EDUARDO CUNHA DE SOUZA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Characterisation of macular neovascularisation subtypes in age-related macular degeneration to optimise treatment outcomes(2023) MATHIS, Thibaud; HOLZ, Frank G.; SIVAPRASAD, Sobha; YOON, Young Hee; ETER, Nicole; CHEN, Lee-Jen; KOH, Adrian; SOUZA, Eduardo Cunha de; STAURENGHI, GiovanniThe aim of this review is to identify the common characteristics and prognoses of different subtypes of neovascular age-related macular degeneration (nAMD). We also propose recommendations on how to tailor treatments to the subtype of neovessels to optimise patient outcomes. The authors, selected members of the Vision Academy, met to discuss treatment outcomes in nAMD according to macular neovascularisation (MNV) subtypes, using evidence from a literature search conducted on the PubMed database (cut-off date: March 2019). This review article summarises the recommendations of the Vision Academy on how the characterisation of MNV subtypes can optimise treatment outcomes in nAMD. The identification of MNV subtypes has been facilitated by the advent of multimodal imaging. Findings from fluorescein angiography, indocyanine green angiography and spectral-domain optical coherence tomography collectively help refine and standardise the determination of the MNV subtype. To date, three subtypes have been described in the literature and have specific characteristics, as identified by imaging. Type 1 MNV is associated with better long-term outcomes but usually requires more intense anti-vascular endothelial growth factor dosing. Type 2 MNV typically responds quickly to treatment but is more prone to the development of fibrotic scars, which may be associated with poorer outcomes. Type 3 MNV tends to be highly sensitive to anti-vascular endothelial growth factor treatment but may be associated with a higher incidence of outer retinal atrophy, compared with other subtypes. Accurately assessing the MNV subtype provides information on prognosis and helps to optimise the management of patients with nAMD.
- A Brazilian case of exudative perifoveal vascular anomalous complex responsive to aflibercept intravitreal injections(2024) SOUZA, Eduardo Cunha de; TOMBOLINI, Beatrice; SACCONI, Riccardo; BANDELLO, Francesco; QUERQUES, GiuseppePurpose To report a case of exudative perifoveal exudative vascular anomalous complex (ePVAC) in a Brazilian healthy patient that underwent a complete resolution after aflibercept intravitreal injections.Case description A 41-year-old healthy Brazilian man complained of acute central vision loss in his right eye (RE). Fundus examination showed a perifoveal hemorrhagic aneurysmal lesion, accompanied by several hard exudates in RE. On fluorescein angiography, these abnormalities showed a progressive hyperfluorescence with surrounding leakage. Optical coherence tomography (OCT) revealed a deep, perifoveal hyporeflective cystic space with a hyperreflective wall and hyperreflective material inside of fibrin-like aspect. Around this aneurism, intraretinal hyporeflective spaces suggestive of exudation were detected. Nor pathological flow signal, or telangiectatic dilations were evidenced on OCT-angiography. Therefore, a diagnosis of exudative ePVAC in RE was hypothesized. After an initial observation, the patient underwent three monthly aflibercept intravitreal injections (0.05 ml/2 mg), with a significative anatomical and functional improvement after two weeks from first dose. On last follow-up at five months from baseline, patient experienced no evidence of new exudation and a stable visual acuity.Discussion Placental growth factor (PlGF) may impact on pericytes' dropout, and thus on ePVAC development. In contrast to the other anti-VEGF drugs, aflibercept is the only molecule contrasting PlGF. Therefore, aflibercept would act on ePVAC not as an anti-VEGF drug, but rather as an anti-PlGF one.Conclusion This report encouraged the use of aflibercept as a therapeutic option for ePVAC. Further studies are required to confirm our result and the impact of PlGF on ePVAC pathogenesis.
- STELLATE MULTIFORM AMELANOTIC CHOROIDOPATHY Clinical and Multimodal Imaging Features(2023) RAMTOHUL, Prithvi; PELLEGRINI, Marco; PICHI, Francesco; PREZIOSA, Chiara; MARCHESE, Alessandro; CICINELLI, Maria Vittoria; MISEROCCHI, Elisabetta; MUNDAE, Rusdeep; MREJEN, Sarah; ROFAGHA, Soraya; MEIN, Calvin E.; MEIN, Luke; OBER, Michael D.; SOUZA, Eduardo Cunha de; COHEN, Salomon Yves; DIJK, Elon H. C. van; JAMPOL, Lee; BOON, Camiel J. F.; FREUND, K. BaileyPurpose:To describe the clinical and multimodal imaging features of stellate multiform amelanotic choroidopathy (SMACH; also known as serous maculopathy due to aspecific choroidopathy).Methods:Retrospective observational case series of eyes presenting with SMACH. Multimodal imaging including fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and indocyanine green angiography (ICGA) was analyzed.Results:Eighteen eyes from 18 patients (mean age: 28 & PLUSMN; 19 years) were included. The mean follow-up duration was 9 years. Ophthalmoscopy showed a yellowish orange, dendriform choroidal lesion. At presentation, subretinal fluid (SRF) was seen in 10 of 18 cases (56%). Eight patients (44%) showed no evidence of SRF during a mean follow-up of 6 years. Cross-sectional OCT showed hyperreflective fibrous-like changes within the inner choroid with choriocapillaris flow preservation on OCTA. En face OCT showed a hyperreflective choroidal lesion with finger-like projections oriented in a stellate configuration. On ICGA, SMACH showed early and late hypofluorescence. None of the cases showed lesion growth.Conclusion:SMACH seems to be a unilateral choroidopathy characterized by distinctive multimodal imaging features. As SRF was absent in some cases, while a dendriform pattern was a consistent finding in all eyes, the authors propose renaming this entity ""stellate multiform amelanotic choroidopathy,"" a name that retains its previous abbreviation ""SMACH.""
- VITRECTOMY for STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS ASSOCIATED with OUTER RETINAL LAYER DEFECT(2022) MORAES, B. R. M.; FERREIRA, B. F. A.; NOGUEIRA, T. M.; NAKASHIMA, Y.; JúNIOR, H. P. P.; SOUZA, E. C.Purpose:To describe a case of stellate nonhereditary idiopathic foveomacular retinoschisis associated with outer retinal layer defect treated with pars plana vitrectomy, internal limiting membrane removal, and C3F8 tamponade.Methods:Spectral-domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) scans of a 46-year-old woman with unilateral stellate nonhereditary idiopathic foveomacular retinoschisis were acquired at baseline and 1, 3, 6, and 12 months after surgery.Results:Pars plana vitrectomy was performed after phacoemulsification. The vitreous was circumcised, and the internal limiting membrane was removed with a Tano brush, releasing tangential forces. The patient experienced progressive recovery of the outer retinal layers and improvement of visual acuity during follow-up.Conclusion:Stellate nonhereditary idiopathic foveomacular retinoschisis may be associated with outer retinal layer defect and severe vision loss. Pars plana vitrectomy with internal limiting membrane removal and C3F8 infusion seems to be a safe and feasible treatment in such cases, with potentially good anatomical and functional outcome. © 2022 Lippincott Williams and Wilkins. All rights reserved.
- Fovea-threatening and fovea-involving peripheral Coats disease: effects of posture and intervention (vol 8, 42, 2022)(2023) SOUZA, Eduardo Cunha de; ROSA, Evandro; DIAS, Joao Rafael de Oliveira; MALERBI, Fernando Korn; LEAL, Bruno Campelo; PRIMIANO JUNIOR, Helio Paulo
- THE CHRYSANTHEMUM PHENOTYPE OF IDIOPATHIC MULTIFOCAL CHOROIDITIS(2023) RAMTOHUL, Prithvi; CICINELLI, Maria Vittoria; DOLZ-MARCO, Rosa; GAL-OR, Orly; MREJEN, Sarah; GARCIA-MARTINEZ, Jesus R.; GOLDBERG, Alla; SOUZA, Eduardo Cunha de; MISEROCCHI, Elisabetta; CUNNINGHAM, Emmett T.; YANNUZZI, Lawrence A.; FREUND, K. Bailey; TSUI, EdmundPurpose:To describe the clinical characteristics and multimodal imaging features of a distinctive subtype of active idiopathic multifocal choroiditis (iMFC) lesions with grey-yellow chorioretinal lesions surrounded by smaller satellite dots, a presentation referred to as ""chrysanthemum lesions.""Methods:Retrospective, observational, multicenter case series of eyes with active iMFC and chrysanthemum lesions. Multimodal imaging features were reviewed and presented.Results:Twenty-five eyes from 20 patients (12 women and 8 men), with a mean age of 35.8 & PLUSMN; 17.0 years (range, 7-78 years) were included. Chrysanthemum lesions were equally located in the macula (48.0%) or the mid/far periphery (52.0%). The number of lesions per eye varied from 1 (16.0%) to more than 20 (56.0%). On optical coherence tomography, chrysanthemum lesions showed typical features of iMFC, including subretinal hyperreflective material splitting the retinal pigment epithelium/Bruch membrane. Chrysanthemum lesions were hypoautofluorescent on fundus autofluorescence imaging, hyperfluorescent on fluorescein angiography, hypofluorescent on indocyanine green angiography, and associated with choriocapillaris flow signal deficit on optical coherence tomography angiography.Conclusion:Active iMFC may present with findings resembling chrysanthemum lesions. The distinctive lesion morphology on ophthalmoscopic examination, the large number of lesions, and the high prevalence of exclusive midperipheral and far peripheral involvement may represent a distinctive phenotype of iMFC.
- Short-pulse laser plus subthreshold diffuse laser for serous retinal detachment in dome-shaped macula(2023) RODRIGUES, Murilo Wendeborn; BASTOS, Thais; GONCALVES, Annelise Nicotti; CARDILLO, Jose Augusto; MESSIAS, Andre; SOUZA, Eduardo Cunha de; JORGE, RodrigoBackgroundFirst described by Gaucher and associates in 2008, dome-shaped macula (DSM) is an anterior convex protrusion of the macula visible on OCT (optical coherence tomography). Visual impairment in DSM results mainly from sub-foveal serous retinal detachment (SRD). Herein, this original study from retrospective data analysis evaluate the anatomical and functional effects of Pascal & REG; short-pulse (SP) laser plus endpoint management (EpM) subthreshold diffuse laser (SDL) in patients with SRD due to DSM.MethodsThis retrospective study included seven consecutive patients (eight eyes) with SRD secondary to dome-shaped macula who underwent a comprehensive ophthalmological evaluation including logMAR BCVA, slit-lamp biomicroscopy, indirect ophthalmoscopy, and spectral-domain optical coherence tomography (SD-OCT) (Spectralis; Heidelberg Engineering, Germany) before combined Pascal & REG; SP laser plus EpM-SDL with 1 to 6 month intervals, postoperatively, with a mean & PLUSMN; standard error (SE) follow-up time of 12.92 & PLUSMN; 1.34 months.ResultsEight eyes from seven patients were analyzed in this study. At baseline, mean BCVA (LogMAR) & PLUSMN; standard error (SE) and mean CST (central subfield thickness)(& mu;m) & PLUSMN; SE were 0.6125 & PLUSMN; 0.14 and 412.50 & PLUSMN; 24.65, respectively. After a mean follow-up time of 12.92 & PLUSMN; 1.34 months, mean CST (& mu;m) & PLUSMN; SE and BCVA (LogMAR) & PLUSMN; SE were 294.75 & PLUSMN; 19.68 (p = 0.0078) and 0.4537 & PLUSMN; 0.12 (p = 0.0313), respectively. A statistically significant reduction in mean CST and an improvement in mean BCVA were noted after SRD resolution with laser therapy application. The mean serous retinal detachment resolution time (months) & PLUSMN; SE was 3.75 & PLUSMN; 1.08. No adverse events were registered, including enlargement of atrophic alterations and choroidal neovascularization.ConclusionsThe novel combined laser modality with Pascal & REG; SP laser plus EpM-SDL treatment may induce subretinal fluid regression and BCVA improvement 1 year after treatment in DSM patients with SRD.