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Rodrigues R, Santos Silva R, Penas S, Moleiro A, Estrela Silva S, Faria O, Magalhães A. Alström syndrome mimicking spasmus nutans: report of a novel ALMS1 variant. J AAPOS 2024; 28:103853. [PMID: 38378129 DOI: 10.1016/j.jaapos.2024.103853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
We report the case of an otherwise healthy 6-year-old girl presenting with poor visual acuity, photophobia, and abnormal eye and head movements who was initially diagnosed with spasmus nutans. A remote history of presumed viral cardiomyopathy and further electroretinography testing raised suspicion for Alström syndrome. She was diagnosed with a novel ALMS1 variant.
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Affiliation(s)
- Rita Rodrigues
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - R Santos Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Moleiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S Estrela Silva
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Olinda Faria
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Martins L, Martinhão L, Garcia I, Ribas D, Grázia J, Faria O, Figueiredo R, Viana J. 94 Effect of follicle-stimulating hormone source used during. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab94] [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: 12/12/2022] Open
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Breda J, Magalhães A, Faria O, Silva R, Freitas-da-Costa P. Advancement of the muscle insertion toward the limbus as an alternative or adjunct to resection. J AAPOS 2022; 26:176.e1-176.e4. [PMID: 35868625 DOI: 10.1016/j.jaapos.2022.03.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe the surgical outcomes of patients that underwent strabismus surgery involving advancement of the muscular insertion line toward the limbus. METHODS The medical records of patients who underwent rectus muscle advancement surgery between January 2009 and June 2019 and had at least 1 year of follow-up were reviewed retrospectively. Patients were classified into one of four types of deviation: (1) convergence insufficiency, without distance deviation; (2) small-angle distance esotropia, with diplopia; (3) residual strabismus after previous surgery; and (4) large-angle exotropia. The first group underwent 2 mm advancement of the medial rectus insertion bilaterally; the second, 2-3 mm advancement of the lateral rectus muscle bilaterally; the third, 2-3 mm advancement of the lateral or medial rectus muscle, with or without simultaneous resection; and the fourth, 3 mm advancement of the medial rectus with simultaneous resection, with or after maximum recession of the lateral rectus, bilaterally or unilaterally. RESULTS A total of 25 patients were included (mean age, 28.76 ± 22.75 years): 4 with convergence insufficiency, 3 with small-angle distance esotropia and diplopia, 16 with residual strabismus, and 2 with large-angle exotropia. Mean postoperative follow-up was 4.76 ± 2.03 years. Surgery was successful in all patients at 1 year (residual deviation ≤10Δ), and all but 1 at 5 years; 1 patient required reoperation. CONCLUSIONS Advancement of the muscle insertion proved successful as an alternative or adjunctive procedure to other forms of muscle tightening in the subtypes of patients evaluated in this study.
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Affiliation(s)
- Jorge Breda
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
| | - Augusto Magalhães
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal
| | - Olinda Faria
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Renato Silva
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Paulo Freitas-da-Costa
- Department of Ophthalmology, São João University Hospital Center, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Portugal.
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Godinho G, Esteves-Leandro J, Alves G, Madeira C, Faria O, Brandão E, Magalhães A, Falcão-Reis F, Penas S. Correlation Between Ophthalmologic and Neuroradiologic Findings in Type 1 Neurofibromatosis. J Neuroophthalmol 2022; 42:101-107. [PMID: 33770007 DOI: 10.1097/wno.0000000000001241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurofibromatosis Type 1 (NF-1) is a genetic disease affecting the eye, and ocular findings such as Lisch nodules (LN) or optic pathway gliomas (OPGs) are a part of its diagnostic criteria. Recent imaging technologies such as infrared (IR) imaging and optical coherence tomography (OCT) have highlighted the visualization of choroidal focal abnormalities in these patients, even in the absence of other ocular lesions. This study aimed to establish a morphological multimodal evaluation of choroidal findings in patients with NF-1, correlating them with central nervous system (CNS) findings. METHODS This retrospective study included 44 eyes from 22 patients with NF-1. Central 30° IR imaging was obtained, and the number and total area of detectable lesions were calculated. Both macular and optic disc scanning with OCT were performed, with and without the enhanced depth imaging technique, to assess the presence of choroidal focal hyperreflective lesions. Central macular thickness, ganglion cell layer, and outer nuclear layer thickness were assessed, as well as subfoveal choroidal thickness. The peripapillary retinal nerve fiber layer (RNFL) thickness was also assessed. Patients' magnetic resonance images (MRI) were reviewed and categorized by a neuroradiology specialist, determining the presence of OPGs and CNS hamartomas. Correlations between the ophthalmological and neuroradiological findings were established. RESULTS Patients' mean age was 16.4 ± 7.3 years and 59.1% were women. On the MRI, 86.4% of the patients had CNS hamartomas, and 34.1% of the eyes had OPGs. LN were described in 29.5% of the eyes, whereas a total of 63.4% of the eyes presented the characteristic hyperreflective lesions in IR imaging, all of them matching the underlying choroidal lesions. A mean of 2.9 ± 3.3 lesions per eye and a median total lesion area of 1.52 mm2 were found. The presence of OPGs was correlated with a greater number (P = 0.004) and a larger area (P = 0.006) of IR lesions. For a cut-off of 3.5 lesions per eye, the sensitivity and specificity for the presence of OPGs were 75% and 80%, respectively. For a total lesion area of 2.77 mm2, the sensitivity and specificity for the presence of OPGs were 69.2% and 93.1%, respectively. Eyes with OPGs presented a significant reduction in the temporal RNFL (P = 0.018) thickness, as well as a reduction in subfoveal choroid thickness (P = 0.04). No relations were found between CNS hamartomas and ophthalmological findings. CONCLUSIONS This study suggests that focal choroidal abnormalities are correlated with the presence of CNS lesions as OPGs in patients with NF-1, and it might be a surrogate for the need for CNS imaging in these patients.
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Affiliation(s)
- Gonçalo Godinho
- Ophthalmology Department (GG, JE-L, CM, OF, EB, AM, FF-R, SP), and Neuroradiology Department (GA), Centro Hospitalar Universitário São João, Porto, Portugal; and Surgery and Physiology Department (FF-R, SP), Faculty of Medicine, University of Porto, Portugal
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Maria Cunha A, Barbosa‐Breda J, Grangeia A, Estrela‐Silva S, Carneiro Â, Falcão‐Reis F, Faria O. Ophthalmologic Microvascular changes in Wolfram syndrome. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology Centro Hospitalar Universitário de São João Porto Portugal
| | - João Barbosa‐Breda
- Department of Ophthalmology Centro Hospitalar Universitário de São João Porto Portugal
- Faculty of Medicine University of Porto Department of Surgery and Physiology Porto Portugal
| | - Ana Grangeia
- Department of Genetic Centro Hospitalar Univrsitário de São João Porto Portugal
| | - Sérgio Estrela‐Silva
- Department of Ophthalmology Centro Hospitalar Universitário de São João Porto Portugal
- Faculty of Medicine University of Porto Department of Surgery and Physiology Porto Portugal
| | - Ângela Carneiro
- Department of Ophthalmology Centro Hospitalar Universitário de São João Porto Portugal
- Faculty of Medicine University of Porto Department of Surgery and Physiology Porto Portugal
| | - Fernando Falcão‐Reis
- Department of Ophthalmology Centro Hospitalar Universitário de São João Porto Portugal
- Faculty of Medicine University of Porto Department of Surgery and Physiology Porto Portugal
| | - Olinda Faria
- Department of Ophthalmology Centro Hospitalar Universitário de São João Porto Portugal
- Faculty of Medicine University of Porto Department of Surgery and Physiology Porto Portugal
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Cunha AM, Vilares-Morgado R, Moleiro AF, Falcão-Reis F, Faria O. Childhood-Onset Leber Hereditary Optic Neuropathy: Particular Features. Int Med Case Rep J 2021; 14:163-169. [PMID: 33737839 PMCID: PMC7966410 DOI: 10.2147/imcrj.s303460] [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: 01/24/2021] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Leber hereditary optic neuropathy (LHON) is an optic neuropathy of mitochondrial inheritance. Childhood-onset disease is relatively rare and there are limited data on this important patient subgroup. Case Presentation We present 3 particular presentations of LHON. Patient 1 was an 8-year-old boy admitted to the emergency department reporting a progressive bilateral visual loss and intermittent headaches. Neuro-ophthalmological examination revealed a bilateral pseudopapilledema. Lumbar puncture identified intracranial hypertension and the brain and orbits magnetic resonance imaging showed T2 hyperintensity in the posterior region of the left optic nerve and the optic chiasm. Patient 2 was a 12-year-old boy admitted to the emergency department reporting painless, progressive central vision loss in the right eye. Fundus examination revealed a hyperemic disc and vascular network papillary and peripapillary vascular microdilations. Three months later, the left eye presented visual loss. Patient 3 was a 6-year-old female child referred to the neuro-ophthalmology specialist due to painless central visual loss in both eyes. Her BCVA was 1/10 and counting fingers in right and left eye, respectively, and fundus examination revealed a pallor optic disc in the temporal sector. Discussion The phenotype of childhood-onset disease may present itself distinct from classical adult-onset LHON. The absence of classical clinical features could lead to initial misdiagnosis. There should exist a high index of suspicion in children presenting unexplained subnormal vision in order to avoid potential diagnostic delays.
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Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Olinda Faria
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Oliveira-Ferreira C, Leuzinger-Dias M, Tavares-Ferreira J, Faria O, Falcão-Reis F. The Relationship between Intraocular Pressure and Optic Nerve Structural and Functional Damage in Patients with Optic Nerve Head Drusen. Neuroophthalmology 2020; 44:290-293. [PMID: 33012917 DOI: 10.1080/01658107.2019.1691242] [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] [Indexed: 10/25/2022] Open
Abstract
The aim of this retrospective study was to evaluate if, in ocular normotensive patients, at the time of diagnosis of optic nerve head drusen (ONHD), perimetric mean deviation (PMD) on visual field (VF) examination and retinal nerve fibre layer (RNFL) thickness on optical coherence tomography correlated with intraocular pressure (IOP). There was a significant association between IOP and PMD (Spearman's rho = -0.863, p < .01) and between IOP and RNFL thickness (Spearman's rho = -0.630, p < .01). A higher IOP was associated with a greater functional loss in the VF and a reduction in the RNFL thickness. These results suggest that a clinical trial of IOP reduction should be considered in patients with ONHD to decrease the progression of optic nerve damage over time.
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Affiliation(s)
| | | | | | - Olinda Faria
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Surgery and Physiology Department, Faculty of Medicine, Porto University, Oporto, Portugal
| | - F Falcão-Reis
- Ophthalmology Department, Centro Hospitalar São João, Oporto, Portugal.,Surgery and Physiology Department, Faculty of Medicine, Porto University, Oporto, Portugal
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Soares C, Martins DF, Pestana-Silva R, Honavar M, Faria O, Abreu P, Costa A. Intrathecal rituximab in immunoglobulin G4-hypertrophic pachymeningitis. J Neuroimmunol 2019; 334:576997. [DOI: 10.1016/j.jneuroim.2019.576997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 12/24/2022]
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Soares A, Mota Á, Fonseca S, Faria O, Brandão E, Falcão Dos Reis F, Gentil R, Guimarães S, Mendonça L. Ophthalmologic Manifestations of Wolfram Syndrome: Report of 14 Cases. Ophthalmologica 2018; 241:116-119. [PMID: 30056456 DOI: 10.1159/000490535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/31/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to describe ophthalmological abnormalities in 14 cases of Wolfram syndrome belonging to 9 different families. METHODS Patients were submitted to a complete ophthalmological, neurological, otorhinolaryngological, urological, and genetic evaluation. RESULTS Our sample comprised 14 Caucasian patients belonging to 9 different families. Their ages ranged from 10 to 38 years. The mean duration of known disease was 11.3 ± 8.7 years. Genetic confirmation was obtained in 7 families. There was a parental consanguinity history in 2 families. Five families were homozygous for a mutation of exon 8 of the WFS1 gene (Chr. 4), and 2 patients were heterozygous. Diabetes mellitus was the first manifestation in all except 1 patient. The mean age at diagnosis was 8.7 years (range 3-22). None had diabetic retinopathy. The mean age at diagnosis of optic atrophy was 11.1 years (range 8-35). The best-corrected visual acuity ranged from counting fingers to 20/50. CONCLUSIONS Association of optic atrophy with insulin-dependent diabetes mellitus should raise the suspicion of Wolfram syndrome.
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Affiliation(s)
| | - Ágata Mota
- Department of Ophthalmology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Sofia Fonseca
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia, Gaia, Portugal
| | - Olinda Faria
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal
| | | | - Rita Gentil
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
| | | | - Luís Mendonça
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
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Andrade C, Faria O, Guimarães J. Edema Bilateral do Disco Óptico Secundário a Amiodarona: Manifestação de uma Neuropatia Óptica Iatrogénica. ACTA MEDICA PORT 2015. [DOI: 10.20344/amp.5397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 69-years-old male patient was treated with amiodarone 200mg/day over the passed two months for atrial fibrillation. He presented a sudden, painless and unilateral visual loss. Ophthalmologic evaluation revealed a bilateral optic disc edema. Neurological examination was otherwise unremarkable. After properly excluding increased intracranial pressure and giant cell arteritis, the main differential diagnosis was between nonarteritic anterior ischemic optic neuropathy and optic neuropathy secondary to amiodarone. The latter diagnosis was favored due to a presence of bilateral and simultaneous optic disc edema, gradual improvement of symptoms after discontinuation of the drug, and, mostly, by persistence of optic disc edema beyond 6 weeks. Of note, an acute presentation of this disorder is common. Amiodarone optic neuropathy is a rare but potentially serious cause of optic nerve dysfunction, and its discontinuation is usually warrant.
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Andrade C, Faria O, Guimarães J. [Bilateral Optic Disc Edema Secondary to Amiodarone: Manifestation of an Iatrogenic Optic Neuropathy]. ACTA MEDICA PORT 2015; 28:256-259. [PMID: 26061517] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
A 69-years-old male patient was treated with amiodarone 200mg/day over the passed two months for atrial fibrillation. He presented a sudden, painless and unilateral visual loss. Ophthalmologic evaluation revealed a bilateral optic disc edema. Neurological examination was otherwise unremarkable. After properly excluding increased intracranial pressure and giant cell arteritis, the main differential diagnosis was between nonarteritic anterior ischemic optic neuropathy and optic neuropathy secondary to amiodarone. The latter diagnosis was favored due to a presence of bilateral and simultaneous optic disc edema, gradual improvement of symptoms after discontinuation of the drug, and, mostly, by persistence of optic disc edema beyond 6 weeks. Of note, an acute presentation of this disorder is common. Amiodarone optic neuropathy is a rare but potentially serious cause of optic nerve dysfunction, and its discontinuation is usually warrant.
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Affiliation(s)
- Carlos Andrade
- Serviço de Neurologia. Centro Hospitalar de São João. Porto. Portugal. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Olinda Faria
- Serviço de Oftalmologia. Centro Hospitalar de São João. Porto. Portugal. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Joana Guimarães
- Serviço de Neurologia. Centro Hospitalar de São João. Porto. Portugal. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Vilan A, Faria O, Campos MM. [Wolfram syndrome]. Rev Neurol 2009; 49:221-222. [PMID: 19621326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Vilan A, Faria O, Campos MM. Síndrome de Wolfram. Rev Neurol 2009. [DOI: 10.33588/rn.4904.2008236] [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: 11/24/2022]
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