ANDRE AUGUSTO MIRANDA TORRICELLI
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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article 39 Citação(ões) na Scopus Screening of Refractive Surgery Candidates for LASIK and PRK(2014) TORRICELLI, Andre A. M.; BECHARA, Samir J.; WILSON, Steven E.Purpose: The aim of this study was to evaluate exclusion criteria in screening patients for refractive surgery. Methods: Patients screened for initial refractive surgery by a single surgeon at the Cole Eye Institute (Cleveland Clinic) between 2007 and 2012 were reviewed. Exclusion criteria for patients who were not offered refractive surgery based on history and/or examination parameters were analyzed. Results: A total of 1067 refractive candidates were enrolled in the study. Five hundred nineteen (48.6%) were male and 548 (51.4%) were female with a mean age of 39 +/- 12 (range, 17-78) years. Refractive surgery was performed in 657 (61.6%) patients, and photorefractive keratectomy was considered the best option for 106 (9.9%) patients. Four hundred ten (38.4%) of all screened patients did not have refractive surgery, and 134 of these patients (12.6%) were considered to have contraindications for laser in situ keratomileusis and photorefractive keratectomy. Among the excluded patients, 69 (51.5%) were male and 65 (48.5%) were female with a mean age of 40 +/- 14 (range, 18-78) years. Abnormal corneal topography (34.3%) and low or insufficient corneal thickness (23.1%) were the most common reasons for exclusion. High myopia (10.5%) and (insipient or definite) cataract (9.7%) were also common reasons for exclusion. Other common factors for exclusion were high hyperopia (3.7%), need to wear reading glasses after surgery (3.7%), and severe dry eye unresponsive to treatment (3.7%). Conclusions: Abnormal corneal topography and low, or insufficient, corneal thickness remain the most common exclusion factors for corneal refractive surgery. Factors such as cataract, too high of correction, and severe dry eye are also common reasons for exclusion of patients.- Intraocular straylight before and after low myopic photorefractive keratectomy with and without mitomycin C(2016) TORRICELLI, Andre Augusto Miranda; PAREDE, Tais Renata Ribeiro; NETTO, Marcelo Vieira; CRESTANA, Francisco Penteado; BECHARA, Samir JacobPurpose: To evaluate ocular straylight before and after photorefractive keratectomy (PRK) for low myopia with and without topical mitomycin (MMC) treatment. Methods: Patients who underwent PRK for low myopia were enrolled into the study. PRK without MMC was performed in 21 eyes (12 patients), whereas PRK with topical 0.02% MMC was performed in 25 eyes (14 patients). Both groups were treated using the NIDEK EC5000 excimer laser. Measurements were performed using the C-Quant straylight meter preoperatively and at two and four months postoperatively. Results: The mean patient age was 30 +/- 4 years, and the mean spherical equivalent refractive error was -2.2 +/- 0.75 D. The mean preoperative intraocular straylight values were 1.07 +/- 0.10 in the PRK without MMC group and 1.07 +/- 0.11 log(s) in the PRK with topical MMC group. At two months after surgery, there was a decrease in mean intraocular straylight values in both groups. However, a significant difference was only reached in the PRK with MMC group [0.98 +/- 0.09 log(s), p=0.002] compared with preoperative values, which was likely due to a greater scatter of measurements in the PRK without MMC group [1.03 +/- 0.13 log(s), p=0.082]. At four months postoperatively, ocular straylight values were not significantly different compared with those at baseline in either the PRK without MMC group [1.02 +/- 0.14 log(s), p=0.26] or in the PRK with topical MMC group [1.02 +/- 0.11 log(s), p=0.13]. Conclusion: PRK for low myopia decreases ocular straylight, and MMC application further reduces straylight in the early postoperative period. However, ocular straylight values do not significantly differ at four months after surgery compared with those at baseline.
article 9 Citação(ões) na Scopus Predictors of Early Postoperative Pain After Photorefractive Keratectomy(2016) GARCIA, Renato; TORRICELLI, Andre Augusto Miranda; MUKAI, Adriana; PEREIRA, Vinicius Borges Porfirio; BECHARA, Samir JacobPurpose: To compare the profiles of postoperative photorefractive keratectomy (PRK) pain between both eyes under the same conditions and to verify the preoperative predictors of pain such as gender, anxiety, knowledge of the procedure, and spherical equivalent refractive error (SERE). Methods: This prospective study included 86 eyes of 43 patients with myopia who underwent PRK in both eyes at an interval of 14 days between the procedures. Before surgery, subjects answered the State Anxiety Inventory. After surgery, usual PRK pain treatment was given. Subjects answered the Visual Analog Scale, the Brief Pain Inventory (BPI), and the McGill Pain Questionnaire at 1, 24, 48, 72, and 96 hours after surgery. Pain scores and anxiety were compared between each eye using the Wald test and paired Student t test, respectively. The Wald test was performed for gender and SERE for each eye separately. Results: There were no statistically significant differences between both eyes for all time points regarding the Visual Analog Scale, BPI, and McGill Pain Questionnaire Pain Rating Index pain scores. Subjects were less anxious on average before the second surgery compared with before the first surgery (P < 0.001); however, it was not related to pain ratings after surgery. Gender did not significantly affect any scale of pain, and the SERE between 3 diopters (D) and 5 D (P = 0.035) revealed effects on the BPI. Conclusions: The profiles of postoperative pain after PRK were similar between both eyes under the same conditions. In this study, a high SERE was the only predictor for increased pain after PRK.bookPart Caso clínico 3(2022) KITA, Carolina Satie; TORRICELLI, André A. M.- Ablação personalizada guiada por frente de onda após complicação na dissecção lamelar de FemtoLasik(2023) SAITO, Marina Siqueira; SOARES, Paula Virginia Brom dos Santos; BARBOZA, Guilherme Novoa Colombo; BARBOZA, Marcello Novoa Colombo; TORRICELLI, André Augusto Miranda; MOSCOVICI, Bernardo KaplanABSTRACT Femtolasik is one of the most used techniques in refractive surgery due to good refractive results, predictability, reproducibility, and safety, achieving excellent results and a high degree of satisfaction. Although the complication rates are small, it is worth noting that there may be intercurrences. The objective of this work is to report a case of complication in the dissection of the lamella of laser in situ keratomileusis (Lasik) with Femtosecond laser, and subsequent lamella tear. Excimer Laser was applied with mitomycin 0.02% and re-approached with wavefront guided surgery, evolving with good final visual quality.
- Correlation Between Signs and Symptoms of Ocular Surface Dysfunction and Tear Osmolarity With Ambient Levels of Air Pollution in a Large Metropolitan Area(2013) TORRICELLI, Andre A. M.; NOVAES, Priscila; MATSUDA, Monique; BRAGA, Alfesio; SALDIVA, Paulo H. N.; ALVES, Milton R.; MONTEIRO, Mario L. R.Purpose: To evaluate the effect of high levels of environmental air pollution on tear osmolarity and its possible correlation with clinical signs and symptoms. Methods: This was a panel study involving 71 taxi drivers and traffic controllers from Sao Paulo, Brazil. Mean individual levels of 24-hour exposure to nitrogen dioxide (NO2) and particulate matter smaller than 2.5 mu m (PM2.5) were assessed on 4 different occasions. On the first and third visits, subjects were submitted to clinical evaluations including the administration of the Ocular Surface Disease Index questionnaire, slit-lamp examination, estimation of tear breakup time (BUT), the Schirmer test, and vital staining of the cornea and conjunctiva. On the second and fourth visits, tear samples were collected for osmolarity assays. Statistical analysis was performed using generalized estimating equations. Results: Although the taxi drivers and traffic controllers in our sample were exposed to high levels of NO2 and PM2.5, few symptoms were reported on the Ocular Surface Disease Index questionnaire. BUT values were reduced, whereas vital staining and Schirmer test mean results were within normal limits, despite considerable variability. A significant and negative correlation was found between PM2.5 levels and tear film osmolarity levels (P < 0.05). An increase of 10 mu g/m(3) in PM2.5 was associated with a 10.9 mOsm/kg decrease in tear osmolarity. There also was a negative correlation, although not statistically significant, between NO2 and tear osmolarity. Conclusions: Exposure to air pollution reduces tear film stability and influences tear film osmolarity. Combining clinical examination with the assessment of tear osmolarity may help understand ocular surface response to high levels of air pollution.
- Femtosecond Laser-Assisted LASIK Flap Complications(2016) SANTOS, Allisson Mario dos; TORRICELLI, Andre A. M.; MARINO, Gustavo K.; GARCIA, Renato; NETTO, Marcelo V.; BECHARA, Samir J.; WILSON, Steven E.PURPOSE: To discuss intraoperative and postoperative femtosecond laser-assisted LASIK flap complications and their management. METHODS: Review of published literature. RESULTS: Flap creation is a critical step in LASIK. The femtosecond laser has improved the overall predictability and safety of the lamellar incision, but complications can still occur during or after flap creation. Although many complications (eg, epithelial ingrowth and flap striae) were reduced with the femtosecond laser application, other specific complications have emerged, such as vertical gas breakthrough, opaque bubble layer, and transient light-sensitivity syndrome. CONCLUSIONS: The application of femtosecond laser technology to LASIK flap creation has increased greatly since its introduction. These lasers have improved the safety and predictability of the lamellar incision step. The majority of the femtosecond laser-assisted flap complications can be well managed without significant effects on refractive outcomes.
- Injury and and defective regeneration of the epithelial basement membrane in corneal fibrosis: A paradigm for fibrosis in other organs?(2017) WILSON, Steven E.; MARINO, Gustavo K.; TORRICELLI, Andre A. M.; MEDEIROS, Carla S.Myofibroblast-mediated fibrosis is important in the pathophysiology of diseases in most organs. The cornea, the transparent anterior wall of the eye that functions to focus light on the retina, is commonly affected by fibrosis and provides an optimal model due to its simplicity and accessibility. Severe injuries to the cornea, including infection, surgery, and trauma, may trigger the development of myofibroblasts and fibrosis in the normally transparent connective tissue stroma. Ultrastructural studies have demonstrated that defective epithelial basement membrane (EBM) regeneration after injury underlies the development of myofibroblasts from both bone marrow- and keratocyte-derived precursor cells in the cornea. Defective EBM permits epithelium-derived transforming growth factor beta, platelet-derived growth factor, and likely other modulators, to penetrate the stroma at sustained levels necessary to drive the development of vimentin + alpha-smooth muscle actin+ desmin+ (V+A+D+) mature myofibroblasts and promote their persistence. Defective versus normal EBM regeneration likely relates to the severity of the stromal injury and a resulting decrease in fibroblasts (keratocytes) and their contribution of EBM components, including laminin alpha-3 and nidogen-2. Corneal fibrosis may resolve over a period of months to years if the inciting injury is eliminated through keratocyte-facilitated regeneration of normal EBM, ensuing apoptosis of myofibroblasts, and reorganization of disordered extracellular matrix by repopulating keratocytes. We hypothesize the corneal model of fibrosis associated with defective BM regeneration and myofibroblast development after epithelial or parenchymal injury may be a paradigm for the development of fibrosis in other organs where chronic injury or defective BM underlies the pathophysiology of disease.
- Dry eye(2018) TORRICELLI, A. A.; RAMOS-ESTEBAN, J. C.; WILSON, S. E.Dry eye is the most common early and late postoperative complication after LASIK surgery. LASIK-induced dry eye is caused by a combination of decreased corneal innervation and chronic ocular inflammation. LASIK-induced dry eye is manifested clinically by the presence of fluctuation of visual acuity and punctate epithelial erosions but minimally decreased average tear production. LINE is the preferred term to describe this condition when it occurs after LASIK or LASIK enhancements in an eye with no symptoms or signs of dry eye prior to surgery. Some eyes likely have both LINE and underlying inflammatory dry eye disease. Optimization of the ocular surface is an important step to improving patient satisfaction after LASIK surgery. © Springer International Publishing AG 2018. All rights reserved.
- Regeneration of Defective Epithelial Basement Membrane and Restoration of Corneal Transparency After Photorefractive Keratectomy(2017) MARINO, Gustavo K.; SANTHIAGO, Marcony R.; SANTHANAM, Abirami; TORRICELLI, Andre A. M.; WILSON, Steven E.PURPOSE: To study regeneration of the normal ultrastructure of the epithelial basement membrane (EBM) in rabbit corneas that had -9.00 D photorefractive keratectomy (PRK) and developed late haze (fibrosis) with restoration of transparency over 1 to 4 months after surgery and in corneas that had incisional wounds. METHODS: Twenty-four rabbits had one of their eyes included in one of the two procedure groups (-9.00 D PRK or nearly full-thickness incisional wounds), whereas the opposite eyes served as the unwounded control group. All corneas were evaluated with slit-lamp photographs, transmission electron microscopy, and immunohistochemistry for the myofibroblast marker alpha-smooth muscle actin and collagen type III. RESULTS: In the -9.00 D PRK group, corneas at 1 month after surgery had dense corneal haze and no evidence of regenerated EBM ultrastructure. However, by 2 months after surgery small areas of stromal clearing began to appear within the confluent opacity (lacunae), and these corresponded to small islands of normally regenerated EBM detected within a larger area of the excimer laser-ablated zone with no evidence of normal EBM. By 4 months after surgery, the EBM was fully regenerated and the corneal transparency was completely restored in the ablated zone. In the incisional wound group, the two dense, linear corneal opacities were observed at 1 month after surgery and progressively faded by 2 and 3 months after surgery. The EBM ultrastructure was fully regenerated at the site of the incisions, including around epithelial plugs that extended into the stroma, by 1 month after surgery in all eyes. CONCLUSIONS: In the rabbit model, spontaneous resolution of corneal fibrosis (haze) after high correction PRK is triggered by regeneration of EBM with normal ultrastructure in the excimer laser-ablated zone. Conversely, incisional wounds heal in rabbit corneas without the development of myofibroblasts because the EBM regenerates normally by 1 month after surgery.