LEONARDO PROVETTI CUNHA
Projetos de Pesquisa
Unidades Organizacionais
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
25 resultados
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- Bruch Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Helps Differentiate Compressive Optic Neuropathy From Glaucoma(2022) ANDRADE, Thais de Souza; ARAUJO, Rafael Barbosa de; ROCHA, Arthur Andrade do Nascimento; MELLO, Luiz Guilherme Marchesi; CUNHA, Leonardo P.; MONTEIRO, Mario L. R.center dot PURPOSE: To compare optical coherence tomography measured Bruch membrane opening minimum rim width (MRW), peripapillary retinal nerve fiber layer (pRNFL) measurements, and MRW:pRNFL ratios in eyes with compressive optic neuropathy (CON) and glaucoma and controls, and evaluate the ability of these parameters to differentiate CON from glaucoma. center dot DESIGN: Prospective, cross-sectional study. center dot METHODS: Setting : Single-center tertiary hospital and outpatient clinic. Patient population : One hundred fifteen eyes of 77 participants, 34 with CON from chiasmal lesions, 21 with glaucoma, and 22 healthy controls. Observation procedures : Optical coherence tomography-measured MRW, pRNFL, and MRW:pRNFL ratios for each optic disc sector and global average. Main outcome measures: MRW, pRNFL, and MRW:pRNFL ratios compared using generalized estimated equations. Area under the receiver operating characteristic curve and positive and negative likelihood ratios were calculated. center dot RESULTS: MRW and pRNFL measurements were significantly reduced in CON and glaucoma compared with controls. In glaucoma, MRW was thinner than in CON in the global, inferotemporal, superonasal, inferonasal, and vertical average measurements, but a significant overlap was observed in many parameters. MRW:pRNFL ratios increased the ability to discriminate between CON and glaucoma, as shown by the high area under the receiver operating characteristic curve, high positive likelihood ratios, and low negative likelihood ratios, especially in the nasal disc sector and the nasal and temporal average. center dot CONCLUSIONS: MRW measurements alone cannot reliably distinguish CON from glaucoma, but the combination of MRW, pRNFL, and MRW:pRNFL ratios significantly improves accuracy. When comparing the 2 conditions, MRW:pRNFL ratios yielded higher area under the receiver operating characteristic curve and positive and negative likelihood ratios, suggesting this parameter may be helpful in clinical practice. (Am J Ophthalmol 2021;234: 156-165.
conferenceObject Effect of panretinal photocoagulation on confocal laser scanning ophthalmoscopy and stereo photographic parameters of the optic disc topography in diabetic retinopathy patients(2018) AZEVEDO, Breno; ARAUJO, Rafael Barbosa de; CIONGOLI, Marina; CUNHA, Leonardo Provetti; PRETI, Rony Carlos; HATANAKA, Marcelo; ZACHARIAS, Leandro C.; MONTEIRO, Mario L. R.- Acute visual loss and optic disc edema followed by optic atrophy in two cases with deeply buried optic disc drusen: a mimicker of atypical optic neuritis(2018) MONTEIRO, Mario Luiz R.; HOKAZONO, Kenzo; CUNHA, Leonardo P.; BICCAS NETO, LaurentinoBackground: Sudden visual loss and optic disc edema caused by optic neuritis (ON) is usually followed by significant visual recovery. However, little or no recovery occurs when the loss is caused by atypical ON, especially in patients with neuromyelitis optica (NMO). Optic disc drusen (ODD) is a cause of pseudo optic disc edema and may be a predisposing factor for non-arteritic anterior ischemic optic neuropathy (NAION), thereby mimicking atypical ON. In such cases, if globular concretions are seen protruding from the disc substance, ODD may be suspected. The purpose of this paper is to describe two patients with acute visual loss followed by optic disc atrophy initially labeled as atypical ON. Though not suspected on clinical examination, optical coherence tomography (OCT) revealed deeply buried ODD as a predisposing factor for NAION. Case presentations: Case 1: A 48-year-old woman had bilateral sequential visual loss associated with optic disc edema. Despite treatment, vision did not improve and severe disc pallor ensued. Atypical ON was suspected. Eventually, she was started on immunosuppressant therapy based on a tentative diagnosis of NMO-spectrum disorder. On examination 5 years later, only severe optic disc pallor was observed, but OCT radial B-scans showed ovoid hyporeflective areas in the retrolaminar region of both eyes, compatible with ODD; this led to a diagnosis of NAION and deeply buried ODD. Case 2. A 35-year-old woman with suspicion of ON in the left eye and a history of previous atypical ON in the right eye was referred for neuro-ophthalmic examination which revealed diffuse optic disc pallor and a dense arcuate visual field defect in the right eye. OCT B-scans passing through the disc showed large ovoid areas of reduced reflectivity in the retrolaminar region of the optic disc in the right eye. These findings helped confirm the diagnosis of NAION in one eye, with deeply buried ODD as predisposing factor. Conclusions: Deeply buried ODD may be associated with NAION causing irreversible visual loss and optic disc pallor, a condition easily mistaken for atypical ON. Awareness of such occurrence is important to avoid unnecessary testing and minimize the risk of mismanagement.
- Unilateral papilledema and peripapillary polypoidal choroidal vasculopathy as the presenting manifestations of intracranial hypertension(2021) MATOS, Aline Mota Freitas; CUNHA, Leonardo Provetti; SUZUKI, Ana Claudia F.; MELLO, Luiz Guilherme Marchesi; PRETI, Rony C.; ZACHARIAS, Leandro C.; MONTEIRO, Mario L. R.We have reported here the case of a 54-year-old woman with intracranial hypertension that presented with the unique features of unilateral papilledema and peripapillary polypoidal choroidal vasculopathy. Our investigations lead to the diagnosis of idiopathic intracranial hypertension and an incidental small right frontal meningioma. The patient was accordingly treated with oral acetazolamide, followed by three consecutive monthly intravitreal injections of bevacizumab, which resulted in the inactivation of the polypoidal choroidal vasculopathy, marked reduction of lipid exudation, and complete absorption of the subretinal fluid. This case serves as the first documentation of polypoidal choroidal vasculopathy associated with papilledema. It also demonstrates that choroidal vascular abnormalities may occur even when optic disk edema is unilateral, which is an uncommon manifestation of increased intracranial pressure. Prompt recognition of such findings and its appropriate management are essential for adequate treatment and prevention of irreversible visual loss.
conferenceObject Evaluation of OCTA peripapillary vascular density in eyes with temporal hemianopia from chiasmal compression. Correlation with retinal nerve fiber layer and visual field loss(2018) SUZUKI, Ana Franco; CUNHA, Leonardo Provetti; ZACHARIAS, Leandro C.; PRETI, Rony Carlos; MONTEIRO, Mario L. R.- Congenital Retinal Macrovessel and the Association of Retinal Venous Malformations With Venous Malformations of the Brain(2018) PICHI, Francesco; FREUND, K. Bailey; CIARDELLA, Antonio; MORARA, Mariachiara; ABBOUD, Emad B.; GHAZI, Nicola; DACKIW, Christine; CHOUDHRY, Netan; SOUZA, Eduardo Cunha; CUNHA, Leonardo Provetti; AREVALO, J. Fernando; LIU, T. Y. Alvin; WENICK, Adam; HE, Lingmin; VILLARREAL JR., Guadalupe; NERI, Piergiorgio; SARRAF, DavidIMPORTANCE Congenital retinal macrovessel (CRM) is a rarely reported venous malformation of the retina that is associated with venous anomalies of the brain. OBJECTIVE To study the multimodal imaging findings of a series of eyes with congenital retinal macrovessel and describe the systemic associations. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional multicenter study, medical records were retrospectively reviewed from 7 different retina clinics worldwide over a 10-year period (2007-2017). Patients with CRM, defined as an abnormal, large, macular vessel with a vascular distribution above and below the horizontal raphe, were identified. Data were analyzed from December 2016 to August 2017. MAIN OUTCOMES AND MEASURES Clinical information and multimodal retinal imaging findings were collected and studied. Pertinent systemic information, including brain magnetic resonance imaging findings, was also noted if available. RESULTS Of the 49 included patients, 32 (65%) were female, and the mean (SD) age at onset was 44.0 (20.9) years. A total of 49 eyes from 49 patients were studied. Macrovessel was unilateral in all patients. Color fundus photography illustrated a large aberrant dilated and tortuous retinal vein in all patients. Early-phase frames of fluorescein angiography further confirmed the venous nature of the macrovessel in 40 of 40 eyes. Optical coherence tomography angiography, available in 17 eyes (35%), displayed microvascular capillary abnormalities around the CRM, which were more evident in the deep capillary plexus. Of the 49 patients with CRM, 39 (80%) did not illustrate any evidence of ophthalmic complications. Ten patients (20%) presented with retinal complications, typically an incidental association with CRM. Twelve patients (24%) were noted to have venous malformations of the brain with associated magnetic resonance imaging. Of these, location of the venous anomaly in the brain was ipsilateral to the CRM in 10 patients (83%) and contralateral in 2 patients (17%), mainly located in the frontal lobe in 9 patients (75%). CONCLUSIONS AND RELEVANCE Our study has identified an association between macrovessels in the retina and venous anomalies of the brain (24% compared with 0.2% to 6.0% in the normal population). Thus, we recommend new guidelines for the systemic workup of patients with CRM to include brain magnetic resonance imaging with contrast. These lesions may be more accurately referred to as retinal venous malformations, which may raise awareness regarding potential cerebral associations.
- Multifocal Visual Evoked Potential in Eyes With Temporal Hemianopia From Chiasmal Compression: Correlation With Standard Automated Perimetry and OCT Findings(2017) SOUSA, Rafael M.; OYAMADA, Maria K.; CUNHA, Leonardo P.; MONTEIRO, Mario L. R.PURPOSE. To verify whether multifocal visual evoked potential (mfVEP) can differentiate eyes with temporal hemianopia due to chiasmal compression from healthy controls. To assess the relationship between mfVEP, standard automated perimetry (SAP), and Fourier domain-optical coherence tomography (FD-OCT) macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements. METHODS. Twenty-seven eyes with permanent temporal visual field (VF) defects from chiasmal compression on SAP and 43 eyes of healthy controls were submitted to mfVEP and FD-OCT scanning. Multifocal visual evoked potential was elicited using a stimulus pattern of 60 sectors and the responses were averaged for the four quadrants and two hemifields. Optical coherence tomography macular measurements were averaged in quadrants and halves, while peripapillary RNFL thickness was averaged in four sectors around the disc. Visual field loss was estimated in four quadrants and each half of the 24-2 strategy test points. Multifocal visual evoked potential measurements in the two groups were compared using generalized estimated equations, and the correlations between mfVEP, VF, and OCT findings were quantified. RESULTS. Multifocal visual evoked potential-measured temporal P1 and N2 amplitudes were significantly smaller in patients than in controls. No significant difference in amplitude was observed for nasal parameters. A significant correlation was found between mfVEP amplitudes and temporal VF loss, and between mfVEP amplitudes and the corresponding OCT-measured macular and RNFL thickness parameters. CONCLUSIONS. Multifocal visual evoked potential amplitude parameters were able to differentiate eyes with temporal hemianopia from controls and were significantly correlated with VF and OCT findings, suggesting mfVEP is a useful tool for the detection of visual abnormalities in patients with chiasmal compression.
- Circumpapillary and macular vessel density assessment by optical coherence tomography angiography in eyes with temporal hemianopia from chiasmal compression. Correlation with retinal neural and visual field loss(2020) SUZUKI, Ana Claudia F.; ZACHARIAS, Leandro C.; PRETI, Rony C.; CUNHA, Leonardo P.; MONTEIRO, Mario L. R.Aims To compare the circumpapillary and macular vessel density (cpVD/mVD) of eyes with temporal visual field (VF) defect and band atrophy (BA) of the optic nerve and normal controls using OCTA and to verify the association of VD parameters with circumpapillary retinal nerve fibre layer (cpRNFL) thickness, macular ganglion cell complex (mGCC) thickness and VF loss. Methods Thirty-three eyes of 26 patients with BA and 42 eyes of 22 age-matched normal controls underwent OCT + OCTA scanning. cpVD and cpRNFL were expressed as average and sector measurements. mVD and mGCC were calculated as averages and in quadrants and hemiretinas. VF loss was estimated using the 24-2 and the 10-2 protocols. Generalized estimated equation models were used for comparisons and area under the receiver operating characteristics (AROC) were calculated. Results Compared with controls, BA eyes displayed smaller average cpVD and mVD values (p < 0.001 and AROC = 0.91 for both). Sectorial measurements were also reduced, especially the nasotemporal sector average cpVD (p < 0.001 and AROC = 0.96) and the nasal retina mVD measurements (p < 0.001 and AROC = 0.93). cpVD and mVD correlated strongly with corresponding cpRNFL and mGCC thickness measurements in affected regions (r range: 0.67-0.78 and 0.56-0.76, respectively). Similarly, cpVD and mVD parameters correlated significantly with corresponding VF loss (r range: 0.45-0.68). Conclusions cpVD and mVD are significantly reduced in BA eyes compared with controls and are strongly correlated with retinal neural and VF loss. cpVD and mVD reduction on OCTA could serve as a surrogate for retinal neural loss in compressive optic neuropathy and might be useful in its management.
- Optical coherence tomography angiography in a case of multiple retinal arterial macroaneurysms(2020) LIMA, L. H.; CUNHA, L. P.
conferenceObject The Association of Venous Malformations of Retina and Brain(2018) CORRADETTI, Giulia; PICHI, Francesco; FREUND, K. Bailey; CIARDELLA, Antonio; ABBOUD, Emad; GHAZI, Nicola; DACKIW, Christine; CHOUDHRY, Netan; CUNHA-SOUZA, Eduardo; CUNHA, Leonardo Provetti; AREVALO, J. Fernando; LIU, Tin Yan Alvin; WENICK, Adam; VILLARREAL JR., Guadalupe; HE, Lingmin; SARRAF, David
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