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Tomas Loureiro,1 Sandra Rodrigues-Barros,1 Ana Rita Carreira,1 Filipe Gouveia-Moraes,1 Pedro Carreira,1 Ana Vide Escada,1 Paul Campos,1 Ines Machado,1 Nuno Campos,1 Renato Ambrosio Jr,2 Timothy J Archer,3 Dan Z Reinstein3 1Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal; 2Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; 3London Vision Clinic, London, UKCorrespondence: Tomas Loureiro, Ophthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, Portugal, Tel +351 913 513 175, Email loureiro.tomas@gmail.comPurpose: To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED).Methods: This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value < 0.05.Results: The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p< 0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p< 0.01) and lower TMH (211.2 ± 68.4 μm vs 217.2 ± 60.1μm; p< 0.01) than the control group, whereas SICCA OSS and OSDI were higher (p< 0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 μm vs 43.1± 2.3 μm, p< 0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p< 0.01), and superior epithelium thickened (p< 0.01) in the SS-DED group.Conclusion: Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.Keywords: dry eye disease, Sjogren’s syndrome, epithelial thickness, AS-OCT

Tomás Loureiro,1 Sandra Rodrigues-Barros,1 Ana Rita Carreira,1 Filipe Gouveia-Moraes,1 Pedro Carreira,1 Ana Vide Escada,1 Paul Campos,1 Inês Machado,1 Nuno Campos,1 Timothy J Archer,2 Dan Z Reinstein,2 Renato Ambrósio Jr3 1Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal; 2London Vision Clinic, London, UK; 3Federal University of the State of Rio de Janeiro, Rio de Janeiro, BrazilCorrespondence: Tomás Loureiro, Ophthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, Portugal, Tel +35 1 913 513 175, Email loureiro.tomas@gmail.comPurpose: To evaluate the effect of eye rubbing on the epithelial thickness profile in tomographically normal corneas by AS-OCT and to compare right and left eyes in right-handed children.Methods: Thirty right-handed boys (mean age 11.2 years) with ocular allergy and history of eye rubbing were evaluated using Scheimpflug (Pentacam HR, Oculus Wetzlar, Germany) and anterior segment optical coherence tomography. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared between right and left eyes with a non-parametric Mann–Whitney test. A p-value lower than 0.05 was considered for statistical significance.Results: No eyes had topometric nor tomographic criteria for keratoconus. The min-max ET was lower in right eyes (− 2.8 μm vs − 3.5; p = 0.02). The difference between inferior and superior (I-S) octants was lower in right eyes (1.1 μm vs 1.9 μm; p = 0.03) as a result of inferotemporal thinning. The highest ET difference was registered between nasal and temporal octants and was more pronounced in the right eyes (2 μm vs 3.1 μm; p < 0.001).Conclusion: AS-OCT analyses reveal different epithelial thickness patterns between the eyes in young atopic patients, likely eye rubbers. Inferior and temporal epithelial thickness seem to be more affected by thinning in the eye on the side of the dominant hand.Keywords: eye rubbing, keratoconus, epithelial thickness, AS-OCT, pediatrics

INTRODUCTION: Retinopathy is the most frequent ophthalmological manifestation of sickle cell disease (SCD). Advances in retinal multimodal imaging have revealed the presence of retinopathy in asymptomatic patients. The present study aims to characterize the typical retinal changes by multimodal imaging in a pediatric population with SCD, allowing the non-invasive observation of the vascular effects of the disease. MATERIAL AND METHODS: Observational study that included children diagnosed with SCD referred from the Pediatric Hematology consultation at Hospital Garcia de Orta. The evaluation consisted of a complete ophthalmologic evaluation and multimodal imaging: wide-field fundus photography (Zeiss CLARUS 700), optical coherence tomography (OCT) and OCT- angiography (OCT-A) (Zeiss Cirrus HD-OCT 5000), with particular interest in the assessment of the vascular zone area and superficial macular vascular flow and density. RESULTS: Our study included 28 children with SCD, mean age 12.33 ± 3.19 years, 16 (57%) female and 12 (43%) male. The most frequent genotype was SS (26 patients). Of the 56 eyes evalu- ated, 20 (36%) had non-proliferative retinopathy and 1 (1.8%) had proliferative retinopathy. The most frequently detected retinal change was the sunburst lesion (9 eyes, 16%). Also noteworthy is the presence of dark without pressure lesions in 4 eyes (2%). There was a statistically significant difference (p, INTRODUÇÃO : A retinopatia é a manifestação oftalmológica mais frequente da doença de células falciformes (DCF). Os avanços em imagem multimodal retiniana têm revelado a presença de retinopatia em doentes assintomáticos. O presente estudo tem como objetivo caracterizar as alterações retinianas típicas por imagem multimodal numa população pediátrica com DCF, permitindo observar os efeitos vasculares da doença de modo não invasivo. MATERIAL E MÉTODOS: Estudo observacional que incluiu crianças com o diagnóstico de DCF referenciadas da consulta de Hematologia Pediátrica do Hospital Garcia de Orta. A avaliação consistiu numa avaliação oftalmológica completa e imagem multimodal: retinografia de campo alargado (Zeiss CLARUS 700), tomografia de coerência ótica (OCT) e OCT-angiografia (OCT-A) (Zeiss Cirrus HD-OCT 5000), com particular interesse na avaliação da área de zona avascular e da densidade e fluxo vascular macular superficial. RESULTADOS: O nosso estudo incluiu 28 crianças com DCF, com idade média de 12,33 ± 3,19 anos, 16 (57%) do sexo feminino e 12 (43%) do sexo masculino. O genótipo mais frequente foi o SS (26 doentes). Dos 56 olhos avaliados, 20 (36%) apresentaram retinopatia não proliferativa e 1 (1,8%) apresentava retinopatia proliferativa. A alteração retiniana mais frequentemente detetada foi a lesão sunburst (9 olhos, 16%). Destaca-se ainda a presença de lesões dark without pressure em 4 olhos (2%). Verificou-se uma diferença estatisticamente significativa (p

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

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

Background: To evaluate retinal morphological and vascular parameters in patients recently diagnosed with obstructive sleep apnea syndrome (OSAS) and determine the correlation between retinal vascular density and the severity of OSAS.Methods: We performed a retrospective study on the retinal vasculature of patients with OSAS and age-match healthy controls. OSAS was confirmed by full-night cardiorespiratory polygraphy. Patients were divided into three groups according to disease severity given by apnea-hypopnea index (AHI) i.e., mild, moderate or severe. Retinal thicknesses and vascular density were compared between groups, for both the macula and optic disc. Correlation between vascular density and clinical features were also assessed.Results: The study included 30 eyes of patients with OSAS and 12 controls. No differences were found regarding retinal thickness in both the macula and the optic disc between OSAS patients and controls. In contrast significant differences were found in the peripapillary vessel density between groups versus control patients. The greatest difference being between severe OSAS and controls (49.4% ± 2.1 versus 40.4% ± 4.2 respectively, p=0.01). Peripapillary vessel density was found to significantly and negatively correlate with AHI (p=0.02; r= -0.74) and directly correlate with the lowest percutaneous oxygen saturation (p=0.02; r= 0.58).Conclusions: This study indicates that OSAS is associated with retinal microvasculature impairment, that seems to mainly affect the optic disc. This suggests that microvascular damage increases with the increasing severity of OSAS. As such prospective trials are needed to clarify if this vascular peripapillary damage precedes glaucomatous optic neuropathy in OSAS patients.

Apresentamos um caso clínico de hipertensão intracraniana (HIC) numa criança com síndrome de Turner sob tratamento com hormona do crescimento (HC). Criança de 14 anos com síndrome de Turner sob terapêutica hormonal com estrogénio e hormona de crescimento (1,6 mg/dia) apresentou-se no serviço de urgência por diminuição da acuidade visual. A fundoscopia revelou edema bilateral da papila, confirmada por tomografia de coerência ótica (OCT). A tomografia computorizada e a ressonância magnética cerebrais não revelaram quaisquer alterações. A criança foi referenciada ao departamento de Neuropediatria. Realizou-se punção lombar que revelou aumento da pressão intracraniana e, desta forma, fez-se o diagnóstico de HIC. Optou-se pela suspensão da hormona do crescimento. A hipertensão intracraniana é uma entidade rara na população pediátrica. Há uma relação causal entre o HIC, o tratamento com hormona do crescimento e a síndrome de Turner. Do nosso conhecimento, é o primeiro caso em Portugal que descreve esta associação. Dado que a HIC pode levar a perda irreversível da acuidade visual, todas as crianças sob terapêutica hormonal com hormona do crescimento devem ser avaliadas de forma rotineira por oftalmologista., Revista Sociedade Portuguesa de Oftalmologia, Vol. 45 N.º 2 (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

Background/objectives: Continuous subcutaneous insulin infusion (CSII) is a treatment for type 1 diabetes that improves metabolic control and reduces micro and macrovascular complications. The aim of this study was to compare the effect of CSII versus traditional multiple daily injections (MDI) therapy on retinal vasculature. Methods: We performed a prospective study with type 1 diabetic patients with no prior history of ocular pathology other than mild diabetic retinopathy. The patients were divided into two groups according to their therapeutic modality (CSII vs MDI). The retinal nerve fiber layers thickness and vascular densities were compared between groups in both macula and optic disc. The correlations between vascular density and clinical features were also determined. Statistical significance was defined as p Results: The study included 52 eyes, 28 in the insulin CSII group. The mean age was 36.66 ± 12.97 years, with no difference between groups ( p = 0.49). The mean glycated hemoglobin (HbA1c) was found to be lower in the CSII group (7.1% ± 0.7 vs 7.5% ± 0.7 p Conclusion: We found that CSII provided better metabolic control than MDI and this seemed to result in higher parafoveal vascular density. As lower vascular density is associated with an increased risk of diabetic retinopathy, these results suggest that CSII could be the safest therapeutic option to prevent retinopathy.

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.

Objectivo: Analisar as características clínicas de um grupo de pacientes com exotropia consecu- tiva ao tratamento cirúrgico de endotropia e os resultados do tratamento cirúrgico da exotropia consecutiva. Materiais e Métodos: Estudo retrospectivo de 9 pacientes submetidos a cirurgia por exotropia consecutiva, após cirurgia de endotropia. Os pacientes sem limitação da adução foram submeti- dos a cirurgia dos rectos externos, nos casos com limitação da adução ou insuficiência de con- vergência, foi realizado a reposição do recto interno afectado. Resultados: A média pré-operatória do exodesvio para longe foi de 24,7 dioptrias prismáticas. Dois pacientes foram submetidos a reposição unilateral do recto interno. Num um paciente foi realizada a reposição bilateral dos rectos internos com avanço unilateral do recto interno. Num outro paciente foi realizado o recuo bilateral dos rectos externos e reposição bilateral dos rectos internos, um foi submetido ao recuo unilateral do recto externo e reposição do recto interno, e um foi submetido a reposição unilateral do recto interno e recuo do recto externo no olho con- tralateral. Outros dois pacientes foram submetidos ao recuo bilateral dos rectos externos, pois não tinham limitação na adução. O intervalo médio entre a primeira intervenção e a cirurgia por exotropia consecutiva foi de 2,2 anos (variação entre 1 mês e os 9 anos). A média pós-operatória do exodesvio para longe foi de 5,3 dioptrias prismáticas. O alinhamento satisfatório (≤ 10 diop- trias prismáticas, para perto e para longe) foi alcançado em 6 pacientes (média de 66,7%) um ano após a intervenção. Conclusão: O tipo de cirurgia efectuada no tratamento da endotropia, e a presença de limitação de adução ou insuficiência de convergência, são muito importantes para melhor escolher a estra- tégia operatória da exotropia consecutiva., Revista Sociedade Portuguesa de Oftalmologia, Vol. 38 N.º 1 (2014)

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina Diabetes mellitus is a chronic disease characterized by the presence of high blood sugar levels over a prolonged period. The increasing prevalence of diabetes mellitus in Portuguese population influences morbidity and mortality of the patients, causing chronic complications in several organs of the body. The diabetic nephropathy corresponds to a diabetes complication and is primarily responsible for chronic kidney disease and end-stage kidney disease.In diabetic nephropathy the first sign of renal problems is the presence of albuminuria. It is recognized that the control and treatment of glycaemia levels is critical to prevent the disease progression and in case there are already complications it is essential to delay renal failure and the need to replacement treatment (dialysis and/or renal transplantation).According to Kidney Disease Improving Global Outcomes (KDIGO), chronic kidney disease corresponds to the presence of renal structural or functional alterations maintained for at least three months that causes implications on the individual’s health. It presents five stages, which are classified depending on the glomerular filtration rate and the albuminuria. The purpose of this work is based on literature data, to realize a revision about oral hypoglycemic agents and insulin used on high blood sugar levels treatments limited to type 2 diabetes mellitus and chronic kidney disease, according to the effects of renal clearance on the pharmacokinetics and pharmacodynamics of these therapeutics, the chronic kidney disease stage and the effects of the therapeutic. A diabetes mellitus (DM) é uma doença crónica caraterizada pela presença de hiperglicemia mantida durante um período de tempo prolongado. Esta apresenta uma prevalência crescente na população portuguesa e tem um impacto negativo na morbilidade e mortalidade dos doentes, causando complicações crónicas em vários órgãos do organismo. A nefropatia diabética corresponde a uma das complicações da DM, sendo a principal causa de doença renal crónica (DRC) e doença renal terminal (DRT). Na nefropatia diabética (ND) o primeiro sinal de problema renal é a presença de albuminúria, sendo reconhecido que o controlo e tratamento dos níveis de glicemia são fulcrais para impedir a progressão da doença e, em caso de já existirem complicações são essenciais para atrasar a insuficiência renal e a necessidade de recorrer a substituição da sua função pela diálise e/ou transplantação renal. A DRC, segundo a Kidney Disease Improving Global Outcomes (KDIGO), corresponde à presença de alterações da estrutura ou função renais mantidas pelo menos durante três meses, com implicações na saúde do indivíduo. Esta doença apresenta cinco estadios que são classificados consoante a taxa de filtração glomerular (TFG) e a albuminúria.O intuito deste trabalho é realizar a partir dos dados da literatura uma revisão acerca dos fármacos hipoglicemiantes utilizados no tratamento da hiperglicemia circunscrito aos indivíduos com DM tipo 2 e DRC, tendo em conta os efeitos da depuração renal sobre a farmacocinética e a farmacodinâmica destas terapêuticas, o estadio da DRC e os efeitos da própria terapêutica.