PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measur... more PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measurements of the thickness of femtosecond laser-created laser in situ keratomileusis (LASIK) flaps.
PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measur... more PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measurements of the thickness of femtosecond laser-created laser in situ keratomileusis (LASIK) flaps.
ABSTRACT We present two cases of posterior amorphous corneal dystrophy in members of the same fam... more ABSTRACT We present two cases of posterior amorphous corneal dystrophy in members of the same family. We correlated the clinical findings with refraction, topography, and ultrasound biomicroscopy (UBM). This is the first report of UBM findings in amorphous corneal dystrophy and we describe the depth of stromal opacification measured in this exam. Additional cases will be of great help to reinforce these findings.
The term fundus flavimaculatus (Stargardt disease) describes a group of inherited macular dystrop... more The term fundus flavimaculatus (Stargardt disease) describes a group of inherited macular dystrophies characterized by multiple yellow to yellow-white flecks at the level of the retinal pigment epithelium. The authors describe findings in the patient with Stargardt's disease using optical coherence tomography (OCT), and suggest the examination to be valid as subsidiary method in the study of the characteristics of the retina in Stargardt's disease patients, but studies involving a series of patients should be able to show the most frequent findings in these cases.
Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can als... more Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.
To describe quantitative and qualitative features of eyes with advanced bullous keratopathy asses... more To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively…
Objective: To evaluate clinical and refractive results of myopic angle-supported intraocular lens... more Objective: To evaluate clinical and refractive results of myopic angle-supported intraocular lenses (IOLs). Design: Prospective, noncomparative case series. Participants: Twenty-one eyes of 12 patients (7 female) with a mean age of 29.5 years and a follow-up of 24 months. The prospective study included highly myopic eyes (more than Ϫ11.00 diopters [D]) with spectaclecorrected visual acuity better than 20/200.
To evaluate the equivalence of Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM) in... more To evaluate the equivalence of Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM) in determining corneal epitheliumϪintraocular lens (IOL) and border IOLϪiris distances.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2011
The treatment of small choroidal melanoma is controversial. Thermal laser-induced treatment is ut... more The treatment of small choroidal melanoma is controversial. Thermal laser-induced treatment is utilized by some centers but there is still sparse literature about the subject, mainly with short-term follow-up time. The efficacy of transpupillary thermotherapy (TTT) for the treatment of small choroidal melanomas was evaluated. A prospective nonrandomized study of transpupillary thermotherapy for small (thickness ≤ 4.0 mm and basal diameter ≤ 12 mm) pigmented choroidal melanomas presenting either growth or risk factors for growth and metastasis. Ophthalmoscopic aspect, tumor control, visual acuity and complications were evaluated. Twenty-seven patients were treated; mean age 61 years; mean tumor thickness before treatment was 2.7 mm and base was 8.52 mm. After a mean of three treatment sessions and 45-month follow-up, mean tumor thickness decreased significantly to 1.34 mm (p < 0.001) and mean tumor base to 5.48 mm (p < 0.001). Complications were observed in 12 patients (44%) and included retinal vascular occlusion, optic disc atrophy, retinal traction, vitreous hemorrhage, rhegmatogenous retinal detachment, and maculopathy. Lesions touching the optic disc were associated with a significantly higher rate of disc atrophy after treatment (60% vs. 40%, p=0.030). Visual acuity remained the same in nine eyes (33%), improved in five (19%) and decreased during the first 6 months after treatment in 13 eyes (48%). Complete tumor control without recurrence was observed in 25 patients (93%). Recurrence at tumor margin was detected in two (7%). All eyes were preserved. One patient had tumor-related death. TTT is an effective treatment in the management of selected small choroidal melanoma. Decrease in visual acuity occurred early after treatment mainly associated with subfoveal and perifoveal tumors treatment and complications. Long-term randomized studies are still needed in order to better situate this treatment.
Prospective randomized clinical trial to evaluate the efficacy of lyophilized corneas for deep an... more Prospective randomized clinical trial to evaluate the efficacy of lyophilized corneas for deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. Ten eyes underwent DALK and received corneas that had been lyophilized, and 10 eyes received corneas kept in Optisol. Follow-up examinations included measurement of visual acuity (VA; Early Treatment Diabetic Retiropathy Study chart), topography, pachymetry, specular microscopy, contrast sensitivity, and confocal microscopy. All variables improved similarly in both groups, without statistical differences between them, except for the uncorrected VA in the sixth postoperative month, which was better in the lyophilized group (0.46) compared with the Optisol group (0.70). The best spectacle-corrected VA was 0.16 in the lyophilized group and 0.26 in the Optisol group. The mean endothelial cell count during the sixth postoperative month was 2778.5 in the lyophilized group and 2611.5 in the Optisol group. Optisol corneas had greater keratocyte density, and the keratocyte density improved in lyophilized corneas during follow-up. Lyophilized corneas can be used successfully for DALK to treat keratoconus with results similar to Optisol corneas.
To study two cases of corneal scarring due to trauma (one case) and infection (one case) unrelate... more To study two cases of corneal scarring due to trauma (one case) and infection (one case) unrelated to a previous photorefractive keratectomy (PRK) for the correction of myopia. The patients are part of an Institutional Review Board-approved study of the safety and efficacy of PRK. Both patients underwent bilateral, nonsimultaneous corneal ablation based on preoperative spherical equivalent. Seven months after PRK, the first patient sustained an alkali burn in one eye that caused severe corneal scarring and myopic regression. The other patient developed bilateral keratoconjunctivitis, more intense in the right eye (1 month after the operation) than in the left eye (4 months after the operation). This right eye subsequently developed diffuse scarring and loss of visual acuity. Patients who have undergone PRK may develop severe corneal scarring after relatively mild ocular traumas or infections.
Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2014
Takayasu arteritis (TA) is a chronic, granulomatous, idiopathic, inflammatory disease that primar... more Takayasu arteritis (TA) is a chronic, granulomatous, idiopathic, inflammatory disease that primarily affects large vessels. The objective of this study was to evaluate and describe the ocular manifestations of TA, correlating the resistivity and pressure in retrobulbar vessels by colour Doppler and retinal angiography. Cross-sectional study. Twenty-one patients with TA, 42 eyes, and 21 patients without TA (42 eyes) as control subjects. This study was performed in clinical practice. Patients with TA received complete ophthalmologic examination, fluorescein and indocyanine green angiography, and colour Doppler ultrasound to evaluate blood flow in the retrobulbar vessels. A statistical correlation was found between peak systolic velocity (PSV) in the ophthalmic artery (OA) and Heidelberg retinal angiography (HRA) examination results (p = 0.006), and resistivity index (RI) in the OA was abnormal in patients with long (average, 14 years) versus short (average, 5.5 years) onset time of the disease (p = 0.035). RI in the central retinal artery (CRA) was abnormal in patients with a long time of disease onset (mean 14.4 years) versus those with a short time (mean 4.6 years) of onset (p = 0.006). The longer the onset of the disease, the more commonly the RI showed changes in the OA and CRA, and, to a lesser extent, in the short posterior ciliary artery. When abnormalities are observed in the HRA examination, abnormal PSV in the OA may be present. Doppler blood flow evaluation and HRA may have predictive value in all patients with TA as part of serial monitoring.
Presbyopia is characterized as a progressive age-related loss of accommodative amplitude. In rece... more Presbyopia is characterized as a progressive age-related loss of accommodative amplitude. In recent years, attempts have been made to surgically reverse presbyopia. This article discusses different procedures proposed for treatment of presbyopia in phakic patients.
Purpose: To present how the section of Refractive Surgery of the Federal University of São Paulo ... more Purpose: To present how the section of Refractive Surgery of the Federal University of São Paulo assesses the candidates and the reasons to indicate for corneal refractive surgery. Methods: We examined 1626 patients. Anamnesis, complete ophthalmologic examination and corneal topography were performed in all patients. The patients spontaneously seeked evaluation at the Refractive Surgery Section by telephone without a previous screening. Reasons to refuse patients for refractive surgery were previously established by the Refractive Surgery Section. Results: Based on current technology and clinical experience, 265 patients (16.29%) were refused for excimer laser corneal refractive surgery. Myopia of patients who had insufficient preoperative corneal pachymetry for the laser treatment was the main cause for refusal (51 patients). Cataract (45 patients), keratoconus (31 patients), amblyopia (21 patients), hyperopia > 5 diopters and mixed astigmatism (19 patients), presbyopia (unaware ness of the need for optical correction after the procedure; 16 patients), pupillary diameter > 5mm (9 patients), single eye (9 patients), progressive myopia (8 patients), postradial keratotomy (7 patients) and low ametropia (7 patients) were among the reasons for the refusal. Conclusion: Candidates for excimer laser corneal refractive surgery may present risk factors that should be known in order to avoid complications.
PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measur... more PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measurements of the thickness of femtosecond laser-created laser in situ keratomileusis (LASIK) flaps.
PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measur... more PURPOSE-To evaluate the repeatability of Fourier-domain optical coherence tomography (OCT) measurements of the thickness of femtosecond laser-created laser in situ keratomileusis (LASIK) flaps.
ABSTRACT We present two cases of posterior amorphous corneal dystrophy in members of the same fam... more ABSTRACT We present two cases of posterior amorphous corneal dystrophy in members of the same family. We correlated the clinical findings with refraction, topography, and ultrasound biomicroscopy (UBM). This is the first report of UBM findings in amorphous corneal dystrophy and we describe the depth of stromal opacification measured in this exam. Additional cases will be of great help to reinforce these findings.
The term fundus flavimaculatus (Stargardt disease) describes a group of inherited macular dystrop... more The term fundus flavimaculatus (Stargardt disease) describes a group of inherited macular dystrophies characterized by multiple yellow to yellow-white flecks at the level of the retinal pigment epithelium. The authors describe findings in the patient with Stargardt's disease using optical coherence tomography (OCT), and suggest the examination to be valid as subsidiary method in the study of the characteristics of the retina in Stargardt's disease patients, but studies involving a series of patients should be able to show the most frequent findings in these cases.
Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can als... more Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.
To describe quantitative and qualitative features of eyes with advanced bullous keratopathy asses... more To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively…
Objective: To evaluate clinical and refractive results of myopic angle-supported intraocular lens... more Objective: To evaluate clinical and refractive results of myopic angle-supported intraocular lenses (IOLs). Design: Prospective, noncomparative case series. Participants: Twenty-one eyes of 12 patients (7 female) with a mean age of 29.5 years and a follow-up of 24 months. The prospective study included highly myopic eyes (more than Ϫ11.00 diopters [D]) with spectaclecorrected visual acuity better than 20/200.
To evaluate the equivalence of Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM) in... more To evaluate the equivalence of Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM) in determining corneal epitheliumϪintraocular lens (IOL) and border IOLϪiris distances.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2011
The treatment of small choroidal melanoma is controversial. Thermal laser-induced treatment is ut... more The treatment of small choroidal melanoma is controversial. Thermal laser-induced treatment is utilized by some centers but there is still sparse literature about the subject, mainly with short-term follow-up time. The efficacy of transpupillary thermotherapy (TTT) for the treatment of small choroidal melanomas was evaluated. A prospective nonrandomized study of transpupillary thermotherapy for small (thickness ≤ 4.0 mm and basal diameter ≤ 12 mm) pigmented choroidal melanomas presenting either growth or risk factors for growth and metastasis. Ophthalmoscopic aspect, tumor control, visual acuity and complications were evaluated. Twenty-seven patients were treated; mean age 61 years; mean tumor thickness before treatment was 2.7 mm and base was 8.52 mm. After a mean of three treatment sessions and 45-month follow-up, mean tumor thickness decreased significantly to 1.34 mm (p < 0.001) and mean tumor base to 5.48 mm (p < 0.001). Complications were observed in 12 patients (44%) and included retinal vascular occlusion, optic disc atrophy, retinal traction, vitreous hemorrhage, rhegmatogenous retinal detachment, and maculopathy. Lesions touching the optic disc were associated with a significantly higher rate of disc atrophy after treatment (60% vs. 40%, p=0.030). Visual acuity remained the same in nine eyes (33%), improved in five (19%) and decreased during the first 6 months after treatment in 13 eyes (48%). Complete tumor control without recurrence was observed in 25 patients (93%). Recurrence at tumor margin was detected in two (7%). All eyes were preserved. One patient had tumor-related death. TTT is an effective treatment in the management of selected small choroidal melanoma. Decrease in visual acuity occurred early after treatment mainly associated with subfoveal and perifoveal tumors treatment and complications. Long-term randomized studies are still needed in order to better situate this treatment.
Prospective randomized clinical trial to evaluate the efficacy of lyophilized corneas for deep an... more Prospective randomized clinical trial to evaluate the efficacy of lyophilized corneas for deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. Ten eyes underwent DALK and received corneas that had been lyophilized, and 10 eyes received corneas kept in Optisol. Follow-up examinations included measurement of visual acuity (VA; Early Treatment Diabetic Retiropathy Study chart), topography, pachymetry, specular microscopy, contrast sensitivity, and confocal microscopy. All variables improved similarly in both groups, without statistical differences between them, except for the uncorrected VA in the sixth postoperative month, which was better in the lyophilized group (0.46) compared with the Optisol group (0.70). The best spectacle-corrected VA was 0.16 in the lyophilized group and 0.26 in the Optisol group. The mean endothelial cell count during the sixth postoperative month was 2778.5 in the lyophilized group and 2611.5 in the Optisol group. Optisol corneas had greater keratocyte density, and the keratocyte density improved in lyophilized corneas during follow-up. Lyophilized corneas can be used successfully for DALK to treat keratoconus with results similar to Optisol corneas.
To study two cases of corneal scarring due to trauma (one case) and infection (one case) unrelate... more To study two cases of corneal scarring due to trauma (one case) and infection (one case) unrelated to a previous photorefractive keratectomy (PRK) for the correction of myopia. The patients are part of an Institutional Review Board-approved study of the safety and efficacy of PRK. Both patients underwent bilateral, nonsimultaneous corneal ablation based on preoperative spherical equivalent. Seven months after PRK, the first patient sustained an alkali burn in one eye that caused severe corneal scarring and myopic regression. The other patient developed bilateral keratoconjunctivitis, more intense in the right eye (1 month after the operation) than in the left eye (4 months after the operation). This right eye subsequently developed diffuse scarring and loss of visual acuity. Patients who have undergone PRK may develop severe corneal scarring after relatively mild ocular traumas or infections.
Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2014
Takayasu arteritis (TA) is a chronic, granulomatous, idiopathic, inflammatory disease that primar... more Takayasu arteritis (TA) is a chronic, granulomatous, idiopathic, inflammatory disease that primarily affects large vessels. The objective of this study was to evaluate and describe the ocular manifestations of TA, correlating the resistivity and pressure in retrobulbar vessels by colour Doppler and retinal angiography. Cross-sectional study. Twenty-one patients with TA, 42 eyes, and 21 patients without TA (42 eyes) as control subjects. This study was performed in clinical practice. Patients with TA received complete ophthalmologic examination, fluorescein and indocyanine green angiography, and colour Doppler ultrasound to evaluate blood flow in the retrobulbar vessels. A statistical correlation was found between peak systolic velocity (PSV) in the ophthalmic artery (OA) and Heidelberg retinal angiography (HRA) examination results (p = 0.006), and resistivity index (RI) in the OA was abnormal in patients with long (average, 14 years) versus short (average, 5.5 years) onset time of the disease (p = 0.035). RI in the central retinal artery (CRA) was abnormal in patients with a long time of disease onset (mean 14.4 years) versus those with a short time (mean 4.6 years) of onset (p = 0.006). The longer the onset of the disease, the more commonly the RI showed changes in the OA and CRA, and, to a lesser extent, in the short posterior ciliary artery. When abnormalities are observed in the HRA examination, abnormal PSV in the OA may be present. Doppler blood flow evaluation and HRA may have predictive value in all patients with TA as part of serial monitoring.
Presbyopia is characterized as a progressive age-related loss of accommodative amplitude. In rece... more Presbyopia is characterized as a progressive age-related loss of accommodative amplitude. In recent years, attempts have been made to surgically reverse presbyopia. This article discusses different procedures proposed for treatment of presbyopia in phakic patients.
Purpose: To present how the section of Refractive Surgery of the Federal University of São Paulo ... more Purpose: To present how the section of Refractive Surgery of the Federal University of São Paulo assesses the candidates and the reasons to indicate for corneal refractive surgery. Methods: We examined 1626 patients. Anamnesis, complete ophthalmologic examination and corneal topography were performed in all patients. The patients spontaneously seeked evaluation at the Refractive Surgery Section by telephone without a previous screening. Reasons to refuse patients for refractive surgery were previously established by the Refractive Surgery Section. Results: Based on current technology and clinical experience, 265 patients (16.29%) were refused for excimer laser corneal refractive surgery. Myopia of patients who had insufficient preoperative corneal pachymetry for the laser treatment was the main cause for refusal (51 patients). Cataract (45 patients), keratoconus (31 patients), amblyopia (21 patients), hyperopia > 5 diopters and mixed astigmatism (19 patients), presbyopia (unaware ness of the need for optical correction after the procedure; 16 patients), pupillary diameter > 5mm (9 patients), single eye (9 patients), progressive myopia (8 patients), postradial keratotomy (7 patients) and low ametropia (7 patients) were among the reasons for the refusal. Conclusion: Candidates for excimer laser corneal refractive surgery may present risk factors that should be known in order to avoid complications.
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Papers by Norma Allemann