ORCID Profile
0000-0001-5381-4399
Current Organisations
Northumbria University
,
Centre for Eye Research Australia
,
The Royal Victorian Eye & Ear Hospital
,
Universidade de Lisboa
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Publisher: SAGE Publications
Date: 16-10-2017
DOI: 10.5301/EJO.5001066
Abstract: To provide a spectral-domain optical coherence tomography (SD-OCT)-based analysis of retinal layers thickness and nasal displacement of closed macular hole after internal limiting membrane peeling in macular hole surgery. In this nonrandomized prospective interventional study, 36 eyes of 32 patients were subjected to pars plana vitrectomy and 3.5 mm diameter internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH). Nasal and temporal internal retinal layer thickness were assessed with SD-OCT. Each scan included optic disc border so that distance between optic disc border and fovea were measured. Thirty-six eyes had a successful surgery with macular hole closure. Total nasal retinal thickening (p .001) and total temporal retinal thinning (p .0001) were observed. Outer retinal layers increased thickness after surgery (nasal p .05 and temporal p .01). Middle part of inner retinal layers (mIRL) had nasal thickening (p .001) and temporal thinning (p .05). The mIRL was obtained by deducting ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness from overall thickness of the inner retinal layer. Papillofoveal distance was shorter after ILM peeling in macular hole surgery (3,651 ± 323 μm preoperatively and 3,361 ± 279 μm at 6 months p .0001). Internal limiting membrane peel is associated with important alteration in inner retinal layer architecture, with thickening of mIRL and shortening of papillofoveal distance. These factors may contribute to recovery of disrupted foveal photoreceptor and vision improvement after IMH closure.
Publisher: Elsevier BV
Date: 2017
Publisher: Ordem dos Medicos
Date: 31-08-2018
DOI: 10.20344/AMP.10433
Abstract: A fibromialgia é uma doença caracterizada por dor generalizada, com mais de três meses de duração, com dor à palpação em pelo menos 11 de 18 pontos anatomicamente definidos. Um elevado número de doentes com fibromialgia sofre de dor moderada a grave durante vários anos, para a qual os analgésicos convencionais se mostraram ineficazes, de tal forma que foram substituídos por antidepressivos tricíclicos, inibidores seletivos da recaptação da serotonina e noradrenalina e anticonvulsivantes, como a pregabalina e a gabapentina. A pregabalina é um fármaco anti-epilético aprovado para o tratamento da fibromialgia nos Estados Unidos da América, cujo mecanismo de ação se assemelha ao da gabapentina, com efeitos anticonvulsivante, analgésico e ansiolítico. Nesta revisão sistemática Cochrane os autores incluíram um total de oito ensaios clínicos aleatorizados, controlados por placebo, com baixo risco global de viés, que estudaram o efeito da administração de uma dose diária de pregabalina no tratamento da dor crónica moderada a grave, em doentes adultos com fibromialgia. Dos principais resultados desta revisão sistemática destacam-se o efeito substancial que uma dose diária de 300 a 600 mg de pregabalina teve na diminuição da intensidade da dor moderada a grave, numa minoria dos doentes adultos com fibromialgia, durante um período de follow-up de 12 a 26 semanas, bem como a elevada incidência de eventos adversos associados ao tratamento, a maioria dos quais bem tolerados. Neste artigo sumarizam-se e discutem-se os principais resultados e conclusões desta revisão sistemática, bem como as suas implicações para a prática clínica diária.
Publisher: Wiley
Date: 11-03-2022
DOI: 10.1111/AOS.15120
Abstract: To present real‐world adalimumab (ADA) efficacy and safety outcomes in non‐infectious uveitis (NIU) from a single United Kingdom (UK) tertiary centre. Retrospective review of adult patients with NIU treated with ADA. Data were collected at baseline, 6 and 12 months. The primary goal was to evaluate the rate of treatment failure, using the VISUAL‐I/II studies criteria, during 12 months of follow‐up. Secondary aims were to quantify corticosteroid‐sparing effect to identify safety issues to assess change in visual acuity to identify reasons for treatment failure and to compare treatment outcomes at 6 and 12 months for patients classified as active or inactive at baseline. Fifty‐one patients (102 eyes) with mean age of 48.3 years were included. One third had a known underlying systemic disease and 47.6% had panuveitis. The most common indication for ADA was failure to respond to oral immunosuppression. Treatment failure occurred in 9/51 patients (10 eyes) after 6 months and 13/51 (20 eyes) patients after 12 months. The need for rescue treatment in the 12 months prior to ADA was significantly associated with treatment failure at 12 months. The mean prednisolone dosage was mg/day at 6 and 12 months. There were no serious adverse events. Patients with NIU who received ADA therapy for 12 months were likely to achieve disease control, to stabilize or improve visual acuity, to experience a reduction in immunosuppression and to reduce corticosteroid dosage. No new safety events were observed.
Publisher: Springer Science and Business Media LLC
Date: 2010
Publisher: Wiley
Date: 23-09-2015
Publisher: Elsevier BV
Date: 02-2016
Publisher: BMJ
Date: 21-09-2016
DOI: 10.1136/BMJ.I4797
Publisher: Wiley
Date: 09-2017
Publisher: Wiley
Date: 21-11-2018
DOI: 10.1111/AOS.13622
Abstract: Previous studies report that the response of retinal vessels to a decrease in oxygen (hypoxia) is vasodilation, thus increasing blood flow. We aimed to characterize the changes in retinal microvasculature induced by a mild hypoxia stress test in a healthy population, using ocular coherence tomography angiography (OCT-A) technology. Interventional repeated-measures study. The standardized hypoxia challenge test (HCT) was performed to all volunteers, according to the British Thoracic Society protocol. Ocular coherence tomography angiography (OCT-A) was performed at three time-points (baseline, during HCT and 30' posthypoxia). Macular and peripapillary vessel densities were assessed using the built-in software. To minimize bias, analysis was performed separately in right (OD) and left (OS) eyes. Repeated-measures anova and mean comparison analysis were used as statistical tests (stata v13). Studied population included 30 healthy subjects (14 women), with a mean age of 28.8 ± 4.2 [range 22-37] years. Baseline vessel density increased in hypoxic conditions and subsequently decreased to near-baseline values in posthypoxia conditions. This pattern was observed for both eyes in both parafovea (OD: 55.3 ± 2.3 to 56.7 ± 1.9 to 55.8 ± 1.9, p < 0.05 OS: 56.9 ± 2.1 to 57.9 ± 1.9 to 57.3 ± 1.7, p < 0.05) and peripapillary (OD: 60.5 ± 0.5 to 62.6 ± 0.5 to 60.1 ± 0.4, p < 0.05 OS: 60.4 ± 0.4 to 62.3 ± 0.5 to 60.7 ± 0.4, p < 0.05) areas. To our knowledge, there are no published data specifically addressing mild hypoxia conditions and retinal microvasculature changes, using OCT-A. This pilot study may pave way to better understand vascular responses in disease setting.
Publisher: Springer Science and Business Media LLC
Date: 10-02-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2021
DOI: 10.1097/ICB.0000000000000757
Abstract: There are currently limited data addressing the surgical outcomes of pars plana vitrectomy (PPV) in toxoplasmosis-related macular hole (tMH). We aim to report and discuss safety and efficacy of PPV for tMH. Surgical case series (n = 11), with minimum postoperative follow-up time of 6 months. Consecutive patients who underwent PPV for tMH from 2013 to 2016 were included. Indications for surgery were: visual acuity ≥ 0.6 logarithm of the minimum angle of resolution (Snellen 20/80 or less), no intraocular inflammation for more than 6 months, extrafoveal toxoplasmosis scar, elevated tMH borders on optical coherence tomography, and patient agreement with surgery. Surgery was performed—PPV with epiretinal (if present) and internal limiting membrane peeling. Safety and efficacy of PPV for tMH were addressed by evaluating: 1) surgery-related complications and 2) visual acuity improvement. A total of 11 patients (6 male), with a mean age of 33.2 ± 11.0 years were studied. Mean preoperative best-corrected visual acuity significantly improved from 1.10 ± 0.24 (Snellen 20/252) to 0.43 ± 0.18 logarithm of the minimum angle of resolution (Snellen 20/54) at last follow-up visit ( P 0.01). The rate of visual acuity improvement (i.e., a gain of at least three lines) and tMH closure was 100% for both. The only reported surgery-related complication was cataract in one case. Our results suggest that PPV is a safe and effective option in tMH cases. A controlled, longitudinal study would contribute to confirm these findings.
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 23-06-2020
DOI: 10.1167/IOVS.61.6.49
Publisher: Wiley
Date: 06-2022
DOI: 10.1111/CEO.14108
Publisher: Wiley
Date: 14-09-2016
Publisher: Wiley
Date: 23-09-2015
Publisher: SAGE Publications
Date: 26-10-2018
Abstract: The aim of this study is to assess the agreement between manual and automated gonioscopy for iridocorneal angle opening. The research is a cross-sectional observational study. Manual and automated gonioscopy were performed to consecutive patients in a glaucoma clinic. Iridocorneal angle opening grading was performed according to Shaffer’s classification. Automated gonioscopy was performed with NGS-1 automated gonioscope (NIDEK Co., Gamagori, Japan). The automated gonio-photos were graded by two independent observers. Agreement between automated and manual gonioscopy and also among raters was ascertained by Fleiss’ kappa statistic and comparison of area under curve. In total, 88 eyes of 47 subjects were analysed. Mean age was 63 ± 10 years. Twenty eyes (22.7%) were excluded from grading due to poor quality images. Angle closure was detected in 23.4% with dynamic gonioscopy in comparison with 4.3% using automated image grading. The agreement for angle closure diagnosis between dynamic and automated gonioscopy was low (κ = 0.09 ± 0.10 p = 0.18). The area under curve for detecting eyes with angle closure showed poor accuracy between automated and manual methods (area under curve: 0.53 ± 0.05, 95% confidence interval: 0.44–0.62). There was modest inter-rater agreement for angle opening assessment of automated images with Fleiss’ kappa of 0.17 (95% confidence interval: 0.035–0.238). Manual and automated gonioscopy showed only slight agreement for the assessment of iridocorneal angle opening status. Further improvements of the NGS-1 automated gonioscopy and technique are desired for widespread use in a real-life setting.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-07-2018
Publisher: GN1 Genesis Network
Date: 2017
DOI: 10.5935/0004-2749.20170050
Abstract: Studies have suggested that corneal biomechanical properties influence intraocular pressure (IOP) measurements, namely central corneal thickness (CCT) and corneal hysteresis (CH). The present study aimed to investigate the associations of CH and CCT with glaucoma development. We performed a review of the literature and meta-analysis of observational studies (2006-2016) that included both adult glaucoma patients and controls and reported CCT and CH as outcomes. Nineteen studies were conside red eligible, and the mean difference (MD) between groups (patient and control) for both variables was used for statistical analyses. A total of 1,213 glaucoma and 1,055 healthy eyes were studied. Quan titative analysis suggested that CH was significantly lower in the glaucoma group than in the control group (MD=-1.54 mmHg, 95% CI [-1.68, -1.41], P<0.0001). Additionally, CCT was significantly lower in the glaucoma group than in the control group (MD=-8.49 µm, 95% CI [-11.36, -5.62], P<0.001). Corneal properties appear to differ between glaucoma patients and healthy controls. Our results emphasize the importance of corneal biomechanical properties in IOP interpretation and should support further studies on the influence of CH and CCT in glaucoma screening and diagnosis.
Publisher: Ordem dos Medicos
Date: 31-10-2017
DOI: 10.20344/AMP.9743
Abstract: A suplementação alimentar com ácidos gordos poli-insaturados ómega-3, de origem animal e vegetal, é comummente prescrita como alternativa não farmacológica no tratamento da demência, com o objetivo de atrasar a sua progressão e melhorar a função cognitiva dos doentes. Esta utilização deriva em grande medida de estudos pré-clínicos, que estabeleceram o papel dos ácidos gordos poliinsaturados ómega-3 no desenvolvimento e manutenção da integridade do sistema nervoso central, e de estudos epidemiológicos, que demonstraram a ocorrência de estados de malnutrição em doentes com demência. Nesta revisão sistemática Cochrane, os autores incluíram três ensaios clínicos aleatorizados controlados por placebo, com baixo risco de vieses, nos quais doentes com doença de Alzheimer ligeira a moderada foram tratados com ácidos gordos poli-insaturados ómega-3, através de suplementos alimentares. Dos principais resultados desta RS destacam-se a ausência de evidência de um efeito benéfico do tratamento com suplementação com ácidos gordos poli-insaturados ómega-3 sobre a função cognitiva de doentes com doença de Alzheimer e a baixa taxa de efeitos adversos reportados, esta última comparável à dos grupos tratados com placebo. Não existem dados sobre outros tipos de demência. Neste artigo sumarizam-se e discutem-se os principais resultados e conclusões desta revisão sistemática, bem como as suas implicações para a prática clínica diária.
Publisher: Wiley
Date: 23-09-2015
Publisher: Ordem dos Medicos
Date: 08-2019
DOI: 10.20344/AMP.12448
Abstract: N/a.
Publisher: Frontiers Media SA
Date: 24-05-2019
Publisher: Wiley
Date: 27-03-2019
DOI: 10.1111/AOS.14103
Publisher: Wiley
Date: 18-05-2020
DOI: 10.1111/AOS.14467
Publisher: Wiley
Date: 25-03-2018
DOI: 10.1111/AOS.13697
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JCJO.2016.05.018
Abstract: Demographic and clinical characteristics associated with nonarteritic anterior ischemic optic neuropathy (NAION) are well described. Patients with hematologic neoplasms may share some of these characteristics, and it may be useful clinically to better understand this set of patients. Our objective is to review systematically the characteristics of patients with both hematologic malignancies and NAION. Systematic review. Patients with NAION diagnosis related in time to a hematologic neoplasm. Data sources for the study included MEDLINE, Web of Science, LILACS, SciELO, and OpenGrey. The study eligibility criteria included case reports and case series. We found 261 records, with 15 studies included plus our case report. A total of 19 patients (8 female) with mean age of 54.6 years (range, 12-87) were analyzed: 37% (7) non-Hodgkin lymphoma 26% (5) myeloproliferative neoplasms 21% (4) myelodysplasia 16% (3) leukemias. The limitations included verification bias, inability to test statistical association between NAION and hematologic neoplasms, the small number of cases, and confounding factors related to medical history and specific interventions in each case limited the robustness of our conclusions. Our results identified the characteristics of patients with NAION and hematologic neoplasms related in time. Additional observational studies may enlighten the importance of looking for evidence of an occult neoplastic disorder in patients presenting with NAION. A prompt diagnosis would be of invaluable significance for the best management, in terms of follow-up and therapeutics.
Publisher: Wiley
Date: 25-03-2018
DOI: 10.1111/AOS.13699
Abstract: Anti-tumour necrosis factor (TNF) drugs have been extensively used in non-infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side-effects occur. However, systemic anti-TNF therapies are also associated with a myriad of side-effects. Therefore, intravitreal administration of anti-TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti-TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti-TNF drugs with a 4-week minimum follow-up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open-label, single-centre, prospective, non-randomized, interventional case series with a follow-up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti-TNF intravitreal injections, while one study revealed short-term improvement and one study revealed no efficacy of anti-TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti-drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti-TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti-TNF antibodies remains a possible treatment option to be explored through robust clinical investigation.
Publisher: Jaypee Brothers Medical Publishing
Date: 08-2016
Publisher: Oxford University Press (OUP)
Date: 03-06-2020
Publisher: Wiley
Date: 09-2017
Publisher: Springer Science and Business Media LLC
Date: 04-07-2020
Publisher: Wiley
Date: 14-09-2016
Publisher: Wiley
Date: 14-09-2016
Publisher: Wiley
Date: 09-2017
Publisher: Springer Science and Business Media LLC
Date: 06-10-2020
DOI: 10.1007/S00592-020-01602-9
Abstract: To characterize the progression in retinopathy severity of different phenotypes of mild nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes. Patients with type 2 diabetes and mild NPDR (ETDRS 20 or 35) were followed in a 5-year longitudinal study. Examinations, including color fundus photography (CFP) and optical coherence tomography (OCT and OCTA), were performed at baseline, 6 months and then annually. Phenotype classification was performed based on microaneurysm turnover (MAT, on CFP) and central retinal thickness (CRT, on OCT). Phenotype A is characterized by low MAT ( 6) and normal CRT Phenotype B by low MAT ( 6) and increased CRT and Phenotype C by higher MAT (≥ 6) with or without increased CRT. ETDRS grading of seven fields CFP was performed at the initial and last visits. Analysis of ETDRS grade step changes showed significant differences in diabetic retinopathy (DR) progression between the different phenotypes ( p 0.001). Of the 66 participants with phenotype A only 2 eyes (3%) presented 2-or-more-step worsening. None of the 50 participants characterized as phenotype B developed 2-step worsening, whereas 13 eyes (23.2%) characterized as phenotype C had 2-or-more-steps worsening. Phenotype C presents the higher risk for 2-or-more step worsening (OR: 15.94 95% CI: 3.45–73.71 p 0.001) and higher sensitivity, correctly identifying 86.7% of cases at risk (AUC: 0.84 95% CI: 0.72–0.96 p 0.001). Diabetic retinopathy severity progression was associated with HbA 1c ( p = 0.019), LDL levels ( p = 0.043), and ocular factors as MAT ( p = 0.010), MA formation rate ( p = 0.014) and MA disappearance rate ( p = 0.005). Capillary closure at 5-year follow-up, identified by lower vessel density (VD) on OCTA, was also associated with diabetic DR severity progression ( p = 0.035). Different DR phenotypes in type 2 diabetes show different risks of retinopathy progression. Phenotype C is associated with increased HbA 1c values and presents a higher risk of a 2-or-more-step worsening of the ETDRS severity score.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-12-2021
Publisher: Springer Science and Business Media LLC
Date: 08-03-2013
DOI: 10.1007/S00726-013-1484-2
Abstract: The adverse side-effects associated with opioid administration restrain their use as analgesic drugs and call for new solutions to treat pain. Two kyotorphin derivatives, kyotorphin-amide (KTP-NH₂) and ibuprofen-KTP-NH₂ (IbKTP-NH₂) are promising alternatives to opioids: they trigger analgesia via an indirect opioid mechanism and are highly effective in several pain models following systemic delivery. In vivo side-effects of KTP-NH₂ and IbKTP-NH₂ are, however, unknown and were evaluated in the present study using male adult Wistar rats. For comparison purposes, morphine and tramadol, two clinically relevant opioids, were also studied. Results showed that KTP-derivatives do not cause constipation after systemic administration, in contrast to morphine. Also, no alterations were observed in blood pressure or in food and water intake, which were only affected by tramadol. A reduction in micturition was detected after KTP-NH₂ or tramadol administrations. A moderate locomotion decline was detected after IbKTP-NH₂-treatment. The side-effect profile of KTP-NH₂ and IbKTP-NH₂ support the existence of opioid-based mechanisms in their analgesic actions. The conjugation of a strong analgesic activity with the absence of the major side-effects associated to opioids highlights the potential of both KTP-NH₂ and IbKTP-NH₂ as advantageous alternatives over current opioids.
Publisher: Informa UK Limited
Date: 12-2016
Publisher: Elsevier BV
Date: 07-2018
Publisher: Ordem dos Medicos
Date: 31-08-2017
DOI: 10.20344/AMP.9437
Abstract: A hemorragia vítrea pós-operatória é uma complicação da cirurgia de vitrectomia por retinopatia diabética proliferativa, que atrasa a melhoria da acuidade visual e dificulta a visualização do fundo ocular e o seguimento da doença. Quando injetados na cavidade vítrea, os fármacos anti-factor de crescimento do endotélio vascular, como o bevacizumab, diminuem a proliferação vascular e o seu uso tem sido proposto na redução da incidência de hemorragia vítrea pós-operatória. Os autores desta revisão sistemática Cochrane reviram os ensaios clínicos aleatorizados sobre o uso pré- ou intraoperatório de anti-factor de crescimento do endotélio vascular na redução da incidência de hemorragia vítrea pós-operatória após vitrectomia em doentes com retinopatia diabética proliferativa. Dos resultados, destaca-se o efeito benéfico da utilização de bevacizumab na diminuição da hemorragia vítrea pós-operatória precoce (i.e. às quatro semanas), com um bom perfil de segurança. Neste trabalho, sumarizam-se e discutem-se os principais achados e implicações práticas desta revisão sistemática Cochrane.
Publisher: BMJ
Date: 27-06-2018
Publisher: Wiley
Date: 09-2017
Publisher: Springer Science and Business Media LLC
Date: 02-09-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2017
Publisher: SAGE Publications
Date: 16-04-2018
Abstract: To compare the safety and efficacy profiles of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in adult patients with Fuchs’ endothelial dystrophy. Electronic database search on MEDLINE and CENTRAL from inception to August 2017. We included all comparative studies of DMEK versus DSAEK in patients with diagnosed Fuchs’ endothelial dystrophy. Studies assessing rescue procedures were excluded to minimize bias. Primary outcome: mean difference in best-corrected visual acuity (BCVA) at 3, 6, and 12 months postoperatively. Secondary outcomes: rates of graft primary failure, rejection, and rebubbling other graft-related issues mean difference in endothelial cell density subjective visual outcomes and patient satisfaction. A total of 10 retrospective studies of moderate methodological quality were included (n = 947 eyes, 646 DMEK). BCVA was better with DMEK at all evaluated time points (0.16 logMAR at 12 months) comparing to DSAEK (0.30 logMAR p 0.001). DMEK had a 60% lower rate of rejection (risk ratio (RR) 0.4, 95% CI (0.24, 0.67), p = 0.0005), but required more rebubblings (RR = 2.48, 95% CI (1.32, 4.64), p = 0.005). DMEK had more primary graft failures and less endothelial cell density loss, but statistical difference was not reached. More patients were satisfied after DMEK (odds ratio = 10.29, 95% CI (3.55, 29.80), p 0.0001). DMEK showed better postoperative results regarding BCVA, patient satisfaction, and graft-related issues. However, the small number of studies with short follow-up times and other methodological issues prompt us to interpret these results carefully.
Publisher: Wiley
Date: 14-09-2016
Publisher: Jaypee Brothers Medical Publishing
Date: 2018
Publisher: Wiley
Date: 09-2017
Publisher: Medknow
Date: 2017
Publisher: Elsevier BV
Date: 12-2017
Publisher: Frontiers Media SA
Date: 12-06-2019
Publisher: Wiley
Date: 09-2017
Publisher: Hindawi Limited
Date: 02-05-2019
DOI: 10.1155/2019/1345683
Abstract: Purpose . The aim of this work was to describe the ultrastructure and behavior of peeled internal limiting membrane (ILM) in macular hole (MH) surgery. Methods . Seven patients with MH were included, and vitrectomy with ILM peeling was performed in all patients. The ILM inverted flap technique was used. Two other flaps of ILM of the same patient were collected and studied using light and transmission electron microscopy (TEM). ILM cell type, distribution, and morphology were analyzed, and the proliferation or fusion potential of the ILM interface was evaluated. Results . ILM vitreous sides in apposition showed signs of proliferative fibrotic activity, producing a basal membrane that merges ILM sides. Conclusions . Epiretinal cells in ILM show proliferative capacity, with formation of microfibrils between adjacent sides of the ILM, which may explain adherence of ILM flaps to the hole border, contributing to closure of the hole in MH surgery. This trail is registered with NCT03799575.
Publisher: Elsevier BV
Date: 05-2017
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 30-11-2020
DOI: 10.1167/TVST.9.12.34
Publisher: S. Karger AG
Date: 21-10-2016
DOI: 10.1159/000448116
Abstract: b i Purpose: /i /b To determine intra- and inter-rater agreement of anterior lamina cribrosa depth (ALCD) manual measurements using enhanced-depth imaging optical coherence tomography (EDI-OCT). b i Methods: /i /b Observational study. EDI-OCT of the optic nerve head was performed in healthy subjects. ALCD was defined as the perpendicular distance between the line connecting both edges of Bruch's membrane opening and the anterior border of the lamina cribrosa (LC), at the maximum depth point. Two experienced operators performed manual ALCD measurements of the LC independently, and one of the observers performed the same measurements twice. Intra- and inter-rater agreement was evaluated using intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC) for the right eye vertical (REV) and horizontal (REH) scans and left eye vertical (LEV) and horizontal (LEH) scans. b i Results: /i /b 120 eyes of 61 subjects, with a mean age of 62.1 ± 15.0 years. The mean REV, REH, LEV and LEH ALCD were 456.2 ± 84.3, 444.5 ± 92.2, 436.7 ± 81.6, 427.6 ± 82.7 μm, respectively. ALCD intra- and inter-rater ICC and intra- and inter-rater CCC varied between 0.85-0.95, 0.84-0.93, 0.85-0.95 and 0.84-0.93, respectively. b i Conclusions: /i /b ALCD manual intra- and inter-rater measurements with EDI-OCT showed high agreement. EDI-OCT is a reliable tool for ALCD measurement, which can provide potentially useful information for integrated glaucoma management.
Publisher: Ordem dos Medicos
Date: 09-2020
DOI: 10.20344/AMP.14421
Abstract: N/a.
Publisher: SLACK, Inc.
Date: 03-2020
DOI: 10.3928/23258160-20200228-08
Abstract: To compare complete internal limiting membrane (ILM) peeling with the inverted flap technique for macular hole (MH) surgery. An electronic database search on PubMed, CENTRAL, and ClinicalTrials.gov was performed. Inclusion criteria were comparative prospective/retrospective studies including patients with MH of any size with at least 6 months of follow-up. The primary outcome was MH closure rate. Secondary outcomes were best-corrected visual acuity improvement and surgery-related adverse events. Sixteen papers enrolling 1,403 eyes were included (733 ILM peeling, 670 inverted flap). MH mean minimum diameter and time of symptomatic evolution were higher in the inverted flap group (531.1 μm ± 188.8 μm vs. 602.8 μm ± 223.8 μm 10.4 ± 20.2 months vs. 12.0 ± 18.4 months P .01). Overall, MH closure rate was superior with the inverted flap technique (risk-ratio [RR]: 1.25 95% confidence interval [CI], 1.14–1.38 P .0001), as well as in all subgroups: idiopathic large MH (n = 362 RR: 1.12 95% CI, 1.05–1.20 P .001), myopic MH without retinal detachment (n = 133 RR: 1.35 95% CI, 1.14–1.59 P .001), and MH retinal detachment (n = 198 RR: 1.89 95% CI, 1.31–2.73 P .001). This meta-analysis suggests the inverted flap technique is more effective in achieving MH closure. [ Ophthalmic Surg Lasers Imaging Retina . 2020 :187–195.]
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-03-2018
Publisher: Ordem dos Medicos
Date: 30-05-2018
DOI: 10.20344/AMP.10660
Abstract: Non-infectious uveitis is a heterogeneous collection of inflammatory eye diseases and is one of the most important causes of blindness among active adults in developed countries. Inflammation control is crucial in the prevention of ocular structural and functional damage. Regarding acute inflammatory control, corticosteroids are the mainstay of treatment. Several types of intra-ocular corticosteroids have been used with the aim of enhanced efficacy compared to their topical or peri-ocular administration, while minimizing its adverse effects associated with the systemic administration. The purpose of this Cochrane review was to synthetize the available evidence regarding the efficacy and safety of corticosteroid implants in comparison with standard treatment. Due to the heterogeneity in the design of the studies and outcome measures assessed, authors could not conclude that implants are superior to traditional systemic therapy in Non-infectious uveitis. The safety analysis suggested increased risks of post-implant surgery for cataract and high intraocular pressure compared with standard-of-care therapy.
Publisher: BMJ
Date: 30-04-2021
DOI: 10.1136/BJOPHTHALMOL-2021-319039
Abstract: To compare outcomes of primary trabeculectomy using either mitomycin C (MMC) alone versus MMC augmented with intracamerular bevacizumab in patients with open-angle glaucoma. Retrospective, cohort, two-centre, comparative study. Patients’ data were screened between October 2015 and March 2019, with inclusion requiring a minimum follow-up of 24 months. Primary outcome was intraocular pressure (IOP) lowering at 24 months, with surgical success defined with different maximum IOP targets (≤18, ≤16 and ≤14 mm Hg) and at least 30% reduction and higher than 5 mm Hg. Absolute success was achieved if no IOP-lowering medication was needed and a qualified success if otherwise. Safety outcomes were analysed. A total of 110 eyes underwent trabeculectomy with MMC, 51 of these combined with intracamerular bevacizumab. Both strategies were effective in terms of IOP lowering (baseline vs 2 years postoperatively: 24.4 (8.0) mm Hg vs 12.1 (5.3) mm Hg in the MMC group 25.1 (8.7) vs 10.8 (3.8) mm Hg in the MMC+bevacizumab group p .001 in both comparisons). The MMC+bevacizumab group had a significant difference towards higher efficacy on absolute success rates at all targets (IOP≤14 or ≤16 or ≤18 mm Hg p=0.010, p=0.039 and p=0.007, respectively). The large majority (93%) of the MMC+bevacizumab group was drop-free at 24 months, and 41% had IOP below 10 mm Hg. Complication rates were low and similar between groups, with no systemic adverse events. Intracamerular bevacizumab in MMC-augmented primary trabeculectomy increases the chances of obtaining low IOP outcomes. This strategy may be useful when planning for surgeries aiming at target pressures in the low teens. ISRCTN93098069 .
Publisher: Elsevier BV
Date: 09-2020
Publisher: Ordem dos Medicos
Date: 31-10-2018
DOI: 10.20344/AMP.11138
Abstract: n/d
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 12-11-2020
DOI: 10.1167/TVST.9.2.55
Publisher: SAGE Publications
Date: 27-04-2022
DOI: 10.1177/09504222221096279
Abstract: There is limited experience with innovation policies in rural areas, often based on a one-size-fits-all approach. However, rural businesses have erse needs and there is difficulty in applying smart specialisation approaches for the use of European Union Cohesion funding in rural areas. A key resource in rural areas is the local university, and universities face increased demands to support local firms. This paper examines one particular case of a university in a rural region and its use of the European Regional Development Fund to support innovation activities. The challenges of working with rural businesses are explored, as is the focus on one-to-one support rather than the more collective smart specialisation approach. Universities need to take a pragmatic approach to ensure that the needs of firms can be balanced with the capacities of rural universities which are often smaller and more specialised than urban universities.
Publisher: Informa UK Limited
Date: 29-03-2019
Publisher: Elsevier BV
Date: 08-2019
Publisher: Jaypee Brothers Medical Publishing
Date: 2017
Publisher: Wiley
Date: 18-03-2020
DOI: 10.1111/AOS.14400
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000455871
Abstract: b i Background: /i /b Retinoblastoma (RB) is the most common primary intraocular malignancy. Current therapies are associated with high morbidity in the short- and long-term. Human epidermal growth factor receptor 2 (HER2) is a transmembrane protein detected in 15-30% of breast cancers, but it has also been described in other malignancies. Recently, it has been claimed that a truncated version of this protein is expressed in RB, responsive to directed therapies in vitro. We scored HER2 overexpression in RB tissue s les and discussed its potential clinical utility. b i Methods: /i /b HER2 overexpression was investigated using immunohistochemistry the overexpression was evaluated with a score ranging from 0 to 3+ according to the membranous staining pattern in archival formalin-fixed, paraffin-embedded RBs. b i Results: /i /b A total of 60 RB cases and a RB cell line (Y79) were considered. The mean age at enucleation was 31.6 ± 31.5 months. The mean time from diagnosis to enucleation was 11.8 ± 11.2 months (range 1-44). Five (8%) cases were multifocal. HER2 overexpression was negative in all RB cases (49 cases scored 0 and 11 scored 1+) and in the Y79 cell line. b i Conclusions: /i /b Overall, we were not able to demonstrate the overexpression of HER2. Further studies should clarify and better elucidate the potential role of HER2-targeted therapies in RB.
Publisher: BMJ
Date: 11-11-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2019
Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 04-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2020
DOI: 10.1097/IAE.0000000000002607
Abstract: To examine the influence of the inverted flap (IF) internal limiting membrane (ILM) technique in macular hole (MH) closure on outer retinal layers after MH surgery. Retrospective study. Postoperative position of ILM, recovery rate of external limiting membrane and ellipsoid zone, and best-corrected visual acuity were evaluated. The Inserted group, where the IF is placed inside the hole, was compared with the Cover group, where the IF completely covers the hole. Sixty-two eyes of 58 patients who underwent vitrectomy and ILM peeling with the IF technique for large MHs ( µ m) with successful MH closure and a follow-up of 12 months were evaluated. In the 24 eyes of the Inserted group, there was no regeneration of external limiting membrane or ellipsoid zone after 12 months. In the 38 eyes of Cover group, external limiting membrane recovered in 55.3% of patients 1 month after surgery, and in 86.1% after 12 months. The elipsoid zone layer was present in 58% of the patients. Poorer anatomical and visual results were associated with the IF technique where ILM insertion occurs compared with ILM placed over the hole. These findings suggest that insertion of the ILM in the hole might prevent outer retinal layers realignment and visual recovery in MH surgery.
Publisher: Elsevier BV
Date: 02-2022
Publisher: Hindawi Limited
Date: 27-03-2019
DOI: 10.1155/2019/1939523
Abstract: Purpose . Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. Methods . Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 litude and latency, was also measured. Results . All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart ( P 0.001 ), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 litudes in ring 1 increased compared to preoperative values ( P 0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 litude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers ( P = 0.042 ). Conclusions . In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.
Publisher: SAGE Publications
Date: 13-09-2016
DOI: 10.5301/EJO.5000867
Abstract: To investigate the association between anterior lamina cribrosa depth (ALCD), determined with enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT), and intraocular pressure (IOP) in a healthy Portuguese population. In this cross-sectional observational study conducted between January and July 2015, 2 optic nerve head (ONH)–centered EDI-OCT cross-scans were performed and ALCD was defined as the perpendicular distance between the line connecting both edges of Bruch's membrane opening and the anterior border of the lamina cribrosa at the maximum depth point. A multivariate regression model was performed to assess the association of IOP and ALCD. The studied population included 59 subjects (35 women) with a mean age of 61.7 ± 15.1 years. Mean vertical and horizontal maximum ALCD was 444.5 ± 92.2 μm and 427.6 ± 82.7 μm, respectively. When controlling for age and spherical equivalent, maximum vertical and horizontal ALCD were positively correlated with intraocular pressure (R 2 .20) by 8.58 μm (95% confidence interval [CI] 2.80-14.36 μm p .01) and 8.25 μm (95% CI 2.71-13.78 μm p .01) per mm Hg of IOP, respectively. Our s le of healthy subjects presented a statistically significant positive correlation between IOP and ALCD when controlling for possible confounding factors. These results may trigger further studies to better elucidate the role of IOP in the morphologic and functional dynamics of the ONH.
Publisher: S. Karger AG
Date: 05-10-2017
DOI: 10.1159/000480243
Abstract: b i Purpose: /i /b To highlight tomographic structural changes of retinal layers after internal limiting membrane (ILM) peeling in macular hole surgery. b i Methods: /i /b Nonrandomized prospective, interventional study in 38 eyes (34 patients) subjected to pars plana vitrectomy and ILM peeling for idiopathic macular hole. Retinal layers were assessed in nasal and temporal regions before and 6 months after surgery using spectral domain optical coherence tomography. b i Results: /i /b Total retinal thickness increased in the nasal region and decreased in the temporal region. The retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) showed thinning on both nasal and temporal sides of the fovea. The thickness of the outer plexiform layer (OPL) increased. The outer nuclear layer (ONL) and outer retinal layers (ORL) increased in thickness after surgery in both nasal and temporal regions i . /i b i Conclusion: /i /b ILM peeling is associated with important alterations in the inner retinal layer architecture, with thinning of the RNFL-GCL-IPL complex and thickening of OPL, ONL, and ORL. These structural alterations can help explain functional outcome and could give indications regarding the extent of ILM peeling, even though peeling seems important for higher rate of hole closure.
Publisher: Springer Science and Business Media LLC
Date: 21-04-2021
Publisher: Springer Science and Business Media LLC
Date: 06-02-2019
DOI: 10.1007/S00417-019-04256-8
Abstract: This literature review and meta-analysis aims to compare intraocular pressure (IOP) lowering efficacy, failure rates and loss of light perception (LP) rates 6 months after an IOP-lowering surgical procedure in neovascular glaucoma (NVG) eyes. MEDLINE and EMBASE were used as data sources. Only studies including NVG patients who underwent two different surgical approaches were considered. The treatment effect measures were (i) weighted mean difference (WMD) for IOP reduction, (ii) risk ratio (RR) for failure rates and (iii) risk difference (RD) for loss of LP. Outcome measures were reported with a 95% confidence interval (CI) and P < 0.05 was considered statistically significant. Analysis was performed using RevMan v5.0. No RCT were retrieved. Seven comparative non-randomised studies were eligible. In glaucoma drainage devices (GDDs) vs cyclophotocoagulation arm, there was no statistical difference in IOP-lowering efficacy (WMD = - 3.63 CI [- 8.69, 1.43], P = 0.16), although failure rates and loss of LP were lower in the GDDs group (RR = 0.64, CI [0.41, 0.99], P = 0.05 and RD = - 0.15, CI [- 0.25, - 0.05], P = 0.004, respectively). In the Ahmed glaucoma valve (AGV) vs trabeculectomy arm, there was no statistical difference in IOP-lowering efficacy and loss of LP (WMD = 0.78, CI [- 2.29, 3.85], P = 0.62 and RD of 0.04, CI [- 0.05, 0.14], P = 0.34, respectively), but failure rates were lower in trabeculectomy group (RR of 2.25, CI [1.14, 3.71], P = 0.02). There is lack of high-quality evidence on the subject as no RCT were retrieved comparing two different IOP-lowering procedures in NVG patients. Our findings are based, therefore, on non-RCT studies and should be interpreted with caution. There appears to be no difference in IOP-lowering efficacy between GDDs and cyclophotocoagulation, although GDDs appear to be safer. AGV and trabeculectomy also seem to provide similar IOP-lowering results with trabeculectomy showing lower failure rates.
Publisher: American Diabetes Association
Date: 06-11-2020
DOI: 10.2337/DC20-1125
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Gary Bosworth.