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. Objetivo oftalmológico COVID19. COVID19 COVID 19. 19 COVID-19 Métodos oftalmológica 202 2021 demográficos diagnósticas disso Resultados 4598 45 98 45.9 1757 17 17.5 8 ( 90 anos mulheres 11 70,20%. 7020 70,20% . 70 20 (70,20%) 5 35,60% 3560 35 60 (35,60% previamente 7 45.43%, 4543 45.43% , 43 (45.43%) seco 1 9.93%, 993 9.93% 9 93 (9.93%) pterígio 8.07%. 807 8.07% 07 (8.07%) glaucoma retinopatias miopia ceratocone 15193,87% 1519387 151 93,87% 87 151(93,87% online. online on line. line on-line mostrouse mostrou se 94.03% 9403 94 03 (94.03% 90.06%. 9006 90.06% 06 (90.06%) Conclusão universitários consultas mostraramse mostraram orientação COVID1 COVID-1 459 4 45. 175 17. 702 70,20 2 (70,20% 35,60 356 3 6 (35,60 454 45.43 (45.43% 99 9.93 (9.93% 80 8.07 0 (8.07% 15193 15193,87 151938 15 9387 93,87 151(93,87 94.03 940 (94.03 900 90.06 (90.06% COVID- 70,2 (70,20 35,6 (35,6 45.4 (45.43 9.9 (9.93 8.0 (8.07 1519 15193,8 938 93,8 151(93,8 94.0 (94.0 90.0 (90.06 70, (70,2 35, (35, (45.4 9. (9.9 8. (8.0 15193, 93, 151(93, 94. (94. 90. (90.0 (70, (35 (45. (9. (8. 151(93 (94 (90. (70 (3 (45 (9 151(9 (90 (7 (4 151(

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. Purpose COVID19 COVID 19 COVID-1 Brazil Methods 202 reviewed data diagnosis management Moreover analyzed Results 16 4598 45 98 45.9 1757 17 17.5 890 8 90 (8-90 years 113, 113 (113 70.20%. 7020 70.20% . 70 20 70.20%) 5 35.60% 3560 35 60 (35.60% followup follow up 73, 73 (73 45.34%, 4534 45.34% , 34 45.34%) 16, (16 9.93% 993 9 93 13, 13 (13 8.07%. 807 8.07% 07 8.07%) diseases glaucoma retinopathies strabismus keratoconus 15 93.78% 9378 78 (93.78% questionnaire 94.03% 9403 94 03 (94.03% 90.06%. 9006 90.06% 06 (90.06%) Conclusion hospitals appointments guidance COVID1 1 COVID- 459 4 45. 175 17. 89 (8-9 11 (11 702 70.20 7 2 35.60 356 3 6 (35.60 (7 453 45.34 (1 9.93 99 80 8.07 0 93.78 937 (93.78 94.03 940 (94.03 900 90.06 (90.06% (8- 70.2 35.6 (35.6 ( 45.3 9.9 8.0 93.7 (93.7 94.0 (94.0 90.0 (90.06 (8 70. 35. (35. 9. 8. 93. (93. 94. (94. 90. (90.0 (35 (93 (94 (90. (3 (9 (90

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. Objetivo visuais AS (AS ICRS (ICRS irregularassimétrico irregular assimétrico fenótipos FernandezVega/Alfonso. FernandezVegaAlfonso Fernandez Vega/Alfonso . Vega Alfonso Fernandez-Vega/Alfonso) Métodos (6 http//kearing.online httpkearingonline http //kearing.online kearing online (http://kearing.online femtosegundo préoperatórias pré operatórias pósoperatórias pós topográfico coma Ziemer, Ziemer (Ziemer Port Suíça. Suíça Suíça) préoperatório operatório pósoperatório. pósoperatório operatório. Resultados 2634849 8 49 26,34±8,4 anos 56,7% 567 56 7 (56,7% feminino pósoperatório, operatório, 030 0 30 0,3 015 15 0,1 respectivamente 245D 45D 230D 30D 032μm μm 32μm 163D 1 63D 188D 88D 050 50 0,5 010 10 300D 00D 520 5 20 5,2 009μm 09μm 200D 425D 4 25D avaliadas seguimento Conclusão clínica FernandezVega FernandezVega/Alfonso VegaAlfonso Fernandez-Vega/Alfonso ( kearingonline 263484 26,34±8, 56,7 (56,7 03 0, 01 05 52 5, 26348 26,34±8 56, (56, 2634 26,34± (56 263 26,34 (5 26,3 26,

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. Purpose AS (AS irregularasymmetric irregular phenotypes FernandezVega/Alfonso FernandezVegaAlfonso Fernandez Vega/Alfonso Vega Alfonso Keratoconus. Keratoconus . Keratoconus) Methods (6 http//kearing.online httpkearingonline http //kearing.online kearing online (http://kearing.online laser equivalent Kmax Ziemer, Ziemer (Ziemer Port Switzerland. Switzerland Switzerland) Results 2634 26.3 849 8 49 8.4 years 56.7% 567 56 7 (56.7% female 030 0 30 0.3 015 15 0.1 respectively 245D D 45D 230D 30D 032μm μm 32μm 163D 1 63D 188D 88D 050 50 0.5 010 10 300D 00D 520D 5 20D 009μm 09μm 200D 425D 4 25D evaluated followup follow up time Conclusion asymmetricirregular efficacy FernandezVega VegaAlfonso ( kearingonline 263 26. 84 8. 56.7 (56.7 03 0. 01 05 56. (56. (56 (5

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. LowLevel Low Level RedLight Red Light (LLRL body recent clear metaanalysis meta analysis 2022 Databases PUBMED Library Science queried RCTs (RCTs 3‒15 315 3 15 (3‒1 old abnormalities (AL SER, , (SER) 4 ( observational, observational) 68 analyzed 97 9 7 9. 066 0 66 0.6 482 48 2 48,2 71 656 OR 0.58 058 58 95 033 33 0.3 0.83 083 83 000001 00001 0.00001 -0.33 0.52 052 52 -0.5 0.13 013 13 -0.13 0001 001 0.001 respectively, respectively respectively) group 5.76 576 76 50.14 5014 50 14 0.11. 011 0.11 . 11 0.11) noninvasive, noninvasive non invasive, invasive non-invasive effective shortterm short term option however longterm long evaluation therapies investigation 202 3‒1 31 (3‒ (SER 6 06 0. 48, 65 0.5 05 03 0.8 08 8 00000 0000 0.0000 -0.3 -0. 0.1 01 -0.1 000 00 0.00 5.7 57 50.1 501 20 3‒ (3 0.000 -0 0.0 5. 50. -

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. treatment However impact Therefore metaanalysis meta analysis MetaAnalysis Meta Analysis PRISMA (PRISMA 9 2023 Databases PubMed Library Science Embase queried performed months complications nonrandomized non 61 626 (62 eyes. eyes . eyes) OR=4.35 OR435 OR 4 35 (OR=4.35 95%CI=2.089.10 95CI208910 CI 95%CI=2.08 9.10 95 08 10 95%CI=2.08-9.10 p<0.0001 p00001 p 0 0001 I²=9%. I²9 I I²=9% I² I²=9%) postoperative post operative more groups Thus holes protocols followups, followups follow ups, ups follow-ups registration https//www.crd.york.ac.uk/prospero/ httpswwwcrdyorkacukprospero https //www.crd.york.ac.uk/prospero/ www crd york ac uk prospero (https://www.crd.york.ac.uk/prospero/ CRD42023455815 CRD 202 62 (6 OR=4.3 OR43 3 (OR=4.3 089 95%CI=2.089.1 95CI20891 95CI208 95%CI=2.0 910 9.1 1 95%CI=2.08-9.1 p<0.000 p0000 000 I²=9 https//www.crd.york.ac.uk/prospero wwwcrdyorkacukprospero //www.crd.york.ac.uk/prospero (https://www.crd.york.ac.uk/prospero CRD4202345581 20 ( OR=4. OR4 (OR=4. 95%CI=2.089. 95CI2089 95CI20 95%CI=2. 91 9. 95%CI=2.08-9. p<0.00 p000 00 I²= CRD420234558 OR=4 (OR=4 95%CI=2.089 95CI2 95%CI=2 95%CI=2.08-9 p<0.0 p00 CRD42023455 OR= (OR= 95CI 95%CI= 95%CI=2.08- p<0. p0 CRD4202345 (OR 95%CI p<0 CRD420234 p< CRD42023 CRD4202 CRD420 CRD42 CRD4

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. Objetivo Covid19 Covid 19 Covid-1 Brasil Métodos 201 2021 Resultados 316 31 6 31,6 202 prépandêmicos, prépandêmicos pré pandêmicos, pandêmicos pré-pandêmicos 38235 38 235 38.23 3527 35 27 35,27 4.322 4322 4 322 (4.32 2019 163 16 3 16,3 3589 89 35,89 2357 23 57 23,57% respectivamente entanto 127 12 7 12,7 fotocoagulação Conclusão anteriores Covid1 1 Covid- 20 31, 3823 38.2 352 35,2 4.32 432 32 (4.3 16, 358 8 35,8 5 23,57 12, 382 38. 35, 4.3 43 (4. 23,5 4. (4 23, (

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. Objective Covid19 Covid 19 Covid-1 appointments Brazil Methods 201 202 Results 316 31 6 31.6 prepandemic pre 38235 38 235 38.23 evaluations 3527 35 27 35.27 4,322 4322 4 322 (4,32 2019 163 16 3 16.3 3589 89 35.89 2357 23 57 23.57 respectively However 127 12 7 12.7 antiVEGF anti VEGF therapy Conclusion antiangiogenic angiogenic (anti-VEGF increased Covid1 1 Covid- 20 31. 3823 38.2 352 2 35.2 4,32 432 32 (4,3 16. 358 8 35.8 5 23.5 12. 382 38. 35. 4,3 43 (4, 23. 4, (4 (

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 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 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 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 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: 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.