1
|
Freitas-da-Costa P, Falcão-Reis F, Magalhães A. Trends and patterns in pediatric ophthalmology and strabismus surgeries: a decade review from a leading Portuguese university hospital. Strabismus 2024:1-9. [PMID: 38380608 DOI: 10.1080/09273972.2024.2317221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE Strabismus and Pediatrics Ophthalmology surgeries are pivotal in addressing early-onset visual disorders. An 11-year retrospective study at a tertiary hospital center aimed to elucidate evolving surgical trends, focusing on esotropia cases. METHODS The surgical records from January 2009 to January 2020 were analyzed according to the baseline diagnosis. Esotropia cases were evaluated based on the patients' deviation types, surgical techniques, and pre-operative characteristics. A total of 2050 surgeries were performed over the study period. RESULTS Strabismus surgery accounts for 70% of the department's surgical activity. A trend toward a decrease in esotropia surgeries and a proportional increase in exotropia surgeries was noticeable. Esotropia cases, with a median surgical age of 6 years (p25-p75, 4-10) and uniform gender distribution (females, 54.8%), predominantly involved high angular deviations. Posterior fixation sutures emerged as the preferred surgical technique for esotropia. CONCLUSION The study's insights, while aligning with prior European research, introduce new dimensions to the understanding of strabismus surgeries, emphasizing the significance of early interventions, evolving surgical preferences, and the challenges posed by severe deviations.
Collapse
Affiliation(s)
- Paulo Freitas-da-Costa
- Department of Ophthalmology, São João University Hospital Center, Porto
- Department of Surgery and Physiology. Faculty of Medicine, University of Porto, Porto
- Anatomy Unit, Department of Biomedicine. Faculty of Medicine, University of Porto, Porto
| | - Fernando Falcão-Reis
- Department of Ophthalmology, São João University Hospital Center, Porto
- Department of Surgery and Physiology. Faculty of Medicine, University of Porto, Porto
| | - Augusto Magalhães
- Department of Ophthalmology, São João University Hospital Center, Porto
| |
Collapse
|
2
|
Moleiro AF, Oliveira JS, Grangeia A, Faria P, Falcão-Reis F, Magalhães A, Silva SE. Ocular severe involvement in oculofaciocardiodental syndrome: Description of a case series. Eur J Ophthalmol 2024; 34:NP6-NP11. [PMID: 37157789 DOI: 10.1177/11206721231170406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Oculofaciocardiodental (OFCD) syndrome is a rare genetic disorder affecting ocular, facial, dental, and cardiac systems, being an X-linked condition caused by pathogenic variants in the BCL-6 corepressor gene (BCOR). We report a case series of three female patients with OFCD syndrome with severe glaucoma. RESULTS Three female patients with OFCD syndrome with different variants involving BCOR gene, in heterozygosity: a seven-years-old girl with an insertion (c.2037_2038dupCT), a nine years-old girl with a microdeletion in the X (p21.2-p11.4)) spanning the BCOR gene; and a 25 years-old female with a deletion (c.3858_3859del). Systemic involvement is variable among patients ranging from one patient mainly with ocular and dental involvement to one with associated intra-auricular and intra-ventricular defects. All the patients presented with congenital cataracts diagnosed in the first days of life. Cataract surgery was performed without incidents between 6 and 16 weeks of age in all the patients. Postoperatively, the three patients developed ocular hypertension and glaucoma with the need for surgical interventions, including trabeculectomy, Ahmed valve implantation, and cyclophotocoagulation. CONCLUSION OFCD syndrome characterizes by a severe ocular involvement with glaucoma as a characteristic feature. Ocular hypertension after cataract surgery in these patients is challenging, almost always needing surgery during childhood. Therefore, we consider BCOR disruption may predispose to a higher incidence of glaucoma due to its aggressiveness and early onset on our case series. The awareness of these complications is crucial to an adequate follow-up of the patients.
Collapse
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, São João Hospital University Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | | | - Ana Grangeia
- Department of Medical Genetics, São João Hospital University Center, Porto, Portugal
- Department of Genetics, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Pedro Faria
- Department of Ophthalmology, São João Hospital University Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, São João Hospital University Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, São João Hospital University Center, Porto, Portugal
| | - Sérgio Estrela Silva
- Department of Ophthalmology, São João Hospital University Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Freitas-da-Costa P, Alves H, Santos-Silva R, Falcão-Reis F, Breda J, Magalhães A. What to expect from primary inferior oblique overaction after esotropia surgery : Primary inferior oblique overaction in esotropia. BMC Ophthalmol 2023; 23:512. [PMID: 38102543 PMCID: PMC10722715 DOI: 10.1186/s12886-023-03256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Overelevation in adduction is common in patients with primary esotropia. This study evaluates the variation in ocular motility pattern in patients with primary inferior oblique (IO) muscle overaction after esotropia surgery. METHODS The medical records of consecutive patients who underwent surgery for infantile, partially accommodative, and basic esotropia over eleven years and had at least one year of follow-up were reviewed. Patients with primary inferior oblique muscle overaction (IOOA) presented at baseline or during follow-up were selected and divided according to the first surgery performed concurrently with horizontal rectus surgery: without IO recession (NO-recess), with unilateral IO recession (UNIL-recess), and with bilateral IO recession (BIL-recess). The success (version normalisation or at least 2 points upgrade in severity scale [0-4] in the operated eye), recurrence rates, and the evolution of the non-operated IO muscles were evaluated. RESULTS One hundred and ten patients were included - 53 NO-recess, 26 UNIL-recess, and 31 BIL-recess. Medial rectus muscle posterior fixation sutures surgery (PFS) was performed in 88.2% of patients for esotropia. A recession with graded anterior transposition was the weakening IO procedure. In the NO-recess group, 28 (52.8%) patients normalised their mild IOOA after PFS surgery alone. In the UNI-recess group, the success rate was 88.5%, with 16 (61.5%) patients showing worsened IO muscle of the fellow eye, which prompted additional surgery in 10 patients. In the BIL-recess group, all 31 patients improved the adduction pattern of the operated eye for an 80.6% success rate (6 improved marginally). CONCLUSION Graded anterior transposition of the inferior oblique muscle effectively normalises versions. However, it's frequent for a contralateral overaction to become manifest after unilateral IO surgery.
Collapse
Affiliation(s)
- Paulo Freitas-da-Costa
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal.
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
- Anatomy Unit, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.
| | - Hélio Alves
- Anatomy Unit, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Renato Santos-Silva
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Breda
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
| |
Collapse
|
4
|
Freitas-da-Costa P, Alves H, Santos-Silva R, Falcão-Reis F, Breda J, Magalhães A. Revisiting Posterior Fixation Sutures Surgery: Unveiling Novel Approaches for Primary Management of Diverse Esotropia Cases. Ophthalmol Ther 2023; 12:2989-2999. [PMID: 37589933 PMCID: PMC10640408 DOI: 10.1007/s40123-023-00792-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Strabismus, specifically esotropia, presents a significant challenge in ophthalmic surgery, while several treatment options exist. This study aims to evaluate the results of posterior fixation sutures (PFS) on the medial rectus as a primary approach for some types of esotropia. METHODS The medical records of consecutive patients who underwent surgery for esotropia over 11 years and had at least 1 year of follow-up were reviewed retrospectively. Patients were classified into one of three types of deviation: infantile (IE), partially accommodative (PAE) and basic (BE) esotropias. An alignment within 16 prism diopters (PD) of orthotropia was a successful outcome. RESULTS A total of 404 patients were included: 67 IE, 180 PAE and 157 BE. Before surgery, a deviation greater than 30 PD was present in 88.1% and 80.1%, and a deviation greater than 50 PD was present in 66.5% and 52.9% of patients (near and distance, respectively). In the BE group, PFS was the baseline surgery in a smaller number of cases (75%) compared to the other two groups (versus 86.6% [IE] and 88.3% [PAE], p = 0.002). The need for an additional procedure was significantly higher in the infantile esotropia group (44.8% vs. 18.9% and 24.8%, p < 0.001). Final surgical success was achieved in 95.3% of all patients. Orthotropia was achieved in 19.4% (IE), 29.6% (PAE) and 25.5% (BE) of cases. CONCLUSION PFS of the medial rectus without recession proved successful as a first-line procedure for esotropia in the subtypes of patients evaluated in this study.
Collapse
Affiliation(s)
- Paulo Freitas-da-Costa
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal.
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Hélio Alves
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Renato Santos-Silva
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Breda
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
| |
Collapse
|
5
|
Ribeiro M, Barbosa-Breda J, Gonçalves F, Faria Pereira A, Falcão-Reis F, Alves F, E Silva S, B Melo A. [Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study]. ACTA MEDICA PORT 2023; 36:698-705. [PMID: 36929920 DOI: 10.20344/amp.19170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy. MATERIAL AND METHODS Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy. RESULTS Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001). CONCLUSION Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.
Collapse
Affiliation(s)
- Margarida Ribeiro
- Ophthalmology. Centro Hospitalar e Universitário de São João. Porto; Biomedicine Department. Unit of Farmacology and Therapeutics. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - João Barbosa-Breda
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; UnIC@RISE. Departmento of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal; KU Leuven. Research Group Ophthalmology. Department of Neurosciences. Leuven. Belgium
| | | | - Ana Faria Pereira
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - Flávio Alves
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Sérgio E Silva
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - António B Melo
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| |
Collapse
|
6
|
Pinheiro-Costa J, Ribeiro M, Moura R, Madeira D, Falcão-Reis F, Carneiro Â. Macular parameters with and without scleral contact lens in keratoconus using Spectralis optical coherence tomography. Clin Exp Optom 2023; 106:930-932. [PMID: 37914535 DOI: 10.1080/08164622.2022.2131376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Biomedicine, University of Porto, Porto, Portugal
| | - Margarida Ribeiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rodolfo Moura
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Dulce Madeira
- Department of Biomedicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, University of Porto, Porto, Portugal
| |
Collapse
|
7
|
Pinheiro-Costa J, Lima Fontes M, Luís C, Martins S, Soares R, Madeira D, Falcão-Reis F, Carneiro Â. Serum inflammatory biomarkers are associated with increased choroidal thickness in keratoconus. Sci Rep 2023; 13:10862. [PMID: 37407658 DOI: 10.1038/s41598-023-37472-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Inflammation may play a significant role in Keratoconus (KC), but the relationship between inflammatory markers and choroidal thickness (CT) is unknown. The purpose of this study was to evaluate serum inflammatory markers and correlate them with the choroidal profile of KC patients and control subjects. Forty patients with KC and 26 age-matched control subjects were enrolled in a cross-sectional case-control study. Choroidal profile was studied with a Spectralis Heidelberg apparatus and venous blood samples were collected. Neutrophil/lymphocyte ratio (NLR), monocyte/HDL ratio (MHR), platelet/lymphocyte ratio (PLR) and systemic immune inflammation index (SII) were calculated. Serum inflammatory biomarkers IL-1, IL-6 and TNF-alfa were also analyzed. KC group presented thicker choroids in each evaluated point when compared to the control group (subfoveal CT 417.38 ± 79.79 vs 299.61 ± 76.13, p < 0.001 for all measured locations). Mean values of NLR, PLR and SII were significantly higher in patients with KC (NLR p = 0.001; PLR p = 0.042; SII p = 0.007). Although KC patients presented higher mean levels of MHR, IL-1, IL-6 and TNF-α than control group, no significant differences were achieved. Positive correlations were found between subfoveal CT and NLR and SII (0.408, p = 0.001 and 0.288, p = 0.019 respectively). The results presented are in favor of a relationship between the increased CT and inflammatory mechanisms in KC patients. The elevated serum inflammatory indices NLR, SII and PLR provide additional evidence of a role for systemic inflammation in the pathophysiology of KC.
Collapse
Affiliation(s)
- João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Mário Lima Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Carla Luís
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- i3S - Institute of Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Sandra Martins
- Department of Clinical Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - Raquel Soares
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- i3S - Institute of Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Dulce Madeira
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
8
|
Vilares Morgado R, Moura R, Moreira R, Falcão-Reis F, Pinheiro-Costa J. New Promising Therapeutic Approach for Refractory Corneal Epithelial Defects. Cureus 2023; 15:e39324. [PMID: 37351246 PMCID: PMC10283014 DOI: 10.7759/cureus.39324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
The purpose of this case report is to describe a case of continuous wear of a gas-permeable mini-scleral contact lens with a fluid reservoir of autologous serum (AS) combined with AS drops as a successful empirical and accessible alternative therapeutic option for refractory persistent epithelial defects in a patient with severe neurotrophic keratopathy (NK) due to severe dry eye disease and chronic contact lens wear. A 61-year-old Caucasian female with bilateral NK presented a history of multiple episodes of bilateral persistent epithelial defects, having already been submitted to three tectonic-penetrating keratoplasties in her left eye (OS). In May 2017, the patient developed de novo refractory central neurotrophic ulcers in both eyes (OU), unresponsive to conventional treatment with preservative-free lubricants, topical antibiotics, topical anti-inflammatory agents, and oral doxycycline. By March 2018, after initiating hourly AS eyedrops, the ulcer in her right eye (OD) improved to a smaller ulcer, while her OS presented complete graft re-epithelialization. In May 2018, her OD neurotrophic ulcer was complicated with fungal and subsequent bacterial secondary infection. Eventually, a therapeutic penetrant keratoplasty was required for her OD. Subsequently, her OD graft developed a de novo 6x6mm central persistent epithelial defect unresponsive to all the aforementioned therapeutic strategies. After months of unsuccessful treatment, a new therapeutic option was experimented with: a gas-permeable mini-scleral contact lens in combination with AS eyedrops. After two weeks of this treatment regimen, the corneal epithelium eventually started to regenerate, and four weeks later, the cornea was completely re-epithelized. To date, there are no signs of recurrence of the corneal epithelial defect/ulcer.
Collapse
Affiliation(s)
| | - Rodolfo Moura
- Department of Ophthalmology, São João Universitary Hospital Center, Porto, PRT
| | - Raúl Moreira
- Department of Ophthalmology, São João Universitary Hospital Center, Porto, PRT
| | | | - João Pinheiro-Costa
- Department of Ophthalmology, São João Universitary Hospital Center, Porto, PRT
| |
Collapse
|
9
|
Ribeiro M, Oliveira J, Meira J, Soares-Dos-Reis R, Silva ML, Albuquerque L, Falcão-Reis F, Barbosa-Breda J. When a Red Eye Is a Red Flag: A Nontraumatic Case of a Direct Carotid-Cavernous Fistula. J Neuroophthalmol 2023:00041327-990000000-00327. [PMID: 37078899 DOI: 10.1097/wno.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Margarida Ribeiro
- Department of Ophthalmology (MR, JO, JM, FF-R, JB-B), Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Biomedicine (MR), Unit of Pharmacology and Therapeutics, Faculty of Medicine of Porto University, Porto, Portugal; Department of Neurology (RS-d-R), Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health (RS-d-R), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Neuroradiology (MLS, LA), Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Surgery and Physiology (FF-R), Faculty of Medicine of Porto University, Porto, Portugal; UnIC@RISE (JB-B), Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal; and KU Leuven (JB-B), Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Moleiro AF, Vilares-Morgado R, Falcão-Reis F, Torres-Costa S. When the picture masks the diagnosis - an atypical and severe giant cell arteritis case report. Retin Cases Brief Rep 2023:01271216-990000000-00143. [PMID: 36989505 DOI: 10.1097/icb.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
PURPOSE To describe an atypical and severe case of Giant Cell Arteritis (GCA). METHODS Case report description. RESULTS We report the case of a 76-year-old male who presented with severe and progressive bilateral visual loss. Upon presentation at the ophthalmology emergency room, the patient's right eye (OD) displayed aqueous flare, hyphema, rubeosis iridis, and dense posterior capsular opacification. After YAG laser capsulotomy, vitreous densifications, intraretinal hemorrhages, cotton wool spots, retinal ischemia and vasculitis were observed in the fundoscopy. The patient's left eye (OS) also presented intraretinal hemorrhages and cotton wool spots around the temporal arcades. The diagnostic workup excluded infectious diseases, demyelinating diseases, and ocular ischemic syndrome due to carotid obstruction. Proteinogram revealed a monoclonal gammopathy, suggesting a possible hematologic condition. High-dose corticotherapy was initiated, which improved the vitreous densifications and enabled the visualization of a OD pale optic disc. The remaining study did not confirm the diagnosis of hematologic disease. During follow-up, bilateral visual acuity deteriorated, with development of progressive pallor in the OS optic disc. Follow-up fluorescein angiography demonstrated progressive retinal and choroidal ischemia. Finally, due to high clinical suspicion, temporal artery doppler ultrasound was performed, confirming the diagnosis of GCA. CONCLUSION GCA may present multiple ocular features. The knowledge of these different presentations, including retinal and choroidal ischemia or uveitis, is critical for timely diagnosis and treatment initiation. Since patients with GCA often present with vision loss, ophthalmologists may be the first medical doctors that contact with these patients, being on the frontline of GCA diagnosis.
Collapse
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Sónia Torres-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| |
Collapse
|
11
|
Lima-Fontes M, Martinho-Dias D, Leuzinger-Dias M, Cunha AM, Neves Cardoso P, Torrão L, Moreira R, Falcão-Reis F, Pinheiro-Costa J. Microbiological Profile of Infectious Keratitis During Covid-19 Pandemic. Clin Ophthalmol 2023; 17:535-543. [PMID: 36798798 PMCID: PMC9926925 DOI: 10.2147/opth.s395877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/21/2022] [Indexed: 02/11/2023] Open
Abstract
Purpose The Covid-19 pandemic introduced significant changes in our daily life, including the widespread use of face masks. The purpose of this study was to assess if significant changes occurred in the microbiological profile of infectious keratitis. Patients and Methods A retrospective study was performed, based on a survey review of the electronic medical records of all patients with presumed infectious keratitis, between March 2020 and October 2021. The microbiological isolates in this sample (pandemic group) were compared with those obtained in our center between 2009 and 2018 (pre-pandemic group). Results A total of 194 samples were included in the pandemic group. We obtained a culture-positivity rate of 43.3%, which was significantly higher when compared with the pre-pandemic data (35.15%, p = 0.033). Several further significant differences were found between the pandemic and the pre-pandemic groups: the proportion of bacteria, including gram-positive and gram-negative groups, was higher in our sample (pre-pandemic vs pandemic: 76.78% vs 83.33%, p = 0.010; 53.35% vs 60.71%, p = 0.016; 23.43% vs 34.52%, p = 0.005, respectively); two populations of Gram-positive bacteria found in this study were not isolated in the pre-pandemic sample - Dolosigranulum pigrum and Propionibacterium spp.; and two bacterial isolates were significantly increased in our sample - Corynebacterium spp. (18.41% vs 29.76%, p = 0.003) and Pseudomonas aeruginosa (9.00% vs 16.66%, p = 0.012). Conclusion In conclusion, significant changes were found in the microbiological profile of infectious keratitis in our center during the Covid-19 pandemic. While these changes could be related to face mask use, more observational and experimental studies are needed to explore this possible association.
Collapse
Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal,Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, University of Porto Faculty of Medicine, Porto, 4050-313, Portugal,CINTESIS – Center for Health Technology and Services Research, University of Porto, Porto, 4050-313, Portugal,Family Health Unit Ao encontro da Saúde, ACES Santo Tirso-Trofa, Trofa, 4745-559, Portugal
| | - Mariana Leuzinger-Dias
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Pedro Neves Cardoso
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal
| |
Collapse
|
12
|
Lima-Fontes M, Leuzinger-Dias M, Barros-Pereira R, Fernandes V, Falcão M, Falcão-Reis F, Rocha-Sousa A, Alves-Faria P. Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19 mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy. Ophthalmol Ther 2023; 12:377-388. [PMID: 36417092 PMCID: PMC9834446 DOI: 10.1007/s40123-022-00613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2 μg/day; ILUVIEN®) in the treatment of refractory PCME after successful PPV. METHODS This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitário de São João, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300 μm or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. RESULTS Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5 months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6 μm, and IOP was 15.4 ± 2.4 mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2 μm in CMT. During follow-up (44.0 ± 14.8 months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28 months, respectively. The maximum IOP registered was 17.0 ± 6.0 mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. CONCLUSION FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.
Collapse
Affiliation(s)
- Mário Lima-Fontes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Leuzinger-Dias
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ricardo Barros-Pereira
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Vítor Fernandes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Falcão
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Alves-Faria
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
13
|
Lima-Fontes M, Leuzinger-Dias M, Rodrigues R, Barros-Pereira R, Falcão M, Fernandes V, Alves-Faria P, Falcão-Reis F, Rocha-Sousa A. Terson Syndrome - Clinical Presentation, Management, and Visual Outcomes in a Tertiary Centre. Clin Ophthalmol 2023; 17:351-359. [PMID: 36721665 PMCID: PMC9884450 DOI: 10.2147/opth.s396781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Purpose The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal. Patients and Methods A single-centre retrospective study was performed, based on the survey review of the medical records of every consecutive patient diagnosed with Terson syndrome and followed from January 2018 to August 2021. The change in best-corrected visual acuity (BCVA) from baseline to the final evaluation was the primary outcome. Results Fifteen eyes from 8 patients (50% female) were included. The mean age at diagnosis was 55±7 years. The neurological event was traumatic brain injury in 37.5% (n=3) and subarachnoid haemorrhage in 62.5% of the patients (n=5). Bilateral intraocular haemorrhage occurred in 875% (n=7) of the patients. Vitreous and preretinal haemorrhages occurred each in 66.7% (n=10), intraretinal in 30% (n=3) and subretinal in 13.3% (n=2) of the eyes. In 40% of the eyes (n=6), spontaneous resolution of intraocular haemorrhage occurred, while PPV was performed in the remaining 60% (n=9). Ocular haemorrhage detection occurred 58.47 ± 40.94 days after the neurological event (range 11 to 121 days). Baseline BCVA was 1.11 ± 1.01 logMAR and improved to 0.32 ± 0.69 logMAR in the follow-up period (p=0.004). A positive correlation was found between initial and final BCVA (Spearman's rho = 0.643, p=0.01). Baseline BCVA of eyes undergoing PPV was lower than of those conservatively managed (1.84±0.72 vs 0.20±0.28 logMAR, p<0.001). However, there were no statistically significant differences in final BCVA after surgery or observation (0.56 ± 0.90 vs 0.04 ± 0.04 logMAR, p=0.149). Longer periods between the neurological and the ophthalmological diagnosis were correlated with worse final BCVA (Spearman's rho = 0.688, p=0.005). Conclusion Terson syndrome is a potential cause of irreversible visual loss. Diagnosis delay may affect visual prognosis. PPV is indicated when intraocular haemorrhage is dense and does not resolve spontaneously or when visual acuity at presentation is low, allowing for good visual outcomes with minimal complications.
Collapse
Affiliation(s)
- Mario Lima-Fontes
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Correspondence: Mario Lima-Fontes, Department of Ophthalmology, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | - Mariana Leuzinger-Dias
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Rita Rodrigues
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Ricardo Barros-Pereira
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Manuel Falcão
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| | - Vítor Fernandes
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Pedro Alves-Faria
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| |
Collapse
|
14
|
Pinheiro-Costa J, Coelho-Costa I, Falcão-Reis F, Monteiro T, Falcão M. Two-Step Iridocorneal Endothelial Syndrome Management: Endocapsular Intraocular Lens and Artificial Iris Followed by Descemet's Stripping Automated Endothelial Keratoplasty. Case Rep Ophthalmol 2023; 14:583-590. [PMID: 37915518 PMCID: PMC10616668 DOI: 10.1159/000534277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023] Open
Abstract
A 54-year-old female presented with complaints of glare and progressive visual loss OS with a corrected distance visual acuity (CDVA) OS of 20/100. The patient had grade 1 corneal edema with a "beaten bronze" appearance on specularly reflected light, pseudopolycoria, and a nuclear sclerotic cataract. The diagnosis of nuclear cataract and progressive iris atrophy iridocorneal endothelial (ICE) syndrome was made, and the patient underwent uneventful phacoemulsification with capsular bag placement of an AcrySof SA60AT intraocular lens combined with pseudopolycoria repair using an endocapsular Model A REPER artificial iris. Six months later, the patient was submitted to a Descemet's stripping automated endothelial keratoplasty (DSAEK) procedure, and 6 months after that the CDVA was 20/32 with no corneal edema and normal intraocular pressure. This two-step surgical approach, combining phacoemulsification and endocapsular foldable iris prosthesis placement followed by DSAEK, may be considered a promising option to successfully treat progressive iris atrophy ICE syndrome patients.
Collapse
Affiliation(s)
- João Pinheiro-Costa
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Ophthalmology Department, Hospital CUF Porto, Porto, Portugal
| | - Inês Coelho-Costa
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Monteiro
- Ophthalmology Department, Hospital CUF Porto, Porto, Portugal
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Manuel Falcão
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Ophthalmology Department, Hospital CUF Porto, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
15
|
Moleiro AF, Godinho G, Madeira C, Faria Pereira A, Brandão E, Falcão-Reis F, Beato JN, Penas S. Peripapillary and Subfoveal Choroidal Thickness in Retinal Vein Occlusions [Response to Letter]. Clin Ophthalmol 2023; 17:817-818. [PMID: 36926526 PMCID: PMC10013584 DOI: 10.2147/opth.s409948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar Gaia-Espinho, Gaia, Portugal
| | - Ana Faria Pereira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - João Nuno Beato
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
16
|
Ribeiro M, Barbosa C, Correia P, Torrão L, Neves Cardoso P, Moreira R, Falcão-Reis F, Falcão M, Pinheiro-Costa J. Best Fit Sphere Back and Adjusted Maximum Elevation of Corneal Back Surface as Novel Predictors of Keratoconus Progression. Clin Ophthalmol 2022; 16:4239-4248. [PMID: 36573232 PMCID: PMC9789719 DOI: 10.2147/opth.s388614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose We evaluated the Maximum Elevation of Corneal Back Surface adjusted to the same Best Fit Sphere Back (BFSB) between timeline measurements (AdjEleBmax) and the BFSB radius (BFSBR) itself as new tomographic parameters for documentation of ectasia progression and compare them with the most recent and reliable parameters used on keratoconus (KC) progression. Results We evaluated the performance and the ideal cutoff point of Kmax, D-index, posterior radius of curvature from the 3.0 mm centered on the thinnest point (PRC), EleBmax, BFSBR, and AdjEleBmax as isolated parameters to document KC progression (defined as a significant change in two or more variables), we found a sensitivity of 70%, 82%, 79%, 65%, 51%, and 63% and a specificity of 91%, 98%, 80%, 73%, 80%, and 84% to detect KC progression. The area under the curve (AUC) for each variable was 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, respectively. Conclusion AdjEleBmax presented a greater specificity, larger AUC, and better performance compared to EleBmax without any adjustment, with similar sensitivity. Although AdjEleBmax and BFSB demonstrated smaller AUC and specificities comparing with Kmax and D-Index, AdjEleBmax still presented a good performance with a reasonable AUC. Since the shape of the posterior surface, more aspheric and curved than the anterior, may facilitate detection of change, we suggest the inclusion of AdjEleBmax in the evaluation of KC progression in conjunction with other variables to increase the reliability of our clinical evaluation and early detection of progression.
Collapse
Affiliation(s)
- Margarida Ribeiro
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Biomedicine – Faculty of Medicine of Porto University, Porto, Portugal,Correspondence: Margarida Ribeiro, Department of Ophthalmology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernâni Monteiro Porto, 4200-319, Portugal, Email
| | | | - Paulo Correia
- Faculty of Medicine of Porto University, Porto, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Pedro Neves Cardoso
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Biomedicine – Faculty of Medicine of Porto University, Porto, Portugal
| |
Collapse
|
17
|
Moleiro AF, Godinho G, Madeira C, Faria Pereira A, Brandão E, Falcão-Reis F, Beato JN, Penas S. Peripapillary and Subfoveal Choroidal Thickness in Retinal Vein Occlusions. Clin Ophthalmol 2022; 16:3775-3783. [PMID: 36415602 PMCID: PMC9675997 DOI: 10.2147/opth.s379373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/21/2022] [Indexed: 03/11/2024] Open
Abstract
PURPOSE This work aimed to longitudinally assess the peripapillary (PPCT) and subfoveal (SFCT) choroidal thickness (CT), in patients diagnosed with central (CRVO) or branch retinal vein occlusions (BRVO), correlating SFCT with central macular thickness (CMT) and PPCT with peripapillary retinal nerve fiber layer thickness (pRNFL). PATIENTS AND METHODS This was a retrospective longitudinal study of 71 eyes from 71 patients with treatment-naïve retinal vein occlusion (24 CRVO and 40 BRVO). Spectral-domain optical coherence tomography (SD-OCT, Spectralis HRA-OCT, Heidelberg) was used to measure PPCT, SFCT, pRNFL and CMT of the affected and fellow eyes at baseline (acute phase) and at 3 and 9 months post anti-VEGF treatment. IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. A p-value ≤0.05 was considered statistically significant. RESULTS Affected eyes presented a thicker baseline PPCT and SFCT compared to their fellow eyes both in CRVO and BRVO (p < 0.05). Both groups presented a significant decrease of PPCT in the affected eyes at 3 months compared to baseline (p < 0.05). At 9 months, compared to 3 months, PPCT remained stable (p > 0.05). Similarly, affected eyes' SFCT significantly decreased at 3 months (p < 0.05) in both groups. At 9 months, compared to 3 months, SFCT decreased in the CRVO patients (p = 0.047) but remained stable in the BRVO patients (p = 0.850). No correIations between SFCT and CMT were seen at any timepoint in both groups (p > 0.05). PPCT correlates with pRNFL in CRVO at 3 months, although no other correlations were found during the follow-up. In BRVO, PPCT did not show any significant correlation with pRNFL. CONCLUSION Both in CRVO and BRVO eyes, PPCT and SFCT at diagnosis are significantly thicker compared to the fellow eye, suggesting a possible increase in CT immediately after the occlusion, which is followed by a decrease at an early follow-up stage.
Collapse
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar Gaia-Espinho, Gaia, Portugal
| | - Ana Faria Pereira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - João Nuno Beato
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
18
|
Moleiro AF, Cunha AM, Vilares-Morgado R, Cruz AJ, Almeida AI, Peixoto F, Falcão-Reis F, Meira J, Leal V. Rhino-Orbital Mucormycosis After COVID-19 Recovery: A Case Report. Int Med Case Rep J 2022; 15:579-586. [PMID: 36267194 PMCID: PMC9578500 DOI: 10.2147/imcrj.s379078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/03/2022] [Indexed: 11/04/2022] Open
Abstract
The pandemic caused by SARS-CoV-2 remains a health care concern, despite vaccination programs. Mucormycosis, especially rhino-orbital-mucormycosis, has been described as a severe complication of COVID-19. Although it has been described mostly in India and other developing countries, few cases in the western world have also been described. We present a case of rhino-orbito-mucormycosis after recovery from severe COVID-19 in Portugal. A 75-year-old diabetic and obese man presented with right proptosis associated with right eye pain and low vision one month after recovery from severe COVID-19. Considering the most probable etiology for this clinical picture, anti-fungal therapy with liposomal amphotericin B was promptly initiated, followed by endoscopic sinus debridement. However, due to persistent and progressive infection, and after a multidisciplinary revision of the case, orbital exenteration was performed. One year after surgery, the patient is stable, without clinical or imagological signs of relapse of the disease. Although the evolution of the pandemic, along with vaccination programs, led to a lower incidence of severe COVID-19 disease, there are still patients presenting with severe COVID-19, requiring intensive care and at risk for serious complications. This case illustrates the importance of being aware of the development of post-COVID-19 mucormycosis and the need for close surveillance of patients recovering from severe COVID-19. COVID-19 prompt diagnosis and multidisciplinary approach are essential for a timely intervention achieving better survival while minimizing morbidity.
Collapse
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal,Correspondence: Ana Filipa Moleiro, Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Tel +351 915689259, Email
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - António José Cruz
- Department of Infectious Diseases, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Ana Isabel Almeida
- Department of Neuroradiology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Fernanda Peixoto
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Jorge Meira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Vítor Leal
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| |
Collapse
|
19
|
Lima-Fontes M, Godinho G, Cunha AM, Madeira C, Falcão M, Falcão-Reis F, Carneiro Â. Hypotony Maculopathy Related to Anti-VEGF Intravitreal Injection. Int Med Case Rep J 2022; 15:517-520. [PMID: 36164320 PMCID: PMC9507979 DOI: 10.2147/imcrj.s382421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a case of hypotony maculopathy following anti-VEGF intravitreal injection (IVI) in a patient with pseudoxanthoma elasticum (PE). Methods Clinical case report. Results A 52-year-old male complained of right eye (OD) vision loss 2 days after an uncomplicated anti-VEGF IVI for the treatment of choroidal neovascularization secondary to angioid streaks. Relevant medical history included PE, pathologic myopia, and a previous pars plana vitrectomy (PPV) due to a retinal detachment. OD best-corrected visual acuity (BCVA) dropped from 6/12 to 6/18 after the IVI. Intraocular pressure (IOP) was 3 mmHg and chorioretinal folds were evident in the posterior pole. Topical dexamethasone and atropine were prescribed, and full recovery was noticed after 3 days. Four months later, the patient developed a new episode of vision loss after another IVI. His BCVA was counting fingers, IOP was 2mmHg, and more noticeable chorioretinal folds were found. This time, an open scleral wound at the injection site was evident and a scleral suture was necessary. Once again, the patient recovered well. Conclusion Hypotony maculopathy following intravitreal injection is a rare condition. However, the described patient presented several conditions which could be related with poor scleral wound closure: intrinsic scleral fragility due to myopia and pseudoxanthoma elasticum; repeated IVI procedures; and absence of vitreous in the posterior segment due to prior vitrectomy. Despite the good outcome, hypotony maculopathy may be a sight-threatening condition, and special attention is necessary for specific patients with risk factors.
Collapse
Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal, Tel +351 918420563, Fax +351 225513669, Email
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
20
|
Lima-Fontes M, Leuzinger-Dias M, Falcão-Reis F, Sousa C. Injection of Botulinum Toxin A in the Lacrimal Gland for Treatment of Epiphora in Crocodile Tears Syndrome – A Case Report. Int Med Case Rep J 2022; 15:537-542. [PMID: 36171912 PMCID: PMC9512532 DOI: 10.2147/imcrj.s379024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Crocodile tears syndrome is a rare autonomic synkinesia, in which patients tear excessively in response to salivary stimuli. It usually occurs after idiopathic or traumatic facial palsy, as a result of aberrant reinnervation of the lacrimal gland by salivary efferent fibers from either the seventh or ninth cranial nerve. Patients and Methods We report the case of a 54-year-old woman, with a history of left Bell’s palsy, who attended our ophthalmology clinic due to epiphora of the left eye while eating or speaking, for 6 months. Results The ophthalmologic evaluation revealed a mild weakening of the frontal and left orbicularis oculi muscles without lagophthalmos. No other abnormalities were found, namely ocular surface swelling, ectropion, or obstruction of the lacrimal outflow system. Schirmer test II in the left eye increased from 12 to 23 mm while the patient was chewing. All these clues led to the diagnosis of crocodile tears syndrome and treatment with botulinum toxin A injection was proposed. One month after the injection of the palpebral lobe of the left lacrimal gland with 6 units of botulinum toxin A, the patient reported an almost complete resolution of the complaints, stated by a decrease in Munk scale and Lac-Q scores. Six months after injection, the patient conveyed recurrence of symptoms and a new treatment session was performed with comparable results. Conclusion Since crocodile tears syndrome is rare, it is crucial to increase awareness and knowledge about it among ophthalmologists and other medical doctors. Botulinum toxin is a safe and effective treatment modality, dramatically improving these patients’ quality of life.
Collapse
Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | | | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Cristina Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| |
Collapse
|
21
|
Moleiro AF, Vilares-Morgado R, Alves GC, Rodrigues M, Falcão-Reis F, Magalhães A, Leal V, Meira J. Tocilizumab as a Useful Tool for Thyroid Eye Disease in Pediatric Population: A Case Report. Case Rep Ophthalmol 2022; 13:877-884. [PMID: 36466065 PMCID: PMC9710467 DOI: 10.1159/000526546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/23/2022] [Indexed: 10/13/2023] Open
Abstract
Thyroid eye disease (TED) characterizes by inflammation and remodeling of orbital tissues. Although the majority of pediatric TED is mild, some children present progressive and severe disease. The approach to severe disease in this group of patients, especially when noncortico-responsive, is challenging. The purpose of this work was to describe the effective use of tocilizumab as second-line therapy in steroid-resistant pediatric TED. A 13-year-old female with a history of Graves' disease presented with right eye proptosis for at least 8 months associated with mild pain on eye movements and ocular surface complaints. The ophthalmologic evaluation revealed Hertel exophthalmometry readings of 22 mm on the right eye (OD) and 19 mm on the left (OS). The remaining ophthalmic examination was unremarkable. Intravenous methylprednisolone pulses of 500 mg were initiated without any improvement after 4 treatments. Following multidisciplinary team discussion, therapy was switched to monthly tocilizumab injections at 4 mg/kg. Significant reduction of proptosis and resolution of pain and ocular surface complaints were noted immediately after the treatment switch. Exophthalmometry readings after the end of treatment that included 4 tocilizumab injections were 20 mm on OD and 19 mm on OS. No side effects were reported during the entire follow-up. Six months after treatment cessation, the patient remains stable, without any signs of orbitopathy relapse and no ophthalmologic complaints. This is the second case report showing the effectiveness of tocilizumab in pediatric TED and the first one showing its efficacy when steroids fail. Our results support the potential safety and efficacy of this immunosuppressor in children with TED.
Collapse
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Gonçalo Coutinho Alves
- Department of Neuroradiology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Mariana Rodrigues
- Department of Pediatrics, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Vitor Leal
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Jorge Meira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| |
Collapse
|
22
|
Vilares-Morgado R, Silva I, Cunha AM, Carneiro Â, Falcão-Reis F, Falcão M. Prevalence and Area of Retinal Pigment Epithelium and Outer Retinal Atrophy in Eyes with Non-Exudative Macular Neovascularization. Ophthalmologica 2022; 245:528-537. [PMID: 35853434 DOI: 10.1159/000525978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 06/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE The objective of this study wasto assess the prevalence of complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA) in patients with unilateral exudative age-related macular degeneration (AMD) of the fellow eye and establish if the presence of non-exudative macular neovascularization (NE-MNV) influences the prevalence of RPE and outer retinal atrophy in eyes with AMD. METHODS This is an observational cross-sectional study of 68 patients with unilateral exudative AMD. Demographic and clinical data were collected, and multimodal retinal imaging was performed in all patients. Two groups of patients were defined according to the presence (NE-MNV) or absence (no NE-MNV) of NE-MNV in the study eye. We compared the prevalence of tomographic cRORA and fundus autofluorescence (FAF) geographic atrophy (GA) and differences in cRORA greatest linear diameter (GLD) and GA area between groups. RESULTS Globally, cRORA was present in 11 eyes (16.2%), FAF GA was present in 10 eyes (14.7%), and NE-MNV was present in 10 eyes (14.7%) of patients with unilateral exudative AMD of the fellow eye. The overall cRORA GLD was 1,950.64 ± 1,428.31 μm, and the mean area of GA was 9.25 ± 7.50 mm2. Regarding comparisons between groups, cRORA was present in 9 eyes (15.5%) without NE-MNV and in 2 eyes (20%) with NE-MNV (p = 0.66). Tomographic signs of atrophy were more frequent in eyes with NE-MNV (50% vs. 24.1% in eyes without NE-MNV; p = 0.008). No significant differences were found in cRORA GLD (p = 0.30) between groups. Eyes with NE-MNV and eyes without NE-MNV had a similar prevalence of FAF GA (2 eyes out of 10 and 8 eyes out of 58, respectively; p = 0.64). Eyes with NE-MNV had a smaller mean area of GA (2.07 ± 0.24 mm2 vs. 11.05 ± 7.34 mm2; p = 0.01). CONCLUSION In our study, the presence of NE-MNV was not associated with the prevalence of cRORA and/or FAF GA. Nonetheless, eyes with NE-MNV presented smaller areas of GA, which suggests that this type of neovascularization may prevent the progression of RPE and outer retinal atrophy. Longitudinal studies are required to confirm these preliminary results.
Collapse
Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ivo Silva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
23
|
Penas S, Araújo T, Mendonça AM, Faria S, Silva J, Campilho A, Martins ML, Sousa V, Rocha-Sousa A, Carneiro Â, Falcão-Reis F. Retinal and choroidal vasoreactivity in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3825-3836. [PMID: 35838808 DOI: 10.1007/s00417-022-05757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aims to investigate retinal and choroidal vascular reactivity to carbogen in central serous chorioretinopathy (CSC) patients. METHODS An experimental pilot study including 68 eyes from 20 CSC patients and 14 age and sex-matched controls was performed. The participants inhaled carbogen (5% CO2 + 95% O2) for 2 min through a high-concentration disposable mask. A 30° disc-centered fundus imaging using infra-red (IR) and macular spectral domain optical coherence tomography (SD-OCT) using the enhanced depth imaging (EDI) technique was performed, both at baseline and after a 2-min gas exposure. A parametric model fitting-based approach for automatic retinal blood vessel caliber estimation was used to assess the mean variation in both arterial and venous vasculature. Choroidal thickness was measured in two different ways: the subfoveal choroidal thickness (SFCT) was calculated using a manual caliper and the mean central choroidal thickness (MCCT) was assessed using an automatic software. RESULTS No significant differences were detected in baseline hemodynamic parameters between both groups. A significant positive correlation was found between the participants' age and arterial diameter variation (p < 0.001, r = 0.447), meaning that younger participants presented a more vasoconstrictive response (negative variation) than older ones. No significant differences were detected in the vasoreactive response between CSC and controls for both arterial and venous vessels (p = 0.63 and p = 0.85, respectively). Although the vascular reactivity was not related to the activity of CSC, it was related to the time of disease, for both the arterial (p = 0.02, r = 0.381) and venous (p = 0.001, r = 0.530) beds. SFCT and MCCT were highly correlated (r = 0.830, p < 0.001). Both SFCT and MCCT significantly increased in CSC patients (p < 0.001 and p < 0.001) but not in controls (p = 0.059 and 0.247). A significant negative correlation between CSC patients' age and MCCT variation (r = - 0.340, p = 0.049) was detected. In CSC patients, the choroidal thickness variation was not related to the activity state, time of disease, or previous photodynamic treatment. CONCLUSION Vasoreactivity to carbogen was similar in the retinal vessels but significantly higher in the choroidal vessels of CSC patients when compared to controls, strengthening the hypothesis of a choroidal regulation dysfunction in this pathology.
Collapse
Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal. .,Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Teresa Araújo
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Ana Maria Mendonça
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Simão Faria
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Jorge Silva
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Aurélio Campilho
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Engineering, University of Porto, Porto, Portugal
| | - Maria Lurdes Martins
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Vânia Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Alameda Professor Hernâni Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
24
|
Godinho G, Esteves-Leandro J, Alves G, Madeira C, Faria O, Brandão E, Magalhães A, Falcão-Reis F, Penas S. Correlation Between Ophthalmologic and Neuroradiologic Findings in Type 1 Neurofibromatosis. J Neuroophthalmol 2022; 42:101-107. [PMID: 33770007 DOI: 10.1097/wno.0000000000001241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurofibromatosis Type 1 (NF-1) is a genetic disease affecting the eye, and ocular findings such as Lisch nodules (LN) or optic pathway gliomas (OPGs) are a part of its diagnostic criteria. Recent imaging technologies such as infrared (IR) imaging and optical coherence tomography (OCT) have highlighted the visualization of choroidal focal abnormalities in these patients, even in the absence of other ocular lesions. This study aimed to establish a morphological multimodal evaluation of choroidal findings in patients with NF-1, correlating them with central nervous system (CNS) findings. METHODS This retrospective study included 44 eyes from 22 patients with NF-1. Central 30° IR imaging was obtained, and the number and total area of detectable lesions were calculated. Both macular and optic disc scanning with OCT were performed, with and without the enhanced depth imaging technique, to assess the presence of choroidal focal hyperreflective lesions. Central macular thickness, ganglion cell layer, and outer nuclear layer thickness were assessed, as well as subfoveal choroidal thickness. The peripapillary retinal nerve fiber layer (RNFL) thickness was also assessed. Patients' magnetic resonance images (MRI) were reviewed and categorized by a neuroradiology specialist, determining the presence of OPGs and CNS hamartomas. Correlations between the ophthalmological and neuroradiological findings were established. RESULTS Patients' mean age was 16.4 ± 7.3 years and 59.1% were women. On the MRI, 86.4% of the patients had CNS hamartomas, and 34.1% of the eyes had OPGs. LN were described in 29.5% of the eyes, whereas a total of 63.4% of the eyes presented the characteristic hyperreflective lesions in IR imaging, all of them matching the underlying choroidal lesions. A mean of 2.9 ± 3.3 lesions per eye and a median total lesion area of 1.52 mm2 were found. The presence of OPGs was correlated with a greater number (P = 0.004) and a larger area (P = 0.006) of IR lesions. For a cut-off of 3.5 lesions per eye, the sensitivity and specificity for the presence of OPGs were 75% and 80%, respectively. For a total lesion area of 2.77 mm2, the sensitivity and specificity for the presence of OPGs were 69.2% and 93.1%, respectively. Eyes with OPGs presented a significant reduction in the temporal RNFL (P = 0.018) thickness, as well as a reduction in subfoveal choroid thickness (P = 0.04). No relations were found between CNS hamartomas and ophthalmological findings. CONCLUSIONS This study suggests that focal choroidal abnormalities are correlated with the presence of CNS lesions as OPGs in patients with NF-1, and it might be a surrogate for the need for CNS imaging in these patients.
Collapse
Affiliation(s)
- Gonçalo Godinho
- Ophthalmology Department (GG, JE-L, CM, OF, EB, AM, FF-R, SP), and Neuroradiology Department (GA), Centro Hospitalar Universitário São João, Porto, Portugal; and Surgery and Physiology Department (FF-R, SP), Faculty of Medicine, University of Porto, Portugal
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Madeira C, Alves G, Godinho G, Meira J, Leal V, Falcão M, Falcão-Reis F, Barbosa Breda J. Bilateral Episcleral Corkscrew Vessels: Expedition into the Unknown – Case Report. Case Rep Ophthalmol 2022; 13:109-115. [PMID: 35431882 PMCID: PMC8958575 DOI: 10.1159/000515971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/05/2021] [Indexed: 11/21/2022] Open
Abstract
We aim to report a case of a middle-aged woman with bilateral idiopathic elevated episcleral venous pressure (IEEVP) and its difficulties in the diagnostic approach. Particularly in this case, the atypical feature of ocular hypertension without glaucomatous optic nerve damage may be misleading. We present a 66-year-old woman with longstanding bilateral “red eyes.” Clinical findings included bilateral episcleral vessel engorgement and tortuosity and raised intraocular pressure with open iridocorneal angles. Despite ocular hypertension, glaucomatous neuropathy was absent and confirmed by normal structural (optical coherence tomography) and functional (standard automated perimetry) tests. The systemic workup was unremarkable. Magnetic resonance angiography showed bilateral dilated superior ophthalmic veins. Cerebral digital subtraction angiography was requested, and no carotid-cavernous fistula (or other significant vascular findings) was identified. The diagnosis of IEEVP was assumed. In conclusion, our case highlights the systematic investigation necessary in cases of bilateral episcleral vessel engorgement and tortuosity and the possible differential diagnosis to be considered to rule out life-threatening causes of elevated episcleral venous pressure. It is important for clinicians to be aware of IEEVP even in patients with atypical features that despite significative ocular hypertension had no glaucomatous damage.
Collapse
Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- *Carolina Madeira,
| | - Gonçalo Alves
- Department of Neuroradiology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Jorge Meira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Vítor Leal
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - João Barbosa Breda
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Leuven, Belgium
| |
Collapse
|
26
|
Torres-Costa S, Melo AB, Estrela-Silva S, Falcão-Reis F, Barbosa-Breda J. Effect of Prior Phacoemulsification Surgery in Trabeculectomy Surgery Outcomes. Clin Ophthalmol 2022; 16:357-367. [PMID: 35173414 PMCID: PMC8841540 DOI: 10.2147/opth.s348364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
Collapse
Affiliation(s)
- Sónia Torres-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Correspondence: Sónia Torres-Costa, Ophthalmology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernani Monteiro, Porto, 4200, Portugal, Tel +351 225 512 100, Fax +351 225 025 766, Email
| | - António Benevides Melo
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sérgio Estrela-Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Barbosa-Breda
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
27
|
Vilares-Morgado R, Madeira C, Cunha AM, Falcão M, Beato J, Pedrosa AC, Penas S, Brandão E, Falcão-Reis F, Carneiro Â. Covid-19 Impact on Macular Neovascularization and Retinal Vein Occlusion Treatment: Single-Center Experience. Biomed Hub 2022; 6:145-152. [PMID: 35083227 DOI: 10.1159/000519565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to evaluate whether the coronavirus disease 19 (COVID-19) pandemic resulted in undertreatment and subsequent loss of visual acuity (VA) in patients with macular neovascularization (MNV) or retinal vein occlusion (RVO) regularly treated with intravitreal antivascular endothelial growth factor injections. Methods Single-center, retrospective study of patients scheduled for treatment between March 19 and June 1, 2020, the national mandatory quarantine period. Patients' demographics, VA, and scheduled treatment during this period were reviewed via medical records. All patients were analyzed regarding treatment attendance rates. The visual impact of COVID-19 was assessed in patients who had been treated and presented a stable VA for >6 months before the beginning of the quarantine. Results This study included 927 eyes from 769 patients. The attendance rate increased throughout the study timeframe (p < 0.001) and correlated negatively with higher patient's age (r = -0.142; p = 0.005). Patients with age-related macular degeneration (67.6%) had lower attendance rates (p = 0.007) and were older (p < 0.001). The visual impact analysis included 400 eyes from 325 patients. The average VA variation throughout this period was -1.7 ± 8.4 ETDRS letters and was similar in different retinal pathologies (p = 0.334). VA variation did not correlate with the number of missed treatments per patient (r = 0.100; p = 0.150). The prevalence of subretinal fluid and intraretinal fluid, as well as central retinal thickness decreased significantly throughout the study period (p values of <0.001, <0.001, and 0.032, respectively). Conclusion The COVID-19 pandemic had a significant impact on the attendance rate of patients with MNV or RVO to their scheduled treatments, which was higher in the first week of mandatory quarantine. Nevertheless, VA did not decrease significantly during this period, with a limited VA variation regardless of primary retinal disorder and morphological parameters even improved in the eyes included in the visual impact analysis.
Collapse
Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal
| | - Ana Catarina Pedrosa
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal.,Faculty of Medicine of Porto University, Porto, Portugal
| |
Collapse
|
28
|
Penas S, Beato J, Rosinha P, Araújo J, Costa A, Carneiro Â, Falcão-Reis F, Rocha-Sousa A. Longitudinal multimodal functional macular analysis after half-dose photodynamic therapy for central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2021; 37:102704. [PMID: 34954386 DOI: 10.1016/j.pdpdt.2021.102704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Half-dose photodynamic therapy (HD-PDT) has been widely used for central serous chorioretinopathy (CSC) with good anatomical results. However, long-term functional outcomes after this treatment remain uncertain. This study aimed a longitudinal multimodal macular assessment, correlating functional and anatomical outcomes. METHODS This is a retrospective study performed in a tertiary referral center including 111 eyes from 95 CSC patients. Data on best corrected visual acuity (BCVA), central macular thickness (CMT), central retinal sensitivity (CRS) using microperimetry (MP) and multifocal electroretinography (mfERG) at baseline and 3, 6, 12, 18, 24, 36, 48 and 60 months after treatment were registered. A correlation analysis was performed. RESULTS Mean follow-up was 34.5 ± 26.3 months. A significant improvement in BCVA and CMT was registered in all the visits. CRS significantly improved until 24 months (p<0.001 at 12 months, p<0.05 at 24 months), worsening afterwards. The mfERG amplitude of N1 and P1 waves significantly improved in the first 12 months, aggravating afterwards. The implicit time improved until 24 months, deteriorating after 48 months. This long-term decline was also described in some inactive untreated fellow eyes CONCLUSIONS: : A multimodal longitudinal analysis of CSC patients after HD-PDT shows that, after the first 12 to 24 months, the significant sustained improvement in BCVA and CMT is not paired by a sustained improvement in macular sensitivity or electrical response. This long-term functional deterioration might result from the disease itself and not directly from the treatment.
Collapse
Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto.
| | - João Beato
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Patrícia Rosinha
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Joana Araújo
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Ana Costa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Ângela Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| |
Collapse
|
29
|
Leuzinger-Dias M, Godinho G, Lima-Fontes M, Oliveira-Ferreira C, Camisa E, Falcão-Reis F, Silva M, Figueira L. A painful red eye in an intravenous drug abuser: When not everything is what it seems. Eur J Ophthalmol 2021; 33:11206721211060151. [PMID: 34761699 DOI: 10.1177/11206721211060151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Endogenous endophthalmitis is a rare but devastating ocular infection, resulting from microbial seeding of the eye during bacteremia or fungemia. Among other sources of septicemia, intravenous drug abuse is a significant risk factor, and endogenous endophthalmitis should always be thought of in any patient with a history of injectable drug use, presenting with a painful vision loss and a red inflamed eye. CASE DESCRIPTION We report the case of a 47-year-old male, with a history of injectable drug consumption, who presented to our emergency department complaining of a painful red eye and recent deterioration of visual acuity. After the first clinical hypothesis of endogenous endophthalmitis being considered, the final diagnosis of Human Leukocyte Antigen (HLA) B27-associated acute anterior uveitis was established. CONCLUSION Ocular inflammation is one of the most challenging fields in all ophthalmology. Several inflammatory disorders, ranging from a wide variety of infectious and non-infectious conditions, can present themselves with the same clinical signs and symptoms, making their diagnosis extremely defiant.
Collapse
Affiliation(s)
- Mariana Leuzinger-Dias
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Mário Lima-Fontes
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Elisa Camisa
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, 26705Faculty of Medicine of University of Porto, Porto, Portugal
| | - Marta Silva
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Luís Figueira
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Pharmacology and Therapeutics, 26705Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
30
|
Madeira C, Godinho G, Grangeia A, Falcão M, Silva R, Carneiro Â, Brandão E, Magalhães A, Falcão-Reis F, Estrela-Silva S. Two Novel Disease-Causing Variants in the PDE6C Gene Underlying Achromatopsia. Case Rep Ophthalmol 2021; 12:749-760. [PMID: 34720973 PMCID: PMC8460892 DOI: 10.1159/000512284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/10/2020] [Indexed: 12/03/2022] Open
Abstract
We report the clinical phenotype and genetic findings of two variants in PDE6C underlying achromatopsia (ACHM). Four patients with the variant c.1670G>A in exon 13 of the PDE6C gene were identified. Additionally, one had compound heterozygous genotype, with two variants in the PDE6C gene, a variant of c.2192G>A in exon 18 and c.1670G>A in exon 13. All patients presented the symptomatic triad of decreased visual acuity, severe photophobia, and colour vision disturbances. SD-OCT showed an absence of the ellipsoid zone, creating an optically empty cavity at the fovea in three patients. The patient with the compound heterozygous genotype presented a more severe subfoveal outer retina atrophy. ERG recordings showed extinguished responses under photopic and 30-Hz flicker stimulation, with a normal rod response. We identified two new variants in the PDE6C gene that leads to ACHM.
Collapse
Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal
| | - Ana Grangeia
- Department of Genetics, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Renato Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Sérgio Estrela-Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
31
|
Magalhães A, Vilares-Morgado R, Cunha AM, Leão-Teles E, Falcão M, Carneiro Â, Falcão-Reis F. Increased Choroidal Thickness in Morquio Syndrome. Case Rep Ophthalmol 2021; 12:816-823. [PMID: 34720983 PMCID: PMC8543289 DOI: 10.1159/000518443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/11/2021] [Indexed: 12/02/2022] Open
Abstract
The purpose of this clinical case report is to describe a case of mucopolysaccharidosis type IVA (MPS IVA), or Morquio syndrome, with increased choroidal thickness in enhanced-depth imaging optical coherence tomography (EDI-OCT) which can represent choroidal deposition of glycosaminoglycans (GAGs). A 21-year-old male with genetically confirmed diagnosis of MPS IVA was examined at our Pediatric Ophthalmology clinic as part of our follow-up protocol for MPS patients. His best-corrected visual acuity was 4/10 in his right eye (OD) and 6/10 in the left eye (OS). Mild diffuse corneal opacification was evident. Intraocular pressure was within normal range. Fundus examination and color fundus photography revealed no abnormalities. EDI-OCT revealed significantly increased choroidal thickness in his right eye and in his left eye, suggesting the presence of choroidal deposition of GAGs, despite absence of retinal or optic disc GAG deposition or other chorioretinal involvement. To our knowledge, this is the first case of MPS IVA described in the literature with suspected choroidal deposition of GAGs. With improved control of systemic features of MPS IVA, life expectancy of these patients has increased, allowing for more ocular manifestations to develop. The parallel development of technology in ophthalmology, such as the EDI-OCT, further contributes to the detection of these unprecedented ocular features in MPSs.
Collapse
Affiliation(s)
- Augusto Magalhães
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elisa Leão-Teles
- Department of Pediatrics, Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
32
|
Cunha AM, Teixeira D, Cabral D, Estrela-Silva S, Falcão-Reis F, Carneiro Â. Quantitative Optical Coherence Tomography Angiography Biomarkers for Alport Syndrome. Ophthalmologica 2021; 245:41-48. [PMID: 34469897 DOI: 10.1159/000519242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate microvascular abnormalities of patients with Alport syndrome (AS) using optical coherence tomography angiography (OCT-A) quantitative biomarkers. METHODS This was cross sectional, prospective evaluation of consecutive patients with AS and healthy subjects. AS diagnosis was performed by the genetic test. All participants underwent a retinal vasculature evaluation by spectral-domain optical coherence tomography (SD-OCT) and OCT-A of the macula. Quantitative analysis included whole vascular density, foveal avascular zone area, fractal dimension (FD), and lacunarity (LAC). RESULTS Ninety-four eyes were included in this study, 45 eyes from patients with AS and 49 eyes from healthy subjects. The pathogenic mutation in the COL4A5 gene on the chromosome X was found in 14 patients; the pathogenic autosomal recessive mutations in the COL4A3 gene were found in 9 patients. Quantitative evaluation demonstrated a significant difference between AS and healthy subjects on LAC of the superficial capillary plexus and deep capillary plexus (DCP) (p < 0.001 and p < 0.001, respectively) and on FD in the DCP (p < 0.001). CONCLUSION The DCP Alport patients have a higher vessel nonuniformity than DCP of healthy subjects. We hypothesize that endothelial cell lesion in the setting of low resistance at the DCP circuit could lead to long-term structural disorganization.
Collapse
Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Diogo Cabral
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal
| | - Sérgio Estrela-Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
33
|
Leuzinger-Dias M, Lima-Fontes M, Oliveira-Ferreira C, Macedo JP, Falcão-Reis F, Freitas-da-Costa P, Benevides-Melo A. Traumatic Cyclodialysis Cleft Treatment Combined with Cataract Surgery: An Original Triple Procedure. Ophthalmol Ther 2021; 10:1171-1179. [PMID: 34370278 PMCID: PMC8589922 DOI: 10.1007/s40123-021-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction To describe a “triple” surgical procedure, which combined traumatic cataract extraction by phacoemulsification with gas endotamponade and cyclocryotherapy in the successful treatment of a traumatic cyclodialysis cleft. Methods A 44-year-old man who suffered severe left eye blunt trauma with an elastic band developed a 4-hour extent cyclodialysis cleft with consequent hypotony. After 7 weeks of persistent hypotonic maculopathy unresponsive to medical treatment, and with an evolving traumatic cataract, the patient underwent cataract surgery combined with intravitreal gas endotamponade (20% SF6) and cyclocryotherapy. Results Two weeks after the procedure the intraocular pressure increased to 12 mmHg and remained steady during the next 14 months of follow-up. Hypotonic maculopathy resolved and successful closure of the cyclodialysis cleft was confirmed by gonioscopy and ultrasound biomicroscopy. Conclusion Gas endotamponade and cyclocryotherapy constitute a promising option in the treatment of cyclodialysis clefts unresponsive to medical therapy. In our case, this minimally invasive technique was innovatively combined with cataract surgery. Despite early postoperative intraocular inflammation, a successful outcome was achieved.
Collapse
Affiliation(s)
- Mariana Leuzinger-Dias
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Cláudia Oliveira-Ferreira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Paulo Macedo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Paulo Freitas-da-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Anatomy Unit, Biomedicine Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - António Benevides-Melo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| |
Collapse
|
34
|
Madeira C, Godinho G, Vilares-Morgado R, Beato J, Pinheiro-Costa J, Carneiro Â, Falcão-Reis F, Falcão M. Long-term progression of geographic atrophy in age-related macular degeneration does the phakic status matter? Graefes Arch Clin Exp Ophthalmol 2021; 259:3711-3719. [PMID: 34169351 DOI: 10.1007/s00417-021-05255-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the long-term risk of geographic atrophy (GA) progression after cataract surgery. METHODS Subjects with GA secondary to AMD followed for at least 1 year with fundus autofluorescence imaging and with at least two visits at our centre were included. Patients with wet AMD, disciform scar, past history of intravitreal injections or laser treatment, other maculopathies and with poor quality images were excluded. GA area at baseline and at follow-up visit was measured. Three study groups were defined according to their phakic status: (A) pseudophakia, (B) phakic and (C) phacoemulsification surgery performed during the study. Differences of GA area progression were compared between these study groups. In addition, comparison between GA progression rate in group (C) before and after the surgery was performed. The enlargement rate (ER) was calculated for lesion size after transforming the measurements to the square-root scale. RESULTS A total of 92 eyes of 92 patients were enrolled. Median follow-up time was 4 [1-10] years. Regarding the eye's phakic status, 29 (31.5%) were pseudophakic and 63 (68.5%) were phakic; of these, 22 underwent phacoemulsification during the study. Overall, the median baseline and follow-up area of GA were 1.42 [0.04-32.10] mm2 and 6.48 [0.25-47.40] mm2, respectively. The ER was similar between phakic and pseudophakic eyes (0.18 [0.01-1.03] vs 0.15 [0.01-0.65] mm/year, p = 0.62). In patients that underwent cataract surgery during the study, the GA ER remained stable (0.13 [0.01-0.92] vs 0.14 [0.01-0.63] mm/year, p = 0.43). CONCLUSION These results suggest that cataract surgery does not increase the risk of pre-existing GA progression. Therefore, cataract surgery seems safe and a potential therapeutic weapon to improve visual acuity and consequently quality of life in GA patients.
Collapse
Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal.
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
35
|
Moleiro AF, Aires AF, Alves H, Viana Pinto J, Carneiro Â, Falcão-Reis F, Figueira L, Pinheiro-Costa J. The Role of Atopy in the Choroidal Profile of Keratoconus Patients. Clin Ophthalmol 2021; 15:1799-1807. [PMID: 33953539 PMCID: PMC8090985 DOI: 10.2147/opth.s301330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Although classically classified as a non-inflammatory condition, an inflammatory basis for keratoconus (KC) appears to be a growing evidence. Recently, it has been shown that KC patients have an increased choroidal thickness (CT). Among inflammatory disorders, atopy has been associated with KC development; therefore, the aim of this study was to evaluate if the increased CT in patients with KC is related to atopy. Methods This is an analytical cross-sectional study of patients with KC. Patients were classified as atopic and non-atopic according to their atopy history (allergic rhinoconjunctivitis (AR), asthma (AA) and/or atopic dermatitis (AD)) and were also classified based on their eye rubbing habits. Choroidal profile of all subjects was evaluated using a Spectralis optical coherence tomography (OCT) device with enhanced depth imaging (EDI) mode. CT was measured and compared between groups at the center of the fovea and at 500 µm intervals along a horizontal section. A multivariable analysis, adjusted for sex, age, spherical equivalent, history of medication and atopy, was performed to assess the influence of atopy in CT. Results Of the 80 patients included, 51 were atopic and 29 non-atopic. Atopic patients showed a thicker choroid in every measured location than the non-atopic patients (mean subfoveal CT 391.53 µm vs 351.17 µm, respectively), although the differences were not statistically different. The multivariable analysis revealed that being atopic makes the choroid statistically thicker, on average, 55.14 µm, when compared to non-atopic patients (p=0.043). Furthermore, patients who are frequent eye rubbers have significantly thicker choroids than non-rubbers (p=0.004). Conclusion Although some results do not reach statistical significance, atopic KC patients seem to have thicker choroids compared with non-atopic KC patients, suggesting a possible role for atopy in the choroidal profile of KC. This constitutes a completely new sight in this field of research that needs further investigation.
Collapse
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Hélio Alves
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Viana Pinto
- Department of Otorhinolaryngology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Figueira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
36
|
Godinho G, Abreu I, Alves G, Vaz R, Leal V, Carvalho AC, Sarmento A, Falcão-Reis F. Orbital Apex Syndrome due to Orbital Mucormycosis after Teeth Infection: A Successful Case Report. Case Rep Ophthalmol 2021; 12:110-115. [PMID: 33976666 PMCID: PMC8077525 DOI: 10.1159/000510389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
Rhino-orbital-cerebral mucormycosis is a severe and rapidly progressive fungal infection associated with low survival rates. Early diagnosis and proper management are mandatory. We report the case of a 20-year-old female with diabetic ketoacidosis and teeth infection, who presented with sudden orbital apex syndrome. Several surgical procedures were necessary to provide a definite histopathological diagnosis of the fungal infection. Ultimately, given the progressive aggravation of the infection and the ineffectiveness of antifungal and antibiotic agents, an orbital exenteration was performed. A mycobacteriological examination revealed a polymicrobial culture with Mucorales. One year after the initial presentation, the patient is alive and with a good general health condition.
Collapse
Affiliation(s)
- Gonçalo Godinho
- Ophthalmology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Isabel Abreu
- Infectious Diseases Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Gonçalo Alves
- Neuroradiology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Ricardo Vaz
- ORL Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Vitor Leal
- Ophthalmology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Ana Cláudia Carvalho
- Infectious Diseases Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| |
Collapse
|
37
|
Cunha AM, Vilares-Morgado R, Moleiro AF, Falcão-Reis F, Faria O. Childhood-Onset Leber Hereditary Optic Neuropathy: Particular Features. Int Med Case Rep J 2021; 14:163-169. [PMID: 33737839 PMCID: PMC7966410 DOI: 10.2147/imcrj.s303460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Leber hereditary optic neuropathy (LHON) is an optic neuropathy of mitochondrial inheritance. Childhood-onset disease is relatively rare and there are limited data on this important patient subgroup. Case Presentation We present 3 particular presentations of LHON. Patient 1 was an 8-year-old boy admitted to the emergency department reporting a progressive bilateral visual loss and intermittent headaches. Neuro-ophthalmological examination revealed a bilateral pseudopapilledema. Lumbar puncture identified intracranial hypertension and the brain and orbits magnetic resonance imaging showed T2 hyperintensity in the posterior region of the left optic nerve and the optic chiasm. Patient 2 was a 12-year-old boy admitted to the emergency department reporting painless, progressive central vision loss in the right eye. Fundus examination revealed a hyperemic disc and vascular network papillary and peripapillary vascular microdilations. Three months later, the left eye presented visual loss. Patient 3 was a 6-year-old female child referred to the neuro-ophthalmology specialist due to painless central visual loss in both eyes. Her BCVA was 1/10 and counting fingers in right and left eye, respectively, and fundus examination revealed a pallor optic disc in the temporal sector. Discussion The phenotype of childhood-onset disease may present itself distinct from classical adult-onset LHON. The absence of classical clinical features could lead to initial misdiagnosis. There should exist a high index of suspicion in children presenting unexplained subnormal vision in order to avoid potential diagnostic delays.
Collapse
Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Olinda Faria
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
38
|
Esteves-Leandro J, Torres-Costa S, Estrela-Silva S, Santos-Silva R, Brandão E, Grangeia A, Fernandes S, Oliveira R, Falcão-Reis F, Rocha-Sousa A. Cone dystrophy with supernormal rod responses: A rare KCNV2 gene variant. Eur J Ophthalmol 2021; 32:664-672. [PMID: 33706576 DOI: 10.1177/11206721211000000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the clinical, electrophysiological, and genetic findings of three Portuguese families with a rare variant in the KCNV2 gene resulting in "cone dystrophy with supernormal rod responses" (CDSRR). METHODS Retrospective clinical revision of five individuals from three unrelated families with CDSRR. Ophthalmological examination was described in all patients and included color vision testing, fundus photography, fundus autofluorescence (FAF) imaging, spectral domain-optical coherence tomography (SD-OCT), pattern electroretinogram (ERG), and full-field ERG. The mutational screening of the KCNV2 gene was performed with Sanger and Next Generation Sequencing. RESULTS All patients showed childhood-onset photophobia and progressive visual acuity loss with varying degrees of severity. In multimodal imaging, various degrees of retinal pigment epithelium disturbances and outer retinal atrophy, which tend to be worst with advancing age, were observed. Molecular screening identified a rare presumed truncating variant (p.Glu209Ter) in homozygosity in two families and in compound heterozygosity in a third family. Three patients showed ERG changes characteristic of CDSRR, however, two patients presented with incomplete electrophysiological features of the disease. CONCLUSION A rare variant in the KCNV2 gene was identified in five patients from three Portuguese families. This variant often leads to a severe and progressive form of retinopathy. Considerable variability in the ERG responses among patients with this KCNV2 variant was observed.
Collapse
Affiliation(s)
- João Esteves-Leandro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sónia Torres-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sérgio Estrela-Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Renato Santos-Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Grangeia
- Department of Genetics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Susana Fernandes
- Department of Genetics, Centro Hospitalar Universitário de São João, Porto, Portugal.,Institute for Innovation and Health Research (I3S), University of Porto, Porto, Portugal
| | - Renata Oliveira
- Department of Genetics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
39
|
Vilares-Morgado R, Madeira C, Falcão M, Godinho G, Ribeiro M, Beato J, Pedrosa AC, Brandão E, Falcão-Reis F, Carneiro Â. Predicting retinal pigment epithelium remodelling and its functional impact. Graefes Arch Clin Exp Ophthalmol 2021; 259:2583-2595. [PMID: 33651204 DOI: 10.1007/s00417-021-05129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To identify predictive factors for RPE tear remodelling and its correlation with functional and morphological outcomes. METHODS Retrospective longitudinal study of patients with retinal pigment epithelium (RPE) tears secondary to age-related macular degeneration (AMD). Imaging was performed using spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). RPE layer integrity in the RPE-denuded area was examined with SD-OCT, and variation in the RPE-denuded homogeneous hypofluorescent area was examined with FAF over time for each case (eye). Patients were divided in two groups, according to the presence (Rem) or absence (No Rem) of evidence of RPE tear remodelling. Data were collected at three different time points: at baseline (at diagnosis of exudative AMD), at RPE tear diagnosis, and at the last available follow-up. Using SD-OCT, the following parameters were evaluated: type of CNV, type of PED and its dimensions, presence of subretinal (SRF) or intraretinal (IRF) fluid, central retinal thickness (CRT), presence and location of hyperreflective dots, and dimension and location of RPE tear. RESULTS This study included 32 eyes from 31 patients (19 female and 12 male), with RPE tears secondary to AMD. RPE remodelling after tear development was evident in 17 (53.1%) eyes after 7 [1-59] months. Anatomical recovery was associated with a younger age at RPE tear diagnosis (73 ± 7 vs. 81 ± 7 years old, p=0.01), smaller and narrower retinal pigment epithelial detachment (PED) at tear diagnosis (height 369 vs. 602 μm, p=0.02; width 2379 vs. 3378 μm, p=0.04), and the presence of SRF at tear diagnosis (94% vs. 53%, p=0.02). After adjusting for other covariates, a younger age at RPE tear diagnosis maintained significant association with RPE tear remodelling. RPE tear remodelling did not correlate with a better visual outcome at last follow-up (43 ± 22.8 vs. 34 ± 23.8 ETDRS letters, p=0.30). Final VA was directly proportional to VA at tear diagnosis (r= 0.654; p<0.001) and correlated negatively with PED width at tear diagnosis (r = -0.388; p=0.03). CONCLUSION RPE remodelling was evident in half of our sample and was associated with a younger age, smaller and narrower PED at RPE tear diagnosis, and presence of SRF also at tear diagnosis. Nevertheless, this structural recovery did not result in a better functional outcome.
Collapse
Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal.
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Margarida Ribeiro
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Ana Catarina Pedrosa
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
40
|
Torres-Costa S, Penas S, Cerqueira AR, Brandão E, Carneiro Â, Rocha-Sousa A, Falcão-Reis F. Long term outer retinal changes in central serous chorioretinopathy submitted to half-dose photodynamic therapy. Photodiagnosis Photodyn Ther 2021; 34:102235. [PMID: 33631379 DOI: 10.1016/j.pdpdt.2021.102235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate long-term changes in the foveal and parafoveal outer retina after half-dose photodynamic therapy (HD-PDT) in central serous chorioretinopathy (CSC). METHODS Retrospective study including CSC patients submitted to HD-PDT. Best corrected visual acuity (BCVA) was evaluated. Spectral-domain optical coherence tomography automatic segmentation algorithm was used and data on retinal, inner retinal, outer retinal and outer nuclear layers (ONL) in both foveal 1 mm (C) and parafoveal 3 mm ETDRS circles for the superior, nasal, inferior and temporal sectors, were obtained at baseline and 3, 12 and 24 months post-treatment. Subfoveal choroidal thickness, photoreceptors' outer segment thickness, subretinal fluid (SRF) height and width were also measured. RESULTS Twenty-one eyes of 15 patients were included. At baseline, the mean ONL thickness in the foveal area was significantly thinner in affected eyes compared to their fellow unaffected ones (55,50 ± 32,75 μm vs 93,00 ± 17,0 μm; p = 0,011), and was negatively correlated to logMAR BCVA (R=-0,601, p = 0,008) ONL thickness increased by 10,94 ± 11,88 μm at 24 months in the foveal area, and all the parafoveal sectors presented a similar increase. Baseline SRF width was significantly correlated with baseline BCVA (R1 = 0,483, p = 0,036), and with ONL thickness in all sectors. CONCLUSION In our study we found a significant long-term increase in foveal and parafoveal ONL thickness in CSC after HD-PDT, suggesting that this seems to be a safe treatment for the outer retina. This is the first study mapping the outer retinal changes in the macular area to 24 months follow up.
Collapse
Affiliation(s)
- Sónia Torres-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
41
|
Abstract
Purpose: Evaluate the prevalence and incidence, demographic characteristics, anatomical classification, concomitant complications and treatment of uveitis, as well as its association with systemic diseases in the northern Portuguese population referred to a tertiary care centre (São João Hospital, Porto).Methods: A retrospective observational study of 545 consecutive uveitis cases was performed between 12th April 2012 and the 26th October 2017. Uveitis was classified according to Standard Uveitis Nomenclature, while aetiology and complications were diagnosed by specific clinical and laboratory testing.Results: Prevalence was calculated to be 12,4 cases per 100,000 people while incidence was 3.9 cases per 100,000 people annual incidence. The ratio of females to males was 1.32:1 and the mean age at diagnosis was 47,86 years. Anterior uveitis was the most common classification making up 47.5%, followed by non-infectious posterior uveitis 18,0%, infectious posterior uveitis 8,4%, intermediate uveitis 5,5% and panuveitis 4,2%. Extra-uveal entities made up the rest of the causes (16.4%). In terms of aetiology, the majority of uveitis was idiopathic (32,1%) followed by axial spondylarthritis (12.1%), Behçet's disease (8,8%), sarcoidosis (6,1%), tuberculosis (5,5%), herpes (5,1%), toxoplasmosis (3,1%) among other less frequent causes.Conclusion: In our referral region, 72% of uveitis cases were correctly identified surpassing other studies. There was a higher rate of intermediate uveitis and lower number of panuveitis cases when compared to a previous Portuguese study. Extensive monitoring of the development of uveitis by international multicentre prospective studies could be useful for increasing practitioner awareness and diagnostic approach.
Collapse
Affiliation(s)
- Lukasz Hermann
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Ophthalmology, Hospital S. João, Porto, Portugal
| | - Luís Figueira
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Ophthalmology, Hospital S. João, Porto, Portugal.,Center for Drug Discovery and Innovative Medicines (Medinup), University of Porto, Porto, Portugal
| |
Collapse
|
42
|
Cunha AM, Breda J, Rocha-Sousa A, Falcão-Reis F, Santos-Silva R. Child with a mild phenotype of Incontinentia Pigmenti and inner retinal dysfunction. Doc Ophthalmol 2021; 143:93-98. [PMID: 33582953 DOI: 10.1007/s10633-021-09824-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 01/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To describe a case of a child with mild phenotype of Incontinentia Pigmenti (IP), with changes in Spectral-Domain Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCT-A) and an electronegative dark-adapted (DA) 3.0 electroretinogram (ERG), suggestive of inner retinal dysfunction. CASE REPORT We described a 7-year-old female child with IP. Her best corrected acuity was 8/10 in the right eye and 6/10 in the left eye. Biomicroscopy, intraocular pressure and fundoscopy were normal. The electroretinography findings showed an electronegative DA 3.0 ERG with a normal a-wave but a b-wave that did not elevate above baseline. SD-OCT identified irregularities in the outer plexiform layer in both eyes, and OCT-A assessment revealed at the superficial capillary plexus, areas of decrease in the flow in parafoveal and perifoveal regions. CONCLUSION Classically, IP affects the peripheral retina; however, vascular and structural changes in macula can occur as well. To our knowledge, we report the first electronegative electroretinogram in a patient with IP.
Collapse
Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal.
| | - Jorge Breda
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Amândio Rocha-Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Renato Santos-Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
43
|
Pinheiro-Costa J, Correia PJ, Pinto JV, Alves H, Torrão L, Moreira R, Falcão M, Carneiro Â, Madeira MD, Falcão-Reis F. Increased choroidal thickness is not a disease progression marker in keratoconus. Sci Rep 2020; 10:19938. [PMID: 33203915 PMCID: PMC7673983 DOI: 10.1038/s41598-020-77122-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022] Open
Abstract
The recent findings of increased Choroidal Thickness (CT) in Keratoconus (KC) patients raised the question of whether CT could be an indicator of progressive KC. To test this hypothesis, we evaluated and compared the choroidal profile in progressive and non-progressive KC. We ran a cross-sectional observational study in 76 patients diagnosed with KC, age 14–30, to assess KC progression. Progression was defined as when at least two of the studied variables confirmed progression (Kmax, Km, PachyMin, D-Index, Astig, K2, 3 mm PCR). Included patients performed a Spectralis Optical Coherence Tomography (OCT) with enhanced depth image (EDI) technology to evaluate choroidal profile. Choroidal measurements were taken subfoveally and at 500 µm intervals from the fovea, in 7 different locations, and compared between groups. Multivariate linear regression analyses were also performed to assess the influence of CT in KC progression. Thirty-six eyes (47.4%) were classified as KC progressors. The mean subfoveal CT observed in the total sample was 382.0 (± 97.0) μm. The comparison between groups (progressive and non-progressive KC) showed no differences in the locations evaluated (mean subfoveal CT difference between groups was 2.4 μm, p = 0.915). In the multivariate analysis CT seems not be influenced by KC progression (B = 6.72 μm, 95% CI − 40.09 to 53.53, p = 0.775). Assessment of choroidal profile does not appear to be a useful tool to differentiate progressive and non-progressive KC. Further research is needed in order to better understand the role of choroid in KC.
Collapse
Affiliation(s)
- João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - João Viana Pinto
- Department of Otorhinolaryngology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Hélio Alves
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Raul Moreira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria Dulce Madeira
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
44
|
Cunha AM, Loja JT, Torrão L, Moreira R, Pinheiro D, Falcão-Reis F, Pinheiro-Costa J. A 10-Year Retrospective Clinical Analysis of Fungal Keratitis in a Portuguese Tertiary Centre. Clin Ophthalmol 2020; 14:3833-3839. [PMID: 33209016 PMCID: PMC7670085 DOI: 10.2147/opth.s268327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the microbiological profile, risk factors, treatment and surgical intervention rates of fungal keratitis at a tertiary referral centre. Methods A retrospective review of microbiological and medical records from hospitalised patients treated for fungal keratitis at Centro Hospitalar Universitário de São João from 2009 to 2019 was conducted. Results Overall, 43 patients were included in our study. The mean age of patients was 63.7 years and 46.5% were men. In culture were isolated 22 (51.2%) filamentous fungi and 21 (48.8%) yeast. Candida species (n = 20, 46.5%), Fusarium species (n = 10, 23.4%) and Aspergillus species (n = 4, 9.3%) were the most common isolated species. Important risk factors were contact lens use (n = 24, 55.8%), long-term users of topical corticosteroids (n = 19, 44.2%) and previous keratitis (n = 19, 44.2%). Yeast isolates had a statistically significant higher prevalence in long-term users of topical corticosteroids compared to filamentous ones (p = 0.043). Twenty-four cases (55.8%) required surgical intervention, of which 23 cases underwent therapeutic penetrating keratoplasty. Ocular complications, such as evisceration was noted in 12 patients (27.9%) and endophthalmitis in 5 (11.6%). No statistically significant changes of best corrected visual acuity (BCVA) were found after treatment (p = 0.687). Conclusion Most patients with fungal keratitis have associated risk factors. Filamentous and yeast species have equally prevalent etiologies. In general, our results mirror how difficult and challenging the approach and treatment of fungal keratitis could be.
Collapse
Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Dolores Pinheiro
- Laboratory of Microbiology, Service of Clinical Pathology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
45
|
Oliveira-Ferreira C, Leuzinger-Dias M, Tavares-Ferreira J, Faria O, Falcão-Reis F. The Relationship between Intraocular Pressure and Optic Nerve Structural and Functional Damage in Patients with Optic Nerve Head Drusen. Neuroophthalmology 2020; 44:290-293. [PMID: 33012917 DOI: 10.1080/01658107.2019.1691242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The aim of this retrospective study was to evaluate if, in ocular normotensive patients, at the time of diagnosis of optic nerve head drusen (ONHD), perimetric mean deviation (PMD) on visual field (VF) examination and retinal nerve fibre layer (RNFL) thickness on optical coherence tomography correlated with intraocular pressure (IOP). There was a significant association between IOP and PMD (Spearman's rho = -0.863, p < .01) and between IOP and RNFL thickness (Spearman's rho = -0.630, p < .01). A higher IOP was associated with a greater functional loss in the VF and a reduction in the RNFL thickness. These results suggest that a clinical trial of IOP reduction should be considered in patients with ONHD to decrease the progression of optic nerve damage over time.
Collapse
Affiliation(s)
| | | | | | - Olinda Faria
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Surgery and Physiology Department, Faculty of Medicine, Porto University, Oporto, Portugal
| | - F Falcão-Reis
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Surgery and Physiology Department, Faculty of Medicine, Porto University, Oporto, Portugal
| |
Collapse
|
46
|
Godinho G, Madeira C, Falcão M, Penas S, Dinah-Bragança T, Brandão E, Carneiro Â, Santos-Silva R, Falcão-Reis F, Beato J. Longitudinal Retinal Changes Induced by Hydroxychloroquine in Eyes without Retinal Toxicity. Ophthalmic Res 2020; 64:290-296. [PMID: 32932260 DOI: 10.1159/000511592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate the longitudinal changes in retinal layer thickness in patients treated with hydroxychloroquine without retinal toxicity. METHODS This is a longitudinal retrospective study of patients taking hydroxychloroquine followed in a hydroxychloroquine retinal toxicity screening program of a tertiary hospital between January 2010 and April 2019. Patients who performed 2 optical coherence tomography (OCT) scans at least 1 year apart were included. All subjects with hydroxychloroquine suspected or confirmed retinal toxicity, glaucoma, retinal pathology, or poor segmented images were excluded. Spectral-domain optical coherence tomography (Spectralis HRA-OCT, Heidelberg) was used to evaluate the macular area. Automatically segmented ETDRS retinal thickness maps were compared between the first and the last OCT evaluation available. Full retina (FR), inner retina (IRL), ganglion cells (GCL), inner nuclear (INL), and outer retina (ORL) layer thicknesses were measured in the foveolar, paracentral, and peripheral area. RESULTS The population included 144 eyes of 144 patients. The mean interval between OCT scans was 38.1 ± 18.4 months, and the mean cumulative dose was 406.9 ± 223.9 g. Foveolar (p = 0.040, p = 0.006, and p = 0.001, respectively) and paracentral (p = 0.006, p = 0.001, and p = 0.005, respectively) FR, IRL, and GCL decreased overtime. No differences were found in INL or ORL. A very weak correlation was found between age and foveal IRL change overtime (p = 0.037; R = 0.175), as well as between the hydroxychloroquine time of use and foveal GCL variation (p = 0.032; R = 0.179). CONCLUSION Hydroxychloroquine was found to cause progressive thinning of the inner retinal layers, specifically in the GCL of the foveolar and paracentral areas, but no changes were observed in the outer retina.
Collapse
Affiliation(s)
- Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Teresa Dinah-Bragança
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Renato Santos-Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| |
Collapse
|
47
|
Torres-Costa S, Lima-Fontes M, Falcão-Reis F, Falcão M. SARS-COV-2 in Ophthalmology: Current Evidence and Standards for Clinical Practice. ACTA MEDICA PORT 2020; 33:593-600. [PMID: 32662416 DOI: 10.20344/amp.14118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION COVID-19 is caused by the coronavirus SARS-CoV-2. Ocular manifestations have been reported including conjunctivitis and retinal changes. Therefore, it is of the utmost importance to clarify eye involvement in COVID-19 in order to help with its diagnosis and to further prevent its transmission. The purpose of this review is to describe the structure and transmission of SARS-CoV-2, reported ocular findings and protection strategies for ophthalmologists. MATERIAL AND METHODS Literature search on PubMed for relevant articles using the keywords 'COVID-19', 'coronavirus', and 'SARS-CoV-2' in conjunction with 'ophthalmology' and 'eye'. Moreover, official recommendations of ophthalmological societies were reviewed. RESULTS Although the conjunctiva is directly exposed to extraocular pathogens, and the mucosa of the ocular surface and upper respiratory tract are connected by the nasolacrimal duct, the eye is rarely involved in human SARS-CoV-2 infection and the SARS-CoV-2 RNA positive rate by RT-PCR test in tears and conjunctival secretions from patients with COVID-19 is also extremely low. DISCUSSION The eye can be affected by SARS-CoV-2, which is supported by some reports of conjunctivitis and retinal changes, but its role in the spread of the disease is still unknown. CONCLUSION Given the current scarce evidence, more research is needed to clarify the relationship between SARS-CoV-2 and the eye.
Collapse
Affiliation(s)
- Sónia Torres-Costa
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Mário Lima-Fontes
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Department of Surgery and Physiology. Faculty of Medicine. University of Porto. Porto. Portugal
| | - Manuel Falcão
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Department of Surgery and Physiology. Faculty of Medicine. University of Porto. Porto. Portugal
| |
Collapse
|
48
|
Cunha AM, Sardinha T, Torrão L, Moreira R, Falcão-Reis F, Pinheiro-Costa J. Transepithelial Accelerated Corneal Collagen Cross-Linking: Two-Year Results. Clin Ophthalmol 2020; 14:2329-2337. [PMID: 32884233 PMCID: PMC7434572 DOI: 10.2147/opth.s252940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report 2-year outcomes of trans-epithelial accelerated corneal collagen crosslinking (TE-ACXL) procedure in the treatment of progressive keratoconus patients. PATIENTS AND METHODS Twenty-four eyes from 24 patients who underwent TE-ACXL (6mW/cm2 for 15 minutes) were included in this retrospective interventional study. Best-corrected visual acuity (BCVA), keratometry values, thinnest corneal thickness (PachyMin) and topometric indexes were analysed preoperatively and at 6-month, 12-month, 18-month and 24-month postoperative. Progression was assessed by increase ≥1.00D in maximum keratometry (Kmax); increase ≥1.00D in corneal astigmatism; decrease ≥2% in PachyMin; increase ≥0.42 in D-index. RESULTS There were no complications during or after TE-ACXL. No significant differences (Δ) were observed between baseline and 12-month or 24-month postoperative: ∆BCVA (-0.08 ± 0.25, p=0.190; -0.04 ± 0.17, p=0.588), ∆Kmax (-0.08 ± 1.32, p=0.792; -1.04 ± 1.89, p=0.135), ∆Astigmatism (-0.15 ± 0.89, p=0.485; -0.24 ± 1.38, p=0.609), ∆PachyMin (-0.56 ± 15.70, p=0.882; 0.56 ± 18.74, p=0.931), ∆Index Surface Variation (∆ISV) (-2.11 ± 10.27, p=0.395; -4.67 ± 17.32, p=0.442), ∆Index Vertical Asymmetry (∆IVA) (-0.05 ± 0.17, p=0.208; -0.08 ± 0.26, p=0.397), ∆Index Height Decentration (∆IHD) (0.00 ± 0.02, p=0.368; -0.01 ± 0.04, p=0.484), ∆KI (0.00 ± 0.05, p=0.851; 0.01 ± 0.06, p=0.877) and ∆D-index (0.15 ± 1.14, p=0.572; 0.06 ± 1.36, p=0.892). Eleven to 33% of patients had disease progression at 24-month postoperative according to the parameters used to determine progression. CONCLUSION Although some patients maintain disease progression, TE-ACXL seems to be a safe and effective treatment for keratoconus over the 2-year follow-up period. Studies with longer follow-up periods and larger patient cohorts are recommended.
Collapse
Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar De São João, Porto, Portugal
| | - Tiago Sardinha
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar De São João, Porto, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar De São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar De São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar De São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
49
|
Laiginhas R, Guimarães M, Cardoso P, Santos-Sousa H, Preto J, Nora M, Chibante J, Falcão-Reis F, Falcão M. Bariatric Surgery Induces Retinal Thickening Without Affecting the Retinal Nerve Fiber Layer Independent of Diabetic Status. Obes Surg 2020; 30:4877-4884. [PMID: 32779075 DOI: 10.1007/s11695-020-04904-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Obese patients have neurodegeneration of the optic nerve demonstrated by decreased peripapillary nerve fiber layer. Whether bariatric surgery reverses this neurodegenerative process has not been explored. We aimed to evaluate the impact of bariatric surgery in the structure of the retina and optic nerve. METHODS Multicentric observational study. Obese patients scheduled for bariatric surgery were consecutively recruited and included in the study and evaluated before and 6-12 months after the intervention. The retinal structure was evaluated as retinal thickness in the different retinal layers in the foveal, perifoveal, and parafoveal regions using optical coherence tomography. Choroidal thickness and optic nerve retinal nerve fiber layer thickness were also evaluated. RESULTS Eighty eyes from 40 participants were included. Globally, we found a significant thickening of the retina after bariatric surgery (foveal: 273.5 (21.5) μm vs 280.0 (28.8) μm, p < 0.001; parafoveal 332.4 ± 17.8 μm vs 336.6 ± 15.9 μm, p = 0.003; perifoveal: 293.4 ± 13.8 μm vs 295.7 ± 14.9 μm; p = 0.001), whereas no significant differences were found for the ganglion cell layer, choroid, or peripapillary nerve fiber layer thickness. The retinal thickening was confined to inner retinal layers and was independent of the diabetic status of the patients. After multivariate adjustment, HbA1c variation, preoperative C-peptide, preoperative hypertension, preoperative OSA, and preoperative LDL and TG levels seem to be clinical predictors of retinal thickening. CONCLUSIONS We found a significant thickening of the retina after bariatric surgery that was independent of the diabetic status. The thickening was confined to inner retinal layers and may represent and improve perfusion. The peripapillary nerve fiber layer remained unchanged after the surgery.
Collapse
Affiliation(s)
- Rita Laiginhas
- PDICSS, Faculty of Medicine of Porto University (FMUP), Porto, Portugal.,Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Marta Guimarães
- Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal.,Department of Anatomy, Institute of Biomedical Science Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Pedro Cardoso
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Hugo Santos-Sousa
- Department of Surgery, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal
| | - John Preto
- Department of Surgery, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal
| | - Mário Nora
- Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal
| | - João Chibante
- Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal. .,Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal.
| |
Collapse
|
50
|
Oliveira-Ferreira C, Azevedo M, Silva M, Roca A, Barbosa-Breda J, Faria PA, Falcão-Reis F, Rocha-Sousa A. Unexplained Visual Loss After Silicone Oil Removal: A 7-Year Retrospective Study. Ophthalmol Ther 2020; 9:1-13. [PMID: 32399859 PMCID: PMC7406612 DOI: 10.1007/s40123-020-00259-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Unexplained visual loss after removal of silicone oil from the eye has
been described. The purpose of this study is to determine the incidence of
unexplained loss of visual acuity after SO removal and to provide possible
explanations for this phenomenon. Methods This retrospective study included patients that underwent vitreoretinal
surgery, at Centro Hospitalar São João, between January of 2012 and October of 2018.
Inclusion criterion was vitreoretinal surgery in which the chosen endotamponade was
SO, followed by removal of SO and exchange with balanced salt solution (BSS) or air.
After SO removal, patients with documented loss of best corrected visual acuity
(BCVA) on two or more Snellen lines were analyzed and patients in which the cause of
the visual loss was identified, namely OHT (intraocular pressure > 21 mmHg),
retinal re-detachment, glaucoma, retinal proliferative membrane formation, or corneal
decompensation, were excluded. All patients with unexplained visual loss underwent
spectral domain optical coherence tomography (SD-OCT) to exclude causes of visual
reduction such as cystoid macular edema, epiretinal membrane, or
ellipsoid/interdigitation zone disruption. A p
value less than 0.05 was considered statistically significant. Results A total of 46 eyes underwent SO tamponade and SO removal during the
study period. In 34.8% of the cases (n = 16) there
was visual acuity loss in at least two Snellen lines. Of 46 eyes, 23.9% (n = 11) showed vision loss due to known secondary causes.
Unexplained loss of visual acuity after SO removal occurred in 10.9% of cases. OHT
during silicone endotamponade (p = 0.046) and
silicone emulsification (p = 0.001) were
identified as factors associated with unexplained visual loss after SO
removal. Conclusion Unexplained loss of visual acuity after SO removal occurred in 10.9% of
cases. OHT during silicone endotamponade and SO emulsification were identified as
important factors in the ethology of this phenomenon.
Collapse
Affiliation(s)
| | | | - Marta Silva
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal
| | - Ana Roca
- Faculty of Medicine of Porto University, Oporto, Portugal
| | - João Barbosa-Breda
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Oporto, Portugal.,Department of Neurosciences, Research Group Ophthalmology, KULeuven, Leuven, Belgium
| | - Pedro Alves Faria
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Oporto, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Oporto, Portugal
| |
Collapse
|