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Article ; Online: The efficacy of adjunctive mitomycin C and/or anti-VEGF agents on glaucoma tube shunt drainage device surgeries: a systematic review.

Figueiredo, Raquel / Barbosa-Breda, Joao

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie

2024

Abstract: Purpose: The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, ... ...

Abstract	Purpose: The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit. Methods: We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months. Results: Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction. Conclusion: There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.
Language	English
Publishing date	2024-04-24
Publishing country	Germany
Document type	Journal Article
ZDB-ID	8435-9
ISSN	1435-702X ; 0721-832X
ISSN (online)	1435-702X
ISSN	0721-832X
DOI	10.1007/s00417-024-06476-z
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Article ; Online: Differentiating Ischemic Optic Neuropathy from Glaucoma Using Diagnostic Tests.

Smeets, Frédéric / Margot, Astrid / Barbosa-Breda, João / Stalmans, Ingeborg / Lemmens, Sophie

Ophthalmic research

2024 Volume 67, Issue 1, Page(s) 154–171

Abstract: Introduction: Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper was to summarize differences in diagnostic tests that can help perform a correct ... ...

Abstract	Introduction: Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper was to summarize differences in diagnostic tests that can help perform a correct diagnosis. Methods: The search strategy was performed according to the PRISMA 2009 guidelines, and four databases were used: MEDLINE, Embase, Web of Science, and Cochrane. Totally, 772 references were eligible; 39 were included after screening with respect to inclusion criteria that included English language and published in the 20 years before search date. Results: Ninety percent (n = 35) of included studies used optical coherence tomography (OCT). Glaucomatous eyes had a significantly greater cup area, volume and depth, cup-to-disk ratio, a lower rim volume and area, and a thinner Bruch's membrane opening-minimum rim width. Retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes occurred primarily at the superotemporal, inferotemporal, and inferonasal sectors, while AION eyes demonstrated mostly superonasal thinning. Glaucoma eyes showed greater macular ganglion cell layer thickness, except at the inferotemporal sector. OCT angiography measurements demonstrated a significant decrease in superficial and deep macular vessel density (VD) in glaucoma compared to AION with similar degree of visual field damage; the parapapillary choroidal VD was spared in AION eyes compared to glaucomatous eyes. Conclusion: By use of OCT imaging, optic nerve head parameters seem most informative to distinguish between glaucoma and AION. Although both diseases affect the RNFL thickness, it seems to do so in different sectors. Differences in structure and vascularity of the macula can also help in making the differential diagnosis.
MeSH term(s)	Humans ; Optic Neuropathy, Ischemic/diagnosis ; Diagnosis, Differential ; Tomography, Optical Coherence/methods ; Nerve Fibers/pathology ; Retinal Ganglion Cells/pathology ; Optic Disk/pathology ; Optic Disk/diagnostic imaging ; Optic Disk/blood supply ; Glaucoma/diagnosis ; Visual Fields/physiology ; Intraocular Pressure/physiology
Language	English
Publishing date	2024-01-23
Publishing country	Switzerland
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	205708-6
ISSN	1423-0259 ; 0030-3747
ISSN (online)	1423-0259
ISSN	0030-3747
DOI	10.1159/000535568
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Article: Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases [Response to Letter].

Vilares-Morgado, Rodrigo / Ferreira, Ana Margarida / Rocha-Sousa, Amândio / Carneiro, Ângela / Barbosa-Breda, João

Clinical ophthalmology (Auckland, N.Z.)

2023 Volume 17, Page(s) 3799–3800

Language	English
Publishing date	2023-12-12
Publishing country	New Zealand
Document type	Journal Article ; Comment
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S452567
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Article ; Online: Nationwide consensus on quality indicators to assess glaucoma care: A modified Delphi approach.

Iorio-Aranha, Flavio / de Freitas, Cláudia / Rocha-Sousa, Amândio / Azevedo, Ana / Barbosa-Breda, João

European journal of ophthalmology

2023 Volume 34, Issue 1, Page(s) 217–225

Abstract: Purpose: Performance assessments are essential to tracking and improving quality in health care systems. Key aspects of the care process that act as indicators must be measured in order to gain an in-depth understanding of a care unit's operation. ... ...

Abstract	Purpose: Performance assessments are essential to tracking and improving quality in health care systems. Key aspects of the care process that act as indicators must be measured in order to gain an in-depth understanding of a care unit's operation. Without standardized quality indicators (QIs), it is difficult to characterize and compare the abilities of institutions to achieve excellence. The aim of this study is to reach a consensus among glaucoma specialists concerning the development of a set of QIs to assess the performance of glaucoma care units. Methods: A two-round Delphi technique was performed among glaucoma specialists in Portugal, using a 7-point Likert scale. Fifty-three initial statements (comprising process, structure, and outcome indicators) were evaluated and participants had to agree on which ones would be part of the final set of QIs. Results: By the end of both rounds, 28 glaucoma specialists reached consensus on 30/53 (57%) statements, including 19 (63%) process indicators (mainly relating to the proper implementation of complementary exams and the setting of follow-up intervals), 6 (20%) structure indicators, and 5 (17%) outcome indicators. Of the indicators that were part of the final list, functional and structural aspects of glaucoma progression and the availability of surgical/laser procedures were the most prevalent. Conclusions: A set of 30 QIs for measuring the performance of glaucoma units was developed using a consensus methodology involving experts in the field. Their use as measurement standards would provide important information about unit operations and allow further implementation of quality improvements.
MeSH term(s)	Humans ; Quality Indicators, Health Care ; Consensus ; Glaucoma/diagnosis ; Glaucoma/therapy ; Delivery of Health Care ; Portugal
Language	English
Publishing date	2023-04-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	1089461-5
ISSN	1724-6016 ; 1120-6721
ISSN (online)	1724-6016
ISSN	1120-6721
DOI	10.1177/11206721231170033
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Article: Shared Care and Virtual Clinics for Glaucoma in a Hospital Setting.

Simons, Anne-Sophie / Vercauteren, Julie / Barbosa-Breda, João / Stalmans, Ingeborg

Journal of clinical medicine

2021 Volume 10, Issue 20

Abstract: Glaucoma patients require lifelong management, and the prevalence of glaucoma is expected to increase, resulting in capacity problems in many hospital eye departments. New models of care delivery are needed to offer requisite capacity. This review ... ...

Abstract	Glaucoma patients require lifelong management, and the prevalence of glaucoma is expected to increase, resulting in capacity problems in many hospital eye departments. New models of care delivery are needed to offer requisite capacity. This review evaluates two alternative schemes for glaucoma care within a hospital, i.e., shared care (SC) and virtual clinics (VCs), whereby non-medical staff are entrusted with more responsibilities, and compares these schemes with the "traditional" ophthalmologist-led outpatient service (standard care). A literature search was conducted in three large bibliographic databases (PubMed, Embase, and Trip), and the abstracts from the prior five annual meetings of the Association for Research in Vision and Ophthalmology were consulted. Twenty-nine were included in the review (14 on SC and 15 on VCs). Patients with low risk of vision loss were considered suitable for these approaches. Among the non-medical staff, optometrists were the most frequently involved. The quality of both schemes was good and improved with the non-medical staff being trained in glaucoma care. No evidence was found on patients feeling disadvantaged by the lack of a doctor visit. Both schemes increased the hospital's efficiency. Both SC and VCs are promising approaches to tackle the upcoming capacity problems of hospital-based glaucoma care.
Language	English
Publishing date	2021-10-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10204785
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Article ; Online: Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review.

Monteiro-Henriques, Inês / Rocha-Sousa, Amândio / Barbosa-Breda, João

Acta ophthalmologica

2021 Volume 100, Issue 1, Page(s) e1–e15

Abstract: Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several ... ...

Abstract	Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient's CV risk profile in a non-invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.
MeSH term(s)	Cardiovascular Diseases/complications ; Fluorescein Angiography/methods ; Fundus Oculi ; Humans ; Retina/diagnostic imaging ; Retinal Diseases/complications ; Retinal Diseases/diagnosis ; Tomography, Optical Coherence/methods
Language	English
Publishing date	2021-03-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2408333-1
ISSN	1755-3768 ; 1755-375X
ISSN (online)	1755-3768
ISSN	1755-375X
DOI	10.1111/aos.14851
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Article ; Online: Management of ocular arterial ischemic diseases: a review.

Vilares-Morgado, Rodrigo / Nunes, Hugo Miguel Meireles / Dos Reis, Ricardo Soares / Barbosa-Breda, João

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie

2022

Abstract: Purpose: To summarize the existing treatment options regarding central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), arteritic anterior ischemic optic neuropathy (AAION), non-arteritic anterior ischemic optic neuropathy (NAION) ...

Abstract	Purpose: To summarize the existing treatment options regarding central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), arteritic anterior ischemic optic neuropathy (AAION), non-arteritic anterior ischemic optic neuropathy (NAION), and ocular ischemic syndrome (OIS), proposing an approach to manage and treat these patients. Methods: A systematic literature search of articles published since 1st January 2010 until 31st December 2020 was conducted using MEDLINE (PubMed), Scopus, and Web of Science. Exclusion criteria included case reports, non-English references, articles not conducted in humans, and articles not including diagnostic or therapeutic options. Further references were gathered through citation tracking, by hand search of the reference lists of included studies, as well as topic-related European society guidelines. Results: Acute ocular ischemia, with consequent visual loss, has a variety of causes and clinical presentations, with prognosis depending on an accurate diagnosis and timely therapeutic implementation. Unfortunately, most of the addressed entities do not have a standardized management, especially regarding their treatment, which often lacks good quality evidence on whether it should or not be used to treat patients. Conclusion: Ophthalmologic signs and symptoms may be a warning sign of cardiovascular or cerebrovascular events, namely stroke. Most causes of acute ocular ischemia do not have a standardized management, especially regarding their treatment. Timely intervention is essential to improve the visual, and possibly vital, prognosis. Awareness must be raised among non-ophthalmologist clinicians that might encounter these patients. Further research should focus on assessing the benefit of the management strategies already being employed .
Language	English
Publishing date	2022-07-15
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	8435-9
ISSN	1435-702X ; 0721-832X
ISSN (online)	1435-702X
ISSN	0721-832X
DOI	10.1007/s00417-022-05747-x
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Article ; Online: Author Correction: Deep learning on fundus images detects glaucoma beyond the optic disc.

Hemelings, Ruben / Elen, Bart / Barbosa-Breda, João / Blaschko, Matthew B / De Boever, Patrick / Stalmans, Ingeborg

Scientific reports

2023 Volume 13, Issue 1, Page(s) 21456

Language	English
Publishing date	2023-12-05
Publishing country	England
Document type	Published Erratum
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-48939-z
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Article ; Online: Predictors of Glaucoma After Pediatric Cataract Surgery.

Vilares-Morgado, Rodrigo / Ferreira, Margarida / Godinho, Gonçalo / Melo, António Benevides / Barbosa-Breda, João / Magalhães, Augusto / Estrela-Silva, Sérgio

Journal of glaucoma

2023 Volume 33, Issue 5, Page(s) 317–324

Abstract: Prcis: Glaucoma after pediatric cataract surgery is common and challenging. Age at surgery and the presence of microcornea or other anterior segment (AS) abnormalities can be used to identify those at greatest risk.: Objective: To establish risk ... ...

Abstract	Prcis: Glaucoma after pediatric cataract surgery is common and challenging. Age at surgery and the presence of microcornea or other anterior segment (AS) abnormalities can be used to identify those at greatest risk. Objective: To establish risk factors for developing glaucoma after pediatric cataract surgery [glaucoma following cataract surgery (GFCS)]. Methods: Single-center, retrospective, longitudinal study of patients who underwent lensectomy for pediatric cataracts from 2008 to 2020. Included eyes presented with congenital or acquired pediatric cataracts or an anterior form of persistent fetal vasculature, and a follow-up of at least 1 year. Exclusion criteria were the presence of preexisting intraocular pressure elevation, congenital glaucoma, syndromic cataracts, and a history of trauma or uveitis. Demographic and clinical data were collected. Our primary outcome was the development of GFCS. Multivariable logistic regression with generalized estimating equations was used to model the association between potential predictors and the risk of GFCS. Results: A total of 110 eyes from 74 patients were included, 38 with unilateral and 36 with bilateral pediatric cataract surgery. The average surgery age was 24.71 ± 37.26 months, with 74 eyes (67.3%) undergoing surgery ≤12 weeks of age. Patients were followed for 9.96 ± 3.64 years after surgery. Twenty-eight eyes (25.45%) developed GFCS, all requiring glaucoma surgery. In multivariable analysis, surgery before 12 weeks of age [odds ratio (OR): 34.74; P < 0.001], presence of microcornea (OR: 12.90; P = 0.002), and presence of other AS abnormalities (OR: 52.71; P < 0.001) were significantly associated with the development of GFCS. Conclusions: The development of GFCS is a common and relevant adverse event after pediatric cataract surgery whose management is challenging. Age at surgery, the presence of microcornea, and the presence of other AS abnormalities can be used to identify those at greatest risk.
MeSH term(s)	Humans ; Male ; Female ; Retrospective Studies ; Cataract Extraction/adverse effects ; Child, Preschool ; Risk Factors ; Infant ; Intraocular Pressure/physiology ; Glaucoma/etiology ; Postoperative Complications ; Cataract/congenital ; Child ; Visual Acuity/physiology ; Follow-Up Studies
Language	English
Publishing date	2023-12-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	913494-3
ISSN	1536-481X ; 1057-0829
ISSN (online)	1536-481X
ISSN	1057-0829
DOI	10.1097/IJG.0000000000002345
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Article ; Online: Why Should SARS-CoV-2 Post-Pandemic Recovery Funding Be Used to Foster a Physician-Scientist Program?

Barbosa-Breda, João / Leal, Inês / Sousa, David Cordeiro / Soares, Célia Azevedo

Acta medica portuguesa

2020 Volume 33, Issue 9, Page(s) 628

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/economics ; Coronavirus Infections/epidemiology ; Humans ; Pandemics/economics ; Physicians/economics ; Pneumonia, Viral/economics ; Pneumonia, Viral/epidemiology ; Portugal/epidemiology ; Resource Allocation/organization & administration ; SARS-CoV-2 ; Translational Medical Research/economics
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	Portugal
Document type	Letter
ZDB-ID	603078-6
ISSN	1646-0758 ; 0870-399X
ISSN (online)	1646-0758
ISSN	0870-399X
DOI	10.20344/amp.14421
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