Arquivos brasileiros de oftalmologia最新文献

{"title":"Amblyopia in 2026: definitions, diagnosis, treatment, and emerging therapies.","authors":"Roberta Melissa Benetti Zagui","doi":"10.5935/0004-2749.2025-0327","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0327","url":null,"abstract":"<p><p>Amblyopia is a leading, yet largely preventable, cause of visual impairment and is now recognized as a binocular neurodevelopmental disorder characterized by interocular suppression and widespread functional deficits. This narrative review synthesizes contemporary evidence on the epidemiology, pathophysiology, diagnosis, and management of amblyopia, with a focus on clinically applicable guidance. Conventional treatments-including optimal refractive correction, occlusion therapy, and pharmacologic penalization with atropine-remain highly effective when appropriately prescribed, titrated, and monitored for adherence, even among selected older children. Emerging binocular approaches, such as dichoptic digital therapies, perceptual learning, and short-term monocular deprivation, aim to restore binocular balance. Although these strategies may yield improvements in stereopsis and contrast sensitivity, their effects are generally modest and task-specific. Overall, current evidence supports the integration of traditional and novel approaches into etiology-specific, measurement-driven care pathways. Future research should prioritize functional outcomes, long-term durability, and real-world effectiveness.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20250327"},"PeriodicalIF":1.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547676","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":"Conflicting interests and the future of medical education in Brazil.","authors":"Newton Kara-Junior","doi":"10.5935/0004-2749.2026-1024","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-1024","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 4","pages":"e20261024"},"PeriodicalIF":1.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547775","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":"Who will protect society during the crisis in medical education?","authors":"Newton Kara-Junior","doi":"10.5935/0004-2749.2026-1023","DOIUrl":"https://doi.org/10.5935/0004-2749.2026-1023","url":null,"abstract":"","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20261023"},"PeriodicalIF":1.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444139","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":"Diluted brimonidine for improving early postoperative symptoms and subconjunctival hemorrhage after PRK and LASIK.","authors":"Natália Fernandes Gonçalves Napolitano, Ana Vega Carreiro de Freitas, Luís Gustavo de Imparato Rodrigues Ribeiro, Daniella Villas Boas Fairbanks, Fernando Antonio Galhardo Tarcha, Vagner Loduca Lima, Bernardo Kaplan Moscovici, Edmundo José Velasco Martinelli","doi":"10.5935/0004-2749.2025-0330","DOIUrl":"10.5935/0004-2749.2025-0330","url":null,"abstract":"<p><strong>Purpose: </strong>To assess whether low-concentration brimonidine (0.025%) improves early postoperative signs and symptoms following femtosecond laser-assisted in situ keratomileusis and photorefractive keratectomy without affecting pupil diameter or flap safety.</p><p><strong>Methods: </strong>This prospective, randomized, double-masked, contralateral-eye, single-center study was conducted between January and September 2024. In each patient, one eye received 0.025% brimonidine 15-30 min before surgery (mean: 21.3 ± 2.4 min), whereas the fellow eye received 0.15% sodium hyaluronate (control). Primary outcomes on postoperative Day 1 included subconjunctival hemorrhage laser-assisted in situ keratomileusis and patient-reported symptoms (0-10 scale; composite score). Pupil diameter was measured pre-ablation. Statistical analyses included McNemar and paired t tests, with a significant threshold of α=0.05.</p><p><strong>Results: </strong>A total of 124 patients were included (54 laser-assisted in situ keratomileusis and 70 photorefractive keratectomy). Pupil diameter did not differ significantly between brimonidine-treated and control eyes (laser-assisted in situ keratomileusis: 2.63 ± 0.47 vs. 2.69 ± 0.42 mm, p=0.273; photorefractive keratectomy: 2.56 ± 0.44 vs. 2.61 ± 0.39 mm, p=0.116). In laser-assisted in situ keratomileusis, subconjunctival hemorrhage occurred less frequently in brimonidine-treated eyes both intraoperatively (9.3% vs. 46.3%, p<0.001) and on postoperative Day 1 (9.3% vs. 50.0%, p<0.001). Composite symptom scores were significantly lower in brimonidine-treated eyes in both laser-assisted in situ keratomileusis and photorefractive keratectomy groups (p=0.001 for both).</p><p><strong>Conclusions: </strong>Preoperative administration of low-concentration brimonidine (0.025%) significantly reduced subconjunctival hemorrhage in laser-assisted in situ keratomileusis without comprising flap integrity. It also improved early postoperative symptoms in laser-assisted in situ keratomileusis and photorefractive keratectomy, without affecting pupil diameter. These findings support the use of dilute brimonidine as a safe and effective adjunct to enhance the immediate postoperative experience in refractive surgery.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20250330"},"PeriodicalIF":1.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444130","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 impact of trabeculotomy degree on surgical success in gonioscopy-assisted transluminal trabeculotomy surgery.","authors":"Berire Şeyma Durmuş Ece, Erdem Yüksel","doi":"10.5935/0004-2749.2025-0243","DOIUrl":"10.5935/0004-2749.2025-0243","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of varying degrees of trabeculotomy during gonioscopy-assisted transluminal trabeculotomy surgery on postoperative intraocular pressure reduction and surgical success.</p><p><strong>Methods: </strong>Patients who underwent gonioscopy-assisted transluminal trabeculotomy (at least 90°) for open-angle glaucoma and had a follow-up period of at least 12 months were included. Patients were grouped according to trabeculotomy degree (Group 1: 90°<θ≤180°; Group 2: 180°<θ<360°; Group 3: θ=360°). Ophthalmic examination findings, intraocular pressure measurements, number of antiglaucoma medications, and complications were recorded. Surgical success was defined as intraocular pressure <15 mmHg with at least a 20% reduction; surgical failure was defined as failure to meet this criterion or the need for additional surgery.</p><p><strong>Results: </strong>A total of 100 patients were included: 20 in Group 1, 24 in Group 2, and 56 in Group 3. Intraocular pressure levels differed significantly only in the first postoperative month (p=0.013). At 12 months, intraocular pressure levels, percentage reduction in intraocular pressure, and mean number of antiglaucoma medications did not differ significantly (p>0.05). No correlation was found between trabeculotomy degree and percentage intraocular pressure reduction (p=0.173). At 12 months, surgical success rates were similar (60.0%, 58.3%, and 64.3% for Groups 1, 2, and 3, respectively). Complication rates were also comparable among the groups.</p><p><strong>Conclusion: </strong>The degree of trabeculotomy did not affect surgical success over a 12-month follow-up period. Although early intraocular pressure reduction may differ with 360° trabeculotomy, a complete 360° incision may not be necessary to achieve optimal pressure reduction.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20250243"},"PeriodicalIF":1.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444144","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":"Comparison of the Yamane technique with and without simultaneous pars plana vitrectomy: Safety and efficacy analysis.","authors":"Mahmut Oğuz Ulusoy, Muhammed Yelkovan, Ayna Sarıyeva-İsmayilov, Cansu Erseven","doi":"10.5935/0004-2749.2025-0263","DOIUrl":"10.5935/0004-2749.2025-0263","url":null,"abstract":"<p><strong>Purpose: </strong>To compare patients who underwent scleral fixation using the Yamane technique with and without simultaneous pars plana vitrectomy.</p><p><strong>Methods: </strong>A total of 37 patients were included in the study. Eighteen underwent simultaneous pars plana vitrectomy. The Yamane technique alone was performed only in patients with aphakia who had previously undergone pars plana vitrectomy for various reasons. Final lens position, best corrected visual acuity spherical equivalent, complication rates, and optical coherence tomography findings were recorded.</p><p><strong>Results: </strong>The duration of aphakia before intraocular lens implantation ranged from 1 month to 21 yr. Postoperative best corrected visual acuity improved in both groups, with no statistically significant difference (with pars plana vitrectomy: 0.42 ± 0.34; without pars plana vitrectomy: 0.32 ± 0.26; p=0.33). The spherical equivalent was also not significantly different between groups (with pars plana vitrectomy: 0.29 ± 1.08; without pars plana vitrectomy: 0.65 ± 2.23; p=0.53). There were no significant differences between the groups in complication rates, postoperative intraocular lens position or optical coherence tomography findings.</p><p><strong>Conclusion: </strong>There was no difference in terms of safety or efficacy between the two approaches. Surgical decisions may be based on the surgeon's experience and the patient's systemic and ocular condition.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20250263"},"PeriodicalIF":1.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444212","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 diode laser cyclophotocoagulation efficiency in refractory glaucoma and determination of structural changes using ultrasound biomicroscopy.","authors":"Hakan Öztürk, Bediz Özen","doi":"10.5935/0004-2749.2025-0043","DOIUrl":"https://doi.org/10.5935/0004-2749.2025-0043","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of single-session transscleral diode laser cyclophotocoagulation on intraocular pressure in refractory glaucoma and to determine structural changes using ultrasound biomicroscopy.</p><p><strong>Methods: </strong>Forty-three eyes were evaluated. Intraocular pressures at baseline and at the first, third, and sixth months after transscleral diode laser cyclophotocoagulation were compared. Ciliary body thickness, ciliary muscle thickness, ciliary process thickness, iris root thickness, and scleral thickness were assessed at baseline and at the third and sixth months post-treatment.</p><p><strong>Results: </strong>Reductions in intraocular pressure were significant between baseline and the first month (p=0.018), third month (p<0.001), and sixth month (p<0.001) as well as between the first and third months (p=0.034) and the first and sixth months (p=0.036). Compared with baseline, intraocular pressure reduction rates at the first, third, and sixth months were 34.6%, 56.5%, and 55.3%, respectively, while success rates were 30.2%, 62.8%, and 55.8%, respectively. Decreases in ciliary body thickness, ciliary muscle thickness, and ciliary process thickness were significant between baseline and the third month (p<0.05) and between baseline and the sixth month (p<0.05), whereas changes between the third and sixth months were not significant (p>0.05). Iris root and scleral thicknesses did not change after treatment (p>0.05). At the third and sixth months, significant positive correlations were observed between changes in intraocular pressure and changes in ciliary body thickness and ciliary process thickness (p<0.05).</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is one of the few studies comprehensively investigating structural changes after transscleral diode laser cyclophotocoagulation using ultrasound biomicroscopy. Moreover, the relationships between intraocular pressure changes and variations in the ciliary body, ciliary muscle, ciliary process, iris root, and scleral thicknesses were examined in detail. Single-session treatment did not affect iris root or scleral thickness but significantly reduced ciliary body, ciliary muscle, and ciliary process thicknesses. Greater reductions in ciliary body and ciliary process thickness may contribute to more pronounced intraocular pressure reduction.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20250043"},"PeriodicalIF":1.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444191","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":"Barriers to diabetic retinopathy screening in public healthcare in northeastern Brazil.","authors":"Mateus Lins Dos Santos, Lucas Brito de Souza Florêncio, Lucas Rocha Barreto de Almeida, Lis Jacques Zwecker, Melina Alves, Ana Bastos de Carvalho, Daniela Meirelles do Nascimento, Luciana Bahia, Beatriz D'Agord Schaan, Gustavo Barreto Melo, Fernando Korn Malerbi","doi":"10.5935/0004-2749.2025-0248","DOIUrl":"10.5935/0004-2749.2025-0248","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify barriers to diabetic retinopathy screening among a socioeconomically vulnerable urban population in northeast Brazil.</p><p><strong>Methods: </strong>A cross-sectional study was conducted during a diabetic retinopathy screening campaign at primary healthcare units. Ninety-five patients with diabetes underwent retinal examinations and completed a structured interview. Clinical, demographic, and socioeconomic data were collected.</p><p><strong>Results: </strong>The study population consisted predominantly of older adults (mean age: 60.7 ± 10.5 years), with a high prevalence of type 2 diabetes (99.0%) and low educational attainment. Most participants were economically inactive (81.1%) and reported low income (83.2%). Diabetic retinopathy and maculopathy were highly prevalent, affecting 50.0% and 22.9% of participants, respectively. Longer duration of diabetes was significantly associated with greater awareness of diabetic retinopathy (p=0.035), higher HbA1c levels (p<0.001), and increased prevalence of diabetic retinopathy (p=0.013) and maculopathy (p=0.002). Notably, 33.3% of participants reported difficulties attending medical appointments for diabetes management. In addition, 78.1% experienced challenges scheduling ophthalmologic evaluations, and 76.3% reported that no ophthalmologist was available in their city through the public healthcare system. Financial constraints also limited adherence to recommended dietary practices (90.4%) and impaired glycemic control, with more than half of participants reporting difficulty maintaining target glucose levels.</p><p><strong>Conclusion: </strong>Major barriers to diabetic retinopathy screening included limited awareness of the importance of screening, financial hardship, and transportation challenges. Targeted educational initiatives and structural interventions such as expanded screening programs incorporating telemedicine and subsidized transportation-may improve screening adherence among vulnerable populations.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20250248"},"PeriodicalIF":1.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040367","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":"Intravitreal dexamethasone sodium phosphate challenge to predict implant response in refractory diabetic macular edema: a pilot study.","authors":"Rodrigo Pessoa Cavalcanti Lira, Michelle Maria Teixeira Figueiredo Paiva, Gabriel Rocha Lira, Maria Isabel Lynch Gaete","doi":"10.5935/0004-2749.2025-0392","DOIUrl":"10.5935/0004-2749.2025-0392","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the accuracy of a short-term intravitreal dexamethasone sodium phosphate challenge in predicting the anatomical response to a sustained-release dexamethasone implant (Ozurdex) in patients with refractory diabetic macular edema.</p><p><strong>Methods: </strong>This prospective, non-randomized, Phase 2 pilot study enrolled 12 pseudophakic eyes with diabetic macular edema refractory to anti-vascular endothelial growth factor (anti-VEGF) therapy. Participants underwent a challenge phase (Day 0) consisting of a single intravitreal injection of 0.08-mg dexamethasone sodium phosphate, followed by a maintenance phase (Day 7), during which all subjects received a 0.7-mg dexamethasone implant. The primary outcome was concordance between the anatomical response at Day 3 (post-dexamethasone sodium phosphate) and Day 60 (post-implant), defined as a ≥10% reduction in central macular thickness. Secondary outcomes included achieving a clinically \"dry\" macula (central macular thickness ≤300 μm) at Day 60, changes in best-corrected visual acuity, safety outcomes (intraocular pressure), and spectral-domain optical coherence tomography biomarker analysis.</p><p><strong>Results: </strong>The dexamethasone sodium phosphate challenge induced significant macular drying by Day 3 (median central macular thickness reduction, -21 μm; p=0.002). A positive response to dexamethasone sodium phosphate strongly predicted response to the dexamethasone implant, with a positive predictive value and specificity of 100%. The negative predictive value was 80%. Irreversible biomarkers, including disorganization of retinal inner layers and ellipsoid zone disruption, were more prevalent among nonresponders (60% vs. 28.6%). Safety outcomes were acceptable; 16.7% of patients developed ocular hypertension, which was successfully managed with topical therapy.</p><p><strong>Conclusion: </strong>A short-term dexamethasone sodium phosphate challenge is a safe, low-cost, and highly specific predictor of dexamethasone implant efficacy. This \"test-and-treat\" strategy may optimize resource allocation in resource-constrained settings by identifying responders before high-cost implantation.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20250392"},"PeriodicalIF":1.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040419","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":"Eyebrow and eyelid position in anophthalmic sockets reconstructed with conical or spherical implants: a quantitative analysis.","authors":"Carolina Pereira Bigheti, Roberta Lilian Fernandes de Sousa, Simone Milani Brandão, Carlos Roberto Padovani, Silvana Artioli Schellini","doi":"10.5935/0004-2749.2025-0332","DOIUrl":"10.5935/0004-2749.2025-0332","url":null,"abstract":"<p><strong>Purpose: </strong>To quantitatively compare eyebrow and eyelid positions in anophthalmic sockets reconstructed with conical or spherical orbital implants combined with customized external ocular prostheses.</p><p><strong>Methods: </strong>This cross-sectional observational study included 38 patients with unilateral anophthalmic sockets, of whom 21 received conical implants, and 17 received spherical implants. Eyelid and eyebrow parameters-including margin reflex distance 1 and 2, vertical and horizontal palpebral fissure dimensions, eyebrow-to-upper-eyelid margin distance in primary gaze and infraduction, medial and lateral eyelid angles in primary gaze, and superior eyelid sulcus depth -were quantitatively assessed using standardized digital photographs analyzed with Image J software. The contralateral healthy eye served as the control. Statistical analyses were performed to compare measurements between groups.</p><p><strong>Results: </strong>In the primary gaze position, conical and spherical implants showed comparable margin-reflex distance1, margin-reflex distance2, vertical palpebral fissure height, eyelid margin position, and medial and lateral eyelid angles. During infraduction, the upper eyelid margin was significantly lower in sockets reconstructed with conical implants. Compared with contralateral normal eyes, anophthalmic sockets exhibited a reduced horizontal palpebral fissure and a deeper superior eyelid sulcus, irrespective of implant shape.</p><p><strong>Conclusion: </strong>Anophthalmic sockets reconstructed with conical or spherical implants demonstrate similar eyebrow and eyelid positioning in primary gaze. However, conical implants are associated with a lower eyelid margin during infraduction. Independent of implant format, anophthalmic sockets show a narrower horizontal palpebral fissure and increased superior sulcus depth compared with normal eyes.</p>","PeriodicalId":8397,"journal":{"name":"Arquivos brasileiros de oftalmologia","volume":"89 3","pages":"e20250332"},"PeriodicalIF":1.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040409","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}