Current practices and profiles of ophthalmologists involved in retinopathy of prematurity care in Brazil.

Retinopathy of prematurity (ROP) care in Brazil varies in availability of resources and infrastructure. A cross-sectional survey was conducted among ophthalmologists of the Brazilian ROP Group (BRA-ROP) to assess the profiles and practices of ophthalmologists involved in ROP care. A total of 78 responses of BRA-ROP participants (79%) were included. Participants were mostly retina experts (64.1%), female (65.4%), and over 40 years of age (60.2%). Eighty-six percent reported following Brazil's ROP screening criteria. Retinal imaging is available to 16.9% of respondents; fluorescein angiography, to 1.4%. For ROP stage 3 zone II (with plus disease), laser treatment was the preferred treatment (78.9%); for aggressive ROP, anti-VEGF was favored (66.2%). There were significant regional differences in treatment choice. Not all respondents continued to follow treated patients after discharge from the neonatal intensive care unit, highlighting an aspect of ROP care in need of improvement.

Retinopathy of prematurity: risk factors for its development in two neonatal intensive care units in Paraná-Brazil / Retinopatia da prematuridade: fatores de risco para seu desenvolvimento em duas unidades de terapia intensiva neonatais do Paraná-Brasil

ABSTRACT Purpose: Evaluate the patients in two neonatal intensive care units in Paraná/Brazil and identify the risk factors for the development of retinopathy of prematurity. Methods: We performed a prospective cohort study on premature infants with gestational age ≤32 wk and/or with birth weight ≤1500 g who were admitted to the neonatal intensive care unit of Hospital do Trabalhador and Hospital Infantil Waldemar Monastier. These hospitals admit patients referred from other maternity hospitals in the state of Paraná. The study duration was 12 mon. Results: The incidence of retinopathy of prematurity was higher in the Hospital Infantil Waldemar Monastier than in the Hospital do Trabalhador for premature infants who needed to be transported from their birthplace to the intensive care unit (52.2% vs. 29.6%). The following risk factors were associated with the development of the disease: longer hospitalization, low gestational age at birth, longer oxygen use, vasoactive drugs use, no antenatal corticosteroids use, intracranial hemorrhage, and any glycemic disorder. Low birth weight was an independent risk factor for the development of retinopathy of prematurity. Conclusion: Early neonatal care and transportation of premature infants may influence the occurrence and prognosis of retinopathy of prematurity.

RESUMO Objetivos: Avaliar duas unidades de terapia intensiva neonatais do Paraná e identificar os fatores de risco que levam ao desenvolvimento da retinopatia da prematuridade nestas unidades neonatais. Metodos: Foi realizado um estudo de coorte, prospectivo, com avaliação dos bebês prematuros examinados no período de 12 meses com idade gestacional ≤32 semanas e/ou com peso de nascimento ≤1500 gramas, internados na unidade de cuidados intensivos neonatais do Hospital do Trabalhador e do Hospital infantil Waldemar Monastier, que recebe neonatos transportados das maternidades de todo o estado do Paraná. Resultados: A incidência de retinopatia da prematuridade foi maior no Hospital Infantil Waldemar Monastier, entre os prematuros que necessitaram de transporte do local de nascimento para a unidade de cuidados intensivos (52,2% vs 29,6%), Os fatores de risco associados ao desenvolvimento da doença foram; Maior número de dias de internamento, baixa idade gestacional ao nascimento, maior tempo de uso de oxigênio, uso de drogas vasoativas, ausência de uso de corticoide pré-natal, presença de hemorragia intracraniana e qualquer tipo de alteração da glicemia. Conclusão: Os cuidados neonatais precoces e o transporte do recém-nascido pré- termo podem influenciar a ocorrência e o prognostico da retinopatia da prematuridade.

Retinopathy of prematurity: risk factors for its development in two neonatal intensive care units in Paraná-Brazil.

PURPOSE: Evaluate the patients in two neonatal intensive care units in Paraná/Brazil and identify the risk factors for the development of retinopathy of prematurity. METHODS: We performed a prospective cohort study on premature infants with gestational age ≤32 wk and/or with birth weight ≤1500 g who were admitted to the neonatal intensive care unit of Hospital do Trabalhador and Hospital Infantil Waldemar Monastier. These hospitals admit patients referred from other maternity hospitals in the state of Paraná. The study duration was 12 mon. RESULTS: The incidence of retinopathy of prematurity was higher in the Hospital Infantil Waldemar Monastier than in the Hospital do Trabalhador for premature infants who needed to be transported from their birthplace to the intensive care unit (52.2% vs. 29.6%). The following risk factors were associated with the development of the disease: longer hospitalization, low gestational age at birth, longer oxygen use, vasoactive drugs use, no antenatal corticosteroids use, intracranial hemorrhage, and any glycemic disorder. Low birth weight was an independent risk factor for the development of retinopathy of prematurity. CONCLUSION: Early neonatal care and transportation of premature infants may influence the occurrence and prognosis of retinopathy of prematurity.

Surgical results after one-muscle recession for correction of horizontal sensory strabismus in children.

PURPOSE: To report the success rates in children after one-muscle recession for sensory strabismus. METHODS: The medical records of consecutive patients ≤18 years of age who underwent primary unilateral horizontal surgery for sensory strabismus measuring ≤30(Δ) from 2004 to 2010 were retrospectively reviewed. Data collected included age at surgery, sex, length of follow-up, procedure performed, pre- and postoperative deviation, and treatment of associated vertical strabismus. Success was defined as a final deviation within 10(Δ) of orthotropia. RESULTS: A total of 33 patients (16 males) were included. Mean age at surgery was 5.2 years (range, 6 months to 17 years) and mean follow-up was 36 months (range, 6 months-7.4 years). Age at surgery (P = 0.37) and follow-up (P = 0.79) were comparable in patients with esotropia (n = 12) and exotropia (n = 21). Mean preoperative deviation was 23.7(Δ) in the esotropia group and 24(Δ) in the exotropia group (P = 0.875). Successful postoperative alignment was achieved in 76% of esotropic patients and 92% of exotropic patients (P = 0.379). Lateral rectus recessions resulted in a mean correction of 2.8(Δ)/mm of recession compared to 3.0(Δ)/mm for medial rectus recessions (P = 0.71). CONCLUSIONS: Advantages of one-muscle recession include a high success rate, few over-corrections, relatively short duration of surgery, and an intact muscle should reoperation be indicated.

Prevalence of glaucoma in a South brazilian population: Projeto Glaucoma.

PURPOSE: To assess the prevalence of glaucoma in a South Brazilian population. METHODS: Subjects older than 40 years underwent a screening examination that included a medical interview, slit lamp examination, tonometry, and fundoscopy. Those with suspected glaucoma (based on optic disc appearance and/or intraocular pressure) underwent a comprehensive ophthalmic evaluation during the definitive examination. Glaucoma was diagnosed based on the International Society of Geographical and Epidemiologic Ophthalmology classification. RESULTS: A total of 1636 subjects were examined (76.5% participation rate); 71% of the study population self-reported their race as white and 24% as nonwhite (most black and mixed-black/white). Glaucoma was found in 56 subjects (crude prevalence of all glaucoma: 3.4%; 95% CI, 2.5-4.3), primary open-angle glaucoma (POAG) was found in 40 (2.4%; 95% CI, 1.7-3.2), and primary angle-closure glaucoma (PACG) in 12 (0.7%; 95% CI, 0.3-1.1). Six (12%) subjects with primary glaucoma had a previous diagnosis of the disease. Nonwhite persons had a higher prevalence rate of POAG than did white participants, although this difference was not significant (3.8% vs. 2.1%, respectively, P = 0.11). Unilateral blindness due to primary glaucoma was observed in seven subjects (five POAG/2 PACG), and nonwhites had a higher rate of unilateral blindness than did whites (five versus two cases, respectively, P = 0.014). CONCLUSIONS: Compared to incidence in Hispanic and European populations, PACG was more common among South Brazilians, whereas the POAG rates were similar. The rate of undiagnosed glaucoma was almost 90%. The higher POAG prevalence in the population self-reported as nonwhite may affect the estimation of glaucoma in Brazil, as more than 40% of the population self-report their race as nonwhite.