Ana Catarina Almeida

Comparison of the Visual Outcomes and OPD-Scan Results of AMO Tecnis Toric and Alcon Acrysof IQ Toric Intraocular Lenses

PURPOSE To compare the visual outcomes and wavefront analyses of patients who underwent cataract surgery with the implantation of a Tecnis toric intraocular lens (IOL) (Abbott Medical Optics) with those patients who received an Acrysof IQ toric IOL (Alcon Laboratories Inc). METHODS The study included 40 eyes from 26 patients with regular corneal astigmatism between 1.00 and 3.00 diopters (D) who were undergoing phacoemulsification with implantation of a toric IOL. Patients were randomized into two groups (20 eyes in each group): one group received the Tecnis toric IOL (Tecnis group) and one group received the Acrysof IQ toric IOL (Acrysof group). Over a 2-month follow-up period, the main outcome measures were uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical equivalent refraction, residual astigmatism, rotational stability of the IOL, and higher order aberrations, measured with a dynamic retinoscopy aberrometer. RESULTS At 2-month follow-up, UDVA, CDVA, spherical equivalent refraction, and residual astigmatism showed no statistically significant between-group differences (P=.834, P=.178, P=.447, and P=.166, respectively). No eye had IOL rotation >10°. The toric IOL axis misalignment was similar in both groups (3.15°±2.62° in the Tecnis group and 3.25°±2.04° in the Acrysof group, P=.265). No statistically significant between-group differences were noted for all ocular aberrometry values, except for spherical aberration, which was higher in the Acrysof group (P=.029). CONCLUSIONS Both studied IOLs promoted good postoperative UDVA, CDVA, and refractive results. Rotational stability was excellent for both IOLs. Postoperative spherical aberration was higher for the Acrysof toric IOL; however, this difference did not seem to affect overall visual quality.

Bilateral optic neuropathy associated with cryptococcal meningitis in an immunocompetent patient

Cryptococcal meningitis is associated with significant morbidity and is rare among immunocompetent patients. Clinical presentation as well as the course of disease is usually indolent which may delay the diagnosis. We present the case of a 52-year-old woman admitted with headaches, vomiting and fatigue for 3 weeks. She was diagnosed with cryptococcal meningitis and treated with antifungal therapy. She was referred for ophthalmological examination presenting with decreased vision in the left eye (OS; count fingers), left relative afferent pupillary defect and bilateral sixth nerve palsy. Funduscopy revealed florid bilateral papilloedema. Cranial MRI showed indirect signs of intracranial hypertension as well as multiple parenchymal lesions and optic nerve sheath enhancement after contrast administration. A ventriculoperitoneal shunt was placed. In spite of the control of intracranial pressure there was a decrease in vision in the right eye (OD) and deterioration of visual fields. Intravenous methylprednisolone was used to reverse optic neuropathy and to prevent OD visual loss.

Correlation between cataract grading by Scheimpflug imaging and phaco time in phacoemulsification using peristaltic and venturi pumps.

Purpose To study the correlation among cataract grading system by Scheimpflug imaging (Oculus Pentacam® Nucleus Grading System [PNS]), effective phaco time (EPT), and surgical time (ST) using peristaltic and venturi pumps on the Whitestar Signature Phaco System (Abbott Medical Optics, Inc., Santa Ana, California, USA). Methods Patients scheduled to have bimanual microincision phacoemulsification by the same surgeon (T.F.) had Pentacam® Scheimpflug assessment using PNS and were randomly distributed into 2 groups. In group 1, surgery was performed using peristaltic pump, and in group 2, using venturi pump. Parameters assessed in both groups included EPT and ST. Results Sixty eyes that had uneventful clear cornea phacoemulsification with implantation of foldable intraocular lens (IOL) were evaluated, 30 in each group. The EPT was statistically superior with higher nuclear density grades for both groups 1 and 2 (group 1 Spearman R = 0.739, p<0.001; group 2 Spearman R = 0.924, p<0.001). The ST statistically increased with nucleus density for both groups 1 and 2 (group 1 Spearman R = 0.620, p<0.001; group 2 Spearman R = 0.643, p<0.001). Group 2 presented statistically significant reduction on median ST compared with group 1 for nucleus grading 2, 3, 4, and 5. Conclusions The PNS is an objective and reproducible method of grading nuclear cataract density and had a correlation with EPT. Peristaltic and venturi pumps in Signature Phaco System were similar in EPT but venturi pump reduced the median ST in nucleus with higher PNS, without repercussion on complications or anterior chamber stability.

Tubercular serpiginous-like choroiditis

Choroidal tuberculosis (TB) infection may present itself as a diffuse choroiditis that resembles serpiginous choroiditis, usually treated with immunossupressants. Recent studies have demonstrated that patients with serpiginous-like choroiditis and evidence of systemic or latent TB are best treated with antituberculosis treatment (ATT) in addition to the corticosteroid therapy. The authors present a case of a 58-year-old man with decreased vision in his left eye. His best-corrected visual acuity was 20/20 right eye and 20/200 left eye. Funduscopic examination revealed a diffuse choroiditis. Mantoux skin test showed an area of induration measuring 30×35 mm and the patient started ATT with complete resolution of retinal lesions after 2 weeks of treatment. His final visual acuity was 20/25 in the left eye with no recurrences over a follow-up of 6 months. The use of ATT in these patients is likely to reduce active inflammation and eliminate future recurrences.

Acquired retrograde transsynaptic degeneration.

Although retrograde transsynaptic degeneration in the visual pathway of monkeys has been described since 1963, data in humans are sparse. The authors present a 24-year-old female referred to a neuro-ophthalmology consult for assessment before neurosurgery for a right occipital ependymoma. Clinical examination was unremarkable, including visual fields evaluated by computerised static perimetry. Four years after tumour extraction, the patient showed a left homonymous haemianopia documented by computerised static perimetry and a bow-tie like atrophy on the left on funduscopy. MRI revealed right occipital cortex lobectomy and optic tract atrophy. The presence of left homonymous haemianopia, the characteristic pattern of optic disc atrophy and right optic tract atrophy 4 years after right occipital tumour excision, strongly suggest the presence of retrograde transsynaptic degeneration. To our knowledge, this is the first time that retrograde transsynaptic degeneration-associated optic tract atrophy is clearly demonstrated by MRI.

Pressão intraocular (PIO) após cirurgia de extração de catarata

Objetivo: Determinar se existe variacao da PIO em doentes com glaucoma submetidos a cirurgia de catarata. Metodos: Estudo retrospectivo de 101 olhos, de 75 doentes com media de idade de 78,91 ± 7,9 anos submetidos a cirurgia de catarata por facoemulsificacao por dois cirurgioes, sem complicacoes associadas e com follow-up superior a 6 meses. Os olhos foram subdivididos em dois grupos: olhos com glaucoma (G) e olhos sem glaucoma (SG). A PIO foi avaliada por tonometria de Goldmann. Resultados: Analisaram-se 51 olhos do grupo (SG) e 50 olhos do grupo (G). A PIO media nos dois grupos era no pre-operatorio 16,08 ± 3,04, sendo aos 12 meses 14,69 ± 2,7 e aos 24 meses 14,21 ± 3,56. A diminuicao media de PIO do pre-operatorio para os 12 meses foi de 1,49 ± 2,98. A PIO pre-operatoria apresentou uma diferenca com significado estatistico da PIO aos 12 e 24 meses (p 0,05, teste T Student). Determinou-se um modelo de regressao linear stepwise para a variacao de PIO do pre-operatorio para os 12m. As variaveis com valor preditivo eram a PIO pre-operatoria (R2=0,249, p=0,03), e a idade (R2=0,18, p=0,01). Conclusao: O nosso estudo revela que a cirurgia de catarata por facoemulsificacao leva a uma diminuicao significativa da PIO, que se mantem aos 12 e 24m.

Bilateral metastatic melanoma to the extraocular-muscles simulating thyroid eye disease

We report a case of bilateral metastatic melanoma to the extraocular muscles that simulated thyroid eye disease. A 71-year-old man presented with bilateral painless axial proptosis, lid retraction and left gaze restriction. Orbital CT scan demonstrated enlargement of the extraocular muscles with tendon sparing, consistent with thyroid eye disease. However, thyroid function tests and antithyroid antibodies were normal. Systemic review including orbital MRI scan determined the correct diagnosis of metastatic melanoma to the orbit. Metastatic melanoma to the orbit can simulate thyroid eye disease.

Opsoclonus-Myoclonus syndrome.

Opsoclonus-Myoclonus syndrome is a rare dyskinesia due to an underlying infectious, metabolic or neoplastic process.1 It is frequently caused by neuroblastoma in children and breast or lung carcinoma in adults. It is characterised by high amplitude, multidirectional, arrhythmic and conjugate ocular saccadic intrusions without inter-saccadic latency causing oscillopsia2 and it is associated with myoclonus of axial and/or apendicular musculature …

Surgical resection of invasive adenoid cystic carcinoma of the lacrimal gland and wound closure using a vertical rectus abdominis myocutaneous free flap.

A 64-year-old man presented with a 3-month history of recurrent conjunctivitis. He was evaluated by an ophthalmologist and submitted to a CT scan that revealed an intraconic mass with invasion of the lateral orbital wall. He was operated, the mass was completely removed (with preservation of the intraorbital structures) and the lateral orbital wall rebuilt. The histopathological analysis revealed an adenoid cystic carcinoma of the lacrimal gland. 4 months later a painful recurrence of the lesion was diagnosed with invasion of the orbital roof and eyelids. After a multidisciplinary discussion and request from the patient, an exenteration of the orbit and removal of the lateral and superior orbital wall and dura mater was performed with the objective of a total resection. The wound and orbit were closed with a vertical rectus abdominis myocutaneous free flap to ensure closure.