<b><i>Background:</i></b> First-line treatment for diabetic macular edema (DME) is usually with antivascular endothelial growth factor agents, followed by intravitreal corticosteroids as a second-line treatment option. Long-term corticosteroids may offer quality of life and effectiveness benefits over short-term implants. <b><i>Objectives:</i></b> To evaluate outcomes of patients with persistent or recurrent DME who switched from a short-term (dexamethasone) to a long-term (fluocinolone acetonide, FAc) corticosteroid intravitreal implant in a real-world setting. <b><i>Methods:</i></b> This is a retrospective study in 9 Portuguese centers. An FAc intravitreal implant was administered according to product labeling. Effectiveness outcomes were mean change in visual acuity (VA; ETDRS letters), central retinal thickness (CRT; µm), and macular volume (MV; mm³). The safety outcome was mean change in intraocular pressure (IOP; mm Hg). All were analyzed at months 1 and 3, and then quarterly until month 24 after implantation. <b><i>Results:</i></b> Forty-four eyes from 36 patients were analyzed. Mean duration of DME was 3.3 ± 1.9 years, and mean follow-up was 8 months. From baseline following FAc implantation, VA increased significantly at months 1 and 6 (mean +6.82 and +13.02 letters, respectively; <i>p</i> = 0.005), and last observation carried forward (LOCF; mean +8.3 letters; <i>p</i> = 0.002). CRT improved significantly at months 1 and 6 (mean –71.81 and –170.77 µm, respectively; <i>p</i> = 0.001), and LOCF (mean –121.46 µm; <i>p</i> = 0.001). MV was consistently, but not significantly, decreased from baseline to LOCF (mean –0.69 mm³; <i>p</i> = 0.062). The mean change in IOP was –0.25 and +0.88 mm Hg at months 1 and 6, respectively (<i>p</i> = 0.268), and +1.86 mm Hg at LOCF (<i>p</i> = 0.036). Increases were controlled with topical medication in most cases. <b><i>Conclusions:</i></b> The FAc intravitreal implant is effective in patients previously treated with short-term corticosteroid implants. Thus, after a suboptimal response to antiangiogenics or a short-term corticosteroid, a single FAc implant may be considered an effective and tolerable treatment that can improve long-term outcomes for patients with sight-threatening DME.

Aim: Evaluate the real-life experience with ocriplasmin on vitreomacular traction (VMT) release and full-thickness macular hole (FTMH) closure in Portugal. Methods: Multicentric, retrospective study of 83 eyes of 78 patients who were treated with intravitreal ocriplasmin for VMT with and without FTMH. Primary outcomes were VMT release and FTMH closure. Secondary outcomes included visual acuity changes and structural features on spectral-domain ocular coherence tomography. Results: VMT resolved in 47 of the 83 eyes (56.6%) and 6 of the 12 FTMH were closed (50.0%). Mean best-corrected visual acuity (BCVA) improved from 65.1 at baseline to 70.8 ETDRS letters at the end of follow-up (p < 0.0001) with a mean follow-up of 138.8 days. Improvement in BCVA was significantly better in eyes with VMT release (p = 0.021). Approximately 73% of patients had normal ellipsoid zone integrity at the end of follow-up, 87% had no neurosensorial detachment and 40% had no intra- or subretinal fluid. Conclusion: VMT release and FTMH closure were achieved in more than half of the treated eyes and were correlated with significant BCVA improvements and favorable baseline characteristics. In fact, if a careful patient selection is carried out, VMT resolution with ocriplasmin can be optimized, tailoring the best approach to each patient.

RESUMOINTRODUÇÃO: A divulgação de condições clínicas raras, em que a intervenção médica modifica significativamente a abordagem dos doentes, é importante, pois, além de alertar para a sua existência, permite a partilha de conhecimento com potencial impacto na prática clínica. CASO CLÍNICO: Doente do sexo masculino, com 32 anos de idade, previamente avaliado em Dermatologia e Imunoalergologia por urticária crónica. Refere aparecimento de rash urticariforme crónico acompanhado de astenia e artralgias, com oito anos de evolução. Medicado com anti-histamínicos e ciclosporina sem resolução da sintomatologia. Foi referenciado a Medicina Interna por aumento persistente e crescente da velocidade de sedimentação (65 mm). No estudo dirigido efetuado, identificou-se uma gamapatia monoclonal IgM de cadeias kappa. Diagnosticou-se o doente, como tendo síndrome de Schnitzler. Iniciou terapêutica com colquicina com resolução completa dos sintomas. DISCUSSÃO: A síndrome de Schnitzler é uma entidade rara, cuja patofisiologia não se encontra completamente compreendida, sabendo-se que apresenta um perfil autoinflamatório. O diagnóstico da síndrome de Schnitzler exige elevada suspeição clínica, pelo que a descrição de casos como o apresentado é crucial, para que esta seja uma entidade conhecida e discutida, com uma maior notoriedade.

O surgimento do vírus da síndrome respiratória aguda grave – coronavírus 2, responsável pela doença COVID-19, conduziu a um rápido desenvolvimento de métodos moleculares e serológicos para o seu diagnóstico. Apesar de o teste molecular de amostras do trato respiratório ser o teste de diagnóstico standard, verifica-se um interesse crescente pelo uso de exames serológicos, mas existe, ainda, evidência limitada sobre os mesmos. Os autores apresentam dois casos clínicos em que traduzem algumas das vantagens da utilização do teste serológico como complementar no diagnóstico da infeção pelo vírus da síndrome respiratória aguda grave – coronavírus 2, nomeadamente nos casos ativos de COVID-19, que apresentam teste molecular inicial negativo.

Prevalence of chronic kidney disease (CKD) is increasing and CKD has a long asymptomatic phase suitable for screening. SCORED (Screening for Occult Renal Disease) is a prescreening test which has compared favorably with KEEP. We report the results of SCORED testing in subjects attending a World Kidney Day event. After SCORED, subjects were tested for creatinine, urinary albumin and creatinine, and renal ultrasound. Eighty-eight subjects participated (32 men; mean age 59.7 ± 14.8 years; 58% hypertensive and 15.9% diabetics) of which 60 had a high score for kidney disease. Thirty-eight of 47 (80.8%) subjects that were further evaluated had a high-risk score. All subjects with CKD had a high score (100% sensitivity). SCORED showed low specificity (24.3%), but a high negative predictive value (100%). Including albuminuria in the definition of CKD increased the positive predictive value to 43.6%. In conclusion, SCORED is good for prescreening subjects for CKD in a European population as it captures all patients with CKD. Moreover, in subjects with low risk, the probability of CKD is low. SCORED is useful in alerting the general population and the medical community about the risk factors of CKD.