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Rodrigues R, Santos Silva R, Penas S, Moleiro A, Estrela Silva S, Faria O, Magalhães A. Alström syndrome mimicking spasmus nutans: report of a novel ALMS1 variant. J AAPOS 2024; 28:103853. [PMID: 38378129 DOI: 10.1016/j.jaapos.2024.103853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
We report the case of an otherwise healthy 6-year-old girl presenting with poor visual acuity, photophobia, and abnormal eye and head movements who was initially diagnosed with spasmus nutans. A remote history of presumed viral cardiomyopathy and further electroretinography testing raised suspicion for Alström syndrome. She was diagnosed with a novel ALMS1 variant.
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Affiliation(s)
- Rita Rodrigues
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - R Santos Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Moleiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S Estrela Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Olinda Faria
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Teixeira C, Pessoa B, Ruão M, Sousa JPC, Penas S, Silva R, Carneiro Â, Meireles A. ILUVIEN ® in diabetic macular edema that persists or recurs despite treatment: Results from the Retina.pt ® RIVER audit. Eur J Ophthalmol 2023:11206721231217525. [PMID: 38013451 DOI: 10.1177/11206721231217525] [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: 11/29/2023]
Abstract
PURPOSE Persistent diabetic macular edema (DME) remains a problem in clinical practice, with many patients having a suboptimal response to the standard of care (SOC). Evidence supports the long-term efficacy of intravitreal fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients that have responded sub-optimally, although there is still scarce data from real-world Portuguese practices. We aimed to monitor the current SOC in selected Portuguese practices prior to FAc implantation and then assess the long-term effectiveness and safety of the FAc implant. SETTINGS The study included patient data from five Portuguese public hospitals. DESIGN This was a non-interventional, multicenter audit of data collected from Retina.pt registry from patients with persistent or recurrent DME despite treatment. METHODS Outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). Results were compared at regular times over 36 months. RESULTS This study included 222 eyes from 152 patients. A significant decrease in BCVA (P < 0.001) and a significant increase in CMT (P = 0.013) were observed prior to FAc. A significant increase in BCVA was registered at 6 months after FAc implant administration (P < 0.001), which was maintained during follow-up. No relevant changes in IOP were observed. Treatment burden was reduced as a result of treatment with FAc (P < 0.001 for anti-VEGF, corticosteroids, or both treatments) in the full population. CONCLUSIONS In Portuguese practice, data showed that pre-FAc implantation, some patients did not respond to SOC treatment and/or they were undertreated. Following FAc implant administration, there were rapid, sustained, long-term visual and anatomical improvements, and a marked reduction in treatment burden.
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Affiliation(s)
- Carla Teixeira
- Department of Ophthalmology of Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
| | - Bernardete Pessoa
- Diabetes Ocular Department of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
- Department of Ophthalmology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute for the Biomedical Sciences Abel Salazar from University of Porto (UMIB ICBAS - UP), Porto, Portugal
| | - Miguel Ruão
- Department of Ophthalmology of Centro Hospitalar entre Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Susana Penas
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
- Department of Ophthalmology of Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rufino Silva
- Department of Ophthalmology, Ophthalmology Clinic, Faculty of Medicine of the University of Coimbra (FMUC), Coimbra, Portugal
- Department of Ophthalmology of Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Department of Ophthalmology, Coimbra, Centro Académico Clínico de Coimbra (CACC), Coimbra, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
| | - Angelina Meireles
- Department of Ophthalmology of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
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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
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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.
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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
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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.
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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
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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.
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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
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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.
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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
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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.
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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
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Madeira C, Barbosa Breda J, Penas S. Bilateral Central Retinal Vein Occlusion: A Presenting Sign of an Ongoing Life-threatening Condition. JAMA Ophthalmol 2021; 139:1242-1243. [PMID: 34529022 DOI: 10.1001/jamaophthalmol.2021.0993] [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] [Indexed: 11/14/2022]
Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - João Barbosa Breda
- 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.,Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal.,KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
| | - Susana Penas
- 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
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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.
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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
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11
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Aguiar de Sousa D, Pereira-Santos MC, Serra-Caetano A, Lucas Neto L, Sousa AL, Gabriel D, Correia M, Gil-Gouveia R, Oliveira R, Penas S, Carvalho Dias M, Correia MA, Carvalho M, Sousa AE, Canhão P, Ferro JM. Blood biomarkers associated with inflammation predict poor prognosis in cerebral venous thrombosis:: a multicenter prospective observational study. Eur J Neurol 2020; 28:202-208. [PMID: 32918842 DOI: 10.1111/ene.14526] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Experimental studies suggest inflammation can contribute to blood barrier disruption and brain injury in cerebral venous thrombosis (CVT). We aimed to determine whether blood biomarkers of inflammation were associated with the evolution of brain lesions, persistent venous occlusion or functional outcome in patients with CVT. METHODS Pathophysiology of Venous Infarction-Prediction of Infarction and Recanalization in CVT (PRIORITy-CVT) was a multicenter prospective cohort study of patients with newly diagnosed CVT. Evaluation of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) concentrations in peripheral blood samples was performed at admission in 62 patients. Additional quantification of interleukin (IL)-6 was performed at day 1, 3 and 8 in 35 patients and 22 healthy controls. Standardized magnetic resonance imaging was performed at day 1, 8 and 90. Primary outcomes were early evolution of brain lesion, early recanalization and functional outcome at 90 days. RESULTS Interleukin-6 levels were increased in patients with CVT with a peak at baseline. IL-6, NLR and CRP levels were not related with brain lesion outcomes or early recanalization but had a significant association with unfavourable functional outcome at 90 days (IL-6: OR = 1.28, 95% CI: 1.05-1.56, P = 0.046; NLR: OR = 1.39, 95% CI: 1.4-1.87, P = 0.014; CRP: OR = 1.756, 95% CI: 1.010-3.051, P = 0.029). Baseline IL-6 had the best discriminative capacity, with an area under the receiver operating characteristic curve to predict unfavourable functional outcome of 0.74 (P = 0.031). CONCLUSIONS Increased baseline levels of NLR, CRP and IL-6 may serve as new predictive markers of worse functional prognosis at 90 days in patients with CVT. No association was found between inflammatory markers and early evolution of brain lesion or venous recanalization.
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Affiliation(s)
- D Aguiar de Sousa
- Department, of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Lisbon.,Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | | | - A Serra-Caetano
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - L Lucas Neto
- Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon.,Department of Neuroradiology, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - A L Sousa
- Department of Neurology, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - D Gabriel
- Department of Neurology, Centro Hospitalar Universitário do Porto - Hospital Santo António, Porto, Portugal
| | - M Correia
- Department of Neurology, Centro Hospitalar Universitário do Porto - Hospital Santo António, Porto, Portugal
| | - R Gil-Gouveia
- Department of Neurology, Hospital da Luz, Lisbon, Portugal
| | - R Oliveira
- Department of Neurology, Hospital da Luz, Lisbon, Portugal
| | - S Penas
- Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon
| | - M Carvalho Dias
- Department, of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Lisbon
| | - M A Correia
- Department of Neuroradiology, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - M Carvalho
- Department of Neurology, Centro Hospitalar Universitário de São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - A E Sousa
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - P Canhão
- Department, of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Lisbon.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - J M Ferro
- Department, of Neurosciences and Mental Health (Neurology), Hospital Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Lisbon.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
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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.
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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
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Romano MR, Parolini B, Allegrini D, Michalewska Z, Adelman R, Bonovas S, Bopp S, Tekin K, Fiser I, Boon CJF, Dijk ECH, Donvito G, Güngel H, Özdoğan Erkul S, Ünsal E, Osmanbaşoğlu Ö, Dinçer N, Erçalık NY, Yenerel NM, Amar J, Ennemoser A, Besozzi G, Sallam AAB, Ellabban AA, Chang W, Eandi CM, Demir M, Lee J, Pak K, Arrevola L, Sloka A, Morawski K, Kulig ‐ Stochmal A, Romanowska ‐ Dixon B, Striebe N, Feltgen N, Hoerauf H, Inan UU, Tanev I, Dyrda A, Schüler A, Lucke K, Brix A, Pape S, Kusserow‐Napp C, Loo PA, Kanra AY, Ardagil Akçakaya A, Arı Yaylalı S, Bae SH, Kim HK, Kim SJ, Han JR, Nam WH, Odrobina D, Lavaque E, Bertelli E, Coser S, Ziemssen F, Forlini M, Benatti C, Cavallini GM, Stefanickova J, Berrod J, Saksonov S, Lytvinchuk L, Moussa M, Stefaniotou M, Christodoulou E, Zayed MA, Oz O, Tassinari P, Koch P, Declercq C, Johnston R, Rusnak S, Penas S, Ozdek S, Ucgul Y, Cisiecki S, Dziegielewski K, Klimczak D, Michalewska Z, Michalewski J, Nawrocka Z, Nawrocki J, Ornafel K, Pikulski Z, Maciej M, Acar N, Elshafei MM, Hamon F, Soyeur R, Badat I, Brousseau B, Hermouet E, Peiretti E, Lee J, Ferreira N, Yoon H, Alkhars WI, Dudani A, Minu R, Telang O, MorePatil VG, Furtado MJ, Jo Y, Piccolino FC, Finzi A. An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study. Acta Ophthalmol 2020; 98:e549-e558. [PMID: 31808315 DOI: 10.1111/aos.14319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/09/2019] [Accepted: 11/02/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). METHODS This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. RESULTS One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months. CONCLUSION Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.
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Affiliation(s)
- Mario R Romano
- Department of Ophthalmology, Gavazzeni - Castelli Hospital, Humanitas University, Rozzano, Italy
| | - Barbara Parolini
- Department of Ophthalmology, Istituto Clinico S. Anna, Brescia, Italy
| | - Davide Allegrini
- Department of Ophthalmology, Gavazzeni - Castelli Hospital, Humanitas University, Rozzano, Italy
| | | | - Ron Adelman
- Department of Ophthalmology, Yale University, New Haven, Connecticut, USA
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Silvia Bopp
- Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Araújo T, Aresta G, Mendonça L, Penas S, Maia C, Carneiro Â, Mendonça AM, Campilho A. DR|GRADUATE: Uncertainty-aware deep learning-based diabetic retinopathy grading in eye fundus images. Med Image Anal 2020; 63:101715. [DOI: 10.1016/j.media.2020.101715] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/09/2020] [Accepted: 04/24/2020] [Indexed: 01/01/2023]
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Penas S, Castro P, Pereira G, Oliveira AM, Carneiro AM, Rocha-Sousa A, Azevedo E, Falcão-Reis FM. Cerebral Neurovascular Coupling Impairment in Central Serous Chorioretinopathy. Ophthalmic Res 2020; 65:446-454. [PMID: 32564029 DOI: 10.1159/000509553] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
Background Central serous chorioretinopathy (CSCR) is a chorioretinal disorder resulting from choroidal hyperpermeability. Its comorbidities as hypertension, coronary disease and psychological stress, suggest that it might reflect a more generalized vascular dysfunction. Objectives To assess the cerebrovascular regulation integrity, using cerebral autoregulation (CA), carbon dioxide vasoreactivity (VR) and neurovascular coupling (NVC) in CSCR. Methods This observational pilot study included 20 CSCR patients and 14 age and sex-matched controls. A State-Trait Anxiety Inventory (STAI) inquiry was full-filled. Continuous measurement of cerebral blood flow velocity (CBFV), arterial blood pressure, heart rate and end-tidal carbon dioxide was performed. VR was assessed during hypercapnia (inhaling carbogen gas) and hypnocapnia (hyperventilation). For NVC, the CBFV relative increase during mental activation using the N-Back Task was calculated. Results No significant differences in systemic hemodynamic parameters, CA or VR were found between both groups. During the NVC performance, the average CBFV rise during mental stress was significantly lower in CSCR (p=0.011). A significant negative correlation was found between STAI scores and NVC. Conclusions CSCR patients presented a significantly impaired cerebral NVC compared to controls, supporting the theory of a potential systemic vascular dysfunction. Stress could be related to this NVC impairment.
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Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Pedro Castro
- Faculty of Medicine of University of Porto, Porto, Portugal
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Gilberto Pereira
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Ana Marta Oliveira
- Investigation Unit, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Angela M Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Faculty of Medicine of University of Porto, Porto, Portugal
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Fernando M Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
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Matos R, Beato J, Silva M, Silva S, Brandão E, Falcão-Reis F, Penas S. Combined treatment with intravitreal bevacizumab and laser photocoagulation for exudative maculopathy in facioscapulohumeral muscular dystrophy. Ophthalmic Genet 2017; 38:490-493. [PMID: 28121209 DOI: 10.1080/13816810.2017.1279183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/27/2023]
Abstract
PURPOSE To report a rare case of exudative maculopathy in a patient with facioscapulohumeral muscular dystrophy (FSHD), and its management. METHODS Observational case report. RESULTS A 62-year-old man with genetically confirmed FSHD was referred to our department complaining of decreased visual acuity in his left eye. At presentation, right eye examination was unremarkable and best-corrected visual acuity (BCVA) was 20/20. Left eye BCVA was 20/100 and it presented a dense cataract with the evidence of macular lipid exudation. Cataract surgery combined with intravitreal bevacizumab improved BCVA to 20/20. Postoperative fundus examination disclosed focal macular retinal microvascular dilations with lipid exudation inferotemporal to the fovea. Fluorescein angiography highlighted these macular telangiectatic abnormalities but no peripheral lesions were detected. Spectral domain optical coherence tomography (SD-OCT) showed mild temporal retinal thickening, sparing the fovea. A diagnosis of exudative maculopathy due to macular telangiectasia secondary to FSHD was established. One year later, his left eye vision dropped to 20/32 and macular SD-OCT showed an aggravation of the intraretinal fluid and exudation. He was then submitted to a second intravitreal injection of bevacizumab followed by one angio-guided focal laser photocoagulation session, with a significant improvement. Twelve months later, his BCVA remained 20/20 on both eyes with no recurrence of exudation. CONCLUSION The present work shows that in cases of visual-threatening macular exudation, intravitreal anti-vascular endothelial growth factor injections combined with focal laser photocoagulation may be a safe and effective treatment. This article also highlights that all FSHD patients should be screened for asymptomatic retinal vascular disorders.
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Affiliation(s)
- Rita Matos
- a Department of Ophthalmology , Centro Hospitalar São João , Porto , Portugal
| | - João Beato
- a Department of Ophthalmology , Centro Hospitalar São João , Porto , Portugal
| | - Marta Silva
- a Department of Ophthalmology , Centro Hospitalar São João , Porto , Portugal
| | - Sérgio Silva
- a Department of Ophthalmology , Centro Hospitalar São João , Porto , Portugal
| | - Elisete Brandão
- a Department of Ophthalmology , Centro Hospitalar São João , Porto , Portugal
| | - Fernando Falcão-Reis
- a Department of Ophthalmology , Centro Hospitalar São João , Porto , Portugal.,b Department of Sense Organs, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Susana Penas
- a Department of Ophthalmology , Centro Hospitalar São João , Porto , Portugal.,b Department of Sense Organs, Faculty of Medicine , University of Porto , Porto , Portugal
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Rocha de Sousa A, Rosinha P, Rodrigues-Araújo J, Alves-Faria P, Costa A, Falcão-Reis F, Penas S. Analysis of macular sensitivity using multifocal electroretinogram and microperimetry in central serous chorioretinopathy patients after half-dose photodynamic therapy. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Andrade C, Beato J, Monteiro A, Costa A, Penas S, Guimarães J, Reis FF, Garrett C. Reply to Letter: Spectral-domain optical coherence tomography as a potential biomarker in Huntington's disease. Mov Disord 2016; 31:1762-1763. [PMID: 27548531 DOI: 10.1002/mds.26767] [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: 05/30/2016] [Accepted: 06/05/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Carlos Andrade
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal.,Ophthalmology Unit of Sense Organs Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - Ana Monteiro
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - Andreia Costa
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal.,Ophthalmology Unit of Sense Organs Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - Joana Guimarães
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Faculty of Medicine University of Porto, Porto, Portugal.,Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
| | - Fernando Falcão Reis
- Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal.,Ophthalmology Unit of Sense Organs Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - Carolina Garrett
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Faculty of Medicine University of Porto, Porto, Portugal.,Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
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Andrade C, Beato J, Monteiro A, Costa A, Penas S, Guimarães J, Reis FF, Garrett C. Spectral-Domain Optical Coherence Tomography as a Potential Biomarker in Huntington's Disease. Mov Disord 2016; 31:377-83. [PMID: 26853218 DOI: 10.1002/mds.26486] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 02/15/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Spectral-domain optical coherence tomography has been used in several neurological conditions, and peripapillary and macular measurements have been proposed as potential biomarkers in these disorders. The aim of this study was to investigate retinal and choroidal changes in Huntington's disease and to evaluate any potential correlation with the stage of the disease. METHODS A cross-sectional observational study compared patients with Huntington's disease and controls. Patients were evaluated using the Unified Huntington's Disease Rating Scale. Spectral-domain optical coherence tomography with enhanced depth imaging was used, and peripapillary choroidal and retinal nerve fiber layer thickness and macular retinal and choroidal thickness were evaluated. RESULTS Fifteen eyes of 8 patients and 16 eyes of 8 sex-, age-, and mean refractive error-matched healthy controls were included. Average (231.3 ± 52.8 vs 296.2 ± 57.1, P = 0.033), central (341.8 ± 70.5 vs 252.0 ± 57.9, P = 0.015), and inferior (225.3 ± 57.9 vs 313.8 ± 55.2, P = 0.007) macular choroidal thickness were significantly reduced in patients, in comparison with controls. No differences were observed in macular retina or peripapillary retinal and choroidal measurements. However, there was a negative correlation between Total Motor Score of the Unified Huntington's Disease Rating Scale and average (r(2) = 0.585, P = 0.027), superior (r(2) = 0.653, P = 0.015), nasal (r(2) = 0.642, P = 0.017), and inferior (r(2) = 0.574, P = 0.029) macular retinal thickness. CONCLUSIONS Our results suggest that both the choroidal and retinal macula are altered in Huntington's disease and may become useful biomarkers for monitoring neurodegeneration in this disease. The involvement of the choroid may also support the recent findings of vascular involvement in Huntington's disease.
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Affiliation(s)
- Carlos Andrade
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal
| | - Ana Monteiro
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Porto, Portugal
| | - Andreia Costa
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal.,Ophthalmology Unit of Sense Organs Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - Joana Guimarães
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Porto, Portugal.,Institute for Molecular and Cell Biology, University of Porto, Portugal
| | - Fernando Falcão Reis
- Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal.,Ophthalmology Unit of Sense Organs Department, Faculty of Medicine University of Porto, Porto, Portugal
| | - Carolina Garrett
- Department of Neurology, Centro Hospitalar São João, Porto, Portugal.,Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Porto, Portugal.,Institute for Molecular and Cell Biology, University of Porto, Portugal
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Penas S, Costa AF, Araujo JR, Alves Faria P, Brandao E, Sousa AR, Carneiro A, Falcao Reis F. Chronicity and Recurrence as Prognostic Factors in Central Serous Chorioretinopathy after Half-Dose Photodynamic Therapy. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2155-9570.1000594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Araújo J, Tavares-Ferreira J, Penas S, Figueira L, Paiva FP, Falcão-Reis F. Malignant hypertensive retinopathy as a presenting sign of an occult dead fetus. Clin Ophthalmol 2015; 9:971-5. [PMID: 26082609 PMCID: PMC4461088 DOI: 10.2147/opth.s71246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/29/2022] Open
Abstract
We report one case of malignant hypertensive retinopathy as a presenting sign of fetal death in utero. Ophthalmic examination (including intravenous fluorescein angiography and optical coherence tomography) and obstetric and systemic evaluation were performed, providing a multidisciplinary approach. A 33-year-old overweight woman (body mass index 47 kg/m2) with no systemic or ocular known disease was admitted to our emergency department with a one-week history of bilateral vision loss and no systemic complaints. On examination, best corrected visual acuity was 1/10 in the right eye and 1/10 in the left eye. Anterior segment examination of both eyes was unremarkable. Ophthalmoscopic fundus findings included bilateral optic disc edema, diffuse cotton wool spots, intraretinal exudates, retinal hemorrhages, and multiple serous retinal detachments involving both maculae. Physical examination revealed a blood pressure of 220/110 mmHg. Further systemic workup revealed a previously unknown 35-week pregnancy with a dead fetus. An emergency cesarean section was performed. Pre-eclampsia is a life-threatening disorder for both mother and fetus. This case highlights the need to rule out pre-eclampsia in all women of childbearing age presenting with ocular signs of malignant hypertension, even without external signs of pregnancy.
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Affiliation(s)
- Joana Araújo
- Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal
| | | | - Susana Penas
- Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal ; Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Figueira
- Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal ; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Flávio Prézia Paiva
- Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal ; Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal
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Dashtbozorg B, Mendonça AM, Penas S, Campilho A. RetinaCAD, a system for the assessment of retinal vascular changes. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:6328-31. [PMID: 25571444 DOI: 10.1109/embc.2014.6945076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper introduces RetinaCAD, a system, for the fast, reliable and automatic measurement of the Central Retinal Arteriolar Equivalent (CRAE), the Central Retinal Venular Equivalent (CRVE), and the Arteriolar-to-Venular Ratio (AVR) values, as well as several geometrical features of the retinal vasculature. RetinaCAD identifies important landmarks in the retina, such as the blood vessels and optic disc, and performs artery/vein classification and vessel width measurement. The estimation of the CRAE, CRVE and AVR values on 480 images from 120 subjects has shown a significant correlation between right and left eyes and also between images of same eye acquired with different camera fields of view. AVR estimation in retinal images of 54 subjects showed the lowest values in people with diabetes or high blood pressure thus demonstrating the potential of the system as a CAD tool for early detection and follow-up of diabetes, hypertension or cardiovascular pathologies.
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Brito P, Penas S, Carneiro A, Palmares J, Reis FF. Spectral-domain optical coherence tomography features of acute syphilitic posterior placoid chorioretinitis: the role of autoimmune response in pathogenesis. Case Rep Ophthalmol 2011; 2:39-44. [PMID: 21347191 PMCID: PMC3042017 DOI: 10.1159/000324086] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [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] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Syphilis is an infectious disease that can cause a wide variety of ocular signs. One of the rarest manifestations of ocular syphilis is acute syphilitic posterior placoid chorioretinitis (ASPPC). We report on the spectral-domain optical coherence tomography (SD-OCT) features of a case diagnosed with unilateral ASPPC. METHODS A 64-year-old man presented with a sudden loss of visual acuity (VA) in the right eye. His only clinical sign was a large, geographic, yellow-white lesion centered on the right fovea. Our patient was studied with SD-OCT on presentation and during follow-up, as well as with fluorescein and indocyanine green angiography, electrophysiological study, and serologic and autoimmune screening. RESULTS Laboratory workup revealed positive serology for active syphilis and elevated anti-beta2 glycoprotein I antibodies. SD-OCT showed a marked distortion of both the choroidal and outer retinal architecture. After treatment, best-corrected VA improved to 20/25. Pattern electroretinography displayed a severe reduction of P50 amplitude, which improved in late follow-up. Six months after presentation, VA was 20/25 and anti-beta2 glycoprotein I antibodies returned to normal levels. CONCLUSIONS Our findings are compatible with immunologically mediated temporary physiological impairment of the neuroretina, since the changes seen by SD-OCT could not have normalized if they were due to anatomical injury. The results of our study provide clues to understanding the pathogenesis of this disease and allow us to define a characteristic temporal sequence of events in ASPPC.
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Affiliation(s)
- Pedro Brito
- Department of Ophthalmology, Hospital S. João, University of Porto, Porto, Portugal
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