Browsing by Author "Almeida, Ana C."
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- Cataract surgery and IOP: a systematic review of randomised controlled trialsPublication . Brízido, Margarida; Rodrigues, Pedro Filipe; Almeida, Ana C.; Pinto, LuisPurpose: Cataract and glaucoma are two of the most common ocular comorbidities. Cataract surgery has been shown to influence intra-ocular pressure (IOP) in patients with glaucoma; nevertheless, the extent of this effect remains controversial, especially in patients with open-angle glaucoma (OAG). The aim of this review is to determine the real effect of cataract surgery on IOP change in patients with OAG, focusing on data retrieved from randomised controlled trials (RCTs). Methods: A systematic review was performed, including six different RCTs that studied the net effect of cataract surgery on IOP. Eligibility criteria required a full washout from hypotensive therapy, allowing accurate measurement of unmedicated IOP, both before and after surgery. Results: Included studies revealed a consistent reduction on IOP occurring after surgery, varying between 4.1 and 8.5 mmHg depending on the RCT. There was also a decrease in the number of glaucoma medications, with a mean reduction of 0.2-1.0 agents postoperatively. Evaluation of adverse outcomes of cataract surgery showed a very favourable safety profile. Conclusion: Although the role of cataract surgery in the algorithm of glaucoma treatment remains to be established, this review highlights a consistent decrease on IOP following surgery and a reduced dependency on glaucoma medications. Potential downgrade in medication can thus be considered in well-controlled glaucoma patients after phacoemulsification.
- Correlation between hyperglycemia and glycated albumin with retinopathy of prematurityPublication . Almeida, Ana C.; Silva, Gabriela A.; Santini, Gabriele; Brízido, Margarida; Correia, Miguel; Coelho, Constança; Borrego, Luís MiguelTo determine the association between hyperglycemia, glycated albumin (GlyA) and retinopathy of prematurity (ROP). Prospective study of all infants under ROP screening from March 2017 to July 2019. All demographic, clinical and laboratory data were collected. Glucose was measured at birth and every 8 h for the first week and serum GlyA was evaluated at birth, 1st, 2nd and 4th weeks after birth. Reference range for GlyA was obtained. Univariate logistic regression was used to examine risk factors for ROP followed by multivariate regression. A total of 152 infants were included in the study. Median gestational age was 30 weeks and median birth weight 1240 g. Thirty-three infants (21.7%) had ROP. Hyperglycemia was present in 24 (72.7%) infants diagnosed with any ROP versus 6 (0.05%) in those without ROP. Median GlyA at birth, 1st, 2nd and 4th and respective reference ranges were 8.50% (6.00-12.65), 8.20% (5.32-11.67), 8.00% (5.32-10.00) and 7.90% (5.30-9.00) respectively. After multivariate logistic regression, hyperglycemia but not GlyA, remained a significant risk factor for ROP overpowering the other recognized risk factors (Exp (B) 28.062, 95% CI for Exp(B) 7.881-99.924 p < 0.001). In our cohort, hyperglycemia but not GlyA, remained a significant risk factor for ROP overpowering the other recognized risk factors.
- DIGIROP efficacy for detecting treatment-requiring retinopathy of prematurity in a Portuguese cohortPublication . Almeida, Ana C.; Borrego, Luís Miguel; Brízido, Margarida; de Figueiredo, Melissa Brigham; Jorge Teixeira, Filipa; Coelho, Constança; Teixeira, SusanaBackground/objectives: To determine the efficacy of the DIGIROP model in detecting treatment-requiring retinopathy of prematurity (TR-ROP) in a Portuguese cohort. Subjects/methods: Multicentre, retrospective cohort study of all consecutive preterm infants who underwent ROP screening from April 2012 to May 2019 in two neonatal units. Gestational age (GA), birth weight (BW) and sex were inserted in the DIGIROP platform. The optimal cut-off point to achieve 100% sensitivity was calculated. Area under the receiver operating characteristic curve (AUC) was calculated. Results: Of the 431 infants who underwent ROP screening, 257 were eligible for DIGIROP analysis and 174 infants were excluded for having a GA outside the range 24-30 weeks imposed by the DIGIROP algorithm. Median GA was 29 weeks (range 24-30) and BW was 1060 g (range 408-2080). Twenty-tree infants (8.9%) developed TR-ROP. The highest risk obtained for TR-ROP was 0.5404 (95% CI 0.4343-0.6616) with a median achieved risk of 0.0938 (range 0.0016-0.5404). The optimal cut-off point to achieve 100% sensitivity on TR-ROP was 0.0016. The number of infants receiving ROP examinations would have been reduced from 257 to 187 infants (-27.2%) if the model was applied. Conclusions: In our cohort, of 257 infants, the optimal cut-off point to achieve 100% sensitivity for TR-ROP was 0.0016 with moderate accuracy in the AUC (0.70). The number of infants requiring screening would have decreased 27.2% if the model was applied. It is essential that algorithms continue to be tested in different populations, especially in cohorts that include both younger and older GA infants.
- Serum levels of placental growth factor reflect the severity of retinopathy of prematurityPublication . Almeida, Ana C.; Bitoque, Diogo B.; Martins, Catarina; Coelho, Constança; Borrego, Luís Miguel; Silva, Gabriela A.Retinopathy of prematurity (ROP) is a neovascular disorder of the immature retina and a leading cause of preventable blindness worldwide.1 A two-phase hypothesis for ROP pathogenesis has been suggested.1 Phase one is vaso-obliteration, where physiological vascularity is compromised and retinal vascular development is delayed by a hyperoxic environment. This induces vasoconstriction, with decreased levels of vascular endothelial growth factor (VEGF) and insulin growth factor-1. Phase two is vasoproliferation, where the avascular retina becomes hypoxic and releases angiogenic factors. This can lead to increased angiogenesis, with abnormal proliferation of the retinal vessels into the vitreous culminating in a retinal detachment.1 Placental growth factor (PGF) is a member of the VEGF family. Its precise contribution to ocular angiogenesis is not understood,2 but it may be important in ROP.