Showing papers in "Revista Brasileira De Oftalmologia in 2016"

Contact lenses as drug controlled release systems: a narrative review

Abstract: Topically applied therapy is the most common way to treat ocular diseases, however given the anatomical and physiological constraints of the eye, frequent dosing is required with possible repercussions in terms of patient compliance. Beyond refractive error correction, contact lenses (CLs) have, in the last few decades emerged as a potential ophthalmic drug controlled release system (DCRS). Extensive research is underway to understand how to best modify CLs to increase residence time and bioavailability of drugs within therapeutic levels on the ocular surface.These devices may simultaneously correct ametropia and have a role in managing ophthalmic disorders that can hinder CL wear such as dry eye, glaucoma, ocular allergy and cornea infection and injury. In this narrative review the authors explain how the ocular surface structures determine drug diffusion in the eye and summarize the strategies to enhance drug residence time and bioavailability. They synthesize findings and clinical applications of drug soaked CLs as DCRS combined with delivery diffusion barriers, incorporation of functional monomers, ion related controlled release, molecular imprinting, nanoparticles and layering. The authors draw conclusions about the impact of these novel ophthalmic agents delivery systems in improving drug transport in the target tissue and patient compliance, in reducing systemic absorption and undesired side effects, and discuss future perspectives.

Avaliação da adesão aos colírios em pacientes com glaucoma através da Escala de Morisky de 8 itens: um estudo transversal

Abstract: RESUMO Objetivo: Determinar a adesao aos colirios antiglaucomatosos em pacientes do Projeto Glaucoma (Ministerio da Saude) por meio da escala de Morisky de 8 itens. Metodos: Foi realizado um estudo transversal por meio de questionario aplicado a 237 pacientes diagnosticados com glaucoma inscritos regularmente no Projeto Glaucoma do Instituto de Olhos de Maceio, adaptando a escala de Morisky ja validada em portugues para colirios. As variaveis foram a adesao aos colirios antiglaucomatosos, idade, sexo, raca, tempo de diagnostico do glaucoma, numero de colirios utilizados, doencas sistemicas, escolaridade, perfil de visao (ruim, razoavel ou boa) e os fatores correlacionados com a adesao. A analise estatistica entre as variaveis foi realizada com os testes estatisticos do Quiquadrado para as variaveis categoricas e Teste U de Mann-Whitney para as continuas, considerando um nivel de significância de 5%. Resultados: A adesao aos colirios foi de 54%. A idade e o numero de colirios (p=0,02 e 0,03 respectivamente) foram estatisticamente relevantes, assim como a qualidade de visao tambem foi (p<0,001) para o nao uso adequado do tratamento. O motivo mais comum tanto no grupo de aderentes como no de nao aderentes foi o esquecimento (23% e 76,15% respectivamente). Conclusao: Utilizando a escala de Morisky adaptada para colirios antiglaucomatosos a adesao aos colirios foi de 54% .

Platelet-rich plasma in diabetic dry eye disease

Abstract: Objetivo: Avaliar a eficacia do colirio de concentrado de plaquetas (CCP) autologo no olho seco sintomatico de pacientes diabeticos. Projeto Um estudo de intervencao unico grupo prospectivo. Participantes Doze pacientes diabeticos com doenca do olho seco refratario. Metodos Os pacientes foram tratados com colirio de PRP autologo quatro vezes por dia durante um mes. Sintomas de olho seco e sua frequencia, seguindo os criterios de DEWS, tempo de ruptura do filme lacrimal, a melhoria das linhas de acuidade visual e teste de Schirmer. Resultados Todos os pacientes tiveram alguma melhora dos sintomas de ressecamento, coceira, ardor e vermelhidao (p = 0,002). Destes, 41,66% (5/12) tiveram melhora de uma ou mais linhas de acuidade visual em ambos os olhos; 50% e 58,33% nao tinham alteracao no olho direito e esquerdo, respectivamente (p = 0,14) . Considerando o teste de Schirmer, 66,66% (8/12) tiveram melhora no valor do teste, 25% (3/12) nao apresentaram alteracao neste valor de teste e de 8,33% (1/12) tiveram um valor reduzido no teste apos tratamento. (p = 0,04). Considerando o valor de teste BUT 58,33% (7/12) apresentaram melhora no valor de teste e 41,66% (12/05) nao apresentaram alteracao neste valor de teste (p = 0,018). Conclusoes O CCP e seguro e uma terapia alternativa interessante no olho seco diabetico sintomatico. Mais ensaios clinicos sao necessarios para criar protocolos especificos para este tratamento.

Clinical applications of the Scheimpflug principle in Ophthalmology

Abstract: Este artigo apresenta uma revisao dos principios e das aplicacoes clinicas do principio de Scheimpflug na area da imagiologia do segmento anterior. Ao disponibilizar uma imagem tridimensional do segmento anterior, esta tecnologia permite a caraterizacao da elevacao e curvatura das superficies anterior e posterior da cornea, o mapeamento paquimetrico, o calculo do poder refrativo total da cornea e a biometria do segmento anterior. Na subespecialidade de cirurgia refrativa, esta abordagem melhora a capacidade de identificacao de casos com risco de desenvolver ectasia, bem como de planeamento e de avaliacao dos resultados dos procedimentos cirurgicos. Recentemente, esta tecnologia foi introduzida na avaliacao biomecânica in vivo da cornea e na cirurgia de catarata assistida por laser de femtossegundo.

Quedas e qualidade de vida de idosos com catarata

Abstract: Objetivo: Investigar a associacao entre quedas e qualidade de vida em idosos com catarata. Metodos: Tratou-se de estudo observacional com delineamento transversal, realizado no Distrito Federal, Brasil, com uma amostra de 38 idosos comunitarios divididos em dois grupos: idosos caidores (n=18) e idosos nao caidores (n=20). Avaliou-se por meio do instrumento National Eye Institute - Visual Function Questionnaire 25 (NEI-VFQ 25) a saude geral dos individuos da amostra, assim como a qualidade de vida relacionada a saude visual. A caracterizacao da amostra foi realizada por meio da analise descritiva a fim de avaliar a associacao entre quedas e demais variaveis, utilizou-se o teste nao parametrico de Mann-Whitney (p<0,05). Resultados: A faixa etaria ≥ 70 anos prevaleceu entre os participantes da pesquisa (63,16%). Dentre os idosos que fizeram parte deste estudo, 36 (94,74%) relataram ter algum problema para enxergar. Idosos caidores apresentaram escore geral mais baixo, quando comparados aos nao caidores (p=0,0159), apresentaram tambem maior dificuldade em realizar atividades para perto (p=0,0299) e para longe (p=0,0104), pior saude mental (p=0,0001) e nivel mais elevado de dependencia (p=0,0008). Conclusao: As quedas interferem negativamente na qualidade de vida de idosos com catarata, tornando as acoes para prevencao de quedas e o tratamento e/ou correcao do deficit visual importantes para evitar prejuizos futuros.

Falls and quality of life of people with cataracts

Abstract: Objective: To investigate the association between falls and quality of life in elderly individuals with cataract. Methods: This was an observational and cross-sectional study carried out in the Federal District, Brazil, with a sample of 38 community-dwelling elderly individuals, who were divided into two groups: falling elderly (n=18) and non-falling elderly (n=20). The NEI-VFQ-25 was used as a tool to assess the patient overall health and the quality of life related to visual health. Sample characterization was performed by descriptive analysis and the nonparametric Mann-Whitney test (p<0.05) was used to evaluate the association between falls and the other variables. Results: Elders within the age group ≥ 70 years old were the majority in this study. 36 participants (94.74%) of this study claimed to have some vision problems. Falling elderly presented lower scores when compared to the non-falling elderly (p=0.0159) and they also showed worse mental health (p=0.0001), higher level of dependence (p=0.0008) and greater difficulty to perform up close vision tasks (p=0.0299) and far vision tasks (p=0.0104). Conclusion: Falls have a negative impact on the quality of life of elderly individuals with cataract, which makes preventive actions and the treatment and/or correction of visual impairments important in order to avoid future harms.

Trachoma in schoolchildren of the city of Botucatu, Sao Paulo, Brazil: detection and health promotion of a neglected disease

Abstract: Objective: The purpose of this study was to promote the teaching of trachoma and to act in the combat of this leading cause of preventable blindness. Methods: This proposal was approved by the Ministry of Health (PET Program - Health/Health Surveillance), predicting the service training of medicine and nursing graduate students and health workers, in Botucatu, Sao Paulo - Brazil, in 2010. The training covered theory and practice, which consisted of cross-sectional study, with a randomized sampling to study the prevalence of inflammatory trachoma in schoolchildren from first to 4th grades of public elementary schools, following the World Health Organization criteria (WHO) and the supervision of two certified ophthalmologists for clinical diagnosis.The data were statistically analyzed. The staff was evaluated for learning. Results: The fieldwork showed that the prevalence of trachoma in children of Botucatu in 2010 was 3.42%. Compulsory notification, the communicants search, the treatment application to the affected and the follow-up as standardized happened with the active participation of staff. Conclusion: The prevalence of inflammatory trachoma in Botucatu in 2010 was 3.42%.The activities developed by the participants of PET Program - Health/Health Surveillance - Trachoma allowed effective training in service, resulting in the formation of multipliers, an additional force in the fight for the elimination of trachoma as a blindness cause.

Cost-effectiveness in glaucoma. Concepts, results and current perspective

Abstract: Glaucoma is the leading cause of irreversible blindness in Brazil. Its prevalence and incidence tend to increase significantly in the future, mainly due to the population increase and aging. The scarcity of health care resources and the increasing costs in health require a balanced analysis of health interventions and an efficient allocation of resources. The cost-effectiveness and cost-utility studies are important because they allow a comparison between different alternatives in terms of both their costs and their results. For this purpose, mathematical modeling (such as Markov modeling) is commonly used as the analytical method. The literature, including in Brazil, has plenty of evidence of cost-effectiveness and cost-utility in glaucoma. This article aims to review in a practical way the concepts of economic evaluation in health, describe the different types of health economic studies, as well as the results of cost-effectiveness and cost-utility studies in glaucoma in the literature.

Prevalence of detection of visual impairment and treatment in the age group 4 to 7 years

Abstract: Objetivos: Verificar a prevalencia da baixa visual numa fracao dos estudantes matriculados na rede publica municipal de Caratinga, Minas Gerais, bem como mostrar a importância da realizacao de acoes precoces no cuidado com a acuidade visual (AV) em criancas de ate 7 anos de idade. Metodos: Estudo transversal realizado em alunos, com idade entre 4 e 7 anos, matriculados no primeiro e segundo ano do Ensino Fundamental da Escola Municipal Geraldo Marques Cevidanes, do municipio de Caratinga, Minas Gerais. A AV foi avaliada com base na aplicacao do Teste de Snellen e considerada normal quando superior a 0,7. Os alunos que apresentaram dificuldade no exame igual ou inferior a 0,7 foram encaminhados a consultas oftalmologicas. Resultados: Foram avaliadas 118 criancas. Quanto a AV, 5% da amostra apresentou alteracao da AV, sendo 16,6% com alteracao visual apenas no olho esquerdo; 33,3%, somente no olho direito; e 50%, bilateral. Necessitaram da prescricao de orteses 66,6% dos estudantes com baixa visual. Conclusao: Este estudo vai ao encontro de pesquisas nacionais no que tange a prevalencia de baixa AV, entretanto discorda de trabalhos que encontraram prevalencias destoantes. Sugere-se o desenvolvimento de projetos em saude preventiva que abranjam a idade escolar nao apenas de forma medica, mas tambem social.

Fatores de risco e incidência da retinopatia diabética

Abstract: RESUMO Objetivo: Conhecer a incidencia da RD, assim como avaliar os fatores de riscos na amostra em estudo. Metodos: Avalia da incidencia e os fatores de risco da RD (tempo de doenca e presenca de HAS em pacientes com diagnostico de RD atendidos no ambulatorio de retina de um hospital oftalmologico de referencia em Goias para pacientes do Sistema Unico de Saude, no periodo de julho de 2015 a dezembro de 2015 totalizando 6 meses. Resultados: Do total de 160 pacientes avaliados no ambulatorio de Retina, 15% apresentaram diagnostico de retinopatia diabetica. Em relacao ao tempo da doenca 35% dos pacientes, que tiveram indicacao de fotocoagulacao ou injecao intravitrea de inibidores do fator de crescimento do endotelio vascular, apresentavam DM ha mais de 20 anos. Quanto a coexistencia de HAS, 16 pacientes (66%) tambem apresentavam hipertensao arterial sistemica. Conclusao: Conclui-se com o presente estudo que existe importante necessidade de avaliacao de pacientes, quanto a presenca de RD, alem de forte associacao entre a RD, e os fatores de risco avaliados no presente estudo: HAS, tempo do diagnostico do diabetes mellitus e o controle glicemico.

As principais causas de cegueira e baixa visão em escola para deficientes visuais

Abstract: Objetivo: Identificar e analisar as principais causas de cegueira e baixa visao em escola para deficientes visuais. Metodos: Foram revisados 165 prontuarios de alunos portadores de deficiencia visual em instituicao especializada no ensino de cegos, atendidos no periodo de agosto de 2013 a maio de 2014. As variaveis analisadas foram: idade, genero, acuidade visual, diagnostico principal e secundario, tratamento, recursos opticos prescritos e prognostico. Resultados: Dos 165 alunos avaliados, 91 alunos (55%) sao legalmente cegos e apenas 74 (45%) dos alunos sao enquadrados como baixa visao. As principais causas identificadas foram: retinopatia da prematuridade (21%), atrofia de nervo optico (18%), glaucoma congenito (16%), distrofias retinianas (11%) e neoplasias (8%). As causas de baixa visao foram: catarata congenita (18%), glaucoma congenito (15%) e cicatriz de retinocoroidite (12%). As causas de cegueira evitaveis (preveniveis ou trataveis) no estudo perfizeram um total de 52%. Conclusao: As principais causas de cegueira e baixa visao nos alunos do Instituto Benjamin Constant sao por doencas evitaveis.

Comparative study between phenol red thread test and the Schirmer's test in the diagnosis of dry eyes syndrome

Abstract: RESUMO Objetivo: Investigar a concordância entre o teste fenol vermelho e o teste de Schirmer para quantificacao lacrimal junto a um questionario para detectar sintomas de olho seco. Metodos: No total, 49 pacientes participaram do estudo. Cada participante teve um olho examinado pelos dois testes. Os sintomas de olho seco foram avaliados atraves de 5 perguntas. Os dados foram coletados e depois analisados pelo metodo de estatisticas Kappa para avaliar a concordância entre os testes. Resultados: A sintomatologia foi positiva em 65,3%(32) pacientes. Em grupos de idade, pacientes com 60 anos ou mais tiveram sintomatologia em 70,5% das vezes, enquanto no grupo de 40-59 anos foram positivos 59,3%. O teste de Schirmer foi positivo para olho seco em 51%(25) dos pacientes, enquanto o teste fenol vermelho foi positivo em 65,3%(32). O valor de Kappa entre os testes foi de 0.548, demonstrando uma concordância moderada entre eles. Conclusao: A realizacao do questionario sintomatico evidenciou uma maior sintomatologia de olho seco nos pacientes de maior idade. O valor de Kappa resultou em uma concordância moderada, considerada relevante, principalmente pelo fato de nenhum dos dois testes ser o padrao ouro para o diagnostico de olho seco e pela variabilidade de resultados que os testes podem trazer.

Estudo da prevalência das uveítes em hospital oftalmológico terciário em Teresina, Piauí, Brasil

Abstract: Objective: To analyze the prevalence of uveitis in patients treated at a tertiary ophthalmic service in Teresina, Piaui State, Brazil. Methods: This was a retrospective study based on medical records of patients treated at this service. Sex, age, origin, underlying diseases, anatomical diagnosis, clinical aspects and progression time were described. Results: 403 records were included, noting that 3.2 out of every 1,000 patients treated at the service had uveitis.The average age of patients was 42 years old, with both sexes (50.6% females and 49.4% males) affected similarly, and with 61.5% coming from the state capital, Teresina. The most common underlying disease was toxoplasmosis, followed by idiopathic uveitis with ocular manifestations only. As to the anatomical classification, 49.6% of them were posterior and only 3.5% were intermediate. Regarding the clinical aspects, 64% were granulomatous, 24.8% non-granulomatous, and 11.2% were not classifiable. According to the clinical progression, 41.4% were acute, followed by 30.8% chronic, 14.4% recurrent cases, and 13.4% of patients did not return for medical care. Conclusion: we found that for every 1,000 patients treated at the service, 3.2 had uveitis, with toxoplasmosis itself found to be an important source of uveitis.

Perception and quality of life of patients after surgery keratoconus

Abstract: Objective: To know the perception of the patient after surgery keratoconus. Methods: descriptive exploratory study with a qualitative approach. Data were obtained through audio-taped interviews with keratoconus patients undergoing surgery and the transcripts were subjected to content analysis, thematic modality. Results: Transcripts allowed the formation of two categories: Experiencing the disease and change of life after surgery.The first has listed the experience of patients with keratoconus, faced difficulties, mutatis mutandis, search for resources and frustrations and the second category highlights the concerns related to the surgical procedure, then the hope of finding the solution, and surgery considered as something miraculous, because allowed to return to society and brought back the meaning of existence. Conclusion: Patients undergoing keratoconus surgery reported that surgery has promoted the improvement of self-esteem and self-love, bringing back the meaning of life they had lost.

Avaliação das urgências oftalmológicas em um hospital público de referência em Pernambuco

Abstract: Purpose: To evaluate ophthalmological emergencies in a public reference hospital in Pernambuco. Methods: Cross-sectional retrospective study with 26.358 patients attended in the ophthalmic emergency Altino Ventura Foundation, in the period january to june 2013. Data were collected using protocols based on electronic registration forms of ophthalmological emergency Results: It was observed that 52.5% of patients were male, 42.5% were aged 21-40 years; 90.8% were from the region metropolitan area of Recife; 55% classified as less severe. The main diagnoses were conjunctivitis (35.17%) and ocular trauma (19.25%). Conclusion: The prevalence of male patients, aged 21-40 years, from the metropolitan area of Recife, classified as low complexity, attended in January, on Monday, with the diagnosis of conjunctivitis, followed by ocular trauma.

Orbital apocrine hidrocystoma with immunohistochemical confirmation

Abstract: The authors report the first case in Brazilian literature of orbital apocrine hidrocystoma with immunohistochemistry confirmation. The tumor had been growing slowly and progressively, there was no history of impaired vision, diplopia, watering, discharge, or prior trauma. There was no proptosis and extraocular mobility was normal. The radiologic study by orbital computerized tomography revealed an extraconal nodule, with partially defined limits, with cystic and solid areas in the superomedial right orbit. An anterior orbitotomy, with full excision of the tumor was performed. A histopathology examination revealed apocrine hidrocystoma and immunohistochemistry confirmed the diagnosis. After surgery, the patient had total remission of symptoms.

Air-Puff Tonometry in population research - a comparison with Goldmann tonometer in individuals with suspected ocular hypertension

Abstract: Objetivo: Avaliar a utilidade do tonometro de ar (TA) em estudos populacionais em individuos suspeitos de hipertensao ocular, comparando os valores com os fornecidos pelo tonometro de aplanacao de Goldmann (TG). Metodos: Estudo transversal, de amostra probabilistica, composta por 11.452 individuos e"20 anos, compondo-se uma subamostra dos que apresentaram valores de pressao intraocular (PIO) obtidos com o TA e"20mmHg, nos quais a PIO foi repetida com o TG. Os resultados dos dois tonmetros foram comparados considerando sexo, cor da pele referida, lateralidade, relacao escavacao/disco (Â0,6; entre e"0,6 e <0,8; e"0,8) e diagnostico. Foram consideradas tres situacoes: nao-portadores de glaucoma (NG), suspeitos (SG) e portadores de glaucoma (CG). Para comparacao entre as medidas foi utilizado o teste t de Student para amostras pareadas e o teste de correlacao de Pearson para avaliar a associacao entre PIO, idade e tonometria. Resultados: Foram detectados 198 individuos (339 olhos) com PIOe"20mmHg com o TA, que tiveram a medida repetida com o TG. Foram considerados 233 olhos como NG, 47 olhos como SG e 19 olhos como CG. Em olhos com escavacao e"0,8, a medida com TA e TG foram semelhantes. Nos NG e SG, o TA superestimou os valores. Houve associacao entre aumento da PIO e aumento da idade com os dois tonmetros. Conclusao: Valores de PIO sao superiores com TA comparados ao TG, principalmente quando a PIO e normal. Ha concordância entre os metodos quando a PIO e alta e a escavacao do nervo optico e aumentada, o que valida a aplicacao do TA em campanhas populacionais.

Avaliação dos traumas oculares relacionados à queda da própria altura em idosos

Abstract: Objective: Evaluate ocular trauma cases related to falling in elderly patients e compare the prevalence and severity of the cases. Methods: A series of cases was made with 52 patients aging 60 or more within the period of 36 months presenting ocular trauma related to falling, whereas the prevalence between the gender, the need for hospitalization or surgery and subsequent visual deficit were evaluated, as well as the severity of the cases. Results: Thirty-three (63.5%) of 52 patients were from the female gender, over which 30.3% had need for surgery and 18.2% developed visual deficit and 19 (36.5%) were from the male gender where 42.1% needed surgery and 26.3% developed visual deficit. Conclusions: The study has shown a higher prevalence of cases in the female gender, although the severity was higher in the male gender.

Eye health attention of children with developmental disorders in early intervention services: barriers and facilitators

Abstract: Objective: To identify factors that influence on the early detection of visual impairment and in early intervention onset for children with developmental disorders. Methods: The study consisted of a exploratory and descriptive survey, which included the use of questionnaires with institutional representatives, professional team of early intervention and mothers or caregivers of children served in these services. The data received statistical analysis through software SAS Statistical Analysis System 9.3, Wolfram Mathematica and Microsoft Excel. The sample consisted of 434 subjects (19 institutional representatives, 142 professionals of the early intervention services and 273 mothers/ caregivers of children served). Results: The results showed statistical values of p=0.0119 for the realization of eye test with regard to the beginning of early intervention. The mother receive guidance on the development of vision obtained values of p-value=0.0106 for early intervention start and values of p=0.0061 for the first visit to the ophtalmologist. Conclusion: Realise the eye test constitutes as a facilitating factor for the onset of early intervention and have an exclusively visual impairment and attend private institution as a barrier. Late entry into early intervention service adversely affects the age of first ophthalmologic consultation.The mother receive guidance on the development of vision showed as a facilitating factor for the first visit to the ophtalmologist and start of timely intervention.The field of eye health constitutes as public health demand and requires attention to actions and educational programs directed to families, professionals and institutional managers who provide services to children.

Trachoma prevalence among schoolchildren in the municipality of Turmalina, Minas Gerais state

Abstract: Trachoma has been mistakenly assumed as having been eradicated, but is on the list of neglected diseases. It is the leading cause of preventable blindness in the world, being found predominantly in developing countries. Several studies have shown that this disease is currently present in all regions of Brazil, which shows that both the government (at the federal, state and municipal levels) and academia must continue to treat trachoma as one of the causes of blindness. In this study, we sought to identify the prevalence of trachoma among schoolchildren aged between seven and 15 years from public schools in the municipality of Turmalina, Minas Gerais state. The survey was conducted in this municipality, located in the Jequitinhonha Valley, a region that contains populations who live in situations of high social vulnerability, and thus display the characteristics that are conducive to the emergence of the disease. The participants were six doctors and 11 nurses working in primary healthcare, trained and standardized to do so. Health professionals examined 635 students aged 7-15 years in the public schools of Turmalina. Students with a clinical diagnosis of trachoma underwent conjunctiva scraping with a swab and the material was sent for laboratory analysis. All school children diagnosed with trachoma were treated at the Unified Health System (SUS). The collected data were analyzed using the Statistical Package for Social Sciences software, IBM Inc., USA - SPSS, version 22.0. Among the students, a 4.7% prevalence rate of trachoma was found, predominantly in rural areas.

Influence of the home environmental affordances in the mobility of children with low vision mobility: functional skills and caregiver assistance

Abstract: Objective: To analyse and correlate the influence of the present affordances in the home environment in the functional skills and the level of caregiver assistance for the mobility of children with low vision and normal vision. Methods: Participated seven children with low vision diagnosis (32.29 ± 7.09 months) and seven with normal vision (31.57 ± 6.90 months). The instruments used were Affordances in the Home Environment for Motor Development - Self Report (AHEMD-SR) and Pediatric Evaluation of Disability Inventory (PEDI) relative to the parties I (functional skills) and II (caregiver assistance) for the mobility area. Results: According to PEDI, there was no significant difference between children with low vision and normal vision in functional skills (U=13.5; p=0.076) and caregiver assistance (U=13.0; p=0.083) in the mobility area, however there was moderate correlation (r=+0.756; p=0.049) between the parties I and II for children with low vision. In AHEMD-SR, children with low vision showed significant differences in the subscales: fine-motor (U=7.5; p=0.024), gross-motor (U=7.5; p=0.024), and AHEMD total (U=8.0; p=0.035). However, both children received classification "average" for the affordances in the home environment. Conclusion: Children with low vision showed no differences in functional skills and caregiver assistance in the mobility. And the home environment offered reasonable affordances, which favored the functional skills and caregiver´s assistance in the mobility.

A rare case of tick infestation of the eyelid: case report and literature review

Abstract: This article presents a case of tick infestation of the lower eyelid by a previously unreported species. A 71-year-old male presented with a tick attached to the lower eyelid. The tick was identified morphologically, and then molecularly via polymerase chain reaction (PCR) and sequencing of its DNA. In addition, a review of the literature relevant to the genera of ticks associated with infestation of the human eye is provided. The tick, which was in the nymphal developmental stage, was first identified according to taxonomic keys as Dermacentor sp. For complete species identification, 16s rDNA gene PCR and sequencing were performed, which showed that the tick was D. marginatus. Systematizing tick species could assist physicians in determining the potential for transmission of tick-borne human diseases.

Changes of orbital connective tissue after bimatoprost injection. Experimental study in rats

Abstract: O bimatoprost e utilizado comumente como a droga de primeira escolha no tratamento do glaucoma primario de ângulo aberto. Hiperemia conjuntival, crescimento dos cilios, enoftalmia, escurecimento cutâneo periocular, sulco palpebral profundo e prurido ocular tem sido relatados em pacientes que receberam bimatoprost em doses unicas diarias durante cerca de 3 meses. O mecanismo exato para estes efeitos adversos permanece desconhecido. Objetivo: Verificar em animais de experimentacao, as alteracoes do tecido conjuntivo orbitario apos injecao retrobulbar de bimatoprost 0,03%. Metodos Foram utilizados trinta e seis ratos machos (Rattus norvegicus albinus) submetidos a diferentes periodos de injecao retrobulbar de bimatoprost a direita. O material exenterado foi submetido a analise histologica, morfometrica (diâmetro, densidade numerica e densidade de volume dos adipocitos) e imunohistoquimica para marcacao do VEGF. Os resultados destas analises foram submetidos a analise descritiva com o auxilio do software R. O nivel de significância adotado foi 5%. Para as comparacoes foi proposto o modelo de regressao linear com efeitos mistos. Resultados: Na amostra estudada, as orbitas submetidas a injecoes retrobulbares de bimatoprost apresentaram ao redor do nervo optico tecido conjuntivo mais espesso, com inumeros capilares e vasos de varios calibres e a reducao da quantidade, diâmetro e volume das celulas adiposas estatisticamente significativo quando comparado a orbita contralateral e ao grupo controle. Conclusao: Neste estudo observaram-se as seguintes alteracoes potencialmente reversiveis do tecido conjuntivo orbitario nos ratos submetidos a injecao retrobulbar de bimatoprost: 1) reducao da quantidade, do diâmetro e do volume das celulas adiposas orbitarias; 2) neovascularizacao local; 3) espessamento e remodelamento das fibras de colageno na cavidade orbitaria.

Perfil do paciente albino com visão subnormal e melhoria da acuidade visual com a adaptação de recursos ópticos e/ou eletrônicos

Abstract: RESUMO Objetivo: Determinar o perfil do paciente albino no departamento de visao subnormal do Instituto Benjamin Constant. Ressaltar o tempo de acompanhamento, a frequencia do seguimento, e a melhora visual com a adaptacao de recursos opticos e/ou eletronicos. Metodos: Estudo retrospectivo com dados de 77 pacientes albinos com idade entre 1 a 53 anos de idade atendidos no Instituto Benjamin Constant, entre 2003 e 2014. Resultados: O recurso optico mais adaptado foi o telescopio de Galilleu 2.8x. Todos os pacientes referiram ganho de visao com os equipamentos. A maioria dos pacientes apresentaram acuidade visual com recursos opticos entre 20/25 e 20/160. Conclusao: Os recursos opticos auxiliaram na melhora da funcao visual e na qualidade de vida dos pacientes com albinismo ocular.

Perfil epidemiológico dos recém-nascidos prematuros com retinopatia da prematuridade no Hospital Regional de São José Dr. Homero de Miranda Gomes

Abstract: Objectives: To evaluate the prevalence of retinopathy of prematurity (ROP) in premature newborns (gestational age < 37 weeks) and / or birth weight £ 1,500g and those with risk factors, born at the Dr. Homero de Miranda Gomes Regional Hospital in Sao Jose (HRSJ) between January 2007 and January 2011. Methods: Cross-sectional, retrospective, observational and analytical study. Data were obtained from medical records at the HRSJ. Results: The presence of 37.81% of retinopathy in newborns was observed, with stage 1 being the most prevalent. No statistical difference was found between the sexes (p = 0.993). The presence of ROP was higher in the group with PN < 1,000 grams (83.33%), evaluated over 6sixweeks of age and with gestational ages less than 32 weeks (49.48%). Risk factors with statistical significance were: oxygen therapy, mechanical ventilation, patent ductus arteriosus, perinatal asphyxia, respiratory distress syndrome, blood transfusions, intraventricular hemorrhage, sepsis, neonatal infection and hyaline membrane disease. Conclusion: It is concluded that: the gender factor and multiple pregnancy were not statistically significant. The newborns with lower birth weight and gestational age have an increased risk for developing ROP. Regarding oxygentherapy, the prevalence is higher in the exposed and proportional to the period of oxygen.

Síndrome de Goldenhar

Abstract: Os autores apresentam um caso de sindrome de Goldenhar, com seus aspectos caracteristicos e variacoes, observando uma crianca do sexo masculino de 4 anos de idade no Servico de Oftalmologia do Hospital Sao Jose na cidade de Teresopolis (RJ). O diagnostico foi concluido devido as alteracoes externas e internas do paciente apos ter sido avaliado pela pediatria, genetica, otorrinolaringologia e oftalmologia. O espectro oculo-auriculo-vertebral (EOAV) conhecida como Sindrome de Goldenhar e uma condicao rara, complexa e fenotipicamente variavel. De origem ainda desconhecida e caracterizada por cistos dermoides epibulbares, apendices auriculares e hipoplasia mandibular. Objetivamos com este relato de caso, dada a raridade desta sindrome e variedades do espectro de apresentacao, aumentar o conhecimento da classe medica sobre este assunto, para facilitar seu reconhecimento e auxiliar condutas perante casos futuros.

Demographic and behavioral profile of patients with optic medical indication of contact lenses

Abstract: Objectives: To assess the demographic and behavioral profile of patients with optic medical indication of contact lenses (CL) in a public hospital in Curitiba. Methods: Cross-sectional questionnaire study of patients who attended the contact lens service of the national health system (SUS) outpatient clinic from the "Hospital de Olhos do Parana" between September 2nd, 2014 and August 4th, 2015. Results: Of the 69 people interviewed, 56.52% acquired CL. Of these, 55.07% are between 20-49 years old, 69.56% are women, 40.58% had finished high school and 36.23% earned a salary of 2 to 6 times the minimum wage. Rigid lenses prevailed, representing 66.67% of the total, with less than 8 hours of usage in 41.02% of the cases and discomfort during usage was assessed in 59%. The cleaning of CL was done at the moment of insertion and removal in 87.18% of cases, and 71.8% used contact solution. High purchase cost was the main reason for not using CL for 70% of patients who did not use this resource. Conclusions: Of the patients interviewed, 56.52 % started using LC. Keratoconus was the main disease for which CL were indicated. It was demonstrated in this study that patients in question have good guidance on handling and maintenance of LC. Despite the unquestionable advances in medical technology continue to occur the abandonment of the use of this feature mainly the cost and fear of handling. It is the responsibility of the expert clarify the benefits that patients with medical indication will have with the use of LC, as well as encourage their use.

Complicações primárias da interface do 'flap' de LASIK

Abstract: Laser in situ Keratomileusis (LASIK) is one of the most accepted techniques in refractive surgery today. Its predictability, reproducibility, safety and low incidence of side effects justify the wide diffusion of this technique. This is a laser surgical procedure which purpose consists in the modification of corneal structure, allowing a shift of the focal point of the eye. Thus, it is possible to correct refractive errors such as myopia, astigmatism and small degrees of hyperopia. The LASIK technique creates a corneal flap interface with the use of a microkeratome or femtosecond laser. Then, excimer laser is applied on the stroma bed followed by repositioning of the flap, creating an interface between the anterior and posterior corneal lamella. Despite the numerous advantages there are patologies that originate from primary complications of the interface which can caused confusion during diagnosis because they have similarities in their clinical presentation. The aim of this work is to define, characterize and compare those entities with the intention of making the diagnosis easier so that there is appropriate conduct. As result, this study presents recommendations for the management of each kind of interface disease through investigation by medical history and physical examination, in order to allow differential diagnosis between the main primary entities of the LASIK procedure interface.

Descemet Membrane Endothelial Keratoplasty (DMEK)

Abstract: The most common type of endothelial dysfunction we treat in the U.S.A. is Fuchs’ dystrophy.3 The incidence of endothelial decompensation after cataract surgery has decreased with improved phacoemulsification techniques and intraocular lenses. However, we are seeing an increase in corneal decompensation after glaucoma surgery, particularly aqueous shunts. This is a major concern, because numerous studies have shown that previous glaucoma surgery is the single biggest risk factor for endothelial keratoplasty failure […]. Descemet Membrane Endothelial Keratoplasty (DMEK)

The effect of intracameral epinephrine on pupil size during phacoemulsification and its postoperative effect on specular findings and macular thickness

Abstract: Objective: To evaluate pupillary size and vital signs following intraoperative intracameral adrenaline during phacoemulsification and postoperative effect of on co specular microscopy findings and macular thickness by OCT. Methods: A prospective interventional study carried out from December 2014 to December 2015 on 90 eyes. They were divided randomly into further 6 groups (15 each). The inclusion criteria consisted of no history of ocular pathologic conditions, trauma, previous ocular surgery, or recent ocular medication use. All patients were dilated preoperatively by phenylephrine 10% and operated under local peribulbar anesthesia. Then systemic monitoring regarding (pulse rate, blood pressure) and measurement of the horizontal pupil diameter by a caliper to the nearest 0.25mm pre and post intracameral adrenaline injection. Results: In our study there were great effect for intracameral epinephrine, with concentrations used, in dilatation and maintainance of papillary dilatation, The mean pre intracameral epinephrine was 4.53± 1.27 mm.The mean post epinephrine papillary diameter was 6.46± 1.00 mm. Three cases from group 1/10000 weren't dilated properly. Also three cases from group 1/9000 weren't dilated properly after intracameral epinephrine. Conclusion: Intracameral epinephrine even in higher concentrations is effective in papillary dilatation especially in cases with long duration and poorly dilated cases by usual topical mydriatics.