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1.
Pan Afr Med J ; 35(Suppl 2): 135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193950

RESUMO

Tuberculous neuroretinis, a relatively rare manifestation of extra-pulmonary tuberculosis, is characterized by optic disc edema, peripapillary and macula swelling, with hard exudates forming a partial or complete 'macular star' While the disease may present a diagnostic challenge for Ophthalmologists, prognosis is usually good, with proper management. The Coronavirus Disease 2019 (COVID-19) pandemic has presented a healthcare delivery dilemma in many parts of the world, with poor accessibility to, and under-utilization of, important healthcare services by non-COVID-19-related cases. Herein is a report of a case of tuberculous neuroretinitis in Lagos, Nigeria, whose care was negatively impacted by the ongoing pandemic through the combined factors of the interruption of clinical services during the lockdown, patient avoidance of healthcare facilities and the absence of robust telehealth services. These all culminated in the delayed institution of therapy which may be responsible for the poor visual outcome of no-light-perception.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Retinite/tratamento farmacológico , Tuberculose Ocular/tratamento farmacológico , Antituberculosos/uso terapêutico , Telefone Celular , Diagnóstico Tardio , Técnicas de Diagnóstico Oftalmológico , Quimioterapia Combinada , Feminino , Fechamento de Instituições de Saúde , Humanos , Macula Lutea/patologia , Nigéria/epidemiologia , Fotografação , Quarentena , Retinite/diagnóstico , Telemedicina , Tomografia de Coerência Óptica , Resultado do Tratamento , Recusa do Paciente ao Tratamento , Tuberculose Ocular/diagnóstico , Adulto Jovem
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1980-1983, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018391

RESUMO

Symmetry can be defined as uniformity, equivalence or exact similarity of two parts divided along an axis. While our left and right eyes clearly have a high degree of external bilateral symmetry, it is less obvious to what degree they have internal bilateral symmetry. In this paper, we try to find approximate-bilateral symmetry in retina, one of the internal parts of our eye, which plays a vital role in our vision and also can be used as a powerful biometric. Contrary to previous works, we study interretinal symmetry from a biometric perspective. In other words, we study whether the left and right retinal symmetry is strong enough to reliably tell whether a pair of the left and right retinas belongs to a single person. For this, we focus on overall symmetry of the retinas rather than specific attributes such as length, area, thickness, or the number of blood vessels. We evaluate and analyse the performance of both human and neural network based bilateral retina verification on fundus photographs. By experimenting on a publicly available data set, we confirm interretinal symmetry.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Fotografação , Biometria , Humanos , Procedimentos Cirúrgicos Oftalmológicos , Retina/diagnóstico por imagem
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1992-1995, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018394

RESUMO

Diabetic Retinopathy (DR), the complication leading to vision loss, is generally graded according to the amalgamation of various structural factors in fundus photography such as number of microaneurysms, hemorrhages, vascular abnormalities, etc. To this end, Convolution Neural Network (CNN) with impressively representational power has been exhaustively utilized to address this problem. However, while existing multi-stream networks are costly, the conventional CNNs do not consider multiple levels of semantic context, which suffers from the loss of spatial correlations between the aforementioned DR-related signs. Therefore, this paper proposes a Densely Reversed Attention based CNN (DRAN) to leverage the learnable integration of channel-wise attention at multi-level features in a pretrained network for unambiguously involving spatial representations of important DR-oriented factors. Consequently, the proposed approach gains a quadratic weighted kappa of 85.6% on Kaggle DR detection dataset, which is competitive with the state-of-the-arts.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Microaneurisma , Atenção , Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Humanos , Redes Neurais de Computação
4.
Aust J Gen Pract ; 49(10): 656-661, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33015681

RESUMO

BACKGROUND: Patients with red eyes frequently present to general practitioners (GPs). Although infrequent, some patients with COVID-19 may present with features typical of viral conjunctivitis. SARS-CoV-2 is expressed at a low rate in tears, which may be a source of infection to GPs caring for patients at high risk of COVID­19. OBJECTIVE: The aims of this article are to outline: 1) ophthalmic complications of SARS-CoV-2 infection, 2) triage and management of patients with potential COVID-19 conjunctivitis, and 3) triage and management of patients with red eyes during the current COVID-19 pandemic. DISCUSSION: It is important that GPs: 1) have a high index of suspicion that patients with apparently typical viral conjunctivitis may have an uncommon presentation of COVID-19 illness, 2) develop appropriate telephone triage systems to reduce patient consultations, and 3) foster relationships with their ophthalmologist and optometrist colleagues who can provide phone advice, guidance on treatment initiation and definitive care when necessary.


Assuntos
Betacoronavirus/isolamento & purificação , Conjuntivite , Infecções por Coronavirus , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Pneumonia Viral , Triagem/métodos , Comorbidade , Conjuntivite/diagnóstico , Conjuntivite/epidemiologia , Conjuntivite/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Clínicos Gerais , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Exposição Ocupacional/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Lágrimas/virologia
5.
Indian J Ophthalmol ; 68(10): 2199-2201, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32971640

RESUMO

To describe a smartphone-based telemedicine tool for monitoring of corneal ulcer size during the corona pandemic, a simple "U"-shaped tool was constructed using three Schirmer's strips that were provided to the patients with small to medium-sized corneal ulcers. The patient and the attendant were trained to use this simple U-shaped tool at home and send digital images to the treating ophthalmologist, to monitor the course of the ulcer. The tool was used in five eyes of five patients with active microbial keratitis. Patients were followed up regularly with the use of telemedicine facility every 48 h for an average duration of 7.6 days (range 6-9 days). In all the five eyes, assessment of the serial images with U-shaped tool showed decrease in size of corneal ulcer, which corroborated with subjective improvement in symptoms. Hence, the novel "'U'-shaped tool" may provide an effective measure in following-up of corneal ulcer patients in times of the COVID-19 pandemic, obviating frequent hospital visits and risk of contracting COVID.


Assuntos
Betacoronavirus , Úlcera da Córnea/diagnóstico , Infecções por Coronavirus/epidemiologia , Técnicas de Diagnóstico Oftalmológico/instrumentação , Infecções Oculares Bacterianas/diagnóstico , Pneumonia Viral/epidemiologia , Smartphone/instrumentação , Telemedicina/métodos , Adulto , Idoso , Pré-Escolar , Úlcera da Córnea/microbiologia , Infecções Oculares Bacterianas/microbiologia , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Pandemias , Projetos Piloto , Microscopia com Lâmpada de Fenda
6.
Middle East Afr J Ophthalmol ; 27(2): 128-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874047

RESUMO

We report two cases with foveal congenital simple hamartoma of the retinal pigment epithelium (CSHRPE), as both patients presented to our retina services complaining of a unilateral decreased vision. Full ophthalmic examination and multimodal imaging were performed including fundus photography, fundus autofluorescence, optical coherence tomography, fluorescein angiography, and electrophysiological testing. Both patients presented with 20/80 vision in the affected eyes. Foveal CSHRPE was found in both eyes, along with parapapillary hyperpigmented rim, multiple pinpoint macular lesions, and few posterior pole hyperpigmented lesions. Multifocal electroretinogram showed diminished central amplitude in both eyes, with three-dimensional topography map showing blunted foveal peaks in one eye and the absence of a central peak in the other patient. Both patients had a stable vision and clinical examination of the CSHRPE during 5 and 6 years follow up, respectively. Foveal CSHRPE is usually symptomatic and results in a decline in visual acuity. Follow-up of these patients showed stable vision and clinical examination.


Assuntos
Hamartoma/congênito , Doenças Retinianas/congênito , Epitélio Pigmentado da Retina/anormalidades , Adulto , Técnicas de Diagnóstico Oftalmológico , Eletrorretinografia , Angiofluoresceinografia , Fóvea Central/patologia , Fundo de Olho , Hamartoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Doenças Retinianas/diagnóstico , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia
7.
J Fr Ophtalmol ; 43(7): 642-652, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32631687

RESUMO

The COVID-19 pandemic has dramatically changed our daily lives as ophthalmologists. This general review firstly provides a better understanding of the virus responsible for the pandemic: the SARS-CoV-2, and the clinical manifestations of the COVID-19 disease. The second part is detailing the pathophysiology, clinical signs and challenges of ocular involvement, which seems rare and not functionally severe, but which may be a potential source of contamination. Finally, we discuss the preventive measures that need to be implemented in our daily practice to avoid any viral dissemination.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções Oculares Virais/virologia , Pneumonia Viral/complicações , Betacoronavirus/genética , Betacoronavirus/ultraestrutura , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Técnicas de Diagnóstico Oftalmológico , Olho/virologia , Infecções Oculares Virais/fisiopatologia , Infecções Oculares Virais/prevenção & controle , Genoma Viral , Humanos , Microscopia Eletrônica , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Integração Viral
9.
Ulus Travma Acil Cerrahi Derg ; 26(4): 568-573, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589256

RESUMO

BACKGROUND: This study aims to use laser flare photometry to evaluate flare changes in patients following corneal damage from a metallic foreign body (FB). METHODS: Foreign body injured eyes and the healthy fellow eyes of 54 consecutive patients were studied in this comparative, observational, cross-sectional study. Flare levels were analyzed according to demographics, history of previous exposures, foreign body location, and foreign body penetration into the injured cornea. RESULTS: The mean flare value was significantly higher for the eyes with corneal foreign body injury compared to the fellow-control eyes (11.35±14.17 ph/ms and 6.30±3.81 ph/ms, respectively) (p=0.014). The mean flare values were significantly lower in eyes with a history of more than one previous corneal foreign body removal flare values than in other eyes (p=0.029). CONCLUSION: Flare is increased by corneal foreign body exposure. However, eyes that experience multiple previous corneal foreign body exposures may show relatively low flare, probably due to corneal desensitization.


Assuntos
Barreira Hematoaquosa/fisiopatologia , Lesões da Córnea , Corpos Estranhos , Fotometria , Córnea/fisiopatologia , Técnicas de Diagnóstico Oftalmológico , Humanos , Lasers , Metais/efeitos adversos
10.
Enferm. actual Costa Rica (Online) ; (38): 136-150, Jan.-Jun. 2020. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1090092

RESUMO

Resumo O objetivo deste estúdio elaborar protocolo que direcione os enfermeiros das Unidades Básicas de Saúde do município de Currais Novos/RN para a realização do Teste do Reflexo Vermelho às crianças na consulta de Crescimento e Desenvolvimento. Pesquisa do tipo relato de experiência, realizada em duas etapas, a revisão integrativa de literatura e a construção do protocolo. Através da revisão integrativa de literatura nas bases de dados Lilacs, Scielo e Medline, acrescida de manuais e livros, foram analisadas 10 referências entre os anos de 2010 a 2017. Posteriormente, foi elaborado o protocolo para realização do TRV pelos enfermeiros, sendo abordados os principais critérios e técnicas a serem considerados para execução do exame. Conclui-se que o protocolo é de extrema importância, podendo ser utilizado em momentos de capacitações futuras e no cotidiano assistencial dos profissionais enfermeiros, de modo a promover uma melhor assistência à saúde ocular desses indivíduos.


Abstract The aim of this study was to elaborate a protocol that directs the nurses of the Basic Health Units of the municipality of Currais Novos/RN for the accomplishment of the Red Reflex Test to the children in the consultation of Growth and Development. Research type experience report, realized in two stages, the integrative review of findings and the protocol construction. Through the integrative literature review in the Lilacs, Scielo and Medline databases, with manuals and books, 10 references were analyzed between the years 2010 and 2017. Posteriorly, the protocol was elaborated for the accomplishment of the Red Reflex Test by the nurses, being the main criteria and techniques to be considered for the examination. It concluded that the protocol is of extreme importance and can be used in future training sessions and in the day-to-day care of nursing professionals, in order to promote better assistance to the ocular health of these individuals.


Resumen El objetivo de este estudio fue elaborar un protocolo que dirija a los enfermeros de las Unidades Basicas de Salud del Municipio de Currais Novos/RN para la realización del Test del Reflejo Rojo a los niños en la consulta de Crecimiento y Desarrollo. Se realizó un informe de experiencias realizada en dos etapas, la revisión integrativa de literatura y la construcción del protocolo. A través de la revisión integrativa de literatura en las bases de datos Lilacs, Scielo y Medline, más los manuales y libros, se analizaron 10 referencias entre los años 2010 a 2017. Posteriormente, se elaboró el protocolo para la realización del Test de Reflejo rojo por los enfermeros, siendo abordados los principales criterios y técnicas a ser considerados para la ejecución del examen. Se concluye que el protocolo es de extrema importancia, pudiendo ser utilizado en momentos de capacitaciones futuras y en el cotidiano asistencial de los profesionales enfermeros, para promover una mejor asistencia a la salud ocular de estos individuos.


Assuntos
Humanos , Brasil , Desenvolvimento Infantil , Crescimento e Desenvolvimento , Técnicas de Diagnóstico Oftalmológico , Cuidados de Enfermagem
11.
Middle East Afr J Ophthalmol ; 27(1): 22-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549720

RESUMO

PURPOSE: The present study aimed to compare lower eyelid retraction (LER) in individuals with a positive orbital vector with that of individuals with a negative orbital vector. MATERIALS AND METHODS: This cross-sectional study was conducted on 123 normal individuals including 64 men and 59 women aged 20-80 years. After the individuals underwent Hertel exophthalmometry, two side-view and front-view photos were taken using a camera. The orbital vector angle and the extent of scleral show were then measured in millimeter, using the Photoshop software. Eventually, the recorded data were analyzed through statistical software. RESULTS: The findings of this study showed that LER has a significant correlation with orbital vector angle and the extent of proptosis (P < 0.05). The mean value of orbital vector angle in individuals without LER was 9.76°, while this figure was calculated to be - 13.65° in individuals with LER. The mean protrusion value based on Hertel exophthalmometry was 14.08 mm in individuals without LER and 16.27 mm in individuals with LER. The extent of scleral show had a significant correlation with proptosis and orbital vector angle (P = 0.01), with a mean value of - 0.41 mm in individuals without LER and 0.94 mm in participants with LER. CONCLUSIONS: The prevalence of LER and scleral show is positively correlated with the extent of proptosis and negatively correlated with orbital vector angle.


Assuntos
Exoftalmia/diagnóstico , Doenças Palpebrais/diagnóstico , Órbita/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biometria , Estudos Transversais , Técnicas de Diagnóstico Oftalmológico/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Saudi Med J ; 41(6): 622-627, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518929

RESUMO

OBJECTIVES: To validate the web weight gain-based WINROP (weight, insulin-like growth factor I, neonatal, retinopathy of prematurity [ROP]) algorithm retrospectively to identify type 1 ROP in a Saudi cohort of premature infants.  Methods: The records of preterm infants (greater than 23 and less than 32 weeks gestation) born between August 2013 and October 2018, were reviewed. Birth weight, gestational age, and weekly weight measurements of the premature infants were entered online. Based on weekly weight gain, the WINROP algorithm alerted clinicians whether infants were at high-risk for vision­threatening type 1 ROP. Sensitivity, specificity, positive and negative predictive values were calculated. Results: The median gestational age of the infants at birth was 28 weeks, with median birth weight at 1085 g. Of the 175 infants included in the study, 13 (7.4%) developed type 1 ROP. WINROP positive alarm was triggered in 70.9% (124/175) of all infants and 100% (13/13) of those treated for type 1 ROP. The specificity of the algorithm was 31.5%. Positive predictive values was 10.5% and negative was 100%. Conclusion: The general WINROP sensitivity in identifying type 1 ROP was 100% similar to that reported in developed countries; however, its specificity was low at 31.5%. Tweaking of the algorithm based on the population may increase the specificity and promote the practical utility of this non-invasive screening tool for ophthalmologists and neonatologists in this population.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Recém-Nascido Prematuro , Programas de Rastreamento/métodos , Retinopatia da Prematuridade/diagnóstico , Algoritmos , Peso ao Nascer , Estudos de Coortes , Humanos , Lactente , Recém-Nascido , Fator de Crescimento Insulin-Like I , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Ganho de Peso
14.
PLoS One ; 15(6): e0233514, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569310

RESUMO

Diabetic retinopathy (DR) is a serious retinal disease and is considered as a leading cause of blindness in the world. Ophthalmologists use optical coherence tomography (OCT) and fundus photography for the purpose of assessing the retinal thickness, and structure, in addition to detecting edema, hemorrhage, and scars. Deep learning models are mainly used to analyze OCT or fundus images, extract unique features for each stage of DR and therefore classify images and stage the disease. Throughout this paper, a deep Convolutional Neural Network (CNN) with 18 convolutional layers and 3 fully connected layers is proposed to analyze fundus images and automatically distinguish between controls (i.e. no DR), moderate DR (i.e. a combination of mild and moderate Non Proliferative DR (NPDR)) and severe DR (i.e. a group of severe NPDR, and Proliferative DR (PDR)) with a validation accuracy of 88%-89%, a sensitivity of 87%-89%, a specificity of 94%-95%, and a Quadratic Weighted Kappa Score of 0.91-0.92 when both 5-fold, and 10-fold cross validation methods were used respectively. A prior pre-processing stage was deployed where image resizing and a class-specific data augmentation were used. The proposed approach is considerably accurate in objectively diagnosing and grading diabetic retinopathy, which obviates the need for a retina specialist and expands access to retinal care. This technology enables both early diagnosis and objective tracking of disease progression which may help optimize medical therapy to minimize vision loss.


Assuntos
Retinopatia Diabética/classificação , Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Retinopatia Diabética/diagnóstico por imagem , Programas de Triagem Diagnóstica , Técnicas de Diagnóstico Oftalmológico , Fundo de Olho , Humanos , Edema Macular/etiologia , Modelos Teóricos , Redes Neurais de Computação , Retina/patologia , Sensibilidade e Especificidade , Tomografia de Coerência Óptica/métodos
15.
Medwave ; 20(4): e7902, 2020 May 13.
Artigo em Espanhol, Inglês | MEDLINE | ID: covidwho-431949

RESUMO

Introduction: A new type of coronavirus (SARS-CoV-2) causes a respiratory distress syndrome that has been called COVID-19 and has generated an unprecedented pandemic. Serious complications include pneumonia, and mortality ranges from 2 to 5%. Until March 26, the World Health Organization reports 462 684 confirmed cases and 20 834 deaths worldwide. Dissemination occurs from aerosols or respiratory droplets. Different scientific societies have published clinical practice guidelines regarding ophthalmic care in the COVID-19 pandemic, but the information is presented inconsistently, which makes decision-making difficult. Methods: We conducted a sensitive bibliographic search in EMBASE and ophthalmic society webpages, of the clinical practice guidelines of ophthalmic care in pandemic COVID-19. We extracted the recommendations, organizing them into three categories: "Which patients to attend", "How should the clinic work", and "What interventions should be avoided". For each guideline, we assessed whether the search was systematic and whether the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was followed. Results: Fourteen relevant articles were found. Fifty-one recommendations were extracted and are shown in a summary table. None are based on a systematic search for evidence, nor do any use GRADE to develop the recommendations. Conclusions: The clinical practice guidelines that we reviewed all recommend rescheduling all non-urgent consultations and surgeries, reinforcing contact precautions, the use of personal protection elements, and the disinfection of surfaces and instruments. The guidelines should be improved by incorporating systematic searches for evidence, using GRADE for recommendations, and Appraisal of Guidelines for Research and Evaluation (AGREE II) for reporting.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Oftalmologia/normas , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Técnicas de Diagnóstico Oftalmológico/normas , Contaminação de Equipamentos , Humanos , Oftalmologia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Esterilização/métodos
16.
Medwave ; 20(4): e7902, 2020 May 13.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32469854

RESUMO

Introduction: A new type of coronavirus (SARS-CoV-2) causes a respiratory distress syndrome that has been called COVID-19 and has generated an unprecedented pandemic. Serious complications include pneumonia, and mortality ranges from 2 to 5%. Until March 26, the World Health Organization reports 462 684 confirmed cases and 20 834 deaths worldwide. Dissemination occurs from aerosols or respiratory droplets. Different scientific societies have published clinical practice guidelines regarding ophthalmic care in the COVID-19 pandemic, but the information is presented inconsistently, which makes decision-making difficult. Methods: We conducted a sensitive bibliographic search in EMBASE and ophthalmic society webpages, of the clinical practice guidelines of ophthalmic care in pandemic COVID-19. We extracted the recommendations, organizing them into three categories: "Which patients to attend", "How should the clinic work", and "What interventions should be avoided". For each guideline, we assessed whether the search was systematic and whether the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was followed. Results: Fourteen relevant articles were found. Fifty-one recommendations were extracted and are shown in a summary table. None are based on a systematic search for evidence, nor do any use GRADE to develop the recommendations. Conclusions: The clinical practice guidelines that we reviewed all recommend rescheduling all non-urgent consultations and surgeries, reinforcing contact precautions, the use of personal protection elements, and the disinfection of surfaces and instruments. The guidelines should be improved by incorporating systematic searches for evidence, using GRADE for recommendations, and Appraisal of Guidelines for Research and Evaluation (AGREE II) for reporting.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Oftalmologia/normas , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Técnicas de Diagnóstico Oftalmológico/normas , Contaminação de Equipamentos , Humanos , Oftalmologia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Esterilização/métodos
17.
Medwave ; 20(4)30 de mayo de 2020.
Artigo em Inglês, Espanhol | LILACS | ID: biblio-1103970

RESUMO

Introducción Un nuevo tipo de coronavirus, denominado SARS­CoV-2, puede provocar patología respiratoria, denominada COVID-19, y ha generado una pandemia sin precedentes. Las complicaciones graves incluyen neumonía y la mortalidad oscila entre un 2 a un 5%. Hasta el 26 de marzo de 2020 la OMS informó 462 684 casos confirmados, y 20 834 muertes en todo el mundo. Se transmite por aerosoles o gotitas respiratorias. Distintas sociedades científicas han publicado guías de práctica clínica respecto a la atención oftalmológica en pandemia COVID-19. Cada una expone la información de manera diferente, lo que dificulta la toma de decisiones. Métodos Realizamos una búsqueda bibliográfica sensible en EMBASE y dirigida en sociedades oftalmológicas de guías de práctica clínica de atención oftalmológica en pandemia COVID-19. Extrajimos las recomendaciones, organizándolas en tres categorías: "qué pacientes tratar", "funcionamiento del policlínico y consulta" y "qué intervenciones evitar". En cada una se evaluó la búsqueda sistemática de evidencia y el uso en las recomendaciones de metodología Appraisal of Guidelines for Research and Evaluation, GRADE. Resultados Se encontraron 14 artículos relevantes. Se extrajeron 51 recomendaciones, elaborando una tabla resumen. Ninguna efectuó búsqueda sistemática de evidencia, ni incorporó GRADE en las recomendaciones. Conclusiones Las guías de práctica clínica revisadas comparten los principios generales de reprogramar toda consulta y cirugía no urgente, reforzando las precauciones de contacto, el uso de elementos de protección personal y desinfección de superficies e instrumentos. Se deben mejorar las guías de práctica clínica incorporando búsquedas sistemáticas de evidencia, usando metodología GRADE para las recomendaciones y Appraisal of Guidelines for Research and Evaluation (AGREE II) para el reporte.


Introduction A new type of coronavirus (SARS­CoV-2) causes a respiratory distress syndrome called COVID-19 that has generated an un-precedented pandemic. Serious complications include pneumonia, and mortality ranges from 2 to 5%. Up until 26 March 2020, the World Health Organization (WHO) reports 462 684 confirmed cases and 20 834 deaths worldwide. Dissemination occurs from aerosols or respiratory droplets. Different scientific societies have published clinical practice guidelines regarding ophthalmic care in the COVID-19 pandemic, but the information is presented inconsistently, which makes decision-making difficult. Methods We conducted a sensitive bibliographic search in EMBASE and ophthalmic society webpages of the clinical practice guidelines of ophthalmic care in the COVID-19 pandemic. We extracted the recommendations, organizing them into three categories: "which patients to treat", "how should the clinic work", and "what interventions should be avoided". For each guideline, we assessed whether the search was systematic and whether the methodology Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was followed. Results Fourteen relevant articles were found. Fifty-one recommendations were extracted and are shown in a table summary. None are based on a systematic search for evidence, nor do any use GRADE to develop the recommendations. Conclusions All the clinical practice guidelines that we reviewed recommend rescheduling all non-urgent consultations and surgeries, reinforcing contact precautions, using personal protection elements, and disinfecting surfaces and instruments. The guidelines should be improved by incorporating a systematic search for evidence, using GRADE for recommendations, and the Appraisal of Guidelines for Research & Evaluation (AGREE II) for reporting.


Assuntos
Humanos , Oftalmologia/normas , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Oftalmologia/métodos , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Esterilização/métodos , Contaminação de Equipamentos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Técnicas de Diagnóstico Oftalmológico
18.
Cochrane Database Syst Rev ; 5: CD012947, 2020 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-32468576

RESUMO

BACKGROUND: Primary angle closure glaucoma (PACG) accounts for 50% of glaucoma blindness worldwide. More than three-quarters of individuals with PACG reside in Asia. In these populations, PACG often develops insidiously leading to chronically raised intraocular pressure and optic nerve damage, which is often asymptomatic. Non-contact tests to identify people at risk of angle closure are relatively quick and can be carried out by appropriately trained healthcare professionals or technicians as a triage test. If the test is positive, the person will be referred for further specialist assessment. OBJECTIVES: To determine the diagnostic accuracy of non-contact tests (limbal anterior chamber depth (LACD) (van Herick test); oblique flashlight test; scanning peripheral anterior chamber depth analyser (SPAC), Scheimpflug photography; anterior segment optical coherence tomography (AS-OCT), for identifying people with an occludable angle. SEARCH METHODS: We searched the following bibliographic databases 3 October 2019: CENTRAL; MEDLINE; Embase; BIOSIS; OpenGrey; ARIF and clinical trials registries. The searches were limited to remove case reports. There were no date or language restrictions in the searches. SELECTION CRITERIA: We included prospective and retrospective cross-sectional, cohort and case-control studies conducted in any setting that evaluated the accuracy of one or more index tests for identifying people with an occludable angle compared to a gonioscopic reference standard. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and quality assessment using QUADAS2 for each study. For each test, 2 x 2 tables were constructed and sensitivity and specificity were calculated. When four or more studies provided data at fixed thresholds for each test, we fitted a bivariate model using the METADAS macro in SAS to calculate pooled point estimates for sensitivity and specificity. For comparisons between index tests and subgroups, we performed a likelihood ratio test comparing the model with and without the covariate. MAIN RESULTS: We included 47 studies involving 26,151 participants and analysing data from 23,440. Most studies were conducted in Asia (36, 76.6%). Twenty-seven studies assessed AS-OCT (analysing 15,580 participants), 17 studies LACD (7385 participants), nine studies Scheimpflug photography (1616 participants), six studies SPAC (5239 participants) and five studies evaluated the oblique flashlight test (998 participants). Regarding study quality, 36 of the included studies (76.6%) were judged to have a high risk of bias in at least one domain.The use of a case-control design (13 studies) or inappropriate exclusions (6 studies) raised patient selection concerns in 40.4% of studies and concerns in the index test domain in 59.6% of studies were due to lack of masking or post-hoc determination of optimal thresholds. Among studies that did not use a case-control design, 16 studies (20,599 participants) were conducted in a primary care/community setting and 18 studies (2590 participants) in secondary care settings, of which 15 investigated LACD. Summary estimates were calculated for commonly reported parameters and thresholds for each test; LACD ≤ 25% (16 studies, 7540 eyes): sensitivity 0.83 (95% confidence interval (CI) 0.74, 0.90), specificity 0.88 (95% CI 0.84, 0.92) (moderate-certainty); flashlight (grade1) (5 studies, 1188 eyes): sensitivity 0.51 (95% CI 0.25, 0.76), specificity 0.92 (95% CI 0.70, 0.98) (low-certainty); SPAC (≤ 5 and/or S or P) (4 studies, 4677 eyes): sensitivity 0.83 (95% CI 0.70, 0.91), specificity 0.78 (95% CI 0.70, 0.83) (moderate-certainty); Scheimpflug photography (central ACD) (9 studies, 1698 eyes): sensitivity 0.92 (95% CI 0.84, 0.96), specificity 0.86 (95% CI 0.76, 0.93) (moderate-certainty); AS-OCT (subjective opinion of occludability) (13 studies, 9242 eyes): sensitivity 0.85 (95% CI 0.76, 0.91); specificity 0.71 (95% CI 0.62, 0.78) (moderate-certainty). For comparisons of sensitivity and specificity between index tests we used LACD (≤ 25%) as the reference category. The flashlight test (grade 1 threshold) showed a statistically significant lower sensitivity than LACD (≤ 25%), whereas AS-OCT (subjective judgement) had a statistically significant lower specificity. There were no statistically significant differences for the other index test comparisons. A subgroup analysis was conducted for LACD (≤ 25%), comparing community (7 studies, 14.4% prevalence) vs secondary care (7 studies, 42% prevalence) settings. We found no evidence of a statistically significant difference in test performance according to setting. Performing LACD on 1000 people at risk of angle closure with a prevalence of occludable angles of 10%, LACD would miss about 17 cases out of the 100 with occludable angles and incorrectly classify 108 out of 900 without angle closure. AUTHORS' CONCLUSIONS: The finding that LACD performed as well as index tests that use sophisticated imaging technologies, confirms the potential for this test for case-detection of occludable angles in high-risk populations. However, methodological issues across studies may have led to our estimates of test accuracy being higher than would be expected in standard clinical practice. There is still a need for high-quality studies to evaluate the performance of non-invasive tests for angle assessment in both community-based and secondary care settings.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Glaucoma de Ângulo Fechado/diagnóstico , Triagem/métodos , Câmara Anterior/diagnóstico por imagem , Viés , Estudos de Casos e Controles , Intervalos de Confiança , Técnicas de Diagnóstico Oftalmológico/estatística & dados numéricos , Gonioscopia/normas , Humanos , Seleção de Pacientes , Fotografação/métodos , Fotografação/estatística & dados numéricos , Estudos Prospectivos , Padrões de Referência , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia de Coerência Óptica
20.
Telemed J E Health ; 26(9): 1113-1117, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32408801

RESUMO

Virtual visits (VVs) are necessitated due to the public health crisis and social distancing mandates due to COVID-19. However, these have been rare in ophthalmology. Over 3.5 years of conducting >350 ophthalmological VVs, our group has gained numerous insights into best practices. This communication shares these experiences with the medical community to support patient care during this difficult time and beyond. We highlight that mastering the technological platform of choice, optimizing lighting, camera positioning, and "eye contact," being thoughtful and creative with the virtual eye examination, and ensuring good documenting and billing will make a successful and efficient VV. Moreover, we think these ideas will stimulate further VV creativity and expertise to be developed in ophthalmology and across medicine. This approach, holds promise for increasing its adoption after the crisis has passed.


Assuntos
Infecções por Coronavirus/epidemiologia , Oftalmologia/métodos , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Betacoronavirus , Confidencialidade/normas , Técnicas de Diagnóstico Oftalmológico/normas , Documentação , Humanos , Reembolso de Seguro de Saúde , Iluminação , Pandemias , Relações Médico-Paciente , Padrões de Prática Médica/normas
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