Tibial tubercle to trochlear groove and the roman arch method for tibial tubercle lateralisation are reliable and distinguish between subjects with and without major patellar instability.

PURPOSE: Patellofemoral (PF) instability recurrence depends on several factors including the relative lateralisation of tibial tubercle (TT) regarding the trochlear groove (TG). TT relative lateralisation quantification has long been a topic of debate. Multiple measuring techniques have been described including TT-trochlear groove (TT-TG), TT-posterior cruciate ligament (TT-PCL) and TT-roman arch (TT-RA), with no clear consensus regarding the most reliable index or pathologic threshold. We set out to determine the normal value range of each index and their association with age, sex and PF instability status. Also, this study aims to determine a reliable pathologic distance threshold to effectively predict patellar dislocation. METHODS: Skeletally mature patients up to 45 years of age who presented a CT Scan and an MRI of the same knee between 2014 and 2018 were included and divided into subgroups based on history of PF instability. Three indexes (TT-TG, TT-PCL and TT-RA) were assessed by two independent observers blinded to instability history. ROC curves were performed for each index to obtain the cut point that better predicts instability. Univariate and multivariate models adjusted by age, sex, instability history and type of imaging technique were performed to test the influence of these variables. RESULTS: 208 patients were included. Mean age was 27.93 â€‹± â€‹8.48 years, 67.3% were female and 71 patients (34.1%) presented major instability history. Good or excellent inter and intraobserver reliability was found for all three indexes. All indexes presented significantly different distributions between subjects with and without major instability (p â€‹< â€‹0.001), except for TT-PCL. Different cut point values differing between imaging modalities were found: 11.4 â€‹mm for MRI TT-TG, 17 â€‹mm for CT TT-TG, 15.6 â€‹mm for MRI TT-RA and 18.2 â€‹mm for CT TT-RA. CONCLUSIONS: All indexes studied had good or excellent inter and intraobserver reliability. Measurements between imaging techniques (CT and MR) are not interchangeable. Both TT-TG and TT-RA correctly distinguish between subjects with and without major instability, while TT-PCL does not, recommending caution when evaluated on its own. Specific threshold values depending on imaging technique should be considered for surgical decision-making. LEVEL OF EVIDENCE: Level IV, Diagnostic Test.

Enhanced vs conventional monofocal intraocular lens clinical results in patients with cataract: randomized clinical trial.

PURPOSE: To compare clinical outcomes between an enhanced and a conventional monofocal intraocular lens (IOL) after cataract surgery. SETTING: Ophthalmology Unit, Hospital del Salvador, University of Chile (tertiary care hospital). DESIGN: Double-masked, prospective randomized controlled trial. METHODS: 66 healthy adults with corneal astigmatism less than 1.50 diopters and axial length between 21 and 27 mm were randomly allocated (1:1) for bilateral phacoemulsification with either an enhanced monofocal IOL (ICB00) or a conventional aspheric monofocal IOL (ZCB00) implant. The refractive target was emmetropia in both eyes. Visual acuities, defocus curves, Catquest-9SF, and quality of vision (QoV) were measured 3 months postoperatively. RESULTS: Binocular uncorrected intermediate visual acuity was improved in patients implanted with the enhanced monofocal lens (0.37 ± 0.12) compared with the conventional monofocal (0.45 ± 0.10) ( P < .01). There were no significant differences in corrected distance visual acuity (CDVA), Catquest-9SF, or QoV scores. CONCLUSIONS: The enhanced monofocal IOL provided 1 additional line of intermediate visual acuity after cataract surgery. There was no significant change in either CDVA or QoV.

Calibration of SO2 and NO2 Electrochemical Sensors via a Training and Testing Method in an Industrial Coastal Environment.

Low-cost sensors can provide inaccurate data as temperature and humidity affect sensor accuracy. Therefore, calibration and data correction are essential to obtain reliable measurements. This article presents a training and testing method used to calibrate a sensor module assembled from SO2 and NO2 electrochemical sensors (Alphasense B4 and B43F) alongside air temperature (T) and humidity (RH) sensors. Field training and testing were conducted in the industrialized coastal area of Quintero Bay, Chile. The raw responses of the electrochemical (mV) and T-RH sensors were subjected to multiple linear regression (MLR) using three data segments, based on either voltage (SO2 sensor) or temperature (NO2). The resulting MLR equations were used to estimate the reference concentration. In the field test, calibration improved the performance of the sensors after adding T and RH in a linear model. The most robust models for NO2 were associated with data collected at T < 10 °C (R2 = 0.85), while SO2 robust models (R2 = 0.97) were associated with data segments containing higher voltages. Overall, this training and testing method reduced the bias due to T and HR in the evaluated sensors and could be replicated in similar environments to correct raw data from low-cost electrochemical sensors. A calibration method based on training and sensor testing after relocation is presented. The results show that the SO2 sensor performed better when modeled for different segments of voltage data, and the NO2 sensor model performed better when calibrated for different temperature data segments.

Clinical validation of an artificial intelligence-based diabetic retinopathy screening tool for a national health system.

OBJECTIVE: To evaluate the accuracy and validity of an automated diabetic retinopathy (DR) screening tool (DART, TeleDx, Santiago, Chile) that uses artificial intelligence to analyze ocular fundus photographs for potential implementation in the national Chilean DR screening programme. METHOD: This was an observational study of 1123 diabetic eye exams using a validation protocol designed by the commission of the Chilean Ministry of Health personnel and retina specialists. RESULTS: Receiver operating characteristic (ROC) analysis indicated a sensitivity of 94.6% (95% CI: 90.9-96.9%), specificity of 74.3% (95% CI: 73.3-75%), and negative predictive value of 98.1% (95% CI: 96.8-98.9%) for the automated tool at the optimal operating point for DR screening. The area under the ROC curve was 0.915. CONCLUSIONS: The results of this study suggest that DART is a valid tool that could be implemented in a heterogeneous health network such as the Chilean system.

Propuesta de clasificación de huesos suturales / Classification proposal of sutural bones

RESUMEN: Los huesos suturales tienen importancia anatómica y médico-legal. Se observan en las suturas de la cabeza ósea y tradicionalmente son descritos como planos, supernumerarios, irregulares, inconstantes, independientes y de variable morfología y frecuencia. Actualmente, no existe una clasificación única de estos huesos que incorpore todas las categorías descritas en la literatura. El objetivo de este trabajo fue proponer una clasificación actualizada de estos elementos, en función de una revisión bibliográfica exhaustiva y el análisis de cráneos de individuos chilenos. La muestra utilizada correspondió a 113 huesos suturales presentes en 12 cráneos secos, de individuos adultos chilenos. En la clasificación se consideró su ubicación en la cabeza (cráneo o cara), su origen embrionario, su relación con una fontanela, su forma, su posición en la cara y su relación con las tablas óseas. Los datos obtenidos se registraron en formulario especialmente diseñado y se tomaron fotografías digitales. Como resultado general, pudimos desarrollar una propuesta de clasificación de huesos suturales completa y satisfactoria y con ella se analizó los huesos de la muestra, pudiendo evidenciar la presencia de todas las categorías del instrumento. También pudimos constatar que en la totalidad de los cráneos utilizados se observaron huesos suturales, que los cráneos masculinos presentan un mayor número de estos huesos, pero que en los cráneos femeninos fue posible reconocer todas los tipos de huesos suturales, entre otros resultados. También se evidenció un tipo de hueso sutural no descrito anteriormente, el hueso sutural craneal puntiforme. Como conclusión de este trabajo, es importante destacar que los huesos suturales presentan características comunes a otras estructuras utilizadas en identificación forense, es decir, son perennes, únicos, de fácil observación, de fácil comparación y gran variabilidad, por estas razones la presente propuesta de clasificación permite ser planteada como una metodología auxiliar en la identificación humana.

SUMMARY: The sutural bones have anatomical and medico-legal importance. They are observed in the sutures of the bony head and are traditionally described as flat, supernumerary, irregular, inconstant, independent and of variable morphology and frequency. Currently, there is no single classification of these bones that incorporates all the categories described in the literature. The objective of this work was to propose an updated classification of these elements, based on an exhaustive bibliographic review and the analysis of the skulls of Chilean individuals. The sample used corresponds to 113 sutural bones present in 12 dry skulls of Chilean adults. The classification considers its location on the head (skull or face), its embryonic origin, its relationship to a fontanelle, its shape, its position on the face, and its relationship to bone tables. The data obtained was recorded in a specially designed format and digital photographs were taken. As a general result, we were able to develop a complete and satisfactory classification of sutural bones proposal and with it, the bones of the sample were analyzed, showing the presence of all categories of the instrument. We were also able to verify that sutural bones were observed in all the skulls used, that male skulls present a greater number of these bones, but that in the female skulls it was possible to recognize all types of sutural bones, among other results. A type of sutural bone not previously described, the shaped point cranial sutural bone, was also evidenced. As a conclusion to this work, it is important to highlight that sutural bones present characteristics common to other structures used in forensic identification, that is, they are perennial, unique, easily observed, easily compared and great variability, for these reasons the present classification proposal allows it to be proposed as an auxiliary methodology in human identification.

Analysis of OPD-Scan and Pentacam Parameters for Early Keratoconus Detection.

BACKGROUND: PURPOSE: To evaluate Pentacam and OPD-Scan parameters in the early detection of keratoconus. DESIGN: Retrospective case-control study. METHODS: Case group included 50 clinically unaffected fellow eyes diagnosed with asymmetric keratoconus showing subtle qualitative changes at the 0.5-D sensitivity OPD-Scan scale, as well as normal anterior and back elevation difference map at Belin/Ambrósio enhanced ectasia display (BAD) at the Pentacam. Control group included 172 normal eyes that underwent Lasik surgery and presented no complications throughout the 2-year follow-up period. OPD-Scan and Pentacam parameters were compared, calculating sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A multivariate analysis was performed using Pentacam or OPD-Scan variables, and a model using variables of both devices. RESULTS: Pentacam variables with AUC ≥0.8 were keratoconus index (0.85), index of height decentration (0.81), and overall deviation at BAD (0.8). OPD-Scan variables with AUC ≥0.8 were keratoconus prediction index (0.83), surface asymmetry index (0.83), and total of higher-order trefoil aberration (0.8). In the multivariate analysis, the AUC was 0.85 in the case of OPD-Scan whereas it was 0.89 in the case of Pentacam. When combining all variables from the 2 devices, the AUC was 0.93, with a sensitivity of 82% and a specificity of 94%. CONCLUSIONS: Several parameters of OPD-Scan and Pentacam can be useful to differentiate cases from normal control eyes, demonstrating even better results when combining parameters of both devices. Anterior corneal indexes were the most important parameters to discriminate both groups.

Rotational vertebral artery occlusion ("bow hunter syndrome").

PURPOSE: To review the literature, analyze and discuss diagnostic and treatment options for the Bowhunter Syndrome. A clinical case of idiopathic rotatory C1-C2 subluxation causing dynamic vertebral artery occlusion is presented. METHODS: Literature review between 1960 and 2019, discussion of diagnostic methods and treatment options. Description of diagnostic and treatment methods in the aforementioned case. RESULTS: We present a patient with dynamic left vertebral artery occlusion associated with idiopathic rotatory C1-C2 subluxation. A dynamic Angio-CT showed rotatory C1-C2 subluxation with significant flow reduction at the left vertebral artery at the exit of the C2 transverse foramen until the V3 segment when the head rotated towards the right. Due to clinical and radiological worsening in the following months, posterior C1-C2 arthrodesis was performed, with the disappearance of the symptoms. There are 193 cases reported with dynamic vertebral artery occlusion, but in only two, the etiology was primary rotational atlantoaxial instability. The most prevalent etiology was degenerative. CONCLUSION: Rotatory vertebral artery occlusion is a rare condition presented mostly in adults, aged 50-70 years. Vertebrobasilar insufficiency is triggered by the rotation of the head to the contralateral side of the dominant vertebral artery. Dynamic subtraction angiography is considered the diagnostic gold-standard method, but dynamic Angio-CT scan, Angio-MRI, or Doppler ultrasonography are less invasive options. The treatment options are conservative or surgical. Endovascular surgery is another option in specific cases.

Dolor lumbar: revisión y evidencia de tratamiento / Low back pain: review and evidence of treatment

El dolor lumbar corresponde a uno de los síntomas más prevalentes en la humanidad, siendo la segunda causa más frecuente de atención médica a nivel mundial. Existen diversos enfoques de diagnóstico y tratamiento para dolor lumbar, entre ellos la temporalidad del síntoma, el trabajo de diagnóstico sindromático, los síntomas de alarma, también llamados "banderas rojas", que pueden hacer sospechar patologías de mayor gravedad o urgencia. El estudio etiológico puede ser necesario en casos agudos con estas banderas rojas y en casos crónicos. Este estudio se realiza principalmente con imágenes (radiografías, tomografía computada, resonancia magnética, SPECT/CT) y ocasionalmente con exámenes de laboratorio. La mayor parte de los tratamientos están enfocados en el manejo conservador, principalmente el ejercicio físico guiado y asociado a fármacos analgésicos. Existen terapias alternativas tales como la acupuntura, el tai-chi, entre otros, algunas de ellas han mostrado ser un buen complemento al manejo del dolor lumbar. El enfoque multidisciplinario es la tendencia más actual de manejo, esto incluye el trabajo e intervención de diversos profesionales abordando el problema de forma integral, incluyendo el manejo psicoterapéutico. Intervenciones como las infiltraciones de columna han demostrado reducir el dolor por tiempos cortos, siendo útiles como puente para realizar un tratamiento apropiado. La cirugía solo se reserva para casos refractarios, siendo controversiales los resultados existentes en la literatura.

Low back pain is one of the most prevalent symptoms in humanity, being the second most common cause of medical attention worldwide. There are various approaches to diagnosis and treatment for low back pain, including the temporality of the symptom, the work of syndromatic diagnosis, the alarm symptoms, also called "red flags", that can make suspect pathologies of greater severity or emergency. The etiological study may be necessary in acute cases with these "red flags" and in chronic cases. This study is mainly done with images (X-rays, CT scan, MRI, SPECT/CT) and occasionally with laboratory tests. Most of the treatments are focused on conservative management, mainly guided physical exercise associated with analgesic drugs. There are alternative therapies such as acupuncture, tai-chi, among others, some of them have proven to be a good complement to the management of low back pain. The multidisciplinary approach is the most current management trend, this includes the work and intervention of various professionals addressing the problem in an integral way, including psychotherapeutic management. Interventions such as spinal infiltrations have been shown to reduce pain for short times, being useful as a bridge for proper treatment. Surgery is only reserved for refractory cases, the results existing in the literature being controversial.

High-Grade Patellar Chondral Defects: Promising Results From Management With Osteochondral Autografts.

BACKGROUND: Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects. PURPOSE: To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm2. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up. RESULTS: A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm2 (range, 64-250 mm2), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points). CONCLUSION: To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.

Osteochondral Autologous Transplantation for Treating Patellar High-Grade Chondral Defects: A Systematic Review.

BACKGROUND: Patellar cartilage defects account for 34.6% of defects found during routine arthroscopy. These defects pose a challenge in orthopaedic surgery because they have been associated with worse outcomes after surgical repair compared with other chondral lesions within the knee. PURPOSE: To systematically review the literature for evidence on results of osteochondral autologous transplantation (OAT) for the management of isolated patellar cartilage high-grade defects (International Cartilage Repair Society [ICRS] grade 3-4). STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review of the literature was performed to find studies that addressed outcomes regarding OAT to treat patellar high-grade cartilage defects (ICRS grade 3-4). Studies addressing patient-reported outcomes, return to sports, or magnetic resonance imaging (MRI) at follow-up after isolated OAT procedures for patellar cartilage defects were included. RESULTS: A total of 5 studies were included in this review. We were not able to perform a meta-analysis as no studies had available data. A total of 102 patients who received an isolated OAT for a patellar chondral defect were included in these 5 studies. All patients showed significant improvement at final follow-up based on the following patient-reported outcome scores: Lysholm, International Knee Documentation Committee, Kujala, Tegner, and 36-Item Short Form Health Survey. We found that 4 studies used MRI during the first postoperative year to assess osteochondral plug integration and positioning. The results demonstrated that most plugs were integrated and correctly positioned when evaluated at follow-up, conducted on average after 12 months. Whether patients were able to return to sports was queried in 2 of the included studies, revealing that patients could return to their previous level in most cases (Tegner score, 5-9 at 2 years after surgery). CONCLUSION: Results indicate that OAT is a safe and reliable technique to treat patellar high-grade osteochondral defects, allowing for significant improvement in patient-reported outcomes and return to sports.

[Management of diabetic retinopathy using telemedicine and network integration]. / Modelo de manejo en red y por telemedicina de la retinopatía diabética en dos comunas del Servicio de Salud Metropolitano Oriente.

BACKGROUND: If we are able to increase the resolution of complex medical problems at primary health care levels, we would improve the efficiency of the health care systems and would reduce the burden of specialists. AIM: To describe the result of a telemedicine and network management of diabetic retinopathy supervised by an ophthalmological service. MATERIAL AND METHODS: Diabetic patients attended in primary health care centers of the East Metropolitan Health Service in Santiago, Chile, derived for 45° digital retinographies were evaluated using telemedicine by the ophthalmologists of the base hospital. These professionals screened for diabetic retinopathy and classified it. Those patients with diabetic retinopathy were derived to the base hospital for specialized management. RESULTS: Of 2,566 patients evaluated, 22% had signs of diabetic retinopathy, 75% did not have the condition and 2% could not be evaluated with retinography. Seventy percent of patients with retinopathy, equivalent to only fifteen percent of total diabetics, were referred to the specialists for treatment. CONCLUSIONS: This model allowed a reduction of referrals to ophthalmologists, reducing the burden of secondary and tertiary health care systems.

Modelo de manejo en red y por telemedicina de la retinopatía diabética en dos comunas del Servicio de Salud Metropolitano Oriente / Management of diabetic retinopathy using telemedicine and network integration

Background: If we are able to increase the resolution of complex medical problems at primary health care levels, we would improve the efficiency of the health care systems and would reduce the burden of specialists. Aim: To describe the result of a telemedicine and network management of diabetic retinopathy supervised by an ophthalmological service. Material and Methods: Diabetic patients attended in primary health care centers of the East Metropolitan Health Service in Santiago, Chile, derived for 45° digital retinographies were evaluated using telemedicine by the ophthalmologists of the base hospital. These professionals screened for diabetic retinopathy and classified it. Those patients with diabetic retinopathy were derived to the base hospital for specialized management. Results: Of 2,566 patients evaluated, 22% had signs of diabetic retinopathy, 75% did not have the condition and 2% could not be evaluated with retinography. Seventy percent of patients with retinopathy, equivalent to only fifteen percent of total diabetics, were referred to the specialists for treatment. Conclusions: This model allowed a reduction of referrals to ophthalmologists, reducing the burden of secondary and tertiary health care systems.

Clinical features and possible founder mutation of the 8bp duplication mutation in the SLC4A11 gene causing corneal dystrophy and perceptive deafness in three South American families.

BACKGROUND: Corneal Dystrophy and Perceptive Deafness (CDPD) or Harboyan syndrome is an autosomal recessive rare disorder, characterized by congenital corneal opacities and progressive sensorineural hearing loss, which usually begins after the second decades of life. This study reports the ophthalmic, audiological and genetic features, in five CDPD affected patients from three Chilean families. MATERIALS AND METHODS: Five individuals affected with CDPD from three unrelated Chilean families were clinically and genetically examined. To evaluate a putative founder mutation 7 SNPs were analyzed in the three families, an Argentinian patient (carrier of the same mutation previously reported) and 87 Chilean controls. RESULTS: The ophthalmic symptoms in the five patients were bilateral and symmetric, starting before one year of age, and visual acuity varied from 0.1 to 0.3. In all cases, hearing loss began over 8 years old. The sequence of the 19 exons of SLC4A11 gene of all the affected patients exhibited homozygous eight nucleotide sequence duplication (c.2233_2240dup TATGACAC, p.(Ile748Metfs*5)) at the end of exon 16. All the affected patients of the three families were homozygous for a haplotype composed of five SNPs and covering 4,1 Mb. The same haplotype was present in one allele of the heterozygous Argentinean patient and has a frequency of 2.76% in Chilean population. CONCLUSIONS: The five CDPD patients were homozygous for the same mutation in the SLC4A11 gene. Haplotype analysis of all the affected, including the case reported from Argentina was in accordance with a founder mutation.

Arthroscopic Intercondylar Notch Bone Marrow Aspiration During Anterior Cruciate Ligament Reconstruction.

The anterior cruciate ligament is the most commonly injured ligament, with up to 10% of surgery failure. Atraumatic instability in the early postoperative period (<6 months) occurs as the result of poor surgical technique, failure of graft integration, or early mechanical overload during rehabilitation. Engineered cell therapy is a developing resource designed to increase the rate of tendon-to-bone interface healing. We describe a simple and safe technique to harvest mesenchymal stem cells by arthroscopic bone marrow aspiration from the intercondylar notch.

[A model of ophthalmological network care including primary care centers and a tertiary care hospital]. / Experiencia de atención en red entre Hospital del Salvador y tres unidades de Atención Primaria Oftalmológica: Un modelo de salud pública para mejorar la atención oftalmológica.

BACKGROUND: Primary care units of ophtalmology (UAPO) were incorporated in 2003 into the healthcare system of the Ministry of Health, in response to the high demand for hospital care. Three of these primary care units were incorporated to provide a network care with the ophthalmology service of a tertiary care hospital. AIM: To report the public health impact of networking. MATERIAL AND METHODS: A descriptive-prospective study was carried out analyzing all the healthcare attentions carried out between June and August 2016. An epidemiological characterization of the sample was made. We recorded: clinical diagnoses, decisions, resolution of the clinical problem at the primary care or referral to the hospital. RESULTS: A total of 2,096 ophthalmologic attentions were carried out in the three UAPOs during the study period. The main diseases attended were disorders of refraction, cataracts, glaucoma and diabetic retinopathy. The resolution index was 84% of attentions. Only 16% of attentions required referral and consisted mainly of cataracts (covered by a special health care system), diabetic retinopathy, capsulotomies, iridotomies, uveitis, pterygium and lacrimal duct obstruction. CONCLUSIONS: This model of care allowed an efficient management of the high demand for hospital referral. This is expressed in the high-resolution index and low derivation, resulting in a decrease in waiting lists at the tertiary level. This system should be implemented by other tertiary centers of our country.

Experiencia de atención en red entre Hospital del Salvador y tres unidades de Atención Primaria Oftalmológica: Un modelo de salud pública para mejorar la atención oftalmológica / A model of ophthalmological network care including primary care centers and a tertiary care hospital

Background: Primary care units of ophtalmology (UAPO) were incorporated in 2003 into the healthcare system of the Ministry of Health, in response to the high demand for hospital care. Three of these primary care units were incorporated to provide a network care with the ophthalmology service of a tertiary care hospital. Aim: To report the public health impact of networking. Material and Methods: A descriptive-prospective study was carried out analyzing all the healthcare attentions carried out between June and August 2016. An epidemiological characterization of the sample was made. We recorded: clinical diagnoses, decisions, resolution of the clinical problem at the primary care or referral to the hospital. Results: A total of 2,096 ophthalmologic attentions were carried out in the three UAPOs during the study period. The main diseases attended were disorders of refraction, cataracts, glaucoma and diabetic retinopathy. The resolution index was 84% of attentions. Only 16% of attentions required referral and consisted mainly of cataracts (covered by a special health care system), diabetic retinopathy, capsulotomies, iridotomies, uveitis, pterygium and lacrimal duct obstruction. Conclusions: This model of care allowed an efficient management of the high demand for hospital referral. This is expressed in the high-resolution index and low derivation, resulting in a decrease in waiting lists at the tertiary level. This system should be implemented by other tertiary centers of our country.

[History and functions of Chilean ophthalmologic primary care units]. / Unidades de atención primaria en oftalmología en Chile: historia y funciones.

The access to ophthalmological care in Chile has been historically a problem. Only at the end of the twentieth century concrete solutions were promoted. In 1960, Primary Care Ophthalmologic Units were created to ease the access to ophthalmology, due to the efforts of Professor Juan Arentsen. Their functioning was organized and standardized subsequently using a model proposed by the Chilean Ophthalmologic Society, leading to a better patient flow and reducing waiting lists. These units became an innovative initiative to reduce the gaps in Chilean public health, optimizing the professional and infrastructural assets of the public health care system and achieving a new organization for the ophthalmological health care net.

Unidades de atención primaria en oftalmología en Chile: historia y funciones / History and functions of Chilean ophthalmologic primary care units

The access to ophthalmological care in Chile has been historically a problem. Only at the end of the twentieth century concrete solutions were promoted. In 1960, Primary Care Ophthalmologic Units were created to ease the access to ophthalmology, due to the efforts of Professor Juan Arentsen. Their functioning was organized and standardized subsequently using a model proposed by the Chilean Ophthalmologic Society, leading to a better patient flow and reducing waiting lists. These units became an innovative initiative to reduce the gaps in Chilean public health, optimizing the professional and infrastructural assets of the public health care system and achieving a new organization for the ophthalmological health care net.