Teleophthalmology: where are we now? / Teleoftalmologia: onde estamos?

ABSTRACT Information and communication technology has rapidly reached diverse aspects of modern life, including medicine and health-related matters. Aiming to improve teaching, research, and health care delivery for geographic or economic reasons, telemedicine is an ascending trend. Teleophthalmology might be one of the most challenging applications of telemedicine given its need for standardized and high definition digital images. However, technological advances are enhancing information transmission continuously and expanding the potential of teleophthalmology. In this review, we investigate the evolution and current status of teleophthalmology, describe its use in different areas, and explore its applicability. Although teleophthalmology is not a replacement for traditional eye care and still faces challenges for adequate implementation, it represents an effective care delivery method, facilitating appropriate and timely distribution of service especially in remote and/or underdeveloped regions.

RESUMO A tecnologia da informação alcança diversos aspectos da vida moderna, incluindo a medicina. Com o objetivo de aprimorar o ensino, pesquisa e assitência médica, seja por motivos geográficos ou econômicos, a telemedicina é uma tendência em ascenção. A teleoftalmologia é possivelmente uma das aplicações mais desafiadoras da telemedicina, uma vez que requer imagens digitais de alta resolução. Entretanto, avanços tecnológicos estão continuamente melhorando a transmissão de informações e expandindo o potencial da teleoftalmologia. Um revisão da literatura foi realizada para investigar a evolução e o status atual da teleoftalmologia, descrevendo e explorando sua aplicação em diferentes subespecialidades. Apesar de não representar uma substituição para a assistência oftalmológica tradicional, e, embora ainda existam desafios frente a uma implementação adequada, a teleoftalmologia é um método efetivo de assistência, facilitando a distribuição de atendimento, especialmente em regiões remotas e/ou menos desenvolvidas.

Prophylaxis and treatment of cystoid macular edema after cataract surgery / Profilaxia e tratamento do edema macular cistoide após cirurgia de catarata

Macular cystoid edema is one of the major causes of decreased vision after cataract surgery. The inflammatory process appears to be the main causal factor of the edema. The major risk factors are: surgical complications, previous retinal diseases, diabetes, uveitis and use of prostaglandins drops. The diagnosis is clinically, but fluorescein angiography and optical coherence tomography are also important to detect swelling and assist in differential diagnosis. Although pre-operative prophylaxis do not have scientific evidence, it is recommended especially in cases with risk factors. The initial treatment includes a combination of both topic corticosteroid and nonsteroidal anti-inflammatory. Chronic and refractory cases can be managed with alternatives treatment, such as intravitreal triamcinolone and anti-angiogenic. This article aims to discuss various aspects of pseudophakic macular cystoid edema.

O edema macular cistoide é uma das principais causas de baixa de visão após cirurgia de catarata. O processo inflamatório parece ser o principal fator causal do edema. São considerados fatores de risco complicações cirúrgicas, doenças retinianas prévias, diabetes, uveítes e uso de colírios de prostaglandinas. O diagnóstico é feito clinicamente, mas a angiografia fluoresceínica e a tomografia de coerência óptica também são ferramentas importantes para detectar o edema e auxiliar no diagnóstico diferencial. Apesar da profilaxia pré-operatória não ter evidência científica, ela é preconizada especialmente nos casos com fatores de risco. O tratamento inicial é realizado com associação de corticoide e anti-inflamatório não hormonais tópicos. Os casos crônicos e refratários têm diversas alternativas de tratamento, sendo o uso de triancinolona e antiangiogênicos intravítreos as mais utilizadas. Este artigo se propõe a discutir diversos aspectos do edema macular cistoide pseudofácico.

Prevalence of eye disease in Brazilian patients with psoriatic arthritis

OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal). Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%), and the majority had polyarticular disease (57.5%). Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.