The ophthalmic trigeminal placode (opV) is the birth place of one cell type of sensory neurons contributing to the trigeminal ganglion. Signals from the neural tube induce placodal identity within the surface ectoderm. Specified opV placode cells then up-regulate neuron differentiation markers and migrate to the ganglion. Several molecular pathways have been shown to act in opV placode cell development. Despite this, signals that specify individual neurons from within the opV placode remain unknown. However, it is known that components of the Notch signaling pathway are expressed in the opV placode. I tested the role of Notch signaling in opV placode development by separately inhibiting and over-activating the pathway. Using DAPT, an inhibitor of gamma-secretase, I inhibited Notch signaling in 13-15 somite stage chick embryo heads. Attenuated Notch signaling caused increased neuronal differentiation of opV cells at 13-15 somites. I also observed an increase in migratory opV placode (Pax3+) cells in the mesenchyme and expression of neuronal marker Islet1 in the ectoderm. Further, I activated Notch signaling by misexpressing the Notch intracellular domain (NICD) by in ovo electroporation of 10-12 somite stage chick embryos. This resulted in Pax3+ targeted cells failing to differentiate and remain instead in the ectoderm. Thus, Notch/Delta signaling plays an important role in selecting ophthalmic trigeminal cells to differentiate and migrate to the trigeminal ganglion.

This dissertation is divided into three chapters, each discussing the study of different regulatory molecules involved in sensory neurogenesis occurring in the trigeminal placode. Chapter one is a spatiotemporal description of Notch pathway genes in chick opV placode by stage-specific expression analysis, showing expression of many Notch pathway genes and effectors in the opV placode. Notch pathway gene expression is primarily confined to the ectoderm with highest expression of these genes at the beginning stages of peak neuronal differentiation. This information preceded studies of the functional roles that Notch signaling has in the opV placode and how it may affect the transcription factor, Pax3. Chapter two is a study of the transcription factor Pax3 and its role in opV placode development and sensory neuron differentiation. Pax3 is known to activate or repress gene transcription, and its activity may be dependent on the splice variant or isoform present. We show through RT-PCR that alternative splice forms of Pax3 are present at stages of chick development corresponding to cellular competence, cellular differentiation and ingression, and cellular aggregation. We have named these splice forms, Pax3V1 and Pax3V2. Using quantitative RT-PCR we show that Pax3V2 is consistently expressed at lower levels compared to Pax3 during cellular competence and differentiation. In order to determine the function of the three splice forms, we misexpressed them in the opV placode and analyzed the effect on neurogenesis. We looked at markers for neuronal differentiation of targeted cells after in ovo electroporation of Pax3, Pax3V1, and Pax3V2, which showed a significant difference between the control and each construct, but not between the groups of constructs. To enhance the process of neurogenesis we exposed the electroporated embryos to DAPT, a Notch signaling inhibitor that enhances sensory neurogenesis. Using this method we found that misexpression of Pax3 and Pax3V1 resulted in cells failing to differentiate, while Pax3V2 misexpression more closely resembles the neuronal differentiation seen in controls. These results show that the Pax3V2 isoform allows for neuronal differentiation of opV placodal cells after misexpression, while the Pax3 isoform and the Pax3V1 isoform block neuronal differentiation. Chapter three is a study of the necessity of Wnt signaling originating from the neural tube to induce Pax3 expression in the opV placode. A double knockout of Wnt1 and Wnt3a was produced to determine the necessity of these genes in opV placode development. Pax3 expression in the opV placode at E8.5 and E9.5 was markedly reduced in the double mutants when compared to wild type mice. This study shows that Wnt1 and Wnt3a genes are necessary for normal Pax3 expression, but that other signals may contribute to its induction.

Problem statement: Violence against women and intimate partner violence is a bigproblem in society and the healthcare system has an obligation to act already when thereis suspicion of exposure to violence, but there is a lack of clear guidelines in ophthalmiccare. Aim: The aim was to examine nurses´ experiences of caring for patients exposedto IPV. Method: A systematic literature review with qualitive design and inductiveapproach was performed. Result: The emerged categories were readiness to deal withintimate partner violence, different views on exposure to violence, emotions are evoked,having the courage to ask, and organizational support. The result showed that trainingabout intimate partner violence was unusual both in the nursing program and for theprofessional nurses. Because of this they did not feel prepared for neither detect, reportsuspected cases or correctly meet these patients. Conclusion: There is a lack ofknowledge and education about how exposure to violence can be discovered andhandled. In addition, the subject needs to be highlighted and be developed further tostrengthen the societal responsibility to act when there is suspicion about violence. Tobe able to conduct evidence-based care in ophthalmic care more research is neededabout violence against women and intimate partner violence. / Problemställning: Våld mot kvinnor och våld i nära relationer är ett stort problem isamhället och hälso- och sjukvården har skyldighet att vidta åtgärder redan vidmisstanke om våldsutsatthet, men det saknas tydliga riktlinjer inom ögonsjukvården föromhändertagande. Syfte: Syftet var att undersöka sjuksköterskors erfarenheter avomhändertagande av patienter som är utsatta för våld i nära relationer. Metod:Litteraturstudien var systematisk och hade en kvalitativ design med en induktiv ansats.Resultat: Kategorierna som framkom var att ha beredskap att bemöta våld i närarelation, olika syn på våldsutsatthet, vårdrelationen väcker känslor, att fråga omvåldsutsatthet och att ha stöd i organisationen. Det visade sig att utbildning kring våld inära relation var ovanligt både under sjuksköterskeutbildningen och föryrkesverksamma sjuksköterskor. De upplevde sig därför inte vara tillräckligt förbereddaför vare sig att upptäcka, rapportera misstänkta fall eller att på ett korrekt sätt bemötadenna patientkategori. Konklusion: Det saknas tillräcklig kunskap och utbildning omhur våldsutsatthet kan upptäckas och hanteras. Dessutom behöver ämnet belysas ochutvecklas ytterligare för att stärka det samhälleliga ansvaret att agera vid misstanke omvåldsutsatthet. För att kunna bedriva evidensbaserad vård inom ögonsjukvården behövsmer forskning om våld mot kvinnor och våld i nära relationer.

Problem definition: Cataract surgery and intravitreal injections are common treatmentsat eye clinics and these procedures can be preceded by worry and anxiety in the patient.It is the ophthalmic nurse's responsibility to work for good nursing care and promotewell-being for all patients. Increased knowledge of the ophthalmic nurse's experience ofmeeting patients with anxiety during eye procedures would therefore be valuable inpromoting health and well-being. Purpose: To explore ophthalmic nurses’ experiencesof meeting patients with anxiety associated with planned invasive procedures in the eye.Method: A qualitative interview study with semi-structured questions and an inductiveapproach was performed. Ten ophthalmic nurses from five eye clinics in Central andSouth of Sweden participated in the study. Results: The analysis resulted into threecategories and eight subcategories. The three categories where Anxiety vary,Circumstances that can affect anxiety and Anxiety can lead to consequences.Conclusion: The ophthalmic nurses´ experiences were that all patients were anxiouspreoperatively. Individualized information and person-centered nursing care reducedpatients´ anxiety. The importance of the team and specific nursing actions such ashandhold were also of value. Future studies could be interviews with ophthalmic nurses’or patients with focus on nursing actions that can calm anxiety. / Problemformulering: Kataraktkirurgi och intravitreala injektioner är vanliga ingrepppå ögonmottagningar och dessa ingrepp kan föregås av oro och ångest hos patienten. Iögonsjuksköterskans ansvar ligger det att arbeta för en god omvårdnad och främjavälbefinnande för alla patienter. Ökad kunskap om ögonsjuköterskans erfarenhet avmötet med patienter med oro vid ingrepp i ögat skulle därför vara av värde för attfrämja hälsa och välbefinnande. Syfte: Att undersöka ögonsjuksköterskorserfarenheter av att möta patienter med oro i samband med planerade ingrepp i ögat.Metod: En kvalitativ intervjustudie med semistrukturerade frågor och induktiv ansatsgenomfördes. Tio ögonsjuksköterskor från fem ögonmottagningar i mellersta ochsödra Sverige deltog. Resultat: Analysen resulterade i tre kategorier och åttasubkategorier. De tre kategorierna var; Oro varierar, Omständigheter som kanpåverka oro, Oro kan leda till konsekvenser. Konklusion: Ögonsjuksköterskornahade en erfarenhet av att alla patienter hade någon form av oro preoperativt.Individanpassad information och ett personcentrerat omvårdnadsarbete var ett stöd föratt lindra oro hos patienterna. Teamets betydelse och specifika omvårdnadsåtgärdersom till exempel en hand att hålla var också av värde. Framtida studier kan varaintervjuer med ögonsjuksköterskor eller patienter med fokus på omvårdnadsåtgärdersom kan stilla oro.

The eye is our window to the world. Human vision has therefore been extensively studied over the years. However, in-depth studies are often either limited to our central visual field, or, when extended to the periphery, only correct optical errors related to a narrow spectrum of light. This thesis extends the current knowledge by considering the full visible spectrum over a wide visual field. A broad spectrum means that the wavelength dependence of light propagation inside the eye has to be considered; the optics of the eye will therefore not form a retinal image in the same location for all wavelengths, a phenomenon called chromatic aberration. We present here a new methodology to objectively measure the magnitude of transverse chromatic aberration (TCA) across the visual field of the human eye, and show that the ocular TCA increases linearly with off-axis angle (about 0.21 arcmin per degree for the spectral range from 543 nm to 842 nm). Moreover, we have implemented adaptive psychophysical methods to quantify the impact of TCA on central and peripheral vision. We have found that inducing additional TCA degrades peripheral grating detection acuity more than foveal resolution acuity (more than 0.05 logMAR per arcmin of induced TCA peripherally compared to 0.03 logMAR/arcmin foveally). As stimuli to evaluate peripheral vision, we recommend gratings that are obliquely-oriented relative to the visual field meridian. The results of this thesis have clinical relevance for improving peripheral vision and are equally important for retinal imaging techniques. To limit the negative impacts of TCA on vision, inducing additional TCA should be avoided when the peripheral refractive errors are to be corrected, such as for people suffering from macular degeneration and central visual field loss. In retinal imaging applications, TCA leads to lateral offsets when imaging is performed in more than one wavelength. Consequently, the measurement of TCA together with careful pupil alignment and subsequent compensation can improve the functionality of these instruments. / Ögat är vårt fönster mot världen, och syn har mätts och studerats i stor utsträckning över åren. Trots detta är forskningen om mänsklig syn oftast begränsad till det centrala synfältet, och i studier av det perifera synfältet korrigeras optiska fel endast över ett smalt våglängdsområde. Denna avhandling vidgar forskningen om vår syn till att inkludera hela det synliga spektrumet över ett stort synfält. Ett brett spektrum innebär att vi måste ta hänsyn till våglängdsberoendet i ljusets brytning i ögat; ögats optik kan därför inte avbilda ett objekt till samma bildläge på näthinnan för alla våglängder, ett fenomen som kallas kromatisk aberration. Vi presenterar här en ny metod för att mäta mängden transversell kromatisk aberration (TCA) över ögats synfält och visar att ögats TCA ökar linjärt med vinkeln ut i synfältet (ungefär 0,21 bågminuter per grad från 543 nm till 842 nm). Dessutom har vi implementerat adaptiva psykofysiska mätmetoder för att kvantifiera effekten av TCA på central och perifer syn. Våra resultat visar att extra inducerad TCA påverkar den perifera förmågan att upptäcka sinusformade randmönster mer än den centrala förmågan att upplösa motsvarande ränder (mer än 0,05 logMAR per bågminut inducerad TCA i periferin jämfört med 0,03 logMAR/bågminut centralt). Vid utvärdering av perifer syn rekommenderar vi att använda sinusformade randmönster med en sned riktning jämfört med synfältsmeridianen. Resultaten som presenteras i avhandlingen har klinisk betydelse för att förbättra den perifera synen och är även viktiga för tekniker som avbildar ögats näthinna. För att begränsa den negativa effekt TCA har på synen ska man undvika att inducera extra TCA, t.e.x. när ögats perifera refraktiva fel korrigeras med glasögon för människor med makula degeneration och centralt synfältsbortfall. Vid avbildning av näthinnan ger ögats TCA förskjutningar mellan bilder i olika våglängder. Därför kan mätningar av TCA, tillsammans med välkontrollerad linjering av pupillens position och efterföljande kompensation, förbättra funktionen hos dessa instrument. / <p>QC 20160511</p>

Introdução: As doenças que envolvem a órbita representam um complexo problema cirúrgico, principalmente as localizadas no ápice orbitário, por onde passam estruturas críticas e um espaço pequeno. O uso do endoscópio por via endonasal para abordagem cirúrgica das lesões do ápice orbitário é uma técnica recente, com poucas citações na literatura. É necessário o estudo de referências anatômicas objetivas que tornem a cirurgia mais segura. Objetivo: Descrever os parâmetros anatômicos utilizados na abordagem cirúrgica endonasal endoscópica, assim como avaliar a concordância entre os hemicrânios do mesmo cadáver e as diferenças conforme o gênero. Casuística e métodos: Estudo anatômico em 30 cadáveres adultos, ambas as fossas nasais foram dissecadas (n=60 hemicrânios). Sob visibilização endoscópica endonasal, realizou-se a dissecção do ápice orbitário. Mensuramos a distância entre a crista etmoidal e o arco coanal para o forame óptico e para a fissura orbitária superior. Os resultados foram registrados na ficha de protocolo do estudo. Resultados: Foram dissecados 30 cadáveres, 60 hemicrânios ou lados. O sexo masculino foi mais prevalente, representando 63,3% dos cadáveres (19/30), enquanto o sexo feminino representou 36,7% (11/30). 43,3% dos cadáveres eram da raça branca (13/30), 20%, pardos (6/30), e 36,7%, negros (11/30). A correlação entre os valores conforme o lado nas seguintes aferições foi observada: Crista etmoidal - Forame óptico, (r=0,748, p=0.0001); Crista etmoidal - Fissura Orbitária Superior (r=0.785, p=0.0001), Arco coanal - Forame óptico (r=0,835, p=0.0001); Arco coanal - Fissura orbitária superior (r=0.820, p=0.0001). Foi obtido um Kappa de 0,444 na avaliação da concordância entre os lados em relação ao posicionamento da artéria etmoidal anterior no forame óptico. Conclusões: A sistematização da abordagem do ápice orbitário facilita seu acesso cirúrgico e a compreensão da anatomia. A crista etmoidal e o arco coanal se mostraram estruturas relevantes e com medidas constantes nos cadáveres estudados. Os valores do coeficiente de correlação de Spearman (r) foram maiores que 0,7, o que revela uma boa correlação entre as medidas dos hemicrânios do mesmo indivíduo. Ao analisarmos a concordância do posicionamento da artéria oftálmica entre os hemicrânios de um mesmo cadáver, podemos observar que a concordância foi moderada, o que representa assimetria e variação de localização da artéria. Ao compararmos as medidas aferidas entre os lados, observou-se que os valores são semelhantes e não houve diferença estatística das distâncias em nenhuma das referências anatômicas propostas para o estudo / Introduction: Diseases that affect the orbit pose a complex surgical challenge, particularly those involving the orbital apex, a small space through which critically important structures course. Endoscopic endonasal approaches to the surgical treatment of orbital apex lesions are a recent technique, with few citations in the literature. Research is still needed into objective anatomic landmarks that can improve surgical safety. Objective: To describe the anatomic landmarks used in endoscopic endonasal surgical approaches and assess agreement between placement of these landmarks in midsagittal sections of cadaver skulls and potential gender differences. Materials and methods: In this anatomic study, the nasal fossae of 30 adult cadavers were dissected (n=60 half-skulls). The orbital apex was dissected under endoscopic endonasal visualization. The distances between the ethmoidal crest and choanal arch to the optic foramen and to the superior orbital fissure were measured and recorded. Results: Overall, 30 cadavers were dissected for a total of 60 half-skulls or sides. The sample was predominantly male (63.3%, 19/30 cadavers); females accounted for the remaining 36.7% (11/30). Regarding skin color, 43.3% of cadavers were white (13/30), 20% were brown (6/30), and 36.7% were black (11/30). The following correlations between measurements according to side were observed: ethmoidal crest to optic foramen, r=0.748 (p=0.0001); ethmoidal crest to superior orbital fissure, r=0.785 (p=0.0001); choanal arch to optic foramen, r=0.835 (p=0.0001); choanal arch to superior orbital fissure, r=0.820 (p=0.0001). Analysis of the agreement of ophthalmic artery location within the optic foramen between skull halves revealed a kappa of 0.444. Conclusions: The approach systematization to the orbital apex will facilitate surgical access and improve understanding of the anatomy. In the cadavers studied in this sample, the ethmoidal crest and choanal arch were relevant structures and exhibited consistent measurements. Spearman correlation coefficients (r) were greater than 0.7, which is indicative of good correlation between measurements obtained in the skull halves of each cadaver. Analysis of the position of the ophthalmic artery in each skull half of the same cadaver revealed moderate agreement, which indicates asymmetry and variation in the location of this artery. Comparison of the measurements obtained in different sides showed similar values, with no statistically significant differences in the distances between any of the proposed anatomic landmarks

In den letzten Jahren erfuhr Thalidomid auf Grund seiner antiinflammatorischen, immunmodulatorischen und antiangiogenetischen Eigenschaften eine "Renaissance". Bei ophthalmologischen Erkrankungen, die durch Gefäßproliferation gekennzeichnet sind, wie bei der diabetischen Retinopathie und der altersbedingten Makuladegeneration (33) oder bei immunpathologische Erkrankungen wie die Uveitis (44) liegen Berichte zu günstigen Effekten vor. Aufgrund der erheblichen Nebenwirkungen bei der systemischen Verabreichung wurde der Versuch einer topischen Applikation angestrebt. Dieser Applikationsweg ist limitiert durch die schlechte Wasserlöslichkeit und hydrolytische Instabilität bei der Formulierung von wässrigen Augentropfen. Zur Erhöhung der intraokularen Bioverfügbarkeit von Thalidomid wurden Cyclodextrine, speziell HP-ß-CD, als Vehikel zur Verbesserung der physiko-chemischen Eigenschaften verwendet. Die experimentelle Arbeit wurde an 21 pigmentierten Kaninchen durchgeführt, die mit Thalidomid-HP-ß-CD haltigen Augentropfen oder mit einer Thalidomidsuspension behandelt wurden. Nach einer Einwirkungszeit von 30, 60, oder 240 Minuten wurden die Augen enukleiert, präpariert und eingefroren. Anschließend wurde mittels HPLC die jeweilige Thalidomid-Konzentration ermittelt. Unsere Arbeit hat signifikante (p / Background: Thalidomide, which has been rediscovered as an angiogenic, immunmodulatory and anti-inflammatory agent might be a treatment option for several eye diseases. The systemic application causes severe side effects. The water-insolubility and hydrolytic instability of thalidomide limits its ocular bioavailability during local application. Hydroxypropyl-ß-cyclodextrin (HP-ß-CD) is a cyclodextrin derivative, which has the ability to form inclusion complexes with lipophilic drugs increasing their stability and solubility. Methods: 21 pigmented male rabbits were treated with 5x50 mul 0,04 % thalidomide/12,5% HP-ß-CD (THA-CD) or 0,04 % thalidomide suspension (THA-SP). 30, 60 or 240 minutes post instillation the animals were sacrificed and the eyes were enucleated. The thalidomide concentrations where determined using HPLC. Results: A significant (p

INTRODUÇÃO: Comparar duas soluções viscoelásticas, ácido hialurônico 1,6%/sulfato de condroitina 4% (DisCoVisc®, Alcon Laboratórios, EUA) e hidroxipropilmetilcelulose 2% (HPMC, Ophthalmos, Brasil), com relação ao desempenho durante a facoemulsificação (FACO) e o implante de lente intraocular. MÉTODOS: Foi realizado um ensaio clínico randomizado, envolvendo 78 olhos (39 pacientes) submetidos à FACO bilateral, por um único cirurgião. Os pacientes foram randomizados para receber DisCoVisc ou HPMC no primeiro olho. O olho contralateral foi operado mais tarde recebendo a outra solução viscoelástica em todas as etapas da cirurgia. Examinadores mascarados realizaram as avaliações pré e pósoperatórias (5, 24 e 48 horas; 7 e 14 dias; 3 e 6 meses), incluindo a medida da pressão intraocular (PIO), espessura cornena central (ECC) e acuidade visual corrigida. A densidade endotelial foi realizada no pré-operatório e ao final do seguimento (6 meses). Variáveis intraoperatórias incluíram medidas da quantidade total de solução viscoelástica, tempo de ultrassom durante a FACO e tempo para a retirada completa da solução do olho. RESULTADOS: A densidade endotelial foi estatisticamente superior com DisCoVisc (2.214 ± 372 cel/mm2) do que com HPMC (2.032 ± 460 cel/mm2) ao final do seguimento (p = 0,001). Uma redução média de 7% e de 15%, respectivamente. Não houve diferença estatística entre as soluções viscoelásticas com relação a densidade da catarata (p = 0,363) e o tempo de ultrassom (p = 0,456). O tempo de aspiração da HPMC (0,22 ± 0,09 min) foi significativamente maior que o DisCoVisc (0,17 ± 0,06 min) (p = 0,001) e a quantidade de viscoelástico utilizada foi maior com a HPMC (1,35 ± 0,20 ml) do que com DisCoVisc (0,89 ± 0,11 ml) (p < 0,001). Não houve diferença estatisticamente significativa entre as soluções quanto a ECC e a PIO durante o seguimento. CONCLUSÕES: A densidade endotelial ao final do estudo foi significativamente maior com o uso de DisCoVisc, o que pode representar uma melhor proteção endotelial. Foi necessário uma menor quantidade de DisCoVisc e um tempo de aspiração menor durante a FACO com essa solução viscoelástica / INTRODUCTION: To compare two ophthalmic viscosurgical devices (OVDs), 1.6% hyaluronic acid/4% chondroitin sulfate (DisCoVisc®, Alcon Lab., USA) and 2% hydroxypropylmethylcellulose (HPMC, Ophthalmos, Brazil), in terms of their overall performance during phacoemulsification (PHACO) and intraocular lens implantation. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that underwent PHACO by the same surgeon. Patients were randomly assigned to receive DisCoVisc or HPMC on the first eye. The other eye was treated later and received the other OVD. Masked examiners measured intraocular pressure (IOP), central corneal thickness (CCT) and best-corrected visual acuity. The corneal endothelial cell density was measured at baseline and at 6 months postoperatively. Intraoperative variables include the total amount of the OVD, ultrasound and washout times. RESULTS: Corneal endothelial cell density was significantly higher with DisCoVisc (2.214 ± 372 cell/mm2) than HPMC (2.032 ± 460 cell/mm2) at the end of follow-up (p = 0.001). A mean reduction of 7% and 15%, respectively. There were no statistically significant differences between OVDs in terms of cataract density (p = 0.363) or ultrasound time (p = 0.456). Regarding washout time, it took longer to remove HPMC (0.22 ± 0.09 min) than DisCoVisc (0.17 ± 0.06 min) (p = 0.001), and the amount of viscoelastic material used was greater with HPMC (1.35 ± 0.20 ml) than DisCoVisc (0.89 ± 0.11 ml) (p < 0.001). There were no statistically significant differences between the two OVDs regarding CCT or IOP measurements at any point in time. CONCLUSION: The corneal endothelial cell loss was significantly less with DisCoVisc than HPMC, which can improve corneal endothelium protection. DisCoVisc was easier to remove after IOL implantation and fewer amounts were necessary during PHACO

Det ingår i ögonsjuksköterskans arbetsuppgifter att mäta synfunktioner och att informera om undersökningsresultat. Det kan kännas svårt att lämna information om att patientens syn inte uppfyller gällande synkrav för körkort, då informationen kan påverka patientens livskvalité negativt. Syftet med studien var att undersöka ögonsjuksköterskans erfarenheter av att informera patienten om att synkraven för körkort inte uppnås. En intervjustudie genomfördes där nio ögonsjuksköterskor medverkade. En kvalitativ innehållsanalys utfördes sedan på insamlad data. Tre kategorier framkom: personcentrering vid informationstillfället, patientreaktioner påverkar informationstillfället samt omständigheter påverkar informationstillfället. Resultatet visade att ögonsjuksköterskorna var djupt involverade i körkortsärenden och de flesta kände ansvar att informera patienten när synkraven för körkort inte uppnåddes. Genom ett personcentrerat förhållningsätt försökte ögonsjuksköterskorna skapa de bästa förutsättningarna för att göra patienten delaktig. Informationstillfället påverkades av patientens reaktioner samt andra omständigheter så som vilken diagnos patienten hade och vilka konsekvenser informationen skulle kunna innebära för patienten. Det visade sig vara av betydelse att ögonsjuksköterskorna hade goda kunskaper i handhavande och bedömningar i körkortsfrågor varför sådan utbildning rekommenderas. Oftalmologiska verksamheter bör avsätta tillräckligt med tid till dessa patientbesök då även detta visade sig vara viktigt. För att ytterligare förbättra den oftalmologiska omvårdnaden är det angeläget att i kommande studier belysa patientens upplevelse av informationstillfället. / It is part of the ophthalmic nurse’s duties to measure functions relating to sight and to report outcomes of such examinations. It can feel difficult to deliver information about sight no longer being sufficient to fulfil the requirements for a drivers’ licence, as such information may negatively impact quality of life. The purpose of this study was to examine the experiences of ophthalmic nurses in informing the patients that their vision no longer fulfils the requirements for holding a drivers’ license. The study comprised interviews in which nine nurses participated. A qualitative content analysis of the collected data was conducted. Three categories emerged: person-centering the delivery of information, reactions of patient affect the delivery of information and circumstances affect the delivery of information. The results show that ophthalmic nurses were deeply involved in drivers’ licence cases, and most of them felt a responsibility to inform patients when their sight fell short of requirements for drivers’ license. By means of a person-centred approach, nurses attempted to create the best conditions in which to involve patients. The time of information delivery was impacted by the reactions of patients, as well as other circumstances such as the type of patient diagnosis and the consequences this information might have for the patient. It was deemed significant that ophthalmic nurses had good knowledge of process and judgment in matters of drivers’ licenses, why such education is recommended. Sufficient time for those meetings was shown to be important. In order to further improve ophthalmic caring, it is important to also highlight the patients’ experience at the time of information.

A prematuridade está associada com uma alta incidência de complicações no período neonatal sendo uma das mais importantes a retinopatia da prematuridade (ROP) e suas seqüelas: ambliopia, estrabismo, cegueira. Estudos indicam que alterações no fluxo sanguíneo retiniano estão envolvidas na patogênese da ROP causando um crescimento vascular anormal dos vasos da retina. A análise por ultrassonografia Doppler (USD) dos vasos da órbita permite uma estimativa do fluxo sanguíneo local. Objetivo: estabelecer valores de velocidade do fluxo sanguíneo e de seus índices na artéria oftálmica em recém-nascidos pré-termos de muito baixo peso (RNPTMBP) "saudáveis" do nascimento até a alta. Metodologia: Coorte de recémnascidos pré-termos de muito baixo peso, nascidos na UTI Neonatal do Hospital de Clínicas de Porto Alegre (HCPA) no período de agosto de 2006 a abril de 2008. Foram obtidas as medidas de velocidade sistólica (VS), velocidade diastólica (VD), índice de pulsatilidade (IP) e índice de resistência (IR) da artéria oftálmica por USD nas primeiras 24 horas de vida, com sete dias, com 28 dias e no momento da alta hospitalar. Incluímos RN com peso de nascimento abaixo de 1500 gramas e idade gestacional <= 32 semanas, sem ROP graus 2 e 3, e sem hemorragia peri-intraventricular (HPIV) graus 3 e 4. A análise estatística foi realizada utilizando teste t pareado e análise de variância (ANOVA). Resultados: Foram estudados 46 RNPTMBP (92 olhos examinados). No primeiro exame os valores em média do fluxo sanguíneo e índices da artéria oftálmica foram: VS 18,42 cm/s; VD 6,22 cm/s; IP 1,40; IR 0,70 e com 28 dias de vida: VS 22,38 cm/s; VD 6,97 cm/s; IP 1,51; IR 0,75 (p<0.001). Não houve diferença significativa entre as medidas obtidas no olho direito e no esquerdo, e entre primeiro e segundo exames. Da mesma forma, as medidas obtidas com 28 dias de vida foram similares aquelas no momento da alta hospitalar. Conclusão: Ocorre uma elevação nas velocidades de fluxo sanguíneo da artéria oftálmica do período pós-natal até a alta em recémnascidos pré-termo de muito baixo peso de nascimento "saudáveis". Os índices calculados não mostraram diferença estatisticamente significativa. O conhecimento deste padrão normal poderá auxiliar na prevenção e no screening para detecção de doença ocular. / Retinopathy of prematurity (ROP) is a multifactorial disease of very low birth weight infants (VLBWI), and the vascular component has an important role. Evaluation of retinal blood flow is essential to understand its physiopathology. Objective: To establish normal blood flow velocity and Doppler indices of the ophthalmic arteries from birth to discharge of "healthy" VLBWI.Methods: Cohort study of newborns with birth weight < 1500 grams and gestational age <= 32 weeks born at our Hospital from August 2006 to April 2008. Doppler ultrasound exam was done in both eyes in the first 24 hours after birth, at 7 and 28 days old, and at hospital discharge for systolic velocity (SV), diastolic velocity (DV), pulsatility index (PI) and resistance index (RI). We excluded those with ROP stage 2 and higher, periintraventricular hemorrhage grades 3 and 4, and death. Statistical analysis was performed using paired t test and repeated measures ANOVA. The study was approved by our Ethic Committee.Results: 46 VLBWI (92 eyes) were studied. First exam: SV 18.40 cm/s; DV 6.23 cm/s; PI 1.41; RI 0.70 and 28 days after birth: SV 22.30 cm/s; DV 6.77 cm/s; PI 1,50; RI 0.75 ( p<0.001). Both eyes had similar Doppler findings at all examined moments. SV and DV increased significantly from the first 24 hours to hospital discharge. There were no significant changes during the study period in PI and RI. Conclusions: There was a increase of SV and DV retinal blood flow from birth to hospital discharge in "healthy" VLBWI; other Doppler measurements were stable. Knowing this normal pattern will provide prevention and screening for ROP.