ABSTRACT Purpose: Access to cataract treatment and diagnostic tools continues to be hindered by financial and logistical barriers. Thus, photography-based cataract analysis via portable devices offers a promising solution for the detection of cataracts in remote regions. In this study, the accuracy of a portable device that is based on the Lens Opacities Classification III System for diagnosing cataracts was analyzed. Methods: Photographs of the anterior segment of the eye were taken in a low-light environment, and the pupillary region markings were automatically delineated using infrared photography. The captured images were automatically analyzed using a convolutional neural network. The study group included patients with cataracts, and the control group included patients without cataracts. Results: A total of 270 eyes were analyzed, which included 143 eyes with cataracts and 127 control eyes. A total of 599 photos were analyzed. The isolated nuclear cataract was the most frequently detected subtype (37.5%), followed by a nuclear cataract associated with a cortical cataract (30.3%). The device’s accuracy was 88.5% (Confidence intervals (CI), 83.19%-94.69%), specificity was 84.62% (CI 71.79%-97.30%), positive predictive value was 91.78% (CI 74.36%-97.30%), and negative predictive value was 82.50% (CI 74.36%-97.30%). Conclusion: The portable device is a simplified user-friendly cataract screening technique that can interpret results in remote regions. This innovation could mitigate the occurrence of cataract-induced blindness and prevent premature surgical interventions in early-stage cataracts.

ABSTRACT Objective: To compare the effectiveness and safety of phacoviscocanalostomy and phacotrabeculectomy in treating combined glaucoma and cataracts. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. The PubMed, Web of Science, Cochrane, and Embase databases were searched for randomized controlled trials or observational studies comparing phacotrabeculectomy to phacoviscocanalostomy in patients with glaucoma and cataracts. Statistical analysis was used to compare the efficacy (intraocular pressure reduction, mean deviation of the visual field, and failure rates) and safety (general complication rate and rates of hyphema, hypotony, perforation, and intraocular pressure spikes) between the two procedures. Results: The study included 331 eyes from one randomized controlled trial and two non-randomized controlled trials, with 154 undergoing phacoviscocanalostomy and 177 undergoing phacotrabeculectomy. The results indicated no significant differences in surgical failure rates, mean deviation of the visual field, and intraocular pressure at one, three, six, and twelve months between the phacoviscocanalostomy and phacotrabeculectomy groups. Furthermore, although the overall complication rate between the two procedures showed no difference, the rate of intraocular pressure spikes was higher in patients who underwent phacoviscocanalostomy. Conclusion: Phacotrabeculectomy and phacoviscocanalostomy are effective treatments for glaucoma and cataracts. Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42024502391.

ABSTRACT Objective: This systematic review and meta-analysis compare the safety and efficacy of phacoemulsification alone versus combined phacoviscocanalostomy in glaucoma and cataract patients. Methods: We followed PRISMA guidelines. PubMed®, Web of Science, Cochrane, and Embase were searched for randomized clinical trial and non-randomized clinical trial studies comparing phaco versus phacoviscocanalostomy in patients with any glaucoma and cataract type. Statistical analysis was conducted using RevMan software. Results: The study included 889 patients from one randomized clinical trial and three non-randomized clinical trials studies, of whom 499 (56.1%) received phacoviscocanalostomy. Patients treated with phacoviscocanalostomy had significantly lower intraocular pressure at 1 (mean difference: 3.90; p < 0.00001), 3 (mean difference: 2.52; p = 0.03), 6 (mean difference: 1.90; p = 0.04), 18 (mean difference: 3.23; p < 0.00001) and 24 months (mean difference: 2.55; p < 0.00001), except for 12 months (mean difference: 2.26; p = 0.08). A lower medication at six months (mean difference: 0.68; p < 0.00001), no difference in the visual acuity (mean difference: −0.02; p = 0.77), and a higher rate of adverse events (odds ratios: 236.96; p = 0.004) were found. Conclusions: The combined phacoviscocalanostomy approach showed positive outcomes, without increasing the severe complication rates. Registry PROSPERO - CRD42024501313

RESUMO Objetivo: Esta revisão sistemática e meta-análise comparam a segurança e eficácia da facoemulsificação isolada versus a facoviscocanalostomia combinada em pacientes com glaucoma e catarata. Métodos: Seguimos as diretrizes PRISMA. Foram realizadas buscas nas bases PubMed®, Web of Science, Cochrane e Embase para estudos de ensaios clínicos randomizados e não randomizados que comparassem faco versus facoviscocanalostomia em pacientes com qualquer tipo de glaucoma e catarata. A análise estatística foi conduzida utilizando o software RevMan. Resultados: O estudo incluiu 889 pacientes provenientes de um ensaio clínico randomizado e três estudos clínicos não randomizados, dos quais 499 (56,1%) receberam facoviscocanalostomia. Os pacientes tratados com facoviscocanalostomia apresentaram pressão intraocular significativamente menor em 1 (diferença média: 3,90; p < 0,00001), 3 (diferença média: 2,52; p = 0,03), 6 (diferença média: 1,90; p = 0,04), 18 (diferença média: 3,23; p < 0,00001) e 24 meses (diferença média: 2,55; p < 0,00001), exceto aos 12 meses (diferença média: 2,26; p = 0,08). Foi observada uma redução no uso de medicação aos seis meses (diferença média: 0,68; p < 0,00001), nenhuma diferença na acuidade visual (diferença média: −0,02; p = 0,77) e uma maior taxa de eventos adversos (odds ratio: 236,96; p = 0,004). Conclusões: A abordagem combinada de facoviscocanalostomia demonstrou resultados positivos, sem aumento nas taxas de complicações graves. Registro PROSPERO - CRD42024501313

ABSTRACT Purpose: To analyze teleconsultation at a public ophthalmic teaching hospital during the COVID-19 pandemic in Brazil. Methods: Medical records of patients who requested ophthalmological teleconsultation between June 2020 and March 2021 were reviewed. The main outcomes included demographic data, eye disease symptoms, hypothesized diagnosis, and management. Moreover, the results of a satisfaction survey administered after the consultation were analyzed. Results: Medical records of a total of 161 patients were reviewed. The mean age was 45.98 ± 17.57 (8-90) years, and most were women (113, 70.20%). Only 57 (35.60%) of the patients had made previous follow-up visits to the hospital. The most frequent reason for consultation was the need for a new eyeglass prescription (73, 45.34%), followed by dry eye symptoms (16, 9.93%) and pterygium (13, 8.07%). Other reasons were the monitoring of previously diagnosed eye diseases, such as glaucoma, retinopathies, strabismus, and keratoconus. Regarding the satisfaction survey, 151 (93.78%) patients answered the online questionnaire. Most reported that they were satisfied with the teleconsultation (94.03%) and would participate in a future teleconsultation (90.06%). Conclusion: Teleconsultation could be widely used to assist patients in public ophthalmology healthcare and teaching hospitals. Even though new eyeglass prescriptions are a frequent reason for ophthalmological appointments, patients tend to be satisfied with teleconsultation, as it also provides guidance.

RESUMO Objetivo: Analisar a teleconsulta em um hospital público de ensino oftalmológico, durante o período da pandemia do COVID-19. Métodos: Foram revisados os registros médicos dos pacientes que solicitaram teleconsulta oftalmológica, no período de Junho de 2020 a Março de 2021. Os resultados incluem dados demográficos, sintomas de queixas oculares e hipóteses diagnósticas. Além disso, foram analisados dados da pesquisa de satisfação aplicada após cada teleconsulta. Resultados: Um total de 161 prontuários foram revisados. A idade média dos pacientes foi de 45.98 ± 17.57 (8 a 90) anos, a maioria mulheres, 113 (70,20%). Apenas 57 (35,60%) eram pacientes acompanhados no hospital previamente. A principal razão pela busca pela teleconsulta foi o erro refracional, 73 (45.43%), seguido de olho seco, 16 (9.93%), pterígio, 13 (8.07%). Outros motivos foram o acompanhamento de doenças prévias como glaucoma, retinopatias, miopia, estrabismo e ceratocone. Quanto a pesquisa de satisfação, 151(93,87%) pacientes responderam a pesquisa on-line. A maioria deles mostrou-se satisfeito com a teleconsulta (94.03%) e fariam uma nova teleconsulta (90.06%). Conclusão: A teleconsulta pode auxiliar a saúde pública em oftalmologia podendo ser utilizada em hospitais universitários. Embora o erro refracional tenha sido o motivo mais frequente nas consultas, os pacientes mostraram-se satisfeitos com essa modalidade de atendimento que serve como um serviço de orientação.

ABSTRACT Autologous platelet concentrates are rich in growth factors and have shown potential for high anatomical success rates in macular hole treatment. However, no systematic review has yet assessed its impact. Therefore, this study aimed to conduct a comprehensive review and meta-analysis on the comparative efficacy and safety of autologous platelet concentrates in treating macular hole. A systematic review of the literature on autologous platelet concentrate therapy for macular hole was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on September 9, 2023. Databases, including PubMed, the Cochrane Library, Web of Science, and Embase, were queried. A meta-analysis of random effects was performed. Efficacy was evaluated through anatomical closure, reopening of the macular hole at 6 months, average improvement of 2 lines, and visual field loss. Safety was evaluated by monitoring complications. A systematic search of multiple databases identified six studies (three randomized controlled trials and three non-randomized cohort studies) involving 616 patients (626 eyes). Autologous platelets concentrate therapy significantly improved macular hole closure compared to that in the controls (OR=4.35; 95%CI=2.08-9.10; p<0.0001; I²=9%). No significant differences were observed in hole reopening at 6 months, post-operative visual acuity improvement by 2 lines or more, or visual field loss between autologous platelets concentrate and control groups. The overall complication rates were similar between groups. Thus, autologous platelet concentrate therapy shows promise for promoting macular hole closure, particularly in smaller holes. Further research with standardized protocols, prolonged follow-ups, and larger sample sizes is needed to fully understand its benefits and limitations in macular hole closure. Prospero database registration: (https://www.crd.york.ac.uk/prospero/) under ID CRD42023455815.

ABSTRACT Objective: To assess the impact of the Covid-19 pandemic on the number of medical appointments, exams and procedures performed in a public ophthalmic teaching hospital in Brazil. Methods: The total number of consultations, outpatient procedures and surgeries performed between March 2018 and March 2021 were reviewed and compared. Number of surgeries per resident was also reviewed. Results: There was a drop of 31.6% of care provided in the 2020 period compared to the average of the last two pre-pandemic years, with a total of 38.235 ophthalmologic evaluations. All surgical modalities decreased from March to July 2020. There was a drop of 35.27% (4,322 surgeries) in 2020 compared to the average of the years 2018 and 2019. There was a 16.3% decrease in exams performed. Laser capsulotomies and iridotomies followed with a decrease of 35.89% e 23.57% in 2020, respectively. However, there was an increase of 12.7% compared to the average of the last two years before the pandemic in intravitreal injections of anti-VEGF and from photocoagulation therapy. Conclusion: The Covid-19 pandemic reduced surgical procedures and ophthalmologic consultations in training hospitals when compared to prior years, with the exceptions of intravitreal injections of anti-angiogenic (anti-VEGF) and photocoagulation therapy, which increased.

RESUMO Objetivo: Avaliar o impacto da Covid-19 sobre o número de consultas, exames e procedimentos médicos realizados em um hospital público de ensino oftalmológico no Brasil. Métodos: Foi revisado e comparado o número total de consultas, procedimentos ambulatoriais e cirurgias realizadas entre março de 2018 e março de 2021. O número de cirurgias por residente também foi revisado. Resultados: Houve queda de 31,6% dos atendimentos realizados no período de 2020 em relação à média dos dois últimos anos pré-pandêmicos, com um total de 38.235 avaliações oftalmológicas. Todas as modalidades cirúrgicas diminuíram de março a julho de 2020. Houve queda de 35,27% (4.322 cirurgias) em 2020 em relação à média dos anos 2018 e 2019. Houve redução de 16,3% nos exames realizados. As capsulotomias e as iridotomias a laser seguiram com queda de 35,89% e 23,57%, respectivamente, em 2020. No entanto, houve um aumento de 12,7% em relação à média dos últimos 2 anos antes da pandemia nas injeções intravítreas antiangiogênicas e na terapia de fotocoagulação. Conclusão: A pandemia da Covid-19 reduziu os procedimentos cirúrgicos e as consultas oftalmológicas em hospitais de treinamento em comparação com os anos anteriores, com exceção de injeção intravítrea antiangiogênica e terapia fotocoagulação.

Abstract Introduction Low-Level Red-Light (LLRL) Therapy is a safe and natural way to promote healing and reduce inflammation in the body. When it comes to treating myopia in children, LLRL therapy is recent, and its efficacy and safety still are not clear. Methods A systematic review and meta-analysis of the literature for LLRL was conducted in accordance with the PRISMA guidelines on November 5, 2022. Databases, including PUBMED, Cochrane Library, Web of Science, and Embase were queried. A meta-analysis of random effects was conducted. Inclusion criteria included Randomized Controlled Trials (RCTs) or observational studies where LLRL therapy was used in children (3‒15 years old) with myopia. Exclusion criteria were studies with other ocular abnormalities. Efficacy was evaluated through the mean change in Axial Length (AL) and cycloplegic Spherical Equivalent Error (SER), while safety was evaluated by monitoring adverse effects. Results A total of 5 final studies were included (4 RCTs, and 1 observational), in which 685 total patients were analyzed. The mean age was 9.7 ± 0.66 years, with 48,2% female patients. The number of eyes in the LRLL arm is 714 and, in the control, arm is 656. LLRL showed better results in SER and AL mean change (OR = 0.58; 95% CI 0.33 to 0.83; p < 0.00001, and MD -0.33; 95% CI -0.52 to -0.13; p = 0.001, respectively), in comparison to the control group. There was no significant difference in adverse effects between groups (MD = 5.76; 95% CI 0.66 to 50.14; p = 0.11). Conclusion LLRL therapy is a non-invasive, effective, and safe short-term treatment option; however, long-term evaluation, particularly in comparison to other therapies, requires additional investigation.

ABSTRACT Purpose: To evaluate the visual, topographic, and refractive outcomes of the implantation of asymmetric segments (AS) of the ICRS intracorneal ring in eyes with keratoconus and irregular/asymmetric astigmatism (phenotypes type 2 Duck and 3 Snowman by morphological classification of Fernandez-Vega/Alfonso Keratoconus). Methods: Prospective clinical study including 60 patients (60 eyes) with keratoconus who underwent implantation of the Kearing ICRS selected and implanted according to the Mediphacos nomogram (http://kearing.online) with femtosecond laser. Preoperative and postoperative evaluations included uncorrected visual acuity, best corrected visual acuity, refractive astigmatism, spherical equivalent, and topographic astigmatism, Kmax, and coma measured with the Galilei (Ziemer, Port, Switzerland). All parameters were assessed preoperatively and at 3 and 6 months postoperatively. Results: Overall mean age was 26.34 ± 8.49 years; 28 (56.7%) were female, 34 eyes had keratoconus of type 2 phenotype and another 26 eyes of type 3 phenotype. At 6 months postoperatively, eyes with type 2 phenotype obtained gains in uncorrected visual acuity and best corrected visual acuity of 0.30 LogMAR and 0.15 LogMAR, respectively; and reductions of 2.45D in topographic astigmatism; 2.30D in Kmax; 0.32μm in coma; 1.63D in refractive astigmatism and 1.88D in spherical equivalent. At 6 months, eyes with type 3 phenotype obtained gains in UDVA and CDVA of 0.50 logMAR and 0.10 LogMAR, respectively; and reductions of 3.00D in topographic astigmatism; 5.20D in Kmax; 0.09μm in coma; 2.00D in refractive astigmatism and 4.25D in spherical equivalent. The results of the comparisons at 3 and 6 months postoperatively were not statistically significant for any of the variables evaluated, which denotes the stability of the procedure in this follow-up time. Conclusion: Implantation of the asymmetric Kearing in eyes with keratoconus and asymmetric/irregular astigmatism (type 2 and 3 phenotypes) improved visual, topographic, and refractive parameters with safety and clinical efficacy.

RESUMO Objetivo: Avaliar os resultados visuais, topográficos e refrativos do implante de segmentos assimétricos (AS) de anel intracorneano (ICRS) em olhos com ceratocone e astigmatismo irregular/assimétrico (fenótipos tipo 2 Duck e 3 Snowman pela classificação morfológica do ceratocone de Fernandez-Vega/Alfonso). Métodos: Estudo clínico prospectivo realizado com 60 pacientes (60 olhos) com ceratocone que tiveram segmentos assimétricos de Kearing selecionados e implantados de acordo com o nomograma Mediphacos (http://kearing.online) com laser femtosegundo. As avaliações pré-operatórias e pós-operatórias incluíram medida de acuidade visual não corrigida, melhor acuidade visual corrigida, astigmatismo refracional, equivalente esférico e astigmatismo topográfico, Kmax e coma, medidos com o Galilei (Ziemer, Port, Suíça). Todos os parâmetros foram avaliados no pré-operatório e aos 3 e 6 meses de pós-operatório. Resultados: A média de idade dos pacientes foi de 26,34±8,49 anos; 28 (56,7%) eram do sexo feminino, 34 olhos apresentavam ceratocone de fenótipo tipo 2 e outros 26 olhos de fenótipo tipo 3. Aos 6 meses de pós-operatório, os olhos de fenótipo tipo 2 obtiveram ganhos na acuidade visual não corrigida e melhor acuidade visual corrigida de 0,30 LogMAR e 0,15 LogMAR, respectivamente; e reduções de 2,45D no astigmatismo topográfico; 2,30D no Kmax; 0,32μm no coma; 1,63D no astigmatismo refracional e 1,88D no equivalente esférico. Aos 6 meses, os olhos de fenótipo tipo 3 obtiveram ganhos na acuidade visual não corrigida e na melhor acuidade visual corrigida de 0,50 logMAR e 0,10 LogMAR, respectivamente; e reduções de 3,00D no astigmatismo topográfico; 5,20 D no Kmax; 0,09μm no coma; 2,00D no astigmatismo refracional e 4,25D no equivalente esférico. Os resultados das comparações entre 3 e 6 meses de pós-operatório não foram estatisticamente significativos para nenhuma das variáveis avaliadas, o que denotou a estabilidade do procedimento nesse tempo de seguimento. Conclusão: O implante de segmentos assimétricos de Kearing em olhos com ceratocone e astigmatismo irregular/assimétrico (fenótipos tipo 2 e 3) melhoraram os parâmetros visuais, topográficos e refrativos com segurança e eficácia clínica.

RESUMO Objetivo: Analisar a teleconsulta em um hospital público de ensino oftalmológico, durante o período da pandemia do COVID-19. Métodos: Foram revisados os registros médicos dos pacientes que solicitaram teleconsulta oftalmológica, no período de Junho de 2020 a Março de 2021. Os resultados incluem dados demográficos, sintomas de queixas oculares e hipóteses diagnósticas. Além disso, foram analisados dados da pesquisa de satisfação aplicada após cada teleconsulta. Resultados: Um total de 161 prontuários foram revisados. A idade média dos pacientes foi de 45.98 ± 17.57 (8 a 90) anos, a maioria mulheres, 113 (70,20%). Apenas 57 (35,60%) eram pacientes acompanhados no hospital previamente. A principal razão pela busca pela teleconsulta foi o erro refracional, 73 (45.43%), seguido de olho seco, 16 (9.93%), pterígio, 13 (8.07%). Outros motivos foram o acompanhamento de doenças prévias como glaucoma, retinopatias, miopia, estrabismo e ceratocone. Quanto a pesquisa de satisfação, 151(93,87%) pacientes responderam a pesquisa on-line. A maioria deles mostrou-se satisfeito com a teleconsulta (94.03%) e fariam uma nova teleconsulta (90.06%). Conclusão: A teleconsulta pode auxiliar a saúde pública em oftalmologia podendo ser utilizada em hospitais universitários. Embora o erro refracional tenha sido o motivo mais frequente nas consultas, os pacientes mostraram-se satisfeitos com essa modalidade de atendimento que serve como um serviço de orientação.

ABSTRACT Purpose: To analyze teleconsultation at a public ophthalmic teaching hospital during the COVID-19 pandemic in Brazil. Methods: Medical records of patients who requested ophthalmological teleconsultation between June 2020 and March 2021 were reviewed. The main outcomes included demographic data, eye disease symptoms, hypothesized diagnosis, and management. Moreover, the results of a satisfaction survey administered after the consultation were analyzed. Results: Medical records of a total of 161 patients were reviewed. The mean age was 45.98 ± 17.57 (8-90) years, and most were women (113, 70.20%). Only 57 (35.60%) of the patients had made previous follow-up visits to the hospital. The most frequent reason for consultation was the need for a new eyeglass prescription (73, 45.34%), followed by dry eye symptoms (16, 9.93%) and pterygium (13, 8.07%). Other reasons were the monitoring of previously diagnosed eye diseases, such as glaucoma, retinopathies, strabismus, and keratoconus. Regarding the satisfaction survey, 151 (93.78%) patients answered the online questionnaire. Most reported that they were satisfied with the teleconsultation (94.03%) and would participate in a future teleconsultation (90.06%). Conclusion: Teleconsultation could be widely used to assist patients in public ophthalmology healthcare and teaching hospitals. Even though new eyeglass prescriptions are a frequent reason for ophthalmological appointments, patients tend to be satisfied with teleconsultation, as it also provides guidance.

RESUMO Objetivo: Avaliar a eficácia de uma pinça fragmentadora de núcleo, de baixo custo, desenvolvida para reduzir o uso de ultrassom durante a emulsificação do núcleo. Métodos: Sessenta olhos de porco com 10 horas de enucleação foram colocados no forno de microondas, em potência máxima por 10 segundos, para a formação de catarata com dureza comparável à de um núcleo grau IV na Lens Opacities Classification System III. A extração da catarata foi realizada com o facoemulsificador Centurion® (Alcon Laboratories, Genebra, Suíça) e microscópio Leica M620. Todos os olhos foram submetidos a técnica de pre-chop, dividindo o núcleo em quatro partes. Em 30 olhos, após o pre-chop, foi feita a facoemulsificação dos quadrantes com o modo torsional e, nos outros 30 olhos, após o pre-chop, cada quadrante foi fragmentado com a pinça antes da facoemulsificação com o modo torsional. O aparelho foi calibrado para todos os olhos com os seguintes parâmetros: faco torsional linear 40%; pressão intraocular 65 mmHg; vácuo linear 600mmHg e fluxo de aspiração 40cc/minuto. Após cada procedimento, verificaram-se energia dissipada acumulada; média da amplitude do faco torsional; média equivalente do poder ultrassônico; líquido aspirado estimado; tempo total de ultrassom e tempo total de aspiração. A análise estatística foi realizada utilizando o teste de Kruskal-Wallis com o IBM Statistical Package for Social Sciences. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Houve redução estatisticamente significante em favor do uso da pinça fragmentadora de núcleo em todos os parâmetros, menos na média de amplitude do faco torsional. Conclusão: O uso da pinça fragmentadora de núcleo contribuiu para melhorar a eficácia do faco torsional em olhos de porco enucleados.

ABSTRACT Objective: To evaluate the efficacy of low-cost nucleus fragmenting forceps designed to reduce the use of ultrasound during phacoemulsification. Methods: A total of 60 pig eyes enucleated 10 hours before were placed in the microwave oven, at maximum power for 10 seconds, to form cataracts with hardness comparable to a grade IV nucleus in the Lens Opacities Classification System III. Cataract extraction was performed using the Centurion® phacoemulsifier (Alcon Laboratories, Geneve, Switzerland) and Leica M620 microscope. All eyes were submitted to the pre-chop technique dividing the nucleus into four parts. After the pre-chop, the quadrants in 30 eyes were phacoemulsified with the torsional mode and were fragmented in the remaining 30 eyes after the pre-chop was with the fragmentation forceps before torsional mode phacoemulsification. The device was calibrated for all eyes by applying the following parameters: 40% linear torsional phacoemulsification; intraocular pressure of 65 mmHg; the linear vacuum of 600 mmHg; aspiration flow of 40 ccs/minute. After each procedure, the following was recorded: cumulative dissipated energy; equivalent average torsional amplitude; equivalent average ultrasonic power; estimated aspirated fluid; ultrasound total time; and total aspiration time. Statistical analysis was performed using the Kruskal-Wallis test and the IBM Statistical Package for Social Sciences. The p-value <0.05 was considered statistically significant. Results: There was a statistically significant reduction favoring the use of the nucleus fragmenting forceps in all parameters, except for the average torsional amplitude. Conclusion: The use of the nucleus fragmenting forceps contributed to improving the efficacy of torsional phacoemulsification in enucleated pig eyes.

ABSTRACT Objective To evaluate the standards of practice of Brazilian cataract surgeons in relation to the protective measures adopted to mitigate the risks of transmission of COVID-19 during cataract surgery, in asymptomatic patients. Methods A descriptive, cross-sectional, quantitative paradigm study, developed from a self-administered electronic questionnaire sent to ophthalmologists and residents/specialists in ophthalmology in Brazil, who performed cataract surgeries in 2019 and 2020, connected through social media and mail listing from local societies. Results Of the 303 participating surgeons, 159 (n=52.2%) performed elective cataract surgeries between March 20th, 2020 to June 1st, 2020. Among the measures adopted by ophthalmologists with the purpose of preventing viral transmission, the patient’s temperature was measured by 84.3% (n=134), and the verification of respiratory symptoms and contact/exposure to cases of COVID-19 by 87.4% (n=139). Most did not submit their patients to laboratory tests to detect COVID-19 (145; 91.2%). In surgery, 44.7% (n=71) used an N95 mask, and 69.2% (n=110) kept their patients with a mask. No stage of phacoemulsification was modified in 144 (90.6%) participants, 13 (8.2%) added methylcellulose under the main incision, and two (1.3%), modified another surgical stage. Conclusion The COVID-19 pandemic significantly interrupted part of cataract surgeries in Brazil from March to June 2020 and measures to prevent viral spread are being heterogeneously adopted by surgeons. Understanding these measures could be the first step to improve strategies to return to pre-pandemic levels.

RESUMO Objetivo Avaliar os efeitos do uso de lentes oftálmicas com filtro seletivo de luz azul-violeta, sem e com poder adicional de + 0,4D na zona de perto nas funções de acomodação e convergência e para sintomas de astenopia digital (AD). Métodos Ensaio clínico controlado, randomizado e mascarado, com 49 voluntários (idade, 29 ± 5,5 anos; masculino: feminino, 18: 31). Cada participante usou lentes de teste (+0,40 D na zona de perto) e controle (visão simples), por 4 semanas de forma randomizada. Ambas as lentes tinham filtro seletivo de luz azul-violeta. A medição inicial (baseline) foi feita com os óculos atualizados de cada participante. A amplitude de acomodação (AA) e o ponto de convergência próximo (PPC) foram medidos binocularmente com a régua RAF. A AD foi avaliada por um questionário. Resultados Não houve diferença estatisticamente significante (p=0,52) para as medidas de AA comparando as lentes baseline (11,50±1,88 D), teste (11,61±1,62 D) e controle VS (11,88±1,50 D). Nenhuma diferença significativa foi encontrada para a medida do PPC (p=0,94), entre as lentes baseline (6,50 ± 2,89cm), teste (6,71±3,49) e controle VS (6,82±3,50 cm). Nenhuma diferença significativa foi encontrada comparando lentes teste de VS e controle nos sintomas de AD (p=0,20). Conclusões As lentes com +0,40 D não têm impacto negativo na convergência ou na perda de acomodação. As lentes +0,40 D e controle VS, tiveram impacto semelhante na redução dos sintomas de AD.

ABSTRACT Purpose Evaluate blue-violet light filter and additional power of +0.40 D in the near zone ophthalmic lenses, on convergence, accommodative functions, and symptoms of digital asthenopia (DA). Methods Randomized study in cross-over design conducted on 49 volunteers (age, 29 ± 5.5 years; male: female, 18:31). Each subject wore test (+0.40 D in the near zone) and control lenses (regular single vision) for 4 weeks in randomized order. Both lenses had a selective blue-violet light filter. A baseline measurement was taken with the subjects’ current updated glasses. Accommodation amplitude (AA) and near point of convergence (NPC) were measured binocularly with the RAF ruler. DA was evaluated by a questionnaire. Results No significant difference (p=.52) was found for AA comparing baseline (11.50±1.88 D), test (11.61± 1.62 D), and control SV lenses (11.88±1.50 D). No significant difference was found for NPC (p=.94), between baseline (6.50 ± 2.89cm), test (6.71± 3.49) and control SV lenses (6.82± 3.50 cm). No significant difference was found comparing test and control SV lenses in symptoms of DA (p=0.20). Conclusions The +0.40 D lenses have no negative impact on convergence or loss of accommodation power. The +0.40 D and control SV lenses had a similar impact on attenuating symptoms of DA.

Abstract Background: Elderly patients may present with visual function impairment after surgery, which may increase the incidence of postoperative delirium and falls and decrease their quality of life. The aim of this study was to assess visual function in elderly patients after long-duration nonocular surgery to determine the incidence and risk factors for visual function impairment after surgery. Methods: This prospective and observational study included patients aged between 60 and 80 years who had been scheduled for elective non-ocular surgery expected to last longer than 120 minutes under general anaesthesia. Ocular examinations were performed before surgery, on post-operative day 3 and on post-operative day 21 and consisted of a LogMAR-Snellen chart test, a Jager chart test, biomicroscopy, optical tonometry, ocular motility assessment and fundoscopy. Baseline characteristics of all patients as well as intraoperative and postoperative data were collected. Results: A total of 107 patients were included in the final analysis. Visual function impairment was diagnosed in 21 patients (19.6%) at POD 3. Of those, 7 patients (6.5%) still presented with visual changes at POD 21. On POD 3, compared with that at baseline, visual acuity assessed by the Snellen chart test had decreased in these patients. Significant differences regarding refraction tests and intraocular pressure measures were also found. Multivariable analysis identified diabetes mellitus, duration of surgery, hypotension during anaesthesia induction, lower peripheral oxygen saturation at the end of the procedure and body mass index as independent risk factors for postoperative visual impairment. Conclusion: In elderly patients undergoing long-duration non-ocular procedures under general anaesthesia, the incidence of visual function impairment was considerably high. Most patients recovered to baseline visual function, but clinically significant visual changes may still be present 3 weeks after surgery. Obesity, diabetes mellitus, and the duration of surgical and anaesthetic techniques appear to increase the risk of visual impairment after surgery.

RESUMO Relatamos um caso de dois gêmeos em que o ceratocone avançado está presente em um dos irmãos e nenhum sinal da doença foi encontrado no outro.

ABSTRACT We report a case of two twins for whom advanced keratoconus is present in one of the siblings and no clear sign of the disease could be found for the other.

RESUMO Objetivos: Avaliar a sensibilidade, especificidade e acurácia da refratometria obtida através do aparelho photoscreener 2WIN® como método de rastreio de ametropias com indicação de prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria em crianças assintomáticas, de origem extra-hospitalar, de 6 a 36 meses de idade, e determinar se a cicloplegia influencia a capacidade de rastreio do aparelho. Métodos: Cento e setenta e oito (178) de crianças com idades entre 6 e 36 meses tiveram sua refratometria mensurada pelo método padrão-ouro, a retinoscopia manual sob cicloplegia, e pelo método em teste, o photoscreener 2WIN®, antes e após a cicloplegia. Resultados: O photoscreener 2WIN® é capaz de identificar aqueles pacientes que deveriam receber prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria com sensibilidade de 100%, especificidade de 93,18% e acurácia de 93,26%, quando comparado a retinoscopia estática. Sob cicloplegia, o 2WIN® mantém sensibilidade de 100%, porém aumenta sua especificidade para 96,59% e a acurácia para 96,63%. Conclusão: O photoscreener 2WIN® se mostrou altamente sensível, específico e acurado para uso como equipamento de triagem daqueles pacientes de 6 a 36 meses que se beneficiariam do uso de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria, com discreto aumento da especificidade e acurácia quando aplicado em pacientes cicloplegiados.

ABSTRACT Objective: Evaluate the sensitivity, specificity e accuracy of the ocular refraction measured by the 2WIN® photoscreener as a screening method to identify children in need of spectacles prescription according to the criteria published by the Brazilian Society of Pediatric Ophthalmology (BSPO) in asymptomatic children, 6 to 36 months old, and determine the impact of cycloplegia in the sensitivity, specificity and accuracy of this method. Methods: One hundred seventy-eight (178) eyes of asymptomatic children between the ages of 6 and 36 months have been submitted to ocular refraction measurements by the gold-standard method, the manual retinoscopy under cycloplegia, and the method been tested, the 2WIN® photoscreening, both before and under cycloplegia. Results: The 2WIN® photoscreener before cycloplegia was able to identify those patients in need of spectacles prescription according to the criteria published by the BSPO with 100% sensitivity, 93.18% specificity and 93.26% accuracy, when compared to the manual retinoscopy under cycloplegia. The 2WIN® photoscreener under cycloplegia maintained a sensitivity of 100%, but increased specificity to 96.59% and accuracy to 96.63%. Conclusion: The 2WIN® photoscreener before cycloplegia showed high sensitivity, specificity, and accuracy in detection of patients in need of spectacles prescription according to the criteria published by the BSPO in the tested population, with minor increase in specificity and accuracy when the measurements were performed under cycloplegia.