Percorrer por autor "Aguiar, Pedro"
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- Factors associated with the recurrence of intermittent exotropia and reoperations in the long termPublication . Lino, Pedro; Aguiar, Pedro; Cunha, João PauloPurpose: To evaluate long-term reoperation risk after bilateral lateral rectus (BLR) recession for intermittent exotropia (IXT) in a paediatric cohort, and to identify the perioperative factors associated with recurrence and reoperation. Methods: A retrospective observational cohort of 258 children with basic or divergence-excess IXT who underwent BLR recession at CUF Cascais Hospital between 2010 and 2020 was analysed. Clinical variables included age, age at surgery, pre- and immediate postoperative deviation angles, preoperative occlusion therapy, orthoptic treatment, binocular function, and initial surgical success (residual deviation <10 prism dioptres with fusion). Bivariate analyses were performed using t-tests or χ2 tests, and variables with p < 0.10 were entered into multivariable binary logistic regression to identify the independent predictors of reoperation. Model diagnostics included variance inflation factors (VIF), Hosmer-Lemeshow test, and area under the receiver operating characteristic curve (AUC). Significance was set at p < 0.05. Results: Reoperation was required in 11% of cases. Failed initial surgery (adjusted OR = 34.7; p < 0.001), larger preoperative deviation (adjusted OR per PD = 1.143; 95% CI 1.062-1.231; p < 0.001), larger immediate postoperative deviation (adjusted OR per PD = 0.822; 95% CI 0.766-0.881; p < 0.001), and older patient age (adjusted OR per year = 1.261; 95% CI 1.032-1.542; p = 0.024) were independently associated with reoperation. Orthoptic and occlusion therapies showed non-significant trends. Conclusion: In children undergoing BLR for IXT, initial surgical failure and deviation magnitude (pre- and immediate postoperative) are the strongest predictors of reoperation, with age having a modest additional effect. These findings emphasize precise surgical planning and the need for long-term follow-up.
- A review of digital eye strain: binocular vision anomalies, ocular surface changes, and the need for objective assessmentPublication . Barata, Maria João; Aguiar, Pedro; Grzybowski, Andrzej; Moreira-Rosário, André; Lança, CarlaBackground: This study investigates the impact of digital device usage on the visual system, with a focus on binocular vision. It also highlights the importance of objective assessment in accurately diagnosing and guiding therapeutic approaches for Digital Eye Strain Syndrome (DESS). Methods: A comprehensive narrative review was conducted to synthesize existing evidence. The methodological quality of observational and case-control studies was assessed using the Newcastle-Ottawa scale, while randomized controlled trials (RCTs) were evaluated using the Cochrane risk-of-bias (RoB 2) tool. Results: Fifteen articles were included in this review, with a predominant focus on binocular vision anomalies, particularly accommodative and vergence dysfunctions, as well as ocular surface anomalies related to DESS. Clinical assessments relied primarily on symptom-based questionnaires, which represent a significant limitation. The included studies were largely observational, with a lack of longitudinal and RCTs. In contrast, research in dry eye disease has been more comprehensive, with multiple RCTs already conducted. Therefore, it is essential to develop validated objective metrics that support accurate clinical diagnosis and guide evidence-based interventions. Conclusions: It remains unclear whether changes in binocular vision are a cause or consequence of DESS. However, prolonged screen time can exacerbate pre-existing binocular vision anomalies due to continuous strain on convergence and accommodation, leading to symptoms. Future research should prioritize prospective longitudinal studies and well-designed RCTs that integrate objective clinical measures to elucidate causal relationships and improve diagnostic and therapeutic frameworks.
- Surgical management of intermittent exotropia (IXT) in children: a literature reviewPublication . Lino, Pedro; Aguiar, Pedro; Cunha, Maria JoãoIntroduction: Surgical treatment of intermittent exotropia (IXT) in children presents variable outcomes due to diverse surgical techniques, success definitions, and follow-up durations. There is a need to clarify factors influencing prognosis to guide clinical decisions. Methods: This review synthesizes published studies assessing surgical outcomes in pediatric IXT, focusing on success rates, criteria used, surgical approaches, and predictive factors influencing long-term results. Results: Short- and medium-term motor success rates are generally high; however, outcomes tend to decline over time, mainly due to postoperative exodrift, resulting in recurrence and reoperation. Unilateral recess-resect procedures showed better long-term results in some cohorts, while modified techniques like slanted lateral rectus recession yielded promising results in specific IXT subtypes. Preoperative sensory function and deviation control were significant predictors of success. Conclusion: Surgical outcomes in pediatric IXT vary widely, highlighting the importance of standardized success criteria, including sensory and motor measures. Extended follow-up and patient-specific surgical planning are essential for optimizing results. Future prospective research with uniform methodologies is necessary to improve treatment strategies.
- Validation of binocular vision and ocular surface assessment tools in digital eye strain syndrome: the DESIROUS studyPublication . Barata, Maria João; Aguiar, Pedro; Grzybowski, Andrzej; Lança, Carla; jMoreira-Rosário, AndréBackground: To understand if binocular vision disorders are associated with Digital Eye Strain Syndrome (DESS), a study protocol is needed to ensure consistency across observational studies. This study aims to test the feasibility of a protocol to assess DESS, screen time, binocular vision, and dry eye. Methods: DESIROUS is an observational cross-sectional study among Polytechnic students at the Lisbon School of Health Technology, Portugal. The protocol includes three questionnaires (Computer Vision Syndrome Questionnaire [CVS-Q], Convergence Insufficiency Symptom Survey [CISS], and Dry Eye Questionnaire version 5 [DEQ-5]), an assessment of visual acuity and binocular vision (cover test for near and distance, stereopsis, near point convergence (NPC), near point accommodation (NPA), accommodative facility, vergence), and the ocular surface break-up tear (BUT) test. The questionnaires were validated using Cronbach’s alpha. Interobserver variability for BUT was assessed using Cohen’s Kappa, Intraclass Correlation Coefficient (ICC), and Bland–Altman analysis involving three observers (A, B, and C), compared against an expert as the gold standard. Results: A total of 18 students were included in the validation phase (mean age: 21.50 ± 0.62 years; females: 77.8%). The internal consistency of the CVS-Q (α = 0.773) and the CISS (α = 0.756) was considered good, while the DEQ-5 showed a reasonable internal consistency (α = 0.594). Observer A had the highest agreement with the gold standard (Cohen’s Kappa = 0.710 and p < 0.001; ICC = 0.924, p < 0.001). Conclusions: We provide a protocol to assess binocular vision and the ocular surface, with an emphasis on objective measures while integrating other assessment approaches. Further studies are necessary to validate this protocol, potentially incorporating new measures to enhance its validity across different populations.