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Introduction:To report acase of pressure induced stromal keratopathy (PISK) after phacoemulsification and intraocular lens (IOL) implantation in a patient with ectasia after laser in situ keratomileusis (LASIK) previously treated with femtosecond-assisted intracorneal ring segment (ICRS). Case Report:A 53-year-old man with post-LASIK ectasia in his right (OD), underwent phacoemulsification and intraocular lens implantation two months after ICRS implantation in OD. On the first operative day, the patient complained of decreased visual acuity. His best corrected visual acuity (BCVA) was 20/80, intraocular pressure was 55mmHg and biomicroscopy revealed diffuse interface haze and corneal edema. Anterior segment optical coherence tomography (AS-OCT) showed interface fluid accumulation. Steroid drops were discontinued and anti-hypertensive drops were added. One week after surgery, his BCVA was 20/40, the cornea was totally clear, and AS-OCT showed complete fluid reabsorption. Conclusion:Although PISK usually develops early after LASIK, it can also occur different setting associated with high IOP. This report raises concerns regarding postoperative intraocular hypertension prophylaxis in eyes with previous corneal interface creation, in particular the use of corticosteroids, which are known to trigger PISK development., Introdução:Descrição de um caso clínico respeitante a queratopatia estromal induzida pelo aumento da pressão intraocular (PISK) após facoemulsificação num doente previamente submetido a implante de anel intra-estromal por ectasia pós cirurgia refrativa. Descrição do caso: Doente do sexo masculino de 53 anos com história de ectasia pós LASIK no olho direito, foi submetido a facoemulsificação e implante de lente intraocular dois meses após implante de anel intraestromal. No primeiro dia pós-operatório, apresentava queixas de diminuição da acuidade visual.A melhor acuidade visual corrigida (MAVC) para longe era 20/80, a pressão intraocular (PIO) era 55mmHg e a biomicroscopia revelou edema de córnea e a presença de haze difuso na interface. A tomografia de coerência ótica do segmento anterior (OCT-SA) confirmou a presença de líquido na interface. Os corticoesteróides foram suspensos e foi introduzida medicação anti-hipertensora. Uma semana após a cirurgia, a MAVC melhorou para 20/40, a córnea apresentava-se transparente e o OCT-SA revelou uma completa reabsorção do fluido. Conclusão:Embora a PISK normalmente se apresente no pós-operatório imediato de LASIK, pode ocorrer noutras situações clínicas associadas a elevação da PIO. O presente caso clínico realça a importância da profilaxia dos picos hipertensivos pós-operatórios em olhos com história de cirurgia que envolva a criação de uma interface na córnea, particularmente no que respeita ao uso de corticosteróides que parecem potenciar o desenvolvimento de PISK.&nbsp

Introduction: Our purpose was to evaluate the effect of eye rubbing discontinuation on the epithelial thickness profile by spectral-domain AS-OCT (anterior segment optical coherence tomography) in allergic children with no tomographic sign of corneal ectasia. Methods: Right-handed boys (average age 11.2 years, 8-12 years) with history of eye rubbing and relatively normal Pentacam (Oculus; Wetzlar, Germany) exams were recruited for the study. Patients were evaluated using AS-OCT (Zeiss Cirrus 5000 HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA) at the baseline and after 8 weeks of treatment. Treatment included education to avoid eye rubbing and preservative free 0.25 mg/mL topical ketotifen. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared with paired non-parametric Wilcoxon (signed-ranked) test. A p-value lower than 0.05 was considered for statistical significance. Results: Twenty-five boys completed the protocol. No eyes had tomographic criteria for keratoconus (Belin-Ambrosio Deviation Value < 1.22). Minimum epithelial location moved from the inferotemporal to superotemporal octant after treatment. The differences between minimum and maximum epithelial thickness (-2.8 µm vs -5.2 µm; p, Introdução: O nosso objetivo foi fazer a avaliação do efeito de parar de coçar os olhos no perfil epitelial da córnea através de análise com tomografia de coerância ótica do segmento anterior (AS-OCT) em crianças atópicas sem sinais tomográficos de ectasia. Métodos: Rapazes dextros (idade média 11,2 anos) com hábito de coçar os olhos e tomografia de córnea (Pentacam, Oculus; Wetzlar, Germanh) sem alterações foram incluídos. Foi realizado AS-OCT (Zeiss Cirrus 5000 HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA) na baseline e após 8 semanas de tratamento com cetotifeno tópico sem conservantes (0,25 mg/mL). A espessura epitelial e a espessura total da córnea foram comparadas através de testes não paramétricos emparelhados de Wilcoxon. Um p-value inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Vinte e cinco rapazes completaram o estudo. Nenhum olho apresentou critérios tomográficos de ectasia (Belin-Ambrosio Deviation Value < 1,22). A espessura epitelial mínima deslocou-se da região inferotemporal para a região inferotemporal após o tratamento. As diferenças entre a espessura epitelial minima e máxima (-2,8 µm vs -5,2 µm; p

Introduction: Our purpose was to evaluate the effect of eye rubbing discontinuation on the epithelial thickness profile by spectral-domain AS-OCT (anterior segment optical coherence tomography) in allergic children with no tomographic sign of corneal ectasia. Methods: Right-handed boys (average age 11.2 years, 8-12 years) with history of eye rubbing and relatively normal Pentacam (Oculus; Wetzlar, Germany) exams were recruited for the study. Patients were evaluated using AS-OCT (Zeiss Cirrus 5000 HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA) at the baseline and after 8 weeks of treatment. Treatment included education to avoid eye rubbing and preservative free 0.25 mg/mL topical ketotifen. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared with paired non-parametric Wilcoxon (signed-ranked) test. A p-value lower than 0.05 was considered for statistical significance. Results: Twenty-five boys completed the protocol. No eyes had tomographic criteria for keratoconus (Belin-Ambrosio Deviation Value < 1.22). Minimum epithelial location moved from the inferotemporal to superotemporal octant after treatment. The differences between minimum and maximum epithelial thickness (-2.8 ��m vs -5.2 ��m; p, Revista Sociedade Portuguesa de Oftalmologia, Vol. 45 N.�� 4 (2021)

Tomás de Oliveira Loureiro, Sandra Rodrigues-Barros, Diogo Lopes, Ana Rita Carreira, Filipe Gouveia-Moraes, Ana Vide-Escada, Nuno Patricio Campos Ophthalmology Department, Hospital Garcia de Orta, Almada, PortugalCorrespondence: Tomás de Oliveira LoureiroOphthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, PortugalTel +351 913 513 175Email loureiro.tomas@gmail.comIntroduction and Objective: To evaluate corneal epithelial thickness (ET) and corneal thickness (CT) profiles in healthy eyes of Portuguese children and provide information to establish the first normative Caucasian database for these age group.Methods: Sixty healthy eyes of 60 children aged between 8 and 18 were evaluated using the Cirrus high-definition optical coherence tomography device. The average ET and CT were assessed using Cirrus Review Software with predefined concentric corneal ring-shaped zones. Specific regions of ET (central, superior, inferior, temporal, nasal, superonasal, inferotemporal, superotemporal and inferonasal) were also assessed. The mean ET, the mean CT and the difference of ET in corresponding octants were compared by gender. Correlations between central epithelial thickness (CET), age and refractive error were evaluated.Results and Discussion: The average ET was lower in the peripheric zones, whereas the average CT was higher. ET was thinner in the superior area than in the inferior (p< 0.05). ET was thicker in boys than in girls (p< 0.05), but CT did not differ. CET was not correlated with older age or refractive error.Conclusion: Optical coherence tomography analysis of ET reveals that it is thinner in the periphery, where the CT is thicker. Unlike CT, ET seems to be influenced by gender. ET profile proved to be a useful tool in keratoconus diagnosis and subclinical keratoconus detection in adults. As epithelial changes occur early in the disease and keratoconus is more aggressive in pediatric population, a normative database of ET profile could contribute to enhance early recognition of the disease in this age group.Keywords: epithelial thickness, AS-OCT, keratoconus, children

Purpose: To assess long-term vascular density measured by optical coherence tomography angiography (OCT-A) in former preterm children with history of retinopathy of prematurity (ROP) with and without need of laser treatment. Methods: This observational study included former preterm children that developed ROP stage 2 or 3. Infants were divided in two groups according to previous need of laser treatment, and underwent a complete ophthalmologic evaluation, including assessment of macular morphologic and vascular parameters by OCT-A. Results: Fifteen eyes were included in group 1 (laser-requiring ROP) and 19 in group 2 (non-treated ROP). Group 1 had lower mean gestational age and birth weight values than group 2 ( p −1, p = 0.05; 13.74 ± 1.00 vs 15.86 ± 0.64 mm−1, p = 0.05; respectively), and lower avascular zone circularity (0.58 ± 0.06 vs 0.76 ± 0.02, p Conclusion: Laser-requiring ROP seems to result in a decrease of long-term BCVA, which is at least partially attributed to a decrease in superficial macular vascular density. However, prematurity degree was more pronounced in children that required treatment, which might have influenced our results.

Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective study. 64 eyes of 60 patients who underwent cyclophotocoagulation between January 2008 and March 2014. Evaluation of the pre- and post-operative intraocular pressure, the control of ocular pain, the number of anti-glaucoma drugs used in pre- and post-intervention, the rate of complications and the success rate. Results: There was an overall success rate of 81.3%, with 9 eyes needing a second intervention. There was a mean reduction of 52.6% of the preoperative mean intraocular pressure of 41.25 to 19.56 mmHg at 12 months observation (p < 0.001). There was also a statistically significant reduction in the number of anti-glaucoma drugs used from 3.19 to 2.01 per eye and the resolution of pain in 75% of patients. Conclusions: cyclophotocoagulation is an effective procedure, with an expected positive impact on quality of life of patients as a result from the decreased number of anti-glaucoma drugs, sustained intraocular pressure reduction and resolution of pain.

Purpose To show that Straatsma Syndrome can have a good outcome and to highlight an unusual presentation of this disease. Observations A four-year-old boy presents with severe right eye amblyopia in association with high myopia, esotropia, heterochromia iridum and extensive myelinated retinal fibers involving both temporal arcades and the optic nerve head. Right eye initial visual acuity was less than 20/400 for distance and less than R6W10 for near. Left eye examination was unremarkable. Despite the indicators for bad prognosis, intensive occlusion therapy was prescribed. Parents were strongly involved in the treatment regimen. After four months, the patient presented an unexpected good visual recovery both for distance and near, that has persisted until present. Right eye visual acuity is 20/30 with −9.00 dioptres contact lens for distance and R2W1 for near. Esotropia also improved to 12 prism dioptres. Fundoscopic alterations and heterochromia iridum have remained stable. Spectral-domain optical coherence tomography images of the right eye showed thinner superior outer ring measurements. Conclusions and importance Straatsma Syndrome can present with heterochromia iridum. When strabismus is present, early surgery should be withheld. Intensive treatment of Straatsma Syndrome can yield an unexpected good result, despite initial high degree anisometropia and low vision acuity.