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Ana Maria Cunha,1 João Tiago Loja,2 Luís Torrão,1 Raúl Moreira,1 Dolores Pinheiro,3 Fernando Falcão-Reis,1,4 João Pinheiro-Costa1,5 1Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal; 2Faculty of Medicine, University of Porto, Porto, Portugal; 3Laboratory of Microbiology, Service of Clinical Pathology, Centro Hospitalar Universitário São João, Porto, Portugal; 4Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; 5Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PortugalCorrespondence: Ana Maria CunhaDepartment of Ophthalmology of São João Hospital, Centro Hospitalar de São João, Avenida Prof. Hernâni Monteiro, Porto 4202 – 451, PortugalTel +351 225512100Fax +351 225513669Email ana.cunha.18@gmail.comPurpose: To determine the microbiological profile, risk factors, treatment and surgical intervention rates of fungal keratitis at a tertiary referral centre.Methods: A retrospective review of microbiological and medical records from hospitalised patients treated for fungal keratitis at Centro Hospitalar Universitário de São João from 2009 to 2019 was conducted.Results: Overall, 43 patients were included in our study. The mean age of patients was 63.7 years and 46.5% were men. In culture were isolated 22 (51.2%) filamentous fungi and 21 (48.8%) yeast. Candida species (n = 20, 46.5%), Fusarium species (n = 10, 23.4%) and Aspergillus species (n = 4, 9.3%) were the most common isolated species. Important risk factors were contact lens use (n = 24, 55.8%), long-term users of topical corticosteroids (n = 19, 44.2%) and previous keratitis (n = 19, 44.2%). Yeast isolates had a statistically significant higher prevalence in long-term users of topical corticosteroids compared to filamentous ones (p = 0.043). Twenty-four cases (55.8%) required surgical intervention, of which 23 cases underwent therapeutic penetrating keratoplasty. Ocular complications, such as evisceration was noted in 12 patients (27.9%) and endophthalmitis in 5 (11.6%). No statistically significant changes of best corrected visual acuity (BCVA) were found after treatment (p = 0.687).Conclusion: Most patients with fungal keratitis have associated risk factors. Filamentous and yeast species have equally prevalent etiologies. In general, our results mirror how difficult and challenging the approach and treatment of fungal keratitis could be.Keywords: fungal keratitis, risk factors, medical therapy, penetrating keratoplasty, visual outcomes

Ana Maria Cunha,1 Tiago Sardinha,2 Luís Torrão,1 Raúl Moreira,1 Fernando Falcão-Reis,1,3 João Pinheiro-Costa1,4 1Department of Ophthalmology, Centro Hospitalar De São João, Porto, Portugal; 2Faculty of Medicine, University of Porto, Porto, Portugal; 3Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; 4Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PortugalCorrespondence: Ana Maria CunhaDepartment of OphthalmologyJoão, Centro Hospitalar De São, Avenida Prof. Hernâni Monteiro, 4202 – 451, Porto, PortugalTel +351 225512100Fax +351 225513669Email ana.cunha.18@gmail.comPurpose: To report 2-year outcomes of trans-epithelial accelerated corneal collagen crosslinking (TE-ACXL) procedure in the treatment of progressive keratoconus patients.Patients and Methods: Twenty-four eyes from 24 patients who underwent TE-ACXL (6mW/cm2 for 15 minutes) were included in this retrospective interventional study. Best-corrected visual acuity (BCVA), keratometry values, thinnest corneal thickness (PachyMin) and topometric indexes were analysed preoperatively and at 6-month, 12-month, 18-month and 24-month postoperative. Progression was assessed by increase ≥ 1.00D in maximum keratometry (Kmax); increase ≥ 1.00D in corneal astigmatism; decrease ≥ 2% in PachyMin; increase ≥ 0.42 in D-index.Results: There were no complications during or after TE-ACXL. No significant differences (Δ) were observed between baseline and 12-month or 24-month postoperative: ∆BCVA (− 0.08 ± 0.25, p=0.190; − 0.04 ± 0.17, p=0.588), ∆Kmax (− 0.08 ± 1.32, p=0.792; − 1.04 ± 1.89, p=0.135), ∆Astigmatism (− 0.15 ± 0.89, p=0.485; − 0.24 ± 1.38, p=0.609), ∆PachyMin (− 0.56 ± 15.70, p=0.882; 0.56 ± 18.74, p=0.931), ∆Index Surface Variation (∆ISV) (− 2.11 ± 10.27, p=0.395; − 4.67 ± 17.32, p=0.442), ∆Index Vertical Asymmetry (∆IVA) (− 0.05 ± 0.17, p=0.208; − 0.08 ± 0.26, p=0.397), ∆Index Height Decentration (∆IHD) (0.00 ± 0.02, p=0.368; − 0.01 ± 0.04, p=0.484), ∆KI (0.00 ± 0.05, p=0.851; 0.01 ± 0.06, p=0.877) and ∆D-index (0.15 ± 1.14, p=0.572; 0.06 ± 1.36, p=0.892). Eleven to 33% of patients had disease progression at 24-month postoperative according to the parameters used to determine progression.Conclusion: Although some patients maintain disease progression, TE-ACXL seems to be a safe and effective treatment for keratoconus over the 2-year follow-up period. Studies with longer follow-up periods and larger patient cohorts are recommended.Keywords: cornea, keratoconus, disease progression, transepithelial, cross-linking

Objetivo: As técnicas de Queratoplastia Lamelar (KL) permitem a substituição seletiva das camadas de córnea alteradas. A KL associa-se a menos complicações, menor taxa de rejeição e melhores resultados funcionais. O Centro Hospitalar de São João (CHSJ) iniciou a realização de KL em 2009. O objetivo deste trabalho é avaliar a evolução das técnicas cirúrgicas e principais indicações para transplante de Córnea no CHSJ nos últimos 8 anos. Material e Métodos: Análise retrospetiva de todos os pacientes submetidos a transplante de Córnea no CHSJ entre 2011 e 2018. Foram analisadas variáveis demográficas, indicação cirúrgica e tipo de transplante realizado. Resultados: Foram incluídos 1075 olhos nesta análise. Em 2011, 99,3% dos transplantes realizados foram Queratoplastias Penetrantes (KP). A percentagem de KL foi aumentando progressivamente, especialmente depois de 2015. Em 2017 realizaram-se 25% de KL, e, em 2018, 40,9% dos transplantes realizados foram KL. Em 2018, 23,9% foram Descemet’s stripping automated endothelial keratoplasty (DSAEK), 11,4% Descemet membrane endothelial keratoplasty (DMEK) e 5,7% Deep anterior lamellar keratoplasty (DALK)). As principais indicações cirúrgicas foram a patologia endotelial, queratocone e falência de enxerto prévio. Relativamente às ténicas de KL, as principais indicações cirúrgicas foram a patologia endotelial e queratocone, verificando-se um aumento de transplantes por falência de enxerto prévio. Conclusões: O uso de KL no CHSJ tem aumentado progressivamente em detrimento de KP, principalmente desde 2015. Tendo em conta os bons resultados funcionais e baixo número de complicações, a KL deve ser a primeira opção para o tratamento de patologia lamelar seletiva da córnea., Introduction: Lamellar Keratoplasty (LK) allows the selective replacement of altered corneal layers. It is associated with fewer complications, lower rejection rate and better functional results, when compared with penetrant keratoplasty (PK). LK started to be performed in the Centro Hospitalar São João (CHSJ) in 2009, with significant evolution in the number and techniques performed recently. The objective of this study was to evaluate the evolution of surgical techniques and the main indications for corneal transplantation in CHSJ in the last 8 years. Material and methods: Retrospective analysis of the patients undergoing corneal transplantation in CHSJ between 2011 and 2018. Demographic variables, surgical indication and type of transplantation were analyzed. Results: 1075 eyes were included in this analysis. In 2011, 99.3% of the transplants performed were PK. The percentage of LK increased progressively, especially after 2015. In 2017, 25% of the transplants performed were LK, while in 2018 the percentage was 40.9%. In 2018, 23.9% of the transplants were Descemet's stripping automated endothelial keratoplasty (DSAEK), 11.4% were Descemet membrane endothelial keratoplasty (DMEK) and 5.7% were deep anterior lamellar keratoplasty (DALK)). The main surgical indications were endothelial pathology, keratoconus and previous graft failure. Regarding LK techniques, the main surgical indications were endothelial pathology and keratoconus, with a progressive increase of transplants due to previous graft failure. Conclusions: LK techniques performed in CHSJ have increased progressively, especially since 2015. Given the good functional results and low complication rate, LK should be the first option for the treatment of selective lamellar corneal pathology.

Aim: To evaluate the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents on the development of sustained ocular hypertension (OHT) in patients with neovascular age-related macular degeneration (AMD). Methods: A retrospective study of patients with neo- vascular AMD who received unilateral intravitreal anti-VEGF treatment was performed. Fellow non-injected eyes were used as controls. Initial intraocular pressure (IOP) was measured before the first injection and final IOP was measured 3-4 weeks after the last injection. Eyes that re- quired IOP lowering treatment during follow-up were identified. Results: Seventy-two patients were eligible for the study. Sustained ocular hypertension (OHT) developed in 3 (4.2%) of the injected eyes and in 1 (1.4%) of controls. There was no statistically significant difference be- tween final IOP in the study and control groups. In the study group, patients who received >20 anti-VEGF injections showed a significantly larger variation of IOP during follow-up (p=0.034) Conclusion: Eyes receiving a higher number of injections suffer a significantly larger IOP varia- tion than eyes treated with fewer injections, but larger studies are needed to conclude if treatment with intravitreal anti-VEGF agents increases the risk of developing sustained OHT., Revista Sociedade Portuguesa de Oftalmologia, Vol. 38 N.º 4 (2014)