A. P. C. Lupinacci

Cataract Remains an Important Cause of Blindness in Campinas, Brazil

Objective: To estimate the prevalence of blindness in the elderly population of Campinas, Brazil, and to describe the coverage and quality of cataract surgery services in the area. Methods: A brief assessment of cataract surgery services (using the “RACSS” (Rapid Assessment of Cataract Surgical Services Method) was conducted using random cluster sampling, with a sample composed of 60 clusters of 40 people aged 50 years or older. Visual acuity (VA) was measured and the lens status observed by direct visual ophthalmoscopy. From the selected sample of 2,400 subjects, 92.67% were examined. Results: Blindness (VA < 3/60 with available correction) was found in 1.98 % (2.03 % among male subjects, and 1.94 % among female subjects). The prevalence of blindness varied with age, from 0.2%, in the group from 50 to 54 years, to 7.2% in those above 80. Cataract was the main cause of blindness (40.2%) followed by suspected posterior segment disorders (18.2%), diabetic retinopathy (15.9%), and glaucoma (11.4%). The cataract surgical coverage was of 93% (VA < 3/60) and 82.18% when the criterion was VA 6/60 in the best eye. The main reasons the subjects did not receive surgical treatment were: fear of undergoing surgery, 11.1%; lack of awareness about the condition, 16.7%; waiting for maturity, 16.7%; and contraindication to surgery, 44.4%. Conclusion: Cataract is the major cause of blindness in Campinas. Education on eye diseases, their prevention and treatment must become part of the citys public healthcare policies.

Twenty-four-hour ocular perfusion pressure in primary open-angle glaucoma

Aim To compare the 24 h intraocular pressure (IOP), blood pressure (BP), and perfusion pressure (PP) of primary open-angle glaucoma (POAG) patients and healthy individuals. Methods 24 healthy individuals and 29 POAG patients underwent IOP and BP measurements every 2 h, starting at 08:00 until 06:00 of the next morning. IOP measurements were made by a masked observer with a Goldmann tonometer at the slit-lamp from 08:00 to 22:00 and with the Perkins tonometer in supine position from 24:00 to 06:00. Systolic and diastolic BP (SBP and DBP) measurements were performed with an automated device. Results Mean IOPs in POAG patients were significantly higher at all time intervals (p<0.001). The mean SBP was significantly higher in POAG patients from 04:00 to 10:00, and also at 14:00 and 18:00 (p<0.05). In POAG patients, the mean DBP was significantly higher at 08:00 and 10:00, but was significantly lower at 04:00 (p<0.05). In POAG patients, the mean systolic perfusion pressure (SPP) was significantly higher at 08:00 and 10:00 (p<0.01), whereas the mean diastolic perfusion pressure (DPP) was significantly lower from 24:00 to 06:00 (p<0.05). Conclusion Although higher SPPs are observed in POAG patients during the morning, lower DPPs are found during the night.

Intrasession, intersession, and interexaminer variabilities of retinal nerve fiber layer measurements with spectral-domain OCT.

Purpose TO evaluate the intrasession, intersession, and interexaminer variabilities of retinal nerve fiber layer measurements (RNFL) with spectral-domain optical coherence tomography (OCT). Methods A total of 32 healthy individuals and 34 patients with chronic glaucoma underwent RNFL measurements with the Cirrus HD-OCT Model 4000 (Carl Zeiss Meditec, Dublin, CA, USA) 5 times during the same sitting by one examiner to assess intrasession variability. The same examiner performed RNFL measurements in the same patients on 5 different days to assess intersession variability. A second examiner performed RNFL measurements in the same patients to assess interexaminer variability. The coefficients of variation and intraclass correlation coefficients were obtained for the following parameters: average thickness, quadrant thickness, and Clock hour thickness measurements. Results Intrasession variability: In patients with glaucoma, coefficients of variation ranged from 4.51% to 11.84%. Intraclass correlation coefficients ranged from 0.74 to 0.99. In healthy individuals, coefficients of variation ranged from 2.92% to 6.99%. Intraclass correlation coefficients ranged from 0.89 to 0.98. Intersession variability: In patients with glaucoma, coefficients of variation ranged from 3.68% to 10.50%. Intraclass correlation coefficients ranged from 0.82 to 0.99. In healthy individuals, coefficients of variation ranged from 3.13% to 6.92%. Intraclass correlation coefficients ranged from 0.87 to 0.99. Interexaminer variability: In patients with glaucoma, coefficients of variation ranged from 2.62% to 14.94%. Intraclass correlation coefficients ranged from 0.55 to 0.98. In healthy individuals, coefficients of variation ranged from 2.04% to 7.31%. Intraclass correlation coefficients ranged from 0.86 to 0.98. Conclusions These findings indicate that RNFL measurements with spectral-domain OCT display excellent reproducibility, with low intrasession, intersession, and interexaminer variabilities.

Intralenticular metal foreign body: case report

Intralenticular foreign bodies comprise about 5% to 10% of all intraocular foreign bodies and can result in serious complications. The management depends on some factors like size, location, material type and the risk of infection. We present a patient with an intralenticular metal foreign body in the left eye that, following initial treatment with topical steroid and antibiotic, underwent lens aspiration with removal of the intralenticular foreign body and insertion of a posterior chamber intraocular lens with good visual outcome.

Central corneal thickness and intraocular pressure in children undergoing congenital cataract surgery: a prospective, longitudinal study

Aim To investigate changes in central corneal thickness (CCT) and intraocular pressure (IOP) in children after congenital cataract surgery, as well as risk factors associated with these changes. Methods 37 eyes of 26 children with congenital cataract undergoing surgery were prospectively recruited. IOP and CCT measurements were performed before the surgery and 6, 12, 18, 24 and 36 months after the procedure. Results Among the 37 eyes, 15 became aphakic and 22 pseudophakic. Mean CCT significantly increased from 556.24±44.19 to 585.07±56.45 μm (p=0.003) after 3 years, whereas mean IOP significantly increased from 12.05±2.3 to 13.89±2.96 mm Hg (p=0.037). Aphakic eyes underwent surgery at an early age (15.16±32.02 months) compared with pseudophakic eyes (71.48±53.14 months) (p<0.001). After 3 years, mean CCT change in aphakic eyes (56.10±46.97 μm) was significantly higher than in pseudophakic eyes (12.71±38.41 μm) (p=0.015). Age at the time of surgery was inversely correlated to CCT change (r=−0.34, p=0.04), but not to IOP change (r=−0.18, p=0.27). When surgery was performed between 0 and 1 year of age, mean CCT change at 3 years was 70.11±42.3 μm, compared with 6.27±28.09, −17.0±8.04 and 48.33±34.99 μm when surgeries were performed at 1–5, 5–10 and >10 years old, respectively (p<0.001). IOP change was not correlated to CCT change (r=0.31, p=0.06). Conclusions CCT increases in eyes undergoing congenital cataract surgery, especially when the surgery is performed at an early age.

Problem-solving capacity for vitreoretinal diseases in a university health center.

Purpose: To evaluate the effectiveness of the tertiary care delivered to patients with vitreoretinal diseases in a defined urban population; to substantiate the planning and allocation of resources in order to improve the tertiary eye care delivery system in a specific area. Methods: Data were collected from consecutive first-time patients between June 1, 2003 and July 31, 2004 in the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil. Problem-solving capacity values were calculated for vitreoretinal surgery and photocoagulation. Data were entered into the Statistical Package for the Social Sciences (version 10.0). Results: Of the 7500 patients referred to the Department, 641 were deemed suitable for analysis. The diagnoses analyzed were retinal detachment (26.0%), diabetic retinopathy (21.0%), and vitreous hemorrhage (7.7%). The median ages were 52, 59 and 57.5, respectively. Of all patients referred for retinal detachment, 26.5% were inoperable. The values obtained for the problem-solving capacity (PSC) showed that 38.1%, 33.0% and 93.5% of those eligible for an ophthalmic intervention (for retinal detachment, vitreous hemorrhage and diabetic retinopathy) had obtained treatment. The main reason for not giving treatment was the unavailability of operating room time and photocoagulation time (87.1%). Conclusions: This was the first study of tertiary eye care service performance in Latin America. Sight-threatening conditions such as retinal detachment and diabetic retinopathy are not thoroughly covered by the health system in this area. Various ways to reduce the problem are considered. The study has provided valuable information on planning high-complexity eye services in the population in question.

Cataract surgery complications as a cause of visual impairment in a population aged 50 and over

The purpose of this study was to measure the extent to which complications relating to cataract surgery are a cause of visual impairment in a population aged 50 and over from the city of Campinas, São Paulo State, Brazil. An assessment of cataract surgery services was conducted using random cluster sampling, with the sample composed of 60 clusters of 40 people aged 50 years or older. Of the selected sample of 2,400 subjects, 92.67% were examined. Of these 2,224 examined subjects, 75 (3.37%) presented bilateral visual impairment and 164 unilateral, while a total of 314 (7.06%) eyes presented visual impairment. 352 eyes had undergone cataract surgery. The causes of visual impairment after surgery were concurrent eye disease (56%), surgical complications (28.8%) and refractive errors (15.2%). Cataract surgery complications represented the 5th most important cause of visual impairment. The other main causes were cataract, posterior segment disorders, diabetic retinopathy and glaucoma. These results suggest cataract surgery complications are a major cause of visual impairment in this population. Their prevention and treatment must be part of public health care policies.

Importância da ultra-sonografia ocular na avaliação pré-operatória de pacientes com catarata total

With the new techniques of cataract surgery visual success has increased and it became necessary to foresee undesirable postoperative results regarding visual acuity. PURPOSE: To verify the role of ocular ultrasonography in the preoperative evaluation of patients with mature cataract searching for pos terior segment pathologies that may affect surgical results, their prevalence and the main associated risk factors. METHODS: A retrospective study was performed analyzing records of 262 patients indicated for ocular ultrasonography because the presence of mature cataract, thus preventing fundoscopic evaluation of the posterior segment. It was also tried to associate the presence of those changes with sex, age, race, history of ocular trauma, systemic and ocular diseases and the presence of cataract in the contralateral eye. RESULTS: Ecographic changes were found in 24.8% of the examinations performed between 1996 and 2001, of which retinal detachment and vitreous condensations were the most common, with 9.9% of the findings for each. CONCLUSIONS: Among the risk factors pointed out as predisposing to findings in ocular ultrasonography, uveitis was the only statistically significant element. It was not possible to correlate positively the described posterior segment pathology to ocular trauma using obtained data.