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
6 resultados
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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.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.- 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.
- Codeine Plus Acetaminophen for Pain After Photorefractive Keratectomy: A Randomized, Double-Blind, Placebo-Controlled Add-On Trial(2017) PEREIRA, Vinicius B. P.; GARCIA, Renato; TORRICELLI, Andre A. M.; MUKAI, Adriana; BECHARA, Samir J.Background: Pain after photorefractive keratectomy (PRK) is significant, and the analgesic efficacy and safety of oral opioids in combination with acetaminophen has not been fully investigated in PRK trials. Purpose: To assess the efficacy and safety of the combination of codeine plus acetaminophen (paracetamol) versus placebo as an addon therapy for pain control after PRK. Study design: Randomized, double-blind, placebo-controlled trial. Setting: Single tertiary center. Methods: One eye was randomly allocated to the intervention, whereas the fellow eye was treated with a placebo. Eyes were operated 2 weeks apart. The participants were adults older than 20 years with refractive stability for >= 1 year, who underwent PRK for correction of myopia or myopic astigmatism. Codeine (30 mg) plus acetaminophen (500 mg) was given orally 4 times per day for 4 days after PRK. The follow-up duration was 4 months. The study outcomes included pain scores at 1 to 72 hours, as measured by the visual analog scale, McGill Pain Questionnaire, and Brief Pain Inventory, as well as adverse events and corneal wound healing. Results: Of the initial 82 eyes, 80 completed the trial (40 intervention, 40 placebo). Median (interquartile range) pain scores as measured by the visual analog scale were statistically and clinically lower during treatment with codeine/acetaminophen compared with the placebo: 1 hour: 4 (2-4) versus 6 (3-6), P, 0.001; 24 hours: 4 (3-6) versus 7 (6-9), P < 0.001; 48 hours: 1 (02) versus 3 (2-5), P < 0.001; and 72 hours: 0 (0-0) versus 0 (0-2), P = 0.001. Virtually identical results were obtained by the McGill Pain Questionnaire and Brief Pain Inventory scales. The most common adverse events with codeine/acetaminophen were drowsiness (42%), nausea (18%), and constipation (5%). No case of delayed epithelial healing was observed in both treatment arms. Conclusions: When added to the usual care therapy, the oral combination of codeine/acetaminophen was safe and significantly superior to the placebo for pain control after PRK.
- Improved Evaluation of Postoperative Pain After Photorefractive Keratectomy(2016) GARCIA, Renato; HOROVITZ, Roberto Novaes Campello; TORRICELLI, Andre Augusto Miranda; MUKAI, Adriana; BECHARA, Samir JacobPurpose:Postoperative pain remains an important limiting factor to the selection of photorefractive keratectomy (PRK). There is a consensus in neurology pain research that pain should be evaluated as a multidimensional concept, which differs from current practice in ophthalmology. The purpose of this paper was to validate the use of multidimensional questionnaires, such as the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire (MPQ), to provide an improved analysis of pain after PRK and to better describe its temporal profile.Methods:This prospective study included 43 eyes of 43 myopic patients who underwent unilateral PRK. After surgery, usual pain treatment was administered. All of the participants responded to the Visual Analogue Scale (VAS), the BPI and the MPQ 1, 24, 48, 72, and 96 hours after surgery. The internal consistency was evaluated, different postoperative periods were compared, and convergent validity was assessed using correlation testing.Results:The Cronbach alpha test showed high internal consistency for each of the questionnaire subscales. Patients reported higher postoperative pain values at the first measurement of the VAS (4.93 2.38), MPQ-pain rating index (26.95 +/- 10.58), BPI-pain severity index (14.53 +/- 7.36), and BPI-pain interference index (22.30 +/- 15.13). Almost all of the scales and subscales showed a statistically significant direct correlation with the VAS at all of the evaluation periods.Conclusions:This study validated the utility of multidimensional questionnaires to expand the assessment of the PRK postoperative pain profile, including intensity and other qualitative aspects.
- Preoperative Predictors for Acute Pain After Photorefractive Keratectomy(2022) TOYOTA, Adriana M.; GARCIA, Renato; TORRICELLI, Andre A. M.; SILVA, Valquiria A.; GALHARDONI, Ricardo; TEIXEIRA, Manoel J.; ANDRADE, Daniel C. de; BECHARA, Samir J.Purpose: The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain. Methods: This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors. Results: This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores (P > 0.05). Conclusions: Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.