Livros e Capítulos de Livros - LIM/33
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A coleção de Livros e Capítulos de Livros reúne capítulos e resumos de obras produzidas por autores do sistema FMUSP-HC que inclui a Faculdade de Medicina da Universidade de São Paulo (FMUSP), o Hospital das Clínicas da FMUSP e demais institutos associados.
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- Assessing Keratoconus Progression(2022) TZELIKIS, P. F.; SILVA, L. N. P.; ROCHA, G.A variety of methods have been described to both evaluate and document keratoconus progression. In a clinical practice, the ophthalmologist usually evaluates two scans of a patient performed a few months apart to estimate if there is a progression of the disease. Today, besides corneal keratometry, there are many other parameters that are also examined in order to evaluate if the keratoconus is progressing, including change in best-corrected distance visual acuity (CDVA) or uncorrected distance visual acuity (UDVA), manifest refraction, change on the posterior elevation maps, reduction in apical corneal thickness, increase in anterior corneal asymmetry, index of surface variance (ISV), the index of height decentration (IHD), and the maximum anterior saggital curvature (Kmax). In this chapter, we describe in more detail the possible options of markers or indices that can be used to identify keratoconus progression. We also present the reasons why Belin ABCD progression display can be a good option for the diagnosis of keratoconus change. The advantage of using such a wide number of indexes is to provide reproducible and comparable measurements at different time intervals. We support what many authors have just recently published regarding performing more than one imaging at a time to create reliable results (minimal 3 images, ideally 5 images) and recommend evaluating at least two parameters. Only a deep knowledge of the meaning of all these indexes and values increases reliability in the evaluation of keratoconus progression. Further prospective studies are needed to confirm the importance, applicability, and consistency of each index. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
- Clinical Presentation and Evolution of Keratoconus(2022) CRESTA, F. B.; ORLANDIN, L. F.; LUCAS, M. B.Corneal ectasia is a group of disorders affecting the shape of the cornea. Keratoconus is the most common primary ectasia. It usually appears in the second decade of the life and affects both genders and all ethnicities. It is bilateral, usually asymmetric, and characterized by central or paracentral stromal thinning and protrusion that leads to a conical shape. Corneal thinning is thought to be related to a combination of increased activity of stromal proteinase enzymes and decreased proteinase inhibitors with subsequent reduced biomechanical stability. Visual loss occurs primarily from irregular astigmatism and myopia, and secondarily from corneal scarring. Ocular signs and symptoms vary depending on disease severity. The disease process results in mild to marked impairment of the quality of vision. Particular risk factors include vigorous eye-rubbing especially related to ocular allergies. Irregular “scissor” reflex in retinoscopy, “oil droplet” reflex, Rizzuti’s sign, Munson’s sign, Vogt’s striae, and Fleischer’s ring are some of the clinical signs of keratoconus. It is usually diagnosed during the first or second decade of life and progresses until the third or fourth decade when stabilization is expected. Corneal topography and tomography are the usual methods for the early detection and monitoring its progression. When progression stops, clinical features can range from mild irregular astigmatism to severe thinning, protrusion, and scarring requiring keratoplasty. Several classifications have been proposed based on morphology, disease evolution, ocular signs, and index-based systems. Keratoconus is one of the main reasons for keratoplasty in the developed world, although this demand is decreasing with the onset of corneal collagen crosslinking. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
- Corneal Collagen Cross-Linking Controversies(2022) CRESTA, F. B.; SIMONCELLI, R.; LUCAS, M. B.Corneal collagen cross-linking (CXL) has been shown to be a safe and effective surgery to halt the progression of keratoconus. Keratoconus (KC) is a bilateral, asymmetric, noninflammatory, and progressive corneal ectasia. It results in corneal thinning and protrusion leading to myopia and irregular astigmatism. In the past, corneal transplantation was the only surgical option for visual recovery of advanced cases. The conventional or Dresden corneal collagen cross-linking protocol (C-CXL) includes removal of the central corneal epithelium (8–9 mm diameter) followed by soaking the stroma with the photosensitizer riboflavin (vitamin B2). After 30 min of soaking, the stroma is irradiated with ultraviolet-A during 30 minutes (3mW/cm2; total energy 5.4 J/cm2). This leads to the formation of reactive oxygen species (ROS) and a photochemical reaction that induces collagen covalent bonds, with consequent stiffening and strengthening of the cornea. Conventional protocol (C-CXL) is time-consuming and can lead to complications due to the removal of the epithelium. Since the first publication in 2003, corneal collagen cross-linking has evolved with new treatment options. Cross-linking in pediatric patients, the use of oral riboflavin, and transepithelial, accelerate, and pulsed protocols are still controversial about its safety and effectiveness. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
bookPart 0 Citação(ões) na Scopus Vogt-Koyanagi-Harada disease(2011) CARVALHO, J. F. de; SOUZA, A. W. de; YAMAMOTO, J. H.; APPENZELLER, S.The term panuveitis is reserved for diseases that involve all segments of the uveal tract, including the retina and vitreous body. It is usually associated with severe sight-threatening inflammatory response. The common causes of panuveitis in our population are tuberculosis, syphilis, Vogt-Koyanagi-Harada disease, sympathetic ophthalmia, Behçet’s disease and sarcoidosis. Vogt-Koyanagi-Harada disease (VKH) is a multisystem autoimmune disorder affecting pigmented tissues such as the eye, auditory, integumentary and central nervous systems. Patients are typically females between 20 to 50 years old with no previous history of penetrating ocular trauma. Despite the increasing reports published about the clinical features of VKHdisease in various ethnic populations, the etiology of VKH disease is still not completely known. Clinical, laboratorial, experimental data corroborate to the autoimmune nature of VKH disease in a genetically susceptible individual. A stepwise approach is essential while evaluating these patients to be able to identify and treat the disease timely and adequately. Ancillary tests can be appropriately applied once the clinical diagnosis is made. Treatment is based on initial high-dose oral corticosteroids with a low tapering during a minimum period of 6 months. Systemic immunomodulatory agents such as cyclosporine may be used in refractory or corticosteroid non-tolerant patients. Visual prognosis is usually good under a prompt diagnosis and adequate treatment. The aim of this paper is to review the latest research results on VKH disease in order to help to understand better this potentially blinding disease and to improve treatment. © 2011 Nova Science Publishers, Inc.- Intrastromal Corneal Rings and Photorefractive Keratectomy(2022) GIACOMIN, N. T.; STIVAL, L. R. S.The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. ICRS implantation can improve the corneal shape and hence the visual quality and reduce the refractive error; PRK can treat part of the refractive error. The prior use of ICRS induces corneal flattening and reduces keratometric astigmatism allowing a controlled PRK treatment with minimal tissue ablation. Although a combination of PRK + ICRS when associated to CXL demonstrated to be an effective and safe option for correcting mild refractive errors and improving visual acuity, studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
- Natural Progression of Keratoconus(2022) SANTHIAGO, M. R.Keratoconus is an asymmetrical and progressive bilateral corneal ectasia that usually begins in the second decade of life. The inflammatory process’s role in the corneal structural changes present in keratoconus has already been described by quantifying altered levels of inflammatory cytokines in the tear film. It is known that changes in the maximum keratometry value are significantly correlated with changes in the central and thinnest thickness of the cornea and the thinnest epithelial thickness. In general, the steepening and stromal thinning are accompanied by epithelial thinning at the keratoconus’ apex in its natural progression. In conclusion, we realize that many metrics are helpful in monitoring keratoconus. Progressions in 1 year above 1D of Kmax, 0.7 Kmean, thinning of 10 in the thinnest pachymetry, myopic variation in the SE of 0.75D, or loss of two or more lines of vision suggest advancement beyond the natural history, and corneal crosslinking (CXL) is recommended to interrupt the progression if vision is 20/25 or worse. Besides, it is advised to consider CXL in patients under 18 years of age at diagnosis, given the progression speed in this group, if the vision is 20/25 or worse. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
- The Role of Thyroid Gland Dysfunction in the Development of Keratoconus(2022) STIVAL, L. R. S.; GIACOMIN, N. T.; SANTHIAGO, M. R.The number of studies on the development of thyroid gland dysfunction and keratoconus highlights the multifactorial nature of the disease. Many factors seem to be related to keratoconus, such as genetic predisposition, inflammatory markers, environmental conditions, eye rubbing, and metabolic and structural changes, in addition to systemic diseases and hormonal changes. There seems to be evidence that hormonal changes caused by thyroid gland dysfunction are additional factors that, through influencing the corneal structure, could affect keratoconus progression. Thyroid hormones are regulated by the pituitary axis of the thyroid (HPT) and can be imbalanced, besides primary genetic defects, by activating factors that alter homeostasis such as pregnancy, thyroidectomy, or iodine therapy. In this chapter, we emphasize the scientific evidence related to thyroid hormones and the possible correlation to keratoconus. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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