Purposes: To validate a teleophthalmology mobile system aimed at improving and providing eye urgency screenings in remote and poor area settings in Brazil. The system enables one or more ophthalmologists to remotely examine a patient's condition and submit a decision describing the gravity of the case. If necessary, the patient can be forwarded to a hospital for further consultation. Methods: A cellphone (Nexus One model, with a 5 megapixel camera) was used to collect data and pictures from 100 randomly selected patients at the Ophthalmology Emergency Room located at the General Hospital of the Federal University of São Paulo (UNIFESP). Data was then sent remotely to an online recording system to be reviewed by an ophthalmologist who provided feedback regarding the state of ocular urgency. Results were then compared to the gold standard diagnosis provided at the hospital. Results: The diagnosis of urgency was given by two ophthalmologists: one in the hospital (gold standard) and one remotely. When we compared both diagnoses we obtained results of 81.94% specificity, 92.85% sensitivity, and 85% accuracy, with a negative predictive value of 96.72%. This work also included a processing time analysis, resulting in an average time of 8.6 min per patient for remote consultations. Conclusions: This study is the first that has used only a cellphone for diagnosing the urgency of ocular cases. Based on our results, the system can provide a reliable distinction between urgent and non-urgent situations and can offer a viable alternative for the servicing of underprivileged areas. In screening techniques, the most important outcome is to identify urgent cases with a high level of sensitivity and predictive negative value. Thus, our results demonstrate that this tool is robust and we suggest that a major study aimed to verify its efficiency in resource-poor areas should be initiated.

PurposeTo evaluate anatomical differences between laser (VICTUS) and manual constructed phacoemulsification incisions.SettingStudy was conducted at the Hospital de Olhos Paulista, Sao Paulo, Brazil.DesignThis is a prospective, observational, consecutive nonrandomized cohort.Patients and methodsSixteen patients (18 eyes) had phacoemulsification surgery, nine eyes had manual incisions and nine eyes had femtosecond incisions. All incisions were performed by the same surgeon. All incisions were evaluated at the 1st and 30th postoperative day with anterior segment optical coherence tomography to evaluate anatomical features. Inclusion criterion was presence of low visual acuity due to cataract. Exclusion criteria were other ocular pathologies, previous trauma, or corneal wound healing disease, as any intra or postoperative complication. Three different corneal specialists analyzed wound architecture features (epithelial or endothelial gap, incision edema, number of planes, Descemet’s detachment, and loss of wound sealing) at both visits. ImageJ (National Institutes of Health) software was also used to analyze anatomical features of incisions.ResultsAlmost all incisions had edema at the first postoperative day. All femto incisions were triplanar, as intended, unlike manual incisions, which showed two uniplanar incisions (P=0.009). All laser incisions presented partial loss of wound sealing, while five keratome incisions had no loss of wound sealing at the first postoperative day (P=0.03).ConclusionThese findings support the hypothesis that laser constructed incisions are more precisely constructed than manual, although corneal wound healing was similar between the two groups at the 30th postoperative day, with a tendency to a faster anatomical improvement in the keratome group.

Objective: To investigate the role of ICRS in halting keratoconus progression in a large sample of patients. Methods: A retrospective, non-comparative, interventional study based on the review of medical records of patients diagnosed with keratoconus who underwent Ferrara corneal ring segment implantation. A retrospective chart analysis study of 123 operated eyes with follow-up ranging from 3 to 16 years (mean 5.3 ± 3.6 years) was performed. This study was carried out at Ocular Surgery Unit, São Paulo, Brazil. All topographic data were obtained from Pentacam (Oculus, Arlington, USA). The same surgeon performed all surgeries, and the Ferrara ICRS nomogram was used for ICRS selection in all cases. Results: Corrected distance visual acuity, keratometry, and topographic astigmatism improved in most cases, with statistical significance. In 42 eyes (53.8%), there was an increase in K1 or K2, and in 36 (46.2%), there was a reduction or maintenance in K1. Considering a difference higher than 1 D, between 3-month post-surgery and final visit (group 3), 32 eyes (41%) showed an increase, and 46 eyes (59%) ended equal or below this value. Conclusion: The implantation of ICRS showed improvement in visual and keratometric indexes. The majority of patients did not increase more than one diopter in keratometric values after ICRS implantation. ICRS may be effective for slowing disease progression, especially in older patients.

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Nesse estudo foi aplicada uma metodologia de classificação dos eventos de El Niño em seus diferentes tipos (Central, Leste e, quando ambos ocorrem concomitantemente, MIX) no período de janeiro de 1950 a março de 2019. Além disso, os tipos de El Niño foram separados por estação do ano e considerando as diferentes condições de anomalias de temperatura da superfície do mar no oceano Atlântico Tropical Sul (neutras quando ocorrem anomalias de temperatura entre -0,5º e 0,5ºC; quentes quando as anomalias são superiores a 0,5ºC e frias quando as anomalias são inferiores a -0,5ºC). Com base nas combinações de ocorrência de cada tipo de EN e anomalias de temperatura da superfície do mar no Atlântico Tropical Sul, foram determinadas as anomalias de precipitação na América do Sul. Os diferentes tipos de El Niño são mais frequentes quando há condições neutras no Atlântico Tropical Sul. Com relação às anomalias de precipitação na América do Sul, os eventos de El Niño Leste e MIX, em geral, mostram padrão similar na distribuição espacial das anomalias, mas com os eventos MIX mostrando sinal mais fraco. As anomalias de temperatura da superfície do mar no Atlântico Tropical Sul quando negativas ajudam a fortalecer as condições secas entre o norte das regiões norte e nordeste do Brasil propiciadas pelos eventos de El Niño.  Influence of the Different Types of El Niño in the Precipitation over South America  A B S T R A C TIn this study, a specific methodology was applied to classify El Niño events into their different types (Central, East and when both occur at the same time, MIX) from January 1950 to March 2019. In addition, the types of El Niño were separated by season and considering the conditions of sea surface temperature anomalies on the South Tropical Atlantic Ocean (neutrality: temperature anomalies between -0.5º and 0.5ºC, warm: anomalies above 0.5ºC and cold:  anomalies below -0.5ºC). Based on in the combination of different types of El Niño and sea surface temperature anomalies on the South Atlantic Tropical Ocean, precipitation anomalies over South America were computed. The different types El Niño occur, in general, under neutral conditions on the Atlantic Ocean. The events of El Niño - East and MIX, in general, present a similar pattern in the spatial distribution of the precipitation anomalies over South America, but with the MIX events showing weaker signal. Sea surface temperature anomalies in the Tropical South Atlantic when negative, they help to strengthen the dry conditions between the north of the north and northeast regions of Brazil caused by the El Niño events.Keywords: atmospheric circulation, anomaly conditions, tropical oceans, climate