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Marta A, Miranda V, Lume M, Parreira R, Azevedo Soares C, Menéres MJ, Lemos C, Melo Beirão J. The Visual Impairment of Inherited Retinal Diseases in Portugal as per the National Table of Disabilities. Ophthalmol Sci 2024; 4:100443. [PMID: 38304608 PMCID: PMC10831172 DOI: 10.1016/j.xops.2023.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 02/03/2024]
Abstract
Purpose To evaluate the visual impairment of patients with inherited retinal diseases (IRDs), as per the national table of disabilities (TNI). Design Retrospective, single-center cohort study. Participants Patients with a clinical diagnosis of IRD were recruited at a referral center in Portugal. Methods Demographics and clinical data were collected from each individual patient file. The estimated visual disability coefficient was calculated through the evaluation of 7 graduated categories: orbital or eyelid deformities, low vision, visual field change, loss of bi-foveolar fixation, oculomotor palsy, photophobia, and chronic conjunctivitis. The TNI provides minimum and maximum disability values for numerous conditions within each category, which were summed to calculate an overall summary disability coefficient for each patient. Main Outcome Measures Demographic/clinical and estimated minimum and maximum visual disability coefficient according to the TNI for each patient. Results This study included 253 patients from 214 families, aged 3 to 80 years, with a mean age of 39.8 ± 20.0 years. The mean estimated minimum and maximum visual disability coefficients as per the TNI were 0.6 ± 0.4 and 0.7 ± 0.4, respectively. The low vision was the single most frequent contributor category (21.7%) present in the calculation of visual impairment. Low vision and visual field changes were the most frequent double combination (18.2%), and the addition of loss of bi-foveolar fixation was the most frequent triple combination (8.3%). Conclusions This study found that IRD patients had a significant visual disability, with the majority having a disability coefficient ≥0.6, which would qualify them for a "multipurpose disability medical certificate." Financial Disclosures The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Vasco Miranda
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Miguel Lume
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
| | - Ricardo Parreira
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
| | - Célia Azevedo Soares
- Medical Genetics Department, Centro de Genética Médica Jacinto Magalhães, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Medical Science Department, Universidade de Aveiro, Aveiro, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Maria João Menéres
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carolina Lemos
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - João Melo Beirão
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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Marta A, Marques JP, Santos C, Coutinho-Santos L, Vaz-Pereira S, Costa J, Arede P, Félix R, Geada S, Gouveia N, Silva R, Baptista M, Lume M, Parreira R, Azevedo Soares C, Menéres MJ, Lemos C, Melo Beirão J. The socioeconomic epidemiology of inherited retinal diseases in Portugal. Orphanet J Rare Dis 2024; 19:151. [PMID: 38594754 PMCID: PMC11003026 DOI: 10.1186/s13023-024-03161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 03/30/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Inherited retinal diseases (IRDs) are a group of rare degenerative disorders of the retina that can lead to blindness from birth to late middle age. Knowing the target population and its resources is essential to better plan support measures. The aim of this study was to evaluate the socioeconomic characteristics of regions in Portugal where IRD patients reside to inform the planning of vision aid and rehabilitation intervention measures. RESULTS This study included 1082 patients from 973 families, aged 3 to 92 years, with a mean age of 44.8 ± 18.1 years. Patients living with an IRD were identified in 190 of the 308 municipalities. According to this study, the estimated IRD prevalence in Portugal was 10.4 per 100,000 inhabitants, and by municipalities, it ranged from 0 to 131.2 per 100,000 inhabitants. Overall, regions with a higher prevalence of IRD have a lower population density (r=-0.371, p < 0.001), a higher illiteracy rate (r = 0.404, p < 0.001) and an overall older population (r = 0.475, p < 0.001). Additionally, there is a lower proportion of doctor per capita (r = 0.350, p < 0.001), higher social security pensions beneficiaries (r = 0.439, p < 0.001), worse water quality for human consumption (r=-0.194, p = 0.008), fewer audiences at the cinema (r=-0.315, p < 0.001) and lower proportion of foreign guests in tourist accommodations (r=-0.287, p < 0.001). CONCLUSION The number of identified patients with IRD varied between regions. Using data from national statistics (PORDATA), we observed differences in socioeconomic characteristics between regions. Multiple targeted aid strategies can be developed to ensure that all IRD patients are granted full clinical and socioeconomic support.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal.
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal.
| | - João Pedro Marques
- Centro de Responsabilidade Integrado de Oftalmologia do Centro Hospitalar e Universitário de Coimbra, EPE (CRIO-CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University Clinic of Ophthalmology, University of Coimbra (FMUC), Coimbra, Portugal
| | - Cristina Santos
- Instituto de Oftalmologia Dr. Gama Pinto (IOGP), Lisboa, Portugal
- Faculdade de Ciências Médicas, NMS, FCM, NOVA Medical School, Universidade NOVA de Lisboa, 7 iNOVA4Health, Lisboa, Portugal
| | | | - Sara Vaz-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisboa, Portugal
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - José Costa
- Department of Ophthalmology, Hospital de Braga (HB), Braga, Portugal
| | - Pedro Arede
- Department of Ophthalmology, Centro Hospitalar Lisboa Ocidental, EPE (CHLO), Lisboa, Portugal
| | - Raquel Félix
- Centro de Responsabilidade Integrado de Oftalmologia do Centro Hospitalar e Universitário de Coimbra, EPE (CRIO-CHUC), Coimbra, Portugal
| | - Sara Geada
- Centro de Responsabilidade Integrado de Oftalmologia do Centro Hospitalar e Universitário de Coimbra, EPE (CRIO-CHUC), Coimbra, Portugal
| | - Nuno Gouveia
- Centro de Responsabilidade Integrado de Oftalmologia do Centro Hospitalar e Universitário de Coimbra, EPE (CRIO-CHUC), Coimbra, Portugal
| | - Rui Silva
- Department of Ophthalmology, Hospital de Braga (HB), Braga, Portugal
| | - Margarida Baptista
- Department of Ophthalmology, Centro Hospitalar Lisboa Ocidental, EPE (CHLO), Lisboa, Portugal
| | - Miguel Lume
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
| | - Ricardo Parreira
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
| | - Célia Azevedo Soares
- Medical Genetics Department, Centro de Genética Médica Jacinto Magalhães, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Medical Science Department, Universidade de Aveiro, Aveiro, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Maria João Menéres
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carolina Lemos
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
- Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - João Melo Beirão
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, EPE (CHUdSA), Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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Cortinhal T, Santos C, Vaz-Pereira S, Marta A, Duarte L, Miranda V, Costa J, Sousa AB, Peter VG, Kaminska K, Rivolta C, Carvalho AL, Saraiva J, Soares CA, Silva R, Murta J, Santos LC, Marques JP. Genetic profile of syndromic retinitis pigmentosa in Portugal. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-023-06360-2. [PMID: 38189974 DOI: 10.1007/s00417-023-06360-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/11/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE Retinitis pigmentosa (RP) comprises a genetically and clinically heterogeneous group of inherited retinal degenerations, where 20-30% of patients exhibit extra-ocular manifestations (syndromic RP). Understanding the genetic profile of RP has important implications for disease prognosis and genetic counseling. This study aimed to characterize the genetic profile of syndromic RP in Portugal. METHODS Multicenter, retrospective cohort study. Six Portuguese healthcare providers identified patients with a clinical diagnosis of syndromic RP and available genetic testing results. All patients had been previously subjected to a detailed ophthalmologic examination and clinically oriented genetic testing. Genetic variants were classified according to the American College of Medical Genetics and Genomics; only likely pathogenic or pathogenic variants were considered relevant for disease etiology. RESULTS One hundred and twenty-two patients (53.3% males) from 100 families were included. Usher syndrome was the most frequent diagnosis (62.0%), followed by Bardet-Biedl (19.0%) and Senior-Løken syndromes (7.0%). Deleterious variants were identified in 86/100 families for a diagnostic yield of 86.0% (87.1% for Usher and 94.7% for Bardet-Biedl). A total of 81 genetic variants were identified in 25 different genes, 22 of which are novel. USH2A and MYO7A were responsible for most type II and type I Usher syndrome cases, respectively. BBS1 variants were the cause of Bardet-Biedl syndrome in 52.6% of families. Best-corrected visual acuity (BCVA) records were available at baseline and last visit for 99 patients (198 eyes), with a median follow-up of 62.0 months. The mean BCVA was 56.5 ETDRS letters at baseline (Snellen equivalent ~ 20/80), declining to 44.9 ETDRS letters (Snellen equivalent ~ 20/125) at the last available follow-up (p < 0.001). CONCLUSION This is the first multicenter study depicting the genetic profile of syndromic RP in Portugal, thus contributing toward a better understanding of this heterogeneous disease group. Usher and Bardet-Biedl syndromes were found to be the most common types of syndromic RP in this large Portuguese cohort. A high diagnostic yield was obtained, highlighting current genetic testing capabilities in providing a molecular diagnosis to most affected individuals. This has major implications in determining disease-related prognosis and providing targeted genetic counseling for syndromic RP patients in Portugal.
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Affiliation(s)
- Telmo Cortinhal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Cristina Santos
- Instituto de Oftalmologia Dr. Gama Pinto (IOGP), Lisboa, Portugal
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Sara Vaz-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisboa, Portugal
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Marta
- Department of Ophthalmology, Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Lilianne Duarte
- Department of Ophthalmology, Centro Hospitalar de Entre Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
| | - Vitor Miranda
- Department of Ophthalmology, Centro Hospitalar de Entre Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
| | - José Costa
- Department of Ophthalmology, Hospital de Braga (HB), Braga, Portugal
| | - Ana Berta Sousa
- Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Lisboa Norte (CHULN), Lisboa, Portugal
| | - Virginie G Peter
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland
- Department of Ophthalmology, University of Basel, 4031, Basel, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Karolina Kaminska
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland
- Department of Ophthalmology, University of Basel, 4031, Basel, Switzerland
| | - Carlo Rivolta
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031, Basel, Switzerland
- Department of Ophthalmology, University of Basel, 4031, Basel, Switzerland
- Department of Genetics and Genome Biology, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Ana Luísa Carvalho
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- University Clinic of Medical Genetics, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Jorge Saraiva
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Célia Azevedo Soares
- Medical Genetics Department, Centro de Genética Médica Jacinto Magalhães, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Medical Science Department, Universidade de Aveiro, Aveiro, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Rufino Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Joaquim Murta
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | | | - João Pedro Marques
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.
- University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.
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Castro C, Marta A, Marques JH, Ferreira A, José D, Sousa P, Neves I, Menéres MJ, Barbosa I. Ocular Surface Changes in Primary Open Angle Glaucoma Patients Treated With Topical Antihypertensive Drugs. J Glaucoma 2023; 32:e113-e120. [PMID: 37523629 DOI: 10.1097/ijg.0000000000002272] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PRCIS In this study, patients with glaucoma undergoing topical antihypertensive (TAH) drugs had changes in the ocular surface and more dry eye symptoms than controls. Clinicians should recognize the influence of TAH drops on exacerbating ocular surface disease. PURPOSE The purpose of this study was to evaluate the ocular surface of eyes with glaucoma treated with TAH drugs. METHODS Cross-sectional study that included eyes undergoing TAH drugs due to primary open angle glaucoma and controls. The parameters evaluated were: the basal tear flow (basic secretion test); the tear film osmolarity (TearLab); and the noninvasive break-up time, blink score, lipid layer thickness, tear meniscus height, and loss area of the meibomian glands, measured with the IDRA Ocular Surface Analyser. Presence of symptoms [Ocular Surface Disease Index (OSDI)], dry eye disease (DED, TFOS DEWS II criteria), and corneal fluorescein staining were assessed. RESULTS We included 154 eyes (154 patients), 77 undergoing TAH drugs for glaucoma (group 1) and 77 of controls (group 2). The tear film osmolarity ( P =0.003) and the loss area of the meibomian glands ( P =0.004) were higher in group 1. The noninvasive break-up time ( P =0.005), lipid layer thickness ( P =0.006), and tear meniscus height ( P =0.001) were lower in group 1. The global OSDI score ( P <0.001), the proportion of eyes with severe disease ( P =0.002), according to the OSDI, and with DED ( P <0.001), according to the TFOS DEWS II criteria, were higher in group 1. The proportion of patients with corneal fluorescein staining was higher in group 1 ( P <0.001). There were no significant differences in eyes taking TAH drugs with and without preservatives ( P >0.127). CONCLUSIONS DED, in patients with glaucoma, is a multifactorial disease, with a strong contribution from TAH drugs. These eyes had changes in almost every measured parameter, translating into the presence of more dry eye symptoms and corneal damage when compared with controls.
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Affiliation(s)
- Catarina Castro
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
| | - Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
- Department of Ophthalmology, Institute for the Biomedical Sciences Abel Salazar - University of Porto
| | - João H Marques
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Diana José
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
| | - Paulo Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
| | - Isabel Neves
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
| | - Maria João Menéres
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
- Department of Ophthalmology, Institute for the Biomedical Sciences Abel Salazar - University of Porto
| | - Irene Barbosa
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António
- Department of Ophthalmology, Institute for the Biomedical Sciences Abel Salazar - University of Porto
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Castro C, Marques JH, Marta A, Baptista PM, José D, Sousa P, Menéres P, Barbosa I. Comparison of Light-Based Devices in the Treatment of Meibomian Gland Dysfunction. Cureus 2023; 15:e41386. [PMID: 37546127 PMCID: PMC10401307 DOI: 10.7759/cureus.41386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
PURPOSE To compare different light-based devices, namely, intense pulsed light (IPL) and IPL with low-level light therapy (LLLT), in the treatment of meibomian gland dysfunction (MGD). METHODS This was a prospective, observational study that included patients with MGD. Group 1 included 58 eyes treated with IPL (eye-light®, Espansione Marketing S.p.A., Bologna, Italy), followed by LLLT (my-mask®, Espansione Marketing S.p.A., Bologna, Italy); Group 2 included 60 eyes treated with IPL (E>Eye®, E-Swin, Houdan, France); and Group 3 included 58 eyes treated with IPL (Thermaeye Plus®, OptiMed, Sydney, Australia). The presence of symptoms (Ocular Surface Disease Index (OSDI)) and ocular surface changes were evaluated at baseline, three weeks, and six months after treatment. RESULTS At week three, there was an improvement in the OSDI in all groups (p<0.001), without differences among them (p=0.339). The lipid layer thickness (LLT) increased in Groups 1 and 2 (p<0.001), with a similar variation (p=0.144). Patients with superior OSDI and lower LLT at baseline had the greatest improvement in the respective parameters (p<0.001). The basal tear flow increased in Group 1 (p=0.012). Corneal staining (CS) significantly decreased in Groups 2 (p<0.001) and 3 (p<0.001). At six months, compared to three weeks, there was further improvement in the OSDI (p<0.001) and the LLT (p=0.007), in Group 1, and an increase in the presence of CS in Group 3 (p=0.011). CONCLUSION IPL treatment led to a sustained decrease in patients' symptoms, even after six months. Different IPL devices seem to have different beneficial effects. Adding LLLT to IPL appears to have an additional long-term beneficial effect as well as positive effects on the lacrimal gland.
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Affiliation(s)
- Catarina Castro
- Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | | | - Ana Marta
- Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | | | - Diana José
- Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Paulo Sousa
- Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Pedro Menéres
- Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Irene Barbosa
- Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Vieira R, Marta A, Ferreira A, Figueiredo A, Reis RF, Sampaio I, Menéres MJ. Modified Technique of Ex-PRESS ® Filtration Device Combined with a Scleral Pocket for Hereditary Transthyretin Amyloidosis (hATTR) Secondary Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:403-411. [PMID: 36748048 PMCID: PMC9899011 DOI: 10.2147/opth.s394360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/14/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose To evaluate the effectiveness and safety of a modified approach using the Ex-PRESS® implant combined with a scleral pocket in the management of secondary open-angle glaucoma in hereditary transthyretin amyloidosis (hATTR) at our department. Methods This was a retrospective analysis. The primary endpoints included Intraocular pressure (IOP) evaluation (baseline, 1st day, 1st week, 1, 3, 6, 12 months and at last follow-up) and number of hypotensive drugs (baseline, 6th, 12th months and at last follow-up). As secondary endpoints surgical complications, the need for additional glaucoma surgery and LogMAR BCVA were evaluated. Qualified and complete success were defined as ≥ 30% IOP decrease from baseline, with or without additional medications, respectively. The minimum follow-up was 12 months. Results A total of 32 eyes were included with a mean follow-up of 2.4±2.9 years. IOP decreased significantly from baseline (27.4±4.4 mmHg) to 1st day (5.00±2.9 mmHg), 1st week (6.9±4.1 mmHg), 1st month (11.7±7.8 mmHg), 3rd month (11.6±6.1 mmHg), 6th month (13.1±6.8 mmHg), 12th month (12.0±3.5 mmHg) and last visit (11.8±2.4 mmHg), p<0.001. There was also a significant reduction in the number of antiglaucoma medications from baseline (3.8±0.6) and last follow-up (0.4±0.8), p<0.001. LogMAR BCVA remained stable (0.25±0.26 at baseline and 0.25±0.24 at last follow-up), p=0.767. Transient hypotony occurred in 17 eyes (53.1%), but only 11 (34.4%) exhibited anterior chamber shallowing and needed additional care, namely cycloplegic drops and viscoelastic injection. Complete surgical success was achieved in 22 eyes (68.8%) and qualified success in 6 eyes (18.8%). Four eyes (12.5%) needed additional glaucoma surgery. Conclusion The modified ExPRESS® technique appears to be effective, especially when low levels of IOP are required. Additionally, fewer anti-glaucoma drugs were necessary. In the other hand, hypotony was a common side effect with this procedure, although all patients were properly handled, preserving the surgical outcomes.
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Affiliation(s)
- Rita Vieira
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal,Correspondence: Rita Vieira, Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, Portugal, Tel +351913748812, Email
| | - Ana Marta
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal,Ophthalmology Teaching Department, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
| | - André Ferreira
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal,Anamoty Department of Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal
| | - Ana Figueiredo
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Rita Falcão Reis
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Isabel Sampaio
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Maria João Menéres
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal,Ophthalmology Teaching Department, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
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Marques JH, Marta A, Baptista PM, Almeida D, José D, Sousa PJM, Barbosa I. Low-Level Light Therapy in Association with Intense Pulsed Light for Meibomian Gland Dysfunction. Clin Ophthalmol 2022; 16:4003-4010. [PMID: 36510598 PMCID: PMC9739950 DOI: 10.2147/opth.s384360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To study the clinical benefit of low-level light therapy when associated with intense pulsed light for the treatment of meibomian gland dysfunction. Methods An observational study. Two groups of patients that were treated with IPL were considered: group 1 (31 subjects, 62 eyes), intense pulsed light followed by low-level light therapy and group 2 (31 subjects, 62 eyes) intense pulsed light alone. In both groups, treatments were performed in 3 sessions and subjects were evaluated at baseline and 3 weeks after the last treatment session. Values are shown as mean difference ± standard deviation. Results We observed a significant improvement in OSDI-12 score and lipid layer thickness, in both groups (-22.7±17.5, p<0.001 in group 1 and -23.6±23.8, p<0.001 in group 2 for OSDI and +18.6 ± 37.0, p<0.001 in group 1 and +19.9 ± 26.4, p<0.001 in group 2 for lipid layer thickness). Despite no differences between groups at baseline (p=0.469), only group 1 had a significant improvement in Schirmer test (+1.6±4.8, p=0.009 in group 1 and +1.7±6.9, p=0.057 in group 2). No significant side effects were noted. No patient in any group felt subjectively "worse" after the treatment. Conclusion Intense pulsed light seems effective and safe for the treatment of meibomian gland dysfunction, improving symptoms and the tear film lipid layer. This study shows no strong evidence of the benefit of low-level light therapy, but it shows weak evidence that it may further improve aqueous tear production.
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Affiliation(s)
- João Heitor Marques
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal,Correspondence: João Heitor Marques, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, Porto, Portugal, Email
| | - Ana Marta
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Pedro Manuel Baptista
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Daniel Almeida
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diana José
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo J M Sousa
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Irene Barbosa
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Barbosa Ribeiro B, Marta A, Ponces Ramalhão J, Marques JH, Barbosa I. Pulsed Light Therapy in the Management of Dry Eye Disease: Current Perspectives. Clin Ophthalmol 2022; 16:3883-3893. [PMID: 36452044 PMCID: PMC9703996 DOI: 10.2147/opth.s349596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 08/08/2023] Open
Abstract
PURPOSE To review the indications and efficacy of Intense Pulsed Light (IPL) application in the treatment of Meibomian Gland Dysfunction (MGD). Its main purpose is to describe its physiology, efficacy, indications, and adverse effects. PATIENTS AND METHODS A two database (PubMed, EMBASE) search was performed from July 2017 to July 2022 using the MeSH terms ("Intense Pulsed Light" AND ("Meibomian Gland Dysfunction" OR "Dry Eye"). We included randomized studies and systematic reviews with meta-analysis. Exclusion criteria were non-randomized trials, studies enrolling non-MGD dry eye disease, and other works older than 5 years. RESULTS Current literature shows that IPL is an effective and safe treatment modality for severe dry eye. Available evidence shows improvement of symptoms and objective indicators, such as noninvasive breakup time, thickness of lipid layer, and Schirmer test. However, our review concluded that the beneficial effects of IPL may lose some efficacy at 6-months after the initial session, and subsequent sessions may be required. Thus, IPL treatment should not be considered as first-line therapy for MGD but instead as an adjuvant option to the standard of care. The optimal treatment modality remains unknown and should be tailored according to each patient's phenotype, clinician's experience, and available technology. There is evidence that IPL treatment may down-regulate pro-inflammatory markers (such as interleukin (IL) 6, IL17a, IL-1) and Prostaglandin E2 (PGE2). CONCLUSION MGD is a multifactorial disease and IPL treatment seems a promising treatment modality. Despite this, more evidence is needed to study its benefits - since this is an emerging technology, it is expected an increase in comparative studies in the following years, with longer follow-up periods, which may enable more precise conclusions about this treatment modality.
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Affiliation(s)
- Bruno Barbosa Ribeiro
- Centro Hospitalar Universitário do Porto’s Department of Ophthalmology (CHUPorto), Oporto, Portugal
| | - Ana Marta
- Centro Hospitalar Universitário do Porto’s Department of Ophthalmology (CHUPorto), Oporto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
| | - João Ponces Ramalhão
- Centro Hospitalar Universitário do Porto’s Department of Ophthalmology (CHUPorto), Oporto, Portugal
| | - João Heitor Marques
- Centro Hospitalar Universitário do Porto’s Department of Ophthalmology (CHUPorto), Oporto, Portugal
| | - Irene Barbosa
- Centro Hospitalar Universitário do Porto’s Department of Ophthalmology (CHUPorto), Oporto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
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Vieira R, Marta A, Abreu AC, Monteiro S, Brochado MDC. Quality of Vision After LASIK, PRK and FemtoLASIK: An Analysis Using the Double Pass Imaging System HD AnalyzerTM ®. Clin Ophthalmol 2022; 16:3351-3359. [PMID: 36237491 PMCID: PMC9553308 DOI: 10.2147/opth.s373448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Analyze and compare the quality of vision of Photorefractive keratectomy (PRK), LASER in situ keratomileusis with mechanical microkeratome (LASIK) and femtosecond-assisted LASIK (FS-LASIK) using the double-pass imaging system HD AnalyzerTM®. Setting Ophthalmology department of Centro Hospitalar Universitário do Porto (CHUPorto). Design Retrospective, non-randomized, single center study. Methods Analysis of three equivalent groups of patients submitted to PRK, LASIK and FS-LASIK at our department. The objective quality of vision assessment included the objective scatter index (OSI), the modular transfer function cutoff frequency (MTF) and the predicted visual acuity within the 100% (PVA), 20% (PVA20) and 9% contrast levels (PVA9) that were evaluated at baseline, 1st week, 1 and 6 months after surgery. Results 118 eyes were included: 40 underwent LASIK, 43 FS-LASIK and 35 PRK. The mean age was 30.6±4.6 years old and 56% were female. There was a significant impact concerning the type of procedure in the objective quality of vision analysis (Repeated measures ANOVA): the FS-LASIK group showed lower OSI values overtime [F(1,2)=4.566, p=0.012, OSI 0.83±0.53 (FS-LASIK) vs 0.87±0.47 (PRK) and 1.21±1.44 (LASIK)], higher MTF values [F(1,2)=6.569, p=0.002, MTF 40.17±8.33 vs 32.37±11.4 (PRK) and 30.26±10.28 (LASIK)], higher PVA 100% [F(1,2)=10.871, p<0.001], PVA 20% [F(1,2)=9.737, p<0.001] and PVA 9% [F(1,2)=6.335), p=0.003]. Conclusion In our study, FS-LASIK showed an excellent optical performance through the HD AnalyzerTM technology, with significantly lower OSI and higher MTF, PVA100, PVA20 and PVA9 values. According to our results, this procedure seems to be superior to PRK and LASIK regarding visual quality objective parameters.
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Affiliation(s)
- Rita Vieira
- Refractive Surgery Unit of Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal,Correspondence: Rita Vieira, Tel +351 913748812, Email
| | - Ana Marta
- Refractive Surgery Unit of Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Ana Carolina Abreu
- Refractive Surgery Unit of Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Sílvia Monteiro
- Refractive Surgery Unit of Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Maria do Céu Brochado
- Refractive Surgery Unit of Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
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Marta A, Marques JH, Almeida D, José D, Sousa P, Barbosa I. Impact of COVID-19 pandemic on the ocular surface. World J Clin Cases 2022; 10:9619-9627. [PMID: 36186209 PMCID: PMC9516944 DOI: 10.12998/wjcc.v10.i27.9619] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/27/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There have been increased reports of dry eyes in the coronavirus disease 2019 (COVID-19) pandemic era.
AIM To analyze the differences in tear film properties from pre- and post-pandemic of the COVID-19 era.
METHODS It was a retrospective comparative study. Patients were divided into three groups according to the data of multimodal ocular surface evaluation: (1) Group 1 if it was before Portugal lockdown decision (from August 2019 to March 2020); (2) Group 2 if it was after Portugal lockdown decision but without mask mandate (from April 2020 to October 2020); and (3) Group 3 if it was after Portugal lockdown but with mask mandate in health public highway (from November 2020 to April 2021). The following variables were analyzed: Lipid layer thickness, blink rate, Schirmer test, tear meniscus height, tear osmolarity, non-invasive break-up time, and loss area of the meibomian glands.
RESULTS The study included 548 eyes of 274 patients, aged 18 years to 89 years, with a mean age of 66.15 ± 13.40 years at the time of multimodal ocular surface evaluation. Compared to group 1: (1) Mean lipid layer thickness was better in group 2 (P = 0.001) and group 3 (P < 0.001); (2) Schirmer test was similar in group 2 (P = 0.576) and better in group 3 (P = 0.002); (3) Tear osmolarity and loss area of the meibomian glands were worse in group 2 (P = 0.031 and P < 0.001, respectively) and in group 3 (both with P < 0.001); (4) Blink rate and tear meniscus height were similar in group 2 (P = 0.821 and P = 0.370, respectively) and worse in group 3 (P < 0.001 and P = 0.038, respectively); and (5) Non-invasive break-up time was worse in group 2 (P = 0.030) and similar in group 3 (P = 0.263).
CONCLUSION Our study demonstrated that differences existed in tear film properties comparing data from the pre- and post-pandemic of the COVID-19 era.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto 4099-001, Portugal
| | - Joao Heitor Marques
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto 4099-001, Portugal
| | - Daniel Almeida
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto 4099-001, Portugal
| | - Diana José
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto 4099-001, Portugal
| | - Paulo Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto 4099-001, Portugal
| | - Irene Barbosa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto 4099-001, Portugal
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Marta A, Abreu AC, Gonçalves N, Miranda V. RETINAL EMBOLIZATION AFTER CAROTID ECHO DOPPLER: A CASE REPORT. Retin Cases Brief Rep 2022; 16:649-652. [PMID: 32969980 DOI: 10.1097/icb.0000000000001052] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To report a case of symptomatic multiple retinal emboli during a carotid Doppler ultrasonography (CDU) procedure. METHODS Case report documented with clinical records, fundus photography, optical coherence tomography angiography of the retina, and computed tomography angiography of the supraaortic vessels. RESULTS A 60-year-old male patient presented to the emergency department with sudden vision loss in the left eye and pain in the left upper eyelid noticed during a CDU procedure. On the left eye, the best-corrected visual acuity was 20/200, and fundus observation revealed retinal arteriolar attenuation, retinal whitening with cherry point, and multiple intraarterial emboli in all arcades of the central retinal artery. Computed tomography angiography of the supraaortic vessels revealed an absence of filling throughout the cervical, petrous, and cavernous segment of the left internal carotid artery, resuming only in the ophthalmic segment and an important stenosis of the left external carotid artery. He had no indication to be submitted to left carotid endarterectomy and began ocular massage and oral anticoagulant. Four months later, ptosis was no longer present, best-corrected visual acuity improved to 20/20 with a residual scotoma, and emboli disappeared on fundus photography. CONCLUSION Embolic occlusion of retinal arteries may be an extremely rare but serious complication associated with CDU, and patients and clinicians should be aware of it.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Porto Hospital and University Center, Oporto, Portugal
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Marques JP, Vaz-Pereira S, Costa J, Marta A, Henriques J, Silva R. Challenges, facilitators and barriers to the adoption and use of a web-based national IRD registry: lessons learned from the IRD-PT registry. Orphanet J Rare Dis 2022; 17:323. [PMID: 36028864 PMCID: PMC9419370 DOI: 10.1186/s13023-022-02489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
Rare disease registries increase research accessibility for patients, while providing clinicians/investigators with a coherent data ecosystem necessary to boost research and patient care. The IRD-PT registry is a national, web-based, interoperable registry for inherited retinal degenerations (IRDs) designed to generate scientific knowledge and collect high-quality data on the epidemiology, genomic landscape and natural history of IRDs in Portugal. In two years, the number of enrolled patients almost doubled (537 to 1060). Still, the registry has a lower-than-expected adoption rate, with only 4 centers across Portugal actively enrolling patients. This highlights a strong need to understand factors that may be hindering the registry’s nationwide adoption. The purpose of this manuscript is to analyze challenges, facilitators and barriers to the adoption and use of the IRD-PT registry, and to discuss avenues for improvement, focusing on keeping the registry sustainable in the long run. We believe that this exercise may help other rare disease registries to improve user adherence and engagement, ultimately contributing to develop more sustainable and successful registries in the field.
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Affiliation(s)
- João Pedro Marques
- Ophthalmology Unit, Centro de Responsabilidade Integrado em Oftalmologia (CRIO), Centro Hospitalar e Universitário de Coimbra (CHUC), Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. .,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal. .,Faculty of Medicine, University Clinic of Ophthalmology, University of Coimbra (FMUC), Coimbra, Portugal.
| | - Sara Vaz-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa (FMUL), Lisbon, Portugal
| | - José Costa
- Ophthalmology Unit, Hospital de Braga (HB), Braga, Portugal
| | - Ana Marta
- Ophthalmology Unit, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal.,Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - José Henriques
- Instituto de Oftalmologia Dr. Gama Pinto (IOGP), Lisbon, Portugal.,Instituto de Retina de Lisboa (IRL), Lisbon, Portugal
| | - Rufino Silva
- Ophthalmology Unit, Centro de Responsabilidade Integrado em Oftalmologia (CRIO), Centro Hospitalar e Universitário de Coimbra (CHUC), Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Faculty of Medicine, University Clinic of Ophthalmology, University of Coimbra (FMUC), Coimbra, Portugal
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Abstract
PURPOSE To compare the choroidal characteristics between the eyes of patients with and without hereditary transthyretin amyloidosis. METHODS Case-control observational study with choroidal thickness and vasculature evaluation by optical coherence tomography with enhanced depth imaging protocol of the macula. RESULTS The study included 332 eyes: 166 eyes of hereditary transthyretin amyloidosis patients and 166 eyes of healthy patients. Mean age was similar between groups (P = 0.979). For hereditary transthyretin amyloidosis patients, on average, in all sectors analyzed (in the full 5 mm-width image [G] and also in 1-mm-width central [C], nasal [N], and temporal [T] sectors), there was a higher stromal area, a lower choroidal thickness, and a lower choroidal vascularity index, compared with the control group. The linear mixed models revealed no differences according to the systemic treatment groups. CONCLUSION Hereditary transthyretin amyloidosis patients showed statistically significant differences in choroidal characteristics, compared with eyes without pathology. These age-related and statistically significant changes compared with the healthy eyes may help in the future to better monitor the systemic hereditary transthyretin amyloidosis disease and complement other systemic evaluations, including on clinical trials to analyze more objectively, the results of new therapies.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário Do Porto (CHUPorto), Oporto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
| | - João Heitor Marques
- Department of Ophthalmology, Centro Hospitalar Universitário Do Porto (CHUPorto), Oporto, Portugal
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário Do Porto (CHUPorto), Oporto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal ; and
| | - João Coelho
- Ocular Amyloid Section, Department of Ophthalmology, Centro Hospitalar Universitário Do Porto (CHUPorto), Oporto, Portugal
| | - João Melo Beirão
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
- Ocular Amyloid Section, Department of Ophthalmology, Centro Hospitalar Universitário Do Porto (CHUPorto), Oporto, Portugal
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Ferreira A, Marta A, Baptista PM, Caiado F, Abreu AC, Maia S, Miranda V, Pinto MC, Parreira R, Menéres P. Refractive Surgery for Older Children and Adults with Accommodative Esotropia: A Systematic Review. Ophthalmic Res 2022; 65:361-376. [PMID: 35226900 DOI: 10.1159/000523816] [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: 09/15/2021] [Accepted: 02/20/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Accommodative esotropia (AET) is characterized by an esodeviation of the eyes due to uncorrected hyperopia, deficient fusional divergence, or high accommodative convergence. Decreasing hyperopia would reduce accommodative convergence and strabismus. We sought to review the existing evidence regarding the outcomes of refractive surgery in patients with AET. METHODS A four-database search (Pubmed, ISI Web of Science, Cochrane, and Scopus) was performed from inception to March 2021 using the following MeSH terms: ("Refractive Surgical Procedures" OR "Keratomileusis, Laser In Situ" OR "Photorefractive Keratectomy" OR "Lens Implantation, Intraocular") AND ("Esotropia" OR "Accommodative Esotropia" OR "Refractive Esotropia" OR "Accommodative Strabismus"). No meta-analysis was performed due to studies' heterogeneity. RESULTS Twenty-eight studies including 22 case series enrolling 378 patients and 6 case reports enrolling 8 patients were selected among 185 original abstracts. In the case series, a total of 378 patients (726 eyes) were recruited with an age range of 8-52 years. All studies reported mean follow-up periods of at least 12 months. Photorefractive keratectomy was performed in 7 studies, laser-assisted in situ keratomileusis in 9 studies, laser-assisted sub-epithelial keratectomy was reported in 1 study, and 3 studies implanted intraocular lenses, including iris-fixated and collamer. Considering the adult patients with a preoperative corrected esodeviation ≤10 prism diopters (PD) (n = 129), all but 5 (3.9%) presented orthophoria or ≤10PD after refractive surgery. All children but 4 (4.5%) ended up with an esodeviation ≤10PD after surgery with those exceptions being in the range of 11-15PD. Six case reports were included in this review, comprising a total of 8 patients (16 eyes) with an age range of 7-34 years and a follow-up range of 4-48 months. Six case reports were included in this review, comprising a total of 8 patients (16 eyes) with an age range of 7-34 years and a follow-up range of 4-48 months. CONCLUSION Evidence produced so far points out that refractive surgery may be an alternative for spectacle correction for adults with AET ≤10PD. There is not enough evidence to recommend its use for patients under 18 years of age. The safety and predictability of these procedures for this purpose remains unclear as the selection criteria used for these patients are much different than the usual indications and there are no studies with long-term follow-up.
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Affiliation(s)
- André Ferreira
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ana Marta
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Filipa Caiado
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Carolina Abreu
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sofia Maia
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Vasco Miranda
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Maria Céu Pinto
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Parreira
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Menéres
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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Marques JH, Marta A, Castro C, Baptista PM, José D, Almeida D, Ribeiro A, Barbosa I. Choroidal changes and associations with visual acuity in diabetic patients. Int J Retina Vitreous 2022; 8:6. [PMID: 34998439 PMCID: PMC8742927 DOI: 10.1186/s40942-021-00355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background The variable visual function observed in diabetic retinopathy (DR) patients is not fully explained by the classic staging system. Our purpose was to evaluate choroidal changes, in standardized sectors, in DR patients and to find associations between choroidal measurements and visual function. Methods Cross-sectional study that included the right eye of diabetic patients (n = 265) without active edema, ischemia or neovascularization and age-matched controls (n = 73). Optical coherence tomography (OCT) imaging was performed with enhanced depth imaging protocol. Choroidal vascularity index (CVI) was calculated in a 5 mm scan centered in the fovea. Results CVI decreased with age (p < 0.001) but was not influenced by axial length. A multivariate analysis adjusting for age confirmed a significant difference in CVI between DR eyes that had previous treatments (intravitreal injections and/or photocoagulation) compared to control eyes (p = 0.013) and to DR eyes that never required treatment (p = 0.002). There was no significant difference between non-DR diabetic patients and normal controls. Considering the group of DR patients that had previous treatments, in eyes without optic media opacification, BCVA correlated with CVI (r = − 0.362, p < 0.001), whereas full retina thickness and individual retinal layer thickness did not (p > 0.066). Conclusions A reduction in CVI was observed in patients with a more advanced stage of DR. In treated DR patients with stable disease, choroidal biomarkers correlated with best-corrected visual acuity whereas retinal biomarkers did not. Trial registration: N/A Supplementary Information The online version contains supplementary material available at 10.1186/s40942-021-00355-z.
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Affiliation(s)
- João Heitor Marques
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Ana Marta
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Catarina Castro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Pedro Manuel Baptista
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Diana José
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Daniel Almeida
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - António Ribeiro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Irene Barbosa
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Marta A, Vieira R, Figueiredo A, Reis R, Sampaio I, Beirão JM, Menéres MJ. Ahmed valve for secondary glaucoma in patients with hereditary transthyretin amyloidosis. Eye (Lond) 2022; 36:111-118. [PMID: 33627759 PMCID: PMC8727566 DOI: 10.1038/s41433-021-01443-y] [Citation(s) in RCA: 5] [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: 10/17/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the surgical outcomes of patients with hereditary transthyretin amyloidosis (TTR-FAP) who underwent Ahmed glaucoma valve (AGV) implantation. METHODS A retrospective cohort study was performed on patients with a diagnosis of TTR-FAP secondary glaucoma, who underwent AGV implantation in our department, between November 2010 and July 2019. The cumulative probability of treatment success was measured with Kaplan-Meier survival analysis. The primary outcome was success, defined as intraocular pressure (IOP) ≥ 6 mmHg and ≤21 mmHg with or without medication, with no need for further glaucoma surgery and without loss of light perception at last follow-up. Secondary outcomes were postoperative IOP, number of IOP-lowering medications, and rates of complications. RESULTS The study included 114 eyes of 87 patients. The mean follow-up duration was 3.81 ± 2.11 years (y) [range, 1.00-8.28 y]. Compared to the preoperative values, the mean IOP was reduced from 28.20 ± 7.01 to 12.87 ± 3.76 mmHg at the final visit (p < 0.001), with a reduction in the number of medications from 3.89 ± 0.66 to 1.86 ± 1.43 (p < 0.001). Early and late postoperative complications occurred in 20 (17.09%) and 9 (7.89%) eyes, respectively. Kaplan-Meier analysis indicated probabilities of success of 0.98 at 1 y, 0.97 at 2 y, 0.95 at 3 y, 0.89 at 4 y, 0.77 at 5 y and 0.72 at 6 y. The linear correlation analysis showed a correlation between some characteristics of the natural history of TTR-FAP patients and AGV implantation success. CONCLUSION Although glaucoma in TTR-FAP patients is very difficult to manage, AGV implantation is an effective and relatively safe procedure.
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Affiliation(s)
- Ana Marta
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - Rita Vieira
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Ana Figueiredo
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Rita Reis
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Isabel Sampaio
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - João Melo Beirão
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - Maria João Menéres
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
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Marta A, Marques JH, Almeida D, José D, Barbosa I. Keratoconus and Visual Performance with Different Contact Lenses. Clin Ophthalmol 2021; 15:4697-4705. [PMID: 34949911 PMCID: PMC8689658 DOI: 10.2147/opth.s345154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the visual performance in contact lens wearers with keratoconus. Methods A retrospective study including contact lens (CL) wearers was performed. The current best-corrected visual acuity with contact lens (BCVA-CL) and with spectacles (BCVA-S) correction, contrast sensitivity (CS) (by Metrovision-MonPack3®), analysis of light scattering in the retina and vision break-up time (HD Analyzer®), and corneal tomography (Oculus Pentacam® HR) were evaluated. Results This study included 96 eyes of 59 patients with Keratoconus. Rigid gas permeable contact lenses (RGPCL), hybrid contact lenses (HCL), and silicone hydrogel/hydrogel contact lenses (HGCL) were fitted in 67, 17, and 12 eyes, respectively. Dynamic objective scatter index (OSI) (p = 0.024), minimum OSI (p = 0.037) and maximum OSI (p = 0.040) were significantly better with RGPCL and worse with HGCL. Mean CS in photopic conditions was significantly worse with HGCL and better with HCL (p = 0.006), without differences in mesopic conditions (p = 0.121). RGPCL wearers showed a higher mean K (p = 0.020), and a lower corneal thickness at the thinnest point (p=0.011). Conclusion Visual quality varied significantly with different types of CL. Although RGPCL was fitted in patients with worse Pentacam tomographic parameters, RGPCL was associated with a better dynamic visual quality.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
| | - João Heitor Marques
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Daniel Almeida
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Diana José
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Irene Barbosa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
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Marques JP, Marta A, Geada S, Carvalho AL, Menéres P, Murta J, Saraiva J, Silva R. Clinical/Demographic Functional Testing and Multimodal Imaging Differences between Genetically Solved and Unsolved Retinitis Pigmentosa. Ophthalmologica 2021; 245:134-143. [PMID: 34695833 DOI: 10.1159/000520305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/14/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to compare clinical/demographic functional testing and multimodal imaging features between genetically solved and genetically unsolved nonsyndromic retinitis pigmentosa (nsRP) patients. METHODS A cross-sectional study was conducted at an inherited retinal dystrophies reference center. Consecutive patients with nsRP and available genetic testing results performed between 2018 and 2020 were included. Genetic testing was clinically oriented, and variants were classified according to the American College of Medical Genetics and Genomics. Only class IV or V variants were considered disease-causing. Clinical/demographic, functional, and imaging features were compared between genetically unsolved (G1) and genetically solved (G2) patients. RESULTS A total of 175 patients (146 families) were included: 68 patients (59 families) in G1 and 107 patients (87 families) in G2. First symptoms <25 years, consanguinity, evidence for a particular inheritance pattern, and the absence of indicators for phenocopies were significantly more prevalent in G2. No significant differences were observed on best-corrected visual acuity. The visual field index and mean central retinal layer thickness were significantly higher in G1. The frequency of atypical features on multimodal imaging did not differ between groups. CONCLUSION Individual clinical/demographic functional testing and multimodal imaging features should be considered when counseling patients about the probability of identifying disease-causing variants.
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Affiliation(s)
- João Pedro Marques
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Ana Marta
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Sara Geada
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Ana Luísa Carvalho
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Department of Medical Genetics, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,University Clinic of Medical Genetics, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Joaquim Murta
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Jorge Saraiva
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,Department of Medical Genetics, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
| | - Rufino Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
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Marques J, Marta A, Baptista PM, José D, Almeida D, Ribeiro A, Barbosa I. RETINAL SENSITIVITY AND STRUCTURAL CHANGES AFTER FOCAL PHOTOCOAGULATION FOR DIABETIC MACULAR EDEMA - A MULTISECTORIAL COMPARISON. Ophthalmic Res 2021; 64:960-966. [PMID: 34348332 DOI: 10.1159/000518622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- João Marques
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Marta
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Diana José
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Daniel Almeida
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - António Ribeiro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Irene Barbosa
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Marta A, Baptista PM, Heitor Marques J, Almeida D, José D, Sousa P, Barbosa I. Intense Pulsed Plus Low-Level Light Therapy in Meibomian Gland Dysfunction. Clin Ophthalmol 2021; 15:2803-2811. [PMID: 34234402 PMCID: PMC8253890 DOI: 10.2147/opth.s318885] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/08/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose To analyse the clinical outcome in patients with meibomian gland dysfunction (MGD) who underwent intense pulsed light (IPL) plus low-level light therapy (LLL). Materials and Methods The prospective non-comparative study included identified by MGD patients with altered interferometry and lower loss area of the meibomian glands (LAMG), who underwent IPL plus LLL, between July 2020 and August 2020. A multimodal assessment was performed before, 2–3 weeks, and 6 months after treatment. The main outcome was lipid layer thickness (LLT) and the secondary outcomes were the ocular surface disease index (OSDI) score, presence of corneal fluorescein staining (CFS), blink rate (BR), Schirmer test (ST), tear meniscus height (TMH), tear osmolarity (OSM), non-invasive break-up time (NIBUT) and LAMG. Results This study included 62 eyes of 31 patients, 61.3% female, with a mean age of 66.94±9.08 years at the time of IPL plus LLL treatment. LLT (<0.001) grades improved 6 months after treatment. The mean OSDI score improved (p<0.001) from 45.02±21.17 (severe symptoms) to 22.35±17.68 (moderate symptoms) at 2–3 weeks and 8.24±17.9.91 (normal) at 6 months after treatment. CFS was identified in 51.6% (32/62) before and in 45.2% (28/62) 6 months (p=0.293) after treatment. ST (p=0.014) grades improved; OSM grades mild worsened (p<0.001); TMH, NIBUT and LAMG grades did not modify 6 months after treatment. No patient suffered any adverse effects. Conclusion IPL combined with LLL was effective and safe, improving the lipid layer thickness in MGD and decreasing the level of symptoms.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
| | - Pedro Manuel Baptista
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
| | - João Heitor Marques
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Daniel Almeida
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Diana José
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Paulo Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal
| | - Irene Barbosa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
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Marta A, Coelho J, Vieira R, Figueiredo A, Reis R, Sampaio I, Menéres MJ, Menéres P. Biometric Predictability in Combined Cataract Surgery and Ahmed Glaucoma Valve Implantation Depending on Tube Position. Clin Ophthalmol 2021; 15:2037-2045. [PMID: 34017168 PMCID: PMC8131069 DOI: 10.2147/opth.s315940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the predictability of biometric results in patients undergoing cataract surgery combined with Ahmed glaucoma valve (AGV) implantation according to tube position. Methods A retrospective cohort study was performed in patients who underwent phacoemulsification surgery combined with AGV implantation with the tube in posterior (group PC) and anterior (group AC) chamber, between November 2012 and April 2020. The main outcome was the mean biometric prediction error, according to tube position, using different formulas. Results The study included 49 eyes of 36 patients, 23 eyes in group PC and 26 eyes in group AC. Gender (p=0.774), age (p=0.822), type of glaucoma (p=0.168), preoperative correct distance visual acuity (p=0.139), axial length (p=0.765), anterior chamber depth (p=0.351), keratometry (p=0.577) and intraocular lens power (p=0.608) were similar between groups. Only preoperative intraocular pressure was higher in group PC (p=0.005). The mean prediction errors using Haigis, SRK/T, Hoffer Q, Holladay 1, Barrett Universal II, Kane and Hill RBF formulas were all positive in group PC (hyperopic) and all negative (myopic) in group AC. In group PC, there was no significant difference in prediction error between these formulas (p>0.05). In group AC, the formula with the worst prediction error was Haigis (p=0.001), and the best was Barrett Universal II (p=0.043). Conclusion The biometric predictability and expected final refraction in phacoemulsification surgery combined with AGV implantation are modified by the position of the tube.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - João Coelho
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Rita Vieira
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Ana Figueiredo
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Rita Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Isabel Sampaio
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Maria João Menéres
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
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Vieira R, Marta A, Figueiredo A, Reis R, Sampaio I, Menéres MJ. Transscleral Cyclophotocoagulation in Familial Amyloidotic Polyneuropathy Secondary Glaucoma after Ahmed Valve Implantation: A Case Series Study. J Curr Glaucoma Pract 2021; 15:32-35. [PMID: 34393454 PMCID: PMC8322595 DOI: 10.5005/jp-journals-10078-1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the outcomes of transscleral cyclophotocoagulation (TSCPC) after Ahmed glaucoma valve (AGV) implantation failure in patients with familial amyloidotic polyneuropathy (FAP) secondary glaucoma. Materials and methods In this retrospective study, all patients with secondary FAP glaucoma who underwent AGV implantation between 2010 and 2019 in our tertiary center were assessed. Among all, those patients who needed TSCPC to control intraocular pressure (IOP) after AGV were selected. Demographic data, value of IOP, best-corrected visual acuity (BCVA), number of antiglaucomatous medications, surgical complications, and need for retreatment were collected. Results From a total of 124 eyes submitted to AGV implantation, 13 eyes (10.48%) needed TSCPC to control IOP. The median age at TSCPC was 49.50 years (43; 55.75), and the median period between AGV implantation and TSCPC was 1.63 years (1.00; 3.65). There was a significant decrease of IOP after the procedure, from 24.33 ± 4.76 to 11.33 ± 2.90 mm Hg at last visit (p < 0.001). A reduction in the number of antiglaucomatous medications was also noticed, from 3.92 ± 0.29 to 1.25 ± 1.42 (p < 0.001). There was no difference in BCVA (p = 0.502). After the procedure, there was an exuberant anterior chamber (AC) reaction in two eyes (16.7%), and one case developed a neurotrophic ulcer (8.3%). There was no need for re-treatment. Conclusion Ahmed glaucoma valve implantation is a promising surgical procedure to treat patients with PAF secondary glaucoma, showing good results. For refractory cases, TSCPC seems to be effective and safe to control IOP. Clinical significance There are only a few studies in current literature that address amyloid secondary glaucoma, maybe because it is a rare pathology worldwide. However, it has a high incidence in certain regions, including the north of Portugal. For the record, this is the first study describing the tool of cycloablative procedures in this type of glaucoma. How to cite this article Vieira R, Marta A, Figueiredo A, et al. Transscleral Cyclophotocoagulation in Familial Amyloidotic Polyneuropathy Secondary Glaucoma after Ahmed Valve Implantation: A Case Series Study. J Curr Glaucoma Pract 2021;15(1):32–35.
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Affiliation(s)
- Rita Vieira
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Ana Marta
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Ana Figueiredo
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Rita Reis
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Isabel Sampaio
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal
| | - Maria J Menéres
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal; Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal
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Silva N, Marta A, Baptista P, Furtado MJ, Lume M. Optical Coherence Tomography Findings (SD-OCT and OCTA) in Early-Stage Type 3 Neovascularization. Case Rep Ophthalmol 2020; 11:493-499. [PMID: 32999681 PMCID: PMC7506272 DOI: 10.1159/000509139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022] Open
Abstract
A 76-year-old male presented with a small hyperreflective density in the outer nuclear layer with subtle retinal pigment epithelium (RPE) elevation and few intraretinal cysts on spectral-domain optical coherence tomography (SD-OCT). Optical coherence tomography angiography (OCTA) confirmed the presence of a tuft-shaped intraretinal neovascular lesion. SD-OCT performed 2 months before showed a smaller RPE elevation at the same location without intraretinal fluid. A 79-year-old male presented with a small hyperreflective density in the outer retina surrounded by scant intraretinal fluid on SD-OCT and a bright vessel on OCTA, suggesting early-stage type 3 neovascularization. SD-OCT performed 2 months before showed a smaller hyperreflectivity at the same location, without intraretinal fluid. An 84-year-old female presented with hyperreflective foci in the outer retina overlying a serous pigment epithelium detachment (PED) with focal RPE disruption on SD-OCT. SD-OCT performed 2 months before showed the same hyperreflective lesion associated with a shallower PED. No neovascular lesions were found on OCTA after six injections of bevacizumab. To conclude, careful evaluation of SD-OCT allows for early detection of type 3 neovascularization at a pre-exudative stage. OCTA may be useful in confirming the presence of intraretinal neovascular lesion and monitoring response to anti-vascular endothelial growth factor agents.
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Affiliation(s)
- Nisa Silva
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana Marta
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Pedro Baptista
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Maria João Furtado
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Miguel Lume
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Marta A, Abreu AC, Monteiro S, Pinto M. A temporary corneal ectasia following airbag trauma. Am J Ophthalmol Case Rep 2020; 19:100822. [PMID: 32671289 PMCID: PMC7350138 DOI: 10.1016/j.ajoc.2020.100822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/18/2020] [Accepted: 07/04/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a case of a temporary corneal ectasia induced by airbag trauma. Observations A patient who suffered a road traffic accident with deployment of the frontal airbag and presented a corneal ectasia in both eyes after 3 months, without changes in visual acuity. After 9 months, he presented a significantly improvement, achieving his basal parameters in pentacam. Conclusions and importance This is a rare case of corneal ectasia induced by airbag trauma that spontaneously reverted and it can emphasize the viscoelastic properties of the human cornea.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Oporto, Portugal
| | - Ana Carolina Abreu
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Oporto, Portugal
| | - Sílvia Monteiro
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Oporto, Portugal
| | - Maria Pinto
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Oporto, Portugal
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Marta A, Silva N, Correia N, Pessoa B, Ferreira N, Beirão M, Meireles A. A 15-year retrospective epidemiologic study of ocular trauma in the north of Portugal. Eur J Ophthalmol 2020; 31:1079-1084. [PMID: 32530713 DOI: 10.1177/1120672120934399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The primary objective of this study was to better understand the epidemiological risk factors associated with severe eye injury of patients and the secondary objective was to evaluate functional outcomes of these severe eye injuries. METHODS A retrospective, noncomparative cohort study of severe ocular trauma, in patients assessed in an emergency room from January 2004 to December 2018 at Centro Hospitalar Universitário do Porto was performed and statistically analyzed. RESULTS This study included a total of 751 patients (758 eyes) suffering ocular trauma. Men had a higher rate of ocular trauma than women (81.4% vs 18.6%). The mean age was 48.9 years old. The most common types of injury were rupture (33.8%) and penetrating (20.9%). Work-related accidents were responsible for 19.3% of injuries. Home was the most common location of trauma (46.3%). In 8.8% of trauma the best corrected visual acuity at presentation was superior to 20/40 while in 6.5% of cases no light perception (NLP) was registered. In 44.8% of trauma the best corrected visual acuity at last follow-up visit (BCVAF) was superior to 20/40 while in 15.7% of cases NLP was registered. CONCLUSION The epidemiological high-risk factors identified were: adult males, economic crisis, home, blunt objects in man and falls in woman. Future primary prevention should take into account these factors. This study also demonstrated an important visual impairment associated with severe ocular trauma, even with timely surgical treatment, with BCVAF of NLP in 15.7% of cases.
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Affiliation(s)
- Ana Marta
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Nisa Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Nuno Correia
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Bernardete Pessoa
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Natália Ferreira
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Melo Beirão
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Angelina Meireles
- Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Pinho A, Marta A, Coutinho I, Gonçalo M. Long-term reproducibility of positive patch test reactions in patients with non-immediate cutaneous adverse drug reactions to antibiotics. Contact Dermatitis 2016; 76:204-209. [PMID: 27910104 DOI: 10.1111/cod.12720] [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: 07/26/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND As in contact allergy, T cell-mediated hypersensitivity in non-immediate (NI) cutaneous adverse drug reactions (CADRs) to antibiotics is considered to be lifelong, but, in this setting, patch tests have rarely been repeated after long time intervals. OBJECTIVE To evaluate the long-term reproducibility of positive patch test reactions to antibiotics in patients with NI CADRs. METHODS Fifty-six patients with NI CADRs to antibiotics who had relevant positive reactions during patch testing were invited to repeat patch tests with a similar antibiotic series 2-15 years thereafter. RESULTS Twenty patients were included (9 males and 11 females; mean age 54.6 years): 18 with maculopapular exanthema, 1 with drug hypersensitivity syndrome, and 1 with acute generalized exanthematous pustulosis. Results were reproducible in 17 of 20 patients after a mean interval of 6.0 years (range 2-14.7 years). Concerning β-lactams, 7 of 8 patients remained positive for aminopenicillins, 4 of 4 for isoxazolyl penicillins, and 1 for cefoxitin. Patch test results were also reproducible for clindamycin in 5 of 7 patients, for vancomycin in 1 patient, and for spiramycin in 1 patient. Reproducibility was not affected by the time interval between tests, sex, or age at testing. CONCLUSIONS In the context of NI CADRs, we showed high reproducibility of positive patch test reactions to various antibiotics, even after several years.
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Affiliation(s)
- André Pinho
- Dermatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-045, Coimbra, Portugal
| | - Ana Marta
- Faculty of Medicine, Clinic of Dermatology, University of Coimbra, 3000-045, Coimbra, Portugal
| | - Inês Coutinho
- Dermatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-045, Coimbra, Portugal
| | - Margarida Gonçalo
- Dermatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-045, Coimbra, Portugal.,Faculty of Medicine, Clinic of Dermatology, University of Coimbra, 3000-045, Coimbra, Portugal
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Belino C, Barreto P, Santos C, Marta A, Fonseca I, Fernandes J. MP520DO THE ELDERLY PATIENTS ON PERITONEAL DIALYSIS HAVE MORE INFECTIOUS RISK? PATIENTS ON PERITONEAL DIALYSIS HAVE MORE INFECTIOUS RISK? Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw195.36] [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: 11/15/2022] Open
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Marta A, Vittorio D, Lenzi GL. The fight against stroke: victories, defeats, strategies. Curr Opin Neurol 2001; 14:55-7. [PMID: 11176218 DOI: 10.1097/00019052-200102000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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