CLEIDE GUIMARAES MACHADO CARANI

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 1 Citação(ões) na Scopus
    Large inferior retinectomies for proliferative vitreoretinopathy in silicone oil-filled eyes
    (2022) BARBOSA, Gabriel Castilho Sandoval; SILVA, Allan Gomes da; REIS, Guilherme Daher Goncalves Monteiro dos; BERMUDES, Frederico Hackbart; LEMOS, Carolina Maria Barbosa; GARCIA, Rafael; MAZZEO, Thiago Jose Muniz Machado; MACHADO, Cleide Guimaraes; GOMES, Andre Marcelo Vieira
    Background: To describe the anatomical and functional outcomes and late complications in patients who developed inferior proliferative vitreoretinopathy (PVR) in silicone oil-filled eyes and who required reoperation with large inferior retinectomy. Methods: This is a single-center, retrospective, interventional case series analysis. The study involved 18 individuals with tractional retinal re-detachment due to PVR development inferiorly in eyes who had undergone prior pars plana vitrectomy and silicone oil as a tamponade. All patients included in the study underwent secondary surgery with large inferior retinectomy (from 120 degrees to 270 degrees) and silicone oil filling. Results: The mean follow-up period was 44.0 +/- 31.5 (+/- SD) months (range: 4 to 96 months. The anatomical success, defined as the complete reattachment of the retina until the last follow-up, was observed in 88.9% of the cases. The postoperative visual acuity ranged from 20/100 to hand motion at 60 cm. Only two cases (11.1%) did not achieve anatomical success at the last follow-up due to recurrent PVR and retinal re-detachment (one including hypotony). All of the patients were pseudophakic. The PVR grade, as well as the presence of PVR prior to primary surgery, showed no statistical correlation with BCVA, the extent of retinectomies, and final macular status. There was a statistically significant correlation between ""Final BCVA"" and ""Initial BCVA"" (r = 0.654) and between ""Final BCVA"" and ""Extent of Retinectomy"" (r = 0.615). Conclusions: Reoperation in eyes filled with silicone oil may be required when PVR is developed. Secondary surgery in these cases with large inferior retinectomy and silicone oil implantation may reach good anatomical success with low rates of late complications, besides improving visual acuity. A better BCVA at the time of re-RD diagnosis and cases of retinectomies with greater extensions showed a positive correlation with better functional outcomes. Trial registration Research Ethics Committee of the Suel Abujamra Institute reviewed and approved this study protocol (approval number, 5.404.961).
  • article 8 Citação(ões) na Scopus
    Parameters associated with outcome in pediatric patients with congenital heart disease and pulmonary hypertension subjected to combined vasodilator and surgical treatments
    (2019) THOMAZ, Ana Maria; KAJITA, Luiz J.; AIELLO, Vera D.; ZORZANELLI, Leina; GALAS, Filomena Regina B. G.; MACHADO, Cleide G.; BARBERO-MARCIAL, Miguel; JATENE, Marcelo B.; RABINOVITCH, Marlene; LOPES, Antonio Augusto
    Management of pediatric pulmonary hypertension associated with congenital heart disease (PHT-CHD) is challenging. Some patients have persistently elevated pulmonary artery pressure (PAP) after cardiac surgery, an undesired condition that is difficult to predict. We investigated the value of clinical, hemodynamic, and histopathological data in predicting the outcome in a prospective cohort. Patients with PHT-CHD received sildenafil orally pre- and postoperatively for six months and then were subjected to a catheter study. Thirty-three patients were enrolled (age range = 4.6-37.0 months). Pulmonary vascular resistance (PVR) was 4.9 (range = 3.9-7.2) Wood units x m(2) (median with IQR). Twenty-two patients had a >= 20% decrease in PVR and pulmonary-to-systemic vascular resistance ratio (PVR/SVR) in response to inhaled nitric oxide (NO). The response was directly related to the degree of medial hypertrophy of pulmonary arterioles (P < 0.05) (morphometric analysis, intraoperative lung biopsy). Subsequently, five of the non-responders had a >= 30% increase in pulmonary blood flow in response to sildenafil (3.0 [2.0-4.0] mg/kg/day). Six months after surgery, PAP and PVR were significantly lower (P < 0.001 vs. baseline), even in seven patients with Heath-Edwards grade III/IV pulmonary vascular lesions (P = 0.018), but still abnormal in 12 individuals (>25 mmHg and >3.0 U x m(2), respectively). A preoperative PVR/SVR of >= 24% during NO inhalation and a wall thickness of arteries accompanying respiratory bronchioli of >= 4.7 (Z score) were identified, respectively, as risk and protection factors for abnormal postoperative hemodynamics (hazard ratio [95% CI] = 1.09 [1.01-1.18], P = 0.036; and 0.69 [0.49-0.98], P = 0.040, respectively). Thus, in PHT-CHD patients receiving oral sildenafil pre- and post-surgical repair of cardiac lesions, mid-term postoperative outcome is predictable to some extent.
  • article 0 Citação(ões) na Scopus
    Pain Perception of Patients Undergoing Laser Panretinal Photocoagulation: Comparison of Single-Spot Versus Multispot Techniques
    (2022) BARBOSA, Gabriel Castilho; SILVA, Allan Gomes; SUSANNA, Bianca Nicolela; MAZZEO, Thiago Muniz; BERMUDES, Frederico Hackbart; MACHADO, Cleide Guimaraes; GOMES, Andre Vieira
    BACKGROUND AND OBJECTIVE: To compare pain intensity with single-spot versus multispot technique in laser panretinal photocoagulation, using a 532-nm, solid-state laser system. MATERIALS AND METHODS: This was a prospective, interventional, randomized, single-masked comparison trial. Patients received two types of intervention: conventional single-spot technique, with an exposure time of 150 ms, and multispot technique, done with an exposure time of 20 ms, Both techniques used power sufficient to produce visible gray-white burns, and spot size of 20 mu m. Participants received both treatments in the same eye, each one in one hemiretina, and were randomized to receive first single-or multispot technique and to the initial site of treatment. We assessed pain intensity using a numerical pain scale immediately after completion of each treatment. RESULTS: A significantly lower pain scale was observed with the multispot when compared with the single-spot technique (coefficient [Coef]: -1.61; 95% CI, -2.49 to -0.74; P .001), which was not affected by treatment order, the hemiretina treated, or treatment duration (P .001), and it was not affected by order of treatment (P = .098), hemiretina (P = .327), pain (P = .141), or demographic data, such as age, sex, and race (P .05). CONCLUSION: The use of the multispot technique, with a short pulse duration (20 ms), is significantly less painful and less time-consuming for patients with proliferative retinopathy compared with the conventional single-spot technique using an exposure time of 150 ms.
  • article 4 Citação(ões) na Scopus
    Leukotriene Pathway Activation Associates with Poor Glycemic Control and with Cardiovascular Autonomic Neuropathy in Type 1 Diabetes
    (2020) SANTOS-BEZERRA, Daniele P.; FILGUEIRAS, Luciano R.; MONTEIRO, Maria Beatriz; ADMONI, Sharon N.; V, Ricardo Perez; CAVALEIRO, Ana M.; MACHADO, Cleide G.; MACHADO, Ubiratan F.; PASSARELLI, Marisa; JANCAR, Sonia; CORREA-GIANNELLA, Maria Lucia
    Background and Aims. Since hyperglycemia promotes inflammation by different pathways and inflammation participates in the development of chronic diabetes complications, we investigated the association between the leukotriene (LT) pathway and microvascular diabetes complications. Methods and Results. Quantitative polymerase chain reaction was employed to quantify the expression of ALOX5 (encodes 5-lipoxygenase), LTB4R (encodes one of the LTB4 receptors), and MYD88 in peripheral blood mononuclear cells from 164 type 1 diabetes (T1D) individuals presenting or not diabetes kidney disease, retinopathy, peripheral neuropathy, and cardiovascular autonomic neuropathy (CAN); 26 nondiabetic subjects were included as controls. LTB4 plasmatic concentrations were also evaluated. The expression of LTB4R was significantly higher in T1D individuals than in controls. T1D individuals with microvascular complications presented lower MYD88 mRNA expression when compared to those without microvascular complications. Higher LTB4 concentrations were found in individuals with CAN versus without CAN. The observation of two distinct subgroups of T1D individuals in the correlation analyses motivated us to evaluate the characteristics of each one of these groups separately. The group presenting higher expression of ALOX5 and of LTB4R also presented higher values of HbA(1)C, of fructosamine, and of plasmatic LTB4. Conclusion. In the diabetes setting, the LT pathway is not only activated by hyperglycemia but is also modulated by the status of the autonomic nervous system.
  • conferenceObject
    Increased serum expression of miR-518d-3p and miR-618 in individuals with type 1 diabetes with microvascular chronic complications
    (2018) SANTOS-BEZERRA, D. P.; SANTOS, A. S.; GUIMARAES, G. C.; ADMONI, S. N.; PEREZ, R. V.; PELAES, T. S.; MACHADO, C. G.; PASSARELLI, M.; MACHADO, U. F.; QUEIROZ, M. S.; SILVA, M. E. R.; CORREA-GIANNELLA, M. L. C.
  • article 2 Citação(ões) na Scopus
    Evaluation of contrast sensitivity in non-high-risk proliferative diabetic retinopathy treated with panretinal photocoagulation with and without intravitreal injections of ranibizumab
    (2022) RENTIYA, Zubir S.; FERRAZ, Daniel A.; HUTNIK, Robert; BAE, Junun; MACHADO, Cleide G.; MUCCIOLLI, Cristina; MOTTA, Augusto Alves L. da; RIBEIRO, Lucas Z.; GUAN, Zeyu; PRETI, Rony Carlos; TAKAHASHI, Walter Y.
    Purpose: To evaluate contrast sensitivity in non-high-risk, treatment-naive proliferative diabetic retinopathy patients treated with panretinal photocoagulation and intravitreal injections of ranibizumab) versus panretinal photocoagulation alone. Methods: Sixty eyes of 30 patients with bilateral proliferative diabetic retinopathy were randomized into two groups: one received panretinal photocoagulation and ranibizumab injections (study group), while the other received panretinal photocoagulation alone (control group). All eyes were treated with panretinal photocoagulation in three sessions according to the Early Treatment Diabetic Retinopathy Study guidelines. Contrast sensitivity measurements were performed under photopic conditions (85 cd/m(2)) with the Visual Contrast Test Sensitivity 6500 chart, allowing for the evaluation of five spatial frequencies with sine wave grating charts: 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd). Outcomes were measured in contrast sensitivity threshold scores among and within groups, from baseline to 1, 3, and 6 months. Results: Fifty-eight eyes (28 in the study group and 30 in the control group) reached the study endpoint. A comparative analysis of changes in contrast sensitivity between the groups showed significant differences mainly in low frequencies as follows: at month 1 in 1.5 cpd (p=0.001) and 3.0 cpd (p=0.04); at month 3 in 1.5 cpd (p=0.016), and at month 6 in 1.5 cpd (p=0.001) and 3.0 cpd (p=0.026) in favor of the study group. Conclusions: In eyes of patients with non-high-risk proliferative diabetic retinopathy, panretinal photocoagulation treatment with ranibizumab appears to cause less damage to contrast sensitivity compared with panretinal photocoagulation treatment alone. Thus, our evaluation of contrast sensitivity may support the use of ranabizumab as an adjuvant to panretinal photocoagulation for the treatment of proliferative diabetic retinopathy.
  • article 7 Citação(ões) na Scopus
    Allelic variations in genes belonging to glutathione system increase proliferative retinopathy risk in type 1 diabetes individuals
    (2019) PEREZ, Ricardo Vessoni; MACHADO, Cleide Guimaraes; SANTOS-BEZERRA, Daniele Pereira; ADMONI, Sharon Nina; PATENTE, Thiago Andrade; MONTEIRO, Maria Beatriz; CAVALEIRO, Ana Mercedes; QUEIROZ, Marcia Silva; NERY, Marcia; CORREA-GIANNELLA, Maria Lucia
    Aims: Given the participation of oxidative stress in the pathogenesis of diabetic complications, we evaluated, in type 1 diabetes (T1D) individuals, the association between diabetic retinopathy (DR) and functional single nucleotide polymorphisms (SNPs) in regulatory regions of two genes belonging to the antioxidant glutathione (GSH) system: rs17883901 in GCLC and rs713041 in GPX4. Methods: A cross-sectional case-control study included 288 individuals (61% women, 34[+/- 11] years old, diabetes duration of 22[+/- 9] years, mean [+/- SD]) sorted according to DR stages: absence of DR (ADR), non proliferative DR (NPDR) and proliferative DR (PDR). SNPs were genotyped by real-time PCR using fluorescent labelled probes. Logistic regression models with adjustment for confounding covariates were employed. Results: The presence of at least one T-allele of rs17883901 in GCLC was an independent risk factor for PDR (OR 4.13, 95% CI 1.38-13.66, p = 0.014) in a polytomous regression model (PDR versus ADR). The presence of at least one T-allele of rs713041 in GPX4 conferred protection against PDR (OR 0.30, 95% CI 0.11-0.80, p = 0.017) in female T1D individuals. Conclusion: The functional SNPs rs17883901 and rs713041 modulate the risk for PDR in the studied population of T1D individuals, widening the spectrum of candidate genes for this complication.
  • article 11 Citação(ões) na Scopus
    Effect of a Single Intravitreal Bevacizumab Injection on Contrast Sensitivity and Macular Thickness in Eyes with Macular Edema from Central Retinal Vein Occlusion: A Prospective, Nonrandomized, Three-Month Follow-Up Study
    (2014) PRETI, Rony C.; RAMIREZ, Lisa M. V.; PIMENTEL, Sergio L. G.; NAKASHIMA, Yoshitaka; MACHADO, Cleide G.; PELAYES, David E.; MONTEIRO, Mario L. R.; TAKAHASHI, Walter Y.
    Purpose: To evaluate the results of intravitreal bevacizumab (IVB) injection on contrast sensitivity (CS), best-corrected visual acuity (BCVA), foveal thickness (FT) and macular volume (MV) as measured by optical coherence tomography in patients with macular edema (ME) from central retinal vein occlusion (CRVO). Methods: Sixteen consecutive eyes from 16 patients with ME from unilateral CRVO were treated with a single IVB injection. The CS, BCVA, FT and MV measurements were obtained before the treatment and 1 and 3 months after the injection. Results: CS demonstrated significant improvement at all spatial frequencies - 1.5, 3, 6, 12 and 18 cycles per degree (cpd) - 1 month after the injection and at 6 cpd at the 3-month follow-up. The mean BCVA measurements in log of the minimum angle of resolution (logMAR) units improved from 1.03 at baseline to 0.83 logMAR 1 month after the injection, but worsened to 0.97 logMAR at 3 months. The mean baseline FT +/- standard deviation (SD; 620.06 +/- 177.60 mu m) was reduced significantly 1 month (270.93 +/- 74.17 mu m) and 3 months (535.56 +/- 222.33 mu m) after the treatment. The mean baseline MV +/- SD (12,765.56 +/- 3,769.70 mm 3) was reduced significantly at the 1-month (8,324.93 +/- 932.04 mm(3)) and 3-month (11,319.44 +/- 3,044.74 mm(3)) follow-up visits. Conclusions: IVB improved CS, BCVA, FT and MV within a short time period (1 month). Although VA was not improved at 3 months, improvements were observed for CS, FT and MV, which indicates that, despite ME recurrence, there still was some benefit to visual function. (C) 2014 S. Karger AG, Basel
  • conferenceObject
    Bacillary layer detachment in Vogt-Koyanagi-Harada disease: a biomarker with prognostic value
    (2022) MISSAKA, Ruy Felippe; GOLDBAUM, Mauro; MACHADO, Cleide Guimaraes; SOUTO, Fernanda Maria Silveira; NOBREGA, Priscilla Figueiredo; LAVEZZO, Marcelo Mendes; SAKATA, Viviane Mayumi; OYAMADA, Maria Kiyoko; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce H.
  • conferenceObject
    Intraretinal cystoid spaces in acute Vogt-Koyanagi-Harada disease
    (2021) MISSAKA, Ruy Felippe Brito Goncalves; GOLDBAUM, Mauro; MACHADO, Cleide Guimaraes; SOUTO, Fernanda Maria Silveira; LAVEZZO, Marcelo Mendes; SAKATA, Viviane Mayumi; NOBREGA, Priscilla Figueiredo Campos; OYAMADA, Maria Kiyoko; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce H.