NEWTON KARA JOSE JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
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- Ocular risk management in patients undergoing general anesthesia: an analysis of 39,431 surgeries(2015) KARA-JUNIOR, Newton; ESPINDOLA, Rodrigo Franca de; VALVERDE FILHO, Joao; ROSA, Christiane Pellegrino; OTTOBONI, Andre; SILVA, Enis DonizeteOBJECTIVE: This study sought to describe and analyze ocular findings associated with nonocular surgery in patients who underwent general anesthesia. METHODS: The authors retrospectively collected a series of 39,431 surgeries using standardized data forms. RESULTS: Ocular findings were reported in 9 cases (2.3: 10,000), which involved patients with a mean age of 58.9 +/- 19.5 years. These cases involved patients classified as ASA I (33%), ASA II (55%) or ASA III (11%). General anesthesia with propofol and remifentanil was used in 4 cases, balanced general anesthesia was used in 4 cases, and regional block was used in combination with balanced general anesthesia in one case. Five patients (55%) underwent surgery in the supine position, one patient (11%) underwent surgery in the lithotomy position, two patients (22%) underwent surgery in the prone position, and one patient (11%) underwent surgery in the lateral position. Ocular hyperemia was detected in most (77%) of the 9 cases with ocular findings; pain/burning of the eyes, visual impairment, eye discharge and photophobia were observed in 55%, 11%, 11% and 11%, respectively, of these 9 cases. No cases involved permanent ocular injury or vision loss. CONCLUSION: Ophthalmological findings after surgeries were uncommon, and most of the included patients were relatively healthy. Minor complications, such as dehydration or superficial ocular trauma, should be prevented by following systematic protocols that provide appropriate ocular occlusion with a lubricating ointment and protect the eye with an acrylic occluder. These procedures will refine the quality of anesthesia services and avoid discomfort among patients, surgeons and anesthesia staff.
article 14 Citação(ões) na Scopus Expectation and knowledge among patients with keratoplasty indication(2011) KARA-JUNIOR, Newton; MOURAD, Paula de Camargo Abou; ESPINDOLA, Rodrigo Franca de; ABILRUSS, Heloisa HelenaPurpose: To know characteristics and difficulties to access patients' treatment selected to keratoplasty in community projects carried out in a university hospital in Sao Paulo. Methods: A questionnaire was applied on patients in two keratoplasty campaigns performed by the hospital. Was analyzed the following variables: gender, age, income, education, number of previous ophthalmologists 'appointment, visual acuity in the better eye, diagnosis, indication for keratoplasty, knowledge about it, the eye disease and the existence of limitations on lifestyle and possible complications after surgery, expectation of rehabilitation, among others. Results: Most of the 99 patients interviewed (57.8%) had left the job because of visual difficulty and dependent on outside help for everyday activities. From the 90 patients who already had early indication of a keratoplasty (91.0%), half of them had not even managed to join the list of eye banks. From the patients with previous indication for keratoplasty, 18.9% didn't know what was their eye problem, 27.8% didn't know what was keratoplasty, 18.7% were not aware of possible complications during and after the surgery and 32, 2% ignored the existence of limitations in lifestyle after surgery. Conclusion: The patients' unknowledge about their condition and treatment is clear. It is extremely important to emphasize that to obtain a satisfactory surgical result, there is a need of an appropriate patient selection and guidance about their eye problem, the proposed surgery, care and risk per and post operative as well as the visual rehabilitation perspective.- Cataract surgery: emotional reactions of patients with monocular versus binocular vision(2012) MARBACK, Roberta Ferrari; ESPINDOLA, Rodrigo Franca de; SANTHIAGO, Marcony Rodrigues de; TEMPORINI, Edmea Rita; KARA-JUNIOR, NewtonPurpose: To analyze emotional reactions related to cataract surgery in two groups of patients (monocular vision - Group 1; binocular vision - Group 2). Methods: A transversal comparative study was performed using a structured questionnaire from a previous exploratory study before cataract surgery. Results: 206 patients were enrolled in the study, 96 individuals in Group 1 (69.3 +/- 10.4 years) and 110 in Group 2 (68.2 +/- 10.2 years). Most patients in group 1 (40.6%) and 22.7% of group 2, reported fear of surgery (p<0.001). The most important causes of fear were: possibility of blindness, ocular complications and death during surgery. The most prevalent feelings among the groups were doubts about good results and nervousness. Conclusion: Patients with monocular vision reported more fear and doubts related to surgical outcomes. Thus, it is necessary that phisycians considers such emotional reactions and invest more time than usual explaining the risks and the benefits of cataract surgery.
- Effect of aspherical and yellow tinted intraocular lens on blue-on-yellow perimetry(2012) ESPINDOLA, Rodrigo Franca de; SANTHIAGO, Marcony Rodrigues de; KARA-JUNIOR, NewtonPurpose: To investigate the possible effect of aspherical or yellow tinted intraocular lens (IOL) on contrast sensitivity and blue-on-yellow perimetry. Methods: This prospective randomized bilateral double-masked clinical study included 52 patients with visually significant bilateral cataracts divided in two groups; 25 patients (50 eyes) received aspherical intraocular lens in one eye and spherical intraocular lens in the fellow eye; and 27 patients (54 eyes) received ultraviolet and blue light filter (yellow tinted) IOL implantation in one eye and acrylic ultraviolet filter IOL in the fellow eye. The primary outcome measures were contrast sensitivity and blue-on-yellow perimetry values (mean deviation [MD] and pattern standard deviation [PSD]) investigated two years after surgery. The results were compared intra-individually. Results: There was a statistically significant between-group (aspherical and spherical intraocular lens) difference in contrast sensitivity under photopic conditions at 12 cycles per degree and under mesopic conditions at all spatial frequencies. There were no between-group significant differences (yellow tinted and clear intraocular lens) under photopic or mesopic conditions. There was no statistically significant difference between all intraocular lens in MD or PSD. Conclusion: Contrast sensitivity was better under mesopic conditions with aspherical intraocular lens. Blue-on-yellow perimetry did not appear to be affected by aspherical or yellow tinted intraocular lens. Further studies with a larger sample should be carried out to confirm or not that hypotheses.
- A clinical comparison between DisCoVisc and 2% hydroxypropylmethylcellulose in phacoemulsification: a fellow eye study(2012) ESPINDOLA, Rodrigo F.; CASTRO, Emerson F. S.; SANTHIAGO, Marcony R.; KARA-JUNIOR, NewtonOBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov:NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.
article 9 Citação(ões) na Scopus Dificuldades de acesso ao tratamento de pacientes com indicação de cirurgia de catarata nos Sistemas de Saúde Público e Privado(2011) KARA-JUNIOR, Newton; DELLAPI JR., Roberto; ESPINDOLA, Rodrigo Franca dePurpose: To identify the difficulties in access to diagnosis and treatment of cataract in patients attended during a cataract campaign. Methods: A questionnaire was administered to patients selected for cataract surgery. We evaluated, among others, the following variables: prior access to ophthalmologists (public or private), reason(s) for not having surgery early in the initial service, the average cost charged by cataract surgery and intraocular lens (IOL) (private services and agreements). Results: A total of 627 patients was evaluated. Most of them - 595 (95%) had previously attended an ophthalmologist, and in 63% of cases (375 patients) the consultation had been held for less than a year. The last evaluation was performed by the Brazilian Public Health System (SUS) in 52% of the cases (307 patients). Regarding the reason for not having surgery in the initial service, the high cost of the surgery (R$ 2.000 - R$ 4.000) and the cost of IOLs (R$ 1.000 - R$ 1.500) was the main obstacle for most attended services and private covenants. Conclusion: The results of this study suggest that the routine of ophthalmologic care in SUS at Sao Paulo is not prepared to answer the demand for cataract surgeries and private healthcare system still excludes a portion of the population. It is important to continue the implementation of community campaigns to serve the population that would be unable to access the surgery through conventional ways.- Cancelamento de cirurgias de catarata em um hospital público de referência(2012) MAGRI, Micheli Patricia de Fatima; ESPINDOLA, Rodrigo Franca de; SANTHIAGO, Marcony Rodrigues de; MERCADANTE, Elisabeth Frolich; KARA JUNIOR, NewtonPurpose: To report the incidence and causes of cataract surgery cancellations in a public hospital. Methods: This is a retrospective study, which examined the number of cancellations of cataract surgery during 2009. We analyzed the type of procedure suspended (phacoemulsification or extracapsular extraction), type of anesthesia, gender, age, covenant (public/private) and the main reasons for suspension of the surgeries (clinical causes, institutional or personal). Results: We analyzed 2,965 scheduled cataract surgeries, with 650 cancellations (21.92%). The main reason for the suspension of the procedure was clinical causes (86.90%). The winter months had the highest suspension rates of cataract surgery. Conclusion: The cancellation rate of cataract surgery in Brazilian public system seems to be the same as 10 years ago. The main cause of the suspension should be in clinical conditions (hypertension, diabetes, lack of exams, etc.).
- Visual Performance of an Apodized Diffractive Multifocal Intraocular Lens With+3.00-D Addition: 1-year Follow-up(2011) SANTHIAGO, Marcony R.; WILSON, Steven E.; NETTO, Marcelo V.; ESPINDOLA, Rodrigo F.; SHAH, Ravindra A.; GHANEM, Ramon C.; BECHARA, Samir J.; KARA-JUNIOR, NewtonPURPOSE: To determine whether implantation of a multifocal intraocular lens (IOL) with a lower addition (+3.00 diopters [D]) at the lens plane results in better intermediate visual acuity 1 year after surgery compared with a multifocal IOL with higher addition (+4.00 D). METHODS: This prospective, randomized, double-masked study included 80 eyes from 40 patients. Twenty patients were implanted bilaterally with the ReSTOR +3.00-D add IOL and 20 patients were implanted bilaterally with the ReSTOR +4.00-D add IOL. Primary outcome measures were distance, intermediate, and near visual acuity. Secondary outcomes were defocus curves, best reading distance, mesopic and photopic contrast sensitivity, quality of life, and spectacle independence. Monocular and binocular visual acuity were measured as uncorrected and corrected distance visual acuity at 4 m, uncorrected near and distance-corrected near visual acuity at 40 cm, and uncorrected intermediate visual acuity and distance-corrected intermediate visual acuity at 50, 60, and 70 cm. RESULTS: Twelve months postoperatively, no statistically significant difference between groups in distance and near visual acuity was noted. The ReSTOR +3.00-D add group performed better than the ReSTOR +4.00-D add group at all intermediate distances studied. The ReSTOR +4.00-D group chose a reading distance 8 cm closer than the +3.00-D group. Both groups performed similarly with respect to contrast sensitivity, quality of life, and spectacle independence rates. CONCLUSIONS: Patients implanted with a multifocal IOL with lower addition (ReSTOR +3.00 D) had better performance at intermediate distances compared with the ReSTOR +4.00-D add IOL with similar performance for distance and near visual acuity, contrast sensitivity, and quality of life. [J Refract Surg. 2011;27(12):899-906.] doi:10.3928/1081597X-20110816-01
- Effects of blue light-filtering intraocular lenses on the macula, contrast sensitivity, and color vision after a long-term follow-up(2011) KARA-JUNIOR, Newton; ESPINDOLA, Rodrigo F.; GOMES, Beatriz A. F.; VENTURA, Bruna; SMADJA, David; SANTHIAGO, Marcony R.PURPOSE: To evaluate the possible side effects and potential protection 5 years after implantation of an intraocular lens (IOL) with a blue-light filter (yellow tinted). SETTING: Ophthalmology Department, University of Sao Paulo, Sao Paulo, Brazil. DESIGN: Prospective randomized clinical study. METHODS: Patients with bilateral visually significant cataract randomly received an ultraviolet (UV) and blue light filtering IOL (Acrysof Natural SN60AT) in 1 eye and an acrylic UV light filtering only IOL (Acrysof SA60AT) in the fellow eye. The primary outcome measures were contrast sensitivity, color vision, and macular findings 5 years after surgery. RESULTS: The study enrolled 60 eyes of 30 patients. There were no significant clinical or optical coherence tomography findings in terms of age-related macular degeneration in any eye. There were no statistically significant differences in central macular thickness between the 2 IOL groups (P=.712). There were also no significant between-group differences under photopic or scotopic conditions at any spatial frequency studied. No statistically significant differences in the color discrimination test were found between the 2 IOL groups (P=.674). CONCLUSIONS: After 5 years, there were no significant differences in color perception, scotopic contrast sensitivity, or photopic contrast sensitivity between the blue light filtering (yellow-tinted) IOL and the IOL with a UV-light filter only (untinted). The potential advantage of the tinted IOL in providing protection to macular cells remains unclear.
- Facoemulsificação versus extração extracapsular no sistema público de saúde: análise de custos para o hospital, para o governo e para a sociedade(2012) KARA-JUNIOR, Newton; SANTHIAGO, Marcony Rodrigues de; ESPINDOLA, Rodrigo Franca dePurpose: To compare the costs of cataract surgery for a public hospital, the government and the society between the techniques of phacoemulsification (PHACO) and extracapsular cataract extraction (EECP). Methods: A review based on several clinical studies between 2002 and 2010 at the Ambulatorial Surgical Center of the University of Sao Paulo. Results: The estimated expenses associated with medical supplies used for surgery were R$ 468.92 and R$ 259.96 in the PHACO and EECP groups respectivelly. The hospital expenditures in the postoperative follow-up was approximately R$ 16.40 (42%) lower in the PHACO. Regarding the estimated spending for Social Security, the EECP group cost an average, US$ 44.58 per patient more than the PHACO group.