Search

© 2023 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/), Introduction and importance: Ocular Surface Squamous-cell Neoplasia (OSSN) is an infrequent diagnosis whose clinical suspicion assumes great importance and should not be overlooked. The following case-report aims to describe the diagnosis and treatment of a patient with OSSN whose complaints were mild in comparison to the severity of the disease. The chosen surgical technique was paramount for a disease-free outcome while minimizing the scarring effects of surgical removal. Case presentation: Patient presented mild discomfort right eye and painless persistent hyperaemia. Slit-lamp observation showed a clear diagnosis and lesion's extent evaluated through multimodal imaging. After surgical excision the patient underwent topical ocular treatment with mitomycin-C for a higher margin of safety even before the pathology results were available. Discussion: Ancillary exam technology improvement has allowed a higher margin of safety while determining the extent of OSSN lesions. In the absence of clear diagnostic criteria and guidelines, clinical reasoning and OSSN awareness are critical for timely diagnosis and treatment, as several treatment options are available, allowing an increasing number of patients to be treated non-invasively. In this case-report, we highlight the importance of early-recognition and the reasoning for choosing a combined treatment option with a higher margin of safety. Conclusion: Early recognition and prompt treatment of OSSN lesions is of paramount importance to avoid ocular invasiveness and potentially preclude both ocular and systemic complication. The choice of a combined surgical and medical approach may provide a higher margin of safety for suitable cases. This patient is currently disease-free at 6-month follow-up.

INTRODUCTION: Our purpose was to assess patients with single digit intraocular pressure (IOP) values and drop-free in primary trabeculectomy after using mitomycin C (MMC augmented with intracamerular bevacizumab). MÉTODOS: Retrospective, observational and comparative study. Charts from patients who underwent trabeculectomy and with IOP ≤9 mmHg at the last follow-up were included. Sub-analysis of patients screened between Oct 2015 and Mar 2019, for inclusion criteria of ≤9 mmHg at last follow-up (24 months). RESULTS: From 110 eyes screened in the initial study, 30 had the intended IOP target (MMC only: 11; MMC+bevacizumab: 19; 26% vs 41%, respectively, odds ratio 1.78, 95% IC (0.80 - 4.89), p=0.178). All these low-IOP patients were drop-free in this moment. No systemic adverse events were found and no vision-threatening complications were recorded. CONCLUSION: Adding intracamerular bevacizumab to MMC in trabeculectomy can be particularly useful in low-target IOP surgeries (such as normal tension glaucoma or very advanced glaucomas) comparing with trabeculectomy with MMC alone., INTRODUCTION: O nosso objetivo foi descrever as características dos doentes submetidos a trabeculectomia com mitomicina C (MMC) e bevacizumab intracamerular que obtiveram valoresde pressão intraocular de apenas um dígito sem recurso a medicação antihipertensora. MÉTODOS: Estudo retrospectivo, observacional e comparativo. Subanálise de doentes que realizaram trabeculectomia com MMC e bevacizumab intracamerular entre Outubro de 2015 e Março de 2019, com critério de inclusão de PIO ≤ 9 mmHg no último follow-up (24 meses). RESULTADOS: Dos 110 olhos presentes no primeiro estudo, 30 obtiveram PIO ≤ 9mmHg aos 24 meses: grupo trabeculectomia com MMC: 11 (26%); grupo trabeculectomia com MCM+bevacizumab: 19 (41%), (odds ratio 1,78, 95% IC (0,80 – 4,89), p=0,178). Nenhum doente estava a realizar medicação antihipertensora. Não foram detectados efeitos adversos sistémicos e a taxa de complicações foi baixa. CONCLUSÃO: Adicionar bevacizumab intracamerular à MMC na trabeculectomia pode ser particularmente útil em cirurgias com PIO-alvo baixas (tal como glaucoma normotensional ou muito avançado), comparando com trabeculectomia apenas com MMC.

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Retinopathy of prematurity (ROP) is a retinal vasoproliferative disorder that represents an important cause of childhood visual impairment and blindness. Although oxidative stress has long been implicated in ROP etiology, other prenatal and perinatal factors are also involved. This review focuses on current research involving inflammation and genetic factors in the pathogenesis of ROP. Increasing evidence suggests that perinatal inflammation or infection contributes to ROP pathogenesis. Cytokines and chemokines with a fundamental role in inflammatory responses and that significantly contributing to angiogenesis are analyzed. Microglia cells, the retinal-resident macrophages, are crucial for retinal homeostasis, however, under sustained pathological stimuli release exaggerated amounts of inflammatory mediators and can promote pathological neovascularization. Current modulation of angiogenic cytokines, such as treatment with antibodies to vascular endothelial growth factor (anti-VEGF), has shown efficacy in the treatment of ocular neovascularization; however, some patients are refractory to anti-VEGF agents, suggesting that other angiogenic or anti-angiogenic cytokines need to be identified. Much evidence suggests that genetic factors contribute to the phenotypic variability of ROP. Several studies have implicated the involvement of candidate genes from different signaling pathways in the development of ROP. However, a genetic component with a major impact on ROP has not yet been discovered. Most studies have limitations and did not replicate results. Future research involving bioinformatics, genomics, and proteomics may contribute to finding more genes associated with ROP and may allow discovering better solutions in the management and treatment of ROP., This work was supported by the Laboratório de Genética and the Instituto de Saúde Ambiental (ISAMB) of the Faculdade de Medicina of Universidade de Lisboa and the Instituto de Investigação Científica Bento da Rocha Cabral. The writing of the manuscript was also supported by funds from Fundação para a Ciência e a Tecnologia to ISAMB (ref. UIDB/04295/2020 and UIDP/04295/2020).

Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticoster-oids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients’ vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3–6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6–8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments. publishersversion published

Neurosensory retinal detachment is a rare ocular finding in acute myeloid leukemia. We describe a case of a 25 year-old female with history of acute myeloid leukemia under chemotherapy that was referred to the Ophthalmology Department due to blurred vision and metamorphopsia in the left eye for the last two weeks. On examination, there was an oval, high, paracentral lesion, superior to the macula with adjacent small hemorrhage. She performed macular spectral domain optic coherence tomography that showed macular edema with neurosensory detachment, fluorescein angiography that revealed a multifocal diffusion with hyperfluorescence and indocyanine green hypofluorescent spots suggesting choroidal ischemia. A diagnosis of neurosensorial retinal detachment that revealed a choroidal infiltration was made. The chemotherapy was continued and, one month after, progressive visual improvement was identified. A systemic disease with atypical retinal findings should alert to diagnose extramedullary disease and a multidisciplinary approach is necessary., O descolamento da retina neurosensorial é um achado raro em doentes com diagnóstico de leucemia mielóide aguda. Descrevemos um caso clínico de uma doente com 25 anos de idade, antecedentes pessoais de leucemia mielóide aguda sob quimioterapia, referenciada ao Departamento de Oftalmologia por visão turva e metamorfopsias no olho esquerdo com duas semanas de evolução. Ao exame oftalmológico, o olho direito não apresentou alterações e no olho esquerdo observou-se uma lesão paracentral, elevada, oval, superior à macula com uma pequena hemorragia adjacente. Foram realizados exames complementares de diagnóstico, dos quais se destacam: tomografia de coerência óptica macular com evidência de um descolamento neurosensorial e edema macular, angiografia fluoresceínica que mostrou uma hiperfluorescência com difusão multifocal e angiografia com verde indocianina que demonstrou uma área hipofluorescente sugerindo isquémia coroideia. Foi realizado o diagnóstico de descolamento neurosensorial por infiltração coroideia subjacente. A doente manteve a quimioterapia, após um mês, o descolamento neurosensorial desapareceu e a acuidade visual foi de 20/20. Este caso evidencia uma apresentação ocular rara de uma doença sistémica e demonstra a importância de uma abordagem multidisciplinar.