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- Ocular repercussions in COVID-19 patients: structural changes of the retina and choroidPublication . Poças, Ilda Maria; Cunha, João Paulo; Camacho, Pedro; Silva, Carina; Ribeiro, Edna; Brito, Miguel; Mendonça, Paula; Barroqueiro, Olga; Lino, Pedro Miguel; Condado, Patrícia; Nicho, Inês; Carmo, Rita; Castelhano, Mariana; Carvalho, Francisca; Almeida, Júlio Costa; Prieto, IsabelPurpose: In March 2022, after 1 year of the emergence of the pandemic by Covid-10 in Portugal, 3413013 positive cases were recorded. The eye can be not only the gateway for coronaviruses (CoV) but also one of their target organs. Conjunctivitis, uveitis, vasculitis, retinitis, and optic neuritis have been documented in animal models. Although most studies focus on respiratory tract involvement, ocular surface involvement such as tears are also reported in other CoVs and their relationship should be valued and studied as a form of treatment, contagion, and transmission. Also, the neurotropism of CoVs, not only through hematogenous dissemination but also through the retrograde neuronal route, associated or not with vascular/ischemic compromise of COVID-19 and its brain sequela may justify the use of non-invasive methodologies to characterize the retina and choroid of patients infected with COVID-19. The possible neurodegeneration associated with the coronavirus will be important to assess the thickness of the innermost layers of the upper hemiretin, with involvement described in other neurodegenerative diseases.
- Coloboma bilateral do nervo óptico: a propósito de um caso clínico de síndroma de CHARGEPublication . Poças, Ilda Maria; Lino, Pedro MiguelIntrodução - Hall, em 1979 após ter observado a combinação de atresia de coanas com outras malformações congénitas, em doentes com cariótipo normal, descreveu pela primeira vez a Associação de Charge. Posteriormente, Pagon et al (1981) propuseram o acrónimo CHARGE para descrever este conjunto de achados [C=Coloboma, H=Heart Defect (cardiopatia congénita), A=Atresia choanae (atresia de coanas), R=Retarded growth (atraso de crescimento), G=Genital hypoplasia (anomalias genitais), E=Ears anomalies (anomalias do ouvido). Embora a causa não seja conhecida, parece resultar de anomalias específicas da diferenciação cerebral. Os critérios de diagnóstico clínico da síndrome de CHARGE foram reformulados por Verloes em 2005, sendo que a existência de coloboma ocular é sinal major para o diagnóstico da mesma. Com uma prevalência de 1:10.000 é uma doença autossómica dominante. O gene CHD 7 localizado no locus 8 q 12 é o único gene conhecido associado à síndroma de CHARGE e encontra-se mutado em 95 dos doentes que cumprem os critérios clínicos da forma típica de Verloes e em 60-70 dos casos suspeitos. Caso clínico - Criança de 9 meses de idade do género masculino, com diagnóstico de Síndroma de Charge. Parto de cesariana às 37 semanas, com historial de crescimento inferior ao normativo para a idade, sendo de relevo a presença de criptorquia. Sem antecedentes familiares com relevância clínica, sem consanguinidade.
- Função visual e variáveis psicológicas nos portadores da síndrome dependência de álcoolPublication . Lino, Pedro Miguel; Poças, Ilda Maria; Grilo, AnaSíndrome de Dependência do Álcool (SDA): consumo excessivo de álcool acompanhado de perturbações a nível físico, emocional e social; normalmente instala-se em situações de maior vulnerabilidade; definida como doença crónica que quando não controlada pode ser fatal; o consumo excessivo afeta a maioria das funções motoras e perceptivas, aumentando o tempo de reação, diminuindo as funções motoras e cognitivas, afetando a atenção de forma severa; alterações psicológicas – ansiedade, dificuldade em dormir, irritabilidade ou depressão; alterações físicas – náuseas, tremores, vertigens, desequilíbrio e perda de coordenação motora; alterações oculares – edema palpebral, lacrimejo, diminuição da acuidade visual, diplopia, diminuição da estereopsia, alterações na sensibilidade ao contraste, alterações vergênciais e acomodativas, redução do campo visual e alterações na visão cromática. Objetivo do estudo - Avaliar a função visual e o estado emocional nos indivíduos com DAS.
- Peters’ anomaly – Strabismus and amblyopia: a case reportPublication . Poças, Ilda Maria; Lino, Pedro Miguel; Abrantes, InêsPeter’s Anomaly, first described by Albert Peter in 1906, consists of a central corneal opacity related to a malformation of the anterior segment of the eye. It’s a disease in a constellation of diseases that causes corneal opacity, iridocorneal adhesions due to dysgenesis of the anterior segment during development. Peters’ Anomaly can cause devastating corneal opacity in an infant leading to severe amblyopia. It frequently occurs with associated strabismus, usually convergent (sensorial type), having also dissociated vertical deviation (DVD). The exact prevalence of Peters’ Anomaly is unknown. This condition is one of a group of disorders known as congenital corneal opacities, which affect three to six individuals per 100,000. Physiopathology: Peter’s Anomaly is a rare dramatic finding at birth, manifests in utero during the first trimester of pregnancy (10-16 weeks of gestation), and can be associated with other systemic malformations. It is classified in two types, which are distinguished by their signs and symptoms. Peters’ Anomaly Type I is characterized by an incomplete separation of the cornea and iris and mild to moderate corneal opacity. Type II is characterized by an incomplete separation of the cornea and lens and severe corneal opacity that may involve the entire cornea. Type II is more associated with systemic alterations and tends to be bilateral. During development of the eyes, the elements of the anterior segment form separate structures. However, in Peters’ Anomaly, development of the anterior segment is abnormal, leading to incomplete separation of the cornea from the iris or the lens. As a result, the cornea is cloudy (opaque), which causes blurred vision. The opaque area (opacity) of the cornea varies in size and intensity from a small, faint streak to a large, white cloudy area that covers the front surface of the eye. Additionally, the location of the opacity varies, the cloudiness may be at the center of the cornea or off-center. Large, centrally located opacities tend to cause poorer vision than smaller, off-center ones. It is important a binocular vision evaluation in order to identify, qualify and quantify the type of ocular deviation, characterize the real and potential binocular single vision and the amblyopia. The motor and sensorial tests must be appropriate to the case in question, in particular, visual acuity and fixation. The treatment involves a corneal transplant which is often complicated due to the young age of the affected. To prevent amblyopia and provide visual rehabilitation a penetrating keratoplasty (PKP) was recommended. Many children with PKP for Peters’ Anomaly Type I can experience good or functional vision in their operated eye. After keratoplasty is very important to improve visual acuity and do amblyopia treatment. Children with glaucoma have a poorer visual prognosis. The treatment of strabismus in cases of Peters’ Anomaly follows the general rules of treatment of concomitant strabismus. The first step should be the best optical correction possible. The surgical proposal must be made after achieving visual acuities between the two eyes. In congenital strabismus, late surgery will only have aesthetic value.
- Impacto subsequente a infeção por COVID-19: mudanças estruturais da retina, da coroide e no nervo óticoPublication . Mendonça, Paula; Poças, Ilda Maria; Camacho, Pedro; Cunha, João Paulo; Silva, Carina; Barroqueiro, Olga; Lino, Pedro Miguel; Condado, Patrícia; Nicho, Inês; Carmo, Rita Barros; Castelhano, Mariana; Carvalho, Francisca; Almeida, Júlio Costa; Prieto, IsabelA conjuntivite, a uveíte, a vasculite, a retinite e a neuropatia ótica têm sido documentadas em modelos animais como possíveis complicações oculares de doenças infeciosas com neurotropismo semelhante ao SARS COV. Considerando a retina uma extensão do SNS e o neurotropismo dos CoVs pode justificar se o uso de metodologias não invasivas como a OCT para caracterizar a retina, coroide e nervo ótico de pacientes infectados com COVID 19 dada a hipótese de uma possível neurodegeneração associada ao coronavírus. Assim, torna-se importante avaliar a espessura das camadas mais internas da retina com envolvimento descrito em outras doenças neurodegenerativas e metabólicas. Objetivo do estudo: Descrever as alterações que ocorrem ao nível da espessura da retina, complexo de células ganglionares fibras nervosas peri-papilares e coróde sub foveal em pacientes infetados por COVID 19 comparando as com um grupo controlo.
- Result of prismatic lenses in the treatment of congenital nystagmus: case reportPublication . Poças, Ilda Maria; Lino, Pedro MiguelIntroduction: Nystagmus is characterized by an involuntary shaking or jerking of the eyes idiopathic or associated with defects of the visual afferent system, which usually results in some degree of visual loss. Congenital motor nystagmus onset is typically between 6 weeks and 3 months of age. Patients with nystagmus often hold their heads in a head abnormal position (HAP), in an effort to maintain a null point - a position whereby eye movement is minimized that reduces the nystagmiform movements. They turn the head to the left while looking to the right or to right, while looking to the left, improving the vision in this position. The use of prismatic lenses with opposite bases placed in the opposite direction to the direction of the look in which the nystagmus decreases, reduces the HAP, and improves visual acuity (VA). The power must be in accordance with the patient's fusional ability to avoid diplopia. Aim of the study: To describe the evolution and impact on VA and HAP, of the use of opposing base prisms for 5 years, in a child with congenital motor nystagmus.
- Visual function and psychological variables in alcohol dependency syndromePublication . Poças, Ilda Maria; Grilo, Ana Monteiro; Lino, Pedro Miguel; Cabrita, Ana; Carvalho, Ana; Ruivo, Claudia; Rocha, Raquel; Cairrão, SaraIntroduction: Alcohol Dependence Syndrome (ADS) is defined as excessive alcohol consumption accompanied by psychological, physical, social, and economic disorders. Alcohol consumption affects motor and proprioceptive functions, decreasing motor and cognitive functions and causing attention deficits. We aim to evaluate visual function and attention, and psychological profiles in consumer and abstainer ADS patients. Methods: This quantitative, descriptive, cross-sectional, and correlational study evaluates visual function in a sample of ADS patients. The Portuguese version of the Brief Symptom Inventory was used to assess patients’ psychological status. The orthoptic examination protocol for visual function consisted of 11 standardized tests: VA for distance and near, ocular movements, near convergence and accommodation point, cover and prismatic cover tests, fusional vergence for distance and near, near stereoacuity, chromatic vision, contrast sensitivity, and visual attention. Results: The sample included 176 patients. 121 were consumers and 55 were abstainers, aged between 31 and 72. The most affected parameters of visual function were visual acuity (80.39%), contrast sensitivity (67.50%), convergence at distance (66.44%), and near stereopsis (62.75%). Visual function was impacted in both groups. Regarding psychological status, consumers had higher averages for the Depression subscale, followed by Paranoid Ideation and Obsession. Abstainers had the highest averages in the Obsession subscale, followed by Paranoid Ideation and Depression. Statistically significant differences existed between the groups in the subscales for depression (p=.046) and paranoid ideation (p=.042). Conclusion: Changes in visual function and attention, as well as psychopathological function, should be considered in the rehabilitation of ADS patients.
- Alterações na retina, coróide e nervo ótico secundárias a SARS-CoVs-2Publication . Lino, Pedro Miguel; Cunha, João Paulo; Poças, Ilda Maria; Camacho, Pedro; Silva, Carina; Ribeiro, Edna; Brito, Miguel; Mendonça, Paula; Barroqueiro, Olga; Condado, Patrícia; Nicho, Inês; Carmo, Rita Barros; Castelhano, Mariana; Carvalho, Francisca; Almeida, Júlio Costa; Prieto, IsabelO novo coronavírus responsável pela síndrome respiratória aguda grave (SARSCoV- 2) surgiu associado a pandemia que hoje vivemos (COVID-19). Como para outros vírus respiratórios altamente contagiosos, as gotículas respiratórias são a principal via de transmissão do SARS-CoV-2. No entanto, outras formas de transmissão foram consideradas - filme lacrimal e saco conjuntival. O contacto próximo com indivíduos infetados e as mãos contaminadas poderão facilitar a sua transmissão mesmo em doentes que não apresentem queixas ou sintomas oculares. O olho pode ser, não só a porta de entrada dos CoVs2, mas também um dos órgãos alvo dos mesmos: conjuntivites, uveítes, vasculites, retinites, nevrites óticas. Apesar de grande parte da atenção dos estudos ser sobre o comprometimento do trato respiratório, o envolvimento da superfície ocular como a lágrima são também referidos em outros CoVs2 e a sua relação deve ser valorizada e estudada enquanto forma de contágio e transmissão. Enquanto ameaça a saúde publica em todo o mundo, a infeção por SARS-CoV-2, realça a necessidade de estudos para a caracterização e compreensão da doença mas também a transmissão de forma a adequar as respostas às necessidades de saúde inerentes. Apesar de grande parte da atenção dos estudos ser sobre o neurotropismo destes coronavírus (não só pela sua disseminação hematogénea mas também por via neuronal retrógrada) e ao possível compromisso vascular/isquémico, com as suas eventuais sequelas no SNC2-3 e envolvimento da retina humana pretendemos descrever as características tomográficas retinianas e coroideias de doentes previamente com COVID-19. Objetivo do estudo: Caracterizar diferentes métricas corio-retinianas em participantes recuperados de COVID-19 comparativamente ao grupo-controlo.
- Peters' anomaly - Strabismus and amblyopia: a case reportPublication . Poças, Ilda Maria; Lino, Pedro MiguelPeters' anomaly is a rare congenital corneal opacity related to a malformation of the anterior segment of the eye, causing severe amblyopia. It can be identified isolated or in association with other ocular or systemic abnormalities. The etiology of Peters' anomaly remains uncertain, but the most likely causes are related to genetic, infectious, traumatic and toxic factors. A range of possible treatment strategies exists, though the effectiveness of each of them depends on how the disease occurs and whether it is identified in early or advanced stages - the earlier diagnosis, the higher the possibility of a successful intervention. This work reports a case of bilateral Peter's anomaly, type I, in a 7-years-old girl with amblyopia, horizontal strabismus also had dissociated vertical deviation, and ocular movements are compatible with a bilateral Duane syndrome, type I.
- Charge syndrome – Amblyopia and coloboma: a case reportPublication . Poças, Ilda Maria; Lino, Pedro MiguelCharge sýndrome is caused by a genetic disorder, with different associated anomalies is a recognizable pattern of congenital malformations. Coloboma, one of the developmental anomalies, is characterized by a poor closure of the embryonary fissure, which can affect the eye different structures. The association with systemic pathology makes the ophthalmologic diagnosis essential for patients' multidisciplinary orientation. From an ophthalmological point of view, patients may present with coloboma associated with other changes, namely strabismus, and nystagmus, and with amblyopia and variable visual acuity.