Prevalence of refractive error in Europe: the European Eye Epidemiology (E3) Consortium

To estimate the prevalence of refractive error in adults across Europe. Refractive data (mean spherical equivalent) collected between 1990 and 2013 from fifteen population-based cohort and cross-sectional studies of the European Eye Epidemiology (E³) Consortium were combined in a random effects meta-analysis stratified by 5-year age intervals and gender. Participants were excluded if they were identified as having had cataract surgery, retinal detachment, refractive surgery or other factors that might influence refraction. Estimates of refractive error prevalence were obtained including the following classifications: myopia ≤−0.75 diopters (D), high myopia ≤−6D, hyperopia ≥1D and astigmatism ≥1D. Meta-analysis of refractive error was performed for 61,946 individuals from fifteen studies with median age ranging from 44 to 81 and minimal ethnic variation (98 % European ancestry). The age-standardised prevalences (using the 2010 European Standard Population, limited to those ≥25 and <90 years old) were: myopia 30.6 % [95 % confidence interval (CI) 30.4–30.9], high myopia 2.7 % (95 % CI 2.69–2.73), hyperopia 25.2 % (95 % CI 25.0–25.4) and astigmatism 23.9 % (95 % CI 23.7–24.1). Age-specific estimates revealed a high prevalence of myopia in younger participants [47.2 % (CI 41.8–52.5) in 25–29 years-olds]. Refractive error affects just over a half of European adults. The greatest burden of refractive error is due to myopia, with high prevalence rates in young adults. Using the 2010 European population estimates, we estimate there are 227.2 million people with myopia across Europe.

Capsulotomy worsens diabetic retinopathy in the Ins2Akitamice

Purpose: Cataract surgery increases the risk of developing diabetic retinopathy (DR) and accelerates the progression of pre-existing DR. Recent evidence suggests that cataract surgery elicits retinal pro-inflammatory gene expression, although the underlying pathogenic mechanisms remain ill-defined. In this study, we investigated the effect of capsulotomy on visual function, retinal immune cell activation and photoreceptor stress in the Ins2Akita mice, a mouse model of Type-1 diabetes. Methods: Male heterozygous Ins2Akita mice (2 months of hyperglycemia) and C57BL/6J age-matched siblings were used in this study. An incision (1mm) was made in the peripheral cornea and Capsulotomy was performed in the anterior lens capsule of the right eye. Control mice received corneal incision without capsulotomy in the right eye. The unoperated left eyes were used as internal controls. Forty days following surgery, retinal function was assessed by electroretinography (ERG). Neuronal retinal damage and microglial activation were assessed by imunohistochemistry. Results: The Ins2Akita mice receiving capsulotomy presented lower scotopic a-wave, b-wave and oscillatory potentials amplitudes compared to other experimental groups. Fundus images, SD-OCT and H&E staining did not show significant changes between different groups. Immunostaining of Iba-1 and CD68 revealed exacerbated microglial activation and giant cell immune cell infiltration in eyes receiving capsulotomy in Ins2Akita mice. This was accompanied by a disruption of cone photoreceptor outer segments and abnormal rhodopsin expression at the outer nuclear layer. Conclusions: Our results suggest that capsulotomy induces retinal microglial activation and worsens retinal neuropathy in diabetic eyes.

Clinical evaluation of three incision size-dependent phacoemulsification systems.

PURPOSE:

To compare the outcomes of cataract surgery performed with 3 incision size-dependent phacoemulsification groups (1.8, 2.2, and 3.0 mm).

DESIGN:

Prospective randomized comparative study.

METHODS:

One hundred twenty eyes of 120 patients with age-related cataract (grades 2 to 4) were categorized according to the Lens Opacities Classification System III. Eligible subjects were randomly assigned to 3 surgical groups using coaxial phacoemulsification through 3 clear corneal incision sizes (1.8, 2.2, and 3.0 mm). Different intraoperative and postoperative outcome measures were obtained, with corneal incision size and surgically induced astigmatism as the main clinical outcomes.

RESULTS:

There were no statistically significant differences in most of the intraoperative and postoperative outcome measures among the 3 groups. However, the mean cord length of the clear corneal incision was increased in each group after surgery. The mean maximal clear corneal incision thickness in the 1.8-mm group was significantly greater than for the other groups at 1 month. The mean surgically induced astigmatism in the 1.8- and 2.2-mm groups was significantly less than that in the 3.0-mm group after 1 month, without significant difference between the 1.8- and 2.2-mm groups.

CONCLUSIONS:

With appropriate equipment, smaller incisions may result in less astigmatism, but the particular system used will influence incision stress and wound integrity, and may thus limit the reduction in incision size and astigmatism that is achievable.

A study of initial therapy for glaucoma in southern India: India Glaucoma Outcomes and Treatment (INGOT) Study.

PURPOSE: To compare initial glaucoma therapy with medications and trabeculectomy in southern India. METHODS: Patients aged ≥ 30 years newly diagnosed with glaucoma were randomized to trabeculectomy with 5-fluorouracil or medical therapy. Subjects with best-corrected vision <6/18 due to cataract underwent phacoemulsification (phaco/intraocular lens, IOL). Intraocular pressure (IOP), vision and visual function were assessed at 12 months. RESULTS: Patients assigned to medications and surgery received the expected therapy in 86% (172/199) and 64% (126/199) of cases, respectively. Forty patients (20%) assigned to surgery refused any treatment and 33 (17%) received medications. Among 199 patients randomized to medications, 52 (26.1%) underwent phaco/IOL, as did 89/199 (43.7%) of patients randomized to trabeculectomy. Baseline parameters of the two groups did not differ, nor did 1-year follow-up rates (medication 65%, trabeculectomy 58%, P = 0.15). Final IOP was lower with randomization to trabeculectomy (16.3 ± 5.1 mmHg) than medication (18.8 ± 6.7 mmHg, P < 0.0001). In regression models, randomization to trabeculectomy (P < 0.0001) was associated with lower IOP, and simultaneous trabeculectomy and cataract surgery was associated with higher IOP (P = 0.008) than trabeculectomy alone. Subjects receiving Phaco/IOL had significantly better final acuity (P < 0.0001) and visual function (P = 0.035), despite concurrent glaucoma treatment. Final visual acuity was worse in those receiving trabeculectomy in addition to cataract surgery, but this was of borderline significance (P = 0.06). CONCLUSIONS: Trabeculectomy lowered IOP significantly more than medical treatment, but with slightly greater loss of visual acuity. Combined phaco/IOL and trabeculectomy improved visual acuity with substantial IOP lowering.

Correlación entre el resultado refractivo post-catarata con la predicción biométrica pre-operatoria

La cirugía de cataratas por Facoemulsificación es tal vez uno de los procedimientos más realizados en la práctica de oftalmología general, sin embargo el resultado refractivo de esta cirugía no siempre llena las expectativas del oftalmólogo y del paciente, es por esto que es de gran importancia observar los resultados post quirúrgicos obtenidos y las distintas variables que pudieron influir en dicho resultado. Objetivo: determinar la capacidad predictiva de la formula biométrica empleada en el preoperatorio con el resultado refractivo post operatorio expresada en porcentajes. Materiales y métodos: se realizó un estudio de correlación basándose en la refracción prevista por la biometría y la refracción encontrada en el post operatorio. Se analizó los diferentes grupos de pacientes miopes, hipermétropes y emétropes en de los rangos de 0,50D, 0,75 D y 1,00D. Resultados: el porcentaje de pacientes que presento 0,50D de diferencia con el previsto fue de 57,7% para el total, 100% para hipermétropes, 53,1% para emétropes, 56,3% para miopes. En el rango de 0,75D 71,2% para el total, 62,5% para emétropes y 81,3% para miopes. En el rango de 1,00D 82,7% para el total, 75% para emétropes y 93,8% para miopes. Conclusiones: la formula SRK/T presento un buen desempeño en todos los grupos encontrándose resultados concordantes con los descritos en la literatura.

El efecto de los anti inflamatorios no esteroideos sobre el espesor retiniano, inflamación y agudeza visual posterior a la extracción de catarata: un estudio prospectivo comparando nepafenac y dexametasona

Objetivos: Comparar el volumen macular total (VMT) y espesor retiniano, la agudeza visual mejor corregida (AVCC) y la incidencia de edema macular post cirugía de catarata, en ojos tratados con nepafenac 0.1%, dexametasona 0.1% o la combinación de los dos. Métodos: En una estudio prospectivo, aleatorizado, controlado y ciego para el observador, se aleatorizaron 147 ojos con catarata para recibir dexametasona 0.1% cada 6 horas por 12 días de forma postoperatoria, nepafenac 0.1% cada 8 horas antes de cirugía y por 15 días postoperatorios o la combinación de los dos. Los desenlaces medidos fueron presión intraocular a la primera y sexta semana, AVCC, VMT (medido por OCT), espesor foveal y perifoveal, y la presencia o ausencia de edema macular (espesor foveal > 240 micras, medido por OCT) a las 6 semanas. Resultados: En la primera semana, la presión intraocular fue significativamente mayor en el Grupo de dexametasona (p<0.05), y luego fue similar entre grupos a la sexta semana. No se presentaron diferencias significativas en agudeza visual. El espesor perifoveal fue significativamente menor en el grupo de nepafenac (p<0.05). La incidencia de edema macular medido por OCT fue de 7.5% (11 ojos); de estos 5 pertenecían al grupo dexametasona, tres al Grupo de Nepafenac y 3 ojos al Grupo de la combinación (p>0.05) Conclusión:. Los resultados demuestran que el nepafenac es por lo menos igual de efectivo para evitar la inflamación postoperatoria al compararlo con dexametasona, y adicionalmente podría ser útil para evitar el edema macular post cirugía de catarata.

Factores asociados a recuperación visual deficiente después de cirugía exitosa para desprendimiento de retina regmatógeno

Introducción: Varias características pueden afectar el pronóstico visual después de resolver quirúrgicamente el desprendimiento de retina. Existen características no observables por el ojo humano por si solo pero si por tomografía óptica coherente que se relacionan con la recuperación visual. Objetivo: Describir las características clínicas y topográfica en los periodos pre y postquirúrgico de ojos que ha sufrido DR regmatógeno con compromiso macular y su relación con la calidad de recuperación visual después de una cirugía considerada exitosa desde el punto de vista anatómico. Materiales y métodos: Estudio descriptivo en el que se comparan algunas características en tres periodos perioeperatorios, uno antes y dos después de cirugía (3 y 6 meses) de 24 ojos con DRregmatógeno y compromiso macular intervenidos mediante retinopexia combinada con vitrectomía pars plana. Resultados: La recuperación visual mejor o igual que logMAR 0,397 (20/50) se dió en 41,7% de ojos y 16,7%. alcanzaron agudeza visual logMAR 0,301 (20/40). Cinco ojos no alcanzaron una ganancia de líneas de visión mayor a cinco. El líquido submacular ausente se observó en la mayoría de ojos que recuperaron más de cinco líneas al igual que aquellos con elipsoide conservado. La regularidad del neuroepitelio y el edema en el periodo posquirúrgico no mostraron comportamientos claros respecto a recuperación visual al igual que la altura del desprendimiento y el número de cuadrantes afectados. Una mejor recuperación visual fue más frecuente en aquellos con menos de cinco semanas de desprendimiento de retina. Conclusiones: El retraso menor a cinco semanas en la resolución del desprendimiento de retina, la conservación del elipsoide y la ausencia de líquido submacular en el periodo postquirúrgico se observó más frecuentemente en ojos con mejor recuperación visual.

Cambios maculares y de capa de fibras nerviosas ganglionares posterior a la vitrectomía pars plana y sus factores pronósticos en la fundación oftalmológica nacional

OBJETIVOS: Determinar los factores pronóstico, cambios maculares morfológicos y de capa de fibras nerviosas ganglionares posterior a vitrectomía pars plana, en la Fundación Oftalmológica Nacional. MATERIALES Y MÉTODOS: Estudio longitudinal de antes y después (3y6 meses) de la vitrectomía pars plana (VPP) en pacientes con membrana epirretiniana, agujero macular, síndrome de tracción vítreo macular y opacidades vítreas no-inflamatorias. Se realizó seguimiento clínico y con tomografía de coherencia óptica. RESULTADOS: Grupo de 60 pacientes (mujeres 65.0%), edad promedio 65.45+9.49años y tiempo de enfermedad promedio 23+29.79meses. Las indicaciones de VPP (n=60ojos) fueron agujero macular (38.3%) y membrana epirretiniana (36.7%). Se encontró diferencia significativa entre grosor del complejo capa de células ganglionares (CCG)+capa plexiforme interna (CPI) inicial y 3 meses (p=0.039), correlación entre grosor del complejo CCG+CPI al tercer y sexto mes (r=0.704,p<0.001) y grosor del complejo CCG+CPI al tercer mes con grosor foveal central (CFT) al tercer y sexto mes (r=–0.594,p<0.001 y r=–0.595,p=0.001). Mayores de 65años tenían menor grosor de CFNG a 6meses (r=-0.528,p=0.007). El grosor de CFNG promedio y la presencia de la zona elipsoide inicial fueron factores pronósticos de buena agudeza visual al tercer mes de VPP (r2=0.414,p=0.018, y r2=0.414,p=0.010). CONCLUSIÓN: El grosor de CFNG y la presencia de la zona elipsoide inicial tienen alta capacidad predictiva de buena agudeza visual al tercer mes de VPP, y, correlación inversa entre grosor del complejo CCG+CPI con CFT al tercer y sexto mes de VPP.

Comportamiento del desprendimiento del vítreo posterior en los pacientes expuestos a cirugía de catarata

Objetivo: Describir el comportamiento del desprendimiento del vítreo posterior (DVP) en pacientes expuestos a cirugía de catarata mediante la biomicroscopia, la ecografía ocular y la tomografía de coherencia óptica macular. Materiales y métodos: Se realizó un estudio descriptivo, una serie de casos clínicos de 13 pacientes expuestos a cirugía de catarata en la Fundación Oftalmológica Nacional entre febrero a julio de 2015, con seguimiento a 12 meses. Durante 6 visitas se les realizó toma de agudeza visual mejor corregida y biomicroscopía. Tambíen se les realizó ecografia ocular y tomografia de coherencia óptica macular. Resultados: El porcentaje de DVP por biomicroscopia cambió desde un 7.7% a un 38.4%. El porcentaje de DVP por ecografía en el área nasal cambió de 92.3% a 76.9%. En el área temporal la tasa de DVP cambió de 84.6% y a 76.9%. En al área superior se mantuvo en un 61.5%. En el área inferior varió de un 69.2% a un 76.9%. Y por último, en el área macular de un 53.8% a un 76.9%. El porcentaje de DVP por OCT cambio desde un 69.2% a un 76.9%, en la visita cero y la visita cuatro, respectivamente. Conclusiones: La cirugía de catarata acelera el proceso del DVP. Hubo una progresión del DVP según la biomicroscopia y el OCT, la ecografía no la consideramos una herramiento eficaz para describir la progresión del DVP. 


The letter contrast sensitivity test : clinical evaluation of a new design

PURPOSE. To compare the reliability, validity, and responsiveness of the Mars Letter Contrast Sensitivity (CS) Test to the Pelli-Robson CS Chart.

METHODS. One eye of 47 normal control subjects, 27 patients with open-angle glaucoma, and 17 with age-related macular degeneration (AMD) was tested twice with the Mars test and twice with the Pelli-Robson test, in random order on separate days. In addition, 17 patients undergoing cataract surgery were tested, once before and once after surgery.

RESULTS. The mean Mars CS was 1.62 log CS (0.06 SD) for normal subjects aged 22 to 77 years, with significantly lower values in patients with glaucoma or AMD (P < 0.001). Mars test-retest 95% limits of agreement (LOA) were ±0.13, ±0.19, and ±0.24 log CS for normal, glaucoma, and AMD, respectively. In comparison, Pelli-Robson test-retest 95% LOA were ±0.18, ±0.19, and ±0.33 log CS. The Spearman correlation between the Mars and Pelli-Robson tests was 0.83 (P < 0.001). However, systematic differences were observed, particularly at the upper-normal end of the range, where Mars CS was lower than Pelli-Robson CS. After cataract surgery, Mars and Pelli-Robson effect size statistics were 0.92 and 0.88, respectively.

CONCLUSIONS. The results indicate the Mars test has test-retest reliability equal to or better than the Pelli-Robson test and comparable responsiveness. The strong correlation between the tests provides evidence the Mars test is valid. However, systematic differences indicate normative values are likely to be different for each test. The Mars Letter CS Test is a useful and practical alternative to the Pelli-Robson CS Chart.

Controlled transscleral drug delivery formulations to the eye: establishing new concepts and paradigms in ocular anti-inflammatory therapeutics and antibacterial prophylaxis

Importance of the field: The use of topical agents poses unique and challenging hurdles for drug delivery. Topical steroids effectively control ocular inflammation, but are associated with the well-recognized dilemma of patient compliance. Although administration of topical antimicrobials as prophylaxis is acceptable among ophthalmologists, this common practice has no sound evidence base Developing a new antimicrobial agent or delivery strategy with enhanced penetration by considering the anatomical and physiological constraints exerted by the barriers of the eye is not a commonly perceived strategy. Exploiting the permeability of the sclera, subconjunctival routes may offer a promising alternative for enhanced drug delivery and tissue targeting.Area covered in this review: Ocular drug delivery strategies were reviewed for ocular inflammation and infections clinically adopted for newer class of antimicrobials, which use a multipronged approach to limit risks of endophthalmitis.What the reader will gain: The analysis substantiates a new transscleral drug delivery therapeutic approach for cataract surgery.Take home message: A new anti-inflammatory and anti-infective paradigm that frees the patient from the nuisance of topical therapeutics is introduced, opening a large investigative avenue for future improved therapies.

Facoemulsificação em cães, com e sem implante de lente intra-ocular em piggyback: estudo clínico da inflamação pós-operatória

A uveíte peri e pós-operatória é o maior problema da cirurgia para extração de catarata no cão, sendo considerada o fator mais importante para o sucesso cirúrgico, imediato e tardio. Diversos protocolos pré e pós-operatórios utilizando agentes anti-inflamatórios esteroidais e não-esteroidais têm sido empregados na tentativa de controle da uveíte cirurgicamente induzida. O objetivo do presente estudo foi avaliar a reação inflamatória pós-operatória, clinicamente e por meio da pressão intraocular (PIO), após a cirurgia de facoemulsificação para extração de catarata em cães, com e sem implante de lente intraocular (LIO) em piggyback. Empregaram-se, 25 cães portadores de catarata, subdivididos em dois grupos: G1 (com implante de LIO), G2 (sem implante de LIO). A técnica cirúrgica adotada foi a facoemulsificação bimanual unilateral. Avaliações clínicas e mensurações da PIO foram aferidas antes do procedimento cirúrgico (0) e nos tempos 3, 7, 14, 21, 28 e 60 dias após o ato cirúrgico. Cães do grupo G1 apresentaram sinais clínicos de uveíte visivelmente mais intensos, relativamente aos do G2. Entretanto, a PIO não demonstrou diferença significativa entre os dois grupos analisados, nem entre os olhos operados e os contralaterais. A utilização de duas LIOs humanas em piggyback no cão é exequível, porém suscita mais inflamação e complicações no pós-operatório.

Anestesia peribulbar com ropivacaína como alternativa ao bloqueio neuromuscular para facectomia em cães

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efetividade do Argirol e do Povidine no pre-operatorio da catarata

Purpose: The purpose of this study was to evaluate the effectiveness of the Silver Vitelinate and Povidine as antiseptics used before the cataract surgery. Place: Faculdade de Medicina de Botucatu - UNESP. Method: Cultures were taken from the conjuntiva of 30 patients after the use of Silver Vitelinate (15 patients) and Povidine (15 patients) immediately before the cataract surgery. Result: Positive culture was observed in 8 patients that received Silver Vitelinate and 8 that received Povidine. Conclusion: The both antiseptics have the same effectiveness in reducing the microorganisms of the conjunctiva in the cataract preoperative preparation.

Análise da fórmula SRK/T no cálculo de lente intra-ocular em cães portadores de catarata

Pós-graduação em Medicina Veterinária - FMVZ