Percorrer por autor "Lino, Pedro"
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- Alterações morfométricas na retina, coroide e nervo ótico após infeção por SARS-CoV-2Publication . Lino, Pedro; Camacho, Pedro; Mendonça, Paula; Silva, Carina; Cunha, João Paulo; Barroqueiro, Olga; Condado, P.; Nicho, I.; Carmo, R.; Castelhano, M.; Carvalho, F.; Almeida, J. C.; Prieto, I.; Poças, Ilda MariaO novo coronavírus responsável pela síndrome respiratória aguda grave (SARS-CoV- 2) surgiu associado à pandemia por COVID-19. A enzima conversora da angiotensina 2 (ACE-2), com aparente importância na COVID-19, pela interação com as proteínas na superfície do vírus, tem expressão em vários tecidos oculares e várias alterações como conjuntivite, uveíte, vasculite e neurite foram descritas inicialmente em modelos animais. Em estudos mais recentes, embora na maioria em doentes COVID-19 moderados/grave, tem sido descrito o comprometimento da superfície ocular anterior e do polo posterior reforçando a ideia de neurotropismo (pela facilidade de envolvimento do sistema nervoso central) que classicamente é descrito em outros coronavirus. Algumas alterações do polo posterior incluem o compromisso vascular/ isquémico tornando relevante também a observação da coroide. A SARS-CoV-2 tem sido associada à diminuição das camadas internas da retina e à presença de lesões hiperrefletivas, micro-hemorragias e manchas algodonosas. No entanto, o envolvimento da retina e a coróide em doentes previamente infetados com COVID-19 ainda não é totalmente compreendido. De forma a clarificar o envolvimento dos fatores de neuro-degeneração e vasculares, descritos em indivíduos recuperados de COVID-19 moderada/grave, é fundamental perceber que alterações existem ao nível da retina interna e da coroide, em indivíduos recuperados de COVID-19 ligeira. Questão de investigação: Existem alterações morfométricas da retina, coroide e nervo ótivo em indivíduos recuperados de COVID-19 ligeira?
- ExotropiasPublication . Lino, PedroEstrabismo - Síndroma oculomotora com duas componentes motora e sensorial. Na componente motora um dos olhos encontra se desviado, estando numa posição anómala face ao outro, dito dominante. Na componente sensorial existe alterações da visão binocular de modo a que as imagens não se formam em pontos retinianos correspondentes o que leva ao desenvolvimento de fenómenos sensoriais subsequentes e/ou compensatórios. Exotropia - Desvio temporal dos eixos visuais. Exotropia intermitente X(T): representa a forma mais comum de exodesvios. Prevalência estimada 60 em crianças com desenvolvimento normal. Exotropia constante: desvio divergente permanente dos eixos visuais XT congénita, XT secundária (sensorial), XT secundária a uma X(T) descompensada.
- Factors associated with the recurrence of intermittent exotropia and reoperations in the long termPublication . Lino, Pedro; Aguiar, Pedro; Cunha, João PauloPurpose: To evaluate long-term reoperation risk after bilateral lateral rectus (BLR) recession for intermittent exotropia (IXT) in a paediatric cohort, and to identify the perioperative factors associated with recurrence and reoperation. Methods: A retrospective observational cohort of 258 children with basic or divergence-excess IXT who underwent BLR recession at CUF Cascais Hospital between 2010 and 2020 was analysed. Clinical variables included age, age at surgery, pre- and immediate postoperative deviation angles, preoperative occlusion therapy, orthoptic treatment, binocular function, and initial surgical success (residual deviation <10 prism dioptres with fusion). Bivariate analyses were performed using t-tests or χ2 tests, and variables with p < 0.10 were entered into multivariable binary logistic regression to identify the independent predictors of reoperation. Model diagnostics included variance inflation factors (VIF), Hosmer-Lemeshow test, and area under the receiver operating characteristic curve (AUC). Significance was set at p < 0.05. Results: Reoperation was required in 11% of cases. Failed initial surgery (adjusted OR = 34.7; p < 0.001), larger preoperative deviation (adjusted OR per PD = 1.143; 95% CI 1.062-1.231; p < 0.001), larger immediate postoperative deviation (adjusted OR per PD = 0.822; 95% CI 0.766-0.881; p < 0.001), and older patient age (adjusted OR per year = 1.261; 95% CI 1.032-1.542; p = 0.024) were independently associated with reoperation. Orthoptic and occlusion therapies showed non-significant trends. Conclusion: In children undergoing BLR for IXT, initial surgical failure and deviation magnitude (pre- and immediate postoperative) are the strongest predictors of reoperation, with age having a modest additional effect. These findings emphasize precise surgical planning and the need for long-term follow-up.
- Ocular repercussions in COVID-19 patients: structural changes of the retina and choroidPublication . Poças, Ilda Maria; Lino, Pedro; Silva, Carina; Mendonça, Paula; Cunha, João Paulo; Barroqueiro, Olga; Carvalho, Francisca; Nicho, Inês; Castelhano, Mariana; Condado, Patrícia; Carmo, Rita; Almeida, Júlio; Prieto, Isabel; Camacho, PedroBackground: Neurotropic capabilities of SARS-COVs allow viruses to reach the central nervous system by hematogenous neuronal dissemination. The human retina, as an extension of the Central Nervous System, may have some neurodegenerative and/or vascular modifications related to COVID-19. Objectives: To evaluate choroidal and inner neural layers in participants previously recovered from COVID-19 compared to the control group using optical coherence tomography. Methods: With a cross-sectional approach, the sample (n = 96), consisting of patients who have recovered from COVID-19 (n = 56) and healthy participants control group (n = 40) were ophthalmologically characterized. The neurodegenerative and vascular histological assessment was performed using SD-OCT and the mean thickness was measured in Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. The retinal nerve fiber layer, Ganglion cell layer, and subfoveal choroidal thickness were obtained through semi-automatic measurement. Results: A total of 40 controls (27 women [67.5%]) and 56 COVID-19 participants (34 women [60.8%]) were included in this first report. There were retinal thickness significant differences in nearly all inner ETDRS subfields: nasal 3 mm (p = .025), I3 (p = .049), and temporal 3 mm (p = .009). Also, a decrease in neural layers was found in the nasal 3 mm (p = .049) and temporal 3 mm (p = .029) during ganglion cell layer assessment. The peripapillary retinal nerve fiber layer thickness was thinner in the COVID-19 group in superior temporal (p = .019), nasal (p = .002), inferior temporal (p = .046), and global (p = .014). Concerning the subfoveal choroidal measurement, an increase was observed in the COVID-19 group (p = .002). Conclusion: Participants who had recovered from COVID-19 showed a non-glaucomatous neuropathy trend pattern. We found differences closer to the classic description of the “bow-tie” observed in other neurological as compressive neuropathies at the chiasma location. OCT assessment also showed an increase in choroidal thickness as a result of vascular changes.
- Orthoptic treatment after strabismus surgery in child intermittent divergent strabismusPublication . Lino, Pedro; Aguiar, Pedro Varques de; Cunha, João PauloPurpose: To evaluate short-term motor and sensory-motor outcomes following postoperative OT in children with IXT after strabismus surgery. Methods: This prospective before-and-after observational study included children with IXT who underwent bilateral lateral rectus recession and were referred for postoperative OT based on predefined clinical criteria. A structured 12-week OT plan was initiated approximately six months after surgery. Outcome measures included angle of deviation (prism diopters, PD), near point of convergence (cm), positive fusional vergence amplitudes (PD), and convergence amplitudes at distance and near (PD). Pre- and post-therapy changes were analysed using paired-samples t-tests with effect sizes calculated using Cohen's d. Final postoperative alignment was additionally compared cross-sectionally between children who underwent OT and those managed without OT. Results: Eighty-eight children had complete paired motor and sensory-motor data and were included in the analyses. Changes in static ocular alignment were small, with mean residual deviation improving from -7.02 ± 6.91 PD to -5.22 ± 6.60 PD after OT (mean change +1.80 PD; p < 0.01; d ≈ 0.30). No significant difference in final postoperative alignment was observed between the OT and non-OT groups (p = 0.827). In contrast, marked improvements were observed in sensory-motor outcomes. Positive fusional vergence amplitude increased from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD (p < 0.001; d ≈ 1.5). Distance convergence amplitude improved from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD, and near convergence amplitude from 10.95 ± 12.50 PD to 33.29 ± 13.89 PD (both p < 0.001; d ≈ 1.5). The near point of convergence showed a modest but significant improvement. Conclusions: Postoperative OT was associated with substantial short-term improvements in sensory-motor function, particularly fusional and convergence capacities, while changes in static ocular alignment were small and of limited clinical relevance. These findings support the role of OT as a functional adjunct to surgery, aimed at enhancing binocular control and postoperative sensory-motor stability in children with IXT.
- Paralisia parcial do III par craniano no contexto de aneurisma intracraniano: relato de casoPublication . Poças, Ilda Maria; Lino, PedroAs queixas de diplopia podem surgir de uma série de doenças que variam de benignas a potencialmente fatais, sendo muitas vezes o primeiro sinal de causas graves, como o caso de aneurismas. A abordagem diagnóstica inicial para diplopia consiste na anamnese e exame neurológico e oftalmológico detalhados, com foco especial na motilidade e alinhamento ocular; assim como no exame imagiológico dirigido. A Paralisia parcial do III par craniano afeta um ou mais músculos enervados por este par. Uma vez que este par craniano é responsável pela inervação da musculatura intrínseca do olho, a mesma também pode estar afetada de acordo com a localização da lesão. Objetivo do estudo: Descrever o caso de uma paralisia parcial do III Par direito, envolvendo a musculatura extrínseca do olho direito, no contexto de um aneurisma cerebral.
- Success of strabismus surgery in intermittent exotropiaPublication . Lino, Pedro; Aguiar, Pedro Vargues de; Cunha, João PauloIntroduction: Intermittent exotropia (IXT) is the most common form of childhood divergent strabismus. Surgery remains the primary approach to control ocular deviation and preserve binocular function. Although previous studies report a success rate of approximately 75%, factors influencing surgical outcomes remain insufficiently explored. This study evaluates the effectiveness of strabismus surgery in children with IXT and identifies predictors of postoperative alignment stability. Methods: This retrospective study included 258 children with basic-type IXT or divergence excess who underwent bilateral lateral rectus recession. Clinical records and surgical data were analyzed to determine the overall success rate and identify associated predictive factors. Results: The sample included 166 females (64.3%) and 92 males (35.7%), with a mean age of 11.19 ± 3.73 years. Surgical success was achieved in 238 patients (92.2%). Success rates were similar across sexes (92.8% in females vs. 91.3% in males). No significant associations were found between surgical success and sex, age, preoperative occlusion therapy, binocular function, or IXT subtype. However, patients with moderate preoperative deviations had higher success rates. A statistically significant difference was observed in the preoperative deviation angle between successful (31 ± 7.08∆) and unsuccessful (42 ± 7.27∆) cases. A lower AC/A ratio was also associated with better outcomes, although it was not the main predictor. Discussion: The high success rate (92.2%) suggests a limited impact of demographic or preoperative variables. The preoperative deviation angle emerged as the strongest predictor of success, with smaller angles correlating with more favorable surgical outcomes. These findings underscore the importance of accurate preoperative assessment in surgical planning for IXT.
- Surgical management of intermittent exotropia (IXT) in children: a literature reviewPublication . Lino, Pedro; Aguiar, Pedro; Cunha, Maria JoãoIntroduction: Surgical treatment of intermittent exotropia (IXT) in children presents variable outcomes due to diverse surgical techniques, success definitions, and follow-up durations. There is a need to clarify factors influencing prognosis to guide clinical decisions. Methods: This review synthesizes published studies assessing surgical outcomes in pediatric IXT, focusing on success rates, criteria used, surgical approaches, and predictive factors influencing long-term results. Results: Short- and medium-term motor success rates are generally high; however, outcomes tend to decline over time, mainly due to postoperative exodrift, resulting in recurrence and reoperation. Unilateral recess-resect procedures showed better long-term results in some cohorts, while modified techniques like slanted lateral rectus recession yielded promising results in specific IXT subtypes. Preoperative sensory function and deviation control were significant predictors of success. Conclusion: Surgical outcomes in pediatric IXT vary widely, highlighting the importance of standardized success criteria, including sensory and motor measures. Extended follow-up and patient-specific surgical planning are essential for optimizing results. Future prospective research with uniform methodologies is necessary to improve treatment strategies.