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- ItemSomente MetadadadosANATOMICAL AND FUNCTIONAL OUTCOMES OF SYMPTOMATIC IDIOPATHIC VITREOMACULAR TRACTION: A Natural History Study From the Pan American Collaborative Retina Study Group(Lippincott Williams & Wilkins, 2016) Wu, Lihteh; Zas, Marcelo; Berrocal, Maria H.; Arevalo, J. Fernando; Figueroa, Marta; Rodriguez, Francisco; Serrano, Martin; Graue, Federico; Alezzandrini, Arturo; Gallego-Pinazo, Roberto; Roca, Jose A.; Iglicki, Matias; Dalma-Weishauz, Jose; Kozak, Igor; Collado, Alberto; Badal, Josep; Maia, Mauricio [UNIFESP]; Salcedo-Villanueva, Guillermo; Quiroz-Mercado, Hugo; Fromow-Guerra, Jans; Lozano-Rechy, David; Avila, Marcos; Chhablani, JayPurpose:To describe the natural history of eyes with symptomatic idiopathic vitreomacular traction (VMT).Methods:Retrospective multicenter study of 168 eyes with spectral-domain optical coherence tomography (SD-OCT) findings consistent with idiopathic VMT. All eyes were graded according to SD-OCT findings. Grade 1 was defined as incomplete cortical vitreous separation with foveal attachment. Grade 2 was defined as Grade 1 plus intraretinal cysts or clefts. Grade 3 was defined as Grade 2 plus a foveal detachment. All patients were followed for at least 6 months.Results:There were 168 patients (51 men) with a mean age of 68.8 10.7 years. Patients were followed for a mean of 22.7 +/- 20.1 months. The mean duration of symptoms before the initial presentation was 3.65 +/- 5.42 months. At baseline, 72 eyes had Grade 1, 74 eyes had Grade 2, and 22 eyes had Grade 3 SD-OCT findings. Over the follow-up period, 36 eyes (21.4%) had spontaneous resolution of the VMT with normalization of the foveal anatomy. The mean time to resolution was 12.3 +/- 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of the eyes, with 6 eyes developing a lamellar macular hole and 7 eyes developing a full-thickness macular hole. This occurred at a mean of 10.3 +/- 10.7 months after the presentation. Subgroup analysis based on baseline SD-OCT grade showed that 4.1% (3 of 73) of Grade 1 eyes compared with 6.8% (5 of 74) of Grade 2 eyes, and 23.8% (5 of 21) of Grade 3 eyes developed a full-thickness macular hole or lamellar macular hole (P = 0.0109, chi-square test). In the remaining 119 eyes, at the last follow-up, 65 eyes had Grade 1, 42 eyes had Grade 2, and 12 eyes had Grade 3 VMT. On average, the best-corrected visual acuity improved from 0.40 +/- 0.35 logarithm of the minimum angle of resolution (Snellen, 20/50) at baseline to 0.35 +/- 0.36 logarithm of the minimum angle of resolution (Snellen, 20/45
- ItemSomente MetadadadosCOMPARISON of 20-, 23-, and 25-GAUGE AIR INFUSION FORCES(Lippincott Williams & Wilkins, 2011-11-01) Machado, Leonardo Martins [UNIFESP]; Magalhaes, Octaviano [UNIFESP]; Maia, Mauricio [UNIFESP]; Rodrigues, Eduardo B. [UNIFESP]; Farah, Michel Eid [UNIFESP]; Ismail, Kamal A. R.; Molon, Leandro; Oliveira, Danilo A.; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)Purpose: To determine and compare 20-, 23-, and 25-gauge retinal infusion air jet impact pressure (force per unit area) in an experimental setting.Methods: Experimental laboratory investigation. Infusion cannulas were connected to a compressed air system. A controlled valve mechanism was used to obtain increasing levels of infusion pressure. Each infusion tube was positioned in front of a manual transducer to measure force. Impact pressure was calculated using known formulas in fluid dynamics.Results: the 20-gauge infusion jet showed similar impact pressure values compared with the 23-gauge infusion jet. Both showed higher levels than the 25-gauge infusion jet. This was because of the smaller jet force for the 25-gauge system.Conclusion: in this experimental study, both the 23- and the 20-gauge air infusion jet showed higher impact pressure values compared with the 25-gauge air infusion jet. This could be of concern regarding air infusion during 23-gauge vitrectomy since retinal damage has been shown in standard-gauge surgeries. RETINA 31:2002-2006, 2011
- ItemSomente MetadadadosEffects of subretinal injection of patent blue and trypan blue in rabbits(Taylor & Francis Inc, 2007-04-01) Maia, Mauricio [UNIFESP]; Penha, Fernando [UNIFESP]; Rodrigues, Eduardo Buchele [UNIFESP]; Principe, Andre [UNIFESP]; Dib, Eduardo [UNIFESP]; Meyer, Carsten H. [UNIFESP]; Freymuller, Edna [UNIFESP]; Moraes, Nilva [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To investigate the histologic and clinical effects of subretinal injection of patent blue (PB) and trypan blue (TB) in rabbits. Methods: Dutch-belted rabbits (n = 8) were vitrectomized followed by subretinal injection of 2.4 mg/ml PB (285 mOsm) and 1.5 mg/ml TB (312 mOsm); balanced salt solution (BSS) (300 mOsm) served as the control. Animals were examined 6, 12, and 24 hr and 14 days after the procedure by fluorescein angiography (FA) and indirect ophthalmoscopy; for retinal toxicity, histologic evaluation studies were performed by light and transmission electron microscopy. Results: FA examination demonstrated window defects suggestive of retinal pigment epithelium (RPE) atrophy in positions of subretinal TB injection, but this was not observed after subretinal injection of PB or BSS. Histologic evaluation disclosed only minimal abnormalities on the photoreceptor outer segment (POS) after subretinal injection of BSS during all follow-up. Subretinal injection of PB caused POS and photoreceptor inner segment (PIS) abnormalities 12 and 24 hr after surgery as well as outer nuclear layer (ONL) damage 14 days after surgery. Subretinal TB injection resulted in POS and PIS damage at 12 hr follow-up. the ONL damage was observed 24 hr after surgery; additionally, POS, PIS, ONL, and RPE abnormalities were observed 14 days after surgery after TB injection. Conclusions: Subretinal injection of TB induced more significant clinical and histologic damage of neurosensory retina/RPE than did PB or BSS. Future human studies are necessary to access the clinical relevance of these in vivo experiments.
- ItemSomente MetadadadosIntravitreal staining of the internal limiting membrane using indocyanine green in the treatment of macular holes(Karger, 2005-01-01) Rodrigues, E. B.; Meyer, C. H.; Farah, M. E. [UNIFESP]; Kroll, P.; Univ Marburg; Universidade Federal de São Paulo (UNIFESP)Surgical management of macular holes consists of pars plana vitrectomy, removal of the posterior hyaloid facia, and peeling of the epiretinal membranes (ERM). Additionally, removal of the internal limiting membrane (ILM) may enable an increase in the anatomic and functional success rates. However, recognition of fine ILM is difficult thus increasing the time that the macula is exposed to intraoperative light. Staining the ILM with indocyanine green (ICG) dye during vitrectomy facilitates recognition of the ILM and assures that all adjacent ERM are removed. Therefore, ICG-assisted ILM peeling has gained worldwide popularity among vitreoretinal surgeons. However, there are some concerns about the intravitreal ICG application. Reports in the literature described a variety of application techniques using different concentrations. the postoperative outcomes were controversial reporting heterogeneous anatomical and functional outcomes after ICG application, as well as descriptions of adverse effects related to the dye. We discuss the indications, techniques, surgical results, and complications after intravitreal ICG injection for the treatment of macular holes. Copyright (C) 2005 S. Karger AG, Basel.
- ItemSomente MetadadadosLUTEIN A New Dye for Chromovitrectomy(Lippincott Williams & Wilkins, 2014-02-01) Maia, Mauricio [UNIFESP]; Furlani, Bruno de Albuquerque [UNIFESP]; Lima Filho, Acácio Alves de Souza [UNIFESP]; Martins, Diogo de Sousa [UNIFESP]; Navarro, Rodrigo Milan [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To evaluate the feasibility, advantages, and safety of a novel lutein-based dye for improving identification and removal of the vitreous, internal limiting membrane, and epiretinal membrane during chromovitrectomy in humans.Methods: We prospectively evaluated 12 eyes that underwent pars plana vitrectomy using the dye in patients with macular hole, epiretinal membrane, or proliferative diabetic retinopathy/tractional diabetic macular edema. One surgeon performed standard chromovitrectomy and completed a postoperative questionnaire to compare the staining with that of the available dyes. The peeled membranes were evaluated histologically. Follow-up examinations were performed on postoperative Days 1, 7, 30, 90 and 180; best-corrected visual acuity, optical coherence tomography, fluorescein angiography, autofluorescence, and visual fields were performed.Results: The green dye was deposited on the posterior pole because of its higher density than balanced saline solution; vigorous dye flushing into the vitreous cavity was unnecessary. The dye stained the posterior hyaloid/vitreous base by deposition onto the vitreous; brilliant blue stained the internal limiting membrane. The epiretinal membrane was poorly stained. The best-corrected visual acuity improved in all eyes without clinical toxicity or toxicity on images/visual fields. Histology showed effective removal of the internal limiting membrane and epiretinal membrane in all eyes.Conclusion: The new dye improved intraoperative identification of the internal limiting membrane and the posterior hyaloid/ vitreous base during chromovitrectomy.
- ItemSomente MetadadadosMechanisms of intravitreal toxicity of indocyanine green dye(Lippincott Williams & Wilkins, 2007-09-01) Rodrigues, Eduardo Buchele [UNIFESP]; Meyer, Carsten H. [UNIFESP]; Mennel, Stefan; Farah, Michel Eid [UNIFESP]; Hosp Reg Sao Jose; Universidade Federal de São Paulo (UNIFESP); Univ MarburgPurpose: Indocyanine green (ICG) dye was shown to improve the visualization of preretinal tissues during chromovitrectomy. However, controversy arose regarding the safety of intravitreal ICG application, because worse functional outcomes and a higher incidence of retinal pigment epithelium (RPE) changes and visual field defects were reported. The mechanisms of ICG-related toxicity and their relevance for chromovitrectomy are reviewed.Methods: A literature search was performed from 1998 through 2005 for relevant information related to the mechanisms of intravitreal ICG toxicity. Animal and clinical data on intravitreal ICG-related toxicity were collected to clarify the mechanisms of the risk of intravitreal ICG injection.Results: Over 80 controversial in vitro, ex vivo, and in vivo animal investigations as well as clinical reports on intravitreal ICG staining were found in the literature. The main postulated mechanisms of intravitreal ICG-related toxicity were as follows: biochemical direct injury to the ganglion cells/neuroretinal cells, RPE cells, and superficial retinal vessels; apoptosis and gene expression alterations to either RPE cells or neuroretinal cells; osmolarity effect of ICG solution on the vitreoretinal interface; light-induced injury; and mechanical cleavage effect to the internal limiting membrane/inner retina. Whereas the exact mechanism of intravitreal ICG-related damage remains yet to be determined, most animal experiments proposed that ICG dye has a dose-dependent toxic effect on retinal tissue. This hypothesis was supported by clinical data, because better functional outcomes were obtained when low dye concentrations and short incubation times were reported.Conclusions: Much evidence supports that ICG dye has a dose-dependent toxic effect on the retina. Therefore, the following recommendations to minimize toxic effects on the retina are proposed: dye injection in concentrations as low as possible; avoidance of repeated ICG injections onto bare retina; dye injection far from the macular hole to prevent direct dye contact with the RPE; short incubation time of ICG in the vitreous cavity to diminish the concentration in contact with the retinal tissue; and the light pipe kept far from the retina throughout the whole surgical procedure.
- ItemSomente MetadadadosOptical coherence tomography characteristics of full-thickness traumatic macular holes(Nature Publishing Group, 2008-11-01) Arévalo, J. F.; Sanchez, J. G.; Costa, R. A.; Farah, Michel Eid [UNIFESP]; Berrocal, M. H.; Graue-Wiechers, F.; Lizana, C.; Robledo, V.; Lopera, M.; Clin Oftalmol Ctr Caracas; Hosp Olhos Araraquara; Universidade Federal de São Paulo (UNIFESP); Univ Puerto Rico; Fdn Conde Valenciana; Inst Ciencias Salud CESPurpose the objective of this paper is to describe the optical coherence tomography (OCT) characteristics of patients with full-thickness traumatic macular hole (TMH) and to correlate them with biomicroscopy findings.Methods Twelve eyes of ten consecutive patients with full-thickness TMH participated in this observational retrospective multicentre study. Patients underwent biomicroscopic fundus examination, colour fundus photography, and OCT.Results Traumatic macular hole was documented with OCT in five women and five men. Mean (range) time between trauma and macular hole (MH) diagnosis was 8.1 (1-24) months. the shape of TMHs was round in 11 (91.7%) eyes. the posterior vitreous was completely detached in six (50%) eyes, and with an operculum in one (8.3%) eye. the common findings seen on OCT were: (1) full-thickness loss of retinal tissue through the hole with sharp edges, perpendicular to the retinal pigment epithelium in five (41.7%) eyes; (2) TMH with an operculum totally detached from the hole's edge in two (16.7%) eyes; (3) presence of epiretinal membrane around of the hole in three (25%) eyes; and (4) presence of abnormalities of the surrounding retina in all (100%) eyes. the OCT characteristics correlated well with biomicroscopic findings, and these characteristics may be predictive for final visual acuity (VA) in TMHs. Only one of the TMHs closed spontaneously in our series.Conclusion Optical coherence tomography complements biomicroscopy in the evaluation of full-thickness TMHs.
- ItemSomente MetadadadosRetinal pigment epithelial abnormalities after internal limiting membrane peeling guided by indocyanine green staining(Lippincott Williams & Wilkins, 2004-02-01) Maia, M.; Haller, J. A.; Pieramici, D. J.; Margalit, E.; De Juan, E.; Farah, M.; Lakhanpal, R. R.; Eong, KGA; Guven, D.; Humayun, M. S.; Univ So Calif; Johns Hopkins Univ; Universidade Federal de São Paulo (UNIFESP)
- ItemSomente MetadadadosSubretinal trypan blue migration during epiretinal membrane peeling(Lippincott Williams & Wilkins, 2006-02-01) Uno, Fausto; Malerbi, Fernando; Maia, Mauricio; Farah, Michel Eid; Maia, Andre; Magalhaes, Octaviano; Universidade Federal de São Paulo (UNIFESP)
- ItemSomente MetadadadosVital dyes for chromovitrectomy(Lippincott Williams & Wilkins, 2007-05-01) Rodrigues, Eduardo B.; Maia, Mauricio; Meyer, Carsten H.; Penha, Fernando M.; Dib, Eduardo; Farah, Michel E.; Universidade Federal de São Paulo (UNIFESP); Univ BonnPurpose of reviewThe aim of this article is to present the current state-of-the-art in 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.Recent findingsA 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.SummaryThis 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.