Browsing by Author "Dutra-Medeiros, Marco"
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- Descemet’s membrane endothelial keratoplasty for corneal endothelial failure secondary to three types of phakic intraocular lens: retrospective studyPublication . Moura-Coelho, Nuno; Cunha, João Paulo; Dias-Santos, Arnaldo; Dutra-Medeiros, Marco; Papa-Vettorazzi, Renato; Manero, Felicidad; Güell, JoséPurpose: To analyze the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) for corneal endothelial failure secondary to phakic intraocular lens implantation (PIOL) at a reference center for corneal transplantation in Spain. Design: Retrospective, single-surgeon case series. Methods: Single-center analysis of patients who underwent DMEK for PIOL-related corneal decompensation between July 2011 and July 2020 with at least 6 months of follow-up postoperatively. The primary outcome was the final best-corrected visual acuity (BCVA, logMAR) compared to pre-DMEK BCVA. Secondary outcomes analyzed included post-DMEK refractive spherical equivalent, endothelial cell loss (%ECL), and graft failure. Results: Sixteen eyes (14 patients) underwent DMEK for PIOL-related corneal decompensation. The Mean (SD) time to PIOL explantation was 9.3 (5.0) years, and the median (P25-P75) time between PIOL explantation and DMEK surgery was 3 (2-4) months. Median pre-DMEK BCVA was 0.80 (1.08-0.60) logMAR. A statistically significant improvement in BCVA was observed 1 month after DMEK (p = 0.001), and the median final BCVA was 0.15 (0.0-0.35) logMAR (p = 0.002). The mean %ECL was 55.6 (18.7) % at 2-year follow-up and 61.7 (11.7) % in eyes with over 4 years of follow-up. Two eyes required re-bubbling (12.5%), one of which ended in primary graft failure (6.2%) and one eye had late endothelial graft failure (LEGF) at 4-year follow-up (1/15 grafts, 6.7%). Conclusion: In patients with PIOL-related corneal decompensation, DMEK leads to good and clinically significant refractive and visual outcomes in the medium-long term, with a good safety profile. Prospective studies are encouraged to ascertain whether these cases are at increased risk of accelerated endothelial cell loss and LEGF.
- DNA methyltransferase expression (DNMT1, DNMT3a and DNMT3b) as a potential biomarker for anti-VEGF diabetic macular edema responsePublication . Camacho, Pedro; Ribeiro, Edna; Pereira, Bruno; Varandas, Teresa; Nascimento, João; Henriques, José; Dutra-Medeiros, Marco; Delgadinho, Mariana; Oliveira, Ketlyn; Silva, Carina; Brito, MiguelPurpose: DNA methylation is involved in Diabetic Retinopathy progression showing a metabolic memory mechanism. However, the association of DNA methyltransferase with diabetic macular edema is still unknown. We aimed to describe the differences in DNA methyltransferase gene expression in patients with different diabetic macular edema responses. Methods: A total of 27 diabetic patients, aged 59-90 years, were prospectively enrolled in this cross-sectional study. The participants were classified into the control group (CG, n = 11), diabetic macular edema responders (rDME, n = 9), and non-responder diabetic macular edema (nrDME, n = 7) after anti-vascular endothelial growth factor (anti-VEGF) treatment. Only cases with a complete ophthalmological examination, digital 133° color fundus, and SD-OCT assessments were used. After RNA extraction and first-strand cDNA synthesis, quantitative real-time PCR was performed with specific primers on the CFX Connect™ Real-Time PCR Detection System to assess differential transcriptional expression patterns. Results: The DNMT1 gene showed a positive correlation (r = 0.617; p = 0.043) with Best Corrected Visual Acuity (BCVA) in CG, a positive correlation (r = 0.917; p = 0.010) with HbA1c in nrDME and a negative correlation (r = -0.659; p = 0.049) with GCL-IPL thickness in rDME. DNMT3A gene showed a positive correlation (r = -0.890; p = 0.001) with Sub-foveal Choroidal thickness in rDME whereas DNMT3b gene showed a negative correlation (r = -0.815; p = 0.007) with HbA1c and RNFL (r = -0.664; p = 0.026) in CG. Conclusions: Patients with similar metabolic profile risk factors showed associated DNA methyltransferase transcriptional expression patterns differences fitting with the anti-VEGF diabetic macular edema response. Further studies are needed to clarify if these results (1) reflect disease evolution, (2) translate the therapeutic impact, (3) or can help to predict the therapeutic resistance profile.
- Ganglion cell complex in early and intermediate age-related macular degeneration: evidence by SD-OCT manual segmentationPublication . Camacho, Pedro; Dutra-Medeiros, Marco; Páris, LilianaPurpose: To evaluate ganglion cell layer (GCL) and ganglion cell complex (GCC) thickness manually by spectral-domain optical coherence tomography in subjects with early and intermediate age-related macular degeneration (AMD) in 12 locations on the horizontal meridian. Methods: A total of 450 eyes (specifically, 246 eyes classified as having early/intermediate AMD plus 204 control eyes) were studied. Mann-Whitney U and Kruskal-Wallis tests were used to compare values between the healthy controls and the AMD group and also between the subgroups under study. Diagnostic performance was also compared calculating the areas under the receiver operating characteristic curve. Results: The manual layer segmentation showed clear boundaries between the GCL and the GCC. It was in the temporal GCC that more changes were found. Conclusions: The GCC, especially in the temporal region, allowed the discrimination of differences between various subgroups that have faint variations as well as between early AMD and the first signs of aging.
- Intraocular lens opacification after Descemet’s membrane endothelial keratoplasty: risk factors and outcomes after intraocular lens exchangePublication . Moura-Coelho, Nuno; Papa-Vettorazzi, Renato; Reyes, Alonso; Cunha, João Paulo; Dutra-Medeiros, Marco; Manero, Felicidad; Güell, José LuisPurpose: To determine risk factors for intraocular lens opacification (IOLop) after Descemet membrane endothelial keratoplasty (DMEK) and to analyze clinical outcomes after IOL exchange. Methods: Cross-Sectional Study: Analysis of all cases of IOL exchange because of post-DMEK IOLop with a minimum of 6-month postoperative follow-up observed in the clinic between November 2021 and April 2022. The main outcomes analyzed at the study visit were changes in the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity after IOL exchange, endothelial cell loss (ECL), and graft survival. A historical cohort of 232 pseudophakic DMEK eyes was retrospectively analyzed to determine risk factors for post-DMEK IOLop. Results: Cross-Sectional Study: Four eyes were observed (median follow-up = 45 (35.5-86.8) months). IOL materials were hydrophilic acrylic IOLs in 2 eyes and hydrophobic-hydrophilic in the other 2. At the study visit, improvement in median best-corrected visual acuity after IOL exchange was statistically significant (0.25 (0.19-0.41) logMAR to 0.00 (0-0.10) logMAR; P = 0.041). ECL ranged between 57.7% and 85.3%, without cases of graft failure. In the historical cohort, 21 eyes (9.05%) had some IOLop. In the multivariate logistic regression model (105 eyes where IOL material data was available), IOLs with high water content material (odds ratio = 65.5, P = 0.0005) and rebubbling (odds ratio = 9.51, P = 0.0138) were independent risk factors for post-DMEK IOLop. Conclusions: Post-DMEK IOLop is infrequent, but a non-neglectable proportion of cases may require IOL explantation. IOL exchange is safe and effective in these eyes but may pose a risk for increased ECL. This study confirms that IOL material and the number of rebubblings are major risk factors for post-DMEK IOLop.
- Manual segmentation of 12 layers of the retina and choroid through SD-OCT in intermediate AMD: repeatability and reproducibilityPublication . Camacho, Pedro; Dutra-Medeiros, Marco; Salgueiro, Luís; Sadio, Sílvia; Rosa, Paulo C.Purpose: To evaluate the repeatability and reproducibility of the segmentation of 12 layers of the retina and the choroid, performed manually by SD-OCT, along the horizontal meridian at three different temporal moments, and to evaluate its concordance with the same measurements performed by two other operators in intermediate AMD. Methods: A cross-sectional study of 40 eyes from 40 subjects with intermediate AMD was conducted. The segmentation was performed manually, using SD-OCT. The 169 measurements per eye were repeated at three-time points to study the intra-operator variability. The same process was repeated a single time by two different trained operators for the inter-operator variability. Results: Forty participants (28 women and 12 men) were enrolled in this study, with an average age of 76.4 ± 8.2 (range, 55–92 years). Overall, the maximum values of the various structures were found in the 3 mm of the macula. Intra-operator variability: the highest ICC values turned out to be discovered in thicker locations. inter-operator variability: except correlation values of 0.826 (0.727; 0.898) obtained in the OPL (T2.5) and 0.634 (0.469; 0.771) obtained in the IPL (N2), all other correlation values were >0.92, in most cases approaching higher values like 0.98. Conclusion: The measurements of several layers of the retina and the choroid achieved at 13 locations presented good repeatability and reproducibility. Manual quantification is still an alternative for the weaknesses of automatic segmentation. Locations of greatest concordance should be those used for clinical control and monitoring.
- Outer retina and choroidal thickness in intermediate age-related macular degeneration: reticular pseudodrusen findingsPublication . Camacho, Pedro; Dutra-Medeiros, Marco; Cabral, Diogo; Silva, RufinoPurpose: To evaluate outer retina and choroidal thickness in subjects with intermediate age-related macular degeneration (iAMD) and to describe associations with the presence of reticular pseudodrusen (RPD). Methods: This was a retrospective, cross-sectional analysis of 157 consecutive eyes (specifically: 62 eyes classified as having RPD and 95 eyes with drusen ≥125 μm). Only cases with digital color fundus photographs, red-free, and infrared, obtained and graded according to the Age-Related Eye Disease Study to define iAMD, were used for this study. Outer retina and choroidal thickness were manually segmented and quantified at 12 locations in the horizontal meridian. Results: RPD appeared to be associated with thinning of the outer layers even after adjustment for gender and age. The presence of RPD in iAMD decreased with increase of choroidal thickness (total odds ratio [OR] 0.991, 95% confidence interval [CI] 0.985-0.996; nasal OR 0.992, 95% CI 0.986-0.997), with increased thickness of the myoid zone of the photoreceptors (total OR 0.812, 95% CI 0.688-0.958; nasal OR 0.863, 95% CI 0.755-0.987) and with increased thickness of the outer segment of the photoreceptors (total OR 0.850, 95% CI 0.731-0.989; nasal OR 0.857, 95% CI 0.736-0.989). Conclusions: The greatest differences between eyes with and without RPD are found at the level of the choroidal thickness and at the level of the photoreceptors.
- Paracentral acute middle maculopathy: review of the literaturePublication . Moura-Coelho, Nuno; Gaspar, Teresa; Ferreira, Joana Tavares; Dutra-Medeiros, Marco; Cunha, João PauloParacentral acute middle maculopathy (PAMM) is a recently identified spectral-domain optical coherence tomography (SD-OCT) finding characterized by a hyper-reflective band spanning the inner nuclear layer (INL), which typically evolves to INL atrophy in later stages. Typical clinical features include the sudden onset of one or multiple paracentral scotomas, normal or mild reduction in visual acuity, and a normal fundus appearance or a fundus with a deep grayish lesion. Although its pathophysiology is not yet fully understood, ischemia at the level of the intermediate and deep capillary plexa has been demonstrated to play a major role. Since its first description, an increasing number of publications on PAMM have been published in ophthalmology scientific journals. The purpose of this study is to provide a review of the current literature on PAMM.
- Predictive factors of long-term visual outcomes after primary Descemet’s membrane endothelial keratoplasty (DMEK): retrospective studyPublication . Moura-Coelho, Nuno; Papa-Vettorazzi, Renato; Dias-Santos, Arnaldo; Cunha, João Paulo; Dutra-Medeiros, Marco; Manero, Felicidad; Güell, José LuisPurpose: To determine predictive factors of higher levels of best-corrected visual acuity (BCVA) in the long-term after primary Descemet's membrane endothelial keratoplasty (DMEK). Methods: Retrospective, single-surgeon case series of 129 successful primary DMEK eyes without graft failure and with a minimum postoperative follow-up of 12 months. A mixed effect model for repeated measurements (MMRM) analysis was performed to determine recipient, donor, surgical, and postoperative factors associated with BCVA ≤ 0.10 logMAR (≥ 20/25 Snellen). Results: After primary DMEK, there was a statistically significant improvement in BCVA with a global reduction in logMAR BCVA (p < 0.00001). There was also a global tendency towards increasing the proportion of eyes with BCVA ≤ 0.10 logMAR at all time points (p < 0.00001), from 1.6% before DMEK to 64.4% in eyes with more than 5 years of F-U. The absence of retinal disease was associated with a decrease of 0.10 logMAR in postoperative BCVA after primary DMEK, maintaining constant the rest of the variables (p < 0.001). The variables age (OR 0.960), postoperative time (OR 1.083), preoperative BCVA ≥ 0.375 logMAR (OR 0.162), and indication for DMEK (OR 5.412) were included in the predictive MMRM model of BCVA ≤ 0.10 logMAR. Conclusion: Primary DMEK is associated with statistically and clinically significant improvement in BCVA that occurs early in the postoperative period and is continuous over time. Eyes with retinal comorbidities have an increased risk of worse postoperative BCVA after DMEK. Younger recipient age, Fuchs' dystrophy eyes, and eyes with better preoperative BCVA are more likely to achieve postoperative BCVA ≤ 0.10 logMAR.
- Role of DNA methylation in persistent diabetic macular edemaPublication . Camacho, Pedro; Pereira, Bruno; Ribeiro, Edna; Varandas, Teresa; Henriques, José; Nascimento, João; Dutra-Medeiros, Marco; Silva, Carina; Delgadinho, Mariana; Oliveira, Ketlyn; Brito, MiguelBackground: a) Disease duration and metabolic control are insufficient to understand Diabetic Macular Edema (DME), the leading cause of vision loss in people with diabetes; b) 30-40% of cases of DME do not respond optimally to AVEGF (loading phase); c) poor genetic association in DR development (<25% RD) and PDR progression (25-50%). Purpose: To study the role of DNA methyltransferase expression (DNMT1,DNMT3a, DNMT3b) in persistent diabetic macular edema.