CARLOS EDUARDO HIRATA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- 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.
- Diagnosis and classification of Vogt-Koyanagi-Harada disease(2014) SAKATA, Viviane Mayumi; SILVA, Felipe Theodoro da; HIRATA, Carlos Eduardo; CARVALHO, Jozelio Freire de; YAMAMOTO, Joyce HisaeVogt-Koyanagi-Harada (VKH) disease is a systemic autoimmune disorder that affects pigmented tissues of the body, with its most dire manifestations affecting the eyes. This review focuses on the diagnostic criteria of VKH disease, including some information on history, epidemiology, appropriate clinical and classification criteria, etiopathogenesis, treatment and outcomes. Expert review of most relevant literature from the disease's first description to 2013 and correlation with the experience in the care of VKH disease patients at a tertiary Uveitis Service in Brazil gathered over the past 40 years. The clinical manifestations and ancillary assessment of VKH disease have been summarized in the Revised Diagnostic Criteria proposed in 2001 in a manner that allows systematic diagnosis of both acute and chronic patients. It includes the early acute uveitic manifestations (bilateral diffuse choroiditis with bullous serous retinal detachment and optic disk hyperemia), the late ocular manifestations (diffuse fundus depigmentation, nummular depigmented scars, retinal pigment epithelium clumping and/or migration, recurrent or chronic anterior uveitis), besides the extraocular manifestations (neurological/auditory and integumentary). There are two exclusion criteria, i.e. absence of previous ocular penetrating trauma or surgery and any other ocular disease that could be confounded with VKH disease. HLA-DRB1*0405 plays an important role in pathogenesis, rendering carriers more susceptible to disease. The primary ocular pathological feature is a diffuse thickening of the uveal tract in the acute phase. Later on, there may be a compromise of choriocapillaris, retinal pigment epithelium and outer retina, mostly due to an ""upstream"" effect, with clinical correlates as fundus derangements. Functional tests (electroretinogram and visual field testing) as well as imaging modalities (retinography, fluorescein/indocyanine green angiography, optical coherence tomography and ultrasound) play an important role in diagnosis, severity grading as well as disease monitorization. Though high-dose systemic corticosteroids remain gold-standard therapy, refractory cases may need other agents (cyclosporine A, anti-metabolites and biological agents). In spite of good visual outcomes in the majority of patients, knowledge about disease progression even after the acute phase and its impact on visual function warrant further investigation.
- Outcomes of phacoemulsification in patients with uveitis at a tertiary center in Sao Paulo, Brazil: a review of cases from 2007 to 2012(2017) CERQUEIRA, Patrcia M. G.; SILVA, Felipe T. B. Gaspar C. da; CARRICONDO, Pedro Carlos; OLIVALVES, Edilberto; HIRATA, Carlos Eduardo; YAMAMOTO, Joyce HisaePurpose: To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. Methods: Consecutive patients with uveitis and cataracts who had phacoemulsification and acrylic IOL implantation during 2007-2012 were evaluated for visual outcomes, etiology, and complications. Inflammation was controlled for at least 3 months before surgery, and oral prednisone (0.5 mg/kg/day) was administered to patients with non-infectious uveitis. Results: This study investigated 45 eyes in 38 patients with a mean age of 52 +/- 12.5 years. The most common etiologies among non-infectious causes (n=32; 73.3%) were Vogt-Koyanagi-Harada disease (n=9), Fuchs heterochromic iridocyclitis (n=4), and sympathetic ophthalmia (n-3). Four cases were idiopathic. Among infectious cases (n=13; 28.9%), the most common causes were toxoplasmosis (n=6) and presumed ocular tuberculosis (n-4). An acrylic IOL was implanted in-the-bag in all cases. After 1-year follow-up, an improvement in visual acuity of two or more lines was observed in 38 eyes (84.4%), and 28 eyes (62.2%) achieved a postoperative visual acuity of >= 0.5. Posterior capsule opacification was observed in 10 eyes (22.2%). Persistent postoperative inflammation (of >6 months) was observed in seven eyes (15.5%) and recurrence occurred in four eyes (8.8%). IOL was explanted in one eye. Intraocular hypertension was observed in six eyes (13.3%). Conclusions: Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataracts and uveitis. Good preoperative and postoperative control of inflammation plays an important role in achieving favorable visual outcomes. Furthermore, the final visual outcome depends on the posterior segment status.