Browsing by Author "Pinto, S"
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- AmbliopiaPublication . Coutinho, I; Santos, C; Pinto, S; Santos, MJPretende-se rever a definição, causas e tratamento da ambliopia.
- Catarata pediátrica: a nossa experiênciaPublication . Roque, J; Basto, R; Lopes, AS; Silva, D; Pinto, S; Pires, G; Prieto, I
- Changes in choroidal thickness following trabeculectomy and its correlation with the decline in intraocular pressurePublication . Silva, D; Lopes, AS; Henriques, S; Lisboa, M; Pinto, S; Vaz, F; Prieto, IPURPOSE: Evaluate whether there are significant changes in choroidal thickness following trabeculectomy, and how they relate do the decline in intraocular pressure. METHODS: This was a prospective evaluation of 28 eyes who underwent Moorfields modified trabeculectomy. The choroidal thickness was measured via OCT with enhanced depth imaging, before surgery and 1 day, 1 week and 1 month after surgery. Measurements were taken at the fovea, 1000 µm temporal to the fovea and 1000 µm nasal to the fovea. The relationship between choroidal thickness and intraocular pressure was statistically evaluated. RESULTS: The mean intraocular pressure before surgery was 25.07 ± 4.64 mmHg; 8.57 ± 3.62 mmHg after 1 day; 10.36 ± 4.39 mmHg after 1 week and 13.71 ± 5.13 mmHg after 1 month. Mean choroidal thickness increased after trabeculectomy with maximal values at 1 week. The largest increase was found at the fovea, with an average before surgery of 253.54 ± 62.01 µm; 286.75 ± 64.20 µm at 1 day, 286.36 ± 63.14 µm at 1 week and 271.00 ± 60.31 µm at 1 month. Increase in choroidal thickness was significant 1 day and 1 week after surgery in the foveal (p = 0.012, p = 0.007) and temporal (p = 0.040, p = 0.000) locations and 1 week postoperatively on the nasal location (p = 0.016). None of them were significant at 1 month after surgery. Preoperative IOP and choroidal thickness were correlated at all macular locations (ρ = 0.449-0.525, p = 0.004-0.016) yet no correlation was found between increase in choroidal thickness and decline in intraocular pressure in the postoperative period. CONCLUSION: Choroidal thickness appears to increase temporarily after trabeculectomy and these changes were not correlated with the decline in intraocular pressure. Further research is required to fully understand this phenomenon.
- Chronic hepatitis C treatment in HIV co-infection in Portugal: Results from a cohort OF 2133 patients presented by GEPCOI (Portuguese Coinfection Study Group)Publication . Miranda, AC; Mendez J, J; Serrão, R; Vale, F; Manata, MJ; Pinto, S; Gomes, A; Valente, C; Pacheco, P, et al.Direct-acting antiviral drugs (DAAs) have recently changed the paradigm of hepatitis C therapy, significantly improving treatment response rates, patient life expectancy and quality of life. In Portugal, sofosbuvir (SOF) and SOF/ledipasvir (SOF/LDV) were fully reimbursed by the National Health System since early 2015 and generalized use of interferon-free DAA based regimens became current practice. During 2016, the remaining DAAs were sequentially added and covered by the same health access policy. The Portuguese Study Group of Hepatitis and HIV Co-infection (GEPCOI) collected data from 15 clinical centres in Portugal, pertaining to the HCV treatment experience with DAA regimens. A cohort of 2133 patients was analysed, representing one of the largest DAA treated HCV/HIV co-infected individuals. The global sustained virologic response (SVR) achieved was 95% in this real-life cohort setting. Linear regression analysis showed significant differences in treatment response rates when using SOF plus ribavirin (RBV) combination in genotype 2 or 3 infected individuals (P < .002) and in those with liver cirrhosis (P < .002). These findings corroborate that early treatment is mandatory in HIV/HCV co-infected patients, as response rates may be negatively influenced by higher fibrosis stages and suboptimal DAA regimens. The current national Portuguese health policy should continue to promote wider treatment access and individualized therapy strategies, aiming at the elimination of HCV infection in this high-risk co-infected population
- Comprimentos Axiais Extremos e Cálculo de Lentes Intraoculares com o IoImaster - Análise de 78 OlhosPublication . Silva, D; Ramalho, M; Pedrosa, C; Coutinho, I; Mota, M; Lopes, A; Pêgo, P; Pinto, S; Vendrell, C; Prieto, IObjetivo: Avaliar a magnitude do erro das fórmulas usadas no cálculo de lentes intraoculares (SRKII, HofferQ, Holladayl, SRK-T) para comprimentos axiais extremos (<22mm e >26mm) e comparar o desempenho relativo destas fórmulas nos dois subgrupos. Métodos: Avaliaram-se retrospectivamente 78 olhos de 65 doentes, com biometria realizada no IolMaster*. Destes, 48 têm comprimento axial inferior a 22mm e 30 têm comprimento axial su- perior a 26mm. A refração prevista calculada pelas diferentes fórmulas foi comparada com a re- fração um mês após a cirurgia. Testou-se a correlação entre comprimento axial e erro verificado. Resultados: A refração final média foi 0,18+0,65D para comprimentos axiais inferiores a 22mm e -1,48+1,03D nos superiores a 26mm. O erro absoluto médio (diferença entre o cálculo de lente e refração final) para comprimentos axiais inferiores a 22mm foi menor na fórmula HofferQ, diferindo com significado estatístico da Holladayl (p=0,016), mas não da SRK-T (p=0,350). Para comprimentos axiais superiores a 26mm, o erro absoluto médio foi menor na fórmula SRK-T. Diferiu com significado estatístico da Holladayl (p=0,032), mas não da HofferQ (p=0,156). Houve correlação entre erro absoluto médio e comprimento axial em com- primentos axiais superiores a 26mm, para as fórmulas SRK-T (R=0,438, p=0,016), HofferQ (R=0,447, p=0,013) e Holladayl (R=0,386, p=0,035). Conclusão: A HofferQ tem o melhor desempenho nos comprimentos axiais menores que 22mm e a SRK-T nos superiores a 26mm. A comprimentos axiais sucessivamente mais extremos corresponde um aumento estatisticamente significativo do erro absoluto médio nos comprimentos axiais superiores a 26mm, mas não nos inferiores a 22mm.
- Doença de Coats: diferentes apresentaçõesPublication . Santos, C; Pina, S; Ramalho, M; Pedrosa, C; Pinto, S; Santos, MJ; Teixeira, SIntrodução: A Doença de Coats caracteriza-se pelo desenvolvimento anormal dos vasos retinianos (telangiectasia), com deposição progressiva de exsudados intra e subretinianos e consequente descolamento de retina exsudativo. É uma patologia rara, esporádica, idiopática e unilateral (95%), que afecta maioritariamente indivíduos do sexo masculino (75%). A idade média de diagnóstico é aos 10 anos de idade. Na maioria dos doentes manifesta-se por diminuição da acuidade visual, estrabismo e/ou leucocória. O diagnóstico é clínico baseando-se nos achados fundoscópicos característicos. Vários exames complementares como a angiografia fluoresceínica, podem auxiliar a caracterizar a patologia. A classificação da Doença de Coats é útil para a escolha da opção terapêutica e prognóstico. Material e métodos: Os autores descrevem 4 casos clínicos de Doença de Coats, quanto à sua clínica, abordagem diagnóstica, opções terapêuticas e seguimento em consulta. Resultados: Os doentes foram submetidos a fotocoagulação laser indirecta e a crioterapia quando indicada. Após tratamento demonstraram melhoria clínica e funcional. Conclusão: A laserterapia e a crioterapia são opções terapêuticas nos estádios iniciais da patologia, permitindo a estabilização da doença. O diagnóstico precoce e a abordagem terapêutica atempada são essenciais para prevenir a diminuição progressiva da função visual. O tempo médio de recorrência da doença é de dez anos, sendo um seguimento regular e a longo prazo essenciais. Bibliografia: 1. Shields J, Shields C. Coats disease: The 2001 LuEsther T. Mertz Lecture. Retina. 2002; 22(1): 80-91. 2. Shields J, Shields C, Honavar S, Demirci H. Clinical variations and complications of Coats disease in 150 cases: The 2000 Sanford Gifford Memorial Lecture. Am J Ophthalmol. 2001 May; 131(5): 561-71. 3. Shields J, Shields C, Honavar S, Demirci H, Cater J. Classification and management of Coats disease: The 2000 Proctor Lecture. Am J Ophthalmol. 2001 May; 131(5): 572-83. 4. Hu Z, Gao R, Jin C, Liang X, Zhang S. Photocoagulation and scleral cryotherapy for Coats disease. Yan Ke Xue Bao. 1996 Dec; 12(4): 199-201. 5. Mosin I, Moshetova L. Tactics of treating children with Coats disease. Vestn Oftalmol. 2002 Mar-Apr; 118(2): 11-5.
- Síndromes restritivos: síndrome de Duane e síndrome de BrownPublication . Mota, M; Santos, C; Ramalho, M; Pedrosa, C; Coutinho, I; Silva, D; Lopes, S; Pinto, S; Santos, MJDescrição e caracterização do Síndrome de Duane e do Síndrome de Brown. Manifestações clínicas e tratamento aconselhado nestes dois síndromes
- Toxina botulínica: aplicações em oftalmologiaPublication . Pedrosa, C; Pina, S; Santos, C; Ramalho, M; Coutinho, I; Prieto, I; Santos, MJ; Pinto, SApresenta-se resumidamente as características e modo de preparação da toxina botulínica para utilização médica e as diversas aplicações da toxina botulínica em oftalmologia.
- Unilateral leukemic infiltration and acute angle closure as the first sign of B-cell acute lymphoblastic leukemia relapsePublication . Silva, D; Mota, M; Bilé, A; Ramalho, M; Pinto, S; Pires, G; Teixeira, S; Prieto, IObjective: Unilateral ocular leukemic infiltration with acute angle closure is an infrequent complication of B-cell acute lymphoblastic leukemia (ALL-B). We present a clinical case of leukemic ocular infiltration as the sole manifestation of ALL-B relapse. Methods: Case description Results: A 15-year-old female with a history of acute lymphoblastic leukemia in remission for 2 years and pulmonary tuberculosis treated in the past year presented with ocular redness and decreased visual acuity in the left eye (LE) with 5 days of evolution. Visual acuity was 20/20 in the right eye (RE) and absence of light perception in the left eye (LE). Biomicroscopy of LE showed a small hypopion, anterior chamber cells 4+, vitreous cells 3+, and a large white mass in the vitreous with associated vitreous hemorrhage in organization. In LE fundoscopy, the vitreous mass occupying most of the vitreous cavity and associated hemorrhage prevented retina visualization. B-scan ultrasound showed a multilobulated mass occupying virtually the entire vitreous cavity with associated choroidal detachment. Forty-eight hours later, she developed acute angle closure of LE with an IOP of 55 mmHg. A flow cytometric analysis of the anterior chamber and vitreous showed leukemic tumor cells. The microbiologic exam and PCR for Mycobacterium tuberculosis were negative. No other signs of relapse of the disease were identified after investigation by the oncology department. Rescue treatment of the underlying disease was started, with symptomatic improvement. Conclusion: Leukemic ocular infiltration can be the only manifestation of ALL-B relapse.
- Urinary tract infections under 24 months old: Is it possible to predict the risk of renal scarring?Publication . Miranda, AM; Garcia, C; Bento, V; Pinto, SBackground: Urinary tract infection is one of the most common bacterial infections in the first two years of life and it can lead to irreversible renal scarring. Renal scintigraphy is the gold standard method for detection of renal scars. The aim of our work was to revise the cases of pyelonephritis, detect the possible predictors for renal scarring and compare those results we would have obtained if we had followed current NICE guidelines. Methods: Retrospective analysis of all patients aged under 24 months evaluated in the paediatric department and diag- nosed with pyelonephritis during a three -year period. We excluded the cases in which no renal scintigraphy was performed. Results: Of the 59 children analysed, 50.8% were boys and 86.4% were under one -year old. Escherichia coli was the predominant bacteria. Renal ultrasonography showed abnormal findings in 23 patients (39%). The incidence of renal scarring was 15.3%. Age, atypical urinary tract infection and abnormal renal ultrasonography seem to be correlated with risk of renal scarring, although the results were not statistically significant. C -reactive protein level is significantly correlated with renal scarring risk (p=0.047). Working outside the NICE guidelines allowed us to catch 7 further renal scars. Conclusions: It’s arguable if renal scintigraphy must be performed in all cases of pyelonephritis diagnosed in the first 24 months of life or only when there are other risk factors for renal scarring. Age, atypical urinary tract infection, C -reactive protein level and renal ultrasonography results must be taken into account in the decision to perform renal scintigraphy in a child. More prospective studies with larger cohorts are needed.