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Roizenblatt M, Gehlbach PL, Marin VDG, Roizenblatt A, Saraiva VDS, Nakanami MH, Noia LDC, Watanabe SES, Yasaki ES, Passos RM, Magalhães O, Fernandes RAB, Stefanini FR, Caiado R, Jiramongkolchai K, Farah ME, Belfort R, Maia M. ASSESSMENT OF SIMULATED SURGICAL DEXTERITY AFTER MODIFIABLE EXTERNAL EXPOSURES AMONG NOVICE VERSUS EXPERIENCED VITREORETINAL SURGEONS. Retina 2024; 44:820-830. [PMID: 38194677 DOI: 10.1097/iae.0000000000004045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
PURPOSE To evaluate novice and senior vitreoretinal surgeons after various exposures. Multiple comparisons ranked the importance of these exposures for surgical dexterity based on experience. METHODS This prospective cohort study included 15 novice and 11 senior vitreoretinal surgeons (<2 and >10 years' practice, respectively). Eyesi-simulator tasks were performed after each exposure. Day 1, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine; day 2, placebo, 0.2 mg/kg propranolol, and 0.6 mg/kg propranolol; day 3, baseline simulation, breathalyzer readings of 0.06% to 0.10% and 0.11% to 0.15% blood alcohol concentrations; day 4, baseline simulation, push-up sets with 50% and 85% repetitions maximum; and day 5, 3-hour sleep deprivation. Eyesi-generated score (0-700, worst-best), out-of-tolerance tremor (0-100, best-worst), task completion time (minutes), and intraocular pathway (in millimeters) were measured. RESULTS Novice surgeons performed worse after caffeine (-29.53, 95% confidence interval [CI]: -57.80 to -1.27, P = 0.041) and alcohol (-51.33, 95% CI: -80.49 to -22.16, P = 0.001) consumption. Alcohol caused longer intraocular instrument movement pathways (212.84 mm, 95% CI: 34.03-391.65 mm, P = 0.02) and greater tremor (7.72, 95% CI: 0.74-14.70, P = 0.003) among novices. Sleep deprivation negatively affected novice performance time (2.57 minutes, 95% CI: 1.09-4.05 minutes, P = 0.001) and tremor (8.62, 95% CI: 0.80-16.45, P = 0.03); however, their speed increased after propranolol (-1.43 minutes, 95% CI: -2.71 to -0.15 minutes, P = 0.029). Senior surgeons' scores deteriorated only following alcohol consumption (-47.36, 95% CI: -80.37 to -14.36, P = 0.005). CONCLUSION Alcohol compromised all participants despite their expertise level. Experience negated the effects of caffeine, propranolol, exercise, and sleep deprivation on surgical skills.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter L Gehlbach
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vitor D G Marin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius da S Saraiva
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio H Nakanami
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana da C Noia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung E S Watanabe
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erika S Yasaki
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato M Passos
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Octaviano Magalhães
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A B Fernandes
- Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | | | - Rafael Caiado
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Michel E Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
- Vision Institute, IPEPO, Universidade Federal de São Paulo, São Paulo, Brazil
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Fernández Zamora Y, Marinho PM, Dias JRO, Cabral T, Casoy J, Muccioli C, Nascimento H, Belfort R. Long-Term Low-Dose Pyrimethamine Use for the Prevention of Ocular Toxoplasmosis Recurrences: A Cohort Study. Ocul Immunol Inflamm 2024:1-6. [PMID: 38441575 DOI: 10.1080/09273948.2024.2321270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To describe the effect of long-term, low-dose pyrimethamine for the prevention of ocular toxoplasmosis (OT) recurrences. METHODS Sixty-three consecutive patients with inactive ocular toxoplasmosis and positive toxoplasma IgG serology were included. Pyrimethamine (25 mg) + folinic acid (15 mg) were administered every other day (three times weekly) for 12 months. Eighteen patients received the treatment for an additional six months as part of an extension study. RESULTS Thirty-eight patients (60.3%, n = 63) were female; 38 (60.3%) had a previous history of recurrence and 37 (58.7%) had active OT within the preceding 12 months. Three (4.8%) patients had unilateral recurrences at 8, 12 and 18 months after starting intermittent pyrimethamine treatment. Five patients (7.9%) were discontinued due to hematological, renal and hepatic changes. Treatment was considered successful in 42 patients (84%). CONCLUSION Long-term, low-dose pyrimethamine can be considered as a treatment option for the prevention of ocular toxoplasmosis recurrence in selected patients, with only a few, mild and reversible systemic adverse events.
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Affiliation(s)
- Yuslay Fernández Zamora
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Paula M Marinho
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| | - João Rafael Oliveira Dias
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Thiago Cabral
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
- Department of Ophthalmology, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Cristina Muccioli
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
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Finamor LPS, Madalosso G, Levi JE, Zamora YF, Kamioka GA, Marinho P, Nascimento H, Muccioli C, Belfort R. Toxoplasmosis outbreak in São Paulo, Brazil: Epidemiology and visual outcome. Arq Bras Oftalmol 2024; 87:e20220374. [PMID: 38422359 DOI: 10.5935/0004-2749.2022-0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/14/2023] [Indexed: 03/02/2024] Open
Abstract
PURPOSE To describe a 2019 acute toxoplasmosis outbreak in the city of São Paulo, Brazil, and to evaluate the laboratory serological profile for toxoplasmosis for three consecutive years. The ophthalmological manifestations of the patients involved in the outbreak were also studied. METHODS A cross-sectional descriptive study of a toxoplasmosis outbreak in São Paulo, Brazil, between February and May 2019. Epidemiological data were described, as were the observed ocular manifestations. As part of this study the number of patients with positive IgM toxoplasmosis serology was obtained from a large laboratory network (DASA) for three consecutive years, including the year of the outbreak (2018, 2019, 2020). RESULTS Eighty-three individuals were identified in the outbreak and two clusters were studied. The clinical picture of at least 77% of the patients, the epidemiological analysis, and the short incubation period (5-8 days) suggested contamination by oocysts. Serological laboratory data analysis revealed an increase of positive toxoplasmosis IgM in 2019 of 73% compared to the previous year. Ophthalmological examination revealed that at least 4.8% of the patients developed toxoplasmic retinochoroiditis, none of whom had been treated during the acute systemic disease. CONCLUSION Our findings indicate vegetable contamination as the possible source of this outbreak, a high prevalence of toxoplasmosis in São Paulo during the outbreak period, and a drop in the number of tests during the COVID-19 pandemic. Retinochoroiditis was observed in at least 4.8% of the cases. We confirm the need to implement effective means for the prevention, diagnosis, and treatment of the disease. This may involve raising awareness among the population of the importance of vegetable hygiene, and improved quality control of food and water.
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Affiliation(s)
| | - Geraldine Madalosso
- Divisão de Vigilância Epidemiológica, Vigilância Sanitária, São Paulo, SP, Brazil
| | | | - Yuslay Fernández Zamora
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Paula Marinho
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisa em Oftalmologia, São Paulo, SP, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisa em Oftalmologia, São Paulo, SP, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisa em Oftalmologia, São Paulo, SP, Brazil
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Gonçalves MB, Nakayama LF, Ferraz D, Faber H, Korot E, Malerbi FK, Regatieri CV, Maia M, Celi LA, Keane PA, Belfort R. Image quality assessment of retinal fundus photographs for diabetic retinopathy in the machine learning era: a review. Eye (Lond) 2024; 38:426-433. [PMID: 37667028 PMCID: PMC10858054 DOI: 10.1038/s41433-023-02717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/26/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
This study aimed to evaluate the image quality assessment (IQA) and quality criteria employed in publicly available datasets for diabetic retinopathy (DR). A literature search strategy was used to identify relevant datasets, and 20 datasets were included in the analysis. Out of these, 12 datasets mentioned performing IQA, but only eight specified the quality criteria used. The reported quality criteria varied widely across datasets, and accessing the information was often challenging. The findings highlight the importance of IQA for AI model development while emphasizing the need for clear and accessible reporting of IQA information. The study suggests that automated quality assessments can be a valid alternative to manual labeling and emphasizes the importance of establishing quality standards based on population characteristics, clinical use, and research purposes. In conclusion, image quality assessment is important for AI model development; however, strict data quality standards must not limit data sharing. Given the importance of IQA for developing, validating, and implementing deep learning (DL) algorithms, it's recommended that this information be reported in a clear, specific, and accessible way whenever possible. Automated quality assessments are a valid alternative to the traditional manual labeling process, and quality standards should be determined according to population characteristics, clinical use, and research purpose.
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Affiliation(s)
- Mariana Batista Gonçalves
- Department of Ophthalmology, Sao Paulo Federal University, São Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, SP, Brazil
- NIHR Biomedical Research Centre for Ophthalmology, Moorfield Eye Hospital, NHS Foundation Trust, and UCL Institute of Ophthalmology, London, UK
| | - Luis Filipe Nakayama
- Department of Ophthalmology, Sao Paulo Federal University, São Paulo, SP, Brazil.
- Massachusetts Institute of Technology, Laboratory for Computational Physiology, Cambridge, MA, USA.
| | - Daniel Ferraz
- Department of Ophthalmology, Sao Paulo Federal University, São Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, SP, Brazil
- NIHR Biomedical Research Centre for Ophthalmology, Moorfield Eye Hospital, NHS Foundation Trust, and UCL Institute of Ophthalmology, London, UK
| | - Hanna Faber
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Edward Korot
- Retina Specialists of Michigan, Grand Rapids, MI, USA
- Stanford University Byers Eye Institute Palo Alto, Palo Alto, CA, USA
| | | | | | - Mauricio Maia
- Department of Ophthalmology, Sao Paulo Federal University, São Paulo, SP, Brazil
| | - Leo Anthony Celi
- Massachusetts Institute of Technology, Laboratory for Computational Physiology, Cambridge, MA, USA
- Harvard TH Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfield Eye Hospital, NHS Foundation Trust, and UCL Institute of Ophthalmology, London, UK
| | - Rubens Belfort
- Department of Ophthalmology, Sao Paulo Federal University, São Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, SP, Brazil
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Affiliation(s)
| | - Maurício Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Vitreoretinal Surgery Unit, Brazilian Institute of Fight Against Blindness, Assis/Presidente Prudente, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- IPEPO, Vision Institute, São Paulo, Brazil
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Souza GM, Finamor LP, Belfort R. Neuroretinitis: A Rare Manifestation of Acute Ocular Toxoplasmosis in a Child. Ophthalmol Retina 2024; 8:48. [PMID: 37943205 DOI: 10.1016/j.oret.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Guilherme Macedo Souza
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Luciana Peixoto Finamor
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, São Paulo, Brazil
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Pessuti CL, Medley QG, Li N, Huang CL, Loureiro J, Banks A, Zhang Q, Costa DF, Ribeiro KS, Nascimento H, Muccioli C, Commodaro AG, Huang Q, Belfort R. Differential Proteins Expression Distinguished Between Patients With Infectious and Noninfectious Uveitis. Ocul Immunol Inflamm 2024; 32:40-47. [PMID: 36637883 DOI: 10.1080/09273948.2022.2150224] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/15/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE We investigated the aqueous humor proteome and associated plasma proteome in patients with infectious or noninfectious uveitis. METHODS AH and plasma were obtained from 28 patients with infectious uveitis (IU), 29 patients with noninfectious uveitis (NIU) and 35 healthy controls undergoing cataract surgery. The proteins profile was analyzed by SomaScan technology. RESULTS We found 1844 and 2484 proteins up-regulated and 124 and 161 proteins down-regulated in the AH from IU and NIU groups, respectively. In the plasma, three proteins were up-regulated in NIU patients, and one and five proteins were down-regulated in the IU and NIU patients, respectively. The results of pathway enrichment analysis for both IU and NIU groups were related mostly to inflammatory and regulatory processes. CONCLUSION SomaScan was able to detect novel AH and plasma protein biomarkers in IU and NIU patients. Also, the unique proteins found in both AH and plasma suggest a protein signature that could distinguish between infectious and noninfectious uveitis.
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Affiliation(s)
- Carmen L Pessuti
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Quintus G Medley
- Ophthalmology, Novartis Institutes for Biomedical, Cambridge, Massachusetts, USA
| | - Ning Li
- Ophthalmology, Novartis Institutes for Biomedical, Cambridge, Massachusetts, USA
| | - Chia-Ling Huang
- Ophthalmology, Novartis Institutes for Biomedical, Cambridge, Massachusetts, USA
| | - Joseph Loureiro
- Ophthalmology, Novartis Institutes for Biomedical, Cambridge, Massachusetts, USA
| | - Angela Banks
- Ophthalmology, Novartis Institutes for Biomedical, Cambridge, Massachusetts, USA
| | - Qin Zhang
- Ophthalmology, Novartis Institutes for Biomedical, Cambridge, Massachusetts, USA
| | - Deise F Costa
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Kleber S Ribeiro
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Qian Huang
- Ophthalmology, Novartis Institutes for Biomedical, Cambridge, Massachusetts, USA
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
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Gameiro GR, Osaki MH, Yabumoto C, Osaki T, Garcia DM, Belfort R, Cruz AAV, Osaki TH. Blinking Parameters Do Not Normalize After Botulinum Toxin Therapy in Blepharospasm and Hemifacial Spasm Patients. J Neuroophthalmol 2023; 43:563-568. [PMID: 37307066 DOI: 10.1097/wno.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Little is known regarding changes induced by botulinum toxin injections on blinking parameters in blepharospasm (BSP) and hemifacial spasm (HFS) patients. The purpose of this study was to investigate objective changes induced by botulinum toxin (BoNT) injections on blinking parameters in BSP and HFS patients. METHODS Thirty-seven patients with BSP and HFS were evaluated before and 30 days after receiving onabotulinumtoxinA injections. Twelve age-matched control subjects were also assessed. Pretreatment and post-treatment parameters were assessed and compared with normal controls. A high-speed camera and microlight-emitting diodes were used to register the blinking in patients and control groups. Outcomes were blinking frequency, amplitude, and maximum velocity of eyelid closure. RESULTS BoNT injections led to a significant reduction in all parameters, compared with baseline, in BSP and on the affected side in HFS, respectively: 22% ( P < 0.001) and 20% ( P = 0.015) in amplitude; 21% ( P = 0.04) and 39% in frequency ( P = 0.002); and 41% ( P < 0.001) and 26% ( P = 0.005) in maximum closing velocity. Blinking amplitude ( P = 0.017 and P = 0.019) and velocity ( P < 0.001 for both groups) were significantly lower at 30 days on BSP and on the affected HFS side, when compared with controls. BSP and HFS patients presented a significantly lower velocity of eyelid closure, even before BoNT, compared with controls ( P = 0.004. and P < 0.001, respectively). CONCLUSIONS Although blinking frequency became close to normal, amplitude and velocity after BoNT applications were significantly lower in BSP and on the affected side of HFS patients when compared with age-matched normal controls, demonstrating that blinking parameters do not normalize after treatment. The velocity of eyelid closure was shown to be significantly lower, even before BoNT treatment, when compared with control subjects.
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Affiliation(s)
- Gustavo R Gameiro
- Department of Ophthalmology and Visual Sciences (GRG, MHO, CY, TO, RB, THO), Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil; and Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (DG, AAVC), University of São Paulo/Ribeirão Preto, R.Preto, Brazil
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Souza GM, Biccas L, Maia A, Silveira C, Belfort R. Atypical pattern of ocular toxoplasmosis: recurrent inner foveal toxoplasmic retinitis (rifter). Int J Retina Vitreous 2023; 9:75. [PMID: 38037158 PMCID: PMC10691084 DOI: 10.1186/s40942-023-00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
Failure to recognize the different possible clinical presentations of ocular toxoplasmosis may delay diagnosis and treatment, compromising visual prognosis. The aim of this paper is to describe an atypical pattern of ocular toxoplasmosis, not yet described. Five Brazilian patients, from 4 different referral centers, presented similar atypical pattern of ocular toxoplasmosis characterized by mild vitritis, foveal cavitation involving predominantly all retinal layers associated with adjacent inner retinal necrosis (a necrotizing retinitis with a persisting inner retinal tissue bridge and loss of subjacent retinal layers). The appearance of the OCT image resembling a "rift", led the authors to define this pattern as a Recurrent Inner Foveal Toxoplasmic Retinitis (RIFTER), which can be considered as a new description of an atypical pattern of toxoplasma retinochoroiditis, and clinicians should be aware of it and consider testing for toxoplasmosis in patients with similar findings.
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Affiliation(s)
- Guilherme Macedo Souza
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, SP, Brazil.
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, Sao Paulo, SP, Brazil.
| | | | - André Maia
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, Sao Paulo, SP, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, Sao Paulo, SP, Brazil
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Beraldo DP, Rezende MP, Alexander JG, Polido J, Belfort R, Cabral T. Correlations between subfoveal choroidal thickness, macular thickness, and visual outcome in neovascular age-related macular degeneration using swept source OCT: insights from intravitreal aflibercept treatment. Int J Retina Vitreous 2023; 9:70. [PMID: 37968771 PMCID: PMC10652476 DOI: 10.1186/s40942-023-00506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a leading cause of visual impairment among individuals aged 50 and above, often resulting in irreversible vision loss (1). Currently, antiangiogenic therapy is the primary treatment approach for neovascular AMD (2). The choroid has gained significant attention in recent years due to its involvement in various ocular pathologies (7). The objective of this study was to evaluate visual acuity and correlate pre-treatment variables, such as foveal thickness and choroidal thickness, with post-treatment outcomes. MATERIALS AND METHODS This study was designed as a prospective interventional study to investigate the changes in choroidal and macular thickness in patients with neovascular AMD who received intravitreal aflibercept injections. The study utilized medical records and employed Swept Source Optical Coherence Tomography (OCT-SS) for evaluation. The data was collected from patients treated in Presidente Prudente, Brazil, during a three-month load dose period. RESULTS The best-corrected mean visual acuity significantly improved from 1.0 logarithm of the minimum resolution angle (logMAR) units to 0.55 logMAR after treatment with aflibercept (p < 0.001). Patients undergoing treatment exhibited a significant decrease in average macular thickness from 323 μm to 232 μm (p = 0.001), as well as a reduction in choroidal thickness from 206 μm to 172 μm (p = 0.031), while maintaining intraocular pressure within the normal range (p = 0.719) without significant variation. Statistically significant associations were found between the difference in pre- and post-treatment choroidal thickness and the pretreatment values of macular thickness (p = 0.005) and choroidal thickness (p = 0.013). There was also a statistically significant correlation between the difference in pre- and post-treatment macular thickness and the pretreatment macular thickness value (p < 0.001). CONCLUSION In this study, aflibercept exhibited remarkable effectiveness in reducing macular and choroidal thickness, as evaluated using OCT-SS, and significantly improved visual acuity in patients with neovascular AMD. The assessment of both choroidal and macular changes, as well as their correlations, can provide valuable insights for clinicians, enabling them to make well-informed therapeutic decisions and effectively monitor treatment outcomes. Notably, this study contributes to the existing body of literature as the first to establish a correlation between pretreatment foveal thickness, variation in choroidal thickness, and post-treatment choroidal thickness.
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Affiliation(s)
- Daniel P Beraldo
- Clínica Oftalmo-Retina, Presidente Prudente, SP, Brazil
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - Marcussi P Rezende
- Clínica Oftalmo-Retina, Presidente Prudente, SP, Brazil
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - João G Alexander
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - Júlia Polido
- Department of Specialized Medicine, CCS and Vision Center Unit, Ophthalmology, EBSERH/HUCAM, CCS-UFES-Federal University of Espírito Santo (UFES), Vitória, ES, 29047-105, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - Thiago Cabral
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil.
- Department of Specialized Medicine, CCS and Vision Center Unit, Ophthalmology, EBSERH/HUCAM, CCS-UFES-Federal University of Espírito Santo (UFES), Vitória, ES, 29047-105, Brazil.
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Roizenblatt M, Gehlbach PL, Marin VDG, Roizenblatt A, Saraiva VS, Nakanami MH, Noia LC, Song Watanabe SE, Yasaki ES, Passos RM, Magalhães Junior O, Fernandes RAB, Stefanini FR, Caiado R, Jiramongkolchai K, Farah ME, Belfort R, Maia M. A Polysomnographic Study of Effects of Sleep Deprivation on Novice and Senior Surgeons during Simulated Vitreoretinal Surgery. Ophthalmol Retina 2023; 7:940-947. [PMID: 37164313 DOI: 10.1016/j.oret.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance. DESIGN Self-controlled cohort study. PARTICIPANTS Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice. METHODS Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance. MAIN OUTCOME MEASURES Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation. RESULTS Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P = 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P = 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P = 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P = 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P = 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P = 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P = 0.005) decrease the following morning. CONCLUSIONS This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Peter L Gehlbach
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vitor D G Marin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius S Saraiva
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio H Nakanami
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana C Noia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung E Song Watanabe
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erika S Yasaki
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato M Passos
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Rafael Caiado
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Michel E Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
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Cypel MC, Berezovsky A, Fernandes AG, Watanabe SS, Kimie Higashi Mitsuhiro MR, Ferraz NN, Sacai PY, Furtado JM, Morales PH, Muñoz S, Cohen JM, Belfort R, Salomão SR. Regional Disparities in Prevalence and Causes of Visual Impairment and Blindness, Cataract Surgical Coverage and Ocular Findings in Adults 50 Years and Older in Brazil: A Comparative Analysis between Two Population-Based Cross-Sectional Surveys Performed Within a 10-Year Interval. Semin Ophthalmol 2023; 38:656-664. [PMID: 37154578 DOI: 10.1080/08820538.2023.2209164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To investigate disparities in the prevalence and causes of visual impairment and blindness, cataract surgical coverage, and ocular findings in older adults from two Brazilian geo-socio-demographic areas, São Paulo and Parintins cities. METHODS Data from two population-based studies including participants 50 years and older from the cities of São Paulo (São Paulo Eye Study - SPES, 2004) and Parintins (Brazilian Amazon Region Eye Survey - BARES, 2014) were aggregated. RESULTS A total of 5318 participants (3677 from SPES;1641 from BARES) were included. The prevalence of severe visual impairment (SVI) and blindness were, respectively, 0.74% (0.46-1.02) and 0.77% (0.48-1.05) in SPES and 1.72% (1.09-2.35) and 3.44% (2.55-4.33) in BARES. SVI and blindness were associated with BARES study [OR = 2.27 (1.30-3.95); p = .004 - SVI] [OR:4.07 (2.51-6.60); p < .001- blindness]; and older age [OR = 10.93 (4.20-28.45); p < .001 - SPES; OR = 17.96 (8.75-36.83); p < .001 - BARES] while higher education level was a protective factor [OR = 0.21 (0.05-0.95) - SPES; p = .042; OR = 0.21 (0.05-0.91); p = .037 - BARES]. Cataract was the main cause of bilateral severe visual impairment (25.93% in SPES and 64.29% in BARES) and bilateral blindness (21.43% in SPES and 35.71% in BARES). Cataract surgical coverage was significantly lower in BARES (36.32%) compared to SPES (57.75%). CONCLUSION The prevalence of SVI and blindness was three times higher in older adults from the Brazilian Amazon compared to those living in São Paulo city, despite a 10-year interval between the two studies. These disparities should be mitigated by initiatives to promote access to eye care services targeting underprivileged and remote Brazilian areas.
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Affiliation(s)
- Marcela Colussi Cypel
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Adriana Berezovsky
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sung Song Watanabe
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Marcia Regina Kimie Higashi Mitsuhiro
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Nivea Nunes Ferraz
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Paula Yuri Sacai
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - João Marcello Furtado
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, Brazil
| | - Paulo Henrique Morales
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sergio Muñoz
- Department of Public Health-CIGES, Universidad de La Frontera, Temuco, Chile
| | - Jacob Moysés Cohen
- Divisão de Oftalmologia, Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Rubens Belfort
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Instituto da Visão, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, Brazil
| | - Solange Rios Salomão
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
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Gobira M, Nakayama LF, Moreira R, Andrade E, Regatieri CVS, Belfort R. Performance of ChatGPT-4 in answering questions from the Brazilian National Examination for Medical Degree Revalidation. Rev Assoc Med Bras (1992) 2023; 69:e20230848. [PMID: 37792871 PMCID: PMC10547492 DOI: 10.1590/1806-9282.20230848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the performance of ChatGPT-4.0 in answering the 2022 Brazilian National Examination for Medical Degree Revalidation (Revalida) and as a tool to provide feedback on the quality of the examination. METHODS A total of two independent physicians entered all examination questions into ChatGPT-4.0. After comparing the outputs with the test solutions, they classified the large language model answers as adequate, inadequate, or indeterminate. In cases of disagreement, they adjudicated and achieved a consensus decision on the ChatGPT accuracy. The performance across medical themes and nullified questions was compared using chi-square statistical analysis. RESULTS In the Revalida examination, ChatGPT-4.0 answered 71 (87.7%) questions correctly and 10 (12.3%) incorrectly. There was no statistically significant difference in the proportions of correct answers among different medical themes (p=0.4886). The artificial intelligence model had a lower accuracy of 71.4% in nullified questions, with no statistical difference (p=0.241) between non-nullified and nullified groups. CONCLUSION ChatGPT-4.0 showed satisfactory performance for the 2022 Brazilian National Examination for Medical Degree Revalidation. The large language model exhibited worse performance on subjective questions and public healthcare themes. The results of this study suggested that the overall quality of the Revalida examination questions is satisfactory and corroborates the nullified questions.
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Affiliation(s)
- Mauro Gobira
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, Vision Institute – São Paulo (SP), Brazil
| | - Luis Filipe Nakayama
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, Vision Institute – São Paulo (SP), Brazil
- Massachusetts Institute of Technology, Institute for Medical Engineering and Science – Cambridge (MA), USA
| | - Rodrigo Moreira
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, Vision Institute – São Paulo (SP), Brazil
| | - Eric Andrade
- Universidade Federal de São Paulo, Department of Ophthalmology – São Paulo (SP), Brazil
| | | | - Rubens Belfort
- Universidade Federal de São Paulo, Department of Ophthalmology – São Paulo (SP), Brazil
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Osaki TH, Gameiro GR, Osaki MH, Osaki T, Campos ED, Belfort R, Marie SKN. Orbicularis Oculi Muscle Immunohistochemical, Metabolic, and Morphometric Differences in Affected and Nonaffected Sides in Hemifacial Spasm vs Healthy Subjects. J Neuroophthalmol 2023; 43:410-416. [PMID: 36730142 DOI: 10.1097/wno.0000000000001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Subtle morphological alterations have been reported even in the nonaffected side of the orbicularis oculi muscle in patients with hemifacial spasm. However, no previous study assessed immunohistochemical, metabolic, and morphometric alterations in orbicularis oculi muscle fibers in affected and nonaffected sides in patients with this condition, compared with samples obtained from healthy subjects. The purpose of this study is to objectively assess and compare orbicularis oculi muscle (OOM) samples of hemifacial spasm affected and nonaffected sides and healthy subjects. METHODS Orbicularis oculi samples from 8 patients with hemifacial spasm who had not been previously treated and 6 healthy subjects were prepared using hematoxylin and eosin, nicotinamide adenine dinucleotide tetrazolium reductase, cytochrome oxidase, succinate dehydrogenase, Gomori staining, and monoclonal antibodies against myosin slow and myosin fast. A digital image analysis software was used for objective analysis. RESULTS OOM fiber area was significantly greater in both affected ( P = 0.0379) and nonaffected sides ( P = 0.0012) of HFS samples when compared with control subjects' fibers. A significantly greater number of oxidative fibers were observed in both affected and nonaffected sides of patients with HFS when compared with control subjects ( P < 0.001 for both). A significantly greater percentage of slow fibers was observed in the affected side of HFS patients ( P = 0.0012) compared with control subjects. CONCLUSIONS This study's findings suggest that repeated contractions might lead to OOM fiber hypertrophy, increased mitochondrial metabolism, and possible conversion of fast-twitch orbicularis oculi muscle fibers into slow-twitch fibers in patients with HFS. Alterations were observed in affected and nonaffected sides, confirming initial findings that the nonaffected side is not normal in this unique condition.
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Affiliation(s)
- Tammy H Osaki
- Department of Ophthalmology and Visual Sciences (THO, GRG, MHO, TO, RB), Paulista School of Medicine/EPM, Federal University of São Paulo/UNIFESP, São Paulo, Brazil; and Laboratory of Molecular and Cellular Biology (GRG, EDC, SKNM), Department of Neurology, University of São Paulo/USP, São Paulo, Brazil
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Araujo-Silva CA, Marinho PM, Marcos AAA, Branco AMC, Sakamoto V, Matuoka ML, Moraes NF, Tierno PFGMM, Mourad WM, Nascimento H, Burnier M, de Souza W, Belfort R. Postmortem Ultrastructural Analysis of the Retina from COVID-19 Deceased Patients. Ocul Immunol Inflamm 2023:1-9. [PMID: 37552861 DOI: 10.1080/09273948.2023.2238817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE COVID-19 (coronavirus disease 2019) is an infectious disease caused by SARS-CoV-2, first reported in 2019 in Wuhan, China. Among the common complications is a pro-inflammatory and hypercoagulative response that compromises the vasculature among various organs. METHODS In this report, we present the postmortem retinal findings of five patients observed by means of optical microscopy and transmission and scanning electron microscopy techniques. RESULTS Clinical manifestations such as retinal hemorrhages and exacerbated inflammatory infiltrate, altered ultra structure with swollen mitochondria and pyknotic cells in both layers of the retina were observed in all analyzed eyes. CONCLUSION Our data point to the fragility of this tissue in cases of severe COVID-19.
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Affiliation(s)
- Carlla A Araujo-Silva
- Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens - INBEB, Rio de Janeiro, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagens - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Mateus L Matuoka
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | - Nara F Moraes
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | | | - Walid M Mourad
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
| | - Heloisa Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
- Hospital Municipal de Barueri Dr. Francisco Moran, São Paulo, Brazil
| | - Miguel Burnier
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens - INBEB, Rio de Janeiro, Brazil
- Centro Nacional de Biologia Estrutural e Bioimagens - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO, São Paulo, Brazil
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Ferraz DA, Guan Z, Costa EA, Martins E, Keane PA, Ting DSW, Belfort R, Scherer R, Koh V, Muccioli C. Proposal of a new slit-lamp shield for ophthalmic examination and assessment of its effectiveness using computational simulations. Arq Bras Oftalmol 2023; 86:322-329. [PMID: 35544928 DOI: 10.5935/0004-2749.20230058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/20/2021] [Indexed: 07/20/2023] Open
Abstract
PURPOSE This study aimed to use computational models for simulating the movement of respiratory droplets when assessing the efficacy of standard slit-lamp shield versus a new shield designed for increased clinician comfort as well as adequate protection. METHODS Simulations were performed using the commercial software Star-CCM+. Respiratory droplets were assumed to be 100% water in volume fraction with particle diameter distribution represented by a geometric mean of 74.4 (±1.5 standard deviation) μm over a 4-min duration. The total mass of respiratory droplets expelled from patients' mouths and droplet accumulation on the manikin were measured under the following three conditions: with no slit-lamp shield, using the standard slit-lamp shield, and using our new proposed shield. RESULTS The total accumulated water droplet mass (kilogram) and percentage of expelled mass accumulated on the shield under the three aforementioned conditions were as follows: 5.84e-10 kg (28% of the total weight of particle emitted that settled on the manikin), 9.14e-13 kg (0.045%), and 3.19e-13 (0.015%), respectively. The standard shield could shield off 99.83% of the particles that would otherwise be deposited on the manikin, which is comparable to 99.95% for the proposed design. Conclusion: Slit-lamp shields are effective infection control tools against respiratory droplets. The proposed shield showed comparable effectiveness compared with conventional slit-lamp shields, but with potentially enhanced ergonomics for ophthalmologists during slit-lamp examinations.
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Affiliation(s)
- Daniel Araújo Ferraz
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Zeyu Guan
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Edinilson A Costa
- Department of Mechanical Engineering, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Martins
- Department of Biomedical Engineering Yonsei University, South Korea
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rafael Scherer
- Department of Ophthalmology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Victor Koh
- Department of Ophthalmology, National University Hospital, Singapore
| | - Cristina Muccioli
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Marquezan MC, Freitas DD, Majumdar S, Wang X, Elisseeff J, Guyton DL, Bower KS, Skurski ZP, Chalita MR, Belfort R, Jun AS. Corneal reshaping: an experiment with a type I collagen-based vitrigel for remodeling porcine corneas. Arq Bras Oftalmol 2023:S0004-27492023005002307. [PMID: 36995816 DOI: 10.5935/0004-2749.2022-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/17/2022] [Indexed: 03/31/2023] Open
Abstract
PURPOSE This study aimed to report an experiment designed to determine anatomical changes in porcine corneas following placement of a novel polymer implant into the cornea. METHODS An ex vivo porcine eye model was used. A novel type I collagen-based vitrigel implant (6 mm in diameter) was shaped with an excimer laser on the posterior surface to create three planoconcave shapes. Implants were inserted into a manually dissected stromal pocket at a depth of approximately 200 μm. Three treatment groups were defined: group A (n=3), maximal ablation depth 70 μm; Group B (n=3), maximal ablation depth 64 μm; and group C (n=3), maximal ablation depth 104 μm, with a central hole. A control group (D, n=3) was included, in which a stromal pocket was created but biomaterial was not inserted. Eyes were evaluated by optical coherence tomography (OCT) and corneal tomography. RESULTS Corneal tomography showed a trend for a decreased mean keratometry in all four groups. Optical coherence tomography showed corneas with implants placed within the anterior stroma and visible flattening, whereas the corneas in the control group did not qualitatively change shape. CONCLUSIONS The novel planoconcave biomaterial implant described herein could reshape the cornea in an ex vivo model, resulting in the flattening of the cornea. Further studies are needed using in vivo animal models to confirm such findings.
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Affiliation(s)
- Maria Carolina Marquezan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Shoumyo Majumdar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xiaokun Wang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Elisseeff
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - David L Guyton
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kraig Scot Bower
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zachary P Skurski
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria Regina Chalita
- Department of Ophthalmology, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dotto PG, Salomão SR, Fernandes AG, Mitsuhiro MRKH, Ferraz NN, Furtado JM, Watanabe SS, Cypel M, Sacai PY, Cunha CC, Vasconcelos GC, Morales PH, Cohen MJ, Cohen JM, Campos M, Muñoz S, Belfort R, Berezovsky A. Impact of pterygium on central corneal thickness measured by optical coherence tomography in older adults. Eur J Ophthalmol 2023:11206721231154433. [PMID: 36726300 DOI: 10.1177/11206721231154433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To measure the central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT) in older adults with and without pterygium from the Brazilian Amazon Region Eye Survey (BARES). METHODS BARES is a population-based epidemiological cross-sectional study conducted in Parintins city. Participants were residents ≥45 years of age identified through a door-to-door interview. Eligible participants were invited for a comprehensive eye exam. Pterygium occurrence and severity were assessed by ophthalmologists through slit-lamp examination considering its location (nasal or/and temporal) and severity (lesion with extension <3 mm, ≥3 mm not reaching the pupillary margin or ≥3 mm reaching the pupillary margin). CCTs were obtained and measurements from the more severely affected eye were included. Images were analyzed offline by masked observers. RESULTS A total of 671 subjects, 533 (79.4%) with pterygium in at least one eye and 138 (20.6%) without pterygium in either eye, were examined. The mean CCT evaluated by multiple linear regression and adjusted for demographic variables and pterygium severity was 521 ± 34 μm (median = 521; range = 304-665). Decreased CCT was significantly associated with age and pterygium severity. Individuals aged 65-74 years had CCT 7 μm thinner than those aged 45-54 years (p = 0.044), individuals aged 75 years and older had CCT 15 μm thinner than those aged 45-54 years (p = 0.001), and eyes with severe pterygium had CCT 33 μm thinner than eyes without pterygium (p < 0.001). CONCLUSIONS The CCT analysis in this population-based sample shows that a thinner cornea is associated with pterygium severity and older age.
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Affiliation(s)
- Pedro Gabriel Dotto
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Solange Rios Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Arthur Gustavo Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcia Regina Kimie Higashi Mitsuhiro
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Nívea Nunes Ferraz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - João Marcello Furtado
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, 544243Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Sung Song Watanabe
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcela Cypel
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Paula Yuri Sacai
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Cristina Coimbra Cunha
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,37871Faculdade de Medicina da Universidade Federal do Pará - UFPA, Belém, PA, Brasil
| | - Galton Carvalho Vasconcelos
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Oftalmologia e Otorrinolaringologia, 28114Faculdade de Medicina da Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brasil
| | - Paulo Henrique Morales
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcos Jacob Cohen
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Divisão de Oftalmologia, Departamento de Cirurgia, 67892Faculdade de Medicina da Universidade Federal do Amazonas - UFAM, Manaus, AM, Brasil
| | - Jacob Moysés Cohen
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Divisão de Oftalmologia, Departamento de Cirurgia, 67892Faculdade de Medicina da Universidade Federal do Amazonas - UFAM, Manaus, AM, Brasil
| | - Mauro Campos
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Sergio Muñoz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Salud Publica, 469458Universidad de La Frontera, Temuco, Chile
| | - Rubens Belfort
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
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19
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Abstract
PURPOSE The purpose of this study is to report one case of ocular toxoplasmosis (OT) recurrence after vitrectomy and review the scientific basis about it. CASE REPORT A 58-year-old male patient with previous OT, properly treated, underwent vitrectomy due to macular hole. During follow-up, patient evolved with recurrence of the OT. After 1 year, patient presents visual acuity of 20/200 and extensive macular scar. CONCLUSION There is no consensus on using perioperative antiparasitic therapy aiming recurrence prophylaxis. Studies with better statistical design are necessary to evaluate the recurrence risk after ocular surgeries and the possible recommendation of prophylaxis, especially in countries where the strains are more virulent and the recurrence more common.
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Affiliation(s)
- Guilherme Macedo Souza
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos Eduardo de Souza
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Magalhães Passos
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
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20
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Paraboni MLR, Manfredini V, Schreiner GE, Gonçalves IL, Silveira C, Commodaro AG, Belfort R. Comparative study of oxidative stress and antioxidative markers in patients infected with Toxoplasma gondii. Parasitol Int 2022; 91:102645. [PMID: 35977613 DOI: 10.1016/j.parint.2022.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
Recently, oxidative stress and antioxidative compounds have been described as potential biomarkers. However, there is no consensus on the most appropriate oxidative and antioxidative biomarkers for patients with Toxoplasma gondii. In the present study, we evaluated the levels of lipid, protein, DNA oxidative damage and antioxidants in samples from patients infected with T. gondii with and without ocular toxoplasmosis. The levels of MDA, TBARS, micronuclei, carbonyl, GSH, vitamin C and vitamin E were measured on samples from 8 patients positive for T. gondii antibodies with ocular toxoplasmosis (OT), 20 patients positive for T. gondii antibodies without ocular toxoplasmosis (non OT), and 12 healthy individuals negative for T. gondii antibodies. The levels of MDA, TBARS, carbonyl and micronuclei were significantly higher in non OT patients, while MDA and TBARS levels were lower in OT patients. In contrast, the antioxidative factors, GSH and vitamin E levels were significantly lower in non OT patients, while vitamin C was lower in non OT and OT patients. Additionally, non OT patients were indicated to be high producers of oxidative markers (TBARS, MDA, micronuclei and carbonyl), while control group was indicated to be high producer of antioxidative markers (GSH, vitamins C and E). However, OT patients were not found as high producers of oxidative nor antioxidative markers. Our results provide a starting point of possible markers to better understand the disease pathogenesis in patients infected with T. gondii. Additional studies are needed to clarify the potential contribution of oxidative and antioxidative markers in these patients population.
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Affiliation(s)
- Marisa Lúcia Romani Paraboni
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil; Universidade Regional Integrada Alto Uruguai e Missões, Sete de Setembro Avenue, 1621, Erechim, Rio Grande do Sul 99709-910, Brazil.
| | - Vanusa Manfredini
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Pampa, BR 472, Km 585, Uruguaiana, RS, Brazil
| | - Gênifer Erminda Schreiner
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Pampa, BR 472, Km 585, Uruguaiana, RS, Brazil
| | - Itamar Luís Gonçalves
- Universidade Regional Integrada Alto Uruguai e Missões, Sete de Setembro Avenue, 1621, Erechim, Rio Grande do Sul 99709-910, Brazil
| | - Claudio Silveira
- Clinica Silveira, Sete de Setembro Avenue, 1502, Erechim, Rio Grande do Sul, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
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21
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Malerbi FK, Andrade RE, Morales PH, Stuchi JA, Lencione D, de Paulo JV, Carvalho MP, Nunes FS, Rocha RM, Ferraz DA, Belfort R. Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera. J Diabetes Sci Technol 2022; 16:716-723. [PMID: 33435711 PMCID: PMC9294565 DOI: 10.1177/1932296820985567] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Portable retinal cameras and deep learning (DL) algorithms are novel tools adopted by diabetic retinopathy (DR) screening programs. Our objective is to evaluate the diagnostic accuracy of a DL algorithm and the performance of portable handheld retinal cameras in the detection of DR in a large and heterogenous type 2 diabetes population in a real-world, high burden setting. METHOD Participants underwent fundus photographs of both eyes with a portable retinal camera (Phelcom Eyer). Classification of DR was performed by human reading and a DL algorithm (PhelcomNet), consisting of a convolutional neural network trained on a dataset of fundus images captured exclusively with the portable device; both methods were compared. We calculated the area under the curve (AUC), sensitivity, and specificity for more than mild DR. RESULTS A total of 824 individuals with type 2 diabetes were enrolled at Itabuna Diabetes Campaign, a subset of 679 (82.4%) of whom could be fully assessed. The algorithm sensitivity/specificity was 97.8 % (95% CI 96.7-98.9)/61.4 % (95% CI 57.7-65.1); AUC was 0·89. All false negative cases were classified as moderate non-proliferative diabetic retinopathy (NPDR) by human grading. CONCLUSIONS The DL algorithm reached a good diagnostic accuracy for more than mild DR in a real-world, high burden setting. The performance of the handheld portable retinal camera was adequate, with over 80% of individuals presenting with images of sufficient quality. Portable devices and artificial intelligence tools may increase coverage of DR screening programs.
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Affiliation(s)
- Fernando Korn Malerbi
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
- Fernando Korn Malerbi, Federal University of
São Paulo, Rua Botucatu, 822. São Paulo, SP 04039-032, Brazil.
| | - Rafael Ernane Andrade
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Hospital de Olhos Beira Rio, Itabuna,
BA, Brazil
| | - Paulo Henrique Morales
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
| | | | | | | | | | | | | | - Daniel A. Ferraz
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
- NIHR Biomedical Research Centre for
Ophthalmology, Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of
Ophthalmology, London, UK
| | - Rubens Belfort
- Department of Ophthalmology and Visual
Sciences, Federal University of São Paulo, São Paulo, Brazil
- Instituto Paulista de Estudos e
Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, Brazil
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22
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Marinho PM, Nascimento H, Marcos AAA, Romano AC, Rosen RB, Belfort R. Reply to Editorial: Interpretation of OCT and fundus findings in COVID-19 patients in recent Lancet publication. Eye (Lond) 2021; 35:3442-3444. [PMID: 33239764 PMCID: PMC7687980 DOI: 10.1038/s41433-020-01283-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Paula M Marinho
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of Sao Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Heloisa Nascimento
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO/Instituto da Visão, São Paulo, Brazil.
- Ophthalmology Department, Federal University of Sao Paulo, Hospital São Paulo, São Paulo, Brazil.
| | - Allexya A A Marcos
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of Sao Paulo, Hospital São Paulo, São Paulo, Brazil
| | - André C Romano
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of Sao Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Rubens Belfort
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia - IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of Sao Paulo, Hospital São Paulo, São Paulo, Brazil
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23
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Marinho PM, Marcos AAA, Branco AMC, Mourad WM, Sakamoto V, Romano AC, Farah M, Rosen RB, Schor P, Abraao P, Nascimento H, Belfort R. Retinal autofluorescence findings after COVID-19. Int J Retina Vitreous 2021; 7:71. [PMID: 34838147 PMCID: PMC8626712 DOI: 10.1186/s40942-021-00341-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/01/2021] [Indexed: 01/01/2023] Open
Abstract
The main purpose of this study was to investigate the presence of retinal autofluorescence findings in COVID-19 patients. Observational study conducted in São Paulo in 2020. Demographic, medical history, and concomitant events, as well as medications used, hospitalization details, and laboratory test results, were obtained. Patients underwent eye examination and multimodal imaging, including color, red-free, autofluorescence fundus photography and optical coherence tomography. Eighteen patients had autofluorescence findings (6 females; average age 54 years, range 31 to 86 years; 26 eyes). Hyper-autofluorescence findings were present in 6 patients, Hypo-autofluorescence in 14 patients, and 6 patients had mixed pattern lesions. Retinal autofluorescence abnormalities were present in COVID-19 patients and may be secondary to primary or secondary changes caused by the SARS-CoV-2.
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Affiliation(s)
- Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil. .,Vision Institute - IPEPO, São Paulo, Brazil.
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil.,Young Leadership Program, National Academy of Medicine, Rio de Janeiro, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil
| | - Walid M Mourad
- Vision Institute - IPEPO, São Paulo, Brazil.,Santo Amaro University, São Paulo, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil
| | - Andre C Romano
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
| | - Michel Farah
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Paulo Schor
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
| | - Paulo Abraao
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil
| | - Heloisa Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil.,Young Leadership Program, National Academy of Medicine, Rio de Janeiro, Brazil
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Rua Botucatu 816 Vila Clementino, São Paulo, Brazil.,Vision Institute - IPEPO, São Paulo, Brazil
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24
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Nakayama LF, Gonçalves MB, Ferraz DA, Santos HNV, Malerbi FK, Morales PH, Maia M, Regatier CVS, Belfort R. The Challenge of Diabetic Retinopathy Standardization in an Ophthalmological Dataset. J Diabetes Sci Technol 2021; 15:1410-1411. [PMID: 34259085 PMCID: PMC8655300 DOI: 10.1177/19322968211029943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luis F Nakayama
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
- Luis Filipe Nakayama, MD, Department of
Ophthalmology, Universidade Federal de São Paulo, EPM - São Paulo (SP), Botucatu, Street,
821, Vila Clementino., São Paulo 04023-062, Brazil.
| | - Mariana B Gonçalves
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
- Instituto Paulista de Estudos e Pesquisas em
Oftalmologia, IPEPO, Vision Institute, São Paulo (SP), Brazil
- NIHR Biomedical Research Centre for
Ophthalmology, Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of
Ophthalmology, London, UK
| | - Daniel A Ferraz
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
- Instituto Paulista de Estudos e Pesquisas em
Oftalmologia, IPEPO, Vision Institute, São Paulo (SP), Brazil
- NIHR Biomedical Research Centre for
Ophthalmology, Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of
Ophthalmology, London, UK
| | - Helen N V Santos
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
| | - Fernando K Malerbi
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
| | - Paulo H Morales
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
- Instituto Paulista de Estudos e Pesquisas em
Oftalmologia, IPEPO, Vision Institute, São Paulo (SP), Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
| | - Caio V S Regatier
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade
Federal de São Paulo - EPM - São Paulo (SP), Brazil
- Instituto Paulista de Estudos e Pesquisas em
Oftalmologia, IPEPO, Vision Institute, São Paulo (SP), Brazil
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25
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Saraceno JJF, Souza GM, Dos Santos Finamor LP, Nascimento HM, Belfort R. Vogt-Koyanagi-Harada Syndrome following COVID-19 and ChAdOx1 nCoV-19 (AZD1222) vaccine. Int J Retina Vitreous 2021; 7:49. [PMID: 34462013 PMCID: PMC8404022 DOI: 10.1186/s40942-021-00319-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
The challenge of COVID-19 has rapidly changed medical management worldwide. The relatively small time from pandemic to vaccines regulatory approval triggered a race toward vaccines development. However, important questions regarding SARS-CoV-2 vaccines remain. A case of complete Vogt-Koyanagi-Harada (VKH) Syndrome that occurred 4 days following SARS-CoV-2 vaccination and another patient that developed VKH 14 days post COVID-19 clinical onset are presented. A causal relationship between COVID-19 and uveitis may exist.
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Affiliation(s)
| | - Guilherme Macedo Souza
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Heloisa Moraes Nascimento
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil. .,Research Department, Instituto Paulista de Estudos e Pesquisas em Oftalmologia/Instituto da Visão (IPEPO), Sao Paulo, Brazil.
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil.,Research Department, Instituto Paulista de Estudos e Pesquisas em Oftalmologia/Instituto da Visão (IPEPO), Sao Paulo, Brazil
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26
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Araujo-Silva CA, Marcos AAA, Marinho PM, Branco AMC, Roque A, Romano AC, Matuoka ML, Farah M, Burnier M, Moraes NF, Tierno PFGMM, Schor P, Sakamoto V, Nascimento H, de Sousa W, Belfort R. Presumed SARS-CoV-2 Viral Particles in the Human Retina of Patients With COVID-19. JAMA Ophthalmol 2021; 139:1015-1021. [PMID: 34323931 DOI: 10.1001/jamaophthalmol.2021.2795] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance The presence of the SARS-CoV-2 virus in the retina of deceased patients with COVID-19 has been suggested through real-time reverse polymerase chain reaction and immunological methods to detect its main proteins. The eye has shown abnormalities associated with COVID-19 infection, and retinal changes were presumed to be associated with secondary microvascular and immunological changes. Objective To demonstrate the presence of presumed SARS-CoV-2 viral particles and its relevant proteins in the eyes of patients with COVID-19. Design, Setting, and Participants The retina from enucleated eyes of patients with confirmed COVID-19 infection were submitted to immunofluorescence and transmission electron microscopy processing at a hospital in São Paulo, Brazil, from June 23 to July 2, 2020. After obtaining written consent from the patients' families, enucleation was performed in patients deceased with confirmed SARS-CoV-2 infection. All patients were in the intensive care unit, received mechanical ventilation, and had severe pulmonary involvement by COVID-19. Main Outcomes and Measures Presence of presumed SARS-CoV-2 viral particles by immunofluorescence and transmission electron microscopy processing. Results Three patients who died of COVID-19 were analyzed. Two patients were men, and 1 was a woman. The age at death ranged from 69 to 78 years. Presumed S and N COVID-19 proteins were seen by immunofluorescence microscopy within endothelial cells close to the capillary flame and cells of the inner and the outer nuclear layers. At the perinuclear region of these cells, it was possible to observe by transmission electron microscopy double-membrane vacuoles that are consistent with the virus, presumably containing COVID-19 viral particles. Conclusions and Relevance The present observations show presumed SARS-CoV-2 viral particles in various layers of the human retina, suggesting that they may be involved in some of the infection's ocular clinical manifestations.
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Affiliation(s)
- Carlla A Araujo-Silva
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens-INBEB, Rio de Janeiro, Brazil.,Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Centro Nacional de Biologia Estrutural e Bioimagens-CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil.,Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Alexandre Roque
- Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - André C Romano
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Mateus L Matuoka
- Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - Michel Farah
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | | | - Nara F Moraes
- Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | | | - Paulo Schor
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Heloisa Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil.,Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, Brazil
| | - Wanderley de Sousa
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens-INBEB, Rio de Janeiro, Brazil.,Laboratório de Ultraestrutura Celular Hertha Meyer, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Centro Nacional de Biologia Estrutural e Bioimagens-CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
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Damasceno RWF, Barbosa JAP, Cortez LRC, Belfort R. Orbital lymphatic vessels: immunohistochemical detection in the lacrimal gland, optic nerve, fat tissue, and extrinsic oculomotor muscles. Arq Bras Oftalmol 2021; 84:209-213. [PMID: 33567024 DOI: 10.5935/0004-2749.20210035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/02/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify the lymphatic vessels in orbital specimens from human cadavers using light microscopy and immunohistochemical analysis. METHODS A postmortem study included 10 orbital specimens from 10 human cadavers. The orbital specimens were obtained no later than 12 hours after death. The orbital specimens were dissected into lacrimal gland, optic nerve, fat tissue, and oculomotor muscles. The histologic criteria to qualify as a lymphatic vessel were thin-walled channels of endothelium without a well-developed basal membrane and with an erythrocyte-free, irregular lumen. The immunohistochemical criteria were irregularly shaped, thin-walled vessels with an erythrocyte-free, irregular lumen and immunopositivity for podoplanin D2-40. RESULTS The lacrimal gland, optic nerve, fat tissue, and extraocular muscle sections were positively stained with podoplanin D2-40. CONCLUSIONS This study demonstrated lymphatic vessels in the human orbit, more precisely, in the lacrimal gland, dura mater of the optic nerve, adipose tissue, and extrinsic oculomotor muscles via light microscopy and immunohistochemistry.
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Affiliation(s)
- Renato Wendell Ferreira Damasceno
- Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brazil.,Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil.,Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Juliana Arôxa Pereira Barbosa
- Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brazil.,Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Lucas Rafael Costa Cortez
- Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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28
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Ventura CV, Zin A, Paula Freitas BD, Ventura LO, Rocha C, Costa F, Nery N, De Senna TCR, Lopes Moreira ME, Maia M, Belfort R. Ophthalmological manifestations in congenital Zika syndrome in 469 Brazilian children. J AAPOS 2021; 25:158.e1-158.e8. [PMID: 34082114 DOI: 10.1016/j.jaapos.2021.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze the spectrum of ophthalmologic manifestations in a large sample of children with congenital Zika syndrome (CZS) in Brazil. METHODS The medical records of infants born in the states of Pernambuco, Bahia, and Rio de Janeiro, Brazil, between December 2015 and December 2016 with clinical manifestations of CZS and positive reverse transcription polymerase-chain-reaction (RT-PCR) and/or serology for the Zika virus were reviewed retrospectively. Data were collected from the record of the first ophthalmological assessment, performed on admission. Children with other congenital infectious diseases, genetic conditions, and incomplete medical records were excluded. RESULTS A total of 469 infants (242 female [51.6%]) were included. Mean age at examination was 5.0 ± 7.1 months (range, 0.0-36.0 months). Of the 469 infants, 197 (42.0%) were from Rio de Janeiro, 144 (30.7%) from Pernambuco, and 128 (27.3%) from Bahia States. Microcephaly at birth was detected in 214 (45.6%) children; 62 cases (29.0%) were severe. Pernambuco had significantly more children born with microcephaly compared with Bahia and Rio de Janeiro (P < 0.001). Ocular manifestations were found in 269 of 938 eyes (28.7%; 148/469 children [31.6%]). The main ocular alterations were optic nerve pallor in 122 of 938 eyes (13.0%), focal pigment mottling in 112 eyes (11.9%), and chorioretinal scars in 101 eyes (10.8%). A higher prevalence of ocular manifestations was seen in Pernambuco (P < 0.001). No microcephaly was observed in 252 of 466 children (54.1%); of these, 19 children (7.5%) had funduscopic findings. CONCLUSIONS One-third of children with CZS had ocular manifestations. Children from Pernambuco were more affected. Ocular abnormalities were found in 7.5% of children without microcephaly.
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Affiliation(s)
- Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil.
| | - Andrea Zin
- Clinical Research Unit, Fernandes Figueira Institute-FIOCRUZ, Rio de Janeiro, Brazil
| | - Bruno de Paula Freitas
- Department of Ophthalmology, Hospital Geral Roberto Santos, Salvador, Brazil; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Camilla Rocha
- Department of Research, Altino Ventura Foundation, Recife, Brazil
| | - Federico Costa
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | - Nivison Nery
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Tatiana C R De Senna
- Clinical Research Unit, Fernandes Figueira Institute-FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Mauricio Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
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Marinho PM, Marcos AAA, Branco AMC, Romano AC, Sakamoto V, Matuoka ML, Moraes NF, Roque A, Tierno PFGMM, Ferreira PRA, Mourad WM, Schor P, Farah M, Rosen RB, Belfort R, Moraes Do Nascimento H. COVID-19 Retinal Findings in Patients Admitted to Intensive Care Units and Wards. Ocul Immunol Inflamm 2021; 29:705-708. [PMID: 33978538 DOI: 10.1080/09273948.2021.1912362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The main purpose of this study was to investigate ocular clinical findings in patients with confirmed COVID-19 infection, of various levels of disease severity, who required mechanical ventilation and admission to intensive care units or specialized wards. Longitudinal, observational study conducted from March 2020 to June 2020. Color fundus and red-free photography were performed in both eyes following pupillary dilation. 104 participants were recruited from 2 different centers: 60 (58%) from the Hospital Municipal de Barueri intensive care unit (ICU) and 44 (42%) from specialized wards for patients with COVID-19 at the Hospital São Paulo. 21.9% presented with eye lesions, in 3% these lesions were vision compromising. Our results have shown similar rate of intraocular lesions in patients in both the ward or intensive care unit, regardless of medication use, including anticoagulant drugs.
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Affiliation(s)
- Paula M Marinho
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Alléxya A A Marcos
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Ana M C Branco
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - André C Romano
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Victoria Sakamoto
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - Mateus L Matuoka
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Nara F Moraes
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil
| | - Alexandre Roque
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil
| | - Paulo F G M M Tierno
- Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil
| | - Paulo R A Ferreira
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - Walid M Mourad
- Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Paulo Schor
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Michel Farah
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Richard B Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Rubens Belfort
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
| | - Heloisa Moraes Do Nascimento
- São Paulo Hospital, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Department of General Medicine -General Intensive Care, Hospital Municipal de Barueri Dr. Francisco Moran, Barueri, SP, Brazil.,Research Department, Instituto da Visão - IPEPO, São Paulo, SP, Brazil
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Ferraz DA, Tovar-Moll F, Belfort R. Artificial intelligence: from the retina to the brain. Arq Bras Oftalmol 2021; 84:197-198. [PMID: 33787669 DOI: 10.5935/0004-2749.20210061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniel Araújo Ferraz
- Instituto da Visão, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | | | - Rubens Belfort
- Instituto da Visão, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Lima LH, Melo GB, Zett C, Morais FB, Leal BC, Farah ME, Belfort R. Optical Coherence Tomography Angiography Findings in Diffuse Unilateral Subacute Neuroretinitis. Ophthalmic Surg Lasers Imaging Retina 2021; 51:76-83. [PMID: 32084279 DOI: 10.3928/23258160-20200129-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report a unique case series of diffuse unilateral subacute neuroretinitis (DUSN) patients imaged with optical coherence tomography angiography (OCTA). PATIENTS AND METHODS In this retrospective case series, multimodal imaging was performed in four patients with DUSN at the time of patient visit. The study patients underwent standard clinical treatment for DUSN. RESULTS The clinical findings were consistent with the diagnosis of DUSN. Cross-sectional OCT showed disruption of outer retinal layers in the foveal area and an irregular structure of the outer plexiform layer. En face OCT revealed hyperreflective spots and a large hyperreflective lesion in the foveal area correspondent to the outer retina disruption seen on cross-sectional OCT. OCTA demonstrated decreased vascular perfusion in both the superficial and deep retinal capillary plexuses along with choriocapillaris preservation. CONCLUSION OCTA may provide a more detailed assessment of the retinal microvascular changes, allowing a more precise anatomical-functional correlation in DUSN. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:76-83.].
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Conceição AR, Belucik DN, Missio L, Gustavo Brenner L, Henrique Monteiro M, Ribeiro KS, Costa DF, Valadão MCDS, Commodaro AG, de Oliveira Dias JR, Belfort R. Ocular Findings in Infants with Congenital Toxoplasmosis after a Toxoplasmosis Outbreak. Ophthalmology 2021; 128:1346-1355. [PMID: 33711379 DOI: 10.1016/j.ophtha.2021.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE We investigated the prevalence of ocular abnormalities in infants vertically exposed to Toxoplasma gondii infection during an outbreak in Santa Maria City, Brazil. DESIGN Consecutive case series. PARTICIPANTS A total of 187 infants were included. METHODS The infants were recruited from January 2018 to November 2019. All mothers were screened for syphilis and human immunodeficiency virus before delivery. Toxoplasmosis infection was confirmed in all mothers and infants based on the presence of serum anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. All infants underwent an ophthalmologic examination; ocular abnormalities were documented using a wide-field digital imaging system. Neonatal cranial sonography or head computed tomography was performed in 181 infants, and the cerebrospinal fluid (CSF) was screened for anti-T. gondii IgG and IgM antibodies in 159 infants. Peripheral blood samples from 9 infants and their mothers were analyzed for the presence of T. gondii DNA by real-time polymerase chain reaction. MAIN OUTCOME MEASURES Ocular abnormalities associated with congenital toxoplasmosis. RESULTS A total of 187 infants were examined. Twenty-nine infants (15.5%) had congenital toxoplasmosis, of whom 19 (10.2%) had ocular abnormalities, including retinochoroiditis in 29 of 38 eyes (76.3%), optic nerve abnormalities in 5 eyes (13.2%), microphthalmia in 1 eye (2.6%), and cataract in 2 eyes (5.3%). Bilateral retinal choroidal lesions were found in 10 of 19 infants (52.6%). Nine eyes of 6 infants had active lesions, with retinal choroidal cellular infiltrates at the first examination. Thirteen (7.2%) of 181 infants screened presented with cerebral calcifications. Eighty-three percent of the screened infants were positive for anti-T. gondii IgG and negative for IgM antibodies in the CSF. Congenital toxoplasmosis was higher in mothers infected during the third pregnancy trimester, and maternal treatment during pregnancy was not associated with a lower rate of congenital toxoplasmosis. CONCLUSIONS High prevalence rates of clinical manifestations were observed in infants with congenital toxoplasmosis after a waterborne toxoplasmosis outbreak, the largest yet described. Cerebral calcifications were higher in infants with ocular abnormalities, and maternal infection during the third pregnancy trimester was associated with a higher rate of congenital toxoplasmosis independent of maternal treatment.
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Affiliation(s)
| | | | - Lilian Missio
- Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | | | - Kleber Silva Ribeiro
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP, Brazil
| | - Deise Fialho Costa
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP, Brazil; Vision Institute, São Paulo, SP, Brazil
| | | | | | | | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP, Brazil; Vision Institute, São Paulo, SP, Brazil
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Aguilar Ticona JP, Nery N, Ladines-Lim JB, Gambrah C, Sacramento G, de Paula Freitas B, Bouzon J, Oliveira-Filho J, Borja A, Adhikarla H, Montoya M, Chin A, Wunder EA, Ballalai V, Vieira C, Belfort R, P. Almeida AR, Reis MG, Harris E, Ko AI, Costa F. Developmental outcomes in children exposed to Zika virus in utero from a Brazilian urban slum cohort study. PLoS Negl Trop Dis 2021; 15:e0009162. [PMID: 33544730 PMCID: PMC7891708 DOI: 10.1371/journal.pntd.0009162] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/18/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background The prevalence of developmental alterations associated with in-utero Zika virus (ZIKV) exposure in children is not well understood. Furthermore, estimation of the Population Attributable Fraction (PAF) of developmental alterations attributed to ZIKV has not been performed due to lack of population-based cohorts with data on symptomatic and asymptomatic ZIKV exposures and an appropriate control group. The aim of this study was to characterize neurodevelopmental outcomes of children at 11 to 32 months of age with intrauterine ZIKV exposure and estimate the PAF of alterations secondary to ZIKV exposure. Methodology/Principal findings We performed a cohort of biannual community-based prospective serosurveys in a slum community in Salvador, Brazil. We recruited women participating in our cohort, with a documented pregnancy from January 2015 to December 2016 and children born to those mothers. Children were classified as ZIKV exposed in utero (born from women with ZIKV seroconversion during pregnancy) or unexposed (born from women without ZIKV seroconversion or that seroconverted before/after pregnancy) by using an IgG monoclonal antibody blockade-of-binding (BoB). We interviewed mothers and performed anthropometric, audiometric, ophthalmological, neurologic, and neurodevelopmental evaluations of their children at 11 to 32 months of age. Among the 655 women participating in the cohort, 66 (10%) were pregnant during the study period. 46 (70%) of them completed follow-up, of whom ZIKV seroconversion occurred before, during, and after pregnancy in 25 (54%), 13 (28%), and 1 (2%), respectively. The rest of women, 7 (21.2%), did not present ZIKV seroconversion. At 11 to 32 months of life, the 13 ZIKV-exposed children had increased risk of mild cognitive delay (RR 5.1; 95%CI 1.1–24.4) compared with the 33 children unexposed, with a PAF of 53.5%. Exposed children also had increased risk of altered auditory behavior (RR 6.0; 95%CI 1.3–26.9), with a PAF of 59.5%. Conclusions A significant proportion of children exposed in utero to ZIKV developed mild cognitive delay and auditory behavioral abnormalities even in the absence of gross birth defects such as microcephaly and other neurodevelopmental domains. Furthermore, our findings suggest that over half of these abnormalities could be attributed to intrauterine ZIKV exposure. ZIKV is a neurotropic virus associated with congenital abnormalities that have been grouped under congenital Zika syndrome (CZS), the most prominent being microcephaly. Recent studies have uncovered a spectrum of other abnormalities. However, what remains unclear is the Population Attributable Fraction (PAF) of developmental alterations attributable to ZIKV intrauterine exposure in children (> one year of life). In this population-based cohort study, we found that children (without microcephaly) exposed in utero to ZIKV have an increased incidence of mild cognitive delay and auditory behavior abnormalities, with over half of these events attributable to intrauterine exposure. The results of this study suggest that more than half of alterations found in the population study can be attributed to intrauterine ZIKV exposure, thus demonstrating the importance of monitoring apparently healthy children born during the epidemic, even to asymptomatic mothers. Health services should implement early interventions to limit the morbidity of congenital ZIKV infection.
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Affiliation(s)
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
| | - Joseph B. Ladines-Lim
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Claudia Gambrah
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Gielson Sacramento
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
| | - Bruno de Paula Freitas
- Hospital Geral Roberto Santos (HGRS), Salvador, Brazil
- Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jamary Oliveira-Filho
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pòs-Graduação em Ciencias da Saude (PPgCS) Universidade Federal da Bahia, Salvador, Brazil
| | - Ana Borja
- Departamento de Fonoaudiologia. Instituto de Ciências da Saúde. Universidade Federal da Bahia, Salvador, Brazil
| | - Haritha Adhikarla
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Magelda Montoya
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Athena Chin
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Elsio A. Wunder
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Carina Vieira
- Hospital Geral Roberto Santos (HGRS), Salvador, Brazil
| | - Rubens Belfort
- Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Mitermayer G. Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Albert I. Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail: (AIK); (FC)
| | - Federico Costa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail: (AIK); (FC)
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Arruda S, Vieira BR, Garcia DM, Araújo M, Simões M, Moreto R, Rodrigues MW, Belfort R, Smith JR, Furtado JM. Clinical manifestations and visual outcomes associated with ocular toxoplasmosis in a Brazilian population. Sci Rep 2021; 11:3137. [PMID: 33542439 PMCID: PMC7862362 DOI: 10.1038/s41598-021-82830-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2021] [Indexed: 11/09/2022] Open
Abstract
Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with ocular toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical ocular toxoplasmosis (OR 4.99; 95% CI 1.14–22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45–47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82–30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28–22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53–13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00–1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95–12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.
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Affiliation(s)
- Sigrid Arruda
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Barbara R Vieira
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Denny M Garcia
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Michelle Araújo
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Milena Simões
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Renata Moreto
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Murilo W Rodrigues
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil.
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Roizenblatt M, Dias Gomes Barrios Marin V, Grupenmacher AT, Muralha F, Faber J, Jiramongkolchai K, Gehlbach PL, Farah ME, Belfort R, Maia M. Association of Weight-Adjusted Caffeine and β-Blocker Use With Ophthalmology Fellow Performance During Simulated Vitreoretinal Microsurgery. JAMA Ophthalmol 2021; 138:819-825. [PMID: 32525517 DOI: 10.1001/jamaophthalmol.2020.1971] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Vitreoretinal surgery can be technically challenging and is limited by physiologic characteristics of the surgeon. Factors that improve accuracy and precision of the vitreoretinal surgeon are invaluable to surgical performance. Objectives To establish weight-adjusted cutoffs for caffeine and β-blocker (propranolol) intake and to determine their interactions in association with the performance of novice vitreoretinal microsurgeons. Design, Settings, and Participants This single-blind cross-sectional study of 15 vitreoretinal surgeons who had less than 2 years of surgical experience was conducted from September 19, 2018, to September 25, 2019, at a dry-laboratory setting. Five simulations were performed daily for 2 days. On day 1, performance was assessed after sequential exposure to placebo, low-dose caffeine (2.5 mg/kg), high-dose caffeine (5.0 mg/kg), and high-dose propranolol (0.6 mg/kg). On day 2, performance was assessed after sequential exposure to placebo, low-dose propranolol (0.2 mg/kg), high-dose propranolol (0.6 mg/kg), and high-dose caffeine (5.0 mg/kg). Interventions Surgical simulation tasks were repeated 30 minutes after masked ingestion of placebo, caffeine, or propranolol pills during the 2 days. Main Outcomes and Measures An Eyesi surgical simulator was used to assess surgical performance, which included surgical score (range, 0 [worst] to 700 [best]), task completion time, intraocular trajectory, and tremor rate (range, 0 [worst] to 100 [best]). The nonparametric Friedman test followed by Dunn-Bonferroni post hoc test was applied for multiple comparisons. Results Of 15 vitreoretinal surgeons, 9 (60%) were male, with a mean (SD) age of 29.6 (1.4) years and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 23.15 (2.9). Compared with low-dose propranolol, low-dose caffeine was associated with a worse total surgical score (557.0 vs 617.0; difference, -53.0; 95% CI, -99.3 to -6.7; P = .009), a lower antitremor maneuver score (55.0 vs 75.0; difference, -12.0; 95% CI, -21.2 to -2.8; P = .009), longer intraocular trajectory (2298.6 vs 2080.7 mm; difference, 179.3 mm; 95% CI, 1.2-357.3 mm; P = .048), and increased task completion time (14.9 minutes vs 12.7 minutes; difference, 2.3 minutes; 95% CI, 0.8-3.8 minutes; P = .048). Postcaffeine treatment with propranolol was associated with performance improvement; however, surgical performance remained inferior compared with low-dose propranolol alone for total surgical score (570.0 vs 617.0; difference, -51.0; 95% CI, -77.6 to -24.4; P = .01), tremor-specific score (50.0 vs 75.0; difference, -16.0; 95% CI, -31.8 to -0.2; P = .03), and intraocular trajectory (2265.9 mm vs 2080.7 mm; difference, 166.8 mm; 95% CI, 64.1-269.6 mm; P = .03). Conclusions and Relevance The findings suggest that performance of novice vitreoretinal surgeons was worse after receiving low-dose caffeine alone but improved after receiving low-dose propranolol alone. Their performance after receiving propranolol alone was better than after the combination of propranolol and caffeine. These results may be helpful for novice vitreoretinal surgeons to improve microsurgical performance.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil.,Johns Hopkins University School of Medicine, The Wilmer Eye Institute, Baltimore, Maryland
| | | | | | - Felipe Muralha
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jean Faber
- Department of Neurology and Neurosurgery, Neuroengineering and Neurocognition Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kim Jiramongkolchai
- Johns Hopkins University School of Medicine, The Wilmer Eye Institute, Baltimore, Maryland
| | - Peter Louis Gehlbach
- Johns Hopkins University School of Medicine, The Wilmer Eye Institute, Baltimore, Maryland
| | - Michel Eid Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.,Vision Institute, Universidade Federal de São Paulo, São Paulo, Brazil
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Botelho GIS, Salomão SR, Tengan CH, Karanjia R, Moura FV, Rocha DM, da Silva PBE, Fernandes AG, Watanabe SES, Sacai PY, Belfort R, Carelli V, Sadun AA, Berezovsky A. Impaired Ganglion Cell Function Objectively Assessed by the Photopic Negative Response in Affected and Asymptomatic Members From Brazilian Families With Leber's Hereditary Optic Neuropathy. Front Neurol 2021; 11:628014. [PMID: 33584522 PMCID: PMC7874135 DOI: 10.3389/fneur.2020.628014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose: The photopic negative response (PhNR) is an electrophysiological method that provides retinal ganglion cell function assessment using full-field stimulation that does not require clear optics or refractive correction. The purpose of this study was to assess ganglion cell function by PhNR in affected and asymptomatic carriers from Brazilian families with LHON. Methods: Individuals either under suspicion or previously diagnosed with LHON and their family members were invited to participate in this cross-sectional study. Screening for the most frequent LHON mtDNA mutations was performed. Visual acuity, color discrimination, visual fields, pattern-reversal visual evoked potentials (PRVEP), full-field electroretinography and PhNR were tested. A control group of healthy subjects was included. Full-field ERG PhNR were recorded using red (640 nm) flashes at 1 cd.s/m2, on blue (470 nm) rod saturating background. PhNR amplitude (μV) was measured using baseline-to-trough (BT). Optical coherence tomography scans of both the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) were measured. PhNR amplitudes among affected, carriers and controls were compared by Kruskal-Wallis test followed by post-hoc Dunn test. The associations between PhNR amplitude and OCT parameters were analyzed by Spearman rank correlation. Results: Participants were 24 LHON affected patients (23 males, mean age=30.5 ± 11.4 yrs) from 19 families with the following genotype: m.11778G>A [N = 15 (62%), 14 males]; m.14484T>C [N = 5 (21%), all males] and m.3460G>A [N = 4 (17%), all males] and 14 carriers [13 females, mean age: 43.2 ± 13.3 yrs; m.11778G>A (N = 11); m.3460G>A (N = 2) and m.14484T>C (N = 1)]. Controls were eight females and seven males (mean age: 32.6 ± 11.5 yrs). PhNR amplitudes were significantly reduced (p = 0.0001) in LHON affected (-5.96 ± 3.37 μV) compared to carriers (-16.53 ± 3.40 μV) and controls (-23.91 ± 4.83; p < 0.0001) and in carriers compared to controls (p = 0.01). A significant negative correlation was found between PhNR amplitude and total macular ganglion cell thickness (r = -0.62, p < 0.05). Severe abnormalities in color discrimination, visual fields and PRVEPs were found in affected and subclinical abnormalities in carriers. Conclusions: In this cohort of Brazilian families with LHON the photopic negative response was severely reduced in affected patients and mildly reduced in asymptomatic carriers suggesting possible subclinical abnormalities in the latter. These findings were similar among pathogenic mutations.
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Affiliation(s)
- Gabriel Izan Santos Botelho
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Solange Rios Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Célia Harumi Tengan
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rustum Karanjia
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States.,Department of Ophthalmology, Doheny Eye Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Ottawa Eye Institute, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Felipo Victor Moura
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniel Martins Rocha
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paula Baptista Eliseo da Silva
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung Eun Song Watanabe
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paula Yuri Sacai
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto da Visão-IPEPO, São Paulo, Brazil
| | - Valerio Carelli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna School of Medicine, Bologna, Italy
| | - Alfredo Arrigo Sadun
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States.,Department of Ophthalmology, Doheny Eye Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Roizenblatt M, Fidalgo TM, Polizelli M, Cruz NFSD, Roizenblatt A, Jiramongkolchai K, Gehlbach PL, Farah ME, Belfort R, Maia M. Effect of chronic cocaine use on fine motor coordination tested during ophthalmic vitreoretinal simulated performance. J Psychiatr Res 2021; 132:7-12. [PMID: 33035762 DOI: 10.1016/j.jpsychires.2020.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
We conducted a case-control study using the Eyesi simulator to assess the surgical performance of 24 chronic cocaine users (CCUs) and 24 sex-/age-matched controls to numerically quantify ophthalmic microsurgical simulator performance and fine motor deficiencies. The inclusion criteria were no exposure to illicit drugs other than cocaine, marijuana, or alcohol within the previous month and no health conditions that could impact manual task performance. The outcomes included surgical scores (0-100, worst-best) and task completion time (minutes). Fisher's exact test, analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test followed by Dunn-Bonferroni post-hoc were conducted for statistical analysis. The Eyesi scores were lower among CCUs compared to controls for bimanual tasks (4.50 ± 14.30 vs. 18.46 ± 26.64, p = 0.012), for exercises demanding upper and lower limb coordination (both hands and two foot pedals, respectively) (74.13 ± 35.01 vs. 85.21 ± 24.1, p = 0.045), and in the overall score for all three tasks (27.38 ± 15.06 vs. 39.5 ± 18.66, p = 0.021). CCUs took longer to complete tasks when performing exercises demanding upper and lower limb coordination compared to controls (1.26 ± 0.38 vs. 1.02 ± 0.44 min, p = 0.006). Individuals who used cocaine during the previous month had an independent lower bimanual score compared to controls (1.42 ± 4.91 vs. 18.46 ± 26.64, p = 0.018). No differences in performance among the CCUs were attributable to sporadic cannabis or alcohol use. Chronic use of cocaine negatively impacted fine dexterity as measured by bimanual tasks or maneuvers that required simultaneous coordination of the upper and lower limbs. This was most notable among individuals who used cocaine during the 1-month period before the simulation.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil; Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Thiago Marques Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, 570, Borges Lagoa Street, 04038-000, Administrative Office, São Paulo, Brazil.
| | - Murilo Polizelli
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Natasha Ferreira Santos da Cruz
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Kim Jiramongkolchai
- Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Peter Louis Gehlbach
- Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Michel Eid Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
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38
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Marinho PM, Marcos AA, Branco AMPC, Sakamoto V, Romano A, Schor P, Farah ME, Nascimento H, Belfort R. Results from the SERPICO-19 study - the role of retinal evaluation and in vivo vascular assessment in COVID-19. EClinicalMedicine 2020; 29:100655. [PMID: 33251502 PMCID: PMC7678456 DOI: 10.1016/j.eclinm.2020.100655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Paula M. Marinho
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Allexya A.A. Marcos
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | | | - Victoria Sakamoto
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - André Romano
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Paulo Schor
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Michel E. Farah
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Heloisa Nascimento
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
- Corresponding author. Present address: Vision Institute and Federal, University of São Paulo, Rua Botucatu, 822. São Paulo, Brazil.
| | - Rubens Belfort
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia – IPEPO/Instituto da Visão, São Paulo, Brazil
- Ophthalmology Department, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
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Marquezan MC, Marquezam JP, Nascimento H, Chalita MR, de Freitas D, Belfort R. Conjunctivitis Related to not Severe COVID-19: A Case Report. Ocul Immunol Inflamm 2020; 29:631-633. [DOI: 10.1080/09273948.2020.1837186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Maria Carolina Marquezan
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of Sao Paulo, UNIFESP, São Paulo, Brazil
- Eye Clinic, Cuiabá, Brazil
| | | | - Heloisa Nascimento
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of Sao Paulo, UNIFESP, São Paulo, Brazil
| | - Maria Regina Chalita
- Department of Ophthalmology, University Hospital of Brasilia, University of Brasilia, UnB Brasilia, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of Sao Paulo, UNIFESP, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Federal University of Sao Paulo, UNIFESP, São Paulo, Brazil
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Khurana RN, Kunimoto D, Yoon YH, Wykoff CC, Chang A, Maturi RK, Agostini H, Souied E, Chow DR, Lotery AJ, Ohji M, Bandello F, Belfort R, Li XY, Jiao J, Le G, Kim K, Schmidt W, Hashad Y. Two-Year Results of the Phase 3 Randomized Controlled Study of Abicipar in Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 128:1027-1038. [PMID: 33221326 DOI: 10.1016/j.ophtha.2020.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/02/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To report the 2-year efficacy and safety of abicipar every 8 weeks and quarterly (after initial doses) compared with monthly ranibizumab in patients with treatment-naïve neovascular age-related macular degeneration (nAMD). DESIGN Two multicenter, randomized, phase 3 clinical trials with identical protocols (CEDAR and SEQUOIA). Analyses used pooled trial data. PARTICIPANTS The trials enrolled 1888 patients (1 eye/patient) with active choroidal neovascularization secondary to age-related macular degeneration and best-corrected visual acuity (BCVA) of 24 to 73 Early Treatment Diabetic Retinopathy Study letters. METHODS At enrollment, patients were assigned to study eye treatment with abicipar 2 mg every 8 weeks after initial doses at baseline and weeks 4 and 8 (abicipar Q8, n = 630), abicipar 2 mg every 12 weeks after initial doses at baseline and weeks 4 and 12 (abicipar Q12, n = 628), or ranibizumab 0.5 mg every 4 weeks (ranibizumab Q4, n = 630). MAIN OUTCOME MEASURES Efficacy measures included stable vision (<15-letter loss in BCVA from baseline) and change from baseline in BCVA and central retinal thickness (CRT). Safety measures included adverse events (AEs). RESULTS For patients who completed the study, efficacy of abicipar after initial doses was maintained through week 104. At week 104, the proportion of patients with stable vision was 93.0% (396/426), 89.8% (379/422), and 94.4% (470/498); mean change in BCVA from baseline was +7.8 letters, +6.1 letters, and +8.5 letters, and mean change in CRT from baseline was -147 μm, -146 μm, and -142 μm in the abicipar Q8 (14 injections), abicipar Q12 (10 injections), and ranibizumab Q4 (25 injections) groups, respectively. The overall incidence of intraocular inflammation (IOI) AEs was 15.4%, 15.3%, and 0.3% from baseline through week 52 and 16.2%, 17.6%, and 1.3% from baseline through week 104 in the abicipar Q8, abicipar Q12, and ranibizumab Q4 groups, respectively. CONCLUSIONS Two-year results show efficacy of abicipar Q8 and Q12 in nAMD. First onset of IOI events with abicipar was much reduced in the second year and comparable with ranibizumab (0.8% and 2.3% vs. 1.0%). The extended duration of effect of abicipar allows for quarterly dosing and reduced treatment burden.
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Affiliation(s)
- Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, California.
| | | | - Young Hee Yoon
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | | | - Andrew Chang
- Sydney Retina Clinic, Sydney, Australia; Save Sight Institute, University of Sydney, Sydney, Australia
| | - Raj K Maturi
- Midwest Eye Institute, Indianapolis, Indiana; Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hansjürgen Agostini
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eric Souied
- Centre Hospitalier Creteil, Service Universitaire d'Ophthalmologie, Creteil, France
| | - David R Chow
- St Michael's Hospital, University of Toronto, Toronto, Canada; Toronto Retina Institute, North York, Canada
| | | | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Francesco Bandello
- University Vita-Salute Scientific Institute, Hospital San Raffaele, Milan, Italy
| | - Rubens Belfort
- Vision Institute, Federal University of São Paulo, São Paulo, Brazil
| | - Xiao-Yan Li
- Allergan, an AbbVie company, Irvine, California
| | - Jenny Jiao
- Allergan, an AbbVie company, Irvine, California
| | - Grace Le
- Allergan, an AbbVie company, Irvine, California
| | - Kimmie Kim
- Allergan, an AbbVie company, Irvine, California
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Costa DF, Madeira RP, Torrecilhas AC, Nascimento H, Ribeiro KS, Paraboni MLR, Rizzo LV, Silveira C, Burnier MN, Lowen MS, Garcia JL, Gava R, Pereira-Chioccola VL, Commodaro AG, Belfort R. Ocular Disease in Mice Inoculated with Pork Heart Samples Infected with Toxoplasma gondii. Ocul Immunol Inflamm 2020; 30:463-469. [PMID: 32976068 DOI: 10.1080/09273948.2020.1807024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We analyzed the frequency, viability, and genetic characteristics of T. gondii in pork heart samples.Methods: Thirty-five fresh pork samples were purchased in a slaughterhouse in Erechim city. The DNA was extracted and qPCR was performed. T. gondii genotyping was performed using PCR-RFLP analysis. Positive samples were digested and inoculated in mice for viability analysis.Results: Our results showed that T. gondii DNA was detected in 25.7% of the pork heart samples and genotyping revealed one new atypical strain. The viability analyses demonstrated that 40% of mice presented clinical signs of T. gondii infection. qPCR was positive in the lung, liver, and brain of mice that presented clinical signs of T. gondii infection. Also, the histopathology analysis showed retinal disorganization, retinal detachment, inflammatory cell infiltration, and fibrosis in the eyes analyzed.Conclusion: Our findings have shown that pork eat from southern Brazil may contain live T. gondii that could be associated with toxoplasmosis.
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Affiliation(s)
- Deise F Costa
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology, McGill University Ocular Pathology Laboratory, Montreal, Canada
| | - Rafael Pedro Madeira
- Department of Pharmaceutical Sciences, Federal University of Sao Paulo, Diadema, Brazil
| | | | - Heloisa Nascimento
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - Miguel N Burnier
- Department of Ophthalmology, McGill University Ocular Pathology Laboratory, Montreal, Canada
| | - Marcia Serva Lowen
- Department of Pathology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - João Luis Garcia
- Protozoology Laboratory, Preventive Veterinary Medicine Department, Universidade Estadual De Londrina, Londrina, PR, Brazil
| | - Ricardo Gava
- Laboratory of Molecular Biology of Parasites and Fungi, Center of Parasitology and Mycology, Adolfo Lutz Institute, Sao Paulo, Brazil
| | - Vera Lucia Pereira-Chioccola
- Laboratory of Molecular Biology of Parasites and Fungi, Center of Parasitology and Mycology, Adolfo Lutz Institute, Sao Paulo, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
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Marinho PM, Nascimento H, Marcos AAA, Romano AC, Belfort R. Seeking clarity on retinal findings in patients with COVID-19 - Authors' reply. Lancet 2020; 396:e40. [PMID: 32950102 PMCID: PMC7498255 DOI: 10.1016/s0140-6736(20)31912-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Paula M Marinho
- Department of Ophthalmology, Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Instituto da Visão, São Paulo, Brazil; Ophthalmology Department, Hospital São Paulo, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology, Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Instituto da Visão, São Paulo, Brazil; Ophthalmology Department, Hospital São Paulo, Federal University of São Paulo, São Paulo 04023-062, Brazil.
| | - Allexya A A Marcos
- Department of Ophthalmology, Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Instituto da Visão, São Paulo, Brazil; Ophthalmology Department, Hospital São Paulo, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - André C Romano
- Department of Ophthalmology, Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Instituto da Visão, São Paulo, Brazil; Ophthalmology Department, Hospital São Paulo, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Instituto da Visão, São Paulo, Brazil; Ophthalmology Department, Hospital São Paulo, Federal University of São Paulo, São Paulo 04023-062, Brazil
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Sallum JMF, Motta FL, Arno G, Porto FBO, Resende RG, Belfort R. Clinical and molecular findings in a cohort of 152 Brazilian severe early onset inherited retinal dystrophy patients. Am J Med Genet C Semin Med Genet 2020; 184:728-752. [PMID: 32865313 DOI: 10.1002/ajmg.c.31828] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022]
Abstract
Leber congenital amaurosis (LCA) and early-onset retinal dystrophy (EORD) are severe inherited retinal dystrophy that can cause deep blindness childhood. They represent 5% of all retinal dystrophies in the world population and about 10% in Brazil. Clinical findings and molecular basis of syndromic and nonsyndromic LCA/EORD in a Brazilian sample (152 patients/137 families) were studied. In this population, 15 genes were found to be related to the phenotype, 38 new variants were detected and four new complex alleles were discovered. Among 123 variants found, the most common were CEP290: c.2991+1655A>G, CRB1: p.Cys948Tyr, and RPGRIP1: exon10-18 deletion.
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Affiliation(s)
- Juliana Maria Ferraz Sallum
- Department of Ophthalmology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Instituto de Genética Ocular, Sao Paulo, Brazil
| | - Fabiana Louise Motta
- Department of Ophthalmology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Instituto de Genética Ocular, Sao Paulo, Brazil
| | - Gavin Arno
- UCL Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital, London, UK
| | - Fernanda Belga Ottoni Porto
- INRET Clínica e Centro de Pesquisa, Belo Horizonte, Minas Gerais, Brazil.,Centro Oftalmológico de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, Sao Paulo, Brazil
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Smith JR, Ashander LM, Arruda SL, Cordeiro CA, Lie S, Rochet E, Belfort R, Furtado JM. Pathogenesis of ocular toxoplasmosis. Prog Retin Eye Res 2020; 81:100882. [PMID: 32717377 DOI: 10.1016/j.preteyeres.2020.100882] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
Ocular toxoplasmosis is a retinitis -almost always accompanied by vitritis and choroiditis- caused by intraocular infection with Toxoplasma gondii. Depending on retinal location, this condition may cause substantial vision impairment. T. gondii is an obligate intracellular protozoan parasite, with both sexual and asexual life cycles, and infection is typically contracted orally by consuming encysted bradyzoites in undercooked meat, or oocysts on unwashed garden produce or in contaminated water. Presently available anti-parasitic drugs cannot eliminate T. gondii from the body. In vitro studies using T. gondii tachyzoites, and human retinal cells and tissue have provided important insights into the pathogenesis of ocular toxoplasmosis. T. gondii may cross the vascular endothelium to access human retina by at least three routes: in leukocyte taxis; as a transmigrating tachyzoite; and after infecting endothelial cells. The parasite is capable of navigating the human neuroretina, gaining access to a range of cell populations. Retinal Müller glial cells are preferred initial host cells. T. gondii infection of the retinal pigment epithelial cells alters the secretion of growth factors and induces proliferation of adjacent uninfected epithelial cells. This increases susceptibility of the cells to parasite infection, and may be the basis of the characteristic hyperpigmented toxoplasmic retinal lesion. Infected epithelial cells also generate a vigorous immunologic response, and influence the activity of leukocytes that infiltrate the retina. A range of T. gondii genotypes are associated with human ocular toxoplasmosis, and individual immunogenetics -including polymorphisms in genes encoding innate immune receptors, human leukocyte antigens and cytokines- impacts the clinical manifestations. Research into basic pathogenic mechanisms of ocular toxoplasmosis highlights the importance of prevention and suggests new biological drug targets for established disease.
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Affiliation(s)
- Justine R Smith
- Eye & Vision Health and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine & Public Health, Adelaide, Australia; Formerly of Casey Eye Institute, Oregon Health & Science University, USA.
| | - Liam M Ashander
- Eye & Vision Health and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine & Public Health, Adelaide, Australia; Formerly of Casey Eye Institute, Oregon Health & Science University, USA
| | - Sigrid L Arruda
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Cynthia A Cordeiro
- Cordeiro et Costa Ophtalmologie, Campos dos Goytacazes, Brazil; Formerly of Department of Ophthalmology, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Shervi Lie
- Eye & Vision Health and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine & Public Health, Adelaide, Australia
| | - Elise Rochet
- Eye & Vision Health and Flinders Centre for Innovation in Cancer, Flinders University College of Medicine & Public Health, Adelaide, Australia
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - João M Furtado
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Formerly of Casey Eye Institute, Oregon Health & Science University, USA
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de Oliveira Dias JR, Campelo C, Novais EA, de Andrade GC, Marinho P, Zamora YF, Peixoto LF, Maia M, Nascimento H, Belfort R. New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis. Int J Retina Vitreous 2020; 6:30. [PMID: 32670613 PMCID: PMC7346631 DOI: 10.1186/s40942-020-00231-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background Ocular toxoplasmosis is one of the most common causes of intraocular inflammation and posterior uveitis in immunocompetent patients. This paper aims to investigate swept-source optical coherence tomography angiography (SS-OCTA) findings in eyes with active toxoplasmic retinochoroiditis. Methods This case series was conducted from November 2017 through October 2019 in two Brazilian centers. 15 eyes of 15 patients with active toxoplasmic retinochoroiditis were included, and were imaged at baseline and after at least 4 weeks of follow-up. All patients underwent ophthalmic examinations and multimodal imaging including SS-OCT and SS-OCTA before and after treatment of ocular toxoplasmosis. The differential diagnoses included toxoplasmosis, syphilis, and human immunodeficiency virus, which were eliminated through serologic and clinical evaluations. Results All 15 patients presented with positive anti-Toxoplasma gondii immunoglobulin G titers and three also presented with positive anti-T. gondii immunoglobulin M titers. The mean age at examination was 32.4 years ± 12.7 years (range 15–59 years). Sixty percent of the patients were female. In all eyes, the inner retinal layers were abnormally hyperreflective with full-thickness disorganization of the retinal reflective layers at the site of the active toxoplasmic retinochoroiditis. At baseline, 80% of eyes had focal choroidal thickening beneath the retinitis area, and all eyes had a choroidal hyporeflective signal. Before treatment, SS-OCTA showed no OCTA decorrelation signal next to the lesion site in all eyes, and flow signal improvement was noticed after treatment. Three eyes presented with intraretinal vascular abnormalities during follow-up. SS-OCTA showed retinal neovascularization in one patient and a presumed subclinical choroidal neovascular membrane in another patient. Conclusions SS-OCT and SS-OCTA are useful for assessing unexpected structural and vascular retinal and choroidal changes in active and post-treatment toxoplasmic retinochoroiditis and these findings are useful for clinical practice.
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Affiliation(s)
- João Rafael de Oliveira Dias
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil.,Rua Marechal Bormann, 243-E., Chapecó, SC 89802-120 Brazil
| | - Camila Campelo
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Eduardo Amorim Novais
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Gabriel Costa de Andrade
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Paula Marinho
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Yusláy Fernández Zamora
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Luciana Finamor Peixoto
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Maurício Maia
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Heloísa Nascimento
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP Brazil.,Vision Institute, São Paulo, SP Brazil
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46
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Affiliation(s)
- Paula M Marinho
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, São Paulo, Brazil; Instituto da Visão, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Allexya A A Marcos
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, São Paulo, Brazil; Instituto da Visão, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - André C Romano
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, São Paulo, Brazil; Instituto da Visão, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Heloisa Nascimento
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, São Paulo, Brazil; Instituto da Visão, Federal University of São Paulo, São Paulo 04023-062, Brazil.
| | - Rubens Belfort
- Instituto Paulista de Estudos e Pesquisas em Oftalmologia, São Paulo, Brazil; Instituto da Visão, Federal University of São Paulo, São Paulo 04023-062, Brazil
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Osaki MH, Osaki TH, Garcia DM, Osaki T, Gameiro G, Belfort R, Cruz AAV. An objective tool to measure the effect of botulinum toxin in blepharospasm and hemifacial spasm. Eur J Neurol 2020; 27:1487-1492. [DOI: 10.1111/ene.14258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- M. H. Osaki
- Department of Ophthalmology Paulista School of Medicine Federal University of São Paulo São Paulo SP Brazil
- Osaki Clinics São Paulo SP Brazil
| | - T. H. Osaki
- Department of Ophthalmology Paulista School of Medicine Federal University of São Paulo São Paulo SP Brazil
- Osaki Clinics São Paulo SP Brazil
| | - D. M. Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery University of São Paulo/Ribeirão Preto Ribeirão Preto SP Brazil
| | - T. Osaki
- Department of Ophthalmology Paulista School of Medicine Federal University of São Paulo São Paulo SP Brazil
- Osaki Clinics São Paulo SP Brazil
| | - G. Gameiro
- Department of Ophthalmology Paulista School of Medicine Federal University of São Paulo São Paulo SP Brazil
| | - R. Belfort
- Department of Ophthalmology Paulista School of Medicine Federal University of São Paulo São Paulo SP Brazil
| | - A. A. V. Cruz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery University of São Paulo/Ribeirão Preto Ribeirão Preto SP Brazil
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Cabral T, Lima de Carvalho JR, Kim J, Oh JK, Levi SR, Park KS, Duong JK, Park J, Boudreault K, Belfort R, Tsang SH. Comparative Analysis of Functional and Structural Decline in Retinitis Pigmentosas. Int J Mol Sci 2020; 21:ijms21082730. [PMID: 32326409 PMCID: PMC7215932 DOI: 10.3390/ijms21082730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022] Open
Abstract
Retinitis pigmentosa (RP) is a category of inherited retinal dystrophies that is best prognosticated using electroretinography (ERG). In this retrospective cohort study of 25 patients with RP, we evaluated the correlation between 30 Hz flicker ERG and structural parameters in the retina. Internationally standardized 30 Hz flicker ERG recordings, short-wavelength autofluorescence (SW-AF), and spectral domain–optical coherence tomography (SD-OCT) were acquired at two visits at least one year apart. Vertical and horizontal hyperautofluorescent ring diameter measurements with SW-AF, as well as ellipsoid zone (EZ) line width measurements with SD-OCT, were used as structural parameters of disease progression. The 30 Hz flicker ERG amplitude decreased by 2.2 ± 0.8 µV/year (p = 0.011), while implicit times remained unchanged. For SD-OCT, the EZ line decreased by 204.1 ± 34.7 µm/year (p < 0.001). Horizontal and vertical hyperautofluorescent ring diameters decreased by 161.9 ± 25.6 µm/year and 146.9 ± 34.6 µm/year, respectively (p = 0.001), with SW-AF. A correlation was found between the progression rates of the 30 Hz flicker amplitude recorded with Burian–Allen electrodes and both the horizontal ring diameter (p = 0.020) and EZ line (p = 0.044). SW-AF and SD-OCT, two readily available imaging techniques, may be used to prognosticate disease progression because of the reliability of their measurements and correlation with functional outcome.
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Affiliation(s)
- Thiago Cabral
- Department of Ophthalmology, Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY 10032, USA; (T.C.); (J.R.L.d.C.J.); (J.K.O.); (S.R.L.); (K.S.P.); (K.B.)
- Department of Specialized Medicine, CCS and Vision Center Unit, Ophthalmology, EBSERH/HUCAM, CCS-UFES—Federal University of Espírito Santo (UFES), Vitória, ES 29047-105, Brazil
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP 04039-032, Brazil
| | - Jose Ronaldo Lima de Carvalho
- Department of Ophthalmology, Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY 10032, USA; (T.C.); (J.R.L.d.C.J.); (J.K.O.); (S.R.L.); (K.S.P.); (K.B.)
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP 04039-032, Brazil
- Department of Ophthalmology, Empresa Brasileira de Serviços Hospitalares (EBSERH)–Hospital das Clínicas de Pernambuco (HCPE), Federal University of Pernambuco (UFPE), Recife, PE 50740-465, Brazil
| | - Joonpyo Kim
- Department of Statistics, Seoul National University, Seoul 08826, Korea;
| | - Jin Kyun Oh
- Department of Ophthalmology, Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY 10032, USA; (T.C.); (J.R.L.d.C.J.); (J.K.O.); (S.R.L.); (K.S.P.); (K.B.)
- College of Medicine, State University of New York at Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Sarah R. Levi
- Department of Ophthalmology, Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY 10032, USA; (T.C.); (J.R.L.d.C.J.); (J.K.O.); (S.R.L.); (K.S.P.); (K.B.)
| | - Karen Sophia Park
- Department of Ophthalmology, Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY 10032, USA; (T.C.); (J.R.L.d.C.J.); (J.K.O.); (S.R.L.); (K.S.P.); (K.B.)
| | - Jimmy K. Duong
- Department of Biostatistics, Columbia University, New York, NY 10032, USA;
| | - Junhyung Park
- Department of Statistics, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Katherine Boudreault
- Department of Ophthalmology, Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY 10032, USA; (T.C.); (J.R.L.d.C.J.); (J.K.O.); (S.R.L.); (K.S.P.); (K.B.)
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP 04039-032, Brazil
| | - Stephen H. Tsang
- Department of Ophthalmology, Jonas Children’s Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY 10032, USA; (T.C.); (J.R.L.d.C.J.); (J.K.O.); (S.R.L.); (K.S.P.); (K.B.)
- Department of Pathology & Cell Biology, Stem Cell Initiative (CSCI), Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
- Correspondence: ; Tel.: +1-(212)-342-1189; Fax: +1-(212)-305-4987
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Osaki TH, Osaki MH, Garcia DM, Osaki T, Ohkawara L, Belfort R, Cruz AAV. Evaluation of botulinum toxin effects in hemifacial spasm patients: correlation between clinical rating scales and high-speed video system measurements. J Neural Transm (Vienna) 2020; 127:1041-1046. [PMID: 32232566 DOI: 10.1007/s00702-020-02183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to compare the scores of two clinical rating scales and high-speed video system measurements obtained during spontaneous eyelid movements in hemifacial spasm (HFS) patients before and after treatment. Patients were evaluated before and 30 days after receiving treatment with onabotulinumtoxinA injections. Using a high-speed video system, the eyelid movements were recorded bilaterally for 3 min and the energy power generated by the upper eyelid during spontaneous eyelid movements was assessed before and after treatment. The scores of the Jankovic rating scale (JRS) and Hemifacial Spasm Grading System (HSGS) were also assessed before and after treatment. The authors studied 22 patients. Significant reduction in JRS and HSGS scores and in the energy generated by the upper eyelid was observed after treatment. A power spectrum of less than 23,000 was associated with JRS and HSGS scores less than 4 and 6.25, respectively and a power spectrum greater than or equal to 23,000 was associated with JRS and HSGS scores greater than or equal to 4 and 6.25, respectively (p < 0.0001 and p = 0.0025). Rating systems are easy to use, but they may exhibit limitations in sensitivity to assess differences between distinct disease patterns and between subtle differences in treatment responses. The high-speed video system permits a greater degree of accuracy, which allows for the assessment of differences in eyelid movement patterns and would permit better tailoring of treatment to patients. However, simpler devices employing this system would need to be developed, so that it could be used in clinical practice.
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Affiliation(s)
- Tammy H Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
- Department of Ophthalmology, University of Santo Amaro, São Paulo, SP, Brazil
- Osaki Clinics, R. Vergueiro, 2045 cj. 1009, São Paulo, SP, 04101-000, Brazil
| | - Midori H Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil.
- Osaki Clinics, R. Vergueiro, 2045 cj. 1009, São Paulo, SP, 04101-000, Brazil.
| | - Denny M Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of S. Paulo/Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Teissy Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
- Osaki Clinics, R. Vergueiro, 2045 cj. 1009, São Paulo, SP, 04101-000, Brazil
| | - Lilian Ohkawara
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
| | - Antonio Augusto V Cruz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of S. Paulo/Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Belfort R, Paula JS, Lopes Silva MJ, Della Paolera M, Kim T, Chen MY, Goodkin ML. Fixed-combination Bimatoprost/Brimonidine/Timolol in Glaucoma: A Randomized, Masked, Controlled, Phase III Study Conducted in Brazil ☆. Clin Ther 2020; 42:263-275. [PMID: 32089329 DOI: 10.1016/j.clinthera.2019.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Many patients with open-angle glaucoma eventually require >2 medications to lower their intraocular pressure (IOP). Fixed-combination ophthalmic solutions can be advantageous in patients who require multiple medications, but the number of fixed combinations combining 3 complementary IOP-lowering agents remains limited. This study assessed the efficacy and safety of a triple fixed combination (TFC) of bimatoprost 0.01%/brimonidine 0.15%/timolol 0.5% ophthalmic solution in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT), compared with a dual fixed combination (DFC) of brimonidine 0.2%/timolol 0.5%. METHODS Patients with a baseline IOP of 23-34 mm Hg in both eyes and no history of IOP-lowering procedures were eligible for participation in this multicenter, double-masked, randomized, Phase III study. After washout of previous treatment (if applicable), patients were randomized to receive TFC or DFC twice daily in each eye for 3 months. The primary efficacy variable was the change from baseline in mean IOP in the worse eye at week 12 in the modified intent-to-treat (mITT) population. TFC was superior to DFC if the treatment difference (TFC - DFC) favored TFC at week 12 (P ≤ 0.05; 2-sample t test). Secondary and sensitivity analyses were also performed. Safety, including adverse events, was assessed at all visits. FINDINGS The mITT/safety population included 185 patients (TFC, n = 90; DFC, n = 95). TFC superiority was demonstrated at all postbaseline visits (all, P < 0.001) through week 12 (week 12 treatment difference: ─2.17 mm Hg; 95% CI, ─3.12 to ─1.22). While treatment-related conjunctival hyperemia was more frequent with TFC than with DFC (47.8% vs 23.2%; P < 0.001), consistent with the additional presence of bimatoprost in TFC, most cases were mild and the numbers of patient discontinuations at week 12 were similar between the TFC and DFC groups (11 [12.2%] vs 7 [7.4%] patients; P = 0.266). No unexpected adverse events were reported. IMPLICATIONS Compared with DFC, TFC provided superior IOP lowering throughout the primary efficacy period. An acceptable tolerability profile was observed through 12 months of use of TFC, offering an effective therapeutic option in patients with POAG or OHT who require multiple medications to control their IOP. Additional studies are required for the assessment of the long-term effects of TFC. ClinicalTrials.gov identifier: NCT01217606.
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Affiliation(s)
- Rubens Belfort
- Hospital São Paulo, Federal University of São Paulo, São Paulo, Brazil.
| | - Jayter Silva Paula
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Jordão Lopes Silva
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
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