Ana Luísa Basílio’s research while affiliated with North Lisbon Hospital Center and other places

Purpose: To compare the 1-year efficacy and safety of the XEN45 Stent (Allergan, Irvine, CA) implantation alone versus combined Xen implantation and phacoemulsification (Phaco-Xen) in patients with medically refractory open-angle glaucoma (mrOAG) at a tertiary center for Ophthalmology in Portugal, reporting the initial experience with XEN nationwide. Methods: Retrospective, comparative, interventional case series of 19 eyes (18 patients) with mrOAG who underwent XEN surgery (isolated or Phaco-Xen) at our institution with at least 12 months of follow-up post-implantation. Outcomes measured at 12-month follow-up included intra-ocular pressure (IOP) reduction and reduction rate (IOP-RR), number of IOP-lowering drugs, and complications. Success was defined as IOP-RR ≥ 20% and IOP < 18 mmHg and > 5 mmHg, with (qualified) or without (complete) need for IOP-lowering drugs, without further procedures for glaucoma including needling. Results: At 12-month post-XEN implantation, there was a statistically significant reduction in median IOP (5,0 mmHg, p-value = 0,050) in the isolated XEN group, but not in the Phaco-Xen group (median IOP reduction 8,0 mmHg, p-value = 0,123). Nevertheless, no statistically significant differences between both patient groups were observed in IOP-RR (p-value = 0,680) drug reduction (p-value = 0,056), number of successful cases (p-value = 0,605), and number of complications (p-value= 0,457). Conclusions: In our study, XEN45 implantation showed good efficacy in medically refractory OAG at 1 year. Combining cataract surgery showed neither added IOP-lowering benefit nor association with inferior success or increased number of complications. Larger, prospective studies are needed to ascertain whether cataract surgery may have an added IOP-lowering benefit in XEN surgery.

Purpose: The authors present a case report of age-related macular degeneration (AMD) and provide a review on the clinical and pathological evidence on outer retinal tubulations (ORT) and the clinical utility of spectral-domain optical coherence tomography imaging (SD-OCT) in the evaluation and follow-up of patients with AMD. Methods: Case report analysis of a 81 year-old female patient with diagnosis of advanced AMD with 4 years of follow-up. Her left eye (OS) had "hand-motion perception" (HM) vision and a disciform scar on fundus examination. Clinical and imaging follow-up was performed using SD-OCT. Results: During the 4 years of follow-up, vision in the patient's OS remained stable, without significant fundus changes by ophthalmoscopy. SD-OCT documented progressive changes in the outer retinal layers, characterized by the "rolling" of the external limiting membrane (ELM) and formation of multiple ORTs in the outer nuclear layer (ONL). These structures showed different temporal and spatial evolution with time. Conclusions: ORTs are a SD-OCT finding that reliably reflects the interesting pathologic process of the latest stages of AMD. They represent a protective gliotic response in macular areas of severe dysfunction and loss of the retinal pigment epithelium (RPE), occurring due to failure of the photoreceptor support system. ORTs are a final, common pathway of retinal neurodegeneration that occurs in a number of disease processes, including AMD. Finally, ORTs have shown to be of prognostic relevance. Outer retinal changes such as ORTs have made OCT imaging and increasingly important tool in the diagnosis and follow-up of patients with AMD.

AIM: To evaluate and compare the quality of life of patients submitted to XEN® implant or trabeculectomy and the relationship with potentially involved variables. METHODS: A cross-sectional study of patients with advanced open-angle glaucoma who underwent implantation of XEN® (group 1) and trabeculectomy (group 2) between October 2015 and February 2017. The studied variables were: age, gender, follow-up time, need of topical anti-hypertensive therapy, visual acuity and intraocular pressure (IOP). The quantification of the quality of life was attained through the Glaucoma Symptom Scale (GSS) questionnaire. RESULTS: Totally 34 eyes (34 patients) were included, 17 in each group. The mean GSS scores for group 1 were 42.6±6.8 (median, 47; p25, 36.5; p75, 48.5) and for group 2 it was 41.6±7.0 (median, 43; p25, 36.5; p75, 47.0; P=0.34). There was a strong negative correlation between the need for topical anti-hypertensive drugs and the GSS result in both groups (r=-0.88, P

Chronic lacrimal canaliculitis is a rare infection of the lacrimal system, and can lead to misdiagnosis due to its overlapping presentation to other common entities. The authors report a case of lacrimal canaliculitis with a three-year history of recurrent unilateral red eye and mucopurulent discharge. Here, we describe the clinical course, surgical details, and microbial analysis of canaliculitis infection.

Purpose: To analyze the area of retinal nonperfusion in branch retinal vein occlusion (BRVO) and its relation to retinal ganglion cell (RGC) layer thickness. Procedures: Patients with ischemic BRVO, with no signs of fluid, were evaluated by Cirrus HD-OCT-A, Zeiss. Nonperfusion findings and RGC layer thickness were evaluated in a 6x6 mm area centered in fovea. Results: 10 eyes (8 patients) were included (mean age of 75.60±12.57years min 60, max 88). Area of ischemia in deep plexus was superior to superficial plexus (p=0.013). There was a strong correlation between ischemic area of superficial and deep plexus (r=0.915; p<0.001) and an important correlation between ischemic area of superficial plexus and area of reduced RGC layer thickness (r=0.661; p=0.038). Conclusions: In ischemic BRVO, deep capillary plexus reveals a greater area of ischemia than superficial plexus. This study suggests that ischemia may cause the decrease of RGC layer thickness. Keywords: BRVO; Capillary plexus; Ischemia; OCT-A; RGC layer thickness

Purpose The differential diagnosis between Irvine‐Gass Syndrome (IGS) and Diabetic Macular Edema (DME) is currently established by angiography, which is an invasive and time‐consuming tool. The aim of this study is to evaluate differences in optic disc's nerve fiber layer thickness (RNFL) in patients with macular edema associated with IGS and Diabetes Mellitus (DM). Methods Retrospective case control study of 28 eyes of 28 patients with macular edema divided into 2 groups. Group 1 included 14 eyes with IGS diagnosed by clinical and angiographic criteria and group 2 included 14 eyes with cystoid diabetic macular edema (DME) without previous ocular surgery. A control group (group 3) of 14 eyes of 14 healthy patients paired by age and gender were also included. Ophthalmologic examinations included visual acuity (VA) measurements, slit‐lamp examination, Goldmann applanation tonometry, Spectral‐Domain Optic Coherence Tomography (SD‐OCT) and fluorescein angiography. Results Forty two patients (21 females and 21 males), with a mean age of 66.57 ± 10.80 years were included in this study. Optic disc nasal and temporal RNFL thicknesses as well as central macular thickness were significantly higher in group 1 and 2 compared with control group (p < 0.05). Nasal RNFL thickness was higher in IGS than in patients with DME (p < 0.001). To detect IGS (Group 1), comparative to DME (Group 2), using Nasal RNFL thickness, the area under the curve was 0.842 p < 0.002. A cut‐off criterion of 82.50 μm resulted in 92.9% sensitivity and 71.4% specificity. Conclusions Optic disc SD‐ OCT imaging might be a useful diagnostic tool to differentiate IGS from DME.

Purpose To establish the efficacy and safety of an Ab Interno Collagen Stent (AICS) in combination with subconjunctival Mitomycin C (MMC) in patients with open angle glaucoma (OAG), in the reduction of intraocular pressure (IOP), hypotensive treatment (HT) and progression on structural retinal nerve fiber layer (RNFL) exams. Methods Prospective, non-randomized study involving 10 eyes with OAG, not controlled by HT, submitted to AICS implantation (Xen Gel Stent, Aquesys, Calif., USA) following subconjuntival MMC, with 6 month of follow-up. Patients were reevaluated on the 1st day, 1st week and at 1st, 3rd and 6th months of follow-up. IOP and bubble dimensions were registered and the need for re-interventions or HT was analyzed. Structural RNFL evaluation was performed at 6 months (Spectralis OCT, Heidelberg Engineering, Heidelb., Germany), and compared to preoperative values. Correlation analysis was made between IOP reduction, bubble dimensions and age. Results Mean IOP values were 21.8 ± 5.87 mmHg, 11.4 ± 4.5 mmHg, 13.2 ± 3.93 mmHg; 18.1 ± 6.9 mmHg, 14.2 ± 3.19 mmHg and 13.7 ± 3.10 mmHg and mean bubble dimensions were 3.1; 2.5; 2.5; 2.5 and 2.6 at 1st day, 1st week and 1st, 3rd and 6th months, respectively. Re-interventions were necessary in 4 cases. IOP reductions compared to preoperative values were statistically significant at all follow-up visits (p < 0.05), except for the 1st post-operative month. There was a statistically significant correlation between bubble dimensions and IOP reduction (p < 0.05; r = −0.788). There was no significant progression of RNFL loss. Hypotensive medication was reduced by 87.5%. No complications were reported. Conclusions The insertion of an Ab Interno Collagen Stent with adjunctive MMC significantly reduced IOP over a 6 months follow-up period without significant complications, notwithstanding a considerable need for re-interventions.

Purpose Hydroxychloroquine has been used for decades in treatment of rheumatic disorders. Macular toxicity is an adverse effect dependent to duration of treatment and daily dosage. Although, the exactly retinal structure under this toxic effect is not yet totally understandable. To study the sectorial effect of Hydroxychloroquine in all retinal layers in 1st, 2nd, 3th and 6th mm centered on fovea by automatic segmentation using Spectral-Domain Optical Coherence Tomography. Methods Retrospective, non-randomized study involving 44 eyes of 44 patients under treatment with Hydroxychloroquine. The authors have created two age-matched groups. A group 1 of patients in treatment duration under 10 years (n = 30) and a group 2 above 10 years of treatment (n = 14). Results The inner retinal layers thickness of 1st and 2nd mm is impaired in group 2 but the results did not showed significant difference between groups. The automatically segmentation of layer by layer did not prove a sectorial defect in inner retina. The thickness of Outer Nuclear Layer (ONL) was impaired in group 2, in opposition to Outer Plexiform Layer (OPL). This analysis has demonstrated a tendency for inversion of ONL and OPL thickness values in both groups. Conclusions The toxicity of Hydroxychloroquine apparently was not responsible for significant alterations in inner retinal thickness. That is a tendency for reduction in ONL thickness. The higher thickness of OPL in group 2 is a surprising aspect that needs additional analysis. The outcomes were very dependent to the limited number of patients in our sample. Further longitudinal studies about this topic will be necessary.

Purpose: The authors aim to present a clinical case of a patient with macular telangiectasia type 2. Method: The patient was treated bilaterally with intravitreal bevacizumab after progression to proliferation. The patient was initially screened at the retina department for diminished visual acuity and suspicion of central serous coroidopathy. At observation best corrected visual acuity was OD 0.3 LogMAR and OS 0.1 LogMAR and bilateral macular telangiectasia was present. Results: Initial fluoresceinic angiography and OCT documented non-proliferative macular telangiectasia. During 3 years of follow-up visual acuities and angiographies remained relatively stable. After this period there was a progression to proliferation. In the right eye there was an extensive retinal hemorrhage. Visual acuities were then reduced to OD 1.0 LogMAR and OS 0.5 LogMAR. Treatment with intravitreal bevacizumab (OD 2 injections and OS 3 injections) induced an increase in visual acuities (OD 0.5 LogMAR and OS 0.4 LogMAR) correlated with better structural outcomes in OCT and angiography. Conclusion: Treatment with intravitreal bevacizumab in a treat as needed scheme appears to be effective in patients with macular telangiectasia type 2. Security and efficacy of this treatment with anti-VEGF agents needs to be further studied.