Trabeculectomy Vs Non-penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes.

Introduction: Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma. Patients and methods: Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication. Results: Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively. Conclusion: Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.

Recurrent macular neurosensory detachment in hypotony maculopathy managed with topical corticosteroids.

A female patient in her late 70s underwent uncomplicated non-penetrating deep sclerectomy surgery. Three years after surgery, she presented with a sudden decrease in visual acuity, intraocular pressure (IOP) of 2 mmHg, macular folding and significant macular subretinal fluid. Assuming hypotony as the cause, topical dexamethasone was started, with complete functional and imagological improvement. Two months after withdrawal, she returned with the same symptoms and imagological findings. The same topical treatment was re-established, with progressive and complete improvement. After 14 months of follow-up and a maintenance dose of topical dexamethasone (1id), the patient remained stable with an IOP of 16 mm Hg. Hypotony maculopathy can, in rare cases, lead to subretinal fluid and neurosensory detachment. Topical corticosteroids can reverse and prevent hypotony in patients who are corticosteroid responsive. In advanced glaucoma, extremely low IOP may be as dangerous as high IOP. Timely normalisation of IOP may restore normal retinal architecture with associated functional improvement.

Unilateral Myelinated Retinal Nerve Fiber Layer, High Myopia, and Amblyopia: A Case Report.

Straatsma syndrome corresponds to the presence of myelinated retinal nerve fibers with ipsilateral myopia and amblyopia. Strabismus is also a common finding in this entity, and patients with strabismus usually present a poor visual prognosis. We report the case of a two-year-old male diagnosed with Straatsma syndrome with a follow-up period of 2.5 years. Despite the early diagnosis and institution of treatment, there was no significant response to therapy. Early recognition of Straatsma syndrome and aggressive treatment of amblyopia may result in better outcomes.

[Pediatric Cataracts: A Retrospective Study of 12 Years (2004 - 2016)]. / Cataratas em Idade Pediátrica: Estudo Retrospetivo de 12 Anos (2004 - 2016).

INTRODUCTION: Cataracts are a major cause of preventable childhood blindness. Visual prognosis of these patients depends on a prompt therapeutic approach. Understanding pediatric cataracts epidemiology is of great importance for the implementation of programs of primary prevention and early diagnosis. MATERIAL AND METHODS: We reviewed the clinical cases of pediatric cataracts diagnosed in the last 12 years at Hospital Pedro Hispano, in Porto. RESULTS: We identified 42 cases of pediatric cataracts with an equal gender distribution. The mean age at diagnosis was 6 years and 64.3% of patients had bilateral disease. Decreased visual acuity was the commonest presenting sign (36.8%) followed by leucocoria (26.3%). The etiology was unknown in 59.5% of cases and there was a slight predominance of nuclear type cataract (32.5%). Cataract was associated with systemic diseases in 23.8% of cases and with ocular abnormalities in 33.3% of cases. 47.6% of patients were treated surgically. Postoperative complications occurred in 35% of cases and posterior capsular opacification was the most common (25%). DISCUSSION: The report of 42 cases is probably the result of the low prevalence of cataracts in this age. Although the limitations of our study include small sample size, the profile of children with cataracts in our hospital has characteristics relatively similar to those described in the literature. CONCLUSION: Given the high proportion of idiopathic pediatric cataracts, prevention of the disease remains a challenge worldwide.

Introdução: As cataratas são consideradas uma das principais causas de cegueira evitável em idade pediátrica. O prognóstico visual destas crianças depende de uma abordagem terapêutica atempada, sendo fundamental o conhecimento da sua epidemiologia para a implementação de programas de prevenção primária e diagnóstico precoce das cataratas. Material e Métodos: Analisámos os processos clínicos de doentes com cataratas diagnosticadas em idade pediátrica, nos últimos 12 anos, no Hospital Pedro Hispano, Porto. Resultados: Foram diagnosticados 42 casos de cataratas pediátricas, com igual distribuição em ambos os géneros. A média etária no momento do diagnóstico foi de seis anos e em 64,3% das crianças, as cataratas eram bilaterais. A manifestação clínica mais comum foi a diminuição da acuidade visual (36,8%) seguida pela leucocória (26,3%). A etiologia idiopática foi a mais frequente (59,5%), e houve predomínio das cataratas do tipo nuclear (32,5%). As cataratas associaram-se a doenças sistémicas em 23,8% dos casos e a outras anomalias oculares em 33,3% das crianças. Relativamente ao tratamento, 47,6% das crianças foram submetidas a cirurgia. As complicações pós-operatórias registaram-se em 35% das crianças, sendo a opacificação da cápsula posterior a mais comum (25%). Discussão: A descrição de 42 casos reflete, provavelmente, a baixa prevalência das cataratas nesta idade. Apesar das limitações inerentes a uma amostra pequena, o perfil epidemiológico das cataratas pediátricas, neste hospital, apresenta características similares às descritas na literatura. Conclusão: O elevado número de cataratas de etiologia idiopática observado a nível global e neste estudo, em particular, constitui um desafio ao planeamento de estratégias de prevenção.

When an Easy Thing Goes Wrong: Foreign Body Induced Granuloma-Associated Scleritis Following Pterygium Surgery.

PURPOSE: To report a case of pterygium surgery with conjunctival autograft followed by focal necrotizing scleritis due to foreign body entrapment in the scleral bed. CASE REPORT/RESULTS: This is a case report of a 76-years-old male patient who underwent nasal pterygium surgery and developed focal necrotizing scleritis secondary to foreign body entrapment under conjunctival autograft. One month following surgery, slit-lamp examination demonstrated a progressive thinning of the surgical area with focal inflammatory signs. A small synthetic fiber was identified to be trapped under the graft. A second intervention was performed with foreign body removal and a new conjunctival graft. Despite the surgery, focal scleral melting continued to progress and the patient was placed under systemic corticotherapy and submitted to amniotic membrane graft with epithelial side up. During the follow-up period there was a good tissue response. CONCLUSION: Despite being a safe and quick procedure, pterygium surgery can sometimes elicit new challenges.

Astigmatism management in cataract surgery with Precizon(®) toric intraocular lens: a prospective study.

PURPOSE: The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon(®) toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. SETTING: Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. DESIGN: This was a prospective clinical study. PATIENTS AND METHODS: A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon(®) toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster(®)). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month's evaluations. RESULTS: The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from -3.35±3.10 D to -0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. CONCLUSION: Precizon(®) toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery.