RODRIGO FRANCA DE ESPINDOLA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
19 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 19
- Ocular risk management in patients undergoing general anesthesia: an analysis of 39,431 surgeries(2015) KARA-JUNIOR, Newton; ESPINDOLA, Rodrigo Franca de; VALVERDE FILHO, Joao; ROSA, Christiane Pellegrino; OTTOBONI, Andre; SILVA, Enis DonizeteOBJECTIVE: This study sought to describe and analyze ocular findings associated with nonocular surgery in patients who underwent general anesthesia. METHODS: The authors retrospectively collected a series of 39,431 surgeries using standardized data forms. RESULTS: Ocular findings were reported in 9 cases (2.3: 10,000), which involved patients with a mean age of 58.9 +/- 19.5 years. These cases involved patients classified as ASA I (33%), ASA II (55%) or ASA III (11%). General anesthesia with propofol and remifentanil was used in 4 cases, balanced general anesthesia was used in 4 cases, and regional block was used in combination with balanced general anesthesia in one case. Five patients (55%) underwent surgery in the supine position, one patient (11%) underwent surgery in the lithotomy position, two patients (22%) underwent surgery in the prone position, and one patient (11%) underwent surgery in the lateral position. Ocular hyperemia was detected in most (77%) of the 9 cases with ocular findings; pain/burning of the eyes, visual impairment, eye discharge and photophobia were observed in 55%, 11%, 11% and 11%, respectively, of these 9 cases. No cases involved permanent ocular injury or vision loss. CONCLUSION: Ophthalmological findings after surgeries were uncommon, and most of the included patients were relatively healthy. Minor complications, such as dehydration or superficial ocular trauma, should be prevented by following systematic protocols that provide appropriate ocular occlusion with a lubricating ointment and protect the eye with an acrylic occluder. These procedures will refine the quality of anesthesia services and avoid discomfort among patients, surgeons and anesthesia staff.
- Censo Brasileiro de Cirurgia Refrativa(2013) VIEIRA NETTO, Marcelo; ESPÍNDOLA, Rodrigo França de; NOGUEIRA, Rafael Garcia Fernandes; CAMPOS, Mauro; AMBRÓSIO JR., Renato; ANDRADE, Newton Leitão dePURPOSE: To determine preferences and practices of refractive surgeons in Brazil. METHODS: A cross-sectional study was conducted based on the data collected from a questionnaire applied during the VI Brazilian Congress of Cataract and Refractive Surgery and by e-mail sent to all members of that society. Refractive surgery techniques, use of emerging technologies, surgical volume, type of excimer laser and microkeratomes, mitomycin C, postoperative medications were analyzed among others questions. RESULTS: Two hundred ninety-two surgeons replied to the questions. The majority has a surgical volume between 2 and 4 eyes per week (57.60%). Most of the surgeons (64.50%) perform corneal tomography routinely and 22.00% of them do never customize their surgeries. The laser in situ keratomileusis (LASIK) is the main technique performed and when the photorefractive keratectomy (PRK) is applied; most of the surgeons uses mitomycin C (52.60%) in these patients. The excimer laser of choice was the Nidek (26.12%). CONCLUSION: LASIK is the preferred surgical procedure and the majority customizes their refractive surgeries. When photorefractive keratectomy is performed, mitomycin C is used by most of the surgeons (52.60%). Bilateral surgery is routinely performed and the femtosecond laser is still used by few refractive surgeons.
article 14 Citação(ões) na Scopus Expectation and knowledge among patients with keratoplasty indication(2011) KARA-JUNIOR, Newton; MOURAD, Paula de Camargo Abou; ESPINDOLA, Rodrigo Franca de; ABILRUSS, Heloisa HelenaPurpose: To know characteristics and difficulties to access patients' treatment selected to keratoplasty in community projects carried out in a university hospital in Sao Paulo. Methods: A questionnaire was applied on patients in two keratoplasty campaigns performed by the hospital. Was analyzed the following variables: gender, age, income, education, number of previous ophthalmologists 'appointment, visual acuity in the better eye, diagnosis, indication for keratoplasty, knowledge about it, the eye disease and the existence of limitations on lifestyle and possible complications after surgery, expectation of rehabilitation, among others. Results: Most of the 99 patients interviewed (57.8%) had left the job because of visual difficulty and dependent on outside help for everyday activities. From the 90 patients who already had early indication of a keratoplasty (91.0%), half of them had not even managed to join the list of eye banks. From the patients with previous indication for keratoplasty, 18.9% didn't know what was their eye problem, 27.8% didn't know what was keratoplasty, 18.7% were not aware of possible complications during and after the surgery and 32, 2% ignored the existence of limitations in lifestyle after surgery. Conclusion: The patients' unknowledge about their condition and treatment is clear. It is extremely important to emphasize that to obtain a satisfactory surgical result, there is a need of an appropriate patient selection and guidance about their eye problem, the proposed surgery, care and risk per and post operative as well as the visual rehabilitation perspective.- Cataract surgery: emotional reactions of patients with monocular versus binocular vision(2012) MARBACK, Roberta Ferrari; ESPINDOLA, Rodrigo Franca de; SANTHIAGO, Marcony Rodrigues de; TEMPORINI, Edmea Rita; KARA-JUNIOR, NewtonPurpose: To analyze emotional reactions related to cataract surgery in two groups of patients (monocular vision - Group 1; binocular vision - Group 2). Methods: A transversal comparative study was performed using a structured questionnaire from a previous exploratory study before cataract surgery. Results: 206 patients were enrolled in the study, 96 individuals in Group 1 (69.3 +/- 10.4 years) and 110 in Group 2 (68.2 +/- 10.2 years). Most patients in group 1 (40.6%) and 22.7% of group 2, reported fear of surgery (p<0.001). The most important causes of fear were: possibility of blindness, ocular complications and death during surgery. The most prevalent feelings among the groups were doubts about good results and nervousness. Conclusion: Patients with monocular vision reported more fear and doubts related to surgical outcomes. Thus, it is necessary that phisycians considers such emotional reactions and invest more time than usual explaining the risks and the benefits of cataract surgery.
- Effect of aspherical and yellow tinted intraocular lens on blue-on-yellow perimetry(2012) ESPINDOLA, Rodrigo Franca de; SANTHIAGO, Marcony Rodrigues de; KARA-JUNIOR, NewtonPurpose: To investigate the possible effect of aspherical or yellow tinted intraocular lens (IOL) on contrast sensitivity and blue-on-yellow perimetry. Methods: This prospective randomized bilateral double-masked clinical study included 52 patients with visually significant bilateral cataracts divided in two groups; 25 patients (50 eyes) received aspherical intraocular lens in one eye and spherical intraocular lens in the fellow eye; and 27 patients (54 eyes) received ultraviolet and blue light filter (yellow tinted) IOL implantation in one eye and acrylic ultraviolet filter IOL in the fellow eye. The primary outcome measures were contrast sensitivity and blue-on-yellow perimetry values (mean deviation [MD] and pattern standard deviation [PSD]) investigated two years after surgery. The results were compared intra-individually. Results: There was a statistically significant between-group (aspherical and spherical intraocular lens) difference in contrast sensitivity under photopic conditions at 12 cycles per degree and under mesopic conditions at all spatial frequencies. There were no between-group significant differences (yellow tinted and clear intraocular lens) under photopic or mesopic conditions. There was no statistically significant difference between all intraocular lens in MD or PSD. Conclusion: Contrast sensitivity was better under mesopic conditions with aspherical intraocular lens. Blue-on-yellow perimetry did not appear to be affected by aspherical or yellow tinted intraocular lens. Further studies with a larger sample should be carried out to confirm or not that hypotheses.
- A clinical comparison between DisCoVisc and 2% hydroxypropylmethylcellulose in phacoemulsification: a fellow eye study(2012) ESPINDOLA, Rodrigo F.; CASTRO, Emerson F. S.; SANTHIAGO, Marcony R.; KARA-JUNIOR, NewtonOBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov:NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.
article 9 Citação(ões) na Scopus Dificuldades de acesso ao tratamento de pacientes com indicação de cirurgia de catarata nos Sistemas de Saúde Público e Privado(2011) KARA-JUNIOR, Newton; DELLAPI JR., Roberto; ESPINDOLA, Rodrigo Franca dePurpose: To identify the difficulties in access to diagnosis and treatment of cataract in patients attended during a cataract campaign. Methods: A questionnaire was administered to patients selected for cataract surgery. We evaluated, among others, the following variables: prior access to ophthalmologists (public or private), reason(s) for not having surgery early in the initial service, the average cost charged by cataract surgery and intraocular lens (IOL) (private services and agreements). Results: A total of 627 patients was evaluated. Most of them - 595 (95%) had previously attended an ophthalmologist, and in 63% of cases (375 patients) the consultation had been held for less than a year. The last evaluation was performed by the Brazilian Public Health System (SUS) in 52% of the cases (307 patients). Regarding the reason for not having surgery in the initial service, the high cost of the surgery (R$ 2.000 - R$ 4.000) and the cost of IOLs (R$ 1.000 - R$ 1.500) was the main obstacle for most attended services and private covenants. Conclusion: The results of this study suggest that the routine of ophthalmologic care in SUS at Sao Paulo is not prepared to answer the demand for cataract surgeries and private healthcare system still excludes a portion of the population. It is important to continue the implementation of community campaigns to serve the population that would be unable to access the surgery through conventional ways.bookPart Tomografia de córnea (Orbscan, Pentacam, Galilei)(2022) ESPíNDOLA, Rodrigo França de- 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.
- Cancelamento de cirurgias de catarata em um hospital público de referência(2012) MAGRI, Micheli Patricia de Fatima; ESPINDOLA, Rodrigo Franca de; SANTHIAGO, Marcony Rodrigues de; MERCADANTE, Elisabeth Frolich; KARA JUNIOR, NewtonPurpose: To report the incidence and causes of cataract surgery cancellations in a public hospital. Methods: This is a retrospective study, which examined the number of cancellations of cataract surgery during 2009. We analyzed the type of procedure suspended (phacoemulsification or extracapsular extraction), type of anesthesia, gender, age, covenant (public/private) and the main reasons for suspension of the surgeries (clinical causes, institutional or personal). Results: We analyzed 2,965 scheduled cataract surgeries, with 650 cancellations (21.92%). The main reason for the suspension of the procedure was clinical causes (86.90%). The winter months had the highest suspension rates of cataract surgery. Conclusion: The cancellation rate of cataract surgery in Brazilian public system seems to be the same as 10 years ago. The main cause of the suspension should be in clinical conditions (hypertension, diabetes, lack of exams, etc.).