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Margarida Ribeiro,1,2,&ast; João Nogueira Freitas,3,&ast; Mário Lima-Fontes,1 Mariana Leuzinger-Dias,1 Marta Inês Silva,1 Joana Araújo,1,4 Sérgio Estrela-Silva,1,4 António Benevides Melo,1,4 João Tavares-Ferreira,1 Flávio Alves,1 João Barbosa-Breda1,4– 6 1Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal; 2Department of Biomedicine – Unit of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Porto, Portugal; 3Faculty of Medicine of the University of Porto, Porto, Portugal; 4Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; 5UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; 6KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium&ast;These authors contributed equally to this workCorrespondence: Margarida Ribeiro, Department of Ophthalmology – Unidade Local de Saúde de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email margarida.ribeiro.guimaraes@gmail.comPurpose: To evaluate the efficacy and safety of transscleral diode cyclophotocoagulation (TSCPC) at 2 years of follow up.Methods: This is a retrospective review of the records of all adult patients who underwent their first TSCPC treatment between 2014 and 2019 at Unidade Local de Saúde de São João, Porto, Portugal. Data regarding intraocular pressure (IOP), best corrected visual acuity, number of IOP-lowering medications, use of oral acetazolamide, retreatments and complications during a 2-year period following TSCPC were registered. The primary outcome was overall success at 2 years, defined as IOP≥ 6 and ≤ 21 mmHg, with at least 20% IOP reduction from baseline, with or without IOP-lowering medications (qualified and complete success, respectively), without the development of phthisis bulbi or loss of light perception due to glaucoma and no further glaucoma procedures except TSCPC retreatment.Results: Ninety-six eyes from 96 patients were included, mean age was 63 (± 14) years. Mean IOP at baseline was 39.1 (± 13.3) mmHg. Mean IOP reduction at 2 years was 18.5 (42.9%) mmHg (± 16.0, min − 16.0, max 56.0) (p < 0.001) and a significant reduction in the number of IOP-lowering medications and use of oral acetazolamide was observed. IOP reduction at 2 years was positively correlated with baseline IOP (r=0.682; p < 0.001). Overall success (including complete and qualified) was achieved in 42 patients (43.8%), with 34 (35.4%) presenting qualified success. Neovascular glaucoma (NVG) was the predominant diagnosis (n = 30, 31.3%), with a higher mean baseline IOP of 46.3 mmHg (± 11.8, min 21.0, max 70.0) and a larger mean IOP reduction at 2 years of 24.7 (51.0%) mmHg (± 16.4, min − 2.0, max 55.0). Thirteen patients (13.5%) developed persistent hypotony, eight of which converted to phthisis bulbi, of which half had NVG.Conclusion: TSCPC can be an effective IOP-lowering procedure, demonstrating a stronger effect when the preoperative IOP is highest. However, there is a wide variability in the effect (specially in eyes with NVG) and some relevant complications, including 8.3% of patients developing phthisis bulbi after 2 years of follow up.Keywords: intraocular pressure, glaucoma, ocular hypotension, transscleral cyclophotocoagulation, neovascular glaucoma, phthisis bulbi

Margarida Ribeiro,1,2,&ast; Cláudia Barbosa,3,&ast; Paulo Correia,3 Luís Torrão,1 Pedro Neves Cardoso,1 Raúl Moreira,1 Fernando Falcão-Reis,1,4 Manuel Falcão,1,4 João Pinheiro-Costa1,2 1Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; 2Department of Biomedicine – Faculty of Medicine of Porto University, Porto, Portugal; 3Faculty of Medicine of Porto University, Porto, Portugal; 4Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal&ast;These authors contributed equally to this workCorrespondence: Margarida Ribeiro, Department of Ophthalmology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernâni Monteiro Porto, 4200-319, Portugal, Email margarida.ribeiro.guimaraes@gmail.comPurpose: We evaluated the Maximum Elevation of Corneal Back Surface adjusted to the same Best Fit Sphere Back (BFSB) between timeline measurements (AdjEleBmax) and the BFSB radius (BFSBR) itself as new tomographic parameters for documentation of ectasia progression and compare them with the most recent and reliable parameters used on keratoconus (KC) progression.Results: We evaluated the performance and the ideal cutoff point of Kmax, D-index, posterior radius of curvature from the 3.0 mm centered on the thinnest point (PRC), EleBmax, BFSBR, and AdjEleBmax as isolated parameters to document KC progression (defined as a significant change in two or more variables), we found a sensitivity of 70%, 82%, 79%, 65%, 51%, and 63% and a specificity of 91%, 98%, 80%, 73%, 80%, and 84% to detect KC progression. The area under the curve (AUC) for each variable was 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, respectively.Conclusion: AdjEleBmax presented a greater specificity, larger AUC, and better performance compared to EleBmax without any adjustment, with similar sensitivity. Although AdjEleBmax and BFSB demonstrated smaller AUC and specificities comparing with Kmax and D-Index, AdjEleBmax still presented a good performance with a reasonable AUC. Since the shape of the posterior surface, more aspheric and curved than the anterior, may facilitate detection of change, we suggest the inclusion of AdjEleBmax in the evaluation of KC progression in conjunction with other variables to increase the reliability of our clinical evaluation and early detection of progression.Keywords: keratoconus, cornea, progression, best fit sphere back, maximum elevation of corneal back surface

Marcos Ribeiro, Kenneth R ChapmanAsthma and Airway Centre, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, CanadaAbstract: Long-acting bronchodilators have been shown to improve multiple clinical outcomes in chronic obstructive pulmonary disease (COPD) including lung function, symptoms, dyspnea, quality of life, and exacerbations. Indacaterol is a novel, inhaled, long-acting β2-agonist providing 24-hour bronchodilation with once-daily dosing. It is currently approved for the maintenance treatment of COPD to be administered as 150 or 300 µg once-daily doses as licensed in many countries and 75 µg as licensed in the US by means of a single-dose dry powder inhaler. The data from clinical development support a favorable safety and tolerability profile within the β2-agonist drug class, with no relevant issues identified. Current evidence indicates that indacaterol is suitable for use as first-line monotherapy in COPD patients with moderate disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II) and beyond that do not require an inhaled corticosteroid (ICS) as per GOLD guidelines, or in combination with an ICS in severe or very severe patients with repeated exacerbations. Data from trials with the novel once-daily β2-agonist, indacaterol, indicate superior bronchodilation and clinical efficacy over twice-daily long-acting β2-agonists and at least equipotent bronchodilation as once-daily tiotropium. Bronchodilators are central in the symptomatic management of COPD. It is likely that once-daily dosing of a bronchodilator would be a significant convenience and probably a compliance-enhancing advantage, leading to improved overall clinical outcomes in patients with COPD.Keywords: indacaterol, onset of action, chronic obstructive pulmonary disease, bronchodilators, once-daily, long-acting β2-agonists