PUBLICAÇÕES

Publicado em 2019 nos Arquivos Brasileiros de Oftalmologia Authors: Patricia Zanotelli Cagliari, Vanessa Carvalho Lucas, Isabela Carolina Borba, Danieli Mayumi Kimura Leandro, Carmem Luiza Gascho, Tiago Neves Veras, Jean Carl Silva, João Borges Fortes Filho RESUMO Objetivos: Avaliar a sensibilidade, especificidade e os valores de pontos de corte do ROPScore, um escore baseado em fatores de risco cumulativos capaz de prever a ocorrência da retinopatia da prematuridade em prematuros de baixo peso no sul do Brasil. Métodos: Estudo retrospectivo por meio de análise de prontuários de todos os prematuros com peso ao nascer ≤1500g e/ou idade gestacional ≤32 semanas selecionados para retinopatia da prematuridade em duas instituições brasileiras entre agosto de 2009 e dezembro de 2015. Resultados: O estudo incluiu 322 pacientes. A média do peso ao nascer foi de 1181,8 ± 292,5 gr e a idade gestacional média foi de 29,5 ± 2,3 semanas. A incidência de retinopatia da prematuridade em qualquer estágio e retinopatia da prematuridade grave foi de 68,3% e 17%, respectivamente. Os valores do ROPScore variaram de 8,7 a 19,9. O melhor ponto de corte para sensibilidade e especificidade foi estabelecido em 11 para retinopatia da prematuridade em qualquer estágio e 14,5 para retinopatia da prematuridade grave. Para retinopatia da prematuridade em qualquer estadiamento, o ROPScore apresentou sensibilidade de 98,6% (95%IC 97,9-99,3) e especificidade de 35,3% (95%IC 32,3-38,3), valor preditivo positivo (VPP) de 76,6% (95%IC 74,0-79,2) e valor preditivo negativo de 92,3% (IC95% 90,6-94,0). Para retinopatia da prematuridade grave, foi registrada sensibilidade de 100%, especificidade de 57,3% (95%IC 54,2-60,4), valor preditivo positivo de 22% (95%IC 19,4- 4,6)e valor preditivo negativo de 100%. Os pontos de corte identificaram corretamente todos os pacientes que desenvolveram qualquer estágio ou retinopatia da prematuridade grave no estudo. Conclusão: O ROPScore foi importante para detectar pacientes prematuros com risco de retinopatia da prematuridade. Nesta população, o ROPScore detectou todos os pacientes em risco para qualquer retinopatia da prematuridade em estágio e retinopatia da prematuridade grave. Este estudo mostrou valores semelhantes aos descritos anteriormente, validando com sucesso a ROPScore para detecção precoce de retinopatia da prematuridade em prematuros de muito baixo peso.

Publicado em 2019 na Ophthalmology Retina Authors: Odalis Arámbulo, MD, Gabriel Dib, MD, Juan Iturralde, MD, Miguel Brito, MD, João B. Fortes Filho, MD, PhD ABSTRACT ​ Purpose: To assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II, and of aggressive posterior ROP treated with a single dose of intravitreal ranibizumab (IVR) as monotherapy. ​ Design: Retrospective study. Participants: The study included premature babies diagnosed with aggressive posterior ROP or ROP 3þ in zone I or posterior zone II. Methods: Intravitreal injection of 0.25 mg (0.025 mL) ranibizumab was performed in the operating room. A disposable 1-mL syringe with a 30-gauge needle was used. Main Outcome Measures: Favorable outcome was considered regression of ROP after treatment (meaning regression of the retinal neovascularization and plus disease). Unfavorable outcome was progression to stages 4 and 5 of ROP. Results: The study included 43 infants (85 eyes). The mean birth weight and gestational age were 1276302 g and 29.72.0 weeks, respectively. The mean postmenstrual age at ROP diagnosis was 362.7 weeks and at treatment was 37.22.2 weeks. All 85 eyes demonstrated total regression of plus disease after a single dose of IVR. Twelve infants (29.2%) developed full vascularization of the peripheral retina in both eyes. Twenty-two infants (43 eyes [53.6%]) developed ROP reactivation at a mean interval of 7.13 weeks (range, 3e15 weeks) after IVR and needed rescue laser treatment of the peripheral avascular retina. The mean postmenstrual age at rescue laser was 433.2 weeks (range, 35.5e54.5 weeks). Six patients (11.6%) had persistent peripheral avascular retina in zone II for >6 months (or 24 weeks) after IVR treatment. Conclusions: Although there was complete regression of plus disease in all treated eyes, only 29.2% of the patients reached complete peripheral retinal vascularization. There was a disease reactivation in 53.6% of the patients and they needed additional laser therapy. The results of IVR treatment in severe ROP, even when initial control of the disease was achieved, did not eliminate the risk of late reactivation of the disease by retinal neovascularization. Some of the treated patients may achieve a permanent interruption in the development of the peripheral retinal vascularization.

Publicado en 2019 Capítulo do Livro Retinopatia del Prematuro editado pela Sociedad Panamericana de Retinopatía del Prematuro SP-ROP e lançado durante o XXIV Congresso Panamericano de Oftalmologia em Cancun, México. "Prevalencia y tamizaje de la retinopatía del prematuro en América Latina" Autores: João Borges Fortes Filho y Luz Consuelo Zepeda Romero

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.

Capítulo do Livro Oftalmologia Pediátrica publicado pelo Conselho Brasileiro de Oftalmologia CBO em 2017 FACOMATOSES OU HAMARTOMATOSES ​ Autores: João Borges Fortes Filho, Marcia Beatriz Tartarella, Bárbara Gastal Borges Fortes

Capítulo do Livro Oftalmologia Pediátrica editado pelo Conselho Brasileiro de Oftalmologia CBO em 2017 PERSISTÊNCIA DA VASCULATURA FETAL Autores: João Borges Fortes Filho, Marcia Beatriz Tartarella, Bárbara Gastal Borges Fortes

Publicado em 2017 no E-Oftalmo Retinopathy of Prematurity Retinopatia da prematuridade Retinopatía de la Precocidad Authors: Márcia Beatriz Tartarella. Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil e João Borges Fortes Filho. Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil. ABSTRACT This study discusses current aspects regarding retinopathy of prematurity (ROP), a clinical disorder that leads to the highest number of children in the world becoming blind. This emphasizes the importance of screening for the disease in all preterm infants with a very low birth weight, identifying retinopathy at a proper time, and treating it using laser at about 37 weeks post-conception while there is still a chance for treatment, which should preferably be conducted during the child stay at the Neonatology Center. The first ophthalmic examination should be performed using binocular indirect ophthalmoscopy, with dilated pupils, between 4 and 6 weeks after birth in all newborns weighing 1,500 g or less and/or at the gestational age of 32 weeks or less, as proposed by the Brazilian Guidelines for ROP Screening and Detection. The follow-up of children with or without retinopathy should be conducted periodically until vascularization of Zone 3 temporal retina is normalized, and this normalization should be maintained during the first years of life for the prevention of amblyopia and strabismus and for the correction of refractive errors related to prematurity.

Publicado em 2017 no E-Oftalmo Prelenticular leukocorias Leucocorias pré-cristalinianas Leucocoria Precristaliniana Authors: Márcia Beatriz Tartarella. Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil e João Borges Fortes Filho. Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, RS, Brazil. ABSTRACT Purpose: To present a clinical report of patients with prelenticular leukocoria. Methods: Retrospective study included patients with an initial diagnosis of unilateral leukocoria referred for pediatric cataract surgical treatment during the period between 2005 and 2015 at São Paulo-SP, Brazil. Complete ophthalmological evaluation was performed. Results: Seven patients younger than 4 years were evaluated to determine the need for cataract surgery. Slit-lamp biomicroscopy evaluation disclosed two patients with juvenile xanthogranuloma and inflammatory pupillary membrane, threewith secondary inflammatory pupillary membrane caused by idiopathic anterior uveitis, one with prelenticular leukocoria due to presumed congenital toxoplasmosis, and one with an inflammatory membrane due to repeated hyphema caused by iris hemangioma. In all these cases, ultrasonographic examination did not show retinal or lens abnormalities in the affected eye. Conclusion: All patients presented unilateral prelenticular leukocoria with clear lens, requiring no cataract removal.

Publicado em 2017 no E-Oftalmo Recommendations for Refractive Error in Preverbal Children Recomendações sobre refração em crianças pré-verbais Recomendaciones sobre refracción en niños pre-verbales Authors: Márcia Beatriz Tartarella. Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil. ​ Rosane Cruz Ferreira. Universidade Federal de São Paulo - UNIFESP, São Paulo-SP, Brasil. Islane Maria de Castro Verçosa. Hospital Geral de Fortaleza - HGF, Fortaleza, CE, Brasil. João Borges Fortes Filho. Faculdade de Medicina da Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil. ABSTRACT Uncorrected refractive errors in children may generate abnormalities in visual function and affect their future academic studies, as well as their neuromotor development. Refractive errors are easy to diagnose and correct. An ophthalmologic examination with visual acuity measurements should be performed to arrive at a diagnosis of refractive error. Lenses should then be prescribed which could minimize these serious consequences for childhood development.

Publicado em 2015 no Clinical Ophthalmology Authors: Odalis Arámbulo, Gabriel Dib, Juan Iturralde, Fahir Duran, Miguel Brito, João Borges Fortes Filho Abstract Purpose: This study aims to assess outcomes of severe ROP in zone I or posterior zone II treated with intravitreal ranibizumab (IVR) as monotherapy or combined with laser photocoagulation. Methods: Study included patients in two groups: Group 1 included patients that received only IVR treatment. Group 2, divided in Group 2A included patients with IVR as initial treatment and complementary laser photocoagulation if retinal neovascularization or plus disease did not regress; Group 2B included patients with initial laser photocoagulation and IVR as rescue. Favorable outcomes were regression of the retinal neovascularization and plus disease meaning control of the disease. Unfavorable outcomes were progression to stages 4 and 5 of ROP. Results: Fifty-seven eyes were included. Mean birth weight and gestational age were 1,281 ± 254 grams and 29.5 ± 2.1 weeks, respectively. Sixteen eyes included group 1 with favorable outcomes in 14 eyes (87.5%). Forty-one eyes comprised group 2 with favorable outcome in 29 eyes (70.7%), in a mean follow-up period of 12.8 months. Conclusion: Intravitreal ranibizumab was effective to treat severe cases of ROP as a primary or a combined treatment. Forty-three of 57 treated eyes (75.4%) achieved regression of ROP and favorable outcomes.

Publicado em 2014 nos Arquivos Brasileiros de Oftalmologia Autores: Márcia 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, Márcia 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 2013 no Clinics Autores: Marlene Coelho da Costa, Gabriela Unchalo Eckert, Bárbara Gastal Borges Fortes, João Borges Fortes Filho, Rita C. Silveira, Renato S. Procianoy ABSTRACT Background: Ophthalmologic examination for retinopathy of prematurity (ROP) is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed in order to reduce pain during eye examination. Purpose: To evaluate the use of oral 25% glucose solution to relief pain during ophthalmologic examinations for ROP. Methods: A masked randomized clinical trial with the use of 1 ml of oral 25% glucose solution once 2 minutes before the first ophthalmologic examination for ROP was carried out between March 2008 and April 2010 comparing with a control group that did not receive oral glucose solution. Pain was evaluated by Neonatal Infant Pain Scale (NIPS) immediately before and immediately after the ophthalmologic examination in both groups. Results: One hundred and twenty four patients who were examined for the first time for ROP were included. Seventy were included in intervention group and 54 in control group. The number of patients with pain immediately before the procedure was similar in both groups, and after ophthalmologic examination was: intervention group 15.7% and control group 68.5% (P<0.001). Conclusions: One ml of oral 25% glucose solution given 2 minutes before the ophthalmologic examination for ROP was an effective measure for pain relief.

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 Clinics Autores: Rodrigo Leivas Lindenmeyer, Lucas Farias, Taís Mendonça, João Borges Fortes Filho, Renato Soibelmann Procianoy, Rita C. Silveira ABSTRACT Objective: To evaluate intraocular pressure in very low birth weight preterm infants and correlate it with the postconceptional age. Methods: A longitudinal and prospective cohort study evaluated weekly measurements of intraocular pressure in very low birth weight premature infants (defined as birth weight ≤1,500 g and/or gestational age ≤32 weeks) admitted to Hospital de Clínicas de Porto Alegre, Brazil. The evaluated outcome was the variation of intraocular pressure according to the postconceptional age (defined as the gestational age at birth plus the age in weeks at the time of examination) in the weeks following preterm birth. Statistics: Mixed-effects models were used for the statistical analysis to determine intraocular pressure variation according to postconceptional age. Means, 10th and 90th percentiles were calculated for intraocular pressure values. Results: Fifty preterm infants, with a mean gestational age of 29.7 ± 1.6 weeks and mean birth weight of 1,127.7 ± 222.7 g, were evaluated. Mean intraocular pressure in the whole cohort considering both eyes was 14.9 ± 4.5 mmHg, and 13.5% of all measurement values were greater than 20 mmHg. The analysis revealed a mean intraocular reduction of 0.29 mmHg for each increase of postconceptional (P=0.047; 95% CI: -0.58 to -0.0035). Mean intraocular pressure (P10-P90) decreased from 16.3 mmHg (10.52-22.16) at 26.3 weeks to 13.1 mmHg (7.28-18.92) at 37.6 weeks of postconceptional age. Conclusions: Mean intraocular pressure in very low birth weight preterm infants was 14.9 ± 4.5 mmHg. This value decreases by 0.29 mmHg per week as the postconceptional age increases.

Publicado em 2012 no Clinical Ophthalmology 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 2012 no Eye (London) Autores: Gabriela Unchalo Eckert, João Borges Fortes Filho, Mauricio Maia, Renato Soibelmann Procianoy ABSTRACT Aims: This study describes the development of a score based on cumulative risk factors for the prediction of severe retinopathy of prematurity (ROP) comparing the performance of the score against the birth weight (BW) and gestational age (GA) in order to predict the onset of ROP. Methods: A prospective cohort of preterm infants with BW ≤1,500 g and/or GA ≤32 weeks was studied. The score was developed based on BW, GA, proportional weight gain from birth to the 6th week of life, use of oxygen in mechanical ventilation, and need for blood transfusions from birth to the 6th week of life. The score was established after linear regression, considering the impact of each variable on the occurrences of any stage and severe ROP. Receiver operating characteristic (ROC) curves were used to determine the best sensitivity and specificity values for the score. All variables were entered into an Excel spreadsheet (Microsoft) for practical use by ophthalmologists during screening sessions. Results: The sample included 474 patients. The area under the ROC curve for the score was 0.77 and 0.88 to predict any stage and severe ROP, respectively. These values were significantly higher for the score than for BW (0.71) and GA (0.69) when measured separately. Conclusions: ROPScore is an excellent index of neonatal risk factors for ROP, which is easy to record and more accurate than BW and GA to predict any stage ROP or severe ROP in preterm infants. The scoring system is simple enough to be routinely used by ophthalmologists during screening examination for detection of ROP.

Publicado em 2011 no Clinical Ophthalmology Autores: Mário Martins dos Santos Motta, João Borges Fortes Filho, Jacqueline Coblentz, Claudia Amaral Fiorot

Publicado em 2011 no Journal of Pediatrics Autores: João Borges Fortes Filho, Marlene Coelho da Costa, Gabriela Unchalo Eckert, Paula Gabriela Batista de Souza, Rita C. Silveira, Renato Soibelmann Procianoy ABSTRACT Objective: To study the influence of the presence of maternal preeclampsia on the occurrence of any stage and severe retinopathy of prematurity. Methods: A prospective cohort study from 2002 to 2009 included 324 preterm neonates with birth weight ≤1,500 grams and gestational age ≤32 weeks. Multiple maternal and perinatal factors were analyzed for association and confounding. Multiple logistic regression analysis was used. Results: Mean birth weight was 1,128 240 grams, and mean gestational age 29.7 1.9 weeks. 24 newborns (7.4%) presented severe retinopathy of prematurity; 97 any stage of retinopathy and 227 no retinopathy of prematurity at all. Preeclampsia and complete antenatal steroid course had 60% and 54% reduction in risk for any stage of retinopathy of prematurity, respectively. Preeclampsia had 80% reduction in risk for severe retinopathy of prematurity. Conclusions: Preeclampsia lowered the risk for occurrence of any stage and severe retinopathy of prematurity in very low birth weight infants.

Publicado em 2011 no Clinical Ophthalmology Autores: Juliana Zimmermann Carrion, João Borges Fortes Filho, Marcia Beatriz Tartarella, Andrea Araújo Zin, Ignozy Dorneles Jornada Jr

Publicado em 2011 no Clinical Ophthalmology Autores: Carmen Sílvia Bongiovanni, Carla Cristina Serra Ferreira, Ana Paula Silvério Rodrigues, João Borges Fortes Filho, Marcia Beatriz Tartarella.

Publicado em 2011 no European Journal of Ophhalmology Autores: Roberto Freda, Melissa M. Dal Pizzol, João Borges Fortes Filho ABSTRACT Purpose: A case of Phialemonium curvatum wound corneal infection after phacoemulsification is reported. Methods: A case report Results: The marked aggressiveness of this fungus is demonstrated by the absence of therapeutic response to both medical and surgical treatment. Conclusions: The poor outcome resulted in evisceration of the affected eye.

Publicado em 2011 no IOVS - Investigative Ophthalmology & Visual Science Autores: Rita C. Silveira, João Borges Fortes Filho, Renato Soibelmann Procianoy