RICARDO HOLZCHUH
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
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Tacrolimus Ointment for Refractory Posterior Blepharitis(2017) SAKASSEGAWA-NAVES, Fernando Eiji; RICCI, Helena Maria Moraes; MOSCOVICI, Bernardo Kaplan; MIYAMOTO, Daniela Akemi; CHIACCHIO, Brenda Biagio; HOLZCHUH, Ricardo; SANTO, Ruth Muyuki; HIDA, Richard YudiPurpose: This prospective, randomized, double-blind interventional case series was designed to evaluate the short-term efficacy of 0.03% tacrolimus ointment as a new therapeutic approach for refractory cases of posterior blepharitis.Methods: Forty eyes (20 patients) with posterior blepharitis refractory to previous treatment were randomized. Eighteen eyes (9 patients) were treated with 0.03% tacrolimus ointment and 20 eyes (10 patients) with placebo ointment twice daily. Patients were evaluated with a questionnaire and slit-lamp examination 14days and 28days after treatment, and symptoms and signs of blepharitis were compared to those observed at baseline.Results: We could observe statistical difference in the outcome measurements of meibomian gland secretion, conjunctival hyperemia, telangiectasia of inferior lid, Rose Bengal, and fluorescein scoring for the study group. As for the symptoms score, we observed statistical difference in the symptoms scoring for pruritus and dry eye sensation in the tacrolimus group.Conclusion: This study suggests that topical administration of 0.03% tacrolimus ointment can improve some symptoms and some ocular surface status in patients with refractory posterior blepharitis.
- Clinical Treatment of Ocular Demodex folliculorum by Systemic Ivermectin(2011) HOLZCHUH, Flavio Gaieta; HIDA, Richard Yudi; MOSCOVICI, Bernardo Kaplan; ALBERS, Marcos Bottene Villa; SANTO, Ruth Miyuki; KARA-JOSE, Newton; HOLZCHUH, RicardoPURPOSE: To report clinical outcomes of the treatment of ocular Demodex folliculorum with oral ivermectin. DESIGN: Noncomparative, interventional case series. METHODS: Setting. Institutional. Study Population. Twenty-four eyes of 12 patients (3 male and 9 female; mean age +/- standard deviation, 50.4 +/- 21.0 years) with refractory posterior blepharitis with the presence of D. folliculorum in lash samples were enrolled in this study. Intervention. Patients were instructed to take 1 dose of oral ivermectin (200 mu g/kg). All patients were instructed to repeat the treatment after 7 days. Main outcome measures. Tear meniscus height, Schirmer I test results, noninvasive tear film break-up time (BUT), quantification of the absolute number of D. folliculorum found in the lashes, and corneal fluorescein and rose bengal staining scores were obtained from all patients 1 day before and 28 days after treatment. RESULTS: Statistical improvement was observed in the absolute number of D. folliculorum found in the lashes after the treatment with oral ivermectin. Average values of Schirmer I test results and tear film break-up time improved statistically after the treatment of oral ivermectin. No statistical improvement was observed in average lacrimal meniscus height or value of corneal fluorescein and rose bengal staining after treatment with oral ivermectin. CONCLUSIONS: Ivermectin successfully reduced the number of D. folliculorum found in the lashes of patients with refractory blepharitis. Oral ivermectin may be very useful as a complement in the treatment of D. folliculorum infestation with ocular manifestation, especially in cases of unsuccessful treatment related to patient compliance. (Am J Ophthalmol 2011;151:1030-1034.
- Two-Year Outcome of Partial Lacrimal Punctal Occlusion in the Management of Dry Eye Related to Sjogren Syndrome(2011) HOLZCHUH, Ricardo; ALBERS, Marcos Bottene Villa; OSAKI, Tammy Hentona; IGAMI, Thais Zamudio; SANTO, Ruth Miyuki; KARA-JOSE, Newton; HOLZCHUH, Nilo; HIDA, Richard Y.Purpose: To analyze the influence of thermal partial punctal occlusion on the ocular surface of dry eye related to Sjogren syndrome. Material and Methods: Thirty-seven eyes of 19 patients (3 male and 16 female; 49.11 +/- 14.33 years old) with keratoconjunctivitis sicca were enrolled in this study. Superior and inferior partial occlusion were performed in both eyes under topical anesthesia using thermal cautery with a sterile tip to obtain lacrimal punctum smaller than 0.5 mm. Schirmer I, break-up-time, diameter of lacrimal puncta, corneal fluorescein, and rose Bengal staining scores were analyzed before and after 24 weeks and after 24 months of the procedure. All measurements were performed under controlled climate. Results: The average lacrimal punctum diameter before the procedure was 0.65 +/- 0.134 mm. All lacrimal puncta were successfully reduced to less than 0.5 mm after 4 weeks of the procedure. The average Schirmer I test values improved statistically after 24 weeks and maintained stable after 24 months. Average break-up-time, rose Bengal, and fluorescein staining score values improved statistically after 24 weeks and improved even more after 24 months. Average Schirmer I test, break-up-time, rose Bengal, and fluorescein staining scores showed significant improvement (p < 0.0001) after 24 months of partial thermal punctal occlusion. Conclusion: Our study showed that reducing the punctum diameter to 0.5 mm can improve vital staining scores, break-up-time, and Schirmer I test in dry eye related to Sjogren syndrome.
- In Vitro Antimicrobial Long-Term Evaluation of Corneal Preservation Media Against Microorganisms Using A Closed-Chamber Study Model(2013) RUIZ, Diego R. Hoshino; WU, Davi Chen; HOLZCHUH, Ricardo; MIMICA, Lycia M. J.; SILVA, Cely B.; HIDA, Richard Y.Purpose:To evaluate the existence of in vitro long-term antimicrobial activity of Optisol-GS against microorganisms related to corneal infection using a closed-chamber study model.Methods:Optisol-GS was contaminated with microorganisms related to corneal infections, and different times after contamination was analyzed using a closed-chamber study model. Microbial growths were analyzed by macroscopic observation.Results:For Staphylococcus aureus and Pseudomonas aeruginosa, bacterial growth was observed in samples taken 1 hour through 7 days and 14 days after contamination occurred. For Staphylococcusepidermidis, Streptococcus agalactiae, and Candida albicans, microbial growth was observed in all samples studied. For Streptococcus pneumoniae, bacterial growth was observed in samples taken 1 hour through 72 hours after contamination. For Streptococcus pyogenes, bacterial growth was observed in samples taken 1 hour through 7 days after contamination. For Escherichia coli, bacterial growth was observed in samples taken 1 hour through 48 hours after contamination occurred.Conclusions:We conclude that no in vitro antimicrobial effect for any microorganism analyzed was observed in contaminated Optisol-GS after 72 hours; however, effective antimicrobial activity was observed for S. aureus, Str. pneumoniae, Str. pyogenes, P. aeruginosa, and E. coli after 7 to 10 days.
conferenceObject Corneal Endothelial Severity Scoring System for Fuchs's Endothelial Dystrophy: Sectorial Corneal Endothelial Deterioration Imaging(2018) HOLZCHUH, Ricardo; HIDA, Richard Y.; CHAMMAS, Sabrina Marques; CARVALHO, Fbio Ursulino Reis; TEIXEIRA, Ivan Corso; ABIB, Fernando Cesar- Clinical Treatment of Dry Eye Using 0.03% Tacrolimus Eye Drops(2012) MOSCOVICI, Bernardo K.; HOLZCHUH, Ricardo; CHIACCHIO, Brenda B.; SANTO, Ruth M.; SHIMAZAKI, Jun; HIDA, Richard Y.Purpose: To report the clinical outcome of the treatment of dry eyes using 0.03% tacrolimus eye drops (olive oil + tacrolimus 0.03%) (Ophthalmos, Sao Paulo, Brazil). Methods: Sixteen eyes of 8 patients with Sjogren syndrome dry eyes (age, 51.13 +/- 9.45 years) were enrolled in this study (prospective noncontrolled interventional case series). Patients were instructed to use topical 0.03% tacrolimus eye drops twice a day (every 12 hours) in the lower conjunctival sac. Schirmer I test, break-up time, corneal fluorescein, and rose bengal staining score were performed in all patients 1 day before, and 14, 28, and 90 days after treatment with 0.03% tacrolimus eye drops. Results: The average fluorescein staining and rose bengal staining scores improved statistically significantly after 14 days of treatment and improved even more after 28 and 90 days. The average Schirmer I test did not improve statistically significantly after 28 days of treatment, although we did observe a significant improvement after 90 days of treatment with 0.03% tacrolimus eye drops. The average break-up time did not improve statistically after 14 days of treatment, although we observed a significant improvement after 28 and 90 days of treatment with 0.03% tacrolimus eye drops. Conclusions: Topical 0.03% tacrolimus eye drops successfully improved tear stability and ocular surface status in patients with dry eyes.
- Oral Azithromycin for Treatment of Posterior Blepharitis(2011) IGAMI, Thais Zamudio; HOLZCHUH, Ricardo; OSAKI, Tammy Hentona; SANTO, Ruth Miyuki; KARA-JOSE, Newton; HIDA, Richard Y.Purpose: To evaluate the effects of oral azithromycin in patients with posterior blepharitis. Methods: Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. Results: All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. Conclusions: The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.
- Possible Sampling Error in Corneal Specular Microscopy: Can Central Endothelial Data Generated by Specular Microscope Represent the Real Clinical Condition of the Whole Cornea?(2020) BERG, Arthur Buffara van den; HOLZCHUH, Ricardo; HIDA, Richard YudiPurpose: To estimate the minimum number of cells required to obtain reliable data in a specular microscope, which could possibly represent the real clinical condition of the corneal endothelium. Methods: A cross-sectional study of 122 eyes of 61 individuals submitted to noncontact specular microscope was conducted. Data generated by the manufacturer's software were uploaded to specific statistical software for sampling relative error calculation. When relative error was above 5%, new images were acquired and more cells counted until the desired relative error was reached. Data analyzed in this study for the desired relative error were number of cells marked by the examiner for each eye (marked cells), number of cells used for data analysis (analyzed cells), endothelial area used for analysis, sampling error, and absolute number of images used for each eye. Results: The average number of marked cells required to obtain a relative sampling error of less than 5% was 425.2 +/- 102.2 cells. The average number of analyzed cells used by the specular microscope to generate the data was 247.4 +/- 51.6 cells. The average endothelial area of the analyzed cells was 0.43 +/- 0.08 mm(2). The mean sampling error was 3.7% +/- 0.6%, and an average of 2.95 +/- 0.74 images was needed to obtain a relative sampling error of less than 5%. Conclusions: We conclude that, theoretically, a minimum of 425.2 cells from 2.95 images must be marked to obtain reliable results, which could possibly represent the real endothelial clinical condition of the whole cornea.
- Treatment of Sjogren's syndrome dry eye using 0.03% tacrolimus eye drop: Prospective double-blind randomized study(2015) MOSCOVICI, Bernardo Kaplan; HOLZCHUH, Ricardo; SAKASSEGAWA-NAVES, Fernando Eiji; HOSHINO-RUIZ, Diego Ricardo; ALBERS, Marcos Bottene Villa; SANTO, Ruth Miyuki; HIDA, Richard YudiObjective: To describe the clinical efficacy of the treatment of Sjogren's syndrome dry eye using 0.03% tacrolimus eye drop. Design: Prospective double-blind randomized study. Setting: Institutional outpatient clinic. Participants: Forty-eight eyes of twenty-four patients with dry eye related to Sjogren syndrome were enrolled in this study. The patients were randomized in 2 groups: tacrolimus (n= 14) and vehicle (n=10) group. Intervention: The tacrolimus group received a vial containing tacrolimus 0.03% (almond oil as vehicle) and the other group received the almond oil vehicle. All patients were instructed to use the eye drops every 12 h in the lower conjunctival sac. Main outcome measures: Schirmer I test, break-up-time (BUT), corneal fluorescein and Rose Bengal staining scores were evaluated in all patients one day before the treatment (baseline), 7, 14, 28 and 90 days after treatment with the eye drops. Results: The average fluorescein and Rose Bengal scores improved statistically after 7 days of treatment and even more after 90 days. The average Schirmer I and BUT values were unchanged after 7, 14 and 21 days but did show an improvement relative to baseline after 28 days of treatment. Schirmer I, BUT, fluorescein and Rose Bengal did not show any statistical significance in the vehicle group. Conclusion: Topical 0.03% tacrolimus eye drop improved tear stability and ocular surface status in cases of inflammatory or SS-related dry eye. Trial registration: ClinicalTrials.gov Identifier: NCT01850979.