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
8 resultados
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- 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.
- Intraocular pressure (IOP) after intravitreal dexamethasone implant (Ozurdex) amongst different geographic populations-GEODEX-IOP study(2020) SHARMA, Ashish; KUPPERMANN, Baruch D.; BANDELLO, Francesco; LANZETTA, Paolo; ZUR, Dinah; PARK, Sung Wook; YU, Hyeong Gon; SARAVANAN, V. R.; ZACHARIAS, Leandro Cabral; BARREIRA, Alan K.; IGLICKI, Matias; MIASSI, Fernando; VERITTI, Daniele; TSAO, Sean; MAKAM, Deepika; JAIN, Nidhee; LOEWENSTEIN, AnatPurpose To analyse the intraocular pressure rise after intravitreal dexamethasone implant (Ozurdex) amongst different geographic populations. Methods The medical charts of 294 dexamethasone implants between February 2011 and 2017 were reviewed retrospectively. South Asian (India), White (Europe, US and Israel) Latino (Argentina and Brazil) patient data was included in the study. Ocular hypertension (OHT) was defined as intraocular pressure of >25 mmHg or an increase of at least 10 mmHg from baseline. The main indications for treatment were diabetic macular edema (ME) (65.6%), retinal vein occlusion (26.5%), uveitis (7.8%). Results Amongst 294 intravitreal implants, ocular hypertension (>25 mmHg) was recorded in 0, 8 and 9.5% in White, Latino, and South Asian groups, respectively. However, IOP > 20 mmHg was recorded in 14%, 28% and 27% in White, Latino, and South Asian groups, respectively. Incidence of very high IOP (>35 mmHg) was lower in all geographical groups. It was 3% in Latino followed by 2% in South Asian group. Conclusion Latino and South Asian groups have higher IOP rise compared to White population. Most patients with elevated IOP fluctuate between 20-25 mmHg.
- Spontaneous macular hole closure after posterior vitreous detachment in an eye with hyperreflective OCT stress line(2020) PRETI, R.C.; ZACHARIAS, L.C.; CUNHA, L.P.; MONTEIRO, M.L.R.; SARRAF, D.Purpose: The aim of this report is to describe a patient who presented with a central hyper-reflective line (HRL) with spectral domain-optical coherence tomography (SD-OCT) after posterior vitreous detachment that evolved to full thickness macular hole (FTMH) with subsequent spontaneous resolution. Observations: A 59-year-old patient presented with a history of photopsia and floaters followed by the development of a central scotoma in the right eye (OD). The left eye (OS) was normal. On examination, visual acuity (VA) was 20/20- OD and 20/20 OS. Retinal examination OD was remarkable for a retinal tear, and SD-OCT demonstrated a central HRL. The patient underwent laser retinopexy to barricade the retinal tear. Sequential SD-OCT of the macula was performed and the patient eventually developed a small FTMH 8 months after the baseline presentation. VA was correspondingly reduced to 20/80 OD. Upon return after 4 months, the hole was completely resolved with improvement of VA to 20/20 OD. Conclusion: Vitreomacular traction (VMT) may lead to foveal dehiscence. This instability can be detected with SD-OCT as a vertical hyperreflective stress line that is a risk factor for progression to a FTMH. With release of VMT, FTMH can spontaneously close. © 2020
- The Effect of Glycemia on Choroidal Thickness in Different Stages of Diabetic Retinopathy(2020) ABALEM, Maria Fernanda; VELOSO, Helen Nazareth Santos; GARCIA, Rafael; CHEN, Xing Dong; CARRICONDO, Pedro C.; ZACHARIAS, Leandro Cabral; PRETI, Rony C.Objective:The purpose of this study was to evaluate the influence of renal and glycemic parameters on choroidal thickness (CT) in patients with diabetes with and without diabetic retinopathy (DR).Methods:This cross-sectional study included patients with and without diabetes. Patients underwent comprehensive ocular examination. CT was obtained using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode. Clinical parameters were body mass index, mean arterial pressure, glycated hemoglobin, fasting plasma glucose, estimated glomerular filtration rate, and capillary plasma glucose (CPG) a few minutes before EDI-SD-OCT.Results:The study included 275 participants: 42 with diabetes and no DR, 43 with mild nonproliferative diabetic retinopathy (NPDR), 46 with moderate NPDR, 39 with severe NPDR, 24 with proliferative diabetic retinopathy (PDR), 40 with previous panretinal photocoagulation (PRP) treatment for DR, and 41 without diabetes. The diabetic patients had thinner subfoveal CT than the nondiabetic participants (280.5 +/- 83.4 vs. 327.1 +/- 48.8 mu m,p< 0.001). After multivariable adjustment, CT was significantly correlated with age, DR stage, and CPG. In patients with mild and moderate NPDR, a higher level of CPG was associated with thicker CT. This relationship was not found in patients with PDR.Conclusion:CPG had the strongest correlation with CT in patients with NPDR (mild, moderate, and severe), but not in PDR and PRP PDR patients. Our study suggests that the glucose level at the time of the test should be aggregated to other systemic and ocular parameters, such as age and axial length, when studying the choroid using SD-OCT.
- Inverted internal limiting membrane flap for the management of optic disc pit maculopathy(2020) ZACHARIAS, Leandro Cabral; NASCIMENTO, Micael Valtoni Dantas do; GHOSN, Nagilton Bou; CIONGOLI, Marina Ravagnani; PRETI, Rony Carlos; MONTEIRO, Mario Luiz RibeiroOptic disc pit is a rare congenital anomaly that can cause serous macular detachment. It has no universally accepted single treatment. Recently, several investigators have performed new procedures to directly seal the pit. Herein, we report a case showing a promising method for optic pit maculopathy surgical treatment. We created an inverted internal limiting membrane flap and fold it over the pit to promote barrier in order to stop further fluid accumulation. Gradual absorption of subretinal fluid was observed over 12 months of follow-up. Optical coherence tomography can demonstrate internal limiting membrane folded over the pit and progressive subretinal fluid resolution. This technique resulted in a satisfactory anatomic outcome with good functional improvement in the best-corrected visual acuity.
- Optic coherence tomography features of subretinal vitreous substitutes(2020) ZACHARIAS, Leandro Cabral; SILVA NETO, Epitacio Dias da; RODRIGUES NETO, Taurino dos Santos; CARVALHO JUNIOR, Jose Ronaldo Lima de; PRETI, Rony Carlos; CUNHA, Leonardo Provetti; TANAKA, Tatiana; MONTEIRO, Mario Luiz RibeiroBackgroundTo draw comparisons between spectral domain optic coherence tomography (SD-OCT) features of subretinal silicon oil (SO), perfluoro-n-octane (PFO) or C3F8 gas.MethodsCases diagnosed with retained subretinal vitreous substitutes (VS) were retrospectively selected. Demographic data were collected and OCT features were analyzed.ResultsIn the 13 cases with subretinal PFO, hyper-reflectivity under the bubble was noted in 8 eyes (61.5%); choroidal shadow at the borders of the bubble in 11 eyes (84.6%); hyper-reflective halo around the bubble in 5 eyes (38.4%) and a hyper-reflective apical dot in 8 eyes (61.5%).The two cases with multiple PFO bubbles had complete septum dividing the bubbles. The one case with subretinal SO had hyper reflectivity under the bubble; no choroidal shadow at the edge of the bubble; hyper-reflective halo was noted around the bubble and the apical hyper-reflective dot was present; there was no complete septum dividing multiple bubbles. The single case with subretinal C3F8 had some bubbles with totally round base, incomplete septum, hyper reflectivity under the bubble, choroidal shadow at the edge of the bubble, a hyper-reflective halo and an apical dot.ConclusionDifferent subretinal VS share similar SD-OCT characteristics. Round base bubbles are only observed with subretinal C3F8 gas, while incomplete septum are related to retained subretinal SO or gas.
conferenceObject Multimodal Evaluation of patients with Primary Antiphospholipid Syndrome Using Optical Coherence Angiotomography and Microperimetry(2020) ZACHARIAS, Leandro C.; RODRIGUES NETO, Taurino dos Santos; SILVA NETO, Epitacio Dias da; HIGASHI, Alex Haruo; BALBI, Gustavo; BONFA, Eloisa Silva Dutra Oliveira; MONTEIRO, Mario L. R.; ANDRADE, Danieli Castro Oliveira- Current role of intravitreal injections in Irvine Gass syndrome-CRIIG study(2020) SHARMA, Ashish; BANDELLO, Francesco; LOEWENSTEIN, Anat; KUPPERMANN, Baruch D.; LANZETTA, Paolo; ZUR, Dinah; HILELY, Assaf; IGLICKI, Matias; VERITTI, Daniele; WANG, Angeline; MIASSI, Fernando; BELLOCQ, David; ZACHARIAS, Leandro Cabral; MAKAM, Deepika; KUMAR, Nilesh; PARACHURI, Nikulaa; BARRIERA, Alan K.; SHARMA, Rohini; FARIDI, Hafeez; MATHIS, Thibaud; KODJIKIAN, LaurentObjective To analyze the role of intravitreal anti-vascular endothelial growth factor (anti-VEGF) or steroid injection for the management of Irvine Gass syndrome. Methods It is an interventional, retrospective, multicenter study. One hundred and thirty-two injections were given in 79 eyes of 72 patients with Irvine Gass syndrome. Patients were treated with at least one intravitreal injection of either anti-VEGF or steroid. Outcomes were measured at 12 months (+/- 1 week). [Ranibizumab (Lucentis; Genentech, South San Francisco, CA) (Razumab; Intas Pharmaceutical Ltd, Ahmedabad, India) Bevacizumab (Avastin; Genentech, South San Francisco, CA) or Aflibercept (Eylea; Regeneron, Tarrytown, NY)] or steroids [Dexamethasone implant (Ozurdex, Allergan Inc, Irvine, CA) or intravitreal triamcinolone)]. Results Intravitreal injections were initiated in (67.6%) of eyes within 14 weeks of diagnosis. Intravitreal dexamethasone implant was used as the initial intravitreal therapy in (73.4%) of eyes. More than fifty percent (54.5%) of the patients were switched from anti-VEGF to Intravitreal dexamethasone implant. Reduction in the mean CMT was 336.7 +/- 191.7 and 160.1 +/- 153.1 microns in eyes treated within four weeks and more than 14 weeks from diagnosis (p = 0.005). Mean ETDRS letter gain was 16.7 +/- 12.9 and 5.2 +/- 9.2 in eyes treated within 4 weeks and more than 14 weeks from diagnosis (p = 0.004). Three eyes injected with intravitreal dexamethasone implant reported an intraocular pressure spike of > 25 mmHg which was controlled with topical medications. No other ocular or systemic adverse events were observed. Conclusion Study results suggest that physicians tend to introduce intravitreal therapy within 14 weeks of diagnosis. The most common therapy at initiation and for the switch is intravitreal dexamethasone implant. Patients treated early (within 4 weeks) respond better in terms of structure and function.