Browsing by Author "Lemos, V"
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- Anterior Segment Optical Coherence Tomography Imaging of Filtering Blebs after Deep Sclerectomy with Esnoper-Clip Implant: One-year Follow-upPublication . Vieira, L; Noronha, M; Lemos, V; Reina, M; Gomes, TPurpose: To describe the technique of deep sclerectomy with the new Esnoper-Clip® implant, the clinical outcome and the anatomic characteristics of filtering blebs, using anterior segment optical coherence tomography (AS-OCT). Methods: A prospective case-series study was conducted in five eyes (5 patients) with open angle glaucoma. The fornixbased deep sclerectomy with Esnoper-Clip® implant was done by the same surgeon. In one case, mitomycin C was used during surgery. All participants underwent a complete ophthalmic examination and AS-OCT (Visante®) preoperatively, then at each follow-up visit, at 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. Scans were obtained through sagittal and transversal plans to the implant. Results: Intraocular pressure (IOP) was significantly reduced (p < 0.05) from a mean preoperative value of 23.4 ± 8.6 mm Hg (n = 3.8 glaucoma medications) to a postoperative value of 6.0 ± 2.5 (n = 0), 10.6 ± 5.4 (n = 0), 13 ± 1.6 (n = 0.4), 12.4 ± 2.1 (n = 0.2) and 14.4 ± 1.5 (n = 0.2) at 1 day, 1 week, 1 month, 6 months and 1 year respectively. AS-OCT allowed the visualization of the two plates of the implant (scleral and suprasciliary), the trabeculodescemetic membrane and the hyporeflective spaces in the bleb wall thickness and in suprascleral and suprachoroidal localizations. An immediate postoperative hypotony and an anteriorization of the implant associated to trabeculodescemetic membrane rupture, were detected, although without significant clinical repercussions. Conclusion: Our first five deep sclerectomy with Esnoper-Clip implantation analysis suggest an effective and well-tolerated method to reduce IOP. AS-OCT is a noninvasive imaging technique that allows the anatomic analysis of the drainage mechanisms after glaucoma surgery.
- Correlação entre Espessura Macular e Camada de Fibras Nervosas Peripapilar no Glaucoma InicialPublication . Cabugueira, A; Vicente, A; Lemos, V; Anjos, R; Rosa, R; Flores, R; Gomes, T; Reina, MIntrodução: Os autores pretendem analisar a espessura macular e a camada de fibras nervosas peripapilar (CFN) em doentes com glaucoma inicial e com o diagnóstico de hipertensão ocular (HTO). Também propõem um modelo de correspondência da espessura macular de uma dada região do hemisfério superior com a CFN temporal superior (TS) e do hemisfério inferior com a CFN temporal inferior (TI) no glaucoma inicial. Material e Métodos: Estudo retrospectivo não randomizado, constituído por 48 olhos com glaucoma inicial e 39 olhos com diagnóstico de HTO, submetidos a análise da assimetria da espessura macular do polo posterior e da CFN por Tomografia de coerência óptica Spectral Domain (SD-OCT). Avaliamos a correlação entre a espessura macular de uma região selecionada do hemisfério superior e do inferior, com a CFN TS e TI, respectivamente. Resultados: Nos doentes com glaucoma inicial, a espessura macular e a CFN (global e sectorial) foram significativamente inferiores (p<0,01). A correlação da CFN TS com a espessura macular da região selecionada do hemisfério superior foi moderada (R:0,403; p<0,01), e da CFN TI com a região selecionada do hemisfério inferior foi positiva forte (R:0,612; p<0,001). Conclusão: Dado que, a CFN TI é o sector apontado como precocemente afectado no glaucoma, e se verificou uma correlação forte com a região macular inferior selecionada, consideramos que esta também pode ser mais vulnerável à lesão glaucomatosa inicial. A avaliação desta região isoladamente ou integrada com a CFN, poderá ser valiosa no diagnóstico precoce.
- Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor InjectionsPublication . Lemos, V; Cabugueira, A; Noronha, M; Abegão Pinto, L; Reina, M; Branco, J; Gomes, TPURPOSE: The aim of the this study was to determine the effect of intravitreal antivascular endothelial growth factor injections on intraocular pressure (IOP) and identify possible risk factors for the development of increased IOP. MATERIALS AND METHODS: This prospective study included a total of 106 eyes receiving intravitreal injection of bevacizumab as treatment for macular edema or active choroidal neovascularization. IOP was measured by Goldmann applanation tonometry immediately before the intravitreal injection and 5 min, 1 h and 15 days after the procedure. The records of the study patients were reviewed for age, gender, history of glaucoma, diabetes mellitus, phakic status, systemic and topical medication and number of previous injections. Subconjunctival reflux was registered. IOP elevation was defined as IOP ≥21 mm Hg and/or a change from baseline of ≥5 mm Hg recorded at least on two or more measurements on the same visit. RESULTS: Mean preoperative IOP was 15.31 ± 3.90 mm Hg and postoperative IOP values were 27.27 ± 11.87 mm Hg (after 5 min), 17.59 ± 6.24 mm Hg (after 1 h) and 16.86 ± 3.62 mm Hg (after 15 days). The IOP variation was statistically significant between pre- and postoperative measurements (p < 0.05). Subconjunctival reflux was recorded in 11.3%, and in this subgroup the IOP at 5 min and at 1 h was lower than preoperative IOP (p < 0.05). CONCLUSIONS: More than one third of the eyes achieved IOPs >30 mm Hg 5 min after injection. Subconjunctival reflux contributed to a lower mean postoperative IOP (p < 0.05). Considerations for the management include prophylactic IOP lowering with medical therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to an as-needed injection protocol in patients suffering a marked IOP rise in previous injections. © 2015 S. Karger AG, Basel.
- The Impact of Multifocal Intraocular Lens in Retinal Imaging with Optical Coherence TomographyPublication . Dias-Santos, A; Costa, L; Lemos, V; Anjos, R; Vicente, A; Ferreira, J; Cunha, JPMultifocal intraocular lenses (MF IOLs) have concentric optical zones with different dioptric power, enabling patients to have good visual acuity at multiple focal points. However, several optical limitations have been attributed to this particular design. The purpose of this study is to access the effect of MF IOLs design on the accuracy of retinal optical coherence tomography (OCT). Cross-sectional study conducted at the Refractive Surgery Department of Central Lisbon Hospital Center. Twenty-three eyes of 15 patients with a diffractive MF IOL and 27 eyes of 15 patients with an aspheric monofocal IOL were included in this study. All patients underwent OCT macular scans using Heidelberg Spectralis®. Macular thickness and volume values and image quality (Q factor) were compared between the two groups. There were no statistically significant differences between both groups regarding macular thickness or volume measurements. Retinal OCT image quality was significantly lower in the MF IOL group (p < 0.01). MF IOLs are associated with a significant decrease in OCT image quality. However, this fact does not seem to compromise the accuracy of spectral domain OCT retinal measurements.
- Vision Loss and Subretinal Yellow Deposits Following Cytostatic Therapy for Early-Stage Breast Cancer: a Case ReportPublication . Dias-Santos, A; Lemos, V; Ferreira, J; Cunha, JP; Branco, JIntroduction/Objective: To report a case of ocular toxicity related to two chemotherapeutic regimens approved for early-stage breast cancer: doxorubicin (Adriamycin®) and cyclophosphamide – AC protocol; carboplatin and docetaxel combination. Material and Methods: We report a case of a 39-year-old woman with stage I ductal invasive breast cancer, who presented with bilateral painless reduced visual acuity two days after the first administration of intravenous doxorubicin and cyclophosphamide. Results: The best corrected visual acuity (BCVA) was 20/100 in both eyes and the fundoscopy revealed pearly-yellow lesions in the posterior pole and mid-peripheral retina bilaterally, with retinal pigment epithelium hypertrophy in the right eye (RE). These lesions were hyperfluorescent on fluorescein angiography and appeared as drusen-like deposits under the retinal pigment epithelium in the optical coherence tomography (OCT). The electrophysiological study revealed a diffuse dysfunction of bipolar cells and photoreceptors and macular dysfunction, more pronounced in the RE. Goldmann visual field testing, color vision and optic nerve OCT were normal. 72 hours after the treatment, her BCVA improved spontaneously to 20/25 in the RE and 20/20 in the left eye (LE). A similar drop in BCVA was observed after a second cycle of AC protocol and after second-line cycle of carboplatin and docetaxel, with subsequent recover. The remaining observation remained remarkably similar. Discussion: This can be the first report of a rare idiosyncratic reaction to AC protocol and carboplatin-docetaxel chemotherapeutic regimens, approved for early-stage breast cancer.