Arquivos brasileiros de oftalmologia最新文献

{"title":"A trilogy of the oculomotor system Part II - active, passive, and dissipative forces Part III - diagnostic tests.","authors":"Harley E A Bicas","doi":"10.5935/0004-2749.2025-0242","DOIUrl":"10.5935/0004-2749.2025-0242","url":null,"abstract":"<p><p>In Part II, this paper addresses ocular motions, their causes (forces), and the governing laws, beginning with the fundamental question: Why do the eyes move? Ocular rotations and different types of translations (ocular, orbital, and corporeal) are reviewed. The discussion then turns to how the eyes move, where concepts such as the plane of muscular action, torque, and arc of contact provide possible explanations for the anatomical arrangement of the ocular muscles within the orbit. Sherrington's law of reciprocal innervation is used to explain the distribution of muscular active forces in a conservative mechanical system, but in combination with Hering's law, it may prevent eye rotation (e.g., isometric contractions of antagonist muscles of an asymmetrical convergence). Normally, however, the limitation of an eye rotation is determined by passive forces, evoked by muscular activity itself, particularly natural muscular elasticity. Thus, elongation of an antagonist muscle may passively restrict the active contraction of an agonist. In addition to mechanisms for initiating rotation (active forces) and stopping it (passive forces), the oculomotor system also requires a means of dissipating energy (dissipative forces) to initiate subsequent movements. Hence, it cannot function as a perfectly conservative system of forces. The paper concludes with a review of \"selective\" effects of muscle function (due to the sparse distribution of fibers), the role of intermuscular membranes (and pulleys), and mechanical considerations of surgical procedures, such as muscular transpositions to alter or abolish actions (e.g., bifid reinsertions). Part III will address the diagnostic complexities of the oculomotor system, general treatment principles, and ocular fixation (eye and head positions). Although the basic concept of the primary position is relativized, the absolute need for referential conditions in defining, qualifying, and measuring strabismus is emphasized. The prim-diopter is challenged due to its lack of \"linearity\" relative to angular units, and an alternative is proposed. Methods of examining oculomotor disturbances are outlined, including monocular rotations (ductions), and tests to differentiate between muscular deficiencies and opposing forces. Techniques for identifying the site of a rotational restriction are described, followed by approaches to measuring ocular deviations in diagnostic positions. The concepts of muscular overactions and underactions are analyzed before introducing the concept of diagnostic muscle pairs. Classical knowledge about deviations caused by deficient or restricted muscle actions reinforces the theory of distribution of rotational ocular muscles by diagnostic pairs. For vertical deviations, \"underactive\" muscle pairs must be separately matched (e.g., RSR with LIR, RIO with LSO). Since vertical recti exert stronger vertical actions than oblique muscles, head tilts are recommended to enhance stress on both pairs, mai","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 2","pages":"e20250242"},"PeriodicalIF":1.2,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353764","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":"Myopia control strategies: a survey of Brazilian ophthalmologists.","authors":"Raíra Fortuna Cavaliere Mendes Moraes, Carolina Pelegrini Barbosa Gracitelli, Célia Regina Nakanami, Julia Dutra Rossetto","doi":"10.5935/0004-2749.2025-0192","DOIUrl":"10.5935/0004-2749.2025-0192","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify the strategies adopted by Brazilian ophthalmologists to control myopia in clinical practice.</p><p><strong>Methods: </strong>This was a prospective cross-sectional study. Data were collected using an online questionnaire.</p><p><strong>Results: </strong>Responses from 148 participants were collected between March and May 2024. The majority of respondents were general ophthalmologists (51%) and pediatric ophthalmologists (43%). They came from all regions of Brazil, but more than half (52%) were from the Southeast region. Most participants (30%) had over 20 years of clinical practice experience. A significant proportion (89.2%) treated progressive myopia. The most requested complementary exams were optical biometry (83.78%) and corneal topography or tomography (69.59%). Behavioral measures were considered the most effective myopia treatment strategies by 41.2% of the respondents, followed by optical (33.8%) and pharmacological interventions (25%). Most recommended spending more time outdoors (94.59%) and reducing screen time (93.92%). Spectacle lenses for myopia (83.11%) and 0.025% atropine eye drops (54.73%) were the most prescribed treatments after the recommendation of environmental and behavioral changes.</p><p><strong>Conclusion: </strong>This study presents a novel analysis of the clinical strategies for myopia control among Brazilian ophthalmologists. Understanding current clinical practices and identifying possible improvements are essential steps toward developing evidence-based guidelines and professional education aimed at improving patient care.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 2","pages":"e20250192"},"PeriodicalIF":1.2,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353730","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":"Beyond pressure control: Periorbital impact of prostaglandins vs. laser trabeculoplasty.","authors":"Leonardo Leivas, Fernando Procianoy, Rafaela C Almeida, Marina M Pakter, Marcelo V Fabris, Rodrigo L Lindenmayer, Fábio Lavinsky, Daniel Lavinsky, Helena M Pakter","doi":"10.5935/0004-2749.2025-0181","DOIUrl":"10.5935/0004-2749.2025-0181","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the one-year impact of prostaglandin analog (travoprost) on periorbital appearance and lower eyelid horizontal tension, compared with the contralateral eye treated with Pascal selective laser trabeculoplasty.</p><p><strong>Methods: </strong>This nested case-control study was derived from a non-inferiority randomized clinical trial comparing Pascal selective laser trabeculoplasty efficacy with travoprost in fellow eyes over 12 months. One eye received daily travoprost, while the contralateral eye underwent Pascal selective laser trabeculoplasty. Lower eyelid horizontal tension was measured using a validated digital imaging method, and prostaglandin-associated periorbitopathy signs were graded by masked observers. Statistical analyses included generalized estimating equations and the Mann-Whitney U test for nonparametric data, with p<0.05 considered significant.</p><p><strong>Results: </strong>Ten patients met the inclusion criteria for this subanalysis. Travoprost-treated eyes had significantly lower mean lower eyelid distension compared with Pascal selective laser trabeculoplasty-treated eyes (4.32 mm vs. 5.02 mm; mean difference: 0.70 mm; p<0.001). Prostaglandin--associated periorbitopathy scores were significantly higher in the travoprost group, reflecting more pronounced changes in ptosis, periorbital hyperpigmentation, and eyelid retraction.</p><p><strong>Conclusions: </strong>Chronic use of prostaglandin analogs is associated with notable periorbital changes and increased lower eyelid tension, potentially affecting aesthetics and ocular function. Pascal selective laser trabeculoplasty may offer a safer profile for preserving periorbital anatomy while maintaining effective intraocular pressure control. Laser trabeculoplasty should be considered as an initial treatment when appropriate to minimize cosmetic and functional changes from chronic topical therapy.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 2","pages":"e20250181"},"PeriodicalIF":1.2,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353775","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":"Performance of generative large language models in answering questions from the Brazilian Retina and Vitreous Society certification exam.","authors":"Adriano Cypriano Faneli, Ricardo Danilo Chagas Oliveira, Luis Filipe Nakayama, Rodrigo Amaral Torres, Cristina Muccioli, Caio Vinicius Saito Regatieri","doi":"10.5935/0004-2749.2025-0113","DOIUrl":"10.5935/0004-2749.2025-0113","url":null,"abstract":"<p><strong>Purpose: </strong>Natural language models and chatbots, particularly OpenAI's Generative Pre-Trained Transformer architecture, have transformed human interaction with digital interfaces. The latest versions, including ChatGPT-4o, offer enhanced functionalities compared to their predecessors. This study evaluates the accuracy of ChatGPT-4, ChatGPT-4o, and Claude 3.5 Sonnet in answering questions from the Brazilian Retina and Vitreous Society certification exam.</p><p><strong>Methods: </strong>We compiled 200 multiple-choice questions from the Brazilian Retina and Vitreous Society 2018 and 2019 exams. Questions were categorized into three domains: Anatomy and Physiology of the Retina, Retinal Pathology, and Diagnosis and Treatment. Using a standardized prompt developed according to prompt design guidelines, we tested ChatGPT-4, ChatGPT-4o, and Claude 3.5 Sonnet, recording their first responses as final. Three retina specialists performed a qualitative analysis of the answers. Accuracy was determined by comparing responses to the official correct answers. Statistical analysis was conducted using chi-square tests and Cohen's Kappa.</p><p><strong>Results: </strong>Claude 3.5 Sonnet achieved the highest overall accuracy (72.5%), followed by ChatGPT-4o (66.0%) and ChatGPT-4 (55.5%). Claude 3.5 Sonnet and ChatGPT-4o significantly outperformed ChatGPT-4 (p<0.01 and p=0.03, respectively), while no significant difference was observed between Claude 3.5 Sonnet and ChatGPT-4o (p=0.16). Model responses agreed 74.5% of the time, with a Cohen's κ of 0.47. Retinal Pathology was the best-performing domain for all models, whereas Anatomy and Physiology of the Retina and Diagnosis and Treatment were the weakest domains for Claude 3.5 Sonnet and ChatGPT-4, respectively.</p><p><strong>Conclusions: </strong>This study is the first to assess Claude 3.5 Sonnet, ChatGPT-4, and ChatGPT-4o in retina specialist certification exams. Claude 3.5 Sonnet and ChatGPT-4o significantly outperformed ChatGPT-4, highlighting their potential as effective tools for studying retina specialist board exams. These findings suggest that the enhanced functionalities of Claude 3.5 Sonnet and ChatGPT-4o offer substantial improvements in medical education contexts.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 2","pages":"e20250113"},"PeriodicalIF":1.2,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353794","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":"Kahook Dual-Blade goniotomy combined with phacoemulsification in primary open-angle glaucoma patients: long-term results.","authors":"Antônio Lucas Oliveira Correia, Breno Santos Holanda, Vital Paulino Costa, José Paulo Cabral de Vasconcelos","doi":"10.5935/0004-2749.2025-0140","DOIUrl":"10.5935/0004-2749.2025-0140","url":null,"abstract":"<p><strong>Purpose: </strong>Glaucoma is a chronic and progressive disease that requires long-term treatment and continuous monitoring. The Kahook Dual Blade, a device used to perform goniotomy in adults, is designed to improve intraocular pressure control in patients with glaucoma. This study aimed to evaluate the long-term efficacy and safety of kahook dual blade goniotomy in glaucoma patients undergoing cataract surgery over a 36-month follow-up.</p><p><strong>Methods: </strong>This was a retrospective case series including 56 eyes from 56 patients with mild-to-moderate primary open-angle glaucoma who underwent phacoemulsification combined with kahook dual blade goniotomy. Mean intraocular pressure values, number of preoperative and postoperative hypotensive eye drops, procedure survival, and complications were evaluated over 36 months. Surgical success was defined as either a reduction in intraocular pressure of ≥20% with intraocular pressure between 6 and 18 mmHg without additional medication or a reduction of ≥1 eye drop with intraocular pressure between 6 and 18 mmHg.</p><p><strong>Results: </strong>The mean preoperative intraocular pressure decreased from 15.96 ± 2,83) mmHg to 13.14 ± 2,11) mmHg at 36 months, representing a 14.9% reduction (p<0.001). The mean number of eye drops decreased from 1.91 ± 0,75) to 1.34 ± 0,92), a 29.8% reduction (p<0.001). The overall success rate was 69.6% at 36 months.</p><p><strong>Conclusion: </strong>Kahook dual blade goniotomy combined with cataract surgery significantly reduced intraocular pressure and the number of hypotensive eye drops required in patients with mild-to-moderate primary open-angle glaucoma, with a favorable success rate maintained at 36 months.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250140"},"PeriodicalIF":1.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117657","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":"Surgical procedures in glaucoma: A preferred practice pattern report by the Latin American Glaucoma Society.","authors":"Manuel José Justiniano, Juan José Mura, Jair Giampani Junior, Marcelo Jordão Lopes Silva, Guillermo Barreto Fong","doi":"10.5935/0004-2749.2025-0109","DOIUrl":"10.5935/0004-2749.2025-0109","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the preferred surgical practice patterns for glaucoma among members of the Latin American Glaucoma Society.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using an electronic survey distributed in July 2023 via email to members of the Latin American Glaucoma Society. The questionnaire comprised four sections addressing the specialists' profiles, preferred surgical procedures for open--angle glaucoma, and choices in 10 different clinical scenarios, including congenital glaucoma.</p><p><strong>Results: </strong>Of the 63 members, 49 physicians (77.7%) responded - 13 women and 36 men - from nine Latin American countries. Thirty-one respondents (63.26%) had more than 20 yr of professional experience. For the surgical management of open-angle glaucoma, trabeculectomy was the most preferred procedure (48 physicians), followed closely by glaucoma drainage devices (47 physicians) and minimally invasive glaucoma surgery (29 physicians). Across the 10 clinical scenarios, glaucoma drainage devices were selected most frequently (203 preferences), followed by trabeculectomy (118), ciliary body laser procedures (107), and minimally invasive glaucoma surgery (40). However, minimally invasive glaucoma surgery was the preferred option for primary open-angle glaucoma with mild-to-moderate cataracts.</p><p><strong>Conclusion: </strong>Among specialists of the Latin American Glaucoma Society, trabeculectomy and glaucoma drainage devices remain the most commonly performed surgical procedures. Minimally invasive glaucoma surgery is primarily used in combination with cataract surgery, while ciliary body laser procedures are generally reserved for cases of previous glaucoma drainage device failure or as an initial option for newly diagnosed glaucoma cases.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250109"},"PeriodicalIF":1.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117695","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":"Impact of mydriasis on image gradability and automated diabetic retinopathy screening with a handheld camera. A real-world setting evaluation.","authors":"Iago Diógenes Azevedo Costa, David Restrepo, Lucas Zago Ribeiro, Andre Kenzo Aragaki, Fernando Korn Malerbi, Caio Saito Regatieri, Luis Filipe Nakayama","doi":"10.5935/0004-2749.2025-0025","DOIUrl":"10.5935/0004-2749.2025-0025","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetic retinopathy screening in lowand middle-income countries is limited by restricted access to specialized care. Portable retinal cameras offer a practical alternative; however, image quality - affected by mydriasis - directly influences the performance of artificial intelligence models. This study evaluated the effect of mydriasis on image gradability and AI-based diabetic retinopathy detection in real-world, resource-limited settings.</p><p><strong>Methods: </strong>The proportions of gradable images were compared between mydriatic and non-mydriatic groups. Generalized estimating equations were used to identify factors associated with image gradability, including age, sex, race, diabetes duration, and systemic hypertension. A ResNet-200d model was trained on the mobile Brazilian Ophthalmological dataset and externally validated on both mydriatic and non-mydriatic images. Model performance was evaluated using accuracy, F1 score, area under the curve, and confusion matrix metrics. Sensitivity differences were assessed using the McNemar test, and area under the curves were compared using DeLong's test. The Youden index was used to determine optimal classification thresholds. Agreement between maculaand disc-centered images was analyzed using Cohen's κ.</p><p><strong>Results: </strong>The mydriatic group demonstrated a higher proportion of gradable images compared with the non-mydriatic group (82.1% vs. 55.6%; p<0.001). In non-mydriatic images, lower gradability was associated with systemic hypertension, older age, male sex, and longer diabetes duration. The AI model achieved better performance in mydriatic images (accuracy, 85.15%; area under the curve, 0.94) than in non-mydriatic images (accuracy, 79.68%; area under the curve, 0.93). The McNemar test showed a significant difference in sensitivity (p=0.0001), whereas DeLong's test revealed no significant difference in area under the curve (p=0.4666). The Youden index indicated that optimal classification thresholds differed based on mydriasis status. Agreement between image fields was moderate to substantial and improved with mydriasis.</p><p><strong>Conclusion: </strong>Mydriasis significantly improves image gradability and enhances AI performance in diabetic retinopathy screening. Nonetheless, in lowand middle-income countries where pharmacologic dilation may be impractical, optimizing model calibration and thresholding for non-mydriatic images is essential to ensure effective AI implementation in real-world clinical environments.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250025"},"PeriodicalIF":1.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117662","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":"Custom slow-coagulation transscleral cyclophotocoagulation: a novel cyclophotocoagulation technique for refractory glaucoma patients in a safety-net eye hospital in Mexico.","authors":"Priscila Sánchez Moreno, Aubert Quintanilla Rivera, Mariana Badillo Fernández, Jesús Martín Ayala Flores, Van Charles Lansingh, Van Nguyen","doi":"10.5935/0004-2749.2024-0397","DOIUrl":"10.5935/0004-2749.2024-0397","url":null,"abstract":"<p><strong>Purpose: </strong>Glaucoma is one of the leading causes of irreversible blindness worldwide. When topical hypotensive agents or laser trabeculoplasty fail to adequately control the disease, escalation of therapy becomes necessary, with transscleral cyclophotocoagulation being one of the available options. Several variations of transscleral cyclophotocoagulation exist, including traditional continuous wave, MicroPulse, and slow-coagulation techniques. We propose a novel variation - custom slow-coagulation transscleral cyclophotocoagulation - which combines elements of both continuous wave and slow-coagulation approaches. This study aimed to evaluate the outcomes of this technique in patients with refractory glaucoma.</p><p><strong>Methods: </strong>This retrospective, interventional study included 104 eyes of 83 patients with refractory glaucoma who underwent custom slow-coagulation transscleral cyclophotocoagulation. Changes in intraocular pressure, visual acuity, the number of glaucoma medications, and postoperative complications were analyzed. A paired t test was used to compare changes in intraocular pressure and visual acuity, while the Wilcoxon signed-rank test was applied to categorical variables. Success rates following custom slow-coagulation transscleral cyclophotocoagulation were estimated using Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>Mean intraocular pressure decreased significantly from 38.9 ± 15.8 mmHg at baseline to 16.3 ± 9.9 mmHg at Month 12 (p<0.001). The mean number of glaucoma medications also decreased significantly from 3.6 ± 0.6 to 1.8 ± 1.4 (p<0.001). No significant reduction in mean visual acuity was observed during follow-up.</p><p><strong>Conclusions: </strong>Custom slow-coagulation transscleral cyclophotocoagulation effectively reduced baseline intraocular pressure and the number of glaucoma medications, with a low rate of complications and no decline in visual acuity over a 12-month follow-up period. This novel technique demonstrated a high safety profile in a Hispanic population and represents a low-cost, minimally invasive procedure with rapid recovery and promising efficacy in intraocular pressure control.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20240397"},"PeriodicalIF":1.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117723","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":"Management of glaucoma during pregnancy and lactation: clinical considerations and therapeutic strategies.","authors":"Camila F Netto, Carolina P B Gracitelli, Heloisa Russ, Denise F Barroso de Melo Cruz, Nubia Vanessa Dos Anjos Lima, Heloisa Andrade Maestrini","doi":"10.5935/0004-2749.2025-0051","DOIUrl":"10.5935/0004-2749.2025-0051","url":null,"abstract":"<p><p>Glaucoma is a progressive optic neuropathy that can cause irreversible blindness, though it rarely affects women of reproductive age. Its management during pregnancy and lactation is particularly challenging because of the potential impact of intraocular pressure fluctuations on disease progression and the risks of treatment to both the mother and fetus. Physiological changes in pregnancy, such as decreased intraocular pressure and hormonal alterations, may influence disease activity but do not guarantee disease stability. Preconception counseling plays a key role in mitigating risks and tailoring treatment strategies. Many glaucoma medications carry teratogenic risks, with brimonidine being the only US Food and Drug Administration Category B drug. Surgical interventions - including laser trabeculoplasty and minimally invasive glaucoma surgeries - offer alternative options but require careful timing and consideration of fetal safety. Multidisciplinary collaboration is essential to optimize maternal and neonatal outcomes. This review summarizes evidence-based approaches for glaucoma management during pregnancy and lactation, highlighting clinical considerations, therapeutic strategies, and patient-centered care.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250051"},"PeriodicalIF":1.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117687","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":"Band keratopathy.","authors":"João Vitor Laranjeira, Nicole Bulgarão Maricondi de Almeida, Newton Kara-Junior","doi":"10.5935/0004-2749.2025-0315","DOIUrl":"10.5935/0004-2749.2025-0315","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"88 6","pages":"e20250315"},"PeriodicalIF":1.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}