Performance analysis of pretrained convolutional neural network models for ophthalmological disease classification.

PURPOSE: This study aimed to evaluate the classification performance of pretrained convolutional neural network models or architectures using fundus image dataset containing eight disease labels. METHODS: A publicly available ocular disease intelligent recognition database has been used for the diagnosis of eight diseases. This ocular disease intelligent recognition database has a total of 10,000 fundus images from both eyes of 5,000 patients for the following eight diseases: healthy, diabetic retinopathy, glaucoma, cataract, age-related macular degeneration, hypertension, myopia, and others. Ocular disease classification performances were investigated by constructing three pretrained convolutional neural network architectures including VGG16, Inceptionv3, and ResNet50 models with adaptive moment optimizer. These models were implemented in Google Colab, which made the task straight-forward without spending hours installing the environment and supporting libraries. To evaluate the effectiveness of the models, the dataset was divided into 70%, 10%, and 20% for training, validation, and testing, respectively. For each classification, the training images were augmented to 10,000 fundus images. RESULTS: ResNet50 achieved an accuracy of 97.1%; sensitivity, 78.5%; specificity, 98.5%; and precision, 79.7%, and had the best area under the curve and final score to classify cataract (area under the curve = 0.964, final score = 0.903). By contrast, VGG16 achieved an accuracy of 96.2%; sensitivity, 56.9%; specificity, 99.2%; precision, 84.1%; area under the curve, 0.949; and final score, 0.857. CONCLUSIONS: These results demonstrate the ability of the pretrained convolutional neural network architectures to identify ophthalmological diseases from fundus images. ResNet50 can be a good architecture to solve problems in disease detection and classification of glaucoma, cataract, hypertension, and myopia; Inceptionv3 for age-related macular degeneration, and other disease; and VGG16 for normal and diabetic retinopathy.

Frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil / Incapacidade para o trabalho por doenças oculares na população segurada da Previdência Social da região metropolitana do Recife, Brasil: um estudo de frequência

ABSTRACT Purpose: To identify the frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil. Methods: A review was performed of 217,221 cases of disability benefits granted between 2010 and 2015 by the executive managerial department of the Brazilian National Institute of Social Security (Instituto Nacional do Seguro Social [INSS]) in Recife, which encompasses 14 municipalities of the metropolitan region, including the capital. The frequencies of the identified cases of ocular morbidity were then determined according to their group in the International Classification of Diseases, 10th Revision (ICD-10), their cause, the age, sex, and income of the recipient, and the type and duration of the benefit. Results: Of all disability benefits granted, 5,324 (2.5%) were due to ocular disease, the majority (91.1%) consisting of sick pay. Most of the beneficiaries (64.6%) were males, were 20 to 59 years of age, and 61.2% earned the minimum wage or less. The principal ocular diseases for which sick pay benefits were granted were cataract (24.5%), conjunctivitis (21.1%), and pterygium (8.8%). Blindness and low vision were the principal ocular diseases in cases of accident indemnity and disability retirement. Conclusions: The results highlight the magnitude of the problem of ocular diseases to the social security system, with serious economic and social losses, and emphasize the need for measures aimed at their prevention. Moreover, integration between the national departments of health and social security needs to be improved.

RESUMO Objetivo: Identificar a frequência das doenças oculares entre os segurados com benefícios por incapacidade. Métodos: Estudo retrospectivo de 217.221 benefícios por incapacidade concedidos pelo Instituto Nacional do Seguro Social (INSS) da gerência executiva de Recife, que engloba os 14 municípios da região metropolitana, incluindo a capital, no período de 2010-2015. Os casos de doenças oculares foram avaliados quanto à frequência considerando seu grupo na CID-10. Foi feita ainda uma análise do perfil dos benefícios concedidos por estas doenças com relação à causa, idade, sexo, faixa salarial, espécie e duração do benefício. Resultados Do total dos benefícios concedidos, 5.324 foram decorrentes de doenças oftalmológicas (2,5%) e entre estes, a maioria como auxíliodoença (91,1%). Houve predomínio do sexo masculino (64,6%), faixa etária dos 20 aos 59 anos e valor de até 01 salário mínimo (61,2%). Entre as concessões de auxíliodoença a principal causa foi a catarata (24,5%), seguida pela conjuntivite (21,1%) e pterígio (8,8%). A cegueira e baixa visão foi a principal causa de auxílio-acidente e aposentadoria por invalidez. Conclusões: Os resultados destacam a magnitude do problema das doenças oculares para a Previdência Social, com graves perdas econômicas e sociais, e enfatizam a necessidade de medidas que visem sua prevenção e maior integração entre os serviços de saúde e o INSS (Instituto Nacional do Seguro Social).

Peripapillary choroidal thickness in contralateral eyes after evisceration of diseased eyes / Espessura coroide peripapilar de olhos contralaterais após evisceração do olho doente

ABSTRACT Purpose: To evaluate peripapillary choroidal thickness changes in contralateral eyes of patients who had undergone evisceration of their diseased eyes. Methods: In this retrospective study, peripapillary choroidal thickness parameters in 34 eyes of 34 patients who had undergone diseased-eye evisceration between March 2014 and May 2016 were evaluated using spectral domain optical coherence tomography. The scans were manually delineated to identify the principal surfaces of Bruch's membrane, the Bruch's membrane opening, and the anterior sclera. Peripapillary choroidal thickness was measured between the Bruch's membrane and the anterior sclera at increasing distance away from the Bruch's membrane opening. The mean peripapillary choroidal thickness values in the contralateral eyes of the patients and those of the control group were compared. Results: The mean peripapillary choroidal thickness was higher in the contralateral eyes of the patients compared with that of normal eyes at all distances from the Bruch's membrane opening. Conclusion: Increased peripapillary choroidal thickness was noted in the contralateral eyes of the patients, potentially resulting in a thicker choroid. Although further investigation is required to determine the cause, these findings indicate the presence of a compensatory factor in the contralateral eyes.

RESUMO Objetivo: Avaliar as alterações da espessura coroide peripapilar em olhos contralaterais de pacientes submetidos à evisceração do olho doente. Métodos: Neste estudo retrospectivo, parâmetros da espessura coróide peripapilar de 34 olhos de 34 pacientes submetidos à evisceração, entre março de 2014 e maio de 2016, foram avaliados com tomografia de coerência óptica de domínio espectral. As varreduras foram manualmente delineadas para identificar as principais superfícies da membrana de Bruch, a abertura da membrana de Bruch e a esclera anterior. A espessura coroide peripapilar foi medida entre a membrana de Bruch e a esclera anterior a uma distância crescente da abertura da membrana de Bruch. Compararam-se os valores médios da espessura coroide peripapilar dos olhos contralaterais dos pacientes e do grupo controle. Resultados: A espessura coroide peripapilar média foi mais espessa nos olhos contralaterais dos pacientes, quando comparada com os olhos normais, em todas as distâncias da abertura da membrana de Bruch. Conclusão: O aumento da espessura coroide peripapilar foi notado nos olhos contralaterais dos pacientes. O espessamento da coroide pode ser resultante do distúrbio. Embora seja necessária uma investigação mais aprofundada para determinar a causalidade, esses achados podem apontar para um fator compensatório dos olhos contralaterais.

Peripapillary choroidal thickness in contralateral eyes after evisceration of diseased eyes.

PURPOSE: To evaluate peripapillary choroidal thickness changes in contralateral eyes of patients who had undergone evisceration of their diseased eyes. METHODS: In this retrospective study, peripapillary choroidal thickness parameters in 34 eyes of 34 patients who had undergone diseased-eye evisceration between March 2014 and May 2016 were evaluated using spectral domain optical coherence tomography. The scans were manually delineated to identify the principal surfaces of Bruch's membrane, the Bruch's membrane opening, and the anterior sclera. Peripapillary choroidal thickness was measured between the Bruch's membrane and the anterior sclera at increasing distance away from the Bruch's membrane opening. The mean peripapillary choroidal thickness values in the contralateral eyes of the patients and those of the control group were compared. RESULTS: The mean peripapillary choroidal thickness was higher in the contralateral eyes of the patients compared with that of normal eyes at all distances from the Bruch's membrane opening. CONCLUSION: Increased peripapillary choroidal thickness was noted in the contralateral eyes of the patients, potentially resulting in a thicker choroid. Although further investigation is required to determine the cause, these findings indicate the presence of a compensatory factor in the contralateral eyes.

Frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil.

PURPOSE: To identify the frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil. METHODS: A review was performed of 217,221 cases of disability benefits granted between 2010 and 2015 by the executive managerial department of the Brazilian National Institute of Social Security (Instituto Nacional do Seguro Social [INSS]) in Recife, which encompasses 14 municipalities of the metropolitan region, including the capital. The frequencies of the identified cases of ocular morbidity were then determined according to their group in the International Classification of Diseases, 10th Revision (ICD-10), their cause, the age, sex, and income of the recipient, and the type and duration of the benefit. RESULTS: Of all disability benefits granted, 5,324 (2.5%) were due to ocular disease, the majority (91.1%) consisting of sick pay. Most of the beneficiaries (64.6%) were males, were 20 to 59 years of age, and 61.2% earned the minimum wage or less. The principal ocular diseases for which sick pay benefits were granted were cataract (24.5%), conjunctivitis (21.1%), and pterygium (8.8%). Blindness and low vision were the principal ocular diseases in cases of accident indemnity and disability retirement. CONCLUSIONS: The results highlight the magnitude of the problem of ocular diseases to the social security system, with serious economic and social losses, and emphasize the need for measures aimed at their prevention. Moreover, integration between the national departments of health and social security needs to be improved.

Classifications of vitreomacular traction syndrome: diameter vs morphology.

PURPOSE: The aim of this study is to analyze the agreement between the classifications based on morphology and diameter of vitreomacular traction (VMT) syndrome, as well as to correlate the morphological findings of VMT with specific maculopathies. METHODS: Fifty-three eyes with VMT syndrome were categorized into two classifications based on optical coherence tomography images: the VMT morphology (V- or J-shaped) and the diameter of adhesion (focal ≤ 1500 µm or broad>1500 µm). RESULTS: High correlation was seen between V-shaped and focal-VMT and between J-shaped and broad-VMT (kappa=0.850; P<0.001), except in four cases with broad adhesion despite the presence of a V-shaped pattern. These four cases had common characteristics to those with broad vitreal attachment regarding associated maculopathies and visual function. V-shaped VMT (n=29) and focal-VMT (n=25) led to tractional cystoid macular edema (CME; 79.31% and 84%, respectively) and macular hole (MH; 37.93% and 44%); J-shaped VMT (n=24) and broad-VMT (n=28) were associated with epiretinal membranes (ERMs; 91.66% and 92.85%, respectively) and diffuse retinal thickening (62.50% and 64.28%). The best-corrected visual acuity (BCVA) was not significantly different between the groups (BCVA logarithm of the minimum angle of resolution: V-shaped, 0.45; J-shaped, 0.46; P=0.816; and focal, 0.50; broad, 0.42; P=0.198). CONCLUSIONS: Although highly concordant, the classification based on the diameter of the adhesion and not on the classical adhesion morphology seemed to better reflect the specific macular changes. V-shaped and focal VMT led to tractional CME and MH, while J-shaped and broad VMT were associated with ERM and diffuse retinal thickening.

Ophthalmic manifestations of HIV in the highly active antiretroviral therapy era / Manifestaciones oftálmicas del VIH en la era de la terapia antiretroviral altamente activa

HIV-related eye disease can be classified as retinal HIV microangiopathy, opportunistic infections, neuro-ophthalmic manifestations and unusual malignancies. There is a 52-100% lifetime accumulative risk of HIV patients developing eye problems. Seventy-seven per cent of patients with ocular manifestations of HIV had CD4 counts < 200 cells/µL. Cytomegalovirus (CMV) is the most prevalent opportunistic infection, however, Africa has a low incidence of this, and more commonly squamous cell carcinoma, compared to the western hemisphere. Due to highly active antiretroviral therapy (HAART), the anti-CMV therapy may be discontinued if the CD4+ T cell count is > 100 cells/µL for a minimum of three months. Despite HAART, patients with a CD4 count < 50 cells/µL have a similar risk of developing CMV retinitis as compared to the pre-HAART era. Opportunistic infections include CMV, herpetic retinopathy (progressive outer retinal necrosis - PORN), less commonly toxoplasmosis, pneumocystis and cryptococcus. Malignancies associated with HIV include Kaposi's sarcoma and conjunctival squamous cell carcinoma. Cranial nerve palsies, optic disc swelling and atrophy are characteristic neuro-ophthalmic features. They usually occur secondary to meningitis/encephalitis (from cryptococcus and tuberculosis). With the advent of HAART, new complications have developed in CMV retinitis: immune recovery uveitis (IRU) and cystoid macula oedema (CMO). Immune recovery uveitis occurs in 71% of patients if HAART is started before the induction of the anti-CMV treatment. However, this is reduced to 31% if HAART is started after the induction treatment. Molluscum contagiosum and Kaposi's sarcoma can spontaneously resolve on HAART. Highly active anti-retroviral therapy has reduced the frequencies of opportunistic infections and improved the remission duration in HIV patients.

Las enfermedades oculares relacionadas con el VIH pueden clasificarse como microangiopatía retiniana por VIH, infecciones oportunistas, manifestaciones neuro-oftálmicas, y tumores inusuales. Hay un riesgo acumulativo de por vida de 52-100% de que los pacientes con VIH desarrollen problemas oculares. Setenta y siete por ciento de los pacientes con manifestaciones oculares por VIH tenían conteos de CD4 < 200 células/µL. El citomegalovirus (CMV) es la infección oportunista más frecuente. Sin embargo, África tiene una baja incidencia de CVM, siendo en cambio más común el carcinoma de células escamosas, en comparación con el hemisferio occidental. Debido a la terapia antiretroviral altamente activa (TAAA), la terapia anti-CMV puede suspenderse si el conteo de células CD4+ T es > 100 células/µL por un mínimo de tres meses. A pesar de la terapia TAAA, los pacientes con un conteo de CD4 < 50 células/µL tienen un riesgo similar de desarrollar retinitis por CMV en comparación con la era pre-TAAA. Las infecciones oportunistas incluyen CMV, retinopatía herpética (necrosis retiniana progresiva externa - PORN), y menos comúnmente toxoplasmosis, pneumocistosis, y cryptococcus. Los tumores malignos asociados con el VIH incluyen el sarcoma de Kaposi y el carcinoma de células escamosas de conjuntiva. La parálisis del nervio craneal, la inflamación del disco óptico, así como la atrofia, son características neuro-oftálmicas típicas. Generalmente se presentan de forma secundaria en los casos de meningitis, encefalitis (cryptococcus y tuberculosis). Con el advenimiento de TAAA, se han desarrollado nuevas complicaciones de la retinitis por CMV, a saber, la uveitis por recuperación inmunológica (IRU por su sigla en inglés) y el edema macular cistoide (EMC). La uveitis por recuperación inmunológica ocurre en 71% de los pacientes si la terapia TAAA se comienza antes de la inducción del tratamiento anti-CMV. Sin embargo, esta cantidad se reduce a un 31% si TAAA se inicia después del tratamiento de inducción. El molusco contagioso y el sarcoma de Kaposi pueden desaparecer espontáneamente con el TAAA. La terapia anti-retroviral altamente activa ha reducido las frecuencias de las infecciones oportunistas, y mejorado la duración de la remisión en pacientes con VIH.

Childhood eye diseases in southwestern Nigeria: a tertiary hospital study.

BACKGROUND: Eye diseases are important cause of medical consultation in children, with the spectrum varying in different localities. This study aimed to determine the spectrum of childhood eye diseases in a tertiary hospital serving rural and semi-rural communities. METHODS: We conducted a retrospective review of all patients less than 15 years old who presented to the eye clinic of Wesley Guild Hospital Ilesa, Nigeria between January 2001 and December 2006. Data on age at presentation, age at onset of disease, sex and diagnosis were collected and analyzed using SPSS. A p value less than 0.05 was considered statistically significant. RESULTS: We evaluated the reports of 286 children, with a male:female ratio of 1:1.1. Children aged 11-15 years made up the largest group (p=0.013). Ocular trauma (21.7%), allergic conjunctivitis (17.8%), infections of the eye and its adnexa (15.4%) and refractive errors (14.3%) were the most common conditions. Ocular injury was more common in males (p=0.002) and children aged 6-10 years, and 87.1% of these cases were a closed globe injury. Infections were seen more commonly among females and children aged 0-5 years, with keratitis representing 40.9% of these cases. Congenital eye disease represented 13.3% of childhood eye diseases. CONCLUSION: The prevalent childhood eye diseases recorded here can lead to absenteeism from school and are potentially blinding. Health education aimed at the prevention of ocular trauma and prompt presentation for the management of other eye diseases should be encouraged.

[Use of fibrin glue in ocular surgery]. / Utilização de adesivo de fibrina em cirurgias oftalmológicas.

PURPOSE: To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries. METHODS: A retrospective and non-comparative case series study. 161 eyes were evaluated. The mean age was 51.8 years. Fibrin glue (Beriplast--Aventis Behring, Germany) was used in all patients for tissue adherence or incisional closure. RESULTS: Main preoperatives diseases were pterygium (76 patients), superior limbic keratoconjunctivitis (4 patients), limbal tumor (4 patients), conjunctivochalasis (21 patients), bullous keratopathy (31 patients), limbal stem cell deficiency (7 patients), alkali injury (6 patients), Stevens-Johnson syndrome (2 patients), cataract (5 patients) and glaucoma (5 patients). Complications occurred in 28 patients (17.4%). Detachment of the fixed tissue and granulomatous foreign body reaction were the main complications. Detachment occurred in 10 cases (5.6%) (7 in amniotic membrane transplantation in bullous keratopathy, 2 in autologous conjunctival grafting for pterygium surgery, 1 in autologous limbal transplantation in a Stevens-Johnson syndrome). Granulomatous foreign body reaction was described in 9 patients (5.6%) (5 in amniotic membrane transplantation due to acute alkali injury, 1 in autologous limbal graft due to chronic burn injury, and 3 in autologous conjunctival transplant due to pterygium surgery). All the complications described occurred in the first week after surgery. CONCLUSION: Despite the limitations related to the retrospective and non-comparative setting, this study suggests that the use of fibrin glue seems to be safe and effective for tissue fixation or incisional closure presenting low rates of complications in ocular surface and anterior segment surgeries.

Utilização de adesivo de fibrina em cirurgias oftalmológicas / Use of fibrin glue in ocular surgery

OBJETIVO: Avaliar as diferentes técnicas cirúrgicas oftalmológicas nas quais se pode utilizar a cola biológica e possíveis complicações relacionadas ao seu uso. MÉTODOS: Estudo de série de casos retrospectivo, não-comparativo. Foram avaliados 161 olhos de pacientes com idade média de 51,8 anos em que foi utilizada cola biológica (Beriplast P® - Aventis Behring, Alemanha) para fixação de tecido ou fechamento incisional. RESULTADOS: Foram avaliados 76 pacientes com pterígio, 4 com ceratoconjuntivite límbica superior, 4 com tumor limbar, 21 com conjuntivocálase, 31 com ceratopatia bolhosa, 7 com deficiência límbica, 6 com queimadura alcalina, 2 com Stevens-Johnson, 5 com catarata e 5 com glaucoma. Complicações foram relatas em 28 casos (17,4 por cento). Descolamento do tecido fixado e granuloma foram as complicações mais frequentes. Descolamento ocorreu em 10 casos (5,6 por cento) (7 em transplante de membrana amniótica em ceratopatia bolhosa, 2 em transplante de conjuntiva autólogo após exérese de pterígio, 1 após transplante de limbo autólogo por Stevens-Johnson). Granuloma ocorreu em 9 casos (5,6 por cento) (5 em pacientes com queimadura alcalina aguda tratados com transplante de membrana amniótica, 1 em paciente com sequela de queimadura tratado com transplante de limbo autólogo e 3 em pacientes após exérese de pterígio tratados com transplante de conjuntiva autólogo). Todas as complicações ocorreram dentro da primeira semana de pós-operatório. CONCLUSÃO: Embora o presente seja retrospectivo e não-comparativo, podemos observar que a utilização do adesivo de fibrina parece ser segura e efetiva, além de apresentar baixas taxas de complicações nas cirurgias de superfície ocular e de segmento anterior.

PURPOSE: To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries. METHODS: A retrospective and non-comparative case series study. 161 eyes were evaluated. The mean age was 51.8 years. Fibrin glue (BeriplastTM - Aventis Behring, Germany) was used in all patients for tissue adherence or incisional closure. RESULTS: Main preoperatives diseases were pterygium (76 patients), superior limbic keratoconjunctivitis (4 patients), limbal tumor (4 patients), conjunctivochalasis (21 patients), bullous keratopathy (31 patients), limbal stem cell deficiency (7 patients), alkali injury (6 patients), Stevens-Johnson syndrome (2 patients), cataract (5 patients) and glaucoma (5 patients). Complications occurred in 28 patients (17.4 percent). Detachment of the fixed tissue and granulomatous foreign body reaction were the main complications. Detachment occurred in 10 cases (5.6 percent) (7 in amniotic membrane transplantation in bullous keratopathy, 2 in autologus conjunctival grafting for pterygium surgery, 1 in autologus limbal transplantation in a Stevens-Johnson syndrome). Granulomatous foreign body reaction was described in 9 patients (5.6 percent) (5 in amniotic membrane transplantation due to acute alkali injury, 1 in autologus limbal graft due to chronic burn injury, and 3 in autologus conjunctival transplant due to pterygium surgery). All the complications described occurred in the first week after surgery. CONCLUSION: Despite the limitations related to the retrospective and non-comparative setting, this study suggests that the use of fibrin glue seems to be safe and effective for tissue fixation or incisional closure presenting low rates of complications in ocular surface and anterior segment surgeries.

Childhood eye diseases in southwestern Nigeria: a tertiary hospital study

BACKGROUND: Eye diseases are important cause of medical consultation in children, with the spectrum varying in different localities. This study aimed to determine the spectrum of childhood eye diseases in a tertiary hospital serving rural and semi-rural communities. METHODS: We conducted a retrospective review of all patients less than 15 years old who presented to the eye clinic of Wesley Guild Hospital Ilesa, Nigeria between January 2001 and December 2006. Data on age at presentation, age at onset of disease, sex and diagnosis were collected and analyzed using SPSS. A p value less than 0.05 was considered statistically significant. RESULTS: We evaluated the reports of 286 children, with a male:female ratio of 1:1.1. Children aged 11-15 years made up the largest group (p=0.013). Ocular trauma (21.7 percent), allergic conjunctivitis (17.8 percent), infections of the eye and its adnexa (15.4 percent) and refractive errors (14.3 percent) were the most common conditions. Ocular injury was more common in males (p=0.002) and children aged 6-10 years, and 87.1 percent of these cases were a closed globe injury. Infections were seen more commonly among females and children aged 0-5 years, with keratitis representing 40.9 percent of these cases. Congenital eye disease represented 13.3 percent of childhood eye diseases. CONCLUSION: The prevalent childhood eye diseases recorded here can lead to absenteeism from school and are potentially blinding. Health education aimed at the prevention of ocular trauma and prompt presentation for the management of other eye diseases should be encouraged.

Ophthalmology emergency room at the University of São Paulo General Hospital: a tertiary hospital providing primary and secondary level care.

OBJECTIVE: To assess the need for emergency care in a tertiary hospital, in the Ophthalmology Emergency Room of the University of the São Paulo Medical School General Hospital. MATERIALS AND METHODS: A cross-sectional analytic study of the treatment complexity level was carried out in a readily available sample, n = 574, of patients seen at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital, during a typical week. RESULTS: Of the 574 treated patients, 69.0% of the cases were diagnosed as requiring a simple treatment for their problem. The most frequent diagnoses were related to ocular inflammation and infection (55.0%), mainly including conjunctivitis (29.4%) and eyelid inflammations (10.5%). Next in frequency were ocular trauma (19.2%), particularly foreign bodies on the cornea (7.5%) and blunt trauma (5.2%). Refractive errors (3.1%) was the most prevalent diagnosis in the "other ocular modifications" category. CONCLUSION: Most of the cases (69.0%) treated at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital could have been diagnosed and treated in primary or secondary care units. Also, the fact that return visits to check recovery are seen in the ER demonstrates the lack of referral services. The fact that patients come to a tertiary hospital with rather simple cases shows the poor structure of the Brazilian Public Healthcare System, which overloads the tertiary care facilities, where costs for human resources, materials, and other items are higher.

Ophthalmology emergency room at the University of São Paulo General Hospital: a tertiary hospital providing primary and secondary level care

OBJECTIVE: To assess the need for emergency care in a tertiary hospital, in the Ophthalmology Emergency Room of the University of the São Paulo Medical School General Hospital. MATERIALS AND METHODS: A cross-sectional analytic study of the treatment complexity level was carried out in a readily available sample, n = 574, of patients seen at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital, during a typical week. RESULTS: Of the 574 treated patients, 69.0 percent of the cases were diagnosed as requiring a simple treatment for their problem. The most frequent diagnoses were related to ocular inflammation and infection (55.0 percent), mainly including conjunctivitis (29.4 percent) and eyelid inflammations (10.5 percent). Next in frequency were ocular trauma (19.2 percent), particularly foreign bodies on the cornea (7.5 percent) and blunt trauma (5.2 percent). Refractive errors (3.1 percent) was the most prevalent diagnosis in the "other ocular modifications" category. CONCLUSION: Most of the cases (69.0 percent) treated at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital could have been diagnosed and treated in primary or secondary care units. Also, the fact that return visits to check recovery are seen in the ER demonstrates the lack of referral services. The fact that patients come to a tertiary hospital with rather simple cases shows the poor structure of the Brazilian Public Healthcare System, which overloads the tertiary care facilities, where costs for human resources, materials, and other items are higher.

OBJETIVO: Verificar a necessidade de atendimento em hospital terciário de casos emergenciais do Pronto-Socorro de Oftalmologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. MATERIAL E MÉTODO: Realizou-se um estudo transversal analítico em amostra prontamente acessível, n= 574, de pacientes emergenciais atendidos no Pronto-Socorro Oftalmológico do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, obtida em semana típica de atendimento. RESULTADOS: Dos 574 pacientes atendidos, 69,0 por cento dos casos foram diagnosticados como de simples resolução. Os diagnósticos mais freqüentes estavam relacionados com inflamações e infecções oculares (55,0 por cento), entre elas destacaram-se as conjuntivites (29,4 por cento) e as inflamações palpebrais (10,5 por cento). A seguir vêm os traumatismos oculares (19,2 por cento), destacando-se os corpos estranhos de córnea (7,5 por cento) e trauma contuso (5,2 por cento). Os erros de refração (3,1 por cento) foram preponderantes na categoria de diagnóstico "outras alterações oculares". CONCLUSÃO: A maioria (69,0 por cento) dos casos atendidos no Pronto-Socorro de Oftalmologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo poderia ser diagnosticada e tratada em níveis primário e secundário de atendimento. A procura por um hospital terciário para tratamentos de casos simples, evidencia desestruturação na rede do Sistema Público Brasileiro de Atendimento à Saúde e sobrecarrega uma unidade terciária, cujo custo envolvendo recursos humanos, materiais e de consumo é muito maior.

Patología ocular para el patólogo general / Ocular pathology for the general pathologist

La Patología Ocular incluye el estudio de los procesos o enfermedades que afectan el globo ocular (las estructuras que lo componen) y sus anexos. Esta especialidad ha avanzado en el tiempo en la misma proporción que lo han hecho la Patología General y la Oftalmología, de las cuales se nutren. El objetivo de la presente revisión es la actualización de términos y procedimientos de utilidad para los patólogos generales, que reciben muestras relacionadas con el campo de la Oftalmología. Los especialistas en Oftalmología y sus pacientes se beneficiarán de un óptimo estudio y, con el consiguiente reporte final se accederá a un tratamiento adecuado. Se revisan así mismo, los tópicos más resaltantes y comunes en la práctica diaria de la Patología Ocular.

[Prevalence of ocular diseases in a population of elderly residents of the city of Veranópolis, Brazil]. / Prevalência de transtornos oculares na população de idosos residentes na cidade de Veranópolis, RS, Brasil.

PURPOSE: To evaluate the prevalence of diseases of the eye in a population aged 80 years and above in the city of Veranópolis, Rio Grande do Sul, Brazil. METHODS: 187 elderly people were submitted to ophthalmologic tests including external inspection, ocular motility examination, visual acuity determination for near and far distance, applanation tonometry, biomicroscopy, cycloplegia, direct fundus examination and static skiascopy. RESULTS: The most prevalent disease was presbyopia in 173 (92.5%) patients, cataract in 160 (85.6%), age-related ectropion in 130 (69.5%), hypermetropia in 130 (69.5%) and age-related macular degeneration (ARMD) in 59 (31.5%) patients. 85 (45.4%) patients presented marked low vision whose main causes were cataract in 46 (54.1%) and refractive error in 16 (18.9%) of the studied population. The most prevalent complaint was due to presence of age-related ectropion. CONCLUSIONS: Common diseases as cataract and retractive error are still a challenge to ophthalmologists because these diseases remain main causes of visual deficit in old age resulting in life quality losses.

Prevalência de transtornos oculares na população de idosos residentes na cidade de Veranópolis, RS, Brasil / Prevalence of ocular diseases in a population of elderly residents of the city of Veranópolis, Brazil

OBJETIVO: Avaliar os transtornos oculares e a sua prevalência em pessoas com 80 anos de idade, ou mais, na cidade de Veranópolis, Rio Grande do Sul, Brasil. MÉTODOS: 187 idosos foram submetidos a exame oftalmológico por meio de inspeção externa, motilidade extrínseca, medidas de acuidade visual para longe e perto, tonometria de aplanação, biomicroscopia, cicloplegia, fundoscopia direta e esquiascopia estática. RESULTADOS: As doenças mais prevalentes foram: presbiopia em 173 (92,5 por cento) pacientes, catarata em 160 (85,6 por cento), ectrópio senil em 130 (69,5 por cento), hipermetropia em 130 (69,5 por cento) e a degeneração macular relacionada à idade (DMRI) em 59 (31,5 por cento). Na população estudada, 85 (45,4 por cento) pacientes apresentaram baixa visual acentuada cujas causas principais eram a catarata em 46 (54,1 por cento) e erros de refração em 16 (18,9 por cento) dos idosos. A principal causa de queixas dos idosos foi relacionada com a presença de ectrópio senil. CONCLUSÃO: Doenças comuns como a catarata e os erros de refração continuam a ser um desafio para os oftalmologistas, pois são importantes causas de dificuldade visual nos idosos, com conseqüente perda de qualidade em suas vidas.

Leucocorias na infância / Leukocoria in childhood

No presente trabalho, através de uma revisão bibliográfica, os autores pretendem abordar as causas mais comuns relacionadas a leucocorias na infância, abrangendo desde suas fisiopatologias até aos possíveis tratamentos. O estudo tem como público alvo estudantes de medicina, pediatras e médicos generalistas