ABSTRACT Purpose: To evaluate the prevalence of refractive errors (RE) in children and their association with age group, sex, and racial variations before the COVID-19 Pandemic. Methods: This retrospective cross-sectional study involved 1,086 children with a mean age of 9.1 years (0-15 years) who underwent refraction examination under cycloplegia between 2015 and 2019. Myopia was defined as Spherical Equivalent (SE) −0.50 diopters (D) or more; hyperopia as +2.0 D, and astigmatism as at least −0,50 D. The RE were further divided into groups of 0-3 and correlated with the collected variables. Results: There was a higher prevalence of female individuals (52.4%), aged between 6 and 10 years (63.0%) and white participants (54.9%). Astigmatism was the most prevalent RE in all age groups (27.3%), myopia was present in 14.8% of the sample and hyperopia, in 6.6%. There was an association between the age group >11 years and the prevalence of myopia and astigmatism. There was no association between RE and the variables gender, racial variation, and clinical symptoms of the participants. Conclusion: The prevalence of astigmatism and myopia was higher than in other regions of the world. The data was collected in the pre-COVID-19 pandemic period. More studies could contribute to the analysis, especially of myopic progression in this age group, considering behavioral changes related to the increase in the use of screens and reduction of outdoor activities in this population.

RESUMO Objetivo: Avaliar a prevalência de erros refracionais em crianças e sua associação com faixa etária, sexo cor de pele/raça em período pré-pandemia. Métodos: Este estudo retrospectivo transversal analisou dados de 1.086 crianças com idade média de 9,1 (zero a 15 anos) submetidas a exame de refração sob cicloplegia entre os anos de 2015 e 2019. Miopia foi definida como equivalente esférico −0,50 dioptrias (D) ou mais; hipermetropia como +2,0D e astigmatismo −0,50 D. Os equivalentes esféricos ainda foram subdivididos em grupos, conforme valores em dioptrias, e correlacionados com as variáveis coletadas. Resultados: Houve maior prevalência de indivíduos do gênero feminino (52,4%), na faixa etária de 6 a 10 anos (63,0%) e de cor de pele/raça branca (54,9%). O astigmatismo foi o erro refracional mais prevalente em todas as faixas etárias (27,3%), a miopia esteve presente em 14,8% da amostra e e a hipermetropia em 6,6%. Houve associação entre a faixa etária > 11 anos e prevalência de miopia e astigmatismo. Não houve associação entre os erros refracionais com as variáveis gênero, cor da pele/raça e queixas clínicas dos participantes. Conclusão: A prevalência de astigmatismo e miopia foi maior que em outras regiões do mundo. Os dados foram coletados num período pré-pandemia da COVID-19. Mais estudos poderiam contribuir para análise especialmente da progressão miópica nessa faixa etária, considerando as mudanças comportamentais em relação ao uso de telas e redução de atividades ao ar livre desta população.

ABSTRACT Introduction: Globally, there is an increase of the keratoconus prevalence and its diagnosis in early ages. A great number of subclinical cases and others with a quick progression are notified, conditioned by the early onset of the disease and the association with risk factors. Objective: To describe the epidemiological, clinical aspects and the result of diagnostic means involved in the early detection of infant keratoconus. Development: There are elements that alert the presence of a keratoconus as a cause of the refractive defect in children with ametropia. From the epidemiologic point of view they are: geographical distribution, heredity role and environmental factors. History of previous diseases are clinically pointed out, such as allergies, myopia or myopic astigmatism with refractive instability and the clinical signs related to cone progression. In risk patients it is necessary to carry out exams by means of different diagnostic means according to their availability, being essential the refractive, keratometric and topographic analysis. Conclusions: In the evaluation of children with ametropia, epidemiological and clinical elements should be taken into account that allow to suspect and early diagnose the keratoconus. In the interpretation of results of the diagnostic means involved in their detection the most frequent findings in the infant population, should be considered according to the ectasia degree of progression.

RESUMEN Introducción: Globalmente, existe un aumento de la prevalencia del queratocono y su diagnóstico en edades tempranas. Se notifican un gran número de casos subclínicos y otros con una rápida progresión, condicionada por el inicio precoz de la enfermedad y la asociación a factores de riesgo. Objetivo: Describir los aspectos epidemiológicos, clínicos y el resultado de los medios de diagnóstico implicados en la detección precoz del queratocono infantil. Desarrollo: En niños con ametropía hay elementos que alertan la presencia de un queratocono como causa del defecto refractivo. Desde el punto de vista epidemiológico se encuentran: distribución geográfica, rol de la herencia y factores ambientales. Clínicamente se señalan los antecedentes de enfermedades, tales como las alergias, la presencia de miopía o astigmatismo miópico con inestabilidad refractiva y los signos clínicos relacionados con la progresión del cono. En los pacientes de riesgo es preciso realizar exámenes mediante diferentes medios de diagnóstico según su disponibilidad, siendo primordial el análisis refractivo, queratométrico y topográfico. Conclusiones: En la evaluación de los niños con ametropía se deben tener en cuenta elementos epidemiológicos y clínicos que permiten sospechar y diagnosticar precozmente el queratocono. En la interpretación de los resultados de los medios de diagnóstico involucrados en su detección, se deben considerar los hallazgos más frecuentes en la población infantil según el grado de progresión de la ectasia.

ABSTRACT Purpose: To compare the differences between the apparent and actual chord μ. Methods: In this prospective, comparative, non-randomized, and non-interventional study, imaging examinations using Pentacam and the HD Analyzer were performed in the same room under the same scotopic conditions. The inclusion criteria were patients aged 21-71 years, able to provide informed consent, myopia up to 4D, and anterior topographic astigmatism up to 1D. Patients using contact lenses, those with previous eye diseases or surgeries, corneal opacities, corneal tomographic changes, or suspected keratoconus were excluded. Results: Altogether, 116 eyes of 58 patients were analyzed. The patients’ mean age was 30.69 (±7.85) years. In the correlation analyses, Pearson’s correlation coefficient of 0.647 indicates a moderate positive linear relationship between apparent and actual chord μ. The mean actual and apparent chord μ were 226.21 ± 128.53 and 278.66 ± 123.90 μm, respectively, with a mean difference of 52.45 μm (p=0.01). The analysis of mean pupillary diameter resulted in 5.76 mm using the HD Analyzer and 3.31 mm using the Pentacam. Conclusions: We found a correlation between the two measurement devices, and even though we found considerable differences, both can be used in daily practice. Given their differences, we should respect their peculiarities as well.

RESUMO Objetivo: Comparar as diferenças entre a chord aparente μ e o chord real μ. Métodos: Estudo prospectivo, comparativo, não randomizado e não intervencionista. Os exames de imagem (Pentacam e HD Analyzer) foram realizados na mesma sala e nas mesmas condições escotópicas. Os critérios de inclusão foram idade de 21 a 71 anos; compreensão do termo de consentimento; miopia até 4D e astigmatismo topográfico anterior até 1D. Os critérios de exclusão foram usuários de lentes de contato; pacientes com doenças oculares prévias ou cirurgias; opacidades da córnea; a presença de alterações tomográficas da córnea ou suspeita de ceratocone. Resultados: Em nosso estudo foram analisados 116 olhos de 58 pacientes. A média de idade foi de 30,69 anos (± 7,85). Análises de correlação foram desenvolvidas e o coeficiente de correlação de Pearson (0,647) indica uma relação linear positiva moderada entre as variáveis. A média do chord μ real foi 226,21 ± 128,53 μm e a média do chord μ média foi 278,66 ± 123,90 μm, com diferença média de 52,45 μm (p=0,01). A análise do diâmetro pupilar médio apresentou: 5,76mm no HD Analyzer e 3,31mm no Pentacam. Conclusões: Entendemos a existência de uma diferença significativa entre os métodos e assim a medida de ambos os dispositivos com base em princípios diferentes devemos respeitar suas peculiaridades. Como encontramos correlação entre as duas medidas, acreditamos que ambas podem ser utilizadas na prática diária.

ABSTRACT This case report presents the details of a 33-year-old female patient who was referred to a specialized retina service because of mild vision loss in her right eye). The patient’s visual acuity was 20/25 in right eye and 20/50 in the left eye (; amblyopic); the spherical equivalent was -12.75 diopters (right eye) and -14.75 diopters (left eye). Multimodal retinal imaging showed peripapillary schisis in both the inner and outer retinal layers, grade II posterior vitreous detachment, and a tessellated fundus. Using Humphrey perimetry and MP-3 microperimetry, the functional evaluation indicated macular sensitivity within normal limits and decreased sensitivity in the peripapillary region, especially in right eye. The pattern-re versal visual evoked potential was measured. The N75 and P100 latency and amplitude in right eye were within normal values for checks of 1º. However, the amplitude was low for checks of 15′. Highly myopic patients who have posterior staphyloma that involves the optic nerve are susceptible to posterior hyaloid traction, and the resulting peripapillary vitreous traction may compromise vision.

RESUMO Este relato de caso apresenta um paciente feminino de 33 anos encaminhado para um serviço especializado de retina devido à leve perda de visão em olho direito. A acuidade visual foi de 20/25 no olho direito e 20/50 no olho esquerdo, o equivalente esférico foi de -12,75 dioptrias e -14,75 dioptrias, respectivamente. Avaliações multimodais revelaram isquese peripapilar nas camadas internas e externas da retina, descolamento vítreo posterior grau II e fundo tesselado. Avaliação funcional com perimetria Humphrey e microperimetria MP-3 revelaram sensibilidade macular normais e diminuição da sensibilidade na região peripapilar, especialmente no olho direito. Potencial visual evocado de padrão reverso apresentou no olho direito latência e amplitude N75 e P100 dentro dos valores normais para verificação de 1º. Entretanto, a amplitude foi baixa para a de 15′. Pacientes alto míopes com esfiloma posterior envolvendo o nervo óptico são suscetíveis à tração da hialoide posterior. Portanto a tração vitreopapilar resultante pode causar comprometimento da visão.

ABSTRACT Purpose: In glaucoma, initial visual field scotomas can be peripheral or central, whereas central scotomas are more severe and can disrupt daily activities. Individual anatomical features may influence the distribution of retinal nerve fibers and the starting site of visual field defects in glaucoma. In this study, we aimed to correlate myopia and hyperopia or anatomical variation of the disk-fovea angle with initial central or peripheral lesions in the visual field. Methods: This cross-sectional study included patients with primary open-angle glaucoma divided into a group of isolated central or peripheral scotomas in the visual field with MD > or equal to -6 dB, correlating with the degree of ametropia and anatomical variations, such as the disk-fovea angle. Results: We included 52 patients with glaucoma. Of 20 myopic patients, 6 (30%) had central scotomas, and 14 (70%) had peripheral scotomas. Of 32 hyperopic patients, 12 (37.5%) had central scotomas, and 20 (63.5%) had peripheral scotomas. Regarding the disk-fovea angle, 25 eyes had the disk-fovea angle of < -7°, with 9 (36%) eyes presenting with central scotoma, and 27 eyes presented with the disk-fovea angle of > -7°, with 9 (33.3%) eyes presenting with a central scotoma. Conclusion: This study showed an association between ametropia and scotomas on the perimetry in patients with glaucoma. Patients had a higher incidence of peripheral scotomas, but hyperopic patients had a greater number of central scotomas than myopic patients, and myopic patients had more peripheral scotomas than hyperopic patients. The disk-fovea angle was not correlated with scotomas in initial glaucoma.

RESUMO Objetivos: No glaucoma, os escotomas iniciais no campo visual podem ser periféricos ou centrais. Os escotomas centrais são mais graves e podem atrapalhar as atividades diárias. As características anatômicas individuais podem influenciar a distribuição das fibras nervosas da retina e o local inicial dos defeitos do campo visual no glaucoma. Nesse estudo buscamos correlacionar a miopia e a hipermetropia ou a variação anatômica do ângulo disco-fóvea com lesões iniciais centrais ou periféricos no campo visual. Métodos: Este foi um estudo transversal incluindo pacientes com glaucoma primário de ângulo aberto divididos em grupo de escotomas isolados central ou periférico no campo visual com MD > ou igual a -6 dB, correlacionando com o grau de ametropia e variações anatômicas como o ângulo disco fóvea. Resultados: Incluímos 52 pacientes com glaucoma. Dos 20 míopes, 6 (30%) apresentaram escotoma central e 14 (70%) escotoma periférico) e 32 olhos hipermetrópicos com 12 (37,5%) escotomas centrais e 20 (63,5%) escotomas periféricos. Sobre o ângulo disco fóvea, 25 olhos tiveram ângulo disco fóvea menor que -7º com 9 (36%) olhos apresentando escotoma central e 27 olhos com ângulo disco fóvea maior que -7º com 9 (33,3%) olhos apresentando escotoma central. Conclusão: Este estudo mostrou associação da ametropia e os escotomas na perimetria em pacientes com glaucoma. Pacientes apresentaram maior incidência de escotomas periféricos, porém hipermétropes apresentaram maior quantidade de escotoma central que os míopes e os míopes mais escotomas periféricos que os hipermetropes. O ângulo disco fóvea não foi correlacionado com escotomas na perimetria no glaucoma inicial.

ABSTRACT Objective: To determine the effectiveness of ACRIOL 128 phakic lens implantation for the correction of high myopia and visual quality at three years of follow-up. Methods: A prospective longitudinal descriptive study was performed, with three years of follow-up with 49 patients (91 eyes) with myopia corrected with ACR-128 phakic lens. Effectiveness and visual quality were determined through the following variables: uncorrected and best corrected visual acuity and contrast sensitivity, pre and postoperatively. Results: Uncorrected and best corrected visual acuity improved with significant differences (p < 0.01) between pre- and postoperative. The effectiveness index at three months after surgery was 0.77 in the right eye and 0.70 in the left eye, at 12 months it was 0.80 in the right eye and 0.71 in the left eye, while at three years it was 0.77 in the right eye and 0.67 in the left eye. There was increased contrast sensitivity at different spatial frequencies. Conclusions: ACRIOL 128 phakic lens implantation is an effective technique as it improves uncorrected and better corrected visual acuity that remains stable; as well as the visual quality of patients demonstrated with increased contrast sensitivity at different spatial frequencies after surgery.

RESUMEN Objetivo: Determinar la efectividad del implante de lente fáquica ACRIOL 128 para la corrección de la alta miopía y la calidad visual en tres años de seguimiento. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo, con tres años de seguimiento con 49 pacientes (91 ojos) con miopía corregida con lente fáquica ACR-128. Se determinó efectividad y calidad visual a través de las variables: agudeza visual sin corrección y la mejor corregida y la sensibilidad al contraste, pre- y posoperatorias. Resultados: Mejoró la agudeza visual sin corrección y agudeza visual mejor corregida con diferencias significativas (p< 0,01) entre el pre- y posoperatorio. El índice de efectividad a los tres meses de la cirugía fue 0,77 en ojo derecho y 0,70 en izquierdo, a los 12 meses fue de 0,80 en ojo derecho y 0,71 en ojo izquierdo, mientras que a los tres años fue de 0,77 en ojo derecho y 0,67 en ojo izquierdo. Hubo aumento de la sensibilidad al contraste a diferentes frecuencias espaciales. Conclusiones: El implante de la lente fáquica ACRIOL 128 es una técnica efectiva ya que mejora la agudeza visual sin corrección y mejor corregida que se mantiene estable; así como la calidad visual de los pacientes demostrada con el aumento de la sensibilidad al contraste a diferentes frecuencias espaciales después de la intervención quirúrgica.

ABSTRACT Objective: To determine the progression of myopia in pediatric patients. Methods: A descriptive, longitudinal, ambispective study was performed with 117 patients to determine the refractive changes that justify myopia progression, in the period between March 2021 and December 2022. The sample consisted of 117 myopic patients who met the inclusion and exclusion criteria. The study variables were age, sex, area of origin, family history of refractive error, spherical equivalent with its variation, hours of exposure to screens and sunlight, axial length and keratometry. Results: Myopia progressed to > 0.5 D in the years studied, equal progression by age groups and sexes with p < 0.05 for both. Patients from urban areas, with and without family history of refractive defect had significant myopic progression p < 0.005. Exposure for more than 3 h screens and less than 1 h to sunlight presented myopia progression equal to 0.94 D, with increase in axial length and keratometry not being significant and significant for patients with family history of refractive defects p < 0.000. Conclusions: Myopia progresses over the years, behaves equally regarding sexes and in patients from urban areas. School patients with a history of refractive error, the use of more than 3 h screens and less than one hour of sunlight show an increase in myopia, axial length and keratometry.

RESUMEN Objetivo: Determinar la progresión de la miopía en pacientes pediátricos. Métodos: Se realizó un estudio descriptivo, longitudinal, ambispectivo con 117 pacientes para determinar los cambios refractivos que justifiquen la progresión de la miopía, en el período entre marzo de 2021 y diciembre de 2022. La muestra estuvo conformada por 117 pacientes miopes que cumplieron los criterios de inclusión y exclusión. Las variables del estudio fueron, edad, sexo, zona de procedencia, antecedentes familiares de defecto refractivo, equivalente esférico con su variación, horas de exposición a horas pantallas y a la luz solar, longitud axial y queratometrías. Resultados: La miopía progresó a > 0,5 D en los años estudiados, igual progresión por grupos etarios y sexos con p< 0,05 para ambos. Los pacientes procedentes de zonas urbanas, con y sin antecedentes familiares de defecto refractivo tuvieron progresión miópica significativa p< 0,005. La exposición por más de 3 h pantallas y menos de 1 h a la luz solar presentaron una progresión de la miopía igual 0,94 D, con aumento de la longitud axial y queratometrías no siendo significativas y sí para pacientes con antecedentes familiares de defectos refractivos p< 0,000. Conclusiones: La miopía progresa con los años, se comporta igual por sexos y en pacientes procedentes de zonas urbanas. Los pacientes escolares con antecedente de defecto refractivo, el uso de más de 3 h pantallas y menos de una hora a la luz solar evidencian un aumento de la miopía, longitud axial y queratometrías.

ABSTRACT Objective: To determine the predictability and stability of ACRIOL 128 phakic lens implantation for the correction of high myopia in patients three years after treatment. Methods: A prospective longitudinal descriptive study was performed with a three-year follow-up of 49 patients (91 eyes) with myopia corrected with ACR-128 phakic lens. Predictability and stability were determined through the following variables: estimated spherical component (EEC) and observed spherical component (CEO), spherical equivalent, keratometric cylinder, pre- and postoperative induced astigmatism. Results: The predictive error of -0.07 ± 0.43 D, -0.07 ± 0.59 and -0.10 ± 0.60 in OD at three months, 12 months and three years, respectively, and -0.05 ± 0.47 D, -0.04 ± 0.49 and -0.05 ± 0.49 in OI at three months, 12 months and three years, respectively, was not significant. There was stability in the observed spherical component, keratometric cylinder and spherical equivalent, with no differences between three and twelve months; as well as at three years after surgery. Conclusions: The predictive error was not significant in the study, demonstrating adequate predictability in the calculation of the phakic lens. The refractive parameters showed stability as no differences were found between three and twelve months, as well as three years after surgery.

RESUMEN Objetivo: Determinar la predictibilidad y la estabilidad del implante de lente fáquica ACRIOL 128 para la corrección de la alta miopía, en los pacientes con tres años de haber sido tratados. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo, con tres años de seguimiento con 49 pacientes (91 ojos) con miopía corregida con lente fáquica ACR-128. Se determinó predictibilidad y estabilidad a través de las variables: componente esférico estimado (CEE) y observado (CEO), equivalente esférico, cilindro queratométrico, astigmatismo inducido pre- y posoperatorio. Resultados: No fue significativo el error predictivo de -0,07 ± 0,43 D, -0,07 ± 0,59 y -0,10 ± 0,60 en OD a los tres meses, 12 meses y tres años, respectivamente, y de -0,05 ± 0,47 D, -0,04 ± 0,49 y -0,05 ± 0,49 en OI a los tres meses, 12 meses y tres años, respectivamente. Hubo estabilidad en el componente esférico observado, cilindro queratométrico y equivalente esférico, sin diferencias entre los tres y doce meses; así como a los tres años de la intervención quirúrgica. Conclusiones: El error predictivo no fue significativo en el estudio, lo que demuestra la adecuada predictibilidad en el cálculo de la lente fáquica. Los parámetros refractivos demostraron estabilidad al no encontrarse diferencias entre los tres y doce meses; así como a los tres años de la intervención.

ABSTRACT Keratoconus is an asymmetric bilateral corneal ectasia, in early stages binocular involvement is not evident. Knowledge of the degree of asymmetry in pediatric keratoconus allows timely decisions in patient management. This research was carried out with the objective of describing the clinical characteristics and the treatment of three pediatric cases with different degree of interocular asymmetry of keratoconus, treated in the provincial consultation of pediatric corneal ectasia in Ciego de Avila. Patients showed difference between both eyes in clinical signs, refraction and topographic variables. Patient two was diagnosed with keratoconus in one eye, with no clinical or topographic evidence of the disease in the contralateral eye. All patients showed compound myopic astigmatism in both eyes and optical correction was indicated. Patient one was corrected with glasses, patient two with rigid gas permeable contact lenses and patient three with piggyback in one eye and rigid gas permeable contact lenses in the other eye. They also presented an associated amblyopia and were directed occlusive treatment and near vision tasks in patients two and three. It is common to find interocular asymmetry in pediatric patients with keratoconus due to the difference in progression between the two eyes. Periodic follow-up makes it possible to diagnose the disease in the contralateral eye in patients diagnosed with keratoconus in one eye, to indicate individualized optical correction, especially in the presence of anisometropia, and to monitor the evolution of frequently associated refractive amblyopia.

RESUMEN El queratocono es una ectasia corneal bilateral asimétrica, en etapas iniciales no se evidencia la afectación binocular. El conocimiento del grado de asimetría en el queratocono pediátrico permite tomar decisiones oportunas en el manejo de los pacientes. Se realizó este trabajo con el objetivo de describir las características clínicas y el tratamiento de tres casos pediátricos con diferente grado de asimetría interocular del queratocono, atendidos en la consulta provincial de ectasias corneales pediátricas en Ciego de Ávila. Los pacientes mostraron diferencia entre ambos ojos de los signos clínicos, la refracción y las variables topográficas. Al paciente dos se le diagnosticó queratocono en un ojo, sin evidencias clínicas ni topográficas de la enfermedad en el ojo contralateral. Todos los pacientes mostraron astigmatismo miópico compuesto en ambos ojos y se les indicó corrección óptica. Al paciente uno se le corrigió con cristales, al dos con lentes de contacto rígidos de gas permeable y al tercero con piggyback en un ojo y lentes de contacto rígidos de gas permeable en el otro. Presentaron, además, una ambliopía asociada y se les orientó tratamiento oclusivo y tareas de visión cercana en los pacientes dos y tres. Es frecuente encontrar asimetría interocular en pacientes pediátricos con queratocono por la diferencia de progresión entre ambos ojos. El seguimiento periódico permite diagnosticar la enfermedad en el ojo contralateral en pacientes con diagnóstico de queratocono en un ojo, indicar una corrección óptica individualizada, sobre todo en presencia de anisometropía, y monitorizar la evolución de la ambliopía refractiva asociada con frecuencia.

ABSTRACT Cataract surgery is considered a fast and safe procedure in experienced hands, thanks to the good outcome in most patients. It has become an increasingly popular refractive surgery. However, there are also complex cases, which require a surgical intervention that is always a challenge for the surgeon, among them is high myopia, in which the calculation of the intraocular lens is not exempt from an unexpected post-surgical refractive result, a refractive surprise. The formulas for the calculation of the lens to be implanted in high myopic patients deserve personalized attention and the treatment options for the refractive surprise that may occur in them depend on the particular characteristics of the patient and advantages or disadvantages, risk and benefit should always be evaluated. We present a patient with these characteristics, high myopia for cataract surgery of the second eye and refractive surprise in the operated eye.

RESUMEN La intervención quirúrgica de catarata se considera un procedimiento rápido y seguro en manos experimentadas, gracias al buen resultado en la mayoría de los pacientes. Se ha convertido en una cirugía refractiva que cobra cada vez mayor auge. Sin embargo, también existen casos complejos, que exigen una intervención quirúrgica que siempre supone un reto para el cirujano, dentro de ellos está la alta miopía, en la que el cálculo de la lente intraocular no está exento de un resultado refractivo posquirúrgico no esperado, una sorpresa refractiva. Las fórmulas para el cálculo de la lente a implantar en pacientes miopes altos merecen una atención personalizada y las opciones de tratamiento de la sorpresa refractiva que se puede presentar en ellos depende de las características particulares del paciente y deben evaluarse siempre ventajas o desventajas, riesgo y beneficio. Se presenta una paciente con estas características, miope elevada para intervención quirúrgica de catarata del segundo ojo y sorpresa refractiva en el ojo operado.

ABSTRACT Objective: To determine the safety of ACRIOL 128 phakic lens implantation for the correction of high myopia at three-year follow-up. Methods: Three-year prospective, longitudinal descriptive study of 49 patients (91 eyes) with myopia corrected with ACR-128 phakic lens. Effectiveness and visual quality were determined through the variables uncorrected and best corrected visual acuity, ocular tension, cell density, coefficient of variation, hexagonality and endothelial cell loss, pre- and postoperative; as well as lens-cornea and lens-crystalline distance and complications. Results: The safety index was >1 and there was no loss of line of sight in the three years; ocular tension with no significant differences between pre- and postoperative (p > 0.05). At 3 and 12 months post-surgery, average endothelial cell loss was 2.08% and 2.86% in the right eye, respectively, and 2.30% and 2.65% in the left eye. At three years it was 3.88 % in OD and 4.07 % in OI. The lens-cornea distance was ≥1.50 mm and lens-crystalline lens ≥0.3 mm, in 100 % of cases. Conclusions: ACRIOL 128 phakic lens implantation is safe, with no loss of visual acuity and normal ocular strain. It is a procedure well tolerated by the corneal endothelium, with low cell loss, no intraoperative complications and infrequent postoperative complications. The lens position shows safe margins in relation to the anterior segment structures.

RESUMEN Objetivo: Determinar la seguridad del implante de lente fáquica ACRIOL 128 para la corrección de la alta miopía en tres años de seguimiento. Métodos: Estudio descriptivo longitudinal prospectivo, de tres años de seguimiento con 49 pacientes (91 ojos) con miopía corregida con lente fáquica ACR-128. Se determinó efectividad y calidad visual a través de las variables agudeza visual sin corrección y mejor corregida, tensión ocular, densidad celular, coeficiente de variación, hexagonalidad y pérdida de células endoteliales, pre- y posoperatorias; así como distancia lente-córnea y lente-cristalino y complicaciones. Resultados: El índice de seguridad fue >1 y no hubo pérdida de líneas de visión en los tres años; la tensión ocular sin diferencias significativas entre pre- y posoperatorios (p > 0,05). A los tres y doce meses poscirugía la pérdida de células endoteliales media fue del 2,08 % y del 2,86 % en ojo derecho, respectivamente y del 2,30 % y 2,65 % en el izquierdo. A los tres años fue del 3,88 % en OD y del 4,07 % en OI. La distancia lente-córnea fue ≥1,50 mm y la lente-cristalino ≥0,3 mm, en el 100 % de los casos Conclusiones: El implante de la lente fáquica ACRIOL 128 es seguro, sin pérdida de la agudeza visual y con tensión ocular normal. Es un procedimiento bien tolerado por el endotelio corneal, con una pérdida celular baja, sin complicaciones intraoperatorias y poca frecuencia en posoperatorias. La posición de la lente muestra márgenes seguros en relación con las estructuras del segmento anterior.

RESUMEN Introducción: La cirugía refractiva como método quirúrgico para tratar la miopía es una solución que se ofrece a los pacientes cuando no toleran los lentes de contacto, presenta aberraciones visuales como consecuencia del uso de espejuelos con altas dioptrías o rechazan el uso de los mismos por razones estéticas. Objetivo: Comparar los cambios topoaberrométricos en pacientes miopes operados con técnicas de superficie y perfil de ablación asférico. Métodos: Se realizó un estudio experimental controlado aleatorizado abierto en 160 pacientes (320 ojos). Se formaron dos grupos, al primer grupo (control, 80 pacientes con 160 ojos) se le realizó la técnica quirúrgica queratectomía fotorrefractiva con mitomicina C y al segundo grupo (estudio, 80 pacientes con 160 ojos) queratectomía subepitelial asistida por láser de excímero, en el Instituto Cubano de Oftalmología ¨Ramón Pando Ferrer¨. Resultados: Predominaron en ambos grupos las mujeres, la variación entre el preoperatorio y tres meses posoperatorios del grupo control, fue, asfericidad corneal de -0,31 ± 0,10 µm a 0,25 ± 0,09 µm, RMS total 4,17 ± 1,84 µm a 1,05 ± 0,44 µm, RMS alto orden de 0,24 ± 0,15 µm a 0,38 ± 0,15 µm, aberración esférica de -0,84 ± 1,14 µm a -2,42 ± 2,12 um. En el grupo estudio, la variación entre el preoperatorio y los tres meses de posoperatorio fue, asfericidad corneal de -0,29 ± 0,09 µm a 0,29 ± 0,37 um, RMS total de 4,18 ± 1,93 µm a 1,04 ± 0,45 µm, RMS alto orden de 0,25 ± 0,14 µm a 0,40 ± 0,15 µm, aberración esférica de -0,83 ± 1,19 µm a -2,43 ± 2,15 µm. No hubo diferencias significativas entre ambos grupos. Conclusión: Ambas técnicas quirúrgicas mostraron mejorar la calidad visual en pacientes miopes y pueden ser realizadas indistintamente, por no presentarse diferencias significativas entre ellas.

ABSTRACT Introduction: The refractive surgery as surgical method to treat the myopia is a solution that offers to the patients when they don't tolerate the contact lenses, it presents visual aberrations as consequence of the use of glasses with high diopters or reject the use of glasses for esthetic reasons. Objetive: To compare topoaberrometric changes in myopic patients operated with surface techniques and aspheric ablation profile. Methods: An open randomized controlled experimental study was performed in 160 patients (320 eyes). Two groups were formed, the first group (control group, 80 patients with 160 eyes) underwent the surgical technique photorefractive keratectomy with mitomycin C and the second group (study group, 80 patients with 160 eyes) subepithelial keratectomy assisted by excimer laser, at the Cuban Institute of Ophthalmology ¨Ramón Pando Ferrer¨. Results: Women predominated in both groups, the variation between preoperative and three months postoperative in the control group was, corneal asphericity from -0.31 ± 0.10 µm to 0.25 ± 0.09 µm, total RMS 4.17 ± 1.84 µm to 1.05 ± 0.44 µm, high order RMS from 0.24 ± 0.15 µm to 0.38 ± 0.15 µm, spherical aberration from -0.84 ± 1.14 µm to -2.42 ± 2.12 um. In the study group, the variation between preoperative and three months postoperative was, corneal asphericity from -0.29 ± 0.09 µm to 0.29 ± 0.37 um, total RMS from 4.18 ± 1.93 µm to 1.04 ± 0.45 µm, high order RMS from 0.25 ± 0.14 µm to 0.40 ± 0.15 µm, spherical aberration from -0.83 ± 1.19 µm to -2.43 ± 2.15 µm. There were no significant differences between the two groups. Conclusions: Both surgical techniques were shown to improve visual quality in myopic patients and can be performed interchangeably, as there are no significant differences between them.

Resumen La complejidad rural en Marqués de Comillas, en el sureste de la selva Lacandona, Chiapas, evidencia la brecha que sigue ampliándose entre los modos de vida de la población y las proyecciones idealizadas de la política pública ambiental. Con base en una trayectoria investigativa de media duración y de corte etnográfico, en este artículo se describe y analiza el proceso de constitución de dicha brecha y los límites de algunas acciones ambientales frente a las realidades locales. Posteriormente, se examinan las incertidumbres socioambientales en el contexto regional y se argumenta la presencia de dificultades para reconocer las tendencias globales de cambio agrario que han permeado en la sociedad rural, una miopía que deriva del actual proceso de desconfiguración y reconfiguración de la política pública ambiental en México.

Abstract The rural complexity of Marqués de Comillas Municipality in the southeastern part of the Lacandon Rainforest in Chiapas is clear evidence of the ever-increasing gap between their way of life and the idealized projections of environmental public policy. Based on a medium-term ethnographic research trajectory, this paper describes and analyzes the process that creates this gap and the limitations of various environmental actions in the face of the local realities. This paper also examines the socio-environmental uncertainties in the region’s context, arguing that there are difficulties in recognizing the global trends of agrarian change that have permeated rural society and that this short-sightedness is a spin-off from the current process of deconfiguring and reconfiguring environmental public policy in Mexico.

ABSTRACT Introduction: Myopia is a growing global concern and there is a lack of studies on its prevalence among Brazilian schoolchildren. Methods: This study aimed to determine the prevalence of myopia in Brazilian children aged 3–18 years through a review and meta-analysis of published studies. Eleven high-quality studies were analyzed following the 2022 PRISMA guidelines. Prevalence was calculated using a meta-analysis, considering the heterogeneity among the studies. Results: The overall crude prevalence of myopia in Brazilian children was 7.65%. There was no significant association with the age of the children examined and no significant temporal trend was observed. Approximately one in 13 Brazilian schoolchildren had myopia. Conclusion: Given the increased exposure of Brazilian youth to the risk factors for myopia, it is crucial to monitor myopia in the country. Further studies are required to address and prevent myopia in Brazil. Introduction Methods 318 3 18 3–1 metaanalysis meta analysis highquality high quality 202 guidelines metaanalysis, analysis, Results 765 7 65 7.65% observed 1 Conclusion country Brazil 31 3– 20 76 6 7.65 2 7.6 7.

RESUMO Introdução: A miopia é uma preocupação global crescente, estudos sobre sua prevalência entre os brasileiros ainda são escassos. Métodos: Este estudo teve como objetivo determinar a prevalência de miopia em crianças brasileiras com idades entre 3 e 18 anos por meio de uma revisão sistemática e meta-análise. Seguindo as diretrizes PRISMA de 2022, onze estudos foram analisados. A prevalência foi calculada usando uma meta-análise, considerando a heterogeneidade entre os estudos. Resultados: A prevalência bruta geral de miopia em crianças brasileiras foi de 7,65%. Não houve associação significativa com a idade das crianças examinadas, e não foi observada uma tendência temporal significativa. Aproximadamente um em treze escolares brasileiros tem miopia. Conclusão: Dado o aumento da exposição da juventude brasileira aos fatores de risco conhecidos da miopia, é crucial monitorar a miopia no país. Estudos adicionais são imperativos para abordar e prevenir a miopia no Brasil. Introdução crescente escassos Métodos 1 metaanálise. metaanálise meta análise. análise meta-análise 2022 analisados metaanálise, análise, Resultados 765 7 65 7,65% examinadas Conclusão país Brasil 202 76 6 7,65 20 7,6 2 7,

RESUMO Esta revisão foi baseada na literatura médica e na experiência clínica de um comitê de especialistas membros da Sociedade Brasileira de Oftalmologia Pediátrica e da Sociedade Brasileira de Lentes de Contato e Córnea. Rotineiramente as crianças devem ser submetidas a topografia da córnea no primeiro exame e visitas semestrais com refração cicloplegiada e biometria óptica anual. A progressão da miopia foi definida como um aumento anual no equivalente esférico maior que 0,50 D/ano ou do comprimento axial maior que 0,3 mm (até 10 anos) ou 0,2 mm (mais de 11 anos). Os tratamentos propostos para a progressão são controle ambiental, atropina em baixa concentração, óculos com defocus, lentes de contato ou ortoceratologia, devendo-se considerar associações para casos não controlados. O tratamento deve ser realizado por pelo menos 2 anos. O presente documento é uma diretriz para diagnóstico, tratamento e acompanhamento de crianças pré-míopes e míopes no Brasil. Córnea 050 0 50 0,5 Dano D ano 03 3 0, até 1 anos 02 mais . ambiental concentração defocus ortoceratologia devendose devendo se controlados diagnóstico prémíopes pré Brasil 05 5

ABSTRACT This document on myopia control is derived from a compilation of medical literature and the collective clinical expertise of an expert committee comprising members from the Brazilian Society of Pediatric Ophthalmology and the Brazilian Society of Contact Lenses and Cornea. To manage myopia in children, the committee recommends corneal topography and biannual visits with cycloplegic refraction, along with annual optical biometry. For fast-progressing myopia, biannual biometry should be considered. Myopic progression is defined as an annual increase in spherical equivalent greater than 0.50 D/year or in axial length greater than 0.3 mm (until 10 years old) or 0.2 mm (above 11 years). The proposed treatments for myopia progression include environmental control, low concentration atropine, defocus glasses, contact lenses, or Ortho-K lenses, and combinations of these methods may be necessary for uncontrolled cases. Treatment should be sustained for at least 2 years. This document serves as a comprehensive guideline for diagnosing, treating, and monitoring pre-myopic and myopic children in Brazil. Cornea refraction fastprogressing fast progressing considered 050 0 50 0.5 Dyear D year 03 3 0. until 1 old 02 above . years) atropine glasses lenses OrthoK Ortho K cases diagnosing treating premyopic pre Brazil 05 5