Publicado em 2017 no JAAPOS: Journal of American Academy of Pediatric Ophthalmology & Strabismus
Authors: Marcia Beatriz Tartarella, João Borges Fortes Filho
Abstract:
Purpose: To evaluate the incidence of intra- and postoperative complications of transconjunctival 25-
gauge (25G) sutureless pars plicata lensectomy.
Methods: The medical records of patients <12 months of age with congenital cataracts who underwent 25G
sutureless lensectomy were reviewed retrospectively. Patients were evaluated at postoperative
days 1, 7, 15, 30, 60, and 90 and every 3 months thereafter. Visual acuity outcomes and intraand
postoperative complications were described and analyzed.
Results: A total of 72 eyes of 44 infants were included; 28 patients (64%) had bilateral cataract. Median
follow-up was 28 months (range, 12-93 months). In 47 eyes (81%) there was improved visual
acuity after surgery. Intraoperative adverse events occurred in 9 eyes (13%). Postoperative
complications occurred in 14 eyes (19%): 6 eyes (8%) had secondary visual axis opacification, 6
eyes (8%) had secondary glaucoma, 1 eye (1%) had posterior synechiae, and 1 eye (1.4%) had
retinal detachment.
Conclusions: Transconjunctival pars plicata 25G sutureless lensectomy is a minimally invasive technique for
congenital cataract treatment. No postoperative complications were observed in 81% of eyes.
Visual acuity improved in 81% of the operated eyes.
Publicado em 2014 nos Arquivos Brasileiros de Oftalmologia
Autores: Marcia Beatriz Tartarella, Gloria Fátima Britez-Colombi, Suanne Milhomem, Márcia Cordeiro Emery Lopes, João Borges Fortes Filho
Objetivos: Avaliar as frequências do estrabismo e as características cronológica, etiológica e morfológica das cataratas pediátricas.
Métodos: Estudo retrospectivo dos prontuários de crianças atendidas no Ambulatório de Catarata Congênita do Departamento de Oftalmologia da Universidade Federal de São Paulo no período entre 2001 e 2011. Foram incluídos pacientes com diagnóstico de catarata congênita ou de desenvolvimento. Foram excluídos os pacientes com catarata traumática; secundárias a uveíte, radiação ou medicamentos; pacientes operados em outro serviço; pacientes com glaucoma; leucocorias não cristalinianas (retinoblastoma, retinopatia da prematuridade, leucocorias pré-cristalinianas), e com sub-luxação do cristalino. Foram avaliadas: as frequências cronológicas, etiológicas e morfológicas das cataratas; a lateralidade e a ocorrência de estrabismo associado nestes pacientes.
Resultados: Foram incluídos 207 pacientes. Cento e dezessete (56,5%) apresentavam catarata congênita e 90 (43,5%) apresentavam catarata de desenvolvimento. Cento e nove (52,6%) pacientes eram portadores de catarata unilateral. Quanto à morfologia, 72 crianças (33,8%) apresentavam catarata zonular e 66 (31,9%) apresentavam catarata total. A etiologia idiopática foi a mais frequente (72,5%) afetando 150 pacientes. Foram observados 108 pacientes (52,2%) com estrabismo associado, especialmente endotropias secundárias.
Conclusões: A etiologia idiopática foi a mais frequente neste estudo. O tipo morfológico zonular foi o mais frequentemente diagnosticado. Cataratas unilaterais ocorreram mais frequentemente em pacientes com persistência da vasculatura fetal. O estrabismo associado ocorreu em 52% dos pacientes. A análise dos resultados deste estudo pode contribuir para diagnosticar a catarata pediátrica precocemente e de modo mais preciso.
Publicado em 2013 nos Arquivos Brasileiros de Oftalmologia
Autores: Marcia Beatriz Tartarella, Rodrigo Ueno Takahagi, Ana Paula Braga, João Borges Fortes Filho
ABSTRACT
Purposes: To describe ocular features, management of cataract and functional outcomes in patients with persistent fetal vasculature (PFV).
Methods: Retrospective, descriptive case series of patients with PFV. Data were recorded from the Congenital Cataract Section of Federal University of São Paulo, Brazil from 2001 to 2012. All patients were evaluated for sex, age at diagnosis, systemic findings, laterality, age at surgery, and initial and final follow-up visual acuities. Follow-up and complications after cataract surgery were recorded. Ultrasound was performed in all cases and ocular eco-doppler was performed in most.
Results: The study comprised 53 eyes from 46 patients. Age at diagnosis ranged from 5 days of life to 10 years-old (mean 22.7 months). Twenty-seven patients were male (58.7%). Persistent fetal vasculature was bilateral in 7 patients (15.2%). Forty-two eyes (79.2%) had combined (anterior and posterior forms) PFV presentation, 5 eyes (9.4%) had only anterior PFV presentation and 6 eyes (11.3%) had posterior PFV presentation. Thirty-eight eyes (71.7%) were submitted to cataract surgery. Lensectomy combined with anterior vitrectomy was performed in 18 eyes (47.4%). Phacoaspiration with intraocular lens implantation was performed in 15 eyes (39.5%), and without lens implantation in 5 eyes (13.2%). Mean follow-up after surgery was 44 months. Postoperative complications were posterior synechiae (3 cases), retinal detachment (2 cases), phthisis (3 cases), posterior capsular opacification (8 cases), inflammatory pupillary membrane (5 cases), glaucoma (4 cases), IOL displacement (1 case) and vitreous hemorrhage (2 cases). Complications were identified in 19 (50%) of the 38 operated eyes. Visual acuity improved after cataract surgery in 83% of the eyes.
Conclusions: Patients with PFV have variable clinical presentation. There is an association of PFV with congenital cataract. Severe complications are related to cataract surgery in patients with PFV, but 83% of the operated eyes improved visual acuity.
Publicado em 2012 nos Arquivos Brasileiros de Oftalmologia
Autores: Marcia Beatriz Tartarella, Glória Fátima Britez-Colombi, Marcia Motono, Martha Motono Chojniak, João Borges Fortes Filho
ABSTRACT
Purpose: To study the results of cataract surgery in children with radiation-induced cataract after treatment for retinoblastoma.
Methods: Retrospective interventional case series. Six consecutive patients diagnosed with secondary cataracts due to radiation therapy for retinoblastoma. Intervention: Phacoemulsification and foldable acrylic intraocular lens implantation. Outcomes measured: Visual acuity, binocular indirect ophthalmoscopy and slit-lamp biomicroscopy. Aspirated lens material and aqueous humor samples were collected during surgery.
Results: Six uniocular children between 3 to 5 years of age at time of surgery were studied. The mean time interval between radiotherapy and cataract diagnosis was 22.3 months. The mean follow-up after surgery was 17.2 months (range: 12 to 23 months). All eyes achieved a clear visual axis after surgery allowing monitoring the tumor status. None developed recurrence or retinoblastoma dissemination. Histopathological analysis of the aspired material showed no tumoral cells in all samples. All patients improved vision after cataract surgery.
Conclusions: Phacoemulsification with acrylic intraocular lens implantation seems to be a safe, feasible, and effective method for the removal of radiation-induced cataracts in patients with treated retinoblastoma.
Publicado em 2012 no Clinical Ophthalmological
Autores: Marcia Beatriz Tartarella, Glória Fátima Britez-Colombi, João Borges Fortes Filho
ABSTRACT
Background: To present a clinical report of 10 patients presenting leukocoria without lens opacification or retrolental abnormalities and to propose a classification for the leukocorias.
Methods: An institutional and retrospective study including a case series of patients assisted in the Congenital Cataract Section of Federal University of São Paulo, Brazil, during the period between 2005 and 2010 with pre-lenticular leukocoria and clear lens.
Results: Ten patients younger than 4 years of age presented the diagnosis of unilateral pre-lenticular opacities without cataract. Echography in all patients revealed no posterior segment or lens abnormalities in the affected eye. Among the patients, 2 presented juvenile xanthogranuloma with secondary pupillary membrane, 1 had persistent fetal pupillary membrane, 1 had pre-lenticular membrane due to congenital toxoplasmosis, 2 had idiopathic pre-lenticular membrane formation, 1 had anterior chamber inflammatory membrane due to hyphema caused by intraocular (iris) hemangioma, 1 had limbal dermoid cyst associated to pupillary membrane, 1 had central corneal scar (leukoma) and 1 had anterior segment persistent fetal vasculature.
Conclusions: This group of children presented unilateral pre-lenticular leukocoria without lens opacification or posterior segment abnormalities. Different etiologies were associated with this condition. The exact diagnosis is important in order to avoid clear lens extraction. A classification of leukocorias is proposed herein including: pre-lenticular leukocorias, lenticular leukocorias, retrolenticular leukocorias, mixed presentation leukocorias, and pseudophakic or aphakic leukocorias.