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Teixeira C, Pessoa B, Ruão M, Sousa JPC, Penas S, Silva R, Carneiro Â, Meireles A. ILUVIEN ® in diabetic macular edema that persists or recurs despite treatment: Results from the Retina.pt ® RIVER audit. Eur J Ophthalmol 2023:11206721231217525. [PMID: 38013451 DOI: 10.1177/11206721231217525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE Persistent diabetic macular edema (DME) remains a problem in clinical practice, with many patients having a suboptimal response to the standard of care (SOC). Evidence supports the long-term efficacy of intravitreal fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients that have responded sub-optimally, although there is still scarce data from real-world Portuguese practices. We aimed to monitor the current SOC in selected Portuguese practices prior to FAc implantation and then assess the long-term effectiveness and safety of the FAc implant. SETTINGS The study included patient data from five Portuguese public hospitals. DESIGN This was a non-interventional, multicenter audit of data collected from Retina.pt registry from patients with persistent or recurrent DME despite treatment. METHODS Outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). Results were compared at regular times over 36 months. RESULTS This study included 222 eyes from 152 patients. A significant decrease in BCVA (P < 0.001) and a significant increase in CMT (P = 0.013) were observed prior to FAc. A significant increase in BCVA was registered at 6 months after FAc implant administration (P < 0.001), which was maintained during follow-up. No relevant changes in IOP were observed. Treatment burden was reduced as a result of treatment with FAc (P < 0.001 for anti-VEGF, corticosteroids, or both treatments) in the full population. CONCLUSIONS In Portuguese practice, data showed that pre-FAc implantation, some patients did not respond to SOC treatment and/or they were undertreated. Following FAc implant administration, there were rapid, sustained, long-term visual and anatomical improvements, and a marked reduction in treatment burden.
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Affiliation(s)
- Carla Teixeira
- Department of Ophthalmology of Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
| | - Bernardete Pessoa
- Diabetes Ocular Department of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
- Department of Ophthalmology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute for the Biomedical Sciences Abel Salazar from University of Porto (UMIB ICBAS - UP), Porto, Portugal
| | - Miguel Ruão
- Department of Ophthalmology of Centro Hospitalar entre Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Susana Penas
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
- Department of Ophthalmology of Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rufino Silva
- Department of Ophthalmology, Ophthalmology Clinic, Faculty of Medicine of the University of Coimbra (FMUC), Coimbra, Portugal
- Department of Ophthalmology of Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Department of Ophthalmology, Coimbra, Centro Académico Clínico de Coimbra (CACC), Coimbra, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
| | - Angelina Meireles
- Department of Ophthalmology of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
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Pessoa B, Leite J, Ferreira A, Ramalhão J, Poças J, José D, Coelho C, Figueira J, Meireles A, Beirão JM. Oct biomarkers for early prognosis in diabetic macular edema treatment with ranibizumab. Eur J Ophthalmol 2023:11206721231210753. [PMID: 37919940 DOI: 10.1177/11206721231210753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Diabetic macular edema is the main cause of vision loss in patients with diabetic retinopathy. In this work, we aimed to assess the role of Optical Coherence Tomography (OCT) biomarkers in patients treated with ranibizumab. METHODS A prospective study enrolling 46 eyes with DME under ranibizumab intravitreal therapy with 12 months of follow-up. The primary endpoint was to assess the association between OCT biomarkers at baseline and the type of treatment response. RESULTS Good responders, compared with partial/non responders, had lower number of inner nuclear layer cysts (INLc) at baseline, (26.5% vs 73.5%, p = 0.035) and presented, at 12 months of follow-up, lower percentage of disorganization of retinal inner layers (12.0% vs 88.0%, p = 0.001), lower disruption of outer plexiform layer (8.7% vs 91.3%, p < 0.001) and lower outer nuclear layer cysts (17.4% vs 82.6%, p = 0.013). At the end of follow-up, it was observed a higher frequency of inner nuclear layer cysts in patients with higher glycated haemoglobin (p = 0.028). CONCLUSION This study showed the value and importance of OCT parameters, such as absence of INLc, as a prognostic therapeutic response. A normalization of the macular anatomy with ranibizumab is more likely to happen in early complete responders. The association between INLc and higher glycated haemoglobin levels showed the importance of systemic metabolic control in systemic diabetic manifestations. Clinicaltrials.gov NCT04387604.
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Affiliation(s)
- Bernardete Pessoa
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - João Leite
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Portugal
| | - João Ramalhão
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João Poças
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Diana José
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Constança Coelho
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Figueira
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - João Melo Beirão
- Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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Leite J, Meireles A, Correia NA. Valsalva Retinopathy after a Vomiting Episode. Case Rep Ophthalmol 2022; 13:706-710. [PMID: 36845461 PMCID: PMC9944201 DOI: 10.1159/000525312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
This case presents a minimal invasive alternative for the treatment of subhyaloid hemorrhages. Young, female, 32 years old, with no regular medication and with no personal or ophthalmological history, reports a sudden and profound decrease in visual acuity after an episode of vomiting, with 2 days of evolution. After funduscopic observation and complementary diagnostic tests, subhyaloid hemorrhage was detected and laser hyaloidotomy was performed, with restoration of visual acuity after 1 week. Nd:YAG laser treatment made it possible to quickly restore the visual acuity of the patient after following diagnostic procedures, avoiding other types of treatments, such as pars plana vitrectomy. This case reports a Valsalva retinopathy with clinical presentation in the form of subhyaloid hemorrhage after an episode of self-limited vomiting, effectively treated with Nd: YAG laser.
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Affiliation(s)
- João Leite
- aDepartment of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal,*João Leite,
| | - Angelina Meireles
- aDepartment of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal,bICBAS − Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - Nuno Alves Correia
- aDepartment of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
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Pessoa B, Heitor J, Coelho C, Leander M, Menéres P, Figueira J, Meireles A, Beirão M. Systemic and vitreous biomarkers - new insights in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:2449-2460. [PMID: 35325286 DOI: 10.1007/s00417-022-05624-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Diabetic retinopathy (DR) is a microvascular inflammatory and neurodegenerative disease. The purpose of this study was to analyze the relationship between DR severity and the levels of potential biomarkers in the serum and/or vitreous. METHODS A prospective, consecutive, controlled, observational study was performed between June 2018 and January 2020. Blood and vitreous samples were collected on the day of vitrectomy in patients without diabetes and in patients with diabetes with epiretinal membrane, macular edema, and indication for vitrectomy. RESULTS Transthyretin (TTR) was the only blood biomarker with levels statistically higher in patients with diabetes (p = 0.037). However, no correlation with DR severity was observed. Erythropoietin (EPO) was the only blood biomarker whose levels were associated with DR severity (p = 0.036). In vitreous samples, levels of EPO (p = 0.011), interleukin (IL)-6 (p < 0.001), IL-8 (p < 0.001), IL-17 (p = 0.022), monokine induced by interferon-γ (MIG) (p < 0.001), and interferon gamma-induced protein 10 (IP-10) (p = 0.005) were significantly higher in patients with diabetes. Additionally, in vitreous, IL-6, IL-8, MIG, and IPL-10 levels were also higher in more severe DR cases (p < 0.05). CONCLUSIONS Among the studied biomarkers, vitreous IL-6, IL-8, MIG, and IP-10 were the ones whose levels had the strongest coherent relationship with DR severity prediction and, thus, have the best potential post-vitrectomy prognostic value.
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Affiliation(s)
- Bernardete Pessoa
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal.
- Unit for Multidisciplinary Investigations in Biomedicine (UMIB/ICBAS/UP), Porto, Portugal.
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal.
| | - João Heitor
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade Do Porto, Porto, Portugal
| | - Constança Coelho
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Magdalena Leander
- Unit for Multidisciplinary Investigations in Biomedicine (UMIB/ICBAS/UP), Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Pedro Menéres
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade Do Porto, Porto, Portugal
| | - João Figueira
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research On Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade Do Porto, Porto, Portugal
| | - Melo Beirão
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
- Unit for Multidisciplinary Investigations in Biomedicine (UMIB/ICBAS/UP), Porto, Portugal
- Laboratory of Cytometry, Unit for Diagnosis in Hematology, Clinical Hematology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
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Coelho J, Ferreira A, Kuhn F, Meireles A. Globe ruptures: outcomes and prognostic analysis of severe ocular trauma. Ophthalmologica 2022; 245:376-384. [PMID: 35196665 DOI: 10.1159/000523705] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Eye trauma is an important causes of monocular visual loss worldwide. This study aimed to describe the structural and functional characteristics and outcomes of 281 globe ruptures. METHODS Medical records of all patients undergoing surgery for a ruptured globe at Centro Hospitalar Universitário do Porto in the last 17 years were retrospectively reviewed. RESULTS Two hundred and eighty-one eyes of 277 patients were included. The majority of them were males (71%) with a mean age of 59.7±20.5. In 38.8% of the cases the cause was a fall. At the time of admission, 29.5% of the eyes had a visual acuity greater than 20/200 and 12.5% had no light perception. The median time between trauma and primary repair was less than 8h (interquartile range 5-12 h). A primary reconstruction was always attempted. Primary evisceration was performed in 14 cases (5%). In multivariable analysis, independent predictors of vision survival were male gender, shorter wound size and absence of vitreous hemorrhage. CONCLUSION In this large, retrospective study on globe ruptures we identified male gender, short wound length, and the absence of vitreous hemorrhage or retinal detachment as predictors of improved functional outcome. We found a correlation between the presenting and final visual acuities and the Ocular Trauma Score. Our determination to reconstruct the traumatized eyes as early and as completely as possible was justified by the functional results: despite the severity of the injuries, one out of four eyes reached a final visual acuity greater than 20/200.
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Affiliation(s)
- João Coelho
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - 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,
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA
- Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
| | - Angelina Meireles
- 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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Pessoa B, Castro C, Ferreira A, Leite J, Heitor J, Menéres P, Figueira J, Meireles A, Beirão JM. Changes in ganglion cell layer thickness after treatment with the 0.2 µg/day fluocinolone acetonide implant in vitrectomized and nonvitrectomized eyes with diabetic macular edema. Ophthalmic Res 2022; 65:310-320. [PMID: 35086095 DOI: 10.1159/000520411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To compare changes in ganglion cell layer (GCL) between vitrectomized and nonvitrectomized eyes with diabetic macular edema (DME) over a 2-year period following treatment with 0.2 µg/day fluocinolone acetonide (FAc) implant. METHODS Eighteen vitrectomized (group 1) and 8 nonvitrectomized (group 2) eyes were included in this cohort study. Changes in central macula GCL thickness were measured using the Spectralis spectral domain optical coherence tomography (SD-OCT) at baseline and 6, 12 and 24 months of follow-up. Other parameters analyzed included best-corrected visual acuity (BCVA), central foveal thickness (CFT) and intraocular pressure (IOP). RESULTS Treatment with the FAc implant led to small reductions in mean global GCL thickness versus baseline and contrasts with the control group that was stable or slightly increased versus baseline. FAc therapy also led to improvements in mean BCVA and CFT that were observed at Month 6 and maintained to Month 24. For vitrectomised and non-vitrectomised eyes, no differences were observed between mean global GCL, BCVA and CFT values during follow-up. Linear correlations revealed that in all groups mean BCVA at Month 24 positively correlated with mean GCL thickness at baseline and at Month 24. IOP remained stable throughout the 24 months. CONCLUSION There was no evident retinal neurodegeneration in the 2-year period following treatment with FAc in both groups. GCL thickness may be a useful biomarker for assessing safety and effectiveness in patients with DME.
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Affiliation(s)
- Bernardete Pessoa
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Catarina Castro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - André Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Leite
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Heitor
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Menéres
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Figueira
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Melo Beirão
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Silva N, Ferreira A, Ferreira N, Pessoa B, Meireles A. Intrascleral Knotless Zigzag Suture Fixation of Four-Haptic Hydrophilic Acrylic Foldable IOL: Clinical Outcomes. Clin Ophthalmol 2022; 16:33-41. [PMID: 35023899 PMCID: PMC8747796 DOI: 10.2147/opth.s340039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL). Purpose To describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL. Methods Retrospective cohort study of consecutive cases. Results Ninety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1±15.2 years (range 18–94), and the median follow-up duration was 19.5 months (range 3–81). The best-corrected visual acuity improved from a mean±SD of 1.34±0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49±0.56 logMAR at the end of follow-up (p<0.001). The mean±SD final SE was −1.24±1.82 diopters. The mean±SD prediction error was −0.51±1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7). Conclusion This knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.
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Affiliation(s)
- Nisa Silva
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal.,Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal
| | - Natália Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
| | - Bernardete Pessoa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal
| | - Angelina Meireles
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal
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Iros M, Parolini B, Ozdek S, Gini G, Nawrocka ZA, Ellabban AA, Faramawi MF, Adelman R, Sallam AB, Meireles A, Lee CS, Ducournau D, Tsouris D, Kozina E, Patelli F, Viola F, Ascaso F, Becquet F, Tosi GM, Besozzi G, Oh H, Othman IS, Fiser I, Le Rouic J, Perone J, Amar J, Nawrocki J, Nascimento J, Arrevola L, Nagpal M, Mehrotra N, Demir M, Chelazzi P, Miesbauer P, Turkcuoglu P, Koch P, Uy R, Weinfurter SB, Bopp S, Park S, Schönherr U, Alsanova V, Bonfiglio V, Szijárt Z. Management of optic disc pit maculopathy: the European VitreoRetinal society optic pit study. Acta Ophthalmol 2021; 100:e1264-e1271. [PMID: 34877796 DOI: 10.1111/aos.15076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate a variety of techniques, and their anatomical and functional results, for the treatment of optic disc pit maculopathy (ODP-M). A secondary aim was to report on results of secondary procedures in cases of initial failure or recurrence. METHODS Multicentre retrospective study of 95 eyes with ODP-M, treated by 25 surgeons from 12 countries. Primary outcomes were anatomical resolution of subretinal fluid (SRF), intraretinal fluid (IRF) and visual acuity (VA) at 12 months. RESULTS Higher rates of SRF and IRF resorption were achieved in eyes treated with pars plana vitrectomy (PPV) compared to external laser with or without tamponade: 64/72 (88.9%) versus 8/14 (57.1%) for SRF (p = 0.003), and 50/59 (84.7%) versus 3/10 (30%) for IRF (p = 0.002). The addition of juxtapapillary laser or internal limiting membrane (ILM) peel during PPV did not improve SRF or IRF resolution. Pars plana vitrectomy (PPV) with tamponade and PPV with tamponade plus endolaser were associated with significant visual gain. In the former group, VA improved from a mean of logMAR 0.91 (20/162), to a mean of logMAR 0.52 (20/66) at 12 months; in the latter group, VA improved from a mean of logMAR 0.82 (20/132) to a mean of logMAR 0.47 (20/59) at 12 months. Retreatments were performed in 14 eyes (15.7%), only enhancing anatomical outcomes. CONCLUSION Vitrectomy with tamponade had better final outcomes than external laser treatment with or without gas tamponade. Laser endophotocoagulation and ILM peel provided no additional benefit. A secondary treatment resulted in anatomical but not functional improvement.
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Affiliation(s)
- Mariano Iros
- Instituto de Microcirugía Ocular Córdoba Córdoba Argentina
| | | | - Sengul Ozdek
- Department of Ophthalmology Faculty of Medicine Gazi University Ankara Turkey
| | - Giampaolo Gini
- Western Sussex NHS Trust and Nuffield Haywards Heath Hospital Sussex UK
| | | | - Abdallah A Ellabban
- Hull University Teaching Hospitals Hull UK
- Department of Ophthalmology Suez Canal University Ismailia Egypt
| | - Mohammed F. Faramawi
- Departments of Bioinformatics and Epidemiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - Ron Adelman
- Department of Ophthalmology Yale University New Haven CT USA
| | - Ahmed B. Sallam
- Jones Eye Institute University of Arkansas for Medical Sciences Little Rock AR USA
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Pessoa B, Leite J, Heitor J, Coelho J, Monteiro S, Coelho C, Figueira J, Meireles A, Melo-Beirão JN. Vitrectomized versus non-vitrectomized eyes in diabetic macular edema response to ranibizumab-retinal layers thickness as prognostic biomarkers. Sci Rep 2021; 11:23055. [PMID: 34845300 PMCID: PMC8630028 DOI: 10.1038/s41598-021-02532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
To evaluate the role of the vitreous in the management of diabetic macular edema with ranibizumab intravitreal injections in a pro re nata regimen. Prospective study of 50 consecutive eyes with diabetic macular edema treated with ranibizumab and 12 months of follow-up. Primary endpoint: to assess differences between non-vitrectomized and vitrectomized eyes in the number injections needed to control the edema. Secondary endpoints: comparison of groups regarding best corrected visual acuity, central foveal thickness and thickness of seven retinal layers. 46 eyes from 38 patients, 10 vitrectomized and 36 non-vitrectomized, completed the follow-up. At month 12, the two groups achieved an equivalent anatomical outcome and needed a similar number of ranibizumab intravitreal injections. In vitrectomized eyes final visual acuity was worse when baseline retinal nerve fiber layers in the central foveal subfield were thicker, showing a strong correlation (r = − 0.942, p < 0.001). A similar, albeit moderate correlation was observed in non-vitrectomized eyes (r = − 0.504, p = 0.002). A decrease of retinal nerve fiber layers inner ring thickness was correlated with a better final visual acuity only in vitrectomized eyes (r = 0.734, p = 0.016). The effect of diabetic macular edema seems to be worse in vitrectomized eyes, with a thinner inner retina reservoir. Clinicaltrials.govNCT04387604.
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Affiliation(s)
- Bernardete Pessoa
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal. .,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
| | - João Leite
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
| | - João Heitor
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
| | - João Coelho
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal
| | - Sérgio Monteiro
- Departamento de Oftalmologia, Hospital de Santa Maria Maior de Barcelos, Barcelos, Portugal
| | - Constança Coelho
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Figueira
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Association for Innovation and Biomedical Research On Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - João Nuno Melo-Beirão
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar-Edifício Neoclássico, 4099-001, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
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10
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Pessoa B, Marques JH, Leite J, Silva N, José D, Coelho C, Figueira J, Meireles A, Melo-Beirão JN. Choroidal Blood Flow After Intravitreal Ranibizumab in Vitrectomized and Non-Vitrectomized Eyes with Diabetic Macular Edema. Clin Ophthalmol 2021; 15:4081-4090. [PMID: 34675476 PMCID: PMC8519787 DOI: 10.2147/opth.s325037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
Aim Diabetic retinopathy staging system and progression predictors are soon to be considered insufficient for ophthalmologic practice. Given the growing evidence of the role of choroidal dysfunction, our purpose was to assess choroidal vascular changes with intravitreal ranibizumab (RBZ) treatment in diabetic macular edema (DME). Methods This was a prospective longitudinal cohort study. The study included DME eyes, grouped in vitrectomized (group 1) and non-vitrectomized (group 2) eyes, submitted to RBZ in a pro re nata regimen, with 24 weeks of follow-up. Main outcome measures such as central subfield foveal thickness (CFT), choroidal thickness (CT), and choroidal vascular index (CVI) were obtained from structural OCT, and choriocapillaris flow density (CCD) was obtained from OCT angiography and analyzed before and after treatment. Results Thirty-one patients were included, 10 eyes in group 1 and 24 eyes in group 2. The mean number of injections was 5.18 (range 2–6). Globally, there was an improvement in BCVA (+4.3 ETDRS letters, p=0.004) and CFT (−84.6 µm, p<0.001) with no changes in CT, CVI, or CCD (p>0.05). When considering only group 2, there was a significant decrease in CT (p=0.033) and a significant increase in CCD (p=0.010) 6 months after treatment, with no differences in CVI (p=0.111). Baseline CVI was correlated with visual acuity at week 24 both globally (r=0.406, p=0.029) and in group 2 (r=0.604, p=0.004). Conclusion In non-vitrectomized eyes, choriocapillaris blood flow improves with RBZ. Baseline CVI may correlate with visual function after RBZ. ClinicalTrials.gov NCT04387604.
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Affiliation(s)
- Bernardete Pessoa
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - João Heitor Marques
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Leite
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Nisa Silva
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diana José
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Constança Coelho
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Figueira
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - João Nuno Melo-Beirão
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
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11
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Ferreira A, Afonso M, Silva N, Meireles A. The impact of COVID-19 pandemic on surgical primary retinal detachments. Ophthalmologica 2021; 245:111-116. [PMID: 34673635 PMCID: PMC8678219 DOI: 10.1159/000520342] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the impact of COVID-19 pandemic on the presentation characteristics, timings and surgical decisions for primary rhegmatogenous retinal detachment (RRD). METHODS Historical cohort including all patients who presented to the Surgical Retina Section at Centro Hospitalar Universitário do Porto (CHUPorto), over a 2-year period were recruited and divided in 2 groups: pre-COVID and COVID groups. The onset of the COVID-19 pandemic was recorded as starting on March 18, 2020, the same day the first pandemic-related lockdown came to effect in Portugal. RESULTS This study enrolled four hundred and forty-nine eyes of 443 patients: 272 in the pre-COVID group and 177 in the COVID one. Of the patients, 63.6% were male and the mean±SD age was 63.0±13.2y (range 13 to 92y). Of the eyes, 55.5% (n = 151) presented with macular detachment in the pre-COVID group compared with 66.9% (n = 119) in the COVID group (odds ratio [OR] 1.62; 95% confidence interval [CI], 1.09-3.86; p=0.016). The time from symptoms onset to hospital admission (p=0.021) and from admission to surgery (p<0.001) was longer in the COVID era. In the COVID period, silicone oil (OR 2.03, 95%CI 1.09-3.79, p=0.025) and C3F8 gas (OR 2.42, 95%CI 1.57-3.71, p<0.001) were used more often. No differences in anatomical success or final visual acuity were found. CONCLUSIONS The lockdown due to COVID pandemic affected the epidemiology of RRD. The services must adapt to the novel reality and produce backup plans for similar events. Despite the contingencies, the final results were not different between groups.
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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
- *André Ferreira,
| | - Miguel Afonso
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Nisa Silva
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Angelina Meireles
- 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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12
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Silva N, Ferreira A, Nawrocka (vel Michalewska) ZA, Meireles A. Inverted Internal Limiting Membrane Flap Technique: Is It the Best Option for Macular Holes? Clin Ophthalmol 2021; 15:3295-3303. [PMID: 34408388 PMCID: PMC8360769 DOI: 10.2147/opth.s284614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment is generally necessary to repair full-thickness macular holes (FTMH). Although vitrectomy with or without internal limiting membrane (ILM) peeling remains the standard surgical technique, the inverted ILM flap procedure has increasingly assumed a role in the primary surgical repair of FTMHs. Some vitreoretinal surgeons reserve this technique to treat large or myopic holes, whereas others use it routinely in all cases. This paper is a comprehensive review of the current scientific evidence on the anatomical and functional outcomes of the inverted ILM flap technique in the repair of macular holes, following the International Vitreomacular Traction Study (IVTS) group classification.
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Affiliation(s)
- Nisa Silva
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
| | - André Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal
| | | | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal
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13
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Figueira J, Henriques J, Carneiro Â, Marques-Neves C, Flores R, Castro-Sousa JP, Meireles A, Gomes N, Nascimento J, Amaro M, Silva R. Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization. Clin Ophthalmol 2021; 15:3221-3230. [PMID: 34354341 PMCID: PMC8331083 DOI: 10.2147/opth.s318026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023] Open
Abstract
Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients’ vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3–6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6–8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments.
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Affiliation(s)
- João Figueira
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - José Henriques
- Retina Department, Retinal Surgical Unit, Dr. Gama Pinto Ophthalmology Institute, Lisbon, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Carlos Marques-Neves
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE - Hospital de Santa Maria, Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,ALM Oftalmolaser, Lisbon, Portugal
| | - Rita Flores
- Department of Ophthalmology, Centro Hospitalar de Lisboa Central EPE, Lisbon, Portugal.,CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - João Paulo Castro-Sousa
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal.,CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,Faculty of Medical Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Gomes
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - João Nascimento
- Instituto de Retina e Diabetes Oculares de Lisboa, Lisbon, Portugal
| | - Miguel Amaro
- Ophthalmology Department, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Rufino Silva
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Coimbra Medical Space, Coimbra, Portugal
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14
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Silva R, Arias L, Nunes S, Farinha C, Coimbra R, Marques JP, Cachulo ML, Figueira J, Barreto P, Madeira MH, Pires I, Sousa JC, Distefano L, Rosa P, Carneiro Â, Vaz-Pereira S, Meireles A, Cabrera F, Bures A, Mendonça L, Fernandez-Vega-Sanz A, Barrão S, Koh A, Cheung CMG, Cunha-Vaz JG, Murta J. Efficacy and safety of Intravitreal Aflibercept Vs Verteporfin Photodynamic Therapy in a Caucasian Population with Polypoidal Choroidal Vasculopathy: A Randomized Clinical Trial. Ophthalmologica 2021; 245:80-90. [PMID: 34348351 DOI: 10.1159/000518235] [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: 12/07/2020] [Accepted: 07/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Rufino Silva
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Espaço Médico de Coimbra, Coimbra, Portugal
| | - Luis Arias
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandrina Nunes
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Claudia Farinha
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Rita Coimbra
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
| | - João P Marques
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Maria L Cachulo
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Figueira
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Espaço Médico de Coimbra, Coimbra, Portugal
| | - Patricia Barreto
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Orthoptics, School of Health, Polytechnic of Porto, Oporto, Portugal
| | - Maria H Madeira
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Pires
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | | | | | - Paulo Rosa
- Instituto Retina Diabetes Ocular de Lisboa, Lisbon, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar de São João, EPE, Oporto, Portugal
| | - Sara Vaz-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE - Hospital de Santa Maria, Lisbon, Portugal
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | | | | | - Luís Mendonça
- Department of Ophthalmology, Hospital Braga, Braga, Portugal
| | | | - Sandra Barrão
- Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
| | - Adrian Koh
- Eye & Retina Surgeons, Singapore, Singapore
| | | | - José G Cunha-Vaz
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Espaço Médico de Coimbra, Coimbra, Portugal
| | - Joaquim Murta
- Association of Innovation and Biomedical Research in Light and Image (AIBILI), Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
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15
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Pessoa B, Ferreira A, Leite J, Figueira J, Meireles A, Beirão JM. Optical Coherence Tomography Biomarkers: Vitreous Status Influence in Outcomes for Diabetic Macular Edema Therapy with 0.19-mg Fluocinolone Acetonide Implant. Ophthalmic Res 2021; 64:639-647. [PMID: 33601389 DOI: 10.1159/000515306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The 0.19-mg fluocinolone acetonide (FAc) implant (ILUVIEN®; Alimera Sciences Ltd., Hampshire, UK) was approved for the treatment of vision impairment associated with chronic and refractory diabetic macular edema (DME). OBJECTIVES To quantitatively assess functional and structural features in nonvitrectomized and vitrectomized DME patients after being treated with an FAc implant. METHODS Retrospective review of patients with DME receiving a single intravitreal injection of the FAc implant. The study was designed to analyze the presence of quantitative structural OCT biomarkers at baseline and 12 months after FAc therapy according to vitreous status. RESULTS A total of 41 eyes from 30 patients were included in this study. At 12 months after injection, vitrectomized patients had a lower central foveal thickness (p = 0.017) and fewer hyperreflective dots (p = 0.028) compared with nonvitrectomized. Thirty (73%) patients presented a significant functional improvement with 17 (42%) increasing at least 15 ETDRS letters. Overall, 22 (54%) eyes had a complete resolution of DME at the 12-month visit. Patients who needed additional therapy had a higher prevalence of subretinal fluid (42 vs. 3%, p = 0.005) at baseline. CONCLUSIONS This study supports the effectiveness of the FAc implant and reports significant changes at 12 months after FAc injection.
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Affiliation(s)
- Bernardete Pessoa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
| | - João Leite
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Figueira
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - João Melo Beirão
- Department 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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16
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Marques JH, Abreu AC, Silva N, Meireles A, Pessoa B, Melo Beirão J. Fluocinolone Acetonide 0.19 mg Implant in Patients with Cystoid Macular Edema Due To Irvine-Gass Syndrome. Int Med Case Rep J 2021; 14:127-132. [PMID: 33664598 PMCID: PMC7924132 DOI: 10.2147/imcrj.s295045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/13/2021] [Indexed: 12/05/2022] Open
Abstract
Background Cystoid macular edema (CME) due to Irvine–Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized. Objective To evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (0.2 µg/day; ILUVIEN®) in the off-label treatment of recurrent CME due to IGS. Methods Retrospective 36-month case series in the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Portugal. Consecutive eyes of patients with recurrent cystoid macular edema due to Irvine–Gass syndrome who underwent a single intravitreal injection of fluocinolone acetonide intravitreal implant were included. Best-corrected visual acuity (logMAR), central macular thickness (µm) and safety (intraocular pressure, mmHg) at baseline and at 6, 12, 24 and 36 months post-administration of the fluocinolone acetonide intravitreal implant were recorded. Results Five eyes from three patients were included. The duration of cystoid macular edema was 67.8±25.9 months and all five eyes received more than 2 intravitreal injections of a corticosteroid (triamcinolone and/or dexamethasone implant) prior to fluocinolone acetonide intravitreal implantation. At baseline (median – interquartile range), best-corrected visual acuity was 0.3–0.3; central macular thickness was 492.0–38.0; and intraocular pressure was 16.0–0. By Month 36, best-corrected visual acuity was 0.4 −0.3; central macular thickness was reduced to 369.0–324.0 and intraocular pressure was 17.0–3.0. Four of five eyes had increased intraocular pressure and were managed with intraocular pressure-lowering eye drops. Conclusion We report improved functional and anatomical outcomes after treatment with fluocinolone acetonide intravitreal implant, indicating its use as a therapeutic alternative in recurrent cases of cystoid macular edema due to Irvine–Gass syndrome. Additionally, in eyes with suboptimal response to intravitreal therapies, fluocinolone acetonide intravitreal implant may provide longer recurrence-free periods with reduced treatment burden.
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Affiliation(s)
- João Heitor Marques
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana Carolina Abreu
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Nisa Silva
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Angelina Meireles
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Bernardete Pessoa
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Melo Beirão
- Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Pessoa B, Malheiro L, Carneiro I, Monteiro S, Coelho J, Coelho C, Figueira J, Meireles A, Melo Beirão JN. Intravitreal Ranibizumab or Aflibercept After Bevacizumab in Diabetic Macular Edema: Exploratory Retrospective Analysis. Clin Ophthalmol 2021; 15:253-260. [PMID: 33519187 PMCID: PMC7837538 DOI: 10.2147/opth.s280644] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in eyes with diabetic macular edema (DME) unresponsive to bevacizumab. Methods Single-center retrospective comparative study of patients with DME unresponsive to intravitreal bevacizumab that was switched to ranibizumab or aflibercept. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analysed prior to and 4 months after the switch. Ocular coherence tomography (OCT) biomarkers were also analysed. Results Fifty-six eyes from 40 patients were included in the study, 33 eyes switched to ranibizumab and 23 to aflibercept. A significant median CFT decrease was observed in both groups (p<0.001), with no between-group differences. BCVA gain was only significant in the ranibizumab group (p<0.001). None of the pre-baseline or baseline parameters were associated with the response to ranibizumab or aflibercept. Conclusion In persistent DME unresponsive to bevacizumab, both anatomical and functional improvements were observed with ranibizumab whereas aflibercept only showed an anatomical improvement. Clinicaltrials.gov NCT04018833.
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Affiliation(s)
- Bernardete Pessoa
- Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Luísa Malheiro
- Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Inês Carneiro
- Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Sílvia Monteiro
- Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - João Coelho
- Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Constança Coelho
- Genetics Laboratory, Institute of Environmental Health, Lisbon Medical School, University of Lisbon, Porto, Portugal
| | - João Figueira
- Centro Hospitalar e Universitário de Coimbra, Porto, Portugal.,Faculty of Medicine of the University of Coimbra, Porto Portugal.,Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Nuno Melo Beirão
- Ophthalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Baptista PM, Silva N, Coelho J, José D, Almeida D, Meireles A. Microperimetry as Part of Multimodal Assessment to Evaluate and Monitor Myopic Traction Maculopathy. Clin Ophthalmol 2021; 15:235-242. [PMID: 33519185 PMCID: PMC7837539 DOI: 10.2147/opth.s294662] [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: 12/04/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To characterize a population of high myopes with myopic traction maculopathy (MTM), to assess their retinal function, and to correlate it with anatomic status. Patients and Methods This was an observational cross-sectional study including 50 eyes from 27 patients. Demographic and clinical data were analyzed. Macular structure was assessed with spectral domain optical coherence tomography (SD-OCT, Heidelberg®) and macular function was studied with Microperimeter MP-3, NIDEK®. Results The average for central foveal thickness (CFT) and choroid thickness (CT) was 213±151 μm and 36±23 μm, respectively, in a total of 50 eyes from 27 patients. In the microperimetry analysis, the average sensitivity on the foveal-centered 12º polygon (CPS) was 14.37±9.1 dB. CT was negatively associated with the bivariate contour ellipse areas (BCEA) 1 (r=−0.314; p=0.034), 2 (r=−0.314; p=0.034), and 3 (r=−0.316; p=0.033). CPS had a strong positive correlation with best-corrected visual acuity (BCVA) (r=0.661; p=0.000). We found a trend to worse microperimetric results in eyes with schisis (n=19) (p>0.05) but eyes with atrophic areas (n=33) presented significant inferior CPS (p<0.001). The presence of staphyloma showed significant impact on macular sensitivities in eyes with areas of macular atrophy/fibrosis (p<0.05). Conclusion Macular microperimetry analysis can have a role as part of a multimodal anatomo-functional assessment for a more precise characterization of the high myopic patients with MTM, optimizing medical and surgical decisions.
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Affiliation(s)
| | - Nisa Silva
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Coelho
- 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
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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19
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Silva N, Ferreira A, Marques JH, Ferreira N, Correia N, Pessoa B, Beirão JM, Kuhn F, Meireles A. Epiretinal membrane vitrectomy: outcomes with or without cataract surgery and a novel prognostic factor for cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 2021; 259:1731-1740. [PMID: 33492546 DOI: 10.1007/s00417-021-05076-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/01/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To assess the outcomes of vitrectomy with or without cataract surgery for the treatment of idiopathic ERM in phakic eyes and evaluate predictors of functional and anatomical outcomes. METHODS Retrospective cohort of consecutive phakic ERM eyes distributed in three groups: a) combined (phacovitrectomy) group, b) PPV-only group, and c) consecutive group (PPV followed by cataract surgery). Main outcomes were final visual acuity (VA) and cystoid macular edema (CME) occurrence. Potential predictors of VA or CME included clinical variables and SD-OCT parameters. RESULTS A total of 108 eyes were included in this study. There were no differences in the final VA between consecutive and combined groups (0.22 vs 0.10 logMAR, p = 0.851). Twelve eyes from the combined group (23%) and one eye from the PPV-only group presented CME (p = 0.001). There were no differences between postoperative CME occurrence in combined versus consecutive group (12 vs 7, p = 0.38). The presence of cotton-ball sign predicted the development of CME [OR 2.86 (95%CI 1.01-8.18), p = 0.049] while separated ERM-ILM complex was found to be protective [OR 0.25 (95%CI 0.08-0.77), p = 0.015]. CONCLUSIONS Functional and anatomical results of PPV with ERM and ILM peeling combined with cataract surgery was equivalent to the consecutive procedure, with both strategies being effective. Separated ERM-ILM complex has prognostic value in these patients, as its presence at baseline was found to be protective for postoperative CME.
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Affiliation(s)
- Nisa Silva
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal. .,Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Al. Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - João Heitor Marques
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Natália Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Nuno Correia
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Bernardete Pessoa
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal
| | - João Melo Beirão
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, AL, USA.,Milos Eye Hospital, Belgrade, Serbia.,Zagorskiego Eye Hospital, Krakow, Poland
| | - Angelina Meireles
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.,Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal
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20
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Marques JH, Castro C, Malheiro L, Alves Correia N, Pessoa B, Melo Beirão J, Meireles A, Ferreira N. Dealing with rhegmatogenous retinal detachment in patients under 40 years old: a tertiary center results. Int Ophthalmol 2020; 41:475-482. [PMID: 33090311 DOI: 10.1007/s10792-020-01597-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The risk of rhegmatogenous retinal detachment (RRD) increases with age, but some studies report a secondary peak in younger patients. Since visual recovery in RRD depends on surgical treatment and, considering the personal, social and economic burden of low vision in the working-age population, our purpose was to analyze the features and outcomes of RRD in young patients. METHODS Clinical data of patients under 40 years old submitted to surgery for first time RRD, consecutively selected between 2016 and 2019, was analyzed. Patients with less than 3 months follow-up were excluded. RESULTS Eighty-nine eyes from 89 patients were included. Mean age was 31.2 ± 7.8 years (minimum 10 years) and 56% were female gender. Most patients (63%) had high myopia. Pars plana vitrectomy (79%) alone, combined with scleral buckling (1%) or scleral buckling alone (20%) was performed. Primary anatomical success was 72%, and final anatomical success was 91%. Final visual acuity of 20/40 or better was achieved in 29% of cases, but 28% remained under 20/400. The presence of myopia (p = 0.022), localized RRD (p = 0.007) and attached macula at presentation (p < 0.001) was associated with a better final visual acuity. CONCLUSION Management of RRD in young patients must be thorough. In younger patients, anatomical outcomes may be worse than in older patients. Myopia may be recognized as a major risk factor for RRD in this age group, but also as a protective factor for retinal function after surgery.
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Affiliation(s)
- João Heitor Marques
- 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
| | - Luísa Malheiro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Nuno Alves Correia
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Bernardete Pessoa
- 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
| | - João Melo Beirão
- 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
| | - Angelina Meireles
- 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
| | - Natália Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
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Silva N, Ferreira N, Pessoa B, Correia N, Beirão JM, Meireles A. Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience. Int Ophthalmol 2020; 41:499-507. [PMID: 33057865 DOI: 10.1007/s10792-020-01600-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the ellipsoid zone (EZ) structural recovery, hole closure rate, and visual acuity improvement after inverted internal limiting membrane (ILM) flap technique. METHODS Retrospective cohort of eyes affected by idiopathic macular holes (MH) that underwent pars plana vitrectomy combined with inverted ILM flap technique in a tertiary center, over an 8-year period (2011-2019). The main outcomes were the postoperative qualitative analysis of EZ structure on spectral-domain optical coherence tomography, hole closure rate, and best-corrected visual acuity (BCVA) improvement of ≥ 0.3 units in the logarithm of minimal angle of resolution (logMAR) scale. RESULTS Our study included 76 eyes of 72 patients; 65% were female, with a mean age of 70 ± 8 years-old. Median (range) follow-up was 21 (3-92) months. Hole closure rate was 92%. Structural defects in EZ were observed in 66% of closed holes (EZ atrophy in 33%, EZ disruption in 22%, and EZ thinning in 11%). The mean final BCVA was 0.5 ± 0.4 logMAR (Snellen 20/63), but visual acuity improvement occurred in 80% of the eyes. Final BCVA was significantly worse in eyes with EZ atrophy compared with eyes with EZ disruption (0.75 vs. 0.36 logMAR, p = 0.004) and EZ thinning (0.75 vs. 0.32 logMAR, p = 0.015). In multivariate regression, minimum linear diameter (OR 1.01; IC 95% 1.01-1.02) independently predicted a final BCVA (logMAR) < 0.3 units. CONCLUSION Inverted ILM flap technique provided a hole closure rate above 90%, similar to previous studies. Although the modest value of the final BCVA, a significant visual acuity improvement occurred in most eyes. Structural defects of EZ were found in more than half of closed MHs after surgery. Evidence of postoperative retinal atrophy was associated with a worse visual outcome.
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Affiliation(s)
- Nisa Silva
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Natália Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Bernardete Pessoa
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Nuno Correia
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - João Melo Beirão
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
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22
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Silva N, Laiginhas R, Meireles A, Barbosa Breda J. Impact of the COVID-19 Pandemic on Ophthalmology Residency Training in Portugal. ACTA MEDICA PORT 2020; 33:640-648. [PMID: 32914750 DOI: 10.20344/amp.14341] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The purpose of this study was to provide objective and real-life data concerning the impact of the COVID-19 pandemicon ophthalmology residency training in Portugal. MATERIAL AND METHODS Descriptive survey-based study applied to current Portuguese ophthalmology residents (n = 80 eligible). RESULTS Seventy-five residents participated (94% response rate). All except one (99%) admitted a change in their routine clinical practice during the pandemic, and most (89%) continued to be engaged in ophthalmology department duties. Twenty-five percent were deployed to COVID-19 units, which was combined with ophthalmological activities in about half of them (47%). A significant proportion of participants stated that they were enrolled in the following ophthalmological activities: emergency/inpatient care (87%), outpatient visits (73%; general 70% vs subspecialty 29%), and surgical procedures (64%). Twenty-five percent did not assist in any outpatient visits and 36% did not participate in any surgical procedures. On a scale from 1 (no impact) to 5 (maximum impact), most participants classified their perceived negative impact of the pandemic on the training program as 3 (24%), 4 (40%), or 5 (27%). Participants highly agreed with the extension of the residency program (80%) in order to to make up for training disruption. DISCUSSION Most trainees provided ophthalmological care during the pandemic. However, those clinical activities were essentially related to general and emergency care. Surgical experience was significantly curtailed. As such, strategies are needed to guarantee a high-quality learning process. Further studies are required to develop an international perspective on how ophthalmology training programs have been affected so that educational organizations can make recommendations regarding standardized adjustments to training programs. CONCLUSION The COVID-19 pandemic has significantly impacted the training of ophthalmology residents nationwide.
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Affiliation(s)
- Nisa Silva
- Department of Ophthalmology. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Rita Laiginhas
- Department of Ophthalmology. Centro Hospitalar de Entre o Douro e Vouga. Santa Maria da Feira. Portugal
| | - Angelina Meireles
- Department of Ophthalmology. Centro Hospitalar Universitário do Porto. Porto. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal
| | - João Barbosa Breda
- Cardiovascular R&D Center. Faculty of Medicine. Universidade do Porto. Porto. Department of Ophthalmology. Centro Hospitalar e Universitário São João. Porto. Research Group Ophthalmology. Department of Neurosciences. Katholieke Universiteit Leuven. Leuven. Belgium. Portugal
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23
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Pessoa B, Melo-Beirão J, Meireles A, Menéres P. Challenging Clinical Cases - A Walk Through Supplemental Therapy with Intravitreal Ranibizumab Therapy Following Treatment of Diabetic Macular Edema with the 0.19 mg Fluocinolone Acetonide Implant (ILUVIEN ®). Int Med Case Rep J 2020; 13:437-448. [PMID: 32982484 PMCID: PMC7501957 DOI: 10.2147/imcrj.s262587] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose There are limited published data regarding the use of supplemental intravitreal therapies in patients with diabetic macular edema (DME) following treatment with the 0.19 mg fluocinolone acetonide (FAc; ILUVIEN®) intravitreal implant. The aim of this report was to analyze five challenging eyes that required supplemental therapies after treatment with the FAc implant. Methods This is a retrospective case series conducted at the Centro Hospitalar Universitário do Porto in Porto, Portugal, between 2015 and 2019. It aimed to assess the patient background, treatment history and patient outcomes in challenging clinical cases in which intravitreal injections (IVI) of ranibizumab had been given pro re nata following treatment with the FAc implant (with a minimum follow-up of 33 months). Parameters measured included best-corrected visual acuity in early treatment diabetic retinopathy scale, central macular thickness and intraocular pressure. Patients Five eyes (three patients) diagnosed with persistent or recurrent DME and suitable for treatment with the FAc implant according to its licensed indication in Europe. Results In the first 2 patients, one bilateral, DME was refractory to IVI of short-acting corticosteroids and anti-VEGF. Following FAc therapy, there was a favorable evolution and a clear regression of diabetic retinopathy (DR) severity. Supplemental treatments were adopted, but a reduced number of treatments were needed beyond three years in these cases. The third case had bilateral DME. One eye had been vitrectomized and FAc therapy led to resolution of DME within 6 months. In the contralateral eye, the control of DME was dependent on anti-VEGF supplemental treatments until a pars plana vitrectomy was performed. Conclusion The multifactorial nature of DME means there is a need for an individualized treatment approach to the management of DME. It also explains why some patients need a combined or a more aggressive approach to therapy in order to achieve successful outcomes for the patient.
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Affiliation(s)
- Bernardete Pessoa
- Ophtalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Melo-Beirão
- Ophtalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Angelina Meireles
- Ophtalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Pedro Menéres
- Ophtalmology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Carneiro A, Meireles A, Castro Sousa JP, Teixeira C. Clinical impact of the 0.2 µg/day fluocinolone acetonide intravitreal implant: outcomes from the ILUVIEN ® clinical evidence study in Portugal. Ther Adv Ophthalmol 2020; 12:2515841420917768. [PMID: 32548568 PMCID: PMC7249555 DOI: 10.1177/2515841420917768] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: The ILUVIEN® (fluocinolone acetonide) Clinical Evidence in
Portugal (ICE-PT) study is a retrospective, multicenter, observational study
evaluating the effectiveness and safety of the FAc implant in patients with
diabetic macular edema. Methods: Patients included in this study had received the 0.2 µg/day fluocinolone
acetonide implant for the treatment of diabetic macular edema and had
measurements of visual acuity and retinal thickness assessed by optical
coherence tomography for at least 12 months pre- and post-fluocinolone
acetonide implant administration, with ⩾2 follow-up visits. Outcomes
measured included visual acuity, central foveal thickness, and intraocular
pressure. Results: There was a significant increase in mean visual acuity compared with baseline
at 3, 6, 9, and 12 months post-fluocinolone acetonide in both the overall
study population and the pseudophakic subgroup (p < 0.05
at all time points in both groups). A significant reduction in mean central
foveal thickness compared with baseline was seen in the overall study
population at 3, 6, 9, and 12 months post-fluocinolone acetonide
(p < 0.05 at all time points). At 12-month
post-fluocinolone acetonide, a small but significant intraocular pressure
increase of 1.0 mmHg was seen in the overall study population. Conclusion: The results of this analysis show that switching from the current standard of
care to the fluocinolone acetonide implant leads to beneficial effects in
terms of vision and retinal structure in patients with diabetic macular
edema and that patients benefited from FAc implant administration,
regardless of lens status.
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Affiliation(s)
- Angela Carneiro
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Department of Ophthalmology of Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
| | - Angelina Meireles
- Department Ophthalmology of Centro Hospitalar Universitário do Porto, Porto Portugal
| | | | - Carla Teixeira
- Department of Ophthalmology of Hospital Pedro Hispano, Matosinhos, 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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Pessoa B, Coelho J, Malheiro L, José D, Pires S, Coelho C, Figueira J, Meireles A, Melo-Beirão J. Comparison of Ocular Ultrasound Versus SD-OCT for Imaging of the Posterior Vitreous Status in Patients With DME. Ophthalmic Surg Lasers Imaging Retina 2020; 51:S50-S53. [DOI: 10.3928/23258160-20200401-07] [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] [Received: 07/21/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022]
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27
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Coelho J, Malheiro L, Melo Beirão J, Meireles A, Pessoa B. Real-world retrospective comparison of 0.19 mg fluocinolone acetonide and 0.7 mg dexamethasone intravitreal implants for the treatment of diabetic macular edema in vitrectomized eyes. Clin Ophthalmol 2019; 13:1751-1759. [PMID: 31571814 PMCID: PMC6750204 DOI: 10.2147/opth.s201611] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023] Open
Abstract
Purpose The aim of this study was to evaluate the long-term real-world effectiveness of FAc and DEX implants in vitrectomized DME eyes in a real-world setting. Methods This was a non-interventional, retrospective, comparative study of 46 vitrectomized eyes in 33 patients with persistent or recurrent DME quantified best-corrected visual acuity (BCVA), central foveal thickness (CFT) and intraocular pressure (IOP) over up to 37 months. Results Both FAc and DEX treatment led to statistically and clinically significant improvements in BCVA and CFT. FAc >10-letter improvement on the Early Treatment Diabetic Retinopathy Study [ETDRS] chart over months 3–24 and a sustained ~200 µm CFT reduction over months 1–24; DEX: >5-letter improvement on the ETDRS chart at months 1 and 3 and >100 µm CFT reduction at month 1. FAc demonstrated sustained, stable and predictable effects on BCVA and CFT over 24 months and also improved BCVA and decreased CFT in a cohort of DME eyes that was refractory to DEX over 6 months. Conclusion This real-world study demonstrates long-term effectiveness of FAc in vitrectomized DME eyes and sustained effectiveness in DME eyes that did not respond to DEX therapy.
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Affiliation(s)
- João Coelho
- Unit of Ophthalmology, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Luísa Malheiro
- Unit of Ophthalmology, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - João Melo Beirão
- Unit of Ophthalmology, Centro Hospitalar Universitário Do Porto, Porto, Portugal.,Unit of Ophthalmology, Universidade Do Porto-Instituto Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Angelina Meireles
- Unit of Ophthalmology, Centro Hospitalar Universitário Do Porto, Porto, Portugal.,Unit of Ophthalmology, Universidade Do Porto-Instituto Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Bernardete Pessoa
- Unit of Ophthalmology, Centro Hospitalar Universitário Do Porto, Porto, Portugal.,Unit of Ophthalmology, Universidade Do Porto-Instituto Ciências Biomédicas Abel Salazar, Porto, Portugal
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Pessoa B, Coelho J, Coelho C, Monteiro S, Abreu C, Figueira J, Meireles A, Melo Beirão JN. Enzymatic vitreolysis for the treatment of tractional diabetic macular edema. Ther Adv Ophthalmol 2019; 11:2515841419869511. [PMID: 31489401 PMCID: PMC6710704 DOI: 10.1177/2515841419869511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/27/2018] [Accepted: 07/22/2019] [Indexed: 11/16/2022] Open
Abstract
Background: A new approach to address focal vitreomacular adhesion in patients with diabetic macular edema may control and stabilize diabetic macular edema with fewer anti-vascular endothelial growth factor injections. Objectives: The aim of this study was to demonstrate that diabetic macular edema can be improved by inducing the release of a vitreomacular adhesion, with less than 2500 μm, with enzymatic vitreolysis. Methods: From a retrospective analysis of clinical records from patients with diabetic retinopathy, patients with diabetic macular edema and vitreomacular adhesion <2500 μm were selected for a single-arm prospective study. The primary endpoint was to control diabetic macular edema with fewer anti-vascular endothelial growth factor injections after an observed vitreomacular adhesion release. A statistical subanalysis was performed for the following two groups: the group with vitreomacular adhesion release (group 1) and the group without vitreomacular adhesion release (group 2). Results: A total of 23 eyes from 19 patients were included. A reduction of the median number of injections was achieved in group 1 (p = 0.006). Adverse events were mild and transitory. Conclusion: Release of vitreomacular adhesion <2500 μm through enzymatic vitreolysis contributed to the control and stabilization of diabetic macular edema with fewer anti-vascular endothelial growth factor injections, reducing the burden and the risks related to these invasive and frequently chronic treatments.
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Affiliation(s)
- Bernardete Pessoa
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Coelho
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Constança Coelho
- Genetics Laboratory, Institute of Environmental Health, Lisbon Medical School, University of Lisbon, Lisbon, Portugal
| | - Sílvia Monteiro
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carolina Abreu
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Figueira
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Angelina Meireles
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Nuno Melo Beirão
- Departamento de Oftalmologia, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Coelho J, Pessoa B, Meireles A. Long-term management of non-ischemic central retinal vein occlusion with fluocinolone acetonide intravitreal implant 190 μg (ILUVIEN®). Ther Adv Ophthalmol 2019; 11:2515841418820755. [PMID: 30643869 PMCID: PMC6322089 DOI: 10.1177/2515841418820755] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/29/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction: Macular edema after central retinal vein occlusion is a common cause of vision loss. Upregulation of vascular endothelial growth factor and higher levels of inflammatory mediators have been involved in the pathogeny of the macular edema in central retinal vein occlusion. Case report: The authors report a case with non-ischemic central retinal vein occlusion that was successfully treated with a single sustained-release fluocinolone acetonide intravitreal implant. After a course of repeated injections of shorter-acting corticosteroid, the affected eye presented a visual acuity of 20/200 and a central subfield foveal thickness of 587 µm. After fluocinolone acetonide in intravitreal implant and during a follow-up period of 12 months, a continuous and sustained increase in visual acuity until 20/25 with significant anatomical improvements and an acceptable safety profile was observed. Conclusion: These results, demonstrate that fluocinolone acetonide intravitreal implant might be an effective treatment option in macular edema secondary to non-ischemic central retinal vein occlusion.
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30
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Pessoa B, Dias D, Baptista P, Coelho C, Beirão J, Meireles A. Vitrectomy Outcomes in Eyes with Tractional Diabetic Macular Edema. Ophthalmic Res 2018; 61:94-99. [DOI: 10.1159/000489459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/20/2018] [Indexed: 11/19/2022]
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31
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Monteiro S, Meireles A. Prophylactic Chorioretinectomy in Open Ocular Trauma: A Series of 36 Eyes. Ophthalmologica 2018; 240:55-60. [DOI: 10.1159/000486549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 12/28/2017] [Indexed: 11/19/2022]
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Pessoa B, Coelho J, Correia N, Ferreira N, Beirão M, Meireles A. Fluocinolone Acetonide Intravitreal Implant 190 μg (ILUVIEN®) in Vitrectomized versus Nonvitrectomized Eyes for the Treatment of Chronic Diabetic Macular Edema. Ophthalmic Res 2017; 59:68-75. [PMID: 29248913 DOI: 10.1159/000484091] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/08/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the functional and anatomical outcomes after a 0.2 µg/day fluocinolone acetonide (FAc) implant between vitrectomized and nonvitrectomized eyes with chronic diabetic macular edema (DME). METHODS This is a retrospective, comparative analysis of 43 eyes with chronic DME. All eyes were treated with a single 0.2 µg/day FAc implant and followed up for a mean period of 8.5 months (median, 6.0 months; range, 1-21 months). The patients with a 0.2 µg/day FAc implant were divided into 2 groups: 24 eyes which had undergone pars plana vitrectomy prior to 0.2 µg/day FAc (group 1) and 19 eyes which had not been vitrectomized (group 2). Outcome measures included mean changes in best corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study letters, central subfield foveal thickness (CSFT), and intraocular pressure (IOP), and were measured prior to administration of the 0.2 µg FAc implant, in the first week, at month 1, and quarterly thereafter. RESULTS Following the 0.2 μg/day FAc implant, the mean change in BCVA at the last observation point, from baseline, was +16.9 ± 3.39 (mean ± SE) letters (p ≤ 0.001) in group 1 and +8.2 ± 4.62 letters (p = 0.092) in group 2. From baseline, a gain of ≥15 letters was achieved in 37.5 and 36.8% of the eyes in group 1 and group 2, respectively. Additionally, an improvement in vision ≥20/40 in 29.2% of group 1 and 15.8% of group 2 was observed. The mean change in CSFT was -217.7 ± 40.8 µm and -155.6 ± 43.4 µm in group 1 and group 2, respectively. The mean change in IOP was +1.6 ± 0.7 mm Hg in group 1 and +0.8 ± 1.3 mm Hg in group 2, relative to baseline. At the last observation point, there were no significant differences between groups 1 and 2 (p > 0.05) in terms of their changes in BCVA, CSFT, and IOP. CONCLUSION The results from the real-life practice study demonstrate that the 0.2 μg/day FAc implant is effective and well tolerated in vitrectomized and nonvitrectomized eyes of patients with chronic DME. Our results support the use of a 0.2 μg/day FAc implant to obtain long-term functional and anatomical improvements (mean, 8.5 months; median, 6.0 months) in vitrectomized and nonvitrectomized eyes.
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Affiliation(s)
- Bernardete Pessoa
- Serviço de Oftalmologia, Centro Hospitalar do Porto, Hospital de Santo Antonio, Porto, Portugal
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33
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Meireles A, Goldsmith C, El-Ghrably I, Erginay A, Habib M, Pessoa B, Coelho J, Patel T, Tadayoni R, Massin P, Atorf J, Augustin AJ. Efficacy of 0.2 μg/day fluocinolone acetonide implant (ILUVIEN) in eyes with diabetic macular edema and prior vitrectomy. Eye (Lond) 2017; 31:684-690. [PMID: 28085139 PMCID: PMC5437318 DOI: 10.1038/eye.2016.303] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose Limited data are available on the efficacy of the 0.2 μg/day fluocinolone acetonide (FAc) implant in eyes with prior vitrectomy. Here, we present a collection of 26 vitrectomized eyes treated with the 0.2 μg/day FAc implant. Methods Retrospective study involving six centers from four European countries analyzing the safety and efficacy data from patients (26 eyes from 25 patients) with DME and a prior vitrectomy that had been treated with one 0.2 μg/day FAc implant. Results Prior intravitreal therapies included anti-VEGF (mean, 3.8 injections) and steroids (mean, 1.9 injections). Pars plana vitrectomy (PPV) was performed in these eyes primarily for abnormalities of vitreoretinal interface, followed by proliferative diabetic retinopathy and vitreous hemorrhage. The 0.2 μg/day FAc implant was injected 24.2 months, on average, after PPV and the mean duration of follow-up after injection was 255 days (range, 90 to 759 days). The mean change in BCVA was +11.7 ETDRS letters (range, −19 to +40 letters; P<0.0004) and the mean change in central foveal thickness (CFT) was −233.5 μm (range, −678 to 274 μm; P<0.0001). The mean change in IOP from baseline at the last visit was +1.4 mm Hg (range, −9 to +8 mm Hg; P=0.0090). Eight eyes initiated or continued IOP lowering medications. Conclusions These data suggest the 0.2 μg/day FAc implant is effective in vitrectomized patients with an acceptable safety profile. Further studies are still required to confirm the current findings and to assess the effect of the 0.2 μg/day FAc implant over a longer period of follow-up.
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Affiliation(s)
- A Meireles
- Unit of Ophthalmology, CHP-Hospital Santo António, Porto, Portugal.,Unit of Ophthalmology, Universidade do Porto-Instituto Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - C Goldsmith
- Unit of Ophthalmology, James Paget University Hospital, Great Yarmouth, UK
| | - I El-Ghrably
- Unit of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - A Erginay
- Unit of Ophthalmology, Lariboisiere University hospital, Paris, France
| | - M Habib
- Unit of Ophthalmology, Sunderland Eye Hospital, Sunderland, UK
| | - B Pessoa
- Unit of Ophthalmology, CHP-Hospital Santo António, Porto, Portugal
| | - J Coelho
- Unit of Ophthalmology, CHP-Hospital Santo António, Porto, Portugal
| | - T Patel
- Unit of Ophthalmology, James Paget University Hospital, Great Yarmouth, UK
| | - R Tadayoni
- Unit of Ophthalmology, Lariboisiere University hospital, Paris, France
| | - P Massin
- Unit of Ophthalmology, Lariboisiere University hospital, Paris, France
| | - J Atorf
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - A J Augustin
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
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Figueira J, Martins D, Pessoa B, Ferreira N, Meireles A, Sampaio A, Carneiro Â, Vaz F, Nascimento J, Moreno N, Roque J, Domingues M, Flores R, Teixeira C, Conde E, Henriques F, Proença H, Pita Negrão J, Barbosa M, Silva R, Vaz-Pereira S, Pereira Neves P, Gomes N, Raimundo M. The Portuguese Experience with Ocriplasmin in Clinical Practice. Ophthalmic Res 2016; 56:186-192. [PMID: 27438077 DOI: 10.1159/000446842] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/12/2016] [Indexed: 11/19/2022]
Abstract
AIM Evaluate the real-life experience with ocriplasmin on vitreomacular traction (VMT) release and full-thickness macular hole (FTMH) closure in Portugal. METHODS Multicentric, retrospective study of 83 eyes of 78 patients who were treated with intravitreal ocriplasmin for VMT with and without FTMH. Primary outcomes were VMT release and FTMH closure. Secondary outcomes included visual acuity changes and structural features on spectral-domain ocular coherence tomography. RESULTS VMT resolved in 47 of the 83 eyes (56.6%) and 6 of the 12 FTMH were closed (50.0%). Mean best-corrected visual acuity (BCVA) improved from 65.1 at baseline to 70.8 ETDRS letters at the end of follow-up (p < 0.0001) with a mean follow-up of 138.8 days. Improvement in BCVA was significantly better in eyes with VMT release (p = 0.021). Approximately 73% of patients had normal ellipsoid zone integrity at the end of follow-up, 87% had no neurosensorial detachment and 40% had no intra- or subretinal fluid. CONCLUSION VMT release and FTMH closure were achieved in more than half of the treated eyes and were correlated with significant BCVA improvements and favorable baseline characteristics. In fact, if a careful patient selection is carried out, VMT resolution with ocriplasmin can be optimized, tailoring the best approach to each patient.
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Affiliation(s)
- João Figueira
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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35
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Ferreira N, Monteiro S, Meireles A, Kuhn F. Outcome of vitrectomy and chorioretinectomy in perforating eye injuries. Ophthalmic Res 2015; 53:200-6. [PMID: 25896147 DOI: 10.1159/000371494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the anatomical and functional results of patients who underwent pars plana vitrectomy for perforating eye injuries as well as to analyze the benefit of the chorioretinectomy procedure. METHODS Retrospective and descriptive study of 24 eyes of 22 patients with perforating eye injuries operated on at the Centro Hospitalar do Porto between January 2006 and December 2012. RESULTS An early vitrectomy was accomplished in 67% of the eyes and a delayed vitrectomy in 33% of the eyes. A concomitant chorioretinectomy was carried out in 78%. Final proliferative vitreoretinopathy (PVR) was found in 11%. The anatomical success was 83%. At the final follow-up, 78% had best-corrected visual acuity equal to or superior to 5/200. Of the eyes that underwent early vitrectomy, 58% regained a visual acuity of 40/200 or better, versus 17% of the cases that underwent delayed vitrectomy. CONCLUSION Early vitrectomy with prophylactic chorioretinectomy seems to be an effective approach to prevent PVR and improve the visual outcome and globe survival in perforating injuries.
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Affiliation(s)
- Natália Ferreira
- Department of Ophthalmology, Centro Hospitalar do Porto, EPE, Porto, Portugal
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Abstract
Purpose To report and describe the clinical course of four pediatric traumatic macular hole (TMH) cases and respective management. Case Report Four pediatric patients with macular hole following blunt ocular trauma underwent early pars plana vitrectomy, with consecutive hole closure. Initial visual acuity was <20/400 or worse in all patients. After surgery, all patients had visual acuity improvement, with final visual acuity being <20/50 in 2 of the patients by the end of the follow-up. Macular hole closure was achieved in all patients with a single procedure, and anatomical success was confirmed by optical coherence tomography until the end of the follow-up. Conclusions Although spontaneous closure of TMH is not uncommon, especially in pediatric patients, early pars plana vitrectomy seems to be a safe and effective choice in pediatric TMH management. The risk/benefit ratio of surgery seems to be better than observation.
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Affiliation(s)
- S Azevedo
- Department of Ophthalmology, Santo António Hospital, Oporto, Portugal
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Queirós J, Maia S, Seca M, Friande A, Araújo M, Meireles A. Atypical Cogan's Syndrome. Case Rep Ophthalmol Med 2013; 2013:476527. [PMID: 23691387 PMCID: PMC3638509 DOI: 10.1155/2013/476527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/05/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Cogan's syndrome is a rare clinical entity whose etiopathology is still unknown, and the treatment strategies are not clearly defined. Case. A 23-year-old male presented with symptoms of headache, peripheral facial palsy, persistent right hearing loss and bilateral papillitis. Workup excluded all infectious, granulomatous, neoplastic, and immune causes. The diagnosis of atypical Cogan's syndrome was established, and the patient was treated with systemic corticosteroids and later on with cyclophosphamide and methotrexate. There were improvement of visual symptoms and stabilisation of left hearing. Conclusion. Cogan's syndrome is a very rare disease with no specific biological tests for the diagnosis. The diagnostic exams are mostly important to exclude other etiologies. The atypical ocular and audiovestibular manifestations make the diagnosis difficult, delaying the institution of appropriate therapy which may result in profound bilateral deafness.
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Affiliation(s)
- João Queirós
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Sofia Maia
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Mariana Seca
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - António Friande
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Maria Araújo
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Angelina Meireles
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
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Abstract
Purpose To report the surgical outcomes of reoperation of unclosed macular holes after initial vitrectomy with internal limiting membrane peeling. Procedures Seven eyes of 7 patients were submitted to a second procedure in which five radial retinal incisions were made, as deep as the retinal pigment epithelium, beginning one hole diameter away from its borders and extending centripetally until the hole's margins, avoiding the papilomacular bundle. Gas tamponade was performed and face-down positioning was recommended. Results Anatomical closure was achieved in all cases with the second procedure. Functional success was achieved in every patient; there was no loss of best corrected visual acuity (BCVA) lines. Mean line score gain was 5.6 lines (range 1–9 lines), with a mean final BCVA of 0.42 (range 0.05–0.5). Conclusions Perifoveal relaxing incisions in stage IV macular holes that remained unclosed after internal limiting membrane peeling vitrectomy seem to have a positive effect on MH closure rates. Larger case series and an extended follow-up period are necessary in order to assess the efficacy and safety profile of this so far promising technique.
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Affiliation(s)
- R Reis
- Department of Ophthalmology, Santo Antonio Hospital, Oporto, Portugal
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Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [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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Nobuyoshi M, Gonzalez-Mansilla A, Martin-Asenjo R, Unzue L, Torres J, Garralda E, Coma RR, Rodriguez Garcia JE, Yaegashi T, Furusho H, Kato T, Chikata A, Takashima S, Usui S, Takamura M, Kaneko S, Kutarski A, Pietura R, Czajkowski M, Chudzik M, Kutarski A, Mitkowski P, Przybylski A, Lewek J, Malecka B, Smukowski T, Maciag A, Castrejon Castrejon S, Perez-Silva A, Estrada A, Doiny D, Ortega M, Lopez-Sendon JL, Merino JL, O'mahony C, Coats C, Cardona M, Garcia A, Calcagnino M, Lachmann R, Hughes D, Elliott PM, Conti S, Pruiti GP, Puzzangara E, Romano SA, Di Grazia A, Ussia GP, Tamburino C, Calvi V, Radinovic A, Sala S, Latib A, Mussardo M, Sora S, Paglino G, Gullace M, Colombo A, Ohlow MAG, Lauer B, Wagner A, Schreiber M, Buchter B, Farah A, Fuhrmann JT, Geller JC, Nascimento Cardoso RM, Batista Sa LA, Campos Filho LFC, Rodrigues SV, Dutra MVF, Borges TRSA, Portilho DR, Deering T, Bernardes A, Veiga A, Gartenlaub O, Goncalves A, Jimenez A, Rousseauplasse A, Deharo JC, Striekwold H, Gosselin G, Sitbon H, Martins V, Molon G, Ayala-Paredes F, Rousseauplasse A, Sancho-Tello MJ, Fazal IA, Brady S, Cronin J, Mcnally S, Tynan M, Plummer CJ, Mccomb JM, Val-Mejias JE, Fazal IA, Tynan M, Plummer CJ, Mccomb JM, Oliveira RM, Costa R, Martinelli Filho M, Silva KR, Menezes LM, Tamaki WT, Mathias W, Stolf NAG, Misawa T, Ohta I, Shishido T, Miyasita T, Miyamoto T, Nitobe J, Watanabe T, Kubota I, Thibault B, Ducharme A, Simpson C, Stuglin C, Gagne CE, Gagne CE, Williams R, Mcnicoll S, Silvetti MS, Drago F, Penela D, Bijnens B, Doltra A, Silva E, Berruezo A, Mont L, Sitges M, Mcintosh R, Baumann O, Raju P, Gurunathan S, Furniss S, Patel N, Sulke N, Lloyd G, Mor M, Dror S, Tsadok Y, Bachner-Hinenzon N, Katz A, Liel-Cohen N, Etzion Y, Mlynarski R, Mlynarska A, Wilczek J, Sosnowski M, Sinha AM, Sinha D, Noelker G, Brachmann J, Weidemann F, Ertl G, Jones M, Searle N, Cocker M, Ilsley E, Foley P, Khiani R, Nelson KE, Turley AJ, Owens WA, James SA, Linker NJ, Velagic V, Cikes M, Pezo Nikolic B, Puljevic D, Separovic-Hanzevacki J, Lovric-Bencic M, Biocina B, Milicic D, Kawata H, Chen L, Phan H, Anand K, Feld G, Birgesdotter-Green U, Fernandez Lozano I, Mitroi C, Toquero Ramos J, Castro Urda V, Monivas Palomero V, Corona Figueroa A, Hernandez Reina L, Alonso Pulpon L, Gate-Martinet A, Da Costa A, Rouffiange P, Cerisier A, Bisch L, Romeyer-Bouchard C, Isaaz K, Morales MA, Bianchini E, Startari U, Faita F, Bombardini T, Gemignani V, Piacenti M, Adhya S, Kamdar RH, Millar LM, Burchardt C, Murgatroyd FD, Klug D, Kouakam C, Guedon-Moreau L, Marquie C, Benard S, Kacet S, Cortez-Dias N, Carrilho-Ferreira P, Silva D, Goncalves S, Valente M, Marques P, Carpinteiro L, Sousa J, Keida T, Nishikido T, Fujita M, Chinen T, Kikuchi T, Nakamura K, Ohira H, Takami M, Anjo D, Meireles A, Gomes C, Roque C, Pinheiro Vieira A, Lagarto V, Reis H, Torres S, Ortega DF, Barja LD, Montes JP, Logarzo E, Bonomini P, Mangani N, Paladino C, Chwyczko T, Smolis-Bak E, Sterlinski M, Maciag A, Pytkowski M, Firek B, Jankowska A, Szwed H, Nakajima I, Noda T, Okamura H, Satomi K, Aiba T, Shimizu W, Aihara N, Kamakura S, Brzozowski W, Tomaszewski A, Kutarski A, Wysokinski A, Bertoldi EG, Rohde LE, Zimerman LI, Pimentel M, Polanczyk CA, Boriani G, Lunati M, Gasparini M, Landolina M, Lonardi G, Pecora D, Santini M, Valsecchi S, Rubinstein BJ, Wang DY, Cabreriza SE, Richmond ME, Rusanov A, Quinn TA, Cheng B, Spotnitz HM, Kristiansen HM, Vollan G, Hovstad T, Keilegavlen H, Faerestrand S, Kawata H, Phan H, Anand K, Feld G, Brigesdotter-Green U, Nawar AMR, Ragab DALIA, Eluhsseiny RANIA, Abdelaziz AHMED, Nof E, Abu Shama R, Buber J, Kuperstein R, Feinberg MS, Barlev D, Eldar M, Glikson M, Badran H, Samir R, Tawfik M, Amin M, Eldamnhoury H, Khaled S, Tolosana JM, Martin AM, Hernandez-Madrid A, Macias A, Fernandez-Lozano I, Osca J, Quesada A, Mont L, Boriani G, Gasparini M, Landolina M, Lunati M, Santini M, Padeletti L, Botto GL, De Santo T, Lunati M, Szwed A, Martinez JG, Degand B, Villani GQ, Leclercq C, Rousseauplasse A, Ritter P, Estrada A, Doiny D, Castrejon Castrejon S, Perez-Silva A, Ortega M, Lopez-Sendon JL, Merino JL, Watanabe I, Nagashima K, Okumura Y, Kofune M, Ohkubo K, Nakai T, Hirayama A, Mikhaylov E, Vander M, Lebedev D, Zarse M, Suleimann H, Bogossian H, Stegelmeyer J, Ninios I, Karosienne Z, Kloppe A, Lemke B, John S, Gaspar T, Rolf S, Sommer P, Hindricks G, Piorkowski C, Berruezo A, Fernandez-Armenta J, Mont LL, Zeljko H, Andreu D, Herzcku C, Boussy T, Brugada J, Yamauchi Y, Okada H, Maeda S, Tao S, Obayahi T, Aonuma K, Hegrenes J, Lim E, Mediratta V, Bautista R, Teplitsky L, Van Huls Van Taxis CFB, Wijnmaalen AP, Gawrysiak M, Schuijf JD, Bax JJ, Schalij MJ, Zeppenfeld K, Huo Y, Richter S, Hindricks G, Arya A, Gaspar T, Bollmann A, Akca F, Bauernfeind T, Schwagten B, De Groot NMS, Jordaens L, Szili-Torok T, Hegrenes J, Miller S, Kastner G, Teplitsky L, Maury P, Della Bella P, Delacretaz E, Sacher F, Maccabelli G, Brenner R, Rollin A, Jais P, Vergara P, Trevisi N, Ricco A, Petracca F, Bisceglia C, Baratto F, Maccabelli G, Della Bella P, Salguero Bodes R, Fontenla Cerezuela A, De Riva Silva M, Lopez Gil M, Mejia Martinez E, Jurado Roman A, Montero Alvarez M, Arribas Ynsaurriaga F, Baszko A, Krzyzanowski K, Bobkowski W, Surmacz R, Zinka E, Siwinska A, Szyszka A, Perez Silva A, Doiny D, Castrejon Castrejon S, Estrada Mucci A, Ortega Molina M, Lopez Sendon JL, Merino Llorens JL, Kaitani K, Hanazawa K, Izumi C, Nakagawa Y, Yamanaka I, Hirahara T, Sugawara Y, Suga C, Ako J, Momomura S, Galizio N, Gonzalez J, Robles F, Palazzo A, Favaloro L, Diez M, Guevara E, Fernandez A, Greenberg S, Epstein A, Deering T, Goldman DS, Sangli C, Keeney JA, Lee K, Piers SRD, Van Rees JB, Thijssen J, Borleffs CJW, Van Der Velde ET, Van Erven L, Schalij MJ, Leclercq CH, Hero M, Mizobuchi M, Enjoji Y, Yazaki Y, Shibata K, Funatsu A, Kobayashi T, Nakamura S, Amit G, Pertzov B, Katz A, Zahger D, Robles F, Galizio N, Gonzalez J, Medesani L, Rana R, Palazzo A, Albano F, Fraguas H, Pedersen SS, Hoogwegt MT, Jordaens L, Theuns DAMJ, Van Den Broek KC, Tekle FB, Habibovic M, Alings M, Van Der Voort P, Denollet J, Vrazic H, Jilek C, Badran H, Lesevic H, Tzeis S, Semmler V, Deisenhofer I, Kolb C, Theuns DAMJ, Gold MR, Burke MC, Bardy GH, Varma N, Pavri B, Stambler B, Michalski J, Investigators TRUST, Safak E, Schmitz D, Konorza T, Wende C, Schirdewan A, Neuzner J, Simmers T, Erglis A, Gradaus R, Alings M, Goetzke J, Coutrot L, Goehl K, Bazan Gelizo V, Grau N, Valles E, Felez M, Sanjuas C, Bruguera J, Marti-Almor J, Chu SY, Li PW, Ding WH, Schukro C, Leitner L, Siebermair J, Stix G, Pezawas T, Kastner J, Wolzt M, Schmidinger H, Behar NATHALIE, Kervio G, Petit B, Maison-Balnche P, Bodi S, Mabo P, Foley PWX, Mutch E, Brashaw-Smith J, Ball L, Leyva F, Kim DH, Lee MJ, Lee WS, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Man S, Algra AM, Schreurs CA, Van Erven L, Van Der Wall EE, Cannegieter SC, Schalij MJ, Swenne CA, Adachi M, Yano A, Miake J, Ogura K, Kato M, Iitsuka K, Kondo T, Zarse M, Goebbert K, Bogossian H, Karossiene Z, Stegelmeyer J, Ninios I, Kloppe A, Lemke B, Goldman D, Kallen B, Kerpi E, Sardo J, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Tsiachris D, Mytas D, Asimakopoulos S, Stefanadis C, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Sideris S, Kartsagoulis E, Mytas D, Stefanadis C, Barbosa O, Marocolo Junior M, Silva Cortes R, Moraes Brandolis RA, Oliveira LF, Pertili Rodrigues De Resende LA, Vieira Da Silva MA, Dias Da Silva VJ, Hegazy RA, Sharaf IA, Fadel F, Bazaraa H, Esam R, Deshko MS, Snezhitsky VA, Stempen TP, Kuroki K, Tada H, Igawa M, Yoshida K, Igarashi M, Sekiguchi Y, Kuga K, Aonuma K, Ferreira Santos L, Dionisio T, Nunes L, Machado J, Castedo S, Henriques C, Matos A, Oliveira Santos J, Kraaier K. Poster Session 3. Europace 2011. [DOI: 10.1093/europace/eur229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Melo A, Moura L, Meireles A, Costa G. Danazol. A new perspective in the treatment of HTLV-1 associated myelopathy (preliminary report). Arq Neuropsiquiatr 1992; 50:402-3. [PMID: 1308424 DOI: 10.1590/s0004-282x1992000300025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We investigated the efficacy of danazol treatment in eight patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). Treatment with danazol yielded clinical improvement of urinary control and gait disturbances in 7 out of the 8 patients. The improvement was noted within 15 days of danazol administration. Analysis of factors of relevance to the clinical improvement with danazol showed that the beneficial response was preferentially found in females.
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Affiliation(s)
- A Melo
- Departamento de Ciências da Biorregulaçäo, Instituto de Ciências da Saúde, Salvador BA, Brasil
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Abstract
Recent studies of tropical spastic paraparesis have confirmed the existence of human T-cell leukemia virus type-1 (HTLV-I) in several tropical areas of the world. In order to determine the role of HTLV-I as an etiologic agent of myelopathies in Salvador, we conducted a clinical and serological study in 43 patients with non-traumatic and non-tumoral myelopathies. We found 9 patients with HTLV-I associated myelopathy (HAM) which points to a new endemic area of HAM.
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Meireles A, Sobrinho-Simões MA, Capucho R, Brandão A. Hughes-Stovin syndrome with pulmonary angiitis and focal glomerulonephritis: a case report with necropsy study. Chest 1981; 79:598-600. [PMID: 7226941 DOI: 10.1378/chest.79.5.598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A clinicopathologic case of Hughes-Stovin syndrome with pulmonary eosinophilic angiitis and focal proliferative extracapillary glomerulonephritis is reported.
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