Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Vitrectomy"

Navegando por Palavras-chave "Vitrectomy"

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Acesso 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.
Acesso aberto (Open Access)
Aqueous misdirection syndrome in persistent fetal vasculature (PFV)
(Consel Brasil Oftalmologia, 2017) Kato, Renata Tiemi [UNIFESP]; Borba, Paula Delegrego [UNIFESP]; de Moura, Christiane Rolim [UNIFESP]; Allemann, Norma [UNIFESP]; Bueno de Moraes, Nilva Simeren [UNIFESP]
We report a case of a 5-year-old girl with persistent fetal vasculature who presented with unilateral acute angle closure caused by aqueous misdirection syndrome that was apparently associated with regression of cycloplegia. Initial treatment with topical steroids, anti-glaucomatous drops, and atropine showed insufficient control of the intraocular pressure (IOP). Surgical treatment with lensectomy and vitrectomy resulted in satisfactory IOP control and no complications at the 6-month follow-up.
Somente Metadadados
Avaliação de um modelo de anestesia local (com sedação) para vitrectomias via pars plana
(Universidade Federal de São Paulo (UNIFESP), 1994) Goncalves, Joao Carlos de Miranda [UNIFESP]; Farah, Michel Eid [UNIFESP]
Acesso aberto (Open Access)
Confecção de ponteira de vitrectomia 23-gauge de dupla-porta para cirurgia de vitrectomia posterior
(Universidade Federal de São Paulo (UNIFESP), 2019-03-28) Takahashi, Vitor Kazuo Lotto [UNIFESP]; Lima, Luiz Henrique Soares Goncalves de [UNIFESP]; http://lattes.cnpq.br/0399713306487727; http://lattes.cnpq.br/6303182759726045; Universidade Federal de São Paulo (UNIFESP)
Objective: To evaluate the possibility and functionality of making a 23gauge vitrectomy tip with a cutting port located 180 degrees from the original port. Methods: A standard 23gauge vitrectomy tip (UltravitAlcon apparatus, USA) of the Constellation Vision System (Alcon Laboratories, Inc., Fort Worth, TX, USA) was used for customization. A second port was made by high a precision NdYag laser equipment (300W Water Cooled Automatic Laser Welding Machine). To evaluate the functionality of the tip after the second port was made, it was connected to the Constellation Vision System and tested with a microscope. Results: A second port with a horizontal diameter of 0.47 mm and a vertical diameter of 0.33 mm was successfully made after 3 attempts on a 23gauge vitrectomy tip, maintaining the functionality of the internal cutting system. Conclusion: The construction of a 23gauge vitrectomy tip with a functioning double port is feasible and could increase the effectiveness of vitreous removal by decreasing the time of vitreoretinal surgery.
Acesso 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 Ophthalmology
The 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.
Acesso aberto (Open Access)
Emprego das medidas anatômicas do buraco macular idiopático obtidas pela tomografia de coerência óptica como fator preditivo nos resultados visuais: um estudo piloto
(Conselho Brasileiro de Oftalmologia, 2007-10-01) Negretto, Alan Diego; Gomes, André Marcelo Vieira; Gonçalves, Fernando Pistarini; Jiun, Huang Sheau [UNIFESP]; Abujamra, Suel; Nakashima, Yoshitaka; Universidade de São Paulo (USP); Instituto Suel Abujamra; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro Faculdade de Medicina; Hospital das Clínicas Clínica Oftalmológica
PURPOSE: To evaluate the anatomy of idiopathic macular hole (IMH) using Optical Coherence Tomography (OCT) and to construct a prognostic index that can be correlated with the visual outcomes and the anatomical closing. METHODS: Prospective study, in which 22 eyes with IMH had been evaluated through OCT in the daily postoperative period of IMH surgery. The Prognostic of Macular Hole Index (PMHI) was created which was correlated with the anatomical result and the postoperative visual acuity (VA) six months after surgery. RESULTS: Sixteen eyes (72.7%) got anatomical closing at the end of six months of follow-up. On analysis of PMHI, there was significant difference between group 1 (open MH) and group 2 (closed MH) (p=0.0018). The risk for failure of anatomical closing is 11 times greater when the diameter of the internal base is over 600 µm or IPBM is less than 0.6 (p=0.0495). Regarding final VA, it was observed that the IPBM had a significant negative correlation with AV (p=0.001). CONCLUSIONS: IPBM showed to be the best predictor of anatomical closing and postoperative visual acuity among the studied variables. It predicted 41% of the postoperative final visual acuity, leading us to believe that other factors, such as the time of history and the degeneration of photoreceptors in these older BM, can be involved in the visual outcomes.
Acesso aberto (Open Access)
Facoemulsificação, vitrectomia via pars plana e implante de lente intra-ocular em olhos com retinopatia diabética proliferativa
(Conselho Brasileiro de Oftalmologia, 2004-06-01) Mattos, Armando Belfort [UNIFESP]; Bonomo, Pedro Paulo [UNIFESP]; Freitas, Lincoln Lemes [UNIFESP]; Farah, Michel Eid [UNIFESP]; Flynn Jr, Harry; Pereira, Maurício Bastos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Miami Bascom Palmer Eye Institute
PURPOSE: To evaluate the outcomes and the best technique for a combined phacoemulsification (PHACO), pars plana vitrectomy (PPV) and posterior chamber intraocular lens insertion (PCIOL) in one single procedure for patients with proliferative diabetic retinopathy. METHODS: We reviewed charts of 47 (53 eyes) patients with proliferative diabetic retinopathy who underwent combined phacoemulsification with posterior chamber intraocular lens implant and pars plana vitrectomy performed between January 1991 and September 1998 at the Bascom Palmer Eye Institute, eye hospital affiliated with the University of Miami. The study was done in conjunction with the Federal University of São Paulo. A total of 43 eyes from 40 patients were elected to participate in the study. RESULTS: The follow-up range was three to 60 months (mean 20 months). The age ranged from 37 to 77 years with a mean of 59. Preoperative visual acuity improved two lines or more in 26 (60.4%) eyes, remained the same in 9 (20.9%) and got worse in 8 (18.6%). In 10 (23.2%) eyes visual acuity improved to 20/40. The study showed to be statistically significant for the improvement of the final visual acuity. Recurrent vitreous hemorrhage was the most frequent postoperative complication found in 12 (27.9%) eyes and it was followed by transient anterior chamber reaction in 9 (20.9%) eyes. Intraoperative and postoperative complications related to phacoemulsification were rare. IOL capture was found in 2 (4.6%) eyes and intraocular lens subluxation in 1 (2.3%) eye. CONCLUSION: Combined phacoemulsification with posterior chamber intraocular lens implant and pars plana vitrectomy in proliferative diabetic retinopathy is a feasible procedure, well-tolerated and usually presents significant visual acuity improvement. One single procedure, to remove the cataract and to perform pars plana vitrectomy, instead of performing a second surgery that would be only to remove the cataract after the pars plana vitrectomy is safe, improves visual acuity and is also less aggressive for the patient. The potential for improving final visual acuity is limited by the severity of retinopathy.
Acesso aberto (Open Access)
Farmacologia ocular aplicada no tratamento de doenças do vítreo, retina e coróide
(Conselho Brasileiro de Oftalmologia, 2010-06-01) Mello Filho, Paulo Augusto de Arruda [UNIFESP]; Maia, Maurício [UNIFESP]; Rodrigues, Eduardo Buchele [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Retinal diseases are frequently causes of impaired visual acuity and blindness. Recent progress in ocular pharmacology leads to the development of new promising drugs and better functional outcomes. Drug delivery and local management of diseases affecting the choroid and retina should enable better a natomical and functional outcomes. An overview of ocular pharmacology, emerging drug technologies and drug delivery is provided. Some relevant clinical features are discussed.
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Fluidics in a Dual Pneumatic Ultra High-Speed Vitreous Cutter System
(Karger, 2013-01-01) Diniz, Bruno [UNIFESP]; Ribeiro, Ramiro M.; Fernandes, Rodrigo Brant [UNIFESP]; Lue, Jaw-Chyng; Teixeira, Anderson Gustavo [UNIFESP]; Maia, Mauricio [UNIFESP]; Humayun, Mark S.; Univ So Calif; Universidade Federal de São Paulo (UNIFESP); Hosp Univ Curitiba FEMPAR
Background: Dual pneumatic systems use two separate air line tubes to open and close the cutter and can achieve high cut rates. the purpose of this study is to evaluate the influence of gauge size, cut rate and aspiration on the flow rate performance of ultra high-speed cutters operated with a commercially available dual pneumatic vitrectomy system. Methods: Analysis of a high-speed video was used to determine duty cycle. Flow rates from 20-, 23- and 25-gauge cutters were calculated in predetermined conditions of aspiration levels and cut rates; water and fresh porcine vitreous samples were studied. Results: for all three gauges of cutters, the duty cycle and water flow showed an inverse correlation with increasing cut rates and a direct correlation with increasing aspiration levels (p < 0.05). Vitreous flow rates from all gauges increased with increasing aspiration and cut rates (p < 0.05). Conclusion: Larger gauges of the cutters as well as higher aspiration and cut rate levels resulted in improvement of the vitreous flow rates. A good understanding of the different flow rate settings is essential for the surgeon and optimizes the safety of surgical procedures. Copyright (C) 2012 S. Karger AG, Basel
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Intravitreal Angiostrongylus cantonensis: first case report in South America
(Consel Brasil Oftalmologia, 2018) de Andrade, Gabriel Costa [UNIFESP]; de Oliveira Dias, Joao Rafael [UNIFESP]; Maia, Andre [UNIFESP]; Kanecadan, Liliane de Almeida [UNIFESP]; Bueno Moraes, Nilva Simeren [UNIFESP]; Belfort Junior, Rubens [UNIFESP]; Lasiste, Jade Marie Edenvirg; Burnier, Miguel N.
This study reports the first case of intravitreal angiostrongyliasis in South America treated with posterior worm removal via pars plana vitrectomy. This was a retrospective, observational case study. Data from medical charts, wide-field digital imaging, ocular ultrasound, and visual evoked potential studies were reviewed. A 20-month-old boy presented with eosinophilic meningitis and right eye exotropia. Polymerase chain reaction analysis of the cerebrospinal fluid showed a positive result for Angiostrongylus cantonensis. Fundus examination revealed a pale optic disc, subretinal tracks, vitreous opacities, peripheral tractional retinal detachment, and a dead worm in the vitreous cavity. The patient underwent pars plana vitrectomy with worm removal. This case report illustrates the first case of intravitreal angiostrongyliasis in South America, possibly related to the uncontrolled spread of an exotic invasive species of snail.
Acesso aberto (Open Access)
Nd:Yag laser em catarata infantil
(Conselho Brasileiro de Oftalmologia, 2006-02-01) Di Giovanni, Maria Elizabeth [UNIFESP]; Tartarella, Marcia Beatriz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
PURPOSE: To describe and to evaluate the usefulness of Nd: Yag laser in pseudophakic children. METHODS: Twenty-four eyes of 22 pseudophakic patients with posterior capsule opacification, that had been submitted to posterior capsulotomy with Nd:Yag-laser were prospectively analyzed at the Infantile Cataract Section of the Federal University of São Paulo/Paulista School of Medicine, from June 2001 to March 2003. Age at surgery, IOL type, IOL placement, time interval between surgery and posterior capsule opacification, energy needed (mJ), laterality, initial and final visual acuity were analyzed. RESULTS: Capsulotomy was performed in all pseudophakic eyes. Four (16.6%) eyes received polyacrylic implants and 18 (75%) PMMA lenses. Twelve IOL were in the capsular bag and nine in the ciliary sulcus. The laser energy level required was 0,8 mJ to 2 mJ per spot, total amount was 100 mJ. Nd:Yag laser was feasible in 22 (91.6%) eyes. Only two (8.3%) eyes required capsulotomy surgery. CONCLUSION: The obtained results suggest that Nd:Yag laser capsulotomy may be a good option to improve visual acuity in pseudophakic children.
Acesso aberto (Open Access)
Novas tecnologias na cirurgia do buraco macular
(Universidade Federal de São Paulo (UNIFESP), 2020-11-26) Amaral, Oswaldo Ferreira Moura Brasil Do [UNIFESP]; Maia, Mauricio [UNIFESP]; Universidade Federal de São Paulo
Objective: To study new technologies in macular hole surgery, both in the feasibility of new techniques and in their anatomical and functional results. Methods: Three retrospective studies were performed. In the first study, 43 cases were revised where phacovitrectomy assisted by femtosecond laser was used to treat cataracts associated with various retinal pathologies, including macular holes. In the second study, we revised 46 eyes with macular holes submitted to 23g-caliber vitrectomy with internal limiting membrane peeling stained with brilliant blue G, with 3 years of follow-up. Only pseudophakic patients or those who underwent phacovitrectomy were included. In the third study, we revised the postoperative optical coherence tomography angiography of 10 cases of macular hole submitted to 2 different surgical techniques. Images of the outer retina were analyzed by ImageJ (imageJ.nih.gov) that created black-and-white pixel binarization histograms. Results: Femtosecond laser phacovitrectomy led to improved visual acuity in all cases. Mean visual acuity was 1.03 ±0.54 LogMAR in the baseline and 0.34 ±0.26 LogMAR in the final follow-up visit. There were no complications related to capsulorhexis, intraocular lens implantation, or scleral indentation. In this first study, perioperative retinal tears were detected in 11.6% of the cases, and there was no increase in postoperative central retinal thickness. In the second study, 42 (91.3%) eyes had macular hole closure after a single surgical procedure and 45 (97.8%) after one additional surgery. No complications related to the dye or reopening of the macular hole were observed. In the third study, a significantly higher percentage of white pixels was observed in the central 0.5mm of the internal limiting membrane removal group compared with the inverted or fragmented membrane group (12.3% x 5.6%, P=0.028). A significant correlation was found between visual acuity and the percentage of white pixels in the membrane removal group (r=0.917, P=0.029) when the square area of 3 x 3mm was evaluated. Conclusion: Phacovitrectomy assisted by femtosecond laser can successfully treat retinal diseases. Macular hole surgery with internal limiting membrane peeling stained by brilliant blue G leads to satisfactory anatomical and functional results. Analysis of the outer retinal layer by binarization histograms may be a new method for functional evaluation during macular hole healing, where the greatest number of white pixels would correspond to the highest cell viability.
Acesso aberto (Open Access)
Optical coherence tomography angiography artifactual choroidal neovascularization in optic disc pit maculopathy
(Consel Brasil Oftalmologia, 2017) Roizenblatt, Marina [UNIFESP]; Muller, Leo [UNIFESP]; Lobos, Claudio Z. [UNIFESP]; Saraiva, Vinicius S. [UNIFESP]; Magalhaes, Octaviano, Jr. [UNIFESP]; Maia, Andre [UNIFESP]
This case report describes a 19-year-old Caucasian man presented with decreased visual acuity in the right eye for 3 months. Dilated funds exam revealed optic disk pit associated with serous macular detachment. Optical coherence tomography identified communication between the optic disk pit and the macular serous detachment, and optical coherence tomography angiography displayed a subfoveal area suggestive of subfoveal choroidal neovascularization. However, there was no evidence of leakage in the fluorescein angiogram and no evidence of choroidal neovascularization in optical coherence tomography in the area corresponding to the suspicious subfoveal choroidal neovascularization. The patient underwent 23-gauge pars plana vitrectomy in the right eye. Six weeks after surgery, multimodal imaging was repeated and there was near-complete resorption of the subretinal fluid. Optical coherence tomography angiography signal superimposed on optical coherence tomography B-scan also demonstrated normal choriocapillaris signal throughout the macula. In conclusion, optical coherence tomography angiography may produce artifacts in optic disk pit maculopathy that simulate choroidal neovascularization.
Somente Metadadados
Staining Properties of Brilliant Blue Depending on Different Incubation Times and Solvents in Humans
(Karger, 2013-01-01) Rodrigues, Eduardo B. [UNIFESP]; Maia, Mauricio [UNIFESP]; Penha, Fernando M. [UNIFESP]; Dib, Eduardo [UNIFESP]; Melo, Gustavo B. [UNIFESP]; Maia, Andre [UNIFESP]; Farah, Michel E. [UNIFESP]; Int Chromovitrectomy Collaboration [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: Intravitreous injection of vital dyes, e.g. brilliant blue (BBG), promotes better visualization of the internal limiting membrane (ILM). This paper investigates the staining properties of BBG depending on different incubation times and 2 types of solvents - 5% glucose (GL) or saline solution - in a prospective study in patients. Methods: This paper investigates various aspects of BBG in various methods. An interventional prospective study was conducted in patients to examine the binding properties of the blue dye diluted in either saline or 5% GL to epiretinal membranes (ERMs) and ILMs. Forty-nine consecutive patients older than 18 years scheduled for macular ERM, vitreomacular traction and macular hole surgeries were prospectively recruited. the primary outcomes of this study were the degree of ILM and ERM staining. the secondary outcomes of the study were the need of reinjection of BBG or any other dye, the ability of BBG to stain the vitreous, and frequency of complications. the staining of the ILM and ERM were graded as no staining, little, moderate or strong staining. Results:There was no correlation between age (p = 0.32) or gender (p = 0.33) in the staining affinity of BBG to either the ILM or ERM. BBG may be an appropriate staining agent for the ILM in the majority (82%) of surgeries; however, in approximately half of the cases (45%) surgeons considered BBG not enough for ERM coloring and visualization. There is a tendency of BBG to stain the ILM better when saline solution is used compared to GL 5%; however, this was not statistically significant (p = 0.64). There was no difference in the staining efficacy of BBG to the ERMs by either solution (p = 0.70), despite the low staining affinity. Conclusion: BBG became the state-of-the-art dye for ILM identification. Differences in staining properties may imply that BBG should not be considered as first-line stain for ERM surgery. BBG is effective in ILM staining in over 80% of macular hole surgeries. (C) 2013 S. Karger AG, Basel
Acesso aberto (Open Access)
Tração vitreomacular: novos conceitos
(Universidade Federal de São Paulo (UNIFESP), 2015-05-31) Bottos, Juliana Mantovani [UNIFESP]; Maia, Mauricio [UNIFESP]; Elizalde, Javier; http://lattes.cnpq.br/6377105744231862; http://lattes.cnpq.br/7342331288788635; Universidade Federal de São Paulo (UNIFESP)
O presente estudo foi conduzido em três etapas, tendo os seguintes objetivos: 1. Estudar e revisar os principais conceitos relacionados à fisiopatologia e maculopatias associadas à tração vitreomacular. 2. Analisar a concordância entre as diferentes classificações baseadas na morfologia e no diâmetro de tração vitreomacular, assim como correlacionar as maculopatias associadas à síndrome. 3. Avaliar os diferentes tipos de tração vitreomacular para estabelecer a classificação que melhor reflita o prognóstico visual e anatômico pós-cirúrgico. A tração vitreomacular (TVM) decorre do descolamento do vítreo posterior (DVP) de forma anormal e incompleta, com persistente aderência vitreomacular, levando às alterações funcionais e estruturais de origem tracional e consequente baixa visual. O termo "aderência vitreomacular" (AVM), por si só, equivale a um estágio normal de descolamento parcial perifoveal do vítreo posterior ainda aderido à região foveal, formando um ângulo agudo entre o vítreo e a superfície interna da retina, sem implicar em alterações anatômicas da retina neurossensorial decorrentes dessa aderência. Porém, até o momento, não existe um consenso universalmente aceito para a classificação das doenças vitreomaculares. Se, no passado, a síndrome de TVM era considerada uma patogenia isolada, hoje, acredita-se que tenha participação em um enorme espectro de doenças maculares como: edema macular cistóide (EMC); buraco macular (BM) e membrana epirretiniana (MER). O reconhecimento da associação da TVM na etiologia dessas doenças é imperativo para o adequado tratamento dessas maculopatias. Entretanto, ainda é incerto o porquê pacientes com TVM desenvolvem diferentes maculopatias, e qual configuração de tração pode se beneficiar de tratamentos específicos, sejam eles expectantes, cirúrgicos ou enzimáticos. O segundo estudo analisou duas propostas de classificação para a síndrome de TVM, através da avaliação de 53 olhos de pacientes diagnosticados com essa doença. Todos os olhos foram categorizados segundo as duas propostas de classificação baseados em imagens por tomografia de coerência óptica (OCT): a classificação baseada na morfologia (tração em forma de V ou em J) e na classificação baseada no diâmetro de tração vitreomacular (focal?1500?m ou difusa>1500?m). É importante ressaltar que o termo ?diâmetro? refere-se, aqui, à maior extensão linear da área de aderência vitreomacular, não necessariamente representada por um círculo perfeito. Foi observada alta concordância entre os tipos de TVM em V e focal, e entre as TVM em J e difusa (kappa=0,850; p<0,001), exceto em 4 casos cuja aderência, apesar de maior que 1500 ?m (difusa) apresentava a forma em V. Todos esses 4 casos apresentaram características comuns às TVM difusas, e não como as TVM em V, quando consideramos as maculopatias associadas e funções visuais. TVM em V (n=29) e focais (n=25) estiveram associados à formação de EMC tracional (79,31% e 84% respectivamente) e BM (37,93% e 44%); enquanto TVM em J (n=24) e difusas (n=28) estiveram associados à presença de MER (91,66% e 92,85% respectivamente) e espessamento retiniano difuso (62,50% e 64,28%). Embora concordante, a classificação baseada no diâmetro de TVM e não na morfologia da aderência reflete de forma mais acurada as alterações maculares decorrentes dessa tração. O terceiro estudo analisou 36 olhos de pacientes com diagnóstico de síndrome de TVM submetidos à cirurgia vitreorretiniana e categorizados segundo as duas propostas de classificação (morfológica: V ou J e diâmetro: focal ou difusa). A acuidade visual corrigida (AV) pós-operatória foi muito semelhante entre os diferentes tipos de TVM (P=0,393). Entretanto, casos de TVM focais apresentaram uma variação entre a AV pré e pós-operatória maior (P=0,027), já que a AV pré-operatória era significantemente menor quando comparada à TVM difusa, alcançando AV pós-operatória final semelhante entre ambos os tipos (P=0,007). Já quando consideramos as TVM baseadas na morfologia, não observamos diferença na AV pré e pós-operatória (P=0,235). A evolução pós-operatória e as maculopatias associadas estão intimamente relacionadas ao tamanho da aderência vitreomacular. O diâmetro de aderência medido em micrômetros (focal ou difuso) e não a forma clássica relacionada à morfologia (V ou J) é o preditor mais fidedigno dos prognósticos funcionais e anatômicos pós-operatório. Concluímos, nesses estudos, que: 1. A TVM decorre do descolamento incompleto do vítreo posterior e tem participação em um espectro de doenças maculares sendo as principais o BM, o EMC tracional e a MER. 2. TVM em V e focais associam-se ao EMC tracional e BM enquanto que TVM em J e difusas relacionam-se à MER e ao espessamento retiniano difuso. A classificação baseada no diâmetro de TVM e não na morfologia da aderência reflete de forma mais acurada tais maculopatias. 3. O diâmetro de aderência medido em micrômetros (focal ou difuso) e não a forma clássica relacionada à morfologia (V ou J) reflete de forma mais fidedigna o prognóstico anatômico e funcional pós-operatório.
Acesso aberto (Open Access)
Twenty-five gauge vitrectomy in uveitis
(Conselho Brasileiro de Oftalmologia, 2012-04-01) Kamei, Roger Roberto Wada [UNIFESP]; Arantes, Tiago Eugênio Faria E [UNIFESP]; Garcia, Claudio Renato [UNIFESP]; Muccioli, Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
PURPOSE: To evaluate anatomical and functional results of 25-gauge transconjunctival sutureless pars plana vitrectomy in patients with uveitis. METHODS: Vitrectomy was performed on 20 eyes with residual vitritis secondary to infectious and noninfectious uveitis. Patients were evaluated 1 week before surgery and after surgery at day 1, week 1, week 4 and week 12. Visual acuity (VA), intraocular pressure, anterior chamber cells and flare and vitreous haze were measured. RESULTS: Mean VA improved from 2.06 ± 0.94 logMAR before surgery to 0.58 ± 0.46 logMAR at week 12 (p<0.05). No case required conversion to standard 20-gauge instrumentation or suture placement, no intraoperative complications were noted. Transient postoperative hypotony was seen in three eyes. One patient with toxoplasmic retinochoroiditis had a relapse during follow-up. CONCLUSION: 25-gauge vitrectomy has proven its efficacy on cleansing vitreous opacities and improving visual acuity on patients with residual vitritis secondary to uveitis with minimal postoperative inflammation and complications.
Acesso aberto (Open Access)
Vitrectomia transconjuntival: dados preliminares com o sistema Millennium TSV-25
(Conselho Brasileiro de Oftalmologia, 2005-12-01) Rezende Filho, Flávio [UNIFESP]; Alcântara, Simone; Régis, Luiz Gustavo Tonelli; Universidade Federal de São Paulo (UNIFESP); Pontifícia Universidade Católica do Rio de Janeiro; Centro de Estudos e Pesquisas Oculistas Associados
PURPOSE: To report the preliminary surgical results of pars plana vitrectomy with a transconjunctival technique using the TSV-25 Millennium system. METHODS: Twenty consecutive patients (20 eyes) that underwent transconjunctival vitrectomy with the TSV-25 Millennium system, between July 2003 and January 2004, were prospectively postoperatively followed for a minimum period of one month. Eyes with macular hole, epiretinal membrane, macular edema, rhegmatogenous retinal detachment, endophthalmitis, and vitreous hemorrhage with or without tractional retinal detachment were included. Intra and post-operative complications and difficulties were recorded. RESULTS: All 20 patients completed at least one month postoperative follow-up. There were 4 macular holes, 2 epiretinal membranes, 2 cystoid macular edemas post-cataract surgery, 1 diabetic macular edema, 5 rhegmatogenous retinal detachments, 5 vitreous hemorrhages (2 associated with tractional retinal detachment), and 1 endophthalmitis. Mean postoperative day one intraocular pressure was 15.7 mmHg (6 - 46 mmHg) and at one postoperative month it was 14.2 mmHg (8 - 22 mmHg). There were no cases of sclerotomy-related retinal breaks, postoperative endophthalmitis, or ocular hypotony. Three of 5 eyes (60%) with retinal detachment needed further surgical intervention (all pseudophakic) and 4 of 5 eyes (80%) with vitreous hemorrhage had postoperative residual hemorrhage. All cases with macular diseases and phakic retinal detachments were successful with one surgery. CONCLUSION: This transconjunctival vitrectomy technique showed as its main benefits the low incidence of sclerotomy-related breaks and postoperative ocular hypertension. An adequate case selection seems to be crucial.

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