MILTON RUIZ ALVES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina - Docente
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Microvasculature of the Optic Nerve Head and Peripapillary Region in Patients With Primary Open-Angle Glaucoma(2019) SILVA, Rafaella Nascimento e; CHIOU, Carolina A.; WANG, Mengyu; WANG, Haobing; SHOJI, Marissa K.; CHOU, Jonathan C.; D'SOUZA, Erica E.; GREENSTEIN, Scott H.; BRAUNER, Stacey C.; ALVES, Milton R.; PASQUALE, Louis R.; SHEN, Lucy Q.Purpose: To assess optic nerve head (ONH) and peripapillary microvasculature in primary open-angle glaucoma (POAG) of mild to moderate severity using swept-source optical coherence tomography angiography (OCTA). Materials and Methods: In a cross-sectional study, swept-source OCTA images were analyzed for 1 eye from each of 30 POAG patients with glaucomatous Humphrey visual field loss and 16 controls. The anatomic boundary of ONH was manually delineated based on Bruch's membrane opening and large vessels were removed from en face angiography images to measure vessel density (VD) and the integrated OCTA by ratio analysis signal (IOS), suggestive of flow, in the ONH and peripapillary region. POAG subgroup analysis was performed based on a history of disc hemorrhage (DH) matched by visual field mean deviation (MD). Results: POAG (mean MD +/- SD, -3.3 +/- 3.0 dB) and control groups had similar demographic characteristics and intraocular pressure on the day of imaging. Groups did not differ in superficial ONH VD or flow indicated by IOS (P=0.28). POAG eyes showed significantly lower VD (39.4%+/- 4.0%) and flow (38.8%+/- 5.6%) in deep ONH, peripapillary VD (37.9%+/- 2.9%) and flow (43.6%+/- 4.0%) compared with control eyes (44.1%+/- 5.1%, 44.7%+/- 6.9%, 40.7%+/- 1.7%, 47.8%+/- 2.5%, respectively; P=0.007 for all). In the subgroup analysis, POAG eyes with (n=14) and without DH (n=16) had similar measured OCTA parameters (P>0.99 for all). Conclusions: The image processing methodology based on the anatomic boundary of ONH demonstrated compromised microvasculature in the deep ONH and peripapillary region in eyes with mild to moderate POAG, regardless of the history of DH.
- Architecture evaluation of the main clear corneal incisions in femtosecond laser-assisted cataract surgery by optical coherence tomography imaging(2019) CHAVES, Mario Augusto Pereira Dias; MEDEIROS, Andre Lins de; VILAR, Cesar Martins Cortez; MAGALHAES, Klayne Rafaella Pereira; GONCALVES, Michelle Rodrigues; TZELIKIS, Patrick Frenzel de Moraes; HIDA, Wilson Takashi; CARRICONDO, Pedro Carlos; ALVES, Milton RuizPurpose: To assess the stability and reliability of femtosecond laser-assisted cataract surgery (FLACS) incisions design and dimensions using anterior segment optical coherence tomography (AS-OCT) imaging. Setting: Renato Ambrosio Ophthalmologic Study Center from Hospital Oftalmologico de Brasilia, Brasilia, Brazil. Design: Prospective nonrandomized controlled case series. Methods: Eyes undergoing FLACS with triplanar main temporal clear corneal incision (CCI) were evaluated at the end of the case. Eyes that required any incision hydration, surgical complications or lacked follow-up were excluded. The AS-OCT was performed after femtosecond delivery; at the end of the case; at 1 day and at 30 days after surgery. Data of pachymetry, endothelial and epithelial gaps, Descemet detachment and CCI architecture were compared. Results: Eleven eyes from 11 patients completed follow-up. Corneal thickness was statistically different between after femtosecond delivery and the end of the case (P-value <0.05), but without difference compared to 30 days evaluation. There was an increase of Descemet detachments (P-value,0.05) and endothelial gaps (P-value =0.0133) at the end of the case compared to post-femtosecond delivery. As for the architecture of the CCI, significant difference was found between the parameters of entry angle and exit angle measured with AS-OCT and the programmed. Conclusion: The AS-OCT was capable of visualizing changes in the cornea at the CCI. Despite the stress caused by manipulation, results indicated good stability of incision and reproducibility of tunnel length. Synopsis: Difference of corneal thickness at the CCI between after femtosecond and after phacoemulsification measurements (P-value,0.05), with increase of endothelial gaps (P-value =0.0133) and Descemet detachments (P-value,0.05).
- Glaucoma Management in Patients With Aniridia and Boston Type 1 Keratoprosthesis(2019) SILVA, Rafaella Nascimento E; SHEN, Lucy Q.; CHIOU, Carolina A.; SHANBHAG, Swapna S.; PASCHALIS, Eleftherios I.; PASQUALE, Louis R.; COLBY, Kathryn A.; LMAN, Claes H. Doh; CHODOSH, James; ALVES, Milton R.PURPOSE: To assess outcomes and glaucoma management in eyes with aniridia following Boston type 1 Keratoprosthesis (KPro) implantation. DESIGN: Retrospective, interventional comparative case series. METHODS: The population included patients with aniridia and patients with other preoperative diagnoses (excluding Stevens-Johnson syndrome, mucous membrane pemphigoid, and congenital disorders) who underwent KPro implantation at Massachusetts Eye and Ear with at least 2 years of follow-up. One eye per patient was selected based on the longer follow-up time. The main outcome was intermediate and long-term outcomes related to glaucoma. RESULTS: The aniridia (n = 22) and comparison (n = 61) groups had similar preoperative visual acuity (VA, mean +/- standard deviation, 1.86 +/- 0.52 logMAR, P = .33) and follow-up time (65.6 +/- 26.3 months, P = .25). Before KPro implantation, eyes with aniridia had more glaucoma (76.2%) and glaucoma surgery (57.1%) than comparison eyes (51.8%, P = .053; 23.2%, P = .005, respectively). More Ahmed valves were co-implanted with KPro in aniridia (47.6%) vs comparison eyes (17.9%, P = .008). At final follow-up, more aniridia eyes had glaucoma (90.5%) than comparison eyes (64.3%, P = .02), but the 2 groups had similar percentages of eyes with cup-to-disc ratio (CDR) > 0.8 (23.8% vs. 30.4%, P = .57) or CDR progression of >= 0.2 (42.9% vs 44.6%, P = .89, respectively). None of the eyes with prophylactic tube implantation developed glaucoma. Eyes with and without aniridia did not differ in post-KPro VA improvement (72.7%, 72.1%, P = .96), and final VA (1.28 +/- 0.79 logMAR, 1.23 +/- 0.98 logMAR, P = .51). CONCLUSION: Despite a higher glaucoma prevalence, eyes with aniridia achieved similar VA as comparison eyes with more than 5 years of mean follow-up time. Boston KPro offers satisfactory visual rehabilitation in aniridia when glaucoma is managed aggressively.
- Age-related Autoimmune Changes in Lacrimal Glands(2019) SOUZA, Rodrigo G. de; PAIVA, Cintia S. de; ALVES, Milton R.Aging is a complex process associated with dysregulation of the immune system and low levels of inflammation, often associated with the onset of many pathologies. The lacrimal gland (LG) plays a vital role in the maintenance of ocular physiology and changes related to aging directly affect eye diseases. The dysregulation of the immune system in aging leads to quantitative and qualitative changes in antibodies and cytokines. While there is a gradual decline of the immune system, there is an increase in autoimmunity, with a reciprocal pathway between low levels of inflammation and aging mechanisms. Elderly C57BL/6J mice spontaneously show LGs infiltration that is characterized by Th1 but not Th17 cells. The aging of the LG is related to functional alterations, reduced innervation and decreased secretory activities. Lymphocytic infiltration, destruction, and atrophy of glandular parenchyma, ductal dilatation, and secretion of inflammatory mediators modify the volume and composition of tears. Oxidative stress, the capacity to metabolize and eliminate toxic substances decreased in aging, is also associated with the reduction of LG functionality and the pathogenesis of autoimmune diseases. Although further studies are required for a better understanding of autoimmunity and aging of the LG, we described anatomic and immunology aspects that have been described so far.
- Tratamento da aniseiconia induzida na correção óptica de anisometropia em escolares do ensino fundamental(2019) PRIMIANO JUNIOR, Helio Paulo; ORLANDIN, Luiz Fernando; TAKATSU, Marcus Vinicius; ALVES, Milton Ruiz; ALVES, Milton Ruiz RodriguesAbstract Objectives: To compare the aniseikonia and the stereopsis in school children anisometropes of the first-year of elementary school corrected with stock ophthalmic lenses with base curve selected to minimize the interocular size difference of retinal images and with size lenses suggested by the software Aniseikonia Inspector 3, and to check the preference of them for one of these forms of correction. Methods: Nineteen school children with anisometropia ≥ 1.5 D in corresponding meridians, in the use of glasses with stock ophthalmic lenses and with size lenses were evaluated for aniseikonia (software Aniseikonia Inspector 3) and stereopsis (Stereo Fly test with LEA symbols). The preference for one of the forms of correction was verified after 40-50 days of wearing glasses. Results: The mean and standard deviations of the vertical and horizontal aniseikonia in the use of glasses with stock ophthalmic lenses and with size lenses were, respectively, -1.05% ± 2.20% and-1.37% ± 2.36% (p = 0,82739) and -0.895% ± 2.23% and -1.16% ± 2.03% (p = 0,77018). 31.6% of the school children corrected with size lenses and 21.1% of the students corrected with stock ophthalmic lenses identified the optotypes that suggest stereopsis less than 100 seconds of arc (p = 0.475). Regarding the preference, 4/15 (26.7%) of the students chose the glasses with size lenses, 2/15 (13.3%) chose the glasses with stock ophthalmic lenses, and for 9/15 (60%) the choice was indifferent. Conclusion: The induced aniseikonia in school children with anisometropia corrected with size lenses suggested by the software Aniseikonia Inspector 3 was similar to that obtained in the correction with stock ophthalmic lenses with base curves selected to minimize the difference of interocular size of retinal images.
- Evaluation of antimitotic and antiangiogenic effect of preoperative subconjunctival application of mitomycin C in primary pterygium: a randomized trial(2019) MARTINS, Thiago Goncalves dos Santos; COSTA, Ana Luiza Fontes de Azevedo; FURUZAWA, Karina Mie; CHAMMAS, Roger; ALVES, Milton RuizPurpose To evaluate the influence of preoperative mitomycin C (MMC) on the proliferative behavior of fibroblasts and fibrovascular tissue derived from the primary pterygium using the immunohistochemical method (Ki67 and CD34). Design Randomized clinical trial. Subjects, participants and/or controls Sixty-five patients with primary pterygium were randomly selected and divided into one of three groups. The control group had 29 patients that were only submitted to pterygium removal. The group that received the MMC injection a month before surgery had 16 patients, and the group that received the MMC 2 weeks before surgery had 20 patients. Each patient only had one eye operated on. Methods Sixty-five patients were selected to undergo pterygium excision surgery. We randomly placed the patients into three groups: one without MMC (n = 29), one with MMC application 1 month before surgery (n = 16) and another with MMC application 2 weeks before surgery (n = 20). Subconjunctival injection was applied with 0.1 ml of 0.02% MMC in the pterygium body, and patients were followed for 2 years. Main outcome measures Proliferative behavior of fibroblasts and fibrovascular tissue using the immunohistochemical method (Ki67 and CD34) comparing the three groups. Results Of the total 29 patients (44.6%) in the control group (without MMC application), 11 cases had recurrence (37.9%), of which seven (63.6%) were within 3 months of follow-up and four (36.3%) within 6 months of follow-up. The mean proliferation index of the recurrent cases was 4.5%, and of the cases without recurrence, it was 6.1%. There were 16 patients (24.6%) in the MMC application group 1 month before surgery, in which one case (6.25%) recurred at 6 months. In the group with MMC application 2 weeks before surgery, of the total of 20 patients (30.7%), there was one case of recurrence (5%) at 6 months. The proliferation index of the group that had MMC administered and did not have a recurrence was 7.2%, and in the group with recurrence, it was 6.4%. The CD34-labeled cell count was 5.8% among cases with recurrence and 5.6% in cases without recurrence. No side effects of MMC application were reported during the study follow-up period. Conclusion MMC was efficient to reduce the recurrence index despite the absence of a direct relation with its antimitotic and antiangiogenic effect in the samples that were analyzed.
conferenceObject Trends in pathogens and antibiotic resistance of corneal culture isolates in infectious keratitis in Sao Paulo, Brazil, over a 5-year period(2019) OLIVEIRA, Luiza Manhezi Shin de Shin de; TANAKA, Tatiana; KATO, Juliana Mika; ROSSI, Flavia; ALMEIDA JUNIOR, Joao Nobrega de; GIOIA, Thais Romano Sabato di; GIGLIO, Veronica Bresciani; ALVES, Milton Ruiz; SANTO, Ruth Miyuki