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- Intense Pulsed Plus Low-Level Light Therapy in Meibomian Gland DysfunctionPublication . Marta, Ana; Baptista, Pedro Manuel; Marques, Joao Heitor; Almeida, Daniel; José, Diana; Sousa, Paulo; Barbosa, IrenePurpose: To analyse the clinical outcome in patients with meibomian gland dysfunction (MGD) who underwent intense pulsed light (IPL) plus low-level light therapy (LLL). Materials and methods: The prospective non-comparative study included identified by MGD patients with altered interferometry and lower loss area of the meibomian glands (LAMG), who underwent IPL plus LLL, between July 2020 and August 2020. A multimodal assessment was performed before, 2-3 weeks, and 6 months after treatment. The main outcome was lipid layer thickness (LLT) and the secondary outcomes were the ocular surface disease index (OSDI) score, presence of corneal fluorescein staining (CFS), blink rate (BR), Schirmer test (ST), tear meniscus height (TMH), tear osmolarity (OSM), non-invasive break-up time (NIBUT) and LAMG. Results: This study included 62 eyes of 31 patients, 61.3% female, with a mean age of 66.94±9.08 years at the time of IPL plus LLL treatment. LLT (<0.001) grades improved 6 months after treatment. The mean OSDI score improved (p<0.001) from 45.02±21.17 (severe symptoms) to 22.35±17.68 (moderate symptoms) at 2-3 weeks and 8.24±17.9.91 (normal) at 6 months after treatment. CFS was identified in 51.6% (32/62) before and in 45.2% (28/62) 6 months (p=0.293) after treatment. ST (p=0.014) grades improved; OSM grades mild worsened (p<0.001); TMH, NIBUT and LAMG grades did not modify 6 months after treatment. No patient suffered any adverse effects. Conclusion: IPL combined with LLL was effective and safe, improving the lipid layer thickness in MGD and decreasing the level of symptoms.
- Long-Term Visual Function Effects of Pan-Retinal Photocoagulation in Diabetic Retinopathy and Its Impact in Real LifePublication . Baptista, Pedro Manuel; Marta, Ana; Marques, Joao Heitor; José, Diana; Almeida, Daniel; Ribeiro, António; Barbosa, IrenePurpose: To address the long-term visual function after bilateral pan-retinal photocoagulation (PRP) and its impact in real life, namely on visual field (VF) legal criteria to drive. To determine potential predictors related to clinical factors and treatment strategies. Patients and methods: Observational cross-sectional study. Eyes from diabetic patients diagnosed with diabetic retinopathy who underwent bilateral PRP, with or without macular treatments and with visual acuity legal criteria for non-professional driving were randomly assigned. Main outcomes were: demographic and clinical data including best corrected visual acuity; binocular visual field (EBST-Esterman Binocular Suprathreshold Test, Humphrey analyzer3®); contrast sensitivity (CS-Metrovision-MonPack3®); light scattering in the retina (HD Analyzer, Visiometrics®). Results: Seventy-one diabetic patients included (44 men and 27 women), with a mean age of 62.2±11.8 years. PRP was performed, on average, 9.7±6.9 years before the study. The average EBST Score was 85.8±17.0 and the average CS (2-5cpd) was 19.5±2.9 dB in photopic and 14.2±4.1 dB in mesopic conditions. Through a multivariate regression model, after adjusting to the clinical and demographic factors as possible confounders, we found that treatment factors associated with worse results were the use of Argon laser for the EBST Score, the very confluent PRP for the number of non-viewed points in the central 30°x20° of the EBST and the presence of macular treatments for the CS tests. According to Portuguese law, 79% (n=56) of patients had minimal EBST amplitudes for non-professional driving. Conclusion: The functional results achieved in our sample are compatible with an active life, allowing most of the patients included to overcome the requirements of Portuguese legislation for driving light vehicles, namely at the level of the binocular visual field. These results highlight the role of PRP in the treatment of diabetic retinopathy in an era with evolving less aggressive laser options.
- 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.
- 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.
- Comparison of Light-Based Devices in the Treatment of Meibomian Gland DysfunctionPublication . Castro, Catarina; Marques, Joao Heitor; Marta, Ana; Baptista, Pedro Manuel; José, Diana; Sousa, Paulo; Menéres, Pedro; Barbosa, IrenePurpose: To compare different light-based devices, namely, intense pulsed light (IPL) and IPL with low-level light therapy (LLLT), in the treatment of meibomian gland dysfunction (MGD). Methods: This was a prospective, observational study that included patients with MGD. Group 1 included 58 eyes treated with IPL (eye-light®, Espansione Marketing S.p.A., Bologna, Italy), followed by LLLT (my-mask®, Espansione Marketing S.p.A., Bologna, Italy); Group 2 included 60 eyes treated with IPL (E>Eye®, E-Swin, Houdan, France); and Group 3 included 58 eyes treated with IPL (Thermaeye Plus®, OptiMed, Sydney, Australia). The presence of symptoms (Ocular Surface Disease Index (OSDI)) and ocular surface changes were evaluated at baseline, three weeks, and six months after treatment. Results: At week three, there was an improvement in the OSDI in all groups (p<0.001), without differences among them (p=0.339). The lipid layer thickness (LLT) increased in Groups 1 and 2 (p<0.001), with a similar variation (p=0.144). Patients with superior OSDI and lower LLT at baseline had the greatest improvement in the respective parameters (p<0.001). The basal tear flow increased in Group 1 (p=0.012). Corneal staining (CS) significantly decreased in Groups 2 (p<0.001) and 3 (p<0.001). At six months, compared to three weeks, there was further improvement in the OSDI (p<0.001) and the LLT (p=0.007), in Group 1, and an increase in the presence of CS in Group 3 (p=0.011). Conclusion: IPL treatment led to a sustained decrease in patients' symptoms, even after six months. Different IPL devices seem to have different beneficial effects. Adding LLLT to IPL appears to have an additional long-term beneficial effect as well as positive effects on the lacrimal gland.