Prevalencia de la discapacidad visual en el adulto diabético en Cuba / Prevalence of visual impairment among adult diabetics in Cuba

Objetivo: Describir la discapacidad visual del diabético 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 que tomó la encuesta rápida de ceguera evitable realizada en Cuba en el año 2016, la cual incluyó la retinopatía diabética validada por la Organización Mundial de la Salud. Con los datos obtenidos en los cuestionarios se confeccionó una base de datos donde se tomaron todos los diabéticos conocidos o no con discapacidad visual. Resultados: La prevalencia de cualquier tipo de discapacidad visual en el diabético es de 25,4 por ciento (21,8-28,9). El riesgo de desarrollar discapacidad visual moderada, grave y ceguera es de 19,4 por ciento (16,5-22,3), 2,8 por ciento (1,0-4,6) y 3,2 por ciento (1,5-4,8) respectivamente. La catarata es la primera causa de discapacidad. El riesgo de discapacidad visual en el diabético es similar para uno y otro sexo y se incrementa con la edad. Las coberturas de tratamiento son bajas. Conclusiones: En Cuba, alrededor de un cuarto de los diabéticos tienen algún riesgo de discapacidad visual. El diabético tiene mayor riesgo de discapacidad visual moderada; sin embargo, el riesgo de discapacidad visual grave y de ceguera es el mismo para toda la población de 50 años y más de edad. La catarata y la retinopatía diabética son las causas más frecuentes de discapacidad visual en el diabético. Se evidencian dificultades con la atención oftalmológica, que incluye el examen y la cobertura de tratamiento de la catarata y del láser para la retinopatía diabética(AU)

Objective: Describe visual impairment among diabetics aged 50 years and over, and the coverage of ophthalmological care in Cuba in the year 2016. Methods: A descriptive cross-sectional epidemiological study was conducted based on the Rapid Assessment of Avoidable Blindness survey developed in Cuba in the year 2016, which included diabetic retinopathy with validation by the World Health Organization. The data obtained from the questionnaires were transferred to a database of visually impaired known and unknown diabetics. Results: Prevalence of any sort of visual impairment among diabetics is 25.4 percent (21.8-28.9). Risk of developing moderate visual impairment, severe visual impairment or blindness is 19.4 percent (16.5-22.3), 2.8 percent (1.0-4.6) and 3.2 percent (1.5-4.8), respectively. Cataract is the leading cause of impairment. Risk of visual impairment among diabetics is similar in the two sexes and increases with age. Treatment coverage is low. Conclusions: In Cuba, about one fourth of the diabetics are at some risk of visual impairment. Diabetics are at a higher risk of moderate visual impairment. However, the risk of severe visual impairment and blindness is the same as for the population aged 50 years and over. Cataract and diabetic retinopathy are the most common causes of visual impairment among diabetics. Difficulties were found in ophthalmological care, including examination and treatment coverage for cataract and laser therapy for diabetic retinopathy(AU)

Associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual / Association between diabetes mellitus and eye diseases in people with visual impairment / Asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual

Objetivo: verificar associação entre diabetes mellitus e doenças oculares em pessoas com deficiência visual. Método: estudo transversal com 51 pessoas com diabetes e deficiência visual, em um centro de reabilitação visual do interior paulista, que participaram de entrevista estruturada, em 2018. Utilizou-se os testes: Kolmogorov Smirnov, Regressão de Poisson, Regressão de Logística Binária, e Correlação de Spearman. Resultados: a maioria das pessoas era cega e relatou que a retinopatia diabética, o glaucoma e a catarata foram causa da deficiência visual; com tempo de diagnóstico do diabetes acima de 109 meses. A catarata apresentou um nível de correlação baixa (r=0,280 e p=0,047), e a retinopatia diabética um nível de correlação moderada (r=0,565 e p=0,000), considerando o tempo de diagnóstico do diabetes. Conclusão: associação estatisticamente significante entre o tipo de diabetes e a retinopatia, e correlação estatisticamente significante entre o tempo de diagnóstico do diabetes, a catarata e a retinopatia diabética.

Objective: to verify the association between diabetes mellitus and eye diseases in people with visual impairment. Method: this cross-sectional study involved 51 people with diabetes and visual impairment at a Visual Rehabilitation Center in São Paulo, who participated in a structured interview in 2018. The tests used were: Kolmogorov Smirnov, Poisson Regression, Binary Logistic Regression, and Spearman Correlation. Results: most participants were blind, reported that diabetic retinopathy, glaucoma and cataracts were the causes of their visual impairment, and had been diagnosed with diabetes over 109 months earlier. Cataract returned a low level of correlation with time with diagnosis of diabetes (r = 0.280 and p = 0.047), and diabetic retinopathy, moderate correlation (r = 0.565 and p = 0.000). Conclusion: a statistically significant association was found between type of diabetes and retinopathy, and statistically significant correlations between the time diagnosed with diabetes, cataracts and diabetic retinopathy.

Objetivo: verificar la asociación entre diabetes mellitus y enfermedades oculares en personas con discapacidad visual. Método: este estudio transversal involucró a 51 personas con diabetes y discapacidad visual en un Centro de Rehabilitación Visual en São Paulo, quienes participaron en una entrevista estructurada en 2018.Las pruebas utilizadas fueron: Kolmogorov Smirnov, Regresión de Poisson, Regresión Logística Binaria y Spearman Correlación. Resultados: la mayoría de los participantes eran ciegos, informaron que la retinopatía diabética, el glaucoma y las cataratas eran las causas de su discapacidad visual y habían sido diagnosticados con diabetes más de 109 meses antes. La catarata devolvió un bajo nivel de correlación con el tiempo con el diagnóstico de diabetes (r = 0,280 yp = 0,047) y la retinopatía diabética, correlación moderada (r = 0,565 yp = 0,000). Conclusión: se encontró asociación estadísticamente significativa entre tipo de diabetes y retinopatía, y correlaciones estadísticamente significativas entre el tiempo de diagnóstico de diabetes, cataratas y retinopatía diabética.

Prevalence of cataract complications in patients with pseudoexfoliation syndrome in Northwestern Spain / A prevalência de complicações de catarata em pacientes com síndrome pseudoesfoliativa no noroeste da Espanha

ABSTRACT Purpose: To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. Methods: We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. Results: We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. Conclusion: Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.

RESUMO Objetivo: Avaliar a relação entre a síndrome de pseudoexfoliação e a prevalência de complicações e fatores clínicos relacionados em pacientes submetidos à cirurgia de catarata. Métodos: Foi realizado um estudo retrospectivo de coorte de 503 de 551 pacientes que se submeteram à cirurgia de facoemulsificação durante 2 anos em um distrito de saúde no noroeste da Espanha. No total, 120 dos 681 olhos submetidos ao procedimento apresentavam síndrome de pseudoexfoliação. Dados sobre o procedimento cirúrgico e complicações associadas foram obtidos dos prontuários médicos. As complicações incluíram qualquer combinação de ruptura da cápsula posterior, perda de humor vítreo, diálise zonular e luxação do núcleo ou do cristalino. Resultados: Encontramos uma associação significativa entre síndrome de pseudoexfoliação e diálise zonular (razão de probabilidade [RP]: 6,89; IC 95%, 2,27-20,93), a miose perioperatória (RP: 2,15; IC 95%, 1,10-4,22) e luxação do cristalino >1,5 mm (RP: 9,49; IC 95%, 0,85-105,54). Porém, ao ajustar para o risco global de complicações em pacientes com síndrome de pseudoexfolição em consideração à miopia, uso de anticoagulantes ou α-agonistas, midríase prévia e comprimento da câmara anterior, a RP diminuiu para 1,02 (IC 95%, 0,47-2,21) e não foi, portanto, significativo. Conclusão: A diálise zonular e a miose intraoperatória foram complicações intraoperatórias em pacientes submetidos à cirurgia de catarata com síndrome de pseudoexfoliação quando comparados aos controles.

Prevalence of Lens Opacity in Interventional Cardiologists and Professional Working in the Hemodynamics in Brazil / Prevalência de Opacidades do Cristalino em Cardiologistas Intervencionistas e Profissionais Atuantes na Área de Hemodinâmica no Brasil

Abstract Background: Posterior subcapsular cataract is a tissue reaction commonly found among professionals exposed to ionizing radiation. Objective: To assess the prevalence of cataract in professionals working in hemodynamics in Brazil. Methods: Professionals exposed to ionizing radiation (group 1, G1) underwent slit lamp examination with a biomicroscope for lens examination and compared with non-exposed subjects (group 2, G2). Ophthalmologic findings were described and classified by opacity degree and localization using the Lens Opacities Classification System III. Both groups answered a questionnaire on work and health conditions to investigate the presence of risk factors for cataract. The level of significance was set at 5% (p < 0.05). Results: A total of 112 volunteers of G1, mean age of 44.95 (±10.23) years, and 88 volunteers of G2, mean age of 48.07 (±12.18) years were evaluated; 75.2% of G1 and 85.2% of G2 were physicians. Statistical analysis between G1 and G2 showed a prevalence of posterior subcapsular cataract of 13% and 2% in G1 and G2, respectively (0.0081). Considering physicians only, 38% of G1 and 15% of G2 had cataract, with the prevalence of posterior subcapsular cataract of 13% and 3%, respectively (p = 0.0176). Among non-physicians, no difference was found in the prevalence of cataract (by types). Conclusions: Cataract was more prevalent in professionals exposed to ionizing radiation, with posterior subcapsular cataract the most frequent finding.

Resumo Fundamento: A catarata subcapsular posterior é uma reação tecidual encontrada com frequência nos profissionais expostos à radiação ionizante. Objetivo: Avaliar a prevalência de catarata nos profissionais que atuam na área de hemodinâmica no Brasil. Métodos: Profissionais expostos à radiação ionizante (grupo 1, G1) foram submetidos ao exame biomicroscópico com lâmpada de fenda para avaliação do cristalino, e comparados aos não expostos (grupo 2, G2). Os achados foram descritos e classificados quanto ao grau de opacidade e localização por meio do Lens opacities classification system III. Ambos os grupos responderam questionário sobre condições de trabalho e de saúde para afastar fatores de risco para catarata, e foram comparados quanto aos achados. Foi utilizado um nível de significância de 5% (p < 0,05). Resultados: Foram avaliados 112 voluntários (G1) com média de idade 44,95 (±10,23) anos e 88 voluntários (G2) com média de 48,07 (±12,18) anos. Desses, 75,2% (G1) e 85,2% (G2) eram médicos. A análise estatística entre os grupos G1 e G2 mostrou uma prevalência da catarata no grupo G1 de 33% comparada ao G2 de 16% (p = 0,0058), sendo a catarata subcapsular posterior presente em 13% no G1 e 2% no G2 (p = 0,0081). Considerando apenas os médicos, 38% no G1 e 15% no G2 (p = 0,0011) apresentaram catarata, sendo a subcapsular posterior 13% e 3% (p = 0,0176), respectivamente. No grupo dos profissionais não médicos, não houve diferença estatisticamente significativa na prevalência dos achados oftalmológicos. Conclusões: A catarata esteve mais presente no grupo de profissionais expostos à radiação ionizante, sendo que a catarata subcapsular posterior foi o dano tecidual mais encontrado.

Pediatric traumatic cataract review: origin of the trauma / Catarata traumática pediátrica: origem do trauma

Abstract Objective: To identify the main causes of traumatic cataracts in childhood, based on a scientific review. Methods: Review in Lilacs, Pubmed, Cochrane, Bireme and Sciencedirect databases for the keywords: infant cataract, traumatic cataract, child, pediatrics, low vision, blindness, cause, incidence, ocular trauma. Results: Seventy-two (72) articles on traumatic cataract were found. From these, 17 presented tables relating the cause of ocular trauma to the formation of cataract in pediatrics. This article presents the main findings and analysis of the topic in the literature. Conclusion: The traumas etiologies which were most prominent in the studies analyzed were pointed objects such as cuttings, splinters and wood stick. Boys were more affected and there was a relation with practice of internal and external activities of domicile, in rural and urban zones.

Resumo Objetivo: Identificar as principais causas das cataratas traumáticas na infância, baseado numa revisão científica. Métodos: Pesquisa nas bases de dados Lilacs, Pubmed, Cochrane, Bireme e Sciencedirect com as palavras- chave: catarata infantil, catarata traumática, criança, pediatria, baixa visão, cegueira, causa, incidência, trauma ocular. Resultados: Foram encontrados setenta e dois (72) artigos sobre catarata traumática. Destes, 17 apresentaram tabelas relacionando a causa do trauma ocular com a formação de catarata em pediatria. Este artigo apresenta os principais achados e análise do tema na literatura. Conclusão: As etiologias dos traumas que apresentaram maior destaque nos estudos analisados foram com objetos pontiagudos como estaca, lascas e graveto de madeira. Meninos foram mais acometidos e houve relação com prática de atividades internas e externas ao domicilio, em zona rural e urbana.

Modificaciones en la capa de fibras nerviosas poscirugía de catarata en glaucoma primario de ángulo abierto / Changes undergone by the nerve fiber layer after cataract surgery in patients with primary open angle glaucoma

RESUMEN Objetivo: Evaluar la modificación de la capa de fibras nerviosas después de la cirugía de catarata en pacientes con glaucoma primario de ángulo abierto. Métodos: Se realizó un estudio prexperimental en dos grupos de pacientes, 31 de ellos con glaucoma primario de ángulo abierto (49 ojos) y 29 pacientes sin glaucoma (50 ojos). Se analizó el comportamiento del espesor de la capa de fibras nerviosas retinianas antes y después de la cirugía de catarata (facoemulsificación). Fue evaluado el comportamiento pre y posoperatorio de la agudeza visual, así como la presión intraocular. Resultados: La edad promedio fue 71,8 ± 8,0 años en el grupo sin glaucoma y 67,8 ± 8,9 años en el grupo con glaucoma primario de ángulo abierto. La mediana de la agudeza visual sin corrección pasó de 0,20 a 0,90 en el grupo sin glaucoma y 0,30 a 0,80 en el grupo con glaucoma primario de ángulo abierto, donde resultó la p< 0,05 en ambos casos. La mediana de la presión intraocular cayó 1 mmHg en ambos grupos. En los cuadrantes superior e inferior hubo un incremento del espesor de la capa de fibras después de la operación en ambos grupos, pero solo se observó en cuadrantes nasal y temporal en el grupo con glaucoma. Conclusiones: Después de la cirugía de catarata se produce un incremento del espesor de la capa de fibras. La opacidad impide la transmisión de la señal a la retina(AU)

ABSTRACT Objective: Evaluate the changes undergone by the nerve fiber layer after cataract surgery in patients with primary open angle glaucoma. Methods: A pre-experimental study was conducted of two groups of patients, 31 with primary open angle glaucoma (49 eyes) and 29 without glaucoma (50 eyes). The behavior of retinal nerve fiber layer thickness was analyzed before and after cataract surgery (phacoemulsification). Visual acuity and intraocular pressure were evaluated during the pre- and postoperative periods. Results: Mean age was 71.8 ± 8.0 years in the group without glaucoma and 67.8 ± 8.9 years in the group with primary open angle glaucoma. Median visual acuity without correction rose from 0.20 to 0.90 in the group without glaucoma, and from 0.30 to 0.80 in the group with primary open angle glaucoma, with p < 0.05 in both. Median intraocular pressure fell 1 mmHg in both groups. An increase in fiber layer thickness was observed after surgery in the upper and lower quadrants of both groups, but only in the nasal and temporal quadrants of the group with glaucoma. Conclusions: Fiber layer thickness increased after cataract surgery. Opacity hindered signal transmission to the retina(AU)

Perfil epidemiológico do paciente submetido ao mutirão de catarata / Epidemiological profile of the patient undergoing cataract surgery

Resumo Objetivo: Avaliar a eficácia do mutirão de cirurgia de catarata realizado em um município, em 2017, visando o incremento na produção de cirurgias de catarata e a redução da prevalência de catarata na população. Métodos: Trata-se de um estudo observacional, descritivo, transversal e retrospectivo a partir da análise de dados do mutirão de catarata desenvolvida, no ano de 2017, por intermédio de informações de registros obtidas junto ao Sistema de Informação Ambulatorial (SIA/SUS) e o Sistema de Informação Hospitalar (SIH/SUS), concomitante com a Secretaria de Saúde de Itajubá. Foram realizadas análises estatísticas de acordo com características da amostra e considerado p-valor. Resultados: No estudo, observou-se que a significativa demanda regional por cirurgias de catarata, com destaque para a Fundação Hilton Rocha em Belo Horizonte, com 2030 no total. Na Santa Casa, foram atendidos 538 pacientes, em que todos estes realizaram o exame de ceratometria, 269 fizeram a biometria e o mapeamento de retina em ambos os olhos e por fim 195 pessoas fizeram a cirurgia de catarata do olho direito e 193 do olho esquerdo, totalizando 388 cirurgias. Sendo que 54% da demanda foi agendada. Em uma Clínica Especializada Assistência Médica, foram atendidos 446 pacientes, em que todos estes realizaram o exame de ceratometria, 352 fizeram a biometria do olho direito e 387 do olho esquerdo, 321 realizaram o mapeamento de retina do olho direito e 376 do olho esquerdo e por fim 200 pessoas fizeram a cirurgia de catarata do olho direito e 200 do olho esquerdo, totalizando 400 cirurgias. Conclusão: Os dados vão de encontro com a amostragem do presente estudo, já que foi possível perceber a grande demanda por cirurgias de catarata nas diferentes regiões e o grande impacto que o mutirão realizou na cidade, melhorando a qualidade de vida das pessoas. Dessa forma, o mutirão realizado foi de extrema importância, uma vez que com a cirurgia, evita-se que o quadro de catarata evolua para uma perda total da visão.

Abstract Objective: To evaluate the efficacy of cataract surgery performed in the city in 2017, aiming to increase the production of cataract surgeries and reduce the prevalence of cataract in the population. Methods: This is an observational, descriptive, cross-sectional and retrospective study based on the data analysis of the cataract mutirão developed in Itajubá, in the year 2017, through information from records obtained from the Outpatient Information System (SIA / SUS) and the Hospital Information System (SIH / SUS), concomitant with the Health Department. Statistical analyzes were performed according to sample characteristics and considered p-value. Results: In the study, there was a significant regional demand for cataract surgeries, especially the Hilton Rocha Foundation in Belo Horizonte, with 2030 in total. At Santa Casa, 538 patients were seen, all of whom underwent keratometry, 269 did the biometry and the retinal mapping in both eyes and finally 195 people underwent cataract surgery of the right eye and 193 of the left eye, totaling 388 surgeries. Being that 54% of the demand was scheduled. At the Specialized Medical Assistance Clinic, 446 patients were attended, all of whom performed the keratometry exam, 352 did the right eye biometrics and 387 left eye examinations, 321 performed the right eye retinal mapping and 376 of the left eye and finally 200 people underwent cataract surgery of the right eye and 200 of the left eye, totaling 400 surgeries. Conclusion: The data are in agreement with the sample of the present study, since it was possible to perceive the great demand for cataract surgeries in the different regions and the great impact that the collective mobilization for cataract surgery carried out in the city, improving the quality of life of the people. Thus, the effort made was extremely important, since with surgery, it is avoided that the cataract situation evolves into a total loss of vision.

Barriers between community screening for visual problems and treatments in a tertiary center

ABSTRACT OBJECTIVE To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.

Épidémiologie de la cataracte en stratégies avancées

But. Identifier les caractéristiques épidémiologiques de la cataracte diagnostiquée en stratégie avancée. Méthodologie. Nous avons mené une étude transversale descriptive documentaire dans la région du Centre au Cameroun. Etaient inclus tous les sujets présentant une cataracte diagnostiquée lors de nos stratégies avancées. Les variables étudiées étaient: l'âge, le genre, le type de déficience visuelle. Résultats. Le nombre total de patients examinés était de 3754 dont 193 ont présenté une cataracte, soit prévalence de la cataracte de 5,14 %. L'âge médian de la population était de 70 ans (min 12 ans et max 103 ans) ; il était de 70,5 ans chez les femmes et de 70 ans pour les hommes (P= 0,47). Le nombre d'yeux ayant présenté une cataracte était de 323 dont 164 yeux droits (50,77 %) et 159 yeux gauches (49,23 %). Un pourcentage de 54,80 % des yeux atteints de cataracte avaient une cécité. Conclusion. Les activités de stratégies avancées dans la région du Centre du Cameroun que nous avons menées ont été efficaces dans le dépistage des cas de cataracte dans nos communautés. Les patients âgés en sont les premières victimes et la cécité est fréquente chez ces derniers

Resultados a corto plazo de la facotrabeculectomía por una vía en el Instituto Cubano de Oftalmología Ramón Pando Ferrer / Short-term outcomes of one-site phacotrabeculectomy at Ramón Pando Ferrer Cuban Institute of Ophthalmology

Objetivos: describir los resultados a corto plazo de la facotrabeculectomía por una vía. Métodos: se realizó un estudio descriptivo de series de casos en 19 ojos de 18 pacientes tratados con facotrabeculectomía por una vía y por un mismo cirujano del Departamento de Glaucoma del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre los meses de febrero y octubre del año 2016. Se controlaron las siguientes variables: edad, sexo, color de piel (blanco o negro), número de fármacos hipotensores, agudeza visual mejor corregida, presión intraocular, estadio de daño glaucomatoso, tipo de glaucoma y complicaciones posquirúrgicas con seguimiento durante tres meses. Resultados: la edad promedio de la muestra fue 69 ± 12 años, igual número de masculinos y femeninos. Predominó el glaucoma primario de ángulo abierto y el color de piel negra. En el preoperatorio la presión intraocular media fue 22,5 ± 5,9 mmHg; la agudeza visual mejor corregida 51,77 ± 31,89 VAR y el número de fármacos hipotensores 3,2 ± 0,5. A los tres meses posoperatorios la presión intraocular media fue 15,6 ± 4,3 mmHg (p< 0,05); la agudeza visual mejor corregida 71,15 ± 33,05 VAR y el número de fármacos hipotensores 0,7 ± 1 (p< 0,05). Las complicaciones posquirúrgicas fueron atalamia, desprendimiento coroideo y quiste de Tenon. Conclusiones: la facotrabeculectomía por una vía constituye una alternativa quirúrgica que ofrece a pacientes con glaucoma y catarata el control de la presión intraocular, la recuperación visual, la reducción del número de fármacos hipotensores oculares y mínimas complicaciones(AU)

Objectives: describe the short-term outcomes of one-site phacotrabeculectomy. Methods: a descriptive case-series study was conducted of 19 eyes of 18 patients treated with one-site phacotrabeculectomy by the same surgeon at the Glaucoma Department of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February to October 2016. The variables evaluated were age, sex, skin color (black or white), number of hypotensive drugs, best corrected visual acuity, intraocular pressure, glaucomatous damage, glaucoma type and postsurgical complications during a three-month follow-up. Results: mean age of the sample was 69 ± 12 years, with an equal number of males and females. There was a predominance of primary open-angle glaucoma and black skin color. In the preoperative period mean intraocular pressure was 22.5 ± 5.9 mmHg, best corrected visual acuity was 51.77 ± 31.89 VAR, and the number of hypotensive drugs was 3.2 ± 0.5. Three months after surgery mean intraocular pressure was 15.6 ± 4.3 mmHg (p< 0.05), best corrected visual acuity was 71.15 ± 33.05 VAR and the number of hypotensive drugs was 0.7 ± 1 (p< 0.05). The postoperative complications were athalamia, choroidal detachment and Tenon cyst. Conclusions: one-site phacotrabeculectomy is a surgical alternative offering patients with glaucoma and cataract intraocular pressure control, visual recovery, a reduction in the number of hypotensive drugs, and minimal complications(AU)

Epidemiologic Aspects of Medical Retirement from the Republic of Korea Army due to Visual Impairment

This study was done to report the epidemiologic characteristics of medical retirement from the Republic of Korea (ROK) Army due to visual impairment and to suggest a practical screening system for the draft. The medical records of 423 eyes of 301 patients who retired from the ROK Army due to visual impairment were reviewed retrospectively between January 2010 and December 2014. The patients were grouped by the presence of trauma, and each group was subdivided by military rank. We analyzed demographic and ophthalmic data, including the etiology of ophthalmologic disease. The etiology was classified into 5 anatomical categories (ocular surface, lens, retina, optic nerve and extraocular visual pathway, and extraocular muscle and orbit), which were then subdivided into the type of disease. The mean age was 24.5 years, and non-traumatic mechanisms accounted for 81.1% (343/423 eyes) of medical retirements. Visual acuity was better in patients without trauma. In enlisted soldiers, disease in the optic nerve and extraocular visual pathway was the most common anatomical category (40.5%), and primary open angle glaucoma (30.8%), retinal dystrophy (18.3%), congenital cataract (14.5%), and retinal detachment (9.7%) were the four most common diseases. Most medical retirements due to visual impairment resulted from non-traumatic mechanisms, even though patients were young. The fundus examination and visual field test would be more useful tools than a conventional vision test for large-scale draft screening for the most common two disease types: primary open angle glaucoma and retinal dystrophy.

Retinal diseases in a reference center from a Western Amazon capital city / Doenças retinianas em um centro de referência de capital estadual na Amazônia Ocidental

ABSTRACT Objective To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. Methods Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. Results A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. Conclusion Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.

RESUMO Objetivo Descrever as doenças de retina encontradas em pacientes que aguardavam tratamento para doenças retinianas em um hospital terciário de Rio Branco, Acre, Brasil. Métodos Foi realizado um exame oftalmológico compreendendo biomicroscopia com lâmpada de fenda, mapeamento de retina e ultrassonografia ocular. Os pacientes foram classificados de acordo com o status fácico e a doença retiniana que acometia o olho de maior gravidade. Resultados Foram atendidos 138 pacientes. A média de idade foi de 51,3 anos. A distribuição de diabetes foi de 35,3% e de hipertensão arterial foi de 45,5%. Catarata esteve presente em pelo menos um dos olhos em 23,2%. Tiveram o exame da retina possibilitado 129 pacientes. As principais doenças retinianas detectadas foram descolamento de retina regmatogênico (n=23; 17,8%) e retinopatia diabética (n=32; 24,8%). Dos 40 pacientes avaliados em função do diabetes, 13 (32,5%) apresentavam retinopatia ausente ou estágios iniciais de retinopatia e necessitavam apenas de acompanhamento. Conclusão A principal doença retiniana foi a retinopatia diabética, uma causa de cegueira evitável que pode ser acompanhada à distância, nos estágios iniciais, por meio de estratégias de telemedicina. A telemedicina pode ser uma importante ferramenta no acompanhamento de doenças retinianas em localidades remotas no Brasil.

Factors Associated with Cataract in Korea: A Community Health Survey 2008-2012

PURPOSE: To investigate sociodemographic factors, health behaviors, and comorbidities associated with cataracts in a large, nationally representative Korean sample. MATERIALS AND METHODS: This cross-sectional study included 715554 adults aged 40 years or older who participated in the 2008-2012 Community Health Survey. Significant risk factors were identified using multivariate logistic regression analysis for self-reported cataract, and a nomogram for analysis of cataract risk was generated. RESULTS: Roughly 11% of participants (n=88464) reported being diagnosed with cataracts by a doctor. Age was the most important independent risk factor [adjusted odds ratio (aOR)=1.11, 99% confidence interval (CI), 1.11-1.11 for each increasing year]. Significant comorbidities with descending order of effect size (aOR, 99% CI), included diabetes mellitus (1.78, 1.71-1.85), osteoporosis (1.62, 1.56-1.69), arthritis (1.54, 1.48-1.59), hepatitis B infection (1.46, 1.31-1.63), atopic dermatitis (1.50, 1.33-1.69), angina (1.46, 1.35-1.57), allergic rhinitis (1.45, 1.36-1.55), dyslipidemia (1.38, 1.31-1.45), asthma (1.35, 1.26-1.44), and hypertension (1.23, 1.19-1.28). Subjects who sleep less than 6 hours/day were more likely to have cataract than subjects who sleep more than 9 hours/day as a reference group (aOR=1.22, 99% CI, 1.11-1.34). CONCLUSION: While the most important cataract risk factor was age, the ten comorbidities mentioned above were also significant risk factors. Interestingly, longer duration of sleep was associated with a protective effect against cataract development.

Encuesta de ceguera y deficiencia visual evitable en Panamá / Survey on avoidable blindness and visual impairment in Panama

OBJETIVO: Determinar la prevalencia de ceguera y deficiencia visual en adultos de 50 años o más de Panamá, identificar sus principales causas y caracterizar la oferta de servicios de salud ocular. MÉTODOS: Estudio poblacional transversal mediante la metodología estándar de evaluación rápida de ceguera evitable. Se seleccionaron 50 personas de 50 años o más de cada uno de 84 conglomerados escogidos mediante muestreo aleatorio representativo de todo el país. Se evaluó la agudeza visual (AV) mediante una cartilla de Snellen y el estado del cristalino y del polo posterior por oftalmoscopía directa. Se calculó la cobertura de cirugía de catarata y se evaluó su calidad, así como las causas de tener AV < 20/60 y las barreras para acceder al tratamiento quirúrgico. RESULTADOS: Se examinaron 4 125 personas (98,2% de la muestra calculada). La prevalencia de ceguera ajustada por la edad y el sexo fue de 3,0% (intervalo de confianza de 95%: 2,3-3,6). La principal causa de ceguera fue la catarata (66,4%), seguida del glaucoma (10,2%). La catarata (69,2%) fue la principal causa de deficiencia visual (DV) severa y los errores de refracción no corregidos fueron la principal causa de DV moderada (60,7%). La cobertura quirúrgica de catarata en personas fue de 76,3%. De todos los ojos operados de catarata, 58,0% logró una AV < 20/60 con la corrección disponible. CONCLUSIONES: La prevalencia de ceguera en Panamá se ubica en un nivel medio con respecto a la encontrada en otros países de la Región. Es posible disminuir este problema, ya que 76,2% de los casos de ceguera y 85,0% de los casos de DV severa corresponden a causas evitables.

OBJECTIVE: Determine prevalence of blindness and visual impairment in adults aged > 50 years in Panama, identify their main causes, and characterize eye health services. METHODS: Cross-sectional population study using standard Rapid Assessment of Avoidable Blindness methodology. Fifty people aged > 50 years were selected from each of 84 clusters chosen through representative random sampling of the entire country. Visual acuity was assessed using a Snellen chart; lens and posterior pole status were assessed by direct ophthalmoscopy. Cataract surgery coverage was calculated and its quality assessed, along with causes of visual acuity < 20/60 and barriers to access to surgical treatment. RESULTS: A total of 4 125 people were examined (98.2% of the calculated sample). Age- and sex-adjusted prevalence of blindness was 3.0% (95% CI: 2.3-3.6). The main cause of blindness was cataract (66.4%), followed by glaucoma (10.2%). Cataract (69.2%) was the main cause of severe visual impairment and uncorrected refractive errors were the main cause of moderate visual impairment (60.7%). Surgical cataract coverage in individuals was 76.3%. Of all eyes operated for cataract, 58.0% achieved visual acuity < 20/60 with available correction. CONCLUSIONS: Prevalence of blindness in Panama is in line with average prevalence found in other countries of the Region. This problem can be reduced, since 76.2% of cases of blindness and 85.0% of cases of severe visual impairment result from avoidable causes.

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey / Evaluación rápida de la ceguera evitable en Uruguay: resultados de un estudio a escala nacional

OBJECTIVE: To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay. METHODS: All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction. RESULTS: Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see ≥ 20/60 and 15.3% could not see 20/200 post-surgery. CONCLUSIONS: Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people ≥ 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.

OBJETIVO: Investigar y describir la prevalencia y las causas de la ceguera y de la discapacidad visual moderada y grave en los adultos mayores residentes en Uruguay. MÉTODOS: Todas las personas de 50 años o más que vivían en los agrupamientos seleccionados aleatoriamente reunían los requisitos para participar. En cada unidad de enumeración censal seleccionada, se escogieron 50 residentes de = 50 años de edad para participar en el estudio mediante el empleo de un muestreo por segmentos compactos. Los participantes fueron sometidos a una medición de la agudeza visual (AV) y a un examen del cristalino; los que mostraban una AV de presentación (AVP) < 20/60 también fueron sometidos a oftalmoscopia directa. La discapacidad visual moderada (DVM) se definió como una AVP < 20/60–20/200, la discapacidad visual grave (DVG) como una AVP < 20/200–20/400, y la ceguera como una AVP< 20/400, todas ellas basadas en la visión del ojo que obtuvo un mejor resultado con la corrección disponible. RESULTADOS: De las 3 956 personas que reunieron los requisitos, se examinaron 3 729 (94,3%). La prevalencia ajustada por edad y sexo de la ceguera fue de 0,9% (intervalo de confianza (IC) de 95%: 0,5–1,3). La catarata (48,6%) y el glaucoma (14,3%) fueron las principales causas de ceguera. La prevalencia de la DVG y la DVM fue de 0,9% (IC de 95%: 0,5–1,3) y 7,9% (IC de 95%: 6,0–9,7), respectivamente. La catarata fue la causa principal de DVG (65,7%), seguida del error de refracción no corregido (14,3%), que fue la principal causa de DVM (55,2%). La cobertura quirúrgica de la catarata fue de 76,8% (calculada por ojo) y de 91,3% (calculada por persona). De todos los ojos operados de catarata, 70,0% presentaba una agudeza visual de = 20/60 y 15,3% tenía una agudeza visual < 20/200 después de la intervención quirúrgica. CONCLUSIONES: En Uruguay, la prevalencia de la ceguera es baja en comparación con otros países latinoamericanos, pero es factible lograr una reducción adicional. Como consecuencia de la alta cobertura quirúrgica de la catarata y la creciente proporción de personas de = 50 años en Uruguay, la repercusión de las enfermedades de la cámara ocular posterior como factor contribuyente a la ceguera podría aumentar en el futuro.

Complexities and challenges of surgical data collection from cataract patients: comparison of cataract surgery rates between 2001 and 2008 in all provinces of Argentina / Complexidades e desafios da coleta de dados cirúrgicos de catarata: comparação das taxas de cirurgia de catarata em todas as províncias da Argentina de 2001 em relação a 2008

Purpose: To compare the cataract surgical rate (CSR) in 2001 with that in 2008 in all Argentinean provinces using current reporting methods and verify the accuracy of CSRs by crosschecking these methods with the number of sold intraocular lenses (IOLs) within the country. Methods: A longitudinal study including public and private setups was conducted, and it included 40 ophthalmologists from 22 provinces who provided cataract surgery data for 2001 and 2008. Other data were obtained from the Ministry of Health. Estimates were crosschecked against the market data for sold intraocular lens (IOLs) in 2008 and 2010. Results: The number of cataract surgeries increased 2.7-fold, from 62,739 in 2001 to 169,762 in 2008, with increases in every province except Mendoza. Although the population also increased by 9.4% during the same time period, the apparent CSR jumped from 1,744 to 4,313 per million population. The number of IOLs sold in Argentina in 2008 was 186,652, suggesting that the number of cataract surgeries performed was slightly greater than anticipated. Crosschecks with other countries using IOL sales data did not show discrepancies when compared with previously reported CSRs. Conclusions: Although the CSR in Argentina increased considerably from 2001 to 2008 for several reasons, the main reason was that thorough crosschecking between the number of surgeries reported and the number of IOLs sold revealed that the number of surgeries performed annually were being underestimated as a result of incomplete reporting by private practitioners. Furthermore, the presence of multiple societies of ophthalmology in the country complicated the process of obtaining accurate data. .

Objetivo: Comparar a taxa de cirurgia de catarata (TCC) em todas as províncias da Argentina entre 2001 e 2008, utilizando métodos de relatórios convencionais e verificar a precisão da TCC por meio do cruzamento desses métodos com o número de lentes intraoculares (LIOs) vendidas no país. Métodos: Estudo longitudinal realizado em clínicas públicas e privadas, com a participação de 40 oftalmologistas de 22 províncias, que forneceram dados sobre cirurgias de catarata para 2001 e 2008. Outros dados foram obtidos a partir do Ministério da Saúde. As observações foram cruzadas com os dados de mercado para LIOs no período de 2008 a 2010. Resultados: O número de cirurgias de catarata aumentaram 2,7 vezes, de 62.739 em 2001 para 169.762 em 2008, com aumentos em todas as províncias, exceto Mendoza. Embora a população também tenha aumentado 9,4 % durante o mesmo período de tempo, a aparente TCC saltou de 1.744 para 4.313 por milhão de população. O número de LIOs vendidas na Argentina em 2008 foi de 186.652, o que pode significar que tenham sido realizadas um pouco mais de cirurgias de catarata do que o estimado. Verificações cruzadas com outros países que utilizam dados de vendas de LIOs não apresentam discrepâncias quando comparado a TCC anteriormente relatadas. Conclusões: De 2001 a 2008, a TCC na Argentina aumentou consideravelmente por várias razões mas, principalmente, porque foi revelada, por meio do cruzamento de dados sobre cirurgias relatadas com o número de LIOs vendidas, que o número de cirurgias realizadas anualmente foi hipoestimado no passado, como resultado de relatórios incompletos feitos por médicos privados. Há também várias sociedades de oftalmologia no país, o que dificulta a obtenção de dados precisos. .

Prevalence of myopic shifts among patients seeking cataract surgery / Prevalencia de cambios miópicos en pacientes con catarata

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

La cirugía moderna de facoemulsificación del cristalino tiene una recuperación muy rápida. La elección correcta del lente intraocular que se coloca en la cirugía permite, muchas veces, anticipar si el paciente va a precisar anteojos luego de la cirugía. Este estudio analiza una muestra de pacientes con catarata, mostrando la frecuencia relativa de cambios miópicos que permiten a los pacientes ver de cerca sin lentes antes de la cirugía. Se estudiaron retrospectivamente una serie de pacientes consecutivos que realizaron cirugía electiva de catarata. El cambio refractivo miópico fue documentado comparando las prescripciones antiguas con la medición subjetiva al momento del estudio. Los sujetos fueron agrupados de acuerdo a la presencia o ausencia de cambios miópicos, y se estudiaron las proporciones con respecto a su grado de opacidad nuclear. La edad promedio de los 229 sujetos estudiados fue de 71.5 ± 10.4 años, 109 (47.6%) varones. Se halló un cambio miópico, definido como un cambio mayor de - 0.5 dioptrías, en 85 (37.1%, IC95%: 30.8-43.4%). El porcentaje de sujetos con cambio miópico fue significativamente mayor en aquellos que tenían mayor opacidad nuclear al tiempo del examen. En este estudio de pacientes no seleccionados que buscaban realizar cirugía de catarata, más de un tercio tuvo cambios miópicos en la refracción. Si el paciente lograba ver bien de cerca antes de la cirugía, esto debería ser tenido en cuenta a la hora de elegir un correcto lente intraocular para que el sujeto no pierda este beneficio de la catarata.

Prevalence of congenital eye anomalies in a paediatric clinic in Ghana

There is little information about the epidemiology of congenital eye anomalies in Ghana. We retrospectively reviewed the clinical records of 485 admissions to the paediatric eye centre of the Korle-Bu Teaching Hospital, Ghana [2004-2009] and 263 were diagnosed with at least one anomaly. Visual acuity was quantitatively assessed in 209 patients and 130 had some visual impairment; 49 with bilateral and 64 with unilateral blindness. The most frequent congenital anomaly overall was cataract [n = 44]. In infants, cataract was the most frequent finding [28/121]. Toddlers most frequently presented with retinoblastoma [10/65]. Glaucoma was the most frequent anomaly in preschool [9/39] and school [10/38] children. We conclude that avoidable causes of childhood blindness caused most congenital eye anomalies. Intensification of community-based health promotion and preventive eye care, early detection and provision of adequate resources for effective therapy could reverse these trends

Cataracts among Adults Aged 30 to 49 Years: A 10-Year Study from 1995 to 2004 in Korea

PURPOSE: To investigate the long-term characteristics of cataracts among adults aged 30 to 49 years in Korean over a span of 10 years. METHODS: Subjects between the ages of 30 to 49 years who underwent cataract surgery at St. Mary's Hospital from 1995 to 2004 (n = 976) were included. Patients with a history of ocular trauma, uveitis, other ocular or systemic diseases, and congenital cataracts were excluded. Additional information including type of lens opacity, urban/rural region, and pre- and postoperative visual acuities were analyzed. Lens opacity grading was conducted using Lens Opacity Classification System III. The Cochran-Armitage proportion trend test was used to analyze vision changes with the passage of time. RESULTS: Among the patients who had undergone cataract surgeries, 8.8% (976 / 11,111) met the inclusion criteria. The mean age was 41.7 +/- 5.45 years. Gender breakdown of the patient population included 79.0% male and 21.0% female. In terms of home environment, 60.9% were from an urban region and 39.1% from a rural region. Opacity type included anterior polar (AP), posterior subcapsular (PSC), AP and PSC, cortical, and nuclear in 35.7%, 35.1%, 7.0%, 6.0%, and 5.4% of patients, respectively. At a 2-month postoperative follow-up appointment, 92.7% of patients showed a best-corrected visual acuity of more than 20 / 40. CONCLUSIONS: Predominance of AP and PSC opacities as well as male patients was observed in this study population.