Multifocalidade e Estereopsia

Introdução: A visão binocular proporciona uma interpretação única e tridimensional do mundo. Objectivo: Comparar a estereopsia dos doentes com de lentes intra-oculares (LIO) multifocais implantadas. Métodos: Os autores realizaram um estudo transversal com 40 doentes, que tinham sido submetidos a facoemulsificação com implante de LIO multifocal bilateralmente (26 Restor, 6 tecnis Multifocal e 8 "Mix & Match"). Estudaram a estereopsia de longe com o Vectograph e utilizaram o "Titmus Stereo Test" para perto, nos 3 grupos. Resultados: No grupo 1 (Restor bilateral: idade média 63,38 anos; 4 doentes do sexo masculino e 22 do feminino) obtivemos 80 a 90% de boa estereopsia; no grupo 2 (Tecnis Multifocal bilateral: idade média 73,67 anos; 6 doentes do sexo feminino) registou-se 100% de boa estereopsia e no grupo 3 ("Mix & Match": idade média 74,25 anos; 2 doentes do sexo masculino e 6 do feminino) obteve-se 50 a 75% de boa estereopsia. Conclusões: Os doentes com lentes intra-oculares multifocais similares implantadas bilateralmente obtiveram melhor estereopsia para perto e para longe

Interictal Spike EEG Source Analysis in Hypothalamic Hamartoma Epilepsy

Objective: The epilepsy associated with the hypothalamic hamartomas constitutes a syndrome with peculiar seizures, usually refractory to medical therapy, mild cognitive delay, behavioural problems and multifocal spike activity in the scalp electroencephalogram (EEG). The cortical origin of spikes has been widely assumed but not specifically demonstrated. Methods: We present results of a source analysis of interictal spikes from 4 patients (age 2–25 years) with epilepsy and hypothalamic hamartoma, using EEG scalp recordings (32 electrodes) and realistic boundary element models constructed from volumetric magnetic resonance imaging (MRIs). Multifocal spike activity was the most common finding, distributed mainly over the frontal and temporal lobes. A spike classification based on scalp topography was done and averaging within each class performed to improve the signal to noise ratio. Single moving dipole models were used, as well as the Rap-MUSIC algorithm. Results: All spikes with good signal to noise ratio were best explained by initial deep sources in the neighbourhood of the hamartoma, with late sources located in the cortex. Not a single patient could have his spike activity explained by a combination of cortical sources. Conclusions: Overall, the results demonstrate a consistent origin of spike activity in the subcortical region in the neighbourhood of the hamartoma, with late spread to cortical areas

Macular and Optic Disc Edema and Retinal Vascular Leakage in Familial Amyloid Polyneuropathy with a Transthyretin Val30Met Mutation: a Case Report

Introduction: Familial amyloid polyneuropathy is a group of autosomal dominant disorders characterized by extracellular amyloid deposition in several target organs. This paper aims to report an unusual manifestation of retinal vascular leakage including optic disc and macular edema in a patient with familial amyloid polyneuropathy. Case presentation: A 37-year-old Portuguese Caucasian man with Val30Met transthyretin-related familial amyloid polyneuropathy presented with rapidly progressing visual loss in his left eye. He had undergone liver transplantation at the age of 30 with neurologic stabilization. Fundoscopy and fluorescein angiogram revealed optic disc and macular edema as well as vessel wall staining with leakage in the posterior pole and mid-periphery, without vitreous opacities. A diagnostic work-up for infectious, autoimmune and neoplasic conditions was negative. Systemic immunosuppression was increased but without improvement. Sustained resolution of macular edema was observed after intravitreal injection of dexamethasone implant and laser panretinal photocoagulation. Conclusions: To the best of our knowledge, this is the first report of a rare ocular manifestation of familial amyloid polyneuropathy which represents a new therapeutic challenge. Intravitreal injection of sustained release dexamethasone implant and panretinal photocoagulation may be an effective eye-saving therapeutic approach.info:eu-repo/semantics/publishedVersio

Impacto da COVID-19 na Cirurgia de Transplantação Corneana: Primeiro EuCornea Educational Webinar

info:eu-repo/semantics/publishedVersio

Papillary carcinoma arising in struma ovarii versus ovarian metastasis from primary thyroid carcinoma: a case report and review of the literature

We present a case of a postmenopausal woman diagnosed with an ovarian mass containing thyroid follicles and foci of papillary thyroid carcinoma during pathological examination. This patient referred having had a metachronous thyroid malignancy 10 years before. The differential diagnosis between a thyroid malignancy arising from a struma ovarii and a metastatic ovarian tumor originating from thyroid-cancer is challenging. Struma ovarii should be considered when thyroid components are the predominant element or when thyroid malignant tissue is identified within an ovarian lesion. Thyroid carcinoma arising from a struma ovarii is reported to occur in a minority of cases. Of these, papillary carcinoma is the most frequent subtype encountered. Regarding primary thyroid carcinomas, papillary carcinomas have a lower metastatic potential when compared to follicular carcinomas, and most of the metastases occur in the cervical lymph nodes. Ovarian metastases are exceedingly rare and generally associated with widespread disease. However, they must be considered in the presence of previous history of malignant thyroid carcinoma. The authors review the main clinical, imaging and therapeutic aspects of both these entities and present the most likely diagnosis

Intraorbital Abducens Nerve Schwannoma

BACKGROUND: Schwannomas of the abducens nerve are extremely rare tumors. The tumor may be located within the cavernous sinus or more often at the prepontine region. However, literature research has identified only one case of isolated schwannoma of the orbit, arising from the terminal branches of the abducens nerve to the lateral rectus muscle. This is only the second report of an abducens nerve schwannoma located entirely intraconal. CASE DESCRIPTION: We report a case of an intraorbital abducens nerve schwannoma in a 42-year-old man with no signs of neurofibromatosis. The lesion resulted in progressive diplopia and focal abducens palsy. The clinical, radiologic, and pathologic features are presented. RESULTS: We point the particular aspects and discuss the possible treatments and approaches to preserve nerve function. CONCLUSIONS: Being a benign lesion, one of the goals has always been total removal. The knowledge of the correct anatomic features made us believe that the VI nerve function could be preserved. Our case is the first example of a total removal with eye abduction preserved. Because of that, we believe that it is reasonable to aim for these goals in future cases

Phacoemulsification Versus Peripheral Iridotomy in the Management of Chronic Primary Angle Closure: Long-Term Follow-Up

Primary angle closure occurs as a result of crowded anterior segment anatomy, causing appositional contact between the peripheral iris and trabecular meshwork, thereby obstructing aqueous outflow. Several studies highlight the role of the crystalline lens in its pathogenesis. The objective of this work is to compare the long-term efficacy of phacoemulsification versus laser peripheral iridotomy (LPI) in the management of chronic primary angle closure (CPAC). Prospective case-control study with 30 eyes of 30 patients randomly divided in two groups: 15 eyes in the LPI group and 15 eyes in the IOL group. Patients in the LPI group underwent LPI using argon and Nd:YAG laser. Patients in the IOL group underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Examinations before and after the procedure included gonioscopy, Goldmann applanation tonometry, and anterior chamber evaluation using the Pentacam rotating Scheimpflug camera. The mean follow-up time was 31.13 ± 4.97 months. There was a statistically significant reduction in the intraocular pressure (IOP) and number of anti-glaucoma medications (p < 0.01) only in the IOL group. Anterior chamber depth, angle, and volume were all higher in the IOL group (p < 0.01) at the end of the follow-up period. Phacoemulsification with posterior chamber IOL implantation results in a higher anterior chamber depth, angle, and volume, when compared to LPI. Consequently, phacoemulsification has greater efficacy in lowering IOP and preventing its long-term increase in patients with CPAC and cataract

Diabetic Choroidopathy: a Review of the Current Literature

Diabetic retinopathy is an increasingly prevalent disease, and a leading contributor to the burden of all-cause blindness worldwide. In addition to retinal changes, choroidal abnormalities are common in patients with diabetes. The first studies concerning this vascular structure were based on histologic, indocyanine angiography and laser Doppler flowmetry techniques, but the development of new optical coherence tomography (OCT) technologies and imaging software for enhanced depth imaging (EDI)-OCT in recent years has made it possible to provide more detailed images of the choroidal anatomy and topography.In diabetic patients, several choroidal changes have been described in the literature throughout the years; the recent focus is choroidal thickness, which is significantly different from that in healthy patients. However, understanding choroidal manifestations of diabetic eye disease remains a real challenge, and this gap is hindering efforts towards better defining choroidal evaluation as a predictive factor for disease evolution and treatment response.This review aims to summarize the recent literature concerning changes in choroidal structure in diabetic patients, the relationship to diabetic retinal disease progression, and finally, the current and potential application of the measurement of variations in choroidal thickness for patient management.info:eu-repo/semantics/publishedVersio

Vision Loss and Subretinal Yellow Deposits Following Cytostatic Therapy for Early-Stage Breast Cancer: a Case Report

Introduction/Objective: To report a case of ocular toxicity related to two chemotherapeutic regimens approved for early-stage breast cancer: doxorubicin (Adriamycin®) and cyclophosphamide – AC protocol; carboplatin and docetaxel combination. Material and Methods: We report a case of a 39-year-old woman with stage I ductal invasive breast cancer, who presented with bilateral painless reduced visual acuity two days after the first administration of intravenous doxorubicin and cyclophosphamide. Results: The best corrected visual acuity (BCVA) was 20/100 in both eyes and the fundoscopy revealed pearly-yellow lesions in the posterior pole and mid-peripheral retina bilaterally, with retinal pigment epithelium hypertrophy in the right eye (RE). These lesions were hyperfluorescent on fluorescein angiography and appeared as drusen-like deposits under the retinal pigment epithelium in the optical coherence tomography (OCT). The electrophysiological study revealed a diffuse dysfunction of bipolar cells and photoreceptors and macular dysfunction, more pronounced in the RE. Goldmann visual field testing, color vision and optic nerve OCT were normal. 72 hours after the treatment, her BCVA improved spontaneously to 20/25 in the RE and 20/20 in the left eye (LE). A similar drop in BCVA was observed after a second cycle of AC protocol and after second-line cycle of carboplatin and docetaxel, with subsequent recover. The remaining observation remained remarkably similar. Discussion: This can be the first report of a rare idiosyncratic reaction to AC protocol and carboplatin-docetaxel chemotherapeutic regimens, approved for early-stage breast cancer.info:eu-repo/semantics/publishedVersio

Terapia Celular Cardíaca com Células Mesenquimatosas

Cardiovascular disease is among the main causes of mortality and morbidity worldwide. Despite significant advances in medical and interventional therapy, the prognosis of conditions such as ischemic heart disease is still dismal. There is thus a need to investigate new therapeutic tools, one of which is stem cell therapy. Hematopoietic stem cells are the most studied type, and the fact that their biology is relatively well understood has led to their being used in preclinical research and clinical trials. However, the results of some of these studies have been controversial, which has opened the way for studies on other cell types, such as mesenchymal stem cells. These cells have immunomodulatory properties which suggest that they have therapeutic potential in cardiology. In the present article, the authors review the state of the art regarding mesenchymal stem cells, from basic and translational research to their use in clinical trials on ischemic heart disease, heart failure and arrhythmias, and discuss possible future uses