Publications by authors named "Emmerson Badaró"

28 Publications

  • Page 1 of 1

New perspectives on macular hole surgery at three years of follow-up.

Arq Bras Oftalmol 2019 30;82(6):481-487. Epub 2019 Sep 30.

Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Purpose: The aim of this study was to determine the functional and anatomical success rates as well as the safety of sutureless combined surgery involving vitreous base removal and internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining for the management of idiopathic macular holes after three years.

Methods: Forty-six eyes of 46 patients with an idiopathic macular hole were enrolled in this retrospective study. The inclusion criteria were macular holes with a minimum linear diameter below 1,500 mm, 0.05 or better decimal best-corrected visual acuity and duration of symptoms less than two years. The exclusion criteria included pregnancy, optic nerve atrophy, advanced glaucoma, and other chronic ocular diseases. The surgical procedure included internal limiting membrane peeling after Brilliant Blue G (0.5 mg/mL) staining, along with C3F8 tamponade and face-down positioning for three days postoperatively. Ophthalmologic examinations and optical coherence tomography were performed at 1 and 7 days and 1, 6, 12, 24, and 36 months postoperatively. If no anatomic closure of the macular holes occurred within the first month, the area of the internal limiting membrane peeling was enlarged in a second procedure. Multiple logistic regression and chi-squared tests were used for data analyses, and p-values of <0.05 were considered significant.

Results: Out of 46 eyes with a preoperative idiopathic macular hole, anatomic closure was achieved in 42 (91.3%) after one procedure and in 45 (97.8%) after an additional surgery. The median postoperative best-corrected visual acuity improvement was 0.378 (range: 0.050-0.900) decimal. None of the patients experienced macular hole reopening, surgery-related complications, or ocular complications related to the dye.

Conclusion: Combined surgery including vitreous base removal and internal limiting membrane peeling after staining with Brilliant Blue G (0.5 mg/mL) for the management of idiopathic macular holes resulted in adequate staining, best-corrected visual acuity improvement, and macular hole closure with no signs of ocular toxicity at the three-year follow-up examination.
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http://dx.doi.org/10.5935/0004-2749.20190101DOI Listing
March 2020

Experimental model to evaluate the benefits of lutein to prevent retinal phototoxicity during pars plana vitrectomy surgery using xenon source light illumination in rabbits.

Int J Retina Vitreous 2019 7;5:11. Epub 2019 May 7.

Departamento de Oftalmologia, Universidade Federal de São Paulo, Secretaria Administrativa, Rua Botucatu, 821, 1o andar, São Paulo, SP 04023-062 Brazil.

Background: To evaluate the benefits of lutein in preventing retinal phototoxicity generated by xenon light sources during vitreoretinal surgery.

Methods: A prospective cross-sectional study in pigmented rabbit eyes exposed to different vitreoretinal surgery lighting simulations. Twenty Dutch-belted rabbits were divided into two groups exposed to two different xenon wavelength light sources filters (420 nm and 435 nm). In addition, two subgroups were administered with daily supplemental of 10 mg of Lutein systemically. Electroretinography (ERG), optical coherence tomography (OCT) and fluorescein angiography (FA) were performed before and after surgery to quantify the retinal damage.

Results: All animals submitted to the experiment presented some degree of phototoxicity independent of wavelength light filter used. Retinal damage was evident as the FA presented areas of hyperfluorescence, and the OCT depicted increased reflective areas of the inner and outer retinal layers, and RPE. ERG showed a diffuse reduction of the a and b waves amplitudes in all animals.

Conclusion: Use of systemic administration of lutein showed no benefit to avoiding retinal phototoxicity generate to xenon light source using filters of 435 nm and 420 nm when comparing to the control group.
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http://dx.doi.org/10.1186/s40942-019-0161-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503373PMC
May 2019

Effectiveness of monthly and fortnightly anti-VEGF treatments for age-related macular degeneration.

Arq Bras Oftalmol 2019 May-Jun;82(3):225-232. Epub 2019 Feb 25.

Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Purpose: To study the efficacy and safety of treatments with ranibizumab and bevacizumab for exudative age-related macular degeneration.

Methods: A parallel randomized clinical trial was conducted to compare the efficacy and safety of three regimens (bevacizumab every month, bevacizumab every 2 weeks, and ranibizumab every month), followed by as-needed retreatments, for 1 year, in previously untreated individuals with age-related macular degeneration. The primary outcome was change in visual acuity and in central macular thickness after 1 year of follow-up. Subjects were assigned randomly to one of the three groups in a 1:1:1 ratio, and investigators and examiners were blinded to the randomization results.

Results: We included 15 patients in each group. After 1 year of follow-up, we found statistically significant improvements in visual acuity and central macular thickness reduction in all groups. However, we found no statistically significant differences between the three groups.

Conclusions: The bi-weekly follow-up was effective and we found no significant differences in efficacy or safety between the treatments with ranibizumab and bevacizumab.
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http://dx.doi.org/10.5935/0004-2749.20190043DOI Listing
January 2020

Combined Femtosecond Laser-Assisted Cataract Surgery and Small-Gauge Pars Plana Vitrectomy Using Different Devices: A New Trend for Vitreoretinal Surgery?

Ophthalmic Surg Lasers Imaging Retina 2018 05;49(5):374-379

Background And Objective: To report the efficacy, safety, and benefits of femtosecond laser-assisted cataract surgery (FLACS) combined with sutureless 23-gauge pars plana vitrectomy (PPV).

Patients And Methods: This multicenter, retrospective study evaluated patient records and videos of 43 cases with retinal pathologies and cataract who underwent the combined procedure.

Results: In 44.2% and 55.8% of cases, respectively, the LenSx Laser (femtosecond machine; Alcon, Fort Worth, TX) and the Constellation (vitreous cutter; Alcon, Fort Worth, TX), and the Victus (femtosecond machine; Bausch + Lomb, Rochester, NY) and Stellaris PC (vitreous cutter; Bausch + Lomb, Rochester, NY) were used. No complications developed during capsulorrhexis, even without a red fundus reflex, retrobulbar block, or scleral indentation. Foldable intraocular lenses remained stable in the capsular bag during the vitreoretinal surgeries and postoperative visits. The mean times of femtosecond phacoemulsification, vitreoretinal surgery, and total surgery were 22.9 minutes ± 4.7 minutes, 43.1 minutes ± 9.8 minutes, and 65.3 minutes ± 8.6 minutes, respectively.

Conclusion: This emerging technology is safe and offers several potential benefits for the success of the combined procedure. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:374-379.].
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http://dx.doi.org/10.3928/23258160-20180501-13DOI Listing
May 2018

Retinal Toxicity of Acai Fruit (Euterpe Oleracea) Dye Concentrations in Rabbits: Basic Principles of a New Dye for Chromovitrectomy in Humans.

Curr Eye Res 2017 08 11;42(8):1185-1193. Epub 2017 May 11.

a Department of Ophthalmology , Federal University of São Paulo , São Paulo , Brazil.

Purpose: Evaluate toxicity of acai fruit (Euterpe oleracea) dye concentrations in a rabbit model.

Methods: Rabbits were injected intravitreously with 10%, 25%, and 35% acai dye concentrations. Control eyes received balanced salt solution (BSS). Electroretinogram (ERG), fundus imaging, fluorescein angiography (FA), optical coherence tomography (OCT), and light and transmission electron microscopy (LM/TEM) were performed.

Results: Fundus imaging showed increased vitreous opacity with increased dye concentrations. FA and OCT showed normality with all concentrations. Comparisons between BSS and dye concentrations were analyzed using Kruskal-Wallis and Mood's median test (p < 0.05). At 24 h, ERGs showed reduced amplitudes from baseline in all eyes. Median b-wave amplitudes nonsignificantly decreased and latency increased with 10% and 25%; findings were significant (p < 0.05) for 35%. LM and TEM showed no abnormalities for 10% and 25%. With 35%, TEM showed ganglion cell edema at 24 h that resolved after 7 days. Vacuolization, multilamellar bodies, and nerve bundle damage occurred at 24 h/7 days in the inner nuclear layer. Mitochondrial cristae disruption occurred in the inner photoreceptor segment at 24 h that decreased by 7 days.

Conclusion: Ten and twenty-five percent concentrations were safe and may improve identification of the posterior hyaloid and internal limiting membrane during chromovitrectomy in humans.
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http://dx.doi.org/10.1080/02713683.2017.1297995DOI Listing
August 2017

Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes.

J Ophthalmol 2016 18;2016:7984576. Epub 2016 Sep 18.

Department of Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil.

. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. . This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. . Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months ( < 0.001). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 ( < 0.001) 12 months after one ( = 0.001), two ( = 0.041), and three ( < 0.001) implants but not four implants ( = 0.068). The mean baseline CRT decreased significantly ( < 0.001) from 463 to 254 microns after 12 months with one ( < 0.001), two ( = 0.002), and three ( = 0.001) implants but not with four implants ( = 0.114). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%). . Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes.
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http://dx.doi.org/10.1155/2016/7984576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046017PMC
September 2016

Daily Optical Coherence Tomography Examinations after First Antivascular Endothelial Growth Factor Injections: An Interventional Case Series.

J Ophthalmol 2016 5;2016:6971831. Epub 2016 May 5.

Department of Ophthalmology, Federal University of São Paulo, 04023-062 São Paulo, SP, Brazil.

Purpose. To evaluate daily spectral-domain optical coherence tomography (SD-OCT) changes in naive-treatment patients with diagnosis of exudative age-related macular degeneration (AMD) treated with intravitreous bevacizumab (1.25 mg), during a 30-day follow-up period. Methods. In prospective, interventional study, SD-OCT was performed daily for 30 days after the first intravitreal injection. The baseline, initial-decrease, minimal, and final central retinal thicknesses (CRTs) were assessed. Results. Nine eyes of nine patients with neovascular AMD were enrolled. The mean baseline CRT was 625.3 ± 182.5 μm, and the mean final CRT was 383.4 ± 163.0 μm (mean difference, 206.1 ± 167.6 μm), a difference that reached significance (P = 0.006). After the first injection, the initial decrease in the CRT was seen as an average of one day after injection (mean CRT, 503.6 ± 189.10 μm; P = 0.0431). The speed of the reduction in the CRT tended to decrease by day 17. The mean CRT was 336.5 ± 105.44 μm and the mean minimal CRT on day 30 was 320.75 ± 96.38 μm. Conclusion. The CRT decreased early after the first injection. We observed a tendency for reductions in the speed with which the CRT decreased by day 17 after the first injection, which may affect retreatment regime.
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http://dx.doi.org/10.1155/2016/6971831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871969PMC
June 2016

Three-Dimensional Enhanced Imaging of Vitreoretinal Interface in Diabetic Retinopathy Using Swept-Source Optical Coherence Tomography.

Am J Ophthalmol 2016 Feb 6;162:140-149.e1. Epub 2015 Nov 6.

New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts. Electronic address:

Purpose: To analyze the vitreoretinal interface in diabetic eyes using 3-dimensional wide-field volumes acquired using high-speed, long-wavelength swept-source optical coherence tomography (SSOCT).

Design: Prospective cross-sectional study.

Methods: Fifty-six diabetic patients (88 eyes) and 11 healthy nondiabetic controls (22 eyes) were recruited. Up to 8 SSOCT volumes were acquired for each eye. A registration algorithm removed motion artifacts and merged multiple SSOCT volumes to improve signal. Vitreous visualization was enhanced using vitreous windowing method.

Results: Of 88 diabetic eyes, 20 eyes had no retinopathy, 21 eyes had nonproliferative diabetic retinopathy (NPDR) without macular edema, 20 eyes had proliferative diabetic retinopathy (PDR) without macular edema, and 27 eyes had diabetic macular edema (DME) with either NPDR or PDR. Thick posterior hyaloid relative to healthy nondiabetic controls was observed in 0 of 20 (0%) diabetic eyes without retinopathy, 4 of 21 (19%) eyes with NPDR, 11 of 20 (55%) eyes with PDR, and 11 of 27 (41%) eyes with DME (P = .0001). Vitreoschisis was observed in 6 of 22 (27%) healthy nondiabetic eyes, 9 of 20 (45%) diabetic eyes without retinopathy, 10 of 21 (48%) eyes with NPDR, 13 of 20 (65%) eyes with PDR, and 17 of 27 (63%) eyes with DME (P = .007). While no healthy nondiabetic controls and diabetic eyes without retinopathy had adhesions/pegs between detached posterior hyaloid and retina, 1 of 21 (4%), 11 of 20 (55%), and 11 of 27 (41%) eyes with NPDR, PDR, and DME, respectively, demonstrated this feature (P = .0001).

Conclusion: SSOCT with motion-correction and vitreous windowing provides wide-field 3-dimensional information of vitreoretinal interface in diabetic eyes. This may be useful in assessing progression of retinopathy, planning diabetic vitreous surgery, and predicting treatment outcomes.
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http://dx.doi.org/10.1016/j.ajo.2015.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911896PMC
February 2016

Correlation Between Choroidal Thickness and Ciliary Artery Blood Flow Velocity in Normal Subjects.

Ophthalmic Surg Lasers Imaging Retina 2015 Oct;46(9):920-4

Background And Objective: To study the correlation between the choroidal thickness (CT) measured by spectral-domain optical coherence tomography (SD-OCT) and retrobulbar blood flow measured by color Doppler flowmetry (CD) in normal subjects.

Patients And Methods: Healthy subjects underwent enhanced-depth imaging SD-OCT and CD using a linear 6 MHz to 18 MHz transducer. The maximal peak systolic velocity and resistance index (RI) were obtained for the ophthalmic artery (OA), short posterior ciliary artery (SPCA), and central retinal artery (CRA) and correlated with the subfoveal CT measured by SD-OCT.

Results: Twenty-seven eyes of 27 healthy patients were enrolled (mean age: 40.6 ± 12.4 years; range: 27-68 years). An inverse proportional relationship (P = .0496) was identified between the RI of the SPCA (mean, 0.6117 ± 0.07911) and the subfoveal CT (319.9 µm ± 83.79 µm) but not between the RI and the OA (mean: 0.7019 µm ± 0.07317 µm) or the CRA (mean: 0.68843 µm ± 0.08994 µm).

Conclusion: The results of this study suggested there is an inverse proportional relationship between the RI of the SPCA and the subfoveal CT. The data also suggested a correlation between a decrease in the CT and increased RI in the retrobulbar arteries. Therefore, lower choroidal blood flow may explain the thinner CT in normal subjects.
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http://dx.doi.org/10.3928/23258160-20151008-04DOI Listing
October 2015

Characterization of Choroidal Layers in Normal Aging Eyes Using Enface Swept-Source Optical Coherence Tomography.

PLoS One 2015 14;10(7):e0133080. Epub 2015 Jul 14.

Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States of America.

Purpose: To characterize qualitative and quantitative features of the choroid in normal eyes using enface swept-source optical coherence tomography (SS-OCT).

Methods: Fifty-two eyes of 26 consecutive normal subjects were prospectively recruited to obtain multiple three-dimensional 12 x 12 mm volumetric scans using a long-wavelength high-speed SS-OCT prototype. A motion-correction algorithm merged multiple SS-OCT volumes to improve signal. Retinal pigment epithelium (RPE) was segmented as the reference and enface images were extracted at varying depths every 4.13 μm intervals. Systematic analysis of the choroid at different depths was performed to qualitatively assess the morphology of the choroid and quantify the absolute thicknesses as well as the relative thicknesses of the choroidal vascular layers including the choroidal microvasculature (choriocapillaris, terminal arterioles and venules; CC) and choroidal vessels (CV) with respect to the subfoveal total choroidal thickness (TC). Subjects were divided into two age groups: younger (<40 years) and older (≥ 40 years).

Results: Mean age of subjects was 41.92 (24-66) years. Enface images at the level of the RPE, CC, CV, and choroidal-scleral interface were used to assess specific qualitative features. In the younger age group, the mean absolute thicknesses were: TC 379.4 μm (SD ± 75.7 μm), CC 81.3 μm (SD ± 21.2 μm) and CV 298.1 μm (SD ± 63.7 μm). In the older group, the mean absolute thicknesses were: TC 305.0 μm (SD ± 50.9 μm), CC 56.4μm (SD ± 12.1 μm) and CV 248.6μm (SD ± 49.7 μm). In the younger group, the relative thicknesses of the individual choroidal layers were: CC 21.5% (SD ± 4.0%) and CV 78.4% (SD ± 4.0%). In the older group, the relative thicknesses were: CC 18.9% (SD ± 4.5%) and CV 81.1% (SD ± 4.5%). The absolute thicknesses were smaller in the older age group for all choroidal layers (TC p=0.006, CC p=0.0003, CV p=0.03) while the relative thickness was smaller only for the CC (p=0.04).

Conclusions: Enface SS-OCT at 1050 nm enables a precise qualitative and quantitative characterization of the individual choroidal layers in normal eyes. Only the CC is relatively thinner in the older eyes. In-vivo evaluation of the choroid at variable depths may be potentially valuable in understanding the natural history of age-related posterior segment disease.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133080PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501794PMC
April 2016

Hyperbaric oxygen therapy for choroidal neovascularization: a pilot study.

Undersea Hyperb Med 2015 Mar-Apr;42(2):125-31

Introduction: Choroidal neovascularization (CNV) is one of the leading causes of blindness worldwide and affects patients with wet age-related macular degeneration (AMD). Its natural course may lead to impaired central vision and macular fibrosis. Even VEGF blockade, currently the best available treatments for CNV, may fail to improve vision. Hyperbaric oxygen (HBO2) therapy may be an alternative or ancillary treatment for CNV.

Methods: AMD patients with active CNV underwent 10 daily sessions of HBO2 at 2 atmospheres absolute (atm abs) for 120 minutes each session. After the end of the sessions, patients with clinical or tomographical signs of CNV activity underwent standard anti-VEGF treatment.

Results: Seven patients (average age 73) underwent 10 daily 120-minute sessions of HBO2 at 2 atm abs. After the sessions, five patients underwent intravitreal injection of bevacizumab. Average follow-up was 150 days. Average CNV area at baseline was 14.42 mm2; average CNV greatest linear diameter at baseline was 4.56 mm. Statistical analysis of variance (ANOVA) was performed for central retinal thickness and volume mean percentage changes post-treatment. At the end of follow up, five patients showed anatomical improvement, one patient maintained anatomical aspect and one patient showed anatomical worsening.

Conclusion: HBO2 may be a safe and tolerable treatment option for patients with active CNV, potentially delaying its progression, as monotherapy or in combination with intravitreal bevacizumab.
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June 2015

Diabetes induces changes in neuroretina before retinal vessels: a spectral-domain optical coherence tomography study.

Int J Retina Vitreous 2015 15;1. Epub 2015 Apr 15.

Department of Ophthalmology, Federal University of São Paulo, R. Botucatu 820, 04023-062 SP São Paulo, Brazil.

Purpose: To investigate retinal changes prior to vascular signs in patients with type 2 diabetes without diabetic retinopathy or with mild non proliferative diabetic retinopathy.

Methods: A cross-sectional study was performed in three groups: patients without diabetes, patients with type 2 diabetes without diabetic retinopathy, and patients with diabetes with mild diabetic retinopathy. Analysis of retinal layers was performed objectively with the Cirrus Review Software 6.0 (Carl Zeiss Meditec, Dublin, CA, USA). Macular cube scans were analyzed with regard to: the ganglion cell layer + inner plexiform layer analysis, retinal nerve fiber layer thickness, central subfoveal retinal thickness and average macular thickness.

Results: In total, 102 patients were included in this study, of which 28 (27.4%) were classified into control group, 46 (45.0%) classified as diabetic patients with no diabetic retinopathy and 28 (27.4%) classified as mild diabetic retinopathy. Quantitative analysis with the Cirrus software showed that the mean ganglion cell layer and mean retinal nerve fiber layer were thinner in diabetes without diabetic retinopathy group when compared to controls. ANOVA with Bonferroni indicated a statistically significant reduction in average retinal thickness in mild diabetic retinopathy group (P = 0.032) compared to control and reduction in ganglion cell layer in diabetes with no diabetic retinopathy (P = 0.039) and mild diabetic retinopathy (P = 0.003). Also indicated reduction in retinal nerve fiber layer in diabetic without diabetic retinopathy and eyes with mild diabetic retinopathy (P < 0.001), compared to controls.

Conclusions: Our study found reduction in thickness of ganglion cell layer and retinal nerve fiber layer in patients with diabetes without diabetic retinopathy, which suggests neuroretinal changes before vascular signs of diabetic retinopathy.
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http://dx.doi.org/10.1186/s40942-015-0001-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066512PMC
April 2015

Investigation of new dyes for chromovitrectomy: preclinical biocompatibility of trisodium, orangell and methyl violet.

Int J Retina Vitreous 2015 15;1. Epub 2015 Apr 15.

grid.411249.b0000000105147202Department of Ophthalmology, Federal University of São Paulo, 821 Botucatu Street, 1st floor, Sao Paulo, CEP Brazil.

Purpose: To investigate the retinal toxicity by electroretinography (ERG), clinical examination and histology after intravitreal injection of biological stains in two concentrations: Trisodium (0.50 g/L and 1.00 g/L), Orangell (0.25 g/L and 1.00 g/L) and Methyl Violet (0.50 g/L and 1.00 g/L).

Methods: Eighteen New-Zealand albinos rabbits were assigned in six groups (n = 3 in each group). The animals in group 1 received Trisodium in the dose of 0.50 g/L and group 2 received 1.00 g/L; Group 3 received Orangell in the dose of 0.25 g/L and group 4 received 1.00 g/L; Group 5 received Methyl Violet in the dose of 1.00 g/L and group 6 received 0.50 g/L. A volume of 0.05 mL of dye was injected in the right eyes, whereas the left eyes received the same volume of balanced salt solution (BSS) as control. ERG recordings and clinical examination were performed at baseline and seven days after intravitreal injection. The ERG responses at one week after injection were compared with baseline levels. A decrease in the post-injection amplitude of more than 50% was considered remarkable. After the 7-day follow-up, rabbits were euthanized and eye enucleated for light microscopy (LM) histological evaluation.

Results: At clinical examination by indirect ophthalmoscopy seven days after dye injection, all eyes were negative for cataract, hemorrhage, retinal detachment, and intraocular opacities. Amplitude analysis of maximum scotopic b-wave showed no significant reduction in either dye injected or control eyes. Neither dye nor BSS caused significant retinal alteration on LM at doses tested.

Conclusions: Trisodium, Orangell and Methyl Violet can be applied in future studies in order to prove the capacity to stain preretinal tissues and vitreous without toxicity. The three dyes did not induce significant ERG amplitude reduction or LM alterations in this preliminary experimental research. Trisodium, Orangell and Methyl Violet may be potentially useful vital dyes for ocular surgery, and deserve further investigation.
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http://dx.doi.org/10.1186/s40942-015-0003-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066516PMC
April 2015

Regression of drusen after combined treatment using photodynamic therapy with verteporfin and ranibizumab.

Ophthalmic Surg Lasers Imaging Retina 2015 Feb;46(2):275-8

Drusen are the clinical hallmark of age-related macular degeneration. The regression of these deposits in patients treated with argon, krypton, or diode laser photocoagulation has been reported previously. However, previous protocols with conventional laser for drusen may result in retinal pigment epithelium (RPE) damage and unwanted scotomas. The authors report a case of complete regression of soft drusen in a 65-year-old man with central visual loss and metamorphopsia due to a drusenoid RPE detachment and soft drusen who underwent reduced-fluence photodynamic therapy (PDT) and three monthly intravitreal injections of ranibizumab. Reduced-fluence PDT combined with anti-VEGF therapy may reduce drusen without inducing RPE cell damage.
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http://dx.doi.org/10.3928/23258160-20150213-16DOI Listing
February 2015

Intraocular pressure fluctuation in healthy and glaucomatous eyes: a comparative analysis between diurnal curves in supine and sitting positions and the water drinking test.

Arq Bras Oftalmol 2014 Oct 1;77(5):288-292. Epub 2014 Sep 1.

Glaucoma Sector, Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Purpose: To compare intraocular pressure (IOP) using the simplified daily tensional curve (SDTC) between supine and sitting positions in terms of peak levels and amount of fluctuation in both, glaucomatous and healthy subjects. The secondary endpoint was the comparison of these measures with those derived from the water drinking test (WDT). Methods: Thirty patients with primary open-angle glaucoma (POAG) that were undergoing medical therapy and 30 healthy subjects were enrolled in this study. Each patient underwent a diurnal curve between 8 am and 4 pm. After lying down for 5 minutes, the IOP was measured with the Perkins tonometer. Patients were instructed to sit in the upright position for 5 minutes and the tonometry was repeated. At 4:15 pm, the WDT test was performed. Fluctuation was defined as the difference between the highest and the lowest IOP readings (range). The Student's t test was used to assess differences and a P value <0.05 was considered to be statistically significant. Results: The diurnal curve in the supine position demonstrated higher IOP average values (on average 3-4 mmHg higher) compared to the sitting position (p<0.0001) for both groups. IOP peaks were higher in the supine position; however, the IOP range was essentially the same between the three methods. Treated glaucomatous patients had higher IOP levels in all measurements, but the fluctuation for all tests performed appeared to be similar to that of healthy patients. Conclusion: The data suggested that WDT can be used to estimate the diurnal IOP peak and fluctuation observed in the SDTC of the supine position for treated glaucomatous patients. Further studies can compare the possible correlation between the WDT results and those obtained from nocturnal supine measurements.
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http://dx.doi.org/10.5935/0004-2749.20140073DOI Listing
October 2014

Preclinical investigations of intravitreal ziv-aflibercept.

Ophthalmic Surg Lasers Imaging Retina 2014 Nov-Dec;45(6):577-84

Background And Objective: To investigate the retinal safety of intravitreal (IVT) ziv-aflibercept in rabbits.

Materials And Methods: Eighteen rabbits were given an IVT injection of ziv-aflibercept (25 mg/mL) or aflibercept (40 mg/mL) and examined by funduscopy, electroretinography (ERG), optical coherence tomography (OCT), light microscopy, and transmission electron microscopy (TEM). Serum, aqueous, and vitreous were obtained afterward for osmolarity analysis. The effect of ziv-aflibercept on human retinal cultured cells (ARPE-19) was assessed by the MTT cell viability assay.

Results: All eyes showed normal funduscopy, OCT, and ERG findings at baseline and 24 hours or 7 days after the procedure. Median baseline serum, vitreous, and aqueous osmolarity remained unchanged. Histology and TEM showed no major anatomic signs of toxicity. No cytotoxic effect was observed in ARPE-19 cells exposed to ziv-aflibercept.

Conclusion: IVT injection ziv-aflibercept at a concentration of 25 mg/mL proved to be safe for the rabbit retina.
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http://dx.doi.org/10.3928/23258160-20141118-15DOI Listing
May 2015

Susac syndrome: diverse clinical findings and treatment.

Arq Bras Oftalmol 2014 May-Jun;77(3):188-90

Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

We report a case of a 19-year-old woman presenting bilateral neurosensorial hearing loss, mental abnormalities, and loss of visual field in the left eye. Visual acuity was 20/20 in OD and 20/25 in OS. Patient was examined systemically. Audiometry showed sensorineural hearing loss in both ears. The magnetic resonance imaging (MRI) of brain revealed multiple small lesions in the white matter in both cerebral hemispheres and at the corpus callosum. Fundoscopy showed bilateral normal optic disc and sheathing of the arterioles in the middle periphery of OD. Retinal edema and cotton-wool spots were observed. Fluorescein angiography showed bilateral peripheral occlusive arterial vasculopathy. The patient was diagnosed with Susac syndrome and treated with quetiapine fumarate, flunitrazepam, and prednisone, which resulted in stabile outcome. This case shows that a high index of suspicion leading to early recognition and treatment is important to avoid irreversible damage.
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http://dx.doi.org/10.5935/0004-2749.20140048DOI Listing
April 2015

Retinal biocompatibility of brilliant blue g with deuterated water for chromovitrectomy.

J Ophthalmic Vis Res 2014 Apr;9(2):204-9

Department of Ophthalmology, Vision Institute (IPEPO), Federal University of São Paulo, São Paulo, Brazil.

Purpose: To investigate the retinal biocompatibility of Brilliant Blue G with deuterated water (BBG-D2O) as a vital dye for chromovitrectomy.

Methods: In this animal study, 0.05 mL of 0.25 g/L Brilliant Blue G (BBG) associated with 0.13 mL/mL of deuterium oxide (D2O) was injected intravitreally in the right eye and the same amount of balanced salt solution (BSS) was injected similarly in the left eye of rabbits. Clinical examination and histology with light microscopy were performed after seven days. Retinal cell layers were evaluated for morphologic alterations. Electroretinographic (ERG) changes were also assessed at baseline and 7 days after the injections.

Results: A total of 6 rabbits were included in the study. The gross histopathologic appearance of the retina, choroid, sclera and optic nerve was within normal limits without any sign of severe retinal necrosis or cystic degeneration. Light microscopy showed that BBG-D2O caused no substantial alterations in retinal layers as compared to control eyes. The injection of BBG-D2O did not induce considerable functional ERG alterations.

Conclusion: Intravitreal injection of BBG-D2O 0.25 g/L seems to induce no retinal toxicity as documented by lack of functional and histological changes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181203PMC
April 2014

Effect of lens status in the surgical success of 23-gauge primary vitrectomy for the management of rhegmatogenous retinal detachment: the Pan American Collaborative Retina Study (PACORES) group results.

Retina 2015 Feb;35(2):326-33

*Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; †Brazilian Institute of Fight Against Blindness (INBRACE), Assis/Presidente Prudente, Brazil; ‡Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; and ¶Retina and Vitreous Service, Instituto de Cirugia Ocular, San Jose, Costa Rica.

Purpose: To determine the effects of lens status on the success rate of primary pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment using either perfluoropropane gas (C3F8) or silicone oil (SO) tamponade.

Methods: A retrospective chart analysis was made of 97 eyes from 92 patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy that were treated with primary 23-gauge PPV. Eyes included in this were phakic (n = 28), pseudophakic (n = 41), or phakic eyes subject to simultaneous phacoemulsification, intraocular lens implantation, and PPV during primary rhegmatogenous retinal detachment repair (n = 28). Tamponade at the end of PPV was with either C3F8 (n = 65) or SO (n = 32). Success was defined as retinal reattachment at 1 year follow-up after a single procedure in eyes submitted to C3F8 injection; in eyes treated with SO injection, the success rate was defined as retina reattached 1 year after oil removal. Statistical comparisons were made between groups using chi-square, Fisher's exact test, Kruskal-Wallis, Mann-Whitney, and multivariate analysis. All eyes were operated by 2 experienced retina surgeons and had a minimum follow-up of 12 months.

Results: The vitreoretinal redetachment rate in eyes subjected to C3F8 tamponade was significantly higher (28.6%) for phakic eyes (P = 0.011) compared with pseudophakic or phakic eyes that underwent to phacoemulsification and intraocular lens implantation (4.5%). Eyes in which SO was used at the end of the surgical procedure demonstrated a similar trend of higher reoperation rates in phakic eyes (28.6%) compared with pseudophakic or phakic eyes (8%) subjected to phacoemulsification and intraocular lens implantation; however, no statistically significant difference was observed (P = 0.201). No statistically significant differences were found between groups in relation to the number of tears (P = 0.863) and their location (inferior: P = 0.189, superior: P = 0.708, nasal: P = 0.756, and temporal: P = 0.08).

Conclusion: The success rates of primary 23-gauge PPV with either C3F8 or SO tamponade in pseudophakic eyes with rhegmatogenous retinal detachment was higher than the same procedure performed in phakic eyes. Still, the retrospective and limited data presented is too preliminary to suggest or recommend that practitioners perform simultaneous combined cataract surgery with retinal detachment and requires further studies in a larger and prospective design to confirm these present findings.
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http://dx.doi.org/10.1097/IAE.0000000000000307DOI Listing
February 2015

Dye solutions based on lutein and zeaxanthin: in vitro and in vivo analysis of ocular toxicity profiles.

Curr Eye Res 2015 Jul 25;40(7):707-18. Epub 2014 Aug 25.

Department of Ophthalmology and Visual Sciences, Instituto da Visão (IPEPO), Universidade Federal de São Paulo , São Paulo , Brasil .

Purpose: To study the safety profile of Lutein/Zeaxanthin(L/Z)-based natural dye solutions in in vitro and in vivo models.

Material And Methods: In vitro cytotoxicity and cellular growth experiments were carried out on ARPE-19 and human corneal epithelial (HCE) cell lines using different L/Z-based dye solutions, either alone or in association with brilliant blue (BB) or trypan blue (TB). Light and transmission electron microscopy studies were performed seven days after intravitreal injection of dye solutions in rabbits. Electroretinogram (ERG) recordings were taken at baseline and before histopathology.

Results: In vitro cytotoxicity assays demonstrated that the different L/Z-based solutions (from 0.3 to 2%), either alone or in association with BB (0.025%) or TB (0.04%), did not significantly alter mitochondrial activity (≤15%) in the cell lines tested. In addition, in vitro cell growth was inhibited by up to 60% depending on the dye solution, and in direct proportion to the concentration assayed. There was no evidence of structural alterations in the neurosensory retina, retinal pigment epithelium (RPE), or choriocapillaris-choroidal complex. b-Wave ERG records showed no significant differences (±15.2%) in comparison with baseline.

Conclusions: L/Z-based dye solutions demonstrated a safe profile in in vitro and in vivo models, and may be a useful tool for staining intraocular structures.
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http://dx.doi.org/10.3109/02713683.2014.952831DOI Listing
July 2015

Development of an experimental model of proliferative retinopathy by intravitreal injection of VEGF165.

J Ocul Pharmacol Ther 2014 Nov 16;30(9):752-6. Epub 2014 Jul 16.

Department of Ophthalmology, Vision Institute (IPEPO), Federal University of São Paulo , São Paulo, Brazil .

Purpose: To develop an experimental model of proliferative retinopathy by intravitreal injection of vascular endothelial growth factor 165 (VEGF165) in pigmented rabbits.

Methods: A prospective, controlled, comparative intervention study. Six pigmented rabbits (Chinchilla breed) were subjected to intravitreal injection of VEGF165 in their right eye. The left eye was used as control and received an injection of balanced salt solution. In group 1, 3 rabbits received a 10-μg injection, and in group 2, 3 rabbits received a 20-μg injection. At baseline, all subjects were analyzed by anterior biomicroscopy, retinography, fluorescein angiography, and optical coherence tomography (OCT) fundus images. Biomicroscopy and all ancillary examinations were repeated at weeks 1, 2, and 5. In the fifth week after the injection, the rabbits were euthanized and the eyes were enucleated and subjected to histological evaluation.

Results: Seven days after the intravitreal VEGF165 injection, all rabbits developed intense neovascularization of the retina and anterior segment. Neovascularization of the posterior pole was similar in both groups, and the anterior segment was more florid in group 2. At weeks 1 and 2, neovascularization persisted with a minor decrease in conjunctival hyperemia in both groups. At week 5, there was a partial regression of neovascularization of the posterior pole, which was more prominent in group 1 than group 2, with persistent anterior neovascularization in both groups. OCT showed a statistically significant increase in retinal thickness, hyaloid detachment, and tractional retinal detachment. After the 5-week period, ocular histopathological evaluation showed an increase in retinal thickness, hyaloid detachment, and intense neovascularization in both groups, especially group 2.

Conclusion: This pilot study of a neovascularization model using intravitreal injection of VEGF165 in pigmented rabbits showed that both doses of 10 and 20 μg were successful and effective in inducing vascular growth in the retina and anterior segment and can therefore be used for evaluating drug efficacy in future studies.
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http://dx.doi.org/10.1089/jop.2014.0036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220700PMC
November 2014

Spectral-domain optical coherence tomography for macular edema.

ScientificWorldJournal 2014 14;2014:191847. Epub 2014 May 14.

Department of Ophthalmology, Federal University of São Paulo, 821 Botucatu Street, 1st Floor, Vila Clementino, 06023-062 São Paulo, SP, Brazil.

Optical coherence tomography (OCT) is a rapid noncontact method that allows in vivo imaging of the retina and it has become an important component in clinical practice. OCT is a useful ancillary tool for assessing retinal diseases because of its ability to provide cross-sectional retinal images and quantitatively analyze retinal morphology. The introduction of spectral-domain OCT provided major improvements in image acquisition speed and image resolution. Future studies will address how these major technologic advances will impact the use of OCT in research and clinical practice.
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http://dx.doi.org/10.1155/2014/191847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053271PMC
February 2015

Anti-VEGF for the management of diabetic macular edema.

J Immunol Res 2014 5;2014:632307. Epub 2014 Feb 5.

Retina Division, Retina Division, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), 821 Botucatu Street, 2nd Floor, 04023-062 São Paulo, SP, Brazil ; Department of Ophthalmology, Goethe University, 7 Theodor Stern Kai, 60590 Frankfurt am Main, Germany.

Diabetic retinopathy (DR) is an important cause of vision loss around the world, being the leading cause in the population between 20 and 60 years old. Among patients with DR, diabetic macular edema (DME) is the most frequent cause of vision impairment and represents a significant public health issue. Macular photocoagulation has been the standard treatment for this condition reducing the risk of moderate visual loss by approximately 50%. The role of vascular endothelial growth factor (VEGF) in DR and DME pathogenesis has been demonstrated in recent studies. This review addresses and summarizes data from the clinical trials that investigated anti-VEGF for the management of DME and evaluates their impact on clinical practice. The literature searches were conducted between August and October 2013 in PubMed and Cochrane Library with no date restrictions and went through the most relevant studies on pegaptanib, ranibizumab, bevacizumab, and aflibercept for the management of DME. The efficacy and safety of intravitreal anti-VEGF as therapy for DME have recently been proved by various clinical trials providing significantly positive visual and anatomical results. Regarding clinical practice, those outcomes have placed intravitreal injection of anti-VEGF as an option that must be considered for the treatment of DME.
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http://dx.doi.org/10.1155/2014/632307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987934PMC
December 2014

Soluble lutein in combination with brilliant blue as a new dye for chromovitrectomy.

Graefes Arch Clin Exp Ophthalmol 2014 Jul 19;252(7):1071-8. Epub 2014 Jan 19.

Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.

Unlabelled: A new dye for vitreoretinal surgery comprised of soluble lutein/zeaxanthin 1 % and brilliant blue 0.025 % is advantageous compared with other dyes currently used for chromovitrectomy, and showed no signs of toxicity at 1 month of follow-up.

Purpose: To evaluate the feasibility and safety of a dye [soluble lutein/zeaxanthin (LZ) 1 % and brilliant blue (BB) 0.025 %] for improving removal of vitreous, epiretinal membranes (ERM), and internal limiting membranes (ILM) in humans.

Methods: We prospectively evaluated 18 eyes treated surgically for a macular hole or ERM. Eighteen surgeons performed chromovitrectomy using the dye, and completed a questionnaire to evaluate the efficacy and safety of the dye. . Examinations included best-corrected visual acuity and intraocular pressure measurements and optical coherence tomography, fluorescein angiography, and autofluorescence performed at baseline and days 1, 7, and 30 postoperatively.

Results: The green dye was deposited on the posterior pole; vigorous dye flushing into the vitreous cavity was unnecessary. All surgeons reported that the ILM stained greenish-blue; 94.4 % reported ILM peeling adequate; the ERM stained poorly. No evidence of toxicity was observed.

Conclusion: The new dye deposited on the posterior pole due to its higher density. The ability to stain the ILM was similar to BB. The new dye has ability to stain the vitreous, hyaloid, and especially the ILM satisfactorily. The new dye may be useful during chromovitrectomy.
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http://dx.doi.org/10.1007/s00417-013-2539-5DOI Listing
July 2014

Vital dyes in ophthalmology: a chemical perspective.

Curr Eye Res 2014 Jul 8;39(7):649-58. Epub 2014 Jan 8.

Department of Ophthalmology, Paulista School of Medicine, Vision Institute, Federal University of Sao Paulo , Sao Paulo , Brazil.

Vital dyes have advanced diagnosis and surgical technique in various specialties, including oncology, gastroenterology and ophthalmology. Intra-operative and diagnostic dyes are finding uses in all areas of ophthalmology, including cornea, cataract, retina, glaucoma, orbit and conjunctiva. We provide a summary of current knowledge of the chemical concepts of vital dyes in ophthalmology. We review the properties of dyes, techniques of application, indications and complications in ocular surgery. Vital dyes represent an expanding area of research, and novel dyes deserve further investigation.
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http://dx.doi.org/10.3109/02713683.2013.865759DOI Listing
July 2014

Color variation assay of the anthocyanins from Açai Fruit (Euterpe oleracea): a potential new dye for vitreoretinal surgery.

J Ocul Pharmacol Ther 2013 Oct 24;29(8):746-53. Epub 2013 Jul 24.

1 Department of Ophthalmology, Vision Institute (IPEPO), Federal University of São Paulo , São Paulo, Brazil .

Aim: The goals of this study were to determine the potential for use of the natural anthocyanins from the açai fruit (Euterpe oleracea) during vitreoretinal surgery and the ideal physicochemical properties of the dye.

Methods: We evaluated the color variations of the dye at different pHs and osmolarities with or without the use of mordants as a potential new tool for internal limiting membrane peeling. The extracts of anthocyanin from the açai fruit were analyzed by spectrophotometry to determine the degree of color variations associated with various pHs and osmolarities. The experiments were conducted in test tubes filled with tryptophan soya media and Petri dishes prepared with agar media.

Results: We observed various shades of green, red, and purple in the extracts of the anthocyanin dye at different pHs and osmolarities. The assay to adjust the anthocyanin solution similar to the physiologic retinal environment (osmolarity, 300 mOsm; pH, 7.00) resulted in a shade of purple that may be useful to stain the intraocular microstructures during vitreoretinal surgery. The physicochemical property of the purple anthocyanin solutions from the açai fruit was observed at physiologic pH and osmolarity.

Conclusion: Anthocyanins from the açai fruit may be useful to enhance visualization of the intraocular microstructures during vitreoretinal surgery.
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http://dx.doi.org/10.1089/jop.2013.0003DOI Listing
October 2013