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- ItemAcesso aberto (Open Access)Análise de parâmetros de segurança e novas indicações em vitrectomia via pars plana de pequeno calibre(Universidade Federal de São Paulo (UNIFESP), 2016-02-26) Machado, Leonardo Martins [UNIFESP]; Maia, Mauricio [UNIFESP]; http://lattes.cnpq.br/6377105744231862; http://lattes.cnpq.br/1079630547050748; Universidade Federal de São Paulo (UNIFESP)Objectives: The present study was developed in three parts that aimed the following: 1 ? To measure and compare the impact pressure values of the air jet from vitrectomy infusion cannulas of three different sizes (20, 23 and 25 gauge). 2 ? To correlate pre and intraoperative findings with postoperative results in patients undergoing small gauge pars plana vitrectomy (23 gauge) to treat epiretinal membranes with the double peeling technique. 3 ? To determine the efficacy and safety of the treatment for symptomatic posterior vitreous detachment through small gauge pars plana vitrectomy (23 gauge) in pseudophakic patients with multifocal intraocular lens. Methods: The first study consisted in an experimental research conducted in an engineering laboratory, in which the impact pressure of the air jet of the infusion cannulas was measured using a manual transducer and the values found were compared between groups (considering the 20 gauge the control group). In the following retrospective study, patients previously submitted to 23 gauge pars plana vitrectomy with removal of both the epiretinal membrane and the internal limiting membrane had data regarding preoperative (best-corrected visual acuity, optical coherence tomography, fluorescein angiography and fundus autofluorescence) and intraoperative evaluation (behavior of the internal limiting membrane after the epiretinal membrane peeling with separation in three groups: A ? Absent; B ? Intact; C ? Fragmented) collected to observe possible parameters related to the visual and anatomic outcomes. The last study was a prospective case series in which patients with multifocal intraocular lenses and complaining of symptoms related to posterior vitreous detachment were submitted to small gauge pars plana vitrectomy. Data regarding best-corrected visual acuity and a questionnaire of visual function related to quality of life were compared between the pre and postoperative periods. Possible intra and postoperative complications were also observed. Results: In the first study, the impact pressure measurements were similar between the 20 and 23 gauge groups, for all the infusion pressure values, but the 25 gauge group presented lower values. In the second study, patients with hiperautofluorescent exams were more prone to an increased retinal thickness reduction postoperatively. Patients in group A tended to have higher retinal thickness values. The third study showed a significant improvement in the postoperative visual acuity and questionnaire values. There were no complications in the intra and postoperative periods. Conclusions: The current line of research in the usage of small gauge pars plana vitrectomy resulted in the following conclusions: 1 ? The air jet impact pressure values were similar between 20 and 23 gauge instruments and both showed higher results than the smaller cannulas (25 gauge). 2 ? Patients with a predominant hiperautofluorescent signal showed a higher amount of retinal thickness reduction postoperatively. A system for intraoperative classification of the internal limiting membrane was proposed and may be useful for future surgical studies. 3 ? 23 gauge pars plana vitrectomy is a safe and effective method to reduce visual disturbances associated to symptomatic posterior vitreous detachment in patients with previous multifocal intraocular lens implants, due to the findings of this study, and may be useful for the clinical setting.
- ItemAcesso aberto (Open Access)Corantes vitais em cromovitrectomia(Conselho Brasileiro de Oftalmologia, 2009-12-01) Dib, Eduardo [UNIFESP]; Rodrigues, Eduardo Buchele [UNIFESP]; Maia, Maurício [UNIFESP]; Meyer, Carsten H.; Penha, Fernando Marcondes [UNIFESP]; Furlani, Bruno de Albuquerque [UNIFESP]; Costa, Elaine de Paula Fiod [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); University of Bonn Department of OphthalmologyThe aim of this article is to present the current data with regard to the application of vital dyes during vitreoretinal surgery, chromovitrectomy, as well as to overview the current literature regarding the properties of dyes, techniques of application, indications and complications in chromovitrectomy. A large body of published research has recently addressed the toxicity profile of indocyanine green for chromovitrectomy. Experimental data demonstrate dose-dependent toxicity of indocyanine green to various retinal cells. Newer generation vital dyes for chromovitrectomy include trypan blue, patent blue, triamcinolone acetonide, infracyanine green, sodium fluorescein, bromophenol blue, fluorometholone acetate and brilliant blue. Novel instruments may enable a selective painting of preretinal tissues during chromovitrectomy. This review suggests that the field of chromovitrectomy represents an expanding area of research. The first line agents for internal limiting membrane staining in chromovitrectomy are indocyanine green, infracyanine green, and brilliant blue. Patent blue, bromophenol blue and trypan blue arose as outstanding biostains for visualization of epiretinal membranes. Novel dyes available for chromovitrectomy deserve further investigation.