Purpose To analyse the clinical outcome in patients with meibomian gland dysfunction (MGD) who underwent intense pulsed light (IPL) plus low-level light therapy (LLL). Materials and Methods The prospective non-comparative study included identified by MGD patients with altered interferometry and lower loss area of the meibomian glands (LAMG), who underwent IPL plus LLL, between July 2020 and August 2020. A multimodal assessment was performed before, 2–3 weeks, and 6 months after treatment. The main outcome was lipid layer thickness (LLT) and the secondary outcomes were the ocular surface disease index (OSDI) score, presence of corneal fluorescein staining (CFS), blink rate (BR), Schirmer test (ST), tear meniscus height (TMH), tear osmolarity (OSM), non-invasive break-up time (NIBUT) and LAMG. Results This study included 62 eyes of 31 patients, 61.3% female, with a mean age of 66.94±9.08 years at the time of IPL plus LLL treatment. LLT (<0.001) grades improved 6 months after treatment. The mean OSDI score improved (p<0.001) from 45.02±21.17 (severe symptoms) to 22.35±17.68 (moderate symptoms) at 2–3 weeks and 8.24±17.9.91 (normal) at 6 months after treatment. CFS was identified in 51.6% (32/62) before and in 45.2% (28/62) 6 months (p=0.293) after treatment. ST (p=0.014) grades improved; OSM grades mild worsened (p<0.001); TMH, NIBUT and LAMG grades did not modify 6 months after treatment. No patient suffered any adverse effects. Conclusion IPL combined with LLL was effective and safe, improving the lipid layer thickness in MGD and decreasing the level of symptoms.

Background The variable visual function observed in diabetic retinopathy (DR) patients is not fully explained by the classic staging system. Our purpose was to evaluate choroidal changes, in standardized sectors, in DR patients and to find associations between choroidal measurements and visual function. Methods Cross-sectional study that included the right eye of diabetic patients (n = 265) without active edema, ischemia or neovascularization and age-matched controls (n = 73). Optical coherence tomography (OCT) imaging was performed with enhanced depth imaging protocol. Choroidal vascularity index (CVI) was calculated in a 5 mm scan centered in the fovea. Results CVI decreased with age (p < 0.001) but was not influenced by axial length. A multivariate analysis adjusting for age confirmed a significant difference in CVI between DR eyes that had previous treatments (intravitreal injections and/or photocoagulation) compared to control eyes (p = 0.013) and to DR eyes that never required treatment (p = 0.002). There was no significant difference between non-DR diabetic patients and normal controls. Considering the group of DR patients that had previous treatments, in eyes without optic media opacification, BCVA correlated with CVI (r = − 0.362, p < 0.001), whereas full retina thickness and individual retinal layer thickness did not (p > 0.066). Conclusions A reduction in CVI was observed in patients with a more advanced stage of DR. In treated DR patients with stable disease, choroidal biomarkers correlated with best-corrected visual acuity whereas retinal biomarkers did not. Trial registration: N/A

Purpose: To address the long-term visual function after bilateral pan-retinal photocoagulation (PRP) and its impact in real life, namely on visual field (VF) legal criteria to drive. To determine potential predictors related to clinical factors and treatment strategies. Patients and Methods: Observational cross-sectional study. Eyes from diabetic patients diagnosed with diabetic retinopathy who underwent bilateral PRP, with or without macular treatments and with visual acuity legal criteria for non-professional driving were randomly assigned. Main outcomes were: demographic and clinical data including best corrected visual acuity; binocular visual field (EBST-Esterman Binocular Suprathreshold Test, Humphrey analyzer3 ®); contrast sensitivity (CS-Metrovision-MonPack3 ®); light scattering in the retina (HD Analyzer, Visiometrics ®). Results: Seventy-one diabetic patients included (44 men and 27 women), with a mean age of 62.2±11.8 years. PRP was performed, on average, 9.7±6.9 years before the study. The average EBST Score was 85.8±17.0 and the average CS (2-5cpd) was 19.5±2.9 dB in photopic and 14.2±4.1 dB in mesopic conditions. Through a multivariate regression model, after adjusting to the clinical and demographic factors as possible confounders, we found that treatment factors associated with worse results were the use of Argon laser for the EBST Score, the very confluent PRP for the number of non-viewed points in the central 30°x20° of the EBST and the presence of macular treatments for the CS tests. According to Portuguese law, 79% (n=56) of patients had minimal EBST amplitudes for non-professional driving. Conclusion: The functional results achieved in our sample are compatible with an active life, allowing most of the patients included to overcome the requirements of Portuguese legislation for driving light vehicles, namely at the level of the binocular visual field. These results highlight the role of PRP in the treatment of diabetic retinopathy in an era with evolving less aggressive laser options.

Purpose To study the clinical benefit of low-level light therapy when associated with intense pulsed light for the treatment of meibomian gland dysfunction. Methods An observational comparative study. Sixty-two (62) subjects were assigned 1:1 to one of two treatment arms: group 1 (31 subjects, 62 eyes), intense pulsed light followed by low-level light and group 2 (31 subjects, 62 eyes) intense pulsed light alone. In both groups, treatments were performed in 3 sessions and subjects were evaluated at baseline and 3 weeks after the last treatment session. Values are shown as Δ = mean difference ± standard deviation. Results We observed a significant improvement is OSDI-12 score and lipid layer thickness, in both groups (Δ=-22.7 ± 17.5, p < 0.001 in group 1 and Δ=-23.6 ± 23.8, p < 0.001 in group 2 for OSDI and Δ=+18.6 ± 37.0, p < 0.001 in group 1 and Δ=+19.9 ± 26.4, p < 0.001 in group 2 for lipid layer thickness). Despite no differences between groups at baseline (p = 0.469), only group 1 had a significant improvement in Schirmer test (Δ = + 1.6 ± 4.8, p = 0.009 in group 1 and Δ=+1.7 ± 6.9, p = 0.057 in group 2). No significant side effects were noted. No patient in any group felt subjectively “worse” after the treatment. Conclusion Intense pulsed light seems effective and safe for the treatment of meibomian gland dysfunction, improving symptoms and the tear film lipid layer. This study shows no strong evidence of the benefit of low-level light, but it shows weak evidence that it may further improve aqueous tear production.

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 ® ) and macular function was studied with Microperimeter MP-3, NIDEK ® . 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.