Association between axial length and level of education in elderly patients with cataracts unexposed to electronic devices in the first two decades of life / Associação entre diâmetro axial e nível educacional em pacientes idosos com catarata não expostos a dispositivos eletrônicos nas duas primeiras décadas de vida

ABSTRACT Purpose: To determine whether the axial length is associated with the education level in elderly patients with cataracts who were not exposed to electronic devices in the first two decades of life. Methods: This cross-sectional study was conducted in elderly patients with cataracts in Campinas, Brazil. Patients were divided into 2 groups: Group 1 included those who completed, at most, elementary school (including the illiterate and those who partially or totally attended elementary school), which corresponded to 12 years of schooling; Group 2 included, at least, high school graduates (including those who completed high school and those who partially or fully attended university). The sample was selected randomly with stratification for sex and age. The main outcome was the axial length. Results: The sample consisted of 472 elderly patients (236 per group) who underwent cataract surgery. There were 272 (57.6%) men and 200 (42.4%) women; the distribution was symmetrical between the two groups. The median age (IQR; range) was 66 (12; 50-89) years. The median axial length (IQR; range) was 22.82 (1.51; 20.34-28.71) mm in Group 1 and 23.32 (1.45; 20.51-31.34) mm in Group 2 (p<0.001). Conclusion: A greater axial length was associated with a higher level of education in elderly patients with cataracts, suggesting that myopization is related to an increase in activities requiring near-vision even before exposure to electronic devices.

RESUMO Objetivo: Determinar se o diâmetro axial está asso­ciado ao nível educacional em pacientes idosos com catarata que não foram expostos a dispositivos eletrônicos nas duas primeiras décadas de vida. Métodos: Este estudo transversal foi conduzido em pacientes idosos com catarata na cidade de Campinas, Brasil. Os Pacientes foram divididos em 2 grupos: no Grupo 1 foram incluídos aqueles que completaram, pelo menos, o ensino fundamental (incluindo analfabetos e aqueles com ensino fundamental completo ou incompleto), o que corresponde a 12 anos de escolaridade; no Grupo 2 foram incluídos indivíduos que, pelo menos, estudaram até o ensino médio (incluindo indivíduos com ensino médio completo e superior completo ou superior incompleto). A amostra foi selecionada aleatoriamente com estratificação por sexo e idade. O desfecho principal foi a medida do diâmetro axial. Resultados: A amostra foi constituída por 472 indivíduos que foram submetidos a cirurgia de catarata. Duzentos e trinta e seis indivíduos (50%) foram alocados no Grupo 1 e duzentos e trinta e seis indivíduos (50%) no Grupo 2. A mediana da idade (IIQ; intervalo) foi 66 (12; 50-89) anos. Duzentos e setenta e dois (57,6%) eram homens e duzentos (42,4%) mulheres, com distribuição simétrica entre os dois grupos. A mediana do diâmetro axial (IIQ; intervalo) foi 22,82 (1,51; 20,34-28,71) mm no Grupo 1 e 23,32 (1,45; 20,51-31,34) mm no Grupo 2 (p<0,001). Conclusão: Maiores medidas de diâmetro axial foram asso­ciadas a níveis educacionais mais elevados em pacientes idosos submetidos a cirurgia de catarata. Tal achado sugere que a miopização relacionada ao aumento de atividades que utilizam a visão de perto é fenômeno que ocorre antes mesmo da exposição a dispositivos eletrônicos.

Association between axial length and level of education in elderly patients with cataracts unexposed to electronic devices in the first two decades of life.

PURPOSE: To determine whether the axial length is associated with the education level in elderly patients with cataracts who were not exposed to electronic devices in the first two decades of life. METHODS: This cross-sectional study was conducted in elderly patients with cataracts in Campinas, Brazil. Patients were divided into 2 groups: Group 1 included those who completed, at most, elementary school (including the illiterate and those who partially or totally attended elementary school), which corresponded to 12 years of schooling; Group 2 included, at least, high school graduates (including those who completed high school and those who partially or fully attended university). The sample was selected randomly with stratification for sex and age. The main outcome was the axial length. RESULTS: The sample consisted of 472 elderly patients (236 per group) who underwent cataract surgery. There were 272 (57.6%) men and 200 (42.4%) women; the distribution was symmetrical between the two groups. The median age (IQR; range) was 66 (12; 50-89) years. The median axial length (IQR; range) was 22.82 (1.51; 20.34-28.71) mm in Group 1 and 23.32 (1.45; 20.51-31.34) mm in Group 2 (p<0.001). CONCLUSION: A greater axial length was associated with a higher level of education in elderly patients with cataracts, suggesting that myopization is related to an increase in activities requiring near-vision even before exposure to electronic devices.

The contact lens dry eyes questionnaire (CLDEQ-8) validation and ocular surface dysfunction among soft contact lens wearers / Validação do questionário de olho seco em lentes de contato (CLDEQ-8) e a disfunção de superfície ocular em usuários de lente de contato

ABSTRACT Purpose: To translate and validate the Contact Lens Dry Eyes Questionnaire (CLDEQ-8) to Portuguese language and to describe the impact of soft contact lenses on the ocular surface. Methods: We conducted a descriptive transversal study with the aim to: (1) translate and validate the CLDEQ-8 questionnaire to Portuguese language and (2) apply the CLDEQ-8 to a group of contact lens wearers along with a broad evaluation of the impact of soft contact lens on the ocular surface. The evaluation of the impact of soft contact lens was performed for a study population of 81 subjects, categorized in two groups: Group A: 61 contact lens wearers and Group B (control): 20 noncontact lens wearers. The study exclusion criteria were rigid contact lens wear, systemic or ocular diseases, the use of medications predisposing to ocular surface damage, and previous ocular surgeries. Results: For the CLDEQ-8 questionnaire translation and validation, Kappa agreement values were ³0.7 in all questions, implying a good agreement between the Portuguese and English language versions. Considering the ocular surface evaluation of the subjects, all parameters differed in Soft contact lens wearers when compared with the controls (p<0.05), except in those related to tear volume, such as the tear meniscus height and Schirmer test. Conclusions: This study provided a translated and validated Portuguese version of CLDEQ-8 questionnaire, which represents an important tool for the evolution of contact lens wearers. The broad evaluation of the ocular surface revealed an association between soft contact lens wearing and ocular surface disturbances.

RESUMO Objetivo: Traduzir e validar o questionário de olho seco e lentes de contato (CLDEQ-8) para o português e descrever o impacto das lentes de contato gelatinosas na superfície ocular. Métodos: Estudo transversal e descritivo com o objetivo de (1) traduzir e validar o CLDEQ-8 para o português e (2) aplicar o CLDEQ-8 em um grupo de usuários de lentes de contato, juntamente com uma ampla avaliação do impacto das lentes gelatinosas na superfície ocular. A avaliação do impacto das lentes gelatinosas foi realizada em uma amostra composta por 81 indivíduos, divididos em dois grupos: 61 usuários de lente de contato (Grupo A) e um grupo controle de 20 não usuários (Grupo B). Como critério de exclusão: usuário de lentes de contato rígidas, doenças sistêmicas ou oculares prévias, uso de medicamentos que podem causar danos a superfície ocular e cirurgias oculares prévias. Resultados: Para a tradução e validação do questionário CLDEQ-8, os valores de concordância Kappa foram iguais ou superiores a 0,7 em todas as perguntas, o que implica em uma boa concordância entre as versões em português e inglês. Considerando a avaliação da superfície ocular dos sujeitos, todos os parâmetros diferiram nos usuários de lente de contato em comparação com os controles (com p<0,05), exceto naqueles relacionados ao volume lacrimal, como altura do menisco lacrimal e teste de Schirmer. Conclusões: Este estudo forneceu uma versão traduzida para o português e validada do questionário CLDEQ-8, que representa uma importante ferramenta na avaliação de usuários de lente de contato. A avaliação da superfície ocular realizada demonstra a relação entre o uso de lentes de contato gelatinosas e os distúrbios da superfície ocular.

Translation and validation of the Portuguese version of the Keratoconus Outcomes Research Questionnaire (KORQ) / Tradução e validação do Keratoconus Outcomes Research Questionnaire (KORQ)

ABSTRACT Purpose: The purpose of this study is to translate and validate a Portuguese version of the Keratoconus Outcomes Research Questionnaire. The Keratoconus Outcomes Research Questionnaire is a psychometrically robust and valid instrument used to assess the impact of keratoconus on activity limitations and symptoms. Methods: We performed a translation, cross-cultural adaptation, and validation of the Portuguese version of the Keratoconus Outcomes Research Questionnaire. The initial translation of the English version to the Portuguese language was performed by two independent native speaker translators, followed by an interdisciplinary panel evaluation of the translated version. The Portuguese version was then back-translated into English by two independent native speakers, followed by evaluation and comparison with the original English version by the same interdisciplinary panel. For subsequent validation, the translated questionnaire was administered at two different times to a population of 30 subjects, and the results were compared in a concordance analysis. Results: The translation into Portuguese and back-translation were determined to be correct. Thirty participants were enrolled in the study (mean age, 29.23 ± 7.56 years). Nine questions (31%) had almost perfect agreement (questions 3, 4, 5, 8, 18, 22, 27, 28, and 29), 15 questions (51.7%) had substantial agreement (questions 1, 2, 6, 7, 9, 12, 14, 15, 16, 17, 20, 21, 23, 25, and 26), 4 questions (13.8%) had moderate agreement (questions 10, 11, 19, and 24) and 1 question (3.5%) had reasonable agreement (question 13). High-correlation coefficients were obtained when comparing results of the initial application and second application of this questionnaire to a sample of 30 individuals, which indicated excellent concordance with regard to results, repeatability, and reliability. Conclusions: This translated and validated questionnaire can be applied to a larger population with the intent to assess quality of life in keratoconus patients in the overall Brazilian population as well as in distinct regions of the country.

RESUMO Objetivo: Desenvolver a versão em Português do Keratoconus Outcomes Research Questionnaire (KORQ). O Keratoconus Outcomes Research Questionnaire é um instrumento psicometricamente válido e robusto para avaliação do impacto do ceratocone na limitação de atividades e sintomas. Métodos: Foi realizado no estudo a tradução, adaptação transcultural e validação em Português do Keratoconus Outcomes Research Questionnaire. A tradução inicial da versão em inglês para o idioma português foi realizada por dois tradutores de língua nativa inglesa independentes, seguida de uma avaliação interdisciplinar da versão traduzida. Após isso, a versão em Português foi traduzida novamente para o inglês por dois tradutores nativos de língua portuguesa independentes, seguida de avaliação e comparação com a versão original em inglês pelo mesmo painel interdisciplinar. Para a subsequente validação, o questionário traduzido foi aplicado em dois tempos diferentes em uma população de 30 indivíduos, e os resultados foram comparados em uma análise de concordância. Resultados: O processo de tradução para a língua portuguesa e tradução reversa do questionario Keratoconus Outcomes Research Questionnaire foi conduzido de maneira satisfatória. Trinta participantes foram incluídos no estudo (média idade, 29.23 ± 7.56 anos). Nove questões (31%) com concordância quase perfeita (questões 3, 4, 5, 8, 18, 22, 27, 28 e 29), cinco questões (51.7%) com concordância substancial (questões 1, 2, 6, 7, 9, 12, 14, 15, 16, 17, 20, 21, 23, 25 e 26), quatro questões (13.8%) com concordância moderada (questões 10, 11, 19 e 24) e uma questão (3.5%) com concordância razoável (questão 13). Os altos coeficientes de correlação obtidos ao comparar os resultados da aplicação inicial com a re-aplicação do questionário em uma amostra de 30 indivíduos indicam a excelente concordância em relação aos resultados, repetibilidade e confiabilidade. Conclusão: Esse questionário traduzido e validado pode ser aplicado em populações maiores com o objetivo de avaliar a qualidade de vida em pacientes com ceratocone na população brasileira em geral, assim como em regiões distintas do país.

Comparison Between Nylon and Polyglactin Sutures in Pediatric Cataract Surgery: A Randomized Controlled Clinical Trial.

Purpose: To compare the performance of nylon sutures to that of polyglactin sutures in pediatric patients undergoing cataract surgery. Setting: University of Campinas (UNICAMP), Campinas, São Paulo, Brazil Design: A prospective, randomized, partially masked, single-site clinical trial. (https://clinicaltrials.gov/ct2/show/NCT03812640). Methods: A total of 80 eyes from 80 patients who underwent pediatric cataract surgery were randomized into two groups in block sizes of four. Group A consisted of 41 patients whose surgical incisions were sutured with polyglactin 10-0 material. Group B consisted of 39 patients whose surgical incisions were sutured with nylon 10-0 material. The primary outcome was frequency of suture-related complications in each group. Secondary outcomes were the frequency with which suture removal was necessary. Results: The incidence of suture-related complications within 6 months of follow up was 0 out of 41 eyes (0.00%) in the polyglactin group and 17 out of 39 eyes (43.59%) in the nylon control group (p < 0.001). In all of the eyes with suture-related complications, the sutures were promptly removed. The most frequent complications were vascularization near the suture (17.95%) and loose sutures (17.95%). No ocular or systemic study-related adverse events were observed. Conclusions: Polyglactin sutures were found to be safe and effective for pediatric patients undergoing cataract surgery. Their lower rate of complications and reduced likelihood of removal (and the subsequent need for general anesthesia) make their use preferrable to that of nylon sutures. This study represents the first controlled randomized clinical trial to compare nylon sutures to polyglactin sutures in pediatric patients undergoing cataract surgery. Clinical Trial Registration: URL: https://clinicaltrials.gov/ct2/show/, Identifier: NCT03812640.

Corneal Collagen Cross-Linking in Young Patients for Progressive Keratoconus.

PURPOSE: The goal of this study was to compare the effect of early corneal collagen cross-linking (CXL) intervention (before 17 years of age) with that of late intervention (after 17 years of age) on the characteristics and progression of keratoconus. PATIENTS AND METHODS: One hundred five eyes of 94 patients with keratoconus undergoing treatment with CXL were included. The patients were divided into 2 groups by age: group 1 (mean age of 13.8 yrs; range 10-16) and group 2 (mean age of 21.5 yrs; range 17-36). Eyes were evaluated regarding best-corrected visual acuity (BCVA), refractive error, corneal endothelial cell density, and central corneal thickness, as well as using slit-lamp biomicroscopy, Goldmann tonometry, and the keratometry (Kmax, Ksteep, and Kflat parameters) test before CXL and at 1, 3, 6, and 12 months thereafter. RESULTS: The mean (SD) BCVA of group 1 was 0.45 (±0.25) before CXL and 0.56 (±0.29) 1 year after CXL (P = 0.030); mean (SD) Kmax, Ksteep, and Kflat were 58.47 (±7.2), 52.93 (±5.4), 47.22 (±4.2) before CXL respectively, and 58.21 (±7.7), 52.25 (±5.5), and 46.56 (±4.6) 1 year after CXL, respectively (P = 0.897, 0.481, and 0.491). The mean (SD) BCVA of group 2 was 0.50 (±0.30) before CXL and 0.56 (±0.32) 1 year thereafter (P = 0.346); mean (SD) Kmax, Ksteep, and Kflat were, respectively, 57.64 (±7.1), 54.02 (±6.2), and 48.60 (±4.1) before CXL and 56.46 (±8.0), 52.46 (±5.8), and 47.85 (±4.9) 1 year after CXL, respectively (P = 0.553, 0.258, and 0.640). CONCLUSIONS: The study showed no statistical differences between younger and older patients. These findings support the indication of CXL treatment in pediatric patients for early stabilization of the disease and better progress regarding BCVA and keratometry parameters.

Comparing Resident Outcomes in Cataract Surgery at Different Levels of Experience.

PURPOSE: To evaluate outcomes of resident-performed cataract surgeries in different training levels in a retrospective case series. PATIENTS AND METHODS: A total of 730 surgeries performed by residents were evaluated into three groups: surgeries performed during residents' first semester of training in phacoemulsification (Level 1 - L1), surgeries performed during the second semester (Level 2 - L2), and surgeries performed during the third semester (Level 3 - L3). The primary outcome was the incidence of intraoperative complications in each group. Secondary outcomes were the comparisons between initial and final corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), and central corneal thickness (CCT) in each group. Descriptive statistical analyses were employed in the presentation of the results using central tendency and variance measurements. RESULTS: The rate of complications within six weeks of follow-up was 24 out of 102 eyes (23.53%) in the L1 group, 63 out of 301 eyes (20.93%) in the L2 group, and 37 out of 327 (11.31%) in the L3 group (p=0.001). Posterior capsule rupture (PCR) was the most frequent intercurrence observed in all three semesters: it occurred in 12.7% of the surgeries in the first semester (13/102), 16.9% of surgeries in the second semester (51/301), and 9.5% of surgeries in the third semester (31/327). There was no significant difference in CDVA (p=0.298), ECD (p=0.067), IOP (p=0.217), or CCT (p=0.807) between the groups. CONCLUSION: When measured by rates of complications and by the aforementioned parameters, surgical competency was found to improve as surgical experience and frequency increased. Therefore, this study identified some patterns of skill development that can be applied to teaching strategies and better assist surgeons in training.

Costs and benefits of bevacizumab vial sharing for the treatment of retinal diseases.

BACKGROUND: Antiangiogenic therapy has proved to be an important therapeutic tool for many retinal vascular diseases; however, its availability is limited in developing countries. This study sought to describe the bevacizumab vial sharing process and to evaluate the impact of this repackaging system on the costs incurred in a Brazilian public hospital. METHOD: This retrospective study compared the number and costs of intravitreal antiangiogenic injections approved via court order in the first year of the study (2015) to the number and costs of the bevacizumab injections provided through the use of vial sharing in the second year of the study (2016). Vial sharing consists of the traditional process used to repackage bevacizumab; in this case, however, the drug samples used were the residual volume from the preparation of bevacizumab for oncology patients. The hospital adhered to the guidelines established by the Brazilian Health Surveillance Agency (ANVISA). RESULTS: In the first year of the study and using medication obtained through court orders, 550 intravitreal injections were performed in the ophthalmology ambulatory care center. Based on local pricing tables, the total cost of the medication was BRL$1,036,056.25 (USD$267,546.58), and the average cost of each application was BRL$1883.74 (USD$486.45). In the second year of the study, 1081 intravitreal applications were performed at the same hospital using doses obtained through bevacizumab vial sharing. The total cost was BRL$21,942.49 (USD$5663.30) and the per-unit cost was BRL$20.30, or USD$5.23 (a savings of 97.88%). CONCLUSION: This study found that bevacizumab vial sharing led to a significant reduction in public health care costs associated with antiangiogenic treatment and increased the availability of the drug to public health care patients. These results can be extrapolated to other types of drugs and health care systems.

Pediatric traumatic cataract review: origin of the trauma / Catarata traumática pediátrica: origem do trauma

Abstract Objective: To identify the main causes of traumatic cataracts in childhood, based on a scientific review. Methods: Review in Lilacs, Pubmed, Cochrane, Bireme and Sciencedirect databases for the keywords: infant cataract, traumatic cataract, child, pediatrics, low vision, blindness, cause, incidence, ocular trauma. Results: Seventy-two (72) articles on traumatic cataract were found. From these, 17 presented tables relating the cause of ocular trauma to the formation of cataract in pediatrics. This article presents the main findings and analysis of the topic in the literature. Conclusion: The traumas etiologies which were most prominent in the studies analyzed were pointed objects such as cuttings, splinters and wood stick. Boys were more affected and there was a relation with practice of internal and external activities of domicile, in rural and urban zones.

Resumo Objetivo: Identificar as principais causas das cataratas traumáticas na infância, baseado numa revisão científica. Métodos: Pesquisa nas bases de dados Lilacs, Pubmed, Cochrane, Bireme e Sciencedirect com as palavras- chave: catarata infantil, catarata traumática, criança, pediatria, baixa visão, cegueira, causa, incidência, trauma ocular. Resultados: Foram encontrados setenta e dois (72) artigos sobre catarata traumática. Destes, 17 apresentaram tabelas relacionando a causa do trauma ocular com a formação de catarata em pediatria. Este artigo apresenta os principais achados e análise do tema na literatura. Conclusão: As etiologias dos traumas que apresentaram maior destaque nos estudos analisados foram com objetos pontiagudos como estaca, lascas e graveto de madeira. Meninos foram mais acometidos e houve relação com prática de atividades internas e externas ao domicilio, em zona rural e urbana.

Prevalence and Risk Factors of self-reported dry eye in Brazil using a short symptom questionnaire.

To evaluate dry eye prevalence and investigate associated risk factors in Brazil by applying a short questionnaire of symptoms and risk factors. A cross-sectional study of 3,107 participants from all the five different geopolitical regions of Brazil. Overall prevalence of dry eye in this study population was 12.8%. Dry eye previous diagnosis was reported by 10.2% and presence of severe symptoms in 4.9%. Logistic regression analysis confirmed some significantly risk factors, such as female sex (Odds Ratio (OR) 1.74; 95% Confidence Interval (CI): 1.12-1.93), age ≥60 year-old (OR 2.00; 95%CI: 1.44-2.77), history of ocular surgery (OR 1.84; 95%CI: 1.30-2.60), contact lens wear (OR 1.93; 95%CI: 1.36-2.73), cancer treatment (OR 3.03; 95%CI: 1.36-6.59), computer use >6 hours per day (OR 1.77; 95%CI: 1.36-2.31), antidepressants (OR 1.61; 95%CI: 1.12-2.31) and anti-allergy (OR 2.11; 95%CI: 1.54-2.89) medications. Nevertheless, when stratified by regions, each one had its own significant factors and inherent characteristics. This is the first study about prevalence and risk factors of dry eye in a large population sample from all regions of Brazil. Dry eye is a common condition in the Brazilian population and prevalence rates varies substantially in the different geographic regions of the country, possibly reflecting climate and socioeconomic discrepancies.

Translation and validation of the Portuguese version of a dry eye disease symptom questionnaire / Tradução e validação da versão em português de um questionário para sintomas de olho seco

ABSTRACT Purposes: A symptom questionnaire is an important tool used to quantify and qualify the impact of a disease on a patient's related quality of life and to estimate the prevalence of a certain condition within a population. Ophthalmologists frequently encounter patients with dry eye disease (DED), and therefore, evaluating the symptoms reported by these patients influences diagnosis, therapeutic monitoring, and evaluations of disease progression. The latest consensus on dry eye (Dry Eye Workshop, DEWS), published in 2007, led to the standardization of several questionnaires and a better understanding of the prevalence, severity, and overall effect of DED on the patient's quality of life. Methods: In this study, we translated into Portuguese a symptom questionnaire from DEWS that has already been used in several other population-based studies. For subsequent validation, the translated questionnaire was applied by two independent observers to a population of 30 subjects, and the results were compared in a concordance analysis. Results: The processes of translating to Portuguese and back translating the dry eye symptom questionnaire were conducted without difficulty. The high-correlation coefficients obtained when comparing the results of the initial application and the re-administration of this questionnaire to a sample of 30 individuals indicated excellent concordance with regard to results, repeatability, and reliability. Conclusions: This translated and validated questionnaire can be applied to a larger population with the intent to determine the prevalence of DED symptoms in the overall Brazilian population, as well as in distinct regions of the country.

RESUMO Objetivos: A aplicação de questionários sobre os sintomas é uma forma de quantificar e qualificar o impacto de uma determinada doença na qualidade de vida dos pacientes portadores e ainda de estimar a prevalência de uma determinada condição na população estudada. O olho seco é uma condição ocular muito prevalente na prática oftalmológica e a avaliação dos sintomas reportados pelos pacientes é uma importante ferramenta propedêutica e de acompanhamento terapêutico e evolução da doença. De acordo com o último consenso sobre olho seco (Dry Eye Worshop, DEWS) publicado em 2007, diversos questionários foram padronizados e tem sido utilizados para o melhor entendimento sobre a prevalência, gravidade e impacto na qualidade de vida dos pacientes. Métodos: Foi realizada a tradução para o português de um dos questionários de sintomas reportado no DEWS, seguido de sua validação. Trata-se de um questionário de sintomas de olho seco já utilizado em diversos outros estudos populacionais. O questionário traduzido foi aplicado em uma população de 30 indivíduos por dois observadores diferentes e os resultados foram comparados para verificação de concordância. Resultados: O processo de tradução e contra tradução do questionário de sintomas de olho seco para a língua portuguesa foi realizada sem dificuldades. A análise dos resultados obtidos na aplicação teste e re-teste do questionário em uma amostra de 30 indivíduos apresentou coeficientes de correlação altos demonstrando excelente concordância de resultados, reprodutibilidade e confiabilidade. Conclusões: A tradução e validação deste questionário permitirá sua aplicação em estudos de prevalência dos sintomas de olho seco na população brasileira, bem como comparação em diversas regiões do país.

The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil.

OBJECTIVES: Viral conjunctivitis is a common, highly contagious disease that is often caused by an adenovirus. The aim of this study was to evaluate the prevalence of adenoviral conjunctivitis by analyzing data from a prospective clinical study of 122 consecutively enrolled patients who were treated at the Clinical Hospital of the State University of Campinas (UNICAMP) after a clinical diagnosis of infectious conjunctivitis between November 2011 and June 2012. METHODS: Polymerase chain reaction was used to evaluate all cases of clinically diagnosed infectious conjunctivitis and based on the laboratory findings, the prevalence of adenoviral infections was determined. The incidence of subepithelial corneal infiltrates was also investigated. RESULTS: Of the 122 patients with acute infectious conjunctivitis included, 72 had positive polymerase chain reaction results for adenoviruses and 17 patients developed subepithelial corneal infiltrates (13.93%). CONCLUSIONS: The polymerase chain reaction revealed that the prevalence of adenoviral conjunctivitis was 59% in all patients who presented with a clinical diagnosis of infectious conjunctivitis from November 2011 to June 2012. The prevalence of adenoviral conjunctivitis in the study population was similar to its prevalence in other regions of the world.

The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil

OBJECTIVES: Viral conjunctivitis is a common, highly contagious disease that is often caused by an adenovirus. The aim of this study was to evaluate the prevalence of adenoviral conjunctivitis by analyzing data from a prospective clinical study of 122 consecutively enrolled patients who were treated at the Clinical Hospital of the State University of Campinas (UNICAMP) after a clinical diagnosis of infectious conjunctivitis between November 2011 and June 2012. METHODS: Polymerase chain reaction was used to evaluate all cases of clinically diagnosed infectious conjunctivitis and based on the laboratory findings, the prevalence of adenoviral infections was determined. The incidence of subepithelial corneal infiltrates was also investigated. RESULTS: Of the 122 patients with acute infectious conjunctivitis included, 72 had positive polymerase chain reaction results for adenoviruses and 17 patients developed subepithelial corneal infiltrates (13.93%). CONCLUSIONS: The polymerase chain reaction revealed that the prevalence of adenoviral conjunctivitis was 59% in all patients who presented with a clinical diagnosis of infectious conjunctivitis from November 2011 to June 2012. The prevalence of adenoviral conjunctivitis in the study population was similar to its prevalence in other regions of the world.

Dexamethasone/Povidone Eye Drops versus Artificial Tears for Treatment of Presumed Viral Conjunctivitis: A Randomized Clinical Trial.

PURPOSE: To determine whether topical dexamethasone 0.1%/povidone-iodine 0.4% reduces the duration of presumed viral conjunctivitis better than artificial tears and whether the treatment relieves the symptoms of this disease. METHODS: Randomized, masked and controlled trial. One-hundred twenty-two patients with a clinical diagnosis of presumed viral conjunctivitis were randomized to either the treatment group or the control group. Physicians and patients were masked to the treatment. Swabs were taken from the conjunctival fornix for adenovirus PCR analyses. Patients in the treatment group received topical dexamethasone 0.1%/povidone-iodine 0.4% eye drops four times daily, and patients in the placebo group received artificial tears four times daily, both for seven days. Symptoms were recorded on the day of recruitment and at the time of a follow-up examination 5, 10 and 30 d later. The main outcome was duration of the disease. The others outcomes were overall discomfort, itching, foreign body sensation, tearing, redness, eyelid swelling, side effects of the eye drops, intraocular pressure and the incidence of subepithelial corneal infiltrates. RESULTS: There was no statistically significant difference between the treatment group and the control group in terms of the patients' symptoms, intraocular pressure and incidence of subepithelial cornea infiltrates during the entire follow-up period. Patients of the treatment group reported more stinging (p < 0.001) and a shorter conjunctivitis duration (9.4 ± 4.6 d in the dexamethasone 0.1%/povidone-iodine 0.4% group versus 11.8 ± 4.9 d in the artificial tears group, p = 0.009). CONCLUSIONS: The use of topical dexamethasone 0.1%/povidone-iodine 0.4% eye drops four times daily appears to reduce the duration of conjunctivitis, although it causes more stinging than artificial tears.

Comparação das características de citação entre os relatos de caso/séries de casos versus demais desenhos de estudos nos artigos publicados em periódicos brasileiros de Oftalmologia / Comparison of the citation characteristics between the case reports/cases series versus the other study designs in the articles published in brazilian journals of ophthalmology

Objetivo: Comparar as características de citação entre relatos de caso / séries de casos versus demais desenhos de estudos publicados nos periódicos brasileiros de oftalmologia indexados no Science Citation Index Expanded (SCIE). Métodos: Artigos originais foram identificados a partir da revisão dos documentos publicados nos "Arquivos Brasileiros de Oftalmologia" ou "Revista Brasileira de Oftalmologia". Todos os documentos listados no SCIE, de 01/01/2008 a 31/12/2009, foram incluídos, exceto: "editoriais"; "correções"; "cartas"; e "biografias". Os desfechos foram as distribuições, número de citações, média do número de citações e probabilidade de citação. Resultados: A pesquisa revelou 382 artigos. A distribuição dos artigos segundo desenho do estudo foram relatos de caso 106, séries de casos 50, estudos transversais 92, ensaios clínicos fase I / fase II 40, ensaios clínicos fase III / fase IV 29, revisões não-sistemáticas 33 e estudos experimentais 32. A média do número de citações foi menor (p<0,001) entre relatos de caso / séries de casos (0,55) quando comparados aos outros desenhos de estudos (1,04). A probabilidade de citação foi menor (p<0,001) entre relatos de caso/séries de casos (31,4%) quando comparados aos outros desenhos de estudos (48,7%). Conclusão: Os relatos de caso / séries de casos apresentaram média do número de citações e probabilidade de citação menores que os demais desenhos de estudo. Os resultados deste estudo sugerem que os conselhos editoriais devem publicar apenas relatos de caso / séries de casos originais ou muito raros que tenham repercussão clínica. Este esforço trará benefícios para o pesquisador, para o oftalmologista que estiver em busca ...

Objective: To compare the citation characteristics of the case reports and the case series versus the other study designs of articles published, in 2008-2009, in Brazilian journals of ophthalmology indexed in Science Citation Index Expanded (SCIE). Methods: This study was a systematic review. Original articles were identified by review of documents published at the two Brazilians ophthalmology journals indexed at SCIE ("Arquivos Brasileiros de Oftalmologia" and "Revista Brasileira de Oftalmologia"). All documents ("articles" and "reviews") listed at SCIE from January 1, 2008 to December 31, 2009 were included, except: "editorial materials"; "corrections"; "letters"; and "biographical items". The outcomes were the distributions, the number of citations (through the end of second year after publication date), the mean of the number of citations, and the likelihood of citation (cited at least once vs. no citation), according the study design of the article. Results: The search at the Web of Science revealed 382 articles. The distribution of articles according to study design was: Case Reports 106 articles (27.7%) Case Series 50 (13.1%), Sectional Studies 92 (24.1%), Clinical Trials, Phase I or Phase II 40 (10.5%), Clinical Trials, Phase III or Phase IV 29 (7.6%), Non-Systematic Reviews 33 (8.6%) and Experimental Studies 32 (8.4%). The citation count was statistically lower (P < .001) in the Case Reports/Case Series (0.55 - SD 1.05) compared with the others study designs (1.04 - SD 1.63). The likelihood citation was statistically lower (P < .001) in the Case Reports/Case Series (49/156 - 31.4%) compared with the others study designs (110/226 - 48.7%). Conclusion: Case reports and case series showed lower number of citations and likelihood citation than others study designs. The results of this study suggest that the editorial boards should publish only original or very rare Case Reports / Case Series with clinical significance ...

Influence of English language in the number of citations of articles published in Brazilian journals of ophthalmology.

PURPOSE: To determine the association between language and number of citations of ophthalmology articles published in Brazilian journals. METHODS: This study was a systematic review. Original articles were identified by review of documents published at the two Brazilian ophthalmology journals indexed at Science Citation Index Expanded - SCIE ["Arquivos Brasileiros de Oftalmologia (ABO)" and "Revista Brasileira de Oftalmologia (RBO)"]. All document types ("articles" and "reviews") listed at SCIE in English (English Group) or in Portuguese (Portuguese Group) from January 1, 2008 to December 31, 2009 were included, except: "editorial materials"; "corrections"; "letters"; and "biographical items". The primary outcome was the number of citations through the end of second year after publication date. Subgroup analysis included likelihood of citation (cited at least once versus no citation), journal, and year of publication. RESULTS: The search at the web of science revealed 382 articles [107 (28%) in the English Group and 275 (72%) in the Portuguese Group]. Of those, 297 (77.7%) were published at the ABO and 85 (23.3%) at the RBO. The citation counts were statistically significantly higher (P<0.001) in the English Group (1.51 - SD 1.98 - range 0 to 11) compared with the Portuguese Group (0.57 - SD 1.06 - range 0 to 7). The likelihood citation was statistically significant higher (P<0.001) in the English Group (70/107 - 65.4%) compared with the Portuguese Group (89/275 - 32.7%). There were more articles published in English at the ABO (98/297 - 32.9%) than at the RBO (9/85 - 10.6%) [P<0.001]. There were no significant difference (P=0.967) at the proportion of articles published in English at the years 2008 (48/172 - 27.9%) and 2009 (59/210 - 28.1%). CONCLUSION: The number of citations of articles published in Portuguese at Brazilian ophthalmology journals is lower than the published in English. The results of this study suggest that the editorial boards should strongly encourage the authors to adopt English as the main language in their future articles.

Clinical trials in Brazilian journals of ophthalmology: where we are.

PURPOSE: To compare clinical trials published in Brazilian journals of ophthalmology and in foreign journals of ophthalmology with respect to the number of citations and the quality of reporting [by applying the Consolidated Standards for Reporting Trials (CONSORT) statement writing standards]. METHODS: The sample of this systematic review comprised the two Brazilian journals of ophthalmology indexed at Science Citation Index Expanded and six of the foreign journals of ophthalmology with highest Impact Factor® according ISI. All clinical trials (CTs) published from January 2009 to December 2010 at the Brazilians journals and a 1:1 randomized sample of the foreign journals were included. The primary outcome was the number of citations through the end of 2011. Subgroup analysis included language. The secondary outcome included likelihood of citation (cited at least once versus no citation), and presence or absence of CONSORT statement indicators. RESULTS: The citation counts were statistically significantly higher (P<0.001) in the Foreign Group (10.50) compared with the Brazilian Group (0.45). The likelihood citation was statistically significantly higher (P<0.001) in the Foreign Group (20/20 - 100%) compared with the Brazilian Group (8/20 - 40%). The subgroup analysis of the language influence in Brazilian articles showed that the citation counts were statistically significantly higher in the papers published in English (P<0.04). Of 37 possible CONSORT items, the mean for the Foreign Group was 20.55 and for the Brazilian Group was 13.65 (P<0.003). CONCLUSION: The number of citations and the quality of reporting of clinical trials in Brazilian journals of ophthalmology still are low when compared with the foreign journals of ophthalmology with highest Impact Factor®.

Corneal endothelial rejection after penetrating keratoplasty treated with intravenous and topic corticosteroid: one year follow up / Tratamento da rejeição endotelial pós-ceratoplastia penetrante através da associação do pulso de metilprednisolona intravenosa com acetato de prednisolona tópico. Seguimento de um ano

OBJECTIVE: To analyze the recovery of visual acuity (VA) and graft survival after first episode of endothelial rejection in penetrating keratoplasty (PKP) treated with intravenous (IV) and topic corticosteroid. METHODS: Interventional, prospective, non-comparative case series study evolving 32 PKP patients in one year follow up, who presented first episode of corneal endothelial rejection. The patients were submitted to 500 mg IV injection of methylprednisolone in association with topical prednisolone. Main outcome measures included VA recovery and corneal edema regression. Second outcome included new rejections and graft failure. Multivariate analysis techniques were used to estimate rates of graft outcome events and the impact of risk factors. RESULTS: A total of 32 eyes from 32 patients (13 male and 19 female) were included in the study. The mean VA (in number of letters) before rejection was 48 (22 to 88 letters). Patients treated within 7 days or less of initial symptoms had better VA recovery, corneal edema regression and less graft failure (p<0.001). Patients with previous ocular surgery had worse VA recovery and more graft failure (p<0.047). CONCLUSION: The association between the other risk factors and the outcomes did not reach statistical significance in the multivariate model because of the small numbers of patients. Methylprednisolone in association with topical prednisolone is an alternative treatment for graft rejection. Our study showed that patients treated within 7 days of symptoms and no previous anterior segment surgery had better visual outcome and graft survival after treatment.

OBJETIVO: Analisar a recuperação da acuidade visual (AV) e sobrevivência do enxerto após primeiro episódio de rejeição endotelial em ceratoplastia penetrante (PK) em pacientes submetidos ao corticóide intravenoso (IV) associado ao tópico. MÉTODOS: Estudo descritivo, prospectivo, tipo série de casos envolvendo 32 pacientes com PK tratados com 2 doses de 500mg de metilprednisolona IV (com intervalo de 1 semana) associado ao acetato de prednisolona 1%. O parâmetro principal analisado foi a recuperação da AV e a regressão do edema corneano. O parâmetro secundário utilizado foi a recorrência das rejeições e a falência do enxerto. RESULTADOS: Um total de 32 olhos de 32 pacientes foram incluídos no estudo (13 homens e 19 mulheres). A média da AV (em número de letras) foi 48. Pacientes tratados dentro de 7 dias ou menos após o surgimento dos sintomas apresentaram melhor recuperação da AV e menor falência do enxerto (p<0,001). Pacientes com antecedente de cirurgia ocular anterior à PK apresentaram pior recuperação da AV e maior índice de falência do enxerto. CONCLUSÃO: A associação entre os outros fatores de risco não atingiram significância estatística devido ao baixo número de pacientes do estudo. A metilprednisolona IV em associação com a prednisolona tópica pode ser uma alternativa para o tratamento da rejeição endotelial do enxerto. Nossos resultados sugerem que pacientes tratados dentro de 7 dias do início dos sintomas e a ausência de cirurgia ocular prévia apresentam melhor recuperação da AV e melhor sobrevivência do enxerto.

Clinical trials in Brazilian journals of ophthalmology: where we are / Ensaios clínicos em periódicos brasileiros de oftalmologia: onde estamos

PURPOSE: To compare clinical trials published in Brazilian journals of ophthalmology and in foreign journals of ophthalmology with respect to the number of citations and the quality of reporting [by applying the Consolidated Standards for Reporting Trials (CONSORT) statement writing standards]. METHODS: The sample of this systematic review comprised the two Brazilian journals of ophthalmology indexed at Science Citation Index Expanded and six of the foreign journals of ophthalmology with highest Impact Factor® according ISI. All clinical trials (CTs) published from January 2009 to December 2010 at the Brazilians journals and a 1:1 randomized sample of the foreign journals were included. The primary outcome was the number of citations through the end of 2011. Subgroup analysis included language. The secondary outcome included likelihood of citation (cited at least once versus no citation), and presence or absence of CONSORT statement indicators. RESULTS: The citation counts were statistically significantly higher (P<0.001) in the Foreign Group (10.50) compared with the Brazilian Group (0.45). The likelihood citation was statistically significantly higher (P<0.001) in the Foreign Group (20/20 - 100%) compared with the Brazilian Group (8/20 - 40%). The subgroup analysis of the language influence in Brazilian articles showed that the citation counts were statistically significantly higher in the papers published in English (P<0.04). Of 37 possible CONSORT items, the mean for the Foreign Group was 20.55 and for the Brazilian Group was 13.65 (P<0.003). CONCLUSION: The number of citations and the quality of reporting of clinical trials in Brazilian journals of ophthalmology still are low when compared with the foreign journals of ophthalmology with highest Impact Factor®.

OBJETIVO: Comparar ensaios clínicos publicados em periódicos brasileiros de oftalmologia e em periódicos estrangeiros de oftalmologia em relação ao número de citações e à qualidade da informação [através da aplicação do Consolidated Standards for Reporting Trials (CONSORT) statement]. MÉTODOS: A amostra desta revisão sistemática abrangeu os dois periódicos brasileiras de oftalmologia indexaoas no Science Citation Index Expanded (Grupo Brasileiro) e seis dos periódicos estrangeiros de oftalmologia com maior fator de impacto de acordo com o ISI (Grupo Estrangeiro). Todos os ensaios clínicos, publicados entre janeiro de 2009 a dezembro de 2010, nos dois periódicos brasileiros e numa amostra aleatória 1:1 dos periódicos estrangeiros foram incluídos. O desfecho primário foi o número de citações até o final de 2011. A análise de subgrupos incluiu o idioma. O desfecho secundário incluiu a probabilidade de citação (citado ao menos uma vez versus não citado), e a presença ou ausência de indicadores da declaração CONSORT. RESULTADOS: O número de citações foi significativamente maior (P<0,001) no Grupo Estrangeiro (10,50) em comparação com o Grupo Brasileiro (0,45). A probabilidade de citação foi estatisticamente superior (P<0,001) no Grupo Estrangeiro (20/20-100%) comparado com o Grupo Brasileiro (8/20-41%). A análise de subgrupo sobre a influência da língua em artigos Brasileiros mostrou que o número de citações foi significativamente maior nos artigos publicados em Inglês (P<0,04). Dos 37 itens do CONSORT possíveis, a média para o Grupo Estrangeiro foi de 20,55 e para o Grupo Brasileiro foi 13,65 (P<0,003). CONCLUSÃO: O número de citações e a qualidade da redação dos ensaios clínicos em periódicos Brasileiros de oftalmologia ainda são baixos quando comparados com os periódicos estrangeiros de oftalmologia com mais alto fator de impacto.