Maria Reina’s research while affiliated with North Lisbon Hospital Center and other places

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

Purpose The aim of this study was to evaluate and compare macroscopic and microscopic morphological features of functioning filtering blebs after XEN Gel Stent (XEN) implantation and trabeculectomy. Methods Prospective, observational case-control study of 10 eyes submitted to XEN implantation, 10 eyes submitted to trabeculectomy and 11 control eyes treated medically. A complete ophthalmological examination was performed, including Goldmann applanation tonometry, slit-lamp examination, anterior segment photography and in vivo confocal microscopy (IVCM – Heidelberg Retina Tomograph II, Rostock Cornea Module). Photographs were analyzed with Moorfields bleb grading system classification. The IVCM images were analyzed for the density of intraepithelial microcysts, the density of subepithelial connective tissue, the number, diameter and tortuousity of blood vessels and the presence of inflammatory cells. The examinations were performed from 6 to 16 months postoperatively and only blebs resulting from a surgery with total success were included (Intraocular pressure <21 mmHg without therapy). Results The analyze of anterior segment photographs didn't showed diferences between blebs's features after XEN implantation and trabeculectomy. The IVCM showed an increase in the density of intraepithelial microcysts and subepithelial connective tissue in XEN and trabeculectomy blebs comparing with the controls (p < 0.05). All morphological findings were similar when comparing the group of XEN and trabeculectomy blebs. Conclusions Functioning blebs after XEN implantation showed similar features comparing with functioning blebs after trabeculectomy. Further longitudinal studies are needed to increase the postsurgery understanding and management of filtering blebs.

Purpose: Plateau iris configuration (PIC) is a rare condition involving an angle closure unrelated to pupillary block. It may be defined by a narrow angle and a double-hump configuration on gonioscopy. Plateau iris syndrome (PIS) may lead to acute angle-closure glaucoma due to an anterior displacement and rotation of the ciliary body. It has been proposed that ultrasound biomicroscopy (UBM) is helpful in PIC/PIS diagnosis. Our work aims to describe UBM quantitative and qualitative findings in patients whose gonioscopy suggested a PIC/PIS Methods: Cross-sectional study involving patients with a double hump gonioscopic finding. UBM was then performed by a blinded observer and evaluated for the presence of following ultrasonographic (US) criteria: (1) a thick and flat iris, (2) a sharp, square root angulation on its insertion, (3) an anterior rotation of the ciliary body, (4) irido-ciliary sulcus narrowing, (5) iris-trabecular apposition and (6) a relatively normal anterior chamber (AC) depth. Only high-quality images were accepted Results: From September 14 to May 15, 35 patients (59 eyes) were recruited. Only 3 eyes presented the six US criteria, 23 eyes filled five of the criteria, 13 satisfied four criteria, 16 presented three criteria and 4 two criteria. The most commonly verified criteria (over 95% of them) were a thick and flat iris and a square root insertion. There was no association between any of these criteria and sex nor age (p > 0.10). Furthermore, the presence/absence of these criteria did not correlate with either anterior chamber depth, lens vault and lens length (p > 0.10) Conclusions: The majority of patients presenting with clinical iris plateau syndrome do not fulfill the entire US criteria for this condition. However, the US-based iris morphological parameters seem to be present in nearly all iris plateau patients.

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.

The aim of the this study was to determine the effect of intravitreal antivascular endothelial growth factor injections on intraocular pressure (IOP) and identify possible risk factors for the development of increased IOP. This prospective study included a total of 106 eyes receiving intravitreal injection of bevacizumab as treatment for macular edema or active choroidal neovascularization. IOP was measured by Goldmann applanation tonometry immediately before the intravitreal injection and 5 min, 1 h and 15 days after the procedure. The records of the study patients were reviewed for age, gender, history of glaucoma, diabetes mellitus, phakic status, systemic and topical medication and number of previous injections. Subconjunctival reflux was registered. IOP elevation was defined as IOP ≥21 mm Hg and/or a change from baseline of ≥5 mm Hg recorded at least on two or more measurements on the same visit. Mean preoperative IOP was 15.31 ± 3.90 mm Hg and postoperative IOP values were 27.27 ± 11.87 mm Hg (after 5 min), 17.59 ± 6.24 mm Hg (after 1 h) and 16.86 ± 3.62 mm Hg (after 15 days). The IOP variation was statistically significant between pre- and postoperative measurements (p < 0.05). Subconjunctival reflux was recorded in 11.3%, and in this subgroup the IOP at 5 min and at 1 h was lower than preoperative IOP (p < 0.05). More than one third of the eyes achieved IOPs >30 mm Hg 5 min after injection. Subconjunctival reflux contributed to a lower mean postoperative IOP (p < 0.05). Considerations for the management include prophylactic IOP lowering with medical therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to an as-needed injection protocol in patients suffering a marked IOP rise in previous injections. © 2015 S. Karger AG, Basel.

Purpose To evaluate macroscopic and microscopic morphological features of filtering blebs after trabeculectomy with Mitomycin C (MMC) or 5‐Fluorouracil (5‐FU) and correlate them with function. Methods Retrospective case control study of 28 eyes (21 patients) submitted to trabeculectomy (15 with MMC and 13 with 5‐FU) and 11 eyes (10 patients) treated medically. Ophthalmologic examinations included Goldmann applanation tonometry, slit‐lamp examination and photography (Moorfields bleb grading system classification) and in vivo confocal microscopy (Heidelberg Retina Tomograph II, Rostock Cornea Module). Eyes were classified into 3 groups: control, functioning blebs (Intraocular pressure (PIO)<21mmHg without therapy) and nonfunctioning blebs (PIO<21mmHg with therapy or ≥21mmHg). Results Biomicroscopically, functioning blebs, in comparison to nonfunctioning blebs, showed a significant increase in the central (p=0,009) and maximal (p=0,017) bleb area and a decrease in central (p=0,021) and maximal (p=0,028) bleb vascularization. When comparing successful with failed blebs, in vivo confocal microscopic showed a significant increased number of epithelial microcysts (p=0,014), a liquid content of epithelial microcysts (p=0,008), a lower density of stromal connective tissue (p=0,039) and a decreased number (p=0,041) and diameter (p=0,045) of the vessels. All morphological findings were similar when comparing the usage of MMC with the usage of 5‐FU (p>0,05). Conclusion This study suggests that both biomicroscopy and in vivo confocal microscopy findings can lead to a better understanding and management of filtering blebs.

Purpose: To describe the technique of deep sclerectomy with the new Esnoper-Clip® implant, the clinical outcome and the anatomic characteristics of filtering blebs, using anterior segment optical coherence tomography (AS-OCT). Methods: A prospective case-series study was conducted in five eyes (5 patients) with open angle glaucoma. The fornix-based deep sclerectomy with Esnoper-Clip® implant was done by the same surgeon. In one case, mitomycin C was used during surgery. All participants underwent a complete ophthalmic examination and AS-OCT (Visante®) preoperatively, then at each follow-up visit, at 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. Scans were obtained through sagittal and transversal plans to the implant. Results: Intraocular pressure (IOP) was significantly reduced (p < 0.05) from a mean preoperative value of 23.4 ± 8.6 mm Hg (n = 3.8 glaucoma medications) to a postoperative value of 6.0 ± 2.5 (n = 0), 10.6 ± 5.4 (n = 0), 13 ± 1.6 (n = 0.4), 12.4 ± 2.1 (n = 0.2) and 14.4 ± 1.5 (n = 0.2) at 1 day, 1 week, 1 month, 6 months and 1 year respectively. AS-OCT allowed the visualization of the two plates of the implant (scleral and suprasciliary), the trabeculodescemetic membrane and the hyporeflective spaces in the bleb wall thickness and in suprascleral and suprachoroidal localizations. An immediate postoperative hypotony and an anteriorization of the implant associated to trabeculodescemetic membrane rupture, were detected, although without significant clinical repercussions. Conclusion: Our first five deep sclerectomy with Esnoper-Clip implantation analysis suggest an effective and well-tolerated method to reduce IOP. AS-OCT is a noninvasive imaging technique that allows the anatomic analysis of the drainage mechanisms after glaucoma surgery. How to cite this article: Vieira L, Noronha M, Lemos V, Reina M, Gomes T. Anterior Segment Optical Coherence Tomography Imaging of Filtering Blebs after Deep Sclerectomy with Esnoper-Clip Implant: One-year Follow-up. J Curr Glaucoma Pract 2014;8(3):91-95.

Purpose: To compare structural optic disc evaluations performed by optic coherence tomography (OCT) and confocal microscopy (HRT). Structural evaluations were also compared to functional damage using static perimetry (SP). Methods: The authors present a retrospective study of 90 patients with glaucoma. Structural evaluation was performed with OCT (SPECTRALIS® - Heidelberg Engineering GmbH) and HRT (HRT3® Heidelberg Engineering GmbH) and functional evaluation with the mean defect determined by SP (Octopus Perimetry®, Haag-Streit). Disc area, cup area, rim area, cup/disc area ratio, rim/disc area ratio, cup volume, rim volume, mean cup depth, maximum cup depth and average retinal nerve fiber layer (RNFL) thickness were obtained with HRT. OCT was used to establish average RNFL thickness and thickness by quadrant. Results: Patients were in average 60.4±12.6 years old and 52.2% were men. Average RNFL evaluated by OCT and HRT was positively correlated (r=0.476). This correlation was stronger in the superior temporal area (r=0.485) and weaker in the nasal area (r=0.284). Average RNFL determined by OCT was negatively correlated with cup/disc area ratio (r=-0.485), cup area (r=-0.360), cup volume (r=-0.256) and positively correlated with rim/disc area ratio (r=0.560), rim area (r=0.556), rim volume (r=0.546) evaluated with HRT. MD was also negatively correlated with RNFL thickness. This correlation was stronger when thickness was determined by OCT (r=-0.643) and weaker when determined by HRT (r=-0.385). All correlations were statistically significant. Conclusions: Structural damage documented by OCT and HRT is similar and is usually associated with functional damage. Therefore, early detection of optic disc and RNFL structural damage is extremely useful and can be determined by both methods. OCT appears to be more accurate in predicting functional damage.