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Abstract

Objetivo: Analisar os resultados de um estudo comparativo entre as estratégias dinâmica e normal utilizando o perí-metro Octopus 1-2-3. Métodos: Utilizando o Octopus 1-2-3 nas estratégias dinâmica e normal foi realizada a perimetria automatizada em 24 pacientes glaucomatosos (8 homens e 16 mulheres) com uma média de intervalo entre os 2 exames de 6 meses. Todos pacientes já haviam sido previamente submetidos a pelo menos um exame de perimetria automatizada no Octopus 1-2-3. Os dados comparados, para ambos os olhos, foram: a idade do paciente, número de estímulos, sensibilidade média (MS), defeito médio (MD), perda localizada (LV), flutuação em curto prazo (SF) e o fator de confiabilidade (RF). Na análise estatística, utilizando o teste t pareado, somente os campos visuais com RF menor que 10 foram incluídos. O nível de significância foi igual a 5% (p < 0,05). Resultados: Não houve diferença estatisticamente significativa entre as duas estratégias em relação à idade, LV, SF e RF. Entretanto, houve diferença estatisticamente significativa na duração do teste, número de estímulos, MS e MD. A estratégia dinâmica mostrou uma sensibilidade difusa maior e um menor defeito médio quando comparada à estratégia normal. Conclusões: Nossos resultados indicam que os valores dos limiares medidos pela estratégia dinâmica estão em concordância com os valores obtidos utilizando a estratégia normal nos pacientes portadores ou suspeitos de glaucoma, cujos campos visuais estão normais ou limítrofes. Estes resultados também confirmam a redução na duração do exame. Também sugerem que, quando compararmos campos visuais realizados com a estratégia dinâmica com aqueles realizados com a estratégia normal, é necessária cautela em relação aos valores do MS e MD.

Keywords: Perimetria automatizada; Glaucoma; Octopus 1-2-3

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Foi pesquisada a presença de fungos na conjuntiva ocular de 23 pacientes com AIDS, 24 pacientes infectados pelo HIV, ambos de controle ambulatorial e 48 indivíduos HIV negativos, durante um ano, nos meses de fevereiro, abril, julho e outubro. O fungo mais isolado foi Penicillium sp, seguido de Aspergillus sp, Candida sp e Rhodotorula sp. Embora sem diferença significante, em todas as coletas foi verificado um crescimento maior de fungos na conjuntiva dos portadores de AIDS, seguido pelo grupo infectado pelo HIV e em menor número nos indivíduos HIV-negativos.

Keywords: Flora fúngica; Conjuntiva; AIDS; HIV

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OBJETIVO: Comparar a gravidade e a lateralidade do ceratocone de acordo com a rinite alérgica, os hábitos de coçar e dormir e a destreza manual.
MÉTODOS: Foram realizadas questões objetivas sobre rinite alérgica, prurido ocular e posição do sono em pacientes com ceratocone, diagnosticados com base na tomografia corneana. Esses exames foram analisados e classificados de acordo com a classificação de Amsler-Krumeich.
RESULTADOS: O prurido ocular foi referido por 29 (85,29%) dos 34 voluntários. Dezoito sujeitos (62,07%) relataram coçar ambos os olhos igualmente, 6 (20,69%) mais no olho direito e 5 (17,24%) mais no olho esquerdo. Comparando-se a posição de dormir principal e o olhos com apresentação mais grave da doença, foi encontrada alguma relação baseada no teste exato de Fisher (0,567 no olho direito e 0,568 no olho esquerdo), embora nenhuma comparação parecesse estatisticamente significante.
CONCLUSÕES: A associação entre maiores valores de ceratometria e posição do sono parece ser mais importante do que entre ceratometria e prurido ou destreza manual.

Keywords: Ceratocone; Hipersensibilidade; Sono/fisiologia; Rinite alérgica; Córnea; Tomografia

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O objetivo deste estudo é apresentar os resultados da trabeculotomia ab-interno com Kahook Dual Blade em pacientes com glaucoma congênito primário. Foi realizada trabeculotomia ab-interno com dispositivo de lâmina dupla em 3 olhos de 2 pacientes com diagnóstico de glaucoma congênito primário. Um deles no olho esquerdo e o outro paciente nos dois olhos. No primeiro paciente, houve resposta adequada uma vez que a pressão intraocular diminuiu de 36 mmHg para 14mmHg. O segundo paciente não respondeu adequadamente ao procedimento, mantendo altos níveis de pressão intraocular em ambos os olhos após o procedimento. A indicação da trabeculotomia ab-interno com o Kahook Dual Blade no glaucoma congênito primário deve ser cautelosa e são necessários mais estudos para estabelecer a eficácia e as melhores indicações. Parece que esse procedimento não deve ser indicado no tratamento do glaucoma congênito primário.

Keywords: Glaucoma congênito primário; Kahook Dual Blade; Trabeculotomia ab-interno; Malha trabecular; Cirurgia incisional de glaucoma

Abstract

Objetivo: Descrever o perfil epidemiológico das uveítes atendidas no Hospital Universitário Clementino Fraga Filho - UFRJ. Identificando o padrão de apresentação da inflamação intraocular a partir de critérios clínicos, anatômicos, etiológicos e demográficos.
Métodos: Estudo retrospectivo, com base em prontuários de 408 pacientes com doença ativa, atendidos no serviço de oftalmologia no período de março a outubro de 2018. Foram descritos a idade, sexo, acuidade visual no momento do diagnóstico, diagnóstico anatômico e etiológico, aspecto clínico, além dos principais sintomas relatados durante a anamnese.
Resultados: Dos 408 pacientes do estudo, 52% eram do sexo masculino e 48% do feminino. A idade média dos pacientes foi de 42 anos, a maioria (84%) entre 19 e 64 anos. Uveíte anterior foi observada em 37,75% dos pacientes, uveíte posterior em 49,75%, panuveíte em 4,66% e uveíte intermediária em 3,43%; apenas 18 pacientes (4,41%) apresentaram diagnóstico de esclerite. Dos 390 pacientes com classificação anatômica, a etiologia foi determinada em 76% deles, com os diagnósticos mais prevalentes sendo Toxoplasmose (35,4%), artrite idiopática juvenil (6,4%), espondilite anquilosante (5,9%) e sífilis (4,9%). ) A uveíte infecciosa correspondeu a 49,7% desses pacientes, enquanto 26,6% eram de origem não infecciosa. A uveíte anterior teve o maior número de casos classificados como idiopáticos (49,4%), enquanto a uveíte posterior teve a etiologia estabelecida em 94% das vezes. Os sintomas mais frequentes foram dor ocular (71,8%) e visão embaçada (56,8%).
Conclusões: O presente estudo confirmou a importância histórica da uveíte infecciosa em nossa população, principalmente a toxoplasmose ocular. As uveítes parecem não ter predileção por sexo, mas afetam principalmente jovens em idade ativa, gerando consequências sociais e econômicas. Apesar da evolução nos métodos diagnósticos, a uveíte idiopática continua sendo uma das principais causas. Estudos epidemiológicos apontam para diferentes padrões de uveíte nas populações, estes podem refletir características particulares de cada instituição.

Keywords: Uveíte/epidemiologia; Uveíte/etiologia; Uveíte/ diagnóstico; Toxoplasmose ocular; Hospital universitário; Brasil/epidemiologia

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A esporotricose ocular envolvendo anexos pode se apresentar de quatro formas: conjuntivite granulomatosa, dacriocistite, Síndrome Oculoglandular de Parinaud e conjuntivite bulbar. A esporotricose ocular, apesar de incomum, tem aumentado em regiões com alta incidência de esporotricose. Apresentamos uma série de três casos de envolvimento ocular pelo fungo Sporothrix sp.: suas manifestações, abordagem e sua relevância em áreas com alta incidência de esporotricose.

Keywords: Infecções oculares fúngicas; Conjuntivite; Esporo­tricose/tratamento farmacológico; Sporothrix/isolamento e purificação; Itraconazol/uso terapêutico.

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PURPOSE: This study aimed to evaluate the perception and degree of satisfaction of blind individuals regarding an electronic cane prototype with a wearable haptic interface.
METHODS: Two scenarios with different obstacles were created to conduct tests with the canes (the user's cane and the prototype one). The perception and satisfaction of participants regarding the electronic cane were assessed using a questionnaire, the number of collisions during the tests, and the time each individual took to complete the course in each scenario.
RESULTS: Ten blind individuals who used the white cane participated in this study. Eight were males, and two were females. Their age ranged from 23 to 43 (average 32.3 ± 7.13 years and median 32 years). There was a tendency for fewer collisions with ground obstacles when the electronic cane was used than when the white cane was used. However, there was no statistically significant difference between the number of collisions and the course completion time in each scenario with either canes tested.
CONCLUSION: Overall, the perception and satisfaction of individuals regarding the prototype used were positive.

Keywords: Blindness; Canes; Patient satisfaction; Perception; Haptic technology; Wearable electronic devices; Surveys and questionnaires

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PURPOSE: To determine the impact of prophylactic intracameral cefuroxime administration on the post-cataract surgery endophthalmitis rates and analyze its safety.
METHODS: The incidence of post-phacoemulsification endophthalmitis before and after the introduction of antibiotic prophylaxis with cefuroxime was compared. Data were extracted from the electronic medical records of patients who underwent cataract surgery between July 2019 and July 2022 at a tertiary-care hospital. Data were also collected from the Hospital Infection Control Service database. Statistical analysis was performed to assess the efficacy of cefuroxime prophylaxis in reducing endophthalmitis rates.
RESULTS: Of the 4459 cataract surgeries included in the study, 2247 were included in the control group (pre-cefuroxime), and 2212 were included in the post-cefuroxime (ATB-P) Group. In the control group, 6 (0.13%) cases of endophthalmitis were reported. In the ATB-P Group, there were no cases of acute endophthalmitis. The frequency of endophthalmitis was significantly higher in the control group than in the ATB-P Group (p=0.016). Furthermore, Staphylococcus sp. was the most identified causative agent (75%). No adverse effects were reported after cefuroxime administration.
CONCLUSION: The introduction of intracameral prophylaxis with cefuroxime significantly reduced the incidence of post-cataract surgery endophthalmitis. Additionally, its administration is safe.

Keywords: Cataract extraction; Endophthalmitis; Antibiotic prophylaxis; Injections; Cefuroxime

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PURPOSE: This study aimed to modify scleral contact lenses to achieve a desired compression standard and to evaluate the effectiveness and reliability of the adjustments.
METHODS: In this nonrandomized, noncomparative, and partially masked study Scleral contact lens fittings were analyzed in 20 eyes of 12 patients (50% women, 50% men) diagnosed with keratoconus. Participants were selected based on their need for scleral contact lenses (SCLs), which was determined in complete ophthalmological examinations. Patients were tested with Zenlens scleral contact lenses (Bausch & Lomb, Vaughan, Ontario, Canada). We evaluated compression in the lens support area after one hour of use, excluding cases of peripheral lifting. Photos of the adaptations were sent to five experts for analysis of the quadrants (nasal, temporal, superior, and inferior). We used Fisher's exact test for statistical analysis.
RESULTS: The proposed adjustment was highly effective (93.5% correct) in lens delivery (BL=0), with the interrater agreement between doctors ranging from 68.8% to 80.9%.
CONCLUSION: The clinical parameters proposed for scleral contact lenses adjustment proved useful and reproducible, enabling their practical application to scleral lens adaptation.

Keywords: Contact lenses; Lifting; Keratoconus; Rehabilitation

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Myopia is a significant risk factor for glaucoma and a growing public health problem worldwide. Detecting glaucomatous changes in highly myopic eyes is diagnostically challenging due to the abnormal appearance of the optic nerve head. These patients also have a greater biomechanical susceptibility to pressure-induced glaucomatous damage. Refractive surgery has become increasingly popular, and many candidates for refractive surgery are myopic. Therefore, we sought to review the aspects of patient evaluation in those who have undergone refractive surgery for myopia concerned with the detection and monitoring of glaucoma development. We identified several important elements of patient evaluation for glaucoma after refractive surgery. These included the need for both structural and functional assessments before and after surgery, and the importance of monitoring for postoperative biomechanical changes in the cornea and their impact on intraocular pressure. We conclude that, in patients who undergo refractive surgery for myopia, it is essential to assess for the presence of glaucoma, to identify staging, and to plan for long-term control of the disease, regardless of IOP.

Keywords: Glaucoma; Intraocular pressure; Myopia; Refractive surgery

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PURPOSE: This clinical study aimed to assess the effectiveness of microemulsion artificial tears containing povidone and propylene glycol in the management of dry eye disease. Secondary objectives included evaluating improvements in tear-film stability, measured by tear break-up time and corneal staining scores, along with the tolerability and safety of the formulation.
METHODS: This was a prospective, single-arm interventional study involving 30 participants (52 eyes) diagnosed with dry eye disease. Participants self-administered the investigational eye drops twice daily for 28 consecutive days. Primary and secondary outcomes included changes in the Ocular Surface Disease Index, tear break-up time, and corneal staining scores. Adverse events were documented throughout the study period.
RESULTS: Significant improvements in Ocular Surface Disease Index scores were observed, reflecting a reduction in dry eye disease symptoms. Tear break-up time increased notably between baseline and follow-up assessments, with the proportion of eyes exhibiting tear break-up time ≥10 srising from 25.0% to 63.5%. Additionally, the percentage of eyes with a corneal staining score of zero improved from 23.1% to 69.2%. Conjunctival staining also decreased, with the proportion of eyes with scores of 2 and 3 dropping from 11.5% to 3.8% and 5.8% to 0%, respectively.
CONCLUSIONS: The findings suggest that povidone and propylene glycol-based artificial tears significantly enhance tear-film stability and alleviate symptoms in patients with mild to moderate dry eye disease, with minimal adverse effects. This formulation represents a safe and effective short-term treatment option for dry eye disease management.

Keywords: Artificial tears; Dry eye disease; Tear-film stability; Propylene glycol; Povidone; Visual acuity; Surveys and questionnaires

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PURPOSE: Glaucoma is a chronic and progressive disease that requires long-term treatment and continuous monitoring. The Kahook Dual Blade, a device used to perform goniotomy in adults, is designed to improve intraocular pressure control in patients with glaucoma. This study aimed to evaluate the long-term efficacy and safety of kahook dual blade goniotomy in glaucoma patients undergoing cataract surgery over a 36-month follow-up.
METHODS: This was a retrospective case series including 56 eyes from 56 patients with mild-to-moderate primary open-angle glaucoma who underwent phacoemulsification combined with kahook dual blade goniotomy. Mean intraocular pressure values, number of preoperative and postoperative hypotensive eye drops, procedure survival, and complications were evaluated over 36 months. Surgical success was defined as either a reduction in intraocular pressure of ≥20% with intraocular pressure between 6 and 18 mmHg without additional medication or a reduction of ≥1 eye drop with intraocular pressure between 6 and 18 mmHg.
RESULTS: The mean preoperative intraocular pressure decreased from 15.96 ± 2,83) mmHg to 13.14 ± 2,11) mmHg at 36 months, representing a 14.9% reduction (p<0.001). The mean number of eye drops decreased from 1.91 ± 0,75) to 1.34 ± 0,92), a 29.8% reduction (p<0.001). The overall success rate was 69.6% at 36 months.
CONCLUSION: Kahook dual blade goniotomy combined with cataract surgery significantly reduced intraocular pressure and the number of hypotensive eye drops required in patients with mild-to-moderate primary open-angle glaucoma, with a favorable success rate maintained at 36 months.

Keywords: Glaucoma, open-angle/surgery; Gonioscopy/methods; Intraocular pressure/physiology; Lens implantation, intraocular; Phacoemulsification/methods; Trabeculectomy/instrumentation; Treatment outcome

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PURPOSE: To evaluate structural differences in amniotic membrane fragments subjected to different preservation techniques for potential ophthalmologic applications.
METHODS: Three placentas were collected from healthy donors, and four amniotic membrane fragments were prepared from each placenta. The fragments were divided into four groups with three samples each: cryopreserved, lyophilized, vacuum-dried using a vacuum concentrator, and fresh (control). After processing, the fragments were fixed, sectioned, and analyzed using scanning transmission electron microscopy to assess tissue morphology.
RESULTS: All samples met the established evaluation criteria. No morphological differences were observed among the groups. The structural characteristics of lyophilized and vacuum-dried membranes were comparable with those of cryopreserved and fresh membranes. However, vacuum drying demonstrated the greatest practicality for ophthalmologic use, as it allows membrane availability at any time and storage at room temperature.
CONCLUSION: Vacuum drying using a vacuum concentrator, lyophilization, and cryopreservation preserve the morphological characteristics of the human amniotic membrane similar to those of fresh tissue. A standardized protocol using a vacuum concentrator may be established owing to its advantages in storage convenience and accessibility.

Keywords: Amnion/transplantation; Cryopreservation/methods; Freeze drying; Lyophilization; Ophthalmologic surgical procedures; Regenerative medicine

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PURPOSE: To assess musculoskeletal symptoms, identify the most affected body areas, and investigate factors associated with the development of musculoskeletal disorders among ophthalmologists in Brazil.
METHODS: A survey was conducted using an online questionnaire and snowball sampling. Statistical analyses were performed using Jamovi version 2.3.28, and graphs were generated using RStudio version 2023.06.2 + 561.
RESULTS: A total of 233 participants (42 ophthalmology residents and 191 ophthalmologists) were included, with a mean age of 40.4 years (standard deviation 11.3; range 25–73 years). Musculoskeletal symptoms were reported by 83% of participants. The cervical region (57.1%), upper back (54.5%), and lumbar region (53.6%) were the most frequently reported sites of pain. A high body mass index was identified in 54.9% of the sample, and 50.2% of participants reported using painkillers in the previous year for musculoskeletal symptoms. The mean duration of professional activity in ophthalmology was 13.5 years, and the mean weekly workload was 39 hours. A significant association was observed between weekly workload and the presence of musculoskeletal disorders (p=0.045).
CONCLUSION: This study demonstrated a high prevalence of musculoskeletal disorders among ophthalmologists in Brazil, particularly involving the cervical, lumbar, and upper back regions, consistent with findings reported in international studies. Important contributing factors include long working hours, a high patient volume, and repetitive or awkward postures during examinations and procedures. Preventive strategies and improvements in working conditions are needed to protect the health and well-being of ophthalmologists.

Keywords: Musculoskeletal Diseases/epidemiology; Back pain; Lumbar Vertebrae; Occupational diseases/epidemiology; Ergonomics; Ophthalmic practice; Ophthalmologists/statistics & numerical data; Brazil/epidemiology