LEANDRO CABRAL ZACHARIAS
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
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- Relationship between automated choroidal thickness measurements and retinal sensitivity using microperimetry in patients with myopia and different stages of myopic maculopathy(2024) SILVA, Fillipe de Biaggi Borges da; SILVA, Luis Claudio Pimentel; CUNHA, Leonardo Provetti; ZACHARIAS, Leandro Cabral; NAVAJAS, Eduardo V.; MONTEIRO, Mario L. R.; PRETI, Rony C.Purpose To assess the relationship between macular choroidal thickness (CT) measurements and retinal sensitivity (RS) in eyes with myopia and different stages of myopic maculopathy. Methods A masked, cross-sectional, and consecutive study involving patients with emmetropia/myopia (control group) and high myopia (HM) eyes. Automated choroidal thickness (CT) and manual outer retinal layer (ORL) thickness were acquired using swept-source optical coherence tomography, while retinal sensitivity (RS) assessed by microperimetry (MP3) in all regions of the macular Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Comparisons were made between groups, and correlations were performed among these measurements, demographic and ocular parameters and myopic maculopathy classification. Results A total of 37 (74 eyes) patients were included in the study. The mean age was 39 +/- 13 years, and 28 patients (76%) were female. HM eyes exhibited inferior best-corrected visual acuity and a more advanced myopic maculopathy classification compared to the control group. The mean macular CT were 255 and 179 mu m in the control and HM eyes (P < 0.001), respectively. In the HM eyes, superior ETDRS region presented the greatest values. Mean RS in control and HM groups was 28 and 24 dB (P = 0.001), respectively. Inner temporal followed by superior, were the regions of higher RS. Mean ORL thickness was 83 and 79 mu m (P < 0.001), in the control and HM groups, respectively. The inner temporal ETDRS region presented the thickest measure. CT correlated significantly with RS (r = 0.41, P < 0.001) and ORL thickness, (r = 0.58, P < 0.001), which also correlated with RS (r = 0.40, P < 0.001). Spherical equivalent, axial length and myopic maculopathy stage were the parameters that most correlated with CT, RS and ORL thickness. For every 100 mu m increase in thickening of CT there was an average increase of 3.4 mu m in ORL thickness and 2.7 dB in RS. Myopic maculopathy classification demonstrated influence only with CT. Conclusion Myopia degree is related to ORL and choroidal thinning and deterioration of retinal sensitivity in some ETDRS regions of the macula. Choroidal thinning is associated to with a decline of retinal sensitivity, thinning of ORL, and worsening of myopic maculopathy classification, so new treatments are necessary to prevent myopia progression.
conferenceObject Assessment of the outflow drainage system in AMD after multiple anti-VEGF intravitreous injections(2018) CARRICONDO, Pedro C.; ZACHARIAS, Leandro C.; RODRIGUES, Taurino; YAGAESHI, Larissa Y.; PIMENTEL, Sergio Luis G.; ABALEM, Maria Fernanda; MORAES, C. Gustavo De; SUSANNA, RemoconferenceObject 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.- Correlation between cognitive impairment and retinal neural loss assessed by swept-source optical coherence tomography in patients with mild cognitive impairment(2019) ALMEIDA, Ana L. M.; PIRES, Leopoldo A.; FIGUEIREDO, Evelyn A.; COSTA-CUNHA, Luciana V. F.; ZACHARIAS, Leandro C.; PRETI, Rony C.; MONTEIRO, Mario L. R.; CUNHA, Leonardo P.Introduction: We compared peripapillary retinal nerve fiber layer and macular thickness measurements in patients with mild cognitive impairment (MCI) and control subjects using swept-source optical coherence tomography (SS-OCT). We also assessed the relationship between SS-OCT measurements and the severity of cognitive impairment. Methods: Peripapillary retinal nerve fiber layer and macular thickness were measured in 23 patients and 24 control subjects using SS-OCT. Cognitive status was assessed using the Mini-Mental State Examination, the Montreal Cognitive Assessment, and the Pfeffer Questionnaire. Results: Most inner retinal layer thickness parameters were significantly smaller in patients with MCI, especially macular ganglion cell complex thickness measurements. Mini-Mental State Examination and Montreal Cognitive Assessment findings were significantly correlated with most macular thickness parameters. Discussion: The SS-OCT-measured inner retinal layers of patients with MCI displayed thinning, especially in the central macular area. SS-OCT technology can provide useful information on ocular involvement patterns and holds promise as an ocular biomarker in this patient population. (C) 2019 The Authors.
- Ocular retinal findings in asymptomatic patients with antiphospholipid syndrome secondary to systemic lupus erythematosus(2023) NETO, Epitacio D. S.; NETO, Taurino S. R.; SIGNORELLI, Flavio; BALBI, Gustavo G. M.; HIGASHI, Alex H.; MONTEIRO, Mario Luiz R.; BONFA, Eloisa; ANDRADE, Danieli C. O.; ZACHARIAS, Leandro C.The objective is to perform a multimodal ophthalmological evaluation, including optical coherence angiography ( OCTA), asymptomatic APS secondary to SLE (APS/SLE), and compare to SLE patients and control group (CG). We performed a complete structural/functional ophthalmological evaluation using OCTA/microperimetry exam in all participants. One hundred fifty eyes/75 asymptomatic subjects [APS/SLE (n = 25), SLE (n = 25), and CG (n = 25)] were included. Ophthalmologic abnormalities occurred in 9 (36%) APS/SLE, 11 (44%) SLE, and none of CG (p < 0.001). The most common retinal finding was Drusen-like deposits (DLDs) exclusively in APS/SLE and SLE (16% vs. 24%, p = 0.75) whereas severe changes occurred solely in APS/SLE [2 paracentral acute middle maculopathy (PAMM) and 1 homonymous quadrantanopsia]. A trend of higher frequency of antiphospholipid antibody (aPL) triple positivity (100% vs. 16%, p = 0.05) and higher mean values of adjusted Global Antiphospholipid Syndrome Score ( aGAPSS) (14 +/- 0 vs. 9.69 +/- 3.44, p = 0.09) was observed in APS/SLE with PAMM vs. those without this complication. We identified that ophthalmologic retinal abnormalities occurred in more than 1/4 of asymptomatic APS/SLE and SLE. DLDs are the most frequent with similar frequencies in both conditions whereas PAMM occurred exclusively in APS/SLE patients. The possible association of the latter condition with aPL triple positivity and high aGAPSS suggests these two conditions may underlie the retinal maculopathy. Our findings in asymptomatic patients reinforce the need for early surveillance in these patients.
bookPart Oclusão de artéria central da retina (OACR)(2022) RISSOLI, Pedro Luis; ZACHARIAS, Leandro Cabral- 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.- OPTICAL COHERENCE TOMOGRAPHY ANALYSIS OF OUTER RETINAL TUBULATIONS Sequential Evolution and Pathophysiological Insights(2018) PRETI, Rony C.; GOVETTO, Andrea; AQUETA FILHO, Richard Geraldo; ZACHARIAS, Leandro Cabral; PIMENTEL, Sergio Gianotti; TAKAHASHI, Walter Y.; MONTEIRO, Mario L. R.; HUBSCHMAN, Jean Pierre; SARRAF, DavidPurpose: To describe the sequential evolution of outer retinal tubulations (ORTs) in patients diagnosed with choroidal neovascularization and/or retinal pigment epithelium atrophy. Methods: Retrospective evaluation of spectral domain optical coherence tomography of a consecutive cohort of patients with various retinal conditions. Results: We reviewed the clinical findings of 238 eyes of 119 consecutive patients (54 men and 65 women) with a mean age of 76.2 +/- 14.2 years (range: 57-90) and a mean follow-up of 3 +/- 1.6 years (range 1-7). Over the follow-up period, ORTs were diagnosed in 67 of 238 eyes (28.1%), 9 of which were imaged with sequential, eye-tracked spectral domain optical coherence tomography dating from the beginning of ORT formation. The presence of geographic atrophy and subretinal hyperreflective material at baseline were found to be risk factors for ORT development (P < 0.001 and P < 0.001, respectively). Outer retinal tubulations were divided into forming versus formed morphologies. The latter was comprised open and closed ORTs of which the open subtype was the most common. The formation of ORTs was significantly associated with microcystic macular lesions in the inner nuclear layer and the downward displacement of the outer plexiform layer, referred to as the outer plexiform layer subsidence sign (P < 0.001). Conclusion: Outer retinal tubulation is a frequent optical coherence tomography finding in eyes with choroidal neovascularization and geographic atrophy. Open ORTs with progressive scrolled edges and shortened diameter were significantly associated with microcystic macular lesions in the inner nuclear layer and the outer plexiform layer subsidence sign.
- 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.