5 research outputs found
Associação entre retinopatia falciforme e hidroxiuréia: coorte retrospectiva
No full textSalvadorA anemia falciforme é uma doença genética caracterizada por uma alteração na conformação das hemoglobinas. Entre todas as complicações vasculares da Anemia Falciforme, a retinopatia falciforme é a mais prevalente e representa uma das principais causas de cegueira. A terapia com Hidroxiureia, por meio do incremento do nível sérico de Hemoglobina Fetal, possui associação com a melhora de alguns sintomas da anemia falciforme. Entretanto, a associação entre o uso da Hidroxiureia e a prevenção de retinopatia falciforme, especificamente, ainda não é um tema esclarecido pela literatura. Nesse contexto, esse trabalho teve como objetivo verificar a associação entre o uso da Hidroxiureia e a prevenção de retinopatia falciforme. Sendo assim, foi realizado um estudo de caráter observacional tipo coorte retrospectivo, com o objetivo de buscar uma associação entre o uso de Hidroxiureia e a ausência de retinopatia falciforme. As variáveis categóricas foram comparadas através do teste qui-quadrado ou teste exato de Fisher. A variável contínua, idade, foi comparada através do teste não-paramétrico U de Mann-Whitney. Ao analisar os prontuários de maio de 2021 à fevereiro de 2022, dos pacientes atendidos em uma clínica oftalmológica de Salvador-BA, 26 pacientes atenderam aos critérios de inclusão do estudo. 24 pacientes eram portadores de retinopatia falciforme. Dos 10 pacientes que utilizavam Hidroxiureia, todos apresentavam Retinopatia Falciforme. Entre os 16 pacientes que não utilizavam Hidroxiureia, 8 apresentavam Retinopatia Falciforme. A mediana da idade da amostra é 35 anos. Após realização de teste exato de Fisher, não foi encontrada associação entre o uso da Hidroxiureia e a ausência de Retinopatia Falciforme (p=0.50). Nesse sentido, esse estudo não conseguiu associar o uso da Hidroxiureia à prevenção de Retinopatia Falciforme
Comparing benzodiazepine-ketamine and benzodiazepine-fentanyl sedation in phacoemulsification: A double-blind crossover non-inferiority clinical trial (BEKEF study)
No full textBackground: Topical anesthesia for cataract surgery often requires adjunctive sedation to manage intraoperative discomfort and improve patient cooperation. Ketamine and fentanyl, combined with benzodiazepines, are commonly used sedation regimens, but their comparative safety and efficacy in the cataract surgery context remain underexplored. This study aimed to evaluate whether ketamine combined with midazolam is non-inferior to fentanyl combined with midazolam for sedation during phacoemulsification, with a non-inferiority margin of 10%. Methods: This prospective, double-blind, crossover, non-inferiority trial randomized 75 patients to receive both sedation regimens for bilateral phacoemulsification. A 15-day washout period was implemented between surgeries. Adequate sedation was defined as a Ramsay Sedation Scale score of 2–3. The primary outcome was sedation adequacy, with secondary outcomes including patient and surgeon satisfaction, surgical metrics, and complications. Results: Of the 75 randomized patients, 65 (130 eyes) completed the study. Adequate sedation was achieved in 86.2% of cases with ketamine and 89.2% with fentanyl, with a within-participant difference of 3.1% (95%CI: −2.3%–5.3%), confirming non-inferiority. Patient satisfaction scores were similarly high between regimens (ketamine: 4.87 ± 0.36; fentanyl: 4.91 ± 0.28; P = 0.45). Complications were infrequent, with two cases of nausea and two of bradycardia in the fentanyl group and one case of nausea and two of hypertension in the ketamine group. Conclusions: Ketamine combined with midazolam is a safe and effective alternative to fentanyl-based sedation for cataract surgery, providing comparable sedation quality and satisfaction. These findings support ketamine's use in cataract surgery
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Performance of a Small Language Model Versus a Large Language Model in Answering Glaucoma Frequently Asked Patient Questions: Development and Usability Study
No full textLarge language models (LLMs) have been shown to answer patient questions in ophthalmology similar to human experts. However, concerns remain regarding their use, particularly related to patient privacy and potential inaccuracies that could compromise patient safety.
This study aimed to compare the performance of an LLM in answering frequently asked patient questions about glaucoma with that of a small language model (SLM) trained locally on ophthalmology-specific literature.
We compiled 35 frequently asked questions on glaucoma, categorized into 6 domains, including pathogenesis, risk factors, clinical manifestations, diagnosis, treatment and prevention, and prognosis. Each question was posed to both a SLM using a retrieval-augmented generation framework, trained on ophthalmology-specific literature, and to a LLM (ChatGPT 4.0, OpenAI). Three glaucoma specialists from a single institution independently assessed the answers using a 3-tier accuracy rating scale: poor (score=1), borderline (score=2), and good (score=3). Each answer received a quality score ranging from 3 to 9 points based on the sum of ratings from the 3 graders. Readability grade level was assessed using 4 formulas, such as the Flesch-Kincaid Level, the Gunning Fog Index, the Coleman-Liau Index, and the Simple Measure of Gobbledygook Index.
The answers from the SLM demonstrated comparable quality with ChatGPT 4.0, scoring mean 7.9 (SD 1.2) and mean 7.4 (SD 1.5), respectively, out of a total of 9 points (P=.13). The accuracy rating was consistent overall and across all 6 glaucoma care domains. Both models provided answers considered unsuitable for health care-related information, as they were difficult for the average layperson to read.
Both models generated accurate content, but the answers were considered challenging for the average layperson to understand, making them unsuitable for health care-related information. Given the specialized SLM's comparable performance to the LLM, its high customization potential, lower cost, and ability to operate locally, it presents a viable option for deploying natural language processing in real-world ophthalmology clinical settings
A Morphometric Study of the Pars Plana of the Ciliary Body in Human Cadaver Eyes
No full textThis study aimed to determine the pars plana length in postmortem human eyes using advanced morphometric techniques and correlate demographics to ocular metrics such as age, sex, ethnicity, and axial length. Between February and July 2005, we conducted a cross-sectional observational study on 46 human cadaver eyes deemed unsuitable for transplant by the SBO Eye Bank. The morphometric analysis was performed on projected images using a surgical microscope and a video-microscopy system with a 20.5:1 correction factor. The pars plana length was measured three times per quadrant, with the final value being the mean of these measurements. Of the 46 eyes collected, 9 were unsuitable for the study due to technical constraints in conducting intraocular measurements. Overall, the average axial length was 25.20 mm. The average pars plana length was 3.8 mm in all quadrants, with no measurements below 2.8 mm or above 4.9 mm. There were no statistically significant variations across quadrants or with age, sex, axial length, or laterality. Accurately defining the pars plana dimensions is crucial for safely accessing the posterior segment of the eye and minimizing complications during intraocular procedures, such as intravitreal injections and vitreoretinal surgeries
Systematic review and meta-analysis of myopia prevalence in Brazilian school children
No full textABSTRACT Introduction: Myopia is a growing global concern and there is a lack of studies on its prevalence among Brazilian schoolchildren. Methods: This study aimed to determine the prevalence of myopia in Brazilian children aged 3–18 years through a review and meta-analysis of published studies. Eleven high-quality studies were analyzed following the 2022 PRISMA guidelines. Prevalence was calculated using a meta-analysis, considering the heterogeneity among the studies. Results: The overall crude prevalence of myopia in Brazilian children was 7.65%. There was no significant association with the age of the children examined and no significant temporal trend was observed. Approximately one in 13 Brazilian schoolchildren had myopia. Conclusion: Given the increased exposure of Brazilian youth to the risk factors for myopia, it is crucial to monitor myopia in the country. Further studies are required to address and prevent myopia in Brazil
