Carlos Neves
Portuguese Retina and Vitreous Group
https://pubmed.ncbi.nlm.nih.gov/37603408/
This article serves to reinforce the need for concrete, measurable concepts to be created in Portugal, supported by reference literature, on the admissible times for retinal detachment surgery, as well as the concept of macula on-off. This evaluation is based on 1675 cases from the Primary Retinal Detachment Outcomes (PRO) study database, in line with the evaluation of the British database, Yorston et al, with 2074 cases.
"The study by Zeeshan Haq and colleagues investigates the impact of surgical timing on visual acuity outcomes in patients with rhegmatogenous retinal detachment (RD), based on their preoperative foveal status. They classified cases into three groups: fovea-on, fovea-split, and fovea-off. The study found that the timing of surgery did not significantly affect the final postoperative visual acuity in the fovea-on and fovea-split groups. However, in the fovea-off group, delaying surgery for two or more days resulted in significantly worse visual outcomes compared to surgeries performed within one day.
The study used data from the Primary Retinal Detachment Outcomes (PRO) study database and included a total of 1,675 cases. The findings emphasized that fovea-on and fovea-split RDs have comparable visual outcomes, while fovea-off RDs have worse outcomes that further decline with delayed surgery. The study suggests that while fovea-on RDs may not require emergent intervention, fovea-off RDs could benefit from earlier surgical repair. This study challenges traditional paradigms regarding the urgency of RD surgery based on macular involvement and advocates for a classification scheme based on the foveal status due to its implications for management and visual prognosis. The results are important for informing surgical timing decisions to maximize visual outcomes in RD patients."
The study by Zeeshan Haq and colleagues investigates the impact of surgical timing on visual acuity outcomes in patients with rhegmatogenous retinal detachment (RD), based on their preoperative foveal status. They classified the cases into three groups: fovea-on, fovea-split and fovea-off. The study proved that the timing of surgery did not significantly affect final postoperative visual acuity in the fovea-on and fovea-split groups. However, in the fovea-off group, delaying surgery by two or more days resulted in significantly worse visual outcomes compared to surgeries performed within one day.
The study used data from the Primary Retinal Detachment Outcomes (PRO) study base and included a total of 1,675 cases. The results emphasized that fovea-on and fovea-split RDs have comparable visual outcomes, while fovea-off RDs have worse outcomes that decline further with delayed surgery. The study suggests that while fovea-on RDs may not require emergent intervention, fovea-off RDs could benefit from earlier surgery.
This study challenges traditional paradigms regarding the urgency of RD surgery based on macular involvement and advocates a classification scheme based on foveal status due to its implications for visual management and prognosis. The results of the study are important for informing surgical timing decisions to maximize visual outcomes in patients with RD.
Ricardo Parreira
Portuguese Group of Pediatric Ophthalmology and Strabismus
We now have a variety of treatments to reduce the progression of myopia. And how do we measure their effectiveness? In previous publications, Kaymak demonstrated the importance of axial length. We know that the annual growth rate decreases with age. In this study, the annual growth rate is compared with a database of eyes that have become emmetropic (adjusted for age). In this way, the authors identify eyes with growth above the physiological rate, in which they suggest instituting or scaling up treatment. For this purpose, an online version of the system used by the authors is also provided(https://myopia-solutions.com).
https://onlinelibrary.wiley.com/doi/10.1111/joa.14009
In this article, the author reviews orbital anatomy and ocular kinematics in the light of concepts that research has clarified over the years. The importance of the pulleys and the contact arc in effectively determining the rotational force is analyzed. These concepts are of great importance in planning and understanding the consequences of strabismus surgery.
Nuno Alves
Portuguese Group of Ocular Surface, Cornea and Contactology
João Feijão
Portuguese Group of Implanto-Refractive Surgery
https://pubmed.ncbi.nlm.nih.gov/30882538/
This article reviews the various stages in the evolution of the corneal CXL technique. It highlights the importance of oxygen and the associated photochemical reactions that dictate the success or failure of this technique, and consequently the impact of these conclusions on the decision about the best therapeutic protocol.
Lígia Ribeiro
Portuguese Group of Neurophthalmology
'Time is vision'
A retrospective analysis of cases of optic neuritis associated with antibodies to the myelin glycoprotein of oligodendrocytes (MOG-ON) has been published in the journal Ophthalmology, with the aim of defining the proportion of patients with poor visual outcome and determining possible related factors. The 45 patients (65 eyes) included in the study were treated with intravenous methylprednisolone (1000 mg) or a bioequivalent dose of oral prednisolone (1250 mg) for 3 to 5 days, followed by prednisolone weaning. Cases that didn't respond were additionally treated with plasmapheresis or immonoglobulins.
There was a poor functional outcome in 42.2% of cases, defined as a final visual acuity greater than or equal to 0.4 logMar and MD less than -5D in Humphrey perimetry. The delay in treatment was the determining factor in the poor visual outcome. The average time elapsed between the onset of symptoms and treatment was 6.65 days in the group of patients with a good outcome and 32.9 days in the cases with a poor outcome. Treatment with an oral bioequivalent dose of corticoid was not inferior to intravenous administration. Visual acuity, campimetric defect or neuroradiological findings in the initial evaluation were not predictive of the final outcome.
You can listen to Dr. Margolin discuss the results of the study on the AAO podcast, available on Google Podcasts, Apple Podcasts and Spotify:
https://sites.libsyn.com/399476/predictors-of-poor-visual-outcome-in-mog-related-optic-neuritis
Nádia Lopes
Portuguese Orbit and Oculoplastic Group
https://pubmed.ncbi.nlm.nih.gov/37728602/
In this section, I would like to highlight the importance of Targeted Therapy and Immunotherapy for the treatment of patients with locally irresectable or metastatic periocular tumors.
Targeted therapy and immunotherapy have been increasingly used in the field of oncology. In the first case, an agent or drug is used that targets a specific protein involved in a molecular pathway responsible for the growth of a specific cancer. In the second case, it is based on the patient's immune system fighting the immune evasion of the tumor cells (for example: monoclonal antibodies, checkpoint inhibitors and vaccines).
This article focuses on the most recent updates in the evaluation of these therapies in the treatment of periocular tumors, namely: basal cell carcinoma, squamous cell carcinoma, cutaneous melanoma, Merckel cell carcinoma, sebaceous gland carcinoma, solitary fibrous tumor, dermatofibrosarcoma protuberans, neurofibromatosis, ocular appendage lymphoma, orbital meningioma, Langerhans cell histiocytosis, orbital lymphatic malformations and adenoid cystic carcinoma.
These therapies have proven their efficacy and are poised to become an important therapeutic tool in the treatment of advanced periocular tumors by allowing a more personalized approach with minimal toxicity. However, their cost and availability represent the main limitations.
João Breda
Portuguese Research Group
For this newsletter I've chosen to bring you two curiosities from the world of research.
A study published in JAMA Ophthalmology reveals that greater racial and ethnic diversity in the members of research teams responsible for patient recruitment increased the participation of patients from minority groups1. This study was carried out with 1380 potential study participants, and showed that individuals from minority groups and low socio-economic status were less likely to agree to take part in studies. Portugal has seen an increase in the number of highly complex clinical studies and Ophthalmology is no stranger to this reality. It is therefore important to take this data into account2.
I also wanted to make a note of the ability that already exists to use 3D printers to create ophthalmic tissue, still only for research use. They have managed to use stem cells to print tissue with the properties of the external blood-retinal barrier and so have unlimited access to tissue to study diseases such as AMD, among others3.
1 - https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2810430
2 - https://ordemdosmedicos.pt/investigacao-clinica-em-portugal-como-estamos-e-para-onde-vamos/
Vanda Nogueira
Portuguese Group for Ocular Inflammation
White spot syndromes are challenging in terms of diagnosis and therapeutic strategy. The development of multimodal imaging has played a crucial role in the rediscovery of these chorioretinopathies, as the article we are proposing explains very well; together with two other recent papers, new and atypical variants of these syndromes are characterized, as well as their secondary forms, which accompany other chorioretinal diseases.
https://pubmed.ncbi.nlm.nih.gov/37574123/
https://pubmed.ncbi.nlm.nih.gov/37071923/
https://pubmed.ncbi.nlm.nih.gov/37657077/
Teresa Gomes
Portuguese Glaucoma Group
My choice this time falls on two FDA approvals in 2023 that reinforce the paradigm shift in the diagnosis and treatment of glaucoma.
With regard to diagnostics, a remote visual field monitoring platform has been registered by the FDA, Peripherex is the name of the product developed. The company BioLight, responsible for developing this technology, cites as advantages the high frequency with which recordings can be made and the existence of alerts for the attending physician when peripheral field loss is observed.
This technology was developed by Professor Jeffrey Goldberg of Stanford University in the USA in collaboration with an Isrealite company called UMOOVE, which leads us to think that there may currently be constraints on the progress of this project. Despite this eventuality, it seems to us that this path of self-monitoring will be followed and many innovations are expected in this area.
With regard to treatment, in December 2023, Glaukos Corporation received FDA approval for iDose TR (travoprost slow-release intracameral implant) 75 μg, for the reduction of intraocular pressure in patients with ocular hypertension or open-angle glaucoma.
Data from two main prospective, randomized, multicenter, double-blind, phase 3 trials (GC-010 and GC-012) supported this approval.
Glaukos Corporation expects to begin the commercial launch of the iDose TR at the end of the first quarter of 2024.
The launch of an angled device/reservoir with a slow-release drug follows on from other products and systems that aim, among other things, to overcome the problem of compliance in glaucoma.
This formula, supposedly positioned between topical drugs and surgery, taking into account the need for an emergency room visit, the invasiveness of the procedures and the potential for complications, will certainly have to prove its worth over less invasive, non-emergency and demonstrably effective procedures such as SLT and other alternatives that will soon emerge.
https://iovs.arvojournals.org/article.aspx?articleid=2788577
https://pubmed.ncbi.nlm.nih.gov/38345710/
Guilherme Castela
Portuguese Group for Oncologic Pathology and Ocular Genetics
https://pubmed.ncbi.nlm.nih.gov/17077661/
This article describes the role of cimetidine in the treatment of recurrent conjunctival papillomatosis. Conjunctival papillomas, although benign neoplasms, are a therapeutic challenge due to their recurrent nature. Various therapies associated with surgical treatment have been advocated, including cryotherapy, alpha interferon and mitomycin C, in an attempt to reduce the likelihood of recurrence.
Cimetidine is an H2 receptor antagonist drug and results in an increase in humoral immunity by inhibiting these receptors on suppressor T cells, thus acting as an immunomodulator. It has been used clinically in the treatment of chronic infectious and neoplastic diseases, including gammaglobulinemia, psoriasis, erythema multiforme, herpes zoster, Castleman's disease, HIV infection, recalcitrant warts, etc.
The association of papillomas with HPV-6 and -11 means that immunomodulation plays an important role in their irradiation.
Oral cimetidine can be used as initial medical therapy in recurrent conjunctival papillomatosis, reserving surgery, with or without mitomycin C, for a second stage and for removal of the residual lesion.
Despite the fact that only isolated clinical cases have been published on the use of this immunomodulator, its efficacy seems to be superior to previously recommended treatments.
Ana Almeida
Portuguese Group of Ergoftalmology
The father of a boy with low vision has created an application that transforms any text, with paragraphs, intervals, into a single continuous line that can be controlled by the hand or run automatically from right to left, allowing the user to read texts without getting lost in line changes, to have control over the size of the font, the speed at which it passes across the screen, the colors of the text and the background.
This application is free and available at this link: https://web-app-x-read.web.app
Smartglasses Use ChatGPT To Help The Blind And Visually Impaired | 5G Playbook
Envision Glasses are smartglasses that use artificial intelligence (ChatGPT and Google hardware) to capture and convert visual information from the user's surroundings into auditory information.
Diogo Hipólito
SPO Youth
First of all, we have selected and invite you to read a review article available in the March issue of the journal Retina , which provides an extraordinary systematization of the various imaging biomarkers of optical coherence tomography (OCT).
This is a topic on the agenda, and the way it is organized in this article makes it an extremely useful study tool. The biomarkers and OCT characteristics of vitreoretinal interface pathologies, age-related macular degeneration, uveitis, pharmacological toxicities, pachychoroidopathies, vascular diseases, macular telangectasia, among others, are presented.
https://pubmed.ncbi.nlm.nih.gov/379034557
Secondly, we would like to highlight another review article, this time in the area of anterior segment surgery. In the latest issue of Survery of Ophthalmology, we are presented with a systematic review of the approach to cataract surgery in patients who have previously undergone laser refractive surgery, in order to achieve maximum satisfaction. Over the years, the number of patients with these conditions who come to us for cataract surgery is increasing and it is essential to know the particularities and precautions to be taken in the preoperative assessment in order to obtain the best possible result.
