Afectación iatrogénica de la motilidad ocular por fármacos antitumorales inhibidores de los puntos de control / Iatrogenic impairment of ocular motility by immune checkpoint inhibitors

Se encontraron 4 revisiones sistemáticas que incluían este tipo de iatrogenia ocular, así como numerosos reportes de casos aislados. Los efectos adversos reportados comprenden: paresias oculomotoras, neuropatía óptica, atrofia óptica, síndromes miasteniformes, pseudo-orbitopatía tiroidea, síndrome del ápex orbitario e hipofisitis. La mayoría se manejaron sin interrupción o con interrupción parcial del tratamiento oncológico. Se requirieron tratamientos sistémicos agresivos para el manejo adecuado de la iatrogenia ocular.Es imprescindible que el oftalmólogo se familiarice con los nuevos tratamientos oncológicos ICI, capaces de provocar iatrogenia sobre la motilidad ocular grave e incapacitante para el paciente. La comunicación de efectos adversos con los tratamientos empleados puede ayudar al manejo más adecuado de estos pacientes. La investigación debe ir orientada al diagnóstico diferencial complejo y a optimizar las decisiones sobre los tratamientos oncológicos. (AU)

Cancer therapy relies on new antitumoral drugs called immune checkpoint inhibitors (ICI), which produce long-lasting anti-tumor responses and lengthen survival, but cause autoimmune-type toxicity. The clinical characteristics induced by ICI are not well characterized to date and careful collection of clinical data is required to accurately define its safety profile.We conducted a literature search in the main clinical search engines to identify pharmacological ocular iatrogenic events of ICIs related to ocular motility. Four systematic reviews were found that included this type of ocular iatrogenesis as well as numerous isolated case reports. Reported adverse effects include: oculomotor paresis, optic neuropathy, optic atrophy, myastheniform syndromes, thyroid pseudo-orbitopathy, orbital apex syndrome, and hypophysitis. Most were managed without interruption or with partial interruption of cancer treatment. Aggressive systemic treatments were required for adequate management of ocular iatrogenic events.It is essential that the ophthalmologist become familiar with the new ICI oncological treatments, capable of causing severe and disabling motilidad ocular iatrogenesis for the patient. The communication of adverse effects and the report of the treatments used can help the most appropriate management of these patients. Research should be oriented towards complex differential diagnosis and to optimize decisions on cancer treatments. (AU)

Situation of ophthalmology education in Brazil: supply versus demand / A situação da educação em Oftalmologia no Brasil: oferta versus demanda

ABSTRACT Purpose: The number of medical schools in Brazil has increased in recent years; however, vacancies for specialization in ophthalmology probably have not kept up with the growing demand. This study wants to estimate the increase in medical schools, the demand for ophthalmology specialization, and evaluate learning opportunities in ophthalmology. Methods: This was a retrospective study with research from the Ministry of Education and Brazilian Council of Ophthalmology database from 2002 to 2021. These data were checked through 120 notices published by the institutions in 2021. Results: The number of medical school vacancies increased by 370%, whereas the number of certified ophthalmology vacancies increased by 64%. There was an 11.4% misalignment between the Brazilian Council of Ophthalmology data in the Ministry of Education. Conclusion: The proportion of medical graduates has increased much more than opportunities for ophthalmology specialization. The effect on the search for unaccredited specialization positions is unknown, and policies for monitoring the specialization of ophthalmology vacancies should be established.

RESUMO Objetivo: Nos últimos 20 anos, o número de escolas médicas no Brasil aumentou, mas as vagas para especialização em Oftalmologia não acompanharam a demanda crescente. Este estudo quer estimar a demanda por especialização e avaliar a oferta de oportunidades de aprendizado em Oftalmologia. Métodos: Estudo epidemiológico com pesquisa em banco de dados provenientes do Ministério da Educação e Conselho Brasileiro de Oftalmologia. Estes dados foram checados através de 120 editais publicados pelos serviços de Residência em 2021. Resultados: De 2002 a 2021, o número de vagas em faculdades de Medicina aumentou 370%, enquanto o número de vagas certificadas de especialização em Oftalmologia aumentou 64%. Houve um desalinhamento de 11.4% entre os dados do Conselho Brasileiro de Oftalmologia e do Ministério da Educação. Conclusão: A proporção de graduados em Medicina aumentou muito mais do que a oferta de oportunidades de especialização em Oftalmologia, o impacto disto na busca por vagas de especialização não acreditadas é desconhecido, políticas de monitoramento das vagas de especialização em Oftalmologia devem ser estabelecidas.

Breaking bad news in ophthalmology: a literature review / Comunicação de más notícias em oftalmologia: uma revisão de literatura

ABSTRACT Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians' confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies.

RESUMO O reconhecimento sobre a comunicação de más notícias como mitigadora de conversas difíceis por outras especialidades médicas, incentiva o estudo desta temática na oftalmologia. Sendo assim, o objetivo deste estudo é revisar a produção de pesquisas científicas sobre a comunicação de más notícias em oftalmologia. Para isso, foi realizada uma revisão de literatura. As bases de dados utilizadas foram MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE e SCIELO. Dois revisores independentes leram todos os artigos e selecionaram a amostra final. Sete artigos foram escolhidos nos formatos de artigo original, revisão, editorial, comunicação oral e correspondência. Os oftalmologistas estão preocupados em comunicar as más notícias de forma eficaz, mas faltam estudos sobre o tema. No entanto, há uma crescente percepção de que o treinamento de comunicação de más notícias aumenta a confiança dos médicos na comunicação, beneficiando a relação terapêutica. Portanto, seria valioso incluir este treinamento no currículo das residências.

Applicability of portable retinal cameras and telemedicine as facilitating tools in screening diabetic retinopathy in the COVID-19 pandemic scenario / Aplicabilidade do retinógrafo portátil e telemedicina como ferramentas facilitadoras na triagem de retinopatia diabética no cenário de pandemia de COVID-19

ABSTRACT Purpose: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Methods: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. Results: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Conclusion: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.

RESUMO Objetivo: A diabetes mellitus é considerada uma epidemia global e causa de baixa visual em países em desenvolvimento. Este estudo foi realizado com o objetivo de avaliar a viabilidade do retinógrafo portátil e análise remota de imagens associada a questionário virtual para o rastreio de retinopatia diabética em Unidades Básicas de Saúde da cidade de Ribeirão Preto/SP durante a pandemia de Covid-19. Métodos: Trezentos e sessenta pacientes compareceram a campanha. O acolhimento foi realizado na Unidade Básica de Saúde pela equipe de enfermagem, respeitando medidas de prevenção do Covid-19 Os realizou-se aferição da pressão arterial e glicemia capilar seguida de dilatação. Dados demográficos e sociais foram coletados através de questionário on-line padronizado via smartphone e realizou-se a triagem da retinopatia diabética através da obtenção de imagens com retinógrafos portáteis realizados por residentes de oftalmologia previamente treinados, com a aquisição de 2 imagens padronizadas de 45º: uma do segmento posterior e outra nasal ao nervo óptico. Resultados: Trezentos e sessenta pacientes foram atendidos durante a campanha. Dez pacientes (1,02%) foram excluídos devido à opacidade de meios e impossibilidade de obtenção de imagens de fundo de olho. Foram avaliados 350 pacientes, 64% do sexo feminino, 45% entre 55 e 70 anos e 55% brancos. A Campanha foi a primeira avaliação de retina para 40,5% dos pacientes e 47,56% apresentavam diabetes mellitus há mais de 10 anos. Na análise comparativa da classificação da retinopatia diabética segundo Early Treatment Diabetic Retinopathy Study (triagem X Nuvem) observou-se uma diferença de 7,8% nos resultados. Retinopatia diabética leve foi observada em 12,23%, moderada em 6,31%, proliferativa em 2,58%; edema macular presente em 4,58% e ausência de retinopatia diabética em 72,78% dos pacientes. Conclusão: A utilização de retinógrafos portáteis juntamente a telemedicina, para o rastreamento da retinopatia diabética pode ser considerada uma alternativa eficiente para triagem e diagnóstico da retinopatia diabética dentro ou fora do cenário pandêmico, auxiliando na prevenção de perda visual pelo diabetes.

Iatrogenic affectation of ocular motility by immune checkpoint inhibitors.

Cancer therapy relies on new antitumoral drugs called immune checkpoint inhibitors (ICI), which produce long-lasting anti-tumor responses and lengthen survival, but cause autoimmune-type toxicity. The clinical characteristics induced by ICI are not well characterized to date and careful collection of clinical data is required to accurately define its safety profile. We conducted a literature search in the main clinical search engines to identify pharmacological ocular iatrogenic events of ICIs related to ocular motility. Four systematic reviews were found that included this type of ocular iatrogenesis as well as numerous isolated case reports. Reported adverse effects include: oculomotor paresis, optic neuropathy, optic atrophy, myastheniform syndromes, thyroid pseudo-orbitopathy, orbital apex syndrome, and hypophysitis. Most were managed without interruption or with partial interruption of cancer treatment. Aggressive systemic treatments were required for adequate management of ocular iatrogenic events. It is essential that the ophthalmologist become familiar with the new ICI oncological treatments, capable of causing severe and disabling motilidad ocular iatrogenesis for the patient. The communication of adverse effects and the report of the treatments used can help the most appropriate management of these patients. Research should be oriented towards complex differential diagnosis and to optimize decisions on cancer treatments.

Epidemiología de las urgencias oftalmológicas en menores de 18 años en un hospital comarcal de 2019 a 2021 / Epidemiology of eye-related emergencies in children under 18 years of age at a General Hospital in Spain from 2019 to 2021

Objetivo Conocer las enfermedades oftalmológicas más prevalentes en la atención del servicio de urgencias de un hospital comarcal y evaluar qué cambios se han producido como consecuencia de la pandemia por la COVID. Método Revisión de los informes de urgencias en pacientes menores de 18 años atendidos en nuestro hospital desde enero de 2019 hasta diciembre de 2021 y comparación de los datos prepandemia, durante la pandemia y en la recuperación al comparar los períodos 2019--2021 entre sí. Resultados Hay una reducción del 57% en las visitas a urgencias por enfermedad oftalmológica en 2020. Esta reducción afecta a los 3 grupos diagnósticos más prevalentes: conjuntivitis y ojo rojo (descenso del 69%), traumatismo y cuerpo extraño (disminución del 45%) y afectación palpebral (35% menos). En 2021 hay una recuperación parcial en los 3 grupos, pero no llega a los datos de 2019. Por otro lado, el dolor ocular y periocular muestra un aumento en la consulta tanto en 2020 (16,7% más) como en 2021 (aumento del 100%). Conclusiones Existen diferencias en la distribución de las afecciones oculares por las que se consultó en el servicio de urgencias de nuestro hospital durante los años 2019-2021. Esto sugiere un uso más racional del sistema de salud, consultas por enfermedad menos banal y un impacto de las restricciones de movilidad, lavado de manos y uso de mascarillas sobre la afección oftalmológica (AU)

Objective To know which ophthalmological pathologies are the most prevalent attending the emergency department. To assess what changes have occurred because of the COVID pandemic. Method Review of emergency reports in children under 18 years of age attended in our Hospital from January 2019 to December 2021. Comparison of pre-pandemic, pandemic and «back-to-normal» data when comparing the periods 2019–2021 with each other. Results There is a 57% reduction in the eye-related emergency visits in 2020. This reduction affects the three more prevalent diagnostic groups: conjunctivitis and red eye (69% fall), trauma and foreign body (45% decrease) and palpebral pathology (35% less). In 2021 there is a partial recovery in the three groups, but not reaching the 2019 data. On the other side, eye and periocular pain show an increase in consultation in both 2020 (16.7% more) and 2021 (100% increase). Conclusion There are differences in the distribution of eye-related conditions that consulted at the Emergency Department at our hospital during years 2019–2021. This suggests a more rational use of the Health System, less banal pathology attending and an impact of mobility restrictions, handwashing and face masks wearing on ophthalmological pathology (AU)

Epidemiology of eye-related emergencies in children under 18 years of age at a General Hospital in Spain from 2019 to 2021.

PURPOSE: To know which ophthalmological pathologies are the most prevalent attending the emergency department. To assess what changes have occurred because of the COVID pandemic. METHOD: Review of emergency reports in children under 18 years of age attended in our Hospital from January 2019 to December 2021. Comparison of pre-pandemic, pandemic and "back-to-normal" data when comparing the periods 2019-2021 with each other. RESULTS: There is a 57% reduction in the eye-related emergency visits in 2020. This reduction affects the three more prevalent diagnostic groups: conjunctivitis and red eye (69% fall), trauma and foreign body (45% decrease) and palpebral pathology (35% less). In 2021 there is a partial recovery in the three groups, but not reaching the 2019 data. On the other side, eye and periocular pain show an increase in consultation in both 2020 (16,7% more) and 2021 (100% increase). CONCLUSION: There are differences in the distribution of eye-related conditions that consulted at the Emergency Department at our hospital during years 2019-2021. This suggests a more rational use of the Health System, less banal pathology attending and an impact of mobility restrictions, handwashing and face masks wearing on ophthalmological pathology.

Quejas visuales durante la pandemia de COVID-19 en España y Portugal / Visual complaints during the COVID-19 pandemic in Spain and Portugal

Objetivo Este estudio reporta los hábitos de la población y las quejas oculares relacionadas con la salud visual en el contexto de la pandemia de COVID-19 a partir de visitas realizadas durante 2021 en España y en Portugal. Material y métodos Invitación por correo electrónico a una encuesta transversal online y también realizada en persona a pacientes de clínicas de oftalmología de España y de Portugal de septiembre a noviembre de 2021. Participaron 3.833 encuestados mayores de 18años con respuestas anónimas válidas. Resultados El 60% de los encuestados explicó mucha incomodidad causada por el aumento de los síntomas de ojo seco debido al trabajo digital más intenso y el empañamiento de los lentes al usar mascarillas. El 81,6% de los encuestados usaba dispositivos digitales al menos 3horas en promedio por día, y el 40% comenzó a usar dispositivos digitales más de 8horas en promedio por día. Además, el 44% de los encuestados sintió que su visión de cerca había empeorado en este período. El primer síntoma importante de la presbicia estaba relacionado con la dificultad para leer las letras más pequeñas de los paquetes. El 86% presentó los primeros síntomas a los 40años. Las ametropías más frecuentes identificadas fueron miopía (40,2%) y astigmatismo (36,7%). Para los padres, tener buena vista (87,2%) era el aspecto más valorado en la vida de sus hijos. Conclusiones Los hallazgos brindan una idea de los desafíos durante la COVID-19 para las prácticas oftalmológicas. En una sociedad altamente dependiente de la visión, es fundamental centrarse en los signos y los síntomas que conducen a afecciones oftalmológicas. El uso excesivo de dispositivos digitales y el uso de mascarillas durante esta pandemia han agravado algunos, señalando la importancia de la referencia para planificar una atención ocular eficiente en situaciones similares (AU)

Purpose This study reports visual health during the COVID-19 pandemic in 2021 in Spain and Portugal, focusing on eye complaints and population habits. Material and methods Cross-sectional survey through an online email invitation to patients attending ophthalmology clinics in Spain and Portugal from September to November 2021. Around 3833 participants offered valid anonymous responses in a questionnaire. Results Sixty percent of respondents identified significant discomfort related to dry eye symptoms for increased screen time and lens fogging using facemasks. 81.6% of the participants used digital devices for more than 3h per day and 40% for more than 8h. In addition, 44% of participants referred to worsening near vision. The most frequent ametropias were myopia (40.2%) and astigmatism (36.7%). Parents considered eyesight the most important aspect of their children (87.2%). Conclusions The results show the challenges for eye practices during the initial COVID-19 pandemic. Focusing on signs and symptoms that lead to ophthalmologic conditions is an essential concern, especially in our digital society highly dependent on vision. At the same time, the excessive use of digital devices during this pandemic has aggravated dry eye and myopia (AU)

Aplicación web para los procesos docentes de la especialidad Oftalmología

Introducción: Las tecnologías de la información y las comunicaciones (ICT por sus siglas en inglés) han originado la enseñanza mediante los llamados entornos virtuales de enseñanza-aprendizaje. La Universidad Virtual de la salud (UVS) de Pinar del Río, es una de las instituciones que se destaca en este quehacer, no obstante, son insuficientes las publicaciones relacionadas con la virtualización de contenidos en la especialidad de Oftalmología. Objetivo: desarrollar una aplicación web para la virtualización de los procesos docentes en la especialidad de Oftalmología en la Universidad de Ciencias Médicas de Pinar del Río. Métodos: La investigación se basa en el enfoque dialéctico. Desde este enfoque se utilizaron métodos de investigación teóricos: análisis histórico lógico, análisis y síntesis, inducción y deducción, y empíricos: modelación y análisis documental. Para la modelación y diseño de artefactos de ingeniería se utilizó el Enterprise Architect y para la elaboración de la web el WordPress. Resultados: Se podrán visualizar los contenidos de la especialidad en cada uno de los años de rotación, tanto en pregrado como en el postgrado, a través de interfaz gráfica amigable, sencilla y amena. Conclusiones: Con la elaboración de esta aplicación web se resuelven problemas de masividad, espacio y tiempo, así como de llevar el conocimiento más actualizado y pertinente hasta donde están quienes más lo necesitan, sin que tengan que ausentarse de su entorno laboral y familiar, de forma masiva.

Introduction: ICT have originated training in the so-called virtual teaching-learning environments. The UVS of Pinar del Río is one of the institutions that stands out in this task; however, the publications related to the virtualization of contents in the specialty of Ophthalmology are insufficient. Objective: to develop a web application for the virtualization of teaching processes in the specialty of Ophthalmology at the University of Medical Sciences of Pinar Del Río. Methods: the dialectical approach is the basis of the research. Theoretical methods used were: logical-historical analysis, analysis and synthesis, induction and deduction; empirical methods included modeling and documentary analysis. The Enterprise Architecture was used for the modeling and design of engineering artifacts, and WordPress was used for the development of the Web. Results: the contents of the specialty might be visualized in both undergraduate and postgraduate years of rotation through a friendly, simple and enjoyable graphical interface. Conclusions: the use of this web application can solve problems of massiveness, space and time, bringing the most updated and relevant knowledge to where people need it, without having to be absent from their work and family environment.

Complicaciones oftalmológicas en pacientes con COVID-19 / Ophthalmological complications in patients with COVID.19

Introducción: La enfermedad COVID-19, declarada como pandemia por la Organización Mundial de la Salud, afecta otros sistemas y órganos ajenos al aparato respiratorio, por ejemplo: los ojos. Objetivo: Caracterizar las manifestaciones oculares de la COVID-19 y sus posibles complicaciones. Método: Se realizó un análisis exhaustivo de bibliografía a través de los motores de búsqueda SciELO, PubMed y Google Académico; se seleccionó un total de 55 artículos. Conclusiones: Clínicamente, la COVID-19 se ha asociado a conjuntivitis leve, que puede ser el primer y único síntoma de la enfermedad, así como a afecciones retinianas, enfermedad de Kawasaki, complicaciones neurooftalmológicas y en el paciente de cuidados intensivos. La pronta detección de estas afecciones puede influir directamente en la posterior evolución del paciente.

Introduction: COVID-19, a pandemic declared by the World Health Organization, affects not only the respiratory system but other systems and organs, for example the eyes. Objective: to characterize ocular manifestations of COVID-19 and their possible complications. Methods: an exhaustive analysis of the bibliography was carried out through SciELO, PubMed and Google Scholar search engines; a total of 55 articles were selected. Conclusions: COVID-19 has been clinically associated with mild conjunctivitis, which may be the first and only symptom of the disease, as well as retinal disorders, Kawasaki disease, neuro-ophthalmological complications, and in intensive care patients. Early detection of these conditions can directly influence the subsequent evolution of the patient.

Visual complaints during the COVID-19 pandemic in Spain and Portugal.

PURPOSE: This study reports visual health during the COVID-19 pandemic in 2021 in Spain and Portugal, focusing on eye complaints and population habits. MATERIAL AND METHODS: Cross-sectional survey through an online email invitation to patients attending ophthalmology clinics in Spain and Portugal from September to November 2021. Around 3833 participants offered valid anonymous responses in a questionnaire. RESULTS: Sixty percent of respondents identified significant discomfort related to dry eye symptoms for increased screen time and lens fogging using facemasks. 81.6% of the participants used digital devices for more than 3 h per day and 40% for more than 8 h. In addition, 44% of participants referred to worsening near vision. The most frequent ametropias were myopia (40.2%) and astigmatism (36.7%). Parents considered eyesight the most important aspect of their children (87.2%). CONCLUSIONS: The results show the challenges for eye practices during the initial COVID-19 pandemic. Focusing on signs and symptoms that lead to ophthalmologic conditions is an essential concern, especially in our digital society highly dependent on vision. At the same time, the excessive use of digital devices during this pandemic has aggravated dry eye and myopia.

Eye-related emergency visits during the early phase of the coronavirus disease pandemic in a reference hospital in Sao Paulo, Brazil / Atendimento no pronto-socorro de oftalmologia durante o início da pandemia do Covid-19 em um hospital de referência em São Paulo, Brasil

ABSTRACT Purpose: To evaluate the profile of emergency eye-related visits at a reference eye hospital in Sao Paulo during the first months of the quarantine due to the coronavirus disease (COVID-19) pandemic and to compare it with that in the same period of the previous year. Methods: Data were obtained from the emergency department of Ophthal Hospital Especializado, Sao Paulo, Brazil. All the cases registered between March 23 and May 19, 2020, were included in the study as Group 2020. The cases registered between March 23 and May 19, 2019, were included in the study as Group 2019. Frequency tables were used for the descriptive analyses. The chi-square and Fisher exact tests were applied to compare categorical variables between the groups. Results: We observe a decrease of 46.15% in the number of cases during the COVID-19 pandemic in 2020 compared with the same period in 2019. We observed a significant increase in the incidence rates of the following pathologies in 2020 compared with 2019: eyelid disorders (12.3%), corneal disorders (97.1%), retinal pathologies (173.1%), refraction (62.9%), glaucoma (acute and chronic; 43.9%), scleral alterations (68.8%), trauma (39.3%), herpes (54.7%), and cataracts (549.9%). On the other hand, the incidence rates of the following disorders decreased: conjunctivitis (-33.4%), disorders of lacrimal system (-81.0%), iridocyclitis (-39.9%), and postoperative visits (-80.1%). Conclusion: During the early phase of the COVID-19 pandemic, we observed a drastic decrease in the number of patients who visited the emergency eye service. The main reasons for visiting were also changed, with higher frequencies of high-severity cases such as retina disturbances, cornea disturbances, glaucoma, and trauma and lower frequencies of transmittable conditions such as conjunctivitis.

RESUMO Objetivos: Avaliar o perfil das consultas de emergência oftalmológicas durante os primeiros meses de quarentena por pandemia de covid-19 em um hospital oftalmológico de referência em São Paulo e compará-lo com o mesmo período do ano anterior. Métodos: Os dados foram extraídos do serviço de emergência do Hospital Ophthal Especializado, São Paulo, Brasil. Todos os casos registrados entre 23 de março e 19 de maio de 2020 foram incluídos no estudo como Grupo 2020. Os casos registrados entre 23 de março e 19 de maio de 2019 foram incluídos no estudo como Grupo de 2019. Tabelas de frequência foram utilizadas para análises descritivas. Os testes Qui-quadrado e Exato de Fisher foram aplicados para comparar variáveis categóricas entre os grupos. Resultados: Observamos uma diminuição de 46,15% no número de casos durante a pandemia Covid-19 em 2020 quando comparado ao mesmo período sem pandemia em 2019. Foi observado um aumento significativo nos achados de pálpebra (+12,3%), córnea (+97,1%), retina (+173,1%), refração (+62,9%), glaucoma (+43,9%), esclera (+68,8%), trauma (+39,3%), herpes (+54,7%) e catarata (+549,9%) em 2020 quando comparado para 2019. Por outro lado, houve redução nos casos de conjuntivite (-33,4%), transtornos do aparelho lacrimal (-81,0%), iridociclite (-39,9%) e consultas pós-operatórias (-80,1%). Conclusão: durante a fase inicial da pandemia Covid-19, foi observada uma redução drástica no número de pacientes que procuram o serviço de emergência ocular. Houve também uma mudança nos principais motivos para visitas com frequências mais altas de casos de alta gravidade como distúrbios da retina, distúrbios da córnea, glaucoma e trauma, e frequências mais baixas de condições transmissíveis como conjuntivite.

Results of one decade of optical keratoplasty in pediatric patients.

BACKGROUND: Keratoplasty in the pediatric population has been considered a high-risk procedure. OBJECTIVE: To know the demographic data of patients younger than 18 years treated with optical keratoplasty, indications for surgery and its results. MATERIAL AND METHODS: A retrospective study was carried out at Conde de Valenciana Ophthalmology Institute, in which the medical records of patients younger than 18 years treated with optical keratoplasty from 2009 to 2019 were analyzed. RESULTS: A total of 53 eyes were included. The most common diagnosis and procedure were keratoconus and penetrating keratoplasty, respectively. Mean initial visual acuity was 2.05 ± 0.99 logMAR, and 0.82 ± 1.33 at last visit. Survival time was 130.34 months. Four failures were recorded. As for associated surgeries, corneal wound closure was recorded in seven eyes prior to transplant; during the keratoplasty procedure, anterior vitrectomy in two eyes, and after the transplant, Ahmed valve implantation and re-suture. A total of eight eyes had glaucoma, five of them diagnosed prior to transplantation. Regarding rejection, 15 eyes had an episode during follow-up, and mean time to transplant rejection was 10.8 months. CONCLUSION: Prolonged graft survival can be achieved with better knowledge and management of different associated factors.

ANTECEDENTES: La queratoplastia en población pediátrica ha sido considerada un procedimiento de alto riesgo. OBJETIVO: Conocer datos demográficos de pacientes menores de 18 años tratados con queratoplastia óptica, indicaciones de la cirugía y sus resultados. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo en el Instituto de Oftalmología Conde de Valenciana, en el que se revisaron expedientes de pacientes menores de 18 años tratados con queratoplastia óptica de 2009 a 2019. RESULTADOS: Un total de 53 ojos fueron incluidos. El diagnóstico y el procedimiento más comunes fueron el queratocono y la queratoplastia penetrante. El promedio de agudeza visual inicial fue de 2.05 ± 0.99 logMAR y en la última visita, 0.82 ± 1.33. El tiempo de supervivencia del injerto fue de 130.34 meses. Se registraron cuatro fallas. En cuanto a las cirugías asociadas, antes del trasplante se registró cierre de herida corneal en siete ojos y durante la queratoplastia, vitrectomía anterior en dos ojos y después del trasplante, implante de válvula de Ahmed y resutura. Un total de ocho ojos tuvieron glaucoma, cinco con diagnóstico antes del trasplante. Respecto al rechazo, 15 ojos tuvieron un episodio durante el seguimiento y el tiempo promedio de rechazo al trasplante fue de 10.8 meses. CONCLUSIÓN: Se puede lograr una supervivencia prolongada del injerto con el mejor conocimiento y manejo de los diferentes factores asociados.

Estudio IMPULSO: impacto de la COVID-19 en el presente de la oftalmología centrada en superficie ocular y tendencias de futuro / IMPULSE Study: Impact of COVID-19 in the present of ophthalmology focusing on ocular surface and future trends

Antecedentes y objetivo La evolución digital supone una oportunidad para que la oftalmología se adapte a nuevos modelos asistenciales. Este estudio tuvo como objetivo conocer cómo la pandemia ha modificado la práctica clínica y actividades formativas del oftalmólogo especializado en superficie ocular, y analizar tendencias y necesidades emergentes. Materiales y métodos Estudio realizado mediante encuesta online. Un comité de 3 especialistas diseñó un cuestionario de 25 preguntas estructurado en: 1) Perfil del participante; 2) Impacto de la pandemia en el manejo del paciente y las actividades profesionales; 3) Tendencias y necesidades. Resultados Participaron 68 oftalmólogos clínicos. Hubo un alto grado de acuerdo (90%) en que la pandemia demoró las visitas de seguimiento oftalmológico y el diagnóstico. Los participantes coincidieron en que aumentó la frecuencia de pacientes con enfermedad de ojo seco (75%), orzuelo/chalazión (62%) y blefaritis (60%). Según un 28%, será habitual el teleseguimiento mediante teleconsulta de dolencias como ojo seco, glaucoma, diabetes, conjuntivitis, hiposfagmas, orzuelos, etc., especialmente en población joven. Esto será especialmente relevante en las enfermedades crónicas o leves de la superficie ocular, y en el seguimiento de pacientes tras operación de cataratas y retinopatía diabética. Conclusiones Durante la pandemia se ha percibido un aumento de la incidencia de ciertas enfermedades de superficie ocular. El seguimiento de enfermedades crónicas o leves de la superficie ocular se vincula a la necesidad de proporcionar formación específica tanto para el paciente como para el profesional que lo atiende, además de protocolos de cribado y derivación que optimicen el flujo asistencial (AU)

Background and objective Digital evolution represents an opportunity for ophthalmology to adapt to new care models. This study aimed to find out how the pandemic has modified the clinical practice and training activities of the ophthalmologist specialized in ocular surface, as well as to analyze emerging trends and needs. Materials and methods This study was carried out through an online survey. A committee of 3 specialists developed a questionnaire of 25 questions structured in: 1) Participant profile; 2) Impact of the pandemic on patient management and professional activities; 3) Trends and needs. Results Sixty-eight clinical ophthalmologists participated. There was a high degree of agreement (90%) that the pandemic has delayed ophthalmological follow-up visits and diagnosis. The participants agreed that the frequency of patients with dry eye disease (75%), stye/chalazion (62%) and blepharitis (60%) has increased. According to 28%, remote monitoring of pathologies such as dry eye, glaucoma, diabetes, conjunctivitis, hyposphagmas, styes, etc., will be common, especially in the young population. This will be especially relevant in chronic or mild pathologies of the ocular surface, and in the follow-up of patients after cataract and diabetic retinopathy interventions. Conclusions During the pandemic, an increase in the incidence of certain ocular surface diseases has been perceived. The telematic follow-up of chronic or mild pathologies of the ocular surface entails the need to provide specific training for both the patient and the healthcare professional, in addition to screening and referral protocols that would optimize the flow of care (AU)

Resultados de una década de queratoplastia óptica en pacientes pediátricos / Results of one decade of optical keratoplasty in pediatric patients

Resumen Antecedentes: La queratoplastia en población pediátrica ha sido considerada un procedimiento de alto riesgo. Objetivo: Conocer datos demográficos de pacientes menores de 18 años tratados con queratoplastia óptica, indicaciones de la cirugía y sus resultados. Material y métodos: Se realizó un estudio retrospectivo en el Instituto de Oftalmología Conde de Valenciana, en el que se revisaron expedientes de pacientes menores de 18 años tratados con queratoplastia óptica de 2009 a 2019. Resultados: Un total de 53 ojos fueron incluidos. El diagnóstico y el procedimiento más comunes fueron el queratocono y la queratoplastia penetrante. El promedio de agudeza visual inicial fue de 2.05 ± 0.99 logMAR y en la última visita, 0.82 ± 1.33. El tiempo de supervivencia del injerto fue de 130.34 meses. Se registraron cuatro fallas. En cuanto a las cirugías asociadas, antes del trasplante se registró cierre de herida corneal en siete ojos y durante la queratoplastia, vitrectomía anterior en dos ojos y después del trasplante, implante de válvula de Ahmed y resutura. Un total de ocho ojos tuvieron glaucoma, cinco con diagnóstico antes del trasplante. Respecto al rechazo, 15 ojos tuvieron un episodio durante el seguimiento y el tiempo promedio de rechazo al trasplante fue de 10.8 meses. Conclusión: Se puede lograr una supervivencia prolongada del injerto con el mejor conocimiento y manejo de los diferentes factores asociados.

Abstract Background: Keratoplasty in the pediatric population has been considered a high-risk procedure. Objective: To know the demographic data of patients younger than 18 years treated with optical keratoplasty, indications for surgery and its results. Material and methods: A retrospective study was carried out at Conde de Valenciana Ophthalmology Institute, in which the medical records of patients younger than 18 years treated with optical keratoplasty from 2009 to 2019 were analyzed. Results: A total of 53 eyes were included. The most common diagnosis and procedure were keratoconus and penetrating keratoplasty, respectively. Mean initial visual acuity was 2.05 ± 0.99 logMAR, and 0.82 ± 1.33 at last visit. Survival time was 130.34 months. Four failures were recorded. As for associated surgeries, corneal wound closure was recorded in seven eyes prior to transplant; during the keratoplasty procedure, anterior vitrectomy in two eyes, and after the transplant, Ahmed valve implantation and re-suture. A total of eight eyes had glaucoma, five of them diagnosed prior to transplantation. Regarding rejection, 15 eyes had an episode during follow-up, and mean time to transplant rejection was 10.8 months. Conclusion: Prolonged graft survival can be achieved with better knowledge and management of different associated factors.

Incidentes en oftalmología: estudio nacional en Argentina / Incidents in ophthalmology: A National Survey in Argentina

Resumen Objetivo: Realizar un análisis descriptivo de los incidentes en oftalmología reportados por médicos oftalmólogos de Argentina. Métodos: Se realizó un estudio basado en una encuesta desarrollada mediante un sistema electrónico, en agosto de 2021, dirigido a médicos oftalmólogos de Argentina. Se solicitó la descripción de incidentes oftalmológicos, clasificándolos en cuatro grupos, acorde a lo descrito por Organización Mundial de la Salud, en A: "Incidentes, casi-accidentes (no alcanzaron a los pacientes)"; B: "Incidentes (que alcanzaron al paciente, pero sin daño)"; C: "Incidentes prevenibles con daño" y D: "Incidentes no prevenibles con daño". El instructivo de la encuesta explicó la terminología y ofreció ejemplos de cada tipo de incidentes, que fueron evaluados mediante un proceso estadístico descriptivo. Resultados: Participaron 264 médicos oftalmólo gos quienes informaron 434 incidentes. A- Incidentes sin alcance al paciente: 125 casos (28.8%). B- Incidentes que alcanzaron al paciente sin daño: 117 casos. (27%). C- Incidentes prevenibles, con daño: 96 casos (22.1%). D- Incidentes no prevenibles con daño: 96 casos (22.1%). Los incidentes vinculados al uso de gotas fueron los más frecuentes en los 4 grupos (68, 75, 13 y 29 incidentes respectivamente). Conclusión: El 77.9% de los incidentes comunicados en este estudio se podrían haber evitado con adecuadas medidas de seguridad, siendo los más frecuentes los asociados a la utilización de gotas oftálmicas.

Abstract Objective: To perform a descriptive analysis of incidents in ophthalmology reported by ophthal mologists of Argentina. Methods: A questionnaire-based study was performed by an electronic survey during August 2021, including ophthalmologists of Argentina, requesting the description of ophthalmological incidents, which were classified in four groups, in accordance with World Health Organization Definition, as follow: A- "Inci dents, almost-accidents (patient no affected)"; B: "Incidents (patient affected without damage)"; C: "Preventable incidents, with damage", and D: "Not Preventable incidents, with damage". An instructive was supported in the survey explaining these definitions with examples of each kind of incidents. Data was processed for descriptive statistics. Results: The survey was performed by 264 ophthalmologists, reporting 434 incidents: A- Incidents, almost-accidents (patient not affected): 125 cases (28.8%). B- Incidents (patient affected without damage): 117 cases (27%). C- Preventable incidents, with damage: 96 cases (22.1%). D- "Not Preventable incidents, with damage: 96 cases (22.1%). In four groups the most frequent incidents were those associated with the use of ophthalmic drops (68, 75, 13, and 29 incidents respectively). Conclusion: Most of the incidents (77.9%) reported in this study could be avoided if appropriate safety measures were taken. Ophthalmic drops related incidents were the most frequent.

Características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular que acuden a un centro de referencia en oftalmología en Paraguay

Introducción: La toxoplasmosis es una enfermedad parasitaria, en América Latina la prevalencia es relativamente alta, se sabe que la enfermedad no solo es la causa más frecuente de uveítis posterior, sino también la causa principal de la uveítis en sí misma. En Paraguay no se dispone de datos epidemiológicos publicados sobre la misma. Objetivo: Determinar las características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular. Metodología: El presente estudio es observacional, descriptivo, de corte transversal, temporalmente retrospectivo, con muestreo no probabilístico de casos consecutivos. Se enfocó en pacientes con diagnóstico de Toxoplasmosis que acudieron al servicio de Oftalmología del Hospital de Clínicas, durante el periodo de junio de 2020 a febrero 2022. Resultados: Se observó un 54,3 % de mujeres, una media de 30,62 +/- 12,96 años y un 62,8 % de procedencia urbana. El 88,3 % de los casos fueron unilaterales, la mitad de episodios primarios, el 93,6 % casos agudos, y el 97,9 % tuvo un mecanismo de trasmisión adquirido. La mayoría se presentó como Panuveítis, las localizaciones más frecuentes de las lesiones retinocoroideas fueron el Polo posterior (extramacular) y la periferia. El principal abordaje terapéutico fue el tratamiento con Trimetoprim Sulfametoxazol y corticoides sistémicos, la duración del tratamiento fue de 6,51 +/- 1,52 semanas, y las principales complicaciones fueron la Vitritis residual y la Hipertensión ocular. Discusión: La toxoplasmosis ocular es una causa importante de morbilidad visual. Se hace fundamental la prevención de la infección por este parásito mediante medidas higiénico-sanitarias, así como el diagnóstico y tratamiento precoz de los pacientes infectados, de tal manera a disminuir las complicaciones asociadas a esta patología.

Introduction: Toxoplasmosis is a parasitic disease, in Latin America the prevalence is relatively high, it is known that the disease is not only the most frequent cause of posterior uveitis, but also the main cause of uveitis itself. In Paraguay there are no published epidemiological data on it. Objective: To determine the characteristics of retinal lesions in patients diagnosed with ocular Toxoplasmosis. Methods: This study is observational, descriptive, cross-sectional, temporally retrospective, with non-probabilistic sampling of consecutive cases. It focused on patients diagnosed with Toxoplasmosis who attended the Ophthalmology service of the Hospital de Clínicas, during the period from June 2020 to February 2022. Results: 54.3% of women were observed, an average of 30.62 +/ - 12.96 years old and 62.8% of urban origin. 88.3% of the cases were unilateral, half were primary episodes, 93.6% acute cases, and 97.9% had an acquired transmission mechanism. Most presented as panuveitis, the most frequent locations of retinochoroidal lesions were the posterior pole (extramacular) and the periphery. The main therapeutic approach was treatment with trimethoprim sulfamethoxazole and systemic corticosteroids, the duration of treatment was 6.51 +/- 1.52 weeks, and the main complications were residual vitritis and ocular hypertension. Discussion: Ocular toxoplasmosis is an important cause of visual morbidity. It is essential to prevent infection by this parasite through hygienic-sanitary measures, as well as early diagnosis and treatment of infected patients, in order to reduce the complications associated with this pathology.

IMPULSE Study: Impact of COVID-19 in the present of ophthalmology focusing on ocular surface and future trends.

INTRODUCTION AND OBJECTIVE: Digital evolution represents an opportunity for ophthalmology to adapt to new care models. This study aimed to find out how the pandemic has modified the clinical practice and training activities of the ophthalmologist specialised in ocular surface, as well as to analyse emerging trends and needs. MATERIALS AND METHODS: This study was carried out through an online survey. A committee of 3 specialists developed a questionnaire of 25 questions structured in: 1) Participant profile; 2) Impact of the pandemic on patient management and professional activities; 3) Trends and needs. RESULTS: 68 clinical ophthalmologists participated. There was a high degree of agreement (90%) that the pandemic has delayed ophthalmological follow-up visits and diagnosis. The participants agreed that the frequency of patients with dry eye disease (75%), stye/chalazion (62%) and blepharitis (60%) has increased. According to 28%, remote monitoring of pathologies such as dry eye, glaucoma, diabetes, conjunctivitis, hyposphagmas, styes, etc., will be common, especially in the young population. This will be especially relevant in chronic or mild pathologies of the ocular surface, and in the follow-up of patients after cataract and diabetic retinopathy interventions. CONCLUSIONS: During the pandemic, an increase in the incidence of certain ocular surface diseases has been perceived. The telematic follow-up of chronic or mild pathologies of the ocular surface entails the need to provide specific training for both the patient and the healthcare professional, in addition to screening and referral protocols that would optimise the flow of care.

Cabello impeinable, un diagnóstico clínico fácil / Uncombable hair, an easy diagnosis

El cabello impeinable o indomable es una entidad benigna con unas características clínicas muy peculiares y fácilmente reconocibles. La sospecha diagnóstica es clínica y la confirmación se realiza mediante estudio por microscopía óptica de una muestra de cabello del paciente. Requiere evaluación dermatológica y oftalmológica. Su pronóstico es favorable y en ocasiones se consiguen buenos resultados con champú de piritiona de zinc (AU)

Uncombable hair is a benign entity with very peculiar and easily recognizable characteristics. The diagnostic suspicion is clinical and confirmation is made by an optical microscopy study of a sample of the patient's hair. A dermatological and ophthalmological evaluation are required. Its prognosis is favorable and good results are sometimes achieved with pyrithione zinc shampoo. (AU)

Estudio retrospectivo de parálisis facial periférica en un hospital de tercer nivel a lo largo de 3 años / Retrospective study of peripheral facial paralysis in a tertiary hospital over 3 years

Objetivo Identificar las características clínicas y epidemiológicas de los pacientes con parálisis facial periférica (PFP) en un hospital terciario. Método Es un estudio observacional retrospectivo de pacientes con PFP atendidos en un centro hospitalario de tercer nivel. Se recogieron datos demográficos, etiología, lateralidad, recurrencia, recuperación, clínica oftalmológica, severidad según la escala de House-Brackmann (HB), realización de pruebas electrofisiológicas, los servicios médicos que los atendieron, tratamiento médico y quirúrgico. Resultados Se incluyeron 283 pacientes con PFP, 135 (48%) eran varones y 148 (52%) eran mujeres (p=0,47). Todos con afectación unilateral. La media de edad fue de 54±20 años. La etiología principal fue idiopática en 215 (76%) pacientes. La mediana del tiempo de recuperación fue 7 semanas. La recuperación fue completa en 190 (67%) pacientes. Ciento setenta pacientes (84%) con PFP idiopática tuvieron recuperación completa, frente a 30 (16%) pacientes con PFP no idiopática (p<0,01). El 84% de los pacientes con parálisis grado II de la escala de HB se recuperaron completamente, mientras que con el grado VI de la escala de HB se recuperó solo el 17% (p=0,003). Doscientos veintenueve pacientes (81%) presentaron lagoftalmos. La mayor parte recibieron como tratamiento el cuidado de la superficie ocular 271 (96%) pacientes y de estos 249 (88%) pacientes recibieron corticoterapia oral. Trece pacientes (5%) requirieron cirugía oftalmológica. Conclusiones La PFP es una enfermedad que afecta a todos los rangos de edad, sin predilección por el sexo y unilateral. Su causa principal es idiopática. La recuperación es completa en la mayoría de los casos, siendo más favorable en afectaciones leves e idiopáticas. La mayoría solo requiere tratamiento médico (AU)

Purpose To identify clinical and epidemiological characteristics of patients with peripheral facial palsy (PFP) at a tertiary care hospital. Method This is a retrospective observational study of patients with PFP treated at a tertiary medical center. We gathered demographic data, etiology, laterality, recurrence, recovery, clinical ophthalmology, severity according to the House–Brackmann (HB) scale, electrophysiological tests, medical services attended, medical and surgical treatment. Results Two hundred and eighty-three PFP were included, 135 (48%) were men and 148 (52%) were women (P=.47). All patients had unilateral involvement. The mean age was 54±20 years. The main etiology was idiopathic in 215 (76%) patients. Median recovery time was 7 weeks. Recovery was complete in 190 (67%) patients. One hundred and seventy (84%) patients with idiopathic PFP had complete recovery, versus 30 (16%) patients with non-idiopathic PFP (P<.01). The 84% of patients with HB grade II, recovered completely, while with HB grade VI only 17% recovered (P=.003). Two hundred and twenty-nine patients (81%) had lagophthalmos. The majority received ocular surface care treatment in 271 (96%) patients and of these 249 (88%) patients received oral corticosteroid therapy. Thirteen patients (5%) required ophthalmologic surgery. Conclusions PFP affects all age ranges, without predilection for sex and unilateral. Its main cause is idiopathic. Recovery is complete in most cases, being more favorable in mild and idiopathic affections. Most only require medical treatment (AU)