Carlos Neves
Portuguese Retina and Vitreous Group
Gene and cell therapy for age-related macular degeneration: A review
Age-related macular degeneration (AMD) is reviewed, with an emphasis on novel gene and cell therapies. It talks on how to treat late-stage AMD and covers developments in gene therapy vectors, cell transplantation, and anti-VEGF drugs. These methods hold potential for improving patient outcomes and delaying the course of disease.
Full-Thickness Macular Hole Closure With Topical Medical Therapy
In a retrospective investigation, Wang et al. found that topical drops were safe and effective for closing full-thickness macular holes (FTMHs), and that they worked especially well for smaller holes that did not require vitreomacular traction (VMT). Although the results might not differ considerably from spontaneous closure rates, they discovered a 71% closure rate in post-vitrectomy cases and 31% closure rate in idiopathic instances. To elucidate these results, the authors propose larger sample sizes and additional controlled investigations.
Retina 44(3):p 392-399, March 2024.
Ricardo Parreira
Portuguese Group of Pediatric Ophthalmology and Strabismus
I would like to highlight this article from the American Journal of Ophthalmology, which analyzed the effects of a peripheral blur lens with a non-concentric design on the progression of myopia in Israeli children over 12 months. The results showed a reduction in the progression of axial length and spherical equivalent, especially in children under the age of 10 and children with both myopic parents. It should be noted that the control group in this study has a significantly lower annual myopia progression rate compared to the Asian population. We await the results at 2 years.
https://www.ajo.com/article/S0002-9394(23)00351-3/pdf
In this article, the author reviews the literature on the causes of Acute Concomitant Endotropia, using relevant databases (PubMed, MED- LINE, EMBASE, BioMed Central, Cochrane Library, Web of Science). It should be noted that functional etiological factors have increased recently, associated with the use of smartphones and other digital devices for close work. This increase has also been observed during the COVID-19 pandemic.
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/37145335/
Nuno Alves
Portuguese Group of Ocular Surface, Cornea and Contactology
João Feijão
Portuguese Group of Implanto-Refractive Surgery
Fungal keratitis is a major diagnostic and therapeutic challenge, affecting more than a million patients a year and posing a serious threat to vision and the integrity of the eyeball itself. This is an excellent review article on diagnostic and therapeutic strategies for a pathology that poses so many challenges.
https://journals.lww.com/corneajrnl/toc/2024/09000
Lígia Ribeiro
Portuguese Group of Neurophthalmology
In this newsletter, I suggest the July issue of Eye magazine, entirely dedicated to neurophthalmology. Susan Mollan and Clare Fraser have put together a series of opinion articles on key topics in this area.
This Update in Neuro-Ophthalmology consists of articles with practical information on the investigation, diagnosis and treatment of common pathologies such as optic neuritis and idiopathic intracranial hypertension, and review articles on pituitary pathology, non-arteritic ischemic optic neuropathy and traumatic optic neuropathy. A general approach is taken to the most common agents of infectious optic neuropathies, and two articles focus on herpes zoster ophthalmicus and syphilis. The diagnostic criteria and biological basis of visual snow syndrome are also characterized and an approach is taken to functional visual loss. The supporting role of neuroimaging, OCT and electrophysiological tests in the diagnosis and follow-up of patients is highlighted in three articles and smartphone applications that have been validated for clinical use are presented. Giant cell arteritis from the rheumatologist's point of view and new therapeutic targets in myasthenia gravis are two topics that remind us of the importance of multidisciplinary collaboration. This is a very interesting compilation of articles that will be very useful in our clinical practice, demonstrating the dynamism that we have been witnessing in neurophthalmic pathology.
https://www.nature.com/collections/eeifggbghf
Nádia Lopes
Portuguese Orbit and Oculoplastic Group
The efficacy of amniotic membrane transplantation in ocular surface diseases is widely recognized. In this newsletter, I would like to highlight its use in the field of oculoplastics, particularly in the reconstruction of the posterior lamella, fundus-saco-conjunctival and anophthalmic cavity.
https://pubmed.ncbi.nlm.nih.gov/38427832/
João Breda
Portuguese Research Group
A large number of associations have already been made with the risk of glaucoma. Many have been confirmed, while others have fallen by the wayside or are still controversial. In this newsletter, I share two cohort studies that found less common risk factors for developing de novo glaucoma during follow up (incidence).
One of them (link 1) used data from the UK BioBank and revealed a higher risk of glaucoma in those who experience social isolation or loneliness. In this context, I'd like to highlight this systematic review and meta-analysis from Nature (link 2) which shows how social isolation and loneliness are also associated with a higher risk of all-cause and cancer-related mortality.
The second association I'd like to highlight is diet. Another cohort study (link 3) revealed a higher risk of glaucoma in those who consumed more ultra-processed foods, especially sweets.
In conclusion, we'll see in the future if these associations with the risk of glaucoma are confirmed, but it's safe to say that socializing is life-giving! Enjoy!
link 1: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19649-6
link 2: https://www.nature.com/articles/s41562-023-01611-y
link 3: https://www.mdpi.com/2072-6643/16/7/1053
Vanda Nogueira
Portuguese Group for Ocular Inflammation
In recent years, janus kinase inhibitors (JAK inhibitors) have been used to treat patients with non-infectious uveitis (NIU) refractory to biological drugs. Their efficacy in controlling immune-mediated inflammatory diseases is recognized, and there is already some evidence to suggest superiority over adalimumab. They also have the advantage of being orally administered drugs. Their side-effect profile is still unclear, making their definitive position in the therapeutic algorithm for NIUs still dubious. However, this new generation of drugs is already a therapeutic weapon to consider in severe uveitis refractory to biological drugs. The partial results of the phase 2 NEPTUNE (Brepocitinib) study were recently presented at EURETINA 2024. They are very promising and have even supported the move towards a phase 3 study with the same drug (CLARITY), which is currently being recruited. While we wait for the results, I suggest reading 2 studies published in recent months, one based on the AIDA registry and prospectively analyzing various JAK inhibitors in NICUs (1), and the other with the results of the randomized phase 2 study HUMBOLDT (filgotinib in NICUs) (2).
Teresa Gomes
Portuguese Glaucoma Group
I bring you a review article published in Curr Opin Ophthalmol. last March on AI.
This article presents the state-of-the-art in the use of this tool in glaucoma. It also reflects on the challenges that the implementation of AI in the diagnosis and assessment of disease progression will bring, and outlines strategies for solving these problems. Prof. Luís Abegão Pinto's group, whose pioneering work in the use of AI in glaucoma screening has been recognized by the international scientific community, is the author of this text.
https://pubmed.ncbi.nlm.nih.gov/38018807/
The second article selected was published in Ophthalmology last July. Despite all the efforts to diagnose glaucoma at an early stage, the truth is that we still have patients coming to our consultations with very serious or even terminal conditions. The margin for error in these cases is minimal because the residual visual function is very limited. Any evidence that helps us make the right decision to prolong good QOL for these patients is of the utmost importance. The study now published, carried out in the UK over a five-year period in 27 hospitals, compared medical therapy to surgical therapy as the first approach in this group of patients. The results point to an advantage of initial surgical therapy, essentially in terms of controlling the progression of the disease.
https://pubmed.ncbi.nlm.nih.gov/38199528/
Guilherme Castela
Portuguese Group for Oncologic Pathology and Ocular Genetics
Basal cell carcinoma is the most common tumor of the periocular area. It is slow-growing, but its local extension can cause major eyelid and orbital destruction. These locally invasive tumors are challenging from a surgical point of view, involving major reconstructions associated with high morbidity. Exenteration is often necessary, complemented by radiotherapy, to ensure complete excision of these tumors.
Most of these sporadic tumors are associated with mutations in the sonic hedgehog pathway. Vismodegib is the first selective hedgehog inhibitor approved for the treatment of advanced and metastasized basal cell carcinoma.
This article describes the results of treatment with Vismodegib in advanced basal cell carcinoma in the periocular area by reviewing 11 articles published in the literature between 2012 and 2022.
This literature review confirms the effectiveness of this medical treatment with high rates of orbital preservation, reducing the need for exenteration to 6%. Despite this, some side effects have been described, with the need to discontinue therapy in a small percentage of patients. Its use as a neoadjuvant before surgical treatment also seems promising in very aggressive cases.
Vimodegib has been proven to be an effective therapy, but there are still some doubts about its application, particularly the duration of treatment to prevent relapses.
https://journals.lww.com/op-rs/toc/2024/01000
Ana Almeida
Portuguese Group of Ergoftalmology
In this newsletter we have chosen two valuable articles by Portuguese authors published in indexed international journals:
In this article by Pedro Lima Ramos et al., the authors sought to estimate the prevalence and causes of low vision in northwest Portugal. The crude prevalence of visual impairment was 1.97% (95% CI 1.56% to 2.54%), which is within the expected range and in line with other European countries. Women and the elderly seem to be more affected and therefore require more attention. The five main causes of visual impairment found were diabetic retinopathy, cataracts, age-related macular degeneration, glaucoma and eyeball pathologies.
https://pubmed.ncbi.nlm.nih.gov/36691224/
In this study by Ana Marta et al. the authors assessed the socio-economic characteristics of the regions in Portugal where patients with hereditary retinal diseases (HRD) live, in order to better plan support and rehabilitation strategies. This study involved 1082 patients from 973 families and revealed an estimated prevalence of 10.4 per 100,000 inhabitants. Regions with a higher prevalence of RHD tend to have a lower population density, a higher illiteracy rate, an older population, a lower proportion of doctors per capita, and a poorer quality of life in some socio-economic aspects. These disparities indicate the need for targeted support strategies to ensure that all patients with RHD receive adequate clinical and socioeconomic support.
https://pubmed.ncbi.nlm.nih.gov/38594754/
Diogo Hipólito
SPO Youth
For this newsletter we decided to select two publications that we feel are particularly important and useful from a didactic point of view, especially for interns and young specialists
First of all, we advise everyone to read the recently published Guidelines on Cataract Surgery from the European Society of Cataract and Refractive Surgeons (ESCRS). The ESCRS has always been concerned with systematizing and disseminating evidence-based guidelines in the most diverse areas of refractive and cataract surgery. In these extremely comprehensive guidelines we find everything from the definition of the pathology, to the updated classification of intraocular lenses, the calculation of lens power, preoperative, intraoperative and postoperative care, as well as the potential complications of the surgical procedure. This is still a preliminary version as comments and suggestions from members for improvement will be accepted until October 31, 2024.
Secondly, we'd like to highlight a thesis published in this October's issue of the American Journal of Ophthalmology with an evidence-based diagnostic approach to patients with orbital inflammatory syndromes. This is a heterogeneous group of diseases that share many radiographic and clinical findings. The aim of this study is to find a rationale for the diagnostic assessment of these cases, with a flowchart at the end that is very useful for clinical practice.
https://www.ajo.com/article/S0002-9394(24)00210-1/fulltext
