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- Alterações morfométricas na retina, coroide e nervo ótico após infeção por SARS-CoV-2Publication . Lino, Pedro; Camacho, Pedro; Mendonça, Paula; Silva, Carina; Cunha, João Paulo; Barroqueiro, Olga; Condado, P.; Nicho, I.; Carmo, R.; Castelhano, M.; Carvalho, F.; Almeida, J. C.; Prieto, I.; Poças, Ilda MariaO novo coronavírus responsável pela síndrome respiratória aguda grave (SARS-CoV- 2) surgiu associado à pandemia por COVID-19. A enzima conversora da angiotensina 2 (ACE-2), com aparente importância na COVID-19, pela interação com as proteínas na superfície do vírus, tem expressão em vários tecidos oculares e várias alterações como conjuntivite, uveíte, vasculite e neurite foram descritas inicialmente em modelos animais. Em estudos mais recentes, embora na maioria em doentes COVID-19 moderados/grave, tem sido descrito o comprometimento da superfície ocular anterior e do polo posterior reforçando a ideia de neurotropismo (pela facilidade de envolvimento do sistema nervoso central) que classicamente é descrito em outros coronavirus. Algumas alterações do polo posterior incluem o compromisso vascular/ isquémico tornando relevante também a observação da coroide. A SARS-CoV-2 tem sido associada à diminuição das camadas internas da retina e à presença de lesões hiperrefletivas, micro-hemorragias e manchas algodonosas. No entanto, o envolvimento da retina e a coróide em doentes previamente infetados com COVID-19 ainda não é totalmente compreendido. De forma a clarificar o envolvimento dos fatores de neuro-degeneração e vasculares, descritos em indivíduos recuperados de COVID-19 moderada/grave, é fundamental perceber que alterações existem ao nível da retina interna e da coroide, em indivíduos recuperados de COVID-19 ligeira. Questão de investigação: Existem alterações morfométricas da retina, coroide e nervo ótivo em indivíduos recuperados de COVID-19 ligeira?
- Manifestações oculares em pacientes diabéticos avaliados no Serviço de Oftalmologia do Hospital Dr. Batista de Sousa nos últimos cinco anosPublication . Amaral, Lídia Pires; Sousa, Luana; Camacho, PedroIntrodução – A diabetes mellitus (DM) e suas complicações macro e microvasculares implicam consequências diretas e indiretas na vida da população mas também para o sistema de saúde de Cabo Verde. Este trabalho pretende caracterizar pela primeira vez as complicações oculares da DM nos utentes diabéticos monitorizados no Serviço de Oftalmologia do Hospital Dr. Batista de Sousa nos últimos cinco anos. Método – Trata-se de um estudo transversal retrospetivo através da consulta das fichas clínicas dos utentes diabéticos monitorizados no Serviço de Oftalmologia em São Vicente, no período de 2015 a 2020. Das 57 fichas clínicas inicialmente consultadas, e de acordo com os critérios de inclusão e exclusão, foram incluídas 22 fichas clínicas, perfazendo um total de 44 olhos. Resultados – A retinopatia diabética (100%) e o edema macular diabético (45,45%) foram as alterações mais frequentes na amostra estudada. Adicionalmente foram descritas diferentes alterações oculares, como catarata (72,27%), ptose (4,54%), pterígio (13,63%), pinguécula (2,27%), hiperemia conjuntival (6,81%), neovascularização de íris (4,54%) e glaucoma (4,54%). Discussão/Conclusão – Estes achados são importantes para desenvolver uma primeira caracterização local do impacto da DM na saúde ocular e simultaneamente fornecer ferramentas para melhoria das políticas de saúde local. A caracterização foi útil para documentar não apenas o impacto ocular da diabetes mellitus, mas também clarificar potenciais ações prioritárias.
- Ocular repercussions in COVID-19 patients: structural changes of the retina and choroidPublication . Poças, Ilda Maria; Cunha, João Paulo; Camacho, Pedro; Silva, Carina; Ribeiro, Edna; Brito, Miguel; Mendonça, Paula; Barroqueiro, Olga; Lino, Pedro Miguel; Condado, Patrícia; Nicho, Inês; Carmo, Rita; Castelhano, Mariana; Carvalho, Francisca; Almeida, Júlio Costa; Prieto, IsabelPurpose: In March 2022, after 1 year of the emergence of the pandemic by Covid-10 in Portugal, 3413013 positive cases were recorded. The eye can be not only the gateway for coronaviruses (CoV) but also one of their target organs. Conjunctivitis, uveitis, vasculitis, retinitis, and optic neuritis have been documented in animal models. Although most studies focus on respiratory tract involvement, ocular surface involvement such as tears are also reported in other CoVs and their relationship should be valued and studied as a form of treatment, contagion, and transmission. Also, the neurotropism of CoVs, not only through hematogenous dissemination but also through the retrograde neuronal route, associated or not with vascular/ischemic compromise of COVID-19 and its brain sequela may justify the use of non-invasive methodologies to characterize the retina and choroid of patients infected with COVID-19. The possible neurodegeneration associated with the coronavirus will be important to assess the thickness of the innermost layers of the upper hemiretin, with involvement described in other neurodegenerative diseases.
- Initial medication adherence in newly diagnosed glaucoma patients: three adherence measuresPublication . Menino, Joana; Camacho, Pedro; Coelho, AndréAim: To determine initial medication adherence in newly diagnosed glaucoma patients treated with anti-glaucoma drugs. Methods: This retrospective and observational study included all patients diagnosed with glaucoma in the Primary Health Care units in Portugal during the years 2012 and 2013, which in consequence received a first prescription for anti-glaucoma drugs. Data were collected from electronic prescribing records of the primary care units and from pharmacy claims records. Initiation of glaucoma treatment and early discontinuation were measured, and the combination of (non)-initiation and early discontinuation accounted for the initial medication (non)-adherence. Results: A total of 3548 new glaucoma patients (40.1% male; 59.9% female) were included. 1133 (31.9%) patients were initially classified as non-users since there was no pharmacy claim found for their first prescription for glaucoma treatment. Additionally, 277 (11.5%) patients early discontinued their treatment, acquiring only their first prescription. Overall, the initial medication non-adherence rate was 39.7% since 1410 patients either didn't initiate treatment or discontinued it early. Conclusion: This study, reveals a major opportunity to improve glaucoma treatment and its control since a large proportion of patients fail to engage with their prescribed therapy, which implies that implementation of individual or group strategies that enable patients with glaucoma to correctly perform their treatment is still needed.
- Off-label use of bevacizumab in age-related macular degeneration: protocol for a systematic review and meta-analysisPublication . Estarreja, João; Valente, Carina; Silva, Carina; Camacho, Pedro; Mateus, VanessaBackground: Age-related macular degeneration (AMD) is recognized as the leading cause of vision loss in elderly people. Taking into account the phenomenon of aging worldwide, the prevalence of AMD is expected to increase gradually in the future. AMD can be divided into early, intermediate and late stages, where early and intermediate are mainly asymptomatic, late-stage can be classified as non-vascular AMD and vascular AMD. Current pharmacological treatment in vascular AMD includes the administration of anti-VEGF agents, such as ranibizumab, pegaptanib, and aflibercept. Additionally, it has been reported that the off-label use of bevacizumab, through intravitreal administrations, demonstrates to be effective along with a lower cost in comparison to other agents used, which makes it a new possible pharmacological approach. Objective: This review aims to evaluate the efficacy, safety, and efficiency of the use of bevacizumab in the treatment of neovascular AMD. Methods: To identify and select relevant articles present in current literature, it will be developed a highly sensitive search strategy. To develop this search, it will be used MEDLINE via the Pubmed platform. It will be only considered randomized controlled clinical trials, where it is compared the use of bevacizumab with another pharmacological agent, such as ranibizumab, or even a placebo, in patients aged 50 years and older, diagnosed with vascular AMD. Results: This project has no funding and it has been done by a multidisciplinary research team of pharmacologists and orthoptists. The study was initiated in May 2021 with the lineation of the protocol, now the data are been extracted and analyzed, and it is expected to be released by the end of 2022. Conclusions: This review will provide a synthesis of the current information and underlying evidence, about the influence of the off-label use of bevacizumab in this disease. Altogether, it will allow having a clearer vision of a new possible accepted pharmacological approach for the treatment of vascular AMD. Clinical Trial: The protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the code CRD42021244931.
- Manual segmentation of 12 layers of the retina and choroid through SD-OCT in intermediate AMD: repeatability and reproducibilityPublication . Camacho, Pedro; Dutra-Medeiros, Marco; Salgueiro, Luís; Sadio, Sílvia; Rosa, Paulo C.Purpose: To evaluate the repeatability and reproducibility of the segmentation of 12 layers of the retina and the choroid, performed manually by SD-OCT, along the horizontal meridian at three different temporal moments, and to evaluate its concordance with the same measurements performed by two other operators in intermediate AMD. Methods: A cross-sectional study of 40 eyes from 40 subjects with intermediate AMD was conducted. The segmentation was performed manually, using SD-OCT. The 169 measurements per eye were repeated at three-time points to study the intra-operator variability. The same process was repeated a single time by two different trained operators for the inter-operator variability. Results: Forty participants (28 women and 12 men) were enrolled in this study, with an average age of 76.4 ± 8.2 (range, 55–92 years). Overall, the maximum values of the various structures were found in the 3 mm of the macula. Intra-operator variability: the highest ICC values turned out to be discovered in thicker locations. inter-operator variability: except correlation values of 0.826 (0.727; 0.898) obtained in the OPL (T2.5) and 0.634 (0.469; 0.771) obtained in the IPL (N2), all other correlation values were >0.92, in most cases approaching higher values like 0.98. Conclusion: The measurements of several layers of the retina and the choroid achieved at 13 locations presented good repeatability and reproducibility. Manual quantification is still an alternative for the weaknesses of automatic segmentation. Locations of greatest concordance should be those used for clinical control and monitoring.
- Avaliação do endotélio corneano através de microscopia especular em participantes com edema macular diabéticoPublication . Sabino, Bárbara; Pinto, Joana; Branco, Tiago; Batista, Ricardo; Pereira, Bruno; Camacho, PedroIntrodução: Apesar da integridade morfológica e funcional do endotélio corneano, essencial para a transparência corneana, ser afetada com a Diabetes Mellitus (DM) a sua relação com severidade de retinopatia diabética e presença de edema macular diabético não é clara. Objetivos: Avaliar as características morfológicas do endotélio corneano em doentes com Diabetes Mellitus Tipo 2 (DMT2) com diferentes perfis de resposta terapêutica ao edema macular diabético (EMD). Métodos: Com uma abordagem transversal, 24 participantes com DMT2 foram divididos em 2 grupos (sem EMD e com EMD). Posteriormente, o grupo com EMD foi subdividido de acordo o tipo de resposta terapêutica (respondedor e persistente). Parâmetros obtidos através da microscopia especular (densidade de células endoteliais, coeficiente de variação, hexagonalidade e espessura central da córnea) e da tomografia de coerência ótica (espessura mínima da fóvea, espessura no 1mm central, a espessura da camada de células ganglionares macular, e a espessura da camada de fibras nervosas peripapilar) foram analisados e comparados nos diferentes grupos. Resultados: Não foram encontradas alterações significativas do endotélio corneano entre os grupos com e sem EMD (p>0,05). No entanto, foram encontradas diferenças na densidade de células endoteliais (p=0,04) nos participantes com diferentes EMD persistente (1900,3 ± 270,1) comparativamente ao EMD respondedor (2307,9 ± 121,2) e grupo de controlo (2191,7 ± 165,5). Conclusão: Os diferentes parâmetros do endotélio corneano não mostraram diferenças entre participantes com e sem EMD. No entanto, o tipo de resposta terapêutica ao EMD parece estar associada à diminuição da densidade de células endoteliais.
- DNA methyltransferase expression (DNMT1, DNMT3a and DNMT3b) as a potential biomarker for anti-VEGF diabetic macular edema responsePublication . Camacho, Pedro; Ribeiro, Edna; Pereira, Bruno; Varandas, Teresa; Nascimento, João; Henriques, José; Dutra-Medeiros, Marco; Delgadinho, Mariana; Oliveira, Ketlyn; Silva, Carina; Brito, MiguelPurpose: DNA methylation is involved in Diabetic Retinopathy progression showing a metabolic memory mechanism. However, the association of DNA methyltransferase with diabetic macular edema is still unknown. We aimed to describe the differences in DNA methyltransferase gene expression in patients with different diabetic macular edema responses. Methods: A total of 27 diabetic patients, aged 59-90 years, were prospectively enrolled in this cross-sectional study. The participants were classified into the control group (CG, n = 11), diabetic macular edema responders (rDME, n = 9), and non-responder diabetic macular edema (nrDME, n = 7) after anti-vascular endothelial growth factor (anti-VEGF) treatment. Only cases with a complete ophthalmological examination, digital 133° color fundus, and SD-OCT assessments were used. After RNA extraction and first-strand cDNA synthesis, quantitative real-time PCR was performed with specific primers on the CFX Connect™ Real-Time PCR Detection System to assess differential transcriptional expression patterns. Results: The DNMT1 gene showed a positive correlation (r = 0.617; p = 0.043) with Best Corrected Visual Acuity (BCVA) in CG, a positive correlation (r = 0.917; p = 0.010) with HbA1c in nrDME and a negative correlation (r = -0.659; p = 0.049) with GCL-IPL thickness in rDME. DNMT3A gene showed a positive correlation (r = -0.890; p = 0.001) with Sub-foveal Choroidal thickness in rDME whereas DNMT3b gene showed a negative correlation (r = -0.815; p = 0.007) with HbA1c and RNFL (r = -0.664; p = 0.026) in CG. Conclusions: Patients with similar metabolic profile risk factors showed associated DNA methyltransferase transcriptional expression patterns differences fitting with the anti-VEGF diabetic macular edema response. Further studies are needed to clarify if these results (1) reflect disease evolution, (2) translate the therapeutic impact, (3) or can help to predict the therapeutic resistance profile.
- Assessment of medication therapy adherence in glaucoma: scoping reviewPublication . Rosu, Amalia Mihaela; Coelho, André; Camacho, PedroIntroduction: Glaucoma is an asymptomatic disease, which can cause irreversible blindness, with a worldwide prevalence of around 64.3 million people. Adherence to glaucoma treatment is crucial to control the disease and to prevent its complications. Low medication adherence results in visual loss, which can lead to irreversible blindness. In this sense, it is important to know and evaluate adherence to pharmacological therapy among patients with glaucoma. Areas covered: A scoping review was conducted, according to the methodology proposed by Arksey and O’Malley. The databases used were Medical Literature Analysis and Retrieval System Online (MEDLINE) and the Biblioteca do Conhecimento Online (B-on). Our research used as primary sources articles in Portuguese and English. Expert opinion: The identified adherence rates were very different, and the conditions of how under medication adherence was assessed were highly variable. These conditions impossibilities a proper comparative study. Further efforts are needed to increase health literacy and thus identify and support patients with low medication adherence rates. It is important that health care personnel could improve patients’ knowledge about the importance of medication adherence, glaucoma disease, and the consequences that result from a lack of treatment.
- Impacto subsequente a infeção por COVID-19: mudanças estruturais da retina, da coroide e no nervo óticoPublication . Mendonça, Paula; Poças, Ilda Maria; Camacho, Pedro; Cunha, João Paulo; Silva, Carina; Barroqueiro, Olga; Lino, Pedro Miguel; Condado, Patrícia; Nicho, Inês; Carmo, Rita Barros; Castelhano, Mariana; Carvalho, Francisca; Almeida, Júlio Costa; Prieto, IsabelA conjuntivite, a uveíte, a vasculite, a retinite e a neuropatia ótica têm sido documentadas em modelos animais como possíveis complicações oculares de doenças infeciosas com neurotropismo semelhante ao SARS COV. Considerando a retina uma extensão do SNS e o neurotropismo dos CoVs pode justificar se o uso de metodologias não invasivas como a OCT para caracterizar a retina, coroide e nervo ótico de pacientes infectados com COVID 19 dada a hipótese de uma possível neurodegeneração associada ao coronavírus. Assim, torna-se importante avaliar a espessura das camadas mais internas da retina com envolvimento descrito em outras doenças neurodegenerativas e metabólicas. Objetivo do estudo: Descrever as alterações que ocorrem ao nível da espessura da retina, complexo de células ganglionares fibras nervosas peri-papilares e coróde sub foveal em pacientes infetados por COVID 19 comparando as com um grupo controlo.
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