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
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- Role of Corneal Epithelial Measurements in Differentiating Eyes with Stable Keratoconus from Eyes that Are Progressing(2023) SANTHIAGO, Marcony R.; STIVAL, Larissa R.; ARAUJO, Daniella C.; KARA-JUNIOR, Newton; TOLEDO, Marcia C.Purpose: To evaluate measures of corneal epithelium in eyes that showed documented signs of keratoconus (KC) progression and compare with stable eyes and healthy controls. Also, to determine the correlation of these epithelial parameters with maximum keratometry (K max) and pachymetry. Design: Prospective, observational, comparative study. Participants: One-hundred and fifty eyes from 150 patients. The study included 50 eyes from patients with documented KC progression, 50 eyes with stable KC, and 50 clinically normal eyes to serve as controls. Methods: A spectral-domain (SD)-OCT imaging was obtained in all eyes, and mean values were compared between the groups. The correlation of epithelial parameters with K max and thinnest pachymetry was also investigated. Main Outcome Measures: For the purposes of this study, the epithelial measures maximum, minimum, superior, and inferior values as well as the difference between the minimum and maximum (min-max) and epithelial standard deviation were considered, obtained from SD-OCT and compared between groups. Measurements of the thinnest point and min-max in pachymetry were also recorded. Results: The only epithelial parameter that presented a statistically significant difference between stable and progressive KC was epithelium min-max. Although stable KC presented epithelium min-max mean values of -18.2 +/- 6.6, progressive KC eyes presented mean values of -23.4 +/- 10.3 (P < 0.0001). Epithelial maximum (P = 0.16), minimum (P = 0.25), superior (P = 0.28), inferior (P = 0.23), and standard deviation (P = 0.25) values were not significantly different between stable and progressive eyes. Difference min-max pachymetry points in stable (-108.3 +/- 33.5) and progressive KC (-115.2 +/- 56.0) were not significantly different (P = 0.723). There was no significant correlation between epithelium min-max with corneal thinning (P = 0.39) or K max (P = 0.09) regardless of disease progression. Conclusions: Epithelial measures are useful to identify KC eyes that are progressing; the parameters that measure the difference between min-max epithelium points were significantly different between stable and progressive groups, unlike this difference in pachymetry. Finally, this epithelial parameter seems to be inde-pendent of corneal thinning and K max. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. (c) 2022 by the American Academy of Ophthalmology.
- Avaliação das urgências oftalmológicas em um hospital público de referência em Pernambuco(2016) ALMEIDA, Hirlana Gomes; FERNANDES, Viviane Bandeira; LUCENA, Ana Carolina Vieira Peixoto e; KARA-JUNIOR, NewtonABSTRACT Purpose: To evaluate ophthalmological emergencies in a public reference hospital in Pernambuco. Methods: Cross-sectional retrospective study with 26.358 patients attended in the ophthalmic emergency Altino Ventura Foundation, in the period january to june 2013. Data were collected using protocols based on electronic registration forms of ophthalmological emergency Results: It was observed that 52.5% of patients were male, 42.5% were aged 21-40 years; 90.8% were from the region metropolitan area of Recife; 55% classified as less severe. The main diagnoses were conjunctivitis (35.17%) and ocular trauma (19.25%). Conclusion: The prevalence of male patients, aged 21-40 years, from the metropolitan area of Recife, classified as low complexity, attended in January, on Monday, with the diagnosis of conjunctivitis, followed by ocular trauma.
- Comparison of different surgical approaches for pediatric cataracts: complications and rates of additional surgery during long-term follow-up(2019) KOCH, Camila R.; KARA-JUNIOR, Newton; SANTHIAGO, Marcony R.; MORALES, MartaOBJECTIVES: To compare long-term postoperative complications of pediatric cataract surgery with primary intraocular lens (IOL) implantation associated with posterior capsulotomy (PC) and anterior vitrectomy (AV) between patients treated with a corneal or pars plicata/pars plana approach. METHODS: Children who underwent cataract surgery with in-the-bag primary IOL implantation were divided into two groups according to PC and AV surgical approach: a corneal approach (group 1) and a pars plicata/pars plana approach (group 2). Only patients with a follow-up duration of more than two years were included. Longterm surgical outcomes were retrospectively reported. RESULTS: The mean follow-up period was 10.00 +/- 3.13 years. No cases of glaucoma or retinal detachment were reported. The mean age at surgery was 34.57 +/- 22.66 months. Forty-six children were included (27 eyes in group 1 and 29 eyes in group 2). The most frequent postoperative complication was corectopia, followed by visual axis opacification. Both complications occurred more frequently in group 1 (p < 0.001). After cataract surgery, the rate of additional surgeries in group 1 was 51.9%, while in group 2, the rate was 27.6% (p=0.1132). CONCLUSION: The pars plicata/pars plana approach with PC and vitrectomy with primary in-the-bag IOL implantation for pediatric cataracts is a safe procedure.
- 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.
- Long-term results of in-the-bag primary intraocular lens implantation in children younger than 24 months(2021) KOCH, Camila Ribeiro; KARA-JUNIOR, Newton; SANTHIAGO, Marcony Rodrigues; MORALES, MartaPurpose: The purpose of this study was to analyze the safety of primary intraocular lens implantation in a large number of eyes in children aged <24 months. Methods: The medical records of patients aged 5-24 months, who underwent primary intraocular lens implantation in the capsular bag, were reviewed. A foldable three-piece acrylic intraocular lens was implanted by the same surgeon using a single surgical technique. Patients who had <1 year of follow-up after the surgery were excluded. The main outcome measurements included visual acuity, myopic shift, follow-up complications, and additional surgeries. Results: Sixty-eight patients (93 eyes) were analyzed. The mean age of the patients at the time of surgery was 15.06 +/- 6.19 months (range: 5-24 months), and the spherical equivalent 1 month after surgery was 3.62 +/- 2.32 D. After 5.67 +/- 3.10 years, the spherical equivalent was -0.09 +/- 3.22 D, and the corrected distance visual acuity was 0.33 +/- 0.33 and 0.64 +/- 0.43 logMAR in bilateral and unilateral cases, respectively (p=0.000). The highest myopic shift was observed in infants who underwent surgery at ages 5 and 6 months. The most frequent complications included visual axis opacification and corectopia. Glaucoma and retinal detachment were not reported. Conclusion: Primary in-the-bag intraocular lens implantation in children aged 5-24 months is safe, and is associated with low rates of adverse events and additional surgery.
- Predictability and Vector Analysis of Laser In Situ Keratomileusis for Residual Errors in Eyes Implanted With Different Multifocal Intraocular Lenses(2016) SANTHIAGO, Marcony R.; VENTURA, Bruna V.; GHANEM, Ramon C.; KARA-JUNIOR, Newton; MORAES JR., Haroldo V.; GHANEM, EmirPurpose:To investigate potential differences in predictability, efficacy, and safety of corneal excimer laser to correct residual myopia, hyperopia, and astigmatism in eyes previously implanted with multifocal intraocular lenses using distinct optical surfaces and platforms for multifocality.Methods:This prospective comparative study included 37 eyes submitted to laser in situ keratomileusis correction for residual errors after implantation of either an apodized diffractive-refractive (Restor) or a full-diffractive (Tecnis) multifocal intraocular lens. Data analysis included investigation of predictability, efficacy, and safety of excimer laser surgery to correct residual errors. A double-angle plot, using vector analysis, was also created to evaluate predictability of astigmatism correction.Results:At 6-month follow-up, statistical analyses revealed a significant improvement when comparing preoperative (0.51 0.25 and 0.44 +/- 0.18) and postoperative values (0.17 +/- 0.10 and 0.09 +/- 0.07) of uncorrected distance visual acuity (P < 0.0001 and <0.0001), preoperative (0.92 +/- 0.61 and 1.02 +/- 0.45) and postoperative values (0.33 +/- 0.23 and 0.19 +/- 0.17) of manifest refractive spherical equivalent (P = 0.0006 and <0.0001), and preoperative (-1.08 +/- 0.70 and -0.65 +/- 0.42) and postoperative values (-0.25 +/- 0.28 and -0.14 +/- 0.21) of astigmatism (P < 0.0001 and <0.0001) in eyes implanted with Restor and Tecnis, respectively. Vector analysis revealed a predictable correction of astigmatism in all groups. Ninety-two percent of total eyes achieved a manifest refractive spherical equivalent within +/- 0.5 of emmetropia.Conclusions:Corneal excimer laser refractive surgery seems to be equally effective to correct different residual errors, including astigmatism, in eyes implanted with intraocular lenses with various platforms for multifocality.
- Elaboração e validação do questionário de satisfação dos pacientes pseudofácicos em português(2013) HIDA, Wilson Takashi; NAKANO, Celso Takashi; YAMANE, Iris; MOTTA, Antonio Francisco Pimenta; TZELIKS, Patrick Frenzel; GUIMARAES, Aline Silva; ALENCAR, Luciana Malta de; VENTURA, Dora Selma Fix; ALVES, Milton Ruiz; JOSÉ JÚNIOR, Newton KaraPURPOSE: Development and validation of quality of life questionnaire in pseudophakic patients in Portuguese. METHODS: The modified Cataract TyPESpecification questionnaire was specifically developed to assess quality of life after cataract surgery, functional status evaluated with 10 items and contains 18 questions. All questions were applied by a single examiner, with the goal of graduating visual satisfaction from 0 to 10 (0 means very dissatisfied, 5 neutral, 10 very satisfied).This prospective comparative study included 142 eyes of 71 patients in Sao Paulo University. The ophthalmologic evaluation performed included near, intermediate and distance corrected and uncorrected visual acuity and quality of life questionaire. The minimum follow-up was 6 months. RESULTS: The mean age of patients was 60.7± 6.6 years in theTecnis®MF, 63.1 ±4.4 years in-groupRestor®63.7±4.2 years in-group SN60AT/SN60WF. Uncorrected and distance-corrected near visual acuity were statistically higher in theRestor® and Tecnis® groups compared to the SN60AT/SN60WF group (p<0.001). There were no statistical differences between groups comparing uncorrected and best-corrected distance visual acuity (p=0.56). Satisfaction questionnaire showed high glasses independence fortheTecnis®MF (9.3 /10) and Restor® (8.7 /10), but with more unsatisfied of halos (18.8% Restor®, Tecnis®21, 7%) and glare (Restor® 25%;Tecnis®26.1%) than the group SN60AT/SN60WF. CONCLUSION: Cataract patients who received multifocal (Restor®; Tecnis®MF) IOLs at time of surgery obtained better uncorrected and distance corrected near visual acuity and reported better overall vision, less limitation in visual function, less spectacle dependency, and more glare or halo than those who received monofocal (SN60AT; SN60WF) IOLs. Cataract TyPESpecification questionnaire was a strong predictor of change in patient satisfaction caused by cataract surgery.
- Topographic outcomes after corneal collagen crosslinking in progressive keratoconus: 1-year follow-up(2017) TIVERON JR., Mauro C.; PENA, Camila Ribeiro Koch; HIDA, Richard Yudi; MOREIRA, Luciane Bugmann; BRANCO, Felipe Roberto Exterhotter; KARA-JUNIOR, NewtonPurpose: We aimed to report and analyze topographic and refractive outcomes following corneal collagen crosslinking (CXL) in patients with progressive keratoconus (KC). Methods: We performed a retrospective, analytical, and observational study of 100 eyes from 74 progressive KC patients who underwent CXL at the Eye Hospital of Parana. Keratometric values were analyzed preoperatively as well as 3 and 12 months postoperatively. Results: For a total of 100 eyes, 68 belonged to male patients. The mean age of our study population was 19.9 +/- 5.61 years. The average visual acuity and topographic parameters overall were stable after 1 year (p<0.05). After 3 months, steepest keratometry reading (K2) and maximum keratometry (Kmax) were significantly decreased (p<0.05). Regarding topographic astigmatism (dK), there was no significant difference between the 3-month and 12-month follow-ups. When we made comparisons between genders following CXL, there were no significant differences related to the changes in Kmax, K2, and spectacle-corrected distance visual acuity (SCDVA). Conclusions: CXL promoted stabilization or improvement of keratometric values and visual acuity. We found that keratoconus apex stability may be achieved 3 months after the procedure. There was no significant difference in keratometric and refractive values measured between male and female patients.
- Avaliação das características do atendimento de urgências oftalmológicas em um hospital público da Grande São Paulo(2015) HUSSEIN, Renata Prota; RANGEL, Flavia Lucia Beraldi; ALMEIDA, Hirlana Gomes; GRACIA, Marina; REHDER, Jose Ricardo; KARA-JUNIOR, NewtonPurpose: Evaluate the characteristics of patients seen in the emergency department of ophthalmology in order to identify measures to improve the effectiveness of care and guide the enhancement of other emergency services. Methods: Cross-sectional, observational study with 300 patients treated at the Municipal Hospital of Santo Andre - Sao Paulo from 15 to 22 august 2011. Data were collected through interviews with patients based on a questionnaire. Results: It was observed that 73.7% lived at a distance of up to 20 km from the hospital and 71.6% of real emergencies and 61.3% of false emergencies sought treatment within a week of the onset of symptoms. Conclusions: Considered the need to provide information to the population about the type and severity of ocular emergencies, with emphasis on prevention and the importance of the most prevalent diseases such as corneal foreign body and corneal ulcer, and health policies aimed at creation of regional centers of specialized care in order to minimize barriers to access and increase the speed in the treatment of ocular emergencies.