11 3.42 3.86Cup Area mm 2 2.81 3.15 1.81 2.57 2.91 2.92Cup/Dis AreaRatio 0.80 0.82 0.614 0.83 0.85 0.76Rim Area mm 2 0.67 0.63 1.136 0.542 0.51 0.94‹Ù·Ó ȉȷ›ÙÂÚ· ÌÂÁ¿ÏË ÛÙÔ ·ÓÒÙÂÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔ ÙÔ˘¢.O, Î·È ÛÙÔ Î·ÙÒÙÂÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔ ÙÔ˘ ∞.O. (∂ÈÎ. 3).˘˙‹ÙËÛË – ˘ÌappleÂÚ¿ÛÌ·Ù·ÙÔ appleÂÚÈÛÙ·ÙÈÎfi appleÔ˘ appleÂÚÈÁÚ¿ÊÔ˘ÌÂ Ë ÛÙ·ıÂ-ÚfiÙËÙ· ÙˆÓ ‚Ï·‚ÒÓ ÙˆÓ ÔappleÙÈÎÒÓ apple‰›ˆÓ ÛÙÔ ‰È¿-ÛÙËÌ· Ù˘ apple·Ú·ÎÔÏÔ‡ıËÛ˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓÂÎÙÂٷ̤ÓË ‚Ï¿‚Ë ÛÙÔÓ ÔappleÙÈÎfi ‰›ÛÎÔ ı¤ÙÂÈ ÙÔ ÂÚÒ-ÙËÌ·, ·Ó Ë ÌË ÂͤÏÈÍË Ù˘ ‚Ï¿‚˘ ÛÙ· ÔappleÙÈο apple‰›·Â›Ó·È ·appleÔÙ¤ÏÂÛÌ· Ù˘ Âapple¿ÚÎÂÈ·˜ Ù˘ ıÂÚ·apple›·˜ ‹fiÙÈ Ë ÂΉ‹ÏˆÛË appleÚÔfi‰Ô˘ ÛÙ· ÔappleÙÈο apple‰›· ›ӷÈ˙‹ÙËÌ· ¯ÚfiÓÔ˘ Ì appleÈı·ÓÔÏÔÁÔ‡ÌÂÓË ÙËÓ Û˘Ó¯È˙fi-ÌÂÓË ·appleÒÏÂÈ· Ó¢ÚÈÎÒÓ ÈÓÒÓ, appleÔ˘ ÂÎÊÚ¿˙ÂÙ·È ˆ˜È‰È·›ÙÂÚ· ÏÂappleÙ‹ ÛÙÈ‚¿‰· Ó¢ÚÈÎÒÓ ÈÓÒÓ (fiappleˆ˜ η-Ù·ÁÚ¿ÊÂÙ·È ·applefi ÙÔ GDx Î·È ÙÔ OCT), Î·È ı· ÂÎ-ÊÚ·ÛÙ› ·ÚÁfiÙÂÚ· Ì ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÏÂÈÙÔ˘ÚÁÈ΋¤ÎappleÙˆÛË.O ·ÛıÂÓ‹˜ Ì·˜ Ì ‚¿ÛË Ù· ÔappleÙÈο ÙÔ˘ apple‰›·(Ù· ÔappleÔ›· ÛËÌÂȈ٤ÔÓ ‹Ù·Ó ·appleÔχو˜ ·ÍÈfiappleÈÛÙ·ÏfiÁˆ Ù˘ ¿ÚÈÛÙ˘ Û˘ÓÂÚÁ·Û›·˜ ÙÔ˘), apple·ÚÔ˘Û›·˙·گfiÌÂÓÔ-̤Û˘ ÂͤÏÈ͢ ÁÏ·‡ÎˆÌ·, ÂÓÒ Ì ‚¿ÛËÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ ÛÙÈ‚¿‰·˜ ÙˆÓ ÔappleÙÈÎÒÓ ÈÓÒÓ Ë‚Ï¿‚Ë ı· ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó appleÚÔ¯ˆÚË̤ÓË. Ÿappleˆ˜ÁÓˆÚ›˙Ô˘ÌÂ, ÙÔ ÛÙ¿‰ÈÔ Ù˘ ‚Ï¿‚˘ ·appleÔÙÂÏ› ÛËÌ·-ÓÙÈ΋ apple·Ú¿ÌÂÙÚÔ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ apple›ÂÛ˘-ÛÙfi¯Ô˘13 . ÙÔÓ ·ÛıÂÓ‹ Ì·˜ ·ÓÙÈÌÂÙˆapple›Û·Ì ÙÔ ‰›-ÏËÌÌ· Ù˘ ηٿٷ͋˜ ÙÔ˘ Û ·Ú¯fiÌÂÓÔ-̤Û˘ Âͤ-ÏÈ͢ ‹ appleÚÔ¯ˆÚË̤ÓÔ ÁÏ·‡ÎˆÌ· Ì ‚¿ÛË Ù· ·appleÔ-ÙÂϤÛÌ·Ù· ÔappleÙÈÎÒÓ apple‰›ˆÓ ‹ ·appleÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓappleÔ˘ ‚Ú›ÛÎÔÓÙ·È Û appleÚÔÊ·Ó‹ ·Ó·ÓÙÈÛÙÔȯ›·.∏ appleÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ Ê·ÈÓÔÙ˘appleÈ΋ ¤ÎÊÚ·ÛË ·appleÔ-ÙÂÏ› Âapple›Û˘ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ ÁÏ·˘ÎÒÌ·ÙÔ˜.ª¤¯ÚÈ appleÚfiÙÈÓÔ˜ Ë ¤ÏÏÂÈ„Ë ·ÎÚÈ‚Ô‡˜ Î·È ·ÓÙÈÎÂÈ-ÌÂÓÈ΋˜ ηٷÁÚ·Ê‹˜ Ù˘ ·Ó·ÙÔÌÈ΋˜ ‚Ï¿‚˘ Âapple¤-ÙÚÂapple ÙËÓ ÛÙ·‰ÈÔappleÔ›ËÛË Ù˘ ‚Ï¿‚˘ ΢ڛˆ˜ Ì ‚¿-ÛË Ù· ÔappleÙÈο apple‰›·. OÈ Ó¤Â˜ ·appleÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ-‰ÔÈ ÂappleÈÙÚ¤appleÔ˘Ó ÙËÓ ·ÎÚÈ‚‹ ηٷÁÚ·Ê‹ Ù˘ ·Ó·ÙÔ-ÌÈ΋˜ ‚Ï¿‚˘. Δ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ appleÂÚÈÛÙ·ÙÈ-ÎÔ‡ appleÔ˘ apple·ÚÔ˘ÛÈ¿˙Ô˘Ì ı¤ÙÔ˘Ó ÙÔ ÂÚÒÙËÌ· ÙÔ˘

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 147ηٿ applefiÛÔÓ Ë ÛÙ·‰ÈÔappleÔ›ËÛË Ù˘ ‚Ï¿‚˘ appleÚ¤appleÂÈ Ó·Á›ÓÂÙ·È Ì ‚¿ÛË Ù· ÔappleÙÈο apple‰›· ‹ Ì ‚¿ÛË Ù· ¢-Ú‹Ì·Ù· ÙˆÓ ·appleÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÛÙËÓ appleÂÚ›-appleÙˆÛË appleÔ˘ ˘apple¿Ú¯ÂÈ ·ÓÙ›ıÂÛË ÌÂٷ͇ ÙÔ˘˜.μÈ‚ÏÈÔÁÚ·Ê›·1. Quigley, HA, Addicks, EM, Green, WR. Optic nervedamage in human glaucoma, III: quantitative correlationof nerve fiber loss and visual field defect in glaucoma,ischemic neuropathy, disc edema, and toxicneuropathy Arch Ophthalmol 100: 135-146, 1982.2. Kerrigan–Baumrind LA, Quigley HA, Pease ME, et al.Number of Ganglion Cells in Glaucoma Eyes Comparedwith Threshold Visual Field Tests in the SamePersons. Invest. Ophthalmol. Vis Sci 41: 741-748,2000.3. Airaksinen PJ, Drance SM, Douglas GR, et al. Diffuse andlocalized nerve fiber loss in glaucoma. Am J Ophthalmol98: 566-571, 1984.4. Quigley HA. Number of people with glaucoma worldwide.Br J Ophthalmol 80: 389-393, 1996.5. Tielsch JM, Somer A, Katz, et al. Racial variation in theprevalence of primary open angle glaucoma: the BaltimoreEye Survey. JAMA 266: 369-374, 1991.6. Quigley HA, Miller NR, George T. Clinical evaluation ofnerve fiber layer atrophy as an indicator of glaucomatousoptic nerve damage. Arch Ophthalmol 98: 1564-1571, 1980.7. Sommer A, Katz J, Quigley HA, et al. Clinically detectablenerve fiber layer atrophy precedes the onset of glaucomatousfield loss. Arch Ophthalmol 109: 77-83,1991.8. Quigley HA, Katz I, Derick RJ, et al. An evaluation of opticdisc and nerve fiber layer examinations in monitoringprogression of early glaucoma damage. Ophthalmology99: 19-28, 1992.9. Harwerth RS, Carter-Dawson L, Shen F, et al. Ganglioncell losses underlying visual field defects from experimentalglaucoma. Invest Ophthalmol Vis Sci 40:2242-2250, 1999.10. The Advanced Glaucoma Intervention Study Investigators.Advance Glaucoma Intervention Study. Visualfield test scorring and reliability. Ophthalmology. 101:1445-1455, 1994.11. Joanne Katz. Scoring system for measuring progressionof visual field loss in clinical trials of glaucomatreatment. Ophthalmology 106: 391-395, 1999.12. Bayer A, Harasymowycz P, Henderer JD, et al. Validity ofa new disk grading scale for estimating glaucomatousdamage: correlation with visual field damage. Am JOphthalmol 133: 758-63, 2000.13. European Glaucoma Society-2003.Terminology andGuidelines for Glaucoma ππnd Edition.

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 149Owing to the fact that it requires approximately halfthe energy of the Nd: YAG laser, cyclodiode laser hasbeen shown to be safer and present a lower risk ofhypotony and pathisis. However, its outcome is oftenunpredictable and it may need to be appliedrepeatedly to achieve the desired result. Furthermore,a standardized protocol regarding the optimumlaser settings is still under debate.The main objectives of this study were to reviewcurrent practice on the use of cyclodiode laserfor the treatment of refractory glaucoma atMayday Hospital of London, UK, and to comparetwo different clinical approaches towards laserapplication.Materials and MethodsA retrospective analysis was carried out using thecase notes of all the patients who had undergone cyclodiodelaser treatment over a two-year period at MaydayUniversity Hospital, London, UK. Data were collected byuse of a standardized survey sheet. The followingparameters were recorded: indication for treatment, lasersettings, type of anaesthesia used, intraocular pressure(IOP) and visual acuity pre-laser, at six weeks and at sixmonths post-laser, number of antiglaucoma medicationspre- and at six months post-treatment, and any adverseevents following cyclodiode laser application. The sixmonthlimit in our follow-up period was chosen, so as toobtain comparable laser results for all patients. However,due to this fact, we cannot exclude a possible bias towardsimmediate and short-term results of cyclodiode laser.In most cases laser was applied over 270 degrees ofthe ciliary body avoiding the 3 and 9 o’clock positions.Laser settings varied according to the clinical approachfollowed, which will be discussed later in the text. In theimmediate post-laser period, patients were prescribedtopical steroid drops in order to prevent any post-laserinflammation.The outcome of treatment was evaluated in termsof IOP reduction at six months post-laser. Success oftreatment was defined as an IOP reduction of greaterthan 30% compared to pre-laser levels. The decrease inIOP following cyclodiode treatment was evaluated usingthe Wilcoxon matched pairs signed rank sum test, whilefor comparison of the two laser practices the Mann-Whitney test was used.ResultsThirty-one cases of cyclodiode laser treatmentwere identified (19 males, 12 females). The meanage of patients was 60 years (SD 10.5 years) with arange of 42-84 years. In 13 cases the right eye wasinvolved in treatment, whereas in 18 cases theinvolved eye was the left one.Indications for laser treatment included:neovascular glaucoma in 10 (32%) cases, primaryopen-angle glaucoma in 8 (26%) cases, secondaryglaucoma in 3 (10%) cases, non-tolerance and/ornon-compliance of patients to drops in 5 (16%)cases, failed filtration surgery in 5 (16%) cases.Cases of secondary glaucoma included one patientwith post-inflammatory glaucoma, one patient withaphakic glaucoma, and another with post-traumaticglaucoma.Subtenon anaesthesia was employed in mostcases. Other, less frequent, types of anaesthesiawere peribulbar and general anaesthesia.On average, IOP was 26.1 (SD 10.04) mmHgin the immediate pre-laser period. At six weekspost-treatment IOP had been reduced to an averageof 20.1 (SD 6.39) mmHg. At that time, successof cyclodiode treatment (as defined in the previoussection) was noticed in 21% of cases. At six monthspost-laser mean IOP was 19.8 (SD 7.29) mmHg,significantly reduced (Wilcoxon statistic= 44.0, p=0.013) by 24% compared to pre-treatment levels,with a success rate of 44%. Interestingly, a significantrate of failure of the cyclodiode laser treatmentwas also noticed; in four cases the IOP at sixmonths post-laser was actually higher than pretreatmentlevels (Fig. 1).The median pre-laser best corrected visualacuity was 6/60. At six months post-laser visual acuitywas preserved in 71% of cases, decreased in 19%,while in 10% of cases data regarding visual acuitywere unavailable. In most cases, any change in visualacuity was not greater than one Snellen line.The mean number of pre-laser antiglaucomamedications was 2.2, which was only slightly reducedto 2.1 at six months post-treatment.Mild uveitis developed in two cases (6.5%),while there were another two cases (6.5%) of posttreatmenthypotony (defined as an IOP lower than10 mmHg).Over the period studied, two different practicesof cyclodiode laser treatment have been followed. Inpractice A, consistent laser settings were used (alaser power of 1.5-2 Watts was applied for 1.5-2seconds) irrespective of the hearing of ‘pops’ duringthe procedure 1-3 . On the other hand, practice Ballowed adjustments of the laser settings to be made

150 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)Table 1. Comparison of the two cyclodiode laser practices in our UnitPractice A Practice B Statistical analysis(Mann-Whitney test)Laser settings 1.5- 2 Watt x 1.5- 2 sec Adjusted (see text)Number of patients 11 20Mean total energy (Joules) 73.8 47.9 U=129.0, p=0.015Average IOP (mmHg)Pre-laser IOP 24.4 (SD 6.7) 27.0 (SD 11.5) U=115.0, p=0.85IOP at 6 months 19.75 (SD 5.3) 19.8 (SD 8.2) U=73.5, p=0.74Average IOP reduction 3.8 (SD 6.5) 6.4 (SD 12.4) U=75.0, p=0.68Post-laser IOP (mmHg)70805040302010010 20 30 40 50 60 70Pre-laser IOP (mmHg)Fig. 1. Scatter diagram of the pre-laser IOP against theIOP at six months post-treatment. Data for the sixmonthIOP were available for 24 patients.so that the energy delivered at each laser shot wouldbe just below the energy level of hearing ‘pops’. 4 Therationale behind reducing the energy so as not to hear‘pops’ is that ‘pops’ are indicative of tissue disruption,and that such a response might induce moredistruction in the ciliary body than desired. Althoughpractice A resulted in higher total energies beingdelivered per laser session, no significant differencein IOP reduction was noticed when the two practiceswere compared (Mann-Whitney U statistic= 75.0,p= 0.68) (Table 1). However, since the patients ineach treatment subgroup were not individuallymatched to the patients of the other subgroup, wecannot exclude the possibility of differences in patientcharacteristics between the two groups, and thereforewe think that a prospective, individual-matched studyis needed in order to reach reliable answers as towhat is the best cyclodiode laser practice.ConclusionsTable 2 shows the comparison of our studywith other studies conducted in the UK, usingvarious laser parameters. However, since there areno agreed optimum laser settings yet, directcomparisons between studies are difficult, becauseof treatment protocol differences as well asdifferences in patient characteristics.Overall, we achieved comparable results interms of post-treatment IOP levels with otherstudies, although our success rate seemed to belower than others. This may be due to the fact thatour follow-up of patients was limited only to thefirst six months post-laser; cyclodiode laser hasbeen found to have beneficial effects on IOP overa period of time much longer than six months. 2 Inaddition, the results of the other studies regardingsuccess rate shown on Table 2 refer to the last follow-upvisit, which on average took place long afterthe first six months post-treatment.Regarding visual acuity preservation, our studyyielded similar results with others. The same is true forthe adverse events following laser treatment; wenoticed a 6.5% incidence of hypotony, while other UKstudies have reported rates varying from 1% 1 to 10%. 3It has been suggested that hypotony is associated withneovascular glaucoma as well as high total energydelivered at the ciliary body. 5 Indeed, in one of ourcases of hypotony, the patient had undergonecyclodiode laser treatment for neovascular glaucoma.However, in both hypotony cases, patients hadreceived low total energies, below 50 Joules.It should be noted that the cyclodiode lasertreatment in our Unit was not followed by a significantreduction in the number of antiglaucomamedications prescribed, as was the case in theother UK series. Although in some cases antiglaucomamedications may have been considered a

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 151Table 2. Comparison of our results with major UK cyclodiode laser studies.Mayday Moorfields 1 Nottingham 2 Norwich 3 Bristol, Norfolk& Norwich 5Mean follow-up (months) 6.0 10.0 18.7 10.8 17.0Settings Not standard 1.5W x 1.5sec 2W x 2sec 1.5W x 1.5sec Not standardAnaesthesia Mainly ST PB, RB PB, RB, G PB PB, RB, GIOP (mmHg)Pre-laser 26.1 34.1 33.0 51.0† 40.7At 6 months post-laser 19.8 21.1 20.0 22.0* 17.7*dIOP>30% 44% 67%* 78%* 73%* 79.5%*Visual AcuityDecreased 19% 28% 32% N/A 20%Increased / No change 71% 72% 68% N/A 80%Adverse eventsUveitis 6.5% N/A N/A 6.6% 1.9%Hypotony 6.5% 1.0% 3.7% 10.0% 9.5%MedicationsPre-laser 2.2 2.3 2.4 N/A 1.7Post-laser 2.1 1.7 1.4 N/A 0.8dIOP: reduction in IOP, ST: subtenon, PB: peribulbar, RB: retrobulbar, G: general (anaesthesia),N /A: not available. Results with an asterisk (*) refer to the last follow-up visit.†: in this study there was an inclusion criterion of an IOP>30 mmHgnecessary adjunctive treatment method to cyclodiodelaser, we cannot account for the reluctancyof clinicians in our Unit to withdraw drops afterlaser, in spite of the fact that withdrawal of eyedrops has been established as a routine practice inthe post-laser period. Perhaps differences inpatient characteristics have contributed to this attitude,as our Unit covers the population of SouthLondon area, which is characterized by variablenational and racial background.Finally, a significant difference was noticed interms of the type of anaesthesia used for laser treatment.Most of our patients had undergonesubtenon anaesthesia, whereas in other studies themost prevalent types were peribulbar and retrobulbaranaesthesia. Despite this discrepancy weachieved satisfactory pain control during the laserprocedure, which denotes that subtenon anaesthesiacan be safely and effectively employed in cyclodiodelaser, as it provides adequate anaesthesia and isassociated with less severe adverse events.In conclusion, cyclodiode laser was overall asafe and effective method of reducing the IOP inpatients with refractory glaucoma. Its applicationin our Unit achieved all the primary goals of thismode of treatment: IOP reduction, preservation ofvisual acuity, and elimination of any ocular pain ordiscomfort.No difference in effectiveness of treatment wasobserved when the two current practices at our Unitwere compared. However, the optimum treatmentparameters for cyclodiode laser remain unclear anda large prospective trial may be required to establisha safe and predictable treatment protocol.References1. Bloom PA, Tsai JC, Sharma K, et al. “Cyclodiode”. Transscleraldiode laser cyclophotocoagulation in thetreatment of advanced refractory glaucoma. Ophthalmology1997; 104 (9): 1508-1519; discussion 1519-1520.2. Spencer AF, Vernon SA. “Cyclodiode”: results of a standardprotocol. Br J Ophthalmol 83: 311-316, 1999.3. Martin KRG, Broadway DC. Cyclodiode laser therapy forpainful, blind glaucomatous eyes. Br J Ophthalmol 85:474-476, 2001.4. Kosoko O, Gaasterland DE, Pollack IP, Enger CL. Longtermoutcome of initial ciliary ablation with contactdiode laser transscleral cyclophotocoagulation for severeglaucoma. The Diode Laser Ciliary Ablation StudyGroup. Ophthalmology 103: 1294-1302, 1996.5. Murphy CC, Burnett CAM, Spry PGD, Broadway DC,Diamond JP. A two centre study of the dose-responserelation for transscleral diode laser cyclophotocoagulationin refractory glaucoma. Br J Ophthalmol 87:1252-1257, 2003.

EӉȷʤÚÔÓÙ· appleÂÚÈÛÙ·ÙÈο∂appleÈ̤ÏÂÈ·: ¡. ¢ËÌËÙÚ·ÎÔ‡ÏÈ·˜e-mail: Ôkebe@otonet.grO ÚfiÏÔ˜ ÙÔ˘ ÎÚ˘ÛÙ·ÏÏÔÂȉԇ˜ Ê·ÎÔ‡ ηÈÙÔ˘ ˘·ÏÔÂȉԇ˜ ÛÙÔ ·ÓıÂÎÙÈÎfi ÁÏ·‡ÎˆÌ· ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜(ÙÚÂȘ appleÂÚÈappleÙÒÛÂȘ)T. ∞ÚÁ˘ÚfiappleÔ˘ÏÔ˜1, ∫. ªapple·Úapple¿Î˘2The important role of the crystalline lens and the vitreous body inthe pathogenesis and management of the persistent angle closure glaucomaT. Argyropoulos, K. Barpakis‡Á¯ÚÔÓ˜ ·appleÂÈÎÔÓÈÛÙÈΤ˜ Ù¯ÓÈΤ˜, ›Ù Ì ˘appleÂÚ‹¯Ô˘˜(UBM = μÈÔÌÈÎÚÔÛÎfiappleËÛË ˘appleÂÚ‹¯ˆÓ), ›Ù Ì ÙÔÌÔÁÚ·-Ê›· ÔappleÙÈ΋˜ Û˘ÓÔ¯‹˜ (OCT) appleÚÔÛı›Ô˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ÔÊı·ÏÌÔ‡, ηٷÁÚ¿ÊÔ˘Ó ÙÔÓ apple·ıÔÁÂÓÂÙÈÎfi ÚfiÏÔ ÙÔ˘ ËÏÈ-Îȷο ‰ÈÔÁΈ̤ÓÔ˘ ÎÚ˘ÛÙ·ÏÏÔÂȉԇ˜ Ê·ÎÔ‡ ÛÙËÓ appleÚfi-ÎÏËÛË Î·È ÛÙËÓ ÂappleÈÌÔÓ‹ ÂÓfi˜ ÔͤԘ ÁÏ·˘ÎÒÌ·ÙÔ˜ ÎÏÂÈ-ÛÙ‹˜ ÁˆÓ›·˜, ·ÎfiÌË Î·È apple·Ú¿ Ì›· ÂappleÈÙ˘¯‹ appleÂÚÈÊÂÚÈ΋ ÈÚÈ-‰ÂÎÙÔÌ‹. O apple·ıÔÁÂÓÂÙÈÎfi˜ ·˘Ùfi˜ Ì˯·ÓÈÛÌfi˜ χÂÙ·È Î˘-Ú›ˆ˜ Ì ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ÎÚ˘ÛÙ·ÏÏÔÂȉԇ˜ Ê·ÎÔ‡,fiappleˆ˜ appleÂÚÈÁÚ¿ÊÔ˘Ì Û ‰‡Ô appleÂÚÈappleÙÒÛÂȘ ÔͤˆÓ ÁÏ·˘-Έ̿وÓ, Ì›· Ì ›Úȉ· “en plateau” Î·È Ì›· Ì ¯ÚfiÓÈÔÁÏ·‡ÎˆÌ· ÛÙÂÓ‹˜ ÁˆÓ›·˜ Ì ¯·Ú·ÎÙ‹Ú· apple·Ú·ÙÂٷ̤ÓÔ˘ÌË Ï˘fiÌÂÓÔ˘ ÔͤԘ, ÛÙȘ Ôappleԛ˜ ›¯Â appleÚÔËÁËı› appleÂÚÈÊÂ-ÚÈ΋ ÈÚȉÂÎÙÔÌ‹ (Ã3) ¯ˆÚ›˜ ·appleÔÙ¤ÏÂÛÌ·.  ̛· ÙÚ›ÙË appleÂ-Ú›appleÙˆÛË, Ë ÔappleÔ›· ‹Ù·Ó ¯ÚfiÓÈ· ·ı·Ï·Ì›· Ì ˘appleÂÚÙÔÓ›·ÌÂÙ¿ ·applefi ÙÚ·ÌappleÂÎÔ˘ÏÂÎÙÔÌ‹, Ë ·Ê·›ÚÂÛË ÙÔ˘ Û˘ÌappleϤÁ-Ì·ÙÔ˜ ˘·ÏÔÂȉԇ˜ Î·È ÎÚ˘ÛÙ·ÏÏÔÂȉԇ˜ Ê·ÎÔ‡ ¤‰ˆÛÂÙËÓ Ï‡ÛË ÛÙÔÓ ¯ÚfiÓÈÔ ·appleÔÎÏÂÈÛÌfi Ù˘ ÁˆÓ›·˜ Î·È Ú‡ıÌÈ-Û ÙÔ ÁÏ·‡ÎˆÌ·.Recent advances (like UBM or OCT) in imaging of theanterior structures of the eye, e.g. of the angle, demonstratedthe pathogenetic role of the growing crystallinelens in crowded eyes suffering acute angle-closure glaucoma,which insisted despite successful peripheral iridectomies.The pathogenetic mechanism can be solvedmainly by removal of the thickened crystalline lens. Wepresent two cases of persistent acute anlge-closure glaucomadespite iridectomies: The 1st case is “iris en plateau”and the 2nd is a case of chronic angle-closure glaucomain an acute four months lasting phase, where thecrystalline lens was removed. In a 3rd case, a chronic flatanterior chamber combined with elevated IOP postoperativelyafter trabeculectomy, the removal of the crystallinelens and the hyaloid (ppV) resulted in the solutionof this difficult complication.ËÌÂÈÒÓÔ˘Ì ÂÈÛ·ÁˆÁÈο, fiÙÈ Ë apple·ÚÔ˘Û›·ÛË·˘Ù‹ ‰ÂÓ ·ÊÔÚ¿ ÙÔ Ù˘appleÈÎfi «Ô͇ appleÚˆÙÔapple·ı¤˜ ÁÏ·‡-Έ̷ ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜», appleÔ˘ ÔÊ›ÏÂÙ·È Û ·applefi-ÊÚ·ÍË Ù˘ ÁˆÓ›·˜ ÏfiÁˆ ÎÔÚÈÎÔ‡ ·appleÔÎÏÂÈÛÌÔ‡ ηÈÙÔ ÔappleÔ›Ô ·ÓÙ·appleÔÎÚ›ÓÂÙ·È ÛÙËÓ appleÂÚÈÊÂÚÈ΋ ÈÚȉÂ-ÎÙÔÌ‹.£· ·Û¯ÔÏËıԇ̠̠ÌÔÚʤ˜ ·applefiÊڷ͢ Ù˘ÁˆÓ›·˜, ÔÍ›·˜ ‹ ¯ÚfiÓÈ·˜, Ì ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ì˯·-ÓÈÛÌÔ‡˜, Ù· ÏÂÁfiÌÂÓ· ·ÓıÂÎÙÈο ÁÏ·˘ÎÒÌ·Ù·ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ («Refractory angle-clossure glau-1Euromedica “∫˘·ÓÔ‡˜ Ù·˘Úfi˜” OÊı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, £ÂÛÛ·ÏÔÓ›ÎË2OÊı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °ÂÓ. ¡ÔÌ. ¡ÔÛÔÎÔÌ›Ԣ μfiÏÔ˘OÊı·ÏÌÔÏÔÁ›·, 18, 2 : 152 - 155, 2006

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 153coma»), appleÔ˘ ‰ÂÓ ·apple·ÓÙÔ‡Ó ÛÙËÓ appleÂÚÈÊÂÚÈ΋ ÈÚȉÂ-ÎÙÔÌ‹ Î·È ÂϤÁ¯ÔÓÙ·È appleÔχ ‰‡ÛÎÔÏ· Î·È ÁÈ· appleÂ-ÚÈÔÚÈṲ̂ÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ì ʿÚ̷η.Δ· ·Ó·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÂÓfi˜ Ì·ÙÈÔ‡appleÔ˘ appleÚԉȷı¤ÙÔ˘Ó Û ÎÏ›ÛÈÌÔ Ù˘ ÁˆÓ›·˜ ›ӷÈ:• μÚ·¯‡ ·ÍÔÓÈÎfi Ì‹ÎÔ˜ ‚ÔÏ‚Ô‡ 1• ∞‚·ı‹˜ appleÚfiÛıÈÔ˜ ı¿Ï·ÌÔ˜2,3• ∫Ú˘ÛÙ. Ê·Îfi˜ ˢÍË̤ÓÔ˘ apple¿¯Ô˘˜ ÌÂÙ·ÙÔappleÈ-Ṳ̂ÓÔ˜ appleÚÔÛıȤÛÙÂÚ·1• ∫ÂÚ·ÙÔÂȉ‹˜ ÌÈÎÚ‹˜ Û¯ÂÙÈο ‰È·Ì¤ÙÚÔ˘4,5 .∂apple›Û˘ ¤¯ÂÈ Û‹ÌÂÚ· ηٷ‰Âȯı›, Ì ۇÁ¯ÚÔ-Ó˜ ·appleÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ (UBM Î·È OCTappleÚÔÛı›Ô˘ ÙÌ‹Ì·ÙÔ˜), Ë ‰Ú·ÛÙÈ΋ ·‡ÍËÛË ÙÔ˘ ‡-ÚÔ˘˜ Ù˘ ÁˆÓ›·˜ ÌÂÙ¿ ·applefi ÙËÓ ·Ê·›ÚÂÛË ÂÓfi˜ÔÁÎÒ‰Ô˘˜ ÎÚ˘ÛÙ·ÏÏÔÂȉԇ˜, ηı·ÚÔ‡ ‹ ηٷÚÚ·-ÎÙÈÎÔ‡, Ê·ÎÔ‡ (Karandish et al). °ÂÓÈÎÒ˜ Ô ÚfiÏÔ˜ÙÔ˘ Ê·ÎÔ‡ ÛÙÔ ÁÏ·‡ÎˆÌ· ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ ÂappleÈÛË-Ì·›ÓÂÙ·È ÔÏÔ¤Ó· Î·È Û˘¯ÓfiÙÂÚ· (Karandish,Obstbaum, Padmanabhan, Gunning).ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈÀÏÈÎfi: ∂appleÈϤͷÌ ÙÚÂȘ appleÂÚÈappleÙÒÛÂȘ ÁÏ·˘ÎˆÌ¿-ÙˆÓ ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ Ì ÎÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙËÓ Âapple›-ÌÔÓ· ˘„ËÏ‹ ∂O apple·Ú¿ ÙËÓ Î·Ù¿ÏÏËÏË Ê·Ú̷΢ÙÈ΋·ÁˆÁ‹ Î·È ÙËÓ ‰ÈÂÓ¤ÚÁÂÈ· appleÂÚÈÊÂÚÈ΋˜ ‹ appleÂÚÈÊÂÚÈÎÒÓÈÚȉÂÎÙÔÌÒÓ (›Ù Ì YAG-Laser ›Ù ¯ÂÈÚÔ˘ÚÁÈο).ª¤ıÔ‰Ô˜: ∫ÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÛÙË ıÂÚ·apple›··˘ÙÒÓ ÙˆÓ ·ÓıÈÛÙ¿ÌÂÓˆÓ (ÛÙË ıÂÚ·apple›·) ÁÏ·˘ÎˆÌ¿ÙˆÓÂ›Ó·È Ë ·Ê·›ÚÂÛË ÙÔ˘ Ê·ÎÔ‡ (Ì ¤ÓıÂÛË ÂÓ‰ÔÊ·ÎÔ‡ ÛÙÔappleÂÚÈÊ¿ÎÈÔ). ∏ ·Ê·›ÚÂÛË ·˘Ù‹ Û˘Ó‰˘¿ÛÙËΠ̠ÂappleÈappleÚfi-ÛıÂÙ˜ ÂÁ¯ÂÈÚËÙÈΤ˜ Ù¯ÓÈΤ˜ (ÈÚȉÔappleÏ·ÛÙÈ΋, ‚ÈÛÎÔ-η-Ó·ÏÔÛÙÔÌ›·, Ôapple›ÛıÈ· ‚ÈÙÚÂÎÙÔÌ‹), ·Ó¿ÏÔÁ· Ì ÙÔÓ ·Ï-ÁfiÚÈıÌÔ Ù˘ οı appleÂÚ›appleÙˆÛ˘.1Ë appleÂÚ›appleÙˆÛË: .μ., ÂÙÒÓ 35, AO: 18 Ì‹Ó˜ ·ı·-Ï·Ì›· Ì ˘appleÂÚÙÔÓ›· ÌÂÙ¿ TRC, ÛÙËÓ ÔappleÔ›· appleÚÔÛÂÙ¤ıËÎ·È ÔȉËÌ·ÙÈÎfi˜ ηٷÚÚ¿ÎÙ˘, Ô ÔappleÔ›Ô˜ Î·È ¤appleÂÈÛ ÙËÓ¿ÚÚˆÛÙË Ó· ¯ÂÈÚÔ˘ÚÁËı›. ÚÔÂÁ¯ÂÈÚËÙÈο Ë apple›ÂÛËÂÎ˘Ì·›ÓÂÙÔ 30-41 mmHg Ì ·ÓÙÈÁÏ·˘ÎˆÌ·ÙÈ΋ ·ÁˆÁ‹.ŒÁÈÓ ʷÎÔıÚ˘„›·, Ôapple›ÛıÈ· ‚ÈÙÚÂÎÙÔÌ‹, ÙÔappleÔı¤ÙËÛËIOL Ôapple. ı·Ï¿ÌÔ˘. 8 ¯ÚfiÓÈ· ÌÂÙÂÁ¯ÂÈÚËÙÈο Ë ∂O ›-Ó·È

154 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)∂ÈÎ. 3. ˘Ó‰˘·Ṳ̂ÓË ÂÁ¯Â›ÚËÛË Phaco + Visco-canalostomyÛÙËÓ 4Ë ÒÚ· ·Ì¤Ûˆ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈο. ∂O=2mmHg.ÌÔÓ҉˘ ·ÁˆÁ‹ Û˘Ó¯›ÛÙËΠÁÈ· 1 Ì‹Ó· ·ÎfiÌË, Ë ∂OÎ˘Ì¿ÓıËΠÁ‡Úˆ ÛÙÔ 23 mmHg (Ì Diamox). ∏ ÁˆÓ›·‹Ù·Ó ÛÙÂÓ‹ ·ÏÏ¿ ·ÓÔȯً 2-6-8Ë ÒÚ·, ‹ÙÔÈ ÔÈ ˘applefiÏÔÈapple˜6 ÒÚ˜. ŒÁÈÓ ʷÎÔıÚ˘„›· Î·È VCS (4h)+ PC IOL.¢‡Ô ¯ÚfiÓÈ· ÌÂÙÂÁ¯ÂÈÚËÙÈο O.O.= 0.9 cc, ∂O=15 mmHg ¯ˆÚ›˜ ıÂÚ·apple›·.˘˙‹ÙËÛË∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ∂O ÌÂÈÒÓÂÙ·È ÌÂÙÂÁ¯ÂÈ-ÚËÙÈο, ÌÂÙ¿ ·applefi ·Ê·›ÚÂÛË ÙÔ˘ ÎÚ˘ÛÙ·ÏÏÔÂȉԇ˜Ê·ÎÔ‡, ‰È·˘ÁÔ‡˜ ‹ ηٷÚÚ·ÎÙÈÎÔ‡, Ì ÔappleÔÈ·‰‹appleÔ-Ù ̤ıÔ‰Ô Á›ÓÂÈ ·˘Ùfi (ECCE ‹ Ê·ÎÔıÚ˘„›·), ̤ÓıÂÛË ÂÓ‰ÔÊ·ÎÔ‡ Ôapple. ı·Ï¿ÌÔ˘ ‹ ¯ˆÚ›˜. To ÁÂÁÔ-Ófi˜ ·˘Ùfi Ô‰ËÁ› appleÔÏÏÔ‡˜ ¯ÂÈÚÔ˘ÚÁÔ‡˜, Û ̿ÙÈ· ÌÂηٷÚÚ¿ÎÙË Î·È ‹appleÈÔ, Ú˘ıÌÈ˙fiÌÂÓÔ (Û˘Ó‹ıˆ˜ ̤ӷ Ê¿ÚÌ·ÎÔ) ÁÏ·‡ÎˆÌ·, Ó· ¯ÂÈÚÔ˘ÚÁÔ‡Ó ÌfiÓÔÓÙÔÓ Î·Ù·ÚÚ¿ÎÙË, ‰È·ÙËÚÒÓÙ·˜ ·Ó¤apple·ÊÔ ÙÔÓ ÂappleÈappleÂ-Ê˘ÎfiÙ· ÁÈ· ÂӉ¯fiÌÂÓË ÌÂÏÏÔÓÙÈ΋ ·ÓÙÈÁÏ·˘Îˆ-Ì·ÙÈ΋ ÂÁ¯Â›ÚËÛË, ÂappleÂȉ‹ ·ÎÚÈ‚Ò˜ ÁÓˆÚ›˙Ô˘Ó fiÙÈË ∂O ı· ÌÂȈı› ÌÂÙÂÁ¯ÂÈÚËÙÈο ÁÈ· ¤Ó· Ì ‰‡Ô¯ÚfiÓÈ·. ∞˘Ùfi ‚‚·›ˆ˜ ÔÊ›ÏÂÙ·È ÛÙÔ ¿ÓÔÈÁÌ· Ù˘ÁˆÓ›·˜ (Murchison).To ¿ÓÔÈÁÌ· Ù˘ ÁˆÓ›·˜ ÌÂÙÂÁ¯ÂÈÚËÙÈο, ÌÂ-ÙÚÔ‡ÌÂÓÔ Â›Ù Û ÌÔ›Ú˜, ›Ù Û Ìm ˘appleÂÚÙÚÈappleÏ·-ÛÈ¿˙ÂÙ·È (Karandish).ÙËÓ 1 Ë appleÂÚ›appleÙˆÛË, Ì ̷ÎÚÔ¯ÚfiÓÈ· ·ı·Ï·-Ì›· ÌÂÙ¿ ·applefi TRC Î·È Ì ÔȉËÌ·ÙÈÎfi ηٷÚÚ¿ÎÙË,‰ÂÓ ·ÚÎÔ‡ÛÂ Ô Û¯ËÌ·ÙÈÛÌfi˜ ÙÔ˘ appleÚfiÛıÈÔ˘ ı·Ï¿-ÌÔ˘, apple.¯. ÌfiÓÔÓ Ì È͈‰ÔÂÏ·ÛÙÈÎfi. ŒappleÚÂapple ӷÎÂÚ‰Ëı› ¯ÒÚÔ˜ ÁÈ· Ó· ·ÓÔ›ÍÂÈ Ë ÁˆÓ›· Î·È Ó·Û¯ËÌ·ÙÈÛı› ¿ÓÂÙ· Ô appleÚfiÛıÈÔ˜ ı¿Ï·ÌÔ˜. OappleˆÛ‰‹-appleÔÙ ¤appleÚÂapple ӷ ·Ê·ÈÚÂı› Ô ÔȉËÌ·ÙÈÎfi˜ ηٷÚ-Ú¿ÎÙ˘, ·ÏÏ¿ ÂappleÈappleÚfiÛıÂÙ· ·appleÔÊ·Û›ÛıËΠӷ·Ê·ÈÚÂı› Î·È ÙÔ ˘·ÏÔÂȉ¤˜ (Ôapple›ÛıÈ· ‚ÈÙÚÂÎÙÔÌ‹).O ÔȉËÌ·ÙÈÎfi˜ ηٷÚÚ¿ÎÙ˘ ‹Ù·Ó οÙÈ appleÔ˘ appleÚÔ-ÛÙ¤ıËΠÛÙËÓ fiÏË ÂappleÈappleÏÔ΋ appleÚÔ˜ ÙÔ Ù¤ÏÔ˜, Î·È ·˘-Ùfi ‹Ù·Ó appleÔ˘ ¤appleÂÈÛ ÙËÓ ·ÛıÂÓ‹ Ó· ¤ÚıÂÈ ÁÈ· ¯ÂÈ-ÚÔ˘ÚÁ›Ô. ∂appleÔ̤ӈ˜, ÁÓˆÚ›˙·Ì ·applefi ÙËÓ appleÂÚ›Ô‰ÔappleÔ˘ Ô Ê·Îfi˜ ‹Ù·Ó ·ÎfiÌË Î·ı·Úfi˜ Î·È ˘apple‹Ú¯Â Ë·ı·Ï·Ì›·, fiÙÈ ÙÔ Ì¿ÙÈ ·˘Ùfi ‹Ù·Ó ¤Ó· «Û˘ÌÊÔÚË̤-ÓÔ» Ì¿ÙÈ (“crowded” eye). ÿÛˆ˜ ·˘Ùfi˜ (Ô Ê·Îfi˜)Ó· ‹Ù·Ó Î·È Ë ·ÈÙ›· Ù˘ ÂappleÈappleÏÔ΋˜.ÙËÓ 2 Ë appleÂÚ›appleÙˆÛË (iris en plateau) ÔÈ appleÂÚÈ-ÊÂÚÈΤ˜ ÈÚȉÂÎÙÔ̤˜ ‰ÂÓ ¿ÓÔÈÍ·Ó ÙËÓ ÁˆÓ›· , ·appleÏ¿‰ÈfiÙÈ Ô apple·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ‰ÂÓ ‹Ù·Ó Ô ÎÔ-ÚÈÎfi˜ ·appleÔÎÏÂÈÛÌfi˜. ∏ ·Ê·›ÚÂÛË ÙÔ˘ Ê·ÎÔ‡ ÛÂÛ˘Ó‰˘·ÛÌfi Ì ÙËÓ appleÏ·ÛÙÈ΋ Ù˘ ›ÚȉԘ ¤‰ˆÛ·Ó ÙÔÓ·apple·Ú·›ÙËÙÔ ¯ÒÚÔ, ÒÛÙ ӷ ·ÓÔ›ÍÂÈ Ë ÁˆÓ›· Î·È Ó·ÙÚ·‚˯Ù› Ë Ú›˙· Ù˘ ›ÚȉԘ appleÚÔ˜ ÙÔ Î¤ÓÙÚÔ, ÂÏ¢ıÂÚÒÓÔÓÙ·˜¤ÙÛÈ ÙË ÁˆÓ›·, Ë ÔappleÔ›· ÏÂÈÙÔ‡ÚÁËÛÂÊ˘ÛÈÔÏÔÁÈο ¯ˆÚ›˜ Ê·Ú̷΢ÙÈ΋ ˘appleÔÛÙ‹ÚÈÍË.ÙËÓ 3 Ë appleÂÚ›appleÙˆÛË, fiappleÔ˘ Û˘Ó˘apple‹Ú¯Â Ô ¯Úfi-ÓÈÔ˜ apple·Ú¿ÁˆÓ, appleÚԂϤÊıËΠÂÎÙfi˜ ·applefi ÙËÓ ·Ê·›-ÚÂÛË ÙÔ˘ Ê·ÎÔ‡ – Ô ÔappleÔ›Ô˜ ›¯Â ‹‰Ë ıÔÏÒÛÂȘ, Ó·‚ÔËı‹ÛÔ˘Ì ÙËÓ ÂÓ·appleÔÌ›ӷ۷ ·ÓÔÈÎÙ‹ ÁˆÓ›· (6ÒÚ˜, ‹ÙÔÈ 2-6-8 Ë ÒÚ·) Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ Ê˘ÛÈÔÏÔ-ÁÈÎfiÙÂÚ·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ¤ÁÈÓ ÂappleÈappleÚfiÛıÂÙ· ‚È-ÛÎÔ-ηӷÏÔÛÙÔÌ›· ÛÙËÓ 4 Ë Î·È 1/2 Ë ÒÚ·. ∏ Ù¿ÛËÁˆÓÈÔÛ˘Ó¯ÂÈÒÓ Ù˘ ›ÚȉԘ Âapple¤‚·Ï ÙËÓ appleÂÚÈÊÂÚÈ-΋ ÈÚȉÂÎÙÔÌ‹ ÛÙÔ ÛËÌÂ›Ô Ù˘ VCS.˘ÌappleÂÚ·ÛÌ·ÙÈο, Ë Î·Ù·ÓfiËÛË ÙÔ˘ apple·ıÔÁÂ-ÓÂÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ Û ¤Ó· ·ÓıÂÎÙÈÎfi ÁÏ·‡ÎˆÌ·ÎÏÂÈÛÙ‹˜ ÁˆÓ›·˜ Â›Ó·È ·apple·Ú·›ÙËÙË ÁÈ· Ó· ۯ‰ȿ-ÛÔ˘Ì ÙËÓ ıÂÚ·apple¢ÙÈ΋ ·ÓÙÈÌÂÙÒappleÈÛË, Ë ÔappleÔ›· ‰ÂÓÂ›Ó·È ÛÙÂÚÂfiÙ˘appleË, ·ÏÏ¿ ‰È·Ê¤ÚÂÈ Î·Ù¿ appleÂÚ›appleÙˆÛË.Ú¤appleÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· Ì¿ÙÈ· ·˘Ù¿ Û¯Â-‰fiÓ apple¿ÓÙÔÙ ÊÏÂÁÌ·›ÓÔ˘Ó ¤ÓÙÔÓ·, appleÚ¿ÁÌ· appleÔ˘ ›-Ó·È Î·Îfi˜ apple·Ú¿ÁˆÓ ÁÈ· ·ÓÙÈÁÏ·˘ÎˆÌ·ÙÈΤ˜ ÂappleÂÌ-‚¿ÛÂȘ ¿ÌÂÛ·.O ÎÚ˘ÛÙ·ÏÏÔÂȉ‹˜ Ê·Îfi˜ Ì ÙËÓ ËÏÈÎȷ΋ ·‡-ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘, Û˘Ì‚¿ÏÏÂÈ appleÔχ Û˘¯Ó¿ ÛÙËÓapple·ıÔÁ¤ÓÂÈ· ·˘ÙÒÓ ÙˆÓ ÁÏ·˘ÎˆÌ¿ÙˆÓ. ∏ ·Ê·›ÚÂ-Û‹ ÙÔ˘ ¤¯ÂÈ Â˘ÂÚÁÂÙÈÎfi ·appleÔÙ¤ÏÂÛÌ· ÛÙÔ ¿ÓÔÈÁÌ·Î·È ÙËÓ Âapple·Ó·ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÁˆÓ›·˜.μÈ‚ÏÈÔÁÚ·Ê›·1. Lowe RF. Causes of shallow anterior chamber in primaryangle-closure glaucoma; ultrasonic biometry ofnormal and angle-closure glaucoma eyes. Am JOphthalmol 67: 87-93, 1969.2. Smith P. On the growth of crystalline lens. TransOphthalmol Soc UK 1883; 3: 79-99, 1968.3. Lowe RF. Time-amplitude ultrasonography for ocular

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 155biometry. Am J Ophthalmol 66: 913-918, 1968.4. Delmarcelle Y, Collignon J, Luyckx J, Weekers R. Etudebiometrique du globe oculare dans le glaucome aangle ferme. Bull Mem Soc Fr Ophtalmol 84: 449-460,1972.5. Grieten J, Weekers R. Etude des dimensions de la chambreanterieure de lãoeil humaine; 3e partie – Dans leglaucome a angle ferme et dans le glaucome a angleouvert. Ophthalmologica 143: 409-422, 1962.6. Karandish A, Wirbelauer C, Haeberle H, Pham DT. OCT-Goniometrie vor und nach Kataraktextraktion beiengem Kammerwinkel. In “Auffarth GU, Welt R,Demeler U: 17. Kongress der DeutschsprachigenGesellschaft fuer Intraokularlinsen-Implantation undRefraktive Chirurgie”, 14.-15.02.2003, Ludwigshafen,Biermann: 65-71, 2003.7. Murchinson JF Jr, Shields MB. An evaluation of threesurgical approaches for coexisting Cataract andGlaucoma. Ophthalmic Surg 20: 393-398, 1989.8. Gunning FP, Greve EL. Lens extraction for uncontrolledangle-closure glaucoma: Long-term follow-up. J CataractRefract Surg 24: 1347-1356, 1998.9. Padmanabhan Vish. Researcher recommends phaco fortreatment of PACG. Eurotimes 26, 2004.10. Kim YY, Jung HR. Clarifying the nomenclature forprimary angle-closure glaucoma. Surv Ophthalmol 42:125-136, 1997.11. Wirbelauer C, Karandish A, et al. Optical CoherenceTomography in malignant glaucoma followingfiltration syrgery. Br J Ophthalmol 87: 952-955, 2003.12. Yang CH, Jung PT. Intraocular lens position andanterior chamber angle changes after cataract extractionin eyes with primary angle-closure glaucoma. JCataract Refract Surg 23(7): 1109-1113, 1997.

AÁÁÂÈ˝Ùȉ· ÎÏ¿‰Ô˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÈ΋˜ ÊϤ‚·˜ÛÂ Ó¤Ô ¿ÙÔÌÔ∂. ·apple·‚·ÛÈÏ›Ԣ, §. ƒ·˙‹˜, ∫. æ‡ÏÏ·˜, ∞. °Ú·ÙÛˆÓ›‰Ë˜, ∞. ·apple·appleÔÛÙfiÏÔ˘Interesting case report of vasculitis in branch retinal vein in a young person∂. Papavasiliou, L. Razis, K. Psillas, A. Gratsonidis, A. PapapostolouÎÔapplefi˜: ∏ apple·ÚÔ˘Û›·ÛË ÂÓfi˜ appleÂÚÈÛÙ·ÙÈÎÔ‡ Ì ·ÁÁÂÈ˝Ùȉ·ÎÏ¿‰Ô˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÈ΋˜ ÊϤ‚·˜. ÀÏÈÎfi - ª¤ıÔ‰ÔÈ:ÕÚÚÂÓ 40 ÂÙÒÓ Ì ·ÈÊÓ›‰ÈÔ ÛÎfiو̷ ÙÔ˘ ÔappleÙÈÎÔ‡ ÙÔ˘ appleÂ-‰›Ô˘ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÔÊı·ÏÌfi ÌÂÏÂÙ‹ıËÎÂ Î·È ·ÓÙÈÌÂÙˆapple›-ÛÙËÎÂ. ∏ ÌÂϤÙË appleÂÚÈÂÏ¿Ì‚·Ó ̤ÙÚËÛË ÔappleÙÈ΋˜ Ô͇ÙË-Ù·˜, ÔÊı·ÏÌÔÛÎfiappleÈÛË, ¤ÏÂÁ¯Ô ÔappleÙÈÎÒÓ apple‰›ˆÓ, „ËÊȷ΋·ÁÁÂÈÔÁÚ·Ê›· Ì ÊÏÔ˘ÔÚÂÛνÓË Î·È Û˘ÛÙËÌ·ÙÈÎfi ÂÚÁ·-ÛÙËÚÈ·Îfi – ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô (·ÈÌÔÛÊ·ÈÚ›ÓË, ·ÈÌ·ÙÔ-ÎÚ›Ù˘, Mantoux, C3, C4, ANA, CRP, Ra-test, P-ANCA, C-ANCA, apple·Ú¿ÁÔÓÙ˜ V, II, ·ÓÙÈıÚÔÌ‚›ÓË III, appleÚˆÙ½ÓË C,appleÚˆÙ½ÓË S, PT, INR, APTT, ∞/· ıÒÚ·ÎÔ˜, HIV, Toxo-πgG,Toxo-IgM, Ca Ô‡ÚˆÓ 24ÒÚÔ˘ Î.¿. ∏ ̤ıÔ‰Ô˜ ·ÓÙÈÌÂÙÒappleÈÛ˘appleÂÚÈÂÏ¿Ì‚·Ó ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ô˘˜·ÁˆÁ‹˜, ·ÓÙÈ·ÈÌÔappleÂÙ·Ïȷ΋˜ Î·È ÎÔÚÙÈ˙ÔÓÔıÂÚ·apple›·˜.∞appleÔÙÂϤÛÌ·Ù·: O ·ÛıÂÓ‹˜ ·Ó·Ê¤ÚÂÈ Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ÙÔ˘ ÛÎÔÙÒÌ·ÙÔ˜ ÛÙË ‰Â‡ÙÂÚË Âapple›ÛÎÂ„Ë ¤Ó· Ì‹Ó·ÌÂÙ¿, Ì ÔappleÙÈ΋ Ô͇ÙËÙ· 10/10. O ·Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·-Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ˘ÌappleÂÚ¿ÛÌ·Ù·: 1) ∏ ·ÈÙÈÔ-ÏÔÁ›· Û˘¯Ó¿ apple·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. 2) ∏ ‰È·ÊÔÚÈ΋ ‰È¿-ÁÓˆÛË appleÂÚÈÏ·Ì‚¿ÓÂÈ appleÏ‹ıÔ˜ Û˘ÛÙËÌ·ÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ.3) ∏ appleÚfiÁÓˆÛË Ù˘ ÔappleÙÈ΋˜ Ô͇ÙËÙ·˜ Â›Ó·È Î·Ï‹. 4) O·ÛıÂÓ‹˜ Ó· apple·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈο.Purpose: To present a case report of vasculitis in abranch retinal vein. Material - Methods: Male 40 yearsold with acute scotoma in his visual field at the left eyewas studied and treated. We evaluated visual acuity,ophthalmoscopy, perimetry, fluorescein angiography andblood examinations (Hb, Hct, PPD, C3, C4, ANA, CRP,Ra-test, P-ANCA, C-ANCA, Factors V, II, AT III, protein C,protein S, PT, INR, APTT, chest x-ray, HIV, Toxo-IgG, Toxo-IgM,Ca 24h etc.). He was prescribed an anti-inflammatory,an antiplatelet and steroids. Results: The patientfeels that the scotoma has been smaller in size at hissecond visit one month later and his visual acuity was 10/10. The results of his first examinations were negative.Conclusions: 1) We usually don’t know what causedvasculitis. 2) Differential diagnosis includes many diseases.3) The prognosis of visual acuity is good. 4) The patientshould be examined regularly.ÙÔȯ›· ÈÛÙÔÚÈÎÔ‡ ÙÔ˘ ·ÛıÂÓÔ‡˜ÚfiÎÂÈÙ·È ÁÈ· ¿ÚÚÂÓ· ËÏÈΛ·˜ 40 ¯ÚÔÓÒÓ, ÔÔappleÔ›Ô˜ apple·Ú·apple¤ÌÊıËΠÛÙÔ È·ÙÚÂ›Ô Ì·˜ ·applefi Û˘Ó¿-‰ÂÏÊÔ ·Ó·Ê¤ÚÔÓÙ·˜ ¤Ó· ·ÈÊÓ›‰ÈÔ ÎÂÓÙÚÈÎfi ÛÎfiÙˆ-Ì· ÛÙÔ ·ÚÈÛÙÂÚfi ÔappleÙÈÎfi ÙÔ˘ apple‰›Ô. O ·ÛıÂÓ‹˜ ›¯Â·ÚÓËÙÈÎfi ÈÛÙÔÚÈÎfi appleÚÔËÁÔ‡ÌÂÓˆÓ ÔÊı·ÏÌÔÏÔÁÈÎÒÓÎ·È Û˘ÛÙËÌ·ÙÈÎÒÓ apple·ı‹ÛˆÓ, ·Ó¤ÊÂÚ fiÙÈ ‰ÂÓ Â›¯ÂοÓÂÈ Ï‹„Ë Î¿appleÔÈÔ˘ Ê·Ú̷΢ÙÈÎÔ‡ Û΢¿ÛÌ·ÙÔ˜Î·È ‰ÂÓ Â›¯Â ˘appleÔ‚ÏËı› Û ¯ÂÈÚÔ˘ÚÁÈ΋ Âapple¤Ì‚·ÛË. O·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â Âapple·Ê‹ Ì ÔÈÎȷο ˙Ò·.∫ÏÈÓÈ΋ ÂͤٷÛËO ·ÛıÂÓ‹˜ ›¯Â ÔappleÙÈ΋ Ô͇ÙËÙ· 10/10 ¯ˆÚ›˜‰ÈfiÚıˆÛË ¿Ìʈ, Ê˘ÛÈÔÏÔÁÈ΋ ·ÓÙ›ÏË„Ë ¯ÚˆÌ¿-ÙˆÓ ¿Ìʈ Î·È apple·ÚÔ˘Û›·˙Â Ê˘ÛÈÔÏÔÁÈο ·ÓÙ·Ó·-ÎÏ·ÛÙÈο ÎfiÚ˘. ŒÁÈÓ ÙÔÓÔ̤ÙÚËÛË Ë ÔappleÔ›· ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈ΋ (15 mmHg ¿Ìʈ) Î·È ÂͤٷÛË ÛÙËÛ¯ÈÛÌÔÂȉ‹ Ï˘¯Ó›·, fiappleÔ˘ ‰ÂÓ ‚Ú¤ıËΠοÙÈ ·applefi Ù·appleÚfiÛıÈ· ÌfiÚÈ·, ÙÔ ˘·ÏÔÂȉ¤˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi·ÏÏ¿ Ô ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹˜ apple·ÚÔ˘Û›·˙ ̛· appleÂÚÈ-ÊÏ‚È΋ ÂÍ›‰ÚˆÛË Á‡Úˆ ·applefi ÙÔÓ Î¿Ùˆ ÎÚÔÙ·ÊÈÎfiOÊı·ÏÌÔÏÔÁ›·, 18, 2 : 156 - 160, 2006

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 157EÈÎ. 1. ºˆÙÔÁÚ·Ê›· ‚˘ıÔ‡ Ì appleÂÚÈÊÏ‚È΋ ÂÍ›‰ÚˆÛËÁ‡Úˆ ·applefi ÙÔÓ Î¿Ùˆ ÎÚÔÙ·ÊÈÎfi ÊÏ‚ÈÎfi ÎÏ¿‰Ô ηÈÔ›‰ËÌ· ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜.ÊÏ‚ÈÎfi ÎÏ¿‰Ô Î·È Ô›‰ËÌ· ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹appleÏËÛ›ÔÓ. (∂ÈÎ. 1). ∂appleÈappleϤÔÓ, Ô ÚÈÓÈÎfi˜ ·ÌÊÈ‚ÏË-ÛÙÚÔÂȉ‹˜ apple·ÚÔ˘Û›·˙ ¤Ó· ÛËÌÂ›Ô Ì ÂÛÙÈ·Îfi Ô›-‰ËÌ· ÛÙÔ ¿ÎÚÔ ÂÓfi˜ ÊÏ‚ÈÎÔ‡ ÎÏ¿‰Ô˘ (∂ÈÎ. 2).ÙËÓ ÂͤٷÛË Ì ÙÔÓ apple›Ó·Î· Amsler Ê¿ÓËΠ¤Ó·¤ÏÏÂÈÌÌ· ÛÙÔ ÔappleÙÈÎfi apple‰›Ô ÙÔ˘ ·ÛıÂÓÔ‡˜ (∂ÈÎ. 3).EÈÎ. 2. ºˆÙÔÁÚ·Ê›· ÚÈÓÈÎÔ‡ ‚˘ıÔ‡ Ì appleÈı·Ófi ÂÛÙÈ·ÎfiÔ›‰ËÌ· ÛÙÔ ¿ÎÚÔ ÂÓfi˜ ÊÏ‚ÈÎÔ‡ ÎÏ¿‰Ô˘.∞appleÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ŒÁÈÓ ·˘ÙÔÌ·ÙÔappleÔÈË̤ÓË appleÂÚÈÌÂÙÚ›· ÛÙËÓÔappleÔ›· Ê¿ÓËΠ¤Ó· ÎÂÓÙÚÈÎfi ÛÎfiو̷ ÛÙÔ ·ÚÈÛÙÂ-Úfi ÔappleÙÈÎfi apple‰›Ô Î·È Ê˘ÛÈÔÏÔÁÈÎfi ÙÔ ‰ÂÍÈfi ÔappleÙÈÎfiapple‰›Ô (∂ÈÎ. 4, 5). O ·ÛıÂÓ‹˜ ˘appleÔ‚Ï‹ıËΠ۠ÊÏÔ˘-ÔÚÔ·ÁÁÂÈÔÁÚ·Ê›·, Ù· Â˘Ú‹Ì·Ù· Ù˘ ÔappleÔ›·˜ ‹Ù·ÓÌ›· Ï¢΋ ·Û·Ê‹˜ ıÔÏÂÚfiÙËÙ· Ë ÔappleÔ›· appleÂÚÈ‚¿ÏÏÂÈÙË ÛÙ‹ÏË ·›Ì·ÙÔ˜ οو ÎÚÔÙ·ÊÈÎÔ‡ ÊÏ‚ÈÎÔ‡ ÎÏ¿-‰Ô˘ ηٿ ÙfiappleÔ˘˜, ÙÌËÌ·ÙÈο Û ‰‡Ô ÛËÌ›· Ì ‰È·Ú-ÚÔ‹ ÊÏÔ˘ÔÚÂÛÎ½Ó˘ Ì staining ÛÙȘ fi„È̘ Ê¿-ÛÂȘ. Àapple‹Ú¯Â ηı˘ÛÙ¤ÚËÛË ÛÙËÓ appleÏ‹ÚˆÛË Ù˘ ÛÙ‹-Ï˘ ·›Ì·ÙÔ˜ ÂÓfi˜ ÊÏ‚ÈÎÔ‡ ÎÏ¿‰Ô˘. ÏËÛ›ÔÓ ÙÔ˘·ÁÁ›Ԣ ˘apple‹Ú¯Â ˘appleÔÊıÔÚÈÛÌfi˜, ÏfiÁˆ ÂÛÙÈ·ÎÔ‡ ÔÈ-‰‹Ì·ÙÔ˜, Ì ηϋ fï˜ ·ÈÌ·ÙÈ΋ ‰È‹ıËÛË Ù˘ appleÂ-ÚÈÔ¯‹˜ Ù˘ ˆ¯Ú¿˜. Δ· ÛÙÔȯ›· ·˘Ù¿ Û˘ÓËÁÔÚÔ‡Ó˘apple¤Ú ·ÁÁÂÈ˝Ùȉ·˜ ÊÏ‚ÈÎÔ‡ ÎÏ¿‰Ô˘ (∂ÈÎ. 6-8).EÈÎ. 3. ›Ó·Î·˜ AMSLER ·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÔ‡ fiappleÔ˘Ê·›ÓÂÙ·È ÙÔ apple·Ú¿ÎÂÓÙÚÔ ÛÎfiو̷ ÛÙÔ ÔappleÙÈÎfi apple‰›Ô.¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛËÙËÓ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ·ÁÁÂÈ˝Ùȉ·˜·ÌÊÈ‚ÏËÛÙÚÔÂȉÈÎÔ‡ ·ÁÁ›Ԣ appleÂÚÈÏ·Ì‚¿ÓÂÙ·È ¤Ó·appleÏ‹ıÔ˜ Û˘ÛÙËÌ·ÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, Ù· ÔappleÔ›· ›ӷÈÙ· ÂÍ‹˜: ·) º˘Ì·Ù›ˆÛË ‚) ·ÚÎÔ›‰ˆÛË Á) ΔÔÍÔappleÏ¿Û̈Ûˉ) ˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜Â) ∫ÔÎÎȈ̿وÛË Wegener ÛÙ) ¡fiÛÔ˜ ∞‰·Ì·-EÈÎ. 4. OappleÙÈÎfi apple‰›Ô ·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÔ‡ Ì apple·Ú¿ÎÂ-ÓÙÚÔ ÛÎfiو̷.ÓÙÈ¿‰Ë-Behcet ˙) ƒÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›ÙȘ Ë) AIDSı) £ÚÔÌ‚ÔÊÈÏ›· È) ∞appleÏfi˜ ¤Úapple˘ Ù‡appleÔ˘ I Î·È ππ Î)ŒÚapple˘ ˙ˆÛÙ‹Ú·˜ Ï) ∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ Ì) πfi˜Epstein- Barr Ó) ¡fiÛÔ˜ ÙÔ˘ Lyme Í) ΔÔÍÔηڛ·-

158 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)EÈÎ. 5. OappleÙÈÎfi apple‰›Ô ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡ Ê˘ÛÈÔÏÔÁÈÎfi.EÈÎ. 8. Ÿ„ÈÌË Ê¿ÛË Ù˘ ·ÁÁÂÈÔÁÚ·Ê›·˜, fiappleÔ˘ ÂappleÈappleϤÔÓ˘apple¿Ú¯ÂÈ ˘appleÔÊıÔÚÈÛÌfi˜ ÏfiÁˆ Ôȉ‹Ì·ÙÔ˜ appleÏËÛ›ÔÓ ÙÔ˘·ÁÁ›Ԣ Ì ·ÓÂappleËÚ¤·ÛÙË ÙËÓ appleÂÚÈÔ¯‹ Ù˘ ˆ¯Ú¿˜.ÛË Ô) ‡Ó‰ÚÔÌ· ÌÂÙ·ÌÊ›ÂÛ˘ (appleÔÏÏ·appleÏ‹ ÛÎÏ‹-Ú˘ÓÛË).∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜¢ÈÂÓÂÚÁ‹ıËΠ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ¯ˆÚ›˜È‰È·›ÙÂÚ· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ÙËÓ ÁÂÓÈ΋ÂͤٷÛË ·›Ì·ÙÔ˜ Ù· ·appleÔÙÂϤÛÌ·Ù· ‹Ù·Ó ·˘Ù¿ appleÔ˘Ê·›ÓÔÓÙ·È ÛÙÔÓ apple›Ó·Î· 1.˘ÓÂappleÒ˜ Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ·Ó¤-‰ÂÈÍ ÙÔ ·›ÙÈÔ Ù˘ apple¿ıËÛ˘, ·appleÏ¿ Ê¿ÓËÎÂ Ë ¤Ó‰ÂÈ-ÍË ÊÏÂÁÌÔÓ‹˜.EÈÎ. 6. ºÏÔ˘ÔÚÔ·ÁÁÂÈÔÁÚ·ÊÈ΋ ·appleÂÈÎfiÓÈÛË ·ÚÈÛÙÂÚÔ‡ÔÊı·ÏÌÔ‡ – ÚÒÈÌË Ê¿ÛË Ì ηı˘ÛÙ¤ÚËÛË ÛÙËÓappleÏ‹ÚˆÛË Ù˘ ÛÙ‹Ï˘ ·›Ì·ÙÔ˜ ÛÙÔ apple¿Û¯ÔÓ ·ÁÁ›Ô.£ÂÚ·apple¢ÙÈ΋ ·ÓÙÈÌÂÙÒappleÈÛËÙÔÓ ·ÛıÂÓ‹ ¯ÔÚËÁ‹ıËÎ·Ó Ù·ÌappleϤÙ˜ Persantin25 mg ÁÈ· ÙËÓ ·ÓÙÈ·ÈÌÔappleÂÙ·Ïȷ΋ ÙÔ˘‰Ú¿ÛË, Ù·ÌappleϤÙ˜ Salospir (ÌË ÛÙÂÚÔÂȉ¤˜ ·ÓÙÈ-ÊÏÂÁÌÔÓ҉˜) Î·È Ù·ÌappleϤÙ˜ Medrol 16 mg ÌÂ-Ù¿ ·applefi ÙËÓ ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·-ÎÔ˜ Î·È ÙËÓ ·Ó¿ÁÓˆÛË Ù˘ Mantoux, ÒÛÙ ӷ ÌËÓ¤¯Ô˘Ì ·ÏÏÔ›ˆÛË ÙÔ˘ ·appleÔÙÂϤÛÌ·ÙÔ˜ ηٿ ÙÔÂÍ‹˜ ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì·: ÁÈ· 10 ̤Ú˜ ‰‡Ô Ù·-ÌappleϤÙ˜, ÌÂÙ¿ ÌÈ¿ÌÈÛË Ù·ÌappleϤٷ ÁÈ· ¿ÏϘ 10̤Ú˜ Î·È Ì›· Ù·ÌappleϤٷ ÁÈ· ÙÔ ÙÂÏÂ˘Ù·›Ô ‰Âη‹-ÌÂÚÔ.∞appleÔÙÂϤÛÌ·Ù· – ˘ÌappleÂÚ¿ÛÌ·Ù·EÈÎ. 7. ºÏÔ˘ÔÚÔ·ÁÁÂÈÔÁÚ·ÊÈ΋ ·appleÂÈÎfiÓÈÛË ÛÙÔ 1.32,fiappleÔ˘ Ê·›ÓÂÙ·È Ï¢΋ ·Û·Ê‹˜ ıÔÏÂÚfiÙËÙ· Á‡Úˆ ·applefiÙÔ ·ÁÁÂ›Ô ÙÌËÌ·ÙÈο, Û ‰‡Ô ÛËÌ›·.ÙËÓ ‰Â‡ÙÂÚË Âapple›ÛÎÂ„Ë ÌÂÙ¿ ·applefi ¤Ó· Ì‹Ó· Ô·ÛıÂÓ‹˜ ·Ó·Ê¤ÚÂÈ ˘appleÔÎÂÈÌÂÓÈ΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ÛÎÔÙÒÌ·ÙÔ˜ Î·È Ë ÔappleÙÈ΋ ÙÔ˘ Ô͇ÙËÙ· ‰È·ÙËÚ›ٷÈ

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 159›Ó·Î·˜ 1∂Ú˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ· : 4,88 M/Ìl (º.Δ. : 4,6- 6,2)∞ÈÌÔÛÊ·ÈÚ›ÓË (HGB) : 14,7 gr/dl ( º.Δ. :13,5-18,0)∞ÈÌ·ÙÔÎÚ›Ù˘ (HCT) : 44,2 % (º.Δ. : 40,0-54,0)ª¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ (MCV) : 90,5 fl (º.Δ. : 79-98)ª¤ÛË appleÂÚÈÂÎÙÈÎfiÙ˘ Hb (MCH) : 30,2 pgr (º.Δ. : 26-32)ª¤ÛË apple˘ÎÓfiÙ˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (MCHC): 33,3 gr/dl (º.Δ. : 32-36)∂‡ÚÔ˜ ηٷÓÔÌ‹˜ ÂÚ˘ıÚÒÓ (RDW) : 14,4 % ( º.Δ. : 11,5-15,0)§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· : 10,6 ∫/Ìl ( º.Δ. : 4,0-10,0)O˘‰ÂÙÂÚfiÊÈÏ· (NEUT) : 55,9% ( º.Δ. : 40-75%)§ÂÌÊÔ·ÙÙ·Ú· (LYM) : 34,1% (º.Δ. : 20-45%)ªÔÓÔapple‡ÚËÓ· (ªO¡O) : 8,8 % ( º.Δ. : 2-10%)∏ˆÛÈÓfiÊÈÏ· (∂O) : 0,7% (º.Δ. : 0-5%)μ·ÛÂfiÊÈÏ· (μ∞SO) : 0,5% ( º.Δ. : 0-1%)∞ÈÌÔappleÂÙ¿ÏÈ· (PLT) : 338 ∫/Ìl (º.Δ. : 150-450)ª¤ÛÔ˜ fiÁÎÔ˜ ·ÈÌÔappleÂÙ·Ï›ˆÓ (MPV) : 7,0 fl (º.Δ. : 7,9-11,9)∂‡ÚÔ˜ ηٷÓÔÌ‹˜ ·ÈÌÔappleÂÙ·Ï›ˆÓ (PDW) : 16,7 fl (º.Δ. : 9-17)∞ÈÌÔappleÂÙ·ÏÈÔÎÚ›Ù˘ (PCT): 0,24% ( º.Δ. : 0,15-0,35)∂ƒ°∞Δ∏ƒπ∞∫∂ ∂•∂Δ∞∂πΔ·¯‡ÙËÙ· ∫·ı›˙ËÛ˘ ∂Ú˘ıÚÒÓ : 22 mm (º.Δ. :

160 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)ÔappleÙÈ΋˜ ÙÔ˘ Ô͇ÙËÙ·˜ Â›Ó·È Î·Ï‹ Î·È ÂÍ·Úٿٷȷapplefi ÙËÓ Û˘ÌÌÂÙÔ¯‹ ‹ fi¯È Ù˘ ˆ¯Ú¿˜.μÈ‚ÏÈÔÁÚ·Ê›·EÈÎ. 9. ºˆÙÔÁÚ·Ê›· ‚˘ıÔ‡ ¤Ó· Ì‹Ó· ÌÂÙ¿. ÀappleÔ¯ÒÚË-ÛÂ Ë ·ÁÁÂÈ˝Ùȉ· Ì apple·Ú·ÌÔÓ‹ ÌfiÓÔ ÛÙÔȯ›ˆÓ ÂÍ›-‰ÚˆÛ˘.ÛÙ· 10/10. ÀappleÔÏ›appleÂÙ·È Ô Ó¢ÚÔ·appleÂÈÎÔÓÈÛÙÈÎfi˜¤ÏÂÁ¯Ô˜ Î·È Ù· ·appleÔÙÂϤÛÌ·Ù· ·applefi οappleÔȘ ÂȉÈΤ˜ÂÍÂÙ¿ÛÂȘ ÁÈ· ÈÔ‡˜ (CMV, EBV, Borrelia). ÙËÓ ¤Á-¯ÚˆÌË ÊˆÙÔÁÚ¿ÊËÛË ‚˘ıÔ‡ apple·Ú·ÙËÚ‹ıËΠ˘appleÔ-¯ÒÚËÛË Ù˘ ·ÁÁÂÈ˝Ùȉ·˜ Î·È ÙÔ˘ Û˘ÓÔ‰Ô‡ Ôȉ‹Ì·-ÙÔ˜ Î·È apple·Ú·ÌÔÓ‹ οappleÔÈˆÓ ÛÙÔȯ›ˆÓ ÂÍ›‰ÚˆÛ˘(∂ÈÎ. 9).∫·Ù·Ï‹ÁÔ˘ÌÂ Û˘ÓÂappleÒ˜ ÛÙÔ Û˘Ìapple¤Ú·ÛÌ· fiÙÈ Ë·ÁÁÂÈ˝Ùȉ· ÌappleÔÚ› Ó· appleÚÔ¤ÏıÂÈ ·applefi ¤Ó· appleÏ‹ıÔ˜Û˘ÛÙËÌ·ÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, Ë ·ÈÙÈÔÏÔÁ›· Ù˘ fï˜Û˘¯Ó¿ apple·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË apple·Ú¿ ÙÔÓ ÂÓ‰Âϯ‹ ÂÚ-Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. O ·ÛıÂÓ‹˜ ¯ÚÂÈ¿˙ÂÙ·È Ó· apple·-Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈο ÁÈ· ÙÔ ÂӉ¯fiÌÂÓÔ ·ÏÏ·-Á‹˜ Ù˘ ÎÏÈÓÈ΋˜ ÙÔ˘ ÂÈÎfiÓ·˜. ∏ appleÚfiÁÓˆÛË Ù˘1. Ysasaga JE, Davis J. Frosted Branch Angiitis with OcularToxoplasmosis. Arch Fam Med 9: 962-963, 2000.2. Park DW, Folk JC, Whitcup SM, Polk D, Kansupada K,Fountai C, Brown J, Nussenblatt RB. Phakic patientswith Cystoid Macular Edema, Retinal Periphlebitis,and Vitreous Inflammation. Arch Ophthalmol 116:1025-1029, 1998.3. Rabb M, Jampol L, Fish R, Campo R, Sobol W, Becker N,Retinal periphlebitis in patients with acquiredimmunodeficiency syndrome with cytomegalovirusretinitis mimics acute frosted retinal periphlebitis.Arch Ophthalmol 9: 110, 1992.4. Ysasaga JE, Davis J. Frosted branch angiitis with oculartoxoplasmosis Arch Ophthalmol. 117: 1260-1261,1999.5. Lynn WA, Lightman S. The eye in systemic infection. TheLancet 364: 1439-1450, 2004.6. Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S.The neuro-ophthalmology of multiple sclerosis.Lancet Neurology 4: 111-121, 2005.7. Nowosielska A, Czarnecki W, Brydak-Godowska J, et al.Acute, idiopathic, bilateral uveitis with periphlebitis –case report. Klin Oczna 107: 372-5, 2005.8. Chen L, Gordon LK. Ocular manifestations of multiplesclerosis. Curr Opin Ophthalmol 16(5): 315-20, 2005.9. Janati K, Omari K, Benchiki H, Hamdani M, Lakhadar H.Ocular manifestation of Behcet disease. Rev MedInterne 26(10): 771-6, 2005.

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162 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)ÂÏÏËÓÈ΋ OÊı·ÏÌÔÏÔÁ›· ·applefi ¤Ó·Ó ·ÎÔ‡Ú·ÛÙÔ·ÍÈfiÏÔÁÔ ÂappleÈÛÙ‹ÌÔÓ· Î·È ÂÚ¢ÓËÙ‹».ΔÔ 1882 ·Ó·ÎÔ›ÓˆÛ ÛÙËÓ π.∂.∞. ‰È΋ ÙÔ˘ ̤ıÔ‰Ô,ÙÚÔappleÔappleÔ›ËÛË appleÚÔËÁÔ˘Ì¤Ó˘ (1879) «∞Ó·Ú-Ú·Ê‹ ÌÂı’ ˘appleÔÙÔÌ‹˜» appleÔ˘ ·ÊÔÚ¿ ÛÙË Û˘ÓÙÔÌfiÙÂ-ÚË ıÂÚ·apple›· ÙÔ˘ ÙÚ·¯ÒÌ·ÙÔ˜.ΔÔ 1882 apple·ÚÔ˘ÛÈ¿˙ÂÈ ¿ÏÏË ÂÚÁ·Û›· ÙÔ˘ ÛÙËÓπ.∂.∞.: «ÂÚ› ıÂÚ·apple›·˜ ÙˆÓ ÙÚ·¯ˆÌ¿ÙˆÓ ÂÓ ‚Ú·-¯˘Ù¿Ùˆ ¯ÚfiÓˆ, ¿Ó¢ Ô˘ÏÒÓ ·Ó ÌË appleÚÔ¸apple‹Ú¯·ÓÙÔÈ·‡Ù·È η ¿Ó¢ ˘appleÔÙÚÔapple‹˜».’ ·˘Ù‹Ó ·Ó·Ê¤ÚÂÈ ÂÓ ÂÎÙ¿ÛÂÈ ÙË ıÂÚ·apple›·ÙˆÓ ÙÚ·¯ˆÌ¿ÙˆÓ ·applefi ÙÔÓ πappleappleÔÎÚ¿ÙË, ÙË Ì¤ıÔ‰Ô°·ÏËÓÔ‡, ηıÒ˜ Î·È ÙÔ˘ ·‡ÏÔ˘ ∞ÈÁÈÓ‹ÙË. ŸÏÔÈÂÊ¿ÚÌÔ˙·Ó ÙË Ì¤ıÔ‰Ô Í¤Ûˆ˜ ÙˆÓ ıËÏÒÓ Ì ÙÚ·-¯¤· ÛÒÌ·Ù· Î·È ÛÙËÓ Û˘Ó¤¯ÂÈ· ¤‚·˙·Ó Âapple¿Óˆ ÛÙȘÙÚ·˘Ì·ÙÈΤ˜ ÂappleÈÊ¿ÓÂȘ ‰È¿ÊÔÚ· Ô Î·ı’ ¤Ó·˜Ê¿Ú̷η.∏ ÙÚÔappleÔappleÔ›ËÛË ÙÔ˘ ∫ˆÛÙÔÌÔ›ÚË ·ÊÔÚÔ‡ÛÂÙËÓ ·ÓÙÈηٿÛÙ·ÛË Ù˘ ͤÛˆ˜ ‰È· ÙÚ›„ˆ˜ ÙˆÓÙÚ·¯ˆÌ¿ÙˆÓ Ì ÙÔ ÌÈÎÚfi ‰¿ÎÙ˘ÏÔ Ù˘ ‰ÂÍÈ¿˜ ¯ÂÈÚfi˜,·ÊÔ‡ ·Ó·ÛÙÚ·Ê› ÙÔ ‚ϤʷÚÔ Ì ÙÔÓ ·ÓÙ›¯ÂÈÚ· ηÈÙÔ ‰Â›ÎÙË. ÙË Û˘Ó¤¯ÂÈ· ¤‚·˙ ٷ ‰È¿ÊÔÚ· Ê¿ÚÌ·-η appleÔ˘ ¯ÚËÛÈÌÔappleÔÈÔ‡Û·Ó Î·È ÔÈ apple·Ï·ÈfiÙÂÚÔÈ.OÓÔÌ¿˙ÂÈ ÙË Ì¤ıÔ‰fi ÙÔ˘ ÙÔÏÌËÚ‹ Î·È Î˘Ú›ˆ˜ÙÔÓ ÈÛ¯˘ÚÈÛÌfi ÙÔ˘ fiÙÈ ıÂÚ·apple‡ÂÈ ÙÔ ÙÚ¿¯ˆÌ·.ÙËÓ ·Ó·ÎÔ›ÓˆÛ‹ ÙÔ˘ ·˘Ù‹, ÂÎÙfi˜ ÙˆÓ appleÚÔ·Ó·-ÊÂÚı¤ÓÙˆÓ ·Ú¯·›ˆÓ ∂ÏÏ‹ÓˆÓ ÁÈ·ÙÚÒÓ ·Ó·Ê¤ÚÂÈÎ·È ÙÔ˘˜ Û‡Á¯ÚÔÓÔ‡˜ ÙÔ˘˜ Â˘Úˆapple·›Ô˘˜ ηıËÁËÙ¿˜Arlt, Stellvag, Schweiger, Galejowski, ÙÔ˘˜ ÔappleÔ›-Ô˘˜ ·appleÔηÏ› «ÔÊı·ÏÌfiÛˆÌÔ˘˜».°ÓˆÚ›˙ÂÈ ¿ÚÈÛÙ· Á·ÏÏÈο, ÁÂÚÌ·ÓÈο Î·È ·Á-ÁÏÈο. ΔÔ‡ÙÔ Ê·›ÓÂÙ·È ·applefi ÙȘ ÂÚÁ·Û›Â˜ appleÔ˘ ‰Ë-ÌÔÛ›Â˘Â Û ͤӷ ÂappleÈÛÙËÌÔÓÈο appleÂÚÈÔ‰Èο.ΔÔ 1887 Ì ÙË ‰È·ÙÚÈ‚‹ ÙÔ˘ appleÔ˘ Â›Ó·È ‰ËÌÔÛÈ-Â˘Ì¤ÓË ÛÙÔ Á·ÏÏÈÎfi appleÂÚÈÔ‰ÈÎfi “Archives d’Opthalmologie” ÙÔ 1893, ÛÂÏ. 640, Ì ٛÙÏÔ “Rechercheset commentaries sur l’ apobronchisme,Operation hippocratique du trisiasis per petueepour d’ emprisme tradionell”, ·Ó·ÎËÚ‡ÛÛÂÙ·È ˘-ÊËÁËÙ‹˜ ÙÔ˘ ·ÓÂappleÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ.ΔÔ 1880 ‹Ù·Ó ˘appleÔ„‹ÊÈÔ˜ ÙÔ˘ ˘Ì‚Ô˘ÏÈ‰Â›Ô˘∞ÁˆÓ›ÛÌ·ÙÔ˜ Ì ÂÈÛËÁËÙ‹ ÙÔÓ Î·ıËÁËÙ‹ apple˘Ú.ª·ÁÁ›Ó·, Ê›ÏÔ ÙÔ˘ apple·Ó›Û¯˘ÚÔ˘ ÙfiÙ ∞Ó·ÁÓˆÛÙ¿-ÎË. ΔÔ ‚Ú·‚Â›Ô ‰›ÓÂÙ·È Û οappleÔÈÔÓ ÃÚÈÛÙ›‰Ë.O ∫ˆÛÙÔÌÔ›Ú˘ Û˘Ó¤¯ÈÛ ÙÔ ÂappleÈÛÙËÌÔÓÈÎfi,Û˘ÁÁÚ·ÊÈÎfi Î·È ÂÚ¢ÓËÙÈÎfi ÙÔ˘ ÂÚÁÔ, apple·Ú’ fiϘÙȘ ·ÓÙÈÍÔfiÙËÙ˜ Î·È ÙÔÓ Î·Ù·ÙÚÂÁÌfi ÙÔ˘ ·apple’ ÙÔÓ∞Ó·ÁÓˆÛÙ¿ÎË Î·È ÙÔÓ appleÂÚ›Á˘Úfi ÙÔ˘. ΔÔ 1891 Á›-ÓÂÙ·È ·ÓÙÂappleÈÛÙ¤ÏÏÔÓ Ì¤ÏÔ˜ Ù˘ π·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ÙˆÓ ·ÚÈÛ›ˆÓ (ÂÚ. °·ÏËÓfi˜ 1891 ÛÂÏ. 493).O ηٷÙÚÂÁÌfi˜ Î·È Ë appleÔÏÂÌÈ΋ appleÔ˘ ÙÔ˘ ÂÁ›-ÓÔÓÙÔ ·applefi ÙËÓ ¤‰Ú· Ù˘ ÂÏÏËÓÈ΋˜ ÔÊı·ÏÌÔÏÔÁ›·˜Î·È Ù˘ π.∂.∞. ( appleÚfi‰ÚÔ˜ ∞Ó·ÁÓˆÛÙ¿Î˘) ‡ÎÔÏ·Û˘Ó¿ÁÂÙ·È, ·Ó ηÓ›˜ ‰È·‚¿ÛÂÈ Ù· appleÚ·ÎÙÈο Ù˘π.∂.∞. ÙˆÓ ÂÙÒÓ 1880-1882.∂Λ Ê·›ÓÂÙ·È Ë ÔÚÁ·ÓˆÌ¤ÓË Âapple›ıÂÛË ·applefiÙÔ˘˜ appleÂÚ› ÙÔÓ ∞Ó·ÁÓˆÛÙ¿ÎË ÁÈ·ÙÚÔ‡˜, appleÔÏϤ˜ ÊÔ-Ú¤˜ Ì ϤÍÂȘ ·appleÚÂapple›˜, ·ÎfiÌ· Î·È ÁÈ· ·ÓıÚÒappleÔ˘˜¿ÍÂÛÙÔ˘˜.ªappleÔÚԇ̠ӷ ˘appleÔı¤ÛÔ˘Ì fiÙÈ Ë ‰È·Ì¿¯Ë ·˘-Ù‹, appleÔ˘ ı‡Ì· Ù˘ ‹Ù·Ó fi¯È ÌfiÓÔ Ô ∫ˆÛÙÔÌÔ›Ú˘·ÏÏ¿ Ë ¤Ú¢ӷ Î·È Ë ÂappleÈÛÙËÌÔÓÈ΋ appleÚfiÔ‰Ô˜ Ù˘OÊı·ÏÌÔÏÔÁ›·˜ Ù˘ ÂappleÔ¯‹˜, ÌÂÁ¿ÏÔ ÚfiÏÔ ¤apple·ÈÍÂË ·Ó·ÁÓÒÚÈÛË Ù˘ ·Í›·˜ ÙÔ˘ ÂȘ ÙËÓ ∂˘ÚÒappleË.O ∞Ó·ÁÓˆÛÙ¿Î˘ ÂÛÙËÚ›˙ÂÙÔ ·applefi Ù· ·Ó¿ÎÙÔ-Ú· Î·È ‰ÂÓ ‹ıÂÏ ӷ ¢‰ÔÎÈÌ‹ÛÂÈ Ô ∫ˆÛÙÔÌÔ›Ú˘,ÙÔÓ ÔappleÔ›Ô ›Ûˆ˜ ¤‚ÏÂapple ÂÓ ‰˘Ó¿ÌÂÈ ·ÓÙ›apple·Ïfi ÙÔ˘.ÕÏψÛÙÂ, Ô ·Â›ÌÓËÛÙÔ˜ ηıËÁËÙ‹˜ π. ÷ڷ-Ì‹˜, fiÙ·Ó Ì·˜ ‰›‰·Í ÙËÓ ÙÚÔappleÔappleÔ›ËÛË ÙÔ˘ ÔÊı·Ï-ÌÔÛÎÔapple›Ô˘ ·apple’ ÙÔÓ ∞Ó·ÁÓˆÛÙ¿ÎË Â›appleÂ: « ∂›Ó·ÈÎڛ̷ appleÔ˘ Ô ∞Ó·ÁÓˆÛÙ¿Î˘ ·appleÔÚÚÔÊ‹ıËΠ·apple’ÙËÓ ÎÔÈÓˆÓÈ΋ ˙ˆ‹ Î·È ·appleÔÌ·ÎÚ‡ÓıËΠ·apple’ ÙËÓ¤Ú¢ӷ ÎÈ ¤ÙÛÈ Î·Ì›· apple¿ıËÛË ÙÔ˘ ‚˘ıÔ‡ ‰ÂÓ Ê¤ÚÂÈÙÔ fiÓÔÌ¿ ÙÔ˘».∂›Ó·È ÂÏ¿Ùو̷ Ù˘ Ê˘Ï‹˜ «·È ¤Úȉ˜ appleÂÚ› ÙÔÁ¤Ú·˜» appleÔ˘ Ì·˜ Û˘Óԉ‡ÂÈ ·apple’ Ù· ¯ÚfiÓÈ· ÙÔ˘ OÌ‹-ÚÔ˘ (∞Á·Ì¤ÌÓˆÓ-∞¯ÈÏχ˜). ŒÙÛÈ ÏÔÈapplefiÓ Ô ∫ˆ-ÛÙÔÌÔ›Ú˘ ‰ÂÓ ÌapplefiÚÂÛ ӷ οÓÂÈ apple·ÓÂappleÈÛÙËÌȷ΋ηÚȤڷ ·ÏÏ¿ Ô‡Ù ‹Ù·Ó Âapple·ÁÁÂÏÌ·Ù›·˜ ÎÈ ¤ÙÛȉÂÓ ÌapplefiÚÂÛ ӷ ÚÈ˙ÒÛÂÈ ÔÚÈÛÙÈο Û ÙfiappleÔ.ΔÔÓ ‚Ú›ÛÎÔ˘Ì ÛÙË ª˘ÙÈÏ‹ÓË, ÛÙËÓ ∫ˆÓÛÙ·-ÓÙÈÓÔ‡appleÔÏË, ÛÙÔ ·Ú›ÛÈ, ÛÙËÓ ∞ı‹Ó·, ÛÙË μȤÓÓË,ÛÙË §ÂÈ„›·, ÛÙËÓ ∞ÏÂÍ¿Ó‰ÚÂÈ· (¤Î·Ó ÂÚÁ·Û›·ÁÈ· ÙÔ ÙÚ¿¯ˆÌ·), ÛÙË Ã›Ô ÌÂÙ¿ ÙÔ˘˜ ÛÂÈÛÌÔ‡˜ ÙÔ˘1881, fiappleÔ˘ ¤Ûapple¢Û ӷ appleÚÔÛʤÚÂÈ ‰ˆÚÂ¿Ó ÙȘ˘appleËÚÂۛ˜ ÙÔ˘ ÛÙÔ˘˜ ÛÂÈÛÌÔapple·ı›˜.ΔȘ ·Ó·ÎÔÈÓÒÛÂȘ ÙÔ˘ Ô ∫ˆÛÙÔÌÔ›Ú˘, ÂÎÙfi˜Ù˘ π.∂.∞., ˘apple¤‚·ÏÏÂ Î·È ÛÙȘ π·ÙÚÈΤ˜ ∂Ù·ÈÚ›˜·ÚÈÛ›ˆÓ, μȤÓÓ˘, §ÂÈ„›·˜.ª¿ÏÈÛÙ·, Ë ·ÊÔÚÒÛ· ÙËÓ ÙÚÔappleÔappleÔ›ËÛË Ù˘˘appleÔÙÔÌ‹˜ ÛÙÔ˘˜ ÙÚ·¯ˆÌ·ÙÈÎÔ‡˜ Âapple·ÈÓ¤ıËΠÛÙËÓÂÙ·ÈÚ›· Ù˘ μȤÓÓ˘ ·apple’ ÙÔ˘˜ ηıËÁËÙ¤˜ Arlt,Mautner Î·È ·Ó·ÁÓˆÚ›ÛıËÎÂ Ë ‰È·ÊÔÚ¿ Ù˘ ·applefiÙȘ ÂÁ¯ÂÈÚ‹ÛÂȘ ÙˆÓ Wecker Î·È Jasche-Arlt ηȷapplefi ÙȘ ÌÂıfi‰Ô˘˜ ÙˆÓ apple·ÏÈÒÓ ∂ÏÏ‹ÓˆÓ ÁÈ·ÙÚÒÓ·‡ÏÔ˘ ∞ÈÁÈÓ‹ÙË Î·È ∞ÂÙ›Ô˘ ∞ÌȉÈÓÔ‡ ( ÂÚ. °·-ÏËÓfi˜ 1882 ÛÂÏ. 297).∏ ÛappleÔ˘‰·ÈfiÙÂÚË appleÚÔÛÊÔÚ¿ ÙÔ˘ ∫ˆÛÙÔÌÔ›ÚËÛÙË Û‡Á¯ÚÔÓË π·ÙÚÈ΋ Â›Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÙÔ ÂÎ248 ÛÂÏ›‰ˆÓ Û‡ÁÁÚ·ÌÌ¿ ÙÔ˘ «ÂÚ› OÊı·ÏÌÔÏÔ-Á›·˜ Î·È øÙÔÏÔÁ›·˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ ·applefi ∞Ú¯·ÈÔÙ¿-ÙˆÓ ÃÚfiÓˆÓ Ì¤¯ÚȘ πappleappleÔÎÚ¿ÙÔ˘˜» appleÔ˘ ÂΉfiıËÎÂ

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 163ÛÙËÓ ∞ı‹Ó· ÙÔ 1887 ·applefi ÙȘ ÂΉfiÛÂȘ ∞ÊÒÓ ÂÚÚ‹.ÙÔ ‚È‚Ï›Ô ·˘Ùfi ηıÒ˜ Î·È ÛÙ· ¿ÏÏ· ‰‡Ô appleÔ˘‰˘ÛÙ˘¯Ò˜ ‰ÂÓ Â͉fiıËÛ·Ó Ô ∫ˆÛÙÔÌÔ›Ú˘ ÂÚ·Ó›-˙ÂÙ·È ·applefi fiÏÔ˘˜ ۯ‰fiÓ ÙÔ˘˜ ·Ú¯·›Ô˘˜ Û˘ÁÁÚ·-Ê›˜ ÎÂÊ¿Ï·È· appleÔ˘ ·ÊÔÚÔ‡Ó ÛÙËÓ È·ÙÚÈ΋ Î·È È‰È-·›ÙÂÚ· ÛÙÔ fiÚÁ·ÓÔ Ù˘ ÔÚ¿Ûˆ˜.ÙÔÓ appleÚfiÏÔÁÔ ÙÔ˘ ‚È‚Ï›Ô˘ appleÔ˘ Âͤ‰ˆÛ ÁÚ¿-ÊÂÈ fiÙÈ Ë ÌÂϤÙË ·˘Ù‹ ÙˆÓ ·Ú¯·›ˆÓ Û˘ÁÁڷʤˆÓÙÔÓ ·apple·Û¯fiÏËÛ ÁÈ· 12 ¯ÚfiÓÈ· ÛÙȘ ‚È‚ÏÈÔı‹Î˜fi¯È ÌfiÓÔ Ù˘ ∂ÏÏ¿‰·˜ ·ÏÏ¿ ΢ڛˆ˜ Ù˘ ∂˘ÚÒapple˘.∂ÎÙfi˜ ·applefi ÙÔ Û‡ÁÁÚ·ÌÌ· ·˘Ùfi, ÙÔ 1892 ‰ËÌÔ-ÛȇÂÈ ÛÙËÓ ∞ÏÂÍ¿Ó‰ÚÂÈ· ÙÔÓ ¢Â‡ÙÂÚÔ ÏfiÁÔ ÙÔ˘∞¤ÙÈÔ˘ ∞ÌȉÈÓÔ‡.ΔÔ ÂappleÈÛÙËÌÔÓÈÎfi ÙÔ˘ ¤ÚÁÔ, appleÏÔ‡ÛÈÔ Î·È ·ÍÈfi-ÏÔÁÔ, ÙÔÓ Ê¤ÚÓÂÈ ÛÙËÓ appleÚÒÙË ÛÂÈÚ¿ ÙˆÓ Â˘Úˆapple·›-ˆÓ ÔÊı·ÏÌÈ¿ÙÚˆÓ.∏ ¢ÌÂÓ‹˜ ˘appleÔ‰Ô¯‹ Î·È ÎÚÈÙÈ΋ ÙÔ˘ ¤ÚÁÔ˘ ÙÔ˘·applefi ÙÔ˘˜ Â˘Úˆapple·›Ô˘˜ ÔÊı·ÏÌÈ¿ÙÚÔ˘˜, Ê·›ÓÂÙ·È·applefi ÙÔÓ ı·˘Ì·ÛÌfi ÙÔ˘ Hirschberg Ì ÙËÓ ÂÍ‹˜ÊÚ¿ÛË:«ŸÛÙȘ appleÚ·ÁÌ·Ù‡ÂÙ·È appleÂÚ› ÈÛÙÔÚ›·˜ Ù˘OÊı·ÏÌÔÏÔÁ›·˜ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ apple·Ú¿ ÌÂÙ’ ¢¯·-ÚÈÛÙ‹Ûˆ˜ Î·È ÈηÓÔappleÔÈ‹Ûˆ˜ Ó· appleÚÔÛÙÚ¤¯ÂÈ ÂȘ·˘ÙÔ‡˜». ∞applefi appleÔÏϤ˜ Ì·ÚÙ˘Ú›Â˜ Ù˘ ÂappleÔ¯‹˜ appleÚÔ·-appleÙÂÈ fiÙÈ Ô ∫ˆÛÙÔÌÔ›Ú˘ ‹Ù·Ó ·ÊÈÏÔÎÂÚ‰‹˜ ηȷÍÈfiappleÈÛÙÔ˜ ÛÙËÓ ¿ÛÎËÛË ÙÔ˘ Âapple·ÁÁ¤ÏÌ·Ùfi˜ ÙÔ˘.O ∫ˆÛÙÔÌÔ›Ú˘ ›¯Â apple¿ÚÂÈ ˘appleÔÙÚÔÊ›· ·applefiÙËÓ ∫˘‚¤ÚÓËÛË ΔÚÈÎÔ‡appleË (˘appleÔ˘ÚÁfi˜ apple·È‰Â›·˜ ÔÎÔ˘ÏÔ‡‰Ë˜) ÁÈ· Ó· ÌÂÙ·‚› ÛÙÔ ·Ú›ÛÈ Î·È Ó··Û¯ÔÏËı› Ì ÙËÓ ¤Ú¢ӷ ·Ú¯·›ˆÓ ÂÏÏËÓÈÎÒÓ È·-ÙÚÈÎÒÓ ÎÂÈÌ¤ÓˆÓ appleÔ˘ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ÂΛ ‚È‚ÏÈÔı‹ÎË.¢˘ÛÙ˘¯Ò˜ fï˜, ÙÔ 1889 Ë ∫˘‚¤ÚÓËÛË ¿ÏÏ·-ÍÂ. ∏ Ó¤· ˘applefi ÙÔÓ ¢ÂÏËÁÈ¿ÓÓË ∫˘‚¤ÚÓËÛË ‰È¤ÎÔ-„ ÙËÓ ˘appleÔÙÚÔÊ›· ÙÔ˘ ∫ˆÛÙÔÌÔ›ÚË, Ô ÔappleÔ›Ô˜ fÂÓ Á‡ÚÈÛ ÛÙËÓ ∂ÏÏ¿‰·.ŒÌÂÈÓ ÛÙË °·ÏÏ›· Î·È appleÚÔÛapple¿ıËÛ ӷ ‚ÔËı‹ÛÂÈÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ·ÛÎÒÓÙ·˜ ÙËÓ π·ÙÚÈ΋.°Ú‹ÁÔÚ· fï˜ ÙÔ˘ ·apple·ÁÔÚ‡ıËÎÂ Ë ¿ÛÎËÛË ÙÔ˘Âapple·ÁÁ¤ÏÌ·ÙÔ˜ - ÁÈ· apple·Ú¿‚·ÛË Î·Ù·ÛÙ·ÙÈÎÒÓ Î·-ÓfiÓˆÓ - ›Ûˆ˜ ¤Êı·Û ̤¯ÚÈ ÂΛ ÙÔ Ì·ÎÚ‡ ¯¤ÚÈ ÙÔ˘∞Ó·ÁÓˆÛÙ¿ÎË.ŒÙÛÈ ¤˙ËÛ ٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘Û ÌÂÁ¿ÏË ÊÙÒ¯ÂÈ· appleÔ˘ ¤Êı·Û ̤¯ÚÈ ÙËÓ ÂÍ·-ıÏ›ˆÛË (∏irschberg).∞˘Ùfi ÙÔ ıÏÈ‚ÂÚfi Ù¤ÏÔ˜ ›¯Â ÌÈ· Âͤ¯Ô˘Û·,ʈÙÂÈÓ‹ Î·È ·ÓȉÈÔÙÂÏ‹˜ appleÚÔÛˆappleÈÎfiÙËÙ· Ù˘∂ÏÏËÓÈ΋˜ OÊı·ÏÌÔÏÔÁ›·˜ ÙÔ˘ appleÂÚ·Ṳ̂ÓÔ˘ ·ÈÒ-Ó·. ∫·È Ë ¯ÚÔÓÔÏÔÁ›· ÙÔ˘ ı·Ó¿ÙÔ˘ ÙÔ˘ ‰ÂÓ Ì·˜ ›-Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹, fiappleˆ˜ ÎÈ ÂΛÓË Ù˘ ÁÂÓÓ‹ÛÂ-Ò˜ ÙÔ˘.O Ô˘ÚÓ·ÚfiappleÔ˘ÏÔ˜ ÙÔappleÔıÂÙ› ÙÔ ı¿Ó·Ùfi ÙÔ˘Á‡Úˆ ÛÙÔ 1900.μÈ‚ÏÈÔÁÚ·Ê›·1. ∑·¯·ÚÈ¿‰Ë˜ π. ŒÎıÂÛË Âapple› Ù˘ ∂ÚÁ·Û›·˜ ÙÔ˘ °. ∫ˆÛÙÔ-ÌÔ›ÚË. ¢ÂÏÙ. π.∂.∞. 1886, 16.1.1986.2. Hirschberg I. Die Augenheilkunde in der Neuzeit. Graefe– Saemisch Handbuch der Gesamten. Augenheilkunde.Buch II, Kap. XXIII, 1919, S.355, Leipzig.3. Hruby K. The Successirs of A. Anagnostakis. ¢ÂÏÙ.∂.O.∂. Δ. 51, 1983, Û. 237-239.4. ∫·ÓÓÂÏ¿Î˘ ∫. Ãȷο ∞Ó¿ÏÂÎÙ·. 1980, ∞ı‹Ó·.5. ª¿Îη˜ °.¡., ƒ¿ÏÏ˘ °.Ã. Ú·ÎÙÈο Ù˘ ÂÓ ∞ı‹Ó·È˜ ∞¢˘Ófi‰Ô˘ ÙˆÓ ∂ÏÏ‹ÓˆÓ π·ÙÚÒÓ, 1882.6. ÂÚÈÔ‰Èο: Arch. d’ Opht. 1880, p 37-39, 1983, p180-1888, p267-1893, p.640.Ann. D’ Ocul . IXC, 1888, p. 228.°·ÏËÓfi˜. 1880, Û. 238-1880, Û. 272-1891, Û. 493.Gazet. Med.d’ Or. 1883, p.10.Ú·ÎÙÈο ˘ÓÔ‰. ∂ÏÏ. π·ÙÚ. 1878, Û.25-1882, Û.293Î·È 360.7. Ô˘ÚÓ·ÚfiappleÔ˘ÏÔ˜ ∫.°. «¿apple˘ÚÔ˜ Larouche» 1964, Δ. 9Ô˜. . 189 Î·È ÂÁ΢ÎÏ. «◊ÏÈÔ˜» 1952, Δ. 11Ô˜, Û. 935.8. ƒËÁ¿ÙÔ˜ °. ∏ ÈÛÙÔÚ›· Ù˘ π·ÙÚ. ∂Ù·ÈÚ. ∞ıËÓÒÓ 1835-1985, Û.759. ºÚÔÓÈÌfiappleÔ˘ÏÔ˜ π, °ÂˆÚÁfiappleÔ˘ÏÔ˜ ∞., ÷‚È¿Ú· – ∫·Ú·-¯¿ÏÈÔ˘ ‚·ÛÙ‹. O ÔÊı·ÏÌ›·ÙÚÔ˜ °ÂÒÚÁÈÔ˜ . ∫ˆ-ÛÙÔÌÔ›Ú˘ Î·È ÙÔ ¤ÚÁÔ ÙÔ˘ (1847-1900). OÊı/ο ÃÚÔ-ÓÈο. OÎÙÒ‚ÚÈÔ˜-¢ÂΤ̂ÚÈÔ˜ 1988.

°ÂÒÚÁÈÔ˜ ªËÙ·Ú¿Î˘. ÷‚È¿Ú·- ∫·Ú·¯¿ÏÈÔ˘°ÂÓÓ‹ıËΠÛÙË Ã›Ô ÙÔ 1875. ªÂÁ¿ÏˆÛ ÛÙËÓ∞›Á˘appleÙÔ, fiappleÔ˘ ÙÂÏ›ˆÛ ÙȘ Á˘ÌÓ·ÛȷΤ˜ ÙÔ˘ÛappleÔ˘‰¤˜. °Ú¿ÊÙËΠÛÙËÓ π·ÙÚÈ΋ ¯ÔÏ‹ Ù˘ ∞ı‹-Ó·˜ ·apple’ fiappleÔ˘ apple‹Ú ÙÔ ‰›appleψ̿ ÙÔ˘ ÙÔ 1897. °‡ÚÈÛÂÛÙËÓ ∞›Á˘appleÙÔ fiappleÔ˘ ¿ÛÎËÛ ÙËÓ π·ÙÚÈ΋ ̤¯ÚÈ ÙÔ1920. ∂ÁηٷÛÙ¿ıËΠÛÙË Ã›Ô ˆ˜ oÊı·ÏÌ›·ÙÚÔ˜ÙÔ 1922, ·ÊÔ‡ appleÚÒÙ· apple‹Ú ÂȉÈ΋ ÂÍ¿ÛÎËÛË Ù˘OÊı·ÏÌÔÏÔÁ›·˜ ÛÙËÓ OÊı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ÙÔ˘ apple‹ÏÈÔ˘ ÷ڷ̋.O ªËÙ·Ú¿Î˘ appleÚfiÛÊÂÚ ÙȘ ˘appleËÚÂۛ˜ ÙÔ˘Î·Ù’ ·Ú¯‹Ó ÛÙÔ ¢ËÌfiÛÈÔ OÊı·ÏÌÈ·ÙÚ›Ô. ∞ÚÁfiÙÂ-Ú· ›‰Ú˘Û ÙÔ È‰ÈˆÙÈÎfi ÙÔ˘ È·ÙÚ›Ô. ¢Â ¯ÂÈÚÔ˘ÚÁÔ‡-ÛÂ. ΔȘ ÂχıÂÚ˜ ÒÚ˜ ÙÔ˘, ηٿ ÙȘ appleÏËÚÔÊÔÚ›Â˜ÙˆÓ Û˘ÁÁÂÓÒÓ ÙÔ˘, ÙȘ appleÂÚÓÔ‡ÛÂ Û·Ó ÂÚ·ÛÈÙ¤¯Ó˘„·Ú¿˜, Ûapple¿ÓÈ· ÁÈ· ÙËÓ ÂappleÔ¯‹ ÙÔ˘ Âapple›‰ÔÛË ‹ ‰È·-‚¿˙ÔÓÙ·˜ ÛÙËÓ appleÏÔ‡ÛÈ· ‚È‚ÏÈÔı‹ÎË ÙÔ˘. ΔÔ ÙÚ·ÁÈ-Îfi Â›Ó·È fiÙÈ Ë ı¿Ï·ÛÛ·, appleÔ˘ ÙfiÛÔ ·Á·appleÔ‡ÛÂ, ¤ÁÈÓÂÔ ˘ÁÚfi˜ Ù¿ÊÔ˜ ÙÔ˘. O ªËÙ·Ú¿Î˘ appleÓ›ÁËΠÙÔ 1945ÛÙÔ Ó·˘¿ÁÈÔ ÙÔ˘ «appleÂÚ¯ÂÈÔ‡».OÊı·ÏÌÔÏÔÁ›·, 18, 2 : 164, 2006

O James Ware (1756-1815) Î·È Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ÛÙËÓ oÊı·ÏÌÔÏÔÁÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· Ì ٷ ¤ÚÁ· ÙÔ˘“Extracting the Cataract”, “Remarks on the FistulaLachrymalis”, “Ophthalmy”* Î.¿.°. ªapple·Ï·Ó›Î·˜O James Ware ÁÂÓÓ‹ıËΠÛÙÔ Portsmouth Ù˘∞ÁÁÏ›·˜ ÙÔ 1756 1 (EÈÎ. 1). °ÈÔ˜ ÂappleÈÊ·ÓÔ‡˜ Ó·˘appleË-ÁÔ‡ ÛÙÔ Deptford, ÌÂÙ¿ ÙËÓ ‚·ÛÈ΋ ÙÔ˘ ÂÎapple·›‰Â˘-ÛË Ì·ı‹Ù¢Û ÎÔÓÙ¿ ÛÙÔÓ ¯ÂÈÚÔ˘ÚÁfi Ù˘ μ·ÛÈÏÈ-΋˜ ∞˘Ï‹˜ Ramsay Karr. ∏ ıËÙ›· ÙÔ˘ ÛÙ· ÓÔÛÔ-ÎÔÌ›· Haslar Î·È ·ÚÁfiÙÂÚ· ÛÙÔ St. Thomas ÙÔ˘§ÔÓ‰›ÓÔ˘, fiappleÔ˘ ‰È·ÎÚ›ıËΠÁÈ· ÙËÓ ÂappleÈ̤ÏÂÈ¿ÙÔ˘,, ÙÔÓ appleÚÔ›ÎÈÛ Ì ÁÓÒÛÂȘ appleÔ˘ ÁÈ· ÙËÓ ÂappleÔ¯‹ÙÔ˘ ıˆÚÔ‡ÓÙ·Ó ÂÍ·ÈÚÂÙÈΤ˜ Î·È ÙÔ˘ ¤‰ˆÛ appleÔχ·ÍÈfiÏÔÁ˜ Âapple·ÁÁÂÏÌ·ÙÈΤ˜ ¢ηÈڛ˜2.ΔÔÓ ÙÂÏÂ˘Ù·›Ô ¯ÚfiÓÔ ÙˆÓ ÛappleÔ˘‰ÒÓ ÙÔ˘, ÏfiÁˆÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÙÔ˘, ı‹Ù¢Û ˆ˜ ‚ÔËıfi˜ ÛÙÔ ÂÚÁ·-ÛÙ‹ÚÈÔ Ù˘ ∞Ó·ÙÔÌ›·˜. ºÂ‡ÁÔÓÙ·˜ ·applefi ÙÔ St. ThomasÛ˘ÓÂÚÁ¿ÛÙËΠÂapple·ÁÁÂÏÌ·ÙÈο Ì ÙÔÓ JonathanWathen, ÌÈ· Û˘ÓÂÚÁ·Û›· appleÔ˘ ÎÚ¿ÙËÛ 14¯ÚfiÓÈ·. O Wathen ‹Ù·Ó ¤Ó·˜ ·Û˘Ó‹ıÈÛÙÔ˜ ¯ÂÈ-ÚÔ˘ÚÁfi˜, appleÔ˘ ·ÊȤڈÓ ÙÔÓ ¯ÚfiÓÔ ÙÔ˘ ΢ڛˆ˜ ÛÂapple·ı‹ÛÂȘ ÙˆÓ ÔÊı·ÏÌÒÓ. O ÂÓıÔ˘ÛÈ·ÛÌfi˜ Ì ÙÔÓÔappleÔ›Ô ÂÚÁ·˙fiÙ·Ó ÛÙÔ apple‰›Ô ·˘Ùfi Ô Wathen ÂÓ¤appleÓ¢ÛÂÙÔÓ Ware Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ÙÔ apple·Ú¿‰ÂÈÁÌ·ÙÔ˘ Û˘ÓÂÙ·›ÚÔ˘ ÙÔ˘ ÎÈ ¤ÙÛÈ Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÙÔ˘ÔÊı·ÏÌÔ‡ ¤ÁÈÓ ÙÔ apple¿ıÔ˜ ÙÔ˘˜.ΔÔ 1791 Ô Ware ÛÙ·Ì¿ÙËÛ ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘Ì ÙÔÓ Wathen Î·È ¿Ú¯ÈÛ ӷ ·ÛΛ π·ÙÚÈ΋ ÛÙÔPortsmouth, ·Ú¯Èο ˆ˜ ÁÂÓÈÎfi˜ ¯ÂÈÚÔ˘ÚÁfi˜ ·ÏÏ¿Û‡ÓÙÔÌ· ÛÙÚ¿ÊËΠÛÙȘ apple·ı‹ÛÂȘ ÙˆÓ ÔÊı·ÏÌÒÓ.∏ ÂÌappleÂÈÚ›· ÙÔ˘ ˆ˜ ÔÊı·ÏÌÔ¯ÂÈÚÔ˘ÚÁÔ‡ ‚·Û›-ÛÙËΠ·appleÔÎÏÂÈÛÙÈο ÛÙËÓ È‰ÈˆÙÈ΋ È·ÙÚÈ΋. ¢ÂÓ˘apple¿Ú¯Ô˘Ó ÛÙÔȯ›· ÁÈ· οappleÔÈ· Û˘ÓÂÚÁ·Û›· ÙÔ˘ ÌÂÓÔÛÔÎÔÌ›·, Ô‡Ù ÁÈ· οappleÔÈÔ˘ ›‰Ô˘˜ ÂÎapple·È‰Â˘ÙÈ-Îfi ¤ÚÁÔ. **∂ÈÎ. 1. O James Ware (1756-1815).* ΔÔ ¿ÚıÚÔ ·˘Ùfi ·Ó‹ÎÂÈ ÛÙËÓ ÂÓfiÙËÙ· “ËÌ·ÓÙÈο Û˘ÁÁÚ¿ÌÌ·Ù· Î·È Û˘ÁÁÚ·Ê›˜ ÛÙËÓ πÛÙÔÚ›· Ù˘ π·ÙÚÈ΋˜ ηÈOÊı·ÏÌÔÏÔÁ›·˜”.** ÙȘ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ· Ô ·ÚÈıÌfi˜ ÙˆÓ ı¤ÛÂˆÓ Û ÓÔÛÔÎÔÌ›· Ì ·ÓÙÈΛÌÂÓÔ ÙËÓ OÊı·ÏÌÔÏÔÁ›· ‹Ù·Ó ·ÌÂÏË-Ù¤Ô˜. ¢ÂÓ ˘apple‹Ú¯Â ·Ó¿ÁÎË ÔÊı·ÏÌÔ¯ÂÈÚÔ˘ÚÁÒÓ ÂappleÂȉ‹ Ù· ÔÊı·ÏÌÔÏÔÁÈο appleÂÚÈÛÙ·ÙÈο ÛÙ· ÁÂÓÈο ÓÔÛÔÎÔÌ›· η-χappleÙÔÓÙ·Ó ·applefi ÙÔÓ ¯ÂÈÚÔ˘ÚÁÈÎfi ÙÔ̤·. ÙÔ §ÔÓ‰›ÓÔ ÙÔ 1805 ˘apple‹Ú¯·Ó ‰‡Ô ÓÔÛÔÎÔÌ›· ÔÊı·ÏÌÈÎÒÓ apple·ı‹ÛˆÓ: ÙÔLondon Infirmary for Diseases of the ∂ye (ÙÔ ÁÓˆÛÙfi Moorfields) (EÈÎ. 3) Î·È ÙÔ Westminster Ophthalmic Hospital.O John Cunningham Saunders (1773-1810), È‰Ú˘Ù‹˜ ÙÔ˘ appleÚÒÙÔ˘ (1805), ·appleÔÁÔËÙ‡ıËΠ‰ÈfiÙÈ ÔÈ appleÔÏÈÙÈΤ˜ ·Ú¯¤˜appleÚfi‚·ÏÏ·Ó ÙÔ ‰Â‡ÙÂÚÔ, appleÚÈÓ Î·Ó ·Ú¯›ÛÂÈ Ó· ˘ÏÔappleÔÈ›ٷÈ, Ì ·appleÔÙ¤ÏÂÛÌ· Ó· ηı˘ÛÙÂÚ‹ÛÂÈ Ë appleÚÔ‚ÔÏ‹ Î·È Ë ÏÂÈ-ÙÔ˘ÚÁ›· ÙÔ˘ appleÚÒÙÔ˘.OÊı·ÏÌÔÏÔÁ›·, 18, 2 : 165 - 172, 2006

166 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)∂ÈÎ. 2. Baron Michael de Wenzel (1755-1810), ‰È¿ÛËÌÔ˜°¿ÏÏÔ˜ ¯ÂÈÚÔ˘ÚÁfi˜, appleÚÔÛˆappleÈÎfi˜ ÔÊı·ÏÌ›·ÙÚÔ˜ ÙÔ˘‚·ÛÈϤˆ˜ °ÂˆÚÁ›Ô˘ ÙÔ˘ πππ, ÁÓˆÛÙfi˜ ÁÈ· ÙȘ ÂappleÂÌ‚¿-ÛÂȘ ηٷÚÚ¿ÎÙË appleÔ˘ ¤Î·Ó ηٿ ÙȘ ÂappleÈÛΤ„ÂȘ ÙÔ˘ÛÙËÓ ∞ÁÁÏ›·.∏ Û˘Ì‚ÔÏ‹ ÙÔ˘ Ware ÛÙËÓ OÊı·ÏÌÔÏÔÁ›·˘apple‹ÚÍ ÂÓÙ˘appleˆÛȷ΋, ȉ›ˆ˜ Â¿Ó ·Ó·ÏÔÁÈÛı› η-Ó›˜ fiÙÈ ˘apple‹ÚÍ ·appleÏfi˜ ȉÈÒÙ˘. ∏ ÌÂÁ¿ÏË Û˘Ì‚ÔÏ‹ÙÔ˘ ÛÙËÓ ÔÊı·ÏÌÔÏÔÁÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· appleÚÔ¸appleÔı¤-ÙÂÈ fiÙÈ ÛÙÔ È·ÙÚÂ›Ô ÙÔ˘ ·ÓÙÈÌÂÙÒappleÈ˙ ηıËÌÂÚÈÓ¿appleÔÏÏ¿ Î·È appleÔÈΛϷ appleÂÚÈÛÙ·ÙÈο, ‰È·ÊÔÚÂÙÈο ‰ÂÓı· ›¯Â ˘ÏÈÎfi ÁÈ· ÙȘ apple·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘. O Ware‹Ù·Ó ›Ûˆ˜ ·applefi ÙÔ˘˜ appleÈÔ ‰È·‚·Ṳ̂ÓÔ˘˜ ÂappleÈÛÙ‹ÌÔ-Ó˜ Ù˘ ÂappleÔ¯‹˜ ÙÔ˘. ΔÔ Û˘Ìapple¤Ú·ÛÌ· ·˘Ùfi Û˘Ó¿ÁÂ-Ù·È ·applefi ÙÔ ÁÂÁÔÓfi˜ ÙˆÓ apple·Ú·appleÔÌappleÒÓ ÙÔ˘ Û appleÔÏ-Ï¿ ÎÏ·ÛÛÈο ¤ÚÁ· Í¤ÓˆÓ Û˘ÁÁڷʤˆÓ Î·È ·applefi ÙËÓapple·Ú·‰Ô¯‹ ÙÔ˘ ÁÈ· ÙÔÓ ¯ÚfiÓÔ appleÔ˘ ·ÊȤڈÛ ÛÙËÌÂϤÙË ¤ÚÁˆÓ ¿ÏÏˆÓ Û˘Ó·‰¤ÏÊˆÓ ÙÔ˘.ΔÔ 1791 ÌÂÙ¤ÊÚ·Û ÙÔ ¤ÚÁÔ ÙÔ˘ ‚·ÚÒÓÔ˘ Jacobde Wenzel (1755-1810) “Traite de la cataracte”3 . ∏ appleÚ·ÁÌ·Ù›· ·˘Ù‹ ÁÚ¿ÊÙËΠ·applefi ÙÔÓ ˘ÈfiÙÔ˘ ÊËÌÈṲ̂ÓÔ˘ ‚·ÚÒÓÔ˘ Michael de Wenzel(EÈÎ. 2) appleÔ˘ appleÂÚȤÁÚ·„ ÙȘ ÌÂıfi‰Ô˘˜ ÙÔ˘ apple·Ù¤Ú·ÙÔ˘ ÛÙËÓ Âapple¤Ì‚·ÛË ÙÔ˘ ηٷÚÚ¿ÎÙË Î·È ÛÙËÓ ‰Ë-ÌÈÔ˘ÚÁ›· Ù¯ÓËÙ‹˜ ÎfiÚ˘. ΔÔ ¤ÚÁÔ appleÂÚÈÏ·Ì‚¿ÓÂÈ·ÚÎÂÙ¿ appleÂÚÈÛÙ·ÙÈο ·applefi ÙËÓ ÂÌappleÂÈÚ›· ÙÔ˘ M. deWenzel. O Benjamin Travers * (1783-1858) Ì·ıË-Ù‹˜ ÙÔ˘ sir Astley Cooper, ¯ÂÈÚÔ˘ÚÁfi˜ ÛÙÔ St. Thomas’sHospital Î·È ‰È¿‰Ô¯Ô˜ ÙÔ˘ Saunders, Âapple·›ÓÂ-Û ÛÙËÓ ‰Â‡ÙÂÚË ¤Î‰ÔÛË ÙÔ˘ ‚È‚Ï›Ô˘4 ÙÔ˘ ÙÔÓ WareÁÈ· ÙÔ ÌÂÙ·ÊÚ·ÛÙÈÎfi ÙÔ˘ ¤ÚÁÔ (΢ڛˆ˜ ÁÈ· ÙÔ ¤Ú-ÁÔ ÙÔ˘ de Wenzel).∏ ÌÂÁ·Ï‡ÙÂÚË ÙÈÌ‹ appleÔ˘ ·appleÔ‰fiıËΠÛÙÔÓ Wa-∂ÈÎ. 3. London Ophthalmic Infirmary & c. Finsbury, ÁÎÚ·‚Ô‡Ú· ÙÔ˘ Robert Acon, 1829. ΔÔ ÁÓˆÛÙfi Moorfields EyeHospital, fiappleˆ˜ ‹Ù·Ó ÛÙȘ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·È. Ï›ÁÔ ÌÂÙ¿ ÙËÓ ›‰Ú˘Û‹ ÙÔ˘ ·applefi ÙÔÓ J. C. Saunders (1773-1810). (∞applefi ÙËÛ˘ÏÏÔÁ‹ ÙÔ˘ Û˘ÁÁڷʤ·).* O Benjamin Travers (1783-1858) ‰È·‰¤¯ıËΠÙÔÓ J.C. Saunders ÛÙÔ London Infirmary for Diseases of the Eye (Moorfields),Î·È ‹Ù·Ó Ô appleÚÒÙÔ˜ ÓÔÛÔÎÔÌÂÈ·Îfi˜ ¯ÂÈÚÔ˘ÚÁfi˜ ÛÙËÓ ∞ÁÁÏ›· appleÔ˘ ·Û¯ÔÏ‹ıËΠ·appleÔÎÏÂÈÛÙÈο Ì ÙËÓ ÌÂϤÙËÁÈ· ÙȘ apple·ı‹ÛÂȘ ÙÔ˘ ÔÊı·ÏÌÔ‡.

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 167re ‹Ù·Ó Ë ÂÎÏÔÁ‹ ÙÔ˘ ˆ˜ ̤ÏÔ˘˜ Ù˘ μ·ÛÈÏÈ΋˜ ∂-Ù·ÈÚ›·˜ ÙÔ 1801. ∏ ÂÎÏÔÁ‹ ÙÔ˘ ¤ÁÈÓ ÏfiÁˆ Ù˘ Ê‹-Ì˘ ÙÔ˘ ˆ˜ ÔÊı·ÏÌÈ¿ÙÚÔ˘ Î·È ‹Ù·Ó Ë appleÚÒÙË ÛÙÔÓÙÔ̤· ·˘Ùfi ·applefi ÙËÓ Royal Society Î·È ·˘Ù‹ Ë ÂÎÏÔ-Á‹ ·apple¤‰ÂÈÍ ÙÔÓ Û‚·ÛÌfi ÙˆÓ ÂÎÏÂÎÙfiÚˆÓ ÛÙËÓ ÂÈ-‰ÈÎfiÙËÙ· Ù˘ OÊı·ÏÌÔÏÔÁ›·˜, apple·Ú¿ ÙȘ ·ÓÙÈÚÚ‹-ÛÂȘ ·˘ÙÒÓ appleÔ˘ ‹Ù·Ó ·ÓÙ›ıÂÙÔÈ ÛÙËÓ π·ÙÚÈ΋ ÂÍÂÈ-‰›Î¢ÛË 5 .O James Ware ˘apple‹ÚÍÂ È‰Ú˘Ù‹˜ Û¯ÔÏ›Ԣ ÊÙˆ-¯ÒÓ Î·È Ù˘ÊÏÒÓ apple·È‰ÈÒÓ Î·È ÛËÌ·›ÓÔÓ ÛÙ¤ÏÂ¯Ô˜Û˘ÏÏfiÁÔ˘ ÛÙ‹ÚÈ͢ ¯ËÚÒÓ Î·È ÔÚÊ·ÓÒÓ ·applefi È·ÙÚÈ-Τ˜ ÔÈÎÔÁ¤ÓÂȘ.¤ı·Ó ÙÔ 1815 ÛÙÔ Turnham Green Î·È ÂÙ¿-ÊË ÛÙÔ Bunhill Fields Û ÔÈÎÔÁÂÓÂÈ·Îfi Ù¿ÊÔ 2 .∏ Û˘Ì‚ÔÏ‹ ÙÔ˘ James Ware ÛÙËÓ OÊı·ÏÌÔ-ÏÔÁ›·1 Û˘Ó›ÛÙ·Ù·È Û ‰‡Ô apple‰›·:1) ÛÙËÓ ÙÂÏÂÈÔappleÔ›ËÛË Î·È ÛÙËÓ appleÚfiÔ‰Ô ÙˆÓ ÙÂ-¯ÓÈÎÒÓ ÛÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛ˘ ÙÔ˘ ηٷÚÚ¿-ÎÙË Î·È2) ÛÙËÓ apple·Ú·Ù‹ÚËÛË ÙˆÓ ÂappleÈappleÙÒÛÂˆÓ Î·È ÙˆÓÂappleÈappleÏÔÎÒÓ ÙˆÓ ÂappleÂÌ‚¿ÛÂˆÓ ·˘ÙÒÓ.ÕÏψÛÙÂ, fiappleˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ô Ware ÌÂϤÙË-ÛÂ Î·È ÌÂÙ¤ÊÚ·Û ÙÔ ¤ÚÁÔ ÙÔ˘ Baron Michael deWenzel “Treatise on Cataract”, ÂÓfi˜ ·applefi ÙÔ˘˜ appleϤ-ÔÓ ÂappleÈÊ·Ó›˜ Î·È ÊËÌÈṲ̂ÓÔ˘˜ ¯ÂÈÚÔ˘ÚÁÔ‡˜ ÙÔ˘18Ô˘ ·ÈÒÓ·. O Wenzel, appleÔ˘ ‹Ù·Ó °¿ÏÏÔ˜, ÂappleÈÛÎÂappleÙfiÙ·ÓappleÂÚÈÔ‰Èο ÙÔ §ÔÓ‰›ÓÔ Î·È ¯ÂÈÚÔ˘ÚÁÔ‡ÛÂηٷÚÚ¿ÎÙ˜, appleÚÔÛÂÏ·ÔÓÙ·˜ ÙËÓ appleÚÔÛÔ¯‹ ÙÔ˘Ware Î·È ¿ÏÏˆÓ ÕÁÁÏˆÓ ¯ÂÈÚÔ˘ÚÁÒÓ. ΔÔ 1795 ÔWare Âͤ‰ˆÛ ÙËÓ ÂÚÁ·Û›· ÙÔ˘: “An enquire into thecauses which have most commonly prevented successin the operation of the extracting the cataract” 6 .ÙËÓ ÂÚÁ·Û›· ÙÔ˘ (EÈÎ. 4, 5) ·˘Ù‹ Ô Ware appleÂ-ÚȤÁÚ·„ ¤ÍÈ appleÂÚÈÛÙ·ÙÈο ·Ê·›ÚÂÛ˘ ηٷÚÚ¿-ÎÙË, ηٷÁÚ¿ÊÔÓÙ·˜ Ì ÏÂappleÙÔ̤ÚÂȘ ÙËÓ ¯ÂÈÚÔ˘Ú-ÁÈ΋ Ù¯ÓÈ΋ ·ÏÏ¿ Î·È ÙËÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ appleÔÚ›·ÙˆÓ ·ÛıÂÓÒÓ 2,6,7 . ∏ Û¯ÔÏ·ÛÙÈ΋, ‚‹Ì·-‚‹Ì· Ù¯ÓÈ-΋, ‹Ù·Ó Î·È Î˘Ú›·Ú¯Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÌÂıÔ-‰ÔÏÔÁ›·˜ ÙÔ˘. ∂›¯Â ¤Ó·Ó ηٿÏÔÁÔ 24 mementos,fiappleˆ˜ Ù· ·appleÔηÏÔ‡ÛÂ, appleÔ˘ Û οı Âapple¤Ì‚·ÛË ·ÎÔ-ÏÔ˘ıÔ‡Û ÌÂ Â˘Ï¿‚ÂÈ·, apple·Ú¿ ÙÔ fiÙÈ Ì ÙËÓ ÂÌappleÂÈ-Ú›· ÙÔ˘ ›Ûˆ˜ ‰ÂÓ ¯ÚÂÈ·˙fiÙ·Ó Ó· ÙÔÓ Û˘Ì‚Ô˘Ï¢Ù›.ÙÔÓ Î·Ù¿ÏÔÁÔ ·˘Ùfi appleÂÚÈÂÏ¿Ì‚·ÓÂ Î·È ÙȘ appleÈÔ appleÈı·Ó¤˜ÂappleÈappleÏÔΤ˜ ·ÏÏ¿ Î·È ÙËÓ ·ÓÙÈÌÂÙÒappleÈÛ‹ ÙÔ˘˜Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Âapple¤Ì‚·Û˘.∏ Û˘Ó‹ıÂÈ· ·˘Ù‹ Ê·ÓÙ¿˙ÂÈ ˘appleÂÚ‚ÔÏÈ΋ ‹ ηÈ∂ÈÎ. 4, 5. ΔÔ ‚È‚Ï›Ô ÙÔ˘ James Ware “An Enquiry into the causes which have prevented success in the Operation ofExtracting the Cataract…” ηıÒ˜ Î·È ·appleÂÈÎÔÓ›ÛÂȘ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ÂÚÁ·Ï›ˆÓ Î·È Ù¯ÓÈ΋˜ ÂappleÂÌ‚¿ÛÂˆÓ Î·Ù·ÚÚ¿-ÎÙÔ˘. (∞applefi ÙË Û˘ÏÏÔÁ‹ ÙÔ˘ Û˘ÁÁڷʤ·).

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OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 171∂ÈÎ. 9, 10. ΔÔ ‚È‚Ï›Ô ÙÔ˘ James Ware Ì ٷ ¤ÚÁ· ÙÔ˘ ‘Remarks on the Fistula Lachrymalis..., Observations on Haemorrhoidsand Additional Remarks on the Ophthalmy. ∏ ÛÂÏ›‰· ÙˆÓ Ù›ÙÏˆÓ Î·È apple›Ó·Î·˜ Ì ¯ÂÈÚÔ˘ÚÁÈο ÂÚÁ·Ï›· ÁÈ·ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋ ·appleÔηٿÛÙ·ÛË ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ Ô‰ÒÓ. ¢˘ÛÙ˘¯Ò˜ ·applefi ÙÔ ‚È‚Ï›Ô ¤¯ÂÈ ·Ê·ÈÚÂı› Ô apple›Ó·Î·˜ Ì ÙËÓ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋ (∞applefi ÙË Û˘ÏÏÔÁ‹ ÙÔ˘ Û˘ÁÁڷʤ·).·applefiÊڷ͢ ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ Ô‰ÒÓ appleÚÔÙ›ÓÂÈ Âapple¤Ì-‚·ÛË ÛÙÔ 8Ô ‹ 9Ô ¤ÙÔ˜ Ù˘ ˙ˆ‹˜. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓÙ¯ÓÈ΋ Ù˘ Âapple¤Ì‚·Û˘, ÂÊ’ fiÛÔÓ ‰ÂÓ ¤¯ÂÈ ·appleÔÛÙË-Ì·ÙÔappleÔÈËı› Ô ‰·ÎÚ˘˚Îfi˜ ·ÛÎfi˜, appleÚÔÙ›ÓÂÈ ÙËÓ apple·-ڷΤÓÙËÛ‹ ÙÔ˘ ÔÚÈ˙fiÓÙÈ· appleÚÔ˜ ÙËÓ appleÏÂ˘Ú¿ Ù˘ ̇-Ù˘ Ì ÌÂÙ·ÏÏÈ΋ Ì·ÎÚÈ¿ ‚ÂÏfiÓ·. ªÂÙ¿ ·applefi ÙËÓ ÌÈ-ÎÚ‹ ÙÔÌ‹ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ ÂÈÛ¿ÁÂÙ·È ÌÂÙ·ÏÏÈÎfi˜·ÛË̤ÓÈÔ˜ ηıÂÙ‹Ú·˜ Ì ·Ì‚χ ¿ÎÚÔ Î·È appleÚÔˆı›ٷÈappleÚÔÛÂÎÙÈο ÛÙÔÓ ‰·ÎÚ˘˚Îfi applefiÚÔ Ì ÈηӋ‰‡Ó·ÌË fiÛË ·ÚΛ ÁÈ· ÙËÓ ˘appleÂÚapple‹‰ËÛË Ù˘ ·applefi-Êڷ͢ ̤¯ÚÈ Ó· ‰È·appleÈÛÙˆı› Ë ‰È¿ÓÔÈÍË Ù˘ ‰·-ÎÚ˘˚΋˜ Ô‰Ô‡. ªÂÙ¿ ÙÔappleÔıÂÙÂ›Ù·È ÌfiÓÈÌÔ˜ ·ÛË̤-ÓÈÔ˜ ηıÂÙ‹Ú·˜ ÏÂappleÙfiÙÂÚÔ˜ Ù˘ ̇Ï˘ appleÔ˘ ›¯Â ÂÈ-Û·¯ı› ·Ú¯Èο. ºÚÔÓÙ›‰· Ï·Ì‚¿ÓÂÙ·È ÁÈ· ÙËÓ ·appleÔ-Ê˘Á‹ ÊÏÂÁÌÔÓ‹˜ Î·È ÌfiÏ˘ÓÛ˘ Ì ÙËÓ ¯Ú‹ÛË ·ÛıÂ-ÓÔ‡˜ ÌÔÏ˘‚‰Ô‡¯Ô˘ Á·Ï·ÎÙÒÌ·ÙÔ˜ Î·È appleχÛˆ˜ÙÔ˘ applefiÚÔ˘ Ì ˙ÂÛÙfi ÓÂÚfi. O ηıÂÙ‹Ú·˜ ηı·Ú›˙Â-Ù·È Î·È ·ÓÙÈηı›ÛÙ·Ù·È ·Ú¯Èο οı ̤ڷ, ÌÂٿοı ‰‡Ô ‹ ÙÚÂȘ ̤Ú˜. ªÂÙ¿ ·ÚÎÂÙ¤˜ Ë̤Ú˜ ÙÔÂÚÁ·ÏÂ›Ô ·appleÔÌ·ÎÚ‡ÓÂÙ·È Î·È Ë ÂappleÈÊÔÚ¿ ˘appleÔ¯ˆ-Ú›, ÂÓÒ Û ‰‡Ô appleÂÚÈappleÙÒÛÂȘ ›¯Â ‰·ÎÚ˘Ô΢ÛÙ›Ùȉ·Ì apple˘Ò‰Ë Û˘ÏÏÔÁ‹ Î·È ÌÂÙ¿ ÙËÓ apple·ÚÔ¯¤Ù¢ÛË ËÂappleԇψÛË Î·È Ë ‰È¿ÓÔÈÍË Ù˘ ‰·ÎÚ˘˚΋˜ Ô‰Ô‡ η-ı˘ÛÙ¤ÚËÛ ·ÚÎÂÙ¿. ÙȘ appleÂÚÈappleÙÒÛÂȘ appleÔ˘ ÙÔ ÚÈÓÈ-Îfi ÛÙfiÌÈÔ ÙÔ˘ applefiÚÔ˘ ‹Ù·Ó ÎÏÂÈÛÙfi ÙfiÙÂ Ô WareÙÚ˘appleÔ‡Û ÙÔ ‰È¿ÊÚ·ÁÌ· Ì ӢÛÙ¤ÚÈ ÛÙÔ ÏÂappleÙfiÙÂÚÔÛËÌÂ›Ô ÙÔ˘ ‰·ÎÚ˘˚ÎÔ‡ ÔÛÙÔ‡, ·appleÔηıÈÛÙÒÓÙ·˜¤ÙÛÈ ÙËÓ ÂappleÈÎÔÈÓˆÓ›· ÙˆÓ ‰·ÎÚ˘˚ÎÒÓ Ô‰ÒÓ. Àapple‹Ú-Í ‚‚·›ˆ˜ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ȉÈÔapple·ı‹˜ apple¿¯˘ÓÛË ÙÔ˘‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ÔÛÙÔ‡ appleÔ˘ ‰˘ÛÎfiÏ„ ÙÔÓ WareÛÙË ‰ËÌÈÔ˘ÚÁ›· Ù˘ ÙÔÌ‹˜.O Ware ‹Ù·Ó Ô appleÚÒÙÔ˜ ÕÁÁÏÔ˜ ÔÊı·ÏÌ›·ÙÚÔ˜appleÔ˘ ÂÊ¿ÚÌÔÛ ÙËÓ Ù¯ÓÈ΋ Ù˘ apple·Ú·Î¤ÓÙËÛ˘. ∏̤ıÔ‰fi˜ ÙÔ˘ ÙÂÏÂÈÔappleÔÈ‹ıËΠ·ÚÁfiÙÂÚ· ·applefi ÙÔÓJames Wardrop appleÔ˘ ÙËÓ appleÂÚȤÁÚ·„ ÙÔ 1808 ÛÙÔ“Observations on the effect of evacuating the aqueoushumour in inflammations of the eye...”.O Ware Âapple›Û˘ Û˘Ó¤‚·Ï ÛÙË ÁÓÒÛË Ì·˜ ÁÈ·ÙË Ì˘ˆapple›· Ì ÙËÓ ‰Â‡ÙÂÚË ·Ó·ÎÔ›ÓˆÛ‹ ÙÔ˘ ÛÙËӤΉÔÛË “Proceedings of the Royal Society” Ì ٛÙÏÔ:“Observations relative to the near and distant sight ofthe different persons”. O ›‰ÈÔ˜ Ô Ware ›¯Â ˘„ËÏ‹Ì˘ˆapple›· Î·È appleÂÚȤÁÚ·„ ÌÂÚÈΤ˜ ·applefi ÙȘ ÂÌappleÂÈڛ˜ÙÔ˘ ·applefi ÙË ¯Ú‹ÛË ÙˆÓ Á˘·ÏÈÒÓ ÁÈ· ÙËÓ ‰ÈfiÚıˆÛË

172 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)ÙÔ˘ ‰È·ıÏ·ÛÙÈÎÔ‡ ÙÔ˘ appleÚÔ‚Ï‹Ì·ÙÔ˜. ∫·Ù¤ÁÚ·„ÂÎ·È Î¿appleÔÈ· ÛÙ·ÙÈÛÙÈο ÛÙÔȯ›·11 ÁÈ· ÙËÓ Ì˘ˆapple›·Î·È ÙËÓ ‡apple·ÚÍ‹ Ù˘ Û ‰Â›ÁÌ· appleÏËı˘ÛÌÔ‡, ·Ó·Ê¤-ÚÔÓÙ·˜ fiÙÈ ÛÙ· ÛÙÚ·Ù‡̷ٷ ÙÔ˘ Footguards ÛÂÛ˘ÓÔÏÈÎfi ·ÚÈıÌfi 10.000 ÛÙÚ·ÙȈÙÒÓ ·appleÔÚÚ›ÊıË-Î·Ó appleÂÚ›appleÔ˘ 12 ¿ÙÔÌ· ÁÈ· ˘„ËÏ‹ Ì˘ˆapple›· ·Â ‰È¿-ÛÙËÌ· ›ÎÔÛÈ ÂÙÒÓ. ∂appleÂÛ‹Ì·Ó fï˜ fiÙÈ Ë Ì˘ˆapple›·‹Ù·Ó ÎÔÈÓfi ‡ÚËÌ· ÌÂٷ͇ ÛappleÔ˘‰·ÛÙÒÓ Û apple·ÓÂappleÈÛÙ‹ÌÈ·. ¤Ó· ·applefi Ù· ÎÔÏϤÁÈ· Ù˘ OÍÊfiډ˘η٤ÁÚ·„ 32 ¿ÙÔÌ· ÌÂ Ì˘ˆapple›· appleÔ˘ ¯ÚÂÈ¿˙ÔÓÙ·ÓÁ˘·ÏÈ¿ Û ۇÓÔÏÔ 127 ÛappleÔ˘‰·ÛÙÒÓ. ¢ÂÓ ¤Î·ÓÂfï˜ οappleÔÈ· Û˘˙‹ÙËÛË ÁÈ· ÙËÓ ÂÚÌËÓ›· ÙˆÓ ·appleÔ-ÙÂÏÂÛÌ¿ÙˆÓ Û¯ÂÙÈο Ì ÙËÓ appleÔÈÎÈÏÔÌÔÚÊ›· ÙˆÓ Â˘-ÚËÌ¿ÙˆÓ ÙÔ˘.O James Ware ˘apple‹ÚÍ ¤Ó·˜ Âͤ¯ˆÓ ÕÁÁÏÔ˜¯ÂÈÚÔ˘ÚÁfi˜ ÙÔ˘ ÔappleÔ›Ô˘ Ë Û˘Ì‚ÔÏ‹ ÛÙËÓ OÊı·ÏÌÔ-ÏÔÁ›· ˘apple‹ÚÍ ηıÔÚÈÛÙÈ΋. To appleÏÔ‡ÛÈÔ ÎÏÈÓÈÎfiÎ·È Û˘ÁÁÚ·ÊÈÎfi ÙÔ˘ ¤ÚÁÔ Û˘ÓÂÙ¤ÏÂÛ ÛÙËÓ Î·ıȤ-ÚˆÛË Ù˘ OÊı·ÏÌÔÏÔÁ›·˜ ˆ˜ ͯˆÚÈÛÙ‹˜ ¯ÂÈÚÔ˘Ú-ÁÈ΋˜ ÂȉÈÎfiÙËÙ·˜, apple·Ú¿ ÙËÓ appleÚÔηٿÏË„Ë appleÔ˘˘apple‹Ú¯Â ÂΛÓË ÙËÓ ÂappleÔ¯‹ ÂÓ·ÓÙ›ÔÓ ÙˆÓ ÏÂÁfiÌÂÓˆÓ“ÔÊı·ÏÌÔÏfiÁˆÓ” * (oculists).Δ· ¤ÚÁ· ÙÔ˘ Ware Â›Ó·È 14 :1. Remarks on the Ophthalmy. Psorophthalmy andPurulent Eye, with Methods of Care. London1780.2. Chirurg. Observations Relative to the Epiphora onWatery Eye, The Scrofulous and IntermittentOphthalmy, etc. London1782; 1804.3. A Treatise on the Cataract, with Cases, London1793.4. Enquiry Into the Causes which Have PreventedSuccess in the Operation of Extracting the Cataract.London 1795; 1804.5. Remarks on the Fistula Lachrymalis London,1798.6. Chirug. Observas. Relative to the Eye. 2 vols.London, 1798; 2nd ed. 1805; 3 rd ed. 18187. Remarks on the Purulent Ophthalmia which HasLately Been Epidemical in this Country. London,1808, 8 vol. 57 ÛÂÏ›‰Â˜.Classics of Ophthalmology Library, Gryphon Editions,Inc Birmingham Alabama 35253, 1988.2. Dunn P. “British Masters of Ophthalmology Series” BritJ Ophthalmol 1: 401, 1917.3. de Wenzel J. A Treatise on the Cataract. Translated fromthe French With Many Additional Remarks by JamesWare. Surgeon, London: C Dilly, 1791.4. Travers B. A Synopsis of the Diseases of the Eye and TheirTreatment. 2nd ed. London, Longmans 1821, 329, 1821.5. Shastid TH. “James Ware” In The American Encyclopediaand Dictionary of Ophthalmology. Vol. 18, Editedby C. A, Wood, Chicago: Cleveland Press 13984-5,1921.6. Ware J. An Enquiry Into the Causes which have most Commonlyprevented Success in the Operation of Extractingthe Cataract. London, C. Dilly in the Poultry 1795.7. Hirschberg J. The History of Ophthalmology. Vol. 3 “TheRenaissance of Ophthalmology in the EighteenthCentury. Part One” Translated by F.C. Blodi. Bonn,Wayenborgh, 1984.8. James RR. Studies on the History of Ophthalmology inEngland Prior to the Year 1800. Cambridge: CambridgeUniversity Press, 1933.9. The Chirurgical Works of Percival Pott, FRS and Surgeonto St. Bartholomew’s Hospital, in Two volumes.James Williams, Dublin 1778.10. Helmholtz HIF. Handbuch der Physiologischen OptikLeipzig: Leopold Voss 1967.11. Hirschberg. The History of Ophthalmology. Vol. 8 (A).“The First Half of the Nineteenth Century. Part Four,Great Britain (A)” Translated by FACT. Blodi, Bonn,Wayenborgh, 1987.12. Albert DM, Edwards DD. The History of Ophthalmology,Blackwell Science Inc, USA 108-109, 149, 1996.13. Ware J. Remarks on the Fistula Lachrymalis, London,Charles Dilly, in the Poultry 1798.14. Becker B. Catalog of the Bernard Becker, M.D., Collectionin Ophthalmology. 2nd Ed. Compiled by C. Hoolihanand M.F. Weimar. St Louis Washington UniversitySchool of Medicine Library, 1983.μÈ‚ÏÈÔÁÚ·Ê›·1. Albert DM, Cogan D. Professor of Ophthalmology, HarvardMedical School, Notes from the Editors. The* Oculists: ∂ÌappleÂÈÚÈÎÔ› “OÊı·ÏÌÔÏfiÁÔÈ” appleÔ˘ ›Ûˆ˜ Ó· ‹Ù·Ó ÎÔ˘Ú›˜, Ù¯ӛÙ˜ ‹ ÛȉËÚÔ˘ÚÁÔ› appleÔ˘ ÂÌÊ·Ó›ÛÙËÎ·Ó Á‡ÚˆÛÙÔÓ 10-11Ô ·ÈÒÓ· Î·È appleÂÚÈfi‰Â˘·Ó ÛÙȘ ¯ÒÚ˜ Ù˘ ∂˘ÚÒapple˘ οÓÔÓÙ·˜ ÂappleÂÌ‚¿ÛÂȘ ÔÊı·ÏÌÔÏÔÁÈΤ˜ Î.¿, ¯ˆÚ›˜ η-Ì›· È·ÙÚÈ΋ ÂÎapple·›‰Â˘ÛË.

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116 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)OÈ ÂÊ·ÚÌÔÁ¤˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·˘ÙÔ‡ ı· ÂappleÂ-ÎÙ·ıÔ‡Ó ÛÙÔ Ì¤ÏÏÔÓ Î·È Û ¿ÏϘ appleÚ·ÎÙÈΤ˜ ‰È·‰È-ηۛ˜. ∂ȉÈÎfiÙÂÚ·, ı· ÌappleÔÚԇ̠̠ÌÈ· Ì·ÙÈ¿ Ó·ÍÂÎÏÂȉÒÓÔ˘Ì ÙËÓ applefiÚÙ· ÙÔ˘ ÛappleÈÙÈÔ‡ Ì·˜, Ó··ÓÔ›ÁÔ˘Ì ٷ ·applefiÚÚËÙ· ÙÔ˘ ˘appleÔÏÔÁÈÛÙ‹ Ì·˜, ӷοÓÔ˘Ì ·ÁÔÚ¤˜ ¯ˆÚ›˜ appleÈÛÙˆÙÈΤ˜ οÚÙ˜ ·applefi ÙÔÓ˘appleÔÏÔÁÈÛÙ‹ Ì·˜ ̤ۈ Internet. OÈ Û˘Ó·ÏÏ·Á¤˜ ·˘-Ù¤˜ ı· ‰ÈÂÍ¿ÁÔÓÙ·È Ì ·applefiÏ˘ÙË ·ÛÊ¿ÏÂÈ·, ̤ۈ·Ó·ÁÓÒÚÈÛ˘ Ù˘ ›Úȉ·˜.¿ÓÙˆ˜, Â›Ó·È ‚¿ÛÈÌÔ˜ Ô appleÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ·Ó·˘Ùfi ÙÔ ËÏÂÎÙÚÔÓÈÎfi ʷΤψ̷ ̤ۈ Û˘Û΢ÒÓ·Ó·appleÙ˘Á̤Ó˘ „ËÊȷ΋˜ Ù¯ÓÔÏÔÁ›·˜, ı· ·appleÔ‰ÂÈ-¯ı› appleÚÔ˜ fiÊÂÏÔ˜ ÙˆÓ appleÔÏÈÙÒÓ, ‹ Ô «ÌÂÁ¿ÏÔ˜ ·-‰ÂÚÊfi˜» ı· Â›Ó·È apple·ÓÙ·¯Ô‡ apple·ÚÒÓ, ·appleÔÙ˘appleÒÓÔ-ÓÙ·˜ fiÏ· ۯ‰fiÓ Ù· appleÚÔÛˆappleÈο Ì·˜ ‰Â‰Ô̤ӷ.

MÂÙÂÎapple·È‰Â˘ÙÈο ı¤Ì·Ù·∂appleÈ̤ÏÂÈ·: ¡. ¢ËÌËÙÚ·ÎÔ‡ÏÈ·˜e-mail: Ôkebe@otonet.grLaser pointers, ÊÔÚËÙ¿ ËÏÂÎÙÚÔÓÈο apple·È¯Ó›‰È·:fiÛÔ ·ÛÊ·Ï‹ Â›Ó·È ÁÈ· ÙËÓ fiÚ·ÛË ÙˆÓ apple·È‰ÈÒÓ;A. ∫·Î·‚Ô‡ÙË-¢Ô‡‰Ô˘, ¢. Δ˙¤Ù˙Ë, ∞. OÈÎÔÓfiÌÔ˘, ø. §ÂÏÈÔappleÔ‡ÏÔ˘Laser pointersΔ· laser pointers (∂ÈÎ. 1,2) ¯ÚËÛÈÌÔappleÔÈÔ‡ÓÙ·È΢ڛˆ˜ ÛÙȘ ‰È¿ÊÔÚ˜ apple·ÚÔ˘ÛÈ¿ÛÂȘ Û ·›ıÔ˘Û˜,·ÏÏ¿ ·appleÔÙÂÏÔ‡Ó Âapple›Û˘ ‰ËÌÔÊÈÏ‹ apple·È¯Ó›‰È· ÛÙ·¯¤ÚÈ· ÙˆÓ apple·È‰ÈÒÓ 1,2 . K˘ÎÏÔÊÔÚÔ‡Ó Û ‰‡Ô ÌÔÚ-ʤ˜, ·Ó¿ÏÔÁ· Ì ٷ ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÂÎappleÂÌapplefi-ÌÂÓ˘ ‰¤ÛÌ˘: ÙÔ ÎfiÎÎÈÓÔ diode laser pointer Î·È ÙÔappleÚ¿ÛÈÓÔ laser pointer. Δ· ÎfiÎÎÈÓ· laser pointers¤¯Ô˘Ó Ì‹ÎÔ˜ ·̷ÙÔ˜ 670 nm, ÂÓÒ Ù· appleÚ¿ÛÈÓ·laser pointers ¤¯Ô˘Ó Ì‹ÎÔ˜ ·̷ÙÔ˜ 532 nm 3 . AÓ¿-ÏÔÁ· Ì ÙËÓ ÈÛ¯‡ ÙÔ˘˜, ˘apple¿Ú¯Ô˘Ó ÔÈ ·ÎfiÏÔ˘ı˜ η-ÙËÁÔڛ˜ laser pointers:Class II, Ì ̤ÁÈÛÙË ÈÛ¯‡ 1mW 4 ηÈClass IIIa, Ì ̤ÁÈÛÙË ÈÛ¯‡ 5mW 5-7∂ÌappleÔÚÈο ‰È·ı¤ÛÈÌÔ Â›Ó·È Î·È ÙÔ, ˘„ËÏ‹˜ÂÓ¤ÚÁÂÈ·˜, Class πV laser pointer, ÙÔ ÔappleÔ›Ô ¯ÚËÛÈ-ÌÔappleÔÈÂ›Ù·È ÛÙÔ ÛÙÚ·Ùfi, ÛÙ· ÂÚÁ·ÛÙ‹ÚÈ· ‹ Û ȷ-ÙÚÈΤ˜ ÂÊ·ÚÌÔÁ¤˜6.ÂÈÚ¿Ì·Ù· Û ˙Ò· ¤¯Ô˘Ó ‰Â›ÍÂÈ ÙËÓ appleÈı·Ófi-ÙËÙ· ʈÙÔappleËÎÙÈ΋˜ ‰Ú¿Û˘ ÙˆÓ laser pointersÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹, ‡ÛÙÂÚ· ·applefi Û˘Ó¯‹ ¤ÎıÂ-ÛË ‰È¿ÚÎÂÈ·˜ 10 sec 2,4,5,8 . ŒÙÛÈ, Ë ÌË ·ÛÊ·Ï‹˜¯Ú‹ÛË ÙˆÓ ÎfiÎÎÈÓˆÓ laser pointers ÌappleÔÚ› Ó· Ô‰Ë-Á‹ÛÂÈ ÙfiÛÔ Û ˘appleÔÎÂÈÌÂÓÈο, fiÛÔ Û ÔÊı·ÏÌÔÛÎÔappleÈÎ¿Î·È ÊÏÔ˘ÔÚÔ·ÁÁÂÈÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÛÙÔÓ¿ÓıÚˆappleÔ 8,9 . ª¿ÏÈÛÙ·, ÔÈ ‚Ï¿‚˜ ·˘Ù¤˜ Â›Ó·È ÂÓÙÔ-ÓfiÙÂÚ˜ ÛÙ· Ó·ڿ ¿ÙÔÌ·8,9 .∞Ó·Ï˘ÙÈÎfiÙÂÚ·, Ë apple·Ú·ÙÂٷ̤ÓË, Û˘Ó¯‹˜ ¤ÎıÂÛËÛÙËÓ ÂÎappleÂÌapplefiÌÂÓË ‰¤ÛÌË Û˘Óԉ‡ÂÙ·È ·applefi:• OÊı·ÏÌÈ΋ ‰˘ÛÊÔÚ›·, Ì ‹ ¯ˆÚ›˜ ·›ÛıËÛËͤÓÔ˘ ÛÒÌ·ÙÔ˜1• ŒÎappleÙˆÛË Ù˘ ÔappleÙÈ΋˜ Ô͇ÙËÙ·˜1,5• ∫fiÎÎÈÓÔ ÎÂÓÙÚÈÎfi 5-7 ‹ apple·Ú¿ÎÂÓÙÚÔ 4 ÛÎfiو̷• ÔÓÔΤʷÏÔ 1• ∂appleÒ‰˘ÓË ÊˆÙÂÈÓfiÙËÙ·• ¯ÂÙÈ΋ ¤ÎappleÙˆÛË Ù˘ ʈÙÂÈÓfiÙËÙ·˜ ÙˆÓ·ÓÙÈÎÂÈ̤ӈӕ ÙÈÎÙ‹ ÎÂÚ·Ù›Ùȉ·1• EÏ¿ÙÙˆÛË ‹ ·appleÒÏÂÈ· ÙÔ˘ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÔ‡EÈÎfiÓ· 1 ∂ÈÎfiÓ· 2A′ ·ÓÂappleÈÛÙËÌȷ΋ OÊı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂∞OÊı·ÏÌÔÏÔÁ›·, 18, 2 : 173 - 175, 2006

174 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)Ù˘ ˆ¯Ú¿˜1• ˘ÛÛÒÚ¢ÛË 5 ‹ ·appleÒÏÂÈ· ¯ÚˆÛÙÈ΋˜4 ÌÂ-Ï·Á¯ÚfiÔ˘ ÂappleÈıËÏ›Ô˘ ÛÙËÓ appleÂÚÈÔ¯‹ Ù˘ ˆ¯Ú¿˜• ÙË ÊÏÔ˘ÔÚÔ·ÁÁÂÈÔÁÚ·Ê›·, ˘appleÔÊıÔÚÈÛÌfi˜·applefi apple·ÚÂÌapplefi‰ÈÛË ÙÔ˘ ÊıÔÚÈÛÌÔ‡ 5 ‹ ˘appleÂÚÊıÔÚÈ-ÛÌfi˜ ·applefi ‰È·Ê¿ÓÂÈ· (window defect) ÙÔ˘ ÌÂÏ·Á-¯ÚfiÔ˘ ÂappleÈıËÏ›Ô˘4,6,7 .ªÂÙ¿ ·applefi οappleÔÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Ù· Û˘-ÌappleÙÒÌ·Ù· ˘appleÔ¯ˆÚÔ‡Ó ·˘ÙfiÌ·Ù· Î·È Âapple·Ó¤Ú¯ÂÙ·ÈÛÙ·‰È·Î¿ Ë ÔappleÙÈ΋ Ô͇ÙËÙ·, ÂÓÒ Ù· ÔÊı·ÏÌÔÛÎÔappleÈÎ¿Â˘Ú‹Ì·Ù· apple·Ú·Ì¤ÓÔ˘Ó, ·ÏÏ¿ Û ËappleÈfiÙÂÚËÌÔÚÊ‹ 1,4,5,7 . øÛÙfiÛÔ, ‰ÂÓ Â›Ó·È ·ÎfiÌ· ÁÓˆÛÙ¿ Ù·Ì·ÎÚÔappleÚfiıÂÛÌ· ·appleÔÙÂϤÛÌ·Ù· ÙˆÓ appleÚÔηÏÔ‡ÌÂ-ÓˆÓ ·applefi ÙÔ laser ‹appleÈˆÓ ÂÁη˘Ì¿ÙˆÓ.Δ· appleÚ¿ÛÈÓ· laser pointers ¯ÚËÛÈÌÔappleÔÈÔ‡ÓÙ·ÈÂapple›Û˘ Ì ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ·. Δ· appleÏÂÔÓÂÎÙ‹-Ì·Ù¿ ÙÔ˘˜ Û˘Ó›ÛÙ·ÓÙ·È Î˘Ú›ˆ˜ ÛÙÔ fiÙÈ Á›ÓÔÓÙ·È·ÓÙÈÏËappleÙ¿ ·applefi ¿ÙÔÌ· Ì appleÚˆÙ·ÓÔapple›· ‹ appleÚˆÙ·Óˆ-Ì·Ï›· (ÛÙÔ ÂÚ˘ıÚfi) Î·È Â›Ó·È ÔÚ·Ù¿ ÙfiÛÔ Û ʈ-ÙÂÈÓfi, fiÛÔ Î·È Û ÛÎÔÙÂÈÓfi appleÂÚÈ‚¿ÏÏÔÓ 10 . ∏ apple·-Ú·ÙÂٷ̤ÓË, Û˘Ó¯‹˜ ¤ÎıÂÛË ÛÙËÓ ÂÎappleÂÌapplefiÌÂÓˉ¤ÛÌË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· appleÚÔηϤÛÂÈ 3 :• ÕÌÂÛ·, apple·ÚÔ‰Èο ¤Á¯ÚˆÌ· ÌÂÙÂÈοÛÌ·Ù·• ªÂÙ¿ ·applefi 24 ÒÚ˜, ΛÙÚÈÓÔ ·appleԯڈ̷ÙÈÛÌfiÙ˘ ˆ¯Ú¿˜, ÛÙÔ Âapple›appleÂ‰Ô ÙÔ˘ ÌÂÏ·Á¯ÚfiÔ˘ ÂappleÈıËÏ›-Ô˘. ªÔÈ¿˙ÂÈ Ì ıÂÚÌÈÎfi ¤Áη˘Ì· appleÚÔηÏÔ‡ÌÂÓÔ·applefi ¤ÎÏÂÈ„Ë ËÏ›Ô˘3.• ÙÔÓ ¤ÏÂÁ¯Ô Ì OCT apple¿¯˘ÓÛË ÛÙÔ Âapple›apple‰ÔÙÔ˘ ÌÂÏ·Á¯ÚfiÔ˘ ÂappleÈıËÏ›Ô˘• ∏ ÔappleÙÈ΋ Ô͇ÙËÙ· apple·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚ¿ Ê˘-ÛÈÔÏÔÁÈ΋• °ÂÓÈο, ÂÌÊ·Ó›˙ÔÓÙ·È ÈÛÙÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜,ÔÈ Ôappleԛ˜ ‰ÂÓ Û˘Óԉ‡ÔÓÙ·È ·applefi ÛÔ‚·Ú¿ Û˘ÌappleÙÒÌ·-Ù·. OÈ ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ Û˘ÓËÁÔÚÔ‡Ó ˘apple¤Ú ıÂÚÌÈ΋˜‚Ï¿‚˘ appleÔ˘ ÂappleËÚ¿˙ÂÈ Î˘Ú›ˆ˜ ÙÔ ÌÂÏ¿Á¯ÚÔ˘Ó ÂappleÈı‹ÏÈÔ,Î·È Û˘Ó›ÛÙ·ÓÙ·È Û apple·ÚÂÎÙfiappleÈÛË ÙˆÓ apple˘Ú‹-ÓˆÓ ·applefi ÙË ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË, ‰È·ÛappleÔÚ¿ ÎÔÎΛˆÓ¯ÚˆÛÙÈ΋˜, ·ÏÏ·Á¤˜ ÛÙ· ÎÔÎΛ· ÌÂÏ·ÓÔÊÔ˘ÛΛÓË˜Î·È apple·ÚÂÎÙfiappleÈÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÌÂÏ·Á¯ÚfiÔ˘ÂappleÈıËÏ›Ô˘ ÛÙÔÓ ˘apple·ÌÊÈ‚ÏËÛÙÚÔÂȉÈÎfi ¯ÒÚÔ.T· appleÚ¿ÛÈÓ· laser pointers ÌappleÔÚ› Ó· ·appleÔ‚Ô‡ÓappleÈÔ ÂappleÈΛӉ˘Ó· ·applefi Ù· ÎfiÎÎÈÓ· laser pointers, η-ıÒ˜ Ô ·ÓıÚÒappleÈÓÔ˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹˜ Â›Ó·È appleÈÔ Â˘-·›ÛıËÙÔ˜ ÛÙ· ‚Ú·¯¤· Ì‹ÎË Î‡Ì·ÙÔ˜ Î·È Ë ÌÂÏ·Ó›-ÓË ÙÔ˘ ÌÂÏ·Á¯ÚfiÔ˘ ÂappleÈıËÏ›Ô˘ ·appleÔÚÚÔÊ¿ appleÂÚÈÛÛfi-ÙÂÚË ÂÓ¤ÚÁÂÈ· Û ·˘Ù¿ Ù· Ì‹ÎË Î‡Ì·ÙÔ˜ (Ì‹ÎÔ˜ ·-Ì·ÙÔ˜ appleÚ¿ÛÈÓÔ˘ laser pointer 532 nm Î·È Ì‹ÎԘ·̷ÙÔ˜ ÎfiÎÎÈÓÔ˘ laser pointer 670 nm) 3 .°ÂÓÈο, ÔÈ apple·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·applefi ÙË ¯Ú‹ÛËÙˆÓ laser pointers Û˘Ó›ÛÙ·ÓÙ·È ÙfiÛÔ Û apple·Ú·ÙÂÙ·-̤ÓË, ÛÎfiappleÈÌË ¤ÎıÂÛË ÛÙËÓ ÂÎappleÂÌapplefiÌÂÓË ‰¤ÛÌË,fiÛÔ Î·È ÛÙËÓ ·˘ÍË̤ÓË ¯ÚˆÛÙÈ΋ ÙÔ˘ ‚˘ıÔ‡. ŒÙÛÈ,Ù· ÛÎÔ˘Úfi¯ÚˆÌ· ¿ÙÔÌ· ‚Ú›ÛÎÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂ-ÚÔ Î›Ó‰˘ÓÔ, ηıÒ˜ ·˘Í¿ÓÂÙ·È Ë ·appleÔÚÚfiÊËÛË Ù˘laser ÂÓ¤ÚÁÂÈ·˜ ÛÙÔ Âapple›appleÂ‰Ô ÙÔ˘ ÌÂÏ·Á¯ÚfiÔ˘ ÂappleÈıËÏ›Ô˘Î·È ÙÔ˘ ¯ÔÚÈÔÂȉ‹ 6 . º˘ÛÈÎÔ‡˜ appleÚÔÛٷ٢ÙÈ-ÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ·appleÔÙÂÏÔ‡Ó ÔÈ ‚ÏÂÊ·ÚÈÛÌÔ› ηÈË Ê˘ÛÈÔÏÔÁÈ΋ ΛÓËÛË ·appleÔÛÙÚÔÊ‹˜, Ë ÔappleÔ›· ÌÂÈÒ-ÓÂÈ ÙË ‰È¿ÚÎÂÈ· ¤ÎıÂÛ˘ Û ÏÈÁfiÙÂÚÔ ·applefi 0.25sec 1,3 . øÛÙfiÛÔ, ÔÈ appleÚˆÙ¿ÓÔapple˜ Â›Ó·È appleÈı·Ófi Ó· ÂÌ-Ê·Ó›˙Ô˘Ó ÌÂȈ̤ÓË Â˘·ÈÛıËÛ›· Û ̋ÎË Î‡Ì·ÙÔ˜670 nm, Ì ·appleÔÙ¤ÏÂÛÌ· ηı˘ÛÙÂÚË̤ÓË Î›ÓËÛË·appleÔÛÙÚÔÊ‹˜ Î·È ·˘ÍË̤ÓÔ ¯ÚfiÓÔ ¤ÎıÂÛ˘1.Δ· laser pointers ‰ÂÓ ·appleÔÙÂÏÔ‡Ó ¤Ó· ·ıÒÔ apple·È-¯Ó›‰È ÛÙ· ¯¤ÚÈ· ÙˆÓ apple·È‰ÈÒÓ. ∂Ó¤¯Ô˘Ó ÙÔÓ Î›Ó‰˘ÓÔappleÚfiÎÏËÛ˘ ÔÊı·ÏÌÈÎÒÓ ‚Ï·‚ÒÓ, ÁÈ· ÙËÓ ·appleÔÊ˘Á‹ÙˆÓ ÔappleÔ›ˆÓ ·apple·ÈÙÂ›Ù·È Ë ÂÁÚ‹ÁÔÚÛË ÙfiÛÔ Ù˘ÔÊı·ÏÌÈ΋˜ ÎÔÈÓfiÙËÙ·˜, fiÛÔ Î·È ÙÔ˘ ¢ڇÙÂÚÔ˘ÎÔÈÓÔ‡ 5 .  ÔÚÈṲ̂Ó˜ Â˘Úˆapple·˚Τ˜ ¯ÒÚ˜, fiappleˆ˜ ÛÙËÌÂÁ¿ÏË μÚÂÙ·Ó›·, Â›Ó·È ÂappleÈÙÚÂappleÙ‹ Ë ¯Ú‹ÛË laserpointers class II, ·ÏÏ¿ ·apple·ÁÔÚÂ˘Ì¤ÓË Ë ¯Ú‹ÛË ÙˆÓlaser pointers class IIπa 4 . ∞apple·Ú·›ÙËÙË ıˆÚÂ›Ù·È ËÛ˘ÌÌfiÚʈÛË ÛÙȘ Ô‰ËÁ›Â˜ “·appleÔʇÁÂÙ ÙËÓ ·apple¢ı›-·˜ ¤ÎıÂÛË ÛÙ· Ì¿ÙÈ·’’ Î·È “ÌËÓ Î·Ù¢ı‡ÓÂÙ ÙË ‰¤-ÛÌË ÛÙ· Ì¿ÙÈ· ¿ÏÏÔ˘ appleÚÔÛÒappleÔ˘’’, ηıÒ˜ Î·È Ë ·appleÔ-Ê˘Á‹ ·ÁÔÚ¿˜ laser pointers ÛÙ· ÔappleÔ›· ‰ÂÓ ·Ó·ÁÚ¿-ÊÔÓÙ·È Ë Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ Î·È Ô‰ËÁ›Â˜. ∞˘Ù¿ Ù·laser pointers ΢ÎÏÔÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ Ì ÙË ÌÔÚÊ‹ÎÏÂȉÔı‹Î˘1. ·Ó Û˘Ìapple¤Ú·ÛÌ·, appleÚ¤appleÂÈ Ó· ·apple·ÁÔ-Ú¢ı› Ë ¯Ú‹ÛË ÙˆÓ laser pointers ·applefi Ù· apple·È‰È¿.ºÔÚËÙ¿ ËÏÂÎÙÚÔÓÈο apple·È¯Ó›‰È·Ì appleÔχ ÌÈÎÚ‹ ÔıfiÓË (Game boy, Nintendo,apple·È¯Ó›‰È· Û ÎÈÓËÙ¿ ÙËϤʈӷ)Δ· apple·È‰È¿ Ù˘ Û¯ÔÏÈ΋˜ Î·È Ù˘ ÂÊË‚È΋˜ ËÏÈ-Λ·˜ appleÔχ Û˘¯Ó¿ appleÂÚÓÔ‡Ó ·ÙÂÏ›ˆÙ˜ ÒÚ˜ ÎÚ·-ÙÒÓÙ·˜ ÌÈ· ÌÈÎÚ‹ ËÏÂÎÙÚÔÓÈ΋ ÔıfiÓË ¯ÂÈÚfi˜ (EÈÎ.3, 4). ∏ Û˘Ó¯‹˜ ·˘Ù‹ ÂÓ·Û¯fiÏËÛË ÙˆÓ apple·È‰ÈÒÓ ÌÂÌÈÎÚ¤˜ ËÏÂÎÙÚÔÓÈΤ˜ ÔıfiÓ˜ ÌappleÔÚ› Ó· ¤¯ÂÈ ÙȘ·ÎfiÏÔ˘ı˜ ÔÊı·ÏÌÈΤ˜ ÂappleÈappleÙÒÛÂȘ:• ˘Ìappleو̷ÙÈ΋ ·ÓÂapple¿ÚÎÂÈ· Û‡ÁÎÏÈÛ˘: ∏Û˘Ó¯‹˜ apple·Ú·ÎÔÏÔ‡ıËÛË ÌÈ·˜ ÌÈÎÚ‹˜ ËÏÂÎÙÚÔÓÈ-΋˜ ÔıfiÓ˘ ·appleÔÙÂÏ› ¤Ó· Âapple›ÌÔÓÔ, Û˘Ó¯¤˜, appleÚÔ-Û·ÚÌÔÛÙÈÎfi ÙÔÓÈÎfi ÂÚ¤ıÈÛÌ·, ÙÔ ÔappleÔ›Ô ·Ó·Áο˙ÂÈÙË Û‡ÁÎÏÈÛË ÙÔ˘ apple·È‰ÈÔ‡ Ó· ‚Ú›ÛÎÂÙ·È Û ÙÔÓÈ΋ηٿÛÙ·ÛË Âapple› Ì·ÎÚfiÓ 11 . ΔÔ ·appleÔÙ¤ÏÂÛÌ· ›ӷÈapple·ÚÔ‰È΋ ·ÓÂapple¿ÚÎÂÈ· Ù˘ Û‡ÁÎÏÈÛ˘. AÓ·ÛÙ¤ÏÏÂ-Ù·È ‰ËÏ·‰‹ Ë ÈηÓfiÙËÙ· ÙÔ˘ apple·È‰ÈÔ‡ Ó· ÂÛÙÈ¿˙ÂÈ¿ÌÂÛ· ·applefi ÙËÓ ÂÁÁ‡˜ appleÚÔۋψÛË ÛÙË Ì·ÎÚÈÓ‹,Î·È ·ÓÙ›ıÂÙ·, ÁÈ· οappleÔÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, appleÂÚ›-appleÔ˘ 2 ˆÚÒÓ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·˘ÙÔ‡ ÙÔ˘ ¯ÚÔÓÈ-ÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ·‰‡Ó·ÙË ÔappleÔÈ·‰‹appleÔÙ ÎÔ-

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 175EÈÎfiÓ· 4EÈÎfiÓ· 3ÓÙÈÓ‹ ÂÚÁ·Û›· (‰È¿‚·ÛÌ·, ÁÚ¿„ÈÌÔ Î.Ï.apple.), ηıÒ˜Î·È ‰Ú·ÛÙËÚÈfiÙËÙ˜ Û ·applefiÛÙ·ÛË (Ô‰‹ÁËÛË).ÔÏÏ¿ apple·È‰È¿ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÂapple¿ÚÎÂÈ· Û‡-ÁÎÏÈÛ˘, ‰ËÏ·‰‹ ·‰˘Ó·Ì›· Ó· Û˘ÁÎÏ›ÓÔ˘Ó Ê˘ÛÈÔ-ÏÔÁÈο Ù· Ì¿ÙÈ· ÙÔ˘˜ ÛÙËÓ ÎÔÓÙÈÓ‹ fiÚ·ÛË ‹ Ó· ‰È·-ÙËÚÔ‡Ó ÙË Û‡ÁÎÏÈÛ‹ ÙÔ˘˜ ÛÙÔ ÂÁÁ‡˜ ÛËÌ›Ô, appleÔ˘·apple·ÈÙÂ›Ù·È ÁÈ· ÙÔ ‰È¿‚·ÛÌ· Î·È ÙËÓ ÎÔÓÙÈÓ‹ fiÚ·-ÛË 12,13 . ÙȘ appleÂÚÈÛÛfiÙÂÚ˜ appleÂÚÈappleÙÒÛÂȘ Ë Î·Ù¿ÛÙ·-ÛË ·˘Ù‹ Â›Ó·È ·Û˘Ìappleو̷ÙÈ΋. ŸÌˆ˜ Â›Ó·È ‰˘Ó·Ù‹Ë ÌÂÙ·ÙÚÔapple‹ Ù˘ ÛÂ Û˘Ìappleو̷ÙÈ΋ ·ÓÂapple¿ÚÎÂÈ· Û‡-ÁÎÏÈÛ˘, fiÙ·Ó Ù· apple·È‰È¿ ·˘Ù¿ ¯ÚËÛÈÌÔappleÔÈÔ‡Ó Âapple›-ÌÔÓ· ÙȘ ÌÈÎÚ¤˜ ÔıfiÓ˜ ÙˆÓ ÊÔÚËÙÒÓ ËÏÂÎÙÚÔÓÈ-ÎÒÓ apple·È¯ÓȉÈÒÓ Âapple·ÓÂÈÏËÌ̤ӷ, ÁÈ· appleÔÏϤ˜ ÒÚ˜.To ·appleÔÙ¤ÏÂÛÌ· Â›Ó·È Ù· apple·È‰È¿ ·˘Ù¿ Ó· ÂÌÊ·Ó›-˙Ô˘Ó Û˘ÌappleÙÒÌ·Ù· ÎÔappleȈapple›·˜, ‰ËÏ·‰‹ ÌÂÙˆappleÈ·›·ÎÂÊ·Ï·ÏÁ›·, ıfiψÛË Ù˘ fiÚ·Û˘ Î·È ‰È·Ï›appleÔ˘Û·‰Èappleψapple›·, οı ÊÔÚ¿ appleÔ˘ appleÚ¤appleÂÈ Ó· ÂÎÙÂϤÛÔ˘ÓÙËÓ ÎÔÓÙÈÓ‹ Û¯ÔÏÈ΋ ÙÔ˘˜ ÂÚÁ·Û›·12,13 . ÙÔ Ù¤ÏÔ˜ÙÔ ‰È¿‚·ÛÌ· ηٷϋÁÂÈ ÌÈ· ÂappleÒ‰˘ÓË ‰ÈÂÚÁ·Û›·ÁÈ· Ù· apple·È‰È¿. ∂apple›Û˘, Û˘¯Ó¿, ·˘Ù¿ Ù· apple·È‰È¿ ηÈÔÈ ÁÔÓ›˜ ÙÔ˘˜ Ù·Ï·ÈappleˆÚÔ‡ÓÙ·È Û ̷ÎÚÔ¯ÚfiÓÈ·È·ÙÚÈ΋ ¤Ú¢ӷ Î·È ¿ÛÎÔappleÔ Ó¢ÚÔ·ÎÙÈÓÔÏÔÁÈÎfi¤ÏÂÁ¯Ô ¯ˆÚ›˜ Û˘Ó‹ıˆ˜ Ó· ·appleÔηχappleÙÂÙ·È Ë ·ÈÙ›·Ù˘ Âapple›ÌÔÓ˘ ÎÂÊ·Ï·ÏÁ›·˜ Î·È Ù˘ ÎÔappleȈapple›·˜.• •ËÚÔÊı·ÏÌ›·: ∏ Û˘Ó¯‹˜ appleÚÔۋψÛË ÛÙȘÌÈÎÚ¤˜ ÔıfiÓ˜ ÙˆÓ ÊÔÚËÙÒÓ ËÏÂÎÙÚÔÓÈÎÒÓ apple·È¯ÓÈ-‰ÈÒÓ, ÏfiÁˆ ¤ÓÙÔÓÔ˘ ÂӉȷʤÚÔÓÙÔ˜, ÎÚ·Ù¿ Ù· Ì¿-ÙÈ· Û˘Ó¯Ҙ ·ÓÔÈÎÙ¿, Ì ·appleÔÙ¤ÏÂÛÌ· ÙËÓ ÍËÚfiÙË-Ù· ÙÔ˘ ÎÂÚ·ÙÔÂȉ‹ Î·È ÙÔ˘ ÂappleÈappleÂÊ˘ÎfiÙ·, Ì ·›ÛıË-Ì· ‚¿ÚÔ˘˜, ¿ÏÁÔ˘˜ Î·È Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜, ·ÓÙ·Ó·-ÎÏ·ÛÙÈ΋ ‰·ÎÚ‡ÚÚÔÈ· Î·È ÂÚ˘ıÚfiÙËÙ· ÙˆÓ ÔÊı·Ï-ÌÒÓ 14 . ∏ Û˘¯Ó‹ ÂÓ·Û¯fiÏËÛË Ì ÙȘ ÌÈÎÚ¤˜ ÔıfiÓ˜ԉËÁ› Û ¯ÚfiÓÈ· ÍËÚÔÊı·ÏÌ›·.¢˘ÛÙ˘¯Ò˜, ÙfiÛÔ Ù· ÊÔÚËÙ¿ ËÏÂÎÙÚÔÓÈο apple·È-¯Ó›‰È· Ì appleÔχ ÌÈÎÚ‹ ÔıfiÓË, fiÛÔ Î·È Ù· apple·È¯Ó›‰È·ÛÙȘ ÔıfiÓ˜ ÙˆÓ ÎÈÓËÙÒÓ ÙËÏÂÊÒÓˆÓ, ΢ÎÏÔÊÔÚÔ‡Ó¢ڤˆ˜ Î·È Ô‡Ù ÔÈ ÁÔÓ›˜, Ô‡Ù ÔÈ ‰¿ÛηÏÔÈ ÁÓˆÚ›-˙Ô˘Ó ÙÔ ‚·ıÌfi ÂappleÈÎÈÓ‰˘ÓfiÙËÙ¿˜ ÙÔ˘˜, ηıÒ˜ Ù· apple·È-‰È¿ ηı›ÛÙ·ÓÙ·È ÙÂÏÈο “·Ó¿appleËÚ·’’ ˆ˜ appleÚÔ˜ ÙËÓÂÎÙ¤ÏÂÛË Ù˘ ηıËÌÂÚÈÓ‹˜ Û¯ÔÏÈ΋˜ ÙÔ˘˜ ÂÚÁ·Û›·˜.μÈ‚ÏÈÔÁÚ·Ê›·1. Sethi C, Grey R, Dean Hart C. Laser pointers revisited: asurvey of 14 patients attending casualty at the BristolEye Hospital. Br J Ophthalmol 83: 1164-7, 19992. Yolton R, Citek K, Schmeisser E, Reichow A, Griffith T.Laser pointers: toys, nuisances, or significant eye hazards?J Am Optom Assoc 70: 285-9, 1999.3. Robertson D, McLaren J, Salomao D, Link T. Retinopathyfrom a green laser pointer: a clinicopathological study.Arch Ophthalmol 123: 629-33, 2005.4. ∑amir E, Kaiserman I, Chowers I. Laser pointer maculopathy.Am J Ophthalmol 127: 728-9, 1999.5. Clive S, Shepard B. Maculopathy from handheld diodelaser pointer. Arch Ophthalmol 117: 1557-8, 1999.6. Luttrull J, Hallisey J. Laser pointer-induced macular injury.Am J Ophthalmol 127: 95-6, 1999.7. Israeli D, Hod Y, Geyer O. Laser pointers: not to be takenlightly. Br J Ophthalmol 84: 554, 2000.8. ∑amir E, Chowers I. Concerns about laser pointers andmacular damage. Arch Ophthalmol 119: 1731-2, 2001.9. Robertson D, Lim T, Salomao D, Link T, Rowe R, Mc LarenJ. Laser pointers and the human eye: a clinicopathologicalstudy. Arch Ophthalmol 118: 1686-91,2000.10. ∂agle R. Laser pointers and color blindness. Ophthalmology105: 760-1, 1998.11. Ishikawa S. Examination of the near triad in VDU o-perators. Ergonomics 33: 787-98, 1990.12. ∫·Î·‚Ô‡ÙË-¢Ô‡‰Ô˘ ∞, ∫·Ú·ÁÈ·ÓÓÔappleÔ‡ÏÔ˘ , °È·ÎfiÌapple, ÈÙÛ¿‚·˜ °, ∫·ÙÚÈÔ‡ ¢, Ù¿ÁÎÔ˜ ¡. ∞ÓÂapple¿ÚÎÂÈ·Û‡ÁÎÏÈÛ˘: ·ÈÙ›· ηÏÔ‹ıÔ˘˜ ÌÂÙˆappleÈ·›·˜ ÎÂÊ·Ï·Ï-Á›·˜. ·ÓfiappleÙ˘ 12: 90-3, 2000.13. ∫·Î·‚Ô‡ÙË-¢Ô‡‰Ô˘ ∞. ∏ÏÂÎÙÚÔÓÈο ªª∂ Î·È ÔÊı·ÏÌÈ-ο appleÚÔ‚Ï‹Ì·Ù· ÛÙÔ apple·È‰›. ·ÓfiappleÙ˘ 11: 67-72, 1998.14. Balik HH, Turgut-Balik D, Balikci K, Ozcan IC. Someocular symptoms and sensations experienced by longterm users of mobile phones. Pathol Biol 53: 88-91, 2005.

Degenerative eye diseasesWith the increase in life expectancy, more andmore people run the risk of developing a degenerativeeye disease and suffering the consequences.The leading disease causing serious vision impairmentaround the world is cataracts. However, becausea defective lens is usually surgically replacedin western countries, this disease rarely leads toblindness there. Instead, in those countries, maculardegeneration (AMD) is now the main source ofserious vision impairment.In Germany, AMD is the most common causeof irreversible blindness in the sense of the law(loss of sight, visus

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 177products under the RPE (soft drusen), which areprobably formed as a result of a sustained overload.The course of the disease is creeping, suchthat people affected do not notice these changesfor a long period of time. Generally, it takes years oreven decades for a perceptible reduction in vision tobecome apparent. In the process, peripheral visionusually remains intact, while central vision isdestroyed. The dry form of AMD, from which 85%of all AMD patients suffer, cannot, to date, betreated. Because this form of the disease can transform into the more aggressive – and treatable – wetvariation, regular check-ups are necessary. Thetypical characteristic of wet (neovascular) AMD isthe growth of new, fragile blood vessels in thesubretinal region. Leakage of fluid from thesevessels leads to edema development in the area andexudative retinal detachment, scar formation andthe loss of photoreceptors. Wet AMD, if leftuntreated, leads to loss of vision within an averageof two years. Using laser coagulation or photodynamictherapy (PDT), progression can be slowed.The therapy can only be employed for a portion ofthe patients, and even then, success is neitherguaranteed nor permanent. Due to the considerablylimited treatment options, prevention approachesare of great significance. Special attention is beingpaid to nutrition, especially the supply of the carotenoidslutein and zeaxanthin.Cataract extraction increases AMD riskDefinite risk factors for AMD include advancedage, genetic disposition and smoking. A lowmacular pigment density is being discussed as arisk factor 3,4 . In addition, cataract extraction appearsto increase the risk for AMD: In the courseof one’s life, in the ocular lens, photooxidativedamage to lens proteins leads to their aggregationand precipitation. The result is a clouding of thelens (cataract). These processes, primarily inducedby UV light, also reduce the light transmission ofthe lens for blue light – at an age in which the lightshield mechanisms of the retina through macularpigment diminishes and the photosensitizer lipofuscinincreases. Here, one could speculate thatthe increased photoprotection in the lens couldcounteract diminishing light shield factors of theretina. If the lens is removed in the context ofcataract surgery, its photoprotective effect is alsoACorneaLensIrisOptical axisRetinagone, such that the probability of photooxidativeretina damage via UV and blue light increases.Lutein and zeaxanthin: Chemistry,occurrence and significancefor nutritionLutein and zeaxanthin are natural, fat-solublepigments of the carotenoid group. Both substancesare categorized as xanthophylls, that is, asoxygenated derivates of carotenoids. In contrast tolycopine and beta-carotene, lutein and zeaxanthinadditionally carry hydroxyl groups in their carbonskeletons. Carotenoids are exclusively produced inplants. Synthesis sites in higher plants are thephotosynthetically active tissues as well as petals,pollen and fruit. The xanthophylls lutein andzeaxanthin are conspicuous in nature due to theiryellow and orange-red colors. Two examples: Luteinlends leaves their golden yellow color in autumnafter chlorophyll is decomposed (“IndianSummer”); lutein and zeaxanthin are the pigmentsthat, for instance, give cornits yellow color.One primary biological effect of carotenoidsin plants is the maximization of the photosynthesisprocess. Especially xanthophylls accumulate to agreat extent in the thylakoid membranes of thechloroplasts and function there as accessory pigments.One of their functions is to make light usablefor photosynthesis, which cannot be absorbedwell by chlorophyll due to an absorption gap in thespectral range of 450-570 nm. Due to deviating absorptionmaxima, carotenoids are capable of transferringabsorbed light energy in this region toneighboring chlorophyll molecules thus increasingefficiency of photosynthesis. The most importantcarotenoid in the plant’s so-called light harvestingcomplexes is lutein, for which absorption maximaAMacula luteawith foveacentralisOptical nerveChoroid membrane

178 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)of 445 nm (main peak), 421 nm and 475 nm havebeen measured. A second important function ofthe carotenoids is their protective effect from oxidationdamage: By capturing excess energy fromexcited chlorophyll, they prevent the formation ofhighly reactive and fast damaging singlet oxygen,among other things, thus functioning in a photoprotectivemanner.A similar photoprotective effect is also assumedfor lutein and zeaxanthin in human tissue aswell. Lutein and zeaxanthin occur along with othercarotenoids in all regions of the eye. Both substancesand their metabolites, however, are the onlycarotenoids that have been detected in the lens andretina. They occur as “macular pigment” in concentratedform in the central region of the retina(Macula lutea and fovea centralis). Here, theiraccumulation in the macula is highly selective inquality and quantity: Their concentrations lie at afactor of 1,000 times higher than in the blood 5 . Asstudies have shown, zeaxanthin and its isomertrans-meso-zea-xanthin accumulate especially a-bundantly in the center of the fovea centralis, whilethe concentration of lutein in peripheral areas istwo times higher. Even if the mechanisms of accumulationare yet unclear, it is currently consideredcertain that lutein and zeaxanthin performspecific biological functions. As with all other carotenoids,lutein and zeaxanthin cannot be synthesizedby the human body. They thus must beintroduced regularly through food.Macular pigment: Protectsphotoreceptors from radiation damage…In the region of the macula lutea and the foveacentralis, the retina is so thin-walled that incidentlight can directly reach the rods and cones locatedin this area. Thus, when exposed to highenergyblue light having a wavelength of 400-475nm over a longer period, the photoreceptors areexposed to an increased risk of irreversible damage(“blue light hazard”). Because lutein and zeaxanthincan absorb very effectively in that wavelength,their selective accumulation in the macula canreduce the risk of radiation damage. It is assumedthat, because of this filtering effect, lutein andzeaxanthin serve as a type of protective shield (“internalsunglasses”). This assumption is supportedby findings from experiments in which animals areexposed to a strong acute light source. In animalswith a high carotenoid content in the retina, asignificantly lower, dose-dependent, apoptosis ofthe photoreceptors was observed in comparison toanimals with lower retinal carotenoid content 6 .The observed spatial distribution of the macularpigment – with the highest concentration in thefoveola, diminishing toward the periphery –correlates conspicuously with the distribution ofcones, and may provide insight into the protectivefunction of the macular pigment.From the animal experiments, we know thatin the case of a lutein and zeaxanthin-free diet, nomacular pigment is formed 7 . In this situation, characteristicchanges result in the density and distributionof the cells in the pigment epithelium 8 . Inthis case, compensatory mechanisms appear toreact to the altered situation in the retina. Due tothe lack of macular pigment, there presumably isa higher exposure of the retina to blue light, whichleads to more intense damage and, as a result, tothe observed loss of RPE cells in the maculalutea. It is also considered certain that macularpigment reduces effects of chromatic aberrationin the short-waverange and thus improves visualacuity. Discussed effects include an improvementof contrast acuity and color perception as well asthe reduction of dazzle effects 9 . Such effectscould be achieved through a preferred spatialorientation of the lutein and zeaxanthinmolecules in the axons of the photoreceptors.This may lead to preferred absorption ofpolarized light at certain angles, which, amongother things, reduces annoying brilliance.….and dazzle effects. ...and stops theformation of reactive oxygencompoundsLutein and zeaxanthin are also present in thephotoreceptors in high concentrations. Here, it isrelevant that the necessary high oxygen supply tothe retina and the naturally pronounced lightexposition foster the formation of reactive, potentiallydamaging oxygen compounds to a high degree.This is especially true in the membranes ofthe external photoreceptor segments, whose tissueshows the highest density of oxidation-pronepolyunsaturated fatty acids (DHA) in the humanbody 10 . Since pronounced antioxidative effects

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 179have been described for lutein and zeaxanthin 11,12 ,it is obvious that a high concentration of thesexanthophylls in this region increases protectionfrom lipid peroxidation. Due to its selective accumulationin the macula and its documented biologicaleffects, it seems plausible that lutein andzeaxanthin contribute to the prevention of age-relateddegenerative eye diseases. In order to optimizethe light protection of the photoreceptors,high lutein and zeaxanthin concentrations wouldbe desirable in the region of the macula.Nutrition and ocular healthBecause carotenoids cannot be synthesized bythe human body, they must be regularly introducedthrough food. This is also true for lutein and zeaxanthin.In Germany, the amounts of lutein ingestedin food have been estimated at an average of1.9 milligrams, while a daily intake of zeaxanthin isestimated at 0.1 to 0.2 milligrams 13,14 . Dependingon individual nutritional habits, however, a verylarge fluctuation margin can be assumed. The mainsources of lutein and zeaxanthin are yellow-red andgreen vegetables, yellow to red fruits and eggs. Onemust take into consideration that the amount ofthe xanthophylls contained in the plants depends,in part, on the location of the plant, period ofmaturity and climate. Depending on the type ofplant, lutein andzeaxanthin are either present intheir free or esterified forms: Green vegetables(e.g. kale, lettuce, broccoli, spinach), as well ascorn and eggs contain the free form; the esterifiedform (lutein ester) is formed in yellow red fruitsand vegetables (e.g. carrots, peppers, peaches andcitrus fruits).In order to investigate the connections betweenthe carotenoid level in the retina and ocularhealth, several epidemiological studies have beenundertaken in the meantime. Two main studies arethe Eye Disease Case Control Study 15 , in which ahigher in-take of lutein and zeaxanthin throughfood correlated with a morein frequent incidenceof neovascular AMD and the Beaver Dam.Eye Study 16 , which could not prove thiseffect. The discussion of a possible cause for thisdiscrepancy focused on the fact that the participantsin the Beaver Dam Eye Study ingested considerablyfewer carotenoids, such that no protectivexanthophyll level could be achieved in themacula. It must be said that epidemiologicalstudies on nutritional status generally pose amethodological problem, since carotenoid levelsin the blood are only partially determined by theingested amounts of lutein and zeaxanthin. In thegeneral population, a number of additionalenvironmental influences must also be taken intoconsideration which can potentially influence thelevel of these substances in a positive or negativemanner. Individual differences in carotenoidlevels after supplementation can be traced tosmoking, physical activity, serum cholesterollevels and inflammatory processes (C-reactiveprotein) 17 . Currently, studies are underway toattempt to determine recommendations onoptimal doses of lutein and zeaxanthin.Dietetic influence of macularpigment densityDespite individually varying success withsupplementation, several studies have demonstratedthat after an increased intake of free lutein orlutein esters, a significant rise in the lutein level inthe blood can be expected. In one current study,the serum levels after supplementation showed anincrease of six to seven times that of the originalvalue. As a result, the macular pigment density wassignificantly increased in both healthy persons andpatients with early forms of AMD 18 . These resultsconfirm findings of earlier studies in which supplementationwith lutein led to a clear rise in serumlevels within one to two weeks. The density ofthe macular pigment increased in these cases afterabout four weeks. However, the effect lasted longerthan in the plasma and even remained sustainedafter the intake of lutein and zeaxanthin hadbeen reduced to its initial values 19 . Further studiesin which lutein was supplemented in doses ofbetween 2.4 and 30 mg daily showed that the extentof macular pigment enhancement was dependentupon the plasma level achieved. The macular pigmentdensity before supplementation had noinfluence on this result 20 .The results of previous studies are presentlybeing confirmed by one current study still beingconducted: 108 subjects with and without AMDare being supplemented with 112 mg of lutein and1 mg of zeaxanthin daily for a period of six months.The control group consists of 28 persons who are

180 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)not receiving supplements. In the verum group,serum concentrations of lutein and zeaxanthin, aswell as the macular pigment density, are checkedevery six weeks using an objective measurementprocedure, autofluorescence spectroscopy with ascanning laser ophthalmoscope (SLO). Followingsupplementation, the macular pigment density isdetermined twice more at intervals of threemonths, in order to obtain further data on thebiokinetics of both carotenoids in the retina. Afteronly three months, an increase in macula rpigmentdensity was observed in the majority of thesubjects, whereby lower initial values apparentlyincreased more and faster compared to higherinitial values 21* .The bioavailability of lutein from varioussources, which is important with regard to theachievable carotenoid plasma levels, has also beenstudied extensively. As was reported in the renownedAmerican Journal of Clinical Nutrition, thebioavailability of the carotenoids in a test personstudy was highest after eating eggs. In three otherinvestigated sources – spinach, supplements containingfree lutein and supplements containingesterified lutein – the bioavailability was comparable22 . Other studies as well, in which lutein wassupplemented through food, also documentedfavorable bioavailability of both forms. Here, thereare indications that the availability of the esterifiedform is higher in comparison to the free form 23 . Insummary, we can say that lutein ester from nutritionalsupplements represents an excellent luteinsource for the human body.LAST studyA newer study indicates that the significance oflutein may extend beyond the prevention of AMD.According to a test known by the acronym LAST(Lutein Antioxidant Supplementation Trial) 24 ,nutritional supplement with the carotenoid luteincan also improve symptoms of an existing case ofAMD. In the prospective and randomized study, 90patients with the dry form of the disease receivedlutein either alone, in combination with vitaminsand trace elements (such as vitamin C, vitamin E,beta-carotene, zinc and selenium), or a placebo.After this period, there was a documented increaseby approximately one third in pigment density in themacula region in both verum groups compared tothe placebo group. Improvements became apparentin several measurable vision parameters, such asvisual acuity and contrast perception, as well as recoveryof the eye after dazzle effects. These effectscould partially be due to a decrease in chromaticaberration. On the other hand, healing propertiesare evident in the improvement in optical distortioneffects and blind spots, which are conceived asdistinct visual phenomena. The authors thus suspectthat the desired effects are based on the interceptionof free radicals and the prevention of apopticprocesses.The results of the LAST study were not verysurprising to experts, since the intake of antioxidantsand trace elements had also resulted in aprogressive slowing of AMD in the previously publishedARED study 25 . In this large-scale inter-Lutein, Zeaxanthin and beta Carotin Content in Selected Foods (mg/100 g), various SourcesLutein* Zeaxanthin ß-CarotinKale 14,7 – 39,6 n.d 2,8 – 14,6Spinach 4,5 – 15, 9 0,2 – 0,3 3,0 – 6,7Broccoli 0,8 – 2,4 n.d. 0,3 – 1,1Peas 1,1 – 2,4 n.d. 0,1 – 1,3Corn 0,4 – 1,9 0,3 – 0,9Carrots 0,2 – 0,3 n.d. 8,5 – 10, 8Peppers (yellow/red) < 0,1 – 8,2 1,5 – 16,8 1,9 – 2,9Oranges 0,1 – 0,2 0,07 < 0,1Peaches < 0,1 < 0,01 =0,1Apples < 0,1 < 0,01 < 0,1Eggs 0,1 – 2,1 0,1 – 1,6 n.d.Potatoes 0,02 – 0,05 < 0,01 – 0,11 < 0,01Grains 0,02 – 0,14 < 0,01 – 0,03 n.d.*For analytical reasons, data in the literature is often represented as lutein plus zeaxanthin; n.d.: no data

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 181vention study of the American National Eye Institute,3,640 patients with varying stages of AMD(AREDS categories 2 to 4) were treated for anaverage of 6.3 years with either antioxidants(500mg of vitamin C, 400 I. E. of vitamin E and 15 mgof beta-carotene daily), high doses of zinc (80 mgdaily), a combination of these substances or a placebo.The results: In patients with several mediumlargedrusen in both eyes and/or atrophy or neovascularizationin one eye, supplementation withvitamins and trace elements reduced the risk ofprogression of the disease by 28% in comparison tothe placebo group. If only zinc was supplemented,the progression risk was 20% less. The authorsextrapolated their results to all AMD patients inthe USA and determined that a consistent interventionwith vitamins and trace elements couldprevent a deterioration of vision in 300,000 of eightmillion patients over a five-year period. Becauselutein and zeaxanthin were not yet commerciallyavailable during the planning of the AREDS study,it did not use supplementation with both carotenoids.Whether or not their regular administrationwould have improved treatment success even moreis now being examined in a new intervention studyin which beta-carotene is replaced by lutein.Expert committee confirms the safetyof high lutein dosagesLutein and zeaxanthin can be ingested for extendedperiods of time without concern. This was determin-edin June of 2004 at a routine meeting ofthe joint expert committee for food additives of theWorld Health Organization and the WorldNutrition Organization (JECFA, Joint FAO/WHOExpert Committee on Food Additives). The basisof this assessment is formed by the results of a safetyevaluation for lutein (together with zeaxanthin)from tagetes erecta (www.who.int/ ipcs/publications/jecfa/en/ summary_final.pdf). According toinformation provided by the committee, the acceptabledaily intake (ADI) lies at 2 mg per day andkg of body weight. A person weighing 60 kg (132 lbs)could thus take up to 120 mg of lutein (pluszeaxanthin), from tagetes erecta. The ADI refers tothe amount of a substance that can be ingested ona daily basis and over a lifetime without discerniblehealth risks 30 .It only refers to the safety of a substance,and should not be confused with recommendationsfor optimal dosage. They are physiologicallyeffective in very small amounts: In studies,an additional intake of 2.4 mg of lutein per dayconsiderably increased lutein levels in the blood aswell as macular pigment density.Procedure for the measurement ofmacular pigment densityFor some time now, scientists have been attemptingto establish a procedure for determiningmacular pigment density. Such a procedure mayprovide insight into potential risks for AMD oreven document the success of supplementation.There is as of yet no standard procedure. One methodthat is currently receiving a good deal ofattention is so-called heterochromatic flicker photometry(HFP). In this psychophysical procedure,test subjects look at a spot of light that rapidlyswitches between blue (460 nm) and green light(540 nm). The brightness of the blue stimulus isadjusted by the subjects until the stimulus appearsconstant. Because in the case of higher macularpigment density more blue light is required to reacha non-flickering state due to increased absorption,the macular pigment density can be estimatedfairly accurately using this procedure. However,we must mention the limitation that measurementresults are primarily determined by thesubjective reaction of test subjects. In addition, anequal sensitivity of the photoreceptors of blue andgreen light is assumed. Under controlled laboratoryconditions, HFP has produced good results;their significance in daily clinical work, however,appears limited for several reasons, i.e. becausetest subjects require a certain amount of practice inthis method. In addition, persons with impairedvision can only conduct the test in a limited manner,if at all. Nonetheless, HFP is the most widespreadmethod of determining macular pigmentdensity, and has been used in most studies 26 .Direct and objective procedures for the measurementof macular pigment density include, forinstance, reflection spectroscopy 27 , autofluorescencespectroscopy 28 and Raman spectroscopy 29 . Thelast of these procedures takes advantage of the factthat, in addition to the line (primary frequency) ofthe stimulating light, the diffused light spectrum ofcarotenoids illuminated with monochromatic lightcontains so-called Ramanlines which are attributed

182 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)to the oscillation and rotation of the scatteredmolecules. The intensity of this so-called Ramansignal is determined by the amount of existing pigment,and can subsequently be quantified. Fundusautofluorescence spectroscopy makes use of thefact that shining blue light is absorbed by the lipofuscingranules of the macula and is reflected asgreen autofluorescence. Since the retinal area, withits higher pigment density, can absorb the bluelight better than areas with a lower density, theseregions can be easily differentiated 29 .These three so-called “objective” methods aretechnically complex and due to a lack of commerciallyavailable equipment, can currently only beemployed by specialized centers.Conclusion– Age-related macular degeneration is themost common cause of blindness (visus 1/50) asdefined by law in persons over the age of 65.– Definite risk factors for AMD are advancedage, genetic disposition and smoking. Currentstudies also indicate a deficiency of the macularcarotenoids lutein and zeaxanthin to be a furtherrisk factor.– Due to limited treatment options, approachesemphasizing prevention have a high priority.– Lutein and zeaxanthin are accumulated inthe macular region in a highly selective manner.The macular pigment is essential for thedevelopment and preservation of a normal RPEprofile in the retina center.– Both carotenoids can optimize the permanentlight protection of the photoreceptors andcontribute to the prevention of age-related degenerativeocular disease.– Favorable effects of supplementation onmacular pigment density have been documented inhealthy persons and patients with AMD.– In the LAST study, AMD patients profitedfrom lutein supplementation through an improvementin vision, i.e. in acuity and contrast perception.– Lutein esters from nutritional supplementsrepresent an excellent lutein source for the humanbody.– Lutein and zeaxanthin can be taken for extendedperiods without concern.Bibliography1 Buch H et al. 14-year Incidence, Progression and VisualMorbidity of Age-Related Maculopathy. The CopenhagenCity Eye Study. Ophthalmology 112: 787-798,20052. www.who.int/hpr/ageing3. Hammond BR, et al. Carotenoids in the retina and lens:possible acute and chronic effects on human visualperformance. ArchBiochem Biophys 385: 41-46review, 2001.4. Bone RA, et al. Macular pigment in donor eyes with andwithout AMD: acase-control study. Invest OphthalmolVis Sci 42: 235-240, 2001.5. Krinsky NI, et al. Biologic mechanisms of the protectiverole of lutein andzeaxanthin in the eye. Annu RevNutr 23: 171-201, 2003.6. Thomson LR, et al. Elevated retinal zeaxanthin andprevention of light-indu-ced photoreceptor cell deathin quail. Invest Ophthalmol Vis Sci 43: 3538-3549,2002.7. Leung I, et al. Nutritional manipulation of primate retinas,II: effects of age, n-3 fatty acids, lutein, and zeaxanthinon retinal pigment epithelium. Invest OphthalmolVis Sci 45: 3244-3256, 2004.8. Neuringer M, et al. Nutritional manipulation of primateretinas, I: effects oflutein or zeaxanthin supplementson serum and macular pigment in xantho-phyll-freerhesus monkeys. Invest Ophthalmol Vis Sci 45: 3234-3243, 2004.9. Hammond BR, et al. Carotenoids in the retina and lens:possible acute andchronic effects on human visualperformance. Arch Biochem Biophys 385: 41-46, 2001.10. Landrum JT, et al. Lutein, zeaxanthin and the macularpigment. ArchBiochem Biophys 385: 28-40, 2001.11. Schalch W. Carotenoids in the retina – a review of theirpossible role in pre-venting or limiting damage causedby light and oxygen. Switzerland 1992, Birkhauser-Verlag Basel.12. Khachik F, et al. Identification of lutein and zeaxanthinoxidation products inhuman and monkey retina.Invest Ophthalmol Vis Sci 38: 1802-1811, 1997.13. Pelz R, et al. Die Carotinoidzufuhr in der NationalenVerzehrstudie. ZeitschrErnährungswiss 37: 319-326,1998.14. Muller H. Daily intake of carotenoids (carotenes andxantophylls) from totaldiet and the carotenoid contentof the selected vegetables and fruits. ZErnährungswiss35: 45-50, 1996.15. Eye Disease Case-Control Study Group. AntioxidantStatus and neovascularage-related macular degeneration.Arch Ophthalmol 111: 104-109, 1993.16. Mares-Perlman JA, et al. Serum antioxidants and age-relatedmacular dege-neration in a population-based casecontrolstudy. Arch Ophthalmol 113: 1518-1523, 1995.

OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 18317. Gruber M, et al. Correlates of serum lutein + zeaxanthin:findings from theThird National Health and NutritionExamination Survey. J Nutr 134: 2387-2394, 2004.18. Koh HH, et al. Plasma and macular responses to luteinsupplement in sub-jects with and without age-relatedmaculopathy: a pilot study. Exp Eye Res 79: 21-27,2004.19. Landrum JT, et al. A one year study of the macular pigment:the effect of 140 days of a lutein supplement.Exp Eye Res 65: 57-62, 1997.20. Bone RA, et al. Lutein and zeaxanthin dietary supplementsraise macular pigment density and serumconcentrations of these carotinoids in humans,J Nutr133: 992-998, 2003.21. Pauleikhoff D, et al. Makuläres Pigment bei Personenmit oder ohne altersbe-dingte Makuladegeneration.Vortrag auf dem 18. DOC Kongress, Nürnberg,23.-28.Juni 2005, Trieschmann et al. Das makuläre Pigment:Änderung unterSupplementierung. Vortrag auf der103. Jahrestagung der DOG, Berlin, 25.-29.September 2005.22. Chung HY, et al. Lutein bioavailability is higher fromlutein-enriched eggsthan from supplements andspinach in men. J Nutr 134: 1887-1893, 2004.23. Bowen PE, et al. Esterification does not impair luteinbioavailability inhumans. J Nutr 132: 3668-3673, 2002.24. Richer S, et al. Double-masked, placebo-controlled, randomizedtrial of luteinand antioxidant supplementationin the intervention of atrophic age-relatedmaculardegeneration: the Veterans LAST study (LuteinAntioxidantSupplementation Trial). Optometry 75:216-230, 2004.25. Age-Related Eye Disease Study Research Group. Arandomized placebo-con-trolled clinical trial of highdose supplementation with vitamins C and E,beta-caroteneand zinc for age-related macular degenerationand vision loss: AREDS report no. 8. ArchOphthalmol 119: 1417-1436, 2001.26. Bone RA, et al. Lutein, zeaxanthin, and the macularpigment. Arch BiochemBiophy; 385: 28-40, 2001.27. Berendschot TT, et al. Objective determination of themacular pigment opti-cal density using fundus reflectancespectroscopy. Arch Biochem Biophys 430:149-155, 2004.28. Delori FC, et al. Macular pigment density measured byautofluorescencespectrometry. Comparison with reflectometryand heterochromatic flickerphotometry. JOpt Soc Am 16: 1212-1230, 2001.29. Bernstein P, et al. Resonance Raman measurement ofmacular carotenoids in normal subjects and in a-gerelated macular degeneration patients. Ophthalmology109: 1780-1787, 2002.30. Diehl JF. Chemie in Lebensmitteln. WILEY-VCH Verlag,Weinheim 2000.31. Bone RA, et al. Lutein and zeaxanthin dietary supplementsraise macular pigment density and serum concentrationsof these carotenoids in humans. J Nutr133(4): 992-998, 2003.

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OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 185ÙˆÓ Á‡Úˆ ÈÛÙÒÓ. Δ· Ó¢ÚÈÓÒÌ·Ù· ÂÓÙÔapple›˙ÔÓÙ·È Ùfi-ÛÔ ÛÙÔ ‰¤ÚÌ· fiÛÔ Î·È ÛÙ· ÛappleÏ¿Á¯Ó·. ∏ apple·ÚÔ˘Û›·Ó¢ÚÈÓÒÌ·ÙÔ˜ ÛÙÔ ¿Óˆ ‚ϤʷÚÔ, Û˘¯Ó¿ Û˘Óԉ‡-ÂÙ·È ·applefi Û˘ÁÁÂÓ¤˜ ÁÏ·‡ÎˆÌ·. ΔfiÛÔ Ù· Û‚·ÓÓÒ-Ì·Ù· fiÛÔ Î·È Ù· Ó¢ÚÈÓÒÌ·Ù· ÌappleÔÚ› Ó· ÂÓÙÔapple›-˙ÔÓÙ·È ÛÙÔÓ ÎfiÁ¯Ô, ÔapplefiÙ ÂΉËÏÒÓÔÓÙ·È Ì appleÚfiappleÙˆÛËÙÔ˘ ‚ÔÏ‚Ô‡.ΔÔ appleÚÔ˚fiÓ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ Nπ 1 ÔÓÔÌ¿˙ÂÙ·Èneurofibromin Î·È ıˆÚÂ›Ù·È appleˆ˜ ¤¯ÂÈ ÔÁÎÔηٷ-ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË. ∞appleÂÓÂÚÁÔappleÔ›ËÛË ÙÔ˘ ÁÔÓȉ›Ô˘·˘ÙÔ‡ ·applefi Ì›· ÌÂÙ¿ÏÏ·ÍË ı· Ô‰ËÁÔ‡Û ÔÁÎÔÁ¤ÓÂ-ÛË. Δ· Ó¢ÚÈÓÒÌ·Ù· appleÈÛÙ‡ÂÙ·È appleˆ˜ appleÚÔ·appleÙÔ˘Ó·applefi ÙËÓ ·appleÂÓÂÚÁÔappleÔ›ËÛË ÙÔ˘ ÁÔÓȉ›Ô˘ ÛÙ· ·ÙÙ·-Ú· ÙÔ˘ Schwann. O Rutkowski Î·È Û˘Ó. 7 Û ÈÓÔ-‚Ï¿ÛÙ˜ ·applefi Ó¢ÚÈÓÒÌ·Ù· ·appleÔÌfiÓˆÛ·Ó ¤Ó· Ê˘-ÛÈÔÏÔÁÈÎfi ·ÏÏËÏfiÌÔÚÊÔ ÙÔ˘ Nπ1 ÁÔÓȉ›Ô˘ Î·È apple·-Ú‹Á·Á·Ó ÙfiÛÔ Nπ1 mRNA fiÛÔ Î·È ÙËÓ neurofibromin,ÂÓÒ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ Schwann ˘apple‹Ú¯Â ¤Ï-ÏÂÈ„Ë ÙÔ˘ ÁÔÓȉ›Ô˘. ˘ÌappleÂÚ·›ÓÔ˘Ó fiÙÈ ·apple·ÈÙÔ‡-ÓÙ·È ÂappleÈappleϤÔÓ ÌÔÚȷΤ˜ ·ÏÏ·Á¤˜ ÛÙ· ·ÙÙ·Ú· ÙÔ˘Schwann ‹ Î·È Û ¿ÏÏ· Â͈‰ÂÚÌÈ΋˜ appleÚÔ¤Ï¢Û˘·ÙÙ·Ú· ÁÈ· ÙËÓ ·Ó¿appleÙ˘ÍË Ó¢ÚÈӈ̿وÓ.  ÌÂ-ϤÙË ·applefi ÙÔÓ John Î·È Û˘Ó., ‚Ú¤ıËΠfiÙÈ ÙÔ 12%ÙˆÓ fiÁÎˆÓ (10/82) ÂÌÊ¿ÓÈ˙ ·appleÒÏÂÈ· Ù˘ ÂÙÂÚÔ˙˘-ÁˆÙ›·˜8.ÔÏϤ˜ ÔÊı·ÏÌÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Nπ1Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘,ÂÓÒ ¿ÏϘ ÏÈÁfiÙÂÚÔ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜. Δ· Ô˙›‰È·ÙÔ˘ Lisch, Ù· ÔappleÔ›· Â›Ó·È ·Ì·ÚÙÒÌ·Ù· Ù˘ ›Úȉ·˜,·appleÔÙÂÏÔ‡Ó ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfiÙÂÚÔ ÔÊı·ÏÌÈÎfi ÛË-ÌÂ›Ô Ù˘ Nπ1. ∞Ó Î·È ÌappleÔÚ› Ó· ·appleÔ˘ÛÈ¿˙Ô˘Ó Î·-Ù¿ ÙË Á¤ÓÓËÛË, Ë ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜ ·ÊÔÚ¿ ÛÙÔ 95 ÌÂ100% Û ÂÓ‹ÏÈΘ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 25 ÂÙÒÓ 9 . OÈRehany Î·È Rumelt 10 ·Ó·Ê¤ÚÔ˘Ó ÙËÓ appleÂÚ›appleÙˆÛËÌ›·˜ 32 ÂÙÒÓ Á˘Ó·›Î·˜ Ì Nπ1, Ë ÔappleÔ›· ·Ó¤appleÙ˘Í¤ӷ ÈÚȉÔÎÂÚ·ÙÔÂȉÈÎfi ηÎfiËı˜ ÌÂϿӈ̷ appleÔ˘appleÈı·Ó¿ ÂappleÂÎÙ¿ıËΠÛÙËÓ ›Úȉ· ÌÂÙ¿ ÙËÓ ·Ú¯È΋ÂÌÊ¿ÓÈÛË ÛÙÔÓ ÎÂÚ·ÙÔÂȉ‹. ∂ÌÊ·Ó‹ ÎÂÚ·ÙÔÂȉÈ-ο Ó‡ڷ Î·È ·Ì·ÚÙÒÌ·Ù· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹11 Î·È ÙÔ˘ ÔappleÙÈÎÔ‡ ‰›ÛÎÔ˘ ·appleÔÙÂÏÔ‡Ó ¿ÏÏ· ÔÊı·Ï-ÌÈο ÛËÌ›· Ù˘ Nπ1. ∂apple›Û˘ ÌappleÔÚ› Ó· ˘apple¿Ú¯Âȉ˘ÛappleÏ·Û›· ÙˆÓ ÔÛÙÒÓ ÛÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô, appleÔ˘Ô‰ËÁ› Û ·‚·ı‹ ÎfiÁ¯Ô ‹ Û ¤ÏÏÂÈ„Ë ÂÓfi˜ ÙÌ‹Ì·-ÙÔ˜ ÙÔ˘ ÎfiÁ¯Ô˘ (Û˘ÁÁÂÓÒ˜ ‹ ·applefi ·Ó¿appleÙ˘ÍË Î¿appleÔÈ-Ô˘ fiÁÎÔ˘). ∏ ·ÓÙÈÌÂÙÒappleÈÛË Û˘Ó›ÛÙ·Ù·È Û ÂÎÙÔÌ‹ÙÔ˘ fiÁÎÔ˘ Î·È ·Ó·Î·Ù·Û΢‹ ÙÔ˘ ÎfiÁ¯Ô˘ Ì ¯Ú‹-ÛË ÔÛÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜12 . O De Vries 13 ·Ó·Ê¤-ÚÂÈ appleˆ˜ Ë ·Ó·Î·Ù·Û΢‹ ÙÔ˘ ¿Óˆ Î·È ¤Íˆ ÙÔȯÒ-Ì·ÙÔ˜ Î·È Ù˘ ÌËÓÈÁÁÔ΋Ï˘ Û ·ÛıÂÓ‹ Ì Nπ1,ÌappleÔÚ› Ó· ·appleÔ‰ÒÛÂÈ Ì ¿„ÔÁÔ ÎÔÛÌËÙÈÎfi ·appleÔÙ¤-ÏÂÛÌ· Î·È ‰È·Ù‹ÚËÛË Ù˘ ÔappleÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜.OÈ fiÁÎÔÈ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜Â›Ó·È Ì›· ·applefi ÙȘ ÛÔ‚·ÚfiÙÂÚ˜ ÂappleÈappleÏÔΤ˜ Ù˘ NF1Î·È ÌappleÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ‰Èappleψapple›· ‹/ηȷappleÒÏÂÈ· Ù˘ fiÚ·Û˘ ÏfiÁˆ apple›ÂÛ˘ ‹ ‰È‹ıËÛ˘ ÁÂÈ-ÙÔÓÈÎÒÓ ÙÔ˘˜ ‰ÔÌÒÓ. OÈ ÔappleÙÈ΋ Ô‰fi˜ Û˘Ó‹ıˆ˜appleÚÔÛ‚¿ÏÏÂÙ·È ·applefi ÁÏÔÈÒÌ·Ù· ÙÔ˘ ÔappleÙÈÎÔ‡ Ó‡ÚÔ˘‹ ÙÔ˘ ¯È¿ÛÌ·ÙÔ˜ Û appleÔÛÔÛÙfi 15 Ì 20% ÙˆÓ ·ÛıÂ-ÓÒÓ Ì Nπ1 14 . ÔÏÏ¿ ÁÏÔÈÒÌ·Ù· ÙˆÓ ÔappleÙÈÎÒÓ Ó‡-ÚˆÓ Â›Ó·È ·ÌÊÔÙÂÚfiappleÏ¢ڷ Î·È ÂÓ›ÔÙ ÂÎÙ›ÓÔ-ÓÙ·È Î·È ÂÎÙfi˜ ÙÔ˘ ÎfiÁ¯Ô˘15 .·ıÔÏÔÁÔ·Ó·ÙÔÌÈο, Ù· ÔappleÙÈο ÁÏÔÈÒÌ·Ù·ÛÙËÓ Nπ1 ÂÌÊ·Ó›˙Ô˘Ó ÂÓÙÔÓfiÙÂÚË ‰È›ۉ˘ÛË ÛÙÔÓ˘apple·Ú·¯ÓÔÂȉ‹ ¯ÒÚÔ Û ۯ¤ÛË Ì ÙȘ ÛappleÔÚ·‰ÈΤ˜appleÂÚÈappleÙÒÛÂȘ16,17 . O Cummings Î·È Û˘Ó 18 . apple·ÚÔ˘-Û›·Û·Ó Ì›· ·Ó·ÛÎfiappleËÛË ÙˆÓ apple·ıÔÏÔÁÔ·Ó·ÙÔÌÈ-ÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ 22 ÁÏÔÈˆÌ¿ÙˆÓ ÙÔ˘ ÔappleÙÈÎÔ‡Ó‡ÚÔ˘ —19 ÂÎ ÙˆÓ ÔappleÔ›ˆÓ ‹Ù·Ó appleÈÏÔ΢ÙÙ·ÚÈο·ÛÙÚÔ΢ÙÒÌ·Ù· Î·È ÙÚ›· ‰È¿¯˘Ù·, ÌË appleÈÏÔ΢ÙÙ·ÚÈ-ο ÁÏÔÈÒÌ·Ù·. ∞applefi ÙÔ˘˜ 19 appleÈÏÔ΢ÙÙ·ÚÈÎÔ‡˜fiÁÎÔ˘˜, ÔÈ apple¤ÓÙ ÂÌÊ¿ÓÈÛ·Ó ÂappleÈıÂÙÈ΋ Û˘ÌappleÂÚÈÊÔ-Ú¿ appleÔ˘ ÂΉËÏÒıËΠ̠‰È¿¯˘ÙË ·Ó¿appleÙ˘ÍË Î·È ‰È‹-ıËÛË ÙˆÓ Á‡Úˆ ÈÛÙÒÓ, Ì ·appleÔÙ¤ÏÂÛÌ· ÙÔ ı¿Ó·ÙÔ‰‡Ô ·ÛıÂÓÒÓ, ¤Ó·˜ ÂÎ ÙˆÓ ÔappleÔ›ˆÓ ¤apple·Û¯Â ·applefiNπ1. ÙÔ˘˜ ÙÚÂȘ ·applefi ÙÔ˘˜ apple¤ÓÙ fiÁÎÔ˘˜, ˘apple‹Ú¯ÂÙÔappleÈ΋ ·‡ÍËÛË Ì ̤ÛÔ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ·‡ÍË-Û‹˜ ÙÔ˘˜ 39,3 Ì‹Ó˜. OÈ Û˘ÁÁÚ·Ê›˜ η٤ÏËÍ·ÓÛÙÔ Û˘Ìapple¤Ú·ÛÌ· fiÙÈ Ù· appleÂÚÈÛÛfiÙÂÚ· appleÈÏÔ΢ÙÙ·Ú-ÚÈο ·ÛÙÚÔ΢ÙÒÌ·Ù· ÙÔ˘ ÔappleÙÈÎÔ‡ Ó‡ÚÔ˘ ‰ÂÓ Â›-Ó·È ÂappleÈıÂÙÈο. ∂ÓÙÔ‡ÙÔȘ, ¤Ó·˜ ˘appleÔappleÏËı˘ÛÌfi˜ ÙˆÓappleÈÏÔ΢ÙÙ·ÚÈÎÒÓ ·ÛÙÚÔÎ˘ÙˆÌ¿ÙˆÓ ÂÌÊ·Ó›˙ÂÈ appleÚÔ-‰È¿ıÂÛË ÁÈ· ÂappleÈıÂÙÈ΋ Û˘ÌappleÂÚÈÊÔÚ¿.Δ· ÁÏÔÈÒÌ·Ù· Ù˘ appleÚfiÛıÈ·˜ ÔappleÙÈ΋˜ Ô‰Ô‡ Û˘-ÌappleÂÚÈʤÚÔÓÙ·È ˆ˜ ·Ì·ÚÙÒÌ·Ù· Î·È Û˘¯Ó¿ apple·Ú·-̤ÓÔ˘Ó ·Û˘Ìappleو̷ÙÈο, ·appleÔÙÂÏÒÓÙ·˜ Ù˘¯·›· ¢-Ú‹Ì·Ù· ÛÙȘ Ó¢ÚÔ·appleÂÈÎÔÓÈÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ.∂Ó›ÔÙ ÌappleÔÚ› Ó· appleÚÔηϤÛÔ˘Ó ÛÙ·‰È·Î‹ ·appleÒ-ÏÂÈ· Ù˘ fiÚ·Û˘ Ì ԛ‰ËÌ· ÙÔ˘ ÔappleÙÈÎÔ‡ Ó‡ÚÔ˘Î·È ·ÙÚÔÊ›· ÙÔ˘.  ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 29 ·ÛıÂ-ÓÒÓ Ì Nπ1 Î·È fiÁÎÔ Ù˘ ÔappleÙÈ΋˜ Ô‰Ô‡, Ô SchroderÎ·È Û˘Ó. 19 η٤ÏËÍ·Ó ÛÙÔ Û˘Ìapple¤Ú·ÛÌ· appleˆ˜ Ù·ÔappleÙÈο ÁÏÔÈÒÌ·Ù· appleÔ˘ Á›ÓÔÓÙ·È Û˘Ìappleو̷ÙÈοÛÙËÓ appleÚÒÙË apple·È‰È΋ ËÏÈΛ· (

186 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)Ù· ÔappleÙÈο ÁÏÔÈÒÌ·Ù· ÂÌÊ·Ó›˙Ô˘Ó ·˘ÙfiÌ·ÙË ˘appleÔ-ÛÙÚÔÊ‹ 24-26 . O Listernick Î·È Û˘Ó. 27 ·Ó·Ê¤ÚÔ˘ÓÙËÓ ¯Ú‹ÛË carboplatin, ÂÓfi˜ ¯ËÌÂÈÔıÂÚ·apple¢ÙÈÎÔ‡apple·Ú¿ÁÔÓÙ· appleÔ˘ ¯ÔÚËÁ‹ıËΠ۠ÂÓÓ¤· apple·È‰È¿ appleÔ˘¤apple·Û¯·Ó ·applefi Nπ1 Î·È Â›¯·Ó ÁÏÔ›ˆÌ· Ù˘ appleÚfiÛıÈ·˜ÔappleÙÈ΋˜ Ô‰Ô‡ (̤ÛË ËÏÈΛ· 3,4 ¤ÙË) Û ‰ÔÛÔÏÔÁ›·560 mg/mm 2 οı 4 ‚‰ÔÌ¿‰Â˜ ÁÈ· ‰È¿ÛÙËÌ· ›ÛÔÌ 15 Û˘Ó‰ڛ˜. Δ¤ÛÛÂÚȘ ·ÛıÂÓ›˜ ›¯·Ó ·ÎÙÈÓÔ-ÏÔÁÈΤ˜ ·appleԉ›ÍÂȘ ˘appleÔÛÙÚÔÊ‹˜ ÙÔ˘ fiÁÎÔ˘ ηȉ‡Ô ÂÌÊ¿ÓÈÛ·Ó Û·Ê‹ ‚ÂÏÙ›ˆÛË ÛÙËÓ fiÚ·ÛË. OÈÛ˘ÁÁÚ·Ê›˜ Û˘ÓÈÛÙÔ‡Ó ÙË ıÂÚ·apple›· ÁÈ· ·ÛıÂÓ›˜Ì ·appleԉ‰ÂÈÁ̤ÓË ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ‹ ¤ÎappleÙˆÛËÙ˘ fiÚ·Û˘.¡˘ÛÙ·ÁÌfi˜, ‰˘ÛÌÂÙÚ›· Û·Îη‰ÈÎÒÓ ÎÈÓ‹ÛÂ-ˆÓ, appleÚÔ‚ÏËÌ·ÙÈΤ˜ ÎÈÓ‹ÛÂȘ ·ÚÁ‹˜ ·ÎÔÏÔ˘ı›·˜ ‹‰Èappleψapple›· ÌappleÔÚ› Ó· appleÚÔ·„Ô˘Ó ·applefi ‡apple·ÚÍË·ÛÙÚÔ΢ÙÙ·ÚÈÎÒÓ fiÁÎˆÓ appleÔ˘ ÂÌappleϤÎÔ˘Ó ÙËÓ apple·ÚÂ-ÁÎÂÊ·Ï›‰· ‹ ÙÔ Û٤ϯԘ. ∏ ‰È·ÊÔÚ¿ ÛÙË Û˘ÌappleÂÚÈ-ÊÔÚ¿ ÙˆÓ ÁÏÔÈˆÌ¿ÙˆÓ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ Û ·ÛıÂÓ›˜Ì Nπ1 Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ Nπ1 ›ӷȷÌÊÈÏÂÁfiÌÂÓË 28,29 . ∏ fiÚ·ÛË ÌappleÔÚ› Âapple›Û˘ Ó· ÂappleË-Ú·Ûı› ·applefi appleÈÂÛÙÈο Ê·ÈÓfiÌÂÓ· Ù˘ ÔappleÙÈ΋˜ Ô‰Ô‡appleÔ˘ appleÚÔηÏÂ›Ù·È ·applefi ¤Ó· ÌËÓÈÁÁ›ˆÌ· ÙÔ˘ ÂχÙÚÔ˘ÙÔ˘ ÔappleÙÈÎÔ‡ Ó‡ÚÔ˘ ‹ Ù˘ appleÙ¤Ú˘Á·˜ ÙÔ˘ ÛÊËÓÔÂÈ-‰Ô‡˜ ÔÛÙÔ‡ 30 . ÕÏÏ· Â˘Ú‹Ì·Ù· ·applefi ÙÔ ∫¡ Û ·ÛıÂ-Ó›˜ Ì Nπ1 appleÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÛÙ¤ÓˆÛË ÙÔ˘ ˘‰Ú·Áˆ-ÁÔ‡, ·ÓˆÌ·Ï›· Chiari, ÙÚ·¯ËÏÈΤ˜ Î·È ÈÓÈÔ·˘¯ÂÓÈ-Τ˜ ·ÚÙËÚÈÔÊÏ‚ÈΤ˜ ·ÓˆÌ·Ï›Â˜31 . OÈ Shuto ηÈYamamoto 32 ·Ó·Ê¤ÚÔ˘Ó ÙËÓ appleÂÚ›appleÙˆÛË ·ÛıÂÓÔ‡˜Ì Nπ1 appleÔ˘ ·Ó¤appleÙ˘Í ¤ÎappleÙˆÛË ÙÔ˘ ÔappleÙÈÎÔ‡ apple‰›Ô˘ÛÙÔÓ ·ÚÈÛÙÂÚfi ÔÊı·ÏÌfi, appleÈı·ÓÒ˜ ÏfiÁˆ ÔappleÈÛıÔ-‚ÔÏ‚È΋˜ ÈÛ¯·ÈÌÈ΋˜ Ó¢ÚÔapple¿ıÂÈ·˜ ·applefi ˘appleÔappleÏ·-ÛÙÈ΋ ¤Ûˆ ηڈٛ‰·, Û˘ÓÂapple›· ·applefiÊÚ·Í‹˜ Ù˘appleÚÈÓ ÙËÓ ¤ÎÊ˘ÛË Ù˘ ÔÊı·ÏÌÈ΋˜ ·ÚÙËÚ›·˜.OÈ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ appleÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·ÊÂ-Á·Ï·ÎÙfi¯ÚˆÌ˜ ÎËÏ›‰Â˜, ʷΛ‰Â˜ Î·È Ó¢ÚÈÓÒÌ·-Ù·. OÈ ÛappleÏ·Á¯ÓÈΤ˜ ‚Ï¿‚˜ appleÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ê·ÈÔ-¯ÚˆÌÔ΢ÙÒÌ·Ù· Î·È Ó¢ÚÈÓÒÌ·Ù· ÙÔ˘ ÂÓÙ¤ÚÔ˘,ÙÔ˘ ÛappleÏËÓfi˜ Î·È ÙÔ˘ ‹apple·ÙÔ˜. ∫·ÎÔ‹ıÂȘ fiappleˆ˜¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›·, fiÁÎÔ˜ ÙÔ˘ WilmsÎ·È Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ ·Ó·appleÙ‡ÛÛÔÓÙ·È Ì ·˘ÍË-̤ÓË Û˘¯ÓfiÙËÙ· Û ÂÓ‹ÏÈΘ Î·È apple·È‰È¿ appleÔ˘ apple¿-Û¯Ô˘Ó ·applefi Nπ1 33 .¡Â˘ÚÔ˚ӈ̿وÛË Ù‡appleÔ˘ 2∏ ¡Â˘ÚÔ˚ӈ̿وÛË Ù‡appleÔ˘ 2 (Nπ2) ÎÏËÚÔÓÔ-ÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂappleÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·-ÎÙ‹Ú· Î·È ÂÌÊ·Ó›˙ÂÈ ˘„ËÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·. ∏Nπ2 Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ ·applefi ÙËÓ Nπ1, ÌÂ Û˘¯Ófi-ÙËÙ· 1:50000 1 . ΔÔ ÁÔÓ›‰ÈÔ Ù˘ Nπ2 , ÂÓÙÔapple›˙ÂÙ·È ÛÙÔ¯ÚˆÌfiۈ̷ 22 Î·È Îˆ‰ÈÎÔappleÔÈ› Ì›· ‰ÔÌÈ΋ ΢ÙÙ·-ÚÈ΋ appleÚˆÙ½ÓË ·appleÔÙÂÏÔ‡ÌÂÓË ·applefi 595 ·ÌÈÓÔ-ͤ·34,35 . OÌÔ›ˆ˜ Ì ÙÔ ÁÔÓ›‰ÈÔ Ù˘ Nπ1, ÙÔ ÁÔÓ›‰ÈÔÙ˘ Nπ2 Â›Ó·È ¤Ó· ÔÁÎÔηٷÛÙ·ÏÙÈÎfi ÁÔÓ›‰ÈÔ appleÔ˘·apple·ÓÙ¿ ÌÂÙ·ÏÏ·Á̤ÓÔ Î·È Û ÛappleÔÚ·‰Èο Û‚·ÓÓÒ-Ì·Ù· Î·È ÌËÓÈÁÁÈÒÌ·Ù·36,37 . Δ· ·ÌÊÔÙÂÚfiappleÏ¢ڷ·ÎÔ˘ÛÙÈο Ó¢ÚÈÓÒÌ·Ù· ·appleÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ¯·-Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÓfiÛÔ˘. OÈ ·ÛıÂÓ›˜ Û˘Ó‹ıˆ˜appleÚÔÛ¤Ú¯ÔÓÙ·È Ì ÂÙÂÚfiappleÏ¢ÚË ‹ ·ÌÊÔÙÂÚfiappleÏ¢ÚËappleÚÔ˚Ô‡Û· ·appleÒÏÂÈ· ·ÎÔ‹˜ Û˘Óԉ¢fiÌÂÓË ·applefi ÂÌ-‚Ô¤˜ Î·È ‰È·Ù·Ú·¯¤˜ Ù˘ ÈÛÔÚÚÔapple›·˜. ∂appleÈappleϤÔÓ,ÌappleÔÚ› Ó· ÂΉËÏÒÛÔ˘Ó ‰Èappleψapple›· ·applefi apple›ÂÛË ÙÔ˘·apple·ÁˆÁÔ‡ Ó‡ÚÔ˘ (VI), ·È̈‰›Â˜ ÙÔ˘ appleÚÔÛÒappleÔ˘·applefi apple›ÂÛË ÙÔ˘ ÙÚȉ‡ÌÔ˘ Ó. (V) ‹ Î·È ·‰˘Ó·Ì›· ÙˆÓÎÈÓËÙÈÎÒÓ Ì˘ÒÓ ÙÔ˘ appleÚÔÛÒappleÔ˘ ·applefi apple›ÂÛË ÙÔ˘ appleÚÔ-ÛˆappleÈÎÔ‡ Ó. (VII). ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘Nπ2 ¤¯Ô˘Ó Âapple›Û˘ apple·Ú·ÙËÚËı› Û ·ÛıÂÓ›˜ ÌÂappleÔÏÏ·appleÏ¿ Û‚·ÓÓÒÌ·Ù· ¯ˆÚ›˜ ·ÎÔ˘ÛÙÈο Ó¢ÚÈÓÒ-Ì·Ù·, ÂappleÂÎÙ›ÓÔÓÙ·˜ ¤ÙÛÈ ÙÔ Ê·ÈÓÔÙ˘appleÈÎfi Ê¿ÛÌ·Ù˘ ÓfiÛÔ˘38 .OÈ ÔÊı·ÏÌÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Nπ2 appleÂÚÈ-Ï·Ì‚¿ÓÔ˘Ó Ôapple›ÛıÈÔ˘˜ ˘appleÔη„ÈÎÔ‡˜ ηٷÚÚ¿ÎÙ˜,Âapple·ÌÊÈ‚ÏËÛÙÚÔÂȉÈΤ˜ ÌÂÌ‚Ú¿Ó˜ Î·È ·Ì·ÚÙÒÌ·-Ù· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜39-42 . Δ· Ô˙›‰È· ÙÔ˘Lisch Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÛÙËÓ Nπ2 Û ۯ¤ÛË ÌÂÙËÓ Nπ1 43 .ÚfiÛÊ·Ù˜ ÏÂappleÙÔÌÂÚ›˜ ·Ó·ÊÔÚ¤˜ apple·ÚÔ˘-ÛÈ¿˙Ô˘Ó Â˘Ú‹Ì·Ù· ·applefi ÙÔ ÔappleÙÈÎfi Ó‡ÚÔ ÛÙËÓ Nπ2,appleÔ˘ appleÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ô›‰ËÌ· ıËÏ‹˜, „¢‰ÔÔ›‰ËÌ·ıËÏ‹˜ Î·È ‰˘ÛappleÏ·Û›· ÙÔ˘ ÔappleÙÈÎÔ‡ Ó‡ÚÔ˘. ‰‡Ô ·ÛıÂÓ›˜ Ì Nπ2, ÔÈ Thomas Î·È Û˘Ó. 45·Ó·Ê¤ÚÔ˘Ó ÙÔ Ô›‰ËÌ· ıËÏ‹˜, Ì ÛËÌ·ÓÙÈ΋ ¤ÎappleÙˆ-ÛË Ù˘ fiÚ·Û˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ˘‰ÚÔΤʷÏÔ. ¿ÏÏË ·Ó·ÊÔÚ¿ 14¯ÚÔÓÔ˜ ¿ÚÚÂÓ ·ÛıÂÓ‹˜ Ì Ó¢-ÚÔ˚ӈ̿وÛË Ù‡appleÔ˘ 2 apple·ÚÔ˘Û›·Û ̛· ·Û˘Ó‹ıˢapple¤ÁÂÚÛË Ù˘ ÔappleÙÈ΋˜ ıËÏ‹˜ Î·È Û˘ÓÔ‰fi appleÂÚȈ¯ÚÈ-΋ Âapple·ÌÊÈ‚ÏËÛÙÚÔÂȉÈ΋ ÌÂÌ‚Ú¿ÓË ÛÙÔÓ ‰ÂÍÈfiÔÊı·ÏÌfi 46 . Δ· Â˘Ú‹Ì·Ù· ‹Ù·Ó ÂÓ‰ÂÈÎÙÈο ÂÓfi˜ ÔÈ-‰‹Ì·ÙÔ˜ ıËÏ‹˜, ·ÏÏ¿ Ë ÊÏÔ˘ÔÚÔ·ÁÁÂÈÔÁÚ·Ê›· ‰ÂÓ¤‰ÂÈÍ ԇÙ ·˘ÙÔÊıÔÚÈÛÌfi, Ô‡Ù ‰È·Ê˘Á¤˜ ¯ÚˆÛÙÈ-΋˜ ÛÙËÓ appleÂÚÈÔ¯‹ ÙÔ˘ ÔappleÙÈÎÔ‡ Ó‡ÚÔ˘, Ô‰ËÁÒÓÙ·˜ÛÙÔ Û˘Ìapple¤Ú·ÛÌ· ÙÔ˘ „¢‰ÔÔȉ‹Ì·ÙÔ˜ ·applefi ÙËÓ apple·-ÚÔ˘Û›· ÁÏÔȈÙÈÎÔ‡ ÈÛÙÔ‡ ÛÙÔ ÔappleÙÈÎfi Ó‡ÚÔ appleÚÔ Ù˘ıËÏ‹˜. OÈ Brodsky Î·È Û˘Ó. 47 ·Ó·Ê¤ÚÔ˘Ó ‰‡Ô appleÂÚÈappleÙÒÛÂȘ·ÛıÂÓÒÓ Ì ÂÙÂÚfiappleÏ¢ÚÔ Û‡Ó‰ÚÔÌÔmorning glory.ÕÏÏÔÈ fiÁÎÔÈ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹-Ì·ÙÔ˜ appleÔ˘ ÌappleÔÚÔ‡Ó Ó· ·Ó·appleÙ˘¯ıÔ‡Ó Û ·ÛıÂÓ›˜Ì Nπ2 Â›Ó·È Ù· ÁÏÔÈÒÌ·Ù·, Ù· ÂappleÂÓ‰˘ÌÒÌ·Ù· ηÈÙ· ÌËÓÈÁÁÈÒÌ·Ù·.

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ÂÚÈÏ‹„ÂȘ ·applefi ͤӷ appleÂÚÈÔ‰Èο∂appleÈ̤ÏÂÈ·: A. M¿ÓıÔ˜e-mail: amanthos@med.auth.grÚˆÙÔappleÔÚȷ΋ ¯Ú‹ÛË Ù˘ ·ÌÓȷ΋˜ ÌÂÌ‚Ú¿Ó˘ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ù˘ ¤ÎıÂÛ˘ ÙˆÓ ·ÓÙÈÁÏ·˘-Έ̷ÙÈÎÒÓ ‚·Ï‚›‰ˆÓ ÌÂÙ¿ ·applefi Û˘ÚÈÁÁÈÔappleÔÈËÙÈ-Τ˜ ÂappleÂÌ‚¿ÛÂȘ ÁÏ·˘ÎÒÌ·ÙÔ˜G Ainsworth, A Rotchford, H S Dua, A J KingBr J Ophthalm 90: 417-419, 2006.OÈ Û˘ÁÁÚ·Ê›˜ ‰ËÌÔÛÈÂ‡Ô˘Ó Ù· ·appleÔÙÂϤÛÌ·-Ù· Ù˘ appleÚˆÙÔappleÔÚȷ΋˜ ¯Ú‹Û˘ Ù˘ ·ÌÓȷ΋˜ ÌÂÌ-‚Ú¿Ó˘ ÁÈ· ÙËÓ Î¿Ï˘„Ë ÙˆÓ ÂÎÙÂıÂÈÌ¤ÓˆÓ ÁÏ·˘-Έ̷ÙÈÎÒÓ ‚·Ï‚›‰ˆÓ.∞ӷʤÚÔÓÙ·È ÛÙË ÌÂϤÙË ÙÚÈÒÓ ·ÛıÂÓÒÓ appleÔ˘˘apple‚ϋıËÛ·Ó ÛÂ Û˘ÚÈÁÁÈÔappleÔÈËÙÈ΋ Âapple¤Ì‚·ÛËÁÏ·˘ÎÒÌ·ÙÔ˜ Ì ÙË ¯Ú‹ÛË ‚·Ï‚›‰ˆÓ Ahmed. ŸÏÔÈÔÈ apple·Ú·apple¿Óˆ ·ÛıÂÓ›˜ ›¯·Ó ÁÏ·‡ÎˆÌ· ÙÂÏÈÎÔ‡ÛÙ·‰›Ô˘. ∏ ¤ÎıÂÛË ÙˆÓ ‚·Ï‚›‰ˆÓ Ahmed ‹Ù·Ó‰Â˘ÙÂÚÔapple·ı‹˜, ÔÊÂÈÏfiÌÂÓË Û ӤÎÚˆÛË ÙÔ˘ Î·Ï˘appleÙËÚ›Ô˘·ÏÏÔÌÔۯ‡̷ÙÔ˜ appleÂÚÈηډ›Ô˘ Î·È ÙÔ˘˘appleÂÚΛÌÂÓÔ˘ ÂappleÈappleÂÊ˘ÎfiÙ·. ∏ ·appleÔηٿÛÙ·ÛË ÙÔ˘ÂÏÏ›ÌÌ·ÙÔ˜ appleÚ·ÁÌ·ÙÔappleÔÈ‹ıËΠ̠ÙË ¯Ú‹ÛË ‰ÈappleÏ‹˜ÛÙÈ‚¿‰Ô˜ ·ÌÓȷ΋˜ ÌÂÌ‚Ú¿Ó˘, Ì ÙË Ì›· ÛÙÈ-‚¿‰· Ó· ‰Ú· ˆ˜ ÌfiÛ¯Â˘Ì· Î·È ÙË ‰Â‡ÙÂÚË, ÙËÓÂÍÒÙÂÚË, ˆ˜ ‚ÈÔÏÔÁÈÎfi˜ Âapple›‰ÂÛÌÔ˜. ∞˘ÙfiÏÔÁÔ˜ÔÚfi˜ ¯ÚËÛÈÌÔappleÔÈ‹ıËΠÛÙÔ Ù¤ÏÔ˜ Ù˘ Âapple¤Ì‚·Û˘ÁÈ· ÙËÓ ÂappleÈÙ¿¯˘ÓÛË Ù˘ ÂappleÈıËÏÈÔappleÔ›ËÛ˘. fiÏ· Ù· appleÂÚÈÛÙ·ÙÈο ÂappleÈÙ‡¯ıËΠۇÁÎÏÂÈ-ÛË Î·È ÂappleÈıËÏÈÔappleÔ›ËÛË Ù˘ ‚Ï¿‚˘ ÙÔ˘ ÂappleÈappleÂÊ˘Îfi-Ù· Ë ÔappleÔ›· ›¯Â Ì·ÎÚ¿ ‰È¿ÚÎÂÈ·.˘ÌappleÂÚ·ÛÌ·ÙÈο ÔÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Óappleˆ˜ ÔÈ ‰È·‚ÚÒÛÂȘ ÙÔ˘ ÂappleÈappleÂÊ˘ÎfiÙ· appleÔ˘ appleÚÔη-ÏÔ‡ÓÙ·È ·applefi ÙȘ appleÚÔı¤ÛÂȘ ÙˆÓ ÁÏ·˘ÎˆÌ·ÙÈÎÒÓ‚·Ï‚›‰ˆÓ ÛÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÙÔ˘ ÁÏ·˘ÎÒÌ·ÙÔ˜ ÌappleÔ-ÚÔ‡Ó, Û ÔÚÈṲ̂Ó˜ appleÂÚÈappleÙÒÛÂȘ, Ó· ·ÓÙÈÌÂÙˆappleÈ-ÛÙÔ‡Ó ÂappleÈÙ˘¯Ò˜ Ì ÙË ¯Ú‹ÛË ‰ÈappleÏ‹˜ ÛÙÈ‚¿‰·˜ ·-ÌÓȷ΋˜ ÌÂÌ‚Ú¿Ó˘ (¡. ÷ς·Ù˙‹˜).∏ ¯Ú‹ÛË Ù˘ ‚ÈÔ„›·˜ ÏÂappleÙ‹˜ ‚ÂÏfiÓ˘ ÛÙÔ ‰·ÎÙ˘-ÏÈÔÂȉ¤˜ ÌÂϿӈ̷ Ù˘ ›ÚȉԘ.D H Char, A E Kemlitz, T Miller, J B CrawfordBr J Ophthalm 90: 420-422, 2006.ÎÔapplefi˜ ÙˆÓ Û˘ÁÁڷʤˆÓ ·˘Ù‹˜ Ù˘ ÌÂϤÙË˜Â›Ó·È Ó· ηıÔÚÈÛÙ› Ë ‰È·ÁÓˆÛÙÈ΋ ·ÎÚ›‚ÂÈ· Ù˘‚ÈÔ„›·˜ ÏÂappleÙ‹˜ ‚ÂÏfiÓ˘ Û appleÂÚÈappleÙÒÛÂȘ ÌÂÏ·ÓÒ-Ì·ÙÔ˜ Ù˘ ›ÚȉԘ ηıÒ˜ Âapple›Û˘ Î·È Ó· appleÚÔÛ‰ÈÔÚÈ-Ûı› Ë Û¯ÂÙÈ˙fiÌÂÓË Ì ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ fiÁÎÔ ıÓË-ÛÈÌfiÙËÙ·.∏ ÌÂϤÙË appleÂÚÈÏ·Ì‚¿ÓÂÈ 22 ·ÛıÂÓ›˜ Ì ÌÂÏ¿-ӈ̷ Ù˘ ›ÚȉԘ ÙÔ ÔappleÔ›Ô Î·Ù·Ï¿Ì‚·Ó 360 ÌÔ›Ú˜Ù˘ ÁˆÓ›·˜ ÙÔ˘ appleÚÔÛı›Ô˘ ı·Ï¿ÌÔ˘.Δ· ‰·ÎÙ˘ÏÈÔÂȉ‹ ÌÂÏ·ÓÒÌ·Ù· Ù˘ ›Úȉ·˜ ‰È·-ÁÓÒÛÙËÎ·Ó Ì ·ÎÚ›‚ÂÈ· Û fiϘ ÙȘ appleÂÚÈappleÙÒÛÂȘ. 11 ·applefi Ù· 16 appleÂÚÈÛÙ·ÙÈο (69%), fiappleÔ˘ Ë ‚ÈÔ„›·Ù˘ ÏÂappleÙ‹˜ ‚ÂÏfiÓ˘ ¤ÁÈÓ 180 ÌÔ›Ú˜ Ì·ÎÚÈ¿ ·applefiÙËÓ ÎÂÓÙÚÈ΋ Ì¿˙· ÙÔ˘ fiÁÎÔ˘, Ù· ·appleÔÙÂϤÛÌ·Ù·‹Ù·Ó ıÂÙÈο ÁÈ· ‰·ÎÙ˘ÏÈÔÂȉ¤˜ ÌÂϿӈ̷ Ù˘ ›ÚÈ-‰·˜. ∏ Û¯ÂÙÈ˙fiÌÂÓË Ì ÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ fiÁÎÔıÓËÛÈÌfiÙËÙ· ÛÙ· apple·Ú·apple¿Óˆ appleÂÚÈÛÙ·ÙÈο ·ÊÔÚÔ‡-Û 4 ·applefi ÙÔ˘˜ 22 ·ÛıÂÓ›˜ (‰ËÏ·‰‹ ÙÔ 18%). ∏ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÂappleÈ‚›ˆÛ˘ ηٿ Kaplan-Meier ¤‰ÂÈÍ ıÓËÛÈÌfiÙËÙ· ̤۷ ÛÙË ‰ÂηÂÙ›· ÛÙÔ15% ÙˆÓ ·ÛıÂÓÒÓ.˘ÌappleÂÚ·ÛÌ·ÙÈο Ë ‚ÈÔ„›· ÏÂappleÙ‹˜ ‚ÂÏfiÓ˘ÌappleÔÚ› Ó· ¯ÚËÛÈÌÔappleÔÈËı› ÛÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‰·-ÎÙ˘ÏÈÔÂȉԇ˜ ÌÂÏ·ÓÒÌ·ÙÔ˜ Ù˘ ›Úȉ·˜ ÂÓÒ ÙÔ Û˘-ÁÎÂÎÚÈ̤ÓÔ ÓÂfiappleÏ·ÛÌ· ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ‚·ıÌfiıÓËÛÈÌfiÙËÙ·˜ Û ۯ¤ÛË Ì ¿ÏÏÔ˘˜ ÙÔappleÈο ÂÎÙÂÈÓfi-ÌÂÓÔ˘˜ fiÁÎÔ˘˜ (¡. ÷ς·Ù˙‹˜).ÃÚfiÓÈ· ·appleÔÙÂϤÛÌ·Ù· Ù˘ ¤ÓıÂÛ˘ ÛˆÏËÓ·Ú›ˆÓÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ù˘ ÚÈÓÔ‰·ÎÚ˘˚΋˜ ÛÙ¤ÓˆÛ˘ÛÙÔ˘˜ ÂÓ‹ÏÈΘ.P P Connell, T P Fulcher, E Chacko, M J O’ Connor,P MoriartyBr J Ophthalm 90: 435-436, 2006.OÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ‹‰Ë ‰ËÌÔÛȇÛÂÈ Ù··appleÔÙÂϤÛÌ·Ù· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ Âapple·ÓÂϤÁ¯ˆÓ,̤ÛÔ˘ fiÚÔ˘ 15 ÌËÓÒÓ, Û ·ÛıÂÓ›˜ Ì ¤ÓıÂÛË ÚÈ-ÓÔ‰·ÎÚ˘˚ÎÒÓ ÛˆÏËÓ·Ú›ˆÓ. ∏ ·appleÔÙÂÏÂÛÌ·ÙÈÎfiÙË-Ù· ·˘Ù‹˜ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÌÂıfi‰Ô˘ ÁÈ· ÙÔÓ ¤ÏÂÁ¯ÔÙ˘ ÂappleÈÊÔÚ¿˜ ÌÂÏÂÙ¿Ù·È Û ̷ÎÚÔ¯ÚfiÓÈ· ‚¿ÛË(̤ÛÔ˜ fiÚÔ˜ Âapple·ÓÂϤÁ¯ˆÓ 78 Ì‹Ó˜).ªÂÏÂÙ‹ıËÎ·Ó 40 ·ÛıÂÓ›˜, 65 ÔÊı·ÏÌÔ›, ÔÈÔappleÔ›ÔÈ ˘apple‚ϋıËÛ·Ó Û ÚÈÓÔ‰·ÎÚ˘˚΋ ‰È·ÛˆÏ‹-ÓˆÛË Ì ̤ÛÔ fiÚÔ ËÏÈΛ·˜ Ù· 59,2 ¤ÙË. O ̤ÛÔ˜fiÚÔ˜ Ù˘ ‰È¿ÚÎÂÈ·˜ ÙˆÓ Âapple·ÓÂϤÁ¯ˆÓ ‹Ù·Ó 6,2 ¤ÙË.Δ· ·appleÔÙÂϤÛÌ·Ù· ‚·Û›ÛÙËÎ·Ó ÛÙË Ì·ÎÚÔ¯ÚfiÓÈ·‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìappleو̿وÓ.Ï‹Ú˘, Ì·ÎÚÔ¯ÚfiÓÈ· ¿ÚÛË ÙˆÓ Û˘Ìappleو̿-ÙˆÓ Î·Ù·ÁÚ¿ÊËΠÛÙÔ 50,7% ÙˆÓ ·ÛıÂÓÒÓ. ªÂÚÈ-΋ ‚ÂÏÙ›ˆÛË apple·Ú·ÙËÚ‹ıËΠÛÙÔ 38,5%, ÂÓÒ ‰ÂOÊı·ÏÌoÏoÁ›·, 18, 2 : 193 - 195, 2006

194 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)‰È·appleÈÛÙÒıËΠ‚ÂÏÙ›ˆÛË ÛÙÔ 10,7% ÙˆÓ ·ÛıÂÓÒÓ.∫·Ï‡ÙÂÚ· ·appleÔÙÂϤÛÌ·Ù· apple·Ú·ÙËÚ‹ıËÎ·Ó Î˘Ú›ˆ˜Û appleÂÚÈappleÙÒÛÂȘ ÛÙ¤ÓˆÛ˘ ηٿ Ì‹ÎÔ˜ ÙˆÓ ‰·ÎÚ˘˚-ÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Î·È ÏÈÁfiÙÂÚÔ Û ÛÙÂÓÒÛÂȘ appleÔ˘ÂÓÙÔapple›˙ÔÓÙ·È ÛÙÔ ÚÈÓÔ‰·ÎÚ˘˚Îfi applefiÚÔ. ÙÔ˘˜ Ì·-ÎÚÔ¯ÚfiÓÈÔ˘˜ Âapple·ÓÂϤÁ¯Ô˘˜ ÙÔ 16,9% ÙˆÓ ·ÛıÂÓÒÓ¯ÚÂÈ¿ÛÙËΠ‰·ÎÚ˘Ô·ÛÎÔÚÚÈÓÔÛÙÔÌ›·.∏ ‰È·ÛˆÏ‹ÓˆÛË ÙÔ˘ ÚÈÓÔ‰·ÎÚ˘˚ÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜ Â›Ó·È Ì›· ÂÏ¿¯ÈÛÙ· ÂappleÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ appleÔ˘Ê·›ÓÂÙ·È Ó· Â›Ó·È ÂappleÈÙ˘¯‹˜ ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÂappleÈÊÔ-Ú¿˜ Û ̷ÎÚÔ¯ÚfiÓÈ· ‚¿ÛË. ·Ú’ fiÏ· ·˘Ù¿, Ë ÂappleÈ-ÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ Ì ΢ڛˆ˜ ÛˆÏËÓ·Úȷ΋ ·applefi-ÊÚ·ÍË ‰›ÓÂÈ appleÈÔ ÂappleÈÙ˘¯‹ ·appleÔÙÂϤÛÌ·Ù·, Ì ÏÈÁfiÙÂ-ÚÔ˘˜ ·ÛıÂÓ›˜ Ó· ·apple·ÈÙÔ‡Ó ÌÂÏÏÔÓÙÈο Âapple¤Ì‚·Ûˉ·ÎÚ˘Ô·ÛÎÔÚÚÈÓÔÛÙÔÌ›·˜ ÁÈ· ÙË Ï‡ÛË ÙÔ˘ appleÚÔ-‚Ï‹Ì·Ùfi˜ ÙÔ˘˜ (¡. ÷ς·Ù˙‹˜).μÂÏÙÈÛÙÔappleÔ›ËÛË Ù˘ ÂÎÙ¤ÏÂÛ˘ ·˘ÙfiÌ·Ù˘ appleÂÚÈ-ÌÂÙÚ›·˜ Û ·ÛıÂÓ›˜ appleÔ˘ «ÂÎÙ›ıÂÓÙ·È» Û ÌÔ˘ÛÈ-΋ ÙÔ˘ ªfiÙÛ·ÚÙV Macedo Batista Fiorelli, N Kasahara, R Cohen,A Suntucci Franca, M Della Paolera, C Mandia Jr,G Vicente de AlmeidaBr J Ophthalmol 90: 543-545, 2006.ÎÔapplefi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ÂÎÙ›ÌËÛË Ù˘ ·applefi-‰ÔÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ‰È¿ÚÎÂÈ· ÂÎÙ¤ÏÂÛ˘ ·˘Ùfi-Ì·Ù˘ appleÂÚÈÌÂÙÚ›·˜ fiÙ·Ó Û˘Á¯ÚfiÓˆ˜ ·ÎÔ‡Ó ÌÔ˘ÛÈ-΋ ÙÔ˘ ªfiÙÛ·ÚÙ.˘ÓÔÏÈο ÌÂÏÂÙ‹ıËÎ·Ó 60 ·ÛıÂÓ›˜ ÔÈ ÔappleÔ›ÔÈÂÎÙÂÏÔ‡Û·Ó ÁÈ· appleÚÒÙË ÊÔÚ¿ ·˘ÙfiÌ·ÙË appleÂÚÈÌÂÙÚ›·(SITA 24-2). 30 ·applefi ·˘ÙÔ‡˜ (ÔÌ¿‰· ÌÂϤÙ˘) ˘appleÂ-‚Ï‹ıËÛ·Ó Û ·˘ÙfiÌ·ÙË appleÂÚÈÌÂÙÚ›· ˘applefi ÙÔ˘˜ ‹¯Ô˘˜Ù˘ ÛÔÓ¿Ù·˜ ÙÔ˘ ªfiÙÛ·ÚÙ ÁÈ· ‰‡Ô appleÈ¿Ó·, ÂÓÒ ÔÈ˘applefiÏÔÈappleÔÈ 30 (ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ) ‰ÂÓ ¿ÎÔ˘Û·Ó Î·-ÌÈ¿ ÌÔ˘ÛÈ΋.∏ ÔÌ¿‰· ÌÂϤÙ˘ ›¯Â ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚ·Ï¿ıË appleÚÔۋψÛ˘, „¢‰Ò˜ ıÂÙÈο ηıÒ˜ Î·È „¢-‰Ò˜ ·ÚÓËÙÈο Ï¿ıË Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· Ì·Ú-Ù‡ÚˆÓ (p

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OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006) 197˘Ó¤‰ÚÈ· ÂÛˆÙÂÚÈÎÔ‡7-11 πÔ˘Ó›Ô˘ 200639 Ô ·ÓÂÏÏ‹ÓÈÔ OÊı·ÏÌÔÏÔÁÈÎfi ˘Ó¤‰ÚÈÔ£ÂÛÛ·ÏÔÓ›ÎË •ÂÓÔ‰Ô¯Â›Ô Hyatt Regency.ΔËÏ:. 210 3232433Fax: 210 3232338Web www.citycongress.comWeb www.oebe.gr1-2 ¢ÂÎÂÌ‚Ú›Ô˘ 20063 Ô ˘Ó¤‰ÚÈÔ ·ÓÂÏÏ‹ÓÈ·˜ ∂Ù·ÈÚ›·˜ πÛÙÔÚ›·˜ Ù˘π·ÙÚÈ΋˜∫¤ÓÙÚÔ πÛÙÔÚ›·˜ £ÂÛÛ·ÏÔӛ΢ÏËÚÔÊÔڛ˜: ∂. ÃÚÈÛÙÔappleÔ‡ÏÔ˘-∞ÏÂÙÚ¿ΔËÏ. 2310 999136Fax: 2310 999139E-mail: ealetra@med.auth.grealetra@hotmail.com1-6 πÔ˘Ï›Ô˘ 2006Aegean Summer School in Visual Optics·ÓÂappleÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ΔËÏ: 2810 394654Fax: 2810 394653E-mail: Aegean@med.uoc.grWeb: www.ivo.gr/summerschool.gr12-13 π·ÓÔ˘·Ú›Ô˘ 20072 Ô ·ÓÂÏÏ‹ÓÈÔ ˘Ó¤‰ÚÈÔÀ·ÏÔÂȉԇ˜ – ∞ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜•ÂÓÔ‰Ô¯Â›Ô HiltonÏËÚÔÊÔڛ˜: Î. ·appleapple¿ΔËÏ. 6978625095, 26510 97528Fax: 26510 22944E-mail: pappamaria@in.gr7-9 πÔ˘Ï›Ô˘ 2006Aegean Cornea VIII meetingContact: University of Crete·ÓÂappleÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ΔËÏ: 2810 394654Fax: 2810 394653E-mail: Aegean@med.uoc.grWeb: www.AegeanCornea.gr13-14 OÎÙˆ‚Ú›Ô˘ 20064 Ô ˘Ó¤‰ÚÈÔ OÊı·ÏÌÈÎÒÓ ºÏÂÁÌÔÓÒÓ Î·È §ÔÈÌÒ-͈Ó÷ÓÈ¿ ∫Ú‹Ù˘•ÂÓÔ‰Ô¯Â›Ô Minoan PalaceÏËÚÔÊÔڛ˜: Aktina City CongressΔËÏ. 210 3232433˘Ó¤‰ÚÈ· Â͈ÙÂÚÈÎÔ‡9-13 ÂappleÙÂÌ‚Ú›Ô˘ 2006LONDON, UKXIV Congress of the ESCRSTel: +353 1 209 1 100 / Fax: +353 1 209 1112E-mail: escrs@ageanda-comm.ieWeb: www.escrs.org11-14 ¡ÔÂÌ‚Ú›Ô˘ 2006LAS VEGAS, USAAmerican Academy of OphthalmologyWeb: www.aao.org

198 OÊı·ÏÌÔÏÔÁ›·, 18, 2 (2006)10-13 ¡ÔÂÌ‚Ú›Ô˘ 2007NEW ORLEANS,LA,USAAmerican Academy of OphthalmologyContact: ASCRSTel: +1 415 561 8500 Ext 304 / Fax: +1 415 561 8583Web: www.aao.org13-17 ÂappleÙÂÌ‚Ú›Ô˘ 2008BERLIN, GERMANYXXVI Congress of the ESCRSTel: +353 1 209 1100 / Fax: +353 1 209 1112E-mail: eccrs@agenda-comm.ieWeb: www.escrs.org12-16 ∞appleÚÈÏ›Ô˘ 2008CHICAGO, IL, USAASCRS/ASOA Symposium and CongressContact: ASCRSTel: +1 703 591 2220 / Fax: +1 703 591 0614Web: www.ascrs.org