Population-Based Cataract Surgery Complications and Their Impact on Visual Status in the Brazilian Amazon Region.

PURPOSE: To investigate cataract surgery prevalence, complications, visual outcomes, and coverage in a population of older adults from the Brazilian Amazon region. DESIGN: Population-based cross-sectional study. METHODS: Individuals ≥45 years of age from urban and rural areas of Parintins City, Brazil, were identified by cluster random sampling. Participants underwent ophthalmic examination, including uncorrected visual acuity, acuity with presenting correction (APC), and best-corrected visual acuity (BCVA) from each eye. In those with previous cataract surgery, surgical technique and complications including its contribution to vision impairment were noted. The association of surgical complications and surgical coverage with sociodemographic variables was assessed by multiple logistic regression. RESULTS: A total of 2,384 persons were determined to be eligible, and 2,041 (85.6%) were examined. Overall, prevalence of cataract surgery was 8.6%, with 11.3% urban and 5.0% rural. Surgical complications were associated with males, older age, and urban residency and were found in 60.4%, with posterior capsule opacification in 29.6% and posterior capsule rupture in 16.3%. Among the 270 eyes having cataract surgery, APC ≥20/32 was found in 44.4%, APC 20/40 to 20/63 in 20.8%, APC <20/63 to 20/200 in 14.4%, APC <20/200 to 20/400 in 2.6%, and APC <20/400 in 17.8%. Low surgical coverage was found with 57.9% of those with visual impairment due to cataract not being treated surgically. CONCLUSIONS: Although a reasonable prevalence of cataract surgery was found, a high complication rate, poor visual outcomes, and low cataract surgery coverage indicated that actions to improve quality and appropriate postsurgical management should be planned and implemented by public health authorities.

Efficacy of a lutein-based dye (Phacodyne™) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification.

PURPOSE: To evaluate the efficacy and safety of a novel lutein-based dye for the anterior capsulorhexis during phacoemulsification in cataract surgery in humans. METHODS: Twenty-five eyes from 25 patients were operated by 25 different surgeons who performed continuous circular capsulorhexis (CCC) guided by a lutein-based dye (Phacodyne™) during cataract surgery by phacoemulsification. A questionnaire assessed the surgeon's opinion regarding the efficacy of the dye. Follow-up examinations were performed at 1, 7, and 30 days post-surgery. Eyes were evaluated by full ophthalmic examination, corneal topography/pachymetry, and corneal endothelial cell count. RESULTS: As revealed by the answers to the questionnaire, the dye facilitated the CCC procedure in all eyes. Baseline nuclear cataract classification (according to the Lens Opacities Classification System III; LOCS III) was 3.24 (± 1.12). Preoperative BCVA (logMAR) was 0.89 ± 0.59 and improved to 0.23 ± 0.22 on day 30 after surgery. The intraocular pressure (IOP) remained stable and the inflammatory reaction subsided in all cases within the first 7 days after surgery. The pre-operative values of corneal pachymetry and IOP were similar to those found on follow-up day 30. Loss in endothelial cell number was similar to earlier reports. CONCLUSION: Phacodyne™ was efficient when used for anterior capsulorhexis during cataract surgery by phacoemulsification and

Efficacy of a lutein-based dye (PhacodyneTM) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification / Eficácia de corante à base de luteína (PhacodyneTM) para observação da capsulorrexis anterior em cirurgia de facoemulsificação

Purpose: To evaluate the efficacy and safety of a novel lutein-based dye for the anterior capsulorhexis during phacoemulsification in cataract surgery in humans. Methods: Twenty-five eyes from 25 patients were operated by 25 different surgeons who performed continuous circular capsulorhexis (CCC) guided by a lutein-based dye (PhacodyneTM) during cataract surgery by phacoemulsification. A questionnaire assessed the surgeon's opinion regarding the efficacy of the dye. Follow-up examinations were performed at 1, 7, and 30 days post-surgery. Eyes were evaluated by full ophthalmic examination, corneal topography/pachymetry, and corneal endothelial cell count. Results: As revealed by the answers to the questionnaire, the dye facilitated the CCC procedure in all eyes. Baseline nuclear cataract classification (according to the Lens Opacities Classification System III; LOCS III) was 3.24 (± 1.12). Preoperative BCVA (logMAR) was 0.89 ± 0.59 and improved to 0.23 ± 0.22 on day 30 after surgery. The intraocular pressure (IOP) remained stable and the inflammatory reaction subsided in all cases within the first 7 days after surgery. The pre-operative values of corneal pachymetry and IOP were similar to those found on follow-up day 30. Loss in endothelial cell number was similar to earlier reports. Conclusion: PhacodyneTM was efficient when used for anterior capsulorhexis during cataract surgery by phacoemulsification and showed no signs of toxicity or side effects during the 30-day follow-up period. .

Objetivos: Avaliar a eficácia e eficiência de um novo corante à base de luteína para coloração da cápsula anterior durante cirurgia de facoemulsificação em humanos. Métodos: Vinte e cinco olhos de 25 pacientes foram operados por 25 cirurgiões diferentes que realizaram capsulorrexis circular contínua e facoemulsificação após coloração da cápsula anterior com corante à base de luteína. Um questionário avaliou a opinião dos cirurgiões sobre a eficácia do corante. Exames pós-operatórios foram realizados nos dias 1, 7 e 30 por meio de exame oftalmológico completo, topografia/ paquimetria e contagem de células endoteliais. Resultados: De acordo com o questionário aplicado, o corante facilitou a cirurgia em todos os olhos. A classificação da catarata de acordo com o LOCS III foi de 3,24 ± 1,12. A acuidade visual pré-operatória com melhor correção foi de 0,89 ± 0,59 (logMAR), passando a 0,23 ± 0,22 no pós-operatório. A pressão intraocular (PIO) permaneceu estável e houve reação de câmara leve que desapareceu em todos os casos durante os primeiros 7 dias de pós-operatório. Não houve significância estatística comparando a paquimetria e PIO pré e pós-operatórios. Conclusão: O novo corante se mostrou eficiente e sem sinais de toxicidade ou efeitos adversos, após 30 dias, quando usado para auxiliar a cirurgia de facoemulsificação. .

Mansonella ozzardi corneal lesions in the Amazon: a cross-sectional study.

OBJECTIVES: To characterise and confirm the presence of Mansonella ozzardi microfilariae in the cornea by biomicroscopy and corneal confocal microscopy. DESIGN: Cross-sectional study. SETTINGS: Clinical practice study in patients from rural communities in Coari city on the Solimões river, Amazonas state, Brazil. PARTICIPANTS: The eyes of 212 consecutive volunteer patients were examined using a flash light and their blood checked for the presence of microfilariae by an expert microscopist. Patients with suspicious corneal lesions (characterised as nummular keratitis) were submitted to biomicroscopy, fundoscopy and corneal confocal microscopy evaluation (CCME). In two patients, a biopsy of the limbal conjunctiva adjacent to the nummular keratitis was carried out and blood collected from the surgical wound for microfilariae investigation by thick blood film examination. PRIMARY AND SECONDARY OUTCOME MEASURES: Positive correlation between corneal biomicroscopic and confocal lesions and M ozzardi microfilaremia. RESULTS: Of the 212 patients, 56 (26.4%) were positive for microfilaremia. 22 patients with nummular keratitis identified under flash light examination underwent biomicroscopy and CCME. Corneal lesions were positively correlated to microfilaremia (p=0.0001). At biomicroscopy, lesions were classified as quiescent or active. At CCME, lesions were categorised as circular or filiform. The associations between corneal lesions, CCME findings and microfilaremia are shown. CONCLUSIONS: We describe M ozzardi microfilariae in the cornea and the associated eye pathology. Further studies using ocular tissue PCR and other imaging techniques would be helpful.

Evaluation of collaborative strategies for ecotourism and recreational activities in natural parks of Rio de Janeiro / Avaliação de estratégias colaborativas para atividades ecoturísticas e recreativas em parques ecológicos do Rio de Janeiro

Na cidade do Rio de Janeiro, as agências gestoras de unidades de conservação ambiental do tipo parque vêm tentando atingir cinco objetivos principais estabelecidos pelo Sistema Nacional de Unidades de Conservação Ambiental (SNUC), adotando diretrizes de gestão participativa para essas unidades. Dois desses objetivos referem-se ao desenvolvimento de atividades recreativas que envolvem o contato com a natureza e o ecoturismo. Este artigo apresenta as análises e conclusões relativas à implementação de estratégias de colaboração com empresas para atingir tais objetivos. Ele é parte de um conjunto de pesquisas mais amplo. Foram realizados estudos de caso em oito parques, por meio de dezenas de entrevistas com gestores e outros atores sociais interessados, assim como pesquisa documental e observação direta. Os resultados sugerem que o objetivo ecoturístico está longe de ser alcançado e que as estratégias colaborativas utilizadas são insuficientes para contrabalançar as limitações organizacionais, materiais e humanas que sobrecarregam essas agências. Com base na amostra, concluiu-se também que os três poderes de governo envolvidos na gestão dos parques carecem de uma visão estratégica, no sentido de considerar o ecoturismo nas unidades de conservação da cidade como um meio poderoso de incentivar o desenvolvimento local sustentável.

In the city of Rio de Janeiro, the management agencies of environmental conservation units of the park type have been attempting to meet five primary objectives set by the National System for Conservation Units (NSCU), using participatory management guidelines for these units. Two of these objectives relate to the development of recreation activities that involve contact with nature and ecological tourism. This article presents the analyses and conclusions regarding the implementation of collaborative strategies with businesses to achieve such objectives; it is part of a series of research studies having a broader scope. Case studies were conducted in eight parks by means of dozens of interviews with managers and other interested social actors, as well as by documentary research and direct observation. The results suggest that the ecotourism objective is still far from being reached, and that the collaborative strategies used are not sufficient to compensate for the organizational, material and human limitations that encumber these agencies. It was also concluded for the sample that there lacks a strategic vision on the part of the three branches of government involved in the management of these parks in the sense of viewing ecotourism in the city's conservation units as a powerful means to foster local sustainable development.

Ética, sustentabilidade e sociedade: desafios da nossa era / Ethics, sustainability and society: challenges of our age

Ética, sustentabilidade e sociedade: desafios da nossa era reúne estudos de diferentes áreas do conhecimento – Filosofia, Administração, Geografia – que tem em comum o foco nas grandes questões éticas de nosso tempo, desde as imediatas que mais afligem os brasileiros, como a corrupção no meio político, às relacionadas ao futuro, como a crise ambiental planetária. Entre a constante violação à ética na política brasileira e o desafio de sobrevivência do planeta, variados temas são discutidos. De um lado, as empresas, pressionadas por mudanças sociais e cobranças institucionais, são levadas a adotar códigos de ética e normas de conduta que, se não implicam garantia de adoção de comportamentos éticos, por outro lado, sinalizam nessa direção. Um dos aspectos em que o comportamento empresarial é forçado a mudanças é no da governança corporativa, e o livro se debruça sobre esse tema. Os pesquisadores também se defrontam com outras vertentes comportamentais em que mudanças se fazem necessárias, como as relacionadas ao ambiente e ao consumo sustentável. Os artigos aqui reunidos certamente contribuirão para o avanço das reflexões sobre ética e sustentabilidade nos negócios e nas suas relações com a sociedade.

Piroxicam-supositório na terapêutica da osteoartrose do joelho / Piroxicam-suppository in the therapeutics of osteoarthrosis of the knee

Em investigaçäo aberta, näo comparativa, avaliou-se a eficácia e a tolerabilidade do piroxicam, administrado por via retal, sob a forma de supositório de 20 mg (dose única, noturna), no tratamento de 30 pacientes com osteoartrose sintomática de joelho. As análises dos parâmetros subjetivos e objetivos, já na 2ª semana de tratamento, mostraram uma melhora estatisticamente significativa. A "qualidade de vida" (avaliaçäo do paciente) melhorou em 24 casos (80%), enquanto a avaliaçäo global, realizada pelo médico, foi considerada excelente ou boa em 22 pacientes (73.4%). Reaçöes adversas ocorreram em 6 pacientes (20%); foram geralmente transitórias e leves, sendo que em apenas um paciente (3.3%) foi necessário interromper a planificaçäo terapêutica. Assim, acredita-se ser o piroxicam muito eficaz por esta via de administraçäo, com boa tolerabilidade, constituindo-se numa opçäo terapêutica em enfermos portadores de osteoartrose