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Article: Optic Nerve Sheath Fenestration as Adjuvant Treatment for Severe Pseudotumor Cerebri Syndrome Induced by All-Trans Retinoic Acid.

Hokazono, Kenzo / Cunha, Leonardo Provetti / Preti, Rony Carlos / Cabral Zacharias, Leandro / Ribeiro Monteiro, Mário Luiz

Case reports in ophthalmology

2023 Volume 14, Issue 1, Page(s) 326–330

Abstract: All-trans retinoic acid (ATRA) is a vitamin A derivative which can increase intracranial pressure, causing visual loss and papilledema. Those patients should be treated similarly to others patients with idiopathic intracranial hypertension. We described ... ...

Abstract	All-trans retinoic acid (ATRA) is a vitamin A derivative which can increase intracranial pressure, causing visual loss and papilledema. Those patients should be treated similarly to others patients with idiopathic intracranial hypertension. We described a case of a 32-year-old woman presenting with severe visual loss and intracranial hypertension induced by ATRA for acute promyelocytic leukemia, which was treated clinically and with optic nerve sheath fenestration. Patients receiving ATRA therapy should be monitored to neurological and ophthalmic signs and symptoms of intracranial hypertension.
Language	English
Publishing date	2023-07-12
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2577666-6
ISSN	1663-2699
ISSN	1663-2699
DOI	10.1159/000531001
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Article ; Online: A importância da tomografia de coerência óptica no papiledema

Leonardo Provetti Cunha

Revista Brasileira de Oftalmologia, Vol 74, Iss 5, Pp 273-

2015 Volume 274

Keywords	Ophthalmology ; RE1-994 ; Medicine ; R
Language	Portuguese
Publishing date	2015-10-01T00:00:00Z
Publisher	Sociedade Brasileira de Oftalmologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Correlation between retinal sensitivity assessed by microperimetry and structural abnormalities on optical coherence tomography after successful epiretinal membrane surgery.

Matos, Aline Mota Freitas / Defina, Raphael Lucas Sampaio / Costa-Cunha, Luciana Virgínia Ferreira / Zacharias, Leandro Cabral / Preti, Rony Carlos / Monteiro, Mário Luiz Ribeiro / Cunha, Leonardo Provetti

International journal of retina and vitreous

2024 Volume 10, Issue 1, Page(s) 24

Abstract: Background: To verify the correlation between retinal sensitivity (RS) assessed by the microperimetry (MP) and optical coherence tomography (OCT) parameters measured in eyes submitted to pars-plana vitrectomy (PPV) for idiopathic epiretinal membrane ( ... ...

Abstract	Background: To verify the correlation between retinal sensitivity (RS) assessed by the microperimetry (MP) and optical coherence tomography (OCT) parameters measured in eyes submitted to pars-plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) treatment. Methods: 43 patients underwent PPV. Best-corrected visual acuity (BCVA) and OCT imaging were acquired preoperatively and 6 months after surgery. The RS values were recorded 6 months after the surgery. Total macular thickness (TMT) measurements and OCT-evaluated structural findings were also analyzed. The MP examination tested 44 points, with direct topographic correspondence with the OCT-ETDRS map. Correlations between BCVA, RS, and OCT parameters were assessed. Results: TMT measurements in patients were significantly thicker preoperatively and reduced after surgery. All patients demonstrated BCVA improvements after surgery. The RS parameters after surgery were significantly lower in patients. For OCT structural analyses, patients with lower RS at the fovea correlated with the preexisting disorganization of retinal inner layers (DRIL). In addition, lower RS values were associated with DRIL, outer retinal changes (ORC), and intraretinal microcysts after surgery. Conclusions: The RS values after surgery were significantly lower when compared to controls. The DRIL presence before and after surgery, and microcysts and ORC after surgery were related to worse visual outcomes.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2836254-8
ISSN	2056-9920
ISSN	2056-9920
DOI	10.1186/s40942-024-00542-8
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Article: Optical coherence tomography detection of retinal neural loss in patients with tuberous sclerosis.

Dias, Paula Basso / Linhares, Anna Carolina Badotti / Urzedo, Ana Barbara Dias Lopes / Preti, Rony Carlos / Zacharias, Leandro Cabral / Cunha, Leonardo Provetti / Monteiro, Mário Luiz Ribeiro / Hokazono, Kenzo

International journal of retina and vitreous

2024 Volume 10, Issue 1, Page(s) 15

Abstract: Purpose: Tuberous Sclerosis (TS) is a rare, multisystem genetic disease caused by mutations in the TSC1 and TSC2 genes, leading to abnormalities in cell differentiation and proliferation. This study aimed to evaluate the neural integrity of individuals ... ...

Abstract	Purpose: Tuberous Sclerosis (TS) is a rare, multisystem genetic disease caused by mutations in the TSC1 and TSC2 genes, leading to abnormalities in cell differentiation and proliferation. This study aimed to evaluate the neural integrity of individuals with TS by using Optical Coherence Tomography (OCT) to examine the peripapillary retinal nerve fiber layer (RNFL) thickness and the macular thickness in patients with TS and to compare with healthy controls. Methods: Peripapillary and macular OCT scans (Optopol Revo NX SD OCT) were performed on 41 eyes from 22 TS patients, divided into two groups based on the presence of retinal hamartomas, and compared to 20 eyes from a control group. The average peripapillary RNFL thickness was measured for each quadrant. The macular total thickness and ganglion cell layer (GCL) + inner plexiform layer (IPL) thickness were measured based on the Early Treatment Diabetic Retinopathy Study (ETDRS) map. All measurements were then compared between the groups and controls. Results: The TS group showed significantly reduced RNFL thickness and macular thickness when compared to the control group. Specifically, patients with retinal hamartomas exhibited an even more pronounced thinning of both RNFL and macular thickness. Conclusions: These findings suggest that TS patients undergo significant changes in retinal neurodevelopment and experience axonal loss. This finding may have significant prognostic utility regarding central nervous system degeneration in TS, particularly among patients with retinal hamartomas. OCT may serve as a valuable tool for assessing axonal structural abnormalities in TS patients. Trial registration number: Not applicable.
Language	English
Publishing date	2024-02-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2836254-8
ISSN	2056-9920
ISSN	2056-9920
DOI	10.1186/s40942-024-00535-7
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Article: Simultaneous Unilateral Abducens Nerve Palsy and Contralateral Anterior Ischaemic Optic Neuropathy as the Presenting Signs of Giant Cell Arteritis.

Ariello, Leonardo E / de Souza Andrade, Thais / Mello, Luiz Guilherme Marchesi / Oyamada, Maria Kiyoko / Cunha, Leonardo Provetti / Monteiro, Mário L R

Neuro-ophthalmology (Aeolus Press)

2022 Volume 47, Issue 2, Page(s) 88–92

Abstract: Ischaemic optic neuropathy is the most common, feared, and recognised ocular manifestation of giant cell arteritis (GCA), while extraocular muscle palsy rarely occurs in the disease. Overlooking the diagnosis of GCA in aged patients with acquired ... ...

Abstract	Ischaemic optic neuropathy is the most common, feared, and recognised ocular manifestation of giant cell arteritis (GCA), while extraocular muscle palsy rarely occurs in the disease. Overlooking the diagnosis of GCA in aged patients with acquired diplopia and strabismus is not only sight- but also life-threatening. Here, we present, for the first time, a case of unilateral abducens nerve palsy and contralateral anterior ischaemic optic neuropathy as the presenting signs of GCA in a 98-year-old woman. Prompt diagnosis and treatment prevented further visual loss and systemic complications and allowed for rapid resolution of the abducens nerve palsy. We also aim to discuss the possible pathophysiological mechanisms of diplopia in GCA and to emphasise that acquired cranial nerve palsy must raise suspicion of this severe disease in elderly patients, particularly in association with ischaemic optic neuropathy.
Language	English
Publishing date	2022-09-07
Publishing country	England
Document type	Case Reports
ZDB-ID	604820-1
ISSN	1744-506X ; 0165-8107
ISSN (online)	1744-506X
ISSN	0165-8107
DOI	10.1080/01658107.2022.2107686
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Article: Relationship between automated choroidal thickness measurements and retinal sensitivity using microperimetry in patients with myopia and different stages of myopic maculopathy.

da Silva, Fillipe de Biaggi Borges / Silva, Luis Claudio Pimentel / Cunha, Leonardo Provetti / Zacharias, Leandro Cabral / Navajas, Eduardo V / Monteiro, Mario L R / Preti, Rony C

International journal of retina and vitreous

2024 Volume 10, Issue 1, Page(s) 26

Abstract: Purpose: To assess the relationship between macular choroidal thickness (CT) measurements and retinal sensitivity (RS) in eyes with myopia and different stages of myopic maculopathy.: Methods: A masked, cross-sectional, and consecutive study ... ...

Abstract	Purpose: To assess the relationship between macular choroidal thickness (CT) measurements and retinal sensitivity (RS) in eyes with myopia and different stages of myopic maculopathy. Methods: A masked, cross-sectional, and consecutive study involving patients with emmetropia/myopia (control group) and high myopia (HM) eyes. Automated choroidal thickness (CT) and manual outer retinal layer (ORL) thickness were acquired using swept-source optical coherence tomography, while retinal sensitivity (RS) assessed by microperimetry (MP3) in all regions of the macular Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Comparisons were made between groups, and correlations were performed among these measurements, demographic and ocular parameters and myopic maculopathy classification. Results: A total of 37 (74 eyes) patients were included in the study. The mean age was 39 ± 13 years, and 28 patients (76%) were female. HM eyes exhibited inferior best-corrected visual acuity and a more advanced myopic maculopathy classification compared to the control group. The mean macular CT were 255 and 179 μm in the control and HM eyes (P < 0.001), respectively. In the HM eyes, superior ETDRS region presented the greatest values. Mean RS in control and HM groups was 28 and 24 dB (P = 0.001), respectively. Inner temporal followed by superior, were the regions of higher RS. Mean ORL thickness was 83 and 79 μm (P < 0.001), in the control and HM groups, respectively. The inner temporal ETDRS region presented the thickest measure. CT correlated significantly with RS (r = 0.41, P < 0.001) and ORL thickness, (r = 0.58, P < 0.001), which also correlated with RS (r = 0.40, P < 0.001). Spherical equivalent, axial length and myopic maculopathy stage were the parameters that most correlated with CT, RS and ORL thickness. For every 100 μm increase in thickening of CT there was an average increase of 3.4 μm in ORL thickness and 2.7 dB in RS. Myopic maculopathy classification demonstrated influence only with CT. Conclusion: Myopia degree is related to ORL and choroidal thinning and deterioration of retinal sensitivity in some ETDRS regions of the macula. Choroidal thinning is associated to with a decline of retinal sensitivity, thinning of ORL, and worsening of myopic maculopathy classification, so new treatments are necessary to prevent myopia progression.
Language	English
Publishing date	2024-03-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2836254-8
ISSN	2056-9920
ISSN	2056-9920
DOI	10.1186/s40942-024-00541-9
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Article ; Online: Morning glory disc anomaly associated with large facial infantile hemangioma as the presenting signs of PHACE syndrome.

Hokazono, Kenzo / Okuyama, Vinícius Tadashi / Cunha, Leonardo Provetti / Monteiro, Mário Luiz Ribeiro

Arquivos brasileiros de oftalmologia

2020 Volume 83, Issue 4, Page(s) 338–341

Abstract: Infantile hemangioma, the most common benign tumor in infancy, is usually an isolated condition occurring in many different locations in the body. However, large infantile hemangioma may be associated with other systemic malformations, including central ... ...

Abstract	Infantile hemangioma, the most common benign tumor in infancy, is usually an isolated condition occurring in many different locations in the body. However, large infantile hemangioma may be associated with other systemic malformations, including central nervous system, cerebrovascular, cardiac, and ophthalmology abnormalities, a condition termed PHACE syndrome. In this paper, we describe a case of PHACE syndrome that was presented with the unique association of a large facial infantile hemangioma and morning glory anomaly.
MeSH term(s)	Abnormalities, Multiple/diagnosis ; Aortic Coarctation/complications ; Eye Abnormalities/complications ; Eye Abnormalities/diagnosis ; Eye Neoplasms/complications ; Eye Neoplasms/diagnosis ; Hemangioma/complications ; Hemangioma/diagnosis ; Humans ; Infant ; Neurocutaneous Syndromes/complications
Language	English
Publishing date	2020-07-29
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	603915-7
ISSN	1678-2925 ; 0004-2749
ISSN (online)	1678-2925
ISSN	0004-2749
DOI	10.5935/0004-2749.20200071
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Article ; Online: Severe bilateral visual loss as the first sign of IgA nephropathy.

Cunha, Leonardo Provetti / Defina, Raphael Lucas Sampaio / Preti, Rony Carlos / Costa-Cunha, Luciana Virgínia Ferreira / Zacharias, Leandro Cabral / Hokazono, Kenzo / Monteiro, Mário Luiz Ribeiro

Arquivos brasileiros de oftalmologia

2022

Abstract: We describe a case of a 33-years-old woman who presents with severe acute bilateral visual loss secondary to massive exudative hypertensive maculopathy as the first sign of immunoglobulin A nephropathy. The patient's ophthalmic examination showed ... ...

Abstract	We describe a case of a 33-years-old woman who presents with severe acute bilateral visual loss secondary to massive exudative hypertensive maculopathy as the first sign of immunoglobulin A nephropathy. The patient's ophthalmic examination showed bilateral cotton-wool spots, flame-shaped retinal hemorrhages, diffuse narrow arterioles, optic disk edema, and exudative maculopathy. Systemic workup demonstrated a systolic and diastolic blood pressure of 240 mmHg and 160 mmHg, respectively, proteinuria, and hematuria, suggesting kidney disease as the causative condition. A kidney biopsy confirmed immunoglobulin A nephropathy. She was treated with systemic corticosteroids, antihypertensive drugs, and a single bilateral intravitreal injection of aflibercept. There was a prompt resolution of macular edema and vision improvement. Our case draws attention to the fact that severe bilateral visual loss can be the first sign of severe hypertension. Secondary causes, such as immunoglobulin A nephropathy, should be ruled out.
Language	English
Publishing date	2022-07-15
Publishing country	Brazil
Document type	Letter
ZDB-ID	603915-7
ISSN	1678-2925 ; 0004-2749
ISSN (online)	1678-2925
ISSN	0004-2749
DOI	10.5935/0004-2749.2021-0314
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Article ; Online: Optical coherence tomography in neurodegenerative disorders.

Cunha, Leonardo Provetti / Pires, Leopoldo Antônio / Cruzeiro, Marcelo Maroco / Almeida, Ana Laura Maciel / Martins, Luiza Cunha / Martins, Pedro Nascimento / Shigaeff, Nadia / Vale, Thiago Cardoso

Arquivos de neuro-psiquiatria

2022 Volume 80, Issue 2, Page(s) 180–191

Abstract: Background: Structural imaging of the brain is the most widely used diagnostic tool for investigating neurodegenerative diseases. More advanced structural imaging techniques have been applied to early or prodromic phases, but they are expensive and not ... ...

Abstract	Background: Structural imaging of the brain is the most widely used diagnostic tool for investigating neurodegenerative diseases. More advanced structural imaging techniques have been applied to early or prodromic phases, but they are expensive and not widely available. Therefore, it is highly desirable to search for noninvasive, easily accessible, low-cost clinical biomarkers suitable for large-scale population screening, in order to focus on making diagnoses at the earliest stages of the disease. In this scenario, imaging studies focusing on the structures of the retina have increasingly been used for evaluating neurodegenerative diseases. The retina shares embryological, histological, biochemical, microvascular and neurotransmitter similarities with the cerebral cortex, thus making it a uniquely promising biomarker for neurodegenerative diseases. Optical coherence tomography is a modern noninvasive imaging technique that provides high-resolution two-dimensional cross-sectional images and quantitative reproducible three-dimensional volumetric measurements of the optic nerve head and retina. This technology is widely used in ophthalmology practice for diagnosing and following up several eye diseases, such as glaucoma, diabetic retinopathy and age-related macular degeneration. Its clinical impact on neurodegenerative diseases has raised enormous interest over recent years, as several clinical studies have demonstrated that these diseases give rise to reduced thickness of the inner retinal nerve fiber layer, mainly composed of retinal ganglion cells and their axons. In this review, we aimed to address the clinical utility of optical coherence tomography for diagnosing and evaluating different neurodegenerative diseases, to show the potential of this noninvasive and easily accessible method.
MeSH term(s)	Humans ; Neurodegenerative Diseases/diagnostic imaging ; Neurodegenerative Diseases/pathology ; Retina/diagnostic imaging ; Retina/pathology ; Tomography, Optical Coherence/methods
Language	English
Publishing date	2022-03-29
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	418916-4
ISSN	1678-4227 ; 0004-282X
ISSN (online)	1678-4227
ISSN	0004-282X
DOI	10.1590/0004-282X-ANP-2021-0134
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Article ; Online: Morphofunctional evaluation of peripapillary retinoschisis associated with myopic posterior staphyloma and hyaloid traction: does it cause peripapillary vitreoretinal traction?

Borges, Fillipe B / Zacharias, Leandro Cabral / Pimentel, Sergio Luis Gianotti / Cunha, Leonardo Provetti / Monteiro, Mário Luis Ribeiro / Preti, Rony Carlos

Arquivos brasileiros de oftalmologia

2022

Abstract: This case report presents the details of a 33-year-old female patient who was referred to a specialized retina service because of mild vision loss in her right eye). The patient's visual acuity was 20/25 in right eye and 20/50 in the left eye (; ... ...

Abstract	This case report presents the details of a 33-year-old female patient who was referred to a specialized retina service because of mild vision loss in her right eye). The patient's visual acuity was 20/25 in right eye and 20/50 in the left eye (; amblyopic); the spherical equivalent was -12.75 diopters (right eye) and -14.75 diopters (left eye). Multimodal retinal imaging showed peripapillary schisis in both the inner and outer retinal layers, grade II posterior vitreous detachment, and a tessellated fundus. Using Humphrey perimetry and MP-3 microperimetry, the functional evaluation indicated macular sensitivity within normal limits and decreased sensitivity in the peripapillary region, especially in right eye. The pattern-re versal visual evoked potential was measured. The N75 and P100 latency and amplitude in right eye were within normal values for checks of 1º. However, the amplitude was low for checks of 15'. Highly myopic patients who have posterior staphyloma that involves the optic nerve are susceptible to posterior hyaloid traction, and the resulting peripapillary vitreous traction may compromise vision.
Language	English
Publishing date	2022-09-23
Publishing country	Brazil
Document type	Letter
ZDB-ID	603915-7
ISSN	1678-2925 ; 0004-2749
ISSN (online)	1678-2925
ISSN	0004-2749
DOI	10.5935/0004-2749.2021-0377
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