David Leonardo Cruvinel Isaac’s research while affiliated with Federal University of Goiás and other places

Background: The aim of this study was to compare vascular density (VD) and foveal avascular zone (FAZ) using optical coherence tomography angiography (OCTA) in patients with type 2 diabetes mellitus (DM) without signs of diabetic retinopathy (DR) with non-diabetic patients. Methods: A total of 26 type 2 DM and 17 non-diabetic subjects were included in a case-control study. All subjects underwent OCTA (DRI OCT-1 SS TRITON PLUS; Topcon, Tokyo, Japan). Average vessel density (VD) in superficial capillary plexus (SCP), deep capillary plexus (DCP), FAZ area (mm2) in SCP, and FAZ area (mm2) in DCP were included in the analysis. The comparisons were evaluated using the analysis of variance (ANOVA) and Tukey’s post hoc test. Results: Parafoveal vessel density in both SCP and DCP decreased in eyes without clinical DR compared to non-diabetic controls (p < 0.001). Statistical significance was also observed when comparing controls with patients diagnosed with type 2 DM 5-10 years ago (p < 0.001), controls with patients diagnosed with type 2 DM more than 10 years ago (p < 0.001), and patients diagnosed with type 2 DM 5-10 years ago with those diagnosed more than 10 years ago (p < 0.001). In addition, the FAZ area in both plexuses increased in case eyes compared to controls (p < 0.001). However, there was no significance of FAZ area in SCP when comparing cases diagnosed between 5-10 years ago to those diagnosed more than 10 years ago (p = 0.06). Conclusion : It was demonstrated that OCTA can detect preclinical DR before the manifestation of clinically apparent retinopathy in diabetic eyes, especially in long-term diagnosed disease. In type 2 DM patients without DR, SCP and DCP were affected, and the changes were progressive and significant with increasing time to diagnosis. Our results suggest that OCTA may be a promising tool for regular screening of diabetic eyes for DR.

Purpose: To determine the influence of strabismus and its surgical correction on the preoperative and postoperative functional and psychosocial aspects of patients being treated at the CEROF/UFG Strabismus Outpatient Clinic. Methods: This prospective cross-sectional study included 27 patients, aged >7 years that were divided into two groups (<18 years and >18 years). The AS 20 questionnaire is composed of two domains (psychosocial and functional). Each domain includes 10 questions, which should be answered using a 5-point Likert scale. The questionnaire was administered preoperatively and 3 months postoperatively. In patients aged <18 years, the questionnaire was concurrently administered to their parents and/or guardians. Results: Preoperatively, the average psychosocial and functional scores were 55 (p=0.01) and 57.5 (p=0.025), respectively, in adults, 70 (p=0.03) and 78.7 (p=0.16), respectively, in children and adolescents, and 46.2 (p=0.002) and 57.5 (p=0.003), respectively, in the parents and/or guardians. Postoperatively, the average psychosocial and functional scores were 80 (p=0.01) and 82.5 (p=0.025), respectively, in adults, 81.2 (p=0.03) and 85 (p=0.16), respectively, in children and adolescents, and 83.7 (p=0.002) and 86.2 (p=0.003), respectively, in parents and/or guardians. Conclusion: The postoperative scores in the psychosocial (p=0.001), functional (p=0.001) and general (p<0.001) domains had increased in all the patients, demonstrating an improvement in the quality of life following strabismus correction surgery.

Background: This study compares the preparation time and the macroscopic integrity of Descemet membrane and endothelium keratoplasty (DMEK) grafts prepared using the modified submerged cornea using backgrounds away (SCUBA) technique compared to those prepared with a newly developed artificial chamber device specifically designed for DMEK preparation. Research design and methods: This is a prospective, comparative, randomized, and experimental study. Fifty corneas from 25 donors were used. The inclusion criteria were that both eyes were of the same donor, a scleral ring greater than 3 mm, and corneas unsuitable for clinical use. Preparation time and macroscopic tissue integrity were evaluated at the end of preparation. Results: The mean preparation time for both techniques was six minutes (p=0.2). The macroscopic integrity of the graft was similar between the inverted artificial chamber device and the modified SCUBA technique (p=1.00). Conclusions: The upside-down artificial chamber operating with the upside-down cornea proved reproducible and macroscopically suitable for endothelial graft preparation for the DMEK technique.

Background The purpose of this study was to compare the impact of intravitreal dexamethasone (DEX) implant during a 12-month period in nondiabetic and diabetic patients without diabetic retinopathy (DR) as a treatment for refractory pseudophakic cystoid macular edema (PCME) following prior treatment with topical nepafenac 0.1% and prednisolone 1%. Methods Forty-two consecutive medical records of patients diagnosed with PCME after uneventful cataract surgery were included. The outcomes measured included best corrected visual acuity (BCVA) and central foveal thickness (CFT). Linear regression analysis was statistically applied. Results Following topical treatment, nondiabetic and diabetic subjects presented a mean ± SD gain of − 0.11 ± 0.11 and − 0.18 ± 0.11 BCVA logMAR and a CFT reduction of − 43.42 ± 53.66 µm and − 58.76 ± 36.28 µm, respectively. The mean BCVA gain at month 12 subsequent to DEX implantation was − 0.35 ± 0.17 in nondiabetic (p < 0.001) and − 0.55 ± 0.26 in diabetic patients (p < 0.001), with CFT reductions of − 195.71 ± 93.23 µm (p < 0.001) and − 260.81 ± 198.69 µm (p < 0.001), respectively. Patients who responded with better VA after topical treatment presented better visual outcomes at month 12 following DEX implantation (r ² = 0.46; rho = − 0.71, p < 0.01). Conclusion Nondiabetic and diabetic patients without DR demonstrated similar results after DEX implant after combined topical therapy, suggesting that selected diabetic patients may have a response comparable to that of nondiabetic patients with PCME.

Combined hamartoma of the retina and retinal pigment epithelium is a rare, benign intraocular tumor. Hamartoma of the retina and retinal pigment epithelium has been described in the literature as a condition presenting with variable retinal damage, ranging from partial epiretinal involvement to complete distortion of the retinal layers and retinal pigment epithelium. We report the case of an 8-year-old girl presenting with longstanding strabismus who was diagnosed with Hamartoma of the retina and retinal pigment epithelium based on multimodal imaging assessment. We explored the particular imaging findings from studies using spectral-domain optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography, and fluorescein angiography. Keywords: Hamartoma/diagnosis; Retinal pigment epithelium; Retinal neoplasm; Tomography, optical coherence; Angiography; Humans; Case report

Despite notable efforts and significant therapeutical advances, age‐related macular degeneration remains the single most common reason for vision loss. Retinal progenitor cells (RPCs) are considered promising candidates for cellular treatments that repair and restore vision. In this allogenic study, the phenotypic profile of pig and human RPCs derived using similar manufacturing processes is compared. The long‐term (12‐week) survival of green fluorescent protein‐pig retinal progenitor cells GFP‐pRPC after subretinal transplantation into normal miniature pig (mini‐pig) retina is investigated. Human eyes are both anatomically and physiologically mimicked by pig eyes, so the pig is an ideal model to show an equivalent way of delivering cells, immunological response and dosage. The phenotypic equivalency of porcine and clinically intended human RPCs was established. Thirty‐nine mini‐pigs are used in this study, and vehicle‐injected eyes and non‐injected eyes serve as controls. Six groups are given different dosages of pRPCs, and the cells are found to survive well in all groups. At 12 weeks, strong evidence of integration is indicated by the location of the grafted cells within the neuro‐retina, extension of processes to the plexiform layers and expression of key retinal markers such as recoverin, rhodopsin and synaptophysin. No immunosuppression is used, and no immune response is found in any of the groups. No pRPC‐related histopathology findings are reported in the major organs investigated. An initial dose of 250 k cells in 100 µl of buffer is established as an appropriate initial dose for future human clinical trials.

ABSTRACT We report the case of a 39-year-old male patient who presented with visual loss in the right eye for 6 weeks. The best-corrected visual acuity was counting fingers in the right eye and 20/30 in the left eye. The fundus examination demonstrated a right retinal detachment inferiorly extending to the fovea and a left macular serous detachment. After multimodal imaging study, the patient was diagnosed as having a bullous variant of central serous chorioretinopathy and treated with oral spironolactone associated with adjuvant laser photocoagulation. The retinal changes resolved after 6 months. The final visual acuity was 20/20 in both eyes.