Deslocamento espontâneo do núcleo do cristalino para câmara anterior / Spontaneous displacement of the lens nucleus into the anterior chamber

RESUMO Ao longo da vida, o cristalino produz novas fibras dispostas de forma concêntrica, que aumentam seu diâmetro anteroposterior e peso, tornando seu núcleo mais compacto e endurecido. A catarata hipermadura é uma forma de progressão avançada dessa proliferação de fibras, que pode desencadear uma variedade de complicações. A ruptura espontânea da cápsula anterior do cristalino, evoluindo com deslocamento anterior do núcleo, é uma complicação rara e com poucos casos publicados na literatura. Descrevemos o caso de uma paciente do sexo feminino, 68 anos, que apresentou ruptura espontânea da cápsula anterior do cristalino com deslocamento anterior do núcleo em olho esquerdo sem histórico de trauma ocular. A paciente foi submetida à facoemulsificação do cristalino e ao controle da pressão intraocular, evoluindo com melhora do quadro clínico.

ABSTRACT Throughout life, the lens produces new fibers arranged concentrically, which increase its anteroposterior diameter and weight, making its nucleus more compact and hardened. Hypermature cataract is an advanced stage of this fiber proliferation, which can trigger a variety of complications. Spontaneous rupture of the anterior lens capsule evolving with anterior displacement of the nucleus is a rare complication, with few cases published in the literature. We describe the case of a 68-year-old female patient, who presented spontaneous rupture of the anterior lens capsule with anterior displacement of the nucleus in the left eye, without a history of ocular trauma. The patient underwent phacoemulsification and clinical control of intraocular pressure, improving her condition.

Síndrome de Lowe, enfermedad renal crónica y síndrome de Lennox-Gastaut / Lowe syndrome, chronic kidney disease and Lennox-Gastaut syndrome

Introducción: El síndrome de Lowe o síndrome oculocerebrorenal es un trastorno multisistémico. Es una enfermedad rara e infrecuente. Objetivo: Exponer un caso clínico típico, con fracaso renal controlado sin método dialítico y que de manera tardía en su adolescencia se diagnostica con síndrome de Lennox-Gastaut. Presentación caso: Adolescente masculino de 18 años nacido de un embarazo sin riesgo y parto por cesárea, macrofeto. Desde el nacimiento, con diagnóstico perinatal de catarata congénita y evolutivamente glaucoma bilateral con tratamiento conservador. A partir del primer año de vida padece de acidosis tubular y síndrome de Fanconi con evolución a una enfermedad renal crónica. Relacionado todo con retraso del desarrollo psicomotor, discapacidad intelectual, estereotipias, síntomas obsesivos compulsivos y depresión. De manera tardía, a los 10 años tuvo inicio de crisis epilépticas de varios tipos con predominio de las tónicas durante el sueño y en vigilia, frecuentes, con electroencefalograma característico de síndrome Lennox-Gastaut. Tuvo atención interdisciplinaria y evolución clínica estable hasta la edad adulta cumplida. El estudio molecular de ADN materno y del niño confirmaron la mutación c2224_2226 del GTA (exón 19), delección de valina en la posición 742 del cromosoma X del OCRL 1, que ratifica el síndrome de Lowe. Conclusiones: El Síndrome de Lowe, es un trastorno multisistémico, ligado al cromosoma X y frecuente en varones. Clínicamente se caracteriza por alteraciones oftalmológicas, renales y neurológicas(AU)

Introduction: Lowe syndrome or oculocerebrorenal syndrome is a multisystemic disorder. It's a rare and uncommon disease. Objective: Show a typical clinical case, with controlled renal failure without dialytic method and that late in the adolescence is diagnosed with Lennox-Gastaut syndrome. Case presentation: 18-year-old male adolescent born of a risk-free pregnancy and cesarean delivery, with macrosomia. From birth, he had a perinatal diagnosis of congenital cataract and evolutionarily bilateral glaucoma with conservative treatment. From the first year of life he suffers from tubular acidosis and Fanconi syndrome with an evolution to chronic kidney disease. All of these were related to delayed psychomotor development, intellectual disability, stereotypies, obsessive-compulsive symptoms and depression. Lately, at 10 years old, epileptic seizures of various types with predominance of tonic ones during sleep and wakefulness began; they were frequent, with characteristic electroencephalogram of Lennox-Gastaut syndrome. He had interdisciplinary care and stable clinical evolution into adulthood. The molecular study of the mother and child DNA confirmed the c2224_2226 mutation of GTA (exon 19), valine deletion at position 742 of the X chromosome of OCRL 1, which ratifies Lowe syndrome. Conclusion: Lowe Syndrome is a multisystemic disorder, linked to the X chromosome and common in males. Clinically, it is characterized by ophthalmological, renal and neurological alterations(AU)

Disfotopsias negativas: un reto pendiente para los cirujanos de catarata / Negative dysphotopsia: a pending challenge for cataract surgeons

La disfotopsia negativa representa un motivo importante de insatisfacción del paciente tras una cirugía de catarata no complicada. Se manifiesta como una sombra oscura en el campo visual temporal, habitualmente en forma de medialuna, que cuando es persistente transforma en frustrante un resultado posquirúrgico que de otra manera sería considerado exitoso. Dada la amplia literatura publicada al respecto, esta revisión pretende resumir lo más actualizado sobre este fenómeno óptico en cuanto a sus causas, factores asociados, diagnóstico y tratamiento. Se realizó una búsqueda en Scholar Google con las palabras clave "Negative dysphotopsia", la cual se confinó a artículos de la Journal of Cataract Refractive Surgery, y se encontró un total de 822 resultados; de ellos, 54 desde el año 2019 hasta el momento de la revisión(AU)

Negative disfotopsia is an important cause of patient´s dissatisfaction after an uncomplicated cataract surgery. The affected individuals perceive a dark shadow on the temporal visual field, in the form of a crescent or arc, that transforms in frustrating a postsurgical result otherwise considered as successful. Given the several articles published on this topic, this review hopes to summarize the most up-to-date literature about this optic phenomenon considering its causes, associated factors, diagnosis and current treatment(AU)

Phacoémulsification versus phacoalternative manuelle sans suture au cours de la chirurgie de masse de la cataracte

Introduction : La pratique de la phacoémulsification (phaco E) reste exceptionnelle dans les pays à faibles revenus contrairement à la phacoalternative manuelle sans suture (phaco A). Le but était de comparer les deux techniques au cours d'une chirurgie de masse de la cataracte. Population et méthodes : Il s'agissait d'une étude prospective menée en 2017 à Libreville. Elle concernait 233 patients (233 yeux) avec une cataracte liée à l'âge. Ils étaient répartis en deux groupes(phaco A, phaco E). Ceux ayant une acuité visuelle (AV) de loin inférieure à 2/10ème et une absence de pathologies oculaires associées pouvant compromettre la récupération visuelle étaient inclus. Résultats : L'âge moyen était de 67,6 ± 10,1 ans, les femmes représentaient 52,4% de l'effectif. La phaco A était pratiquée dans 57,5 % des cas. After surgery, patients operated by Phaco A had an AV without correction considered good in 75.4% of cases, average in 13.4% and bad in 11.2%. Pour ceux opérés par phaco E, elle était bonne dans 81,8% des cas et moyenne dans 18,2%. La récupération visuelle était meilleure pour le groupe phaco E (p = 0,002). La fréquence des complications per opératoires était de 3% pour la phaco E et 4,4% pour la phaco A (p = 0,731). Celle des complications post opératoires était de 3% pour la phaco E contre 3,7% pour la phaco A (p = 0,965). Conclusion : La récupération visuelle était meilleure après chirurgie de la cataracte par phaco E. Les deux techniques présentaient un faible taux de complications

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.

Impacto de la cirugía de catarata en la calidad de vida de pacientes del Hospital Central de la Policía / Cataract surgery impact in quality of life in patients at Hospital Central de la Policía

Objetivo: evaluar el impacto de la cirugía de catarata en la calidad de vida de los pacientes del Hospital Central de la Policía. Diseño del estudio: estudio cuasi experimental. Métodos: se incluyeron pacientes del servicio de oftalmología del Hospital Central de la Policía con diagnóstico de catarata a quienes se les realizo encuesta de calidad de vida (SF-36) previo a la cirugía, con obtención de consentimiento informado para participar en el estudio y con aprobación de la junta institucional. Luego de la cirugía se aplicó de nuevo la encuesta de calidad de vida a cada paciente a los 3 y 6 meses. Se realizó el análisis univariado y se determinaron las correlaciones existentes entre las variables de interés del estudio y la calidad de vida, se utilizó el paquete estadístico SPSS 22.0 de IBM. Resultados: se incluyeron 41 pacientes a quienes se les realizó cirugía de catarata. El puntaje de calidad de vida promedio paso de 63 antes de la cirugía a 78 y 81 en los 3 y 6 meses respectivamente posteriores a la cirugía demostrando gran mejoría en la calidad de vida de los pacientes. Conclusiones: en cuanto al puntaje de cuestionario SF-36, se encontró aumento del puntaje de calidad de vida posterior a la cirugía de catarata tanto a los 3 y 6 meses, pasando de calidad de vida regular a bueno.

Objective: to evaluate the impact of cataract surgery on quality of life of patients in the Central Police Hospital. Methods: a quasi-experimental study. Patients of the ophthalmology department of the Central Police Hospital with a diagnosis of cataract where included and the instrument to measure quality of life was applied (SF-36) before surgery; informed consent was obtained to participate in the study and approval the institutional review board was granted. After surgery the instrument was applied again for each patient at 3 and 6 months. Responses were considered for univariate analysis and correlations, the SPSS 22.0 statistical package was used. Results: 41 patients were included in whom cataract surgery was done. The quality of life score average pace of 63 before surgery to 78 and 81 at 3 and 6 months respectively after surgery showing great improvement in the quality of life of patients. Conclusions: It was evident the improvement on the score of the SF-36 instrument at both 3 and 6 months, ranging form regular quality of life to good quality of life.

Queratopatía bullosa poscirugía de catarata en el adulto mayor / Keratopathy bulosa after cataract surgery in the older adult

OBJETIVO: caracterizar a los pacientes con queratopatía bullosa en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". MÉTODOS: se realizó un estudio descriptivo de serie de casos, de corte transversal, en 50 pacientes atendidos entre enero y diciembre de 2012, para identificar sexo y edad, antecedentes patológicos personales sistémicos y oculares, la agudeza visual sin corregir y corregida en el ojo contralateral, frecuencia de indicación de queratoplastia, tipo de técnica quirúrgica utilizada y el grado de independencia actividades básicas de la vida diaria.RESULTADOS: el 42,8 % del sexo masculino se encontraba entre 70 y 79 años y el 41,3 % del sexo femenino entre 60 y 69 años. La hipertensión arterial esencial fue la enfermedad sistémica más frecuente (36 %) y el 22 % presentó catarata como enfermedad ocular. El 38 % alcanzó una visión corregida entre 0,5 y 0,7. El 82 % de los pacientes poseía indicación de queratoplastia y el 60 % de endoqueratoplastia. El 32 % resultó independiente para todas las actividades básicas de la vida diaria. CONCLUSIONES: en la queratopatía bullosa predominan los pacientes en el rango de edades entre 70 a 79 años de edad y el sexo femenino es el más afectado. La hipertensión arterial y la catarata son las enfermedades más frecuentes. La mayoría de los pacientes tienen una agudeza visual no corregida entre 0,1 y 0,4 y corregida entre 0,5 y 0,7 en el ojo contralateral. El mayor porcentaje tiene indicado el trasplante de córnea, y la técnica más indicada es la queratoplastia lamelar endotelial. Hay un predominio de pacientes independientes en sus actividades básicas de la vida diaria.

OBJECTIVE: to characterize the patients with keratopathy bulosa at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology. METHODS: case-series descriptive and cross-sectional study of 50 patients conducted from January to December 2012. The studied variables were sex and age, personal pathological history, visual acuity in the contralateral eye, frequency of keratoplasty indications, surgical technique and level of indepencence for various daily life activities. RESULTS: in males, 42,8 % aged 70 to 79 years and 41 % of females were 60 to 69 years-old. Blood hypertension affected 36 % and cataract 22 % of patients. In the study, 38 % reached corrected vision of 0,5 to 0,7. Eighty two percent of patients were prescribed corneal transplantation and 73,17 % should undergo endothelial lamellar keratoplasty. Thirty two percent were independents for all the basic daily life activities. CONCLUSIONS: keratopathy bulosa prevails in patients aged 70 to 79 years, and females are the most affected. Blood hypertension and cataract are the most common diseases. Most of patients have uncorrected visual acuity from 0,1 to 0,4 and corrected one from 0,5 to 0,7 in the contralateral eye. The highest percentage of patients should undergo corneal transplantation and the most indicated surgery is endothelial lamellar keratoplasty. Self-sufficient patients in doing their basic daily life activites predominate.

Parinaud's oculoglandular syndrome and possibly causing cortical cataract / Síndrome oculoglandular de Parinaud como possível causa de catarata cortical

According to the World Health Organization, cataract is the leading cause of blindness and visual impairment throughout the world. However, the etiology of cataracts often remains unknown. This report describes the development of cortical cataract in a patient after Parinaud's oculoglandular syndrome caused by the fungus Sporothrix schenckii.

De acordo com a Organização Mundial de Saúde, a catarata é a principal causa de cegueira e deficiência visual em todo o mundo. No entanto, a etiologia das cataratas frequentemente permanece desconhecida. Este relato descreve o desenvolvimento de catarata cortical em um paciente após Síndrome oculoglandular de Parinaud causada pelo fungo Sporothrix schenckii.

Resultados visuales con nuevo lente trifocal AT LISA® tri 839MP: serie de casos / Visual outcomes with new lens trifocal AT LISA® tri 839MP: case series

Objetivo: Evaluar los resultados visuales del implante de lente trifocal AT LISA® tri 839MP en pacientes con cataratas o presbicia. Métodos: reporte de serie de casos de 14 pacientes (24 ojos) en los que se realizó facoemulsificacion del cristalino e implante del lente trifocal AT LISA® tri 839MP. Resultado: en un periodo promedio de 6,3 meses se evaluó la visión la cercana y lejana con promedios de visión logMar sin corrección de 0,004 y 0,008 respectivamente y para la visión intermedia el promedio logMar fue 0,02; con 100% de los pacientes con independencia de gafas Los fenómenos visuales como halos estuvieron presentes en 8,4% de los ojos. Conclusiones: el lente evaluado produce excelentes resultados visuales en función visual lejos, intermedia y cerca con gran satisfacción del paciente.

Objective: to evaluate visual results in trifocal lens implant AT LISA tri 839MP® in patients with cataracts and presbyopia. Methods: this case series report comprised 14 patients (24 eyes) who had lens phacoemulsification and implantation of AT LISA tri 839MP® trifocal lens. Results: during an average period of 6.3 months, mean values of 0,004 and 0,008 logMar were obtained respectively for uncorrected near and distance vision and the average intermediate vision was assessed with logMAR scale at 0,02 ;100% of patients have independence of spectacles. Visual phenomena as halos were presented in 8.4 % of eyes. Conclusions: the evaluated lens produces excellent visual results in far, intermediate and near visual acuity, with great patient satisfaction.

Análisis de costo-efectividad del uso de lentes intraoculares tóricos frente a los lentes monofocales tradicionales en pacientes con catarata y astigmatismo corneal preexistente / Cost-effectiveness analysis of toric intraocular lenses use versus traditional monofocal lenses in cataract patients with pre-existent corneal astigmatism

Objetivo: evaluar la costo-efectividad del uso de lentes intraoculares (LIO) tóricos en la cirugía de pacientes con catarata con astigmatismo corneal pre-existente (> 0.75 D) versus el uso de lentes intraoculares (LIO) monofocales. Método: mediante un modelo tipo árbol de decisión se compararon las intervenciones desde la perspectiva del tercero pagador. El modelo tuvo un horizonte temporal de cinco años. La medida del resultado analizado fue la agudeza visual acumulada de 20/32 o mejor expresada en tiempo de visión normal a distancia libre de soporte adicional. Se aplicó una tasa de descuento del 3% anual para costos y desenlaces clínicos. La efectividad fue tomada de un estudio clínico controlado multicéntrico. Resultados: en el caso base la razón de costo-efectividad incremental (RCEI) para los LIO tóricos fué de (USD) $534,83 por cada año de visión normal a distancia libre de soporte adicional comparados con los LIO monofocales. Se observó que la RCEI mejora si el astigmatismo es mayor antes de la cirugía, así para rangos de dioptría <1.50, >1.50 <2.00 y >2.00 la RCEI fué de (USD) $712.40, (USD) $416.75 y (USD) $382.16, respectivamente. Según el análisis de sensibilidad univariado la probabilidad de quedar sin astigmatismo debido al LIO monofocal, es la variable de mayor impacto en la RCEI. Conclusiones: los LIO tóricos demostraron ser costo-efectivos para el tratamiento de los pacientes con catarata y con astigmatismo corneal preexistente, siendo mejor su beneficio en pacientes con mayor compromiso visual.

Objective: to evaluate the cost-effectiveness of toric intraocular lenses (IOL) use in surgery of patients with cataract and preexisting corneal astigmatism (> 0.75 D) versus the use of monofocal intraocular lenses (IOL) from the perspective of third party payer. Method: interventions were compared using a decision tree model from a third party payer's perspective. The model had a time horizon of 5 years. The measured outcome was the cumulative visual acuity of 20/32, which was expressed in normal vision time without additional support. A discount rate of 3% per annum was applied to costs and clinical outcomes. The effectiveness was taken from a controlled multicenter clinical study. Results: in base case, the incremental costeff ectiveness ratio (ICER) for the toric IOL was (USD) $ 534.83 for each year of normal vision without additional support compared with monofocal IOL. It was noted that the ICER improved if the astigmatism was high before surgery, so in different diopter ranges: <1.50, > 1.50 < 2.00 and > 2.00 the ICER was (USD) $ 712.40, (USD) $ 416.75 and (USD) $ 382.16 respectively. According to univariate sensitivity analysis the probability to end without astigmatism due to monofocal IOL was variable with the greatest impact on the ICER. Conclusion: toric IOLs proved to be cost-effective for the treatment of patients with cataract and preexisting astigmatism.

Clear corneal incision in cataract surgery

Since the introduction of sutureless clear corneal cataract incisions, the procedure has gained increasing popularity worldwide because it offers several advantages over the traditional sutured scleral tunnels and limbal incisions. Some of these benefits include lack of conjunctival trauma, less discomfort and bleeding, absence of suture-induced astigmatism, and faster visual rehabilitation. However, an increasing incidence of postoperative endophthalmitis after clear corneal cataract surgery has been reported. Different authors have shown a significant increase up to 15-fold in the incidence of endophthalmitis following clear corneal incision compared to scleral tunnels. The aim of this report is to review the advantages and disadvantages of clear corneal incisions in cataract surgery, emphasizing on wound construction recommendations based on published literature

El papel del Fondo de Protección contra Gastos Catastróficos en la cobertura de atención a pacientes con cataratas / The role of the Fund against Catastrophic Expenditures in Health on the coverage of patients with cataract

Objetivo. Documentar el efecto que el Fondo de Protección contra Gastos Catastróficos (FPGC) ha tenido sobre la cobertura de servicios y la disponibilidad de recursos para la atención de cataratas. Material y métodos. Con datos 2000-2010 del Sistema Automatizado de Egresos Hospitalarios y las estimaciones de población del Consejo Nacional de Población, se calcularon la tasa anual y la cobertura de atención de cataratas. Los datos de recursos proceden del Sistema Nacional de Información en Salud. Resultados. La cobertura de atención creció de 24 pacientes atendidos por 1 000 pacientes con cataratas en 2000 a 58.8 en 2012. El mayor aumento ocurrió entre 2006 y 2007 como consecuencia de la incorporación de la atención de cataratas al FPGC. Este aumento se sustenta más en la productividad por oftalmólogo que en un incremento de los recursos. Sobresalen los incrementos en la tasa de egresos observados en Aguascalientes, Coahuila, Distrito Federal y Nayarit. Conclusiones. Los resultados aquí presentados muestran beneficios sobre la salud poblacional derivados de decisiones político-organizacionales basadas en evidencias.

Objective. To describe the effect of the Fund against Catastrophic Expenditures in Health on the provision of services for patients with cataract. Materials and methods. We used administrative dataset on hospital discharges and official figures on population to estimate the rate of care and the coverage for cataract. To estimate the variation on resources, we used data from the National System of Health Information. Results. Coverage for this disease had a significant increase between 2000 and 2010, passing from 24 per thousand cataract patients receiving attention to 58.8 per thousand. This growth is mainly due to the incorporation of cataract to the catalog of diseases covered by the Fund against Catastrophic Expenditures in Health, although this variation is not based on additional resources but in a higher productivity. The growth of services is noticeable in Aguascalientes, Coahuila, Distrito Federal and Nayarit. Conclusions. Our results suggest that policy-making based on evidence have actually brought benefits for Mexican population.

Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results.

We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

Implantação do exame do reflexo vermelho em crianças da região do Hospital das Clínicas da Faculdade de Medicina de Botucatu - SP - Brasil / Implementation of red reflex exam in children in the area of Botucatu Medical School Clinical Hospital - São Paulo, Brazil

OBJETIVO: Descrever a implantação do teste de reflexo vermelho nas 30 cidades de inserção do Hospital das Clínicas da Faculdade de Medicina de Botucatu, HC/FMB/UNESP (480.337 habitantes), a criação de um centro para referência de crianças com reflexo vermelho alterado ou duvidoso, a Triagem do reflexo vermelho e outro para o tratamento da catarata infantil, o Centro de tratamento da catarata infantil. MÉTODOS: O exame do reflexo vermelho foi divulgado em 30 cidades da região de Botucatu. Foram realizadas palestras aos municípios, convocados pelo Departamento Regional de Saúde VI do estado de São Paulo (DRS VI). Foram distribuídos 109 "pen torch ophthalmoscope", às maternidades e Unidades Básicas de Saúde (UBSs) das cidades. A Triagem do reflexo vermelho recebeu os casos de reflexo vermelho alterado ou duvidoso e estabeleceu o diagnóstico oftalmológico. O Centro de tratamento da catarata infantil realizou o exame pré-operatório, o tratamento cirúrgico e o acompanhamento das crianças com catarata. RESULTADOS: Após um ano de funcionamento a Triagem do reflexo vermelho atendeu 29 crianças, 17 do sexo masculino e 12 do feminino, com idade média e desvio padrão (dp) de 10,09 ± 20,35 meses (7 dias - 98 meses). 16 pacientes foram encaminhados com reflexo vermelho alterado, idade média e dp de 13,17 ± 24,14 meses (7 dias - 98 meses), a alteração foi confirmada em todos os casos, 13 deles apresentavam catarata. Em 13 encaminhamentos com reflexo duvidoso, idade média e dp de 6,29 ± 14,46 meses (7 dias - 98 meses), a alteração não se confirmou. A incidência de alterações do reflexo vermelho encontradas foi de 9,2/10.000 nascidos vivos e a incidência the catarata foi de 7,9/10.000 nascidos vivos. CONCLUSÃO: Descrevemos a implantação do Teste do reflexo vermelho na Região de Botucatu, a criação da Triagem do reflexo vermelho e do Centro de tratamento da catarata infantil e dificuldades encontradas.

PURPOSE: To describe the implantation of the red reflex test in 30 cities in the area of Botucatu Medical School Clinical Hospital, (480,337 inhabitants) and the creation of a reference Center for children with red reflex changes, the Red reflex screening and another Center for treatment of childhood cataract. METHODS: The red reflex exam was released in 30 cities of the surrounding Botucatu area, lectures were done in the cities invited to participate by the Regional Department of Health.109 pen torch ophthalmoscopes were distributed to the hospital maternities and primary care units. The Red reflex screening attended cases of altered or doubtful red reflex and established the diagnosis. The Center for treatment of childhood cataract performed the preoperative examination, surgical treatment and follow-up of children with cataracts. RESULTS: After one year the Red reflex screening attended 29 children, 17 males and 12 females, mean age and pattern deviation (PD) of 10.09 ± 20.35 months (7 days - 98 months old). 16 patients were referred with altered red reflex, with a mean age and pattern deviation of 13.17 ± 24.14 months (7 days - 98 months old). The alteration was confirmed in all of these cases. 13 children had cataract. In 13 children with doubtful exam, with a mean age and PD of 6.29 ± 14.46 months (7 days - 54 months old), the alteration was not confirmed in any of these patients. The incidence of negative red reflex found among newborns was 9.2/10,000 and the incidence cataracts in this same group was 7.9/10,000. CONCLUSION: We described the implantation of the red reflex exam in the Botucatu area, and the creation of a reference Center for eye examination of children with changes in the red reflex, and the creation of a reference Center for treatment of childhood cataract and difficulties.

The challenges in improving outcome of cataract surgery in low and middle income countries.

Cataract is the leading cause of blindness globally and surgery is the only known measure to deal with it effectively. Providing high quality cataract surgical services is critical if patients with cataract are to have their sight restored. A key focus of surgery is the outcome of the procedure. In cataract surgery this is measured predominantly, using visual acuity. Population- and hospital-based studies have revealed that the visual outcome of cataract surgery in many low and middle income settings is frequently sub-optimal, often failing to reach the recommended standards set by the World Health Organization (WHO). Another way of measuring outcome of cataract surgery is to ask patients for their views on whether surgery has changed the functioning of their eyes and their quality of life. There are different tools available to capture patient views and now, these patient-reported outcomes are becoming more widely used. This paper discusses the visual outcome of cataract surgery and frames the outcome of surgery within the context of the surgical service, suggesting that the process and outcome of care cannot be separated. It also discusses the components of patient-reported outcome tools and describes some available tools in more detail. Finally, it describes a hierarchy of challenges that need to be addressed before a high quality cataract surgical service can be achieved.

Turning the tide of corneal blindness.

Corneal diseases represent the second leading cause of blindness in most developing world countries. Worldwide, major investments in public health infrastructure and primary eye care services have built a strong foundation for preventing future corneal blindness. However, there are an estimated 4.9 million bilaterally corneal blind persons worldwide who could potentially have their sight restored through corneal transplantation. Traditionally, barriers to increased corneal transplantation have been daunting, with limited tissue availability and lack of trained corneal surgeons making widespread keratoplasty services cost prohibitive and logistically unfeasible. The ascendancy of cataract surgical rates and more robust eye care infrastructure of several Asian and African countries now provide a solid base from which to dramatically expand corneal transplantation rates. India emerges as a clear global priority as it has the world's largest corneal blind population and strong infrastructural readiness to rapidly scale its keratoplasty numbers. Technological modernization of the eye bank infrastructure must follow suit. Two key factors are the development of professional eye bank managers and the establishment of Hospital Cornea Recovery Programs. Recent adaptation of these modern eye banking models in India have led to corresponding high growth rates in the procurement of transplantable tissues, improved utilization rates, operating efficiency realization, and increased financial sustainability. The widespread adaptation of lamellar keratoplasty techniques also holds promise to improve corneal transplant success rates. The global ophthalmic community is now poised to scale up widespread access to corneal transplantation to meet the needs of the millions who are currently blind.

Final visual outcome following re exploration of cataracts performed by trainee surgeons in India.

Objective: To investigate the outcome of secondary intraocular lens implantation, compare final visual outcome between different categories of surgeon, and evaluate care provided by teaching hospitals to patients with capsular complications. Materials and Methods: Setting: Teaching hospital. Design: Retrospective study. Subjects were recruited by examination of electronic medical records. All patients operated for corrective surgery following capsular complications during cataract surgery were included. All patient medical records were reviewed, and data were collected for 359 eyes. Main outcome measures: Visual acuity and major complications. All collected data were entered into Microsoft Excel and analyzed by SPSS 17 software using cross tabulation and Chi-squared tests. Results: Surgical intervention made a significant difference to the final visual outcome (P < 0.001). The category of the trainee had a significant effect on the final visual outcome (P = 0.021). Conclusion: Capsular complications during cataract surgery should be surgically treated to improve outcome.

Health seeking behavior of the families of children with cataract attending an eye clinic in Rio de Janeiro, Brazil / Perfil de procura dos serviços de saúde pelas famílias de crianças com catarata assistidas em uma clínica oftalmológica no Rio de Janeiro, Brasil

PURPOSE: To determine the health-seeking behavior of the families of children presenting with congenital and developmental cataract attending "Instituto Brasileiro de Oftalmologia" (IBOL), Rio de Janeiro, Brazil. METHODS: Caregivers of consecutive eligible children were interviewed using a pretested questionnaire and medical records were reviewed to collect information about their health-seeking behavior and socioeconomic status in June and July of 2008. RESULTS: Data from 70 children were gathered, from which 42 (60.0 percent) had bilateral disease. Fifty-eight (82.9 percent) cases were considered congenital and 12 (17.1 percent) developmental. Presentation delay was observed in 33 (47.1 percent) children. Having insurance (adjusted OR 0.17; 95 percent CI 0.04 - 0.82) and being the only child (adjusted OR 0.16; 95 percent CI 0.04 - 0.69) decreased likelihood of late presentation. CONCLUSIONS: Delayed detection and presentation for treatment of non-traumatic pediatric cataract are still significant problems in the state of Rio de Janeiro. Early recognition as well as prompt referral and appropriate treatment have to be improved, especially at the public sector.

OBJETIVO: Determinar o padrão da procura dos serviços de saúde pelas famílias de crianças com catarata congênita e de desenvolvimento, assistidas no Instituto Brasileiro de Oftalmologia (IBOL), Rio de Janeiro, Brasil. MÉTODOS: Os responsáveis das crianças foram entrevistados utilizando um questionário pré-testado e seus prontuários foram revisados para obter informações sobre a procura dos serviços de saúde pelas famílias, assim como suas condições socioeconômicas, nos meses de junho e julho de 2008. RESULTADOS: Dados de 70 crianças foram obtidos, das quais 42 (60 por cento) tinham doença bilateral. Cinquenta e oito (82,9 por cento) casos foram considerados congênitos e 12 (17,1 por cento) de desenvolvimento. Atraso na apresentação foi observado em 33 (47,1 por cento) crianças. O fato de a criança possuir seguro-saúde (OR ajustado 0,17; 95 por cento IC 0,04 - 0,82) e ser filho único ( OR ajustado 0,16; 95 por cento IC 0,04 - 0,69) reduziu a probabilidade de apresentação tardia. CONCLUSÕES: A detecção e apresentação tardia para tratamento da catarata pediátrica não-traumática são problemas ainda significantes no estado do Rio de Janeiro. O reconhecimento precoce assim como o encaminhamento imediato e tratamento apropriado tem que ser melhorados, principalmente no serviço público de saúde.