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- Corneal Biomechanical Assessment with Ultra-High-Speed Scheimpflug Imaging During Non-Contact Tonometry: A Prospective ReviewPublication . Baptista, Pedro Manuel; Ambrósio Jr, Renato; OLIVEIRA, LUIS; Menéres, Pedro; Beirão, JoãoBackground: In recent years, increasing interest has arisen in the application of data from corneal biomechanics in many areas of ophthalmology, particularly to assist in the detection of early corneal ectasia or ectasia susceptibility, to predict corneal response to surgical or therapeutic interventions and in glaucoma management. Technology has evolved and, recently, the Scheimpflug principle was associated with a non-contact air-puff tonometer, allowing a thorough analysis of corneal biomechanics and a biomechanically corrected intraocular pressure assessment, opening up new perspectives both in ophthalmology and in other medical areas. Data from corneal biomechanics assessment are being integrated in artificial intelligence models in order to increase its value in clinical practice. Objective: To review the state of the art in the field of corneal biomechanics assessment with special emphasis to the technology based on ultra-high-speed Scheimpflug imaging during non-contact tonometry. Summary: A meticulous literature review was performed until the present day. We used 136 published manuscripts as our references. Both information from healthy individuals and descriptions of possible associations with systemic diseases are described. Additionally, it exposed information regarding several fields of ocular pathology, from cornea and ocular surface through areas of refractive surgery and glaucoma until vascular and structural diseases of the chorioretinal unit.
- Asymmetric Thickness Intracorneal Ring Segments for KeratoconusPublication . Baptista, Pedro Manuel; Marques, Joao Heitor; Neves, Miguel Mesquita; Gomes, Miguel; OLIVEIRA, LUISPurpose: To describe the anatomical and functional results of the implantation of asymmetric thickness intracorneal ring segments (AS-ICRS) in eyes with keratoconus and asymmetric/irregular astigmatism (type 2 - Duck - and type 3 - Snowman - phenotypes, Fernandez-Vega/Alfonso morphologic Keratoconus classification). Materials and methods: Retrospective observational study including 19 consecutive patients (21 eyes) with keratoconus who underwent manual implantation of the Keraring® Asymmetric ICRS (AS). Analysis included demographic and clinical data and Pentacam (Oculus®) measurements: topographic astigmatism; topographic flat meridian (K1), steepest meridian (K2) and the maximum keratometric point (Kmax); total root mean square (RMS) and high order RMS (HOA) aberrations and comatic Zernike coefficients (Z31;Z3-1) at 0º and 90º meridians. Results: Overall mean age was 35.3±11.7 years and median follow-up was 7.1 months (range 6-12). At the end of follow-up, a significant improvement from baseline was achieved in both UDVA (0.24±0.22; p=0.017) and CDVA (0.21±0.17; p<0.001). Regarding topographic measurements, the greatest decrease was observed in K2 (2.76±1.9D; p<0.001) and astigmatism (1.97±1.5; p<0.001). Aberrometry analysis showed a reduction of 1.27±3.2µm in the total RMS (p=0.085), 0.24±0.9µm in HOA (p=0.227) and 0.78±0.5 (p<0.001) in the 90º component of comatic aberration. The procedure effects in the CDVA, topographic and aberrometric parameters were higher in type 2 cones without statistical significance (p>0.05 in all). Conclusion: Implantation of the Keraring® Asymmetric ICRS in keratoconus with asymmetric/irregular astigmatism allowed an improvement of several clinical, topographic and aberrometric parameters, with clinical efficacy and safety, with a tendency to a greater effect in the type 2 cones.
- Exophiala Keratitis following Descemet Stripping Automated Endothelial KeratoplastyPublication . Marta, Ana; Costa, Paula; Lopes, Virgínia; Neves, Miguel Mesquita; Gomes, Miguel; OLIVEIRA, LUISPurpose: To report a case with Exophiala spp. keratitis in a Portuguese patient. Methods: A case report with deep corneal brown-pigmented infiltrates that developed 2 months after a Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy. Results: Diagnosis was established by positive direct examination and cultures from the surgically obtained corneal button. Slit-lamp images and anterior segment optical coherence tomography (AS-OCT) scans were obtained. Conclusion: This is the first described case of fungal keratitis caused by Exophiala spp. in Portugal and, to our knowledge, the first case following DSAEK in the literature.