MARCONY RODRIGUES DE SANTHIAGO
Projetos de Pesquisa
Unidades Organizacionais
LIM/33 - Laboratório de Oftalmologia, Hospital das Clínicas, Faculdade de Medicina
31 resultados
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Agora exibindo 1 - 10 de 31
- Intrastromal Corneal Ring Segments Implantation and Descemet Membrane Endothelial Keratoplasty for Coexisting Keratoconus and Fuchs Endothelial Dystrophy(2020) BERTINO, Pedro; MAGALHAES, Renata Soares; CRIADO, Guilherme Garcia; NOVAIS, Gustavo Amorim; JR, Renato Ambrosio; SANTHIAGO, Marcony R.PURPOSE: To report two cases of coexisting keratoconus and Fuchs endothelial dystrophy treated with intrastromal corneal ring segments (ICRS) implantation and Descemet membrane endothelial keratoplasty (DMEK). METHODS: Two patients with coexisting keratoconus and Fuchs endothelial dystrophy underwent ICRS implantation and DMEK, in a two-stage procedure. Follow-up evaluation included Scheimpftug tomography and optical coherence tomography. RESULTS: In both cases, ICRS implantation improved corneal topography and DMEK restored normal corneal thickness. Corrected distance visual acuity improved from 20/100 to 20/30 and from 20/60 to 20/25. Urrets-Zavatia syndrome was diagnosed in one case and addressed with colored contact tens fitting. CONCLUSIONS: Low vision resulting from coexisting keratoconus and Fuchs endothelial dystrophy might be addressed more selectively with posterior lamellar keratoplasty and ICRS implantation. Urrets-Zavalia syndrome must be considered a possible complication after DMEK, especially in patients with keratoconus.
- OCT Study of the Femtosecond Laser Opaque Bubble Layer(2017) MARINO, Gustavo K.; SANTHIAGO, Marcony R.; WILSON, Steven E.PURPOSE: To characterize the location and regularity of the opaque bubble layer (OBL) in the corneal stroma after femtosecond laser-assisted LASIK (FS-LASIK) flap generation. METHODS: In this prospective study, 30 eyes of 15 patients who had FS-LASIK surgery for myopia, astigmatism, and/or hyperopia were included. Screen captures were obtained at the end of the flap creation and the eyes with hard type OBL were immediately imaged with anterior segment optical coherence tomography. RESULTS: The mean age of the 9 men and 6 women was 40 +/- 11.3 years (range: 22 to 60 years). Seven eyes (23.3%) developed hard type OBL that was typically localized in the central cornea beneath the LASIK flap and, in the majority of cases, located close to the hinge of the flap. Three of the seven eyes had OBL only within the laser cut, whereas the four other eyes had OBL in a spotty distribution within the stromal bed beneath the flap. None of the eyes had an accumulation of OBL within the flap itself. CONCLUSIONS: The excimer laser ablation of a stroma with OBL may be different from that of a stroma without OBL. Management of OBL when it occurs due to flap production, including allowing the bubble to dissipate when they overlie the pupil, is important to obtain the best outcomes with femtosecond laser-assisted LASIK.
- Regeneration of Defective Epithelial Basement Membrane and Restoration of Corneal Transparency After Photorefractive Keratectomy(2017) MARINO, Gustavo K.; SANTHIAGO, Marcony R.; SANTHANAM, Abirami; TORRICELLI, Andre A. M.; WILSON, Steven E.PURPOSE: To study regeneration of the normal ultrastructure of the epithelial basement membrane (EBM) in rabbit corneas that had -9.00 D photorefractive keratectomy (PRK) and developed late haze (fibrosis) with restoration of transparency over 1 to 4 months after surgery and in corneas that had incisional wounds. METHODS: Twenty-four rabbits had one of their eyes included in one of the two procedure groups (-9.00 D PRK or nearly full-thickness incisional wounds), whereas the opposite eyes served as the unwounded control group. All corneas were evaluated with slit-lamp photographs, transmission electron microscopy, and immunohistochemistry for the myofibroblast marker alpha-smooth muscle actin and collagen type III. RESULTS: In the -9.00 D PRK group, corneas at 1 month after surgery had dense corneal haze and no evidence of regenerated EBM ultrastructure. However, by 2 months after surgery small areas of stromal clearing began to appear within the confluent opacity (lacunae), and these corresponded to small islands of normally regenerated EBM detected within a larger area of the excimer laser-ablated zone with no evidence of normal EBM. By 4 months after surgery, the EBM was fully regenerated and the corneal transparency was completely restored in the ablated zone. In the incisional wound group, the two dense, linear corneal opacities were observed at 1 month after surgery and progressively faded by 2 and 3 months after surgery. The EBM ultrastructure was fully regenerated at the site of the incisions, including around epithelial plugs that extended into the stroma, by 1 month after surgery in all eyes. CONCLUSIONS: In the rabbit model, spontaneous resolution of corneal fibrosis (haze) after high correction PRK is triggered by regeneration of EBM with normal ultrastructure in the excimer laser-ablated zone. Conversely, incisional wounds heal in rabbit corneas without the development of myofibroblasts because the EBM regenerates normally by 1 month after surgery.
- Phototherapeutic Keratectomy: Science and Art(2017) WILSON, Steven E.; MARINO, Gustavo K.; MEDEIROS, Carla S.; SANTHIAGO, Marcony R.PURPOSE: To describe, with videos, the principles of excimer laser phototherapeutic keratectomy (PTK) for the treatment of corneal scars, corneal surface irregularity, and recurrent corneal erosions. METHODS: Depending on the pathology in a treated cornea, the epithelium is removed either by transepithelial PTK ablation with the excimer laser or thorough scraping with a scalpel blade. Stromal PTK can be performed with or without photorefractive keratectomy (PRK), depending on the refractive status of both eyes. Residual surface irregularity is treated with masking-smoothing PTK. Typically, 0.02% mitomycin C treatment is applied for 30 seconds to corneas treated with PTK for scars and surface irregularity. RESULTS: Transepithelial PTK with masking-smoothing typically improves corrected distance visual acuity in the eye even if the entire stromal opacity cannot be removed and can be used to debulk surface irregularity to facilitate subsequent therapeutic customized wavefront-guided or optical coherence tomography-guided PTK or PRK. PTK for recurrent erosion is performed after thorough mechanical epithelial debridement of redundant epithelial basement membrane (EBM) with a scalpel and should only include a dusting of excimer laser to remove residual EBM without inducing central irregular astigmatism or damaging limbal tissues. Meta-analyses are provided for PTK treatment for corneal scars, corneal dystrophies, and recurrent corneal erosions. CONCLUSIONS: Excimer laser PTK is a highly effective treatment for superficial corneal scars, central corneal irregular astigmatism, and recurrent corneal erosions unresponsive to medical treatment or mechanical epithelial debridement alone.
- Losartan Inhibition of Myofibroblast Generation and Late Haze (Scarring Fibrosis) After PRK in Rabbits(2022) SAMPAIO, Lycia Pedral; HILGERT, Guilherme S. L.; SHIJU, Thomas Michael; SANTHIAGO, Marcony R.; WILSON, Steven E.PURPOSE: To study the effect of topical losartan compared to vehicle on the generation of myofibroblasts and development of late haze scarring fibrosis after photorefractive keratectomy (PRK) in rabbits. METHODS: Twelve rabbits had-9.00 diopter (D) PRK in one eye followed by 50 mu L of topical 0.2 mg/mL losartan or 50 mu L of vehicle six times per day for 1 month. Standardized slit lamp photographs were obtained prior to death. Duplex immunohistochemistry was performed on cryofixed corneas for myofibroblast marker alpha-smooth muscle actin (a-SMA) and keratocyte marker keratocan or collagen type IV and transforming growth factor (TGF)-I31. ImageJ software (National Institutes of Health) was used for quantitation. RESULTS: Topical losartan compared to vehicle significantly decreased corneal opacity (P = .04) and anterior stromal myofibroblast generation (P = .01) at 1 month after PRK. Topical losartan compared to vehicle also decreased anterior stromal non-basement membrane collagen type IV at 1 month after PRK (P = .004). CONCLUSIONS: Topical angiotensin converting enzyme II receptor inhibitor losartan, a known inhibitor of TGF-I3 signaling, decreased late haze scarring fibrosis and myofibroblast generation after-9.00 D PRK in rabbits compared to vehicle. It also decreases TGF-I3-modulated, corneal fibroblast-produced, non-basement membrane stromal collagen type IV-likely also through inhibition of TGF-I3 signaling.[J Refract Surg. 2022;38(12):820-829.]
- Pathophysiology of Corneal Scarring in Persistent Epithelial Defects After PRK and Other Corneal Injuries(2018) WILSON, Steven E.; MEDEIROS, Carla S.; SANTHIAGO, Marcony R.PURPOSE: To analyze corneal persistent epithelial defects that occurred at 3 to 4 weeks after -4.50 diopter (D) photorefractive keratectomy (PRK) in rabbits and apply this pathophysiology to the treatment of persistent epithelial defects that occur after any corneal manipulations or diseases. METHODS: Two of 168 corneas that had -4.50 D PRK to study epithelial basement membrane regeneration developed spontaneous persistent epithelial defects that did not heal at 3 weeks after PRK. These were studied with slit-lamp photographs, immunohistochemistry for the myofibroblast marker alpha-smooth muscle actin (alpha-SMA), and transmission electron microscopy. RESULTS: Myofibroblasts developed at the stromal surface within the persistent epithelial defect and for a short distance peripheral to the leading edge of the epithelium. No normal epithelial basement membrane was detectable within the persistent epithelial defect or for up to 0.3 mm behind the leading edge of the epithelium, although epithelial basement membrane had normally regenerated in other areas of the zone ablated by an excimer laser where the epithelium healed promptly. CONCLUSIONS: A persistent epithelial defect in the cornea results in the development of myofibroblasts and disordered extracellular matrix produced by these cells that together cause opacity within, and a short distance beyond, the persistent epithelial defect. Clinicians should treat persistent epithelial defects within 10 days of non-closure of the epithelium to facilitate epithelial healing to prevent long-term stromal scarring (fibrosis).
- Correlation of hair cortisol and interleukin 6 with structural change in the active progression of keratoconus(2022) STIVAL, Larissa R.; AVILA, Laryssa P.; ARAUJO, Daniella C.; CHAVES, Luis F.; TOLEDO, Marcia C.; SILVA, Artur C.; CUNHA, Luiz C.; OLIVEIRA, Tiago F.; SANTHIAGO, Marcony R.Purpose: To evaluate interleukin (IL) and hair cortisol concentrations (HCCs) in progressive keratoconus (KC) and compare them with KC-stable eyes and healthy control, and to determine the correlation of these inflammatory mediators and HCCs and their relationship with structural damage represented by increased corneal curvature. Setting: University of Sao Paulo, Brazil. Design: Prospective observational comparative study. Methods: 133 eyes of 74 patients were included. The concentrations of tear cytokines: IL1B, IL6, IL8, IL10, IL12p70, and tumor necrosis factor alpha were obtained by capillary flow and measured using a flow cytometer. HCCs were determined from the most proximal hair segment as an index of cumulative secretion and measured by liquid chromatography mass spectrometry. Results: 133 eyes of 74 patients. Only IL6 was increased in progressive KC tears compared with stable KC (6.59 +/- 3.25 pg/mL vs 4.72 +/- 1.91 pg/mL; P < .0001) with a positive correlation between IL6 and maximum keratometry (Kmax) (P < .0001). Progressive KC exhibited significantly higher HCC than stable KC (0.624 +/- 0.160 ng/mg vs 0.368 +/- 0.0647 ng/mg; P < .0001) and healthy controls (0.624 +/- 0.160 ng/mg vs 0.351 +/- 0.0896 ng/mg; P < .0001). There was a significant correlation between HCC and Kmax (P < .0001). Conclusions: KC eyes that are progressing have a higher concentration of IL6 and long-term cortisol than patients with stable forms of KC; second, there is a significant correlation between this increase in IL6 and cortisol with corneal structural damage. Finally, there is a meaningful relationship between this interleukin and the previous few months' cortisol levels.
- Intracorneal Ring Segments Implantation for Corneal Ectasia(2016) GIACOMIN, Natalia T.; MELLO, Glauco R.; MEDEIROS, Carla S.; KILIC, Alyin; SERPE, Cristine C.; ALMEIDA, Hirlana G.; KARA-JUNIOR, Newton; SANTHIAGO, Marcony R.PURPOSE: To provide an overview of the predictability, safety, and efficacy of intrastromal corneal ring segment (ICRS) implantation as a tool to improve visual acuity and its association with other techniques such as corneal collagen cross-linking (CXL), addressing biomechanical outcomes, models, surgical planning and technique, indications, contraindications, and complications in ectatic corneas. METHODS: Literature review. RESULTS: ICRSs have been used to regularize the corneal shape and reduce corneal astigmatism and higher order aberrations, improve visual acuity to acceptable limits, and delay, or eventually prevent, a corneal keratoplasty in keratoconic eyes. Changes in ICRS thickness and size, combination of techniques, and the addition of femtosecond lasers to dissect more foreseeable channels represent an improvement toward more predictable results. Several studies have shown, over time, the long-term efficacy and safety of ICRS treatment for keratoconus, with variable predictability, maintaining the early satisfactory outcomes regarding visual acuity, keratometry, and corneal thickness. It is just as important to ensure that the disease will not progress as it is to improve the visual acuity. Therefore, many studies have shown combined techniques using ICRS implantation and CXL. Also, further limitations of ICRS implantation can be addressed when associated with phakic intraocular lens implantation and photorefractive keratectomy. CONCLUSIONS: ICRS implantation has shown effectiveness and safety in most cases, including combined procedures. In properly selected eyes, it can improve both refraction and vision in patients with keratoconus.
- Femtosecond Laser-assisted Cataract Surgery in Patients With Marfan Syndrome and Subluxated Lens(2015) CREMA, Armando S.; WALSH, Aileen; YAMANE, Iris S.; VENTURA, Bruna V.; SANTHIAGO, Marcony R.PURPOSE: To report femtosecond laser-assisted cataract surgeries in patients with Marfan syndrome with mild, moderate, and severe lens subluxation. METHODS: Case reports. RESULTS: Two patients with Marfan syndrome underwent femtosecond laser-assisted cataract surgery (Alcon LenSx Lasers Inc., Aliso Viejo, CA). One patient had a mild lens subluxation in one eye and a moderate lens subluxation in the fellow eye. The other patient had a severe lens subluxation in one eye. In all eyes, the laser was able to perform a circular and free-floating anterior capsulotomy and lens fragmentation. In two of the eyes it was also helpful in decreasing corneal astigmatism by making corneal intrastromal relaxing incisions. There were no postoperative complications. CONCLUSIONS: Femtosecond laser-assisted cataract surgery is an effective approach for cataract surgery in patients with Marfan syndrome with mild, moderate, and even severe lens subluxation, with the benefits of causing minimal further zonular damage and being able to treat corneal astigmatism with relaxing incisions.
- Phacoemulsification with intraocular pinhole implantation associated with Descemet membrane endothelial keratoplasty to treat failed full-thickness graft with dense cataract(2018) TRINDADE, Bruno Lovaglio Cancado; TRINDADE, Fernando Cancado; TRINDADE, Claudio Lovaglio Cancado; SANTHIAGO, Marcony R.We present a case in which a different approach was used to treat an eye with dense cataract associated with an irregular failed full-thickness corneal graft. After cataract surgery, a foldable intraocular pinhole was implanted in the capsular bag to treat the irregular corneal astigmatism. Next, a Descemet membrane endothelial keratoplasty graft was used to improve transparency in the failed penetrating keratoplasty. This approach addressed the cataract, irregular cornea, and failed graft through a standard 2.2 mm clear corneal phacoemulsification incision, thus avoiding open-sky surgical time and expediting visual rehabilitation. (C) 2018 ASCRS and ESCRS