MARCONY RODRIGUES DE SANTHIAGO
Projetos de Pesquisa
Unidades Organizacionais
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
11 resultados
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- 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.
- 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.
- Cataract surgery in patients with chronic severe graft-versus-host disease(2016) SHAH, Ankit; SANTHIAGO, Marcony R.; ESPANA, Edgar M.PURPOSE: To evaluate the surgical outcomes of cataract extraction with phacoemulsification and intraocular lens implantation in patients with severe chronic ocular graft-versus-host disease (GVHD). SETTING: University of South Florida Eye Institute, Tampa, Florida, USA. DESIGN: Retrospective case study. METHODS: A chart review was performed to identify patients with clinically severe, biopsy-proven chronic ocular GVHD who had cataract extraction. Outcome parameters included preoperative and postoperative corrected distance visual acuity (CDVA), type of cataract, postoperative complications, type of underlying malignancy, and time from bone marrow transplant to cataract extraction. RESULTS: This study comprised 10 eyes of 6 patients with severe GVHD. Posterior subcapsular cataract accounted for all cataracts that were surgically removed in this patient cohort. The mean preoperative CDVA was 20/84, which improved to 20/30 at the 1-month postoperative visit and remained stable at 20/28 at the final visit noted in the charts (both P<.05). Two patients developed postoperative corneal melting. All but 1 patient had improved visual acuity after surgery. CONCLUSIONS: With meticulous preoperative biometric measurements and calculations and aggressive assessment and treatment of dry-eye syndrome, patients with severe ocular GVHD who had cataract extraction had excellent postsurgical refractive outcomes. Postoperative corneal melting was a complication seen with greater frequency than anticipated in this patient cohort. (C) 2016 ASCRS and ESCRS
- Corneal Collagen Cross-linking in Advanced Keratoconus: A 4-Year Follow-up Study(2016) GIACOMIN, Natalia T.; NETTO, Marcelo V.; TORRICELLI, Andre A. M.; MARINO, Gustavo K.; BECHARA, Samir J.; ESPINDOLA, Rodrigo F.; SANTHIAGO, Marcony R.PURPOSE: To analyze the safety and efficacy of standard corneal collagen cross-linking (CXL) in advanced cases of progressive keratoconus after 4 years of follow-up. METHODS: A retrospective case series of patients with advanced progressive keratoconus (stages 3 and 4 of Amsler-Krumeich classification) underwent standard CXL treatment. The parameters examined were changes in uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), keratometry values (mean, flat, steep, and apical), pachymetry, and endothelial cell count at the baseline and at 12, 24, and 48 months postoperatively. RESULTS: Forty eyes of 40 patients were enrolled in the study. The mean patient age was 22.5 years (range: 15 to 37 years). Both mean UDVA and CDVA remained stable during the time points; no statistically significant change was noted. Although a slight reduction was observed in all keratometric readings, a statistically significant reduction was only reached in the apical keratometry (P = .037) at 4 years after CXL. A significant reduction in the corneal thickness was also found (ultrasonic: 388 +/- 49 to 379 +/- 48 mu m; slit-scanning: 362 +/- 48 to 353 +/- 51 mu m); however, this change was likely not clinically meaningful. Endothelial cell count was not significantly different at the end of the study. Treatment failure or progression was noted in two patients (5%) over the follow-up period. CONCLUSIONS: Standard CXL treatment was safe and able to stabilize both visual acuity and topographic parameters at 4 years of follow-up in eyes with advanced keratoconus.
- Intense Early Flattening After Corneal Collagen Cross-linking(2015) SANTHIAGO, Marcony R.; GIACOMIN, Natalia T.; MEDEIROS, Carla S.; SMADJA, David; BECHARA, Samir J.PURPOSE: To report two cases of significant flattening after corneal cross-linking (CXL) for keratoconus and discuss its potential explanations and implications. METHODS: Observational case report. RESULTS: One year after standard CXL protocol (3 mW/cm(2) for 30 minutes and total energy of 5.4 J/cm(2)), a 28-year-old woman presented a flattening of greater than 14 diopters and a 14-year-old boy presented a flattening of 7 diopters. CONCLUSIONS: Although rare, a significant flattening effect may occur during the first year after CXL, probably related to intense wound healing, increase in corneal elasticity, CXL effective depth, and central cone location. These cases suggest the necessity of a patient-specific approach and a better understanding regarding the actual mechanism behind its potent effect.
- 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
- Modulation transfer function and optical quality after bilateral implantation of a+3.00 D versus a+4.00 D multifocal intraocular lens(2012) SANTHIAGO, Marcony R.; WILSON, Steven E.; NETTO, Marcelo V.; GHANEN, Ramon C.; MONTEIRO, Mario Luis R.; BECHARA, Samir J.; ESPANA, Edgar M.; MELLO, Glauco R.; KARA-JUNIOR, NewtonPURPOSE: To determine whether the improvement in intermediate vision after bilateral implantation of an aspheric multifocal intraocular lens (IOL) with a +3.00 diopter (D) addition (add) occurs at the expense of optical quality compared with the previous model with a +4.00 D add. SETTING: Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil. DESIGN: Prospective randomized double-masked comparative clinical trial. METHODS: One year after bilateral implantation of Acrysof Restor SN6AD1 +3.00 D IOLs or Acrysof Restor SN6AD3 +4.00 D IOLs, optical quality was evaluated by analyzing the in vivo modulation transfer function (MTF) and point-spread function (expressed as Strehl ratio). The Strehl ratio and MTF curve with a 4.0 pupil and a 6.0 mm pupil were measured by dynamic retinoscopy aberrometry. The uncorrected and corrected distance visual acuities at 4 m, uncorrected and distance-corrected near visual acuities at 40 cm, and uncorrected and distance-corrected intermediate visual acuities at 50 cm, 60 cm, and 70 cm were measured. RESULTS: Both IOL groups comprised 40 eyes of 20 patients. One year postoperatively, there were no statistically significant between-group differences in the MTF or Strehl ratio with either pupil size. There were no statistically significant between-group differences in distance or near visual acuity. Intermediate visual acuity was significantly better in the +3.00 D IOL group. CONCLUSION: Results indicate that the improvement in intermediate vision in eyes with the aspheric multifocal +3.00 D add IOL occurred without decreasing optical quality over that with the previous version IOL with a +4.00 D add.
- Intrastromal corneal ring segments followed by PRK for postkeratoplasty high astigmatism: prospective study(2022) BERTINO, Pedro; MAGALHAES, Renata Soares; JR, Carlos Jose de Souza; ROCHA, Guilherme; SANTHIAGO, Marcony R.Purpose: To evaluate refractive and topographic results of the association of intrastromal corneal ring segments (ICRS) with photorefractive keratectomy (PRK) for the correction of high (>6.0 diopters [D]) postkeratoplasty astigmatism (PKA). Setting: University of Sao Paulo, Sao Paulo, Brazil. Design: Prospective interventional study. Methods: Postpenetrating keratoplasty patients, intolerant to contact lens fitting, and with corneal astigmatism higher than 6.0 D were treated by the combination of ICRS and PRK from January 2017 to June 2019. First, patients underwent femtosecond laser-assisted ICRS implantation to reduce and regularize corneal astigmatism, and 3 months later, submitted to PRK for the residual astigmatism. Outcomes were obtained 12 months after PRK. Results: The study comprised 30 eyes of 29 patients. Mean uncorrected distance visual acuity (logMAR) changed from 1.16 +/- 0.37 in the preoperative to 0.69 +/- 0.40 after ICRS (P < .0001) and to 0.34 +/- 0.29 12 months after PRK (P < .0001). Mean spherical equivalent decreased from -5.19 +/- 4.81 D in the preoperative to -3.38 +/- 4.51 D after ICRS (P < .0001) and to -2.30 +/- 2.84 D after PRK (P = .132). Mean topographic astigmatism decreased from 7.88 +/- 2.13 D in the preoperative to 5.47 +/- 2.29 D after ICRS (P < .0001) and to 4.12 +/- 2.93 D after PRK (P = .003). Mean refractive astigmatism decreased from 7.10 +/- 1.13 D in the preoperative to 4.61 +/- 1.61 D after ICRS (P < .0001) and to 2.58 +/- 1.49 D after PRK (P < .0001). After PRK, the mean correction index (CI) for corneal astigmatism was 0.77 +/- 0.36. The ICRS/PRK combination resulted in a higher CI than ICRS only, both for corneal and refractive astigmatism. 2 eyes (8%) presented clinically significant opacification. Other complications were endothelial rejection (n = 1, 4%), infectious keratitis (n = 1, 4%), and ICRS extrusion after corneal melting (n = 1, 4%). Conclusions: The association of ICRS and PRK was effective for treating high PKA. This strategy improved visual acuity, spherical equivalent, topographic and refractive astigmatism and resulted in a high CI. Safety questions remain open and must be balanced against benefits.
- 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.