Arquivos brasileiros de oftalmologia最新文献

{"title":"Different formulations of corticosteroid eye drops at different treatment times in the control of inflammation and prevention of cystoid macular edema after cataract surgery: randomized clinical trial.","authors":"Adriane Macêdo Feitosa, Maria Clara de Freitas Albano, Sofia Pereira Lopes, José Eduardo de Oliveira Miranda, Thiago Carvalho Barros de Oliveira, Pedro Javier Yugar Rodriguez, André Jucá Machado, Mateus Macêdo Feitosa, João Crispim Moraes Lima Ribeiro","doi":"10.5935/0004-2749.2025-0097","DOIUrl":"10.5935/0004-2749.2025-0097","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of different corticosteroid eye drop formulations (prednisolone acetate 1.0%, dexamethasone 1.0%, and loteprednol etabonate 0.5%) administered for different treatment durations (10 vs. 28 days) in controlling postoperative inflammation following uncomplicated cataract surgery.</p><p><strong>Methods: </strong>This randomized, masked clinical trial was conducted at the Instituto Cearense de Oftalmologia. Eligible participants were aged ≥50 yr and scheduled for routine cataract surgery. Exclusion criteria included preexisting ocular disease (elevated intraocular pressure, retinopathy, maculopathy, or uveitis) or concurrent medication use that could confound results. Patients were randomized to receive prednisolone acetate (1.0%), dexamethasone (1.0%), or loteprednol etabonate (0.5%) four times daily for 28 days (with tapering) or for 10 days. Medication bottles, prescriptions, and examiners were masked. Postoperative assessments included ocular symptoms, visual acuity, intraocular pressure, anterior chamber cell count and flare, pachymetry, endothelial cell density, and macular thickness over a 30-day follow-up.</p><p><strong>Results: </strong>A total of 140 eyes from 140 patients were analyzed (29 prednisolone acetate 1.0%, 18 dexamethasone 1.0%, and 21 loteprednol etabonate 0.5% for 28 days; 28 prednisolone acetate 1.0%, 22 dexamethasone 1.0%, and 22 loteprednol etabonate 0.5% for 10 days). No significant differences were found among the six groups during follow-up. However, eyes treated with dexamethasone (1.0%) showed greater intraocular pressure fluctuations, particularly on Days 7 and 30, and a higher incidence of rebound inflammation in the 28-day regimen. Structural cystoid macular edema without visual impact was observed in 5.9% of eyes in the 28-day groups and 14.2% of eyes in the 10-day groups, as detected by optical coherence tomography at 30 days.</p><p><strong>Conclusion: </strong>Equivalent postoperative inflammation control can be achieved using different corticosteroid eye drop formulations at varying treatment durations following cataract surgery. Brazilian Registry of Clinical Trials (ReBEC): RBR-2frpntv.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250097"},"PeriodicalIF":1.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601918","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":"Regional inequalities in the supply of ophthalmologists and the volume of cataract surgeries between the public and private health sectors in Brazil.","authors":"Mário Scheffer, Jessica Pronestino de Lima Moreira, Lígia Bahia, Sophia Aguiar Monteiro Borges, Alex Jones Flores Cassenote, Gustavo Rosa Gameiro, Rubens Belfort","doi":"10.5935/0004-2749.2025-0218","DOIUrl":"10.5935/0004-2749.2025-0218","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate disparities in the distribution of ophthalmologists and the volume of ca-ta-ract surgeries across Brazil, considering public and private health sectors and the country's federative units.</p><p><strong>Methods: </strong>Data on ophthalmologists were obtained from the National Medical Residency Commission and the Associação Médica Brasileira. Information on cataract surgeries performed through the Unified Health System was collected from the DATASUS database, while data on procedures covered by private health plans were retrieved from the National Supplementary Health Agency. Population estimates from the 2024 Demographic Census of the Brazilian Institute of Geography and Statistics were used to calculate physician density and surgery rates per 100,000 inhabitants. Associations between the number of ophthalmologists and cataract surgery volume were analyzed using Spearman's correlation coefficient.</p><p><strong>Results: </strong>Brazil has 16,784 ophthalmologists, representing 8.96 specialists per 100,000 inhabitants. Marked disparities were observed: large cities (>500,000 inhabitants) had 18.75 ophthalmologists per 100,000 residents, whereas municipalities with <50,000 inhabitants had fewer than one. Across federative units, physician density ranged from 19.18 per 100,000 in the Federal District to 4.22 in Maranhão. In 2024, cataract surgery rates varied widely, from 1,012.61 per 100,000 inhabitants in the Southeast to 435.00 in the North. Nationally, Unified Health System performed 736.30 surgeries per 100,000 inhabitants, compared with 1,276.79 in the private sector. On average, each ophthalmologist performed 96.92 cataract surgeries annually.</p><p><strong>Conclusion: </strong>Significant inequalities persist in the geographic distribution of ophthalmologists and in cataract surgery provision, with higher surgical volumes concentrated in the private sector. Targeted policies are required to address regional disparities and improve the equity and efficiency of cataract care delivery in Brazil.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250218"},"PeriodicalIF":1.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602011","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":"Outcomes of strabismus surgery in patients with Down syndrome.","authors":"André Leite, Rosana Pires da Cunha","doi":"10.5935/0004-2749.2025-0071","DOIUrl":"10.5935/0004-2749.2025-0071","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the outcomes of strabismus surgical correction in patients with Down syndrome.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients with Down syndrome who underwent strabismus surgery between January 1997 and May 2024 at an Ophthalmology Outpatient Clinic in São Paulo, Brazil. The data collected included age, sex, medical and ocular history, surgical details, and follow-up outcomes. The patients were categorized by strabismus type into esotropia, fourth nerve palsy, and mixed groups. Surgical success was defined as final alignment within 10∆ of orthotropia and, where applicable, whether there was resolution of abnormal head posture of ocular origin. Patients with postoperative follow-up <6 months were excluded.</p><p><strong>Results: </strong>A total of 37 patients (21 females) were included. Of these, 22 (59.5%) were in the esotropia group, 10 (27.0%) in the fourth nerve palsy group, and 5 (13.5%) in the mixed group. The surgical success rate in the esotropia group was 86.4%, with a mean preoperative deviation of 35.2 (± 6.5)∆, and mean surgical correction of 30.1 (± 10.4)∆. The success rate in the fourth nerve palsy group was 40.0%, with a mean preoperative deviation of 10.4 (± 4.3)∆. Overall, success was achieved with a single surgical procedure in 73.0% of the sample. No significant associations were found between surgical success and the clinical and demographic variables, including sex, age at surgery, oblique muscle overaction, pattern strabismus, visual acuity, amblyopia, preoperative deviation, or postoperative follow-up duration (p>0.05).</p><p><strong>Conclusions: </strong>When standard surgical tables are applied, strabismus surgery in patients with Down syndrome appears to be safe and effective. We found high success rates, particularly among patients with esotropia. We observed no tendencies toward overor under-correction. These findings support the use of conventional surgical protocols with this patient population.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250071"},"PeriodicalIF":1.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601958","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":"Modified suture-less flanged intrascleral intraocular lens fixation approach accessible for novice retinal surgeons.","authors":"Bo-Een Hwang, Woong-Joo Whang, Young-Hoon Park","doi":"10.5935/0004-2749.2025-0052","DOIUrl":"10.5935/0004-2749.2025-0052","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether two simplified mo-difications of flanged intrascleral fixation techniques (Yamane and Canabrava) provide comparable refractive outcomes and complication rates while reducing surgical complexity in tro-car-assisted vitrectomy.</p><p><strong>Methods: </strong>This retrospective observational study included 88 patients who underwent flanged fixation surgery with vitrectomy. In the modified Yamane technique, a single-path sclerotomy with bilateral symmetry was performed instead of an angled sclerotomy. In the modified Canabrava technique, the intraocular lens was inserted first, followed by the creation of a circular polypropylene loop with 2-mm flange spacing. Postoperative refractive parameters, including intraocular lens astigmatism, and complications such as intraocular lens iris capture were analyzed.</p><p><strong>Results: </strong>Of the 88 patients, 70 underwent the modified Yamane technique, and 18 underwent the modified Canabrava technique. No significant differences were observed between the two techniques regarding refractive outcomes or postoperative complications, except for surgical duration, which was significantly shorter (p<0.001) in one technique. Mean intraocular lens astigmatism was -0.675 D for Yamane and -0.666 D for Canabrava.</p><p><strong>Conclusion: </strong>Optimizing needle engagement for symmetry in the Yamane technique and narrowing flange spacing while ensuring a circular polypropylene configuration in the Canabrava technique may reduce surgical complexity and improve postoperative outcomes.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250052"},"PeriodicalIF":1.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601934","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":"Real-world evidence of the use of Cloudscaper optotypes versus LEA symbols for virtual or digital visual acuity measurement in children aged 3 to 16 years.","authors":"Cristiana Soares Ronconi, Julia Dutra Rossetto, Luisa Moreira Hopker, Ana Carolina Sarmento Barros Carneiro, Bárbara Stofel Ventorin, Paulo Schor","doi":"10.5935/0004-2749.2025-0049","DOIUrl":"10.5935/0004-2749.2025-0049","url":null,"abstract":"<p><strong>Purpose: </strong>This cross-sectional study compared best-corrected visual acuity obtained using Cloudscaper symbols, a novel optotype developed according to ETDRS specifications for children's virtual screening, with that obtained using LEA symbols.</p><p><strong>Methods: </strong>A total of 560 children aged 3-16 yr underwent visual acuity test with both Cloudscaper symbols and LS. The test application was standardized using the EyeSpy algorithm. Additionally, 147 participants were tested with the standard Snellen E paper chart. Paired t tests were performed to assess the clinical significance of logMAR visual acuity differences.</p><p><strong>Results: </strong>The mean logMAR visual acuity with LEA symbols was 0.12 (standard deviation [SD]=0.18; range, -0.10 to 0.80), while with Cloudscaper symbols it was 0.18 (SD=0.19; range, -0.10 to 0.80). The mean difference between Cloudscaper symbols and LEA symbols was 0.099 logMAR (approximately 0.5 optotypes; SD=0.08; range, 0.0-0.14; p<0.0001). Cloudscaper symbols slightly underestimated visual acuity compared to LEA symbols. Visual acuity measured by both methods was highly correlated (Spearman's r=0.74, p<0.0001). The mean visual acuity difference between Cloudscaper symbols and the Snellen E chart was 0.0045 (p=0.805; 95% confidence interval [95% CI]), whereas the difference between LEA symbols and Snellen E was 0.0883 (p<0.001; 95% CI).</p><p><strong>Conclusions: </strong>Cloudscaper symbols provide a reliable tool for visual screening in children. Although they slightly underestimate visual acuity compared to LEA symbols - a finding also reported when comparing ETDRS letters with LEA symbols - Cloudscaper symbols show strong agreement with Snellen E chart measurements. This suggests that Cloudscaper symbols allow precise visual acuity assessment comparable to the gold standard.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 1","pages":"e20250049"},"PeriodicalIF":1.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602008","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":"Ongoing reepithelialization after keratopigmentation.","authors":"Giovanni Garottii, Nicole Bulgarão Maricondi de Almeida, Newton Kara-Junior","doi":"10.5935/0004-2749.2025-0193","DOIUrl":"10.5935/0004-2749.2025-0193","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"88 6","pages":"e20250193"},"PeriodicalIF":1.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556148","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}

{"title":"Should each university department have only one postgraduate program?","authors":"Newton Kara-Junior, Marcony R Santhiago, Luiz Ubirajara Sennes, Mário Luiz Ribeiro-Monteiro","doi":"10.5935/0004-2749.2025-0019","DOIUrl":"10.5935/0004-2749.2025-0019","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"88 6","pages":"e20250019"},"PeriodicalIF":1.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556179","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}

{"title":"Association between axial length and perfluoropropane gas duration after pars plana vitrectomy with fixed-volume pure gas injection.","authors":"Rodrigo Pessoa Cavalcanti Lira, Ana Paula Teles Silveira, Gabriel Rocha Lira, Maria Isabel Lynch Gaete","doi":"10.5935/0004-2749.2025-0238","DOIUrl":"10.5935/0004-2749.2025-0238","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"88 6","pages":"e20250238"},"PeriodicalIF":1.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556182","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}

{"title":"Diagnostic accuracy of a deep learning model for pterygium detection in Barcelos, Brazilian Amazon.","authors":"Diego Casagrande, Mauro Gobira, Arthur G Fernandes, Marcos Jacob Cohen, Paula Marques Marinho, Kevin Waquim Pessoa Carvalho, Ariane Luttecke-Anders, Beatriz Araujo Stauber, Nívea Nunes Ferraz, Jacob Moysés Cohen, Adriana Berezovsky, Solange Rios Salomão, Rubens Belfort","doi":"10.5935/0004-2749.2025-0053","DOIUrl":"10.5935/0004-2749.2025-0053","url":null,"abstract":"<p><strong>Purpose: </strong>This pilot study evaluated the diagnostic accuracy of a deep learning model for detecting pterygium in anterior segment photographs taken using smartphones in the Brazilian Amazon. The model's performance was benchmarked against assessments made by experienced ophthalmologists, considered the clinical gold standard.</p><p><strong>Methods: </strong>In this cross-sectional study, 38 participants (76 eyes) from Barcelos, Brazil, were enrolled. Trained nonmedical health workers captured high-resolution anterior segment images using smartphones. These images were analyzed using a deep learning model based on the MobileNet-V2 convolutional neural network. Diagnostic metrics-including sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve-were calculated and compared with the ophthalmologists' evaluations.</p><p><strong>Results: </strong>The deep learning model achieved a sensitivity of 91.43%, specificity of 90.24%, positive predictive value of 88.46%, negative predictive value of 92.79%, and an area under the curve of 0.91. Logistic regression revealed no statistically significant association between pterygium and demographic variables such as age or gender.</p><p><strong>Conclusions: </strong>The deep learning model demonstrated high diagnostic performance in identifying pterygium in a remote Amazonian population. These preliminary findings support the potential use of artificial intelligence-based tools to facilitate early detection and screening in underserved regions, thereby enhancing access to ophthalmic care.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"88 6","pages":"e20250053"},"PeriodicalIF":1.2,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12997579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421053","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}

{"title":"Perioperative subconjunctival steroid injection in dropless cataract surgery: a systematic review and meta-analysis.","authors":"Laura Goldfarb Cyrino, Dillan Amaral, Alexandre Yamada Fujimura Júnior, Bela J Parekh, Marcela Marino de Azeredo Bastos, Giovana de Souza Gaio, Maria Antônia Torres Arteche, Amanda Souza do Nascimento, Vitor Expedito Alves Ribeiro, Jaime Guedes, Marianna Almeida Hollaender","doi":"10.5935/0004-2749.2024-0394","DOIUrl":"10.5935/0004-2749.2024-0394","url":null,"abstract":"<p><p>The advantages and disadvantages of using perioperative subconjunctival steroid injections in dropless cataract surgery continue to be debated. A systematic review of PubMed, EMBASE, and the Cochrane Central database identified five studies-two randomized controlled trials and three non-randomized studies-encompassing 70,751 eyes. Among these, 12,319 eyes (17.4%) received subconjunctival steroid injections, while 58,432 eyes (82.6%) were managed with topical steroids. The Cochrane Collaboration's RoB 2 tool was applied for bias assessments in randomized controlled trials, and heterogeneity was assessed using the I² statistics. No statistically significant differences were found between the two groups regarding macular edema (p=0.249), visual acuity (p=0.73), or laser flare count (p=0.45). Both subconjunctival injections and topical steroids demonstrated comparable efficacy and safety in controlling postoperative inflammation after cataract surgery. Additional research is warranted to validate these conclusions.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"88 6","pages":"e20240394"},"PeriodicalIF":1.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12997625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298203","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}