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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 ; Online: The natural history of untreated ocular hypertension and glaucoma.

Lauwers, Amelien / Barbosa Breda, João / Stalmans, Ingeborg

Survey of ophthalmology

2022 Volume 68, Issue 3, Page(s) 388–424

Abstract: Glaucoma is a chronic, progressive disease leading to irreversible blindness if left untreated; however, since reducing intraocular pressure has proven to be successful in slowing disease progression, little is known about the natural history of ... ...

Abstract	Glaucoma is a chronic, progressive disease leading to irreversible blindness if left untreated; however, since reducing intraocular pressure has proven to be successful in slowing disease progression, little is known about the natural history of untreated glaucoma. This knowledge can be valuable in guiding management decisions in the era of personalized medicine. A systematic search was performed in Medline (PubMed), Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRIMSA) guidelines. The rate of structural and/or functional progression and conversion to glaucoma or to a more advanced stage of glaucoma are discussed for ocular hypertension and different types of open-angle glaucoma. Forty-three studies were included. Different rates of progression were found both among and within the different diagnostic groups that belong to the open-angle glaucoma spectrum. The highest rate was found in pseudoexfoliation glaucoma, followed by high tension glaucoma, normal tension glaucoma, and ocular hypertension, in decreasing order. The lowest rate was observed in glaucoma suspects. The known rates of progression provide valuable prognostic information for ophthalmologists and patients. Nonetheless, due to high variability among patients, individual progression cannot be accurately predicted and repeated follow-up examinations are required to estimate individual progression.
MeSH term(s)	Humans ; Glaucoma, Open-Angle/complications ; Glaucoma, Open-Angle/diagnosis ; Glaucoma ; Ocular Hypertension ; Intraocular Pressure ; Eye
Language	English
Publishing date	2022-12-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	391346-6
ISSN	1879-3304 ; 0039-6257
ISSN (online)	1879-3304
ISSN	0039-6257
DOI	10.1016/j.survophthal.2022.12.001
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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: Bilateral Central Retinal Vein Occlusion: A Presenting Sign of an Ongoing Life-threatening Condition.

Madeira, Carolina / Barbosa Breda, João / Penas, Susana

JAMA ophthalmology

2021 Volume 139, Issue 11, Page(s) 1242–1243

MeSH term(s)	Fluorescein Angiography ; Fundus Oculi ; Humans ; Longitudinal Studies ; Retinal Vein ; Retinal Vein Occlusion/diagnosis ; Retinal Vein Occlusion/etiology
Language	English
Publishing date	2021-09-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701705-9
ISSN	2168-6173 ; 2168-6165
ISSN (online)	2168-6173
ISSN	2168-6165
DOI	10.1001/jamaophthalmol.2021.0993
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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 ; Online: Advanced vascular examinations of the retina and optic nerve head in glaucoma.

Barbosa Breda, João / Van Eijgen, Jan / Stalmans, Ingeborg

Progress in brain research

2020 Volume 257, Page(s) 77–83

Abstract: Recent technological breakthroughs have facilitated vascular research in the field of glaucoma. In this chapter, we review several of these vascular-oriented technologies, with a special focus given to optical coherence tomography angiography. An update ... ...

Abstract	Recent technological breakthroughs have facilitated vascular research in the field of glaucoma. In this chapter, we review several of these vascular-oriented technologies, with a special focus given to optical coherence tomography angiography. An update is given regarding recent findings in glaucoma, but also on the improvements needed to bring vascular assessments closer to everyday clinical practice.
MeSH term(s)	Glaucoma ; Humans ; Optic Disk ; Retina/diagnostic imaging ; Tomography, Optical Coherence
Language	English
Publishing date	2020-08-05
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	1875-7855 ; 0079-6123
ISSN (online)	1875-7855
ISSN	0079-6123
DOI	10.1016/bs.pbr.2020.07.001
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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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