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Article: Comparison of Color Fundus Photography and Multicolor Fundus Imaging for Detection of Lesions in Diabetic Retinopathy and Retinal Vein Occlusion.

Castro, Catarina / Marques, João Heitor / Silva, Nisa / Abreu, Ana Carolina / Furtado, Maria João / Lume, Miguel

Clinical ophthalmology (Auckland, N.Z.)

2023 Volume 17, Page(s) 2515–2524

Abstract: Purpose: To evaluate the agreement between conventional fundus photography (CFP) and multicolor fundus imaging (MFI) for the detection of lesions of diabetic retinopathy (DR) and retinal vein occlusion (RVO).: Methods: Cross-sectional analysis of ... ...

Abstract	Purpose: To evaluate the agreement between conventional fundus photography (CFP) and multicolor fundus imaging (MFI) for the detection of lesions of diabetic retinopathy (DR) and retinal vein occlusion (RVO). Methods: Cross-sectional analysis of eyes with DR or RVO who underwent CFP and MFI. All images were independently analyzed by two observers (O1 and O2), and the evaluated lesions were classified as "present" or "absent". Then, a paired comparison between both exams of the same eye was performed, to assess which made it easier to detect the lesions. Results: Considering DR, the agreement was substantial for cotton wool spots and photocoagulation scars for both observers (O1: Conclusion: The agreement of MFI and CFP was substantial to almost perfect for most lesions. MFI seems better to detect cotton wool spots and photocoagulations scars in DR and venous sheathing in RVO. Optocilliary shunts seem easier to detect on CFP.
Language	English
Publishing date	2023-08-23
Publishing country	New Zealand
Document type	Journal Article
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S414603
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Article: Intrascleral Knotless Zigzag Suture Fixation of Four-Haptic Hydrophilic Acrylic Foldable IOL: Clinical Outcomes.

Silva, Nisa / Ferreira, André / Ferreira, Natália / Pessoa, Bernardete / Meireles, Angelina

Clinical ophthalmology (Auckland, N.Z.)

2022 Volume 16, Page(s) 33–41

Abstract: Background: The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL).: Purpose: To describe the surgical technique and the outcomes of intrascleral ...

Abstract	Background: The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL). Purpose: To describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL. Methods: Retrospective cohort study of consecutive cases. Results: Ninety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1±15.2 years (range 18-94), and the median follow-up duration was 19.5 months (range 3-81). The best-corrected visual acuity improved from a mean±SD of 1.34±0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49±0.56 logMAR at the end of follow-up (p<0.001). The mean±SD final SE was -1.24±1.82 diopters. The mean±SD prediction error was -0.51±1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7). Conclusion: This knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.
Language	English
Publishing date	2022-01-06
Publishing country	New Zealand
Document type	Journal Article
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S340039
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Article ; Online: Severe ocular involvement in hereditary gelsolin amyloidosis.

da Silva, Nisa Filipa Pinho / Beirão, João Nuno Melo

Porto biomedical journal

2021 Volume 6, Issue 5, Page(s) e146

Abstract: Hereditary gelsolin amyloidosis is a rare subtype of hereditary systemic amyloidosis. An old male presented with the characteristic triad of symptoms, including bilateral facial palsy, cutis laxa, and corneal lattice amyloidosis. The diagnosis was ... ...

Abstract	Hereditary gelsolin amyloidosis is a rare subtype of hereditary systemic amyloidosis. An old male presented with the characteristic triad of symptoms, including bilateral facial palsy, cutis laxa, and corneal lattice amyloidosis. The diagnosis was confirmed by the detection of the mutation in gelsolin gene located on chromosome 9. Although the presenting symptoms were highly suggestive of the disease, reports of severe ocular involvement are scarce in the literature.
Language	English
Publishing date	2021-10-11
Publishing country	United States
Document type	Journal Article
ISSN	2444-8672
ISSN (online)	2444-8672
DOI	10.1097/j.pbj.0000000000000146
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Article ; Online: The Impact of COVID-19 Pandemic on Surgical Primary Retinal Detachments.

Ferreira, André / Afonso, Miguel / Silva, Nisa / Meireles, Angelina

Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde

2021 Volume 245, Issue 2, Page(s) 111–116

Abstract: Purpose: This study aimed to describe the impact of COVID-19 pandemic on the presentation characteristics, timings, and surgical decisions for primary rhegmatogenous retinal detachment (RRD).: Methods: A historical cohort including all patients who ... ...

Abstract	Purpose: This study aimed to describe the impact of COVID-19 pandemic on the presentation characteristics, timings, and surgical decisions for primary rhegmatogenous retinal detachment (RRD). Methods: A historical cohort including all patients who presented to the Surgical Retina Section at Centro Hospitalar Universitário do Porto (CHUPorto), over a 2-year period, was recruited and divided into 2 groups: pre-COVID and COVID groups. The onset of the COVID-19 pandemic was recorded as starting on March 18, 2020, the same day the first pandemic-related lockdown came to effect in Portugal. Results: This study enrolled 449 eyes of 443 patients: 272 in the pre-COVID group and 177 in the COVID one. Of the patients, 63.6% were male, and the mean ± SD age was 63.0 ± 13.2 years (range 13-92 years). Of the eyes, 55.5% (n = 151) presented with macular detachment in the pre-COVID group compared with 66.9% (n = 119) in the COVID group (odds ratio [OR] 1.62; 95% confidence interval [CI]: 1.09-3.86; p = 0.016). The time from symptom onset to hospital admission (p = 0.021) and from admission to surgery (p < 0.001) was longer in the COVID era. In the COVID period, silicone oil (OR 2.03, 95% CI: 1.09-3.79, p = 0.025) and C3F8 gas (OR 2.42, 95% CI: 1.57-3.71, p < 0.001) were used more often. No differences in anatomical success or final visual acuity were found. Conclusions: The lockdown due to COVID pandemic affected the epidemiology of RRD. The services must adapt to the novel reality and produce backup plans for similar events. Despite the contingencies, the final results were not different between groups.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; COVID-19/epidemiology ; Communicable Disease Control ; Female ; Humans ; Male ; Middle Aged ; Pandemics ; Retinal Detachment/diagnosis ; Retinal Detachment/epidemiology ; Retinal Detachment/surgery ; Retrospective Studies ; Vitrectomy ; Young Adult
Language	English
Publishing date	2021-10-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	209735-7
ISSN	1423-0267 ; 0030-3755
ISSN (online)	1423-0267
ISSN	0030-3755
DOI	10.1159/000520342
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Article: Evaluation of Functional Vision and Eye-Related Quality of Life in Children with Strabismus.

Silva, Nisa / Castro, Catarina / Caiado, Filipa / Maia, Sofia / Miranda, Vasco / Parreira, Ricardo / Menéres, Pedro

Clinical ophthalmology (Auckland, N.Z.)

2022 Volume 16, Page(s) 803–813

Abstract: Background: Understanding how strabismus impacts a child's quality of life, as well as their families, should be an important key to guide treatment, not only from the ophthalmological point of view but also regarding psychological and social aspects, ... ...

Abstract	Background: Understanding how strabismus impacts a child's quality of life, as well as their families, should be an important key to guide treatment, not only from the ophthalmological point of view but also regarding psychological and social aspects, which are fundamental for a healthy and harmonious development. Methods: A cross-sectional study was performed to evaluate the functional vision and eye-related quality of life (ER-QOL) in a population of children with strabismus submitted or not to corrective surgery, using the recently developed Pediatric Eye Questionnaire (PedEyeQ) and to compare with age and gender-matched visually normal children. The PedEyeQ was applied to non-operated children with strabismus (n = 18), operated children with strabismus (n = 24), and visually normal children (n = 21). This instrument is composed of 3 components (Child, Proxy, and Parent) and has different versions according to the child's age (0-4, 5-11, or 12-17 years-old versions). Clinical data such as age, type of strabismus, angle of deviation, amblyopia, occlusion treatment, and surgical outcome were also recorded. Results: All PedEyeQ domain scores were significantly lower in children with strabismus compared with visually normal children, except the Child "functional vision" domain. Children with strabismus with successful corrective surgery had significantly lower scores in many domains of the Child, Proxy, and Parent components, compared with visually normal children. Conclusion: This study showed that strabismus has an important impact on affected children and their families, as assessed by PedEyeQ. Interestingly, children with prior successful corrective strabismus surgery had worse PedEyeQ scores compared to visually normal children. Educational programs and psychosocial rehabilitation interventions should be implemented in children with strabismus and their families.
Language	English
Publishing date	2022-03-15
Publishing country	New Zealand
Document type	Journal Article
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S354835
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Article ; Online: PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER COVID-19: MULTIMODAL EVALUATION.

Castro, Catarina S / Ferreira, André S / Silva, Nisa P / Lume, Miguel R / Furtado, Maria J

Retinal cases & brief reports

2022 Volume 17, Issue 6, Page(s) 791–796

Abstract: Purpose: To report the case and multimodal imaging findings of a healthy young woman who developed paracentral acute middle maculopathy 9 weeks after COVID-19.: Methods: Case report. Ultra-widefield fundus photography, macular spectral domain optical ...

Abstract	Purpose: To report the case and multimodal imaging findings of a healthy young woman who developed paracentral acute middle maculopathy 9 weeks after COVID-19. Methods: Case report. Ultra-widefield fundus photography, macular spectral domain optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography were performed. Results: A 36-year-old woman went to the emergency department with sudden, painless, left eye vision loss. The only relevant medical history was COVID-19 9 weeks before. The best-corrected visual acuity was 20/200, a left eye relative afferent pupillary defect was present, and superficial hemorrhages throughout the macular area and peripheral retina were found. Nearly 4 hours after admission, the left eye best-corrected visual acuity recovered to 20/20 without relative afferent pupillary defect. Five days after presentation in the emergency department, the patient returned with recurrent left eye vision loss, with spontaneous recovery within 12 hours. Macular spectral domain optical coherence tomography revealed hyperreflectivity of the inner plexiform and inner nuclear layers, and the diagnosis of paracentral acute middle maculopathy was established. The patient started oral acetylsalicylic acid and oral prednisolone. The patient did not report any new episodes of vision loss, and there was a progressive resolution of abnormal fundus findings. Conclusion: SARS-CoV-2 infection increases the risk of vascular thrombotic events with possible involvement of the retinal circulation, and paracentral acute middle maculopathy may present as a possible complication. Ophthalmologists should be able to recognize it promptly through multimodal imaging findings.
MeSH term(s)	Female ; Humans ; Adult ; COVID-19/complications ; Retinal Diseases/diagnosis ; Retinal Diseases/etiology ; SARS-CoV-2 ; Fluorescein Angiography/methods ; Tomography, Optical Coherence/methods ; Acute Disease ; Pupil Disorders/complications ; Macular Degeneration/complications
Language	English
Publishing date	2022-07-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	1937-1578
ISSN (online)	1937-1578
DOI	10.1097/ICB.0000000000001301
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Article: Scheimpflug-Based Corneal Biomechanical Analysis As A Predictor of Glaucoma in Eyes With High Myopia.

Baptista, Pedro M L / Ferreira, André S / Silva, Nisa P / Figueiredo, Ana R M / Sampaio, Isabel C / Reis, Rita V F / Ambrósio, Renato / Menéres, Pedro M A M / Beirão, João N M / Menéres, Maria J F S

Clinical ophthalmology (Auckland, N.Z.)

2024 Volume 18, Page(s) 545–563

Abstract: Purpose: To address if corneal biomechanical behavior has a predictive value for the presence of glaucomatous optical neuropathy in eyes with high myopia.: Patients and methods: This observational cross-sectional study included 209 eyes from 108 ... ...

Abstract	Purpose: To address if corneal biomechanical behavior has a predictive value for the presence of glaucomatous optical neuropathy in eyes with high myopia. Patients and methods: This observational cross-sectional study included 209 eyes from 108 consecutive patients, divided into four groups: high myopia and primary open-angle glaucoma (POAG) - HMG, n = 53; high myopia without POAG - HMNG, n = 53; non-myopic with POAG - POAG, n = 50; non-myopic and non-POAG- NMNG, n = 53. Biomechanical assessment was made through a Scheimpflug-camera-based technology. Receiver operating characteristic curves were made for the discrimination between groups. Multivariable logistic regression models were performed to address the predictive value of corneal biomechanics for the presence of glaucoma. Results: Areas Under the Receiver Operating Characteristic (AUROCs) above 0.6 were found in 6 parameters applied to discriminate between HMG and HMNG and six parameters to discriminate between POAG and NMNG. The biomechanical models with the highest power of prediction for the presence of glaucoma included 5 parameters with an AUROC of 0.947 for eyes with high myopia and 6 parameters with an AUROC of 0.857 for non-myopic eyes. In the final model, including all eyes, and adjusted for the presence of high myopia, the highest power of prediction for the presence of glaucoma was achieved including eight biomechanical parameters, with an AUROC of 0.917. Conclusion: Corneal biomechanics demonstrated differences in eyes with glaucoma and mainly in myopic eyes. A biomechanical model based on multivariable logistic regression analysis and adjusted for high myopia was built, with an overall probability of 91.7% for the correct prediction of glaucomatous damage.
Language	English
Publishing date	2024-02-22
Publishing country	New Zealand
Document type	Journal Article
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S426635
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Article ; Online: Impact of the COVID-19 Pandemic on Ophthalmology Residency Training in Portugal.

Silva, Nisa / Laiginhas, Rita / Meireles, Angelina / Barbosa Breda, João

Acta medica portuguesa

2020 Volume 33, Issue 10, Page(s) 640–648

Abstract: Introduction: The purpose of this study was to provide objective and real-life data concerning the impact of the COVID-19 pandemicon ophthalmology residency training in Portugal.: Material and methods: Descriptive survey-based study applied to ... ...

Abstract	Introduction: The purpose of this study was to provide objective and real-life data concerning the impact of the COVID-19 pandemicon ophthalmology residency training in Portugal. Material and methods: Descriptive survey-based study applied to current Portuguese ophthalmology residents (n = 80 eligible). Results: Seventy-five residents participated (94% response rate). All except one (99%) admitted a change in their routine clinical practice during the pandemic, and most (89%) continued to be engaged in ophthalmology department duties. Twenty-five percent were deployed to COVID-19 units, which was combined with ophthalmological activities in about half of them (47%). A significant proportion of participants stated that they were enrolled in the following ophthalmological activities: emergency/inpatient care (87%), outpatient visits (73%; general 70% vs subspecialty 29%), and surgical procedures (64%). Twenty-five percent did not assist in any outpatient visits and 36% did not participate in any surgical procedures. On a scale from 1 (no impact) to 5 (maximum impact), most participants classified their perceived negative impact of the pandemic on the training program as 3 (24%), 4 (40%), or 5 (27%). Participants highly agreed with the extension of the residency program (80%) in order to to make up for training disruption. Discussion: Most trainees provided ophthalmological care during the pandemic. However, those clinical activities were essentially related to general and emergency care. Surgical experience was significantly curtailed. As such, strategies are needed to guarantee a high-quality learning process. Further studies are required to develop an international perspective on how ophthalmology training programs have been affected so that educational organizations can make recommendations regarding standardized adjustments to training programs. Conclusion: The COVID-19 pandemic has significantly impacted the training of ophthalmology residents nationwide.
MeSH term(s)	Adult ; Ambulatory Care/statistics & numerical data ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Cross-Sectional Studies ; Emergency Medical Services/statistics & numerical data ; Female ; Humans ; Internship and Residency/statistics & numerical data ; Male ; Ophthalmologic Surgical Procedures/statistics & numerical data ; Ophthalmologists ; Ophthalmology/education ; Ophthalmology/statistics & numerical data ; Pandemics ; Pneumonia, Viral/epidemiology ; Portugal/epidemiology ; SARS-CoV-2 ; Surveys and Questionnaires/statistics & numerical data ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-09-10
Publishing country	Portugal
Document type	Journal Article
ZDB-ID	603078-6
ISSN	1646-0758 ; 0870-399X
ISSN (online)	1646-0758
ISSN	0870-399X
DOI	10.20344/amp.14341
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Article: Fluocinolone Acetonide 0.19 mg Implant in Patients with Cystoid Macular Edema Due To Irvine-Gass Syndrome.

Marques, João Heitor / Abreu, Ana Carolina / Silva, Nisa / Meireles, Angelina / Pessoa, Bernardete / Melo Beirão, João

International medical case reports journal

2021 Volume 14, Page(s) 127–132

Abstract: Background: Cystoid macular edema (CME) due to Irvine-Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized.: Objective: To evaluate the ... ...

Abstract	Background: Cystoid macular edema (CME) due to Irvine-Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized. Objective: To evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (0.2 µg/day; ILUVIEN Methods: Retrospective 36-month case series in the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Portugal. Consecutive eyes of patients with recurrent cystoid macular edema due to Irvine-Gass syndrome who underwent a single intravitreal injection of fluocinolone acetonide intravitreal implant were included. Best-corrected visual acuity (logMAR), central macular thickness (µm) and safety (intraocular pressure, mmHg) at baseline and at 6, 12, 24 and 36 months post-administration of the fluocinolone acetonide intravitreal implant were recorded. Results: Five eyes from three patients were included. The duration of cystoid macular edema was 67.8±25.9 months and all five eyes received more than 2 intravitreal injections of a corticosteroid (triamcinolone and/or dexamethasone implant) prior to fluocinolone acetonide intravitreal implantation. At baseline (median - interquartile range), best-corrected visual acuity was 0.3-0.3; central macular thickness was 492.0-38.0; and intraocular pressure was 16.0-0. By Month 36, best-corrected visual acuity was 0.4 -0.3; central macular thickness was reduced to 369.0-324.0 and intraocular pressure was 17.0-3.0. Four of five eyes had increased intraocular pressure and were managed with intraocular pressure-lowering eye drops. Conclusion: We report improved functional and anatomical outcomes after treatment with fluocinolone acetonide intravitreal implant, indicating its use as a therapeutic alternative in recurrent cases of cystoid macular edema due to Irvine-Gass syndrome. Additionally, in eyes with suboptimal response to intravitreal therapies, fluocinolone acetonide intravitreal implant may provide longer recurrence-free periods with reduced treatment burden.
Language	English
Publishing date	2021-02-26
Publishing country	New Zealand
Document type	Case Reports
ZDB-ID	2495077-4
ISSN	1179-142X
ISSN	1179-142X
DOI	10.2147/IMCRJ.S295045
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Article: Microperimetry as Part of Multimodal Assessment to Evaluate and Monitor Myopic Traction Maculopathy.

Baptista, Pedro Manuel / Silva, Nisa / Coelho, João / José, Diana / Almeida, Daniel / Meireles, Angelina

Clinical ophthalmology (Auckland, N.Z.)

2021 Volume 15, Page(s) 235–242

Abstract: Purpose: To characterize a population of high myopes with myopic traction maculopathy (MTM), to assess their retinal function, and to correlate it with anatomic status.: Patients and methods: This was an observational cross-sectional study including ... ...

Abstract	Purpose: To characterize a population of high myopes with myopic traction maculopathy (MTM), to assess their retinal function, and to correlate it with anatomic status. Patients and methods: This was an observational cross-sectional study including 50 eyes from 27 patients. Demographic and clinical data were analyzed. Macular structure was assessed with spectral domain optical coherence tomography (SD-OCT, Heidelberg Results: The average for central foveal thickness (CFT) and choroid thickness (CT) was 213±151 μm and 36±23 μm, respectively, in a total of 50 eyes from 27 patients. In the microperimetry analysis, the average sensitivity on the foveal-centered 12º polygon (CPS) was 14.37±9.1 dB. CT was negatively associated with the bivariate contour ellipse areas (BCEA) 1 (r=-0.314; p=0.034), 2 (r=-0.314; p=0.034), and 3 (r=-0.316; p=0.033). CPS had a strong positive correlation with best-corrected visual acuity (BCVA) (r=0.661; p=0.000). We found a trend to worse microperimetric results in eyes with schisis (n=19) (p>0.05) but eyes with atrophic areas (n=33) presented significant inferior CPS (p<0.001). The presence of staphyloma showed significant impact on macular sensitivities in eyes with areas of macular atrophy/fibrosis (p<0.05). Conclusion: Macular microperimetry analysis can have a role as part of a multimodal anatomo-functional assessment for a more precise characterization of the high myopic patients with MTM, optimizing medical and surgical decisions.
Language	English
Publishing date	2021-01-22
Publishing country	New Zealand
Document type	Journal Article
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S294662
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