The 2021 Portuguese Society of Ophthalmology joint guidelines with Paediatric Rheumatology on the screening, monitoring and medical treatment of juvenile idiopathic arthritis-associated uveitis.

AIM: To develop the first Ophthalmology joint guidelines with Paediatric Rheumatology with recommendations on the screening, monitoring and medical treatment of juvenile idiopathic arthritis-associated uveitis (JIA-U), endorsed by the Portuguese Society of Ophthalmology (SPO). METHODS: A systematic literature review was conducted to include publications up to July 14th 2020, with no language restrictions, in order to include all the international position papers/guidelines concerning the medical management of JIA-U and randomised clinical trials assessing the efficacy and safety of medical treatment in this field. We searched through MEDLINE (PubMed), Scopus, Web of Science and Cochrane Library. The Delphi modified technique to generate consensus was used. Preliminary evidence statements were subject to an anonymous agreement assessment and discussion process using an online survey, followed by further discussion and update at a national meeting. A draft of the manuscript with all recommendations was then circulated among all participants and suggestions were incorporated. The final version was again circulated before publication. RESULTS: Twenty-six recommendations were developed focusing on the following topics: general management (3), screening and follow-up of uveitis (4), treatment (17) and health education in JIA-U among patients and families (2). CONCLUSION: These guidelines were designed to support the shared medical management of patients with JIA-U and emphasize the need for a multidisciplinary approach between Ophthalmology and Paediatric Rheumatology regarding the comprehensive care of JIA-U. We acknowledge that updating these recommendations will be warranted in the future, as more evidence becomes available. KEY-WORDS: juvenile idiopathic arthritis, uveitis, biological treatment, conventional immunosuppressive treatment, multidisciplinary management, guidelines, consensus, review, Delphi Technique.

Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis.

PURPOSE: This literature review and meta-analysis aims to compare intraocular pressure (IOP) lowering efficacy, failure rates and loss of light perception (LP) rates 6 months after an IOP-lowering surgical procedure in neovascular glaucoma (NVG) eyes. METHODS: MEDLINE and EMBASE were used as data sources. Only studies including NVG patients who underwent two different surgical approaches were considered. The treatment effect measures were (i) weighted mean difference (WMD) for IOP reduction, (ii) risk ratio (RR) for failure rates and (iii) risk difference (RD) for loss of LP. Outcome measures were reported with a 95% confidence interval (CI) and P < 0.05 was considered statistically significant. Analysis was performed using RevMan v5.0. RESULTS: No RCT were retrieved. Seven comparative non-randomised studies were eligible. In glaucoma drainage devices (GDDs) vs cyclophotocoagulation arm, there was no statistical difference in IOP-lowering efficacy (WMD = - 3.63; CI [- 8.69, 1.43], P = 0.16), although failure rates and loss of LP were lower in the GDDs group (RR = 0.64, CI [0.41, 0.99], P = 0.05; and RD = - 0.15, CI [- 0.25, - 0.05], P = 0.004, respectively). In the Ahmed glaucoma valve (AGV) vs trabeculectomy arm, there was no statistical difference in IOP-lowering efficacy and loss of LP (WMD = 0.78, CI [- 2.29, 3.85], P = 0.62 and RD of 0.04, CI [- 0.05, 0.14], P = 0.34, respectively), but failure rates were lower in trabeculectomy group (RR of 2.25, CI [1.14, 3.71], P = 0.02). CONCLUSIONS: There is lack of high-quality evidence on the subject as no RCT were retrieved comparing two different IOP-lowering procedures in NVG patients. Our findings are based, therefore, on non-RCT studies and should be interpreted with caution. There appears to be no difference in IOP-lowering efficacy between GDDs and cyclophotocoagulation, although GDDs appear to be safer. AGV and trabeculectomy also seem to provide similar IOP-lowering results with trabeculectomy showing lower failure rates.

[Analysis of the Cochrane Review: Omega-3 Fatty Acids for the Treatment of Dementia. Cochrane Database Syst Rev. 2016;4:CD009002.] / Análise da Revisão Cochrane: Suplementação Alimentar com Ácidos Gordos Ómega-3 no Tratamento da Demência. Cochrane Database Syst Rev. 2016;4:CD009002.

Dietary supplementation with omega-3 polyunsaturated fatty acids from fish and plant sources is commonly prescribed as a non-farmacological alternative to improve brain functions and slow down the progression of dementia. This use is mostly based on findings of preclinical studies which established the role of omega-3 polyunsaturated fatty acids in the development and integrity of the brain, as well as epidemiological research that found evidence of malnutrition in patients with dementia. This Cochrane systematic review included three randomized, placebo-controlled trials at low risk of bias, in which omega-3 polyunsaturated fatty acids were administered to people with mild to moderate Alzheimer's disease in the form of supplements. Of the main results of this systematic review we highlight the lack of convincing evidence for the efficacy of omega-3 polyunsaturated fatty acids supplementation in the treatment of patients with Alzheimer's disease, as well as the low frequency of reported adverse events, with a comparable overall frequency between omega-3 polyunsaturated fatty acids and the placebo groups. The effects on other populations with dementia remain unclear. This paper aims to summarize and discuss the main results and conclusions of this systematic review, as well as its implications for the daily clinical practice.

A suplementação alimentar com ácidos gordos poli-insaturados ómega-3, de origem animal e vegetal, é comummente prescrita como alternativa não farmacológica no tratamento da demência, com o objetivo de atrasar a sua progressão e melhorar a função cognitiva dos doentes. Esta utilização deriva em grande medida de estudos pré-clínicos, que estabeleceram o papel dos ácidos gordos poliinsaturados ómega-3 no desenvolvimento e manutenção da integridade do sistema nervoso central, e de estudos epidemiológicos, que demonstraram a ocorrência de estados de malnutrição em doentes com demência. Nesta revisão sistemática Cochrane, os autores incluíram três ensaios clínicos aleatorizados controlados por placebo, com baixo risco de vieses, nos quais doentes com doença de Alzheimer ligeira a moderada foram tratados com ácidos gordos poli-insaturados ómega-3, através de suplementos alimentares. Dos principais resultados desta RS destacam-se a ausência de evidência de um efeito benéfico do tratamento com suplementação com ácidos gordos poli-insaturados ómega-3 sobre a função cognitiva de doentes com doença de Alzheimer e a baixa taxa de efeitos adversos reportados, esta última comparável à dos grupos tratados com placebo. Não existem dados sobre outros tipos de demência. Neste artigo sumarizam-se e discutem-se os principais resultados e conclusões desta revisão sistemática, bem como as suas implicações para a prática clínica diária.