Browsing by Author "Pedrosa, C"
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- Adesão e persistência no tratamento do glaucomaPublication . Ramalho, M; Vaz, F; Pedrosa, C; Alves, S; Azevedo, A; Pina, S; Esperancinha, F; Kaku, PDiscute-se a adesão e persistência da terapêutica em doentes com glaucoma
- Alterações morfométricas do endotélio corneano no glaucoma pseudoesfoliativoPublication . Coutinho, I; Pedrosa, C; Santos, C; Mota, M; Silva, D; Ramalho, M; Lisboa, M; Vaz, FIntrodução: Com este trabalho pretende-se analisar a morfometria das células endoteliais corneanas e espessura central da córnea em doentes com glaucoma pseudoesfoliativo (GPX) e glaucoma primário de ângulo aberto (GPAA). Materiais e Métodos: Estudo retrospectivo com 40 doentes. Os parâmetros avaliados, através de microscopia especular, foram: densidade de células endoteliais, coeficiente de variação, percentagem de células hexagonais e espessura central da córnea. Resultados e Conclusões: Não se verificaram diferenças estatisticamente significativas no que diz respeito à densidade e coeficiente de variação das células endoteliais corneanas entre o grupo com GPX e GPAA. Contudo, a percentagem de células hexagonais foi significativamente inferior no GPX, o que poderá constituir um indício de alguma disfunção endotelial.Em relação à espessura central da córnea, verificou-se uma diminuição estatisticamente significativa no grupo GPX. Assim, no glaucoma pseudoesfolitaivo a presença de material fibrilhar na câmara anterior pode contribuir para alterações nas células endoteliais mais rápidas do que seria espectável e em alterações estruturais que se reflectem na menor espessura central da córnea.
- Anatomia clínica: nervos e músculosPublication . Mota, M; Coutinho, I; Pedrosa, C; Ramalho, M; Santos, C; Pina, SRevisão sobre a inervação dos músculos extra-oculares, descrição do III, IV, V, VI e VII pares craneanos. Correlação da anatomia funcional com casos clínicos.
- Anestesia em oftalmologiaPublication . Ramalho, M; Laranjo, J; Vaz, F; Pina, S; Santos, C; Pedrosa, C; Coutinho, I; Mota, M; Melo, ADescrevem-se as várias técnicas anestésicas usadas em oftalmologia. História, indicações e diferentes tipos de anestesia.
- Biomicroscopia ópticaPublication . Pedrosa, C; Pina, S; Azevedo, A; Santos, C; Ramalho, M; Silva, F; Alves, S; Prieto, IApresenta-se a evolução histórica da oftalmologia até à invenção e desenvolvimento da lâmpada de fenda, instrumento principal de trabalho do oftalmologista. Explicita-se ainda todas as suas aplicações de forma a permitir a identificação das várias estruturas do olho e suas alterações
- Black intraocular lens: another cosmetic approach to leukocoriaPublication . Pedrosa, C; Pina, S; Azevedo, A; Pêgo, P; Feijóo, B; Prieto, IPurpose – To present a case report of a black intraocular lens implantation for cosmetic improvement of a blind eye with leukocoria. Setting – Ophthalmology Department - Professor Dr. Fernando Fonseca Hospital, EPE - Amadora, Lisboa, Portugal Methods – We report a 32-year-old woman who was evaluated because of the undesired cosmetic appearance of her amblyopic left eye with exotropia and leukocoria due to traumatic cataract and total retinal detachment during childhood. The Examination revealed no light perception in the left eye and 20/20 visual acuity in the right eye. An external examination showed an obvious leukocoria and exotropia of the left eye and a normal right eye. Biomicroscopy of the left eye showed a clear cornea, quiet anterior chamber, normal iris and a white pupillary reflex due to subluxated white cataract and fibrotic retinal detachment. We proceeded to cosmetic surgery that consisted of retropupillary implantation of an Artisan pupil occluder without cataract extraction, and strabismus correction within the same surgical procedure. Despite the uneventful immediate postoperative course, reevaluation two weeks later revealed dislocation of one of the lens haptics and the increase of the cataract subluxation with need of re-intervention. Intracapsular cataract extraction was done and IOL was repositioned over the iris. A video of the surgeries will be presented. Results - Two months later the eye was still quiet. The exotropia was corrected and the pupil occluder remained well centered with an excellent cosmetic appearance, despite of the optic diameter of 5.4 mm. The leukocoria was thus treated with implantation of a black IOL providing a significant improvement in the patient self-image. Conclusions – This Artisan lens is usually used to pupil occlusion in cases of intractable diplopia. Because of its vaulted configuration, Artisan pupil occluder can be applied in phakic and aphakic eyes but due to the features of this type of lens it´s not very suitable to the retropupillar enclavation . Nevertheless this case shows that in cases of white reflex the use of this pupil occluder can be a cosmetic correction alternative to the classic treatment with contact lenses, corneal tatooing or single crystaline lens extraction.
- Bowman's layer dystrophy with irido-fundal coloboma in the same patient: a case reportPublication . Mota, M; Pedrosa, C; Silva, D; Pires, G; Pêgo, P; Vendrell, C; Prieto, IIntroduction: The corneal dystrophies are rare corneal diseases, defined as bilateral, symmetric and inherited conditions. Ocular coloboma is a congenital defect caused by embryogenesis imperfection, during the sixth week of development. Purpose: The authors report the first clinical case in literature of the association of cornea dystrophy and irido-fundal coloboma. Case report: The authors describe the case of a 34-year-old woman, with decrease visual acuity (VA) in the right and left eyes (RLE). She has had an ocular illness since young, with corneal erosions. Her family members also have alterations in the cornea, her father has held a bilateral corneal transplant. Ophthalmic examination showed a best-corrected visual acuity (BCVA) of 20/40 in the RE and 20/100 in the LE. Biomicroscopy showed an inferior iris coloboma in the LE. A deposition of reticular/granular substance in the Bowman’s layer was observed in both eyes, sparing the limbal portion, compatible with a corneal dystrophy. Fundus examination showed a coloboma in the LE that involves the inferior retina and the optic nerve, no changes in the RE fundus was observed. She started treatment with ocular lubrificant preservative-free eyedrops. The patient has remained stable within 1-year follow-up. Conclusions: This is the first case report of the association of cornea dystrophy and irido-fundal coloboma. The greater decrease in VA in the LE appears to be due to the combination of these two entities in this eye. Despite the Bowman’s layer dystrophy has an autosomal dominant pattern, coloboma seems to have been an acquired change.
- Cataract after proton beam therapy (PBT) for iris melanomaPublication . Coutinho, I; Pêgo, P; Ramalho, M; Pedrosa, C; Prieto, I; Cabral, JIntroduction: Iris melanoma is a very rare tumour in paediatric age group. Treatment depends on, among other factors, tumour size and location, presence of any associated complication and general health of the patient. Management options include local resection, plaque brachytherapy, proton beam therapy (PBT) and enucleation. PBT is nowadays an alternative and effective treatment, with good local control, especially for extensive and diffuse tumours, in which local resection is difficult. The major complication is cataract and in paediatric age, surgery is always a challenge. Methods: A 8-year-old caucasian child, with blue iris, presented with a pigmented lesion in the inferotemporal iris of the left eye. It was interpreted as a nevus and documented by photography of the anterior segment and ultrasonic biomicroscopy in serial reassessments. Twelve months later, the lesion had grown in diameter and thickness associated with corectopia and ectropion uveae but did not involve the angle or ciliary body and intraocular pressure was normal. A diffuse iris melanoma was assumed and it was performed PBT. Results: The clinical evolution was favourable. Three years post PBT, we did not report any recurrence of the tumour neither evidence of metastatic disease. After 18-months, the patient developed a posterior subcapsular cataract in OS. The best correct visual acuity (BCVA) OS passed from 20/20 to light perception during 3 years. At age of 11, it was performed a micro-incision phacoemulsification cataract surgery combined with primary posterior capsulorexis, intracameral triamcinolone injection and implantation of a simple piece intraocular lens. No intra-operative complications were observed. BCVA was OS 20/20 after 9 months of follow up. Conclusion: We present a young boy with a diffuse iris melanoma treated with PBT. Primary PBT was well tolerated and the main complication was cataract, which was successful treatable, although in paediatric age is always a surgical challenge. Paediatric cataract surgery is a complex procedure with all aspects of the surgical process requiring care and attention. The use of micro-incision phacoemulsification with intracameral triamcinolone and posterior capsulorexis seems to provide significantly less anterior segment inflammation and no visual axis obscuration after cataract surgery with IOL implantation.
- A challenged case of Vogt-Koyanagi-Harada syndrome: when dermatological manifestations came first.Publication . Coutinho, I; Pedrosa, C; Santos, C; Pina, S; Lisboa, M; Bernardo, M; Prieto, INTRODUCTION: Vogt-Koyanagi-Harada syndrome (VKHS) is an inflammatory systemic autoimmune disease principally affecting pigmented tissues in the ocular, auditory, integumentary and central nervous systems. Patients are generally women in the fourth decade of life. The prognosis is correlated mainly with the time between diagnosis and the start of treatment and number of recurrent episodes of inflammation. Most complications are mainly ocular. The purpose of this paper is to describe a clinical case of VKHS. MATERIAL AND METHODS: A child with a challenging clinical presentation in which the dermatological symptoms occurred before ocular manifestations. DISCUSSION AND CONCLUSION: VKHS is rare in children and can be a diagnostic challenge. It seemed interesting to share this case as an opportunity to expand our knowledge of the clinical spectrum of diseases and reflect about current diagnostic criteria.
- Cirurgia de catarata secundária em criançaPublication . Coutinho, I; Pedrosa, C; Mota, M; Pêgo, P; Prieto, IIntrodução: A catarata em idade pediátrica constitui um desafio cirúrgico. Este desafio assume maior dimensão quando a catarata pediátrica é secundária ao tratamento com radioterapia por tumor ocular. A complexidade da técnica, a maior fragilidade ou fibrose de estruturas oculares e o maior risco de complicações intra e pós operatórias são obstáculos que o cirurgião deve equacionar. Os autores apresentam um caso clinico de uma cirurgia de catarata unilateral, secundária a radiação por feixe de protões externo para tratamento de melanoma da íris, em criança com 11 anos de idade. Métodos: Criança de 8 anos, com lesão pigmentada infero-temporal no olho esquerdo. Estabeleceu-se o diagnóstico de melanoma da íris, tendo realizado radioterapia com feixe acelerado de protões com excisão e recolocação de células limbares. Após 18 meses de radioterapia, constatou-se desenvolvimento de catarata subcapsular posterior com evolução para catarata branca. Aos 11 anos, foi submetida, sob anestesia geral, a facoemulsificação microincisional. Realizaram-se 2 paracenteses de 1 mm e, através destas, efectuou-se a capsulorexis anterior, após coloração com azul tripano. Procedeu-se à realização da incisão principal (2,2mm), à faco-aspiração do cristalino opacificado e à irrigação/aspiração bimanual do córtex. Implantou-se a lente intra-ocular monobloco monofocal (SN 60WF) no saco capsular e efectuou-se capsulorexis posterior primária. Com o objectivo de excluir a presença de vítreo na câmara anterior e simultaneamente obter um efeito anti-inflamatório, injectou-se intra-camerularmente triamcinolona sem conservantes. Resultados: Não se observaram complicações intra ou pós-operatórias, imediatas ou tardias, de relevo. Com 1 ano de evolução, a acuidade visual do olho esquerdo é de 10/10. Após 4 anos de radioterapia não se observa recorrência do tumor, doença metastática nem complicações da radioterapia. Conclusões: A micro-incisão, a capsulorexis posterior primária e a aplicação de triamcinolona intracamerular asseguram maior segurança no procedimento, mais rápida recuperação visual com transparência duradoura do eixo visual e menor inflamação no pós-operatório.