Navegando por Palavras-chave "Ophthalmology"

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    Aspectos Clínicos, Inflamatórios E Qualidade De Vida Da Doença Do Enxerto Versus Hospedeiro Ocular
    (Universidade Federal de São Paulo (UNIFESP), 2018-09-27) Abud, Tulio Batista [UNIFESP]; Sousa, Luciene Barbosa De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This Thesis Focuses In A Broad Evaluation Of Ocular Graft Versus Host Disease (Gvhd), Describing Clinical Aspects, Inflammatory Mechanisms, A New Therapy Option And Quality Of Life. Three Clinical Studies Were Performed (4.1), (4.2) And (4.3). Clinical Study (4.1). Objective: To Investigate The Levels Of Neutrophil Enzymes In Tears Washes Of Patients With Ocular Gvhd And Patients With No Disease. Methods: Tear Washes Were Analyzed Using Elisa And Correlations Between The Groups Were Performed For Each Enzyme Analyzed. Results: Concentrations Of Four Enzymes With Neutrophilic Source [Neutrophil Elastase (En), Myeloperoxidase (Mpo) And Metalloproteinases (Mmp"S) 8 And 9] Were Statistically Greater In Patients With Ocular Gvhd As Compared With Controls. In Addition, There Was Strong Correlation Between Them. Conclusion: Neutrophil Activity Is Present In Tears Washes Of Ocular Gvhd, Especially Because Of The Enzyme Neutrophil Elastase. Clinical Study (4.2). Objectives: To Assess The Vision-Related Quality Of Life
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    Avaliação da via não formadora de imagem em pacientes com glaucoma: resposta pupilar à luz e distúrbios do sono
    (Universidade Federal de São Paulo (UNIFESP), 2016-08-30) Gracitelli, Carolina Pelegrini Barbosa [UNIFESP]; Paranhos Junior, Augusto [UNIFESP]; http://lattes.cnpq.br/8476823547757955; http://lattes.cnpq.br/9678457609899692; Universidade Federal de São Paulo (UNIFESP)
    This study was conducted to evaluate the non-forming image pathway in patients with glaucoma: analysis of pupillary reflex and sleep disturbance. This study was divided into five steps with the following purposes: 1. To assess the integrity of intrinsically photosensitive retinal ganglion cells (ipRGCs) using the pupillary light reflex (PLR). 2. To use polysomnography and the PLR to evaluate ipRGCs function. 3. To evaluate daytime sleepiness using the Epworth sleepiness scale (ESS) and to correlate the ESS score with ipRGCs function based on polysomnography and the PLR test. 4. Make a critical analysis of sleep disturbances in patients with glaucoma. 5. To examine the relationship between relative afferent pupillary defects and macular structural damage measured by macular thickness and macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with glaucoma. Methods: This was a cross-sectional study. In the first moment, in order to design study numbers 1, 2, and 3, we included 76 eyes of 38 patients with primary open angle glaucoma and 36 eyes of 18 controls. For study numbers 1, 2, and 3, all patients had PLR using the Ganzfeld system. To preferentially stimulate ipRGCs, we used a 1 second 470 nanometers flash with a luminance of 250 cd/m2. Standard automated perimetry (SAP), and high-definition optical coherence tomography (OCT) were performed in all patients. In addition, polysomnography was performed and the ESS was administered to all patients. For study number 4, a literature review was performed about sleep disorders and ipRGCs function in glaucoma. For study number 5, we included 106 patients with primary open angle glaucoma and 85 controls. All subjects involved in study number 5 underwent standard automated perimetry and optic nerve and macular imaging using OCT. Pupil responses were assessed using an automated pupillometer which records the magnitude of relative afferent pupillary reflex. Results: 1. An association was observed between the average retinal nerve fiber layer (RNFL) thickness, as measured by OCT, and the sustained pupillary response to the blue flash (R2 = 0.403; p = 0,024). 2. The glaucoma patients had significantly lower average total sleep time, sleep efficiency and minimum oxyhemoglobin saturation, compared to the healthy subjects (p = 0.008, p = 0.002 and p = 0.028, respectively). Additionally, glaucoma patients had significantly higher arousal durations after falling asleep and more periodic limb movements (p = 0.002 and p = 0.045, respectively). There was an inverse correlation between rapid eye movement (REM) latency and peak of the pupillary response to the blue flash (p = 0.004). The total arousals were inversely correlated with the sustained blue flash response (p = 0.029). 3. The mean ESS score of the glaucoma patients was significantly higher than that of the control group (13.10 ± 5.14 and 9.10 ± 3.73, respectively, p = 0.029). Significant correlations were observed between the ESS score and the following polysomnographic parameters: sleep efficiency, arousal duration after falling asleep, arousals, and arousal index (p = 0.002, p < 0.001, p = 0.039, and p = 0.013, respectively). Regarding the PLR test, significant correlations were observed between the EES score and the peak and sustained responses to the blue flash with a luminance of 250 cd/m2. 4. According to previous studies, there was a correlation between glaucomatous disease and sleep disorders. 5. There was a fair correlation between RAPD score and asymmetric macular structural damage measured by intereye difference in mGCIPL thickness (R2 = 0.285, P < 0.001). The relationship between RAPD score and intereye difference in macular thickness was weaker (R2 = 0.167, P < 0.001). Intereye difference in RNFL thickness (R2 = 0.350, P < 0.001) and SAP mean deviation (R2 = 0.594, P < 0.001) had a stronger association with RAPD scores compared with the intereye difference in mGCIPL and macular thickness. Conclusion: 1. This study showed a correlation between the mean RNFL thickness and the pupillary light response. 2. This study demonstrated that decreased ipRGCs function caused by glaucoma affected not only the pupillary response but also the sleep quality. 3. Decreased ipRGCs function caused by glaucoma is associated with exacerbated sleep disorders, as assessed by the ESS and polysomnography, and impaired PLR. 4. With previous studies and with our results there is strong evidence that glaucoma leads to RGC death, including ipRGCs death and this can affect not only the image-forming but also the non-image-forming visual systems. 5. Objective assessment of pupillary responses using a pupillometer was associated with asymmetric macular structural damage in patients with glaucoma.
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    Avaliação de impacto da capacitação no departamento de oftalmologia e ciências visuais da UNIFESP: um estudo de caso
    (Universidade Federal de São Paulo (UNIFESP), 2016-10-31) Santos, Maria Jose Conceição dos [UNIFESP]; Scarpi, Marinho Jorge [UNIFESP]; http://lattes.cnpq.br/4849663856118153; http://lattes.cnpq.br/4503021025416133; Universidade Federal de São Paulo (UNIFESP)
    The aim of this study was to investigate and map the impact of training activities and training with the needs raised by the Federal University of São Paulo. The research method was focused on investigating the perception of the servers on the offered courses. In this sense the case study, it was through applying descriptive questionnaire, quantitative, semi-structured with 22 closed multiple choice questions, applied to the population and sample of 20 servers, of both sexes and all education levels, classes D and E and various functions that make up the framework of the Career Plan of Positions Technical and administrative Education, crowded in the Academic Department of Ophthalmology and Visual Sciences at UNIFESP. Method - The research instrument was limited to a population survey study, servers who performed or were conducting training and / or training courses in the period 2012-2015 or nearing completion. The survey was conducted in the workplace, in the period 12-24 March 2016. The results were based on analysis of the survey responses, extracted documentary research site and page of the University, Dean of Personnel Management, Department of Development and Personnel Management, Training Committee, Campus Training Subcommittee São Paulo and Supervision Internal Commission of Career Plan of Positions Technical and administrative Education - UNIFESP. Most respondents in this class and, higher level of formal education in the institution over 20 years and female, have over the training requirement of the position in the institution. The degree of satisfaction with the effectiveness of the Training Program and Impact of Training Action, observed the responses of technicians and managers that the program does not meet or meets very little to individual and institutional needs. Conclusion - It was observed in this case study, after analysis, the training program sometimes meets the individual and institutional needs, perhaps for lack of an assessment tool impact of actions taken. The perception of the servers as the courses offered at the institution is dissatisfaction and demotivation, understanding that although more than ten of the conquest of Career Plan - PCCTAE, little has evolved as the management strategies to address the dysfunctions of training. You can see that the development is not in line with the National Plan for Professional Development (PNDP), Institutional Development Plan (IDP), Development Plan members Career (CIDP) and Multi-Year Plan (PPA).
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    Avaliação de um programa para computador de mão no auxílio ao ensino de oftalmologia para estudantes de medicina
    (Sociedade Brasileira de Oftalmologia, 2010-12-01) Pinto, Vladimir Camelo [UNIFESP]; Costa, Thiago Martini da [UNIFESP]; Grottone, Gustavo Teixeira [UNIFESP]; Schor, Paulo [UNIFESP]; Pisa, Ivan Torres [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: In the last decade the handheld computers have been popularized among health professionals, on the USA, for instance, among 60-70% of medical students already use them. Make clinical information available on these devices can aid teaching medical practices, however, the way they are structured may influence students' satisfaction and learning. The purpose of this paper is to present MDFluxo evaluation, a program developed in handheld computers to aid ophthalmology teaching. METHODS: The program was developed with structured flowcharts extracted from The Ophthalmology Guide book. The assessment was placed comparing 20 medical under-graduating students' performance solving clinical cases aided by the program, a book, or no material. RESULTS: The results shown that the performance of students in the evaluation with book was equivalent to MDFluxo in etiology (p <0.01) and conduct (p <0.05) on clinical cases solving and better performance than without the use any material. CONCLUSION: On MDFluxo user satisfaction evaluation 82.5% of students approved it's use on clinical case solving.
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    Ceratocone, crosslinking e fatores moduladores da biomecânica da córnea
    (Universidade Federal de São Paulo (UNIFESP), 2021) Torres Netto, Emilio De Almeida [UNIFESP]; Gomes, Jose Alvaro Pereira [UNIFESP]; Universidade Federal de São Paulo
    Objectives This thesis aims to present new perspectives involving the corneal biomechanical properties and to optimize the application of corneal crosslinking (CXL) in the treatment of keratoconus (KC). Secondary objectives are: 1. Estimate the prevalence of keratoconus in a pediatric population; 2. Establish mechanical forces that patients with keratoconus apply to their eyelids during the act of eye rubbing; 3. Describe the first association of late keratoconus progression after estrogen regulator therapy; 4. Compare high-order aberrations in keratoconus eyes using the Scheimpflug and double Scheimpflug Placido systems; 5. Assess the biomechanical characteristics of the human cornea and study the role of the Bowman layer with optical coherence elastography; 6. Study whether the Bowman's layer contributes to the biomechanical properties of the cornea clinically; 7. Estimate the biomechanical impact of transepithelial CXL assisted by iontophoresis (I-CXL); 8. Emphasize the importance of CXL modulating factors, especially of transepithelial protocols; 9. Compare functional results of CXL using standard, accelerated treatment and with increased fluency; 10. Develop and evaluate an unprecedented CXL algorithm to treat ultra-thin corneas; 11. Investigate target genes and identify molecular pathways that may be related to biomechanical stability after CXL. Methods The corresponding methodology for each study follows. 1. Prospective, crosssectional, observational and multicenter study, which collected data from pediatric patients from 6 to 21 years of age, using a Scheimpflug rotational corneal tomography system in order to estimate KC prevalence in Saudi Arabia; 2. Fifty-five patients with a clinical and topographic diagnosis of KC were prospectively asked to perform their individual eye rubbing movement on a high-precision scale. The type of rubbing movement and the applied force, represented in newtons (N), were recorded and analyzed. 3. Describe the first case of late keratoconus progression in a 49-year-old woman after the use of tibolone estrogen activity regulator. 4. Keratoconus patients were evaluated sequentially by Scheimpflug and dual Scheimpflug–Placido devices. Differences, correlations, and agreement between values for high order aberrations (HOAs) were analyzed. 5. Human corneal donor buttons were obtained, and Descemet’s membrane and endothelium were removed. In some corneas, Bowman’s layer was ablated by a 20 μm stromal excimer laser ablation. A spectral-domain optical coherence tomography scan was obtained, and displacements were analyzed by optical flow tracking. 6. Human corneas were obtained after endothelial removal for Descemet's membrane endothelial keratoplasty (DMEK). In some corneas, the Bowman layer was removed by a 20 μm excimer laser ablation. A 110 μm thick anterior lamella was obtained and then biomechanical properties were analyzed by twodimensional stress-strain extensometry. 7. One hundred and twelve porcine corneas were divided into 7 groups and analyzed: groups 1, 2 and 3 received standard CXL with epithelial removal (S-CXL) and 30 minutes of irradiation with ultraviolet A (UV-A) at 3mW/cm2, 10 minutes at 9mW/cm2, or were not irradiated (controls). Groups 4, 5, 6 and 7 received I-CXL for 60 minutes at 1.5mW/cm2, 30 minutes at 3mW/cm2, 10 minutes at 9mW/cm2 or were not irradiated (controls). Biomechanical properties were analyzed by one-dimensional stress-strain extensometry. 8. Review and clarification on the estimated efficiency of crosslinking procedures, especially during transepithelial protocols. 9. CXL was performed using three protocols with epithelial removal: Dresden (3mW/cm2 for 30 minutes), accelerated with equivalent total fluence (9mW/cm2 for 10 minutes) and accelerated with increased total fluence (30mW/cm2 for 4 minutes). Efficacy measurements were evaluated 12 months after treatment with Scheimpflug images and included changes in maximum keratometry (Kmax), better corrected distance visual acuity (BCVA), other keratometry, pachymetry, keratoconus indexes, astigmatism, asphericity, refraction and high-order aberrations. 10. 52 eyes with progressive keratoconus and stromal thickness below 400 µm were included. With the ‘sub400’ algorithm developed to treat ultra-thin corneas by adapting fluence individually, corneas were treated without alternative corneal thickening solutions. The study evaluated the efficiency of the new treatment in halting the progression of keratoconus up to 12 months after treatment. 11. Fifteen corneas from eight rabbits were analyzed with corneal transcriptome by cDNA sequencing (RNA-seq) before and after treatment with CXL Results The results are presented in the same order. 1. Five hundred and twenty two patients (1044 eyes) in Saudi Arabia, with a mean age of 16.8 ± 4.2 years, were evaluated. The diagnostic agreement between examiners was 0.81 (almost perfect, according to Cohen kappa coefficient), with a discrepancy in only nine cases. Final KC prevalence of 4.79% (95% CI 2.96 to 6.62) or 1:21 individuals. 2. Three different types of rubbing eyes were detected. Eye rubbing with the fingertip was more frequent (51%), followed by eye rubbing with the knuckle (44%) and with the fingernail (6%). Average applied forces were different: knuckle type eye rubbing applied significantly more force (9.6 ± 6.3N) to the eyelids than with the fingertips (4.3 ± 3.1N) or fingernail (2 , 6 ± 3.3N) (p <0.001 and p = 0.016, respectively). 3. Excessive and late bilateral progression of keratoconus occurred in previously stable eyes in a 49-year-old patient after therapy with selective regulator of tissue estrogenic activity (STEAR). 4. Fifty eyes from 50 patients were evaluated. Trefoil, spherical aberration, and total RMS were significantly different between groups (P < .05). 5. Vertical corneal strain distribution was negative in the anterior and positive in the posterior cornea, indicating simultaneous corneal compression and expansion, respectively. Bowman’s layer caused minor localized differences in corneal strain distribution. 6. No significant differences were observed between the flaps with or without the Bowman layer in the elastic module, neither during preconditioning (874±70 vs 937±106 kPa, p=0.086), nor in destructive tests until rupture (1.03±0.14 vs 1.17±0.14 MPa, p=0.080). 7. In groups I-CXL, only irradiation of 1.5 mW/cm2 for 60 minutes (group 4) showed a significant biomechanical stiffening effect. All S-CXL groups provided a significantly greater effect than I-CXL. 8. In addition to riboflavin and UV-A light, oxygen is the third and fundamental element for crosslinking, and must be taken into account specially in transepithelial procedures. 9. The Dresden Protocol achieved greater changes in the surface variance index (IVS), vertical asymmetry index (IVA), keratoconus index (KI) and regularization index compared to other treatment protocols. There were no other differences between the protocols. 10. New algorithm ‘sub400’ for performing individualized CXL halted keratoconus progression in 90% of the evaluated eyes. No eye showed signs of endothelial decompensation. No significant changes were found for BCVA (p=0.868), sphere (p=0.951) or cylinder (p=0.878). 11. A total of 297 differentially transcribed genes were identified after treatment with CXL. In 9.1% of the significantly different genes, the standard CXL induced a more distinct change in gene transcription than accelerated protocols, which induced a lower biomechanical stiffening effect. Conclusions Finally, here are described the conclusions reached in each of the proposed objectives. 1. The prevalence of KC in the pediatric population in Saudi Arabia is considerably higher than reported in previous studies and in similar studies in other countries; 2. There is great variation in the force exerted on the eyelids, depending on the type of movement when rubbing the eyes. Such data are prerequisites for the development of experimental models of eye rubbing; 3. Patients being treated with STEAR must be monitored closely for changes in the cornea. 4. Significant differences were found between measurements of corneal HOAs generated by Scheimpflug and dual Scheimpflug–Placido devices in patients with keratoconus, and measurements from these devices should not be considered equivalent. 5. Corneal strain distribution are more complex than previously assumed, with a fundamental difference in mechanical response between the anterior and posterior stroma. Clinically, OCE technology might be used to monitor the progression of corneal ectatic diseases and to determine the success of corneal cross-linking. 6. The presence or absence of the Bowman layer did not alter the stiffness of a 110μm corneal lamella. Results may have implications for refractive laser surgery procedures, but also for the new Bowman layer transplantation technique for keratoconus treatment. 7. The biomechanical effect of ICXL increased significantly using low irradiance and long UV-A irradiation. The diffusion of oxygen, therefore, represents a limiting factor, even when the penetration of riboflavin is improved via iontophoresis. 8. Stromal riboflavin concentration is not the only modulating factor in CXL. The epithelium serves not only as a barrier for riboflavin penetration but also as a barrier for oxygen diffusion. Epithelial oxygen consumption is approximately 10 times higher than stromal oxygen consumption; thus, oxygen availability might affect the efficacy of CXL in techniques that are claimed to preserve the epithelium, such as I-CXL. 9. All three protocols showed improvements in Kmax, BCVA and other variables, with similar functional results despite the biggest change in keratoconus indexes after the Dresden protocol. 10. Individualized CXL using the ‘sub400’ protocol halted the progression of keratoconus in ultra-thin corneas in 90% of cases. Although failure rate might be higher than standard CXL, treatment with corneas as thin as 215 µm for the first time is possible. 11. Several target genes have been identified that may be related to biomechanical stability and corneal shape. Understanding the molecular mechanisms after CXL will allow an optimization and individualization of clinical treatment.
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    Colchicina no tratamento da oftalmopatias de Graves
    (Universidade Federal de São Paulo (UNIFESP), 2001) Stamato, Francisco Jose da Cunha [UNIFESP]; Furlanetto, Reinaldo Perrone [UNIFESP]
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    Comparação de resposta da pressão intraocular frente a duas diferentes intensidades e volumes do treinamento resistido
    (Sociedade Brasileira de Oftalmologia, 2014-01-01) Conte, Marcelo; Scarpi, Marinho Jorge [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Escola Superior de Educação Física de Jundiaí
    Abstract Purpose: To verify the influence of two different intensities and volumes of resistance training on intraocular pressur.Method: Nineteen athletes boxers (13 male and 6 female; mean age of 22 ± 3 years) were randomly assigned to two different resistance exercise sessions: muscular endurance with 3 sets of 15 repetition maximum and muscular hypertrophy with 4 sets of 8 RM. The intraocular pressure was measured with a Perkins tonometer before, during and after the resistance exercise sessions. Data were expressed as mean and standard deviation. A repeated-measures analysis of variance (ANOVA) was used and the Tukey post hoc test for multiple comparisons were applied.Results: A reduction in intraocular pressure during the resistance exercise session was observed. However, the muscular endurance exercise produced a significant reduction in intraocular pressure when compared with muscular hypertrophy. At the end of session, intraocular pressure returned to pre-exercise levels in muscular endurance session and above to pre-exercise levels in hypertrophy session.Conclusion: Resistance exercises influence intraocular pressure values, thus 3 sets of 15 repetitions with 60%1RM promote better intraocular pressure responses than 3 sets of 8 repetitions with 80% 1RM. This finding of the present research can contribute in prescription of resistance exercise to people with glaucoma risk factors.
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    Contribuições Ao Diagnóstico E Tratamento Cirúrgico De Ceratopatias
    (Universidade Federal de São Paulo (UNIFESP), 2017-05-30) Rocha, Carlos Gustavo Bonfadini [UNIFESP]; Campos, Mauro Silveira De Queiroz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This PhD thesis focuses on many aspects of corneal diseases. Its structure includes five publications – two clinical studies (3.1) and (3.5), a review study (3.2), and two case reports with surgical technique description (3.3) and (3.4). Objective: To study corneal diseases in aspects of: relationship between iris parameters, update the process of corneal donation and transplants as support for public health policies, new surgical instruments, the use of femtosecond laser and the manufacturer constant optimization of intraocular lens on triple procedure (DSAEK). Methods: The clinical study 3.1 studied the relationship between anatomical iris parameters and the presence of keratoconus. The clinical study 3.5 evaluated the results of postoperative refraction planned, from the constant optimization of the intraocular lens in combined cataract surgery, intraocular lens implantation and endothelial keratoplasty (DSAEK). The review study (3.2) discussed issues related to corneal transplant in order to serve as a support for public health policies in the state of Rio de Janeiro. The two case reports described surgical technique: 3.3 described the big-bubble technique in deep anterior lamellar keratoplasty (DALK) and 3.4 the use of femtosecond laser in deep anterior lamellar keratoplasty (FALK). Results: The study of keratoplasty allowed by the trial 3.1 for the first time in literature, correlating the anatomical iris parameters and the presence of keratoconus; and clinical study 3.5, refine the surgical outcomes of combined cataract surgery, intraocular lens implantation and endothelial keratoplasty (DSAEK) through constant optimization calculation of the intraocular lens. The anterior lamellar keratoplasty was presented in the case report 3.3, which shows the creation and use of new surgical instruments coupled with the use of surgical procedures already established to contribute to the spread of the big-bubble technique and increase the efficiency of the enforcement of keratoplasty deep anterior lamellar (DALK). In the case report 3.4, shows the use of femtosecond laser in performing the corneal incisions, and the successful completion of superficial anterior lamellar keratoplasty without the use of surgical sutures (FALK). In the study revision 3.2, it was shown that the creation of the Eye Bank of the State of Rio de Janeiro – INTO associated with management policies stimulated the increase notification and collection of corneas resulting in unprecedented increase in the number of transplants performed. Conclusions: The set of publications suggests the possibility of a new diagnostic method for keratoconus; the development of creation of the Eye Bank of the State of Rio de Janeiro – INTO associated with management policies; suggests changes in surgical technique on DALK and FALK; It presents a method to optimize results of triple DSAEK surgery. Thus, it describes the possible prevention help in the diagnosis of keratoconus, viability of tissues and surgical therapy.
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    Correlação entre tomografia de coerência óptica e histopatologia da região macular em olhos post mortem
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-28) Moreira Neto, Carlos Augusto [UNIFESP]; Burnier, Miguel Noel Nascentes [UNIFESP]; Mattos Neto, Rubens Belfort [UNIFESP]; http://lattes.cnpq.br/4120061586520703; http://lattes.cnpq.br/4487521900423032; http://lattes.cnpq.br/7462211121032251; Universidade Federal de São Paulo (UNIFESP)
    Introdução: Tomografia de coerência óptica (OCT) é um método não invasivo de imagem diagnóstica usado por oftalmologistas. Apesar de fornecer imagens de alta resolução da anatomia ocular, a OCT não é capaz de apresentar o mesmo nível de detalhe celular oferecido pela histopatologia. Dúvidas sobre a interpretação da imagem da OCT são comuns na rotina do retinólogo. Objetivos: Estabelecer uma metodologia que permita a precisa correlação entre OCT e histopatologia no mesmo olho humano post mortem na região macular, e demonstrar como esta metodologia pode ser usada para validar ou reprovar hipóteses criadas sem comprovação histopatológica. Métodos: Dezenove olhos humanos post mortem foram escaneados usando OCT en face. Um dispositivo óptico customizado foi utilizado para a aquisição de imagens na OCT. Foi realizado um controle da orientação do tecido durante o processamento histopatológico para aquisição dos cortes seriados de tecido, que foram identificados com seu scan correspondente na OCT. Resultados: A acurácia da metodologia foi provada com a correspondência histopatológica mostrando as mesmas características e/ou alterações observadas na OCT, tais como drusas, micro-hemorragias, exsudatos e membranas epirretinianas. Esta metodologia foi então empregada para validar a hipótese de que a junção dos segmentos internos e externos dos fotorreceptores é representada por uma linha hiperrefletiva na imagem da OCT. Conclusão: Este estudo mostra um protocolo acurado e reprodutível para correlacionar imagens de OCT com cortes histopatológicos de olhos humanos. Esta metodologia pode ser usada para um melhor entendimento de achados não bem definidos à OCT, e também pode auxiliar oftalmologistas a ter um melhor entendimento das imagens, diminuindo a necessidade de biópsias. Pela primeira vez, foi provado que a junção dos segmentos externos e internos dos fotorreceptores é hiperrefletiva na OCT.
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    Desenvolvimento de interface para coleta de dados em pesquisa clínica em Oftalmologia
    (Universidade Federal de São Paulo (UNIFESP), 2020-05-28) Ribeiro, Ivan Rogerio [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; Universidade Federal de São Paulo
    The Information technology (IT) has a fundamental role in the health, in the fields of care, teaching and research. Clinical research should be widely disclosed and widespread in the academia, once it is one of the pillars in the training of health professionals. One of the difficulties encountered while conducting research is data collection. Objective: To develop a data collection platform for clinical research to facilitate and streamline statistical analysis. Method: The pertinent needs to this subject were detected with the professors involved in the graduate programs of the Department of Ophthalmology. Different possibilities were analyzed with the Information Technology (IT) team at the Federal University of São Paulo (Unifesp) and it was decided to develop a platform hosted within Unifesp existing environment. The platform was called “PAEOFTA” and the interfaces were compiled in the form of a “User Manual” to facilitate its use. Results: A test was carried out using an existing research project at the Ophthalmology Department where forms were created, data were collected and exported and statistical analysis was performed. The flaws in the system ("bugs") were being remedied by the IT team during the tests that were totally satisfactory. Conclusions: The PAEOFTA platform was developed with free access and data security offered by the UNIFESP environment in order to ensure better quality of the data collected in clinical research not only in the Department of Ophthalmology and Visual Sciences but the entire university.
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    Desenvolvimento de tecnologia móvel multiplataformas para monitoramento domiciliar de pacientes em uso de medicação oftalmológica
    (Universidade Federal de São Paulo (UNIFESP), 2020-10-29) Rueda, Gabriel Dourado [UNIFESP]; Graziosi, Maria Elisabete Salvador [UNIFESP]; Universidade Federal de São Paulo
    Objective: the present study aims to develop and develop a prototype of a multiplatforms mobile application to help manage self-medication of eye drops and other medicines for the elderly in their homes. Method: the study was divided into two stages. The first included a bibliographic review on the PubMed portal of the Medline Bibliographic Database, in order to verify the main needs of the elderly at home and the use of mobile applications. From the literature data, functional and non-functional requirements highlighted by the selected scientific studies were identified. Then, there was the phase of analysis, planning and elaboration of a prototype for mobile technology that aimed to assist the elderly in self-management of their medications at home. Results: the literature addressed seven needs of elderly patients who used mobile applications at home. From these notes, it was possible to elaborate 14 functional requirements for the application and 12 nonfunctional requirements. Thus, the prototype for which mobile technology, including installation and use by web (multiple devices), was developed according to the construction planning stages. Conclusion: the present study made it possible to correct substantial errors in the creation of mobile applications that did not appear in development environments due to the version of the databases. In this way, it was possible to create applications for multiple devices, including the description of the development steps, including usability and applicability manual.
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    Doenças endoteliais corneanas: rumo a novas modalidades terapêuticas
    (Universidade Federal de São Paulo (UNIFESP), 2016-04-27) Vianna, Lucas Monferrari Monteiro [UNIFESP]; Belfort Junior, Rubens [UNIFESP]; http://lattes.cnpq.br/4270399167335564; http://lattes.cnpq.br/5467060074735457; Universidade Federal de São Paulo (UNIFESP)
    This PhD thesis focuses on aspects of surgical treatments for corneal endothelial diseases. Its structure includes 3 main publications ? one clinical study (3.1) and two laboratory studies (3.2) and (3.3), one case report, and an ophthalmic image. Clinical Study (3.1). Purpose: to identify possible risk factors for failures during Descemet membrane endothelial keratoplasty (DMEK) graft preparation, currently considered the gold standard technique. Methods: comparision of the rate of failures among donors with or without several ocular and systemic risk factors. Results: it was observed that diabetes and its duration, hypertension and obesity and/or hyperlipidemia were associated with higher failure rates. Conclusion: if tissues from donors with these risk factors were used for other kinds of transplants, the failure rate for DMEK preparation can be considerably reduced. Laboratory studies (3.2) (3.3). Purpose: to relate, for the first time in the literature, the possibility of culturing and cryopreserving corneal endothelial cells using human serum replacing the standard supplement described in the literature (fetal bovine serum). Methods: the comparison of morphology, growth curves, immunohistochemistry and polymerase chain reaction in real time (RT-PCR) for phenotypic and functional markers of corneal endothelial cells. Results: both media behaved similarly before and after cryopreservation. Conclusion: corneal endothelial cells can be cultured and cryopreserved using human serum as a media supplement. The case report (3.4) describes an attempted deep anterior lamellar keratoplasty (DALK) which became complicated with a large rupture in Descemet membrane during dissection. Taking into consideration recent reports of Descemet membrane endothelial transfer (DMET), it was chosen to leave the host DM in the anterior chamber as a potential source of host endothelial cells rather than removing the ruptured host Descemet membrane as part of the conversion to penetrating keratoplasty. The ophthalmic image (3.5) is an illustrative publication of how Fuchs endotheliopathy can influence quality of vision in affected patients.
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    Elaboração de algoritmos de prevenção de indivíduos com possível presença de depressão decorrente de deficiência visual
    (Universidade Federal de São Paulo (UNIFESP), 2020-04-30) Choi, Stefano Neto Jai Hyun [UNIFESP]; Santos, Vagner Rogerio Dos [UNIFESP]; Universidade Federal de São Paulo
    Objective: Develop a solution of Artificial Intelligence named Chatbot capable to apply a test of presence of depression on patients under ophthalmologic treatment for a best clinical monitoring. Methods: By using BLiP®, a prototype of Chatbot was developed introducing in it a social-demographic questionnaire used by the Psychobiology Department of UNIFESP and a test of diagnosis of presence of depression translated and validated in Brazil. After developing the prototype, it was tested by different forms, as functional, structural and validation tests, to ensure its functionality without involving human beings. Results: The prototype of Chatbot presented a great flow of conversation applying the test of presence of depression with reliably, showing that it is possible to apply on patients with depression symptoms when compared to the manual test application. Conclusion: The prototype developed will be a potential applier of the test of presence of depression to previously diagnose the patient, collecting and sending information to the medical team to attendance and interfere when necessary.
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    Ensino extracurricular em Oftalmologia: grupos de estudos / ligas de alunos de graduação
    (Associação Brasileira de Educação Médica, 2007-08-01) Kara José, Andrea Cotait [UNIFESP]; Passos, Lúcia Battistella; Kara José, Flávio Cotait [UNIFESP]; Kara José, Newton; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Universidade Estadual de Campinas (UNICAMP)
    This study aims at identifying the existence and at evaluating the functioning of undergraduate and facult y associations/study groups dedicated to continued education and community services in Ophthalmology. A cross-section descriptive survey based on a convenience sample was conducted by means of a questionnaire answered by residents and students from 107 Brazilian medical schools during the months February and March 2002. Twelve (11.21%) study groups in Ophthalmology were identified among these medical schools. Eleven (91.67%) of these 12 associations are controlled by their own by-laws. The admission criteria normally require having followed an introductor y course and / or admission exam. The number of students in the study groups varies between 9 and 30. Half of the groups admit students from the third year on. All study groups count on the participation of faculty members and 75% of them admit residents. The most common activities of the groups include attendance to regular classes and participation in communit y projects and scientific research. Though most of the study groups fulfill the requirements for providing primar y undergraduate Ophthalmologic education, the number of study groups is still not significant.
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    Estudo da qualidade dos frascos multidose dos colírios: adequação, segurança e melhorias
    (Universidade Federal de São Paulo (UNIFESP), 2021) Costa, Alexandre Xavier Da [UNIFESP]; Gomes, Jose Alvaro Pereira [UNIFESP]; Universidade Federal de São Paulo
    Objectives: The purpose of this thesis was to contribute to quality improvement of multidose eyedrops by analyzing factors related to appropriate eyedrop packaging, identifying safety issues and user perceptions of eyedrop usability, assessing drop volume variability and the impact of eyedrop bottle tip geometry and instillation angle on contamination rates, with the aim of encouraging specification of requirements for topical ophthalmic products. Methods: From the identification of the multidose eyedrops marketed in Brazil, 297 packages and package inserts were analyzed for informational content, alongside an analysis of the variability of the drop volume and the correlation of the mass per drop measured in five samples of five lubricant eyedrop brands and an evaluation of the performance of five samples of six eyedrops on an airplane during varying altitudes. Risk of cross contamination of six samples from nine brands of multidose eyedrops that were contaminated exclusively on the exterior side of rounded versus sharp tips was measured at instillation angles of 45° and 90° degrees. A survey aiming at a qualitative analysis of the perception, knowledge, usability and consumption trends of eyedrop was administered to 1.003 consumers. Results: Eyedrops represent 91.6% of ophthalmic drugs currently sold in Brazil. The mean drop volume reported by the manufacturers was 36.9 ± 7 µL, ranging from 25.6 to 71.4 µL. Instructions for using eyedrops are uneven and not illustrative, and some products were found to have inadequate package inserts. In the performance test at high altitude, one brand presented leakage and an irregular efflux of drops in all samples. An increased risk of infection transmission was observed in vials with a rounded tip versus a sharp tip [69.4% vs. 22.2%, P=0.001], especially when inclined at an instillation angle of 45° versus 90° [83.3% vs. 44.4%, P=0.005]. Among the 1,003 survey respondents, 84.6% indicated experiencing a part of the eyedrop running over the face upon instillation and 76.2% preferred to have information regarding the total number of drops contained in the eyedrop bottles. Conclusions: The data indicate a possible inadequacy and lack of standardization of eyedrop packaging and bottles, which yield drops of excess volume for the human eye. Moreover, eyedrop bottles with perpendicular platform tips showed greater safety than those with rounded nozzles. Manufacturers should inform the total number of drops in each product, in addition to total net volume. A review of user instructions and requirements for quality standards for the registration of ophthalmic products is recommended.
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    Estudo sobre a utilização de pisos táteis no hospital-escola da Universidade Federal de São Paulo
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Machado, Rita De Cassia Carvalho [UNIFESP]; Monteiro, Marcia Rocha [UNIFESP]; http://lattes.cnpq.br/4930117991668673; http://lattes.cnpq.br/7673479267381785; Universidade Federal de São Paulo (UNIFESP)
    Considering that the Brazilian legislation establishes the right to accessibility of persons with reduced mobility and that the operation of establishments providing public services, especially those related to health services, must fulfill this requirement, the present work consists of a research on the use of tactile floors in the environment of the school hospital of the Federal University of São Paulo, with reference to areas where services are provided by the Department of Ophthalmology and Visual Sciences at Campus São Paulo. This study intends to obtain technical and practical subsidies, through technical visits, direct observation of the researcher on the area of study and perception of the visually impaired user, through guided tours, considering the NBR 9050 and NBR 16537 standards, for guide procedures for the specification and execution of works in the Department of Engineering and Architecture, Unifesp, in the elaboration of accessibility projects and improvements of existing buildings. The overall goal is to contribute to the accessibility and inclusion and well-being of users, especially visually impaired people. As a result of the studies, it was concluded that the buildings do not meet the technical standards in this respect, most of the analyzed environments do not have tactile floor, in the part that lacks continuity and is insufficient also the way it is implanted for the proper functioning, thus impairing the autonomy and integration of visually impaired users in the hospital-school environment. Another important aspect of this research was the mapping of the conditions and critical points regarding tactile floors, which gives visibility to the main problems, which leads to the need for a review in the sectors, in the programming of projects and works, including accessibility as a priority and in procedures for specifying materials.
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    Evolução da ceratoplastia lamelar posterior no tratamento das endoteliopatias da córnea
    (Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Pereira, Nicolas Cesario [UNIFESP]; Gomes, Jose Alvaro Pereira [UNIFESP]; Santos, Myrna Serapião dos [UNIFESP]; http://lattes.cnpq.br/7356093529183007; http://lattes.cnpq.br/2506247984223015; http://lattes.cnpq.br/6143837068914101; Universidade Federal de São Paulo (UNIFESP)
    Objectives: This thesis was carried out to evaluate the evolution of posterior lamellar keratoplasty in the treatment of endotheliopathies. Methods: 1. Review of the literature on the evolution of EK. 2. Retrospective review of EK performed by HOS second year cornea fellows between 2007 and 2008, describing early complications and their treatment. 3. A retrospective multicenter study of the first case series of 18 experienced surgeons from 11 different countries to document the results and complications of the DMEK technique during the learning curve. 4. Retrospective study of the first cases performed with a simplified DMEK technique, the "Samba" technique, describing the surgical technique, its results and complications. 5. This prospective study included the first consecutive series of 53 DMEK surgeries performed by corneal fellows at HOS. Results: 1. The literature review on the evolution of EK found different surgical techniques to replace the diseased endothelium. Compared to PK, these techniques are safer and offer better and faster visual rehabilitation. 2. There were 34 EK performed by HOS corneal fellows between July 2007 and August 2008. Of these, 29 were performed using the DSEK technique and 5 with DSAEK technique. The most common complication was graft detachment in 8 eyes (23.5%). Primary failure was found in 7 eyes (20.6%). 3. A total of 431 eyes were analyzed from 401 patients with Fuchs endothelial dystrophy (68.2%) and bullous keratopathy (31.8%) submitted to DMEK by 18 surgeons at the beginning of the learning curve in 11 different countries. Of the 275 eyes with data available for analysis of visual acuity, 217 eyes (78.9%) achieved BCVA of at least 20/40 (0.5), 117 (42.5%) at least 20/25 (0.8) and 61 (22.2%) at least 20 / 20 (1.0). Mean reduction of endothelial cell density at 6 months was 47% (20%) (n = 133 [P = 0.02]). The main postoperative complication was graft detachment (34.6%). 4. Of the 26 operated eyes by DMEK with the "Samba" technique, only 2 (7.7%) presented partial graft detachment requiring rebubbling. There were no cases of primary graft failure, tissue loss, or pupillary block. All patients with good visual potential achieved BCVA of 20/30 or better at 6 months. 5. Of the 33 eyes without ocular comorbities and with complete visual acuity measurements, 97% achieved a BCVA of ≥ 20/40 in 6 months. The mean (SD) preoperative donor ECD was 2453 (361)cells/mm2 and at 6 months postoperative the in vivo mean ECD (SD) was found to be 1300 (587) cells/mm2, an average loss of 47%. Preparation of the DMEK graft by the cornea fellows was successful in all cases. There were 9 eyes (17%) that experienced partial graft detachment requiring rebubbling. A total of 3 eyes (5.7%) failed to clear the cornea, all of which were managed with a successful secondary endothelial keratoplasty (EK). Conclusions: 1. EK is a treatment in evolution that represents a major advance over KP in the treatment of corneal endotheliopathies. DSEK / DSAEK are the most commonly used surgical techniques of EK, providing good visual results. Although more challenging, DMEK exhibits better visual results and lower rejection rate than DSEK / DSAEK. New perspectives, including endothelial cell therapy, may replace keratoplasty techniques for the treatment of corneal endothelial diseases. 2. DSEK / DSAEK have some advantages over PK, but have a long learning curve with potential complications. Beginning surgeons in these techniques must undergo training and have their first surgeries guided by experienced surgeons. 3. The international multicenter study of DMEK showed that the standardization of the “no-touch” technique is feasible for most surgeons, providing rapid visual rehabilitation and few complications. 4.The simplified "Samba" technique of DMEK showed to be reproducible, with good success rate and low number of complications, such as graft detachment, primary failure or pupillary block. 5. Establishing DMEK in a fellowship program with the supervision of an experienced DMEK surgeon was successful both in the preparation of the graft and in the visual results obtained.
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    Expressão imuno-histoquímica da proteína C-kit no Retinoblastoma
    (Universidade Federal de São Paulo (UNIFESP), 2009-09-30) Santos, Leticia Rielo de Moura [UNIFESP]; Burnier Júnior, Miguel Noel Nascente [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: C-kit is a transmembrane tyrosine kinase protein thought to play an important role in tumorigenesis. With the development of the compound Imatinib Mesylate which specifically inhibits tyrosine kinase receptors, C-kit has emerged as a potential therapeutic target. This study aims to determine the immunoexpression of C-kit in retinoblastoma and correlate this expression with histopathological prognostic features. Methods: Eighty-four paraffin-embedded enucleation globes of retinoblastoma were collected from the archives of the Henry C. Witelson Ocular Pathology Registry. C-kit immunostaining was used according to the protocol provided by Ventana Medical System Inc., Arizona. Immunoreactivity was correlated with the presence or absence of invasion into the choroid and optic nerve and the degree of tumour defferentiation. Odds ratios were calculated to quantify differences in C-kit expression between tumours with different patterns of invasion. Results: C-kit expression was identified in 33/63 specimens analysed (53.8%).Two of 13 tumours without choroidal or optic nerve invasio (15.4%) were positive for C-kit. C-kit expression was seen in 31 of the 50 tumours with extraretinal invasion (62%, p<0.01), 26 of 44 specimens with choroidal involvement (59.9%, p<0.02), and 20 of the 29 with optic nerve involvement (68.96%, p<0.02). Fourteen of 25 moderate or well-diferentiated specimens (56%) and 19 of 38 undifferentiated specimens (50%) displayed positivity for C-kit (p>0.5). Conclusions: More than half of Retinoblastomas in this study expressed C-kit. The expression of Ckit in these retinoblastomas strongly correlated with histopathological features of worse prognosis including optic nerve and choroidal invasion.
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    Gestão de tecnologias em oftalmologia
    (Universidade Federal de São Paulo (UNIFESP), 2016-09-30) Santos, Carla Ribeiro da Silva [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; http://lattes.cnpq.br/6575096591259140; http://lattes.cnpq.br/7298165480041720; Universidade Federal de São Paulo (UNIFESP)
    Purpose: Health managers are responsible for planning and controlling health facilities due to the development, incorporation, and use of technologies in health systems, as well as their sustainability deriving from continuous production of goods and services. ANVISA (National Agency of Health Surveillance) introduced the Board Collegiate Resolution (RDC) No. 2 of January 25, 2010, that regulates the management of health technologies as well as the guidelines for the management of the technological park in health facilities. The purpose of this study was to develop a Health Technology Management Plan in ophthalmology according to the guidelines recommended by ANVISA. Methods: The study was based on the equipment and processes of the Secondary Reference Center for Ophthalmology (CERESO) of the Department of Ophthalmology and Visual Sciences, Federal University of São Paulo / EPM, Brazil, in 2014 and was divided into three stages. Step1: Identification and understanding of the Federal Regulation regarding the use of health technologies and their management in clinics and hospitals; Step 2: Identification of ophthalmic equipment and other technologies used at the CERESO in the Department of Ophthalmology and Visual Sciences; Step 3: Development of the Health Technology Management Plan in ophthalmology to meet the requirements of the Brazilian standards. The following equipments were identified in CERESO: optotype projector, slit lamp, Goldmann tonometer, auto-refractor, retinoscope, direct and indirect ophthalmoscopes, lensometer, electric lift chair and refractor. Results: The Health Technology Management Plan for CERESO included: a) the definitions and standardized criteria for each stage for the health technologies management process; b) detailed description of all the technical procedures involved with the technologies in use; c) appointment of a health professional responsible for implementing and monitoring the Management Plan; d) description of the roles and responsibilities of professionals involved in the processes; e) organization of a continuing education program for professionals involved in management activities. Conclusions: The Health Technology Management Plan was successfully developed for the Secondary Reference Center (CERESO) in the Department of Ophthalmology and Visual Sciences. It is a useful management tool and, respecting the characteristics of each service, can be used as a model to meet the Brazilian regulations recommended by ANVISA for public and private services.
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    Linhas de cuidado integral em pacientes portadores de catarata
    (Universidade Federal de São Paulo (UNIFESP), 2020-07-30) Valladares, Marta Sonha Gomes Teixeira [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; Universidade Federal de São Paulo
    The present study aims to track the paths of patients treated at the Cataract Division of the Universidade Federal de São Paulo (UNIFESP)/Hospital São Paulo (HSP) and to propose management flows for care lines. This is a descriptive cross-sectional study with a field research and a data collection instrument based on a questionnaire applied in four distinct moments as the patients were assisted in the institution: Screening, New Case (first visit), Pre-Anesthesia Evaluation (APA), and Post-Surgery. Apart from the information about the difficulties faced during these different phases of the treatment, the Net Promoter Score (NPS) has also been evaluated. The sample consisted of 121 patients attended at the Cataract Outpatient Clinic of HSP at UNIFESP from August 1918 to January 1919. In this study, the average age considering the four groups was 68.2 years, and 52% of the patients were female. In general, the educational profile has shown a poor education population and the majority had no difficulty in finding the place where the treatment would take place as the public transportation suits the region. The Net Promoter Score (NPS) values were the following: Screening: 33.3, New Case: 77.5, APA: 33.3 and PostSurgery: 86.7, suggesting a change in the perception of quality of service as the patients surpassed the different stages of the treatment. The care cycle for Brazilian health system (SUS) cataract patients should follow SUS hierarchy system and decentralization; and the treatment must be patient-oriented, with wide investment to guide users and health providers, using the best available technology within a management environment based on key indicators.