Purpose To determine the microbiological profile, risk factors, treatment and surgical intervention rates of fungal keratitis at a tertiary referral centre. Methods A retrospective review of microbiological and medical records from hospitalised patients treated for fungal keratitis at Centro Hospitalar Universitário de São João from 2009 to 2019 was conducted. Results Overall, 43 patients were included in our study. The mean age of patients was 63.7 years and 46.5% were men. In culture were isolated 22 (51.2%) filamentous fungi and 21 (48.8%) yeast. Candida species (n = 20, 46.5%), Fusarium species (n = 10, 23.4%) and Aspergillus species (n = 4, 9.3%) were the most common isolated species. Important risk factors were contact lens use (n = 24, 55.8%), long-term users of topical corticosteroids (n = 19, 44.2%) and previous keratitis (n = 19, 44.2%). Yeast isolates had a statistically significant higher prevalence in long-term users of topical corticosteroids compared to filamentous ones (p = 0.043). Twenty-four cases (55.8%) required surgical intervention, of which 23 cases underwent therapeutic penetrating keratoplasty. Ocular complications, such as evisceration was noted in 12 patients (27.9%) and endophthalmitis in 5 (11.6%). No statistically significant changes of best corrected visual acuity (BCVA) were found after treatment (p = 0.687). Conclusion Most patients with fungal keratitis have associated risk factors. Filamentous and yeast species have equally prevalent etiologies. In general, our results mirror how difficult and challenging the approach and treatment of fungal keratitis could be.

Moyamoya Disease and Syndrome are neurological conditions that affect the blood vessels in the brain, characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches, and the consequent network of collateral vessels at the base of the skull whose angiographic pattern simulates a "smoke cloud". Both conditions have a universal distribution, although Moyamoya Disease is more frequently seen in the Asian population. The term "Moyamoya" originates from Japanese, meaning puff of cigarette smoke, reflecting the characteristic cerebral angiogram pattern seen in these conditions. The etiology of both conditions is not yet fully understood. Moyamoya Disease corresponds to isolated vasculopathy, without risk factors for cerebrovascular disease, whereas in Moyamoya Syndrome, there is an underlying pathology. In this case report, the angiographic study and the presence of autoimmune pathology (Graves' Disease) suggest the hypothesis of Moyamoya Syndrome. The natural history of Moyamoya Disease and Syndrome varies, and they may have a slow progression with rare intercurrent events or a fulminant course with rapid neurological decline. In the absence of treatment, the progression of the disease is associated with a high risk of recurrence of neurological events. Therefore, it is crucial to consider these conditions in cases of cerebrovascular diseases.