Arthur Gustavo Fernandes

Purpose: To compare the outcomes of intraocular lens (IOL) scleral fixation using Akreos (Bausch + Lomb) lenses with polytetrafluoroethylene (Gore-Tex CV-8, W.L. Gore & Associates) sutures vs 3-piece IOLs (Alcon MA60AC) with 10-0 Prolene (Ethicon, a Johnson & Johnson Company) sutures. Methods: Patients undergoing pars plana vitrectomy between January 2019 and July 2021 were retrospectively selected regardless of the technique used. Patients who completed at least 6 months of follow-up were invited to a new clinic visit to evaluate outcomes of their procedures. The protocol included intraocular pressure assessment using a Goldmann tonometer, subjective refraction, corneal topography with a Pentacam HR (Oculus, Optikgeräte GmbH), IOL decentration assessment on biomicroscopy via slitlamp, and optic disc cupping evaluation by indirect ophthalmoscopy. Complications such as corneal edema, ocular hypertension, hypotony, hyphema, IOL decentration, cystoid macular edema, vitreous hemorrhage, suture breakage, retinal detachment, or uveitis–glaucoma–hyphema syndrome were investigated. Results: A total of 20 eyes from 20 participants were classified into 2 groups according to surgical technique: Akreos plus Gore-Tex (n=11) or MA60AC plus Prolene (n=9). The results showed no statistically significant differences between the 2 groups in terms of refractive outcomes, postoperative complications, or demographic variables, suggesting both techniques provide similar efficacy and safety. Conclusions: Both the Akreos with Gore-Tex and MA60AC with Prolene scleral fixation techniques are effective and safe for patients requiring IOL implantation in the absence of adequate capsular support. Further research is needed to solidify these observations and guide future clinical decisions.

Background To provide population-level estimates of OCT-detected macular pathology in adults living in the Brazilian Amazon region. Methods Population-based, cross-sectional study. Eligible participants were residents aged ≥ 45 years identified through cluster sampling (20 clusters: 14 urban and 6 rural) in Parintins City, Amazonas, Brazil. Ophthalmic examinations included visual acuity testing, biomicroscopy, fundoscopy, and subjective refraction. A subset underwent spectral-domain OCT (SD-OCT; iVue-100, Optovue) using macular mapping protocols. OCT images were graded for predefined abnormalities involving the vitreoretinal interface, inner retina, outer retina/retinal pigment epithelium (RPE)/choroid, and ganglion cell complex (GCC). Generalized estimating equations (GEE) were used to evaluate factors associated with any OCT abnormality. Statistical significance was set at p < 0.05. Results Of 2,384 eligible individuals, 2,041 (85.7%) were examined and 588 (28.8%) underwent OCT (1,176 eyes), of which 1,069 eyes (90.9%) were gradable. OCT macular abnormalities were detected in at least one eye in 180 participants (30.6%). Overall, outer retinal layer changes were most frequent, followed by GCC thinning and epiretinal membrane. OCT abnormalities were independently associated with older age and lower educational level. Structural abnormalities were identified in 340 (31.8%) eyes; of these, 208 (19.5%) showed changes also detectable on dilated fundus examination, whereas 132 (12.3%) had a clinically normal funduscopic appearance. Clinically notable lesions were detected in 46 (4.3%) eyes, including signs of late AMD in 27 (2.5%) eyes, diabetic maculopathy in 6 (0.6%), lamellar macular hole in 6 (0.6%), full-thickness macular hole in 3 (0.3%), and central serous chorioretinopathy in 4 (0.4%) eyes. Among 774 eyes clinically normal at fundoscopy, OCT revealed subclinical disease in 127 (16.4%). Conclusions In this underserved Amazonian population, approximately one-third of gradable eyes showed OCT-detected macular abnormalities, many of them subclinical on fundoscopy. Diabetic maculopathy, choroidal neovascular membranes, and late AMD showed very low prevalence and limited epidemiologic weight in this setting. Incorporating OCT into population-based surveys enhances detection and refines burden estimates of subclinical retinal disease and vision-threatening conditions in aging populations.

Purpose: this study aims to investigate the main complaints and ocular health problems in a specific region to facilitate better planning of public resources and the formulation of strategies aimed at reducing and controlling visual impairments and blindness. The focus is on assessing the epidemiological profile of patients treated at the ophthalmological emergency room of Santo André. Methods: we conducted a cross-sectional and retrospective study involving 165,714 patients who sought primary care at the ophthalmic emergency room of Centro Hospitalar Municipal de Santo André from 2011 to 2016. Data on age, gender, city of origin, diagnosis, conducted treatment, and date of care were collected. Descriptive statistics were employed to summarize the dataset, and distributions were presented using measures of central tendency and variability. Qualitative data were displayed in absolute and relative frequencies. Results: during the analyzed period, a total of 165.714 patients sought treatment at the ophthalmological emergency room. Among them, 52.25% were men, and 47.75% were women. The mean age of the general population seeking care was 37±20 years. External diseases (56.22%) and ocular trauma (14.12%) were the leading reasons for these visits. Conclusion: this study provides a comprehensive analysis of the epidemiological profile of patients attending a reference service in ophthalmic emergency during the proposed period. The findings reveal noteworthy changes in the population’s profile over the last decade. These insights can inform and guide healthcare providers and policymakers in implementing targeted interventions to address eye health issues effectively.

Evaluating field‐sourced samples with poor‐quality and low‐quantity DNA, like animal feces, presents significant challenges in the field of molecular biology. Nonetheless, recent innovations in PCR technology are promoted as effective tools to overcome many of these issues. Here, we evaluate the efficiency of droplet digital PCR (ddPCR) as a method for color vision assessment from feces of white‐faced capuchins ( Cebus imitator ) and report frequencies of alleles and genotypes in a wild population. The sex‐linked color vision polymorphism of monkeys in the Americas is driven by single nucleotide polymorphisms (SNPs) in opsin genes at up to three tuning sites. DNA was extracted from fecal samples collected from 211 wild capuchins (53.1% males) in Sector Santa Rosa, Costa Rica: 56 were evaluated with ddPCR, 24 with both ddPCR and Sanger sequencing, and 141 with Sanger sequencing (historical dataset). The same opsins and genotypes were derived for each monkey using Sanger and ddPCR; however, the latter method was far more sensitive and required far fewer samples to reach a definitive genotype. Overall, the most frequent phenotypes were red and green/red. The distribution of genotypes was: Females ( N = 99): green/red (35.4%), red/red (33.3%), green/yellow (14.1%), yellow/red (12.1%), yellow/yellow (4.0%), and green/green (1.0%); Males ( N = 112): red (60.7%), yellow (23.2%), and green (16.1%). Overall, ddPCR was a reliable method for evaluating color vision noninvasively in wild capuchins with the advantage of excellent sensitivity and high‐throughput. ddPCR is highly robust to PCR inhibitors and can be potentially used to identify other disease‐related SNP mutations noninvasively in wild animals.

Background: Clinically significant macular edema (CME) is the leading cause of visual loss after ophthalmologic surgery due to the release of inflammatory mediators promoted by the procedures. We aimed to evaluate the outcomes of intravitreal Ozurdex^® (700 µg dexamethasone) implants as a primary therapeutical option for post-surgical macular edema cases. Methods: Patients with post-surgical macular edema diagnosed by optical coherence tomography (Cirrus SD-OCT) and treated with Ozudex were selected for the current study. Data was retrospectively collected from medical records from January 2020 to December 2022 and included sex, age, laterality, and timeline of treatment (i.e. implant alone or at the time of silicon oil removal in cases requiring vitreorretinal surgery). Complications associated with treatment were also noted as well as the need of further treatments. The structural analysis focused on measuring central macular thickness (CMT—average thickness within the 1 mm circle of the ETDRS) from the internal limiting membrane to the Bruch’s membrane complex, as well as the average total macular thickness including parafoveal and perifoveal regions determined by the device (CAT). The functional evaluation was based on the best-corrected visual acuity (VA) measured in logMAR. Results: A total of 46 participants were included (56.2% males, mean age: 60.9 ± 11.2 years old). A statistically significant change was observed in the postoperative versus the preoperative period for all parameters (p < 0.05). The mean VA difference was − 0.17 ± 0.24; CMT was − 109.22 ± 124.85 and CAT was − 14.76 ± 58.95. We observed a significant effect of the moment of Ozurdex implantation on VA improvement, so that cases with implantation at the time of oil removal showed lower improvement than cases with implantation at a distinct timing (Coef. 0.19, 95%CI: 0.02 to 0.36, p = 0.027). Eleven cases (23.9%) required further treatment such as new Ozurdex implantation (8 cases) or surgery (3 cases). Only one case (2.17%) showed increased intraocular pressure and underwent glaucoma surgery. Conclusions: Intravitreal Ozurdex implants significantly improved functional and structural aspects in post-surgical macular edema. The timing of implantation influenced VA improvement, with a distinct step approach showing better outcomes than at the time of oil removal.

This pilot study evaluated the diagnostic accuracy of a deep learning model for detecting pterygium in anterior segment photographs taken using smartphones in the Brazilian Amazon. The model's performance was benchmarked against assessments made by experienced ophthalmologists, considered the clinical gold standard. In this cross-sectional study, 38 participants (76 eyes) from Barcelos, Brazil, were enrolled. Trained nonmedical health workers captured high-resolution anterior segment images using smartphones. These images were analyzed using a deep learning model based on the MobileNet-V2 convolutional neural network. Diagnostic metrics-including sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve-were calculated and compared with the ophthalmologists' evaluations. The deep learning model achieved a sensitivity of 91.43%, specificity of 90.24%, positive predictive value of 88.46%, negative predictive value of 92.79%, and an area under the curve of 0.91. Logistic regression revealed no statistically significant association between pterygium and demographic variables such as age or gender. The deep learning model demonstrated high diagnostic performance in identifying pterygium in a remote Amazonian population. These preliminary findings support the potential use of artificial intelligence-based tools to facilitate early detection and screening in underserved regions, thereby enhancing access to ophthalmic care.

This study evaluated macular thickness using spectral-domain optical coherence tomography in healthy participants from a population-based eye survey. The Brazilian Amazon Region Eye Survey was a population-based study assessing the prevalence and causes of visual impairment, blindness, and ocular diseases in adults aged ≥45 years from urban and rural areas of Parintins. A subgroup was selected based on inclusion criteria for both eyes: best-corrected visual acuity ≥20/32, normal eye examination results, and no prior ocular surgery. Scans were performed using the iVue optical coherence tomography device. Measurements were taken from the nine subfields defined by the Early Treatment Diabetic Retinopathy Study, examining the full retina as well as the inner and outer retinal layers. Associations of retinal thickness with age and sex were also analyzed. Statistical significance was set at p≤0.05. In total, 70 healthy participants (25 males), aged 45-65 years (mean=52 ± 5), were included. Mean central foveal thickness was 248.71 ± 18.73 μm. A significant age-related reduction in macular thickness was observed, particularly in the inner superior parafovea (p=0.036), nasal perifovea (p=0.001), superior perifovea (p=0.028), outer layer of inferior parafovea (p=0.049), and the inferior perifovea of the full retina (p=0.029). Males showed significantly greater thickness in the outer layer, especially in the outer parafovea (p=0.004) and perifovea (p<0.0001). This study established normative macular thickness values for healthy older adults in the Brazilian Amazon region using spectral-domain optical coherence tomography. Age and sex were found to significantly influence macular thickness and should be considered when interpreting measurements. These data will support future studies of retinal diseases in this population.

Uncorrected refractive errors and amblyopia are reported as the two main causes of childhood visual impairment and blindness worldwide. Our purpose was to evaluate refractive status, ocular alignment and effective refractive error coverage (eREC) of school-aged children from low-income areas of Sao Paulo city, Brazil. Data from the “Ver na Escola” Project were used for the current study. Children enrolled in the selected schools had an ophthalmic exam including eye alignment assessed by cover test, automatized and subjective dynamic and static refraction. The associations of demographic variables with occurrence and magnitude of refractive errors and eREC were investigated by multiple logistic regressions and multilevel mixed effect models. A total of 17,973 children (51.12% females) with mean ± sd age 8.24 ± 3.54 years old examined from July 2018 to July 2019, were included in the study. Most of the participants (73%) showed orthoposition of the visual axis for both distance and near. Heterophoria was found in about 25% of participants (N = 4,498), with 71.7% of them (N= 3,222) classified as exophoria. Less than 2% (N = 232) showed strabismus, most of them (N = 160) esotropia. Overall, 1,370 (7.70%) of participants had myopia and 577 (3.24%) had hyperopia. Age was found to be significantly associated with increasing static subjective refraction spherical equivalent (Coefficient: -0.18; 95% Confidence Interval (CI): -0.21 to -0.16; p < 0.001). Female sex (Odds Ratio (OR) = 1.13; 95%CI: 1.01–1.27; p = 0.027) and older age (OR = 1.17; 95%CI: 1.16–1.19; p < 0,001) were significantly associated with myopia diagnosis. Older age decreased the odds of hyperopia (OR = 0.95; 95%CI: 0.93–0.98; p < 0.001). The overall effective refractive coverage was 51.76% and was significantly associated with age group, ranging from 32.25% in children aged 3 to 7 years to 61.35% in children aged 8 to 12 years. Most children have shown eye alignment for both distance and near assessments and no refractive error. Myopia was observed in 7.70% of the population and it was associated with older age and female sex. Hyperopia was observed in 3.24% and was associated with younger age. The overall eREC was 51.76%, significantly associated with age.

Objective: To evaluate the epidemiological, clinical, and imaging profile of lesions that mimic choroidal melanoma. Methods: Retrospective study of medical records of suspected choroidal melanoma lesions referred to the Ocular Oncology Service from the Universidade Federal de São Paulo, from 2014 to 2020. Demographic data, clinical history, and exams were evaluated. Results: A total of 104 patients (mean age: 65.57 ± 13.18; 49.04% female) were referred to our service with suspected choroidal melanoma. Of these, 32 (30.77%) were classified [...] ABSTRACT Objective: To evaluate the epidemiological, clinical, and imaging profile of lesions that mimic choroidal melanoma. Methods: Retrospective study of medical records of suspected choroidal melanoma lesions referred to the Ocular Oncology Service from the Universidade Federal de São Paulo, from 2014 to 2020. Demographic data, clinical history, and exams were evaluated. Results: A total of 104 patients (mean age: 65.57 ± 13.18; 49.04% female) were referred to our service with suspected choroidal melanoma. Of these, 32 (30.77%) were classified