Arquivos brasileiros de oftalmologia最新文献

{"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}

{"title":"Comparative retrospective analysis of trabeculectomy with mitomycin C, with and without adjunctive Ologen collagen matrix: Efficacy and safety outcomes.","authors":"Ana Flavia Belfort, Heloisa Andrade Maestrini, Heloisa Helena Abil Russ Giacometti, Aline Domingos Pinto Ruppert, Emilio Rintaro Suzuki Junior, Herika Danielle de Miranda Santos, Alberto Basile Neto, Clarice Freire Dayrell de Souza, Marcos Balbino, Marcelo Jordão Lopes da Silva, Lunna Pires Moreira, Regina Cele Silveira Seixas","doi":"10.5935/0004-2749.2025-0216","DOIUrl":"10.5935/0004-2749.2025-0216","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the efficacy and safety of trabeculectomy with mitomycin C, performed with versus without adjunctive Ologen collagen matrix in a multicenter real-world setting.</p><p><strong>Methods: </strong>This multicenter retrospective comparative study included 277 patients (365 eyes) who underwent trabeculectomy with mitomycin C, with or without Ologen, between 2017 and 2022 across five Brazilian centers. Extracted data comprised demographic characteristics, glaucoma subtype, intraocular pressure, number of glaucoma medications, postoperative interventions, complications, and additional surgical procedures. Surgical success was defined using two criteria: (1) intraocular pressure ≤21mmHg with ≥20% reduction from baseline and (2) final intraocular pressure between 6 and 21mmHg. Outcomes were categorized as complete (without medications) or qualified (with medications).</p><p><strong>Results: </strong>Both groups achieved substantial reductions in intraocular pressure and medication burden at 12 months, with high rates of complete and qualified success under both definitions. The Ologen group required fewer suture lysis procedures (49.0% vs. 60.8%; p=0.025), suggesting a modulatory effect on early postoperative fibrosis. Rates of other postoperative interventions, complications, and additional glaucoma surgeries were comparable between groups. Kaplan-Meier analysis demonstrated no significant difference in cumulative success over time.</p><p><strong>Conclusion: </strong>Trabeculectomy with mitomycin C is effective and safe regardless of adjunctive Ologen use. Although Ologen did not confer superior long-term efficacy, its association with reduced suture lysis suggests a potential role in modulating early wound healing.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20250216"},"PeriodicalIF":1.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683167","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":"Historical underfunding of cataract surgery in Brazil: Impact of a state-level financial incentive on the Public Health System and implications for private health insurance.","authors":"Felipe Augusto Casseb Dos Santos, João Victor Tenório Lossio de Macedo, Daniel Haruo Ishigai, Bernardo Kaplan Moscovici, Ricardo Menon Nosé","doi":"10.5935/0004-2749.2026-0090","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-0090","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20260090"},"PeriodicalIF":1.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683137","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":"Evaluation of early retinal microvasculature changes after cardiopulmonary bypass.","authors":"Mehmet Özbaş, Bengi Demirayak","doi":"10.5935/0004-2749.2025-0344","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0344","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate early postoperative changes in retinal microvasculature in patients undergoing cardiopulmonary bypass surgery by comparing preoperative and postoperative measurements of superficial capillary plexus and, deep capillary plexus vessel density, foveal avascular zone area using optical coherence tomography angiography (OCT-A).</p><p><strong>Methods: </strong>This prospective longitudinal study included 38 patients, undergoing cardiopulmonary bypass surgery. Each patient served as their own control optical coherence tomography angiography imaging was performed at four time points: 3 days preoperatively and at postoperative week 1, week 2, and month 1. Vessel densities in the superficial capillary plexus and deep capillary plexuses and the foveal avascular zone area were measured and analyzed. Depending on data distribution repeated measures analysis of variance or the Friedman test was used for statistical analysis.</p><p><strong>Results: </strong>Data from all 38 patients were included in the analysis. A significant increase in overall superficial capillary plexus vessel density was observed following cardiopulmonary bypass surgery (p=0.008). In contrast, deep capillary plexus vessel density did not differ significantly between the preoperative and postoperative assessments. The foveal avascular zone area showed a significant increase at postoperative week 2 compared with baseline (p=0.016).</p><p><strong>Conclusion: </strong>Cardiopulmonary bypass surgery may induce early retinal microvascular alterations, particularly in the superficial capillary plexus and foveal avascular zone. Optical coherence tomography angiography is a noninvasive and reproducible imaging modality that enables precise assessment of subtle retinal vascular changes after major cardiovascular surgery. These findings may contribute to postoperative monitoring and risk assessment in patients undergoing cardiopulmonary bypass.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20250344"},"PeriodicalIF":1.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683230","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":"Prognostic testing in Brazilian patients with uveal melanoma using 15-gene expression profile and preferentially expressed antigen in melanoma.","authors":"Carolina C Valente, Gustavo R Gameiro, Beatriz K T Oguido, Rodrigo Jorge, J William Harbour, Zelia M Correa","doi":"10.5935/0004-2749.2025-0356","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0356","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the results of the 15-gene expression profile/preferentially expressed antigen in melanoma (15-GEPP) prognostic classifier and associated survival outcomes in a series of Brazilian patients with posterior uveal melanoma.</p><p><strong>Methods: </strong>Patients born and raised in Brazil who were diagnosed with posterior uveal melanoma and underwent fine-needle aspiration biopsy for 15-GEPP prognostic testing using the DecisionDx-Uveal melanoma and DecisionDx-PRAME assays between September 2020 and 2023 were included. All patients were diagnosed and treated by the senior author.</p><p><strong>Results: </strong>Of 236 patients diagnosed with posterior uveal melanoma during the study period, 11 (4.6%) met the inclusion criteria, including six males and five females. Based on 15-GEPP results, seven patients (63.6%) were classified as Class 1 and 4 (36.4%) as Class 2. Preferentially expressed antigen in melanoma (PRAME) expression was negative in six patients (54.6%) and positive in five patients (45.4%). During a mean follow-up of 36.4 ± 17.6 months, five patients developed metastasis: two with Class 2/PRAME-positive tumors, one with Class 2/PRAME-negative tumors, one with Class 1/PRAME-positive tumors, and one with Class 1/PRAME-negative tumors. Three of these patients died. The mean survival after the diagnosis of metastasis was 21.2 months (median: 17.0 months).</p><p><strong>Conclusions: </strong>The proportions of Class 1 versus Class 2 tumors and PRAME-negative versus PRAME-positive tumors as well as the prognostic performance of these biomarkers appear similar in Brazilian patients with posterior uveal melanoma compared with large published cohorts from North America. Further studies with larger Brazilian cohorts are needed to validate these findings.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20250356"},"PeriodicalIF":1.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683165","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":"Change in pupil diameter after phacoemulsification with intraocular lens implantation.","authors":"Hugo Diehl de Souza, José de Mello Rosatelli Neto, Sofia Cabral Saqueti, Maria Antônia Vicente Camargo, Raíssa Gomes Nunes, Renan Nola Schmoeller, Jefferson Luiz Brum Marques","doi":"10.5935/0004-2749.2026-0010","DOIUrl":"10.5935/0004-2749.2026-0010","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate changes in scotopic pupil diameter before and after cataract surgery performed by phacoemulsification with intraocular lens implantation.</p><p><strong>Methods: </strong>This prospective longitudinal observational study included patients who underwent cataract surgery. Scotopic pupil diameter was measured preoperatively and 30-40 days postoperatively using an automated keratometer after a standardized dark-adaptation period under controlled ambient illumination. Each eye was considered an independent unit of observation. Because some participants contributed both eyes, intraindividual correlation was accounted for using a linear mixed-effects model with random patient intercepts. Time of assessment (preoperative versus postoperative), age, sex, and eye laterality were included as fixed effects.</p><p><strong>Results: </strong>A total of 354 eyes from 251 patients were analyzed. The mean patient age was 69.3±7.2 yr. Mean scotopic pupil diameter decreased from 5.3±0.9mm preoperatively to 4.8±0.8mm postoperatively, representing a mean reduction of 0.5mm (9.4%). In the linear mixed-effects model, cataract surgery was associated with a significant reduction in pupil diameter, with an adjusted mean difference of 0.45mm (95% confidence interval [95% CI], 0.39-0.51; p<0.001). Age (p=0.061), sex (p=0.920), and eye laterality (p=0.152) were not significantly associated with the magnitude of pupil diameter change.</p><p><strong>Conclusion: </strong>Phacoemulsification with intraocular lens implantation was associated with a significant reduction in scotopic pupil diameter, independent of age, sex, and eye laterality. This finding should be considered during preoperative planning, particularly when selecting intraocular lenses whose optical performance depends on postoperative pupil size.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20260010"},"PeriodicalIF":1.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683139","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}