Teresa Gomes’s research while affiliated with Universidade NOVA de Lisboa 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.

誗AIM: To investigate the changes in spectral domain optical coherence tomography ( SD - OCT ) quantitative and qualitative parameters in a group of patients with age - related macular degeneration ( AMD ) that underwent bevacizumab intravitreal injections (IV). We assessed if one or more of these parameters can be used as prognostic factors of the post treatment visual acuity (VA). 誗METHODS:Totally 66 eyes of 61 patients, with treatment naive AMD, that were treated with at least 3 monthly bevacizumab IV, were retrospectively studied. SD - OCT quantitative [ central foveal thickness ( CFT ), external limiting membrane ( ELM ) and ellipsoid zone ( EZ ) lengths] and qualitative parameters were studied and compared before and after IV. We also tried to establish correlation between these parameters and before / after treatment VA. 誗RESULTS:Mean VA(logMAR), CFT(滋m), ELM length (滋m) and EZ length(滋m) changed from pre-IV values of 0. 62依0. 41, 419. 3依110. 0, 378. 2依377. 2 and 156. 4 依253. 7 to post-IV values of 0. 53 依0. 44, 325. 8 依117. 9, 547. 1 依421. 5 and 173. 1 依207. 1. There was correlation between pre - IV VA and pre-IV CFT (rs = 0. 27), ELM length (rs = - 0. 30) and ELM disruption ( rs = 0. 43 ). There was also correlation between post- IV VA and post- IV ELM length (rs = -0. 40). Post- IV VA showed correlation with pre- IV VA ( rs = 0. 66 ), ELM length ( rs = - 0. 35 ) and ELM disruption (rs = 0. 46). 誗CONCLUSION: In our study group pre - IV VA, ELM length and ELM disruption can be used as post - IV VA prognostic factors.

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.

Introduction: To present an analysis of the automated macular ganglion cell complex measurements in patients with glaucoma and a comparison with structural optic disc evaluations performed by OCT and confocal microscopy (HRT). A comparison of the functional damage with structural evaluation was performed. Methods or Study Design: Retrospective study of 50 eyes of 50 patients with glaucoma followed at our department. Structural evaluation was performed with Optical Coherence Tomography (OCT SPECTRALIS®) with optic disc and macular scans. Ganglion cell layer and inner plexiform layer (GCL+IPL) average thickness and retinal nerve fiber layer (RNFL) thickness were determined. HRT examination was also performed (HRT3® Heidelberg Engineering GmbH) and 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 RNFL thickness were determined. Functional evaluation was performed with the mean defect obtained with SCP. Results: RNFL (OCT and HRT evaluation) and GCL+IPL thickness was significantly reduced when compared with patients without glaucoma (p<0.05). RNFL and GCL+IPL thickness decrease evaluated by OCT and HRT were positively correlated. GCL+IPL thickness measurements where significantly correlated with optic disc morphological evaluations performed with HRT. MD was negatively correlated with RNFL and GCL+IPL thickness. The RNFL and MD correlation was stronger when RNFL thickness evaluation was performed with OCT than with HRT. There was a strong positive functional and structural correlation between the tomographic, confocal and perimetric evaluations. Conclusions: Structural damage evaluated by evaluation of different retinal layers with OCT and optic disc morphology with HRT are similar and closely related to functional damage determined with visual field examinations. Ganglion cell and inner plexiform layer thickness evaluation is a particularly accurate way of predicting early functional damage and its measurement in glaucoma patients seems to be a useful tool in the follow-up of these patients.

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.