A new approach for single-haptic retropupillary iris-claw lens subluxation - The "fencing" technique.

INTRODUCTION: Single-haptic iris-claw intraocular lens (IOL) dislocation is not an uncommon complication. A few different surgical techniques are available for its refixation but usually involve a more invasive approach. We aim to demonstrate an original and simple approach for refixation of single haptic retropupillary iris-claw IOL subluxations. METHODS: We present a case of an 80-year-old male with a single haptic retropupillary iris-claw IOL subluxation in a previously vitrectomized eye. We used a new surgical approach to refix this type of subluxation. RESULTS: This new technique uses only two 30-gauge needles (one of them connected to a viscosurgical device) to re-enclavate the subluxated haptic of the retropupillary iris-claw IOL. By minimising surgical manipulation, the patient's postoperative period was uneventful. CONCLUSIONS: We highlight a new, quick, safe, and unusual surgical approach to single-haptic retropupillary iris-claw IOL dislocation in vitrectomized eyes. Because of its characteristics, we named it the "fencing" IOL repositioning technique.

Vitamin B3 Supplementation for Optic Neuropathies: A Comprehensive Review.

Optic neuropathies, such as glaucoma, are some of the leading causes of irreversible blindness worldwide. There has been a lot of research for potential therapies that could attenuate and even reduce the impact of the pathological pathways that lead to the loss of retinal ganglion cells (RGCs). In recent years, vitamin B3 (nicotinamide) has gained some interest as a viable option for these neurodegenerative diseases due to its fundamental role in enhancing the mitochondria metabolism of the RGCs. This review focuses on elucidating the impact of vitamin B3 on retinal cells, especially when in a dysfunctional state like what happens in optic neuropathies, especially glaucoma. This review also summarizes the existing and future research on the clinical effects of vitamin B3 in these optic neuropathies, and determines appropriate recommendations regarding its dosing, efficacy, and eventual side effects.

From capillaries to microchips, green electrophoretic features for enantiomeric separations: A decade review (2013-2022).

Enantioseparation by the electromigration-based method is well-established and widely discussed in the literature. Electrophoretic strategies have been used to baseline resolve complex enantiomeric mixtures, typically using a selector substance into the background electrolyte (BGE) from capillaries to microchips. Along with developing new materials/substances for enantioseparations, it is the concern about the green analytical chemistry (GAC) principles for method development and application. This review article brings a last decade's update on the publications involving enantioseparation by electrophoresis for capillary and microchip systems. It also brings a critical discussion on GAC principles and new green metrics in the context of developing an enantioseparation method. Chemical and green features of native and modified cyclodextrins are discussed. Still, given the employment of greener substances, ionic liquids and deep-eutectic solvents are highlighted, and some new selectors are proposed. For all the mentioned selectors, green features about their production, application, and disposal are considered. Sample preparation and BGE composition in GAC perspective, as well as greener derivatization possibilities, were also addressed. Therefore, one of the goals of this review is to aid the electrophoretic researchers to look where they have not.

Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes.

Aim: This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period. Methods: Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm2 and a duty cycle of 31.3%. Results: A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028). Conclusions: Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis. How to cite this article: Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.

Improving Visual Comfort during Computer Gaming with Preservative-Free Hyaluronic Acid Artificial Tears Added to Ergophthalmological Measures.

Digital asthenopia (DA) or Computer Vision Syndrome can occur after prolonged use of digital devices and is usually managed with ergophthalmological measures and the use of artificial tears. This prospective, controlled study evaluated the use of hyaluronic acid artificial tears on the signs and symptoms of DA in participants of a videogame convention. Subjects (n = 56) were randomized into a control group (CG, n = 26), which followed ergophthalmological measures, and a study group (SG, n = 30), which followed ergophthalmological measures and instilled 1 drop of artificial tears with hyaluronic acid 0.15% four times a day. Subjects were evaluated before and after playing for three consecutive days for eye dryness (SPEED questionnaire), conjunctival hyperemia, corneal fluorescein staining, conjunctival lissamine green staining, tear breakup time, Schirmer I test, near convergence and accommodation, and using questionnaires for DA symptoms. After 3 days of intense videogaming, the SPEED score of CG increased significantly (p = 0.0320), while for the SG it was unchanged. Similarly, the CG presented significant increases in ocular fatigue (p = 0.0173) and dryness (p = 0.0463), while these parameters decreased significantly in the SG (p = 0.0149 and p = 0.00427, respectively). This study confirms the protective effect of hyaluronic acid artificial tears against DA symptoms associated with prolonged visual display terminal use.

Thymol-Based Hydrophobic Deep Eutectic Solvents as a Green Approach for Screening Polar Nitrosamines in Sartans Pharmaceutical Products by Ultrasound-Assisted Dispersive Liquid-Liquid Microextraction Combined with HPLC-DAD.

Nitrosamines are carcinogens substances firstly detected in sartans drugs in 2018, leading to new regulations and monitoring programmes that raised the costs and challenges to the pharmaceutical industry. Therefore, reliable and cost-effective methods for screening nitrosamines in medicines are highly desirable. Hydrophobic deep eutectic solvents (HDES), a novel "eco-friendly" alternative to solvents commonly used in microextraction techniques, can meet these requirements. In this study, a simple and rapid method of ultrasound-assisted dispersive liquid-liquid microextraction using thymol-based HDES followed by HPLC-DAD detection was developed for the determination of n-nitrosodimethylamine (NDMA) and n-nitroso-n-methylamino butyric acid (NMBA) from candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan drug substances, and from losartan tablets. Various influencing factors (such as HDES type, HDES:sample ratio, salt addition and sample pH) were investigated. Best extraction efficiencies were achieved with thymol:benzyl alcohol HDES. Under optimal conditions, the linearities ranged from 15 to 1000 ng mL-1 for both NDMA and NMBA (R² > 0.99), with recoveries between 81.8-104.2% and precision from 0.2 to 14.6%. The limits of detection were 17.3 - 220.0 ng g-1 and 16.3 - 290.0 ng g-1 for NDMA and NMBA, consecutively. Finally, the proposed method was successfully applied in spiked sartans drug substances and in losartan potassium tablets collected in the market.

Might Zika virus-associated microcephaly's severity impact deciduous tooth eruption and orofacial structures?

OBJECTIVE: to investigate the impact of the severity of microcephaly caused by the Zika virus (MCZ) on tooth eruption and orofacial structures of children. DESIGN: This case series study developed the research at the Mens Sana Rehabilitation Center, Arcoverde, Brazil. The study included 27 children diagnosed with MCZ. We performed the data collection in June 2018 through a questionnaire answered by the legal guardians, followed by a clinical examination of the children. The data were analyzed by the Mann-Whitney and Fisher's exact tests (p = 0.05). RESULTS: The final sample was composed of 20 children. Of these, 13 (35.0%) had severe microcephaly, 5 (30.0%) had altered sequence of tooth eruption, 10 (50.0%) had delayed eruption, and the mean number of decayed teeth was 2.3. The most identified orofacial changes were teeth grinding habit (65.0%), difficult chewing (50.0%), and non-nutritive sucking (50.0%). The Mann-Whitney test showed that the severity of microcephaly did not affect tooth eruption (p = 0.581). The Fisher's exact test showed that the severity of microcephaly was not associated with orofacial changes (p > 0.05). CONCLUSIONS: The severity of MCZ does not seem to influence changes in deciduous tooth eruption and the presence of orofacial anomalies.

Access to information on oral hygiene and mothers' practices of children with microcephaly caused by Zika virus.

OBJECTIVE: To verify whether access to information about oral hygiene influenced the practices of caregivers of children with microcephaly caused by Zika virus (ZIKV). METHODS: A case series study was developed at the Mens Sana Rehabilitation Center, in the municipality of Arcoverde, Pernambuco, Brazil. The study universe included the mothers of 32 children with microcephaly caused by Zika virus. Data collection took place in June 2018 and was carried out through a structured questionnaire. The variables studied comprised socioeconomic issues, habits, diet, and knowledge about oral hygiene. Fisher's Exact and Pearson's Chi-square tests were used with a significance level of 5%. RESULTS: Out of 32 individuals eligible to participate in the study, only 27 were selected. Most mothers reported receiving information about oral hygiene from their infants (63.0%). Fisher's Exact and Pearson's Chi-square tests showed that access to oral hygiene information was associated with mother's education, family income, regular visits to the dentist, frequency of tooth brushing, age at which the infant started brushing, and brushing time (p < 0.05). CONCLUSION: Access to information about oral hygiene positively influenced the oral health care of mothers with their children with microcephaly caused by ZIKV.

Prevalence and Severity of Burn Scars in Rural Mozambique.

BACKGROUND: Burn injuries are common in low- and middle-income countries (LMICs) and their associated disability is tragic. This study is the first to explore burn scars in rural communities in Mozambique. This work also validated an innovate burn assessment tool, the Morphological African Scar Contractures Classification (MASCC), used to determine surgical need. METHODS: Using a stratified, population-weighted survey, the team interviewed randomly selected households from September 2012 to June 2013. Three rural districts (Chókwè, Nhamatanda, and Ribáuè) were selected to represent the southern, central and northern regions of the country. Injuries were recorded, documented with photographs, and approach to care was gathered. A panel of residents and surgeons reviewed the burn scar images using both the Vancouver Scar Scale and the MASCC, a validated visual scale that categorizes patients into four categories corresponding to levels of surgical intervention. RESULTS: Of the 6104 survey participants, 6% (n = 370) reported one or more burn injuries. Burn injuries were more common in females (57%) and most often occurred on the extremities. Individuals less than 25 years old had a significantly higher odds of reporting a burn scar compared to people older than 45 years. Based on the MASCC, 12% (n = 42) would benefit from surgery to treat contractures. CONCLUSION: Untreated burn injuries are prevalent in rural Mozambique. Our study reveals a lack of access to surgical care in rural communities and demonstrates how the MASCC scale can be used to extend the reach of surgical assessment beyond the hospital through community health workers.

Efficacy and Safety After Toric Posterior Chamber Implantable Collamer Lens and Toric Iris-Fixated Foldable Phakic Intraocular Lens for Myopic Astigmatism.

PURPOSE: To compare visual, refractive, and safety outcomes of toric posterior chamber Implantable Collamer Lens (T-ICL) (STAAR Surgical) and toric iris-fixated foldable phakic intraocular lens (IOL) (T-Artiflex; Ophtec BV) implantation for the correction of myopic astigmatism. METHODS: This retrospective cohort study included 312 eyes of 312 patients who had phakic IOL implantation for myopic astigmatism. Two groups were defined: 205 eyes that underwent T-ICL implantation and 107 eyes that underwent T-Artiflex implantation. Safety, efficacy, and predictability outcomes were evaluated preoperatively and at 12 months postoperatively. Refractive and corneal astigmatic vector analysis were performed using the Alpins method. RESULTS: One year postoperatively, uncorrected distance visual acuity was 0.05 ± 0.18 (T-ICL) and 0.10 ± 0.16 (T-Artiflex) logMAR, with efficacy indexes of 1.16 ± 0.27 and 1.05 ± 0.31, respectively (P < .001). Safety indexes were 1.28 ± 0.30 and 1.21 ± 0.31, respectively (P = .04). Spherical equivalent was within ±0.50 diopters (D) of emmetropia in 165 (80.5%) and 88 (82.2%) eyes, respectively. Refractive astigmatic analysis showed an index of success of 0.28 ± 0.33 (T-ICL) and 0.31 ± 0.26 (T-Artiflex) (P = .07). Surgically induced corneal astigmatism was 0.48 ± 0.74 and 0.81 ± 0.61 D, respectively (P < .001). Mean endothelial loss was 1.11% and 2.05%, respectively (P = .42). Six (2.9%) eyes in the T-ICL group and 1 (0.9%) eye in the T-Artiflex group had phakic IOL repositioning due to significant misalignment. No vision-threatening complications occurred. CONCLUSIONS: Both the T-ICL and T-Artiflex groups showed high visual and refractive efficacy with a good safety profile for the correction of myopic astigmatism. T-ICL implantation demonstrated significantly better efficacy and safety indexes after 12 months. Vector analysis showed similar refractive astigmatic correction in both groups, but T-Artiflex implantation revealed higher surgically induced corneal astigmatism. [J Refract Surg. 2022;38(6):339-347.].

Visual and refractive outcomes following secondary intraocular lens implantation.

PURPOSE: To analyze the visual and refractive results after secondary IOL implantation using different surgical techniques - iris-claw aphakic IOL through a corneal incision or scleral tunnel, and 3-piece IOL into the ciliary sulcus. PATIENTS AND METHODS: Retrospective study including patients that were submitted to secondary IOL implantation from January 2017 to December 2019 at the Department of Ophthalmology of Hospital de Braga, Portugal. We collected demographic data (age, surgical indication, comorbidities, surgical technique, IOL implanted, and intra and postoperative complications) and visual and refractive data [preoperative and 3-month, 6-month, and 12-month postoperative corrected-distance visual acuity (CDVA), spherical equivalent (SE), manifest cylinder, and intraocular pressure]. RESULTS: 128 eyes from 123 patients were included. The most frequent surgical indications were IOL subluxation/luxation (62.5%) and intraoperative posterior capsular rupture (23.4%). CDVA improved from 1.26 ± 0.51 to 0.47 ± 0.49 logMar (p < .001). CDVA was significantly better in the 3-piece into the ciliary sulcus IOL group than both other groups. The final SE was -0.68 ± 0.94 diopters. The mean manifest refractive cylinder remained stable until the 6th month after the surgery (p = .454) and improved in the last 6 months of follow-up (p = .015). In the postoperative period, the cylinder was higher in the corneal incision iris-claw aphakic IOL group and lower in the 3-piece IOL into the ciliary sulcus group (p < 0,05). The corneal incision iris-claw aphakic IOL group presented the most postoperative complications. CONCLUSION: All techniques showed satisfying results. The 3-piece IOL into the ciliary sulcus group showed the best visual and refractive performance, followed by the scleral tunnel iris-claw IOL group and the corneal incision iris-claw IOL group.

Intraocular Lens Position and Anterior Chamber Parameters Evaluation After Nd:YAG Laser Posterior Capsulotomy for Posterior Capsular Opacification Using Anterior Segment Swept-Source Optical Coherence Tomography.

PURPOSE: To evaluate the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy on intraocular lens (IOL) position and anterior segment parameters with a new swept-source anterior segment optical coherence tomography (AS-OCT) device (Anterion®, Heidelberg Engineering GmbH). PATIENTS AND METHODS: A total of 50 eyes from 50 consecutive patients were included. All patients had visually significant posterior capsular opacification (PCO) after uneventful phacoemulsification surgery with manual capsulorhexis and single-piece C-loop acrylic IOL implantation (AcrySof® SA60AT) and were treated with Nd:YAG laser. Anterior segment images were captured with Anterion® in non-dilated conditions before and one month after the procedure. In the "Metrics App", we collected data of the anterior chamber angle (ACA) 3 and 9 o'clock, the anterior chamber depth (ACD), the anterior chamber volume (ACV), and the central corneal thickness (CCT). We also collected demographic and clinical data [age, gender, months from surgery to Nd: YAG capsulotomy, pre- and post-capsulotomy corrected distance visual acuity (CDVA) and spherical equivalent, and axial length]. RESULTS: We did not find a statistically significant difference in ACD after the Nd:YAG capsulotomy (3.96 ± 0.55 vs 3.97 ± 0.55 mm, p = 0.10). In 28 patients, we noted a backward movement of the IOL; in the remaining 22, the IOL moved forward or did not change at all. We did not observe significant changes in ACA at the 3 and 9 o'clock reference points, ACV, or CCT. There was an improvement in CDVA after the procedure (0.37 ± 0.21 vs 0.12 ± 0.27 logMAR, p = 0.015), without statistically significant differences in SE (-0.15 ± 0.84 vs -0.25 ± 0,93, p = 0.42). Axial length was not correlated with ACD variations after the procedure (p = 0.67). CONCLUSION: Our results show that Nd:YAG laser capsulotomy does not change the axial position of a single-piece C-loop acrylic IOL inside the capsular bag, as well as other anterior chamber parameters.

Use of Amniotic Membrane in MMC-Augmented Trabeculectomy: A Retrospective Comparative Study.

PURPOSE: Amniotic membrane transplantation (AMT) has shown promising results as an antifibrotic agent in trabeculectomy. We aimed to evaluate the additional effect of AMT in MMC-augmented trabeculectomy. PATIENTS AND METHODS: This retrospective study analyzed the results of the first 12 postoperative months of glaucomatous eyes submitted to Moorfields Safer Surgery Trabeculectomy with MMC alone (non-AMT group) compared to MMC and AMT (AMT group). Both groups were compared in terms of intraocular pressure (IOP), number of antihypertensive medications and need for surgical reinterventions. Absolute and relative success rates 12 months after surgery were defined as IOP <18 mmHg, without and with the use of antihypertensive medications, respectively. RESULTS: The analysis included 51 eyes of 45 glaucoma patients (29 eyes in the non-AMT group and 22 in the AMT group). Mean IOP decreased from 24.72±5.11 mmHg and 26.86±10.62 mmHg preoperatively in non-AMT and AMT groups to 12.86±4.22 mmHg and 12.60±4.43 mmHg, respectively, at 12 months (p = 0.84). Postoperative number of medications decreased significantly in both groups. Absolute success was seen in 71% of non-AMT eyes and 55% of AMT eyes (p = 0.46), whereas relative success was obtained in 14% and 30%, respectively (p = 0.55). Reinterventions were needed in 28% of the eyes (11 bleb injection/needling and 4 Ahmed tube implantation) in the non-AMT group and in 27% of the AMT group (10 bleb injection/needling and 1 Ahmed tube implantation) (p = 0.89). CONCLUSION: Trabeculectomy combined with MMC and AMT did not show better results than trabeculectomy with MMC alone.

Prevalência da queilite actínica em agricultores de uma região do sertão brasileiro / Prevalencia de queilitis actínica en agricultores de una región del interior brasileño / Prevalence of actinic cheilitis in Brazilian semi-arid region farmers

Introdução: A queilite actínica é uma lesão inflamatória com potencial de transformação maligna e desenvolvimento associado à exposição solar excessiva. Objetivo: Avaliar a prevalência de queilite actínica em um grupo de agricultores, bem como a percepção e conhecimento desse grupo sobre a lesão. Métodos: O estudo observacional de levantamento epidemiológico envolveu uma população de agricultores de uma região do sertão brasileiro. A amostra foi obtida por acessibilidade a essa população, e alcançou-se o total de 219 agricultores. Além do exame físico intraoral, utilizou-se um questionário estruturado para coleta dos dados. Resultados: A queilite actínica foi diagnosticada em 30,6 porcento dos agricultores examinados. A lesão foi encontrada com maior frequência no sexo masculino (86,6 porcento), com mais de 60 anos (64,2 porcento) e leucodermas (58,2 porcento). A maioria dos indivíduos com queilite actínica se expunham à radiação solar por mais de 30 anos (65,7 porcento), por mais de 6h por dia (73,1 porcento) e não se protegiam adequadamente (94 porcento). Sexo, idade, escolaridade, hábito de beber e tempo de exposição solar tiveram uma correlação estatisticamente significante com a presença da queilite actínica (p<0,05). Verificou-se que 76,1 porcento dos participantes não notavam sinais e 61,2 porcento não percebiam sintomas da lesão. O conhecimento sobre queilite actínica foi baixo para 97 porcento dos indivíduos com lesão. Conclusões: Os resultados demonstraram alta prevalência de queilite actínica, além de uma baixa percepção e conhecimento sobre esta lesão, o que indica a necessidade de realização de ações de educação em saúde(AU)

Introducción: La queilitis actínica es una lesión inflamatoria con potencial de transformación maligna y desarrollo asociado con la exposición excesiva al sol. Objetivo: Evaluar la prevalencia de queilitis actínica en un grupo de agricultores brasileños y la percepción y conocimiento que estos tienen sobre la lesión. Métodos: Estudio observacional epidemiológico. Incluyó una población de agricultores de una región rural brasileña. La muestra, constituida por 219 agricultores, se obtuvo por accesibilidad a esta población. Además del examen físico intraoral, se utilizó un cuestionario estructurado para recopilar los datos. Resultados: Se diagnosticó queilitis actínica en el 30,6 por ciento de los agricultores examinados. La lesión se encontró con mayor frecuencia en hombres (86,6 por ciento), mayores de 60 años (64,2 por ciento) y leucodermos (58,2 por ciento). La mayoría de las personas con queilitis actínica estuvieron expuestas a la radiación solar durante más de 30 años (65,7 por ciento), más de seis horas al día (73,1 por ciento) que no se protegieron adecuadamente (94 por ciento). El género, la edad, el nivel de educación, los hábitos de bebida y el tiempo de exposición al sol tuvieron una correlación estadísticamente significativa con la presencia de queilitis actínica (p < 0,05). Se encontró que el 76,1 por ciento de los participantes no notó signos y el 61,2 por ciento no percibió síntomas de la lesión. El conocimiento sobre la queilitis actínica fue bajo para el 97 por ciento de las personas con lesiones. Conclusión: Los resultados mostraron una alta prevalencia de queilitis actínica, además de una baja percepción y conocimiento al respecto de esta lesión, lo que indica la necesidad de acciones de educación para la salud(AU)

Introduction: Actinic cheilitis is an inflammatory, potentially malignant lesion associated with excessive sun exposure. Objective: To evaluate the prevalence of actinic cheilitis in a group of farmers, as well as the perception and knowledge of that group about this lesion. Methods: The observational epidemiological study included Brazilian semi-arid region farmers. The sample was obtained for accessibility to this population and a total of 219 farmers was reached. A structured questionnaire was used to collect the data in addition to the intraoral physical examination. Results: Actinic cheilitis was diagnosed in 30.6 percent of the examined farmers. The lesion was found more frequently in males (86.6 percent), older than 60 years (64.2 percent), and leukoderma (58.2 percent). Most individuals with actinic cheilitis were exposed to solar radiation for more than 30 years (65.7 percent), for more than 6 hours a day (73.1 percent), and did not adequately protect themselves (94 percent). Sex, age, education level, drinking habits, and time of sun exposure had a statistically significant correlation with the presence of actinic cheilitis (p < 0.05). It was found that 76.1 percent of the participants did not notice signs and 61.2 percent did not perceive symptoms of this injury. Knowledge about actinic cheilitis was low for 97 percent of individuals with the lesion. Conclusions: The results showed a high prevalence of actinic cheilitis, in addition to low perception and knowledge about it, which indicates the need for health education actions(AU)

Posterior chamber collamer phakic intraocular lens implantation: Comparison of efficacy and safety for low and moderate-to-high myopia.

PURPOSE: To compare visual, refractive and safety outcomes of central-hole posterior chamber collamer phakic intraocular lens implantation for low and moderate-to-high myopia. SUBJECTS/METHODS: This retrospective cohort study included 338 eyes submitted to posterior chamber collamer phakic intraocular lens implantation that completed a 12-month postoperative follow-up. Two groups were defined depending on preoperative spherical equivalent: group 1 comprised 106 eyes with manifest spherical equivalent of -6.00 D or less; group 2 comprised 232 eyes with manifest spherical equivalent higher than -6.00 D. Effectiveness, predictability, stability and safety outcomes were compared preoperatively and at 1, 6 and 12 months postoperatively. RESULTS: At 1-year postoperative, uncorrected and corrected visual acuities were 0.02 ± 0.17 and -0.01 ± 0.12 logMAR (group 1) and 0.04 ± 0.20 and 0.01 ± 0.16 logMAR (group 2), with an efficacy index of 1.05 ± 0.17 and 1.17 ± 0.28. Respectively, 92 (86.8%) and 199 (85.8%) eyes were within ±0.50 D of targeted refraction, and postoperative manifest refraction changes were -0.07 ± 0.25 D and -0.07 ± 0.35 D. Intraocular pressure did not change significantly. The mean rate of endothelial cell loss was 1.12% and 1.10%, respectively. One case of anterior subcapsular cataract (group 2) was observed. ICL exchange occurred in one case (group 1) and three cases (group 2). No vision-threatening complications were reported. CONCLUSION: The posterior chamber collamer phakic intraocular lens implantation demonstrated high visual and refractive efficacy with an excellent safety profile for the correction of both low and moderate-to-high myopia, revealing equivalent 1-year outcomes regardless of the degree of preoperative myopia.

Long-term efficacy and safety results after iris-fixated foldable phakic intraocular lens for myopia and astigmatism: 6-year follow-up.

PURPOSE: To evaluate the long-term efficacy and safety of iris-fixated foldable phakic intraocular lenses (pIOLs) for the management of myopia and astigmatism after 6-year follow-up. SETTING: Ophthalmology Department, Hospital Braga, Portugal. DESIGN: Retrospective cohort study. METHODS: Patients included underwent iris-fixated foldable Artiflex pIOL implantation between January 2010 and December 2013. Follow-up evaluations were performed 6 months postoperatively and every 12 months until 72 months. Preoperative and follow-up data on uncorrected and corrected distance visual acuity (CDVA), manifest refraction, endothelial cell density (ECD), and anterior chamber depth (ACD) were analyzed. RESULTS: A total of 177 eyes of 98 patients with a mean age of 32.33 ± 7.13 years were analyzed. There was a statistically significant improvement in CDVA from 0.09 ± 0.02 logMAR preoperatively to 0.04 ± 0.02 logMAR (P < .0001) at 6 years postoperatively. The spherical equivalent demonstrated a statistically significant improvement from -9.50 ± 2.93 diopters (D) to -0.41 ± 0.45 D at 6 years. At 72 months, the efficacy and safety indexes were 0.94 and 1.15, respectively. A mean loss of 31.77 cells/mm2 (1.19%) was observed each year until the sixth year. The overall mean ECD loss after correction for the physiological loss was 3.02% after 6 years. No correlations were observed between the mean ECD loss and the preoperative ACD. CONCLUSIONS: The Artiflex pIOL was a safe, effective, and a stable option to correct myopia. A mean ECD loss of 3.02% was observed over 6 years. No pIOL was explanted due to corneal decompensation.

Five-year long-term outcomes of intrastromal corneal ring segment implantation using the manual technique for keratoconus management.

PURPOSE: To evaluate the long-term effectiveness, safety, and stability of Ferrara-type intrastromal corneal ring segments (ICRS) by manual surgery implantation in patients with keratoconus. SETTING: Ophthalmology Department, Hospital de Braga, Braga, Portugal. DESIGN: Retrospective cohort study. METHODS: This study included 124 eyes that had ICRS implantation using the manual technique with a follow-up of 5 years. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), subjective refraction, keratometry, aberrometry, and pachymetry maps were evaluated preoperatively and at 6 months, 1 year, and 5 years postoperatively. A secondary analysis of all variables was performed comparing 2 subgroups of patients: a group younger than 30 years and a group of 30 years or older. RESULTS: At 5 years, both mean UDVA and CDVA improved significantly (P < .0001) from a preoperative value of 0.91 ± 0.36 to 0.46 ± 0.32 logMAR and 0.40 ± 0.27 to 0.22 ± 0.20 logMAR, respectively. Spherical equivalent, refractive cylinder, and all topography values significantly decreased postoperatively (P < .0001). No regression was observed in any visual or topographic parameter during the entire follow-up. Regarding the subgroup analysis, both younger and older patients demonstrated similar and stable results from the preoperative to the 5-year visit, except for minimum pachymetry value change over time. CONCLUSIONS: Ferrara-type ICRS implantation significantly improved visual acuity, refractive error, and topographic values; the improvement was stable throughout a 5-year follow-up period. This study confirms that ICRS implantation surgery for keratoconus is a stable procedure in a long-term follow-up, regardless of the preoperative patient's age.

Public knowledge of cardiovascular disease and response to acute cardiac events in three municipalities in Brazil.

OBJECTIVE: To conduct a landscape assessment of public knowledge of cardiovascular disease risk factors and acute myocardial infarction symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) awareness and training in three underserved communities in Brazil. METHODS: A cross-sectional, population-based survey of non-institutionalised adults age 30 or greater was conducted in three municipalities in Eastern Brazil. Data were analysed as survey-weighted percentages of the sampled populations. RESULTS: 3035 surveys were completed. Overall, one-third of respondents was unable to identify at least one cardiovascular disease risk factor and 25% unable to identify at least one myocardial infarction symptom. A minority of respondents had received training in CPR or were able to identify an AED. Low levels of education and low socioeconomic status were consistent predictors of lower knowledge levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and CPR and AED use. CONCLUSIONS: In three municipalities in Eastern Brazil, overall public knowledge of cardiovascular disease risk factors and symptoms, as well as knowledge of appropriate CPR and AED use was low. Our findings indicate the need for interventions to improve public knowledge and response to acute cardiovascular events in Brazil as a first step towards improving health outcomes in this population. Significant heterogeneity in knowledge seen across sites and socioeconomic strata indicates a need to appropriately target such interventions.

Outcomes of Trabeculectomy With and Without Mitomycin C in Pseudoexfoliative Glaucoma Compared With Mitomycin C in Primary Open Angle Glaucoma.

The aim of this study was to evaluate the outcomes of trabeculectomy with mitomycin C (MMC) in patients with Pseudoexfoliative Glaucoma (PXG) and compare the results with the outcomes of trabeculectomy without MMC in PXG and with MMC in Primary Open Angle Glaucoma (POAG). Ninety eyes (76 patients) submitted to trabeculectomy were included in a one-year retrospective study. Fifty-eight eyes with PXG were divided into group 1 (28 eyes) and group 2 (30 eyes), with and without MMC application respectively. Then, the group 1 results were compared with 32 eyes with POAG that performed trabeculectomy with MMC (group 3). Main outcome measures were intraocular pressure (IOP), number of IOP lowering medications, rate of bleb failure (encapsulation, flattening and/or vascularization) and the number of eyes submitted to surgical procedures after trabeculectomy (needling, 5-fluorouracil (5FU) or 2nd trabeculectomy). Results revealed that compared to trabeculectomy with MMC in POAG and trabeculectomy with MMC in PXG, trabeculectomy without MMC in PXG leads to higher IOP (preoperative mean ± standard deviation [SD] was 28.6 ± 5.4 mmHg in group 1, 32.2 ± 8.2 mmHg in group 2 and 26.1 ± 6.5 mmHg in group 3; and after one year was 13.9 ± 3.9 mmHg in group 1, 16.1 ± 5.9 mmHg in group 2 and 12.5 ± 4.0 mmHg in group 3); higher number of IOP lowering medications (preoperative mean ± SD was 3.1 ± 0.60 in group 1, 2.8 ± 0.81 in group 2 and 3.4 ± 0.76 in group 3; and after one year was 1.1 ± 1.1 in group 1, 1.1 ± 1.0 in group 2 and 0.33 ± 0.89 in group 3); higher prevalence of bleb failure (47% in group 1, 53% in group 2, and 18% in group 3); and increased participation in surgical procedures following trabeculectomy (47% in group 1, 57% in group 2, and 6% in group 3). We concluded that trabeculectomy without MMC in PXG had the worst surgical outcome. Thus, PXG appears to be a potential risk factor for filtration bleb failure. Therefore, it could be considered in surgical protocols of MMC application.

Digital Asthenopia: Portuguese Group of Ergophthalmology Survey.

INTRODUCTION: Given the increasing use of electronic devices, and the increasing number of complaints with its use, we intend to evaluate the prevalence of manifestations of dry eye and ocular fatigue in a population of individuals, who use the computer daily to perform all their professional tasks, as well as to correlate these complaints with the number of hours of digital use as well as their possible improvement with behavioural measures and use of tear drops. MATERIAL AND METHODS: A total of 77 individuals (154 eyes) were evaluated on two separate days with a 1-month interval. They completed two questionnaires: OSDI and PEG Eye Fatigue. An objective ocular surface assessment was performed: Schirmer test without anesthetic, DR-1a Dry Eye Monitor™, hyperemia evaluation, lacrimal break up, presence of keratitis and lesions in the conjunctiva, as well as near accommodation point and near convergence point. After the first evaluation, the subjects were divided into two groups: group A (< 2 hours of computer working) and group B (> 2 hours of computer working). Some environmental measures to reduce complaints and recommendation of use of artificial tears were explained to the latter. RESULTS: There was a statistically significant difference in the majority of the parameters evaluated in the group B, in relation to the morning period (group A) - tear film (p = 0.032), hyperemia (p < 0.001), BUT (p < 0.001), keratitis (p < 0.001), conjunctival lesion (p = 0.002) and accommodation point (p < 0.001). In the evaluation - one month later - there were no statistically significant differences in any of the parameters analysed in the group A, and in group B there was a decrease in most parameters at the end of that period - Schirmer test (p = 0.005), lacrimal film (p = 0.022), keratitis (p < 0.001), conjunctival lesion (p = 0.005) and fatigue score (p < 0.001). DISCUSSION: It was thus possible to show the appearance of ocular fatigue and ocular surface changes with prolonged use of computers (> 2 hours) as well as a significant improvement in symptomatology (subjective assessment) as well as of ocular surface changes (objective evaluation) with the implementation of postural measures, regular breaks and use of lubricants. This is the first study, to the best of our knowledge, of digital asthenopia in which, in addition to the subjective evaluation, the presence of ocular surface modifications (objective assessment) were evaluated and the respective improvement with the aforementioned ergophthalmological measures were evaluated. CONCLUSION: This survey highlights the increased overall level of awareness that we need to have to face the rapid and wide-scale changes driven by the emergence of digital technology and, more particularly, its impact on user's vision and posture. We concluded that the longer we use the electronic devices (more than two hours) the more severe the complaints and rates of ocular surface changes are. Environmental and ocular strategies can attenuate or even eliminate the discomfort caused by this syndrome, and increase professional performance and quality of life.

Introdução: Atendendo ao uso crescente dos dispositivos eletrônicos, e o consequente aumento de queixas oftalmológicas com o seu uso, pretendemos com este estudo avaliar a prevalência de manifestações de olho seco e fadiga ocular numa população de indivíduos, de uma empresa de 'outsourcing services' e que utilizam o computador diariamente para realizar todas as suas tarefas. Material e Métodos: Um total de 77 indivíduos (154 olhos) foram avaliados em dois dias separados por um intervalo de um mês. Completaram dois questionários: OSDI e GPE Fadiga Ocular. Foi realizada uma avaliação objetiva da superfície ocular: teste de Schirmer sem anestesia, DR-1a Dry Eye Monitor™, avaliação hiperémia, rotura lacrimal, presença de queratite e lesões da conjuntiva, bem como avaliação do ponto próximo de acomodação e ponto próximo de convergência. Após a primeira avaliação, dividiu-se a amostra em dois grupos: grupo A (< 2 horas de trabalho no computador) e grupo B (> 2 horas de trabalho no computador). Ao grupo B foram explicadas algumas medidas ambientais para reduzir as queixas de astenopia digital e recomendou-se uso de lágrima artificial de acordo com as necessidades. Resultados: Observou-se uma diferença estatisticamente significante na maioria dos parâmetros avaliados no grupo B, quando comparado com o grupo no período da manhã (grupo A) - filme lacrimal (p = 0,032), hiperémia (p < 0,001), BUT (p < 0,001), queratite (p < 0,001), lesões da conjuntiva (p = 0,002) e ponto próximo de acomodação (p < 0,001). Na avaliaçã o - um mês depois - não houveram diferenças estatisticamente significativas em nenhum dos parâmetros analisados no grupo A, enquanto que no grupo B houve redução na maioria dos parâmetros ao final desse período - teste de Schirmer (p = 0,005), filme lacrimal (p = 0,022), queratite (p < 0,001), lesões da conjuntiva (p = 0,005), ponto de convergência próximo (p = 0,001) e score de fadiga (p < 0,001). Discussão: Foi assim possível objetivar o aparecimento de fadiga ocular e alterações da superfície ocular com o uso prolongado de computadores (> 2 horas) bem como uma melhoria significativa da sintomatologia (avaliação subjetiva) e melhoria da superfície ocular (avaliação objetiva) com a implementação de medidas posturais, pausas regulares e uso de lubrificantes. Este é o primeiro estudo, tanto quanto temos conhecimento, de astenopia digital em que para além da avaliação subjetiva se avalia a presença das referidas alterações da superfície ocular e a sua melhoria com as medidas ergoftalmológicas mencionadas. Conclusão: Este estudo realça a necessidade de estarmos alerta para as constantes e rápidas mudanças relacionadas com o uso crescente dos diferentes dispositivos digitais, bem como com o seu impacto oftalmológico e postural. Concluímos desta forma que quanto mais tempo usamos os dispositivos eletrónicos (> 2 horas), maiores são a probabilidade de desenvolver queixas e alterações da superfície ocular. As estratégias ambientais e oculares podem atenuar ou até mesmo eliminar o desconforto causado por esta síndrome e melhorar a qualidade de vida e o desempenho profissional.