Lineamientos técnicos para la atención integral a la salud visual / Technical guidelines for comprehensive visual health care

Los presentes lineamientos de salud visual serán útiles para poder ejecutar actividades de promoción, prevención, diagnóstico, tratamiento y rehabilitación, a través de diferentes profesionales, que permitan una intervención integral y centrada en el paciente, con el objetivo de reducir significativamente la ceguera y discapacidad visual en el país como problema de salud pública, volviendo más accesibles los servicios de salud visual para toda la población, contribuyendo con ello al derecho a recibir estos servicios con calidad y calidez, profesionalismo y de manera oportuna

These visual health guidelines will be useful to be able to carry out promotion, prevention, diagnosis, treatment and rehabilitation activities, through different professionals, that allow a comprehensive and patient-centered intervention, with the aim of significantly reducing blindness and disability. vision in the country as a public health problem, making visual health services more accessible for the entire population, thereby contributing to the right to receive these services with quality and warmth, professionalism and in a timely manner

Epidemiologia e prevalência da maculopatia miópica em centro de referência em oftalmologia / Epidemiology and prevalence of myopic maculopathy in an ophthalmology reference center

RESUMO Objetivo: Determinar a epidemiologia e a prevalência da maculopatia miópica e da miopia patológica e os fatores de risco associados. Métodos: Trata-se de estudo observacional transversal retrospectivo realizado em um serviço de oftalmologia, com 59 pacientes com idade entre 7 e 70 anos e equivalente esférico maior que -6 dioptrias. Suas retinografias foram laudadas segundo a classificação META-PM, por dois oftalmologistas e um retinólogo experiente. A análise estatística foi realizada conforme o Matlab R2010, com o Excel 2010 e o Statistical Package for the Social Sciences , versão 20.0, sendo utilizado o resultado da análise de regressão logística binária múltipla. Resultados: De acordo com a META-PM, a prevalência da maculopatia miópica nos cem olhos analisados foi de 19% para C0, 53% para C1,18% para C2,2% para C3 e 8% para C4. A prevalência da miopia patológica foi de 39%, sendo que 37% desses olhos possuíam maculopatia miópica C1 com lesões plus , C2 ou pior ou estafiloma posterior, e 2% apresentavam categoria menor que C2, sem lesões plus , porém com estafiloma posterior. A análise de regressão logística binária múltipla revelou associação entre idade e equivalente esférico com a presença da miopia patológica (p<0,05), evidenciando que o aumento de 1 ano na idade implicou em 1,05 vez (razão de chance de 1,05) mais chance de apresentar miopia patológica (p<0,001; intervalo de confiança de 95% de 1,02-1,08). O aumento de 1 dioptria no equivalente esférico maior que -6 dioptrias acarretou 1,19 vez (razão de chance de 1,19) maior risco de apresentar miopia patológica (p=0,001; intervalo de confiança de 95% de1,08-1,32). Por fim, não houve associação entre sexo e presença da miopia patológica (p=0,784). Conclusão: A classificação META-PM é uma ferramenta importante na padronização do estadiamento da lesão miópica, permitindo comparação entre estudos e normatização de condutas. O avançar da idade e o equivalente esféricomiópico estão relacionados à severidade da maculopatia miópica e à presença da miopia patológica.

ABSTRACT Objective: To determine the epidemiology and prevalence of myopic maculopathy and pathologic myopia and associated risk factors. Methods: This is a retrospective cross-sectional observational study performed at an ophthalmology center, including 59 patients aged 7 to 70 years, and spherical equivalent higher than -6 diopters. Their retinographies were assessed by two ophthalmologists and an experienced retina specialist, using the META-PM study classification. Statistical analysis was performed using Matlab R2010, Excel 2010 and Statistical Package for the Social Sciences version 20.0, based on the result of multiple binary logistic regression analysis. Results: According to META-PM, the prevalence of myopic maculopathy in 100 eyes analyzed was 19% C0; 53% C1; 18% C2; 2% C3; 8% C4. The prevalence of pathologic myopia was 39%, and 37% of these eyes having myopic maculopathy category C1 with lesions plus, C2 or worse, or posterior staphyloma, and 2% in category smaller than C2, without lesions plus, but with posterior staphyloma. Multiple binary logistic regression analysis revealed an association between age and spherical equivalent inpathologic myopia (p<0.05), demonstrating the increase by 1 year in age implied in 1.05-fold (odds ratio=1.05) more likelyto present pathologic myopia (p<0.001; 95%CI 1.02-1.08). The increase by 1 diopter in the spherical equivalent higherthan -6 diopters, led to 1.19-fold (odds ratio=1.19) greater risk of presenting pathologic myopia (p=0.001; 95%CI 1.08-1.32). Finally, there was no association between sex and pathologic myopia (p=0.784). Conclusion: The META-PM study classification is an important tool to standardize myopic lesion staging, allowing comparison between studies and establishing management. Advanced age and myopic spherical equivalent are related to severity of myopic maculopathy and pathologic myopia.

Epidemiología de las urgencias oftalmológicas / Epidemiology of ophthalmological emergencies

Objetivo: Determinar el comportamiento de las urgencias oftalmológicas en los pacientes que arriban al Cuerpo de Guardia. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, en 194 285 pacientes (103 859 en el año 2017 y 90 426 en el 2018). Resultados: El 52,3 por ciento perteneció al sexo masculino y 116 444 (59,9 por ciento) tenía entre 19 y 59 años de edad. La conjuntivitis fue el diagnóstico más frecuente, realizado en 72 574 (37,4 por ciento) pacientes, 43 186 (41,6 por ciento) en el año 2017 y 29 388 (32,5 por ciento) en el 2018, seguida de los cuerpos extraños superficiales en la córnea, con un total de 24 920 (12,8 por ciento), dividido en 12 544 (12,1 por ciento) en el año 2017 y 12 376 (13,7 por ciento) en el año 2018. En el 2017, 13 500 pacientes fueron diagnosticados de conjuntivitis hemorrágica como consecuencia de una epidemia que afectó a La Habana. Necesitaron ingreso 573 pacientes y de ellos 327 tuvieron cirugía mayor de urgencia, con una edad media de 45,11 años, y como diagnóstico más frecuente el trauma ocular a globo abierto con o sin cuerpo extraño intraocular. Conclusión: La conjuntivitis, los cuerpos extraños superficiales corneales y la hemorragia subconjuntival fueron los diagnósticos más frecuentes, y el trauma ocular a globo abierto con o sin cuerpo extraño intraocular fue la primera causa de ingreso y de cirugía mayor de urgencia(AU)

Objective: Determine the behavior of ophthalmological emergencies in patients attending the emergency service. Methods: A cross-sectional observational descriptive study was conducted of 194 285 patients (103 859 in the year 2017 and 90 426 in 2018). Results: Of the patients studied, 52.3 percent were male and 116 444 (59.9 percent) were 19-59 years old. The most common diagnosis was conjunctivitis, with 72 574 patients (37.4 percent), of whom 43 186 (41.6 percent) were diagnosed in the year 2017 and 29 388 (32.5 percent) in 2018, followed by superficial corneal foreign bodies with 24 920 (12.8 percent): 12 544 (12.1 percent) in the year 2017 and 12 376 (13.7 percent) in 2018. A total 13 500 patients were diagnosed with hemorrhagic conjunctivitis in the year 2017 due to an epidemic affecting Havana in that year. Of the patients studied, 573 required hospitalization, 327 of them undergoing major emergency surgery. Mean age was 45.11 years and the most common diagnosis was open globe ocular trauma with or without an intraocular foreign body. Conclusions: Conjunctivitis, superficial corneal foreign bodies and subconjunctival hemorrhage were the most common diagnoses, whereas open globe ocular trauma with or without an intraocular foreign body was the leading cause of admission and major emergency surgery(AU)

La asistencia oftalmológica en la sanidad pública y en la sanidad privada ¿confrontación o colaboración? / Ophthalmological assistance in private health care and public health, collaboration or confrontation?

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Hallazgos oftalmológicos de una fístula carotidocavernosa postraumática en un paciente joven / Ophthalmologic findings of a posttraumatic carotid-cavernous fistula in a young patient

Introducción: Se presenta un caso clínico de un paciente joven con una fístula carotidocavernosa traumática que requirió embolización con coils como manejo definitivo. Objetivo: Dar a conocer la importancia de realizar unos adecuados enfoque, diagnóstico y tratamiento ante una fístula carotidocavernosa que presente compromiso oftalmológico, para disminuir el riesgo de presentar complicaciones oculares que pueden ser devastadoras. Resumen del caso: Varón de 27 años que sufrió un traumatismo craneoencefálico, el cual generó afectación oftalmológica que involucra desde el segmento anterior hasta el segmento posterior, con un leve compromiso de la agudeza visual. Requirió manejo multidisciplinario en conjunto con el servicio de neurocirugía para tratamiento endovascular, con posterior resolución de los signos y síntomas clínicos. Conclusiones: Las fístulas carotidocavernosas de alto flujo son las más frecuentes y suelen ocurrir en pacientes jóvenes con antecedentes de traumatismo craneoencefálico. Estas fístulas presentan múltiples manifestaciones clínicas oculares, por lo que los oftalmólogos deben ser capaces de hacer un adecuado enfoque y solicitar los estudios paraclínicos necesarios para hacer el diagnóstico y el tratamiento oportuno

Introduction: We presents a clinical case of a young patient with traumatic carotid-cavernous fistula who required coil embolization as definitive management. Objective: To make known the importance of carrying out an adequate approach, diagnosis and treatment in the patient with carotid-cavernous fistula that presents an ophthalmological findings in order to reduce the risk of presenting ocular complications that can be devastating. Case summary: A 27-year-old male patient who presented cranioencephalic trauma generating ophthalmological changes that involves from the anterior segment to the posterior segment, with a mild compromise of visual acuity, multidisciplinary management required in conjunction with neurosurgery service for endovascular management with subsequent resolution of the clinical signs and symptoms. Conclusions: Carotid-cavernous high-flow fistulas are the most frequent and they are associated with young patients with a history of head trauma. These fistulas present multiple ocular clinical manifestations, so ophthalmologists must be able to make an adequate approach and request the necessary paraclinical to make the diagnosis and timely treatment

Oftalmología domiciliaria: una necesidad creciente / Home care ophthalmology: A growing need

INTRODUCCIÓN: Se estima que la población dependiente está en aumento, evitando que muchos puedan desplazarse a su hospital buscando asistencia. OBJETIVO: Analizar la población diana subsidiaria de atención oftalmológica. Secundariamente, elaboración de un protocolo a partir de unos casos concretos. MATERIAL Y MÉTODOS: Se recogieron todos los casos de atención domiciliaria en patología oftalmológica desde 2011 a 2018 en el hospital do Salnés, de forma retrospectiva, y se analizaron las características de la exploración y de la patología. Se estableció un protocolo de exploración. RESULTADOS: Solo se atendieron a 7 pacientes a domicilio (petición expresa de la familia), todos ellos con movilidad reducida, y se resolvió la patología en 1,4 visitas de media. El 43% fueron nuevos diagnósticos y el 56% ya conocidos. DISCUSIÓN: Estimamos que, en nuestro medio, un 4,15% de la población requeriría atención oftalmológica domiciliaria. Desde nuestro conocimiento, este es el primer protocolo elaborado a tal efecto. CONCLUSIONES: Es posible y necesaria la atención domiciliaria en oftalmología con buena calidad asistencial. Para ello es necesaria la adopción de protocolos y la estandarización de este proceso

INTRODUCTION: It is estimated that the dependent population is on the rise, with many of them unable to have hospital care due to mobility problems. PURPOSE: To determine the ophthalmic needs of this population, as well as to establish an examination protocol, using our experience. MATERIAL AND METHODS: All cases of home care in Ophthalmology from 2011 to 2018 in Hospital do Salnés (Galicia) were collected retrospectively. Characteristics of the examination and diseases were analysed. An examination protocol was established. RESULTS: Only 7 patients (following family request), all with reduced mobility, were attended, and the pathology was resolved in a median of 1.4 visits. The majority (56%) had a previous diagnosis, with 43% a new diagnosis. DISCUSSION: In the area covered, 4.15% of the population was not able to attend this clinic, making home care necessary. To achieve this with quality, the first protocol was written using previous experience

Post-COVID-19 and the Portuguese national eye care system challenge / Post-COVID-19 y el desafío del sistema nacional portugués de atención oftalmológica

The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health care systems. Regarding Portugal, a suppression strategy with social distancing was adopted, attempting to break the transmission chains, bending the epidemy curve and reducing mortality. These measures seek to prevent an eventual National Health Service over-running, enforcing the suspension of all elective and non-urgent health care. Despite the success in so far, there is a consensus on the need to recover the previous level of health care provision and further enhance it. The Portuguese National Health Service, as a public, universal access, health care system funded by the State proved, in this context, its importance and relevance to the Portuguese population. However, long standing issues, such as the pre pandemic over long waiting lists for hospital ophthalmology attendance, whose determinants are fully identified but still unmet, emerge amplified from this pandemic. The lack of primary eye care in the National Health Service is a significant bottleneck, placing a huge stress on hospital-based care. An exclusive ophthalmologist's center care was over-runned before pandemic and will be even more so. The optometrist's exclusion from differentiated, multisectoral and multidisciplinary eye care teams remains the main hurdle to overcome and insure universal eye care in Portugal. National Health Service highlights the consequences of an overcome model. Universal eye care more than ever demands an evidence-based, integrated approach with primary eye care, in the community, on time and of proximity

La pandemia del síndrome respiratorio agudo grave causado por el nuevo coronavirus SARS-CoV-2 (COVID-19) ha tenido amplias repercusiones en muchos países y en sus sistemas sanitarios. En Portugal, se ha adoptado una estrategia de contención basada en el distanciamiento social, con la cual se ha intentado cortar las cadenas de transmisión, frenar la curva de la epidemia y reducir la mortalidad. Con estas medidas se trataba de evitar un eventual desbordamiento del Servicio Nacional de Salud y se imponía la suspensión de toda la atención médica programada, que no fuera urgente. A pesar del éxito logrado hasta este momento, existe consenso sobre la necesidad de recuperar el nivel anterior de atención médica y fomentar su mejora. El Servicio Nacional de Salud de Portugal, como sistema sanitario público y de acceso universal, a cargo del Estado, ha demostrado, en este contexto, su importancia y pertinencia para la población portuguesa. Sin embargo, los problemas que acarrea desde hace mucho tiempo, como las largas listas de espera, anteriores a la pandemia, en la asistencia oftalmológica hospitalaria, cuyos factores determinantes están completamente identificados, pero que continúan sin solución, se han visto agravados a resultas de esta pandemia. La falta de atención primaria oftalmológica en el Servicio Nacional de Salud es un importante cuello de botella, que ejerce una enorme presión en la atención hospitalaria. La atención de un centro exclusivamente oftalmológico estaba desbordada antes de la pandemia y lo estará aún más después de esta. La exclusión de los optómetras de los equipos de atención oftalmológica diferenciados, multisectoriales y multidisciplinarios continúa siendo el principal obstáculo que debe superar y asegurar la atención oftalmológica universal en Portugal. El Servicio Nacional de Salud hace hincapié en las consecuencias de un modelo superado. La atención oftalmológica universal exige, más que nunca, un enfoque integral basado en la evidencia para abordar la atención primaria oftalmológica en la comunidad, puntual y de proximidad

Protocolo APS comentado: saúde ocular em tempos da COVID-19

Série de Aulas Virtuais - Protocolo APS Comentado. Protocolo APS Comentado - Saúde Ocular em tempos da Covid-19.

¿Se ha hecho un uso más racional de los servicios de urgencias oftalmológicas ante la pandemia por COVID-19? / Has there been a more rational use of the ophthalmic emergency services in the face of the COVID-19 pandemic?

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Auditoría inmunitaria de COVID-19 en el servicio de Oftalmología de un hospital de tercer nivel antes del desconfinamiento / Immune audit of COVID-19 at the Department of Ophthalmology of a tertiary hospital before deconfinement

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Recomendaciones para la atención oftalmológica durante el estado de alarma por la pandemia de enfermedad por coronavirus COVID-19 / Recommendations for eye care during the alarm state bythe coronavirus disease pandemic COVID-19

OBJETIVO: Minimizar la exposición al virus SARS-CoV-2, reducir las posibilidades de transmisión cruzada entre pacientes y personal sanitario, y evitar el desarrollo de complicaciones postoperatorias por la atención a pacientes con enfermedades oculares durante la pandemia de Enfermedad por Coronavirus 2019 (COVID-19). MÉTODOS: Elaboración de un documento de revisión del estado del conocimiento sobre COVID-19 y consenso entre diferentes sociedades oftalmológicas españolas y afines, al objeto de proporcionar guías y recomendaciones de máximos recursos primariamente condicionadas por el estado de alerta, confinamiento y distanciamiento social que acontece en España desde el 16 de marzo de 2020. RESULTADOS: Las recomendaciones promoverán la adopción de medidas de actuación y protección para el desarrollo de la actividad asistencial en consultas externas, área quirúrgica y hospitalización, tanto para pacientes no confirmados - asintomáticos y sintomáticos - como confirmados de COVID-19. Deberán ser adaptadas a las circunstancias y disponibilidad de Equipos de Protección Individual (EPI) en cada uno de los Centros y Comunidades Autónomas, debiendo ser actualizadas en función de las fases de la pandemia y de las medidas que adopte el Gobierno de la Nación. CONCLUSIONES: Durante la pandemia COVID-19, la atención a los potenciales riesgos de salud para la población ocasionados por el coronavirus deberá prevalecer sobre la posible progresión de enfermedades oculares comunes. Tanto médicos oftalmólogos como restantes profesionales de la salud ocular deberán asumir una posible progresión de dichas enfermedades ante la imposibilidad de un seguimiento adecuado de los pacientes

OBJECTIVE: Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID -19). METHODS: COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of máximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. Results: The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of Personal Protective Equipment (PPE) in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. Conclusions: During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up

Clinical and epidemiological profile of premature patients in the ambulatory of pediatric ophthalmology of a university health service

INTRODUCTION: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina that affects low birth weight preterm babies and is the leading cause of blindness in children in developed and developing countries. OBJECTIVE: Considering the importance of evaluating the pathology, this study aimed to carry out an epidemiological analysis of premature patients referred to the Pediatric Ophthalmology sector of Centro Universitário FMABC. METHODS: Retrospective study of the medical records of patients referred to the Pediatric Ophthalmology sector of Centro Universitário FMABC, from March 2017 to December 2017, for ophthalmological evaluation due to suspected ROP (59 medical records). RESULTS: Of the total of 43 eyes with the disease, two eyes fit in Zone II and 41 in Zone III. Seventeen eyes were classified as Stage 1, 16 as Stage 2, 4 as Stage 3, 4 as Stage 4 and 2 as Stage 5. CONCLUSION: The development of ROP was inversely proportional to weight and gestational age at birth. Treatment proved to be less prevalent in the disease.

Incidence of clinical and subclinical macular edema in patients submitted to phacoemulsification in a university health service

INTRODUCTION: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. OBJECTIVE: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). METHODS: The incidence of subclinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. RESULTS: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. CONCLUSION: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Dexamethasone intravitreal implant for macular edema: a pilot study in a public health center

INTRODUCTION: Macula edema consists in one of the most common causes of visual impairment. OBJECTIVE: To evaluate the safety and efficacy of continuous release of 0.7 mg dexamethasone (using implantable device) for treatment of macular edema. METHODS: Cross-sectional observational study of 16 patients treated with 0.7 mg dexamethasone intraocular implant. Visual acuity, intraocular pressure and central macular thickness were recorded at baseline, 1-month and 3-month follow-up. RESULTS: 15 eyes of 13 patients were included. Most eyes (n=9) improve visual acuity from baseline at 1-month follow-up; this improvement persisted through 3-monyh follow-up in six eyes. The central macular thickness decreased in the majority of the subjects at 1-month (n=12) and at 3-month (n=10) follow-up. Three eyes presented with elevated intraocular pressure. CONCLUSION: Dexamethasone implant can both reduce the risk of vision loss and improve anatomical features of macular edema due to several pathologies studied. This implant may be used safely and should be considered a therapeutic option to Brazilian Public Health System.

Side effects of 1% cyclopentolate hydrochloride in children and adolescents attended at Centro Universitário FMABC

INTRODUCTION: It is known that vision disorders are within the context of public health problems. In childhood, during the neuropsychomotor development phase, visual changes are crucial, since there is a strong correlation between poor school performance and changes in acuity. For these reasons, ophthalmological examination in children, including refraction, is extremely important, aiming at the early diagnosis of diseases and possible refractive errors that may compromise the child's life and development. 1% cyclopentolate hydrochloride eye drops are the most used during ophthalmic clinical evaluation as a cycloplegic and mydriatic agent to assist in refractive examination. OBJECTIVE: The ocular and systemic side effects of 1% cyclopentolate hydrochloride eye drops were studied in patients who underwent static refractive examination in the strabismus sector of the Ophthalmology Discipline of the Centro Universitário FMABC. METHODS: A drop of 1% cyclopentolate is instilled in both eyes of each patient and the possible ocular and systemic signs and symptoms presented were observed after 40 minutes and 24 hours after instillation. RESULTS: We expect to find ocular side effects more evident than systemic symptoms in the two evaluation times (40 minutes and 24 hours after instillation). All symptoms (ocular and systemic) are reversed spontaneously. CONCLUSION: The present study aims to show that the side effects observed by the topical (ocular) use of cyclopentolate eye drops 1% are few and present spontaneous reversal both from an eye point of view, as well as from a systemic point of view.

Integración de la oftalmología primaria en el ámbito hospitalario: análisis comparativo de resultados / Integration of primary care ophthalmology in the hospital: Comparative analysis of results

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Ocular trauma score como predictor de agudeza visual en pacientes con trauma ocular grave: predictor de pronóstico visual en urgencia oftalmológica / Ocular trauma score as a predictor of visual acuity in patients with severe ocular trauma: visual prognosis in ophthalmological urgency

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.

This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.

Calidad de la atención médica desde un punto de vista bioético en un hospital oftalmológico de Ciudad de México / Qualidade da atenção médica do ponto de vista bioético em um hospital oftalmológico da Cidade do México / Quality of medical care from an bioethical point of view in an ophthalmological hospital in Mexico City

Resumen: Objetivo: Analizar la percepción de la calidad de la atención médica desde un punto de vista bioético. Material y métodos: Estudio trasversal, analítico, descriptivo y cuantitativo. Utilizamos dos cuestionarios para evaluar la percepción la atención médica en cuanto a los principios bioéticos. Hicimos un análisis descriptivo y bivariado con cada una de las variables, y sacamos un puntaje de las preguntas que se relacionaban con los principios bioéticos. Resultados: Incluimos 252 participantes y encontramos que, durante la atención médica, se cumplieron los siguientes principios: 14% autonomía, 72% beneficencia, 51% dignidad, 30% integridad, 42% justicia, 52% no maleficencia y 27% vulnerabilidad. 3% obtuvo todos los principios bioéticos. Conclusiones: Uno de los grandes retos de la medicina es la implementación de modelos de calidad de la atención médica, que garanticen que los pacientes reciban una atención médica que tome en cuenta los principios bioéticos.

Resumo: Objetivo: Analisar a percepção da qualidade da atenção médica do ponto de vista bioético. Material e métodos: Estudo transversal, analítico, descritivo e quantitativo. Utilizamos dois questionários para avaliar a percepção da atenção médica quanto aos princípios éticos. Realizamos uma análise descritiva e bivariada com cada uma das variáveis e extraímos uma pontuação das perguntas que se relacionavam com os princípios bioéticos. Resultados: Incluímos 252 participantes e encontramos que, durante a atenção médica, cumpriram-se os seguintes princípios: 14% autonomia, 72% beneficência, 51% dignidade, 30% integridade, 42% justiça, 52% não maleficência e 27% vulnerabilidade. 3% obteve todos os princípios bioéticos. Conclusões: Um dos grandes desafios da medicina é a implementação de modelos de qualidade da atenção médica, que garantam que os pacientes recebam uma atenção médica que leve em conta os princípios bioéticos.

Abstract: Objective: To analyze the perception of the quality of medical care from a bioethical point of view. Methods: Cross-sectional, analytical, descriptive and quantitative study. We used two questionnaires to assess the perception of medical care regarding bioethical principles. We did a descriptive and bivariate analysis with each one of the variables, and we obtained a score of the questions related to the bioethical principles. Results: We included 252 participants and found that during medical care, the following principles were met: 14% Autonomy, 72% Beneficence, 51% Dignity, 30% Integrity, 42% Justice, 52% No Maleficence and 27% Vulnerability. 3% obtained all the bioethical principles. Conclusions: One of the significant challenges of medicine is the implementation of quality models of medical care, which guarantee that patients receive medical care that takes into account bioethical principles.