Manuel Vilela

Prevalence of asthenopia in children: a systematic review with meta-analysis☆

OBJECTIVE To estimate the prevalence of asthenopia in 0-18 year-old children through a systematic review and meta-analysis of prevalence studies. SOURCES Inclusion criteria were population-based studies from 1960 to May of 2014 reporting the prevalence of asthenopia in children. The search was performed independently by two reviewers in the PubMed, EMBASE, and LILACS databases, with no language restriction. This systematic review was performed in accordance with the Cochrane Collaboration guidelines and the PRISMA Statement. Downs and Black score was used for quality assessment. SUMMARY OF FINDINGS Out of 1692 potentially relevant citations retrieved from electronic databases and searches of reference lists, 26 were identified as potentially eligible. Five of these studies met the inclusion criteria, comprising a total of 2465 subjects. Pooled prevalence of asthenopia was 19.7% (12.4-26.4%). The majority of children with asthenopia did not present visual acuity or refraction abnormalities. The largest study evaluated 1448 children aged 6 years and estimated a prevalence of 12.6%. Associated risk factors were not clearly established. CONCLUSION Although asthenopia is a frequent and relevant clinical problem in childhood, with potential consequences for learning, the scarcity of studies about the prevalence and clinical impact of asthenopia hinders the effective planning of public health measures.

Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children

BackgroundStudies show great variability in the prevalence of hyperopia among children. This study aimed to synthesize the existing knowledge about hyperopia prevalence and its associated factors in school children and to explore the reasons for this variability.MethodsThis systematic review followed PRISMA guidelines. Searching several international databases, the review included population- or school-based studies assessing hyperopia through cycloplegic autorefraction or cycloplegic retinoscopy. Meta-analysis of hyperopia prevalence was performed following MOOSE guidelines and using the random effects model.ResultsThe review included 40 cross-sectional studies. The prevalence of hyperopia ranged from 8.4% at age six, 2-3% from 9 to 14 years and approximately 1% at 15 years. With regard to associated factors, age has an inverse association with hyperopia. The frequency of hyperopia is higher among White children and those who live in rural areas. There is no consensus about the association between hyperopia and gender, family income and parental schooling.ConclusionFuture studies should use standardized methods to classify hyperopia and sufficient sample size when evaluating age-specific prevalence. Furthermore, it is necessary to deepen the understanding about the interactions among hyperopic refractive error and accommodative and binocular functions as a way of identifying groups of hyperopic children at risk of developing visual, academic and even cognitive function sequelae.

Moderate hyperopia prevalence and associated factors among elementary school students

Hyperopia is the most common refractive condition in childhood. There are few studies on moderate hyperopia and associated factors. This study aims to investigate the prevalence of moderate hyperopia and associated factors among school children. A cross-sectional study comprising 1,032 students attending 1st to 8th grades at two public schools was conducted in a Southern Brazilian urban area in 2012. Cycloplegia was used to examine both eyes and refractive error was measured through auto-refraction. A socioeconomic and cultural questionnaire was administered. Multivariable analysis was performed through Poisson regression. Moderate hyperopia prevalence was 13.4% (95% CI, 11.2-15.4) and 85% of these did not wear glasses. Age was inversely associated with moderate hyperopia, while female gender RP = 1.39 (95%CI, 1.02 - 1.90) and white skin RP = 1.66 (95%CI, 1.04 - 2.66) were risk factors for this outcome. This study makes progress in estimating mild and moderate hyperopia prevalence both by age range and specific age. It emphasizes how the lack of this condition being corrected in southern Brazil is a serious problem. It highlights the importance of detailing and characterizing the amount of time spent on close-range, long-range and outdoor activities.

Fístula carotídeo-cavernosa

Carotid cavernous fistulae are an uncommon disease. They are classified as direct or indirect. In direct fistulas there is an abnormal communication between the internal carotid artery and the cavernous sinus. Indirect forms have an abnormal bypass between the meningeal branches of the internal and/or external carotid arteries and the same sinus. The purpose of this article is to provide an overview of the anatomy of the envolved area and the clinical findings, diagnostic evaluation and treatment.

Amplitude of Accommodation in Schoolchildren.

ABSTRACT Purpose: Hofstetter’s equations are based on studies of Amplitude of Accommodation (AA) with methodological limitations, particularly in the case of children younger than 10 years of age. The aim of this study is to evaluate AA by age, gender, economic status, and time of day as well as accommodative insufficiency prevalence. Methods: A cross-sectional study was conducted with 867 schoolchildren aged 6–16 years attending two public schools in the urban area of the South Brazilian city of Pelotas. Subjective refraction was performed using a monocular fogging method to standard end point of maximum plus for best visual acuity (20/25). AA was assessed using the push-up method. Results: The median AA value was 14.3D (P25 13.3–P75 16.7) among children aged 6–16 years, being 15.5D (P25 14.3D–P75 16.7) among children aged 6–10 years, 14.2D (P25 12.5D–P75 15.4) among 11–13-year-olds, 13.3D (P25 12.5D–P75 15.4) among children aged 14–15 and 12.9D (P25 11.1D–P75 14.3) among those aged 16. AA variability was 2.4D in those aged 6–8, 3.4D in children aged 9–12, and 2.9D in those aged 13–16. There was no significant difference in median AA according to gender, time of examination, or economic status; 2.8% of children showed AA of less than 2D lower than Hofstetter’s minimum reference value. Conclusions: This study reports AA in a large sample of children and therefore may contribute to current knowledge on AA norms. In order to avoid the impact of outliers, it proposes the use of the median and percentiles to define AA standards by specific age. A set of studies using precise AA measurement and large sample size are needed to determine clinical standards for AA.

Hepatitis C virus induces abnormalities in surface and intraocular pressure: a comparative study.

Objectives Various ocular lesions are associated with hepatitis C virus (HCV). Few studies have focused on untreated patients. This study aims to describe ocular lesions in untreated HCV-infected patients without ophthalmic symptoms by means of a comprehensive ophthalmologic examination. Materials and methods Ninety-five consecutive naive HCV chronically infected patients and 54 controls (blood donors) were enrolled in a prospective, cross-sectional, single-center study. The following variables were analyzed: age, sex, HCV viral load and genotype, liver fibrosis, visual acuity, biomicroscopy of the anterior segment, lacrimal function (tear break-up time) and Schirmer’s tests), posterior segment examination, and intraocular pressure. Results HCV-infected patients presented an almost four times higher risk of lacrimal function involvement by tear break-up time [odds ratio (OR)=3.76; 95% confidence interval (CI) 1.75–8.04, P=0.001] and Schirmer’s test (OR=4.17; 95% CI 1.83–9.50, P=0.001) than the controls. The chances of palpebral biomicroscopic lesions (blepharitis) were also higher (OR=3.21; 95% CI 1.49–6.94, P=0.003). Mean tonometry was higher in HCV patients (right eye 14.4±2.3 vs. 12.2±1.5, P<0.001 and left eye 14.5±2.3 vs. 12.0±1.4, P<0.001). Conclusion Naive HCV patients even with no ophthalmic complaints presented a greater prevalence of lacrimal function abnormalities and a higher frequency of blepharitis compared with the control group. As never formerly described, intraocular pressure in HCV patients was higher than that in controls.

Prevalence of ophthalmological abnormalities in children and adolescents with CHD: systematic review and meta-analysis of observational studies.

BACKGROUND CHDs form a complex and heterogeneous group of clinical entities, with high morbidity and mortality. With the advancement of surgical and invasive techniques and clinical treatment, the survival of these patients has increased significantly, and there are reports of a high prevalence of ocular abnormalities in this group. The objective of this study was to estimate the prevalence of ocular findings in children and adolescents diagnosed with CHD. METHODS A systematic search was conducted in the following databases: MEDLINE (via PubMed), EMBASE, and Cochrane CENTRAL, in addition to a manual search on studies published on the patient, from inception until August, 2014. Observational studies assessing the prevalence of ocular abnormalities in children and adolescents with CHDs were included. RESULTS Of the 2413 articles identified, eight were included, comprising a total of 1061 patients. Among them, the lowest and highest prevalences observed were 6.3 and 65%, respectively. The weighted average prevalence of ocular abnormalities was 32.5% (CI95% 19.3-49.3). Strabismus, cataracts, and retinopathy were the most frequently observed alterations. CONCLUSION The prevalence of ocular abnormalities in children and adolescents with CHDs was 32.5%, demonstrating that ocular consequences are not uncommon in this population and may have relevant clinical impact. These results reinforce the need for ophthalmological evaluation of patients with CHDs.

Achados epidemiológicos e alterações oftalmológicas em diabéticos atendidos em hospital geral secundário

Objective: To evaluate the association between epidemiological and ophtalmological findings in diabetic patients. Methods: Cross-sectional study. We selected consecutively diabetic patients examined during 2011 which responded to a questionnaire and examination. Results: The sample comprised 103 patients, of whom 72 (69.9%) were female, 66 (64%) were Caucasian, average age 59 (+/- 9,21) years, 64% reported minimum wages, 58.2% did not finish elementary school, 75.7% reported family history of diabetes, 45.6% reported regularly perform metabolic control, 54.3% did not receive special nutritional care. On examination, 72.8% had visual acuity of 20/40. There was a significant association between retinal complications and insulin usage (OR=8,3; p=0,003), and between low visual acuity and age (OR=11,8; p=0,003) and insulin (OR=5,48, p=0,021), as well with lower education and income. Conclusion: In this low-income and low-education population, glycemic control was poor, and related to the development of diabetic retinopathy and the consequent low vision. These findings emphasize the need to adopt broader strategies to improve control and prevention of diabetes mellitus.

Facoemulsificação sob anestesia tópica: série de casos

PURPOSE: To evaluate the outcome and safety of phacoemulsification performed under topical anesthesiain cases with several complexities. METHODS: Cases performed under topical anesthesia from january 2009 to april 2011 were analyzed. Variables analyzed included patients age, sex, race, systemic diseases, eyes comorbidities, type of cataract, visual acuity before and after the surgery, complications, number of conversions to peribulbar anesthesia and IOL power. Patients with uncompleted data were excluded from analysis. RESULTS: A total of 111 eyes were analyzed; only cases with ocular comorbidities were statistically significant (p=0,004). CONCLUSION: the data analysis suggests that phacoemulsification performed under topical anesthesia is safeand effective in cases of different complexities.

Falha a longo prazo no tratamento do melanoma de coróide com termoterapia transpupilar

OBJECTIVE: To evaluate, retrospectively, in a long time interval, the results of transpupillary thermotherapy in selected cases of choroidal melanoma (CM). METHODS: All patients with melanoma treated with transpupillary thermotherapy as sole therapy or supplement were identified. Cases with less than 60 months follow-up, incomplete records or abandonment of monitoring were excluded. RESULTS: A total of 18 eyes, seven (38.9%) were included. Five (71,4%) patients were treated exclusively with transpupillary thermotherapy, in one (14,2%) eye criotherapy was used simultaneously, one (14,2%) was supplemented with brachytherapy - episcleral plate. Three (42.8%) had recurrence, two (28.5%) had metastases (one death), two eyes were enucleated. Complications were found in three eyes: two with macular folds, one with vitreous hemorrhage. In the enucleated eyes, extraescleral did not occur, however intrascleral tumoral cells were identified. CONCLUSION: Transpupillary thermotherapy shows a decline in its effectiveness and retains the risk of metastases in longer periods of follow-up, requiring a more exact definition of its role in choroidal melanoma.