CARLOS EDUARDO HIRATA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
14 resultados
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conferenceObject Comparative analysis of different treatment schedules in the course of Vogt-Koyanagi-Harada disease (VKHD)(2019) YAMAMOTO, Joyce H.; LAVEZZO, Marcelo Mendes; SAKATA, Viviane Mayumi; RODRIGUEZ, Ever Ernesto Caso; KANENOBU, Cintia; ABDALLAH, Smairah Frutuoso; MORITA, Celso; OYAMADA, Maria Kiyoko; HIRATA, Carlos Eduardo- Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes(2016) LAVEZZO, Marcelo Mendes; SAKATA, Viviane Mayumi; MORITA, Celso; RODRIGUEZ, Ever Ernesto Caso; ABDALLAH, Smairah Frutuoso; SILVA, Felipe T. G. da; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce HisaeVogt-Koyanagi-Harada disease (VKHD) is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin and hair. This disease is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA-DRB1*0405 allele. The absence of ocular trauma or previous intraocular surgery sets VKHD appart from sympathetic ophthalmia, its main differential diagnosis. The disease has an acute onset of bilateral blurred vision with hyperemia preceded by flu-like symptoms. The acute uveitic stage is characterized by a diffuse choroiditis with serous retinal detachment and optic disc hyperemia and edema. Fluorescein angiography in this phase demonstrates multiple early hyperfluorescent points. After the acute uveitic stage, ocular and integumentary system pigmentary changes may appear. Ocular findings may be accompanied by lymphocytic meningitis, hearing impairment and/or tinnitus in a variable proportion of patients. Prompt diagnosis followed by early, aggressive and long-term treatment with high-dose corticosteroids is most often ensued by good visual outcomes. However, some patients may experience chronic uveal inflammation with functional eye deterioration. The current review discusses the general features of VKHD, including epidemiology, classification into categories, differential diagnosis and current therapeutic approaches.
conferenceObject Correlation between visual function and clinical/subclinical disease activity parameters in Vogt-Koyanagi-Harada disease (VKHD).(2017) LAVEZZO, Marcelo Mendes; SAKATA, Viviane Mayumi; RODRIGUEZ, Ever Ernesto Caso; ABDALLAH, Smairah Frutuoso; MORITA, Celso; OYAMADA, Maria Kiyoko; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce H.- Outcomes of Intravitreal Bevacizumab in Choroidal Neovascularization in Vogt-Koyanagi-Harada Disease-A Prospective Study(2021) SAKATA, Viviane M.; MORITA, Celso; LAVEZZO, Marcelo M.; RODRIGUEZ, Ever E. C.; ABDALLAH, Smairah F.; PIMENTEL, Sergio L. G.; HIRATA, Carlos E.; YAMAMOTO, Joyce H.Purpose: To assess the effectiveness of intravitreal (IV) bevacizumab and the need for systemic immunosuppressive therapy (IMT) in choroidal neovascularization (CNV) in Vogt-Koyanagi-Harada disease (VKHD). Methods: CNV treatment consisted of three monthly IV bevacizumab injections as a loading dose; if intra/subretinal fluid (IRF) persisted, further injections were proceeded besides increment in systemic IMT. Outcome analyses at 3, 6, and 12 months were visual acuity, central foveal thickness, macular volume, IRF, and addition of IMT. Results: Seven eyes of six patients were included. Five patients (five eyes) completed a 12-month follow-up and received 12 IV bevacizumab injections. At the 12-month follow-up, visual acuity improved in four out of five eyes (p = .0568); all eyes had decreased macular volume (p = .0431) but they still had persistent IRF; and all cases needed IMT introduction/increment. Conclusion: Intravitreal bevacizumab in association with systemic IMT was effective for CNV in VKHD. Active CNV may indicate disease of inadequate clinical control.
conferenceObject Fundus autofluorescence imaging in vogt-Koyanagi-Harada disease from acute onset in a 12-month follow-up(2015) MORITA, Celso; SAKATA, Viviane Mayumi; RODRIGUEZ, Ever Ernesto Caso; ABDALLAH, Smairah F.; HIRATA, Carlos E.; OYAMADA, Maria Kiyoko; YAMAMOTO, Joyce H.conferenceObject Multimodal evaluation of Vogt-Koyanagi-Harada disease: A 12-month prospective longitudinal study from the acute onset(2015) SAKATA, Viviane Mayumi; HIRATA, Carlos E.; OYAMADA, Maria Kiyoko; ABDALLAH, Smairah F.; RODRIGUEZ, Ever E.; MORITA, Celso; YAMAMOTO, Joyce H.- Full-field electroretinogram behavior in Vogt-Koyanagi-Harada disease: a 24-month longitudinal study in patients from acute onset evaluated with multimodal analysis(2019) SAKATA, Viviane Mayumi; LAVEZZO, Marcelo Mendes; SILVA, Felipe T. da; RODRIGUEZ, Ever Ernesto Caso; MORITA, Celso; ABDALLAH, Smairah Frutuoso; OYAMADA, Maria Kiyoko; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce HisaePurpose To prospectively evaluate the dynamic changes of the full-field electroretinogram (ff-ERG) and its association with inflammatory signs in patients with Vogt-Koyanagi-Harada disease (VKHD) followed up after acute onset. Methods Twelve acute VKHD patients, who were followed up for at least 24 months, were enrolled at a tertiary center from June 2011 to January 2017. Treatment consisted of intravenous methylprednisolone followed by 1 mg/kg/day of oral prednisone with a slow tapering associated with late non-steroidal immunosuppressive therapy in previously defined cases. Inflammation was systematically evaluated with clinical and posterior segment imaging (PSI) exams (fluorescein angiography, FA, indocyanine green angiography, ICGA, enhanced depth imaging optical coherence tomography, EDI-OCT). A ff-ERG was performed upon enrollment as well as at predefined intervals. Scotopic ff-ERG parameters changes between the 12th and 24th months defined the ERG-stable or ERG-worsening groups. ""Flare"" was defined as an appearance or worsening of inflammatory signs (after the initial 6 months following disease onset) under the predefined treatment protocol. Results ff-ERG parameters initially improved in all eyes; in the evaluation between the 12th and 24th months, ff-ERG results were stable in 17 eyes (71 %) and worsened in 7 eyes (29 %). Subnormal ff-ERG results were observed in 15 eyes (62 %) at the 24th month. On the other hand, the flare was observed in 8 eyes (33 %) as cells in the anterior chamber and in 24 eyes (100 %) as any PSI inflammatory sign. The ERG-worsening group presented thicker subfoveal choroid at the first month (p = 0.001) and fluctuations in choroidal thickness more often during follow-up when compared to the ERG-stable group (p = 0.02). Conclusions Scotopic ff-ERG parameters worsened between the 12th and 24th months in a quarter of the patients. Subclinical inflammation detected as an increase in CT seems to be related to worsening in visual function measured with ffERG.
conferenceObject Intravitreal Bevacizumab for the Treatment of Choroidal Neovascularization in Vogt-Koyanagi-Harada Disease - A Prospective Study(2014) SAKATA, Viviane Mayumi; PIMENTEL, Sergio; ABDALLAH, Smairah F.; RODRIGUEZ, Ever C.; HIRATA, Carlos E.; YAMAMOTO, Joyce H.- Frosted branch angiitis and cerebral venous sinus thrombosis as an initial onset of neuro-Behçet’s disease: a case report and review of the literature(2017) FERREIRA, B. F. D. A.; RODRIGUEZ, E. E. C.; PRADO, L. L. D.; GONCALVES, C. R.; HIRATA, C. E.; YAMAMOTO, J. H.Background: Frosted branch angiitis is a rare, severe condition. It can be either a primary or a secondary condition and is characterized by rapid deterioration of vision and fulminant retinal vasculitis that manifests as diffuse sheathing of retinal vessels, macular edema, papillitis, vitritis and anterior uveitis. We aimed to describe a case of frosted branch angiitis and cerebral venous sinus thrombosis as an initial neuro-Behçet’s disease onset. Diagnosis of Behçet’s disease was based on the current 2014 International Criteria for Behçet’s Disease and the International consensus recommendation criteria for neuro-Behçet’s disease. In addition, a literature review using search parameters of “frosted branch angiitis”, “Behçet” and “neuro-Behçet” in the PubMed database is presented. Case presentation: A 28-year-old Brazilian pardo woman presented to our hospital with abrupt bilateral vision loss associated with recurrent aphthous oral ulcers 6 months before visual symptom onset. A fundus examination showed bilateral widespread retinal vasculitis with venous and arterial white sheathing, optic disc swelling, macular edema, and retinal hemorrhages, leading to the diagnosis of frosted branch angiitis. An extensive systemic workup for retinal vasculitis was uneventful, except for brain magnetic resonance imaging demonstrating cerebral venous sinus thrombosis and lymphocytic aseptic meningitis. A diagnosis of neuro-Behçet’s disease was made, and treatment was started with methylprednisolone therapy 1 g/day for 5 consecutive days, followed by oral mycophenolate mofetil and infliximab 5 mg/kg infusion. The patient’s response was rapid, with improvement of visual acuity to hand movement and counting fingers by day 7 and final visual acuity of counting fingers and 20/130. Conclusions: Frosted branch angiitis may be associated with infectious, noninfectious, or idiopathic causes. An extensive workup should be done to exclude systemic vasculitis such as Behçet’s disease. Treatment with systemic steroids must be promptly initiated in association with specific treatment aimed at inflammation control and blindness risk reduction. © 2017 The Author(s).
- Mycophenolate mofetil as an immunomodulator in refractory noninfectious uveitis(2016) RODRIGUEZ, Ever Ernesto Caso; SAKATA, Viviane Mayumi; CAVALCANTI, Daniel Cesar Torres Melo; ZAGHETTO, Juliana Marques; OLIVALVES, Edilberto; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce HisaePurpose: To evaluate the efficacy and tolerance of mycophenolate mofetil (MMF) for the treatment of noninfectious uveitis using the methods advocated by the Standardization of Uveitis Nomenclature (SUN) Working Group and to compare this with other studies of immunosuppression in ocular inflammation. Methods: Retrospective case series. Patients with noninfectious uveitis, followed at a tertiary Uveitis Service in Sao Paulo, Brazil, from 2007 to 2014 and receiving oral MMF for a minimum of 6 months, were retrospectively reviewed. After reaching an optimal dose of MMF, patients were evaluated after 6 (T6), 12 (T12), and 24 months (T24). The optimal dose varied for each patient (medium 2.2 g/day, range 1.0-3.0 g/day). The main outcome measures were: 1) success on achieving complete control of inflammation in both eyes and/or oral prednisone dosage reduction to <= 10 mg per day, and 2) the length of time required to reduce oral prednisone to <= 10 mg/day, partial control of ocular inflammation, and side effects. Results: In a cohort of 16 patients with refractory noninfectious uveitis, 67% reached the ideal prednisone dose after 1 year of MMF treatment and 83% after 2 years of MMF treatment. Complete or partial inflammation control was achieved in 43.7% at T12. Two patients (14%) had disease remission after 4.7 years of MMF treatment. Adverse effects were gastrointestinal disturbances, infection, insomnia, and liver function abnormalities at a rate of 0.03 patient-year each. Conclusions: This small retrospective case series is consistent with the literature concerning the high efficacy and moderate tolerability of MMF in noninfectious uveitis. Observation of patients should be continued for at least 1 year to clearly determine MMF efficacy.