Apical bleeding: a rare cause of blindness after orbital decompression / Sangramento apical: uma causa rara de cegueira pós descompressão orbitária

ABSTRACT Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.

RESUMO A descompressão orbitária é uma cirurgia amplamente empregada para correção da proptose em casos cosméticos e funcionais da orbitopatia de Graves. Os principais efeitos colaterais induzidos pela descompressão são olho seco, diplopia e parestesias. Amaurose pós descompressão é uma complicação extremamente rara e cujos mecanismos são pouco discutidos na literatura. Considerando o efeito devastador representado pela perda visual e a escassez de relatos dessa complicação, os autores apresentam dois relatos de amaurose após descompressão orbitária. Nos dois casos a perda visual ocorreu devido a sangramento de pequena monta no ápice orbitário.

Evaluation of applicants unable to perform military service due to eye disease in terms of disease etiology and preventability: A cross-sectional study

Purpose: Our study’s goal was to investigate the individuals who took a pre?military examination and were pronounced “unfit for military service,” in terms of etiological grouping, legal blindness, and whether or not the illness could have been prevented. Methods: The files of 174 individuals deemed “unfit for military service” due to eye disease at the State Hospital Ophthalmology Department between January 2018 and January 2022 were retrospectively evaluated. The disorders were classified as refractive error, strabismus, amblyopia?related, congenital, hereditary, infectious/inflammatory, degenerative, and trauma?related pathologies. The reasons for unsuitability for military service were classified according to monocular and binocular legal blindness, preventability, and treatability with early diagnosis. Results: In our study, the reasons associated with refractive error, strabismus, and amblyopia were placed first in the etiology of unsuitability for military service (40.2%). The next most prevalent condition was trauma (19.5%), which was followed by degenerative (18.4%), congenital (10.9%), hereditary (6.9%), and infectious/inflammatory disorders (4.0%). There was a history of penetrating trauma in 79.4% of trauma patients and blunt trauma in 20.6% of patients. When the etiology was evaluated, 19.5% were in preventable and 51.2% were in treatable group with early diagnosis. In our study, legal blindness was detected in 116 patients. Of these patients, 79% had monocular legal blindness and 21% had binocular legal blindness. Conclusion: It is vital to investigate the etiology of visual disorders, control preventable causes, and determine the methods that will provide early diagnosis and treatment of curable causes.

Need of optical aids for schools for blind students in Pune and Nasik districts and compliance of their use

Purpose: To assess the need for spectacles and low?vision aids (LVA) in students attending schools for the blind and study their compliance with use. Methods: Comprehensive ocular evaluation was performed using a hand?held slit lamp and ophthalmoscope. Vision acuity was measured using a logarithm of the minimum angle of resolution (logMAR) chart for distance, as well as for near. Spectacles and LVAs were dispensed after refraction and LVA trial. Follow?up was performed to assess the vision using the LV Prasad Functional Vision Questionnaire (LVP?FVQ) along with compliance with use after 6 months. Results: Of the 456 students examined from six schools, 188 (41.2%) were female; 147 (32.2%) were <10 years of age. In all, 362 (79.4%) were blind since birth. The students dispensed only LVAs were 25 (5.5%), only spectacles were 55 (12.1%), and both spectacle and LVAs were 10 (2.2%). The vision improved using LVAs in 26 (5.7%) and using spectacles in 64 (9.6%). There was a significant improvement in LVP?FVQ scores (P < 0.001). Also, 68/90 students were available for follow?up, of whom 43 (63.2%) were compliant to use. Causes of not wearing spectacles or LVA in 25 were left somewhere or lost 13 (52%), broken 3 (12%), uncomfortable to use 6 (24%), not interested to use 2 (8%), and got operated 1 (4%). Conclusion: Although the dispensing of LVA and spectacles improved the visual acuity and vision function of 90/456 (19.7%) students, nearly a third were not using them after 6 months. Efforts need to be taken to improve the compliance of use

Visual impairment and blindness due to retinitis pigmentosa in India: 15-year follow-up of the Andhra Pradesh Eye Disease Study cohort

Purpose: To assess the incidence, visual impairment, and blindness due to retinitis pigmentosa (RP) in a rural southern Indian cohort. Methods: This is a population?based longitudinal cohort study of participants with RP from the Andhra Pradesh Eye Disease Study (APEDS) cohorts I and III, respectively. The study included participants with RP of APEDS I who were followed until APEDS III. Their demographic data along with ocular features, fundus photographs, and visual fields (Humphrey) were collected. Descriptive statistics using mean ± standard deviation with interquartile range (IQR) were calculated. The main outcome measures were RP incidence, visual impairment, and blindness as per the World Health Organization (WHO) definitions. Results: At baseline (APEDS I), 7771 participants residing in three rural areas were examined. There were nine participants with RP with a mean age at baseline of 47.33 ± 10.89 years (IQR: 39–55). There was a male preponderance (6:3), and the mean best?corrected visual acuity (BCVA) of 18 eyes from nine participants with RP was 1.2 ± 0.72 logarithm of minimum angle of resolution (logMAR; IQR: 0.7–1.6). Over a mean follow?up duration of 15 years, 5395/7771 (69.4%) were re?examined, which included seven RP participants from APEDS 1. Additionally, two new participants with RP were identified; so, the overall incidence was 370/ million in 15 years (24.7/million per year). The mean BCVA of 14 eyes of seven participants with RP who were re?examined in APEDS III was 2.17 ± 0.56 logMAR (IQR: 1.8–2.6), and five of these seven participants with RP developed incident blindness during the follow?up period. Conclusion: RP is a prevalent disease in southern India that warrants appropriate strategies to prevent this condition.

Prevalence and Pattern of Visual Impairment among Adult Population in Mangu Local Government Area of Plateau State, Nigeria

Aim: Visual impairment is a public health problem globally. This study aimed to determine the prevalence and pattern of visual impairment among adult population in Mangu Local Government Area (L.G.A), Plateau State, Nigeria.Study Design: A population-based descriptive cross-sectional survey of 802 adult population aged 18 years and above was conducted in Mangu L.G.A, Plateau State, Nigeria using a multi-stage cluster random sampling design.Methodology: Subjects were evaluated using a magnifying loupe, Snellen E chart, direct ophthalmoscope and torchlight. Vision status was defined using World Health Organization categories of visual impairment based on presenting visual acuity (VA).Results: Out of a total of 960 respondents enumerated for the study, 802 (83.5%) adults participated. Prevalence of blindness (presenting VA of less than 3/60 in the better eye) was 8.1%; prevalence of low vision (presenting VA of at least 3/60 but less than 6/18 in the better eye) was 27.6%; prevalence of overall visual impairment (presenting VA less than 6/18 in the better eye) was 35.7%. Prevalence of visual impairment was higher in males (40.8%) than in females (34.9%), although not statistically significant (p=0.098). Prevalence of blindness and impaired vision increased significantly with increasing age, from 21.7% at 20 - 39 years to 83.6% among those aged ?80 years (P < 0.001).Conclusion: Much can be done by individuals, governments and non-governmental organizations to reduce so much blindness and vision loss through cost-effective interventions such as wears of sunglasses and other preventive measures to prevent ultraviolet radiation effect on their eyes.

Síndrome de Anton-Babinsky / Anton-Babinski Syndrome

Introducción: El síndrome de Anton-Babinsky es un trastorno neuropsiquiátrico poco frecuente, que se manifiesta por anosognosia y ceguera cortical, debido a lesiones en las áreas visuales asociativas de la corteza occipital sin presentar afectación en la vía visual. En adultos mayores sus manifestaciones clínicas suelen ser atípicas y la valoración geriátrica integral permite orientar el diagnóstico, que se puede asociar con síndromes geriátricos. Objetivo: Describir las manifestaciones clínicas, síndromes geriátricos, paraclínicos y tratamiento de un paciente con Síndrome de Anton-Babinsky. Caso clínico: Paciente de 85 años, quien durante un postoperatorio inmediato de cirugía ocular (pterigión) presentó alteración fluctuante del estado de conciencia, alucinaciones visuales, disminución de la agudeza visual bilateral y anosognosia. La analítica sanguínea no reportó alteraciones y la tomografía computarizada de cráneo documentó isquemia occipital bilateral, se le diagnosticó síndrome de Anton-Babinsky. Conclusiones: El síndrome de Anton-Babinsky puede tener presentación atípica a través de síndromes geriátricos. La valoración geriátrica integral permite realizar un diagnóstico y manejo multicomponente oportuno con el objetivo de influir en el pronóstico tanto a corto como a largo plazo(AU)

Introduction: Anton-Babinski syndrome is a rare neuropsychiatric disorder, with a manifestation of anosognosia and cortical blindness, due to lesions in the associative visual areas of the occipital cortex without presenting visual pathway impairment. In elderly adults, its clinical manifestations are usually atypical and a comprehensive geriatric assessment allows to guide the diagnosis, which can be associated with geriatric syndromes. Objective: To describe the clinical manifestations, geriatric syndromes, paraclinical findings and treatment of a patient with Anton-Babinski syndrome. Clinical case: This is the case of an 85-year-old patient who, during the immediate postoperative period after ocular surgery (pterygium), presented a fluctuating alteration of consciousness, visual hallucinations, decreased bilateral visual acuity and anosognosia. Blood analysis reported no alterations and cranial computed tomography documented bilateral occipital ischemia; the patient was diagnosed with Anton-Babinski syndrome. Conclusions: Anton-Babinski syndrome may have an atypical presentation through geriatric syndromes. Comprehensive geriatric assessment allows for timely multicomponent diagnosis and management with the aim of influencing both short- and long-term prognosis(AU)

La ceguera y la baja visión en Cuba y en el mundo / Blindness and low vision in Cuba and in the world

La discapacidad visual afecta directamente la calidad de vida de las personas. Supone un obstáculo en el aprendizaje, y una menor productividad laboral, por lo que puede ser considerada un problema de salud pública en muchas regiones del planeta. Las grandes limitaciones en el acceso a la atención sanitaria, los diferentes hábitos alimentarios y de vida en general crean diferencias claras en las causas de la misma. Por ello, la lucha contra la discapacidad visual es un factor importante para disminuir la pobreza mundial. definir principales causas que originan la ceguera y la baja visión desde los referentes que brinda la ciencia y la tecnología. Se realizó una búsqueda bibliográfica extensa y actualizada en base de datos que ofrecen Internet, Infomed, Hinari Pubmed y Google académico, así como las páginas oficiales de la Organización Mundial de la Salud (OMS). Se emplearon los términos oftalmología, baja visión y rehabilitación. Se puede afirmar que la ceguera y las discapacidades visuales graves tienen un notable impacto en el desarrollo socioeconómico del individuo y la sociedad(AU)

Visual disability directly affects people's quality of life; it is an obstacle to learning and lower work productivity, so it can be considered a public health problem in many regions of the planet. Where the great limitations in access to health care, the different eating habits and life in general create clear differences in the causes of it. Therefore, the fight against visual impairment is an important factor in reducing global poverty. An extensive and updated bibliographic search was carried out in databases offered by the internet, Infomed as well as Hinari Pubmed and academic Google as well as the official pages of the World Health Organization (WHO), also using basic texts of ophthalmology, low vision and rehabilitation. It is concluded that blindness and severe visual impairment have a significant impact on the socioeconomic development of the individual and society(AU)

Perception of college-going girls towards corneal donation in North India: A latent class analysis study

Purpose: To assess the perception of college?going girls toward corneal donation in Northern India. Methods: An online survey with a pre?structured, pre?validated questionnaire was conducted on 1721 college?going girls in Northern India. The knowledge and attitude scores were regressed, and latent class analysis was carried out. Results: The average of scores for all participants was computed individually for the knowledge questions and the attitude questions, and based on this score, total participants were divided into two groups: Better corneal donation behaviors (BCDB) and poor corneal donation behaviors. The binomial logistic regression model of knowledge domain for predicting BCDB, age of the participant, their awareness about corneal donation, and willingness to discuss eye donation among family members were found significant. Similarly, for the attitude domain, awareness about corneal donation, knowledge about hours within which ideal eye donation needs to be undertaken, and knowledge about eye donation during coronavirus disease 2019 (COVID?19) pandemic were found to be significant. Latent class analysis identified one subset of participants having poorer knowledge and attitude scores and that they were more from a rural background, were having more than first order as birth order, were belonging to SC/ST classes, had illiterate or secondary education of father and mother, and were living in rented houses. Conclusion: The findings of the study significantly contribute to devising a mechanism to improve knowledge and influencing the attitude about eye donation among the youth, especially young women, who can act as counselors and motivators for the masses as well as their own families, in the generations to come.

Prevalence and surgical status of cataract in adults aged 50 years and older in Kandze Tibetan areas of Sichuan, China / 中华实验眼科杂志

Objective:To investigate the prevalence of cataract, cataract surgical coverage and surgical outcomes in people aged 50 years and older in Kandze Tibetan areas of Sichuan Province, and to evaluate the effectiveness of the prevention and treatment of blindness in the region.Methods:A cross-sectional study was conducted to study the population aged 50 years and above in Ganzi Tibetan Autonomous Prefecture, Sichuan Province, from October 2017 to April 2018 using the Rapid Assessment of Avoidable Blindness (RAAB) method.A total of 5 000 permanent residents aged 50 years and older were selected using a stratified, cluster sampling method with reference to the data from the 2010 China Population Census with the RAAB software, and each cluster consisted of 50 people, for a total of 100 clusters.The survey was conducted by two survey teams, and all subjects underwent visual acuity and ophthalmic examinations at home to investigate relevant cataract prevalence, surgical coverage, surgical barriers, and postoperative outcomes according to WHO Standards.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Kandze Prefecture People's Hospital (No.GZZYY-2016-11). Written informed consent was obtained from each subject.Results:Of 5 000 eligible participants, 4 763 were examined, with a response rate of 95.3%.Referred to the visual impairment standard of WHO and the pinhole visual acuity, the prevalence of bilateral blindness, severe, moderate and mild visual impairment was 0.6%(95% [confidence interval, CI]: 0.4%-0.9%), 0.9%(95% CI: 0.6%-1.2%), 2.4%(95% CI: 2.0%-2.9%) and 5.2%(95% CI: 4.6%-5.9%), respectively.The prevalence of cataract blindness was 0.7%(95% CI: 0.4%-1.0%) in females, significantly higher than 0.2%(95% CI: 0.1%-0.5%) in males( P<0.05). The prevalence of cataract blindness was 2.3% among Tibetan, higher than 1.0% among Han Chinese, showing a statistically significant difference ( P<0.05). By the number of eyes, the cataract surgical coverage was 60.8%(95% CI: 55.5%-65.8%) in females, which was lower than 70.1%(95% CI: 63.7%-75.7%) in males, with a statistically significant difference ( P<0.05). By the number of cases, the surgical coverage for cataract blindness in both eyes was 82.0%(95% CI: 75.2%-87.6%), with blindness defined as the pinhole visual acuity <0.05 in the dominant eye.A total of 171 people with untreated cataract received a questionnaire about barriers to cataract surgery.The most important barrier was unaware that treatment was available at 77.8%, followed by inconvenient transportation or being unaccompanied to the hospital at 11.7%.A total of 364 eyes underwent cataract surgery, of which 336 eyes underwent intraocular lens implantation, and the intraocular lens implantation rate was 92.3%.There were 216 eyes with a postoperative cataract visual acuity ≥0.3, accounting for 59.3%(216/364). Conclusions:In the Kandze Tibetan area of Sichuan Province, cataract is still the main cause of blindness among people aged 50 and above, and surgery for cataract remains the focus of blindness prevention work.The cataract surgical coverage in this area is high, but the postoperative outcomes are still poor compared with the WHO reference index for post-cataract surgery (1998), and corresponding measures must be taken to improve the quality of surgery.

Avaliação dos alunos deficientes visuais e videntes do Instituto de Cegos Padre Chico / Evaluation of the visually impaired and sighted students at the Instituto de Cegos Padre Chico

RESUMO Objetivo Avaliar o perfil dos alunos concluintes, deficientes visuais e videntes do Instituto de Cegos Padre Chico entre os anos 2011 e 2020. Métodos Entre janeiro e março de 2021, foi realizada uma análise documental dos alunos concluintes entre os anos de 2011 e 2020. Foram coletados dados relacionados à situação social, educacional, socioeconômica e oftalmológica. Os dados foram tratados no programa Microsoft Excel 2013 da Microsoft e analisados no software livre Bioestat, versão 5.0. Resultados Foram coletados os dados de 110 concluintes cegos, com baixa visão e videntes. Mais de 90% dos alunos declararam rendimento familiar equivalente a um salário-mínimo e meio. Do total da amostra, 52 alunos eram cegos; 38 tinham baixa visão, e 20 eram videntes. Dentre as 36 patologias identificadas entre os alunos, 57,78% levaram à cegueira e 42,22%, à baixa visão. Em alunos cegos, as patologias mais frequentes foram glaucoma congênito (32,69%) e amaurose congênita de Leber (11,53%); em alunos com baixa visão, foram glaucoma congênito e distrofias de retina (ambas em 10,53% da amostra). Conclusão É de suma importância a avaliação da saúde ocular para que o professor realize de forma mais rápida as práticas de ensino e alcance resultados satisfatórios na alfabetização de crianças com deficiência visual.

ABSTRACT Objective To evaluate the profile of visually impaired and sighted students at the Instituto de Cegos Padre Chico (ICPC) between 2011 and 2020. Methods Between January and March 2021, a document analysis of the students who completed the undergraduate course between 2011 and 2020. Data related to social, educational, socioeconomic, and ophthalmological situation were collected. The data were treated in Microsoft Excel 2013 and analyzed in the free software Bioestat, version 5.0. Results Retrospective data were collected from 110 blind, low-vision and sighted students who were graduating. More than 90% of the students declared family income equivalent to one and a half minimum wages. Of the total sample, 52 students were blind; 38 had low vision, and 20 were sighted students. Among the 36 pathologies identified among the students, 57.78% led to blindness, and 42.22%, to low vision. In blind students, the most frequent diagnosis was congenital glaucoma (32.69%) and Leber congenital amaurosis (11.53%); in low vision students, congenital glaucoma and retinal dystrophies (both in 11.53% of the population of this study). Conclusion The evaluation of the eye health is of vital importance for the teacher to perform teaching practices faster and achieve satisfactory results in the literacy of visually impaired children.

Narrativas de mães de crianças cegas congênitas sobre itinerários terapêuticos, arranjos de cuidados e experiências maternas: uma pesquisa no Instituto Benjamin Constant / Narratives of mothers of congenitally blind children on therapeutic pathways, care arrangements and maternal experiences: a study at the Benjamin Constant Institute

O objetivo da tese é analisar as narrativas de oito mães de crianças cegas congênitas, matriculadas no Instituto Benjamin Constant. O estudo abrange itinerários terapêuticos, arranjos de cuidados e experiências maternas. Utilizaram-se os postulados teóricos sobre narrativas de Ricoeur e a análise foi feita sob o marco teórico de Bardin. Optou-se pelo itinerário terapêutico como método de pesquisa, por valorizar as histórias de vidas das mães que participaram da pesquisa. A narrativa reforçou a utilização de metodologias participativas e inclusivas, baseadas no respeito, na solidariedade e na cooperação. As narrativas mostraram que as mães, após o primeiro itinerário, que é na maternidade, encontram na figura do médico pediatra o auxílio que as orienta sobre quais os itinerários a percorrer. Em seguida, elas procuram o oftalmologista, mais especificamente o retinólogo e, também, o neuropediatra. A chegada ao IBC acontece depois da confirmação derradeira da cegueira do filho. As mães das crianças e adolescentes matriculados no IBC permanecem no espaço do Instituto, diariamente, enquanto seus filhos estão em aula ou em algum atendimento. Essa permanência se justifica por razão da distância entre o IBC e suas casas. A espera permite compartilharem, com outras mães, situações vivenciadas para o fortalecimento de vínculos de afetos, mas também existem tensões. O estudo apontou, ainda, que o discurso iatrogênico, com palavras ou ações de alguns médicos, causou ansiedade, desconfiança, confusão e sentimento de desrespeito. Outro dado relevante, encontrado por meio das narrativas, foi a dificuldade que encontraram ao transitarem nos espaços públicos com seus filhos, por causa de barreiras atitudinais. Ainda segundo as narrativas, o cuidado que elas dispensam quase que integralmente aos seus filhos (as), apesar de toda a sobrecarga que relatam, não é considerado um trabalho, pelo fato de não ser remunerado. As mães entendem que a tarefa de cuidar é um ato de amor para com o filho e, não, um trabalho. Por fim, a pesquisa também investigou os impactos que a pandemia de COVID 19 ocasionou nas vidas das mães e de seus filhos, surgindo como principais desafios o afastamento do espaço da escola e o manejo das aulas on-line. (AU)

The objective of the thesis is to study the narratives of eight mothers of congenitally blind children enrolled at the Benjamin Constant Institute. The study covers therapeutic journeys, care arrangements, and maternal experiences. Theoretical postulates on narratives by Ricoeur were utilized, and the analysis was conducted within the theoretical framework of Bardin. The therapeutic journey was chosen as the research method, as it values the life stories of the participating mothers. The narrative reinforced the use of participatory and inclusive methodologies based on respect, solidarity, and cooperation. The narratives showed that mothers, after the initial journey in maternity, seek guidance from pediatricians on the paths to take. They then consult ophthalmologists, specifically retinologists, and neuropediatricians. Arrival at the IBC occurs after the final confirmation of the child's blindness. Mothers of children and adolescents enrolled at the IBC stay at the Institute daily while their children are in class or receiving some form of assistance. This stay is due to the distance between the IBC and their homes. Waiting allows them to share experiences with other mothers, strengthening emotional bonds, but tensions also exist. The study also pointed out that iatrogenic discourse, with words or actions from some doctors, caused anxiety, mistrust, confusion, and feelings of disrespect. Another significant finding from the narratives was the difficulty they encountered when navigating public spaces with their children due to attitudinal barriers. According to the narratives, the care they provide to their children, despite the reported burden, is not considered work because it is unpaid. Mothers view caregiving as an act of love for their children, not as a job. Finally, the research also investigated the impacts of the COVID-19 pandemic on the lives of the mothers and their children, with the main challenges being the separation from the school environment and the management of online classes. (AU)

Intervenção educativa em um estudante com deficiência intelectual, visual, auditiva e motora / Intervención educativa en un estudiante con discapacidad intelectual, visual, auditiva y motriz / An educational intervention in a student with intellectual, visual, hearing and motor disabilities

En este trabajo se presenta el diseño, la implementación y la evaluación de un programa de intervención educativa para un estudiante con diagnóstico de hipoacusia severa, ceguera congénita, discapacidad intelectual y motriz. La finalidad de la intervención es mejorar la conexión del niño con el entorno y trabajar la anticipación de acontecimientos en su vida diaria. Para ello se trabajan principalmente tres áreas de desarrollo: adaptativa, motora y cognitiva. Los resultados obtenidos en las evaluaciones pretest y postest reflejan ligeras mejoras en los tres ámbitos tras la intervención, y por tanto, una evolución en la edad de desarrollo del estudiante. Algunas de las conclusiones más relevantes son que el trabajo individualizado con personas con discapacidad múltiple influye positivamente en su desarrollo, y que existe una falta de instrumentos de evaluación estandarizados que se adapten a las características de las personas con discapacidades múltiples y severas.

Neste estudo apresenta-se a configuração, a implementação e a avaliação de um programa de intervenção educativa para um estudante com diagnóstico de hipoacusia severa, cegueira congênita, deficiência intelectual e motora. A finalidade da intervenção é melhorar a conexão da criança com o entorno e trabalhar a antecipação de acontecimentos em sua vida diária. Para isso trabalham-se principalmente três áreas de desenvolvimento: adaptativa, motora e cognitiva. Os resultados obtidos nas avaliações pré-teste e pós-teste indicam melhora nos três âmbitos após a intervenção, e por tanto, uma leve evolução na idade de desenvolvimento do estudante. Algumas das conclusões mais relevantes são que o trabalho individualizado com pessoas com deficiência múltipla influi positivamente em seu desenvolvimento, e que existe uma falta de instrumentos de avaliação estandardizadas que se adaptem às características das pessoas com deficiências múltiplas e severas.

This paper presents the design, implementation and evaluation of an educational intervention program for a student with a diagnosis of severe hearing loss, congenital blindness and intellectual and motor disability. The aim of the intervention is to improve the child's connection with the environment and to work on anticipating events in his daily life. For that purpose, three areas of development are mainly worked: adaptive, motor and cognitive. The results obtained in pretest and posttest evaluation reflect slight improvements in the three areas after the intervention, and therefore, an evolution in the student's developmental age. Some of the most relevant conclusions are that individualized work with people with multiple disabilities positively influences their development, and that there is a lack of standardized assessment instruments adapted to the characteristics of people with multiple and severe disabilities.

Perfil do diagnóstico inicial em pacientes com glaucoma / Profile of initial diagnosis in patients with glaucoma

RESUMO Objetivo Avaliar o estágio do glaucoma no momento de seu diagnóstico. Métodos Estudo transversal e descritivo, usando dados obtidos por meio de consultas ao banco de dados de pacientes glaucomatosos atendidos em sua primeira consulta, antes da instituição de quaisquer tratamentos. Resultados Foram incluídos 101 pacientes (177 olhos). Apenas 31 (30,69%) deles referiam história familiar positiva para glaucoma. Encontraram-se 26% dos olhos avaliados com alterações perimétricas avançadas, dez olhos (5,8%) com visão pior que 20/400 e, destes, três pacientes apresentavam cegueira legal em ambos os olhos. Os fatores associados à gravidade do glaucoma foram idade avançada e pressão intraocular elevada. Conclusão O conhecimento da situação no diagnóstico inicial retrata a realidade do glaucoma em nosso meio e prediz ações visando à prevenção da cegueira.

ABSTRACT Objective To assess the stage of the disease at the time of diagnosis. Methods Cross-sectional and descriptive study, using data obtained by searching the database of glaucoma patients in their first consultation, before the starting any treatment. Results 101 patients (177 eyes) were included. Only 31 (30.69%) patients reported a positive family history of glaucoma. We found 26% of the evaluated eyes with advanced perimetric alterations, ten eyes (5.8%) with vision worse than 20/400, of these, three patients had legal blindness in both eyes. Factors associated with glaucoma severity were advanced age and high IOP. Conclusion Knowledge of the situation in the initial diagnosis portrays the reality of glaucoma in our environment and predicts actions aimed at preventing blindness.

Avaliação da qualidade de vida relacionada à saúde em um programa de reabilitação para pessoas com deficiência visual / Health-related quality of life assessment in a rehabilitation program for people with visual impairment

RESUMO Objetivo: Aplicar um protocolo para avaliar a qualidade de vida relacionada à saúde de participantes de um programa de reabilitação para pessoas com deficiência visual de um instituto de referência. Métodos: Foi realizado um estudo transversal com 60 adultos com deficiência visual participantes de um programa de reabilitação para pessoas com deficiência visual de um instituto de referência no Rio de Janeiro. O protocolo de pesquisa consistiu em um questionário com dados pessoais, sociais, demográficos e informações clínicas; no European Quality of Life 5 Dimensions 3 Level Version para medição genérica de qualidade de vida relacionada à saúde; no Patient Health Questionnaire-2 para rastrear a depressão e no Visual Function Questionnaire 25 para avaliar a qualidade de vida relacionada à saúde específica da função visual. A principal variável independente analisada foi o tempo de exposição ao programa. Modelos de regressão linear foram utilizados para investigar a relação entre o tempo no programa e a qualidade de vida relacionada à saúde do Visual Function Questionnaire 25 e do European Quality of Life 5 Dimensions 3 Level Version. Resultados: A maioria dos participantes (73%) possuía deficiência visual adquirida; 68% tinham menos de 60 anos e 53% perderam a visão há mais de 10 anos. A condição visual autorreferida mais comum foi cegueira em ambos os olhos (48%) e 42% frequentavam o programa há mais de 3 anos. A mediana do índice de utilidade do European Quality of Life 5 Dimensions 3 Level Version foi de 0,75. O instrumento específico para rastreamento de depressão, o Patient Health Questionnaire, identificou proporção de 27% de participantes positivos. O Visual Function Questionnaire 25 apresentou escores abaixo de 50 (escala de zero a cem) nos subdomínios visão geral, atividades de perto e atividades à distância. As medianas de dor ocular e aspectos sociais do Visual Function Questionnaire 25 foram significativamente menores entre aqueles que realizavam tratamento psiquiátrico. O tempo de reabilitação foi independentemente associado a melhores escores dos subdomínios saúde mental e atividades da vida diária. Conclusão: O protocolo demonstrou aplicabilidade para a avaliação de qualidade de vida relacionada à saúde em pessoas com deficiência visual, permitindo concluir que o maior tempo no programa de reabilitação foi associado a maiores escores de qualidade de vida.

ABSTRACT Purpose: This study aimed to implement a health-related quality of life (HRQoL) assessment protocol to measure the consequences of a rehabilitation program for visual impaired people at a leading reference institute in Brazil. Methods: A cross-sectional study was conducted with 60 visual impaired adults enrolled in a Rehabilitation Program of the Instituto Benjamin Constant. The research protocol consisted of a questionnaire with personal data, social, demographic, and clinical information; the EQ-5D-3L instrument for generic HRQoL measurement; the Patient Health Questionnaire-2 (PHQ- 2) to screen for depression, and the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) to assess specific HRQoL of visual function. The main independent variable analyzed was the exposure time to the rehabilitation. Linear regression models were used to investigate the relationship between rehabilitation time and HRQoL of the NEI VFQ-25 and EQ 5D-3L instruments. Results: Most participants (73%) have acquired visual impairment, 68% are under 60 years old, 53% lost their vision more than 10 years ago, the most common self-reported visual condition (48%) was blindness in both eyes and 42% are in the Rehabilitation Program for more than 3 years. The median HRQoL utility index for EQ 5D-3L was 0.75. The specific instrument for screening for depression, PHQ-2, identified 27% of participants above the cut-off point. The NEI VFQ-25 instrument showed scores below 50 (scale from 0 to 100) in subdomains: "general vision", "near activities" and "distance activities". The medians of "ocular pain" and "social aspects" of the VFQ-25 were significantly lower among those who have undergone psychiatric treatment. "Rehabilitation time" was independently associated with better scores of "mental health" and "role difficulties" subdomains. Conclusion: The protocol showed applicability for the assessment of HRQoL, allowing the conclusion that longer time in the rehabilitation program was associated with higher quality of life scores.

Identification of novel variants in retinitis pigmentosa genes by whole-exome sequencing

SUMMARY OBJECTIVE: Retinitis pigmentosa is an inherited degenerative disorder causing severe retinal dystrophy and visual impairment, mainly with onset in the first or second decades. The next-generation sequencing has become an efficient tool to identify disease-causing mutations in retinitis pigmentosa. The aim of this retrospective study was to investigate novel gene variants and evaluate the utility of whole-exome sequencing in patients with retinitis pigmentosa. METHODS: The medical records of 20 patients with retinitis pigmentosa at Eskişehir City Hospital between September 2019 and February 2022 were analyzed retrospectively. Peripheral venous blood was obtained, followed by the extraction of genomic DNAs. The medical and ophthalmic histories were collected, and ophthalmological examinations were performed. Whole-exome sequencing was performed to determine the genetic etiology of the patients. RESULTS: The proportion of genetically solved cases was 75% (15/20) in the patients with retinitis pigmentosa. Molecular genetic testing identified 13 biallelic and 4 monoallelic mutations in known retinitis pigmentosa genes, including 11 novel variants. According to in silico prediction tools, nine variants were predicted as pathogenic or possibly pathogenic. We identified six previously reported mutations to be associated with retinitis pigmentosa. The age of onset of the patients ranged from 3 to 19, with a mean age of onset of 11.6. All patients had a loss of central vision. CONCLUSION: As the first study of the application of whole-exome sequencing among patients with retinitis pigmentosa in a Turkish cohort, our results may contribute to the characterization of the spectrum of variants related to retinitis pigmentosa in the Turkish population. Future population-based studies will enable us to reveal the detailed genetic epidemiology of retinitis pigmentosa.

Application of improved 3D digital guide plate-assisted guided puncture in microballoon compression for primary trigeminal neuralgia / 口腔疾病防治

Objective @#To investigate the clinical efficacy and application value of an improved 3D-printed guide plate for the treatment of primary trigeminal neuralgia (PTN) by percutaneous microballoon compression (PMC). @*Methods @# This prospective study included 42 patients with primary trigeminal neuralgia treated at the Department of Stomatology, Xuzhou Central Hospital, from September 2019 to January 2022. The group was divided by the random number table method into the experimental group (adopting 3D printing technology to make guide plates to guide the puncture, 22 cases) and the control group (adopting the traditional Hartel anterior approach to position the puncture, 20 cases). The intraoperative success rate of the first puncture, puncture time, operative time, radiation exposure of patients and postoperative complications were compared between the two groups. Postoperative Barrow Neurological Institute Scale (BNI) scores, facial numbness, diminished corneal reflexes and chewing weakness were recorded. The t-test, rank-sum test and chi-square test were used for statistical analysis, with P<0.05 indicating a statistically significant difference. @*Results @#The experimental group was significantly better than the control group in terms of the success rate of the first puncture (χ2 = 21.51, P<0.001), puncture time (Z = -5.51, P<0.001), operative time (t = 9.37, P<0.001), and the number of C-arm scans (Z = -4.59, P<0.001). Postoperative BNI scores of the experimental group included 21 cases of grade Ⅰ (91.5%) and 1 case of grade Ⅱ, while the control group included 17 cases of grade Ⅰ (85.0%), 2 cases of grade Ⅱ (10.0%) and 1 case of grade Ⅲ (5.0%), with no statistical significance (P>0.05). In the experimental group, 16 patients had postoperative masseter weakness, 1 had keratitis and 10 had perilabial herpes, while in the control group, 18 patients had postoperative masseter weakness, 2 had keratitis, 11 had perilabial herpes and 1 had monocular blindness. There was no significant difference in postoperative complications between the two groups (P>0.05). At 12 months of follow-up, there was no recurrence in either the experimental or control group. @* Conclusions @#3D digital guide plate-guided percutaneous microballoon compression for primary trigeminal neuralgia can improve the accuracy and safety of puncture to a certain extent, obviously shorten the operation time, reduce radiation exposure of the patients, improve the success rate of the operation, meaning it has a high clinical application value.

Discapacidad visual y ceguera por catarata en Cuba en 2016 / Visual Impairment and Cataract Blindness in Cuba in 2016

Objetivo: Describir la discapacidad visual por catarata en la población de 50 años y más de edad y la cobertura de la atención oftalmológica en Cuba durante el año 2016. Métodos: Se realizó una investigación epidemiológica, descriptiva y transversal en personas de 50 años o más, que tomó la encuesta rápida de ceguera evitable realizada en Cuba en el año 2016. Con los datos obtenidos en los cuestionarios se confeccionó una base de datos. La muestra estuvo conformada por 3 920 habitantes distribuida en 112 conglomerados. Las variables estudiadas fueron la discapacidad visual, tipo de cirugía, tiempo de operados, resultados visuales y causas de malos resultados. Resultados: La prevalencia de ceguera bilateral fue de un porciento, para la discapacidad visual severa 2,7 por ciento, y moderada un 9,0 por ciento. El 66,2 por ciento de los ojos estudiados presentó buenos resultados visuales, de los cuales al 69,2 por ciento se le implantó una lente intraocular. Las comorbilidades oculares (67,1 por ciento) fueron la causa más frecuente de malos resultados visuales posquirúrgicos y representó el 44,7 por ciento en el total de ojos afectados. Conclusiones: El riesgo de presentar ceguera por catarata es del 1 por ciento. La discapacidad visual moderada es la más prevalente. En todos los rangos de discapacidad, la catarata bilateral no presenta diferencias entre sexo, pero en la unilateral el sexo masculino es el más frecuente. La primera causa de malos resultados posquirúrgicos son los trastornos refractivos en discapacidad visual moderada y las comorbilidades oculares para la discapacidad visual severa y ceguera(AU)

Purpose: To describe visual disability due to cataract in the population aged 50 years and older and the coverage of ophthalmologic care in Cuba during 2016. Methods: An epidemiological, descriptive and cross-sectional research was conducted in people aged 50 years and older, who took the rapid survey of avoidable blindness conducted in Cuba in 2016. With the data obtained from the questionnaires, a database was made. The sample, distributed in 112 clusters, consisted of 3 920 inhabitants. The variables studied were visual impairment, type of surgery, time of surgery, visual results and causes of poor results. Results: The prevalence of bilateral blindness was 1 percent, for severe visual impairment, 2.7 percent and for moderate visual impairment 9.0 percent. Good visual outcomes were observed in 66.2 percent of the eyes studied, of which 69.2 percent were implanted with an intraocular lens. Ocular comorbidities (67.1 percent) were the most frequent cause of poor postsurgical visual outcomes and accounted for 44.7 percent in the total number of affected eyes. Conclusions: The risk of presenting blindness due to cataract is 1 percent. Moderate visual impairment is the most prevalent. In all ranges of disability, bilateral cataract does not show differences between genders, but in unilateral cataract the male gender is the most frequent. The first cause of poor postoperative outcomes are refractive disorders in moderate visual impairment and ocular comorbidities for severe visual impairment and blindness(AU)

Embracing technology in cataract surgical training � The way forward

While ophthalmology as a surgical branch itself has evolved technologically with newer instruments, techniques and procedures; ophthalmic surgical training appears to have stagnated in terms of how it is delivered and how trainees� learning and performance are assessed. This collaborative editorial attempts to identify the lacunae in ophthalmic residency training and highlight how technological tools such as surgical simulators can be incorporated into ophthalmic training even in limited-resource settings with good results

A rare case of cortical blindness following vaccination against SARS-CoV-2

A 61-year-old male presented with sudden loss of vision in both the eyes about 8 days after the first shot of coronavirus disease 2019 (COVID-19) vaccine (Covishield). On examination, the visual acuity was no perception of light in both the eyes. Contrast-enhanced magnetic resonance imaging (MRI) with diffusion-weighted imaging showed acute cerebral infarcts involving bilateral parieto-occipital region. Considering the temporal correlation with the vaccine shot and absence of any other precipitating factor, we hypothesized that this was probably an immunologic response to the vaccine.

The economic and social costs of visual impairment and blindness in India

Purpose: To provide a current estimate of the economic and social costs (or welfare costs) of visual impairment and blindness in India. Methods: Using evidence from the recently conducted Blindness and Visual Impairment Survey across India, the Lancet Global Health Commission on Global Eye Health and other sources, we developed an economic model that estimates the costs of reduced employment, elevated mortality risk, education loss for children, productivity loss in employment, welfare loss for the unemployed, and caregiver costs associated with moderate and severe visual impairment (MSVI) and blindness. Probabilistic sensitivity analyses were also conducted by varying key parameters simultaneously. Results: The costs of MSVI and blindness in India in 2019 are estimated at INR 1,158 billion (range: INR 947–1,427 billion) or $54.4 billion at purchasing power parity exchange rates (range: $44.5–67.0 billion), accounting for all six cost streams. The largest cost was for the loss of employment, whereas the the second largest cost was for caregiver time. A more conservative estimate focusing only on employment loss and elevated mortality risk yielded a cost of INR 504 billion (range: INR 348–621 billion) or $23.7 billion (range: $16.3–29.2 billion). Conclusion: Poor eye health imposes a non?trivial recurring cost to the Indian economy equivalent to 0.47% to 0.70% of GDP in the primary scenario, a substantial constraint on the country’s growth aspirations. Furthermore, the absolute costs of poor eye health will increase over time as India ages and becomes wealthier unless further progress is made in reducing the prevalence of MSVI and blindness