Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine and esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial.

BACKGROUND: Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD), and conflicting evidence suggests that induced dissociation by these drugs can be a clinical predictor of esketamine/ketamine's efficacy. METHODS: This study is a secondary analysis from a bi-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of esketamine (.25 mg/kg) or racemic ketamine (.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. The variation in depression scores was measured with the Montgomery-Asberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hrs, 72 hrs, and 7 days following infusion. RESULTS: Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of -0.5 (SD = 0.25; p-value 0.04) of predicted MADRS score from baseline to 24 hrs. The results for 72 hrs and 7 days following infusion were not significant. Limitations: This study was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, therefore confounding variables for this relationship were not controlled. CONCLUSION: We suggest a positive relationship between dissociation intensity, measured by CADSS, and antidepressant effect 24 hours after ketamine and esketamine infusion for a CADSS score of up to 15 points.

Psychometric properties the of Brazilian Portuguese version of Snaith-Hamilton Pleasure Scale (SHAPS).

INTRODUCTION: Anhedonia is defined as the reduced ability to feel pleasure and is a core symptom of various psychiatric disorders such as depression and schizophrenia. The Snaith-Hamilton Pleasure Scale (SHAPS) was developed to assess the presence of anhedonia. The objective of this study was to assess the psychometric properties of the Brazilian Portuguese version of the SHAPS. METHODS: In this study, the SHAPS (14 items) was translated into Brazilian Portuguese and validated using data obtained from 228 subjects within a clinical sample. Psychometric properties were assessed using item response theory (logistic models) and classical test theory (Cronbach's alpha). We checked for external validity using a non-parametric correlation with an independent scale: Hospital Anxiety and Depression Scale - Depression subscale (HAD-D). RESULTS: The SHAPS presented good internal consistency, with a Cronbach's α coefficient of 0.759 and adequacy to an IRT 1 parameter logistic (Rasch) model. The SHAPS presented significant correlation with the external measure HAD-D, with Spearman's ρ = 0.249 (S = 1368914; p < 0.001). CONCLUSION: These results suggest that the Brazilian Portuguese version of the SHAPS is a reliable and valid instrument to assess hedonic tone.

Sintomas depressivos e aspectos subjetivos associados à cefaleia do tipo primária / Depressive symptoms and subjective aspects associated with primary headache

A cefaleia é um sintoma muito comum na rotina das pessoas e uma queixa frequente na prática dos profissionais de saúde. Caracteriza-se como primária e secundária, sendo a primária aquela que não possui etiologia que a explique a partir de exames clínicos ou laboratoriais. Estudos têm apontado a frequente associação entre cefaleia primária e depressão, bem como mostrado os efeitos trazidos pela cefaleia à vida das pessoas acometidas. Desse modo, o presente estudo teve como objetivo geral identificar a relação entre sintomas depressivos, aspectos subjetivos e cefaleia primária. Trata-se de um estudo transversal no qual foram aplicados questionário sociodemográfico, entrevista semiestruturada, Escala Visual Analógica (EVA) e Inventário de Depressão de Beck (BDI) em 40 participantes de ambos os sexos, maiores de 18 anos, que apresentavam cefaleia primária. Todos os participantes autorizaram sua participação na pesquisa mediante assinatura do Termo de Consentimento Livre e Esclarecido. Constatou-se que 52,5% dos participantes apresentaram sintomas depressivos nos níveis leve a grave, sendo os sentimentos de tristeza e angústia os mais comuns perante a dor.

Headache is a very common symptom in the people's routine and a frequent complaint in the practice of health professionals. It is characterized as primary and secondary. The primary one is the one that cannot be explained by clinical or laboratory tests. Studies show a frequent association between primary headache and depression as well as it shows the effects brought about by headache to the lives of affected people. Therefore, the aim of the present study is to identify the relevance between depressive symptoms, subjective aspects and primary headache. This was a cross-sectional study in which the sociodemographic questionnaire, semi-structured interview, Visual Analogue Scale (VAS) and Beck Depression Inventory (BDI) were applied to 40 people of mixed-gender group, over 18 years old, who were having primary headache. All the participants authorized their participation in the research by signing the Informed Consent Term. It was found that 52.5% of the people were having depressive symptoms from mild to severe levels, being sadness and anguish the most common feelings in face of pain.

MENTAL DISORDERS AND QUALITY OF LIFE IN PATIENTS AWAITING LIVER TRANSPLANTATION.

BACKGROUND: Liver transplantation is the main therapeutic alternative for patients with advanced liver disease. These patients have high prevalence of psychiatric comorbidities that may negatively interfere in clinical outcomes and quality of life. It is not clear in the literature whether the different etiologies of hepatic disease have the same prevalence of psychiatric disorders. OBJECTIVE: The aim of this study was to investigate whether patients in the liver transplant list showed differences in psychiatric characteristics, medical variables and quality of life among different etiological groups. METHODS: This is a cross-sectional study that evaluates quality of life, psychiatric and clinical comorbidities through the application of validated questionnaires and instruments in 248 patients who were on transplant waiting list from 2010 to 2014, assisted in a University Hospital and in a Private Hospital in Salvador/Bahia, Brazil. The patients were evaluated through the Mini International Neuropsychiatric Interview (M.I.N.I. PLUS 5.0) and Medical Outcomes Short-Form Health Survey (SF-36). RESULTS: The etiology of the most prevalent liver disease was hepatitis C virus. A prevalence of 50.8% of at least one mental disorder was identified. When alcohol abuse/dependence was excluded, the prevalence was 25.8%. Mental health did not show a statistically significant difference in the diverse etiological groups, but a higher prevalence of psychiatric comorbidities was detected among women and younger than 40 years. No cases of psychotic disorders were detected, possibly by exclusion prior to listing. There was no difference in the quality of life domains in the different liver etiological groups. CONCLUSION: A high-prevalence of psychiatric disorders was found among all clinical conditions most associated with indication for liver transplantation. Attention is drawn to the absence of patients with psychotic disorders, which suggests that transplantation may not have been indicated for this group of patients. For these reasons, professionals caring for liver transplant candidates should be highly vigilant for the presence of mental disorders, regardless of the etiology of liver disease. Specialized care is recommended to minimize the early exclusion of patients with no other therapeutic possibilities, as well as care of all people with mental disorders.

Desordens mentais e qualidade de vida em pacientes em lista de espera para realização de transplante de fígado / Mental disorders and quality of life in patients awaiting liver transplantation

ABSTRACT BACKGROUND: Liver transplantation is the main therapeutic alternative for patients with advanced liver disease. These patients have high prevalence of psychiatric comorbidities that may negatively interfere in clinical outcomes and quality of life. It is not clear in the literature whether the different etiologies of hepatic disease have the same prevalence of psychiatric disorders. OBJECTIVE: The aim of this study was to investigate whether patients in the liver transplant list showed differences in psychiatric characteristics, medical variables and quality of life among different etiological groups. METHODS: This is a cross-sectional study that evaluates quality of life, psychiatric and clinical comorbidities through the application of validated questionnaires and instruments in 248 patients who were on transplant waiting list from 2010 to 2014, assisted in a University Hospital and in a Private Hospital in Salvador/Bahia, Brazil. The patients were evaluated through the Mini International Neuropsychiatric Interview (M.I.N.I. PLUS 5.0) and Medical Outcomes Short-Form Health Survey (SF-36). RESULTS: The etiology of the most prevalent liver disease was hepatitis C virus. A prevalence of 50.8% of at least one mental disorder was identified. When alcohol abuse/dependence was excluded, the prevalence was 25.8%. Mental health did not show a statistically significant difference in the diverse etiological groups, but a higher prevalence of psychiatric comorbidities was detected among women and younger than 40 years. No cases of psychotic disorders were detected, possibly by exclusion prior to listing. There was no difference in the quality of life domains in the different liver etiological groups. CONCLUSION: A high-prevalence of psychiatric disorders was found among all clinical conditions most associated with indication for liver transplantation. Attention is drawn to the absence of patients with psychotic disorders, which suggests that transplantation may not have been indicated for this group of patients. For these reasons, professionals caring for liver transplant candidates should be highly vigilant for the presence of mental disorders, regardless of the etiology of liver disease. Specialized care is recommended to minimize the early exclusion of patients with no other therapeutic possibilities, as well as care of all people with mental disorders.

RESUMO CONTEXTO: O transplante hepático é a principal alternativa terapêutica para pacientes com doença hepática avançada. Esses pacientes apresentam alta prevalência de comorbidades psiquiátricas que podem interferir negativamente nos desfechos clínicos e qualidade de vida. Não está claro na literatura se as diferentes etiologias de doença hepática têm a mesma prevalência de transtornos psiquiátricos. OBJETIVO: O objetivo deste estudo foi investigar se os pacientes na lista de transplante hepático apresentavam diferenças nas variáveis psiquiátricas, variáveis clínicas e qualidade de vida em diferentes grupos etiológicos. MÉTODOS: Estudo transversal que avalia as comorbidades psiquiátricas e clínicas e as variáveis de qualidade de vida por meio da aplicação de questionários e instrumentos validados em 248 pacientes inseridos em lista de espera para transplante hepático no período de 2010 a 2014, acompanhados no Hospital Universitário Professor Edgard Santos e Hospital Português (Salvador, BA). Os pacientes foram avaliados através da aplicação do Mini International Neuropsychiatric Interview (M.I.N.I. PLUS 5.0) e Medical Outcomes Short-Form Health Survey (SF-36). RESULTADOS: A etiologia da doença hepática mais prevalente foi o vírus da hepatite C. Prevalência de 50,8% de pelo menos um transtorno mental foi identificada. Quando o abuso/dependência de álcool foi excluído, a prevalência foi de 25,8%. A saúde mental não apresentou diferença estatisticamente significante nos diversos grupos etiológicos. Maior prevalência de comorbidades psiquiátricas foi detectada entre mulheres e menores de 40 anos. Não foram detectados casos de transtornos psicóticos, possivelmente pela não inclusão destes pacientes na lista. Não houve diferença nos domínios de qualidade de vida nos diferentes grupos etiológicos. CONCLUSÃO: Uma alta prevalência de transtornos psiquiátricos foi encontrada nos pacientes com todas as condições clínicas mais associadas à indicação de transplante hepático. Chama a atenção a ausência de pacientes com transtornos psicóticos, o que sugere que possivelmente o transplante não tem sido indicado para esse grupo de pacientes. Por esses motivos, os profissionais que cuidam de candidatos ao transplante de fígado devem ser altamente vigilantes para a presença de transtornos mentais, independentemente da etiologia da doença hepática. A atenção especializada é recomendada para os pacientes com transtornos mentais, com minimização de exclusão precoce da lista de pacientes sem outras possibilidades terapêuticas.

Terapia cognitivo-comportamental no manejo da desesperança e pensamentos suicidas / Cognitive-behavioral therapy in the management of hopelessness and suicidal thoughts

O suicídio é um problema de saúde pública, sendo considerado uma das principais causas de morte no mundo. O comportamento suicida envolve ideação, planejamento, tentativa e suicídio propriamente dito, comportamentos em geral motivados por crenças de desesperança. Este estudo teve como objetivo identificar as contribuições da terapia cognitivo-comportamental (TCC) no manejo da desesperança e de pensamentos suicidas, buscando compreender a relação entre eles; identificar a tríade cognitiva relacionada ao problema e verificar estratégias da TCC no tratamento desses pacientes. Para isso, foi realizada uma revisão narrativa da literatura, integrando dados nacionais e internacionais sobre o tema. Os resultados demonstram que o indivíduo que apresenta intenção suicida em geral manifesta a desesperança como crença, caracterizada por uma visão de futuro vazio, sem perspectivas. As intervenções focalizam a relação terapêutica e utilizam estratégias como psicoeducação, resolução de problemas, estratégias de controle de impulsos e busca de apoio social. Muitas vezes, é fundamental a intervenção de áreas como psiquiatria e serviço social, que, juntamente com o processo terapêutico, vão buscar promover esperança. Considerando a gravidade e a complexidade do comportamento suicida, é fundamental que profissionais da saúde mental conheçam estratégias úteis e eficazes como as propostas pela TCC para um manejo eficiente do problema(AU)

Suicide is a public health problem and is one of the leading causes of death worldwide. Suicidal behavior involves ideation, planning, trial and suicide itself, behaviors generally motivated by hopelessness beliefs. This study aimed to identify the contributions of Cognitive Behavioral Therapy - CBT in the management of hopelessness and suicidal thoughts, trying to understand the relationship between them; identify the cognitive triad-related problem and check strategies of CBT in the treatment of these patients. For this, a narrative review of the literature was performed by integrating national and international data on this topic. The results show that the person who has suicidal intent usually expresses hopelessness as belief, characterized by a vision of empty future without prospects. Interventions focus on the therapeutic relationship and use strategies such as psychoeducation, problem solving, impulse control strategies and the seeking of social support. Often, the intervention of areas such as Psychiatry and Social Services, which, along with the therapeutic process, will seek to promote hope, is very important. Considering the seriousness and complexity of suicidal behavior, it is essential that mental health professionals know useful and effective strategies as proposed by TCC for efficient handling of the problem(AU)

Cataract surgery: emotional reactions of patients with monocular versus binocular vision / Cirurgia de catarata: aspectos emocionais de pacientes com visão monocular versus binocular

PURPOSE: To analyze emotional reactions related to cataract surgery in two groups of patients (monocular vision - Group 1; binocular vision - Group 2). METHODS: A transversal comparative study was performed using a structured questionnaire from a previous exploratory study before cataract surgery. RESULTS: 206 patients were enrolled in the study, 96 individuals in Group 1 (69.3 ± 10.4 years) and 110 in Group 2 (68.2 ± 10.2 years). Most patients in group 1 (40.6%) and 22.7% of group 2, reported fear of surgery (p<0.001). The most important causes of fear were: possibility of blindness, ocular complications and death during surgery. The most prevalent feelings among the groups were doubts about good results and nervousness. CONCLUSION: Patients with monocular vision reported more fear and doubts related to surgical outcomes. Thus, it is necessary that phisycians considers such emotional reactions and invest more time than usual explaining the risks and the benefits of cataract surgery.Ouvir.

OBJETIVO: Verificar reações emocionais relacionadas à cirurgia de catarata entre pacientes com visão monocular (Grupo 1) e binocular (Grupo 2). MÉTODOS: Foi realizado um estudo tranversal, comparativo por meio de um questionário estruturado respondido por pacientes antes da cirurgia de catarata. RESULTADOS: A amostra foi composta de 96 pacientes no Grupo 1 (69.3 ± 10.4 anos) e 110 no Grupo 2 (68.2 ± 10.2 anos). Consideravam apresentar medo da cirugia 40.6% do Grupo 1 e 22.7% do Grupo 2 (p<0.001) e entre as principais causas do medo, a possibilidade de perda da visão, complicações cirúrgicas e a morte durante o procedimento foram apontadas. Os sentimentos mais comuns entre os dois grupos foram dúvidas a cerca dos resultados da cirurgia e o nervosismo diante do procedimento. CONCLUSÃO: Pacientes com visão monocular apresentaram mais medo e dúvidas relacionadas à cirurgia de catarata comparados com aqueles com visão binocular. Portanto, é necessário que os médicos considerem estas reações emocionais e invistam mais tempo para esclarecer os riscos e benefícios da cirurgia de catarata.

Cirurgia de catarata: características e opiniões de pacientes com visão mono versus binocular / Cataract surgery: characteristics and opinions of patients with monocular versus binocular vision

OBJETIVO: Verificar em dois grupos de pacientes com visão monocular (grupo 1) e com visão binocular (grupo 2), a serem submetidos à cirurgia de catarata num hospital universitário, opiniões em relação ao problema ocular, à qualidade da visão e à cirurgia de catarata. MÉTODOS: Foi realizado estudo transversal e comparativo, de forma consecutiva, por meio de questionário estruturado, aplicado por entrevista a pacientes, elaborado a partir de estudo exploratório e medidas acuidade visual e causa da perda visual. RESULTADOS: A amostra foi constituída por 96 indivíduos do grupo 1 (50,0 por cento homens; 50,0 por cento mulheres, com idade entre 41 e 91 anos, média 69,3 anos ± 10,4 anos) e 110, do grupo 2 (40,9 por cento homens; 59,1 por cento mulheres, com idade entre 40 e 89 anos, média 68,2 anos ± 10,2 anos). A maioria dos indivíduos de ambos os grupos apresentava baixa escolaridade. Não houve diferença estatisticamente significante entre os grupos em relação ao sexo (p=0,191), à idade (p=0,702) e à escolaridade (p=0,245). Não exerciam atividade laboral 95,8 por cento dos indivíduos do grupo 1 e 83,6 por cento, do grupo 2 (p=0,005) e 30,4 por cento do grupo 1 mencionaram não ter possibilidade de trabalhar por causa da deficiência visual. Observou-se acuidade visual do olho a ser operado menor que 0,05 em 40,6 por cento (grupo 1) e 33,6 por cento (grupo 2), entre 0,25 e 0,05. Quase a totalidade dos indivíduos de ambos os grupos afirmou ter dificuldade para realização das atividades de vida diária e qualificou como insuficiente a respectiva acuidade visual; 71,9 por cento dos entrevistados do grupo 1 e 71,6 por cento, do grupo 2 mencionaram saber a causa da visão fraca; desses, 87,1 por cento do grupo 1 e 83,3 por cento do grupo 2 referiram a catarata como causa da baixa acuidade visual. CONCLUSÃO: Os indivíduos de ambos os grupos tiveram acesso à cirurgia de catarata com acuidade visual menor do que a idealmente indicada; os pacientes com visão monocular apresentaram acuidade visual significativamente menor em relação aos com visão binocular; a maioria dos entrevistados de ambos os grupos referiu dificuldades para realizar atividades cotidianas como consequência da baixa visão; muitos indivíduos de ambos os grupos desconheciam a causa da dificuldade visual ou a atribuíram a outra causa que não a catarata.

PURPOSE: To verify in two groups of patients: monocular (group 1) and binocular vision (group 2) to be submitted to cataract surgery at an University Hospital, opinions, expectances and emotional reactions related to the ocular problem, to the quality of vision and to cataract surgery. METHODS: A transversal comparative and consecutive study was performed using a structured questionnaire applied by patients interview. The questionnaire was elaborated from a previous exploratory study; visual acuity and cause of the visual loss were evaluated. RESULTS: The sample was constituted by 96 persons of group 1 (50.0 percent male; 50.0 percent female, ages ranging from 41 to 91 years; average 69.3 years ± 10.4 years) and 110 persons of group 2 (40.9 percent male; 59.1 percent female, ages ranging from 40 to 89 years; average 68.2 years ± 10.2 years). The majority of persons of both groups presented low educational level. There was no statistically significant difference between the groups in relation to gender (p=0.191), age (p=0.702) and educational level (p=0.245). No work activity was mentioned in 95.8 percent of the persons of group 1 and 83.6 percent of group 2 (p=0.005) and 30.4 percent of group 1 informed the impossibility to work due the visual impairment. Visual acuity of the eye to be operated was less than 0.05 in 40.6 percent (group 1) and in 33,6 percent (group 2), presented visual acuity ranging from 0.05 to 0.25. Almost the totality of the persons of both groups informed difficulties to perform activities of daily life and qualified as insufficient their visual acuities; 71.9 percent of the patients of group 1 and 71.6 percent of group 2 informed to know the reason of low vision; among these, 87.1 percent of group 1 and 83.3 percent of group 2 mentioned cataract as the reason of low visual acuity. CONCLUSION: It was concluded that the patients of both groups were submitted to cataract surgery with visual acuities less than the visual ...

[Cataract surgery: characteristics and opinions of patients with monocular versus binocular vision]. / Cirurgia de catarata: características e opiniões de pacientes com visão mono versus binocular.

PURPOSE: To verify in two groups of patients: monocular (group 1) and binocular vision (group 2) to be submitted to cataract surgery at an University Hospital, opinions, expectances and emotional reactions related to the ocular problem, to the quality of vision and to cataract surgery. METHODS: A transversal comparative and consecutive study was performed using a structured questionnaire applied by patients interview. The questionnaire was elaborated from a previous exploratory study; visual acuity and cause of the visual loss were evaluated. RESULTS: The sample was constituted by 96 persons of group 1 (50.0% male; 50.0% female, ages ranging from 41 to 91 years; average 69.3 years ± 10.4 years) and 110 persons of group 2 (40.9% male; 59.1% female, ages ranging from 40 to 89 years; average 68.2 years ± 10.2 years). The majority of persons of both groups presented low educational level. There was no statistically significant difference between the groups in relation to gender (p=0.191), age (p=0.702) and educational level (p=0.245). No work activity was mentioned in 95.8% of the persons of group 1 and 83.6% of group 2 (p=0.005) and 30.4% of group 1 informed the impossibility to work due the visual impairment. Visual acuity of the eye to be operated was less than 0.05 in 40.6% (group 1) and in 33,6% (group 2), presented visual acuity ranging from 0.05 to 0.25. Almost the totality of the persons of both groups informed difficulties to perform activities of daily life and qualified as insufficient their visual acuities; 71.9% of the patients of group 1 and 71.6% of group 2 informed to know the reason of low vision; among these, 87.1% of group 1 and 83.3% of group 2 mentioned cataract as the reason of low visual acuity. CONCLUSION: It was concluded that the patients of both groups were submitted to cataract surgery with visual acuities less than the visual acuity ideally indicated; the patients with monocular vision showed visual acuities significantly less in relation to the patients with binocular vision; the majority of the patients of both groups mentioned difficulties to perform daily activities as a consequence of low vision; patients with monocular vision mentioned doubts in relation to the surgical results as compared with the patients with binocular vision; many patients of both groups did not know the cause of the visual difficulty or explained the visual difficulty by other cause than the cataract.

Quality of life in patients with age-related macular degeneration with monocular and binocular legal blindness.

OBJECTIVE: To evaluate the quality of life for persons affected by age-related macular degeneration that results in monocular or binocular legal blindness. METHODS: An analytic transversal study using the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was performed. Inclusion criteria were persons of both genders, aged more than 50 years old, absence of cataracts, diagnosis of age-related monocular degeneration in at least one eye and the absence of other macular diseases. The control group was paired by sex, age and no ocular disease. RESULTS: Group 1 (monocular legal blindness) was composed of 54 patients (72.22% females and 27.78% males, aged 51 to 87 years old, medium age 74.61 +/- 7.27 years); group 2 (binocular legal blindness ) was composed of 54 patients (46.30% females and 53.70% males aged 54 to 87 years old, medium age 75.61 +/- 6.34 years). The control group was composed of 40 patients (40% females and 60% males, aged 50 to 81 years old, medium age 65.65 +/- 7.56 years). The majority of the scores were statistically significantly higher in group 1 and the control group in relation to group 2 and higher in the control group when compared to group 1. CONCLUSIONS: It was evident that the quality of life of persons with binocular blindness was more limited in relation to persons with monocular blindness. Both groups showed significant impairment in quality of life when compared to normal persons.

[Visual stability in diabetic retinopathy treated by panretinal laser photocoagulation]. / Estabilidade visual na retinopatia diabética tratada por panfotocoagulação com laser.

PURPOSE: To evaluate the effect of laser treatment in the visual acuity caused by advanced diabetic retinopathy without visual complaints. METHODS: A descriptive observational study was developed in advanced diabetic retinopathy patients not presenting visual complaints. The patients were submitted to argon laser panretinal photocoagulation after ophthalmological examination as well as retinography and retinal angiofluoresceinography. The same initial exams were repeated between third and fifth months after the treatment. The non-parametric Wilcoxon test was employed for statistical evaluation between the visual acuities before and after the treatment. RESULTS: The sample involved 67 eyes of 44 patients. Of these 67 eyes, 37 (55.2%) presented proliferative diabetic retinopathy and 30 (44.8%) showed severe and severe non proliferative diabetic retinopathy. The visual acuity before the treatment ranged from 0.5 to 1.0 (mean 0.81 +/- 0.16). There was no significant statistical difference between the visual acuity (p= 0.057) before and after the treatment during the follow-up period of five months. CONCLUSION: The visual stability after panretinal argon laser photocoagulation indicated the need of this treatment in early phases of diabetic retinopathy in order to preserve the visual function.

Estabilidade visual na retinopatia diabética tratada por panfotocoagulação com laser / Visual stability in diabetic retinopathy treated by panretinal laser photocoagulation

OBJETIVO: Avaliar o efeito da "laserterapia" na acuidade visual em portadores de retinopatia diabética avançada e sem queixas visuais. MÉTODOS: Desenvolveu-se estudo observacional descritivo em portadores de retinopatia diabética avançada e sem queixas visuais, submetidos a panfotocoagulação retiniana com laser de argônio. Foi realizado exame oftalmológico completo. Entre o 3° e o 5° meses do tratamento, foi repetido o exame inicial. Para comparação da acuidade visual, entre período pré e pós-tratamento, foi utilizado o teste não-paramétrico de Wilcoxon. RESULTADOS: A amostra foi constituída por 44 pacientes, totalizando 67 olhos, sendo que 37 (55,2 por cento) apresentavam retinopatia diabética proliferativa e 30 (44,8 por cento) não proliferativa grave ou muito grave. A acuidade visual pré-tratamento variou de 0,5 a 1,0 (média de 0,83 ± 0,17). Não houve alteração estatisticamente significante na acuidade visual (p= 0,057) pré e pós-tratamento no período estudado. CONCLUSÃO: Houve estabilidade visual pós-tratamento com a panfotocoagulação, o que enfatiza a necessidade de intervenções em fases mais precoces da retinopatia diabética para preservar a função visual.

PURPOSE: To evaluate the effect of laser treatment in the visual acuity caused by advanced diabetic retinopathy without visual complaints. METHODS: A descriptive observational study was developed in advanced diabetic retinopathy patients not presenting visual complaints. The patients were submitted to argon laser panretinal photocoagulation after ophthalmological examination as well as retinography and retinal angiofluoresceinography. The same initial exams were repeated between third and fifth months after the treatment. The non-parametric Wilcoxon test was employed for statistical evaluation between the visual acuities before and after the treatment. RESULTS: The sample involved 67 eyes of 44 patients. Of these 67 eyes, 37 (55.2 percent) presented proliferative diabetic retinopathy and 30 (44.8 percent) showed severe and severe non proliferative diabetic retinopathy. The visual acuity before the treatment ranged from 0.5 to 1.0 (mean 0.81 ± 0.16). There was no significant statistical difference between the visual acuity (p= 0.057) before and after the treatment during the follow-up period of five months. CONCLUSION: The visual stability after panretinal argon laser photocoagulation indicated the need of this treatment in early phases of diabetic retinopathy in order to preserve the visual function.

[Delay in ophthalmologic examination of diabetic retinopathy patients]. / Avaliação oftalmológica tardia em portadores de retinopatia diabética.

OBJECTIVE: To assess the delay in the ophthalmic examination of patients affected with severe diabetic retinopathy but no visual complaint. METHODS: A transversal analytical study was conducted of 44 visually asymptomatic diabetic patients. All were eligible to retinal panphotocoagulation in at least one eye. Duration and type of the disease as well as time of the first ophthalmic examination were established. RESULTS: Of the 44 patients, 6 (13.7%) had diabetes type 1 and 38 (86.3%) had diabetes type 2. Proliferative diabetic retinopathy was present in 24 (54.5%) and severe or very severe non proliferative retinopathy was present in 20 (45.5%). Best visual acuity ranged from 0.5 to 1.0 (mean 0.83+/-0.17) according to the Snellen chart. The time interval between diagnosis of diabetes and the first ophthalmic examination ranged from 7 to 19.5 years (13.2+/-5.12) for diabetes type 1 and from 3 months to 18 years (5.2+/-4.81) for diabetes type 2. CONCLUSION: Advanced diabetic retinopathy may be detected at different times of the ophthalmic examination in both types of diabetes. Although the mean interval between the diagnosis and the first examination is 13 years for diabetes type 1 and 5 years for diabetes type 2, this severe kind of retinopathy occurred as early as three months after diagnosis of diabetes. This points to the need for an earlier ophthalmic examination in the case of this disease.

Avaliação oftalmológica tardia em portadores de retinopatia diabética / Delay in ophthalmologic examination of diabetic retinopathy patients

OBJETIVO: Analisar o retardo na avaliação oftalmológica em portadores de retinopatia diabética avançada e sem queixas visuais. MÉTODOS: Foi realizado um estudo transversal analítico com 44 portadores assintomáticos de retinopatia diabética. Todos os pacientes tiveram indicação de tratamento com laser em pelo menos um dos olhos. A duração e tipo da doença, bem como o tempo para a primeira avaliação oftalmológica foram determinados. RESULTADOS: Dos 44 pacientes, 6 (13,7 por cento) eram portadores de diabetes mellitus tipo 1 e 38 (86,3 por cento) do tipo 2. Retinopatia diabética proliferativa estava presente em 24 (54,5 por cento) e retinopatia diabética não proliferativa grave ou muito grave em 20 (45,5 por cento). A acuidade visual, com melhor correção, pré-tratamento, variou de 0,5 a 1,0 (média de 0,83 ± 0,17) na tabela de Snellen. O tempo de intervalo entre o diagnóstico de diabetes e a primeira avaliação oftalmológica variou de 7 a 19,5 anos (13,3 ± 5,1 anos) para os diabéticos tipo 1 e de 3 meses a 18 anos (5,2 ± 4,81 anos) para os tipo 2. CONCLUSÃO: Retinopatia diabética avançada pode estar presente em diferentes momentos na avaliação oftalmológica para ambos os tipos de diabetes. No presente estudo, embora a média de intervalo entre o diagnóstico de diabetes e a primeira avaliação seja de 13 anos para os diabéticos tipo 1 e de 5 anos para os tipo 2, a retinopatia avançada foi observada em até 3 meses após diagnóstico de diabetes. Este fato demonstra a necessidade de avaliação oftálmica mais precoce nesta doença. Dessa forma, conclui-se que a RD deve ter uma abordagem multidisciplinar, no intuito de que o diagnóstico da RD seja feito, em suas fases iniciais, antes que lesões comprometedoras da visão já tenham ocorrido.

OBJECTIVE: To assess the delay in the ophthalmic examination of patients affected with severe diabetic retinopathy but no visual complaint. METHODS: A transversal analytical study was conducted of 44 visually asymptomatic diabetic patients. All were eligible to retinal panphotocoagulation in at least one eye. Duration and type of the disease as well as time of the first ophthalmic examination were established. RESULTS: Of the 44 patients, 6 (13.7 percent) had diabetes type 1 and 38 (86.3 percent) had diabetes type 2. Proliferative diabetic retinopathy was present in 24 (54.5 percent) and severe or very severe non proliferative retinopathy was present in 20 (45.5 percent). Best visual acuity ranged from 0.5 to 1.0 (mean 0.83 ± 0.17) according to the Snellen chart. The time interval between diagnosis of diabetes and the first ophthalmic examination ranged from 7 to 19.5 years (13.2 ± 5.12) for diabetes type 1 and from 3 months to 18 years (5.2± 4.81) for diabetes type 2. CONCLUSION: Advanced diabetic retinopathy may be detected at different times of the ophthalmic examination in both types of diabetes. Although the mean interval between the diagnosis and the first examination is 13 years for diabetes type 1 and 5 years for diabetes type 2, this severe kind of retinopathy occurred as early as three months after diagnosis of diabetes. This points to the need for an earlier ophthalmic examination in the case of this disease.

Quality of life in patients with age-related macular degeneration with monocular and binocular legal blindness

OBJECTIVE: To evaluate the quality of life for persons affected by age-related macular degeneration that results in monocular or binocular legal blindness. METHODS: An analytic transversal study using the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was performed. Inclusion criteria were persons of both genders, aged more than 50 years old, absence of cataracts, diagnosis of age-related monocular degeneration in at least one eye and the absence of other macular diseases. The control group was paired by sex, age and no ocular disease. RESULTS: Group 1 (monocular legal blindness) was composed of 54 patients (72.22 percent females and 27.78 percent males, aged 51 to 87 years old, medium age 74.61 ± 7.27 years); group 2 (binocular legal blindness ) was composed of 54 patients (46.30 percent females and 53.70 percent males aged 54 to 87 years old, medium age 75.61 ± 6.34 years). The control group was composed of 40 patients (40 percent females and 60 percent males, aged 50 to 81 years old, medium age 65.65 ± 7.56 years). The majority of the scores were statistically significantly higher in group 1 and the control group in relation to group 2 and higher in the control group when compared to group 1. CONCLUSIONS: It was evident that the quality of life of persons with binocular blindness was more limited in relation to persons with monocular blindness. Both groups showed significant impairment in quality of life when compared to normal persons.

OBJETIVO: Avaliar a qualidade de vida de portadores de degeneração macular relacionada à idade com cegueira legal monocular e binocular. MÉTODOS: Foi realizado estudo transversal analítico por meio do questionário National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). Os critérios de inclusão foram: indivíduos de ambos os sexos, idade maior que 50 anos, ausência de catarata, diagnóstico de degeneração macular relacionada à idade avançada em pelo menos um dos olhos, sem outras maculopatias. O Grupo Controle foi pareado por sexo, idade e sem doença ocular. RESULTADOS: O Grupo 1 (cegueira monocular) foi composto por 54 pacientes (72,22 por cento de mulheres e 27,78 por cento de homens, idade entre 51 e 87 anos, média de 74,61 anos ± 7,27 anos); o Grupo 2 (cegueira binocular), por 54 (46,30 por cento de mulheres e 53,70 por cento de homens, idade entre 54 e 87 anos, média de 75,61 anos ± 6,34 anos). O Grupo Controle foi composto por 40 pacientes (40 por cento de mulheres e 60 por cento de homens, idade entre 50 e 81 anos, média de 65,65 anos ± 7,56 anos). A maioria dos escores foi significativamente maior no Grupo 1 e no Controle em relação ao Grupo 2 e maior no Controle comparado ao Grupo 1. CONCLUSÕES: Evidenciou-se que a qualidade de vida de indivíduos com cegueira binocular foi mais limitada em relação aos portadores de cegueira monocular. Quando comparados com indivíduos normais, ambos os grupos tiveram prejuízo na qualidade de vida foi significativo.

Cirurgia de catarata: opiniões, expectativas e reações emocionais de pacientes com visão mono versus binocular / Cataract surgery: opinions, expectances and emotional reactions of patients with monocular versus binocular vision

O estudo teve como objetivos verificar em dois grupos de pacientes com visão monocular (grupo 1) e com visão binocular (grupo 2), a serem submetidos à cirurgia de catarata no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, opiniões, expectativas e reações emocionais em relação ao problema ocular, à qualidade da visão e à cirurgia de catarata; influência da característica de apresentar visão mono ou binocular nas reações emocionais relacionadas à cirurgia de catarata. Foi realizado estudo transversal e comparativo, de forma consecutiva, por meio de questionário estruturado, aplicado por entrevista a pacientes, elaborado a partir de estudo exploratório e medidas acuidade visual e causa da perda visual. A amostra foi constituída por 96 indivíduos do grupo 1 (50,0% homens; 50,0% mulheres, com idade entre 41 e 91 anos, média 69,3 anos ± 10,4 anos) e 110, do grupo 2 (40,9% homens; 59,1% mulheres, com idade entre 40 e 89 anos, média 68,2 anos ± 10,2 anos). A maioria dos indivíduos de ambos os grupos apresentava baixa escolaridade. Não houve diferença estatisticamente significante entre os grupos em relação ao sexo (p = 0,191), à idade (p = 0,702) e à escolaridade (p = 0,245). Não exerciam atividade laboral 95,8% dos indivíduos do grupo 1 e 83,6%, do grupo 2 (p = 0,005) e 30,4% do grupo 1 mencionaram não ter possibilidade de trabalhar por causa da deficiência visual. Observou-se acuidade visual do olho a ser operado menor que 0,05 em 40,6% (grupo 1) e 33,6% (grupo 2), entre 0,25 e 0,05. Quase a totalidade dos indivíduos de ambos os grupos afirmou ter dificuldade para realização das atividades de vida diária e qualificou como insuficiente a respectiva acuidade visual; 71,9% dos entrevistados do grupo 1 e 71,6%, do grupo 2 mencionaram saber a causa da visão fraca; desses, 87,1% do grupo 1 e 83,3% do grupo 2 referiram a catarata como causa da baixa acuidade visual...

The purpose of the study was to verify in two groups of patients with monocular vision (group 1) and with binocular vision (group 2) to be submitted to cataract surgery in Hospital das Clínicas, São Paulo University Medical School, opinions, expectances and emotional reactions related to the ocular problem, to the quality of vision and to cataract surgery, the influence of monocular or binocular vision in the emotional reactions related to cataract surgery. A transversal comparative and consecutive study was performed using a structured questionnaire applied by interview of patients. The questionnaire was elaborated from a previous exploratory study, the visual acuity and cause of the visual loss were evaluated. The sample was constituted by 96 persons of group 1 (50% males; 50% females, ages ranging from 41 to 91 years old; average 69,3 years ± 10,4 years) and 110 persons of group 2 (40,9% males; 59,1% females, ages ranging from 40 to 89 years old; average 68,2 years ± 10,2 years). The majority of persons of both groups presented low educational level. There was no statistically significant difference between the groups in relation to gender (p = 0,191), age (p = 0,702) and educational level (p = 0,245). No work activity was mentioned in 95,8% of the persons of group 1 and 83,6% of group 2 (p = 0,005) and 30,4% of group 1 informed the impossibility to work due the visual deficiency. It was observed that the visual acuity of the eye to be operated was less than 0,05 in 40,6% (group 1) and in 33,6% (group 2), presented visual acuity ranging from 0,05 to 0,25. Almost the totality of the persons of both groups informed difficulties to perform activities of daily life and qualified as insufficient their visual acuities; 71,9% of the patients of group 1 and 71,6% of group 2 informed to know the reason of low vision; among these, 87,1% of group 1 and 83,3%...