Arq Bras Oftalmol
· 2025 · PMID 40298750
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PURPOSE: Trachoma is the major infectious cause of preventable blindness in the world, and its sequelae include the presence of cicatricial entropion and trachomatous trichiasis. Trachoma can be corrected by surgical tre...PURPOSE: Trachoma is the major infectious cause of preventable blindness in the world, and its sequelae include the presence of cicatricial entropion and trachomatous trichiasis. Trachoma can be corrected by surgical treatment of the eyelids and, if left untreated, may result in corneal opacification, low vision, and blindness. There are limited data on trachomatous trichiasis in Brazil. This study was conducted to estimate the frequency of entropion and trichiasis surgeries of trachomatous origin based on the records of procedures performed in specialized hospitals that served the Unified Health System (SUS) in the years 2016 and 2017. METHODS: This was a retrospective study conducted in the oculoplastic sectors of the ophthalmology services of the following three hospitals in the state of São Paulo: Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC Botucatu), Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC Ribeirão Preto), and Hospital Estadual de Bauru (HE Bauru). Medical records corresponding to the codes of interest were evaluated. RESULTS: In total, 462 medical records were evaluated, including 170 (36.8%) at HC Botucatu, 61 (13.2%) at HE Bauru, and 231 (50.0%) at HC Ribeirão Preto. There were 39 (8.4%) cases of trachomatous trichiasis, ranging from 9 (14.8%) at HE Bauru to 15 (6.5%) at HC Ribeirão Preto. CONCLUSIONS: The frequency of surgery due to trachoma was low in these oculoplastic services. The state of São Paulo might have reached the goal for trachoma elimination in the surgical component. The questionnaire used for data collection was successfully tested despite some difficulties in collecting data from the medical records. Studies with the same methodology are recommended in other services in the areas of endemic trachoma in the past to understand the frequency of eye lid surgeries performed for treating trachomatous sequelae.
Arq Bras Oftalmol
· 2025 · PMID 40298749
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PURPOSE: This retrospective study evaluated the safety and efficacy of real-world antiangiogenic therapy for ocular conditions in the private healthcare sector in southern Brazil. METHODS: Medical records from patients w...PURPOSE: This retrospective study evaluated the safety and efficacy of real-world antiangiogenic therapy for ocular conditions in the private healthcare sector in southern Brazil. METHODS: Medical records from patients who underwent intravitreal anti-vascular endothelial growth factor injections over the past 12 years were reviewed retrospectively. Data collection included the primary diagnoses, drugs administered, injection techniques, adverse effects, and treatment efficacy. Efficacy was assessed by comparing preand posttreatment visual acuity and central subfield thickness in eyes with followup exceeding 2 years. RESULTS: A total of 1,024 patients, 1,310 treated eyes, and 11,377 injections were analyzed. The injections included aflibercept (6,833), ranibizumab (3,692), bevacizumab (843), and brolucizumab (9), administered either bilaterally (3,696) or unilaterally (7,681). The most common diagnoses were diabetic macular edema, exudative age-related macular degeneration, retinal vein occlusion related macular edema, and proliferative diabetic retinopathy. No endophthalmitis cases were reported. Vitritis with transient visual acuity loss occurred in two cases following aflibercept injections. One retinal detachment case was successfully treated with vitrectomy. The median number of injections per patient was 6 (IQR [interquartile range], 3-13). Among 445 eyes from 328 patients with followup over 2 years (median, 4.05 years; IQR, 2.89-6.29), there was a significant improvement in best-corrected visual acuity from 0.3 to 0.4 (Snellen) (p<0.001) and a reduction in central subfield thickness from 361 to 267 microns (p<0.001). CST comparisons included patients with age-related macular degeneration, diabetic macular edema, and retinal vein occlusion related macular edema. CONCLUSION: This real-world study, the largest of its kind in Brazil, confirms the safety and efficacy of antiangiogenic therapies in the southern Brazilian private healthcare system. The findings highlight a low incidence of severe adverse events and outcomes consistent with global studies, supporting the ongoing use of antiangiogenic agents as effective and well-tolerated treatments for various ocular conditions in developing countries.
Koch CR, Scherer R, Pereira LS
… +3 more, Cândido T, Alves MR, Kara-Junior N
Arq Bras Oftalmol
· 2025 · PMID 40298748
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PURPOSE: Access to cataract treatment and diagnostic tools continues to be hindered by financial and logistical barriers. Thus, photography-based cataract analysis via portable devices offers a promising solution for the...PURPOSE: Access to cataract treatment and diagnostic tools continues to be hindered by financial and logistical barriers. Thus, photography-based cataract analysis via portable devices offers a promising solution for the detection of cataracts in remote regions. In this study, the accuracy of a portable device that is based on the Lens Opacities Classification III System for diagnosing cataracts was analyzed. METHODS: Photographs of the anterior segment of the eye were taken in a low-light environment, and the pupillary region markings were automatically delineated using infrared photography. The captured images were automatically analyzed using a convolutional neural network. The study group included patients with cataracts, and the control group included patients without cataracts. RESULTS: A total of 270 eyes were analyzed, which included 143 eyes with cataracts and 127 control eyes. A total of 599 photos were analyzed. The isolated nuclear cataract was the most frequently detected subtype (37.5%), followed by a nuclear cataract associated with a cortical cataract (30.3%). The device's accuracy was 88.5% (Confidence intervals (CI), 83.19%-94.69%), specificity was 84.62% (CI 71.79%-97.30%), positive predictive value was 91.78% (CI 74.36%-97.30%), and negative predictive value was 82.50% (CI 74.36%-97.30%). CONCLUSION: The portable device is a simplified user-friendly cataract screening technique that can interpret results in remote regions. This innovation could mitigate the occurrence of cataract-induced blindness and prevent premature surgical interventions in early-stage cataracts.
Alkatan HM, Alkuhaimi N, Alsuhaibani AH
… +1 more, Maktabi AMY
Arq Bras Oftalmol
· 2025 · PMID 40298747
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PURPOSE: This study was conducted to report the histopathological and clinical features of the Marcus Gunn phenomenon and other similar conditions of upper eyelid misfiring. METHODS: This was a retrospective study of pat...PURPOSE: This study was conducted to report the histopathological and clinical features of the Marcus Gunn phenomenon and other similar conditions of upper eyelid misfiring. METHODS: This was a retrospective study of patients with congenital ptosis with Marcus Gunn phenomenon who have undergone surgical repair over a period of 12 years and another two patients with upper eyelid misfiring in association with extraocular movements to identify their histopathological findings as subtypes representing ocular congenital cranial dysinnervation disorder. RESULTS: Among 136 patients with congenital ptosis, 11 (8%) patients with Marcus Gunn phenomenon or misfiring were identified, of whom 9 (6.6%) had typical known Marcus Gunn phenomenon and 2 (1.4%) had eyelid misfiring similar to Marcus Gunn phenomenon. In all patients, the histopathological changes of the excised levator muscle included overall loss and/or atrophy of muscle fibers and irregular-modified Gomori trichrome staining. CONCLUSION: The Marcus Gunn phenomenon and similar misfiring conditions with synkinetic extraocular muscle movements share findings that are consistent with the neurogenic type of muscle atrophy. This result suggests a common underlying etiology with variable clinical findings, representing the ocular counterpart of congenital cranial dysinnervation disorder, which has been reported as ocular congenital cranial dysinnervation disorder.
Doganay S, Erdem D, Doganay D
… +1 more, Kiristioglu MO
Arq Bras Oftalmol
· 2025 · PMID 40298746
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PURPOSE: The aim of this study is to describe a minimally invasive and atraumatic technique for managing the polypropylene suture-assisted scleral fixation of intraocular lens-capsular bag complex or artificial iris-intr...PURPOSE: The aim of this study is to describe a minimally invasive and atraumatic technique for managing the polypropylene suture-assisted scleral fixation of intraocular lens-capsular bag complex or artificial iris-intraocular lens complex for repositioning late luxated or subluxated intraocular lens-capsular bags and artificial iris-intraocular lens complexes. METHODS: In this retrospective and observational study, we evaluated 11 patients, including 10 patients with capsular bag-intraocular lens complex subluxation or luxation into the vitreous cavity and 1 patient with an aniridia-intraocular lens complex. A single senior surgeon performed the procedures. After anesthesia, a 4 × 4 mm conjunctival peritomy was created, and a 6-0 polypropylene suture was passed through the sclera marked 2.0 mm posterior to the limbus. The suture ends were cauterized into a flange under 0.5 mm and inserted inversely into a scleral tunnel, concealed within a 2-mm scleral tunnel to ensure secure intraocular lens positioning. RESULTS: We analyzed 11 patients with dislocated or dropped capsular bag-intraocular lens complexes. The patients' median age was 67 (range 44-78) years, with a median follow-up of 10 (range: 4-16) months. There were 8 (72%) men and 3 (27%) women. Conjunctival peritomy was performed in 4 (36%) patients. Predominantly, preoperative diagnoses indicated 7 (63%) patients with dislocated capsular bag-intraocular lens complexes. The capsular bag-intraocular lens complexes were centralized in all patients, and optical coherence tomography confirmed accurate suture positioning within the sclera. No suture-related complications were observed throughout the follow-up period, and no vision-threatening complications were reported during the postoperative follow-up. CONCLUSIONS: Our technique provides a simple, effective solution for treating decentralized or dislocated capsular bag-intraocular lens complexes, eliminating the need for complex interventions such as large corneal wounds, scleral flaps, intraocular lens exchange, and intraocular lens externalization.
Kuiava VA, Kuiava EL, Chielli EO
… +2 more, Ruschel DM, Marafon SB
Arq Bras Oftalmol
· 2025 · PMID 40298745
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PURPOSE: We developed an artificial intelligence program for calculating intraocular lenses and analyzed its accuracy rate via ultrasonic biometry. This endeavor is aimed at enhancing precision and efficacy in the select...PURPOSE: We developed an artificial intelligence program for calculating intraocular lenses and analyzed its accuracy rate via ultrasonic biometry. This endeavor is aimed at enhancing precision and efficacy in the selection of intraocular lenses, particularly in cases where optical biometry is unavailable. METHODS: Data was collected from the Hospital de Clínicas de Porto Alegre, which included cases of phacoemulsification with intraocular lens implantation, in which the lens selection was based on ultrasonic biometry. The program, implemented in Python, Java, and PHP, employs the ridge regression method. Two design options were developed: a basic model, which uses only keratometry variables (K1 and K2), axial size and final target refraction in the spherical equivalent, and an advanced model, which incorporates preoperative refraction and the patient's age. The Universal Barrett II formula was used to compare both models. RESULTS: The sample consisted of 486 eyes from 313 patients, with 350 eyes used for program training and 136 for program validation. The spherical equivalent hit rates, with a variation of ±0.5 D, were 86% and 87.5% for the basic and advanced models, respectively, with no statistically significant difference between them. With the Barret Universal II formula, the success rate was 69%, which was significantly different from the values of the two aforementioned models (p<0.0001). The system was better for medium and long eyes but worse for short eyes (<=22.00 mm). CONCLUSION: The developed artificial intelligence program was superior to the Barrett formula in terms of performance, in the general context and within the subgroup of patients with longer eyes. This innovation can considerably contribute to the selection of intraocular lenses, particularly in cases where optical biometry is unavailable.
Cândido T, Pineda R, Rossi S
… +2 more, Lanza JVM, Kara-Júnior N
Arq Bras Oftalmol
· 2025 · PMID 40008769
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PURPOSE: The OrbiTau surgical simulator is a synthetic eye model developed to enhance cataract surgical training. Herein, we aimed to describe the perspectives of Harvard's Ophthalmology faculty and residents regarding t...PURPOSE: The OrbiTau surgical simulator is a synthetic eye model developed to enhance cataract surgical training. Herein, we aimed to describe the perspectives of Harvard's Ophthalmology faculty and residents regarding the effectiveness of OrbiTau. METHODS: A cross-sectional study was conducted in which 11 surgeons from the Massachusetts Eye and Ear Infirmary, with prior experience utilizing simulated phacoemulsification platforms, conducted cataract surgery with the OrbiTau. Subsequently, they completed a satisfaction questionnaire using the Likert scale. RESULTS: Regarding the various OrbiTau components, 90.90% of the participants reported that the OrbiTau lens capsule was comparable to that of the human lens during capsulotomy. Furthermore, 72.72% of the participants found that the OrbiTau lens consistency was analogous to that of the human lens nucleus. Approximately 63.63% of the participants reported that the model's posterior lens capsule resembled the native posterior capsule, and 72.72% of the participants noted that the model's red reflex was similar to that of the dilated human pupil. Most participants believed that the OrbiTau was easier to use and more realistic than other commercially available simulators. CONCLUSION: Our single-institution survey of the Orbitau demonstrated that this model realistically replicates ocular structures and may be a viable option for cataract surgery training.
Arq Bras Oftalmol
· 2025 · PMID 40008743
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PURPOSE: This study aimed to evaluate the prevalence of orbital conditions in a tertiary ophthalmic outpatient hospital in Sao Paulo, Brazil, with a focus on the main diagnoses and their distribution. METHODS: A retrospe...PURPOSE: This study aimed to evaluate the prevalence of orbital conditions in a tertiary ophthalmic outpatient hospital in Sao Paulo, Brazil, with a focus on the main diagnoses and their distribution. METHODS: A retrospective chart review was conducted involving patients registered and admitted to the orbital disease unit at the Department of Ophthalmology, University of São Paulo Medical School, from January 2004 to March 2018. A total of 838 medical charts were analyzed, of which 37 were excluded due to incomplete data. The remaining charts were categorized into eight diagnostic groups: Graves' orbitopathy , inflammatory disorders, tumors, vascular lesions, acquired structural abnormalities, congenital structural abnormalities, infectious diseases, and others. RESULTS: Of the 837,300 ophthalmological appointments, 3,372 (0.4%) were related to orbital diseases. The study included 801 patients, of whom 63.45% were women. The patients' mean age was 42.86 years. Graves' orbitopathy was the most common (55%), followed by tumor (17%), inflammatory disorders (9%), vascular lesions (7%), acquired structural abnormalities (5%), congenital structural abnormalities (4%), others (2%), and infectious diseases (1%). The study found significant differences in the incidence and types of orbital diseases, indicating the specialized nature of tertiary care and referral biases. CONCLUSIONS: Published data on epidemiological orbital diseases is scarce. Therefore, this study focused on the diverse nature of orbital diseases and their low incidence among ophthalmology appointments. The major trends align with other epidemiological studies, demonstrating a preponderance of Graves' orbitopathy in middle-aged adults and a bimodal distribution of tumors. These findings are essential in shaping resident training programs and healthcare policies, particularly in tertiary settings. Understanding the epidemiology of orbital diseases can improve diagnostic accuracy, treatment approaches, and patient outcomes as well as support future systemic prospective studies.
Arq Bras Oftalmol
· 2025 · PMID 40008742
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Spinocerebellar ataxia type 7 is a form of spinocerebellar ataxia, which is a clinically and genetically heterogeneous group of rare inherited neurodegenerative disorders. Among the spinocerebellar ataxias, the associati...Spinocerebellar ataxia type 7 is a form of spinocerebellar ataxia, which is a clinically and genetically heterogeneous group of rare inherited neurodegenerative disorders. Among the spinocerebellar ataxias, the association between cerebellar ataxia and cone-rod retinal dystrophy is a strong indicator of spinocerebellar ataxia type 7. Spinocerebellar ataxia type 7 cone-rod dystrophy is a progressive, disabling, and incurable form of hereditary retinopathy. However, the field of genetics has markedly progressed in the last decades, which resulted in improved understanding of multiple aspects of spinocerebellar ataxia type 7 retinal degeneration and the emergence of new modalities of genetic therapies for other types of retinal dystrophies. This study aimed to evaluate the current knowledge on spinocerebellar ataxia type 7 retinal degeneration, including genetics and molecular mechanisms as well as their implications in pathogenesis, clinical manifestations, and potential therapeutic strategies.
Arq Bras Oftalmol
· 2025 · PMID 40008741
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PURPOSE: To compare the incidence rates of complications following pediatric cataract surgery between the limbal and pars plana approaches. METHODS: PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and ClinicaIT...PURPOSE: To compare the incidence rates of complications following pediatric cataract surgery between the limbal and pars plana approaches. METHODS: PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and ClinicaITriaIs.gov were systematically searched for studies comparing the two surgical approaches. We pooled the incidence rates of postoperative complications using a random-effects model. RESULTS: Seven studies comprising 375 eyes from 260 patients were included. No significant differences in complication rates were observed between the limbal and pars plana approaches. The pooled incidence rates (95% confidence Interval) of postoperative visual axis opacity (VAO), VAO treated with laser or surgery, secondary glaucoma, wound leakage, corneal edema, anterior chamber reaction, posterior iris synechiae, capsular phimosis, intraocular lens dislocation, posterior capsular rupture, and intravitreal lens fragmentation were 4.7% (0.8%-10.8%), 3.9% (1.0%-8.1%) , 2.8% (0%-11.4%), 0 (0%-1.3%), 2.9% (0%-11.8%), 5.6% (0.1%-16.5%), 2.4% (0%-8.5%), 3.8% (0.6%-8.9%), 2.2% (0%-6.4%), 9.2% (4.1%-15.8%) and 1.3% (0%-6.3%), respectively. Both surgical approaches demonstrated improved visual acuity postoperatively. CONCLUSIONS: Pediatric cataract surgery, performed via the limbal or pars plana approach, is effective and safe, with a low incidence of complications when conducted by trained surgeons. Neither method demonstrated a significant difference in the visual acuity improvement or complication rates.