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- Keratitis by Scopulariopsis brevicaulis Fungus After LASIK – A Case ReportPublication . Baptista, Pedro Manuel; Vieira, Rita; Monteiro, Sílvia; Abreu, Ana Carolina; Gomes, Miguel; Pinto, Maria do CéuPurpose: To describe a rare case of an interface filamentous fungal keratitis and its successful clinical approach and management. Patients and methods: Retrospective case report. Analysis of the patient's clinical records. Results: A healthy 30-year-old woman presenting with complaints of blurred vision, photophobia and intense pain, was previously diagnosed with a suspected unilateral diffuse lamellar keratitis after laser in situ keratomileusis surgery, and accordingly treated with a scheme of oral and subconjunctival corticosteroids. Due to worsening of symptoms, the patient was later referred to our ophthalmology department. Upon examination, a corneal infiltration was observed and a fungal infection was suspected. Treatment with fortified Voriconazole (1%) was initiated and both topical and oral corticosteroids were tapered. The infiltrate resolved after 6 weeks of antifungal topical treatment. Scopulariopsis brevicaulis was isolated on culture media. At the end of follow-up, the uncorrected distance visual acuity was 20/20 with mild scarring. Conclusion: Scopulariopsis brevicaulis can be associated with post-laser in situ keratomileusis interface infection. A quick intervention may dictate a good outcome, when combining early suspicion and microbiological diagnosis, and an appropriate conservative management. Furthermore, Voriconazole seems to be effective and safe in the treatment of such cases.
- Visian® ICLV4c™ and Artiflex®: Comparative Analysis with the HD Analyser™ and Integration with Subjective Performance and Anatomical ParametersPublication . Baptista, Pedro Manuel; Monteiro, Sílvia; Abreu, Ana Carolina; Poças, João; José, Diana; Lume, Miguel; Pinto, Maria do CéuPurpose: To analyze and compare the mid-term objective and subjective performance of two phakic intraocular lenses (PIOLs) - Visian® ICL™ V4c and Artiflex® and to correlate those results with anatomical parameters. Patients and methods: Observational retrospective study including thirty patients (15 for each PIOL) randomly selected from those who underwent bilateral implantation of one of the PIOLs (60 eyes were analysed). Uncorrected and corrected distance visual acuities (UDVA and CDVA), anterior chamber structural parameters, and corneal endothelial cells density and morphology were evaluated. Quality of vision was assessed both subjectively with a questionnaire, and objectively using a double-pass technology optical quality analysis system. Results: At the end of follow-up the Artiflex® group showed better UDVA (0.95±0.11 vs 0.99±0.05, p=0.027) and higher proportion of eyes reaching at least 20/20 (28/30 vs 18/30, p=0.005). Excellent and similar objective scatter index (1.79±0.9 vs 2.14±1.6, p=0.306) and modular transfer function cutoff frequency (26.91±9.2 vs 26.51±11.9, p=0.784) results were achieved in the HD Analyzer® and the questionnaire showed comparable high Satisfaction (55.7±3.5 vs 54.3±5.4, p=0.386) and low Dysphotopsia Scores (3.1±1.8 vs 2.1±2.2, p=0.213). The ICL group showed inferior anterior chamber volume (p<0.001), and angle (p<0.001) and superior pupillary diameter (p=0.007). Minimum follow-up was 24 months. Conclusion: Both the Visian® ICLV4c™ and the Artiflex® showed excellent optical performance through the HD AnalyzerTM technology, translated in high patient satisfaction. Overall, both PIOLs showed similar safety, predictability, stability and effectiveness of for the reduction of high sphero-cylindrical refractive errors, despite better UDVA results with the Artiflex®.
- Intravitreal Ranibizumab or Aflibercept After Bevacizumab in Diabetic Macular Edema: Exploratory Retrospective AnalysisPublication . Pessoa, Bernardete; Malheiro, Luisa; Carneiro, Inês; Monteiro, Sílvia; Coelho, João; Coelho, Constança; Figueira, João P; Meireles, Angelina; Beirão, JoãoAim: 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.
- A temporary corneal ectasia following airbag traumaPublication . Marta, Ana; Abreu, Ana Carolina; Monteiro, Sílvia; Pinto, MariaPurpose: To report a case of a temporary corneal ectasia induced by airbag trauma. Observations: A patient who suffered a road traffic accident with deployment of the frontal airbag and presented a corneal ectasia in both eyes after 3 months, without changes in visual acuity. After 9 months, he presented a significantly improvement, achieving his basal parameters in pentacam. Conclusions and importance: This is a rare case of corneal ectasia induced by airbag trauma that spontaneously reverted and it can emphasize the viscoelastic properties of the human cornea.
- The Role of Corneal Biomechanics in the Assessment of Ectasia Susceptibility Before Laser Vision CorrectionPublication . Baptista, Pedro Manuel; Marta, Ana; Marques, Joao Heitor; Abreu, Ana Carolina; Monteiro, Sílvia; Menéres, Pedro; Pinto, Maria do CéuPurpose: To describe the tomographic and corneal biomechanical status of a sample of eyes excluded from LVC and to present the differences in biomechanical behavior in relation to cutoffs of clinical- and tomography-based screening methods used in clinical practice. Patients and methods: Observational cross-sectional study including 61 eyes from 32 consecutive patients who were excluded from LVC in our department. Clinical and demographic data were collected from the patients' clinical records. Tomographic data was assessed with a Scheimpflug camera (Pentacam, OCULUS®). Ablation depth (µm) and residual stromal bed (µm) were calculated by the WaveLight® EX500 laser system software (Alcon, EUA). The corneal biomechanical assessment was made through ultra-high speed Scheimpflug imaging during noncontact tonometry (Corvis ST, OCULUS®). Several ectasia risk scores were analyzed. Results: Mean age was 31.0±6 years old and mean manifest spherical equivalent was -2.01 ± 2.3D. Belin-Ambrósio deviation index was the tomographic parameter with higher proportion of eyes within the ectasia high risk interval. In the biomechanical assessment, more than 95% of eyes met the criteria for ectasia susceptibility in four of the first generation and in two of the second generation parameters. In a cutoff based comparative analysis, eyes with Kmax ≥45.5 D, eyes with VCOMA <0 and eyes with ARTmax ≤350 presented significantly softer corneal biomechanical behavior. Conclusion: The majority of eyes excluded from LVC in the present study met the criteria for ectasia susceptibility in several biomechanical parameters, validating the clinical and tomographic based screening prior to LVC in our center. Differences found in the biomechanical assessment regarding cutoffs used in clinical practice highlight its differential role in characterizing risk profile of these patients. Tomography should not be overlooked and the integration of all data, including treatment-related parameters, can be the future of risk ectasia screening prior LVC.