Características clínico-oftalmológicas y evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social, Paraguay / Clinical-ophthalmological characteristics and evolution of patients with moderately severe active thyroid ophthalmopathy treated with methylprednisolone boluses who attended the Central Hospital of the Instituto de Previsión Social, Paraguay

Introducción: La oftalmopatía tiroidea (OT) es un trastorno debilitante en pacientes con enfermedad tiroidea autoinmune, principalmente enfermedad de Graves, que se desarrolla entre el 30 a 50% de los casos. Objetivos: Describir las características clínico-oftalmológicas y la evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social en el tiempo comprendido entre enero de 2018 y setiembre de 2021. Materiales y métodos: Investigación de diseño observacional, con estudio descriptivo, retrospectivo. Resultados: Se revisaron fichas de 34 pacientes con OT activa moderada severa que recibieron bolos de metilprednisolona basado en las guías EUGOGO 2016, de los cuáles se excluyeron 3 pacientes por tener fichas incompletas y otros 3 pacientes ya que requirieron tratamiento de segunda línea previo al término del esquema de 12 sesiones. De los 28 pacientes estudiados, la edad promedio fue de 43,6 ±13,1 años, el 89% de sexo femenino y el 28,5%, fumadores. En cuanto a la función tiroidea de la población previo al tratamiento, se constató hipertiroidismo en el 82%, hipotiroidismo en el 11% y eutiroidismo en el 7%; y posterior al tratamiento, se constató hipertiroidismo en el 78,6% (subclínico), eutiroidismo en el 17,9% e hipotiroidismo en el 3,5%. La mayoría (92.6%) contaba con anticuerpos contra el receptor de TSH positivo, con un promedio de 18 ± 9,9 mIU/Ml. Respecto a la actividad de la oftalmopatía según la escala CAS, se constató un promedio de 4,1 ±1,0 previo al tratamiento y posterior 1,2 ±1,4; de ellos el 46,4% presentó un estado leve según escala de gravedad, 39% sin criterios de gravedad y 14 % persistió en moderada -severa. Se constató mejoría de la agudeza visual tras el tratamiento (57,1%), el promedio de exoftalmía previo al tratamiento fue 22,2 mm y posterior 21,1 mm; se presentó diplopía en el 7,1% previo al tratamiento y en el 3,6% posterior al tratamiento. Conclusión: El tratamiento con glucocorticoides endovenosos en la oftalmopatía de Graves moderada-severa (esquema EUGOGO 2016) fue muy efectivo, revirtiendo la actividad y consecuentemente ayudando a disminuir la gravedad, en la gran mayoría de nuestros pacientes. Esto podría explicarse porque la oftalmopatía era incipiente y por el alto grado de adherencia de los pacientes en el contexto de un manejo multidisciplinar bien protocolizado.

Introduction: Graves' orbitopathy (GO) is a debilitating disorder in patients with autoimmune thyroid disease, mainly Graves' disease, which develops in 30 to 50% of cases. Objectives: To describe the clinical-ophthalmological characteristics and evolution of patients with moderate-to- severe active GO treated with methylprednisolone boluses who attended the Central Hospital of the Institute of Social Security between January 2018 and September 2021. Materials and methods: Observational design research, descriptive, retrospective study. Results: Records of 34 patients with active moderate-to-severe GO who received boluses of methylprednisolone based on the EUGOGO 2016 guidelines, were reviewed, of which 3 patients were excluded due to having incomplete records and another 3 patients since they required second-line treatment prior to end the 12-session scheme. Of the 28 patients studied, the average age was 43.6 ±13.1 years, 89% were female and 28.5% were smokers. Regarding the thyroid function of the population prior to treatment, hyperthyroidism was found in 82%, hypothyroidism in 11% and euthyroidism in 7%; and after treatment, hyperthyroidism was found in 78.6% (subclinical), euthyroidism in 17.9% and hypothyroidism in 3.5%. The majority (92.6%) had positive thyrotropin receptor antibodies, with an average of 18 ± 9.9 mIU/Ml. Regarding the activity of orbitopathy according to the CAS scale, an average of 4.1 ±1.0 was found before treatment and 1.2 ±1.4 after; Of them, 46.4% presented a mild condition according to the severity scale, 39% without severity criteria and 14% persisted in moderate-severe. Improvement in visual acuity was noted after treatment (57.1%), the average exophthalmia before treatment was 22.2 mm and after 21.1 mm; Diplopia occurred in 7.1% before treatment and in 3.6% after treatment. Conclusion: Treatment with intravenous glucocorticoids in moderate-severe Graves' orbitopathy (EUGOGO 2016 scheme) was very effective, reversing the activity and consequently helping to reduce the severity, in the vast majority of our patients. This could be explained because the orbitopathy was incipient and by the high degree of patient adherence in the context of well-protocolized multidisciplinary management.

O que os olhos não veem a microcirurgia ensina: modelo de treinamento oftalmológico com olho de boi / What the eye cannot see, microsurgery teaches: a model of ophthalmological training with a bull's eye

RESUMO Objetivo Descrever e validar um modelo oftalmológico para treinamento de transplante e microssutura de córnea utilizando globo ocular bovino. Métodos Para a montagem do modelo de treinamento, o globo ocular foi disposto sob o campo cirúrgico, apoiado sobre um recipiente plástico cilíndrico comum de 3,5cm de diâmetro, para a retirada da córnea. Foi realizada uma incisão circular superficial, e, posteriormente, uma tesoura Castroviejo curva de 9 cm foi utilizada para remoção completa da córnea, que foi recolocada em sua posição original, para que, em seguida, fossem confeccionados nove pontos equidistantes, usando fio de nylon 10-0. Por fim, foram avaliados os seguintes critérios: tempo de realização das suturas; evolução do tempo e da qualidade a cada teste; e destreza e aperfeiçoamento da realização das suturas. Resultados O modelo descrito demonstrou-se viável e adequado para o treinamento de microssuturas na córnea, possibilitando aperfeiçoamento e ganho de habilidades cirúrgicas. Conclusão O modelo de treinamento microcirúrgico apresentado possui alta viabilidade para a simulação de cirurgias oftalmológicas e textura semelhante à do olho humano real, o que o torna próximo à realidade.

ABSTRACT Objective To describe and validate an ophthalmic model for corneal transplantation and micro suture training using a bovine eyeball as a model. Methods For the training model, the eyeball was placed under the sanitary field placed on the ends of a common 3.5cm diameter cylindrical plastic container for corneal removal. A superficial circular incision was made, then 9cm curved Castroviejo scissors were used for complete corneal removal. The cornea was replaced in its original position, and 10-0 nylon thread was used to perform the sutures, with 9 equidistant stitches. Finally, the following criteria were evaluated: suturing time, time and quality progression in each attempt, dexterity and suturing improvement. Results The described model proved to be feasible and suitable for corneal micro suture training, allowing improvement and gain of dexterity in the sport. Conclusion The presented microsurgical training model has a high feasibility for the simulation of ophthalmic surgeries, in addition to a texture similar to the real human eye, which makes it close to reality.

Evaluación del impacto de la especialidad Oftalmología en el desarrollo docente de sus egresados / Assessment of the impact of the Ophthalmology specialty on the teaching development of its graduates

Fundamento: la evaluación del impacto en el contexto de la educación superior es el proceso mediante el cual se valoran los cambios que ocurren en el egresado por influencia del programa, un tiempo después de aplicadas las acciones formativas. Objetivo: evaluar el impacto de la especialidad Oftalmología en el desarrollo docente de sus egresados en la Facultad de Ciencias Médicas "Mariana Grajales Coello" de Holguín. Métodos: se realizó un estudio de evaluación con enfoque mixto y de corte transversal en el campo del posgrado académico, en el período enero 2021-junio 2022. Se aplicaron métodos teóricos y empírico: cuestionario para obtener información sobre la percepción de los egresados respecto al impacto de la especialidad en su preparación docente. El procesamiento incluyó análisis de frecuencias relativas, índice de posición, la correlación elemento escala y el índice de Cronbach para la confiabilidad. Resultados: las subdimensiones aportes al dominio de las categorías de la didáctica, preparación en el trabajo metodológico, preparación en la organización y dirección del trabajo docente calificaron de Alto el impacto de la especialidad en la preparación docente de los egresados. Además, hubo 47 % de participación en la ejecución de actividades docentes de pregrado y posgrado después de haber cursado la especialidad. Conclusiones: la percepción de los egresados evidenció el alto impacto de la especialidad Oftalmología en su preparación docente, componente esencial en la educación médica para la calidad del proceso docente educativo.

Background: impact evaluation in the context of higher education is the process through which the changes that occur in the graduate due to the influence of the program are assessed, sometime after the training actions have been applied. Objective: to assess the impact of the Ophthalmology specialty on the teaching development of its graduates at "Mariana Grajales Coello" Faculty of Medical Sciences in Holguín. Methods: an evaluation study was carried out with a mixed and cross-sectional approach in the field of academic postgraduate studies, from January 2021 toJune 2022. Theoretical and empirical methods were applied: questionnaire to obtain information on the perception of graduates regarding the impact of the specialty on their teaching preparation. The processing included analysis of relative frequencies, position index, scale element correlation and Cronbach's index for reliability. Results: the sub dimensions contributions to the mastery of the categories of didactics, preparation in methodological work, preparation in the organization and direction of teaching work rated the impact of the specialty on the teaching preparation of graduates as High. In addition, there was 47% participation in the execution of undergraduate and graduate teaching activities after having completed the specialty. Conclusions: the perception of the graduates evidenced the high impact of the Ophthalmology specialty on their teaching preparation, an essential component in medical education for the quality of the educational teaching process.

Sistema de acciones educativas para la evaluación integral del residente de Oftalmología / System of educational actions for the comprehensive evaluation of the Ophthalmology resident

Fundamento: el sistema de evaluación es un componente importante del proceso enseñanza aprendizaje del Programa de Formación de las Especialidades Médicas. Objetivo: elaborar un sistema de acciones educativas para contribuir a la evaluación integral del residente de Oftalmología. Métodos: se realizó una investigación cualitativa en el Centro Oftalmológico de Villa Clara, en el período septiembre 2019-octubre 2021. Se emplearon métodos teóricos: análisis-síntesis, inductivo-deductivo, histórico-lógico y enfoque sistémico; empíricos: análisis documental, cuestionario y entrevista; matemáticos: frecuencias absolutas y relativas. Resultados: la totalidad de los docentes consideró importante fomentar la formación de valores, principios éticos y morales en los residentes. El 95 % no supieron argumentar las relaciones que se establecen entre el acápite I de aspectos generales de la tarjeta de evaluación y los demás componentes del proceso enseñanza aprendizaje; la mayoría confunden los métodos y medios con las formas de organización de la enseñanza; solo dos residentes tienen dominio de los aspectos que contempla el plan de estudio de la especialidad y todos tienen escasa percepción de la importancia del acápite I de la tarjeta de evaluación, por lo que se elaboró un sistema de acciones educativas teniendo en cuenta los objetivos, contenidos y métodos educativos para solucionar las carencias encontradas. Conclusiones: el diagnóstico realizado logró la identificación de insuficiencias y potencialidades en la evaluación integral del residente y su concreción en el acápite I de la tarjeta de evaluación; las acciones fueron valoradas satisfactoriamente por los especialistas consultados, quienes sugirieron aspectos que fueron adicionados al producto final.

Background: the evaluation system is an important component of the teaching-learning process of the Training Program for Medical Specialties. Objective: to develop a system of educational actions to contribute to the comprehensive evaluation of the Ophthalmology resident. Methods: a qualitative research was carried out at the Villa Clara Ophthalmological Center, from September 2019 to October 2021. Theoretical methods were used: analysis-synthesis, inductive-deductive, historical-logical and systemic approach; empirical ones: documentary analysis, questionnaire and interview; mathematics: absolute and relative values. Results: all the teachers considered it important to promote the formation of values, ethical and moral principles in the residents. 95% did not know how to argue the relationships established between section I of general aspects of the evaluation card and the other components of the teaching-learning process; most confuse the methods and teaching aids with the forms of organization of teaching; only two residents have mastery of the aspects contemplated in the study plan of the specialty and all have little perception of the importance of section I of the evaluation card, for which a system of educational actions was developed taking into account the objectives, content and educational methods to solve the deficiencies found. Conclusions: the diagnosis made achieved the identification of insufficiencies and potentialities in the comprehensive evaluation of the resident and its concretion in section I of the evaluation card; the actions were satisfactorily valued by the specialists consulted, who suggested aspects that were added to the final product.

The effect of the COVID-19 pandemic on procedures performed by fellows of the Vitreo-Retina Training Program at the Philippine General Hospital

BACKGROUND@#The COVID-19 pandemic has affected ophthalmology training. The Vitreo-Retina Training Program extended the training periods of its trainees in anticipation of a drop in surgical cases during the pandemic to make up for the expected drop.@*OBJECTIVE@#This study aimed to determine the effect of the COVID-19 pandemic on the Vitreo-Retinal Fellowship Program at the Philippine General Hospital (PGH), specifically the number of procedures performed by the Vitreo-Retina Fellows before and during the pandemic and their compliance with the Vitreo-Retina Society of the Philippines (VRSP) standards.@*METHODOLOGY@#This is a document review of vitreo-retinal procedures done at the Department of Ophthalmology and Visual Sciences of the PGH from January 1, 2017, to December 31, 2021.@*RESULT@#During the COVID-19 pandemic in 2020, there was a drop in the number of procedures performed by both the first year and second year vitreo-retina fellows. Despite the drop in numbers, the first year vitreo- retina fellows were still in compliance with the VRSP-recommended number of procedures. The second year vitreo-retina fellows, on the other hand, were not able to comply with the recommended numbers by the VRSP. The extension year allowed the second year fellows to do more procedures and comply with the recommended numbers of pars plana vitrectomy only.@*CONCLUSION@#There was a drop in the vitreo-retinal procedures during the COVID-19 pandemic. The second- year fellows were the most affected with the decrease in the number of surgical cases.

Assessment of fellowship programs in the Department of Ophthalmology and Visual Sciences, Philippine General Hospital

Objective@#The purpose of this study was to describe the perceptions and satisfaction of the graduates and trainees of the fellowship programs of the Philippine General Hospital - Department of Ophthalmology and Visual Sciences (PGH DOVS). @*Methods@#A uniform survey was conducted among all graduates and ongoing trainees of the External Disease and Cornea, Medical and Surgical Vitreo-Retina, Glaucoma, Orbit and Oculoplastics, and Pediatric Ophthalmology and Strabismus fellowship programs. The survey link was emailed to all the participants.@*Results@#Response rate was 74%. Majority of graduates were clustered in the National Capital Region (NCR) (56.4%), and Luzon excluding NCR (46.4%). Majority of the graduates perceived that the objectives of their fellowship program were met (60%). Overall, 65.4% of the fellows assessed their training as completely adequate. Strengths identified were volume of patients, level of independence, and consultant supervision. Weaknesses identified were the lack of specialized instruments, lack of inter-department exposures, and difficulties in the conduct of research.@*Conclusion@#Majority were satisfied with their training and would recommend their training program to others despite the difficulties and deficiencies identified. Some of the perceived weaknesses observed by the graduates have been addressed since their graduation from their program. This is the first attempt to assess post-residency fellowship programs in ophthalmology in the Philippines.

Level of doctors’ satisfaction in ophthalmology telemedicine at the Philippine General Hospital

Objectives@#This quantitative, cross-sectional, descriptive research aims to determine the level of satisfaction of doctors using telemedicine in Ophthalmology.@*Methods@#An online questionnaire was sent to ophthalmologists at the Philippine General Hospital, a tertiary referral center, that partially shifted to ophthalmology telemedicine during the COVID-19 pandemic.@*Results@#Respondents perceived telemedicine positively in terms of usefulness (Mean 2.92, Slightly Satisfied), ability to do quick follow-ups and patient updates (Mean 2.90, Slightly Satisfied), simplicity, and ease of use of technology (Mean 2.78, Slightly Satisfied). They were least satisfied with its effectiveness (Mean 2.37, Slightly Dissatisfied).@*Conclusion@#Ophthalmologists expressed only slight satisfaction with telemedicine. The telemedicine platform was simple and useful for end-users, but some aspects may be improved based on questionnaire results.

Impact of the COVID-19 pandemic on ophthalmology training in the Philippines: A nationwide cross-sectional study among trainees

Objective@#This study was designed to assess the impact of the COVID-19 pandemic on ophthalmology training from the perspective of ophthalmology residents and fellows in the Philippines. @*Methods@#A 55-item online survey on the COVID-19 pandemic’s impact on ophthalmology training was sent to 168 ophthalmologists-in-training from March 15, 2021 to April 19, 2021. Participants from all ophthalmology training programs in the Philippines were selected via random sampling and proportional allocation.@*Results@#A total of 158 ophthalmologists-in-training (138 residents and 20 fellows) completed the survey. The areas of ophthalmology training that were found to be most disrupted during the COVID-19 pandemic were surgical training (95%), clinical activity (94%), and in-person interaction with consultants in the out-patient department (94%) and operating room (85%). In contrast, trainees found an increase in didactic teaching activities (75%) and research activities (39%). Overall, 78% of the trainees felt that the pandemic had a negative impact on their ophthalmology training. The aspects which were most frequently found to be negatively impacted by the pandemic were mental health (70%), followed by technical skills (69%), and clinical skills (61%). No major differences were found on the impact of COVID-19 on training when compared across year levels and across institutions compared by location (National Capital Region vs. non-National Capital Region) and funding type (government vs. private funding). Ninety-nine percent (99%) of institutions shifted most of their didactic teaching activities to online platforms. Surgical video conferences and simulator training or skills labs were thought to be helpful to surgical training by 89% and 81% of the trainees, respectively. Majority of trainees attended to patients via telemedicine averaging 40% of their clinic consults. However, only 16% reported confidence in handling their patients through telemedicine.@*Conclusion@#The COVID-19 pandemic has had an overall negative impact on ophthalmology training in the Philippines. It caused significant disruption in trainees' clinical and surgical activities, and affected their mental health. Despite this, the situation provided an opportunity to boost trainees' theoretical knowledge. Majority are receptive to new technology-based learning tools to preserve the effectiveness of their training. Efforts to re-evaluate current training programs are needed to ensure sustainability and quality of ophthalmology training in the Philippines.

Satisfaction of the ophthalmology residents with online progress test / Satisfação dos residentes de oftalmologia com testes de progresso online

ABSTRACT Objective To investigate if there is knowledge improvement over the Residency years, as well as students' satisfaction about progress test. Finally, to describe the implementation of the online progress test in some Ophthalmological Residency programs in Brazil. Methods It was an observational cross-section study. The participants were all Ophthalmology residents who accepted to join the study. They did an online test and answered demographic and satisfaction questionnaires. Results Two hundred and fifty-nine residents joined the study. 42,86% of the residents answered the demographic questionnaire and 6,95% answered the satisfaction questionnaire. In general, the residents approved the website as a tool for self-learning and to improve residency programs. Conclusion Over the years, the residents acquired knowledge during the residency program. In general, residents were satisfied with the test. The implementation of the online progress test system in the Ophthalmological Residency schools in Brazil was successful.

RESUMO Objetivo Avaliar se ocorre melhora do desempenho na prova dos residentes ao longo dos anos de curso e o grau de satisfação dos residentes com o teste de progresso. Além disso, descrever a implementação do teste de progresso em alguns serviços de residência em oftalmologia no Brasil. Métodos Estudo observacional prospectivo. Os participantes foram todos os residentes de Oftalmologia que aceitaram participar do estudo. Eles fizeram um teste online e responderam a um questionário pessoal e um de satisfação. Resultados Duzentos e cinquenta e nove residentes participaram do estudo. 42,86% dos residentes responderam o questionário pessoal e 6,95% responderam o questionário de satisfação. Em geral, os residentes aprovaram o site como instrumento de autoaprendizado e como instrumento para melhoria dos programas de residência. Conclusão Houve aquisição de conhecimento dos residentes ao longo do curso. De um modo geral, os residentes ficaram satisfeitos com o teste. A implementação do teste de progresso nos serviços de residência de Oftalmologia foi bem-sucedida.

Lente multifocal de tres piezas con captura de la óptica, como manejo de ruptura de la cápsula posterior en paciente sometida a cirugía facorrefractiva / Three-piece multifocal intraocular lens with optic capture as management of posterior capsule rupture in a patient undergoing refractive lens exchange

Se presenta el caso de una paciente sometida a cirugía facorrefractiva que sufre una ruptura de la cápsula posterior en la cirugía del primer ojo. Ante la imposibilidad de usar un lente trifocal de una pieza como inicialmente se tenía planteado, se realiza implante de lente multifocal de tres piezas en el sulcus con captura pupilar. Se reportan las imágenes de Scheimpflug y de retroiluminación del lente de tres piezas de un ojo y el lente de una pieza del ojo contralatera

We present the case of a female patient who suffered a posterior capsule rupture while undergoing refractive lens exchange. In view of the impossibility of using a single piece intraocular lens as was initially planned, a three-piece multifocal intraocular lens with an optic capture was positioned. Scheimpflug and retro-illumination images are presented.

El teléfono inteligente en la obtención de imágenes en oftalmología y su aplicación en el aprendizaje / The Smartphone in Ophthalmology Imaging and its Application in Learning

La imagen es parte de la columna vertebral en la medicina y que llega a su máximo punto en la Oftalmología. La importancia de la fotografía ocular va desde registrar condiciones médicas específicas, rastrear la progresión de enfermedades y crear ilustraciones para la publicación y la enseñanza; en resumen, una herramienta indispensable para el diagnóstico. Los aditamentos que en la presente publicación mostramos, son el resultado de una investigación de desarrollo que se realizó en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", durante el año 2021 con el objetivo de crear aditamentos que, acoplados a los teléfonos inteligentes, permiten tomar imágenes en el área de la Oftalmología utilizando la tecnología de impresión 3D. Inicialmente se identificaron los lugares que permitan crear imágenes en la especialidad con un aditamento y el teléfono inteligente, posteriormente se procederá a diseñar los aditamentos de acuerdo a las características del lugar donde se van a utilizar y finalmente mostramos la utilidad de los prototipos diseñados en la práctica docente(AU)

Imaging is part of the backbone in medicine and it reaches its peak in Ophthalmology. The importance of ocular photography ranges from recording specific medical conditions, tracking disease progression, and creating illustrations for publication and teaching; in short, an indispensable tool for diagnosis. The attachments, which we show in the present publication, are the result of a development research that was carried out at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" during the year 2021 with the aim of creating attachments that, coupled to smartphones, allow taking images in the area of Ophthalmology using 3D printing technology. Initially we identified the places that allow creating images in the specialty with an attachment and the smartphone, then we will proceed to design the attachments according to the characteristics of the place where they will be used and finally we show the usefulness of the designed prototypes in the teaching practice(AU)

Conjunctivitis epidemiological profile in an ophthalmological service in the metropolitan region of Fortaleza - Ceará ­ Brazil / Perfil epidemiológico da conjuntivite em um serviço oftalmológico na região metropolitana de Fortaleza - Ceará ­ Brasil

Objective: to evaluate the seasonal and endemic characteristics of conjunctivitis at the ophthalmology service of the Leiria de Andrade Foundation (FLA) in the last ten years to trace the epidemiological profile of conjunctivitis in Fortaleza - CE. Methods: this was a descriptive and epidemiological study based on quantitative and qualitative analysis, retrospectively, from January to December 2012 to 2019, with a projection for the years 2020 and 2021. Results: 107,778 medical records were analysed, with endemic and seasonal fluctuation, being the months of October to December more frequent in the intervals of the highest incidence of the disease. Two peaks were notorious, one with epidemic characteristics, from July 2013 to November 2014, and the other with outbreak characteristics, probably due to a national-level epidemic, between January and April 2018. The most affected age group was between 19 and 59 years, covering about 72% of cases, with no statistical difference between genders. Conclusion: according to the study data, it was possible to infer that the epidemiological scenario of Fortaleza - CE is in line with the literature regarding age range and sex. The endemicity of the disease reinforces its relevance in the scenario of the Unified Health System (SUS) of the region.

Objetivo: avaliar as características sazonais e endêmicas da conjuntivite no serviço de oftalmologia da Fundação Leiria de Andrade (FLA) nos últimos 10 anos, a fim de traçar o perfil epidemiológico da conjuntivite em Fortaleza - CE. Métodos: estudo descritivo e epidemiológico, com base em análise quantitativa e qualitativa, retrospectivamente, de janeiro a dezembro de 2012 a 2019, com projeção para os anos de 2020 e 2021. Resultados: foram analisados 107.778 prontuários, com variação endêmica e sazonal, estando os meses de outubro a dezembro com maior frequência dentro dos intervalos de maior incidência da doença. Notaram-se dois picos, um com características epidêmicas, de julho de 2013 a novembro de 2014, e outro com características de surto, provavelmente decorrente de uma epidemia de nível nacional entre janeiro e abril de 2018. A faixa etária mais afetada foi entre 19 e 59 anos, compreendendo cerca de 72% dos casos, sem diferença estatística entre os gêneros. Conclusão: de acordo com os dados do estudo, foi possível inferir que o cenário epidemiológico de Fortaleza - CE está de acordo com a literatura quanto à faixa etária e ao sexo. A endemicidade da doença reforça sua pesquisa no cenário do Sistema Único de Saúde (SUS) da região

Manejo del desprendimiento de retina regmatógeno / Management of rhegmatogenous retinal detachment

1. INTRODUCCIÓN El desprendimiento de retina es un problema visual grave que puede ocurrir a cualquier edad, aunque suele darse en individuos de edad media o en personas de la tercera edad. La incidencia es relativamente baja considerando que las estima-ciones varían según zonas geográficas; y, se han reportado datos de entre 6,3 y 17,9 por 100 000 habitantes. Otras características im-portantes a considerar son la degeneración en encaje de 45,75% y la miopía de 47,28% que influyen en la presentación del desprendi-miento de retina. Al mismo tiempo que la edad, los cambios vítreos retinianos y la presencia de pseudofaquia1,2. Además, de los factores oculares relacionados también influyen, el seguimiento inadecuado de los factores de riesgo y el difícil acceso a médicos especialistas que se traduce en retraso en el diagnóstico certero y tratamiento tardío que implica deterioro del pronóstico visual cuando el área macular está incluida en el área desprendida con pobres resultados en adultos jóvenes y en edad productiva.El tratamiento evitará el deterioro o pérdida irreversible de la visión. El pronóstico con tratamiento quirúrgico es bueno si el des-prendimiento no incluye a la mácula.

1. INTRODUCTIONRetinal Detachment is a serious visual problem that can occur at any age, although it usually occurs in middle-aged or elderly in-dividuals. The incidence is relatively low considering that estimates vary ac-cording to geographical areas; and, data have been reported be-tween 6,3 and 17,9 per 100 000 inhabitants. Other important cha-racteristics to consider are socket degeneration of 45,75% and myopia of 47,28% that influence the presentation of retinal deta-chment, as well as age, vitreoretinal changes and the presence of pseudophakia1,2.In addition to the related ocular factors, inadequate follow-up of risk factors and difficult access to medical specialists also play a role, resulting in delayed accurate diagnosis and late treatment that implies deterioration of the visual prognosis when the macular area is included in the detached area with poor results in young adults and those of productive age.Treatment will prevent irreversible deterioration or loss of vision. The prognosis with surgical treatment is good if the detachment does not include the macula.

Etiología de baja visión y ceguera en siete centros de referencia en Colombia entre los años 2012 a 2017 / Etiology of low vision and blindness in seven reference centers in Colombia between the years 2012 to 2017

Introducción: La baja visión y la ceguera tienen alta prevalencia mundial, siendo categorías de discapacidad frecuentes en Colombia. Se requieren estudios que caractericen la etiología de las deficiencias visuales permanentes. Objetivo: Identificar y caracterizar las diferentes causas de baja visión y ceguera en siete centros de referencia para la población con discapacidad visual en Colombia, atendida entre los años 2012 a 2017 en seis ciudades capitales. Materiales y métodos:Estudio retrospectivo, serie de casos, descriptivo y multicéntrico.Resultados: Se contó con una muestra de 879 registros de pacientes con discapacidad visual. El 70% (612/879) con baja visión y 30% (267/879) con ceguera. Para todos los grupos de edad es más prevalente la baja visión. La etiología más frecuente en pacientes con baja visión fue la degeneración macular asociada a la edad (DMAE) (24%, 144/612); en pacientes con ceguera fue el glaucoma (17%, 45/267). Discusión: Posiblemente en Colombia las causas de baja visión y ceguera van más allá de las cataratas, errores de refracción no corregidos y ceguera infecciosa. Discusión: Las etiologías más frecuentes encontradas son condiciones oculares crónicas y diversas, que requieren intervenciones específicas para disminuir su prevalencia y prevenir casos de baja visión y ceguera.

Introduction: Low vision and blindness have high global prevalence, with categories of disability common in Colombia. Studies that characterize the etiology of permanent visual impairments are required. Objective:To identify and characterize the different causes of low vision and blindness in seven reference centers for the visually impaired population in Colombia, attended between 2012 and 2017 in six capital cities. Materials and Methods:Retrospective, case series, descriptive and multicenter study. Results: A sample of 879 records of visually impaired patients was available. Low vision is more prevalent for all age groups. 70% (612/879) low vision and 30% (267/879) blindness. The most common etiology in patients with low vision was age-related macular degeneration (DMAE) (24%, 144/612); in patients with blindness it was glaucoma (17%, 45/267). Discussions: Possibly in Colombia the causes of low vision and blindness go beyond cataracts, un corrected refractive errors and infectious blindness. Conclusions: The most common etiologies found are chronic and diverse eye conditions, which require specific interventions to decrease their prevalence and prevent cases of low vision and blindness.

Introdução: Baixa visão e cegueira têm alta prevalência global, com categorias de incapacidade comuns na Colômbia. São necessários estudos que caracterizem a etiologia das deficiências visuais permanentes. Objetivo: Identificar e caracterizar as diferentes causas de baixa visão e cegueira em sete centros de referência para a população deficiente visual na Colômbia, atendidos entre 2012 e 2017 em seis capitais. Materiais e Métodos: Estudo retrospectivo, série de casos, descritivo e multicêntrico. Resultados: Uma amostra de 879 registros de pacientes com deficiência visual estava disponível. 54% (478/879) homens. A baixa visão é mais prevalente para todas as faixas etárias. 70% (612/879) baixa visão e 30% (267/879) cegueira. A etiologia mais comum em pacientes com baixa visão foi a degeneração macular relacionada à idade (DMAE) (24%, 144/612); em pacientes com cegueira foi glaucoma (17%, 45/267).Discussão: Possivelmente na Colômbia as causas da baixa visão e cegueira vão além da catarata, erros refrativos não corrigidos e cegueira infecciosa. Conclusões: As etiologias mais comuns encontradas são condições oculares crônicas e diversas, que requerem intervenções específicas para diminuir sua prevalência e prevenir casos de baixa visão e cegueira

Aplicações da manufatura aditiva em oftalmologia / Applications of additive manufacturing in ophthalmology

RESUMO A manufatura aditiva, mais popularmente conhecida como impressão tridimensional, baseia-se no desenvolvimento de um objeto com a ajuda de um software de desenho assistido por computador seguido de sua impressão por meio da deposição de uma matéria-prima, camada por camada, para a construção do produto desejado. Existem vários tipos de técnicas de impressão tridimensional, e o tipo de processo de impressão escolhido depende da aplicação específica do objeto a ser desenvolvido, dos materiais a serem utilizados e da resolução necessária à impressão do produto final. A impressão tridimensional abriu perspectivas na pesquisa e revolucionou o campo das ciências da saúde, com a possibilidade de criação e de desenvolvimento de produtos personalizados de maneira rápida, econômica e de forma mais centralizada do que no processo de manufatura tradicional. As tecnologias de manufatura aditiva remodelaram os diagnósticos médicos; as medidas preventivas e pré-operatórias; o tratamento e a reabilitação, assim como os processos de engenharia de tecidos nos últimos anos. Na oftalmologia, as aplicações da impressão tridimensional são extensas. Modelos anatômicos para aplicação na área da educação e planejamentos cirúrgicos, desenvolvimento de implantes, lentes, equipamentos para diagnósticos, novas aplicações terapêuticas e desenvolvimento de tecidos oculares já estão em desenvolvimento. Por possuir um campo amplo e ser alvo de pesquisa constante, a área oftalmológica permite que a manufatura aditiva ainda seja amplamente utilizada a favor dos médicos e dos pacientes.

ABSTRACT Additive manufacturing, more popularly known as three-dimensional (3D) printing, is based on the development of an object with the help of computer-aided design software followed by its printing through the deposition of a material, layer by layer, to create the desired product. There are several types of 3D printing techniques and the type of printing process chosen depends on the specific application of the object to be developed, the materials to be used, and the resolution required to print the final product. 3D printing has brought new perspectives to research and revolutionized the field of health sciences, with the possibility of creating and developing customized products in a faster, more economical, and more centralized way than in the traditional manufacturing process. Additive manufacturing technologies have reformulated medical diagnostics, preventive, preoperative, treatment, and rehabilitation, as well as tissue engineering processes in recent years. In ophthalmology, the applications of 3D printing are extensive. Anatomical models for application in education and surgical planning, development of implants, lenses, diagnostic equipment, new therapeutic applications, and development of ocular tissues (3D bioprinting) are already under development. As it has a wide field and is the subject of constant research, the ophthalmic area allows additive manufacturing to still be widely used in favor of doctors and patients.

Three-dimensional printing of orbital computed tomography scan images for use in ophthalmology teaching / Impressão tridimensional de imagens médicas de tomografia computadorizada para uso no ensino de oftalmologia

ABSTRACT Introduction: The use of tridimensional (3D) printing in healthcare has contributed to the development of instruments and implants. The 3D printing has also been used for teaching future professionals. In order to have a good 3D printed piece, it is necessary to have high quality images, such as the ones from Computerized Tomography (CT scan) exam, which shows the anatomy from different cuts and allows for a good image reconstruction. Purpose: To propose a protocol for creating digital files from computerized tomography images to be printed in 3D and used as didactic material in the ophthalmology field, using open-source software, InVesalius®, Blender® and Repetier-Host©. Methods: Two orbit CT scan exam images in the DICOM format were used to create the virtual file to be printed in 3D. To edit the images, the software InVesalius® (Version 3.1.1) was used to delimit and clean the structure of interest, and also to convert to STL format. The software Blender® (Version 2.80) was used to refine the image. The STL image was then sent to the Repetier-Host© (Version 2.1.3) software, which splits the image in layers and generates the instructions to print the piece in the 3D printer using the polymer polylactic acid (PLA). Results: The printed anatomical pieces printed reproduced most structures, both bone and soft structures, satisfactorily. However, there were some problems during printing, such as the loss of small bone structures, that are naturally surrounded by muscles due to the lack of support. Conclusion: Despite the difficulties faced during the production of the pieces, it was also possible to reproduce the anatomical structures adequately, which indicates that this protocol of 3D printing from medical images is viable.

RESUMO Introdução: O uso de impressão em 3-D na área da saúde tem contribuído para o desenvolvimento de instrumentos e próteses. A impressão 3-D tem sido usada para o ensino de futuros profissionais. Para se alcançar uma boa peça em 3-D, é necessário ter imagens de alta qualidade, como aquelas geradas pelo exame de Tomografia Computadorizada (TC), que mostra a anatomia sob diferentes cortes e permite uma boa reconstrução de imagem. Objetivo: Propor um protocolo para a criação de arquivos digitais a partir de imagens de tomografia computadorizada a serem impressas em 3-D e usadas como modelo de material didático oftalmológico usando software de código aberto, InVesalius®, Bender® e Repetier-Host©. Métodos: Foram utilizadas imagens em formato DICOM provenientes de dois exames de tomografia computadorizada de órbitas para a impressão tridimensional. Para manuseio das imagens, foram utilizados o InVesalius®, versão 3.1.1, para delimitar e limpar a estrutura de interesse e também para converter em formato STL. O Blender®, versão 2.80 foi usado para refinamento. A imagem em STL foi então enviada para o programa Repetier-Host, versão 2.1.3, que divide a imagem em camadas e gera as instruções para impressão da peça em ácido polilático na impressora tridimensional. Resultados: As peças anatômicas impressas reproduziram de forma satisfatória a maioria das estruturas ósseas e musculares. No entanto, houve dificuldade durante a impressão das estruturas ósseas menores, como perda de estrutura óssea pequena, que não possuíam sustentação, por serem envoltas pelo músculo. Conclusão: Apesar das dificuldades encontradas na produção dessas peças de estudo, foi possível reproduzir estruturas com fidelidade, indicando que o protocolo proposto viabiliza a impressão de imagens oriundas da tomografia computadorizada para impressão tridimensional.