Browsing by Author "Prieto, I"
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- Aneis intraestromais –intacts®- a nossa experiência no tratamento do queratoconePublication . Coutinho, I; Pêgo, P; Santos, C; Feijóo, B; Vendrell, C; Prieto, IIntrodução: O queratocone é uma ectasia progressiva e não inflamatória da córnea, relativamente comum na prática clinica, e que se manifesta por uma diminuição progressiva da acuidade visual, associada a miopia e astigmatismo miópico irregular de difícil correcção. Os anéis corneanos intraestromais são uma opção terapêutica nos doentes com queratocone, visando melhorar a acuidade visual, a maior tolerância ao uso de lentes de contacto e protelar a necessidade de um transplante de córnea. Os autores apresentam os resultados da sua experiência, nos últimos 3 anos, com o implante de anéis intraestromais INTACS SK® em doentes com queratocone. Material e Métodos: Foram incluídos 21 olhos de 20 doentes submetidos a colocação de segmentos de anéis intraestromais –Intacs SK®-, por técnica manual assistida por vácuo. A técnica cirúrgica consistiu na criação de uma incisão radial no eixo mais curvo, com zona óptica de 7 mm, e criação de túneis por dissecção mecânica sob vácuo. Os critérios de inclusão foram: queratocone moderado a severo com Km<65D, sem compromisso da transparência central da córnea, baixa acuidade visual e/ou intolerância às lentes de contacto e paquimetria superior a 400 micras na área de inserção. Todos os doentes foram submetidos a exame oftalmológico completo e estudo topográfico corneano com Pentacam®. Foram registados os seguintes parâmetros no pré e pós-operatório (3 a 6 meses): melhor acuidade visual corrigida, equivalente esférico, esfera e cilindro, queratometria e paquimetria. Foram ainda registadas as complicações pós-operatórias. Utilizou-se o Teste Paired-samples t-test e o Teste de Wilcoxon para determinar se existia diferença estatisticamente significativa entre o pré e o pós-operatório em relação aos parâmetros analisados, adoptando-se um nível de significância de 5%. Resultados: Foram incluídos 21 olhos de 20 doentes, 9 mulheres e 11 homens. A idade média foi de 33,81 anos, variando entre os 12 e os 70 anos. Para todos os parâmetros analisados encontrou-se uma diferença estatisticamente significativa (p <0,05) entre o pré e o pós-operatório. Após 3 a 6 meses de colocação dos anéis, verificou-se melhoria de acuidade visual em 85,7% dos doentes, com valor médio de 0,5 pré-operatório para 0,3 unidades LogMar pós-operatório. O equivalente esférico médio diminuiu de -7,13 dioptrias pré-operatórias para -4,19 dioptrias pós-operatórias (redução de 2,94 dioptrias) e a queratometria média de 50,44 dioptrias para 48,01 dioptrias (redução de 2,43 dioptrias). Com um tempo máximo de seguimento de 3 anos, os depósitos estéreis no túnel estromal foram a complicação mais frequente no pós-operatório, não se verificando outras complicações como extrusão ou migração do anel, neovascularização ou infecção corneana. Conclusão: O implante de anéis intraestromais INTACS SK® permitiu melhorar a acuidade visual corrigida na grande maioria dos doentes, com redução do equivalente esférico e da queratometria e aumento da regularidade topográfica.
- 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.
- Catarata pediátrica: a nossa experiênciaPublication . Roque, J; Basto, R; Lopes, AS; Silva, D; Pinto, S; Pires, G; Prieto, I
- Cegueira evitável. Vision 2020, The right to Ssght. Parcerias para o desenvolvimentoPublication . Prieto, I; Pedro, J; Gonçalves, S
- 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.
- 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.
- 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.