Bárbara Borges’s research while affiliated with North Lisbon Hospital Center and other places

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 Diabetes Mellitus is associated with changes in refractive parameters. Some aspects already studied were the corneal biomechanics and lens thickness. Although, the discussion about anterior chamber angle and depth is still open. The author objective was to analyze and correlate the anterior chamber depth, lens vault and lens thickness with disease duration and metabolic status. Methods Prospective case–control study. The anterior chamber and refractive parameters were studied using the Visante OCT and the differences between diabetic patients with metabolic control and disease stability were determined (group 1), without (group 2) and group‐control (3). The metabolic control is based on HbA1c levels. The cut‐off considered was 7%. Results A total of 64 patients were evaluated (group 1 – n = 21; group 2 – n = 20; group 3 – n = 23). The mean age was 64.32 ± 7.55 years and approximately 5 years of disease duration. In both groups of diabetic patients we found thicker lens, narrow anterior chamber and higher lens vault compared to control group. There was a difference between diabetic groups exists, but it was not statistically significant. Conclusions The anterior chamber angle and lens vault are influenced by the serum glucose levels. Further studies will be necessary to clarify the physiopathology mechanism responsible for the anterior segment modifications.

Purpose Diabetes Mellitus is associated with changes in refractive parameters. Some aspects already studied were the corneal biomechanics and lens thickness. Although, the discussion about anterior chamber angle and depth is still open. The author objective was to analyze and correlate the anterior chamber depth, lens vault and lens thickness with disease duration and metabolic status. Methods Prospective case‐control study. The anterior chamber and refractive parameters were studied using the Visante OCT and the differences between diabetic patients with metabolic control and disease stability were determined (group 1), without (group 2) and group‐control (3). The metabolic control is based on HbA1c levels. The cut‐off considered was 7%. Results A total of 64 patients were evaluated (group 1 – n = 21; group 2 – n = 20; group 3 – n = 23). The mean age was 64.32 ± 7.55 years and approximately 5 years of disease duration. In both groups of diabetic patients we found thicker lens, narrow anterior chamber and higher lens vault compared to control group. There was a difference between diabetic groups exists, but it was not statistically significant. Conclusions The anterior chamber angle and lens vault are influenced by the serum glucose levels. Further studies will be necessary to clarify the physiopathology mechanism responsible for the anterior segment modifications.

Purpose: To determine the frequency of epiretinal membranes (ERM) in eyes with primary open-angle glaucoma subjected to trabeculectomy. Methods: We conducted a retrospective study on patients subjected to trabeculectomy with at least a 6-month follow-up. Ophthalmologic examination and spectral-domain optical coherence tomography (SD-OCT) were analyzed. Eyes with previous surgical or laser treatments or other pathologies (other than glaucoma and ERM) were excluded. Results: A total of 50 eyes (40 patients) were included in this study. The mean follow-up time after surgery was 27.8 months. After surgery, 9 eyes (18%) had preretinal macular fibrosis and 19 eyes (38%) had cellophane macular reflex. Of the 16 eyes with a preoperative macular SD-OCT, 3 (18.8%) developed ERM and 4 (25%) progressed from cellophane macular reflex to preretinal macular fibrosis, after surgery. The ERM frequency did not differ significantly between eyes subjected to trabeculectomy with or without the use of antimetabolites (P=0.08), or between eyes subjected to simple or combined surgery (phacotrabeculectomy) (P=0.09). Conclusion: Trabeculectomy may predispose one to the appearance and progression of ERM. Further studies are needed to clarify this intriguing relation.

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.

Purpose: The authors present a case of a patient with anterior lens subluxation submitted to iris fixated AC IOL implantation after trauma with eyeglasses. Setting: Centro Hospitalar Lisboa Central, Lisbon, Portugal Methods: A 40 years old patient who suffered a penetrating corneoscleral eye injury that was initially sutured developed a traumatic cataract with subluxation of the lens to the anterior chamber. The patient also developed high intraocular pressure that was successfully medicated with topical therapy. After the initial surgery, the lens was removed. A third surgical procedure consisted in a pars plana victrectomy and anterior chamber iris-fixated IOL (Artisan®) implantation. Results: There were no complications during the surgical procedure. Follow-up has been secured for 4 months with periodic anterior segment OCT, anterior segment photography and IOP measurements. No postoperative complications occurred. Conclusions: The technique used combined with a correct timing contributed to a good clinical outcome. Visual recovery was considerable. The implantation of an iris-fixated AC lens is a great option when dealing with this type of patients.

Purpose: The authors present a study of the indications, visual outcomes and complications of 57 eyes of 51 patients submitted to Descemet Stripping Automated Endothelial Keratoplasty. Introduction: The surgical treatment of endothelial disease is now mainly performed with Endotelial Keratoplasty. Fuchs endothelial dystrophy and pseudophakic bullous keratopathy are the two most common indications. The surgical procedure consists in stripping Descemet’s membrane and endothelium from the recipient and joining the donor tissue using an air bubble. Methods: Observational study of 57 eyes of 51 patients submitted to DSAEK from 2011 to 2013 by the same surgical team. Indications, visual acuity progress and complications were analyzed. The outcome dissimilarity between the different indications was studied. A comparison between DSAEK and the combined procedure with phacoemulsification was also done. Results: 63.2% were women. Patients had a mean age of 68±11.27 years. Pseudophakic bullous keratopathy was the indication in 47.4% of the cases, Fuchs endothelial dystrophy in 43.9%, bullous keratopathy after AC IOL implantation in 7.0% and after penetrating keratoplasty in 1.8%. A combined procedure with phacoemulsification and IOL implantation was performed 15.8% of the cases. There were no intraoperative complications. Preoperative average visual acuity was 0.22±0.15 and best postoperative average visual acuity was 0,60±0,23. The postoperative complication rate was 15.8% and included graft failures, dislocations and vitritis. Conclusion: An ample average visual acuity increase was obtained, comparable to those described by other studies with a fast visual recovery associated with less postoperative inflammation. Postoperative complication rate was also within the expected results. In patients with endothelial dysfunction DSAEK is now a secure alternative to penetrating keratoplasty.

Purpose To evaluate the clinical presentation, microbiological results and treatment used in cases of infectious keratitis diagnosed in Centro Hospitalar Lisboa Central (CHLC) between July 2009 and July 2013 Methods Retrospective analysis of data from patients who underwent microbiological examination for suspected infectious keratitis between July 2009 and July 2013 in the CHLC (n=86 patients) Results The most prevalent risk factor was the use of contact lenses. Of the 93 samples taken, 59 (63.4%) were positive for at least one pathogen. A total of 64 microorganisms were isolated with 35 (54.8%) being Gram‐negative, 25 (41.9%) Gram‐positive and 2 (3.2%) fungi. The most prevalent pathogen was Pseudomonas aeruginosa. In two patients, Acanthamoeba cysts were isolated by confocal microscopy. Hospitalization was needed in 64.0% of cases. The treatment of choice was the use of fortified eyedrops of vancomycin and ceftazidime. In seven patients surgical therapy was needed for infection control. Conclusion Our work draws attention to the morbidity associated with this disease and reinforces the importance of conducting microbiological studies in these patients. The main predisposing factor in our population was the use of contact lens, with Gram‐negative microorganisms being isolated in the majority of cases.

Purpose To analyze the ganglion cell complex (GCC) by optical coherence tomography (OCT) in Parkinson´s disease and to correlate it with disease´s severity and duration. Methods We conducted a prospective, case‐control study, in healthy subjects and in patients with Parkinson´s disease (PD). Full ophthalmologic examination, OCT (Spectralis ®) and neurological evaluation were performed. Macular thickness of GCC (retinal ganglion cell layer and inner plexiform layer) were measured after manual segmentation. Results The study included 25 healthy subjects (25 eyes) and 25 patients (25 eyes) with PD. Age and sex did not differ between the two groups. A statistically significant decrease in the thickness of GCC was detected in the PD group compared to control (p<0,05). GCC thickness was inversely correlated with Parkinson´s disease severity and duration. Conclusion The decreased GCC thickness detected in this study goes in favor to the characteristic neurodegeneration of this disease. GCC analysis may contribute to the diagnosis and management of this pathology.