Arquivos brasileiros de oftalmologia最新文献

{"title":"Response to: \"Eyebrow and eyelid position in anophthalmic sockets reconstructed with conical or spherical implants: a quantitative analysis\"Response:Enhancement of the cosmetic and functional outcome of enucleation with the conical orbital implantA large retrospective study on long-term complications from osseointegrated orbitofacial prosthetic implants.","authors":"Göksu Alaçamlı, Murat Kaşıkcı","doi":"10.5935/0004-2749.2026-0170","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-0170","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20260170"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal transplantation in the Amazon: a 10-year retrospective study.","authors":"Marcos Jacob Cohen, Sabrina Veloso Avi Cohen, Luci Meire Pereira da Silva, Ariane Pamela Luttecke Anders, Jacob Moyses Cohen, Rubens Belfort","doi":"10.5935/0004-2749.2025-0367","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0367","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the indications and epidemiological characteristics of corneal transplant recipients at a referral center in Amazonas, Brazil, and to evaluate postoperative visual outcomes.</p><p><strong>Methods: </strong>This retrospective, descriptive, observational study included adult patients who underwent corneal transplantation performed by a single surgeon at the Instituto de Oftalmologia de Manaus between 2013 and 2023. Demographic characteristics, occupation, comorbidities, surgical indications, graft type, and best-corrected visual acuity at baseline and 12 months postoperatively were analyzed.</p><p><strong>Results: </strong>A total of 413 corneal transplantations were performed, predominantly in male patients (64.4%) aged 41-70 years (43.3%). Leucoma was the most common indication (26.2%), followed by perforated corneal ulcers (21.1%), bullous keratopathy (17.9%), and keratoconus (10.7%). Penetrating keratoplasty accounted for 94.9% of all procedures. Optical keratoplasty was the most frequently performed procedure (76.3%), followed by tectonic (22.0%) and therapeutic (1.7%) keratoplasty. At 12 months postoperatively, visual improvement was greatest among patients who underwent optical keratoplasty, particularly those with keratoconus, bullous keratopathy, and leucoma. Functional vision (≤0.3 logMAR) was achieved in 32.6% of eyes overall and in 40.3% of eyes that underwent optical keratoplasty. The number of transplantations declined after 2019, coinciding with the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>This study represents the largest retrospective series of corneal transplantations in Amazonas and one of the few such studies from Northern Brazil. The predominance of leucoma and infectious corneal perforation reflects regional socioeconomic and occupational vulnerabilities. Although visual outcomes improved significantly after transplantation, visual recovery was limited by the advanced stage of disease at presentation. These findings underscore the need to expand access to early diagnosis, strengthen eye banking and donor tissue procurement systems, and increase the adoption of lamellar keratoplasty techniques to optimize visual outcomes in the Amazon region.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20250367"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of Rosai-Dorfman disease involving the lacrimal sac.","authors":"Renata Sande Paiva, Cristiane Bedran Milito, Diogo Goulart Corrêa, Nina Ventura, Sérgio Ferreira Alves Júnior","doi":"10.5935/0004-2749.2026-0119","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-0119","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20260119"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduce enophthalmos with fat transfer in anophthalmic sockets.","authors":"Maria Antonieta da A Ginguerra-Nascimento, Laura Goldfarb Cyrino, Mario Padula, Carolina Passareli Diniz, Vitor Expedito Alves Ribeiro, Andrea Alves Morato, Yolanda de Souza Mares, Carlos Augusto Ferraresi Sampaio, Maria Eugenia B Gorski, Mariana Nobrega Meireles Baptista, Jose Byron Vicente Dias Fernandes, Eloisa Maria Mello Santiago Gebrim, Suzana Matayoshi","doi":"10.5935/0004-2749.2026-0041","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-0041","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of autologous fat grafting for treating enophthalmos in anophthalmic sockets.</p><p><strong>Methods: </strong>In this prospective interventional case series, consecutive patients with anophthalmic sockets and enophthalmos were enrolled between August 2013 and July 2025. Clinical ophthalmologic examination, Hertel exophthalmometry, and orbital computed tomography scans were performed. Enophthalmos was assessed clinically and radiologically before and after orbital lipofilling with autologous fat. Fat was harvested from the inner thigh and injected into the inferolateral orbital compartment. The volume of injected fat was determined according to the degree of enophthalmos measured by Hertel exophthalmometry. Follow-up ranged from 2 to 60 months (median, 7 months).</p><p><strong>Results: </strong>Thirteen patients (13 sockets) underwent orbital autologous fat grafting using Coleman's technique. The injected fat volume ranged from 3.7 to 6 mL per procedure (median, 4.2 mL). Clinically, a reduction in enophthalmos of 1-5 mm was observed in 12 cases (median, 2 mm), which was associated with a decrease in prosthesis thickness. One patient developed a fat cyst due to anterior fat migration, and three patients required repeat grafting because of undercorrection. Computed tomography scans, available for nine patients, demonstrated a 6.8%-10.8% increase in intraorbital volume, particularly in the inferolateral quadrant.</p><p><strong>Conclusions: </strong>Clinical and radiological assessments demonstrated that lipofilling is an effective technique for restoring orbital volume in anophthalmic sockets with enophthalmos.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20260041"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the alpha-gal antigen in corneal xenotransplant rejection: a review.","authors":"Augusto Villar, Heloisa Nascimento, Jorge Kalil, Thaís Maria da Mata Martins, Luiz Vicente Rizzo, Gabriel Barbieri, Pedro Pires, Lucimeire N Carvalho, Larissa R Rosa, Rodrigo Moreira, Carmen Luz Pessuti, Henrique Ferrer, José Álvaro Pereira Gomes, Silvano Raia, Rubens Belfort","doi":"10.5935/0004-2749.2025-0337","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0337","url":null,"abstract":"<p><p>Corneal blindness affects more than 12 million individuals worldwide; however, the availability of human donor corneas meets only a small fraction of the demand. Porcine corneal xenotransplantation represents a promising alternative because of the cornea's immune privilege and the anatomical similarities between human and porcine corneas. However, the galactose-α1,3-galactose antigen expressed on porcine cells induces hyperacute rejection through the activation of human anti-Gal antibodies, complement pathways, and innate immune cell infiltration. This review summarizes the mechanisms underlying corneal immune privilege and contrasts them with galactose-α1,3-galactose-mediated rejection pathways. In addition, it evaluates five major mitigation strategies: GGTA1-knockout pigs, enzymatic α-galactosidase treatment, RNA interference, decellularization, and immunosuppressive approaches, including CD40-CD154 blockade and topical tacrolimus. Preclinical studies have demonstrated that GTKO corneas can maintain transparency for longer than 1 year, whereas decellularized matrices preserve corneal architecture while exhibiting low antigenicity. These findings support the future clinical translation of porcine corneal xenotransplantation.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20250337"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rizzuti's sign in advanced keratoconus.","authors":"Rakesh Kumar Jha, Sankalp Seth","doi":"10.5935/0004-2749.2026-0157","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-0157","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20260157"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic distribution and coverage of neuro-ophthalmologists in Brazil.","authors":"Eric Pinheiro de Andrade, Mauro C Gobira Guimarães Filho, Leonardo Provetti Cunha, Kenzo Hokazono, André Márcio Vieira Messias, Clara Lima Afonso, Marcela Bareira, Mário Luiz Ribeiro Monteiro","doi":"10.5935/0004-2749.2026-0067","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-0067","url":null,"abstract":"<p><strong>Purpose: </strong>Neuro-ophthalmology is a highly specialized subspecialty at the interface of neurology and ophthalmology. Globally, workforce shortages and geographic maldistribution limit access to neuro-ophthalmic care. Although Brazil has a large ophthalmology workforce, regional disparities may restrict access to subspecialty services. The national distribution of neuro-ophthalmologists has not previously been quantified. This study aimed to characterize the geographic distribution of neuro-ophthalmologists in Brazil and identify potential gaps in access to neuro-ophthalmic care.</p><p><strong>Methods: </strong>This cross-sectional, population-based study used data from the registry of the Brazilian Neuro-Ophthalmology Association (Associação Brasileira de Neuro-Oftalmologia [ABNO]) to identify practicing neuro-ophthalmologists (data extracted on January 1, 2026). Municipaland state-level population estimates were obtained from the Brazilian Institute of Geography and Statistics. Specialist density was calculated as the number of neuro-ophthalmologists per million inhabitants. States were classified according to the presence or absence of at least one specialist and were further grouped into Brazil's five macroregions for comparative analyses. Descriptive statistical analyses were performed.</p><p><strong>Results: </strong>A total of 66 neuro-ophthalmologists were identified across 14 of Brazil's 27 states. Thirteen states had no registered neuro-ophthalmologists, representing approximately 49.4 million people (23.2% of the national population). Five states-São Paulo (n=31), Rio de Janeiro (n=6), Minas Gerais (n=6), Pernambuco (n=4), and Paraná (n=4)-accounted for more than two-thirds of all specialists. Specialist density ranged from 0 to more than 0.7 per million inhabitants, with higher concentrations in the Southeast and no specialists in several states in the North and Northeast. The distribution was highly clustered in metropolitan areas.</p><p><strong>Conclusion: </strong>Brazil exhibits marked geographic maldistribution of neuro-ophthalmologists, with nearly one-quarter of the population lacking local access to specialized care. The concentration of specialists in urban and economically developed regions mirrors international trends and may exacerbate inequities within the public health system. Expanding the workforce and integrating teleophthalmology into neuro-ophthalmic services may help reduce regional disparities and improve access to specialized care.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20260067"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum thrombospondin-1, growth differentiation factor-15, and resolvin D1 and E1 levels in the pathogenesis of keratoconus.","authors":"Raşit Kılıç, Şerife Gülhan Konuk, Muzaffer Katar, Gamze Bektur","doi":"10.5935/0004-2749.2025-0154","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0154","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the serum levels of thrombospondin-1, growth differentiation factor-15, resolvin D1, and resolvin E1 in patients with keratoconus.</p><p><strong>Methods: </strong>Thirty-five patients with keratoconus and 35 control subjects of similar age and sex were evaluated. The keratoconus group was divided into four stages according to the modified Krumeich classification. Commercial kits were used to determine thrombospondin-1, growth differentiation factor-15, resolvin D1, and resolvin E1 levels in serum samples using enzyme-linked immunosorbent assay (ELISA). Serum thrombospondin-1, growth differentiation factor-15, resolvin D1, and resolvin E1 levels were compared between the patient and control groups.</p><p><strong>Results: </strong>The keratoconus group consisted of 14 females and 21 males, and the control group consisted of 14 females and 21 males, with mean ages of 29.4±8.8 and 30.0±7.8 yr, respectively. There were significant differences in serum thrombospondin-1, growth differentiation factor-15, resolvin D1, and resolvin E1 levels between the serum of the keratoconus and control groups (p=0.006, p<0.001, p<0.001, and p=0.001, respectively). No significant correlations were found between keratoconus stage and serum thrombospondin-1, growth differentiation factor-15, resolvin D1 and resolvin E1 levels (r=-0.025, p=0.892; r=-0.019, p=0.913; r=-0.036, p=0.838; and r=-0.108, p=0.538, respectively).</p><p><strong>Conclusion: </strong>Serum levels of thrombospondin-1, growth differentiation factor-15, resolvin D1, and resolvin E1 were significantly lower in patients with keratoconus. These results suggest that these parameters may be associated with the pathogenesis of keratoconus.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20250154"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the internal astigmatism axis to determine the toric intraocular lens axis: Comparison between C-loop and plate-haptic lenses.","authors":"Alper Can Yilmaz, Onder Ayyildiz","doi":"10.5935/0004-2749.2025-0395","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0395","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the agreement between the internal astigmatism axis obtained using the optical path difference-Scan III (NIDEK Co., Japan) and conventional slit-lamp biomicroscopic measurements for determining the toric intraocular lens axis in non-dilated eyes.</p><p><strong>Methods: </strong>This retrospective study included 56 eyes that underwent toric intraocular lens implantation and were evaluated at postoperative week 6. The toric intraocular lens axis was measured using the optical path difference-derived internal astigmatism axis under mesopic conditions without pharmacologic pupil dilation and compared with slit-lamp biomicroscopic measurements obtained after pharmacologic dilation. Agreement between the two methods was assessed using Bland-Altman analysis, the intraclass correlation coefficient, angular error analysis, and the distribution of clinically relevant deviations. Subgroup analyses were performed for plate-haptic and C-loop haptic intraocular lens.</p><p><strong>Results: </strong>The mean signed angular difference between the two methods was 0.00° (95% CI:, -0.41° to +0.41°), with 95% limits of agreement ranging from -2.99° to +2.99°. No systematic or proportional bias was observed. The mean absolute angular error was 1.21°±0.91°, and no eye demonstrated an intermethod discrepancy exceeding 5°. The difference between the two methods was ≤1° in 73.2% of eyes, ≤3° in 98.2%, and ≤5° in all eyes. Excellent agreement was observed between the two techniques (intraclass correlation coefficient >0.99, p<0.001). Comparable agreement was also observed in both the plate-haptic and C-loop haptic intraocular lens subgroups.</p><p><strong>Conclusions: </strong>Optical path difference-derived internal astigmatism axis measurements demonstrated excellent agreement with conventional slit-lamp biomicroscopic assessment for postoperative evaluation of toric intraocular lens alignment. The low angular error, narrow limits of agreement, and absence of clinically meaningful discrepancies suggest that this technique may serve as a reliable alternative for determining the toric intraocular lens axis in non-dilated eyes with adequate pupil size.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 5","pages":"e20250395"},"PeriodicalIF":1.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Performance of generative large language models in answering questions from the Brazilian Retina and Vitreous Society certification exam\".","authors":"Neeraj Singh, Monika Srivastav","doi":"10.5935/0004-2749.2026-0130","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-0130","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20260130"},"PeriodicalIF":1.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}