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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 ; 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: The ghrelin-GHSR-1a system in the ocular neuro-humoral regulation. Pearls and controversies.

Rocha-Sousa, Amândio

Regulatory peptides

2014 Volume 192-193, Page(s) 53–54

MeSH term(s)	Animals ; Eye/innervation ; Eye/metabolism ; Ghrelin/genetics ; Ghrelin/metabolism ; Humans ; RNA, Messenger/genetics ; RNA, Messenger/metabolism ; Receptors, Ghrelin/metabolism
Chemical Substances	Ghrelin ; RNA, Messenger ; Receptors, Ghrelin
Language	English
Publishing date	2014-06
Publishing country	Netherlands
Document type	Editorial ; Research Support, Non-U.S. Gov't
ZDB-ID	225685-x
ISSN	1873-1686 ; 0167-0115
ISSN (online)	1873-1686
ISSN	0167-0115
DOI	10.1016/j.regpep.2014.06.001
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Article ; Online: A Scoping Review of Process Indicators for Measuring Quality of Care in Glaucoma.

Iorio-Aranha, Flavio / Peleteiro, Bárbara / Rocha-Sousa, Amândio / Azevedo, Ana / Barbosa-Breda, João

Journal of glaucoma

2021 Volume 30, Issue 5, Page(s) e198–e204

Abstract: Prcis: There are no standardized process quality indicators (QIs) in glaucoma care. Although they can be inferred from guidelines and trials, they should be designed and standardized to allow better assessment of the quality of care.: Purpose: QIs ... ...

Abstract	Prcis: There are no standardized process quality indicators (QIs) in glaucoma care. Although they can be inferred from guidelines and trials, they should be designed and standardized to allow better assessment of the quality of care. Purpose: QIs are crucial for assessing the performance of any health care system. To allow efficiency, effectiveness, and patient-centeredness, there is a need for prompt acquisition of up-to-date information. Among the available QIs, process indicators have the highest sensitivity to frequent changes and could better reflect the implementation outcomes of novel ideas and technology. This study aimed to map the available information regarding process QIs in glaucoma care, identify the current development stage of these indicators, and systematically synthesize them. Materials and methods: We performed a scoping review of 4 electronic bibliographic databases for studies reporting on process QIs in glaucoma. We retrieved 7502 references and created a domain list reflecting the core idea underlying each indicator. Results: We summarized information from 18 documents and listed 20 domains. The most mentioned domains were follow-up, optic nerve head assessment, visual field test, and intraocular pressure. Indicators regarding the quality of life assessment, patient assistance, or presence of written protocols were less frequently mentioned. Conclusions: There are notable variations among process QIs in glaucoma and significant heterogeneity in their descriptions in published studies. Although novel indicators can be inferred from guidelines and trials, they should be designed and standardized for better assessment of performance in health systems to improve their quality.
MeSH term(s)	Glaucoma/therapy ; Humans ; Intraocular Pressure ; Quality Indicators, Health Care ; Quality of Life
Language	English
Publishing date	2021-02-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	913494-3
ISSN	1536-481X ; 1057-0829
ISSN (online)	1536-481X
ISSN	1057-0829
DOI	10.1097/IJG.0000000000001825
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Article: Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes.

Cunha, Ana Maria / Iglésias, Maria Manuel / Rocha-Sousa, Amândio / Falcão-Reis, Fernando / Falcão, Manuel

Journal of ophthalmology

2021 Volume 2021, Page(s) 9985821

Abstract: Purpose: To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV).: Methods: This is a single-centre, retrospective study. All ... ...

Abstract	Purpose: To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV). Methods: This is a single-centre, retrospective study. All included patients had acute postoperative endophthalmitis secondary to one of these three procedures. Visual acuity (VA), comorbidities, time to presentation, and treatment were assessed. The primary outcome was visual outcome. A poor outcome was considered if final VA was worse than or equal to counting fingers (CF) and a good outcome was classified as VA better than CF. Results: Over 12 years, a total of 61 patients were included. Twenty-seven cases were post-cataract endophthalmitis; twenty-five were post-IVI and nine post-PPV. Endophthalmitis post-PPV had a worse visual outcome (88.9% of patients with VA worse than or equal to CF 95% CI 51.3 to 100.0%) than endophthalmitis following cataract surgery (25.9% of patients with VA worse than or equal to CF 95% CI 11.0 to 39.9%) and the IVI subgroup (44.0% of VA worse than or equal to CF 95% CI 24.0 to 67.0%) ( Conclusions: The number of patients with poor visual outcomes following acute endophthalmitis was similar in endophthalmitis following IVI and cataract surgery, but better than endophthalmitis following vitrectomy.
Language	English
Publishing date	2021-09-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2546525-9
ISSN	2090-0058 ; 2090-004X
ISSN (online)	2090-0058
ISSN	2090-004X
DOI	10.1155/2021/9985821
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Article ; Online: Child with a mild phenotype of Incontinentia Pigmenti and inner retinal dysfunction.

Cunha, Ana Maria / Breda, Jorge / Rocha-Sousa, Amândio / Falcão-Reis, Fernando / Santos-Silva, Renato

Documenta ophthalmologica. Advances in ophthalmology

2021 Volume 143, Issue 1, Page(s) 93–98

Abstract: Purpose: To describe a case of a child with mild phenotype of Incontinentia Pigmenti (IP), with changes in Spectral-Domain Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCT-A) and an electronegative dark-adapted (DA) ...

Abstract	Purpose: To describe a case of a child with mild phenotype of Incontinentia Pigmenti (IP), with changes in Spectral-Domain Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCT-A) and an electronegative dark-adapted (DA) 3.0 electroretinogram (ERG), suggestive of inner retinal dysfunction. Case report: We described a 7-year-old female child with IP. Her best corrected acuity was 8/10 in the right eye and 6/10 in the left eye. Biomicroscopy, intraocular pressure and fundoscopy were normal. The electroretinography findings showed an electronegative DA 3.0 ERG with a normal a-wave but a b-wave that did not elevate above baseline. SD-OCT identified irregularities in the outer plexiform layer in both eyes, and OCT-A assessment revealed at the superficial capillary plexus, areas of decrease in the flow in parafoveal and perifoveal regions. Conclusion: Classically, IP affects the peripheral retina; however, vascular and structural changes in macula can occur as well. To our knowledge, we report the first electronegative electroretinogram in a patient with IP.
MeSH term(s)	Child ; Electroretinography ; Female ; Fluorescein Angiography ; Humans ; Incontinentia Pigmenti/diagnosis ; Incontinentia Pigmenti/genetics ; Phenotype ; Retinal Diseases/diagnosis ; Tomography, Optical Coherence ; Visual Acuity
Language	English
Publishing date	2021-02-13
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	212594-8
ISSN	1573-2622 ; 0012-4486
ISSN (online)	1573-2622
ISSN	0012-4486
DOI	10.1007/s10633-021-09824-0
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Article ; Online: Cross-sectional study investigating the prevalence and causes of vision impairment in Northwest Portugal using capture-recapture.

Ramos, Pedro Lima / Santana, Rui / Marques, Ana Patricia / Sousa, Ines / Rocha-Sousa, Amandio / Macedo, Antonio Filipe

BMJ open

2022 Volume 12, Issue 9, Page(s) e056995

Abstract: Objectives: The aim of this study was to estimate the prevalence and causes of vision impairment (VI) in Portugal.: Setting: Information about people with VI was obtained from primary care centres, blind association (ACAPO) and from hospitals (the ... ...

Abstract	Objectives: The aim of this study was to estimate the prevalence and causes of vision impairment (VI) in Portugal. Setting: Information about people with VI was obtained from primary care centres, blind association (ACAPO) and from hospitals (the PCVIP study) in the Northwest of Portugal during a period spanning years 2014-2015. Causes of VI were obtained from hospitals. Participants: Administrative and medical records of people with visual acuity in the better seeing eye of 0.5 decimal (0.30logMAR) or worse and/or visual field less than 20° were investigated. Capture-recapture with log-linear models was applied to estimate the number of individuals missing from lists of cases obtained from available sources. Primary and secondary outcome measures: Log-linear models were used to estimate the crude prevalence and the category specific prevalence of VI. Results: Crude prevalence of VI was 1.97% (95% CI 1.56% to 2.54%), and standardised prevalence was 1% (95% CI 0.78% to 1.27%). The age-specific prevalence was 3.27% (95% CI 2.36% to 4.90%), older than 64 years, 0.64% (95% CI 0.49% to 0.88%), aged 25-64 years, and 0.07% (95% CI 0.045% to 0.13%), aged less than 25 years. The female-to-male ratio was 1.3, that is, higher prevalence among females. The five leading causes of VI were diabetic retinopathy, cataract, age-related macular degeneration, glaucoma and disorders of the globe. Conclusions: The prevalence of VI in Portugal was within the expected range and in line with other European countries. A significant number of cases of VI might be due to preventable cases and, therefore, a reduction of the prevalence of VI in Portugal seems possible. Women and old people were more likely to have VI and, therefore, these groups require extra attention. Future studies are necessary to characterise temporal changes in prevalence of VI in Portugal.
MeSH term(s)	Humans ; Male ; Female ; Adult ; Middle Aged ; Cross-Sectional Studies ; Prevalence ; Portugal ; Visual Acuity ; Glaucoma ; Vision Disorders/etiology ; Blindness/complications ; Visually Impaired Persons
Language	English
Publishing date	2022-09-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-056995
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Article: Terson Syndrome - Clinical Presentation, Management, and Visual Outcomes in a Tertiary Centre.

Lima-Fontes, Mario / Leuzinger-Dias, Mariana / Rodrigues, Rita / Barros-Pereira, Ricardo / Falcão, Manuel / Fernandes, Vítor / Alves-Faria, Pedro / Falcão-Reis, Fernando / Rocha-Sousa, Amândio

Clinical ophthalmology (Auckland, N.Z.)

2023 Volume 17, Page(s) 351–359

Abstract: Purpose: The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal.: Patients and methods: A single-centre ...

Abstract	Purpose: The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal. Patients and methods: A single-centre retrospective study was performed, based on the survey review of the medical records of every consecutive patient diagnosed with Terson syndrome and followed from January 2018 to August 2021. The change in best-corrected visual acuity (BCVA) from baseline to the final evaluation was the primary outcome. Results: Fifteen eyes from 8 patients (50% female) were included. The mean age at diagnosis was 55±7 years. The neurological event was traumatic brain injury in 37.5% (n=3) and subarachnoid haemorrhage in 62.5% of the patients (n=5). Bilateral intraocular haemorrhage occurred in 875% (n=7) of the patients. Vitreous and preretinal haemorrhages occurred each in 66.7% (n=10), intraretinal in 30% (n=3) and subretinal in 13.3% (n=2) of the eyes. In 40% of the eyes (n=6), spontaneous resolution of intraocular haemorrhage occurred, while PPV was performed in the remaining 60% (n=9). Ocular haemorrhage detection occurred 58.47 ± 40.94 days after the neurological event (range 11 to 121 days). Baseline BCVA was 1.11 ± 1.01 logMAR and improved to 0.32 ± 0.69 logMAR in the follow-up period (p=0.004). A positive correlation was found between initial and final BCVA (Spearman's rho = 0.643, p=0.01). Baseline BCVA of eyes undergoing PPV was lower than of those conservatively managed (1.84±0.72 vs 0.20±0.28 logMAR, p<0.001). However, there were no statistically significant differences in final BCVA after surgery or observation (0.56 ± 0.90 vs 0.04 ± 0.04 logMAR, p=0.149). Longer periods between the neurological and the ophthalmological diagnosis were correlated with worse final BCVA (Spearman's rho = 0.688, p=0.005). Conclusion: Terson syndrome is a potential cause of irreversible visual loss. Diagnosis delay may affect visual prognosis. PPV is indicated when intraocular haemorrhage is dense and does not resolve spontaneously or when visual acuity at presentation is low, allowing for good visual outcomes with minimal complications.
Language	English
Publishing date	2023-01-25
Publishing country	New Zealand
Document type	Journal Article
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S396781
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Article: Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases.

Vilares-Morgado, Rodrigo / Correia, Vera / Ferreira, Ana Margarida / Alves, Flávio / Melo, António Benevides / Estrela-Silva, Sérgio / Araújo, Joana / Tavares-Ferreira, João / Silva, Marta / Rocha-Sousa, Amândio / Carneiro, Angela / Barbosa-Breda, João

Clinical ophthalmology (Auckland, N.Z.)

2023 Volume 17, Page(s) 3613–3627

Abstract: Purpose: To evaluate whether repeated intravitreal injections (IVI) with an anti-vascular endothelial growth factor (anti-VEGF) agent are associated with glaucomatous progression in eyes with glaucoma spectrum diseases (GSD).: Methods: Single-center, ...

Abstract	Purpose: To evaluate whether repeated intravitreal injections (IVI) with an anti-vascular endothelial growth factor (anti-VEGF) agent are associated with glaucomatous progression in eyes with glaucoma spectrum diseases (GSD). Methods: Single-center, retrospective, longitudinal study of patients with bilateral and similar GSD who: (1) received ≥8 IVI in only one eye during the study period; (2) had ≥2 retinal nerve fiber layer thickness (RNFL) measurements obtained by spectral-domain optical coherence tomography (SD-OCT) at least 12 months apart. The primary outcome was the absolute RNFL thickness change, comparing injected and fellow uninjected eyes. Linear mixed effects models were constructed, including a multivariable model. Results: Sixty-eight eyes from 34 patients were included, 34 injected and 34 fellow uninjected eyes. Average baseline age was 67.68±21.77 years with a follow-up of 3.66±1.89 years and 25.12±14.49 IVI. RNFL thickness decreased significantly from 80.92±15.78 to 77.20±17.35 μm ( Conclusion: Repeated IVI do not seem to accelerate glaucomatous progression. Future studies with a longer follow-up are needed.
Language	English
Publishing date	2023-11-22
Publishing country	New Zealand
Document type	Journal Article
ISSN	1177-5467
ISSN	1177-5467
DOI	10.2147/OPTH.S441500
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