Morphofunctional evaluation of peripapillary retinoschisis associated with myopic posterior staphyloma and hyaloid traction: does it cause peripapillary vitreoretinal traction? / Avaliação morfofuncional da retinosquise peripapilar associada ao estafloma posterior miópico e à tração hialoidea: isso causa tração vitreo-retiniana peripapilar?

ABSTRACT This case report presents the details of a 33-year-old female patient who was referred to a specialized retina service because of mild vision loss in her right eye). The patient's visual acuity was 20/25 in right eye and 20/50 in the left eye (; amblyopic); the spherical equivalent was -12.75 diopters (right eye) and -14.75 diopters (left eye). Multimodal retinal imaging showed peripapillary schisis in both the inner and outer retinal layers, grade II posterior vitreous detachment, and a tessellated fundus. Using Humphrey perimetry and MP-3 microperimetry, the functional evaluation indicated macular sensitivity within normal limits and decreased sensitivity in the peripapillary region, especially in right eye. The pattern-re versal visual evoked potential was measured. The N75 and P100 latency and amplitude in right eye were within normal values for checks of 1º. However, the amplitude was low for checks of 15′. Highly myopic patients who have posterior staphyloma that involves the optic nerve are susceptible to posterior hyaloid traction, and the resulting peripapillary vitreous traction may compromise vision.

RESUMO Este relato de caso apresenta um paciente feminino de 33 anos encaminhado para um serviço especializado de retina devido à leve perda de visão em olho direito. A acuidade visual foi de 20/25 no olho direito e 20/50 no olho esquerdo, o equivalente esférico foi de -12,75 dioptrias e -14,75 dioptrias, respectivamente. Avaliações multimodais revelaram isquese peripapilar nas camadas internas e externas da retina, descolamento vítreo posterior grau II e fundo tesselado. Avaliação funcional com perimetria Humphrey e microperimetria MP-3 revelaram sensibilidade macular normais e diminuição da sensibilidade na região peripapilar, especialmente no olho direito. Potencial visual evocado de padrão reverso apresentou no olho direito latência e amplitude N75 e P100 dentro dos valores normais para verificação de 1º. Entretanto, a amplitude foi baixa para a de 15′. Pacientes alto míopes com esfiloma posterior envolvendo o nervo óptico são suscetíveis à tração da hialoide posterior. Portanto a tração vitreopapilar resultante pode causar comprometimento da visão.

Therapeutic effects of orthokeratology lens combined with 0.01% atropine eye drops on juvenile myopia / Efeitos terapêuticos da lente de ortoceratologia combinados com colírio atropina 0,01% em miopia juvenil

ABSTRACT Purpose: To explore the therapeutic effects of orthokeratology lens combined with 0.01% atropine eye drops on juvenile myopia. Methods: A total of 340 patients with juvenile myopia (340 eyes) treated from 2018 to December 2020 were divided into the control group (170 cases with 170 eyes, orthokeratology lens) and observation group (170 cases with 170 eyes, orthokeratology lens combined with 0.01% atropine eye drops). The best-corrected distance visual acuity, best-corrected near visual acuity, diopter, axial length, amplitude of accommodation, bright pupil diameter, dark pupil diameter, tear-film lipid layer thickness, and tear break-up time were measured before treatment and after 1 year of treatment. The incidence of adverse reactions was observed. Results: Compared with the values before treatment, the spherical equivalent degree was significantly improved by 0.22 (0.06, 0.55) D and 0.40 (0.15, 0.72) D in the observation and control groups after the treatment, respectively (p<0.01). After the treatment, the axial length was significantly increased by (0.15 ± 0.12) mm and (0.24 ± 0.11) mm in the observation and control groups, respectively, (p<0.01). After the treatment, the amplitude of accommodation significantly declined in the observation group and was lower than that in the control group, whereas both bright and dark pupil diameters significantly increase and were larger than those in the control group (p<0.01). After the treatment, the tear-film lipid layer thickness and tear break-up time significantly declined in the two groups (p<0.01). Conclusions: Orthokeratology lens combined with 0.01% atropine eye drops can synergistically enhance the control effect on juvenile myopia with high safety.

RESUMO Objetivo: Explorar os efeitos terapêuticos das lentes de ortoceratologia combinados com colírio atropina 0,01% em miopia juvenil. Métodos: Um total de 340 pacientes com miopia juvenil (340 olhos) tratados entre 2018 e Dezembro de 2020 foram divididos em Grupo Controle (170 casos com 170 olhos, lentes de ortoceratologia) e Grupo Observação (170 casos com 170 olhos, lentes de ortoceratologia combinadas com colírio atropina 0,01%). A acuidade visual melhor corrigida para longe, acuidade visual melhor corrigida para perto, dioptria, comprimento axial, amplitude de acomodação, diâmetro da pupila brilhante, diâmetro da pupila escura, espessura da camada lipídica da película lacrimal e tempo de ruptura do rasgo foram medidos antes do tratamento e 1 ano depois. A incidência de reações adversas foi observada. Resultados: Antes do tratamento, o grau esférico equivalente foi significativamente melhorado em 0,22 (0,06, 0,55) D e 0,40 (0,15, 0,72) D respectivamente no Grupo Observação e no Grupo Controle após o tratamento (p<0,01). Após tratamento, o comprimento axial foi significativamente aumentado em (0,15 ± 0,12) mm e (0,24 ± 0,11) mm respectivamente nos Grupos Observação e controle (p<0,01), enquanto, no grupo de observação, a amplitude de acomodação diminuiu significativamente e foi inferior a do Grupo Controle, e o diâmetro da pupila brilhante e o diâmetro da pupila escura aumentaram significativamente e foram maiores do que os do Grupo Controle (p<0,01). A espessura da camada lipídica da película lacrimal e o tempo de ruptura do rasgo diminuíram significativamente nos dois grupos (p<0,01) após o tratamento. Conclusões: As lentes de ortoceratologia combinadas com colírio atropina 0,01% podem melhorar significativamente o efeito controle em miopia juvenil com elevada segurança.

Actualización sobre el tratamiento óptico en niños miopes

La miopía constituye un problema de salud pública a nivel mundial, y se espera que afecte a un número cada vez mayor de personas en las próximas décadas. El control de la progresión de este defecto refractivo se ha convertido en una parte importante de la práctica clínica, ante la ausencia de un tratamiento protocolizado con el objetivo de disminuirla, se han valorado varias opciones terapéuticas. El objetivo del estudio fue proporcionar información actualizada sobre el tratamiento óptico en niños miopes. Para su realización se revisaron publicaciones, en idioma español e inglés, disponibles en bases de datos como PubMed, Ebsco, Google Académico, SciELO entre otras.

Myopia constitutes a worldwide public health problem, and is expected to affect an increasing number of people in the coming decades. The control of the progression of this refractive defect has become an important part of clinical practice, and in the absence of a protocolized treatment with the aim of reducing it, several therapeutic options have been evaluated. The aim of the study was to provide updated information on optical treatment in myopic children. For its realization, publications were reviewed, in Spanish and English, available in databases such as PubMed, Ebsco, Google Scholar, SciELO, among others.

Assessment of the biometric modifications of the eye in LASIK during suction.

PURPOSE: To study the biometric modifications of the eyeball during suction in Laser assisted in Situ Keratomileusis (LASIK). METHODS: Observational and cross-sectional study. We studied 43 patients who underwent surgery for myopia and myopic astigmatism. Mean age was 38.3 ±â€¯11.5 years, and 19 were female (44.2%). Conventional LASIK surgery with a manual microkeratome was performed. Before and during the suction maneuvre the following parameters were measured using an 11 Mhz biometric probe: aqueous depth (AQD), lens thickness (LT), vitreous cavity length (VCL) and axial length (AXL). Paired t-test was used to compare the biometric measurements before and during suction. RESULTS: The mean spherical equivalent refractive error was -4.5 ±â€¯2.3 diopters. During suction, the AQD did not change significantly (p = 0.231). However, AXL and VCL increased by 0.12 mm and 0.22 mm respectively (p = 0.039 and <0.01) and LT decreased by 0.20 mm (p < 0.01). AXL increased in 42% of the eyes and decreased in 16%, VCL increased in 70% of the eyes and decreased in 9%, and the LT was reduced in 67% of the eyes. CONCLUSIONS: Suction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe, mainly a decrease in LT and an increase in VCL and AXL. Therefore, these modifications are expected to produce minimal anatomic alterations.

Femtosecond laser-assisted laser in situ keratomileusis for the correction of high myopia in Meesmann corneal dystrophy: a case report / Femto-LASIK para correção de alta miopia na distrofa corneana de Meesmann: relato de caso

ABSTRACT The patient was a 26-year-old woman who had manifest refraction and uncorrected and corrected distance visual acuities of -7.00 × -4.50 at 175°, 20/400, and 20/25, respectively, in the right eye, and -3.25 × -5.25 at 179°, 20/200, and 20/25, respectively, in the left eye. In the right and left eyes, the mean corneal thicknesses were 733 and 749 µm, and the maximum epithelial thicknesses were 70 and 68 µm, respectively. Myriads of intraepithelial cysts were observed in the slit-lamp examination. At 30 months after femtosecond laser-assisted laser in situ keratomileusis (femto-LASIK), the manifest refraction and uncorrected and corrected distance visual acuities were respectively 0.00 × -1.25 at 55°, 20/25, and 20/20 in right eye, and 0.00 × -0.50 at 135°, 20/20, and 20/20 in the left eye. In this case of Meesmann dystrophy, myopia was successfully treated with thick flap femto-LASIK without complications or ectasia.

RESUMO A paciente era uma mulher de 26 anos com refração manifesta, acuidade visual para longe não corrigida e corrigida de -7,00 × -4,50 a175°, 20/400 e 20/25 no olho direito e -3,25 × -5,25 a 179°, 20/200 e 20/25 no olho esquerdo. A espessura média da córnea foi de 733 e 749 µm, e a espessura epitelial máxima foi de 70 e 68 µm, respectivamente no olho direito e no esquerdo. Inúmeros cistos intraepiteliais foram observados no exame com lâmpada de fenda. Trinta meses após o femto-LASIK, a refração manifesta, a acuidade visual para longe não corrigida e corrigida eram respectivamente de 0,00 × -1,25 a 55°, 20/25 e 20/20 no olho direito e 0,00 × -0,50 a 135°, 20/20 e 20/20 no olho esquerdo. Neste caso de distrofia de Meesmann, a miopia foi tratada com sucesso com femto-LASIK de retalho espesso sem complicações ou ectasia.

Perspectiva social del impacto de la miopía / Social perspective of the impact of myopia

La visión, el más dominante de los sentidos, tiene un papel esencial en cada aspecto y etapa de la vida. Se da por sentada la visión, pero sin ella, resulta difícil la realización de tareas cotidianas como aprender a caminar, leer, conducir y trabajar. La miopía es una alteración visual que se encuentra entre las cinco condiciones, donde su atención clínica ha sido calificada de prioridad inmediata para la Organización Mundial de la Salud. La prevalencia de la miopía y la miopía magna aumentan a nivel mundial a un ritmo alarmante. Existen diversos factores socioeconómicos, psicológicos y sociales que impactan en la calidad de vida de quienes la padecen. De ahí la motivación de realizar un acercamiento a dichas variables para comprender desde una perspectiva social las implicaciones de esta afección visual mediante una búsqueda actualizada de diversos artículos publicados, con el objetivo de identificar los problemas sociales relacionados a la miopía. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

The vision, the dominantest in the senses, has an essential paper in each aspect and stage of the life. It is given by sitting the vision, but without her, it is difficult the realization of daily tasks as learning how to walk, to read, to drive and to work. The myopia is a visual alteration that is between the five conditions where its clinical attention it has been described as immediate priority for the World Organization of the Health. The prevalencia of the myopia and the great myopia increase at world level to an alarming rhythm. Diverse socioeconomic, psychological and social factors that impact in the quality of life of who you/they suffer it, exist of there the motivation of carrying out an approach to this variables to understand from a social perspective the implications of this visual affection by means of a modernized search of diverse published articles, with the objective of identifying the social problems related to the myopia. The platform Infomed was used, specifically the Virtual Library of Health, with all its searchers(AU)

Impacto de la COVID-19 en la progresión de la miopía en niños / Impact of COVID-19 on myopia progression in children

Introducción: La Organización Mundial de la Salud considera a la miopía un problema de salud mundial debido a su prevalencia creciente. Se espera que afecte al 52 % de la población mundial en 2050. Objetivo: Determinar la progresión de la miopía durante la pandemia de COVID-19 con respecto al período previo al confinamiento. Métodos: Se realizó un estudio descriptivo y ambispectivo de una serie de 12 pacientes atendidos en la Consulta de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" antes de la pandemia y que acudieron en el período de confinamiento por la COVID-19 para su seguimiento. Las variables evaluadas fueron edad, género, antecedentes patológicos familiares de miopía, horas pantalla, equivalente esférico y biometría. Resultados: El promedio de edad fue de 9,7 años y el 58,3 por ciento correspondió al sexo femenino. El 75 por ciento de los pacientes tenían antecedentes patológicos familiares de miopía y el tiempo estimado frente a pantalla fue de 5,3 ± 0,8 h diarias. La media de la biometría se incrementó en el tiempo de 23 mm en 2019 a 25,5 mm en 2021. La diferencia de la media del equivalente esférico previo a la COVID-19 fue -0,89 y -0,84 para ojo derecho y el ojo izquierdo, respectivamente. En la etapa epidémica se percibió un aumento hasta -1,97 y -1,72. Conclusiones: El incremento del uso de los medios digitales debido al confinamiento ha causado la progresión de la miopía(AU)

Introduction: Myopia is considered a global health problem by the World Health Organization due to its increasing prevalence and is expected to affect 52 percent of the world's population by 2050. Objective: To determine the progression of myopia during the COVID-19 pandemic with respect to the pre-confinement period. Methods: A descriptive and ambispective study of a series of 12 patients treated at the Pediatric Ophthalmology Clinic of the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" before the pandemic and who visited the hospital during the COVID-19 confinement period for follow-up, was carried out. The variables evaluated were age, gender, family history of myopia, screen hours, spherical equivalent and biometry. Results: The average age was 9.7 years and 58.3 percent of the patients were females. Seventy-five percent of the patients had a family history of myopia and the estimated time in front of the screen was 5.3 ± 0.8 h per day. The medium biometry increased over time from 23 mm in 2019 to 25.5 mm in 2021. The difference in medium pre-COVID-19 spherical equivalent was -0.89 and -0.84 for right eye and left eye, respectively. In the epidemic stage, an increase to -1.97 and -1.72 was perceived. Conclusions: Increased use of digital media due to confinement has caused myopia progression(AU)

Ultrabiomicroscopía ultrasónica y estabilidad de la lente intraocular en pacientes con miopía axial sometidos a cirugía de facoemulsificación.

PURPOSE: To evaluate the stability and the refractive error of the different intraocular lens (IOL) after cataract surgery. METHOD: Retrospective, observational and single-center study. Patients diagnosed with cataract and myopia who underwent a phacoemulsification surgery with intraocular lens placement without complications were included. All patients underwent a complete ophthalmological examination, ultrasound biomicroscopy was performed at 2 weeks, 1 and 3 months after surgery. Descriptive statistics were performed using measures of central tendency and comparative analyzes. A value of p < 0.05 was considered significant. RESULTS: Thirty-one subjects with a diagnosis of axial myopia and senile cataract were included, 20 women (64.5%) and 11 men (35.5%), with a mean age was 62.8 ± 13.14 years. The IOL displacement were not different for the upper, lower, temporal and nasal quadrants; however, we observed a tendency to inclination to the temporal sector (p = 0.054) between the first and third postoperative month. Therefore, the were no significant differences in spherical equivalent between groups postoperatively. CONCLUSIONS: The inclination of the IOL did not change over time after surgery, the changes were similar with the different three types of IOL.

OBJETIVO: Evaluar la estabilidad y el desplazamiento de diferentes lentes intraoculares (LIO) a los 3 meses y los cambios refractivos asociados después de la facoemulsificación. MÉTODO: Estudio retrospectivo, observacional y unicéntrico. Se revisaron expedientes de pacientes sometidos a cirugía de facoemulsificación con colocación de LIO. Se realizó un examen oftalmológico completo, ultrabiomicroscopía a las 2 semanas, 1 y 3 meses después de la cirugía. Se realizó estadística descriptiva y análisis comparativos. Se tomó como diferencia significativa un valor de p < 0.05. RESULTADOS: Se incluyeron 31 ojos con diagnóstico de miopía y catarata senil, 20 mujeres (64.5%) y 11 hombres (35.5%), con una edad media de 62.8 ± 13.14 años. En cuanto al desplazamiento de la LIO, no se observaron diferencias significativas para los cuadrantes superior, inferior, temporal y nasal. Se observa una tendencia hacia temporal (p = 0.054) entre el primer y el tercer mes posoperatorios. El equivalente esférico tampoco mostró diferencias. CONCLUSIONES: El desplazamiento de la LIO no cambió con el tiempo después de la facoemulsificación. Los cambios fueron similares con los tres diferentes tipos de LIO y al compararlos proporcionan estabilidad refractiva en pacientes miopes.

State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain.

OBJECTIVES: To analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. METHOD: This is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residualrefraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. RESULTS: A sample of 140 eyes was obtained from 140 patients with a mean age of 31.35 ± 7.28 years. Mean preoperative SEQ was -6.33 ± 3.69D, mean CDVA was 0.96 ± 0.16, ACD was 3.30 ± 0.29 mm, WTW 12.02 ± 0.40 mm, CCT 535.03 ± 37.68 µm, ECD 2684.37 ± 313.74 cels/mm2 and IOP 14.84 ± 2.59 mmHg. 66.4% of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of -7.81 ± 4.09D and a mean cylinder of 2.27 ± 1.23D. 5.7% of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04 ± 0.27D. 48.92% of the implanted lenses were of size 13.2 mm, with the remaining 36.69, 10.79 and 3.60% being of sizes 12.6, 12.1 and 13.7 mm, respectively. At one month after surgery a residual SEQ of -0.01 ± 0.31D was obtained. The efficacy and safety indices were 1.06 ± 0.18 and 1.10 ± 0.19, respectively. The mean central vault was 508.80 ± 201.04 µm. The accuracy between the calculated SEQ and the obtained SEQ was 99.3% for spherical lenses and 88.2% for Cyl correction. The mean ECD at 1 month after surgery was 2805.53±273.30céls/mm2, which was a difference from preoperative of 0.11% (p = 0.922), similarly, the mean IOP was 13.98 ± 2.57 mmHg, which was a difference of -0.92 ± 2.80 mmHg. CONCLUSIONS: ICL phakic lens surgery is an effective, safe and predictable procedure. There were no significant changes in endothelial cell count or intraocular pressure measurement one month after surgery.

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.

Resultados sensoriales y motores en pacientes miopes tratados con técnicas de superficies / Sensory and Motor Outcomes in Myopic Patients Treated with Surface Techniques

Objetivo: Evaluar los resultados sensoriales y motores poscirugía refractiva con técnicas de superficie (LASEK-MMC o PRK-MMC) en pacientes miopes con o sin astigmatismo asociado. Método: Se realizó estudio experimental controlado aleatorizado abierto, en el cual fueron incluidos 160 pacientes (320 ojos), de ellos tratados con LASEK-MMC (80 pacientes) y con PRK-MMC (80 pacientes), seguidos por 3 meses. Las principales variables evaluadas fueron: edad, tipo de error refractivo, equivalente esférico, ángulo Kappa, anisometropía, estereopsis, punto próximo de convergencia y su anomalía, amplitud de convergencia y de divergencia (cerca y lejos) y magnitud de la desviación del alineamiento ocular. Resultados: El grupo tratado con PRK-MMC tenía edad media de 26,48 años ± 4,47 y equivalente esférico preoperatorio de -3,27 ±1,54 que disminuyó significativamente (p <0,05) a -0,04 ± 0,23 dioptrías (D) a los tres meses de la cirugía. El grupo tratado con LASEK-MMC tenía edad media de 26,31 años ± 4,86 y equivalente esférico preoperatorio de -3,34 ± 1,66 dioptrías (D) que disminuyó significativamente (p <0,05) a -0,06 ± 0,26 D a los tres meses de la cirugía. Además, disminuyó la anisometropía, mejoró la estereopsis y disminuyó la amplitud la amplitud de convergencia y divergencia para lejos. El alineamiento ocular también mejoró. Conclusiones: Las técnicas de superficies para tratar pacientes con miopía o astigmatismo miópico compuesto disminuyen la anisometropía, mejoran la estereopsis y disminuyen la amplitud de convergencia y divergencia para lejos, con mayor proporción de pacientes con ortoforia después de la operación(AU)

Purpose : To evaluate sensory and motor outcomes after refractive surgery with surface techniques (LASEK-MMC or PRK-MMC) in myopic patients with or without associated astigmatism. Methods : An open randomized controlled experimental study was performed, in which 160 patients (320 eyes) were included, treated with LASEK-MMC (80 patients) and with PRK-MMC (80 patients), followed up during 3 months. The main variables evaluated were: age, type of refractive error, spherical equivalent, Kappa angle, anisometropia, stereopsis, near convergence point and its anomaly, convergence and divergence amplitude (near and far) and magnitude of ocular alignment deviation. Results : The group treated with PRK-MMC had an average age of 26.48 years ± 4.47 and preoperative spherical equivalent of -3.27 ± 1.54 which decreased significantly (p < 0.05) to -0.04 ± 0.23 diopters (D) three months after surgery. The LASEK-MMC treated group had an average age of 26.31 years ± 4.86 and preoperative spherical equivalent of -3.34 ± 1.66 diopters (D) which decreased significantly (p < 0.05) to -0.06 ± 0.26 D three months after surgery. In addition, anisometropia decreased, stereopsis improved, Kappa angle increased, and convergence and divergence amplitude (for far) decreased; ocular alignment also improved. Conclusions : Surface techniques to treat patients with myopia or compound myopic astigmatism decrease anisometropia, improve stereopsis, increase Kappa angle, and decrease near point anomaly and convergence and divergence amplitude (for far), with higher proportion of patients with orthophoria postoperatively(AU)

Errores refractarios en estudiantes de medicina en un hospital docente / Refractory errors in medical students in a Teaching Hospital

Los errores de refracción contribuyen como un gran problema de salud pública. Las crecientes tasas de prevalencia de la miopía han alcanzado los niveles de epidemia en varias áreas. Este estudio tuvo como objetivo determinar las tasas de prevalencia de errores de refracción en los estudiantes de medicina. Se realizó un estudio prospectivo en el Departamento de Oftalmología, durante un período de un año desde enero de 2020 hasta diciembre de 2020. Los estudiantes de medicina fueron seleccionados al azar, como un total de 250 sujetos. Todos se sometieron a un examen oftálmico. De 250 estudiantes, se documentaron 148 (59.2%) casos de RE. La mayoría de los casos comunes eran mujeres (89, 60.1%), mientras que los hombres eran (59, 39.9%). De estos, 98 estudiantes tienen miopía (66.2%), 42 casos tienen astigmatismo (28.4%) y 8 casos tienen hipermetropía (5.4%). La etapa tardía de las clases (sexto) tiene los casos RE más frecuentes. La miopía fue la RE predominante entre los estudiantes de medicina. La clase anticipada y la mujer son factores predisponentes.

Refractive errors are contributing as a major public health problem. The increasing prevalence rates of myopia have reaching to epidemic levels in several areas. This study was aimed to determine the prevalence rates of refractive errors in medical students. A prospective study was conducted in the Department of Ophthalmology, over a period of one year from Jan 2020 to Dec 2020. Medical students were randomly selected, as a total of 250 subjects. All were undergoing an ophthalmic examination. Of 250 students, 148(59.2%) cases of RE were documented. Most common cases were female (89, 60.1%), whereas male was (59, 39.9%). Of these, 98 students have myopia (66.2%), 42 cases have astigmatism (28.4%) and 8 cases have hypermetropia (5.4%). The late stage of classes (6th) has the most frequent RE cases. Myopia was the predominant RE among the medical students. Advance class and female are predisposing factors

Un estudio de prevalencia de error de refracción en niños entrecerrados (6-12 años) asistiendo al Hospital Dr. Aso-Eye Shahed / A study of Prevalence of Refractive Error in Squinted children (6-12 years) attending shahed Dr. Aso-Eye Hospital

Determinar la prevalencia del error de refracción (RE) como causa en los ojos en los niños en niños de esta edad (6-12 años) en la ciudad de Sulaimania. El estudio de tasa de prevalencia entre los pacientes que asisten al Shahed Dr. Aso Eye Hospital para el período del 1 de octubre de 2008 al 1 de junio de 2009. Un total de 116 niños (6-12 años) asisten al departamento de entrecerrares durante aproximadamente 8 meses. El estudio incluyó ambos sexos, eran niños de 55 años y niñas 61. Se sometieron a un examen ocular completo. Encontramos que (72) pacientes (62.02 %) tenían un error de refracción, incluyen: 33 pacientes (45.9 %) = hipermetropia (H); 22 pacientes (29.16%) = miopía [m]; 18 pacientes (24.3%) astigmatismo (AST.); 4 mixtos; 6 h-as. y 8 m-as. En conclusiones, la causa más frecuente del entrecerrar de la infancia a este ancho [6-12 años) es el error refractivo, mientras que las otras causas en su conjunto constituyen solo 1/3 de las causas, y el error de refracción más común es la hipermetropía

To determine the prevalence of refractive error (RE) as a cause in squinted in children in this aged (6-12 years) in Sulaimania city. The prevalence rate study among patient attending Shahed Dr. Aso eye hospital for the period from 1st October 2008 - 1st June 2009. A total of 116 children ( 6-12 years) attending squint department for about 8 months. The study included both sexes, were boys 55 and girls 61. Underwent full ocular examination. We found that (72) patients (62.02%) had refractive error, include: 33 patients (45.9 %) = Hypermetropia (H); 22 patients (29.16%) = Myopia [M]; 18 patients (24.3%) Astigmatism (Ast.); 4 mixed; 6 H-Ast. and 8 M-Ast. In conclusions, the most prevalent cause of childhood squint at this aged [6-12 years) is refractive error while the other causes as a whole constitute only 1/3 of the causes, and most common refractive error is hypermetropia

Alertas en salud sobre el uso de los dispositivos electrónicos y su impacto en el bienestar visual / Health alerts on the use of electronic devices and their impact on visual well-being

Introducción: El incremento del empleo de los dispositivos electrónicos en las actividades de estudio, trabajo, entretenimiento e interacción social desde las plataformas digitales deriva numerosos riesgos y causas de problemas visuales y defectos refractivos. La prevalencia de estos puede conllevar a considerarlos como problemas de salud a nivel global. Objetivo: Describir los riesgos y las repercusiones del uso excesivo de los dispositivos electrónicos en la salud visual a cualquier edad. Métodos: El método de revisión bibliográfica y la sistematización de resultados investigativos de diversos autores posibilitan identificar los riesgos y la repercusión del uso excesivo de los dispositivos electrónicos sobre la salud visual, así como las recomendaciones para afrontar esa realidad. Resultados: La sistematización permite demostrar cómo incide el uso de los dispositivos electrónicos en la elevada prevalencia de trastornos oculares y visuales, como el síndrome visual informático y la miopía en la población mundial actualmente. Conclusiones: Entre los riesgos y las repercusiones del uso excesivo de los dispositivos electrónicos sobre la salud visual, señalados por varios autores, se describieron factores ópticos y ambientales que inciden en la aparición de trastornos como la visión tubular, el síndrome visual informático, además de los defectos refractivos como la miopía, considerados problemas de salud a nivel global en la actualidad(AU)

Introduction: The increase in the use of electronic devices in study, work, entertainment and social interaction activities from digital platforms derives numerous risks and causes of visual problems and refractive defects. The prevalence of these can lead to consider them as global health problems. Objective: To describe the risks and repercussions of excessive use of electronic devices on visual health to prevent eye problems at any age. Methods: The bibliographic review method and the systematization of research results from various authors make it possible to identify the risks and repercussions of the excessive use of electronic devices on visual health, as well as the recommendations to face this reality. Results: The systematization allows us to demonstrate how the use of electronic devices affects the high prevalence of eye and visual disorders, such as computer vision syndrome and myopia in the world population today. Conclusions: The excessive use of electronic devices has caused visual problems and refractive errors globally. An act of responsibility is imposed to inform and raise awareness about the damage to eye health and its harmful effects(AU)

Surgical outcomes of acquired acute comitant esotropia. Causes and classification.

PURPOSE: To study the results of surgical treatment of acquired concomitant esotropia and its posible causes. METHODS: Retrospective study of the patients with acute acquired esotropia that were operated on since 2017. Distance and near horizontal deviation, spherical equivalent and the excessive use of the tablets and smartphones were analyzed. A good sensorial outcome was considered when stereopsis was recovered and good motor outcome if horizontal deviation was ≤10 prism diopters at the end of the follow-up. RESULTS: A total of 15 cases were included (60% women), mean age: 29.07 years (86.66% ≥16 years). Mean time since the beginning of the symptoms to the surgery was 23.3 months. Mean horizontal preoperative deviation was 19.73 ± 7.2 pd at near and 22.93 ± 7.3 dp at distance decreasing to 3.33 ± 3.8 pd at near and 3.86 ± 3.9 pd at distance (P < .001). The 66.6% had diplopía. The 46.66% had decompensated esophoria or microesotropia, 86,66 % myopia and the 33.33% referred excesive use of the tablets and smartphones. The medial rectus recession were done in 10 cases. A good motor outcome was obtained in the 93.33% of the cases and sensorial outcome in the 53.3% without diplopía. CONCLUSION: Surgery was an excellent treatment to resolve the deviation and diplopia. The esophorias and microesotropias represented near the half of the cases and the excesive use of the tablets and smartphones were the third part of the sample. Most of the patients had myopia.

Modified superior inverted internal limiting membrane flap technique with vitrectomy versus vitrectomy with internal limiting membrane peeling for retinal detachment with myopic macular hole.

PURPOSE: To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. METHODS: Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. RESULTS: There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (p=0.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (p=0.62). CONCLUSIONS: ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.

Anisometropía y estereopsis en cirugía fotoablativa en pacientes miopes / Anisometropia and Stereopsis in Myopic Patients Treated with Photoablative Surgery

Objetivo: Relacionar la anisometropía con la estereopsis en pacientes miopes con o sin astigmatismo asociado poscirugía refractiva corneal con láser de excímero (LASEK-MMC o PRK-MMC). Método: Se realizó un estudio preexperimental del tipo antes y después, en el que fueron incluidos 81 pacientes (162 ojos) tratados con LASEK-MMC (65 pacientes) o PRK-MMC (16 pacientes) seguidos por tres meses, en el servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer (ICORPF), en el periodo comprendido entre enero de 2018 a enero del 2019. Las variables estudiadas fueron anisometropía, diferencia de longitudes axiles, así como la estereopsis. Resultados: La edad promedio fue de 24,7 ± 3,7 años en el grupo tratados con LASEK-MMC y 24,1 ± 3,1 años en los tratados con PRK-MMC. El 100 por ciento de los pacientes tenían un astigmatismo miópico compuesto, en ambos ojos. El 47,7 por ciento de los pacientes operados con LASEK-MMC, presentaba anisometropía previo a la operación, mientras que 4 pacientes la presentaron después (6,2 por ciento) (p = 0,000). El 31,3 por ciento de los pacientes tratados con PRK-MMC, estaba afectado previo a la cirugía y ese porcentaje disminuyó más de 5 veces después de la cirugía (p = 0,000). Con la cirugía la estereopsis mejoró en particular cuando no existieron antecedentes de anisometropía. Conclusiones: Los pacientes tratados con PRK-MMC y con LASEK-MMC experimentan una disminución d la anisometropía y una mejoría de estereopsis(AU)

Objective: To relate anisometropia to stereopsis in myopic patients with or without associated astigmatism after excimer laser corneal refractive surgery (laser-assisted subepithelial keratectomy [LASEK] or photorefractive keratectomy [PRK], with intraoperative application of mitomycin-C [MMC]). Methods: A preexperimental, before-and-after study was carried out with 81 patients (162 eyes) treated with LASEK-MMC (65 patients) or PRK-MMC (16 patients) and followed for three months, in the refractive surgery service of Ramón Pando Ferrer Cuban Institute of Ophthalmology, in the period from January 2018 to January 2019. The variables studied were anisometropia, axial length difference, apart from stereopsis. Results: The average age was 24.7±3.7 years in the group treated with LASEKMMC and 24.1±3.1 years among the patients treated with PRK-MMC. 100 percent of the patients had compound myopic astigmatism in both eyes. Anisometropia was present in 47.7 percent of LASEK-MMC patients before the surgery, while four patients had anisometropia after the surgery (6.2 percent) (P=0.000). Of the patients treated with PRK-MMC, 31.3 percent were affected before surgery; this percentage decreased more than five times after surgery (P=0.000). Surgery improved stereopsis, particularly when there was no history of anisometropia. Conclusions: Patients treated with PRK-MMC and LASEK-MMC experience decreased anisometropia and improved stereopsis(AU)

Alteraciones estructurales y funcionales en pacientes con ambliopía / Structural and Functional Alterations in Patients with Amblyopia

Objetivo: Determinar los resultados motores post cirugía refractiva corneal con láser de excímero en pacientes miopes con o sin astigmatismo asociado. Método: Se realizó un estudio preexperimental del tipo antes y después, en el que fueron incluidos 81 pacientes (162 ojos) tratados con LASEK-MMC (65 pacientes) o PRK-MMC (16 pacientes) seguidos por tres meses. Se les realizó un examen oftalmológico completo y se evaluaron las siguientes variables: punto próximo de convergencia, la amplitud de convergencia, divergencia y el alineamiento ocular precirugía y poscirugía. Resultados: Con la cirugía se observó un incremento significativo del punto próximo de convergencia (LASEK-MMC: p = 0,000 y PRK-MMC: p = 0,021). La amplitud de convergencia de cerca y de lejos, así como la amplitud de divergencia tendieron a disminuir, pero la diferencia no fue significativa (p > 0,05). Aumentó el porcentaje de pacientes con exodesviaciones de cerca, después de la cirugía LASEK-MMC (26,2 por ciento → 60,0 por ciento, p = 0,000) y de la PRK-MMC (18,8 por ciento → 81,3 por ciento, p = 0,000), y predominaron las heteroforias pequeñas en ambos casos (LASEK-MMC: 52,3 por ciento y PRK-MMC: 75,0 por ciento). Conclusiones: Con la cirugía fotoablativa con láser, aumentaron las exodesviaciones en el posoperatorio, pero se trató fundamentalmente de heteroforias pequeñas, aunque un número reducido de pacientes desarrolló nuevas exodesviaciones(AU)

Objective: To determine the motor results after corneal refractive surgery with excimer laser in myopic patients with or without associated astigmatism. Method: A pre-experimental study of the before and after type was carried out, in 81 patients (162 eyes) treated with LASEK-MMC (65 patients) or PRK-MMC (16 patients) followed up for three months. A complete ophthalmological examination was performed and the variables were evaluated near point of convergence, amplitude of convergence, divergence, and pre-surgery and postsurgery ocular alignment. Results: A significant increase in the near point of convergence was observed with surgery (LASEK-MMC: p = 0.000 and PRK-MMC: p = 0.021). The amplitude of convergence near and far, as well as the amplitude of divergence tended to decrease, but the difference was not significant (p > 0.05). The percentage of patients with near exodeviations increased after LASEK-MMC surgery (26.2 percent → 60.0 percent, p = 0.000) and PRK-MMC (18.8 percent → 81.3 percent, p = 0.000), and small heterophoria predominated in both cases (LASEK-MMC: 52.3 percent and PRK-MMC: 75.0 percent). Conclusions: The laser photoablative surgery increased postoperative exodeviations, but they were mainly small heterophoria, although a small number of patients developed new exodeviations(AU)

Horas pantallas y miopía en niños / Screen Hours and Myopia in Children

La masificación del Internet y comunicación móvil, así como el mayor acceso a herramientas digitales y de dispositivos electrónicos ha modificado la calidad de vida y salud de la población mundial, con un impacto especialmente importante en los niños. El uso desmedido de pantallas constituye un problema en esta población por su impacto en el sedentarismo, sobrepeso, alteraciones en el comportamiento, trastornos depresivos y del sueño, pero también por el efecto que tiene sobre el sistema visual en desarrollo: predispone a síndrome de ojo seco, a un exceso de acomodación-convergencia, provoca un desenfoque hipermetrópico de la fóvea (se cree que esto estimula el crecimiento axial), aumenta la tensión del cuerpo ciliar y músculos extraoculares, además de los efectos nocivos de la luz azul-violeta para las estructuras intraoculares. Estudios sugieren que los niños son más propensos a desarrollar miopía por estar menos expuestos a la luz natural y pasar más tiempo en ambientes cerrados ante pantallas, muchos incluso han demostrado una asociación entre el uso de pantallas, el trabajo cercano y la presencia de miopía, pero no existen datos concluyentes que aíslen un riesgo independiente. A partir de esta revisión se concluye que la prevalencia de la miopía está aumentando con base en una etiología multifactorial(AU)

The massification of the Internet and mobile communication, as well as increased access to digital tools and electronic devices, have changed the quality of life and health of the world's population, with a particularly important impact on children. The excessive use of screens is a problem among this population because of its impact on sedentary lifestyles, overweight, behavioral alterations, depressive and sleep disorders; but also because of its effect on the developing visual system, since it predisposes to dry eye syndrome, excessive accommodation-convergence, causes hypermetropic defocus at the fovea (this is believed to stimulate axial growth), increases the tension of the ciliary body and extraocular muscles, in addition to the harmful effects of blue-violet light on intraocular structures. Studies suggest that children are more prone to developing myopia because they are less exposed to natural light and spend more time in indoor environments in front of screens; many studies have even shown an association between the use of screens, close-eye work and the presence of myopia, but there are no conclusive data that isolate an independent risk. From this review, the prevalence of myopia is concluded to be increasing based on a multifactorial etiology(AU)

Resultados motores en cirugía fotoablativa en pacientes miopes / Motor Outcomes of Photoablative Surgery in Myopic Patients

Objetivo: Determinar los resultados motores post cirugía refractiva corneal con láser de excímero en pacientes miopes con o sin astigmatismo asociado. Método: Se realizó un estudio preexperimental del tipo antes y después, en el que fueron incluidos 81 pacientes (162 ojos) tratados con LASEK-MMC (65 pacientes) o PRK-MMC (16 pacientes) seguidos por tres meses. Se les realizó un examen oftalmológico completo y se evaluaron las siguientes variables: punto próximo de convergencia, la amplitud de convergencia, divergencia y el alineamiento ocular precirugía y poscirugía. Resultados: Con la cirugía se observó un incremento significativo del punto próximo de convergencia (LASEK-MMC: p = 0,000 y PRK-MMC: p = 0,021). La amplitud de convergencia de cerca y de lejos, así como la amplitud de divergencia tendieron a disminuir, pero la diferencia no fue significativa (p > 0,05). Aumentó el porcentaje de pacientes con exodesviaciones de cerca, después de la cirugía LASEK-MMC (26,2 por ciento → 60,0 por ciento, p = 0,000) y de la PRK-MMC (18,8 por ciento → 81,3 por ciento, p = 0,000), y predominaron las heteroforias pequeñas en ambos casos (LASEK-MMC: 52,3 por ciento y PRK-MMC: 75,0 por ciento). Conclusiones: Con la cirugía fotoablativa con láser, aumentaron las exodesviaciones en el posoperatorio, pero se trató fundamentalmente de heteroforias pequeñas, aunque un número reducido de pacientes desarrolló nuevas exodesviaciones(AU)

Objective: To determine the eye movement outcomes after excimer laser corneal refractive surgery in myopic patients with or without associated astigmatism. Methods: A preexperimental, before-and-after study was carried out with 81 patients (162 eyes) treated with laser-assisted subepithelial keratectomy (LASEK) (65 patients) or photorefractive keratectomy (PRK) (16), with intraoperative application of mitomycin-C (MMC) in both cases, and followed for three months. A complete ophthalmologic examination was performed and the following variables were evaluated before and after the surgery: near convergence point, convergence amplitude, divergence and ocular alignment. Results: With surgery, a significant increase in the near point of convergence was observed (LASEK-MMC: P=0.000; PRK-MMC: P=0.021). The near and far convergence amplitude tended to decrease, but the difference was not significant (P > 0.05). The percentage of patients with near exodeviations increased after LASEK-MMC (26.2 percent → 60.0 percent, P=0.000) and PRK-MMC (18.8 percent → 81.3 percent, P=0.000), while small heterophorias predominated in both cases (LASEK-MMC: 52.3 percent and PRK-MMC: 75.0 percent). Conclusions: With laser photoablative surgery, exodeviations increased after surgery, but these were primarily small heterophorias, although a small number of patients developed new exodeviations(AU)