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Carvalho S, Lima-Fontes M, Falcão M, Artur Paiva J, Pinheiro-Costa J. Ocular Complications of COVID-19 Patients Admitted to Intensive Care in Portugal. ACTA MEDICA PORT 2023; 36:776-778. [PMID: 38048688 DOI: 10.20344/amp.20083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/27/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Sofia Carvalho
- Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Mário Lima-Fontes
- Department of Ophthalmology. Centro Hospitalar Universitário São João. Porto. Portugal
| | - Manuel Falcão
- Department of Ophthalmology. Centro Hospitalar Universitário São João. Porto; Department of Surgery and Physiology. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - José Artur Paiva
- Faculdade de Medicina. Universidade do Porto. Porto; Department of Intensive Care Medicine Department. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology. Centro Hospitalar Universitário São João. Porto; Department of Biomedicine Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Lima-Fontes M, Faria-Pereira A, Leuzinger-Dias M, Silva MI, Barbosa-Breda J, Araújo J, Estrela-Silva S, Benevides-Melo A, Alves F, Tavares-Ferreira J. Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists. J Glaucoma 2023; 32:320-326. [PMID: 36989506 DOI: 10.1097/ijg.0000000000002168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/14/2022] [Indexed: 03/31/2023]
Abstract
PRCIS Resident-performed trabeculectomies present higher intraocular pressure and lower complete success rate at 1 year. PURPOSE To compare the 1-year outcomes of ab externo trabeculectomy between residents in training and staff ophthalmologists. PATIENTS AND METHODS This retrospective study included all consecutive eyes submitted to ab externo trabeculectomy between January 2015 to June 2020. A 1-year complete success rate was considered using all the following criteria: intraocular pressure (IOP)≤21 mm Hg and ≥6mm Hg without ocular hypotensive medications; IOP reduction≥30%; without loss of light perception, phthisis bulbi, and further glaucoma surgery (excluding suture lysis and bleb needling). RESULTS One hundred and ten eyes from 99 patients were included. Thirty percent (n=33) of the trabeculectomies were performed by residents. There were no significant preoperative differences between groups, apart from age at surgery, which was higher in the residents' group (72.39±6.83 vs. 62.00±15.07 years, P<0.001), and visual field index (Humphrey Field Analyzer), which was lower in the ophthalmologists' group (51.81±34.74% vs. 32.04±33.83%, P=0.013). IOP at 1-, 3-, 6 months, and 1 year after surgery was significantly higher in the resident's group (P<0.05). Resident-performed trabeculectomies achieved a significantly lower complete success rate when compared with the ophthalmologists' group (39.39% vs. 64.94%, P=0.013). The overall rate of the postoperative complications and reintervention did not differ between groups, but the occurrence of a shallow anterior chamber was more frequent in the residents' group (15.15% vs. 4.05%, P=0.037). CONCLUSIONS Resident-performed trabeculectomies present significantly higher postoperative IOP levels and a lower complete success rate when compared with staff ophthalmologists. It is, therefore, fundamental to adopt strategies to change this gap, improve patient safety, and strengthen resident confidence.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João
| | - Ana Faria-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário São João
| | | | - Marta Inês Silva
- Department of Ophthalmology, Centro Hospitalar Universitário São João
| | - João Barbosa-Breda
- Department of Ophthalmology, Centro Hospitalar Universitário São João
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto
- KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
| | - Joana Araújo
- Department of Ophthalmology, Centro Hospitalar Universitário São João
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sérgio Estrela-Silva
- Department of Ophthalmology, Centro Hospitalar Universitário São João
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António Benevides-Melo
- Department of Ophthalmology, Centro Hospitalar Universitário São João
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Flávio Alves
- Department of Ophthalmology, Centro Hospitalar Universitário São João
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Lima-Fontes M, Martinho-Dias D, Leuzinger-Dias M, Cunha AM, Neves Cardoso P, Torrão L, Moreira R, Falcão-Reis F, Pinheiro-Costa J. Microbiological Profile of Infectious Keratitis During Covid-19 Pandemic. Clin Ophthalmol 2023; 17:535-543. [PMID: 36798798 PMCID: PMC9926925 DOI: 10.2147/opth.s395877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/21/2022] [Indexed: 02/11/2023] Open
Abstract
Purpose The Covid-19 pandemic introduced significant changes in our daily life, including the widespread use of face masks. The purpose of this study was to assess if significant changes occurred in the microbiological profile of infectious keratitis. Patients and Methods A retrospective study was performed, based on a survey review of the electronic medical records of all patients with presumed infectious keratitis, between March 2020 and October 2021. The microbiological isolates in this sample (pandemic group) were compared with those obtained in our center between 2009 and 2018 (pre-pandemic group). Results A total of 194 samples were included in the pandemic group. We obtained a culture-positivity rate of 43.3%, which was significantly higher when compared with the pre-pandemic data (35.15%, p = 0.033). Several further significant differences were found between the pandemic and the pre-pandemic groups: the proportion of bacteria, including gram-positive and gram-negative groups, was higher in our sample (pre-pandemic vs pandemic: 76.78% vs 83.33%, p = 0.010; 53.35% vs 60.71%, p = 0.016; 23.43% vs 34.52%, p = 0.005, respectively); two populations of Gram-positive bacteria found in this study were not isolated in the pre-pandemic sample - Dolosigranulum pigrum and Propionibacterium spp.; and two bacterial isolates were significantly increased in our sample - Corynebacterium spp. (18.41% vs 29.76%, p = 0.003) and Pseudomonas aeruginosa (9.00% vs 16.66%, p = 0.012). Conclusion In conclusion, significant changes were found in the microbiological profile of infectious keratitis in our center during the Covid-19 pandemic. While these changes could be related to face mask use, more observational and experimental studies are needed to explore this possible association.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal,Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, University of Porto Faculty of Medicine, Porto, 4050-313, Portugal,CINTESIS – Center for Health Technology and Services Research, University of Porto, Porto, 4050-313, Portugal,Family Health Unit Ao encontro da Saúde, ACES Santo Tirso-Trofa, Trofa, 4745-559, Portugal
| | - Mariana Leuzinger-Dias
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Pedro Neves Cardoso
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal
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Lima-Fontes M, Leuzinger-Dias M, Barros-Pereira R, Fernandes V, Falcão M, Falcão-Reis F, Rocha-Sousa A, Alves-Faria P. Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19 mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy. Ophthalmol Ther 2023; 12:377-388. [PMID: 36417092 PMCID: PMC9834446 DOI: 10.1007/s40123-022-00613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2 μg/day; ILUVIEN®) in the treatment of refractory PCME after successful PPV. METHODS This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitário de São João, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300 μm or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. RESULTS Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5 months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6 μm, and IOP was 15.4 ± 2.4 mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2 μm in CMT. During follow-up (44.0 ± 14.8 months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28 months, respectively. The maximum IOP registered was 17.0 ± 6.0 mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. CONCLUSION FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.
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Affiliation(s)
- Mário Lima-Fontes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Leuzinger-Dias
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ricardo Barros-Pereira
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Vítor Fernandes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Falcão
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Alves-Faria
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Lima-Fontes M, Godinho G, Cunha AM, Madeira C, Falcão M, Falcão-Reis F, Carneiro Â. Hypotony Maculopathy Related to Anti-VEGF Intravitreal Injection. Int Med Case Rep J 2022; 15:517-520. [PMID: 36164320 PMCID: PMC9507979 DOI: 10.2147/imcrj.s382421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a case of hypotony maculopathy following anti-VEGF intravitreal injection (IVI) in a patient with pseudoxanthoma elasticum (PE). Methods Clinical case report. Results A 52-year-old male complained of right eye (OD) vision loss 2 days after an uncomplicated anti-VEGF IVI for the treatment of choroidal neovascularization secondary to angioid streaks. Relevant medical history included PE, pathologic myopia, and a previous pars plana vitrectomy (PPV) due to a retinal detachment. OD best-corrected visual acuity (BCVA) dropped from 6/12 to 6/18 after the IVI. Intraocular pressure (IOP) was 3 mmHg and chorioretinal folds were evident in the posterior pole. Topical dexamethasone and atropine were prescribed, and full recovery was noticed after 3 days. Four months later, the patient developed a new episode of vision loss after another IVI. His BCVA was counting fingers, IOP was 2mmHg, and more noticeable chorioretinal folds were found. This time, an open scleral wound at the injection site was evident and a scleral suture was necessary. Once again, the patient recovered well. Conclusion Hypotony maculopathy following intravitreal injection is a rare condition. However, the described patient presented several conditions which could be related with poor scleral wound closure: intrinsic scleral fragility due to myopia and pseudoxanthoma elasticum; repeated IVI procedures; and absence of vitreous in the posterior segment due to prior vitrectomy. Despite the good outcome, hypotony maculopathy may be a sight-threatening condition, and special attention is necessary for specific patients with risk factors.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal, Tel +351 918420563, Fax +351 225513669, Email
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Lima-Fontes M, Leuzinger-Dias M, Falcão-Reis F, Sousa C. Injection of Botulinum Toxin A in the Lacrimal Gland for Treatment of Epiphora in Crocodile Tears Syndrome – A Case Report. Int Med Case Rep J 2022; 15:537-542. [PMID: 36171912 PMCID: PMC9512532 DOI: 10.2147/imcrj.s379024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Crocodile tears syndrome is a rare autonomic synkinesia, in which patients tear excessively in response to salivary stimuli. It usually occurs after idiopathic or traumatic facial palsy, as a result of aberrant reinnervation of the lacrimal gland by salivary efferent fibers from either the seventh or ninth cranial nerve. Patients and Methods We report the case of a 54-year-old woman, with a history of left Bell’s palsy, who attended our ophthalmology clinic due to epiphora of the left eye while eating or speaking, for 6 months. Results The ophthalmologic evaluation revealed a mild weakening of the frontal and left orbicularis oculi muscles without lagophthalmos. No other abnormalities were found, namely ocular surface swelling, ectropion, or obstruction of the lacrimal outflow system. Schirmer test II in the left eye increased from 12 to 23 mm while the patient was chewing. All these clues led to the diagnosis of crocodile tears syndrome and treatment with botulinum toxin A injection was proposed. One month after the injection of the palpebral lobe of the left lacrimal gland with 6 units of botulinum toxin A, the patient reported an almost complete resolution of the complaints, stated by a decrease in Munk scale and Lac-Q scores. Six months after injection, the patient conveyed recurrence of symptoms and a new treatment session was performed with comparable results. Conclusion Since crocodile tears syndrome is rare, it is crucial to increase awareness and knowledge about it among ophthalmologists and other medical doctors. Botulinum toxin is a safe and effective treatment modality, dramatically improving these patients’ quality of life.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | | | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Cristina Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
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Lima-Fontes M, Meira L, Barata P, Falcão M, Carneiro Â. Gut microbiota and age-related macular degeneration: A growing partnership. Surv Ophthalmol 2021; 67:883-891. [PMID: 34843745 DOI: 10.1016/j.survophthal.2021.11.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022]
Abstract
Age-related macular degeneration (AMD) is a leading cause of severe, irreversible vision impairment in developed countries, and its prevalence is rising all over the world, increasing sharply with age. AMD represents an acquired degeneration of the retina that causes significant central visual impairment through a combination of noneovascular and neovascular derangement. The main risk factors for the development of advanced AMD are increasing age, genetic factors, and cigarette smoking; however, the exact pathophysiology of AMD is yet relatively poorly understood. In recent years, the gut microbiota has been intensively studied and linked to several pathologic processes, including ocular diseases. In this sense, the aim of this review is to gather published evidence about the relationship between gut microbiota and AMD.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Biomedicine, Faculty of Medicine, University of Porto, Portugal.
| | - Luís Meira
- Faculty of Medicine, University of Porto, Portugal
| | - Pedro Barata
- I3S: Institute for Research and Innovation in Health, University of Porto, Portugal; Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
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Leuzinger-Dias M, Godinho G, Lima-Fontes M, Oliveira-Ferreira C, Camisa E, Falcão-Reis F, Silva M, Figueira L. A painful red eye in an intravenous drug abuser: When not everything is what it seems. Eur J Ophthalmol 2021; 33:11206721211060151. [PMID: 34761699 DOI: 10.1177/11206721211060151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Endogenous endophthalmitis is a rare but devastating ocular infection, resulting from microbial seeding of the eye during bacteremia or fungemia. Among other sources of septicemia, intravenous drug abuse is a significant risk factor, and endogenous endophthalmitis should always be thought of in any patient with a history of injectable drug use, presenting with a painful vision loss and a red inflamed eye. CASE DESCRIPTION We report the case of a 47-year-old male, with a history of injectable drug consumption, who presented to our emergency department complaining of a painful red eye and recent deterioration of visual acuity. After the first clinical hypothesis of endogenous endophthalmitis being considered, the final diagnosis of Human Leukocyte Antigen (HLA) B27-associated acute anterior uveitis was established. CONCLUSION Ocular inflammation is one of the most challenging fields in all ophthalmology. Several inflammatory disorders, ranging from a wide variety of infectious and non-infectious conditions, can present themselves with the same clinical signs and symptoms, making their diagnosis extremely defiant.
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Affiliation(s)
- Mariana Leuzinger-Dias
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Mário Lima-Fontes
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Elisa Camisa
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, 26705Faculty of Medicine of University of Porto, Porto, Portugal
| | - Marta Silva
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Luís Figueira
- Department of Ophthalmology, 285211Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Pharmacology and Therapeutics, 26705Faculty of Medicine of University of Porto, Porto, Portugal
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Leuzinger-Dias M, Lima-Fontes M, Oliveira-Ferreira C, Macedo JP, Falcão-Reis F, Freitas-da-Costa P, Benevides-Melo A. Traumatic Cyclodialysis Cleft Treatment Combined with Cataract Surgery: An Original Triple Procedure. Ophthalmol Ther 2021; 10:1171-1179. [PMID: 34370278 PMCID: PMC8589922 DOI: 10.1007/s40123-021-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction To describe a “triple” surgical procedure, which combined traumatic cataract extraction by phacoemulsification with gas endotamponade and cyclocryotherapy in the successful treatment of a traumatic cyclodialysis cleft. Methods A 44-year-old man who suffered severe left eye blunt trauma with an elastic band developed a 4-hour extent cyclodialysis cleft with consequent hypotony. After 7 weeks of persistent hypotonic maculopathy unresponsive to medical treatment, and with an evolving traumatic cataract, the patient underwent cataract surgery combined with intravitreal gas endotamponade (20% SF6) and cyclocryotherapy. Results Two weeks after the procedure the intraocular pressure increased to 12 mmHg and remained steady during the next 14 months of follow-up. Hypotonic maculopathy resolved and successful closure of the cyclodialysis cleft was confirmed by gonioscopy and ultrasound biomicroscopy. Conclusion Gas endotamponade and cyclocryotherapy constitute a promising option in the treatment of cyclodialysis clefts unresponsive to medical therapy. In our case, this minimally invasive technique was innovatively combined with cataract surgery. Despite early postoperative intraocular inflammation, a successful outcome was achieved.
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Affiliation(s)
- Mariana Leuzinger-Dias
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Cláudia Oliveira-Ferreira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Paulo Macedo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Paulo Freitas-da-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Anatomy Unit, Biomedicine Department, Faculty of Medicine of University of Porto, Porto, Portugal
| | - António Benevides-Melo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Abstract
Metabolic syndrome (MetS) has emerged as a worldwide health hazard of the modern lifestyle, representing a cluster of metabolic abnormalities and a risk factor for cardiovascular disease. Eye diseases, such as diabetic retinopathy, central retinal artery occlusion, cataract, age-related macular degeneration, glaucoma, and dry eye syndrome have been linked with many of MetS components. Their relationship with MetS itself is, however, a recent topic of investigation. This review aims to gather published evidence supporting associations between ocular findings and MetS and to explore the related physiopathological processes that congregate in this syndrome and lead to these diseases. Despite compiling interesting and compelling evidence, it raises awareness to the need of further studies in this field to keep solidifying these associations and unveiling the pathological processes that support them. It ultimately targets MetS patients as a population of individuals who are at increased risk of developing age-related eye diseases and vision loss.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário de São João.,Department of Biomedicine, Faculty of Medicine
| | - Pedro Barata
- i3S, Institute for Research and Innovation in Health, University of Porto.,Faculty of Health Sciences, Fernando Pessoa University
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar Universitário de São João.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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11
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Torres-Costa S, Lima-Fontes M, Falcão-Reis F, Falcão M. SARS-COV-2 in Ophthalmology: Current Evidence and Standards for Clinical Practice. ACTA MEDICA PORT 2020; 33:593-600. [PMID: 32662416 DOI: 10.20344/amp.14118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION COVID-19 is caused by the coronavirus SARS-CoV-2. Ocular manifestations have been reported including conjunctivitis and retinal changes. Therefore, it is of the utmost importance to clarify eye involvement in COVID-19 in order to help with its diagnosis and to further prevent its transmission. The purpose of this review is to describe the structure and transmission of SARS-CoV-2, reported ocular findings and protection strategies for ophthalmologists. MATERIAL AND METHODS Literature search on PubMed for relevant articles using the keywords 'COVID-19', 'coronavirus', and 'SARS-CoV-2' in conjunction with 'ophthalmology' and 'eye'. Moreover, official recommendations of ophthalmological societies were reviewed. RESULTS Although the conjunctiva is directly exposed to extraocular pathogens, and the mucosa of the ocular surface and upper respiratory tract are connected by the nasolacrimal duct, the eye is rarely involved in human SARS-CoV-2 infection and the SARS-CoV-2 RNA positive rate by RT-PCR test in tears and conjunctival secretions from patients with COVID-19 is also extremely low. DISCUSSION The eye can be affected by SARS-CoV-2, which is supported by some reports of conjunctivitis and retinal changes, but its role in the spread of the disease is still unknown. CONCLUSION Given the current scarce evidence, more research is needed to clarify the relationship between SARS-CoV-2 and the eye.
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Affiliation(s)
- Sónia Torres-Costa
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Mário Lima-Fontes
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Department of Surgery and Physiology. Faculty of Medicine. University of Porto. Porto. Portugal
| | - Manuel Falcão
- Department of Ophthalmology. Centro Hospitalar Universitário de São João. Porto. Department of Surgery and Physiology. Faculty of Medicine. University of Porto. Porto. Portugal
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12
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Lima-Fontes M, Costa R, Rodrigues I, Soares R. Xanthohumol Restores Hepatic Glucolipid Metabolism Balance in Type 1 Diabetic Wistar Rats. J Agric Food Chem 2017; 65:7433-7439. [PMID: 28745504 DOI: 10.1021/acs.jafc.7b02595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Diabetes exhibits increased inflammation, angiogenesis, and apoptosis, three processes attenuated by xanthohumol (XN). Herein, we evaluate the effect of XN-enriched stout beer consumption in hepatic glucolipid metabolism imbalance seen in type 1 diabetes (T1D). Five groups of Wistar rats were established: streptozotocin-induced diabetic rats drinking water, treated with 5% ethanol, stout beer, and stout beer supplemented with 10 mg of XN/L and healthy rats drinking water. Hepatic periodic acid-Schiff, reticulin, sirius red, and oil red O histological staining was performed. Lipogenic enzymes and glucose transporter 2 (GLUT2) expression was evaluated by western blotting. Increased fibrosis in T1D animals was significantly decreased to control levels by XN (3.85 ± 0.38 in T1D-beer versus 1.78 ± 0.27 in controls, p < 0.05; 2.27 ± 0.69 in T1D-beer + XN versus 1.78 ± 0.27 in controls, p > 0.05). XN reduced T1D hepatic reticulin staining (9.74 ± 3.78 in T1D-beer, p < 0.05 versus control) to healthy levels (4.45 ± 1.05 in T1D-beer + XN versus 4.60 ± 0.20 in healthy controls, p > 0.05). XN consumption interfered with the T1D liver catabolic state, reversing glycogen depletion (22.09 ± 7.70 in T1D-beer + XN versus 4.68 ± 4.84 in T1D-beer, p < 0.05) and GLUT2 upregulation (1.71 ± 0.46 in T1D-beer + XN versus 2.13 ± 0.34 in T1D-beer, p < 0.05) and enhancing lipogenesis (1.19 ± 0.11 in T1D-beer + XN versus 1.96 ± 0.36 in T1D, p < 0.05 for acetyl-CoA carboxylase; 1.10 ± 0.04 in T1D-beer + XN versus 0.44 ± 0.31 in T1D, p < 0.05 for fatty acid synthase). These findings reveal that XN can be a therapeutic agent against liver metabolic changes in T1D, playing a possible role in the insulin receptor pathways.
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Affiliation(s)
- Mário Lima-Fontes
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina da Universidade do Porto , Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Raquel Costa
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina da Universidade do Porto , Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto , Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
| | - Ilda Rodrigues
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina da Universidade do Porto , Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Raquel Soares
- Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina da Universidade do Porto , Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto , Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
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