Características clínico-oftalmológicas y evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social, Paraguay / Clinical-ophthalmological characteristics and evolution of patients with moderately severe active thyroid ophthalmopathy treated with methylprednisolone boluses who attended the Central Hospital of the Instituto de Previsión Social, Paraguay

Introducción: La oftalmopatía tiroidea (OT) es un trastorno debilitante en pacientes con enfermedad tiroidea autoinmune, principalmente enfermedad de Graves, que se desarrolla entre el 30 a 50% de los casos. Objetivos: Describir las características clínico-oftalmológicas y la evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social en el tiempo comprendido entre enero de 2018 y setiembre de 2021. Materiales y métodos: Investigación de diseño observacional, con estudio descriptivo, retrospectivo. Resultados: Se revisaron fichas de 34 pacientes con OT activa moderada severa que recibieron bolos de metilprednisolona basado en las guías EUGOGO 2016, de los cuáles se excluyeron 3 pacientes por tener fichas incompletas y otros 3 pacientes ya que requirieron tratamiento de segunda línea previo al término del esquema de 12 sesiones. De los 28 pacientes estudiados, la edad promedio fue de 43,6 ±13,1 años, el 89% de sexo femenino y el 28,5%, fumadores. En cuanto a la función tiroidea de la población previo al tratamiento, se constató hipertiroidismo en el 82%, hipotiroidismo en el 11% y eutiroidismo en el 7%; y posterior al tratamiento, se constató hipertiroidismo en el 78,6% (subclínico), eutiroidismo en el 17,9% e hipotiroidismo en el 3,5%. La mayoría (92.6%) contaba con anticuerpos contra el receptor de TSH positivo, con un promedio de 18 ± 9,9 mIU/Ml. Respecto a la actividad de la oftalmopatía según la escala CAS, se constató un promedio de 4,1 ±1,0 previo al tratamiento y posterior 1,2 ±1,4; de ellos el 46,4% presentó un estado leve según escala de gravedad, 39% sin criterios de gravedad y 14 % persistió en moderada -severa. Se constató mejoría de la agudeza visual tras el tratamiento (57,1%), el promedio de exoftalmía previo al tratamiento fue 22,2 mm y posterior 21,1 mm; se presentó diplopía en el 7,1% previo al tratamiento y en el 3,6% posterior al tratamiento. Conclusión: El tratamiento con glucocorticoides endovenosos en la oftalmopatía de Graves moderada-severa (esquema EUGOGO 2016) fue muy efectivo, revirtiendo la actividad y consecuentemente ayudando a disminuir la gravedad, en la gran mayoría de nuestros pacientes. Esto podría explicarse porque la oftalmopatía era incipiente y por el alto grado de adherencia de los pacientes en el contexto de un manejo multidisciplinar bien protocolizado.

Introduction: Graves' orbitopathy (GO) is a debilitating disorder in patients with autoimmune thyroid disease, mainly Graves' disease, which develops in 30 to 50% of cases. Objectives: To describe the clinical-ophthalmological characteristics and evolution of patients with moderate-to- severe active GO treated with methylprednisolone boluses who attended the Central Hospital of the Institute of Social Security between January 2018 and September 2021. Materials and methods: Observational design research, descriptive, retrospective study. Results: Records of 34 patients with active moderate-to-severe GO who received boluses of methylprednisolone based on the EUGOGO 2016 guidelines, were reviewed, of which 3 patients were excluded due to having incomplete records and another 3 patients since they required second-line treatment prior to end the 12-session scheme. Of the 28 patients studied, the average age was 43.6 ±13.1 years, 89% were female and 28.5% were smokers. Regarding the thyroid function of the population prior to treatment, hyperthyroidism was found in 82%, hypothyroidism in 11% and euthyroidism in 7%; and after treatment, hyperthyroidism was found in 78.6% (subclinical), euthyroidism in 17.9% and hypothyroidism in 3.5%. The majority (92.6%) had positive thyrotropin receptor antibodies, with an average of 18 ± 9.9 mIU/Ml. Regarding the activity of orbitopathy according to the CAS scale, an average of 4.1 ±1.0 was found before treatment and 1.2 ±1.4 after; Of them, 46.4% presented a mild condition according to the severity scale, 39% without severity criteria and 14% persisted in moderate-severe. Improvement in visual acuity was noted after treatment (57.1%), the average exophthalmia before treatment was 22.2 mm and after 21.1 mm; Diplopia occurred in 7.1% before treatment and in 3.6% after treatment. Conclusion: Treatment with intravenous glucocorticoids in moderate-severe Graves' orbitopathy (EUGOGO 2016 scheme) was very effective, reversing the activity and consequently helping to reduce the severity, in the vast majority of our patients. This could be explained because the orbitopathy was incipient and by the high degree of patient adherence in the context of well-protocolized multidisciplinary management.

Triaging ophthalmology outpatient referrals with machine learning: A pilot study.

IMPORTANCE: Triaging of outpatient referrals to ophthalmology services is required for the maintenance of patient care and appropriate resource allocation. Machine learning (ML), in particular natural language processing, may be able to assist with the triaging process. BACKGROUND: To determine whether ML can accurately predict triage category based on ophthalmology outpatient referrals. DESIGN: Retrospective cohort study. PARTICIPANTS: The data of 208 participants was included in the project. METHODS: The synopses of consecutive ophthalmology outpatient referrals at a tertiary hospital were extracted along with their triage categorizations. Following pre-processing, ML models were applied to determine how accurately they could predict the likely triage categorization allocated. Data was split into training and testing sets (75%/25% split). ML models were tested on an unseen test set, after development on the training dataset. MAIN OUTCOME MEASURE: Area under the receiver operator curve (AUC) for category one vs non-category one classification. RESULTS: For the main outcome measure, convolutional neural network (CNN) provided the best AUC (0.83) and accuracy on the test set (0.81), with the artificial neural network (AUC 0.81 and accuracy 0.77) being the next best performing model. When the CNN was applied to the classification task of identifying which referrals should be allocated a category one vs category two vs category three priority, a lower accuracy was achieved (0.65). CONCLUSIONS AND RELEVANCE: ML may be able to accurately assist with the triaging of ophthalmology referrals. Future studies with data from multiple centres and larger sample sizes may be beneficial.

Comparison of the h-indices of the editorial board members of seven ophthalmic subspecialty journals.

PURPOSE: To investigate and compare the h-indices of the editorial board members of ophthalmic subspecialty journals. STUDY DESIGN: Descriptive Cross Sectional Research. METHODS: Bibliometric indices were calculated for the editorial board members of seven ophthalmic subspecialty journals. Correlations between the median h-indexes and journal impact factors (JIF), average citations per article and JIF, and publication count and JIF were analyzed. RESULTS: The median h-indices of the board members of Retina, Journal of Glaucoma, Journal of Cataract and Refractive Surgery, Cornea, Ophthalmic Plastic and Reconstructive Surgery, Journal of Neuroophthalmology and Journal of the American Academy of Pediatric Ophthalmology and Strabismus (J AAPOS) were 34, 26, 23, 17, 15, 14 and 13, respectively. H-indices and publication count were correlated with JIF (P<0.05, for each). CONCLUSION: The board members of Retina have the highest h-index and average citations per article, and J AAPOS have the least. These data provide useful benchmarks for comparison of the various subspecialty areas in ophthalmology.

Topical ophthalmic antimicrobials: unfulfilled demands and possibility of new investments in Brazil and in the United States

In general, topical ophthalmic drug products, especially those used for treating infections, present low effectiveness because of various reasons, from unfavorable drug physicochemical properties to physiological protective mechanisms of the eye. The fact is such group of products holds room for improvement, which could mean the development of better drugs or dosage forms. To achieve this, the knowledge of market composition is essential. The present work studied and compared the antimicrobial ophthalmic markets of Brazil and of the United States (US). Official databank of Brazilian Health Regulatory Agency and of US Food and Drug Administration were assessed for registered antimicrobial topical ophthalmic drug products. Brazilian market has registered greater number of drug products (119) than the US (94), but the latter involves more variety of substances and dosage forms. In both countries, non-innovative products registered as solutions of antibacterials, especially fluoroquinolones and aminoglycosides lead the market. Despite the clinical demand, the US has only one group of antimycotics (polyenes) registered, while in Brazil, there is not any ophthalmic antimycotic product marketed. This study evidences there is not only space for development of newer drugs and formulations but also a demand for already existing technologies and products in both countries.

Medical Devices; Ophthalmic Devices; Classification of the Intranasal Electrostimulation Device for Dry Eye Symptoms. Final order.

The Food and Drug Administration (FDA or we) is classifying the intranasal electrostimulation device for dry eye symptoms into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the intranasal electrostimulation device for dry eye symptoms' classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.

Medical Devices; Ophthalmic Devices; Classification of the Tear Electrostimulation Device. Final order.

The Food and Drug Administration (FDA or we) is classifying the tear electrostimulation device into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the tear electrostimulation device's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.

Medical Devices; Ophthalmic Devices; Classification of Strabismus Detection Device. Final order.

The Food and Drug Administration (FDA) is classifying the strabismus detection device into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the strabismus detection device's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Evaluations of refraction competencies of ophthalmic technicians in Mozambique / Evaluaciones de las competencias sobre refracción de los técnicos oftálmicos en Mozambique

Purpose: Ophthalmic technicians (OT) work at health facilities in Mozambique and are trained to provide primary and secondary eye care services including basic refraction. This study was designed to assess OT competence and confidence in refraction, and investigate whether an upskilling programme is effective in developing their competence and confidence at refraction. Methods: Thirty-one trainee OTs and 16 qualified OTs were recruited to the study. A background questionnaire was administered to determine the demographic profile of the OTs. A confidence levels questionnaire explored their self-reported skills. Clinical competencies were assessed in relation to knowledge (theory exam) and clinical skills (patient exams). 11 OTs were upskilled and the clinical evaluations carried out post training. Results: Initial evaluations demonstrated that confidence and competence levels varied depending on the OTs training (location and duration), and their location of work (clinical load, availability of equipment and other eye care personnel). The qualified OTs were more competent than trainee OTs in most of the evaluations. Post upskilling results demonstrated significant positive impact on confidence and competence levels. Conclusion: These evaluations identified factors affecting the refraction competencies of the OTs and demonstrated that upskilling is effective in improving confidence and competence levels for refraction. They demonstrate the need for a refraction competency framework. The overarching aim of this research was to inform the development of a nationwide programme of OT mentoring, upskilling and leading to the establishment of clinical competency standards for the new OT curricula, relevant to the professional demands (AU)

Objetivo: Los Técnicos Oftálmicos (TO) trabajan en los centros sanitarios de Mozambique, y están formados para aportar servicios de cuidados oculares primarios y secundarios que incluyen la refracción básica. Este estudio fue diseñado para evaluar la competencia y seguridad de los TO en cuanto a refracción, así como investigar la eficacia de un programa para incrementar sus conocimientos para desarrollar la competencia y seguridad en la refracción. Métodos: Para el estudio se reclutó a treinta y un TO en formación y a dieciséis TO cualificados. Se les proporcionó un cuestionario de antecedentes, para determinar el perfil demográfico de los TO. Un cuestionario sobre los niveles de seguridad exploró sus técnicas auto-reportadas. Las competencias clínicas se evaluaron en relación al conocimiento (examen teórico) y las habilidades clínicas (evaluación de los pacientes). Se incrementaron los conocimientos de 11 TO, realizándose la evaluación clínica tras su formación. Resultados: Las evaluaciones iniciales demostraron que los niveles de seguridad y competencia variaban dependiendo de la formación del TO (emplazamiento y duración), y de su emplazamiento de trabajo (carga clínica, disponibilidad de equipos y de personal adicional de cuidados oculares). Los TO cualificados fueron más competentes que los TO en formación en la mayoría de las evaluaciones. Los resultados tras el incremento de conocimientos demostró un impacto considerablemente positivo sobre los niveles de seguridad y competencia. Conclusión: Estas evaluaciones identificaron aquellos factores que afectan a las competencias sobre refracción de los TO, y demostraron que el incremento de conocimientos es eficaz para mejorar los niveles de seguridad y competencia en cuanto a refracción. Demostraron la necesidad de un marco de competencias en refracción. El objetivo más importante de esta investigación fue el de informar sobre el desarrollo de un programa nacional de tutelaje e incremento de conocimientos de los TO, encaminado a establecer los estándares de competencia clínica para los currículum de los nuevos TO, que sean relevantes para las demandas profesionales (AU)

Medical Devices; Ophthalmic Devices; Classification of Nasolacrimal Compression Device. Final order.

The Food and Drug Administration (FDA) is classifying the nasolacrimal compression device into class I (general controls). The Agency is classifying the device into class I (general controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Medical Devices; Ophthalmic Devices; Classification of the Diurnal Pattern Recorder System. Final order.

The Food and Drug Administration (FDA) is classifying the diurnal pattern recorder system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the diurnal pattern recorder system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Efectos de nuevos agentes regenerativos biomiméticos sobre la cicatrización corneal en un modelo experimental de úlceras posquirúrgicas / Effects of new biomimetic regenerating agents on corneal wound healing in an experimental model of post-surgical corneal ulcers

OBJETIVO: El propósito de este estudio es evaluar la eficacia de la aplicación tópica de RGTA-cacicol (Regenerative Agent-cacicol) en un modelo experimental de úlcera corneal tras queratectomía fotorrefractiva (PRK) en ratones. MÉTODOS: Los ratones fueron tratados mediante cirugía PRK con una zona de ablación de 2,0 mm en la córnea central y 45 μm de profundidad con un láser excimer VISX Star S2. Las córneas fueron tratadas tópicamente con gotas de cacicol una hora y 48 h después de la lesión. Los grupos control recibieron BSS (solución estéril de irrigación) en la misma posología. Los eventos clínicos e histopatológicos fueron evaluados 1, 2, 3 y 7 días después de la cirugía. Sobre secciones obtenidas a través de la región central de las córneas se realizaron técnicas inmunofluorescentes para α-SMA (transformación de miofibroblastos), E-cadherina (ensamblaje de las células epiteliales) y β-tubulina neuronal clase III (inervación). RESULTADOS: Las córneas tratadas tópicamente con cacicol durante 7 días mostraron un mayor grado de transparencia en comparación con el control. Además presentaban una mejor citoarquitectura epitelial. El análisis de los perfiles α-SMA en el estroma demostró que el cacicol reduce o retrasa la presencia de miofibroblastos en el estroma en comparación con BSS (p < 0,001). Finalmente se encontró un posible efecto neurorregenerativo de cacicol en córneas tratadas mediante una lesión experimental PRK. En algunos casos se podría dar variabilidad interindividual debido al diseño del modelo experimental, lo que supone una limitación a tener en cuenta pese a la significación estadística de los datos. CONCLUSIONES: En un modelo de lesiones quirúrgicas inducidas por láser en la córnea, la aplicación tópica de RGTA podría evitar la formación de cicatrices y la aparición de miofibroblastos y favorecer la regeneración nerviosa

OBJECTIVE: The purpose of this study is to assess the effectiveness of the topical application of cacicol regenerating agent (RGTA) in an experimental model of corneal ulcer after photorefractive keratectomy (PRK) in mice. METHODS: Mice were subjected to PRK surgery with a 2.0 mm ablation zone on the central cornea and 45 mm of depth on a VISX Star S2 excimer laser. Corneas were treated topically with cacicol drops 1 hour and 48 hours after injury. Control groups received balanced salt solution (BSS) in the same dosage. Clinical and histopathological events were evaluated at 1, 2, 3 and 7 days after surgery. Sections obtained through the central region of the corneas were used to analyze the histopathological events of injured and healed corneas. αSMA (myofibroblast transformation), E cadherin (assembly of epithelial cells) and neuronal class III β-tubulin (innervation) were performed. RESULTS: Corneas treated topically with cacicol for 7 days showed a greater degree of transparency compared to controls. cacicol treated corneas showed improved epithelial cytoarchitecture. Analysis of αSMA profiles in the stroma showed that cacicol reduced or delayed the presence of myofibroblasts in the stroma compared to BSS (P<0.001). Finally, a putative neuroregenerative effect of cacicol was found in corneas subjected to an experimental PRK lesion. In some cases some interindividual variability could be observed due to the design of the experimental model. This is a limitation to consider, despite the statistical significance of the data. CONCLUSIONS: In a model of laser induced surgical lesions in the cornea, topical application of an RGTA (i.e. cacicol) could be involved in avoiding myofibroblast scarring formation and promoting nerve regeneration

Medical Devices; Ophthalmic Devices; Classification of the Oral Electronic Vision Aid. Final order.

The Food and Drug Administration (FDA) is classifying the oral electronic vision aid into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the oral electronic vision aid's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Time to declare ophthalmology an independent discipline by initiating Bachelor of Ophthalmic Surgery programme.

Medical education, associated with lengthy, exhaustive pathways requisite of time, energy and efforts, restrain an individual from pursuing a career in medicine. Most students enrol in medical colleges under the influence of their family members, and only some strive to seek medicine as their own ambition. Medical students confront a number of problems in memorising huge amount of data and the various strategies are integrated in MBBS curriculum from time to time. After MBBS programme, most graduates tend to abandon studies, some migrate abroad, a few continue as general physicians and even fewer strive to get registered for postgraduate specialisation. This results in suboptimal supply of medical workforce. Inconsideration of the current ophthalmologist work ratio and growing demand for eye care services, an initiative is put forward to introduce Bachelors of Ophthalmic Surgery programme similar to Bachelor of Dental Surgery. Such initiative may facilitate effective learning, enable command in a particular area and encourage more individuals to pursue a career in ophthalmology. Using a questionnaire to undergraduate medical students, medical professors and ophthalmologists were surveyed to evaluate the efficacy of the proposed initiative. The results threw a mixed response.

[Evaluation of a new residency program at the department of ophthalmology of the Heinrich Heine University Düsseldorf]. / Evaluation eines neuen Weiterbildungsprogramms in der Augenklinik der Heinrich-Heine-Universität Düsseldorf.

BACKGROUND: The German ophthalmological training is still a very individually organized system with only one final oral examination at the end of the 5-year residency. At the beginning of 2013 a new residency program was introduced at the department of ophthalmology of the Heinrich-Heine University Duesseldorf. This study evaluated the resident satisfaction with the new concept. MATERIAL AND METHODS: The new residency program consists of three main changes: firstly a structured training with fixed rotation in the various subdisciplines of ophthalmology, secondly a list of practical skills examinations that has to be completed during the 5-year program and thirdly annual intermediate oral examinations. The satisfaction of the residents with the new program was anonymously evaluated with a Likert scale-based questionnaire with 15 items and additional free text comments. RESULTS: (1) The structured training was mostly rated positively and 9 out of 12 of residents favored a continuation of the training concept in this form. (2) Only 7 out of 11 residents (64 %) wanted to continue the practical skills examinations in this form and only approximately half of the residents saw a positive effect of these examinations. (3) Regarding the annual examinations 8 out of 11 residents (73 %) reported that the examinations helped them to assess their skills better, 91 % (10 out of 11) reported a learning motivation, 90 % (9 out of 10) an improvement in learning due to the examinations and 73 % (8 out of 11) were of the opinion that the examinations should take place regularly. DISCUSSION: The structured training and the annual examinations were positively evaluated. These changes could be effectively implemented even with a relatively small personnel structure. In comparison the practical skill examinations were rated relatively negatively, probably because of the further increase of daily work. The number of skills to be demonstrated is currently reduced and the integration of testing into the clinical routine of examiners and examinees is under revision.

Simulación en oftalmología secundaria a desprendimiento de retina crónico / Simulation in ophthalmology secondary to an chronic retinal detachment

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Midriasis benigna episódica. Experiencia en una consulta monográfica de neuro-oftalmología de un hospital terciario / Benign episodic mydriasis. Experience in a specialist neuro-ophthalmology clinic of a tertiary hospital

Introducción: Las anisocorias son un motivo de consulta relativamente frecuente en unidades de neuro-oftalmología (UNO). Suponen un reto diagnóstico por la variedad de procesos que pueden ocasionarla. En ausencia de síntomas acompañantes, suelen estar ocasionadas por procesos benignos. La midriasis benigna episódica (MBE) es una causa aislada de asimetría pupilar intermitente, de fisiopatología no esclarecida y predominio en mujeres jóvenes migrañosas. Sujetos, material y métodos: Describimos las características epidemiológicas y clínicas de los pacientes con MBE valorados en una UNO de un hospital terciario. Resultados: Un total de 7 pacientes fueron diagnosticadas de MBE. Todas eran mujeres, con edad media de 33 ± 10 años. Los motivos de consulta fueron asimetría pupilar (n = 5) y visión borrosa (n = 2) de presentación fundamentalmente unilateral (n = 6). La duración fue variable, desde minutos hasta 48 h. Cuatro pacientes (57%) presentaban como antecedente migraña sin aura. En estas, los episodios eran recidivantes (75%), de minutos de duración (75%) y asociaban visión borrosa (50%). Los estudios de neuroimagen (resonancia magnética cerebral) fueron normales. Discusión: La midriasis benigna episódica se presenta predominantemente en mujeres jóvenes. Se asocia al antecedente de migraña y hace plantear si se trata de un síntoma acompañante de la migraña, un aura migrañosa o de migraña oftalmopléjica. De predominio unilateral, puede sin embargo existir alternancia del ojo afectado o ser bilateral de forma simultánea, lo que nos hace cuestionarnos la idoneidad del término. En ausencia de síntomas acompañantes y en episodios de corta duración, no consideramos necesaria la realización de pruebas de imagen

Introduction: Anisocorias are a relatively frequent reason for consultation in neuro-ophthalmology units. They remain a diagnostic challenge for specialists as they may be due to several etiological factors. In the absence of other accompanying symptoms, anisocorias are usually due to benign processes. Benign episodic mydriasis (BEM) is an isolated cause of intermittent pupil asymmetry, in which the pathophysiology is still not fully understood, and is predominant in young women with migraine. Subjects, material and methods: We describe the epidemiological and clinical characteristics of patients with BEM, assessed in a neuro-ophthalmology unit in a tertiary hospital. Results: A total of 7 patients were diagnosed with BEM, all of them females, with a mean age of 33 ± 10 yrs. The patients presented with pupil asymmetry (n = 5) and blurred vision (n = 2), and 6 of the 7 patients had unilateral involvement. The duration of impairment varied from a few minutes to 48 hrs. Four patients (57%) had a clinical history of migraine without aura. The episodes in these 4 patients were recurrent (75%), often lasted for a few minutes (75%), and had associated blurred vision (50%). The neuroimaging studies were normal. Discussion: BEM appears predominantly in young women. It is frequently related to a previous history of migraine, and the specialist must consider if it is a concomitant symptom of common migraine, migraine with aura, or ophthalmoplegic migraine. Although BEM has unilateral predominance, there may be alternation of the affected eye or even bilateral impairment during the same episode, which makes us question the adequacy of the term to describe the process. Imaging tests are not recommended in the absence of other accompanying symptoms, or in short-term episodes

Variabilidad clínica en la cirugía de la catarata / Clinical practice variation in cataract surgery

PROPÓSITO: Las tasas de la cirugía de la catarata han aumentado de forma espectacular en las últimas dos décadas. Sin embargo, las variaciones en la práctica clínica en esta cirugía no han sido estudiadas en profundidad. El objetivo de esta revisión es el análisis de dicha variabilidad, incluyendo los factores que la originan y las consecuencias sobre la calidad asistencial y la planificación sanitaria. Asimismo se resalta la importancia de reducirla y se exponen diversas estrategias que permiten su control. Hallazgos recientes: A lo largo del artículo se presentan las últimas investigaciones en las que se considera que el desarrollo y la implementación de guías de práctica clínica constituyen la mejor herramienta para estandarizar los procesos de cuidados. CONCLUSIÓN: El control del componente injustificado o no deseado de las variaciones, además de mejorar la calidad asistencial, puede suponer un importante ahorro en el gasto sanitario

PURPOSE: Cataract surgery rates have dramatically increased in the last two decades. However, clinical practice variation in cataract surgery has not been thoroughly studied. The aim of this review is to analyze clinical practice variation, including the causes and consequences of this phenomenon. Then, its role in health care planning and health care quality is focused, emphasizing the importance of reducing it and providing several practical strategies to accomplish it. Recent findings: The latest researches are presented in this article. They identify the development and implementation of clinical practice guidelines as the best tool to standardize care processes. CONCLUSION: Managing unwarranted or unwanted variation would improve quality of care and may lead to a significant saving in health care spending

Breve historia de los anteojos / A short history of glasses

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Hamartoma retiniano en esclerosis tuberosa / Retinal hamartoma in tuberous sclerosis

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Correlación en telemedicina de retinopatía del prematuro entre observadores expertos y no expertos / Telemedicine correlation in retinopathy of prematurity between experts and non-expert observers

OBJETIVOS: Evaluar la eficacia de la queratoplastia lamelar anterior profunda (DALK) mediante técnica de Melles (técnica B) en pacientes con queratocono avanzado en comparación con la técnica clásica de queratoplastia penetrante (QPP) (técnica A). METODOLOGÍA: Estudio retrospectivo descriptivo comparativo entre la técnica A y la técnica B en grupos homogéneos. RESULTADOS: La agudeza visual con corrección (test de Snellen, escala decimal) ha sido de 0,77 ± 0,32 para el grupo A y de 0,62 ± 0,29 para el grupo B, no siendo diferencias estadísticamente significativas. El defecto refractivo esférico medio en el grupo A fue de −1,73 ± 5,1 dioptrías y el equivalente esférico medio de −3,92 ± 5,1 dioptrías. El grupo B presentó valores de −2,67 ± 4,02 dioptrías y −4,55 ± 4,08 dioptrías, respectivamente, no habiendo diferencias para estas variables en ambos grupos. El cilindro residual una vez retiradas las suturas fue de 4,47 ± 2,47 dioptrías para el grupo A y de 3,77 ± 1,63 dioptrías para el grupo B, sin ser estadísticamente significativas. CONCLUSIÓN: No se han encontrado diferencias estadísticamente significativas para ninguna de las variables estudiadas al comparar ambos grupos mediante la t de Student para muestras independientes. Más estudios acerca de la homogeneidad del lecho estromal residual y del espesor del mismo pueden aportar las claves para que esta técnica se acerque a las agudezas visuales de una QPP o una DALK mediante técnica descemética

OBJECTIVE: To study the correlation between expert and non-expert observers in the reporting images for the diagnosis of retinopathy of prematurity (ROP) in a telemedicine setting. METHODS: A cross-sectional, multicenter study, consisting of 25 sets of images of patients screened for ROP. They were evaluated by two experts in ROP and 1 non-expert and classified according to telemedicine classification, zone, stage, plus disease and Ells referral criteria. The telemedicine classification was: no ROP, mild ROP, type 2 ROP, or ROP that requires treatment. Ells referral criteria is defined as the presence at least one of the following: ROP in zone I, Stage 3 in zone I or II, or plus + For statistical analysis, SPSS 16.0 was used. For correlation, Kappa value was performed. RESULTS: There was a high correlation between observers for the assessment of ROP stage (0.75; 0.54-0.88) plus disease (0.85; 0.71-0.92), and Ells criteria (0.89; 0.83-1.0). However, inter-observer values were low for zone (0.41; 0.27-0.54) and telemedicine classification (0.43; 0.33-0.6). CONCLUSIONS: When evaluating telemedicine images by examiners with different levels of expertise in ROP, the Ells criteria gave the best correlation. In addition, stage of disease and plus disease have good correlation among observers. In contrast, the correlation between observers was low for zone and telemedicine classification