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 2017 no JAAPOS: Journal of American Academy of Pediatric Ophthalmology & Strabismus

Authors: Islane Verçosa, Paula Carneiro, Reno Verçosa, Renata Girão, Erlane M. Ribeiro, André Pessoa, Nadia G. Almeida, Paloma Verçosa e Marcia Beatriz Tartarella

Abstract:

Purpose: To describe and analyze ocular features in infants with microcephaly due to presumed congenital Zika syndrome.

Methods: Ophthalmologic evaluation, including indirect ophthalmoscopy and eye fundus imaging, visual acuity testing with Teller Acuity Cards, and strabismus assessment were performed in infants with microcephaly at a nongovernmental organization clinic for visually disabled children.

Results: A total of 70 infants with microcephaly were referred to the clinic. Of these, 25 (mean age, 3 months; 14 males) had ophthalmologic changes: 18 (26%) had intraocular abnormalities, including macular chorioretinal atrophy, mottled retinal pigment epithelium and optic nerve pallor; 7 patients (10%) had strabismus or nystagmus without intraocular abnormalities. Visual acuity was below normal range in all 11 infants tested.

Conclusions: Ophthalmologic abnormalities occurred in 36% of the patients. Macular circumscribed chorioretinal atrophy, focal mottled retinal pigment epithelium, optic nerve pallor, early-onset strabismus, nystagmus and low visual acuity were common ophthalmological features in infants with microcephaly due to presumed congenital Zika syndrome. 

Publicado em 2015 nos Arquivos Brasileiros de Oftalmologia

Autores: Maira SA Morales, Marcia Beatriz Tartarella, Enéias B Gouveia, Maria Helena Mandello, Norma Allemann

Resumo:

A Persistência do vítreo primário hiperplasico (PHPV) é uma malformação vítreo-retiniana, caracterizada por uma falha na regressão do vítreo primário. A maioria dos casos é unilateral e esporádica. A forma bilateral é rara (2,4%), podendo associar-se a outras alterações oculares e sistêmicas. É a segunda causa mais comum de catarata adquirida no primeiro ano de vida. A papila de Bergmeister por sua vez ocorre devido à falta de regressão do tecido glial durante o 7º mês gestacional. A associação do PHPV com a papila de Bergmeister ocorre geralmente com a artéria hialóidea ocluída, em raros casos existe esta associação com a artéria pérvia. O objetivo é documentar um caso de PHPV com papila de Bergmeister e artéria hialóide pérvia que teve seu diagnóstico conclusivo feito pelo Doppler colorido. Relatamos um caso de uma criança de 8 meses, sexo feminino, que apresentava leucocoria unilateral, em olho esquerdo, com pequeno desvio ocular percebido pelo pediatra e encaminhada para avaliação oftalmológica. Essa criança apresentava ao exame fundoscópico massa branca sobre o nervo óptico, que se estendia à retina adjacente. Foi solicitado ultra-som que manteve dúvida com as seguintes hipóteses diagnósticas: PHPV, granuloma (toxocaríase), harmartoma e retinoblastoma. O diagnóstico só foi estabelecido com a realização do Doppler colorido que evidenciou fluxo sangüíneo no interior da membrana, confirmando o diagnóstico de persistência hiperplásica do vítreo primário associada à papila de Bergmeister.

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 2014 no International Journal of Ophthalmology

Autores: João Borges Fortes Filho, Maurício Maia, Marcia Beatriz Tartarella, Fabíola Schons Meyer, Bárbara Gastal Borges Fortes, Lúcia Maria Kliemann

ABSTRACT

AIM: To evaluate histopathological retinal and renal response after one single dose of intravitreous injection of antiangiogenic drugs ranibizumab and bevacizumab in rats. 

METHODS: Experimental study in 60 days of life adults Wistar rats. Ten animals were included. Group 1 included 5 animals that were injected with 1µL ranibizumab 1.25mg in the right eye and with 1µL of balanced salt solution (BSS) in the left eye, as control; Group 2 included 5 animals that were injected with 1 µl of bevacizumab in the right eye and with 1µL of BSS in the fellow eye. All injections were performed with Hamilton syringes. After 15 days of the interventions, all animals were sacrificed in CO 2 chamber. Both eyes were enucleated and one kidney was removed, fixed and embedded in paraffin for histopathological analysis by optic microscopy. For statistical purposes the initial expected abnormal histopathological responses were defined as 0%. 

RESULTS: Atypical histopathological retinal response was detected in 2 eyes injected with ranibizumab (40%) as well as in 2 control eyes in group 1. Same was detected in 1 eye injected with bevacizumab (20%) as well as in1 control eye, in group 2. The noted atypical findings were lymphocytes and eosinophils in the vitreous posterior cavity and mild retinal inflammatory reaction with ganglion cell layer edema but without clinical significance. No atypical histopathological renal response was detected. 

CONCLUSIONS: Unexpected atypical histopathological retinal response without clinical significance was observed in 3 eyes injected with antiangiogenic drugs (2 in group 1 and 1 in group 2) as well as in 3 control eyes (2 in group 1 and 1 in group 2). No atypical renal response was detected suggesting no extra ocular involvement of the intravitreous injected antiangiogenic drugs. 

 

Publicado em 2013 no Journal of Tropical Pediatrics


Autores: João Borges Fortes Filho, Bárbara Gastal Borges Fortes, Marcia Beatriz Tartarella, Renato Soibelmann Procianoy

SUMMARY

Objectives: This study evaluated the incidence and risk factors for severe retinopathy of prematurity (ROP) in babies <1,000g at Porto Alegre, Brazil.

Methods: Prospective cohort study including premature children with birth weight ≤1,000g. Main outcome was the occurrence of severe ROP needing treatment.

Results: A total of 157 infants were included. Severe ROP occurred in 20 infants (12.7%). Nineteen patients were treated by laser photocoagulation. Main risk factors for severe ROP were gestational age at birth (P=0.029), infant’s weight measured at 6th week of life (P<0.001) and number of days of oxygen-therapy under mechanical ventilation (P<0.001). After logistic regression infant’s weight at 6th week of life and number of days in mechanical ventilation were associated to severe ROP.

Conclusions: We reported the incidence of 12.7% of severe ROP among babies born ≤1,000 g in our institution. Laser photocoagulation was effective to stabilize the disease among 19 treated patients.

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.

Publicado em 2011 no Clinical Ophthalmology

Autores: Juliana Zimmermann Carrion, João Borges Fortes Filho, Marcia Beatriz Tartarella, Andrea Araújo Zin, Ignozy Dorneles Jornada Jr

ABSTRACT

The purpose of this work was to review the studies published over the last 10 years concerning the prevalence of retinopathy of prematurity (ROP) in Latin American countries, to determine if there was an improvement in ROP prevalence rates in that period, and to identify the inclusion criteria for patients at risk of developing ROP in the screening programs.

A total of 33 studies from ten countries published between 2000 and 2010 were reviewed.

Prevalence of any ROP stage in the regions considered ranged from 6.6% to 82%; ROP severe enough to require treatment ranged from 1.2% to 23.8%.

There was no routine screening for ROP, and there was a lack of services for treatment of the disease in many countries.

Inclusion criteria for patients in the studies ranged between birth weight >1500 g and <2000 g and gestational age >32 and <37 weeks.

Use of different inclusion criteria regarding birth weight and gestational age in several Latin American studies hindered comparative analysis of the published data.

Highly restrictive selection criteria for ROP screening in relation to birth weight and gestational age should not be used throughout most Latin American countries because of their different social characteristics and variable neonatal care procedures.

The studies included in this review failed to provide adequate information to determine if the prevalence of ROP has decreased in Latin America.

Publicado em 2011 nos Arquivos Brasileiros de Oftalmologia

Autores: João Borges Fortes Filho, Gabriela Unchalo Eckert, Marcia Beatriz Tartarella, Renato Soibelmann Procianoy

ABSTRACT

Retinopathy of prematurity (ROP) is related to oxygen-regulated vascular endothelial growth factor and to insulin-like growth factor-I.

After premature birth, supplemental oxygen induces a retinal hyperoxic condition with vasoconstriction and to a definitive interruption of retinal vasculogenesis.

Peripheral ischemia may stimulate retinal neovascularization and the onset of additional ROP-related complications.

The natural course of the disease may result in irreversible blindness if not promptly diagnosed and attended.

Recently, a significant increase in the prevalence of ROP has been observed in survival rates of preterm infants, especially in emerging-economy countries in Latin America, Asia, and Eastern Europe.

This article addresses the main preventive measures in ROP.

Publicado em 2011 no Clinical Ophthalmology

Autores: Carmen Silvia Bongiovanni, Carla Cristina Serra Ferreira, Ana Paula Silvério Rodrigues, João Borges Fortes Filho, Marcia Beatriz Tartarella

ABSTRACT

Knobloch syndrome is an autosomal recessive disorder associated with early-onset ocular abnormalities and central nervous system malformations.

Ocular abnormalities are usually severe, and include high myopia, vitreoretinal degeneration, retinal detachment, macular abnormalities, and cataract.

The most frequent systemic changes are midline malformations of the brain, ventricular dilation, and occipital encephalocele. Cognitive delay may occur. We report a case of cataract in a child with Knobloch syndrome.
Cataract surgery and follow-up are described.

Publicado em 2009 nos Arquivos Brasileiros de Oftalmologia

Autores: Marcia Caires Bestilleiro Lopes, Solange Rios Salomão, Adriana Berezovvsky, Marcia Beatriz Tartarella

RESUMO

Objetivo: Avaliar a qualidade de vida relacionada à visão em crianças com catarata congênita bilateral, utilizando o Questionário de Função Visual Infantil (QFVI).

Métodos: O QFVI possui duas diferentes apresentações: crianças menores e maiores de 3 anos, sendo dividido em seis domínios: saúde geral, saúde geral da visão, competência, personalidade, impacto familiar e tratamento. O QFVI foi aplicado aos pais/cuidadores/responsáveis de crianças com catarata congênita bilateral do Instituto da Visão da Universidade Federal de São Paulo. As notas encontradas nos domínios foram comparadas entre os grupos controle - crianças com visão normal (n=32, média da idade=38 meses; dp=17,3) e experimental - crianças com catarata congênita (menores de 3 anos, n=19, idade média=14,6 meses; dp=10,7 e maiores de 3 anos, n=18, idade média=4,4 anos; dp=1,5, alocados segundo o grau de comprometimento visual em n=16 - sem deficiência visual; n=10 - deficiência visual leve; n=11 - deficiência
visual grave). Para a análise estatística foram utilizados os testes t e análise de variância (ANOVA).

Resultados: O grupo experimental apresentou redução estatisticamente significativa em todos os domínios do
questionário, quando comparado ao grupo controle. O domínio competência apresentou-se com baixa nota havendo redução estatisticamente significante de acordo com a gravidade da deficiência visual (ANOVA
F 5,1, p=0,01; teste de Tukey p<0,01), assim como a nota composta total (ANOVA F 5,4, p=0,01; teste de Tukey p=0,01/0,05).

Conclusões: A catarata congênita bilateral influencia na qualidade de vida relacionada à visão em crianças, confirmada pelos baixos valores obtidos nos domínios estudados, mais evidentemente no domínio competência. O QFVI mostrou-se um importante instrumento para avaliar e mensurar o impacto do comprometimento visual causado pela catarata congênita bilateral na qualidade de vida.