Publications by authors named "Amândio Rocha-Sousa"

43 Publications

Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review.

Acta Ophthalmol 2021 Mar 29. Epub 2021 Mar 29.

Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal.

Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient's CV risk profile in a non-invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aos.14851DOI Listing
March 2021

Cone dystrophy with supernormal rod responses: A rare KCNV2 gene variant.

Eur J Ophthalmol 2021 Mar 11:11206721211000000. Epub 2021 Mar 11.

Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.

Purpose: To describe the clinical, electrophysiological, and genetic findings of three Portuguese families with a rare variant in the 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 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 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 variant was observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/11206721211000000DOI Listing
March 2021

A Scoping Review of Process Indicators for Measuring Quality of Care in Glaucoma.

J Glaucoma 2021 Mar 5. Epub 2021 Mar 5.

EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal Ophthalmology, Faculty of Medicine, Universidade de Brasilia, Brasilia, Brasil Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina da Universidade do Porto, Porto, Portugal Hospital Epidemiology Center, Centro Hospitalar Universitário São João, Porto, Portugal Department of Surgery and Physiology and Cardiovascular R&D Center, Faculdade de Medicina da Universidade do Porto, Porto, Portugal Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium.

Prcis: There are no standardized process quality indicators in glaucoma care. Although they can be inferred from guidelines and trials, they should be designed and standardized to allow better assessment of the quality of care.

Purpose: Quality indicators are crucial for assessing the performance of any health care system. To allow efficiency, effectiveness, and patient-centeredness, there is a need for prompt acquisition of up-to-date information. Among the available quality indicators, process indicators have the highest sensitivity to frequent changes and could better reflect the implementation outcomes of novel ideas and technology. This study aimed to map the available information regarding process quality indicators in glaucoma care, identify the current development stage of these indicators, and systematically synthesize them.

Methods: We performed a scoping review of four electronic bibliographic databases for studies reporting on process quality indicators in glaucoma. We retrieved 7502 references and created a domain list reflecting the core idea underlying each indicator.

Results: We summarized information from 18 documents and listed 20 domains. The most mentioned domains were follow-up, optic nerve head assessment, visual field test, and intra-ocular pressure. Indicators regarding quality of life assessment, patient assistance, or presence of written protocols were less frequently mentioned.

Conclusion: There are notable variations among process quality indicators in glaucoma and significant heterogeneity in their descriptions in published studies. Although novel indicators can be inferred from guidelines and trials, they should be designed and standardized for better assessment of performance in health systems to improve their quality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000001825DOI Listing
March 2021

Long term outer retinal changes in central serous chorioretinopathy submitted to half-dose photodynamic therapy.

Photodiagnosis Photodyn Ther 2021 Feb 22:102235. Epub 2021 Feb 22.

Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.

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 present 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 it seems to be a safe treatment for the outer retina. This is the first long-term study mapping the outer retinal changes in the macular area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pdpdt.2021.102235DOI Listing
February 2021

Child with a mild phenotype of Incontinentia Pigmenti and inner retinal dysfunction.

Doc Ophthalmol 2021 Feb 13. Epub 2021 Feb 13.

Department of Ophthalmology, Centro Hospitalar Universitário de São João, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10633-021-09824-0DOI Listing
February 2021

Metabolomic profiling of aqueous humor from glaucoma patients - The metabolomics in surgical ophthalmological patients (MISO) study.

Exp Eye Res 2020 12 1;201:108268. Epub 2020 Oct 1.

Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium; Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.

Glaucoma is still a poorly understood disease with a clear need for new biomarkers to help in diagnosis and potentially offer new therapeutic targets. We aimed to determine if the metabolic profile of aqueous humor (AH) as determined by nuclear magnetic resonance (NMR) spectroscopy allows the distinction between primary open-angle glaucoma patients and control subjects, and to distinguish between high-tension (POAG) and normal-tension glaucoma (NTG). We analysed the AH of patients with POAG, NTG and control subjects (n = 30/group). H NMR spectra were acquired using a 400 MHz spectrometer. Principle component analysis (PCA), machine learning algorithms and descriptive statistics were applied to analyse the metabolic variance between groups, identify the spectral regions, and hereby potential metabolites that can act as biomarkers for glaucoma. According to PCA, fourteen regions of the NMR spectra were significant in explaining the metabolic variance between the glaucoma and control groups, with no differences found between POAG and NTG groups. These regions were further used in building a classifier for separating glaucoma from control patients, which achieved an AUC of 0.93. Peak integration was performed on these regions and a statistical analysis, after false discovery rate correction and adjustment for the different perioperative topical drug regimen, revealed that five of them were significantly different between groups. The glaucoma group showed a higher content in regions typical for betaine and taurine, possibly linked to neuroprotective mechanisms, and also a higher content in regions that are typical for glutamate, which can indicate damaged neurons and oxidative stress. These results show how aqueous humor metabolomics based on NMR spectroscopy can distinguish glaucoma patients from controls with a high accuracy. Further studies are needed to validate these results in order to incorporate them in clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.exer.2020.108268DOI Listing
December 2020

Cerebral Neurovascular Coupling Impairment in Central Serous Chorioretinopathy.

Ophthalmic Res 2020 Jun 19. Epub 2020 Jun 19.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000509553DOI Listing
June 2020

Unexplained Visual Loss After Silicone Oil Removal: A 7-Year Retrospective Study.

Ophthalmol Ther 2020 Sep 5;9(3):1-13. Epub 2020 Aug 5.

Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40123-020-00259-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406612PMC
September 2020

A Review of Capture-recapture Methods and Its Possibilities in Ophthalmology and Vision Sciences.

Ophthalmic Epidemiol 2020 08 3;27(4):310-324. Epub 2020 May 3.

Department of Medicine, Optometry Linnaeus University Kalmar , Kalmar, Sweden.

Epidemiological information is expected to be used to develop key aspects of eye care such as to control and minimise the impact of diseases, to allocate resources, to monitor public health actions, to determine the best treatment options and to forecast the consequence of diseases in populations. Epidemiological studies are expected to provide information about the prevalence and/or incidence of eye diseases or conditions. To determine prevalence is necessary to perform a cross-sectional screening of the population at risk to ascertain the number of cases. The aim of this review is to describe and evaluate capture-recapture methods (or models) to ascertaining the number of individuals with a disease (e.g. diabetic retinopathy) or condition (e.g. vision impairment) in the population. The review covers the fundamental aspects of capture-recapture methods that would enable non-experts in epidemiology to use it in ophthalmic studies. The review provides information about theoretical aspects of the method with examples of studies in ophthalmology in which it has been used. We also provide a problem/solution approach for limitations arising from the lists obtained from registers or other reliable sources. We concluded that capture-recapture models can be considered reliable to estimate the total number of cases with eye conditions using incomplete information from registers. Accordingly, the method may be used to maintain updated epidemiological information about eye conditions helping to tackle the lack of surveillance information in many regions of the globe.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09286586.2020.1749286DOI Listing
August 2020

Choroidal Thickness and Urinary Albumin Excretion in Type 2 Diabetic Patients without Retinopathy.

J Ophthalmol 2020 25;2020:3648941. Epub 2020 Feb 25.

Ophthalmology Department, Centro Hospitalar São João, Porto, Portugal.

The role of retinal vasculature's dysfunction in the physiopathology of Diabetic Retinopathy (DR) has been extensively described. Recently, the existence of a diabetic choroidal vasculopathy has been proposed. The purpose of this study was to compare choroidal thickness (CT) in nondiabetic patients and in type 2 diabetic patients without retinopathy, using EDI SD-OCT. Additionally, considering the diabetic patient group, compare CT in patients with and without microalbuminuria. This retrospective study selected patients sent from primary health-care centers as part of the national screening of diabetic retinopathy. Inclusion criteria were diagnosis of type 2 diabetes mellitus, absence of diabetic retinopathy, and a 24 hours urinary albumin measurement in the last 3 months at the primary health-care center. Nondiabetic patients were selected from a database in the ophthalmology department, and only healthy patients were included. At the screening visit, all patients performed a complete ophthalmologic examination by the same examiner. All eyes were examined with SD- OCT, and all scans were performed in the EDI mode. Measurements were made at three points: subfoveal, 1500 m temporally and nasally to the foveal center. We included 110 eyes of 110 diabetic patients without diabetic retinopathy and 30 eyes of 30 healthy controls. Mean subfoveal CT was greater in diabetic patients without retinopathy (with normoalbuminuria or microalbuminuria) when compared with nondiabetic patients ( < 0.05). In diabetic patients without retinopathy, the subfoveal and temporal choroid was thicker among patients with microalbuminuria when compared with those of normoalbuminuric patients ( < 0.05). The subfoveal and temporal choroid was thicker among diabetic patients with microalbuminuria compared with nondiabetic patients. ( < 0.05). This study suggests that choroidal changes are present in type 2 diabetic patients even before the clinical development of retinopathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/3648941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060841PMC
February 2020

Incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis.

Eur J Ophthalmol 2020 Feb 4:1120672120902028. Epub 2020 Feb 4.

Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.

Purpose: The purpose was to compare the incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis.

Methods: This is a single-center, retrospective case-control study. All patients treated with intravitreal injection of ranibizumab, bevacizumab, aflibercept, or corticosteroids for a variety of retinal vascular diseases between 1 October 2014 and 30 November 2018 were included. The total number of patients and injections were determined from a review of billing code and practice management records. Endophthalmitis cases were determined from billing records and then confirmed with chart review. A 24-month period when topical antibiotics were prescribed after intravitreal injection was compared with a 24-month period when topical antibiotics were not prescribed.

Results: Between 1 October 2014 and 30 November 2018, a total of 33,515 intravitreal injections were performed and 13 cases of post-intravitreal injection endophthalmitis were identified (incidence rate of 0.0388%; 95% confidence interval, 0.0217%-0.0644%) or approximately 1 case for every 2578 intravitreal injections. Between 1 October 2014 and 31 October 2016, while topical antibiotic prophylaxis was used postoperatively, 14,828 intravitreal injections were performed and 5 cases of endophthalmitis were reported (0.0337%; 95% confidence interval, 0.0129%-0.0739%). Between 1 November 2016 and 30 November 2018, while no prophylaxis was used, 18,687 intravitreal injections were performed and 8 cases of endophthalmitis were identified (0.0428%; 95% confidence interval, 0.0202%-0.0808%). There were no statistical differences in the incidence rates between the two groups ( = 0.675).

Conclusion: The incidence rate of endophthalmitis in the group with topical antibiotic prophylaxis after intravitreal injection was similar to the group with no prophylaxis. Changing the current clinical practice to no antibiotic prophylaxis had no effect on the incidence of endophthalmitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1120672120902028DOI Listing
February 2020

Hypotrichosis with juvenile macular dystrophy.

Ophthalmic Genet 2019 12 13;40(6):574-577. Epub 2019 Nov 13.

Department of Ophthalmology, Centro Hospitalar São João, Oporto, Portugal.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13816810.2019.1688840DOI Listing
December 2019

Heterogeneity in arterial hypertension and ocular perfusion pressure definitions: Towards a consensus on blood pressure-related parameters for glaucoma studies.

Acta Ophthalmol 2019 Jun 12;97(4):e487-e492. Epub 2018 Oct 12.

Research Group Ophthalmology, Department of Neurosciences, KULeuven, Leuven, Belgium.

Purpose: Glaucoma studies have long taken into account the blood pressure (BP) status of patients. This study summarizes and evaluates the impact of the different criteria that have been used for BP-related variables in glaucoma research.

Methods: Studies included in two meta-analyses that reviewed the role of BP in glaucoma were analyzed. Additional studies published after the search periods of the meta-analyses were also included. Criteria for the definition of arterial hypertension and other BP-related variables, such as mean arterial pressure (MAP) and mean ocular perfusion pressure (MOPP), were retrieved.

Results: Sixty-four studies were evaluated. One-third used 140 mmHg as a systolic BP cut-off to define hypertension, 20% used 160 mmHg and the remaining half used various other criteria. Less than 20% of studies reported MAP and/or MOPP. While eight of the ten studies reporting MAP used a correct formula that only happened for five of the eleven studies reporting MOPP. Using as an example average blood pressure values, incorrectly used formulas could have led to an overestimation of more than 100% of the expected values.

Conclusion: Considerable heterogeneity exists in BP-related variables in glaucoma research and different definitions can lead to large disparities. Glaucoma research would benefit from a consensus regarding blood pressure parameters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aos.13942DOI Listing
June 2019

Improved discrimination between normal-tension and primary open-angle glaucoma with advanced vascular examinations - the Leuven Eye Study.

Acta Ophthalmol 2019 Feb 17;97(1):e50-e56. Epub 2018 Sep 17.

Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium.

Purpose: Vascular factors have been suggested to influence the development and progression of glaucoma. They are thought to be especially relevant for normal-tension glaucoma (NTG) patients. We aim to investigate which vascular factors, including advanced vascular examinations, better describe patients with NTG comparing to those with primary open-angle glaucoma (POAG).

Methods: The Leuven Eye Study database (182 NTG and 202 POAG patients; similar structural and functional damage) was used to compute three multivariate logistic regression models: a conventional model (conventional parameters only, including vascular-related self-reported phenomena, such as migraine or peripheral vasospasm); an advanced vascular model (advanced vascular parameters only: colour Doppler imaging (CDI), retinal oximetry, ocular pulse amplitude and choroidal thickness); and a global model, in which both types of parameters were allowed. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated and compared between models.

Results: Patients with NTG had a higher resistive index and lower early systolic acceleration (ESA) in their retrobulbar vessels and a smaller arteriovenous retinal oxygen saturation difference. The global model (AUC 0.743) showed a significantly better discriminative ability when compared to either the conventional (AUC 0.687, p = 0.049) or the advanced vascular (AUC 0.677, p = 0.005) models. Also, the conventional and the advanced vascular models showed a similar discriminative ability (p = 0.823).

Conclusion: Patients with NTG have more signs of vascular dysfunction. Clinical conventional parameters, such as asking simple vascular-related questions, combined with advanced vascular examinations provide information to better understand the value that non-IOP-related factors play in NTG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aos.13809DOI Listing
February 2019

Quantitative automated circumpapillary microvascular density measurements: a new angioOCT-based methodology.

Eye (Lond) 2019 02 11;33(2):320-326. Epub 2018 Sep 11.

Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium.

Purpose: To develop a new methodology to detect glaucoma damage based on circumpapillary microvascular density (cpmVD) as measured by optical coherence tomography angiography (angioOCT).

Methods: AngioOCT scans from a random eye of 40 healthy subjects (aged 63 ± 14 years) and 82 glaucoma patients (aged 66 ± 9 years with an average visual field loss of -7.8 ± 6.5 dB) were used to develop a new angioOCT evaluation methodology. Optic disc-centred 3 × 3 mm images were collected (Angioplex, Zeiss Cirrus 5000 HD-OCT). An annular area with an inner radius of 1.16 mm and outer radius of 1.44 mm was chosen as the region of interest (ROI), with cpmVD calculated through lower envelope modulation avoiding the influence of the major retinal vessels. Additionally, the cpmVD and the microvascular density (mVD), stratified by sectors, were compared with the respective retinal nerve fibre layer (RNFL) thickness.

Results: A significantly lower cpmVD was observed in the glaucoma group, for all visual field sectors (p < 0.001), when comparing to the healthy group. The inferior and superior mVD sectors showed the largest differences between groups. Moreover, glaucoma was linked to a reduction of cpmVD variation when compared to the healthy group. Lastly, a comparison between two healthy subgroups showed that the method is not biased by the presence of slight movement artefacts, optic disc dimensions and vessel crowding (p > 0.05).

Conclusions: The presented open-source methodology provides a robust quantitative analysis of the 360˚ mVD. It shows that cpmVD, and mVD sectors measured by angioOCT, can be used in everyday glaucoma practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41433-018-0207-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367375PMC
February 2019

Predicting participation of people with impaired vision in epidemiological studies.

BMC Ophthalmol 2018 Sep 4;18(1):236. Epub 2018 Sep 4.

Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal.

Background: The characteristics of the target group and the design of an epidemiologic study, in particular the recruiting methods, can influence participation. People with vision impairment have unique characteristics because those invited are often elderly and totally or partially dependent on help to complete daily activities such as travelling to study sites. Therefore, participation of people with impaired vision in studies is less predictable than predicting participation for the general population.

Methods: Participants were recruited in the context of a study of prevalence and costs of visual impairment in Portugal (PCVIP-study). Participants were recruited from 4 Portuguese public hospitals. Inclusion criteria were: acuity in the better eye from 0.5 decimal (0.30logMAR) or worse and/or visual field of less than 20 degrees. Recruitment involved sending invitation letters and follow-up phone calls. A multiple logistic regression model was used to assess determinants of participation. The J48 classifier, chi-square and Fisher's exact tests were applied to investigate the possible differences between subjects in our sample.

Results: Individual cases were divided into 3 groups: immediate, late and non-participants. A participation rate of 20% was obtained (15% immediate, 5% late). Factors positively associated with participation included years of education, annual hospital attendance, and intermediate visual acuity. Females and greater distance to the hospital were inversely associated with participation.

Conclusion: In our study, a letter followed by a phone call was efficient to recruit a significant number of participants from a larger group of people with impaired vision. However, the improvement in participation observed after the phone call might not be cost-effective. People with low levels of education and women were more difficult to recruit. These findings need to be considered to avoid studies whose results are biased by gender or socio-economic inequalities of their participants. Young subjects and those at intermediate stages of vision impairment, or equivalent conditions, may need more persuasion than other profiles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12886-018-0889-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123934PMC
September 2018

Trends in Glaucoma Surgical Procedures in Portugal: A 16-Year Nationwide Study (2000-2015).

J Glaucoma 2018 08;27(8):682-686

CINTESIS-Centre for Health Technology and Services Research, University of Porto, Porto.

Purpose: Glaucoma leads as the first cause of irreversible blindness. The number of patients will greatly increase in upcoming years and changes will have to be accomplished to cope with those numbers. As such, data are important to understand the effect of new policies introduced in glaucoma management. Only few countries have described their glaucoma surgical profile and, in Europe, only the United Kingdom described the last 15 years. The aim of this study is to assess the glaucoma surgical profile and its changes in mainland Portugal from 2000 to 2015.

Methods: Retrospective database analysis of inpatient and surgical outpatients' episodes of all public hospitals in mainland Portugal was performed. The annual absolute numbers of ophthalmic procedures, as well as their surgical rate (per 100,000 inhabitants) were calculated.

Results: Glaucoma patients undergoing glaucoma procedures were 67±14 years old and 50% were female. During the study period there was an increase in the number and surgical rate of glaucoma procedures. Trabeculectomy showed a stable surgical rate (7 per 100,000 inhabitants) despite a reduction in terms of relative weight among glaucoma procedures. At the same time, the surgical rate of glaucoma drainage devices and cyclophotoablation increased, while remaining stable for cyclocryoablation.

Conclusions: In Portugal, trabeculectomy had a stable surgical rate throughout the study period, being the most performed glaucoma surgical procedure. Other surgeries, like glaucoma drainage devices and cyclophotoablation are gaining ground among glaucoma specialists. Our results match what has been published by other countries worldwide and can be used to achieve a better health planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000001011DOI Listing
August 2018

Aflibercept in diabetic macular edema refractory to previous bevacizumab: outcomes and predictors of success.

Graefes Arch Clin Exp Ophthalmol 2018 Jan 29;256(1):83-89. Epub 2017 Oct 29.

Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal.

Purpose: To evaluate functional and anatomical outcomes after aflibercept in patients with diabetic macular edema (DME) with poor response to bevacizumab.

Methods: We retrospectively reviewed patients with DME recalcitrant to bevacizumab who were switched to aflibercept between January and December 2015. All patients had a minimal follow-up of three months before the conversion and underwent at least three injections of bevacizumab. Functional outcome consisted in best corrected visual acuity (VA). Anatomical outcomes were demonstrated through central macular thickness (CMT) measured by optical coherence tomography.

Results: Forty-nine eyes of 34 subjects were reviewed. Mean VA improved from 0.55 ± 0.32 logMAR to 0.46 ± 0.33 logMAR (p = 0.038). Mean CMT decreased from 473 ± 146 μm to 349 ± 85 μm (p < 0.001). Twelve eyes (24%) demonstrated absence of macular edema after aflibercept. Previous bevacizumab exposure did not correlate with different outcomes. The variation of VA in response to aflibercept was significantly superior in the group with poorer VA before the switch (mean variation of -0.097 ± 0.21 logMAR) when compared to eyes with VA < 0.4 logMAR (mean variation of +0.019 ± 0.090 logMAR; p = 0.036). The same scenario was verified for anatomical outcomes as eyes with poor vision before the switch (≥0.4 logMAR) achieved superior reduction in CMT in response to aflibercept (mean CMT variation of -157 ± 171 μm versus -49.5 ± 39.9 μm; p < 0.01). Pre-switch CMT was a predictor of CMT reduction after switching (B = -0.945; confidence interval 95% -1.1; -0.76; p < 0.001).

Conclusions: Conversion to aflibercept for persistent DME resulted in functional and anatomical improvements and these outcomes were not influenced by previous bevacizumab exposure. Pre-switch CMT was a predictor of anatomical changes after aflibercept.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-017-3836-1DOI Listing
January 2018

WAGNER syndrome: anatomic, functional and genetic characterization of a Portuguese family.

Graefes Arch Clin Exp Ophthalmol 2018 Jan 25;256(1):163-171. Epub 2017 Oct 25.

Ophthalmology Department, S. João Hospital, Porto, Portugal.

Purpose: To report the clinical (anatomic and functional) and genetic findings of Wagner Syndrome (WS) in a Portuguese family.

Methods: Nine members of the family agreed to be examined. All had complete clinical eye examinations. The proband and selected patients underwent color fundus photography, spectral domain optical coherence tomography (SD-OCT), automatic static white-on-white computerized perimetry, and electrophysiology assessment (flash ERG, multifocal(mf) ERG and dark adaptometry). A pedigree was constructed based on interviews with known affected subjects. Genomic DNA samples derived from venous blood were collected from all affected family members examined.

Results: Twenty-eight family members are affected. This family has the typical features of Wagner Syndrome, namely an empty vitreous cavity with veils, mild myopia and cataract. Four examined patients underwent vitreoretinal surgery due to abnormal peripheral vitreoretinal adhesions with peripheral retinal traction (n = 3). Retinal detachment was observed in 5 of the examined subjects. Four of them occurred between the ages of 5 and 15 years. Chorioretinal atrophy is also a frequent finding which results in moderate to severe visual field and advanced rod-cone dystrophy from younger ages, also confirmed by absence of scotopic function on dark adaptation. The macular dysfunction on mfERG was profound and of early onset. A heterozygous mutation in intron 7 of the VCAN gene (c.4004-1G > A) was found.

Conclusions: We described a rare autosomal dominant vitreoretinopathy with near complete penetrance in a Portuguese family. Abnormal peripheral vitreoretinal adhesions, retinal detachment and chorioretinal atrophy are present in most of the examined individuals at young ages. Early onset of advanced visual field and electrophysiologic abnormalities were observed in this family. We also added relevant information to the literature by reporting our experience in surgical management of Wagner Syndrome patients with, and at risk of, retinal detachment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-017-3800-0DOI Listing
January 2018

Clinical Metabolomics and Glaucoma.

Ophthalmic Res 2018 1;59(1):1-6. Epub 2017 Sep 1.

Laboratory of Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium.

Glaucoma is one of the leading causes of irreversible blindness worldwide. However, there are no biomarkers that accurately help clinicians perform an early diagnosis or detect patients with a high risk of progression. Metabolomics is the study of all metabolites in an organism, and it has the potential to provide a biomarker. This review summarizes the findings of metabolomics in glaucoma patients and explains why this field is promising for new research. We identified published studies that focused on metabolomics and ophthalmology. After providing an overview of metabolomics in ophthalmology, we focused on human glaucoma studies. Five studies have been conducted in glaucoma patients and all compared patients to healthy controls. Using mass spectrometry, significant differences were found in blood plasma in the metabolic pathways that involve palmitoylcarnitine, sphingolipids, vitamin D-related compounds, and steroid precursors. For nuclear magnetic resonance spectroscopy, a high glutamine-glutamate/creatine ratio was found in the vitreous and lateral geniculate body; no differences were detected in the optic radiations, and a lower N-acetylaspartate/choline ratio was observed in the geniculocalcarine and striate areas. Metabolomics can move glaucoma care towards a personalized approach and provide new knowledge concerning the pathophysiology of glaucoma, which can lead to new therapeutic options.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000479158DOI Listing
March 2018

Safety and Effectiveness of Cataract Surgery with Simultaneous Intravitreal Anti-VEGF in Patients with Previously Treated Exudative Age-Related Macular Degeneration.

Acta Med Port 2017 Feb 27;30(2):127-133. Epub 2017 Feb 27.

Ophthalmology Department. Centro Hospitalar São João. Porto. Portugal.; Department of Sense Organs. Faculdade de Medicina. Universidade do Porto. Porto. Portugal.

Introduction: To evaluate the safety and impact on visual acuity, retinal and choroidal morphology of simultaneous cataract surgery and intravitreal anti-vascular endothelial growth factor on patients with visually significant cataracts and previously treated exudative age-related macular degeneration.

Material And Methods: Prospective study, which included 21 eyes of 20 patients with exudative age-related macular degeneration submitted to simultaneous phacoemulsification and intravitreal ranibizumab or bevacizumab. The patients were followed for 12 months after surgery using a pro re nata strategy. Visual acuity, foveal and choroidal thickness changes were evaluated 1, 6 and 12 months post-operatively.

Results: There was a statistically significant increase in mean visual acuity at one (13.4 letters, p < 0.05), six (11.5 letters, p < 0.05) and twelve months (11.3 letters, p < 0.05) without significant changes in retinal or choroidal morphology. At 12 months, 86% of eyes were able to maintain visual acuity improvement. There were no significant differences between the two anti-vascular endothelial growth factor drugs and no complications developed during follow-up.

Discussion: Simultaneous phacoemulsification and intravitreal anti- vascular endothelial growth factor is safe and allows improvement in visual acuity in patients with visually significant cataracts and exudative age-related macular degeneration. Visual acuity gains were maintained with a pro re nata strategy showing that in this subset of patients, phacoemulsification may be beneficial.

Conclusion: Cataract surgery and simultaneous anti-vascular endothelial growth factor therapy improves visual acuity in patients with exudative age-related macular degeneration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20344/amp.7850DOI Listing
February 2017

Diffusion of anti-VEGF injections in the Portuguese National Health System.

BMJ Open 2015 Nov 23;5(11):e009006. Epub 2015 Nov 23.

Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.

Objectives: To analyse the temporal and geographical diffusion of antivascular endothelial growth factor (anti-VEGF) interventions, and its determinants in a National Health System (NHS).

Setting: NHS Portuguese hospitals.

Participants: All inpatient and day cases related to eye diseases at all Portuguese public hospitals for the period 2002-2012 were selected on the basis of four International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479 and 149.

Primary And Secondary Outcome Measures: We measured anti-VEGF treatment rates by year and county. The determinants of the geographical diffusion were investigated using generalised linear modelling.

Results: We analysed all hospital discharges from all NHS hospitals in Portugal (98,408 hospital discharges corresponding to 57,984 patients). National rates of hospitals episodes for the codes for procedures used were low before anti-VEGF approval in 2007 (less than 12% of hospital discharges). Between 2007 and 2012, the rates of hospital episodes related to the introduction of anti-VEGF injections increased by 27% per year. Patients from areas without ophthalmology departments received fewer treatments than those from areas with ophthalmology departments. The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km(2) raised the rates by 11%.

Conclusions: Our study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments. The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2015-009006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663428PMC
November 2015

Intravitreal injection of recombinant tissue plasminogen activator in submacular hemorrhage: case series.

Eur J Ophthalmol 2016 Apr 12;26(3):e49-51. Epub 2016 Apr 12.

Ophthalmology Department, S. João Hospital, Porto - Portugal.

Purpose: To report the safety and efficacy of intravitreal recombinant tissue plasminogen activator (rtPA) with gas for managing submacular hemorrhage.

Methods: Patients with submacular hemorrhage centered in or close to the fovea underwent hemorrhage displacement with intravitreal injection of rtPA (50 μg/0.05 mL) followed by gas injection (0.3 mL SF6). Anatomic and visual outcomes are described.

Results: Exudative age-related macular degeneration (AMD) (n = 4) and blunt trauma (n = 2) were the etiologies of submacular hemorrhage in this sample. Intravitreal injection of rtPA decreased the extent of submacular hemorrhage in all eyes, with complete hemorrhage displacement in 2 and partial displacement in 4. Visual acuity remained stable (n = 4) or improved (n = 2) after the procedure. Improvements in anatomic and visual outcomes were less evident in exudative AMD cases, which also had longer hemorrhage duration. Recurrence occurred only in 1 eye. No evident rtPA-associated retinal toxicity was observed.

Conclusions: Untreated submacular hemorrhage has poor visual prognosis. Our results suggest that rtPA injection is a minimally invasive, simple, inexpensive procedure with few related complications. Cost-benefit of this injection seems acceptable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/ejo.5000682DOI Listing
April 2016

BAX and BCL-2 polymorphisms, as predictors of proliferative vitreoretinopathy development in patients suffering retinal detachment: the Retina 4 project.

Acta Ophthalmol 2015 Nov 19;93(7):e541-9. Epub 2015 May 19.

Instituto de Oftalmobiología Aplicada (IOBA-Retina Group), University of Valladolid, Valladolid, Spain.

Purpose: To compare the distribution of BCL-2 -938C>A (rs2279115) and BAX -248G>A (rs4645878) genotypes among European subjects undergoing rhegmatogenous retinal detachment (RRD) surgery in relation to the further development of proliferative vitreoretinopathy (PVR).

Methods: A case-control gene association study, as a part of Retina 4 project, was designed. rs2279115 and rs4645878 polymorphisms were analysed in 555 samples from patients with RRD (134 with PVR secondary to surgery). Proportions of genotypes and AA homozygous groups of BCL-2 and BAX polymorphisms between subsamples were analysed in two phases. Genotypic and allelic frequencies were compared in global sample and in subsamples.

Results: BAX: Differences were observed in the genotype frequencies and in AA carriers between controls and cases in the global series. The odds ratio (OR) of A carriers in the global sample was 1.7 (95% CI: 1.23-2.51). Proportions of genotypes in Spain + Portugal were significant different. The OR of A carriers from Spain and Portugal was 1.8 (95% CI: 1.11-2.95). BCL-2: No significant differences were observed in genotype frequencies. However, proportions of genotypes in Spain + Portugal were significant. A protective effect (OR: 0.6 95% CI: 0.43-0.96) was found in A carriers from Spain and Portugal.

Conclusions: Results suggest that A allele of rs4645878 could be a biomarker of high risk of developing PVR in patients undergoing RD surgery. The possible role of BCL-2 (inhibitor of necroptosis pathway) as a possible new target in PVR prophylaxis should be investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aos.12718DOI Listing
November 2015

Evaluation of visual acuity, macular status, and subfoveal choroidal thickness changes after cataract surgery in eyes with diabetic retinopathy.

Retina 2015 Feb;35(2):294-302

*Department of Ophthalmology, Hospital S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal; and †Department of Sense Organs, Faculty of Medicine of Porto University, Hospital S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal.

Purpose: Progression of diabetic macular edema has been reported as a common cause of poor visual acuity recovery after cataract surgery in patients with diabetes. Despite being responsible for the blood supply to the outer retina, the role of the choroidal layer in the pathogenesis of diabetic retinopathy (DR) is not yet understood. Our objective is to characterize macular and subfoveal choroidal thickness changes after cataract surgery in eyes with DR.

Methods: Thirty-five eyes with clinically significant cataract of patients with DR were divided into three groups based on clinical and optical coherence tomography findings: patients with DR without macular edema, patients with DR and macular thickening detected on optical coherence tomography, and finally patients with clinically significant macular edema. All cases were submitted to ophthalmologic examination and spectral domain optical coherence tomography 1 week before cataract surgery and repeated 1 month after surgery. Patients with preoperative clinically significant macular edema were treated with intravitreal bevacizumab at the time of surgery.

Results: All groups showed a significant increase in visual acuity 1 month after surgery (P < 0.001). Mean foveal thickness increased significantly in all groups, including controls (P = 0.013), except in patients who were simultaneously treated with intravitreal bevacizumab (P = 0.933). An increase of maximum macular thickness of at least 11% was found in 25.7% of the DR eyes, but no such increase occurred in the control eyes. No significant change was verified for subfoveal choroidal thickness in any of the studied groups.

Conclusion: Surgical inflammation associated with cataract surgery caused a significant increase of macular thickness in control and DR eyes that were not treated with intravitreous bevacizumab. Such macular changes were not accompanied by subfoveal choroidal thickness changes in any of the study groups, suggesting that the changes in macular thickness associated with the surgery are not related to changes in choroidal thickness and that there is no relation between inner blood-retinal barrier status and diabetic choroidal angiopathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0000000000000298DOI Listing
February 2015

Predicting proliferative vitreoretinopathy: temporal and external validation of models based on genetic and clinical variables.

Br J Ophthalmol 2015 Jan 29;99(1):41-8. Epub 2014 Jul 29.

Medicina Xenómica, Complexo Hospitalario Universitario de Santiago, IDIS, Santiago de Compostela, Spain University of Santiago de Compostela, Galician Public Foundation for Genomic Medicine, CIBERER, Santiago de Compostela, Spain.

Purpose: To validate three models for predicting proliferative vitreoretinopathy (PVR) based on the analysis of genotypic data and relevant clinical characteristics.

Methods: The validation series consisted of data from 546 patients operated on from primary rhegmatogenous retinal detachment (RRD) coming from centres in the Netherlands, Portugal, Spain and the UK. Temporal and geographical validation was performed. The discrimination capability of each model was analysed and compared with the original series, using a receiver operating curve. Then, clinical variables were combined in order to improve the predictive capability. A risk reclassification analysis was performed with and without each one of the variables. Reclassification of patients was compared and models were readjusted in the original series. Readjusted models were further validated.

Results: One of the models showed good predictability in the temporal sample as well as in the original series (area under the curve (AUC) original=0.7352; AUC temporal=0.6457, 95% CI 50.17 to 78.97). When clinical variables were included, only pre-existent PVR improves the predictability of this model in the validation series (temporal and geographical samples) (AUC original=0.7940 vs AUC temporal=0.7744 and AUC geographical=0.7152). The other models showed acceptable AUC values when clinical variables were included although they were less accurate than in the original series.

Conclusions: Genetic profiling of patients with RRD can improve the predictability of PVR in addition to the well-known clinical biomarkers. This validated formula could be a new tool in our current clinical practice in order to identify those patients at high risk of developing PVR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2014-305263DOI Listing
January 2015

The ghrelin-GHSR-1a system in the ocular neuro-humoral regulation. Pearls and controversies.

Regul Pept 2014 Jun-Aug;192-193:53-4. Epub 2014 Jun 13.

Department of Senses Organs, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.regpep.2014.06.001DOI Listing
November 2015

Graded müllerectomy for correction of graves upper eyelid retraction: effect on eyelid movements.

Ophthalmic Plast Reconstr Surg 2014 Sep-Oct;30(5):384-7

*Ophthalmology Unit, Department of Senses Organs, Faculty of Medicine, University of Porto, Porto, Portugal; †Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto; ‡School of Medicine of Ribeirão Preto and Craniofacial Research Support Center, University of São Paulo, São Paulo, Brazil; §King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; and ║Johns Hopkins University, Baltimore, Maryland, U.S.A.

Purpose: To measure the effect of müllerectomy from posterior approach on the amplitudes of spontaneous blinking and downward eyelid saccades.

Methods: Spontaneous blinks and downward upper eyelid saccadic movements of 16 patients (23 eyelids) with Graves orbitopathy were measured before and after müllerectomy from posterior approach. A new video system was used to continuously register the blinking activity while subjects viewed a commercial movie for 5 minutes. Downward eyelid saccades (30° of downgaze) were also measured with the video system.

Results: Müllerectomy had no effect on the amplitude of the blink. However, as the eyelid margins were significantly lowered by the surgery, the amplitude of the blink movements relative to the pupil center increased substantially. The number of movements occluding the pupil center increased from 0% to 13%. Due to the increased efficiency of blinking, the blink rate decreased. Surgery induced a mean increase of 1.1 mm of downward saccades.

Conclusions: The effects of müllerectomy on the blinks are indirect and related to correction of eyelid retraction. The relative amplitude of blink movements increases and blink rate decreases. Müllerectomy does affect the downward eyelid saccades increasing the ability of the upper eyelid to relax on downgaze.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IOP.0000000000000116DOI Listing
March 2015

Open-globe injuries at an emergency department in Porto, Portugal: clinical features and prognostic factors.

Eur J Ophthalmol 2014 Nov-Dec;24(6):932-9. Epub 2014 Apr 16.

Department of Senses Organs, Faculty of Medicine, University of Porto, Porto - Portugal.

Purpose: To describe the epidemiology, characteristics, surgical management, functional outcome, and prognostic factors of open-globe injuries requiring surgical treatment.

Methods: A retrospective review of 180 patients who underwent surgical repair of an open-globe injury at the ophthalmology emergency department of the Hospital S. João (Porto-Portugal) was performed. Prognostic factors for no light perception and for poor vision (visual acuity <3/10) in patients who retained vision after surgical treatment were determined.

Results: We observed a different age distribution between male and female ocular trauma (143 patients were men, with a mean age of 46.4 years, while the mean age for women was 70.9 years). Domestic accidents were the most frequent context of trauma (44.4%). However, work accidents constituted the principal context of trauma among men. Initial visual acuity, concomitant adnexa lesion, associated nonocular trauma, and intentionally caused trauma were predictors of no vision at the end of the follow-up. Older age, lens damage, and retinal detachment were predictors of poor vision in patients with retained visual acuity. Vitreous hemorrhage, posterior segment lesion, and simultaneous lesion of anterior and posterior segment anticipated both no vision and poor vision. Isolated anterior segment lesion was associated with vision survival and good vision (≥3/10).

Conclusions: The prognostic factors identified in this study may aid the process of decision-making in 2 crucial moments: at the initial approach and during the follow-up of patients with vision survival after open-globe injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/ejo.5000471DOI Listing
December 2014

Choroidal and macular thickness changes induced by cataract surgery.

Clin Ophthalmol 2014 16;8:55-60. Epub 2013 Dec 16.

Department of Sense Organs, Faculty of Medicine, University of Porto, Portugal ; Department of Ophthalmology of Hospital de São João, Portugal.

Background: The aim of this study was to evaluate the effect of uneventful phacoemulsification on the morphology and thickness of the macula, the submacular choroid, and the peripapillary choroid.

Methods: In 14 eyes from 14 patients, retinal macular thickness, choroidal submacular thickness, and choroidal peripapillary thickness were measured preoperatively and at one week and one month after phacoemulsification using enhanced depth imaging spectral domain optical coherence tomography. Changes in thickness of the different ocular tissues were evaluated.

Results: There was a statistically significant increase in mean retinal macular thickness at one month. In horizontal scans, the mean increase was +8.67±6.75 μm (P<0.001), and in vertical scans, the mean increase was +8.80±7.07 μm (P=0.001). However, there were no significant changes in choroidal morphology in the submacular and peripapillary areas one month after surgery. In vertical scans, there was a nonsignificant increase in choroidal thickness (+4.21±20.2 μm; P=0.47) whilst in horizontal scans a nonsignificant decrease was recorded (-9.11±39.59 μm; P=0.41). In peripapillary scans, a nonsignificant increase in mean choroidal thickness was registered (+3.25±11.80 μm; P=0.36).

Conclusion: Uncomplicated phacoemulsification induces nonpathologic increases in retinal macular thickness probably due to the inflammatory insult of the surgery; however these changes are not accompanied by significant changes in choroidal thickness. In the posterior segment, the morphologic response to the inflammatory insult of phacoemulsification is mainly observed at the retinal level, and seems to be independent of choroidal thickness changes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S53989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869938PMC
December 2013