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.

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.

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 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: 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.

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.

Resumo Objetivo: Descrever manifestações clínicas e fenotípicas e o prognóstico visual de uma família com aniridia congênita (AC). Métodos: Trata-se de estudo transversal envolvendo 31 indivíduos (56 olhos), de uma mesma família com fenótipo de AC residindo no município de Água Branca, no sertão do estado de Alagoas, região nordeste do Brasil. Foram analisadas variáveis clínicas e fenotípicas. Para a análise, foi utilizada a estatística descritiva (frequência absoluta e relativa e medidas de tendência central e de dispersão) e inferencial (testes de Shapiro-Wilk e t Student). Considerou-se o intervalo de confiança de 95% e a significância de 5%. Resultados: Dos 31 indivíduos, 18 (58,1%) eram do sexo masculino, com média de idade de 27,45±17,49, sem diferença entre os sexos. Dos 56 olhos avaliados, 26 eram olhos direitos e 30 olhos esquerdos: 61,3% (n=19) apresentavam aniridia bilateral total; 25,8% (n=8) referiam perda total de percepção da luz em ambos os olhos. As anormalidades oculares mais prevalentes foram o nistagmo (n=27; 87,09%), catarata (n=20; 64,5%), estrabismo 14 (45,2%), alterações opacidades ou vascularização corneanas (n=13; 41,93%) e ectopia lentis (n=6; 19,4%). Os 13 indivíduos submetidos à tomografia de coerência óptica (OCT) retiniana apresentavam perda da depressão foveal, redução da espessura macular e redução da acuidade visual. Nove indivíduos foram submetidos a cirurgia de facoemulsificação. Conclusão: O estudo mostrou ampla variação fenotípica entre os indivíduos estudados, com pobre prognóstico visual. O estudo destaca a necessidade de estabelecer mecanismos de cuidado integral para as famílias com a doença.

Abstract Objective: We aimed to describe the clinical and phenotypic manifestations as well as the visual prognosis of a family with CA in Northeastern Brazil. Methods: This was a cross-sectional study involving 31 individuals (56 eyes) from the same family presenting CA phenotypes. The study population resided in the municipality of Água Branca, in the backlands of the state of Alagoas, Northeastern Brazil. The clinical and phenotypic variables were analyzed. For the analysis, descriptive statistics (absolute and relative frequency and measures of central tendency and dispersion) and inferential statistics (Shapiro–Wilk and Student's t tests) were used, with 95% confidence intervals and significance set at 5%. Results: Of the 31 individuals, 18 (58.1%) were male, with a mean age of 27.45 ± 17.49 years, with no difference between sexes. Of the 56 eyes evaluated, 26 and 30 were right and left eyes, respectively; 61.3% (n = 19) individuals had complete bilateral aniridia and 25.8% (n = 8) reported a total loss of light perception in both the eyes. The most prevalent ocular abnormalities were nystagmus (n = 27; 87.09%), cataract (n = 20; 64.5%), strabismus (n = 14; 45.2%), corneal changes such as opacities and/or vascularization (n = 13; 41.93%), and ectopia lentis (n = 6; 19.4%). Further, 13 individuals underwent retinal optical coherence tomography, six man and seven women aged 9–48 (mean, 30.15 ± 15.9) years. All patients presented absence of foveal depression as well as reduced macular thickness and visual acuity. Nine subjects underwent phacoemulsification. Conclusion: The study showed wide phenotypic variation among the studied individuals, with poor visual prognosis. The study highlights the need to establish comprehensive care mechanisms for families with the disease.

Resumo Objetivo: Comparadas com lentes oftálmicas regulares, as lentes de visão simples com +0,40D de poder adicicional de perto reduzem os sintomas de astenopia induzida por computador? Métodos: Foi realizado um estudo clínico prospectivo com 39 voluntários que passavam mais de 4h diárias utilizando computador (idade: 27,31±4,24 anos; masculino:feminino = 26:13). A astenopia e a percepção do conforto visual foram avaliadas com questionários. Todos os participantes respoderam ao questionário de astenopia com lentes regulares atualizadas (baseline). Após 4 semanas de uso das lentes +0.40 Eyezen™ os participantes responderam aos questionários de astenopia e de conforto visual. A análise estatística foi feita com os testes de Shapiro-Wilk e Wilcoxon. Valores de p<0,05 foram considerados estatísticamente significantes. Resultados: Comparadas com lentes oftálmicas regulares (baseline), o uso das lentes de visão simples com +0,40D de poder adicional de perto reduziu o escore total de astenopia de 17,44 ± 5,51 para 13,18± 10,22 (p< 0,001). Mais de 90% dos participantes se declaram completamente ou muito satisfeitos com o conforto visual percebido no uso de dispositivos digitais. Conclusão: A astenopia induzida por computadores foi significativamente reduzida pelo uso das lentes +0,40 Eyezen™ combinadas Crizal® Sapphire™.

Abstract Objective: Compared to standard spectacle lenses, do +0.40 EyeZenTM lenses reduce symptoms of asthenopia induced by computer? Methods: A prospective clinical study was carried out with 39 volunteers who spent more than 4 hours a day using a computer (age, 27.31±4.24; male: female =13:26). Asthenopia and visual comfort were assessed using a questionnaires. All participants completed the asthenopia questionnaire with updated regular lenses (baseline). After 4 weeks of +0.40 Eyezen™ lenses wearing all subjects answered the asthenopia questionnaire and a second questionnaire to establish their level of satisfaction with these lenses. Statistical analysis was performed usind the Shapiro-Wilk test and Wilcoxon test, and p-values less than 0.05 were considered statistically significant. Results: Compared to standard spectacle lenses (baseline), +0.40 EyeZenTM lenses wearing reduced the total asthenopia score from17.44 ± 5.51 to 13.18 ± 10.22 (p < 0.001). Regarding the perception of the visual comfort levels with these lenses in the management of digital devices, more than 90% of subjects said they were entirely or delighted with their visual comfort.. Conclusions: Digital asthenopia induced by computer was significantly reduced by +0.40 EyeZen lenses wearing.

Resumo Introdução: Os rastreamentos visuais realizados nas escolas são, às vezes, a única oportunidade de deteção dos erros de refração não corrigidos (ERN) causadores de baixa visual, prejuízo na aquisição do conhecimento, evasão e repetência escolar, habilidades motoras pobres, dificuldade na interação social e baixa autoestima nos escolares. Objetivos: Comparar a detecção de ERN em escolares do ensino fundamental por meio de rastreamento visual (medida da AV com a tabela de Snellen) e por photoscreener; avaliar a acurácia do SpotTM Vision Screener (Welch Allyn) como autorefrator comparando suas medidas de refração com as do autorrefrator Topcon KR 8000 (Japão) e levantar a proporção de óculos com a tecnologia ready to Clip™ que foram dispensados no momento da avaliação dos escolares. Métodos: Duzentos e noventa e sete escolares foram submetidos à rastreamento visual (ponto de corte: AV monocular ≤ 0,7 e/ou diferença duas linhas de Snellen entre os olhos), photoscreening (ponto de corte: hipermetropia ≥3,00D, miopia ≥0,75D e astigmatismo > 1D) e à mensuração do erro de refração sob cicloplegia com o photoscreener e o autorrefrator. Somente os dados de refração do olho direito foram analisados. Os achados foram convertidos em vetores de magnitude para análise. Resultados: Os valores de sensibilidade e especificidade do método de rastreamento visual foram 67,2% e 63,5% e do photoscreening, foram 76,1% e 79,1%. A diferença da refração do SVS com o autorrefrator foi de +0,154 DE com -0,170 DC no eixo de 6 graus para o olho direito de cada paciente. Conclusões: Na população avaliada o método de rastreamento refrativo por photoscreener foi mais efetivo que o do rastreamento visual. A comparação dos resultados da refração sob cicloplegia com o autorrefrator validou o uso do photoscreener como um método de refração acurado para a mensuração de erros refrativos em escolares. A maioria dos escolares receberam os óculos com a tecnologia ready to Clip™ no momento da prescrição.

Abstract Background: The visual screening performed in schools is sometimes the only opportunity to detect uncorrected refraction errors (URE) causing low visual impairments, prejudice in the acquisition of knowledge, dropout and school repetition, poor motor skills, difficulty in social interaction and low self-esteem in schoolchildren. Objectives: To compare the detection of URE in elementary school children by visual screening (measurement of the AV with the Snellen table) and photoscreening; to evaluate the accuracy of the SpotTM Vision Screener (Welch Allyn) as an autorefractor by comparing its refraction measurements with those of the autorefractor Topcon KR 800 (Japan) and to verify the proportion of glasses with ready to ClipTM technology dispensed at the time of the students’ evaluation. Methods: Two hundred ninety-seven students were submitted to visual screening (cutoff point: AV monocular ≤ 0.7 and/or difference two Snellen lines between the eyes), photoscreening (cutoff point: hypermetropia ≥ 3, 00D, myopia ≥ 0, 75D and astigmatism > 1D) and the measurement of the refraction error under cycloplegia with the photoscreener and autorefractor. Only the refraction data of the right eye were analyzed. The findings were converted into vectors of magnitude for analysis. Results: The sensitivity and specificity values of the visual screening method were 67.2% and 63.5% and photo screening were 76.1% and 79.1%. The mean difference between refraction by SVS and autorefractor was of + 0.154 SD combined with -0.170 DC in the 6-degree axis for the right eye of each patient. Conclusions: In the population evaluated the method of refractive screening by photoscreener was more effective than the visual screening. The comparison of the results of refraction under cycloplegia with the autorefractor validated the use of photoscreener as an accurate refraction method for the measurement of refractive errors in schoolchildren. The majority of the students received their glasses with ready to Clip™ technology at the time of prescription.

RESUMO Objetivo: Comparar a previsibilidade refrativa pós-operatória do IOLMaster 500 e Pentacam HR com base nos valores de ceratometria e profundidade de câmara anterior nos olhos com indicação de implante de lentes intraoculares multifocais. Métodos: Estudo retrospectivo realizado em 118 olhos tratados com facoemulsificação e implante de lentes intraoculares multifocal. Apenas os olhos que atingiram a emetropia na refração dinâmica no 30º dia pós-operatório foram incluídos. A fórmula de Haigis foi usada em cada caso para calcular o poder das lentes intraoculares, e a lente intraocular com a refração alvo mais próxima da emetropia foi implantada. Cenários de cálculo de quatro lentes foram testados pela combinação de medidas de ceratometria e profundidade de câmara anterior obtidas usando os dois dispositivos. Resultados: IOLMaster 500 e Pentacam HR diferiram quanto à média de ceratometria (D 0,07 ± 0,03 D; p=0,0065) e profundidade de câmara anterior (D 0,08 ± 0,01 mm; p<0,001). Na análise da covariância, as seguintes diferenças foram obtidas usando a fórmula de Haigis quando confrontadas com os valores biométricos obtidos pela inserção dos valores de ceratometria e profundidade de câmara anterior, respectivamente: Penta/IOL x IOL/Penta (0,13 ± 0,03; p<0,0001); Penta/Penta x IOL/Penta (0,13 ± 0,03; p<0,0001); Penta/IOL x IOL/IOL (0,11 ± 0,03; p=0,001); Penta/Penta x IOL/IOL (0,11 ± 0,03; p=0,002); IOL/IOL x IOL/Penta (0,02 ± 0,03; p=0,865); Penta/IOL x Penta/Penta (0,002 ± 0,03; p=0,99). A diferença foi menor ao medir a profundidade da câmara anterior usando o IOLMaster 500, independentemente de qual dispositivo foi usado para medir a ceratometria. Conclusões: O Pentacam HR diferiu significativamente do IOLMaster 500 no cálculo de ceratometria. Quanto à profundidade da câmara anterior, os dois dispositivos foram igualmente precisos.

ABSTRACT Purpose: To compare the postoperative refractive predictability of IOLMaster 500 and Pentacam HR on the basis of keratometry and anterior chamber depth values in eyes with an indication for multifocal intraocular lens (IOL) implantation. Methods: This was a retrospective study conducted on 118 eyes treated with phacoemulsification and multifocal intraocular lens implantation. Only the eyes that achieved emmetropia in the dynamic refraction performed on postoperative day 30 were included. Haigis’ formula was used in each case to calculate the intraocular lens power, and the intraocular lens with the target refraction closest to emmetropia was implanted. Four lens calculation scenarios were tested by combining keratometry and anterior chamber depth measurements obtained using the two devices. Results: IOLMaster 500 and Pentacam HR differed with regard to mean keratometry (D 0.07 ± 0.03 D; p=0.0065) and anterior chamber depth (D 0.08 ± 0.01 mm; p<0.001). In the analysis of covariance, the following differences were obtained using the Haigis’ formula when confronted with the biometric values obtained by inserting keratometry and anterior chamber depth values, respectively: Penta/IOL x IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/Penta × IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/IOL × IOL/IOL (0.11 ± 0.03; p=0.001); Penta/Penta × IOL/IOL (0.11 ± 0.03; p=0.002); IOL/IOL × IOL/Penta (0.02 ± 0.03; p=0.865); and Penta/IOL × Penta/Penta (0.002 ± 0.03; p=0.99). The difference was smaller when measuring the anterior chamber depth using the IOLMaster 500, regardless of which device was used to measure keratometry. Conclusions: Pentacam HR significantly differed from IOLMaster 500 when calculating keratometry. As regards the anterior chamber depth, the two devices were equally accurate.

Resumo Objetivos: Comparar a aniseiconia e a estereopsia em escolares anisometropes do primeiro ano do ensino fundamental corrigidos com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas e com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 e verificar a preferência dos escolares por uma destas formas de correção. Métodos: Dezenove escolares com anisometropia ≥ 1,5 D em meridianos correspondentes no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram avaliados para aniseiconia (software Aniseikonia Inspector 3) e estereopsia (teste Stereo Fly test com símbolos LEA. A preferência por uma das formas de correção foi verificada após 40-50 dias de uso dos óculos. Resultados: As médias e os desvios-padrão das aniseiconias vertical e horizontal no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram, respectivamente, -1,05% ± 2,20% e -1,37% ± 2,36% (p=0,82739) e -0,895% ± 2,23% e -1,16% ± 2,03% (p=0,77018). 31,6% dos escolares corrigidos com lentes iseicônicas e 21,1% dos escolares corrigidos com lentes oftálmicas de estoque identificaram os optotipos que sugerem estereopsia < 100 segundos de arco (p= 0,475). Em relação à preferência, 4/15 (26,7%) escolheram os óculos com lentes iseicônicas, 2/15 (13,3%) escolheram os óculos com lentes oftálmicas de estoque e para 9/15 (60%) a escolha foi indiferente. Conclusão: A aniseiconia induzida nos escolares anisometropes corrigidos com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 foi similar ao obtido na correção com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas.

Abstract Objectives: To compare the aniseikonia and the stereopsis in school children anisometropes of the first-year of elementary school corrected with stock ophthalmic lenses with base curve selected to minimize the interocular size difference of retinal images and with size lenses suggested by the software Aniseikonia Inspector 3, and to check the preference of them for one of these forms of correction. Methods: Nineteen school children with anisometropia ≥ 1.5 D in corresponding meridians, in the use of glasses with stock ophthalmic lenses and with size lenses were evaluated for aniseikonia (software Aniseikonia Inspector 3) and stereopsis (Stereo Fly test with LEA symbols). The preference for one of the forms of correction was verified after 40-50 days of wearing glasses. Results: The mean and standard deviations of the vertical and horizontal aniseikonia in the use of glasses with stock ophthalmic lenses and with size lenses were, respectively, -1.05% ± 2.20% and-1.37% ± 2.36% (p = 0,82739) and -0.895% ± 2.23% and -1.16% ± 2.03% (p = 0,77018). 31.6% of the school children corrected with size lenses and 21.1% of the students corrected with stock ophthalmic lenses identified the optotypes that suggest stereopsis less than 100 seconds of arc (p = 0.475). Regarding the preference, 4/15 (26.7%) of the students chose the glasses with size lenses, 2/15 (13.3%) chose the glasses with stock ophthalmic lenses, and for 9/15 (60%) the choice was indifferent. Conclusion: The induced aniseikonia in school children with anisometropia corrected with size lenses suggested by the software Aniseikonia Inspector 3 was similar to that obtained in the correction with stock ophthalmic lenses with base curves selected to minimize the difference of interocular size of retinal images.

OBJECTIVE: To evaluate the relationship of biomechanical properties, corneal hysteresis and corneal resistance factor with age, sex and various corneal parameters measured with a Pentacam in normal subjects. METHODS: A total of 226 eyes from 113 patients were enrolled in this study. The subjects underwent Ocular Response Analyzer and Pentacam evaluations. A varying-intercept multilevel regression was implemented using Bayesian inference. The predictor variables were age, sex, central corneal thickness, corneal volume at a 7-mm diameter, anterior chamber angle and volume, anterior chamber depth, mean radius of the corneal curvature and corneal astigmatism. RESULTS: Corneal hysteresis ranged from 5.5 to 14.8 mmHg (mean 10.42±1.74 mmHg), and the corneal resistance factor ranged from 5.7 to 15.5 mmHg (mean 10.23±1.88 mmHg). No predictor variable other than gender and central corneal thickness had a significant correlation with either corneal hysteresis or corneal resistance factor. Corneal hysteresis was positively associated with female sex and with central corneal thickness, and corneal resistance factor was positively associated with central corneal thickness. CONCLUSION: Despite the associations found, only a small fraction of the variance in biomechanical measurements could be explained by the descriptors that were evaluated, indicating the influence of other corneal aspects on the biomechanical characteristics.

Resumo Pterígios são lesões geralmente benignas que na maioria dos casos não requer tratamento específico. É um crescimento fibrovascular sobre a córnea, geralmente a partir do lado nasal. Sua causa ainda não foi elucidada, mas parece estar relacionada à exposição aos raios ultravioleta. Quando os sintomas não são controlados com tratamento conservador, a cirurgia é indicada, porém o índice de recidiva ainda é alto, e os esforços têm sido no sentido de reduzir esse índice. A mitomicina C (MMC) é uma opção de adjuvante à cirurgia por ser um inibidor da proliferação de fibroblastos, diminuindo o risco de recorrência do pterígio. Relatamos aqui um caso que descreve cirurgia de pterígio realizada em ambos os olhos de uma mesma paciente, sendo um com MMC e outro sem ela. Os resultados e o índice de proliferação celular dos dois olhos foram comparados entre si.

Abstract Pterygia are usually benign lesions that do not require specific treatment. It is a fibrovascular growth onto the nasal side of the cornea. It`s cause has not been fully elucidated yet, but seems to be related to long -term ultraviolet ray exposure. When symptoms are not controlled with conservative treatment surgery is considered, but the recurrence rate is still high, and efforts have been made to avoid it. Mitomycin C (MMC) is a fibroblast proliferation inhibitor that can be used as adjuvant to surgery to reduce recurrence. We report here a case that describes pterygium surgery performed in both eyes of the same patient, being one with MMC and the other eye without it. Both pterygium were sent to laboratory analysis. The results and proliferation index were compared between the eyes.