Central corneal thickness in children with congenital cataract and children with surgical aphakia: a case-control study.

AIM: To measure the central corneal thickness (CCT) of children with congenital cataract and surgical aphakia. METHODS: Children with congenital cataract or surgical aphakia were prospectively recruited and divided into four groups: unilateral cataract (group 1, n = 14), bilateral cataract (group 2, n = 17), unilateral aphakia (group 3, n = 32) and bilateral aphakia (group 4, n = 44). An age-, sex-, and race-matched control group of normal individuals was selected. Ultrasonic pachymetry was performed by the same observer. RESULTS: The mean CCT of the control group was not significantly different from the normal (p = 0.747) and cataractous eyes of group 1 (p = 0.252). The mean CCTs of both eyes of group 2 were significantly higher than the control group (p<0.01). The mean CCT of the aphakic eyes in group 3 was significantly higher than the contralateral healthy eyes and control eyes (p<0.001). The mean CCTs of both eyes of group 4 were significantly higher than the control group (p<0.001). The mean CCT was significantly higher in aphakic eyes of groups 3 and 4 than in cataractous eyes of groups 1 and 2 (p<0.001). CONCLUSIONS: Aphakic eyes due to congenital cataract show thicker corneas than normal phakic eyes. Aphakic eyes after congenital cataract extraction show thicker corneas than eyes with congenital cataracts, suggesting that the increase in CCT occurs postoperatively.

Demand incidence of retinal detachment in Brazil.

AIM: To evaluate the epidemiological characteristics of retinal detachment in a defined urban population in the Southeast of Brazil. METHODS: A retrospective study of patients consulted at the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil, with retinal detachment between June 1, 2003 and July 31, 2004. Data were entered into the Statistical Package for the Social Sciences (version 10.0). RESULTS: There were a total population of 3 389 294 in the 42 cities of Campinas catchment area. A total of 313 patients fitted the inclusion criteria. The overall demand incidence of retinal detachment was 9.2:100,000. The number of males peaked in the 50-79 age group, whereas that of the females peaked in the 60 to 80+ age group. The ages ranged from 4 months to 84 years (mean 49.3). The female-to-male ratio was 1:2.1. Nontraumatic phakic detachments had the highest demand incidence of 7.1:100,000. The demand incidence of nontraumatic aphakic detachments was very low at 0.09:100,000. Almost one third of all patients seeking treatment presented inoperable cases of retinal detachments. CONCLUSIONS: This is the first study of demand incidence of retinal detachment in Latin Americans. The age-specific demand incidence increases with age. Nontraumatic phakic detachments were the most common type of detachment. The incidence of the traumatic types of detachment was higher in males than that in females. Such data are important to plan and implement vitreoretinal services taking into account the population likely to be served.

Steroid-induced cataracts in patients with autoimmune hepatitis.

BACKGROUND: Posterior subcapsular cataract (PSC) has been reported in patients on corticosteroids therapy for various pathologies. Autoimmune hepatitis (AIH) is a progressive inflammatory hepatic disease for which corticosteroids are recommended but PSC has not yet been reported in AIH patients on corticosteroids therapy. METHODS: The AIH patients at our service underwent an ophthalmological assessment and their files were analyzed establish the dosage and duration of medication, the presence of visual complaints and the type of AIH, in order to correlate these with the ophthalmological findings. Patients were examined with a slit lamp following pupil dilation. RESULTS: 17 AIH patients evaluated, only one patient had PSC. CONCLUSION: Although the frequency of PSC was low (1/17) in AIH patients on costicosteroid therapy, these individuals should undergo occasional ophthalmological assessment for the presence of cataracts since their visual acuity and quality of life may be adversely affected.

Steroid-induced cataracts in patients with autoimmune hepatitis.

BACKGROUND: Posterior subcapsular cataract (PSC) has been reported in patients on corticosteroids therapy for various pathologies. Autoimmune hepatitis (AIH) is a progressive inflammatory hepatic disease for which corticosteroids are recommended but PSC has not yet been reported in AIH patients on corticosteroids therapy. METHODS: The AIH patients at our service underwent an ophthalmological assessment and their files were analyzed establish the dosage and duration of medication, the presence of visual complaints and the type of AIH, in order to correlate these with the ophthalmological findings. Patients were examined with a slit lamp following pupil dilation. RESULTS: 17 AIH patients evaluated, only one patient had PSC. CONCLUSION: Although the frequency of PSC was low (1/17) in AIH patients on costicosteroid therapy, these individuals should undergo occasional ophthalmological assessment for the presence of cataracts since their visual acuity and quality of life may be adversely affected.

Steroid-induced cataracts in patients with autoinmune hepatitis

BACKGROUND: Posterior subcapsular cataract (PSC) has been reported in patients on corticosteroids therapy for various pathologies. Autoimmune hepatitis (AIH) is a progressive inflammatory hepatic disease for which corticosteroids are recommended but PSC has not yet been reported in AIH patients on corticosteroids therapy. METHODS: The AIH patients at our service underwent an ophthalmological assessment and their files were analyzed establish the dosage and duration of medication, the presence of visual complaints and the type of AIH, in order to correlate these with the ophthalmological findings. Patients were examined with a slit lamp following pupil dilation. RESULTS: 17 AIH patients evaluated, only one patient had PSC. CONCLUSION: Although the frequency of PSC was low (1/17) in AIH patients on costicosteroid therapy, these individuals should undergo occasional ophthalmological assessment for the presence of cataracts since their visual acuity and quality of life may be adversely affected. (AU)

Steroid-induced cataracts in patients with autoinmune hepatitis

BACKGROUND: Posterior subcapsular cataract (PSC) has been reported in patients on corticosteroids therapy for various pathologies. Autoimmune hepatitis (AIH) is a progressive inflammatory hepatic disease for which corticosteroids are recommended but PSC has not yet been reported in AIH patients on corticosteroids therapy. METHODS: The AIH patients at our service underwent an ophthalmological assessment and their files were analyzed establish the dosage and duration of medication, the presence of visual complaints and the type of AIH, in order to correlate these with the ophthalmological findings. Patients were examined with a slit lamp following pupil dilation. RESULTS: 17 AIH patients evaluated, only one patient had PSC. CONCLUSION: Although the frequency of PSC was low (1/17) in AIH patients on costicosteroid therapy, these individuals should undergo occasional ophthalmological assessment for the presence of cataracts since their visual acuity and quality of life may be adversely affected.

[Reasons for cataract surgery cancellation]. / Suspensão de cirurgia de catarata e suas causas.

To study the reasons for cancelling cataract surgeries, and to suggest actions to improve the efficiency of patient care. A cross-sectional study was carried out in a university hospital's ophthalmology clinic of the state of São Paulo, Brazil. Two hundred subjects were randomly selected. The mean age was 68+/- 11.4 years old. The reasons for cancelling surgery were: unpropitious clinical condition (23.1%); tight schedule (35.9%); and patient non-attendance (41%). Most of the reasons related to social issues and the hospital's administrative aspects.

Are routine preoperative medical tests needed with cataract surgery?

OBJECTIVE: The objective of this study was to investigate whether routine medical testing before cataract surgery reduces the rate of complications during the perioperative period in adults. METHODS: The study was carried out in an academic medical center in Brazil, between 10 February 2000 and 10 January 2001. The scheduled cataract operations were randomly assigned to one of two groups: 1) to be preceded by routine testing (the "routine-testing group") or 2) not to be preceded by routine medical testing (the "selective-testing group"). If the patient was assigned to the selective-testing group, it was requested that no preoperative testing be performed unless the patient presented with a new or worsening medical problem that would warrant medical evaluation with testing. In the case of patients assigned to the routine-testing group, three tests were requested: a 12-lead electrocardiogram, a complete blood count, and measurements of serum glucose. RESULTS: The sample of 1,025 patients scheduled to undergo cataract surgery was comprised of 512 assigned to the routine-testing group and of 513 assigned to the selective-testing group. The two groups had similar proportions of operations canceled and not subsequently rescheduled, 2% in each group. The cumulative rate of medical events was similar in the two groups, 9.6% in the routine-testing group and 9.7% in the selective-testing group (P = 0.923). The types of medical events were also similar in both groups. DISCUSSION: The results of this study suggest that routine medical testing before cataract surgery does not reduce the rate of complications during the perioperative period. The results also suggest it would be more efficient not to request routine preoperative tests unless indicated by patient history or physical examination.

Optimization of a university cataract-patient care service in Campinas, Brazil.

PURPOSE: To show the results of operational research techniques applied to the cataract service of a public university hospital in Brazil. METHODS: Using a heuristic approach for operational research, a study was designed to evaluate, develop solutions, and validate the implemented modifications to optimize service performance. RESULTS: Following implementation of the solutions and modifications, 24.9% more patients were examined and 39.9% more cataract surgery was performed than during a similar period prior to implementation. Solutions were provided by group discussion among service professionals and based on common sense, possibility of prompt implementation, and the use of available resources and fixed costs. CONCLUSION: The results of this study show the importance of operational research to a public cataract service wishing to improve its performance with simple and efficient solutions.

Efeito da dorzolamida em glaucoma crônico simples / Dorzolamide in crhronic glaucoma

Foram avaliados os resultados do uso de dorzolamida 2 por cento tópica, um inibidor da andrase carbônica, sobre a pressäo ocular, acuidade visual corrigida e perimetria visual, assim como seus efeitos colaterais em córnea, conjuntiva, câmara anterior, cristalino, fundo de olho e exames laboratoriais (hemograma, Na/K, plaquetas) e clínico geral em 22 olhos (11 pacientes portadores de glaucoma crônico simples. Os resultados obtidos revelam uma diminuiçäo de 26,8 por cento da PO após 30 dias de uso de dorzolamida 2 por cento, a qual se mantém com 6 meses e 1 ano do uso da medicaçäo. Näo houve variaçäo significativa na acuidade visual média durante o tratamento. Houve piora do campo visual em 6 pacientes, sendo que em 3 desses a piora foi inespecífica. Efeitos colaterais oculares leves foram observados em 12 olhos, mas näo se mantiveram em consultas subsequentes. Näo houve alteraçäo laboratorial adversa em nenhum paciente

Utilizaçäo e causas de suspensäo de intervençöes cirúrgicas oculares em centro cirúrgico ambulatorial universitário / Use and causes of suspension of eye surgical interventions in an university ambulatory surgery center

A racionalizaçäo do uso de recursos é fundamental para um maior atendimento da populaçäo necessitada de cuidados em saúde e deve conter medidas que visem ao aproveitamento máximo do tempo disponível dos centros cirúrgicos. Objetivo. Analisar o desempenho do serviço de oftalmologia na realizaçäo e as causas de suspensäo de operaçöes oftalmológicas no CCA (Centro Cirúrgico Ambulatorial) do Hospital das Clínicas da universidade Estadual de Campinas Metodologia. Foram coletados dados referentes às operaçöes agendadas, realizadas e suspensas no CCA durante o ano de 1992. Resultados e Discussäo. Foram realizadas 4.938 (75,11 por cento) das 6.574 cirurgias agendadas. A Oftalmologia ocupa 40 por cento da área cirúrgica e realizou 2.514 (51 por cento) das cirurgias e suspendeu 746 (23 por cento). As outras especialidades realizaram 2.423 (49 por cento) e suspenderam 891 (27 por cento). As principais causas de suspensäo de cirurgias oftalmológicas foram: condiçäo clínica desfavorável, 346 casos (46,38 por cento), falta de comparecimento do paciente com 244 casos (32,71 por cento), e problemas adminsitrativos com 63 casos (8,44 por cento). O melhor controle e planejamento das cirurgias agendadas deve melhorar ainda mais a produtividade do CCA. As seguintes medidas foram colocadas em execuçäo para melhorar a eficiência do CCA: reuniäo com grupo de pacientes no pré-operatório, presença de clínico na admissäo dos pacientes, implantaçäo de um sistema de controle periódico do número de cirurgias e causas de suspensäao e, também, de material necessário para as cirurgias. É de fundamental importância para o aumento de produtividade que haja controle periódico da capacidade cirúrgica, do agendamento e do número de cirurgias realizadas

[Use and causes of discontinuation of eye surgical interventions at a university ambulatory surgery center]. / Utilização e causas de suspensão de intervenções cirúrgicas oculares em centro cirúrgico ambulatorial universitário.

OBJECTIVE: To study the efficiency of an ambulatory surgery center located at a university public hospital we studied the number of surgical interventions performed and suspensions and their causes. METHODS: We collected data on the number of surgical interventions performed, suspension and causes of suspension from January to December of 1992 of the ambulatory surgery center of the Clinical Hospital of University of Campinas, UNICAMP, in São Paulo. A comparison of performance of the Ophthalmology Department and the other medical specialties were made. RESULTS: Of the 6,574 surgical interventions booked 4,938 (75.11%) were performed and 1,636 (24.88%) suspended. Of the 4,938 surgical interventions 2,514 (51%) were performed by the Ophthalmology Department and 2,423 (49%) by other 11 medical specialties. The main causes of suspension of eye operations were unfavorable clinical condition (46.38%), absence of the patient (32.71%) and administrative problems (8.44%). CONCLUSION AND SUGGESTIONS: The Ophthalmology Department has 40% of the space available at the facility and did 51% of the interventions. A better control and planning of the surgical operations may increase the number of interventions and performance of the ambulatory surgery center. It is important for the optimization of the available resources to introduce a periodic control of surgical interventions done, suspension and their causes.

Exequibilidade da cirurgia de catarata em hospital-escola: em busca de um modelo econômico / Practicability of cataract surgery at hospital-school: searching for an economic model

No mundo todo, há escassez de recursos em saúde de forma a atender todas as necessidades no setor. Projetos Zona Livre de Catarata, realizados por vários serviços oftalmológicos brasileiros, demonstraram que apenas 10 por cento a 20 por cento dos pacientes cegos por catarata estäo sendo operados em nosso meio, atualmente. OBJETIVO. Demonstrar a exeqüibilidade da realizaçäo de um modelo de cirurgia de catarata senil com implante de lente intra-ocular, no Hospital das Clínicas da Unicamp, considerando-se a remuneraçäo paga pelo Sistema Unico de Saúde (SUS). MÉTODOS. Foi levantado o custo com insumos e material descartáveis, para realizaçäo da facectomia com implante de lente intra-ocular de câmara posterior no Hospital das Clínicas da Unicamp. O modelo da Unicamp prevê cirurgia ambulatorial sob anestesia local, com racionalizaçäo de custos na aquisiçäo e gastos de insumos. Os hospitais escola apresentam situaçäo diferenciada no sistema de saúde, em que custos fixos e parte dos custos variáveis da cirurgia de catarata säo subsidiados pelo Estado. RESULTADOS. Conclui-se que a facectomia realizada sob a metodologia proposta é economicamente viável, sendo realizada a um custo de USS 77, considerando-se apenas os insumos, com uma remuneraçäo do INAMPS de USS 474. A realizaçäo de um maior número de cirurgias aumenta a eficácia e a eficiência da instituiçäo, além de propiciar maior treinamento cirúrgico aos residentes e melhor atendimento à comunidade. CONCLUSAO. Considera-se dever de todos os envolvidos, respeitados os compromissos com ensino, pesquisa e qualidade de atendimento, realizar o maior número de cirurgias de catarata pelo menor custo

[Practicability of cataract surgery at university hospitals: searching for an economic model]. / Exeqüibilidade da cirurgia de catarata em hospital-escola: em busca de um modelo econômico.

UNLABELLED: Resources available for health care all over the world are not enough to cover all the demand in this sector. Cataract Free Zones conducted in many regions of the country show that only 10% to 20% of blind patients caused by senile cataract can get operated on. PURPOSE: To demonstrate feasibility of a model for cataract surgery with intraocular lens implantation at the Clinical Hospital from the University of Campinas, Unicamp, São Paulo, when considering the remuneration payed by the government for universitary services. METHODS: Costs with disposable material were collected for extracapsular cataract surgery, with posterior intraocular lens implant, at the Clinical Hospital, Unicamp. The model includes outpatient surgery under local anesthesia, and costs rationalization in acquisition and wear of material. University Hospitals have a different situation in the health system, where fixed costs and part of the variable costs of cataract surgery are subsidized by the State government. RESULTS: Cataract surgery performed under the proposed methodology is economically feasible, considering disposable components only, and the price achieved was US$ 77 with government payment of US$ 474. More surgical interventions increases the efficiency of the institution, provides more surgical training to residents and better community health care. CONCLUSION: The authors consider that it is an obligation of University Hospitals, regard their commitment with training, research and quality of eye care deliverance, to increase the number of cataract surgeries for the lowest possible price.

Consideracoes em terapeutica ocular. / Ocular therapy

O autor faz consideracoes sobre o uso de medicamentos na terapeutica ocular, enfatizando as tecnicas e indicacoes pelas vias topicas, sub-conjuntival, retrobulbar e sistemica, assim como suas vantagens e desvantagens

Levantamento do relacionamento casa de optica oftalmologista na cidade de Säo Paulo. / Survey on the relationship between opticians and ophtalmologists at the city of Säo Paulo.

Os autores fizeram um levantamento do relacionamento existente entre opticas e oftalmologistas em 12 bairros da cidade de Sao Paulo percorrendo 150 opticas escolhidas aleatoriamente. Encontraram 92,67% indicando medico, sendo que 7,33% indicavam consulta gratuita, 42,67% indicavam medico com direito a desconto na consulta e 42,67% sem direito a desconto. Das indicacoes de medico sem desconto encontraram 36,67% indicando um medico especificamente e 8,1% indicando varios medicos.Encontraram tambem um optico (0,67%) que efetuou o exame. Academicos emetropes se submeteram a 5 exames gratuitos, tendo sido receitados oculos em 4 casos. Os autores concluem ressaltando a necessidade de se haver maior discussao a respeito do assunto e da necessidade de se reestudar qualitativa e quantitativamente a formacao de medicos no nosso pais.}