Characteristics of ocular trauma in the United States / Características de trauma ocular nos Estados Unidos

ABSTRACT Purpose: We aimed to study the characteristics of ocular trauma, an important but largely preventable global cause of blindness, in the United States. Methods: Retrospective chart review of the National Trauma Data Bank (2008-2014) was performed. All patients with ocular trauma were identified using ICD-9CM codes. The collected data were statistically analyzed with student's t-test, Chi-squared test, and logistic regression analysis performed using the SPSS software. The significance was set at p<0.05. Results: It was found that 316,485 (5.93%) of the 5,336,575 admitted trauma patients had ocular injuries. Their mean (SD) age was 41.8 (23) years, and most of them were men (69.4%). Race/ethnicity distribution was White 66.1%, Black 15.1%, and Hispanic 12.3%. The common injuries were orbital 39.5% and eye/adnexa contusions 34%. Associated traumatic brain injury was present in 58.2%. The frequent mechanisms were falls 25.5%, motor vehicle accident-occupant 21.8%, and struck by/against 17.6%. Patients <21 years of age had higher odds of cut/pierce injuries (OR=3.29, 95%CI=3.07-3.51) than the other age groups, those aged 21-64 years had higher odds of motor vehicle accident-cyclist (OR=4.95, 95%CI=4.71-5.19), and those >65 years had higher odds of falls (OR=16.75, 95%CI=16.39-17.12); p<0.001. The Blacks had a greater likelihood of firearm injuries (OR=3.24, 95%CI=3.10-3.39) than the other racial/ethnic groups, the Hispanics experienced more of cut/pierce injuries (OR=2.01, 95%CI=1.85-2.18), and the Whites experienced more of falls (OR=2.3, 95%CI=2.3-2.4); p<0.001. The Blacks (OR=3.41, 95%CI=3.34-3.48) and Hispanics (OR=1.75, 95%CI=1.71-1.79) mostly suffered assaults, while the Whites suffered unintentional injuries (OR=2.78 95%CI=2.74-2.84); p<0.001. Optic nerve/visual pathway injuries had the greatest association with very severe injury severity scores (OR=3.27, 95%CI=3.05-3.49) and severe Glasgow Coma Scores (OR=3.30, 95%CI=3.08-3.54); p<0.001. The mortality rate was 3.9%. Conclusions: Male preponderance and falls, motor vehicle accident-occupant, and struck by/against mechanisms agree with the previous reports. The identified demographic patterns underscore the need to develop group-specific preventive measures.

RESUMO Objetivo: O trauma ocular é uma causa importante e amplamente evitável de cegueira em todo o mundo. Nosso objetivo é estudar suas características nos EUA. Métodos: Revisão retrospectiva do National Trauma Data Bank (2008-2014). Todos os pacientes com trauma ocular foram identificados com códigos CID-9CM. Os dados coletados foram analisados estatísticamente e o teste t de student foi utilizado. As análises qui-quadrado e de regressão logística foram realizadas com o software SPSS. A significância foi estabelecida em p<0,05. Resultados: 316.485 (5,93%) de 5.336.575 pacientes internados com trauma, apresentaram lesões oculares. A média (DP) de idade foi de 41,8 (23) anos. A maioria era do sexo masculino (69,4%). A distribuição raça/etnia foi branca: 66,1%, negra; 15,1% e hispânica: 12,3%. As lesões comuns foram orbitárias: 39,5% e contusões dos olhos/anexos: 34%. A maioria (58,2%) teve lesão cerebral traumática. Os mecanismos frequentes foram: quedas: 25,5%, acidente com veículos motorizados: 21,8% e acidentes atingidos por algo/contra algo: 17,6%. Os pacientes <21 anos apresentaram chance aumentada de lesões com corte/perfuração (RC=3,29; IC95% = 3,07-3,51) do que outras faixas etárias, aqueles entre 21-64 anos responderam por acidente automobilístico-ciclista: (RC=4,95; IC95% = 4,71-5,19) e aqueles >65 anos foram vítimas de quedas (RC=16,75; IC 95% = 16,39-17,12); p<0,001. Os negros apresentaram maior probabilidade de lesões por arma de fogo (RC=3,24; IC95% = 3,10-3,39) do que outras raças/etnias e os hispânicos tiveram mais lesões de corte/perfuração (RC=2,01; IC95%= 1,85-2,18) enquanto os brancos tiveram mais quedas: (RC=2,3; IC95%= 2,3-2,4); p<0,001. Os negros (RC=3,41; IC95% = 3,34-3,48) e os hispânicos (RC=1,75; IC95% = 1,71-1,79) sofreram principalmente agressões e os brancos tiveram lesões não intencionais (RC=2,78; IC95% 2,74-2,84); p<0,001. Lesões do nervo óptico/via visual apresentaram maior associação com escore de gravidade de lesão muito grave (RC=3,27; IC95%= 3,05-3,49) e escores graves de Coma de Glasgow (RC=3,30; IC95%= 3,08-3,54); p<0,001. A taxa de mortalidade foi de 3,9%. Conclusões: Houve preponderância masculina a quedas, a acidentes com veículo motorizado atingidos por algo/contra algo conforme os relatos anteriores. Os padrões demográficos identificados realçam a necessidade de desenvolver medidas de prevenção específicas para os diferentes grupos.

Percepção sobre aspectos da doença e de seu tratamento em pacientes portadores de glaucoma / Perception about aspects of the disease and its treatment in patients with glaucoma

RESUMO Objetivo: Comparar por meio de questionários estruturados, o conhecimento sobre a doença, o manejo de colírios e a adesão ao tratamento de portadores de glaucoma pertencentes a dois públicos com nível de escolaridade e nível sócio econômico distintos. Métodos: Foi realizado um estudo transversal analítico aplicando-se questionários estruturados, com base em estudo exploratório para avaliação do nível de conhecimento dos portadores de Glaucoma em relação a doença em dois públicos diferentes: sistema único de saúde (SUS) e planos privados de saúde. Os questionários foram aplicados por médicos residentes em Oftalmologia. A amostra é composta de 202 pacientes dentre eles 100 atendidos pelo SUS e os outros 102 pacientes dos planos privados de saúde. Todos os questionários possuem termo de consentimento livre e esclarecido assinado pelo participante e pelo pesquisador responsável. Resultados: Os pacientes foram divididos em dois grupos, compostos por: 100 pacientes SUS e 102 planos de saúde privado. Os resultados revelaram que: 58,6% dos pacientes do SUS tinham escolaridade nenhuma a fundamental incompleto e 25,5% dos pacientes de convênio tinham algum nível superior); 49% do grupo SUS tinham renda com menos de 2 salários mínimos enquanto que grupo convênio apresentou 39,4% com mais de 4 salários mínimos (p<0,001); 51,5% do grupo SUS não tem gastos com compra de colírios e 67,4% do grupo convênio gasta mais de R$30,00 (p<0,001) portanto 77% do grupo SUS recebe ajuda e 52,5% do grupo convenio não recebe ajuda (p<0,001); 63,6% do grupo convenio acredita que a quantidade de instilações a mais do colírios não obtêm uma melhora do glaucoma, enquanto aproximadamente 50% do grupo SUS relata que há uma melhora com aumento das instilações ou não tem ideia (p=0,030); Ambos os grupos obtiveram um nível de conhecimento geral da doença semelhante, sem diferença estatística. Conclusão: Concluímos que, independente do nível de escolaridade e nível socioeconômico, havendo boa relação médico-paciente, além de acompanhamento orientado e próximo, é possível transmitir conhecimento adequado sobre a doença elevando o nível de adesão ao tratamento pelo paciente.

ABSTRACT Objective: Compare, through structured questionnaires, the knowledge about disease, management of eye drops and adherence to treatment of glaucoma patients disposed in two groups according to educational levels and socioeconomic levels. Methods: A cross-sectional analytical study was carried out applying structured questionnaires based on an exploratory study to assess the level of Glaucoma patients' knowledge relationated with the disease in two different audiences: the single health system (SUS) and private health plans. The questionnaires were used by doctors residents in Ophthalmology. A sample was composed of 202 patients among which 100 were attended by SUS and the others 102 patients were holders of private health plans. All questionnaires have a free and informed consent form signed by the participant and the responsible researcher. Results: Patients were divided into two groups, consisting of: 100 SUS patients and 102 private health plans. The results revealed that: 58.6% of SUS patients had incomplete elementary schooling and 25.5% of private health insurance patients had some level of higher education; 49% of the SUS group had an income with less than 2 minimum wages while the health insurance group presented 39.4% with more than 4 minimum wages (p <0.001); 51.5% of the SUS group has no spending on eye drops and 67.4% of the health insurance group spends more than R $ 30.00 (p <0.001) so, 77% of the SUS group receives financial aid and 52.5% of the health insurance group does not receive any financial support (p <0.001); 63.6% of the health insurance group believes that the bigger amount of instillations than eyedrops does not improve glaucoma, while approximately 50% of the SUS group reports that there is an improvement when increasing instillations or has no idea (p = 0.030); Both groups obtained a similar level of general knowledge of the disease, with no statistical difference. Conclusion: We conclude that regardless of educational and socioeconomic level if prevails a good doctor-patient relationship, in addition to close monitoring, it is possible to transmit adequate knowledge about the disease, increasing levels of treatment adherence.

Impact of a mobile unit on access to eye care in São Paulo, Brazil / Impacto do uso de unidade móvel no acesso à saúde ocular em São Paulo, Brasil

ABSTRACT Purpose: The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. Methods: The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. Results: We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. Conclusion: The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.

RESUMO Objetivo: Determinar o impacto do uso de unidade móvel no acesso à saúde ocular e avaliar o perfil da população que necessita de cuidados oftalmológicos, as doenças oculares mais frequentes e o tratamento. Métodos: Estudo transversal realizado em 14 municípios da região sudoeste do Estado de São Paulo utilizando uma unidade móvel oftalmológica. Os participantes eram usuários do Sistema Único de Saúde que procuraram atendimento oftalmológico, sem restrição quanto a idade, gênero ou condição socioeconômica. Os dados foram transferidos para a tabela Excel para análise estatística. Resultados: Participaram do estudo 6.878 pessoas, com média de idade de 44 anos (variação de 4 meses a 96 anos) e 65,5% eram mulheres. Erros refrativos estavam presentes em 78,6% dos participantes, catarata em 9,6% e pterígio em 8,3%. Para 60% foram prescritos óculos, para 10% foi mantida a correção óptica em uso e para 28% foram necessárias apenas orientações. Exames especializados ou procedimentos cirúrgicos foram indicados para 18,1% dos casos que foram encaminhados para tratamento em serviço terciário. Dentre os pacientes referenciados, 36,4% necessitavam de cirurgia oculoplástica ou para tratar afecções externas do olho e 31,8%, de cirurgia de catarata. Conclusão: A grande maioria dos pacientes que procurou atendimento na unidade móvel necessitava de prescrição de óculos. A unidade móvel oftalmológica possui alto grau de resolutividade para os problemas oculares, com oportunidade de tratar os erros refrativos e referenciar os pacientes que necessitam de atendimento espe­cializado, geralmente relacionado a condições cirúrgicas. Unidades móveis podem ser uma alternativa aos cuidados oftalmológicos básicos, melhorando o acesso, atuando na promoção da saúde ocular e prevenindo a cegueira.

Uso de drogas antiglaucomatosas em pacientes com glaucoma severo: quantas são necessarias para controle da doenca? / Use of antiglaucomatous drugs in patients with severe glaucoma: how many are necessary to control the disease?

Resumo Introdução: O glaucoma e a principal causa de cegueira irreversivel no Brasil. Ate o momento nao se dispoe de uma droga ideal para o controle da pressao intraocular (PIO), geralmente necessitando associar dois ou mais medicamentos hipotensores, com frequentes instilacoes diarias e ma aderencia ao tratamento. Objetivos: Descrever quantitativa e qualitativamente as drogas usadas para controle da PIO e a eficacia do tratamento na prevencao da cegueira. Métodos: Estudo transversal retrospectivo, atraves de revisao de 420 prontuarios de portadores de Glaucoma severo acompanhados no ambulatorio do Hospital Emilio Carlos, de Catanduva-SP, de janeiro/2014 a dezembro/2016. As variaveis analisadas foram: idade, acuidade visual e medicamentos antiglaucomatosos utilizados: topicos (colirios) e sistemicos. Resultados: A media de idade dos participantes foi 62,99±16,29 anos. Foram detectados 68 casos de cegueira, sendo que 3 pacientes (0,7%)perderam a visao no tempo investigado, com referencias a periodos sem tratamento/subdose/instilacao indevida/uso de 3 ou 4 colirios. Em 73,3% dos casos conseguiu-se estabilizacao da PIO com o uso de um (38,1%) ou no maximo 02 (35,2%) colirios associados. Houve correlacao significativa entre o no de combinacoes de hipotensores topicos e o no de pacientes em uso de Acetazolamida. O medicamentomais usado foi o Maleato de Timolol (67,1%). Conclusões: Na maioria dos pacientes a PIO foi controlada com 1 ou 2 colirios associados; pequena porcentagem dos casos evoluiu para cegueira; muito provavelmente a evolucao para perda de visao foi decorrente da complexidade e ma aderencia ao tratamento.

ABSTRACT Introduction: Glaucoma is the main cause of irreversible blindness in Brazil. To date, there is no ideal drug for the control of intraocular pressure (IOP), usually requiring the combination of two or more hypotensive drugs, with frequent daily instillations and poor adherence to treatment. Objectives: To describe quantitatively and qualitatively the drugs used to control IOP and the efficacy of treatment in the prevention of blindness. Methods: A retrospective cross-sectional study was carried out through a review of 420 medical records of patients with severe Glaucoma who were followed up at the Emílio Carlos Hospital outpatient clinic in Catanduva, SP, from January 2014 to December 2016. The analyzed variables were: age, visual acuity and antiglaucomatous drugs used: topical (eye drops) and systemic. Results:The mean age of participants was 62.99 ± 16.29 years. Sixty-eight cases of blindness were detected, and three patients (0.7%) lost vision at the time investigated, with references to periods without treatment / subdose / improper instillation / use of 3 or 4 eye drops. In 73.3% of the cases, IOP stabilization was achieved with one (38.1%) or at most 02 (35.2%) associated drops. There was a significant correlation between the number of combinations of topical hypotensive agents and the number of patients taking acetazolamide. The drugmostused was Timolol (67.1%). Conclusions: In the majority of patients IOP was controlled with 1 or 2 associated eye drops; small percentage of cases evolved into blindness; most likely the evolution to loss of vision was due to the complexity and poor adherence to the treatment.

Causes of low vision in patients referred to the Low Vision Service in a Reference Center of Ophthalmology / Causas de baixa visão em pacientes encaminhados ao Serviço de Visão Subnormal em um Centro de Referência em Oftalmologia

Abstract Purpose: To identify the prevalence of the most common diseases diagnosed in the Low Vision Service (LVS) Methods: Seven hundred and thirteen patient's clinical records were evaluated. The best corrected visual acuity (BCVA) in the better eye was collected. All of the diagnosed diseases related to visual impairment were identified and classified. A total of 220 patients (36.6%) fulfilled the concept of low vision (group 1), and 381 patients (63.39%) presented legal blindness (groups 2, 3, 4 and 5), according to the WHO Study Group on the Prevention of Blindness (Geneva, l972). Results: The most prevalent disorder was the group of Retinal Inherited Distrophies (n=124; 20.63%). Following the first group were Ocular toxoplasmosis with chorioretinal scars (118 cases, representing a prevalence of 19.63%), Myopic Maculopathy (38-6.32%), Age related Macular Degeneration (AMD) (36 cases, representing a prevalence of 6%). Conclusion: Planning and implementing preventive actions in ophthalmology requires appropriate comprehension about regional clinical problems. Social support, and a proper partnership between educational and health systems, are important to improve visual outcomes in patients diagnosed with low vision and legal blindness.

Resumo Objetivo: identificar a prevalência dos distúrbios mais comuns em pacientes do Serviço de Visão Subnormal do Centro de Referência de Oftalmologia (CEROF - UFG). Método: Foram avaliados 713 registros de pacientes, t odos apresentavam erros refrativos corrigidos. Coletaram-se dois elementos: melhor acuidade visual corrigida (MAVC) no melhor olho e o diagnóstico da doença oftalmológica responsável pela deficiência visual. Todos os grupos etários foram incluídos, sem distinção entre sexo ou raça. Resultados: As doenças mais prevalentes foram distrofias retinianas hereditárias (124 pacientes; 20,63%), cicatrizes coriorretinianas por toxoplasmose (118-19,63%), maculopatia miópica (38-6,32%), Degeneração macular relacionada à idade (DMRI) (36-6%). 220 pacientes (36,6%) preencheram critério de baixa visão (grupo 1), e 381 (63,39%) apresentaram definição de cegueira legal (grupos 2, 3, 4 e 5) recomendada pelo Grupo de Estudos para a Prevenção da Cegueira WHO (Genebra, l972). Conclusão: Estudos nacionais mostram resultados semelhantes sobre cicatrizes coriorretinianas. Estudos epidemiológicos mostram maior prevalência de DMRI, provavelmente porque as clínicas oftalmológicas primárias falham no encaminhamento destes pacientes. A proporção de cegueira relacionada à ROP nos países desenvolvidos é maior, possivelmente porque não há plano de ação público oferecendo acompanhamento oftalmológico adequado para essas crianças. Não havia número significativo de pacientes com glaucoma congênito no departamento, o que pode se relacionar com as condições socioeconômicas e saúde no Brasil. Ações preventivas em oftalmologia necessitam de conhecimento científico de problemas oftalmológicos regionais aplicados à realidade, que será foco de tal ação. Um suporte social, incluindo parceria entre escola, família e sistema público de saúde, seria importante para gerar benefícios para a população.

Survey of medical resources of eye care in Tibet autonomous region / 中华实验眼科杂志

Background The improvement of the eye care system has being a strong guarantee for blindness prevention.However,medical resources of eye care in Tibet autonomous region cannot jet meet the effective requirement.Knowing the present situation of medical resources of eye care in Tibet can help reasonably allocate scarce medical resources.Objective This survey was to understand the status of eye care in Tibet area.Methods A questionnaire-based study was performed in Lhasa from April 2016 to June 2016,human resources,equipments were issued toward to all level of medical structures and answered by eye doctors.Results The coverage of the questionnaires was 100％ in Tibe area,and the effective response rate was 100％.Up to 2015,Tibet autonomous region had a total of 21 medical institutions with eye clinical ability with 1/151 000 per capita according to the Tibetan population released by national statistics bureau in 2014 and without any eye hospitals or eye clinics.In the 21 medical hospitals,19 (90.5％) had professional eye doctors,13 (61.9％) had independent eye departments,and 11 (52.4％) had operating room special for eye surgeries.One hundred and twenty ward beds were set in Tibet,and 1.6 eye doctors served in average for 100 000 Tibetan.Only 3 eye doctors with master degree and 14 eye nurses in Tibet area.There were a few elementary diagnostic and surgical instruments with an average of 326.2 eye simple operations in 2015.Conclusions The human resources and equipments as well as instruments are still insufficient for eye care in Tibet autonomous region,particularly in community-and county-level.

AppIication of smaII incision extracapsuIar cataract extraction combined with intraocuIar Iens impIantation in bIindness prevention and treatment / 国际眼科杂志(Guoji Yanke Zazhi)

· AlM: To investigate clinical therapeutic effect and safety of small incision extracapsular cataract extraction combined with intraocular lens implantation in blindness prevention and treatment. · METHODS: Clinical data of 425 patients with cataract (425 eyes) were analyzed retrospectively, who received small incision extracapsular cataract extraction combined with intraocular lens implantation in the No.413 Hospital of Chinese PLA, with the help from “handicapped rehabilitation engineering in Dinghai District of Zhoushan City” from September 2013 to August 2014.Visual acuity before and after operation, average corneal curvature, corneal astigmatism and intraoperative and postoperative complications were compared statistically and analyzed emphatically. ·RESULTS: ln all of the 425 patients with cataract (425 eyes) , the preoperative best corrected visual acuity of 99 patients were less than 0.05, and the other 326 patients were 0.05 to 0.3.Classification of lens nucleus hardness:level Ⅲ, 63 cases; level Ⅳ, 257 cases; and level Ⅴ, 105 cases.The preoperative average corneal curvature and corneal astigmatism of all patients were 44.6 ±1.52D and 1.35±0.96D.All the 425 patients underwent small incision extracapsular cataract extraction combined with intraocular lens implantation.Postoperative follow-up of 3mo results: the best corrected visual acuity: 5 cases were less than 0.05 (blindness-free rate 98.8%);8 cases were 0.05 to · CONCLUSlON: lt is effective and safe to apply small incisionextracapsular cataract extraction combined with intraocular lens implantation in blindness prevention and treatment, and it gives excellent visual rehabilitation to cataract patients.Especially in those areas and hospitals having no condition of phacoemulsification, it’s a safe and effective alternative when carrying out the program of blindness prevention and treatment.

Blindness causes analysis of 1854 hospitalized patients in Xinjiang / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AlM:To analyze the blindness causes of 1854 cases in our hospital hospitalized patients, and explore the strategy and direction of blindness prevention according to the different treatment efficacy.?METHODS: Cluster sampling was used to select from September 2010 to August 2013 in our hospital department of ophthalmology patients 5 473 cases, in which total of 1 854 cases of blind patients, accounting for 33. 88% of hospitalized patients. According to the WHO's criteria of blindness. The BCVA enacted <0. 05 or vision radius less than 10 degrees are for the blind, and the exclusion of less than 3 years old children don't cope with visual inspection of the inclusion criteria for age and cause of blindness blind patients were analyzed. To the blind to patient age and etiology were analyzed, the main cause of blindness and statistics of all ages, records of the blind patients after treatment eye sight;and calculating the blindness of the literacy rate, on the blindness through analysis of the causes of the risk treatment.?RESULTS:ln 1 854 cases of blind patients, including 728 people right-eye blinding, 767 people left-eyes blinding, 359 people total blinding, adding up to 2 213 eyes, aged from 60~80 years old were in the majority. The top three diseases resulting blindness were cataract, diabetic retinopathy and glaucoma. ln 2 213 blind eyes, the eyes treated were 2 172, of which 1 762 eyes ( 81. 12%) were succeeded, 410 eyes ( 18. 88%) failed. ln the failed cases, the first three diseases were diabetic retinopathy, glaucoma and retinal detachment.?CONCLUSlON: ln recent years, disease etiology of blinding eye has changed, but cataracts, diabetic retinopathy and glaucoma are still high incidence of blindness due, so the treatment of diabetic retinopathy, glaucoma and retinal detachment should be the emphasis for blindness prevention and treatment in the future.

Application of anti-eyebrow small incision cataract extraction combined with lOL implantation in blindness prevention and treatment / 国际眼科杂志(Guoji Yanke Zazhi)

To observe the application effect of anti-eyebrow small incision cataract extraction combined with lOL implantation in blindness prevention and treatment ●METHODS: A total of 526 cataract patients included in regaining sight project of China Disabled Persons' Federation were underwent anti - eyebrow small incision cataract extraction combined with lOL implantation from May 2010 to August 2013. ●RESULTS: Postoperative 1d, uncorrected visual acuity >0. 3 were 345 cases (65. 6%), 0. 1 - 0. 3 were 152 cases (28. 9%), 0. 5 were 395 cases (75. 1%), 0. 3 - 0. 4 were 101 cases (19. 2%), ●CONCLUSlON: Anti - eyebrow small incision cataract extractio combined with lOL implantation is effective, and has low complication rate, high security, can popularization and application in large - scale sight rehabilitating project.

Survey of cataract rate and surgical coverage in agricultural and pastoral area of Chifeng Keshenketeng in Inner Mongolia / 中华实验眼科杂志

BackgroundCataract is a leading blinding eye disease,and the prevalence of cataract varies in different regions.ObjectiveThe present study was to investigate the incidence of cataract,surgical coverage rate of cataract and postoperative visual acuity,and to propose a strategy for blindness prevention in Chifeng Keshiketengqi.Methods This is a cross-sectional survey of research.A random cluster sampling method was performed in 12 populated areas in Keshiketengqi.Inhabitants over 50 years in the region were included in this survey.This study was approved by the Ethic Committee of Inner Mongolia People' s Hospital.Informed consents were obtained orally from all the subjects.Disease history,visual acuity,intraocular pressure and regular ophthamological examinations were performed.The inclusion criteria of a pilot study and detailed protocol were employed to calculate the incidence rate of cataract.The questionnaire survey was simultaneously adopted to analyze the cataract-related factors.The surgical coverage rate of cataract in this area was calculated.ResultsIn a total 4234 inhabitants,3826 subjects participated in the survey with a response rate of 90.36％.Cataract was found in 1200 participants with an incidence rate of 31.39％.Age,the female gender and illiteracy were identified as risk factors for cataract (x2 =101.005,P =0.000 ;x2 =58.853,P =0.000 ;x2 =12.037,P =0.007 ).The prevalence rates of cataract were 36.98％ and 33.56％ for illiterates and women,respectively.The incidence rate in the Mongol population was significantly higher than that of the Han population ( 34.83％ vs.29.76％ ) (x2 =9.734,P =0.001 ).The cataract surgery rate increased yearly since 1998.When the vision acuity of the fellow eye was ＜0.1,the surgery coverage rate was 20.60％,but the rates were lower in female,illiterates and the Mongol population (x2 =1.993,P =0.038 ;x2 =16.463,P =0.044 ;x2 =8.523,P =0.029).When a pinhole visual acuity of ＜0.05 was determined as the criteria of blindness,the surgical coverage rate was 28.36％.The cataract surgical coverage rates for Han and Mongolian were 30.67％ and 24.53％,respectively,with a significant difference between them (x2 =12.951,P=0.000).The social burden rate was 3.34％ in this area,with a majority of females,illiterates and the Mongol population ( P＜0.05 ).ConclusionsIn agricultural and pastoral areas of Chifeng Keshiketengqi,the ≥50 years old population has a high rate of cataract blindness and low surgery coverage rate.Surgery is still the preferred way for cataract treatment.

Prevalence and causes of visual impairment and blindness in Sichuan province of China / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To describe the prevalence and causes of low vision and blindness in a population within Sichuan province in southwestern China.METHODS: A stratified, multi-phased and cluster probability sampling design was employed to enumerate 125 641 participants from 40 351 households within 38 counties/cities. Participants underwent a comprehensive eye examination, including standardized visual acuity (VA) tests using logarithm of the minimum angle resolution charts. Prevalence was age- and gender-standardized to the 2000 China Census.RESULTS: Population-weighted prevalence of blindness was 0.77% (95% CI: 0.72- 0.82, n=966) and low vision was 1.22% (95% CI: 1.14-1.27, n=1 513). Overall, the prevalence of visual disability was 1.40% in the urban population, and 2.22% in the rural population (P<0.01). Cataract was the leading cause of visual disability (55.7%, n=1 381), and was of similar frequency in both urban and rural populations. Retinal disease was the second leading cause (9.7%, n=236), but was more common in urban than rural participants (34.3% vs 2.7%, P<0.01). Corneal disease accounted for 6.5% (n=161) of cases of visual disability, and was more common in the rural population (7.2% vs 3.9%, P=0.006). CONCLUSION: We estimate that 1.72 million people suffer from visual disability within Sichuan province, of which 525 000 are blind, the focus of blindness prevention should be in rural area.

Análise da frequência de trauma ocular em pacientes de 0-10 anos no setor de plástica ocular do Hospital São Geraldo / Frequency analysis of ocular trauma among 0 to 10-year-old patients at the ocular plastic surgery section of the São Geraldo Hospital

Introdução: As lesões do globo ocular na infância correspondem a considerável parcela dos casos de cegueira infantil no Brasil e refletem a grande exposição da criança ao trauma. O presente estudo tem como objetivo analisar a frequência dos tipos de trauma que levam à perda do globo ocular na faixa etária de 0-10 anos. Métodos: Realizou-se levantamento no arquivo do Setor de Plástica Ocular do Hospital São Geraldo, correspondente a 4.940 prontuários. Foram identificados 643 pacientes na faixa etária de 0-10 anos, portadores de cavidades anoftálmicas, admitidos entre dezembro de 1970 e junho de 2005, dos quais 143 (22,24%) devido à perda do globo ocular. Resultados: As causas mais frequentes de perda do globo ocular na faixa etária de 0-10 anos foram: trauma (58,04%, n=83), infecções (11,89%,n=17) e retinoblastoma (30,07%, n=43). Em relação à distribuição de causas por tipo de trauma foi encontrada a seguinte proporção: domésticos (53,01%, n=44), por arma de fogo (6,02%, n=5), automobilísticos (1,21%, n=1), recreativos extradomiciliares (6,02%, n=5), trauma cirúrgico (2,41%, n=2) e por violência interpessoal (2,41%, n=2). O mecanismo causador do trauma não foi descrito em 28,92% (n=24) dos prontuários. Este grupo foi excluído da análise de resultados. Conclusão: o trauma ocular doméstico prevaleceu como principal causa de cavidade anoftálmica em pacientes com menos de 10 anos, reforçando o dado de que os acidentes são importante causa de morbidade na infância brasileira.

Introduction: Ocular globe injuries in childhood correspond to a large portion of cases of childhood blindness in Brazil and reflect the considerable exposure of children to trauma. The purpose of this study is the frequency analysis of the types of trauma that lead to ocular globe loss in the 0 to 10-year age group. Methods: An archival survey was carried out at the Ocular Plastic Surgery Section of the São Geraldo Hospital, corresponding to 4,940 medical charts. A total of 643 charts were found of patients with an ophthalmic sockets admitted from December 1970 to June 2005, 143 (22,24%) of which corresponded to the loss of an ocular globe among patients in the 0 to 10-year age group. Results: The most frequent causes of ocular globe loss in the 0 to 10-year age group were: trauma (58,04%, n=83), infection (11,89%,n=17) and retinoblastoma (30,07%, n=43). Regarding the distribution of causes by type of trauma, we found the following proportion: domestic accidents (53,01%, n=44), firearms (6,02%, n=5), automobile accidents (1,21%, n=1), outdoors recreation activities (6,02%, n=5), surgical trauma (2,41%, n=2) and interpersonal violence (2,41%, n=2). On 28,92% (n=24) of the charts, the cause mechanism of the trauma was not described, and therefore they were excluded from the analysis. Conclusions: Domestic ocular trauma predominated as the main cause of gloanophthalmic sockets among patients under the age of 10 years, reinforcing data demonstrating that accidents constitute an important cause of morbidity in childhood and adolescents in Brazil.

Retinopathy of prematurity in a tertiary center in the south of Brazil / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the incidence of retinopathy of prematurity in the southern Brazil, the rate of treatment and outcomes in all premature infants born at Hospital de Clinicas de Porto Alegre, Brazil, from October 2002 to October 2006.METHODS: A prospective cohort study was conducted on 323 premature children born at Hospital de Clinicas de Porto Alegre, Brazil, from October 2002 to October 2006 with birth weight equal to or less than 1 500g or a gestational age at birth of 32 weeks or less. All of the newborns were examined by indirect binocular ophthalmoscopy with the 28 diopters lens after pupil's dilation and a lid speculum after the sixth week of life with examinations repeated depending on the disease classification. The main clinical outcome was the occurrence of ROP at any stage.RESULTS: Retinopathy of prematurity occurred in 82 infants with an incidence rate of 25.7％. Threshold disease occurred in only 17 of the patients (5.3％), all of them had the disease affecting posterior Zone Ⅱ needing laser treatment. None of the treated children had Zone Ⅰ or aggressive posterior disease despite that three of the treated children needed a second laser session. One patient of the re-treated group needed scleral buckling with an equatorial silicon band after progression to stage 4 of ROP.CONCLUSION: The incidence of retinopathy and the threshold disease in this study was similar to the international resuits reported. This study showed a high survival rate (70.1％), high incidence of retinopathy, and high laser treatment necessity among newborns under 28 weeks of gestational age or under 1 000g of birth weight. This study drove attention about the no identification of any Zone Ⅰ posterior disease in this cohort of patients.

Incidência da retinopatia e a participação da enfermagem na prevenção da cegueira pela Retinopatia da Prematuridade no Hospital de Clínicas de Porto Alegre: estudo prospectivo observacional descritivo / Incidence of retinopathy and neonatal nurse practioner's role in prevention of blindness due to retinopathy of prematurity at Hospital de Clínicas de Porto Alegre, Brazil: prospective observational descriptive study

Introduction: Retinopathy of prematurity is a leading cause of blindness in children in middle-income countries. Recent improvements in the intensive neonatal cares allied with better personal qualification for assistance to the pre-term neonate increased survival rates among very low birth weight infants. This study aims to evaluate the incidence of the disease in premature children born at Hospital de Clínicas de Porto Alegre - Brazil, and also to describe the neonatal nurse practioner's in prevention of blindness at this institution. Methods: A prospective observational descriptive study was conducted on 329 premature children born with birth weight ≤ 1.500 grams and/or ≤ 32 weeks of gestational age between October of 2002 and October of 2006. All of the children were examined by indirect binocular ophthalmoscopy after pupil dilation with association of Tropicamide 0.5% and Phenylephrine 2.5%, eye drops. The ophthalmological examination was first conducted between the 4th and the 6th weeks of life and repeated according the findings based in the international classification.Results: Retinopathy was diagnosed in 84 of the neonates with an incidence rate of 25.5% (84/329). Eighteen of the 329 screened children (5.5%) reached threshold disease and 17 of them needed diode laser treatment to prevent the disease progression. One patient missed the treatment.Conclusions: The incidence of retinopathy was similar to other international results as well as the occurrence of 5.2% of treatable disease. Only one of the infants developed the disease up to the most serious stage (ROP 5), resulting in a 0.3% of blindness due to the retinopathy at the institution since 2002.

A Retinopatia da Prematuridade é a maior causa de cegueira infantil nos países em desenvolvimento. Grandes avanços no conhecimento e na tecnologia da Neonatologia além da melhor qualificação assistencial nas unidades neonatais têm permitido uma maior sobrevivência de pretermos de risco. Os objetivos deste trabalho são: estudar a incidência da retinopatia num hospital universitário da Região Sul do Brasil e alguns aspectos da participação do profissional de enfermagem no programa de triagem neonatal da instituição. Métodos: Estudo prospectivo observacional descritivo incluindo todos os pretermos admitidos na instituição com peso de nascimento ≤ 1.500 gramas ou com idade gestacional ≤ 32 semanas entre outubro de 2002 e outubro de 2006. O exame oftalmológico inicial foi realizado sob oftalmoscopia binocular indireta após dilatação das pupilas com associação de colírios Tropicamida 0,5% e Fenilefrina 2,5% entre a 4ª e a 6a semana de vida. Realizou-se cálculo de incidência com nível de confiança de 95%. Resultados: O estudo incluiu 329 pretermos. Foi identificada a retinopatia em 84 pacientes num percentual de 25,5%. A doença limiar atingiu 5,5% dos casos (18/329). Apenas uma das crianças no estudo atingiu a doença em estadiamento 5 num percentual de 0,3% (1/329). Conclusões: A incidência de retinopatia foi similar ao de outros trabalhos internacionais. Apenas um dos pretermos desenvolveu perda severa da visão sem possibilidade de tratamento gerando um percentual de 0,3% de cegueira pela retinopatia neste estudo. A permanente colaboração entre neonatologistas, oftalmologistas e a equipe de enfermagem, conforme conseguido nesta instituição, contribuiu para a eficiência da triagem neonatal na busca da doença.

Visual outcome of cataract surgery in three regions of the Philippines

Cataract remains the number one cause of blindness in third world countries. In the Philippines, it accounted for 77 percent of blindness in 1995 with a prevalence rate of 0.70 percent, and 62 percent in 2002 with a prevalence of 0.58 percent. Surgery is still the only treatment for cataract blindness. The two main kinds of cataract extraction are intracapsular and extracapsular. A third procedure, phakoemulsification, is being performed by highly trained ophthalmologists. Laser surgery as a primary procedure for cataract is still considered experimental and is not being performed on cataract patients in the Philippines. The main objective of this study was to determine the percentage of visual rehabilitation and prevention of blindness; and the percentage of complications after cataract surgery. Results were compared versus the different surgical procedures, and the health facility where the procedure was performed. Comparative studies on the different surgical procedures for cataract abound in the literature. However, this is the first report in the Philippines of a community-based study on the visual outcome after each kind of cataract surgery on Filipino patients. The results may also provide important information for the training of cataract surgeons as well as measures for the evaluation of facilities for cataract surgery in the country. This report is a retrospective study of the data gathered in 1999. After randomly sampling municipalities in each province in the 3 selected regions, all cases who had undergone cataract surgery were tracked down, interviewed, and examined especially for visual outcome. A total of 995 post-operative cases were included in this study: 95 in the National Capital Region, 330 in Western Visayas and 530 in Southern Mindanao. The study showed the following findings: Visual rehabilitation (pre-operative low vision that improved to 20/70 or better after surgery)=90.67 percentBlindness prevention (pre-op blindness that improved to Counting Fingers more than 3 meters or better)=92.82 percentOver-all complication rate = 2.20 percent. Some complications after surgery may be surgeon-related or technique-related. (Author)

The advantages of ophthalmology and blindness prevention in health reforms / 眼科

The primary eye care service is still absent in most of primary medical organizations in present China.Since imaging examinations provide main contribution to the diagnosis of eye diseases,ophthalmology and blindness prevention have technical predominance and requiring market in the field of telemedicine or e-healthy.We have explored different paradigms of blindness prevention according to variable levels of the region economy and medical conditions.In the urban community,the paradigm for preventable blindness has been adopted,and however,in the rural areas,the paradigm for curable blindness has been taken.It should be advocated to combine the primary eye care with the primary healthy care.It is in favor of sharing information,enhancing efficiency,improving quality, as well as entire orientation management to carry out digitalized ophthalmology regional cooperative medical service.Moreover,governmental leading function and policy sustaining are needed to complete the reform.