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- ItemAcesso aberto (Open Access)Avaliação clínica e incidência de endoftalmite infecciosa e não-infecciosa após injeção intravítrea de acetonida de triancinolona(Conselho Brasileiro de Oftalmologia, 2006-12-01) Magalhães, Érika; Nehemy, Patrícia; Santos, Daniel Vítor De Vasconcelos; Fujji, Gildo [UNIFESP]; Nehemy, Márcio Bittar; Universidade Federal de Minas Gerais Faculdade de Medicina; UFMG; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of 4 mg of triamcinolone acetonide (Kenalog® - 40 mg/ml; 0.1 ml) and to evaluate distinguishing characteristics that may assist the clinician in differentiating these entities. Design: Observational nonconcurrent prospective study. METHODS: Charts of 121 patients (154 injections) who consecutively underwent intravitreal injection of triamcinolone acetonide to treat various chorioretinal diseases were evaluated. All procedures were performed in an operating room with careful antiseptic protocol. RESULTS: Two eyes (1.29%/injection and 1.65%/patient) presented a noninfectious endophthalmitis characterized by decreased vision, hyperemia, hypopyon and vitreous inflammatory reaction, on the first day after the injection. These eyes were treated with topical and subconjunctival corticosteroids with complete resolution of the inflammatory reaction. CONCLUSION: In the present case series, no case of infectious endophthalmitis occurred. Despite being relatively rare, noninfectious endophthalmitis can be associated with intravitreal injection of triamcinolone simulating an infectious endophthalmitis. In selected cases, the differential diagnosis can be made solely by clinical evaluation.
- ItemAcesso aberto (Open Access)Avaliação das alterações precoces na coróide e esclera ocorridas em coelhos hipercolesterolêmicos: estudo histológico e histomorfométrico(Conselho Brasileiro de Oftalmologia, 2009-02-01) Torres, Rogil José de Almeida [UNIFESP]; Maia, Maurício [UNIFESP]; Noronha, Lucia; Farah, Michel Eid [UNIFESP]; Luchini, Andréa; Brik, Décio; Muccioli, Cristina [UNIFESP]; Précoma, Dalton Bertolin; Universidade Federal de São Paulo (UNIFESP); Universidade Federal dHospital de Olhos Oeste Paulistae São Paulo Serviço de Cirurgia Vitreorretiniana; Pontifícia Universidade Católica do Paraná Departamento de Patologia; Centro Oftalmológico de Curitiba; Hospital Angelina Caron; Pontifícia Universidade Católica do Paraná Departamento de CardiologiaPURPOSE: To demonstrate experimentally, by means of histological and histomorphometric examinations, the sclera and choroid degenerative alterations, which take place at an early stage due to a hypercholesterolemic diet. METHODS: New Zealand rabbits were divided into two groups: CG (control group) of 6 rabbits (6 eyes) received a regular diet for 6 weeks; G1, of 12 rabbits (12 eyes), was first fed a 1% cholesterol diet (Sigma-Aldrich) for 2 weeks and then from the 14th day on a 0.5% cholesterol diet (Sigma-Aldrich). The eyes underwent a histological analysis, stained with hematoxiline-eosine, and a morphometric examination. The histomorphometric analysis was performed in the posterior region, adjacent to the optic disk, and in the peripheral region. RESULTS: The CG presented a mean sclera and choroid thickness of 228.61 ± 31.71 micrometers in the peripheral region, while the thickness in the posterior region was approximately 246.07 ± 25.66 micrometers. In G1, these values were 303.56 ± 44.21 micrometers in the peripheral region and 295.59 ± 62.59 in the posterior region. There was a statistically significant difference in the sclera and choroid thickness between the groups in the peripheral region (p<0.001); however, this difference did not occur in the posterior region (p=0.250). The large number of histiocytes and collagen fibers accounted for the increase of G1 wall thickness in relation to CG. CONCLUSION: This study demonstrated that the hypercholesterolemic diet in rabbits induces a fast increase in the choroid and sclera thickness, mainly due to the increase in the number of histiocytes and collagen fibers.
- ItemAcesso aberto (Open Access)Transscleral diode laser retinopexy in retinal reattachment surgery(Conselho Brasileiro de Oftalmologia, 2004-02-01) Goncalves, Joao Carlos de Miranda [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: Transscleral diode retinal photocoagulation (diopexy) is becoming an accepted technique in the treatment of selected retinal diseases. The objective of this study is to evaluate diopexy technique in the production of adhesive chorioretinal lesions during the surgical treatment of the rhegmatogenous retinal detachment. METHODS: 25 patients with rhegmatogenous retinal detachment were enrolled in a prospective clinical-surgical study to evaluate the technique of transscleral diode laser photocoagulation to obtain adhesive chorioretinal lesions during retinal reattachment surgery. The surgery consisted of the placement of an exoplant silicon to produce a buckle effect combined with a drainage of subretinal fluid in most cases. RESULTS: By a mean follow-up of 10 months, 21 of 25 eyes had their retinas reattached after only one surgery with diopexy used in all cases. CONCLUSION: Transscleral diode laser photocoagulation was a technically easy, controlled, effective, reproducible and safe means of obtaining chorioretinal adhesion in retinal reattachment surgery.
- ItemAcesso aberto (Open Access)Vasculopatia polipoidal idiopática da coróide(Conselho Brasileiro de Oftalmologia, 2002-06-01) Andrade, Rafael Ernane [UNIFESP]; Branco, André Castelo [UNIFESP]; Costa, Rogerio Alves [UNIFESP]; Uno, Fausto [UNIFESP]; Nakanami, Maurício [UNIFESP]; Guia, Tércio [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To describe the role of the optical coherence tomography, fluorescein and indocyanine green angiography findings in the diagnosis of idiopathic polypoidal choroidal vasculopathy (IPCV). Methods: A series of four eyes of three patients thought to have IPCV were examined and evaluated by optical coherence tomography, fluorescein and indocyanine green angiographies. Results: Fluorescein angiography was highly important for the diagnosis only in case 1. Indocyanine green angiography showed a branching network of the vessels with marginal vascular dilatations in all cases. Optical coherence tomography showed hemorrhagic detachment of the retinal pigment epithelium contiguous with the anterior delimitation of the polypoidal elements in two cases. Conclusion: The association of clinical manifestations with fluorescein and indocyanine green angiographies and optical coherence tomography can be useful in the differential diagnosis of exudative maculopathies, particularly IPCV with serohemorrhagic manifestations.
- ItemAcesso aberto (Open Access)Vasculopatia polipoidal idiopática da coróide: aspectos extremos da evolução da doença em um paciente - Relato de caso(Conselho Brasileiro de Oftalmologia, 2005-04-01) Barreira, Ieda Maria Alexandre [UNIFESP]; Aragão, Ricardo Evangelista Marrocos De; Vale, Ariosto Bezerra [UNIFESP]; Holanda Filha, Joana Gurgel; Universidade Federal de São Paulo (UNIFESP); Universidade de Regensburg; Universidade Federal do Ceará Hospital Universitário Walter Cantídeo; Universidade Federal do Ceará Faculdade de Medicina; Hospital de Olhos Dr. René Barreira; Universidade Federal do Ceará Hospital Universitário Walter Cantídeo Serviço de OftalmologiaTo describe a case of idiopathic polypoidal choroidal vasculopathy and the role of indocyanine green angiography findings in the differential diagnosis of exsudative maculopathies, particularly with age-related macular degeneration, and the extreme evolution of idiopathic polypoidal choroidal vasculopathy in one patient. A patient with vitreous hemorrhage was examined and evaluated by fluorescein and indocyanine green angiographies in the right eye and with hemorrhagic detachment of the retinal pigment epithelium in the left eye. The patient was treated by pars plana vitrectomy in the right eye which was followed by retinal detachment and vision loss. In the left eye an involution of the hemorrhagic detachment of the retinal pigment epithelium with preservation of the vision was seen. The idiopathic polypoidal choroidal vasculopathy seems to be a distinct clinical entity that can and should be differentiated from age-related macular degeneration and the fluorescein and indocyanine green angiographies should be performed to evaluate the choroidal vasculature in an attempt to establish a more definitive diagnosis. Particularly in this case the entity had an extreme clinical course in the patient.