Arquivos brasileiros de oftalmologia最新文献

Purpose: Standard automated perimetry has been the standard method for measuring visual field changes for several years. It can measure an individual's ability to detect a light stimulus from a uniformly illuminated background. In the management of glaucoma, the primary objective of perimetry is the identification and quantification of visual field abnormalities. It also serves as a longitudinal evaluation for the detection of disease progression. The development of artificial intelligence--based models capable of interpreting tests could combine technological development with improved access to healthcare.

Methods: In this observational, cross-sectional, descriptive study, we used an artificial intelligence-based model [Inception V3] to interpret gray-scale crops from standard automated perimetry that were performed in an ophthalmology clinic in the Brazilian Amazon rainforest between January 2018 and December 2022.

Results: The study included 1,519 standard automated perimetry test results that were performed using Humphrey HFA-II-i-750 (Zeiss Meditech). The Subsequently, 70%, 10%, and 20% of the dataset were used for training, validation, and testing, respectively. The model achieved 80% (68.23%-88.9%) sensitivity and 94.64% (88.8%-98%) specificity for detecting altered perimetry results. Furthermore, the area under the receiver operating characteristic curve was 0.93.

Conclusions: The integration of artificial intelligence in the diagnosis, screening, and monitoring of pathologies represents a paradigm shift in ophthalmology, enabling significant improvements in safety, efficiency, availability, and accessibility of treatment.

Purpose: This study was conducted to investigate the effect of injectable platelet-rich fibrin on the recovery of compromised epithelium due to crosslinking treatment.

Methods: In this comparative study, the epithelial closure rates and in vivo confocal biomicroscopy results of 26 patients with keratoconus who underwent subconjunctival injection of injectable platelet-rich fibrin near the limbus after epithelium-off corneal crosslinking treatment were compared with those of 25 patients who did not receive the injection of injectable platelet-rich fibrin.

Results: The average time to epithelial defect closure in the injectable platelet-rich fibrin group was 2.76 ± 0.90 days compared to 3.56 ± 0.86 days in the non-injectable platelet-rich fibrin group (p=0.003). At the end of the 1st month, the mean subbasal nerve plexus density was 1.26 ± 1.61 nerves/mm2 in the injectable platelet-rich fibrin group, whereas it was 0.72 ± 0.89 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.016). By the 3rd month, the density increased to 3.42 ± 1.13 nerves/mm2 in the injectable platelet-rich fibrin group and 2.36 ± 1.15 nerves/mm2 in the non-injectable platelet-rich fibrin group (p=0.002). Similarly, the anterior stromal keratocyte density at the end of the 1st month was 93.6 ± 33.5 cells/mm2 in the injectable platelet-rich fibrin group compared to 67.3 ± 26.4 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.001). By the end of the 3rd month, the density increased to 255.2 ± 45.7 cells/mm2 in the injectable platelet-rich fibrin group and 222.1 ± 43.6 cells/mm2 in the non-injectable platelet-rich fibrin group (p=0.011). In the non-injectable platelet-rich fibrin group, one patient developed a sterile infiltrate at the end of the 1st week, whereas no complications were observed in the injectable platelet--rich fibrin group.

Conclusion: Subconjunctival injectable platelet-rich fibrin application is an effective and safe method for corneal epithelial healing after crosslinking treatment.

Purpose: This study aims to describe the technique, feasibility, efficacy, and safety of 360° trabeculotomy ab externo with double access for the treatment of congenital glaucoma.

Methods: This paper provides a detailed description of the 360° trabeculotomy ab externo with double access used to treat pediatric glaucoma. The postoperative outcomes of six eyes from six patients who underwent this procedure for primary and secondary congenital glaucoma are also reported.

Results: Six eyes from six patients were included in this study. The median age of the patients at the time of surgery was 1.25 yr (range: 0.27-5.41 yr). The mean preoperative intraocular pressure was 25 ± 5.87 mmHg (range: 18-35 mmHg). At baseline, the mean number of hypotensive eye drop medications used was 2 ± 0.63. Postoperatively, the mean intraocular pressure decreased to 10 ± 2.20 mmHg (range: 9-14 mmHg), and none of the patients required hypotensive eye drops. The most common postoperative complication was hyphema, observed in one case on the first postoperative day; however, it resolved within 7 days.

Conclusions: The 360° trabeculotomy ab externo with double access is a valuable addition to the surgical options for pediatric glaucoma. This technique facilitates a complete 360° ab externo opening of the trabecular meshwork while enhancing surgical safety.

Purpose: This study aimed to compare the effects of three different daily disposable contact lens materials on contrast sensitivity.

Methods: The participants were aged 18-45 years, with spherical equivalent refraction between -0.50 D and -6.00 D, astigmatism below 0.75 D, and best contact lens-corrected visual acuity of 0.0 logMAR or better. Each patient was fitted binocularly with three daily disposable contact lenses made of different materials on three separate examination days. These materials were kalifilcon A, senofilcon A, and verofilcon A. The contrast sensitivity of each patient was recorded at spatial frequencies of 3, 6, 12, and 18 cycles per degree (cpd) under photopic (85 cd/m2) and mesopic (3 cd/m2) conditions.

Results: The current study comprised 72 eyes of 34 female and two male patients. The mean age of the participants was 25.63 (± 0.80) years. Under photopic conditions, the participants' contrast sensitivity was significantly better with senofilcon A than with kalifilcon A at a frequency of 12 cpd (p=0.008). Under mesopic conditions, participants' contrast sensitivity was significantly higher with kalifilcon A than verofilcon A at 3 cpd (p=0.001), and with senofilcon A than verofilcon A at 12 cpd (p=0.004). The pre-lens non-invasive break-up times did not differ significantly between the three daily disposable contact lenses (p>0.05).

Conclusion: In both photopic and mesopic lighting conditions, the participants in this study exhibited differences in contrast sensitivity when wearing three different daily disposable contact lens types, despite similar visual acuity and pre-lens tear film stability results in their clinical evaluations. These findings demonstrate the potential for subjective visual complaints arising from variations in the contrast sensitivity achieved by different daily disposable contact lenses.

Purpose: To evaluate the changes in the rates and indications of eye removal procedures during the recent COVID-19 pandemic.

Methods: The medical records of all patients who underwent eye removal from 2007 to 2022 were retrospectively reviewed. The patient demographic data and indications for surgery were collected. Data from two groups of patients (prepandemic surgery and postpandemic surgery) were compared. Statistical significance was set at p<0.05.

Results: Fifty-nine patients underwent enucleation (69%), evisceration (27%), or exenteration (3%). The mean (SD) age of the patients was 55.9 (19.4) years, and most (69%) of the patients were males. Most (47%) of the study population were Black. The common indications for eye removal were trauma (41%), painful blind eye (34%), and infection/inflammation (24%). The types of trauma were assault (55%), accidental (39%), and self-inflicted (6%). The mean (SD) monthly rates of eye removal increased from 0.25 (0.50) in the prepandemic period to 0.77 (0.91) during the pandemic (p<0.001). These increases were noted in both males (p=0.003) and females (p=0.001) and were the highest among Black patients [0.42 (0.76); p<0.001]. Among the indications of eye removal, painful blind eyes [0.35 (0.75); p<0.001] and ocular trauma [0.31 (0.47); p=0.051] exhibited the greatest increases following the pandemic.

Conclusion: The rate of eye removal procedures increased during the recent pandemic. Although delayed care of chronic eye conditions may have contributed to the increased rates of painful blind eyes, the increased trauma-related eye removals may be attributed to the simultaneous spike in violent assaults in New York City.

Purpose: This study aimed to identify factors influencing axial length changes in adolescents wearing orthokeratology lenses.

Methods: A retrospective analysis was conducted on 84 adolescents (aged 9-17 yr) who wore orthokeratology lenses at our hospital. Axial length changes were calculated as the difference between the first and last visits. Patients were categorized into two groups based on axial length change: lower-than-average and higher-than-average. Data on sex, age at orthokeratology lens initiation, family history, initial equivalent spherical lens value, initial cylindrical lens value, initial average K value, and initial axial length were collected. Univariate and mixed-effects model analyses were performed to assess their influence on axial length changes.

Results: Age (p<0.05) and initial equivalent spherical value (p<0.05) were significant predictors of axial length changes in both eyes and the left eye. For the right eye, only age was a significant factor (p<0.05). The mixed-effects model revealed that the difference between the left and right eyes, duration of orthokeratology lens use, age, initial equivalent spherical lens value, and initial axial length significantly influenced axial length changes in adolescents (p<0.05).

Conclusion: The factors influencing axial length changes in adolescents wearing orthokeratology lenses differ between the left and right eyes. These changes depend on the duration of lens wear, age, initial equivalent spherical lens value, and initial axial length. This study provides a theoretical basis for evaluating the clinical efficacy of orthokeratology lenses in managing myopia progression in adolescents.

Purpose: This study aimed to evaluate abnormalities in the retinal nerve fiber layer and ganglion cell layer in patients with thyroid-associated orbitopathy using optical coherence tomography and to examine their relationship with disease severity.

Methods: A cross-sectional study was conducted involving 74 participants, comprising 45 individuals with thyroid-associated orbitopathy and 29 healthy controls. All subjects underwent a comprehensive ophthalmological examination and optical coherence tomography using the Cirrus HD-OCT. The clinical activity score and the European Group on Graves' Orbitopathy severity were also evaluated.

Results: In the thyroid-associated orbitopathy group, the mean peripapillary retinal nerve fiber layer thickness was significantly reduced in the temporal quadrant (p<0.05). No significant differences were found in ganglion cell layer thickness across all sectors when compared with the control group. Besides, a significant correlation was observed between orbitopathy severity and decreased mean peripapillary retinal nerve fiber layer thickness (p<0.001).

Conclusion: Optical coherence tomography may serve as a useful tool for identifying changes in the retinal nerve fiber layer and ganglion cell layer in patients with thyroid-associated orbitopathy, including in the inactive phase and prior to the clinical manifestation of dysthyroid optic neuropathy. It may be a helpful adjunct in monitoring disease progression.

Purpose: To compare the short-term (3-month) outcomes of intravitreal aflibercept injections versus intravitreal aflibercept combined with dexamethasone sodium phosphate in treating diabetic macular edema.

Methods: In this Phase-2 clinical trial, 16 eyes of 16 participants with diabetic macular edema were randomly assigned to one of 2 groups. Participants in the aflibercept monotherapy group received 2 mg of intravitreal aflibercept (0.05 mL), while those in the combination therapy group received 2 mg of intravitreal aflibercept (0.05 mL) plus 0.04 mg dexamethasone sodium phosphate (0.01 mL). Identical injections were repeated after 30 and 60 days. The primary outcome was the change in central macular thickness, as measured by optical coherence tomography, from baseline to 1 month after the last injection. Secondary outcomes included changes in best-corrected visual acuity and intraocular pressure over the same period.

Results: The mean baseline central macular thickness was 444 ± 86 μm in the combination therapy group and 394 ± 96 μm in the aflibercept monotherapy group (p=0.293). By day 90, the mean reduction in central macular thickness was significantly greater in the combination therapy group (176 ± 129 μm) compared to the aflibercept monotherapy group (54 ± 49 μm; p=0.034). Best-corrected visual acuity also improved significantly more in the combination therapy group, with a median gain of 0.31 ± 0.16 LogMAR, whereas the aflibercept monotherapy group experienced a minimal change (-0.06 ± 0.13 LogMAR; p=0.020). Intraocular pressure remained stable in both groups, with no significant difference (p=0.855). None of the participants developed elevated intraocular pressure (>21 mmHg) or required ocular hypotensive medications. No significant ocular or systemic adverse events were reported.

Conclusion: The addition of dexamethasone sodium phosphate to the standard intravitreal aflibercept regimen for diabetic macular edema can improve short-term structural and functional outcomes.

Trial registration: Brazilian Clinical Trials Registry (RBR-7468j4q).