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Supplemental material, sj-pdf-2-ejo-10.1177_11206721211019580 for In-vitro assessment of release of silicone oil droplets with the use of variety of syringes and needles used in intravitreal injections by Natasha Ferreira Santos da Cruz, Lydianne Lumack do Monte Agra, Christine Probst, Luiz Henrique Lima, John F. Carpenter, Mauricio Maia, Michel Eid Farah and Gustavo Barreto Melo in European Journal of Ophthalmology

Supplemental material, sj-pdf-1-ejo-10.1177_11206721211019580 for In-vitro assessment of release of silicone oil droplets with the use of variety of syringes and needles used in intravitreal injections by Natasha Ferreira Santos da Cruz, Lydianne Lumack do Monte Agra, Christine Probst, Luiz Henrique Lima, John F. Carpenter, Mauricio Maia, Michel Eid Farah and Gustavo Barreto Melo in European Journal of Ophthalmology

Supplemental material, sj-pdf-2-ejo-10.1177_11206721211019580 for In-vitro assessment of release of silicone oil droplets with the use of variety of syringes and needles used in intravitreal injections by Natasha Ferreira Santos da Cruz, Lydianne Lumack do Monte Agra, Christine Probst, Luiz Henrique Lima, John F. Carpenter, Mauricio Maia, Michel Eid Farah and Gustavo Barreto Melo in European Journal of Ophthalmology

Supplemental material, sj-pdf-1-ejo-10.1177_11206721211019580 for In-vitro assessment of release of silicone oil droplets with the use of variety of syringes and needles used in intravitreal injections by Natasha Ferreira Santos da Cruz, Lydianne Lumack do Monte Agra, Christine Probst, Luiz Henrique Lima, John F. Carpenter, Mauricio Maia, Michel Eid Farah and Gustavo Barreto Melo in European Journal of Ophthalmology

Supplemental Material, sj-docx-1-tpx-10.1177_0192623320968079 for Nonclinical Toxicology and Biocompatibility Program Supporting Clinical Development and Registration of the Port Delivery System With Ranibizumab for Neovascular Age-Related Macular Degeneration by Vladimir Bantseev, Joshua Horvath, Giulio Barteselli, Shrirang Ranade, Mauricio Maia, Daniela Bumbaca Yadav, Chris Schuetz, Amy Shelton and Helen S. Booler in Toxicologic Pathology

Soraya Horowitz1, Nadyr A Damasceno1, Felipe Muralha2, Maurício B Pereira3, Mauricio Maia2, Eduardo F Damasceno3 1Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil; 2Department of Ophthalmology, The Universidade Federal de São Paulo, Brazil; 3Department of Ophthalmology, Universidade Federal Fluminense, Niterói, BrazilCorrespondence: Eduardo F DamascenoMarques do Paraná, 303 Niteroi, 20530050 BrazilTel +55 212 562 2343Email e_damasceno@yahoo.comPurpose: To evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony.Methods: This observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal–Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony.Results: Sclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening.Conclusion: Diathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant (P

PurposeTo evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions.MethodsRetrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period.ResultsA total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up.ConclusionThis is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.

Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p

Purpose: In 2015, a twenty-fold increase in the prevalence of microcephaly in Brazil was reported, and the Ministry of Health associated this abnormal prevalence with the maternal-fetal Zika virus (ZIKV) transmission. Methods: We assessed the ophthalmological findings of ten mothers and their infants that had been clinically diagnosed with ZIKV-related microcephaly and presented ocular abnormalities, born from May to December 2015. Results: Seven mothers (70.0%) referred symptoms during pregnancy (malaise, rash and arthralgia), of which six (85.7%) were in the first trimester. At the time of exam, no ophthalmological abnormalities were identified in the mothers and they did not report ocular symptoms during pregnancy. Serology was negative in all infants for Toxoplasmosis, Rubella, Cytomegalovirus, Syphilis and Human Immunodeficiency Viruses. Ocular findings included macular alterations (gross pigment mottling and/or chorioretinal atrophy) in fifteen eyes (75.0%), and optic nerve abnormalities (hypoplasia with double-ring sign, pallor, and/or increased cup-to-disk ratio) in nine eyes (45.0%). Conclusions: Patients presented normal anterior segment and important macular and optic nerve abnormalities. Further studies will assess the visual significance of these alterations. RESUMO Introdução: No ano de 2015, foi identificado no Brasil um aumento da prevalência de microcefalia em vinte vezes. Esta malformação foi associada pelo Ministério da Saúde à transmissão vertical do Zika vírus (ZIKV). Método: Investigamos dez lactentes com diagnóstico clínico presumido de microcefalia relacionada à ZIKV, que apresentavam anormalidades oculares, nascidos entre maio e dezembro de 2015. Resultados: Sete mães (70,0%) relataram sintomas (mal-estar, rash e artralgia) durante a gestação, sendo seis (85,7%) no primeiro trimestre. No dia da avaliação nenhuma alteração ocular foi identificada nas mães e elas não relataram sintomas oculares durante a gestação. Sorologia foi negativa para toxoplasmose, rubéola, citomegalovírus, sífilis e vírus da imunodeficiência adquirida (HIV) em todos os lactentes. Os achados oculares incluíram alterações maculares (depósito pigmentar grosseiro e/ou atrofia coriorretiniana) em 15 olhos (75,0%) e alterações do nervo óptico (hipoplasia do disco com sinal do duplo anel, palidez e/ou aumento da escavação papilar) em nove olhos (45,0%). Conclusões: Os pacientes apresentaram segmento anterior normal e importantes e anormalidades maculares e do nervo óptico. Estudos futuros vão avaliar a importância destas alterações visuais.

Purpose: To describe the natural history of eyes with symptomatic idiopathic vitreomacular traction (VMT). Methods: Retrospective multicenter study of 168 eyes with spectral-domain optical coherence tomography (SD-OCT) findings consistent with idiopathic VMT. All eyes were graded according to SD-OCT findings. Grade 1 was defined as incomplete cortical vitreous separation with foveal attachment. Grade 2 was defined as Grade 1 plus intraretinal cysts or clefts. Grade 3 was defined as Grade 2 plus a foveal detachment. All patients were followed for at least 6 months. Results: There were 168 patients (51 men) with a mean age of 68.8 ± 10.7 years. Patients were followed for a mean of 22.7 ± 20.1 months. The mean duration of symptoms before the initial presentation was 3.65 ± 5.42 months. At baseline, 72 eyes had Grade 1, 74 eyes had Grade 2, and 22 eyes had Grade 3 SD-OCT findings. Over the follow-up period, 36 eyes (21.4%) had spontaneous resolution of the VMT with normalization of the foveal anatomy. The mean time to resolution was 12.3 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of the eyes, with 6 eyes developing a lamellar macular hole and 7 eyes developing a full-thickness macular hole. This occurred at a mean of 10.3 ± 10.7 months after the presentation. Subgroup analysis based on baseline SD-OCT grade showed that 4.1% (3 of 73) of Grade 1 eyes compared with 6.8% (5 of 74) of Grade 2 eyes, and 23.8% (5 of 21) of Grade 3 eyes developed a full-thickness macular hole or lamellar macular hole (P 0.0109, chi-square test). In the remaining 119 eyes, at the last follow-up, 65 eyes had Grade 1, 42 eyes had Grade 2, and 12 eyes had Grade 3 VMT. On average, the best-corrected visual acuity improved from 0.40 ± 0.35 logarithm of the minimum angle of resolution (Snellen, 20/50) at baseline to 0.35 ± 0.36 logarithm of the minimum angle of resolution (Snellen, 20/45; P 0.0372), and the mean central macular thickness improved from 350 ± 132 m to 323 ± 121 m. Conclusion: Spontaneous resolution of VMT occurred in 21.4% (36 of 168) of eyes after a mean follow-up of 11.4 ± 12.6 months. An unfavorable anatomical outcome occurred in 7.7% (13 of 168) of eyes. The baseline SD-OCT grade may predict the progression to full-thickness macular hole.

Introdução: o estresse descrito pela primeira vez por Hans Selye em 1936 ocorre devido a estímulos de agressão que desencadeiam alterações fisiológicas no organismo. As respostas podem ser positivas (eustresse) ou negativas (distresse), esta subdividida em 3 fases, de alerta, resistência e exaustão. Os fisioterapeutas que atuam na reabilitação ortopédica convivem com estressores que podem acarretar o estresse laboral. Objetivos: realizar revisão integrativa sobre o estresse em profissionais da área da saúde, com ênfase em fisioterapeutas. Definir o perfil sóciodemográfico e profissiográfico dos fisioterapeutas que atuam na reabilitação ortopédica nas cidades de Goiânia e Aparecida de Goiânia. Verificar a incidência e a associação entre o estresse e fatores presentes na atividade laboral destes fisioterapeutas. Metodologia: este trabalho foi dividido em dois estudos. O primeiro de revisão integrativa sobre o estresse nas atividades laborais do Fisioterapeuta. Inicialmente foram definidos os descritores tanto no DeCS, quanto no MeSH, logo após utilizados para levantamento de dados através das bases de dados: SciELO, LILACS, Cochrane e PubMed, durante o período de agosto de 2013 a julho de 2014. Foram encontrados 8.357 artigos, 17 foram incluídos na pesquisa após seleção primária através da data de publicação (1994 a 2014) e da língua utilizada (português, inglês e espanhol). A seleção secundária ocorreu por meio da leitura dos títulos e posteriormente dos resumos. Os artigos selecionados foram tabulados de acordo com o formato metodológico (revisão bibliográfica, qualitativo e quantitativo). O segundo estudo consistiu de pesquisa observacional, transversal, quantitativo, do qual participaram 72 fisioterapeutas, sendo 34 do sexo feminino e 39 do sexo masculino, entre 22 e 42 anos que atuam na reabilitação ortopédica nas cidades de Goiânia e Aparecida de Goiânia. Os participantes responderam um questionário sóciodemográfico e profissiográfico elaborado pelos autores e o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL). Os resultados foram quantificados e tabulados em frequência e porcentagem através do software Microsoft Office Excel 2007. A relação entre a presença de estresse e as variáveis Resumo xiv sóciodemográficas foi avaliada pelo Teste de Qui-quadrado com o software Statistical Package for the Social Sciences, versão 20 (SPSS, Chicago, IL). Resultados: o primeiro estudo encontrou 17 artigos, quatro de revisão bibliográfica, 2 de metodologia qualitativa e 11 de metodologia quantitativa. Dos artigos selecionados, 12 foram publicados na língua inglesa, um artigos em espanhol e quatro em português. Poucos artigos são encontrados sobre a presença do estresse nos fisioterapeutas, porem ele esta presente em alguns locais de trabalho. Os fatores causadores do estresse encontrados foram: ambiente de trabalho inadequado, recursos humanos insuficientes, relações entre os profissionais insatisfatórias, alto volume de atividades, tempo escasso, burocracia excessiva, conflitos de função e gestão autocrática. O segundo estudo mostra que a proporção de fisioterapeutas homens e mulheres encontrada neste trabalho foi semelhante. O perfil dos profissionais que atuam com reabilitação ortopédica na cidade de Goiânia e Aparecida de Goiânia constitui em média 22,7 anos de idade, com 4,5 anos de formado em média, que trabalham predominantemente em clínicas (38,9%), onde 69,4% de todos os fisioterapeutas avaliados não possuem carteira (CLT) assinada. O menor número de pacientes atendidos por semana foi 3 e o maior 200, com média de 56,3 pacientes por semana, 43,1% trabalham 30 horas semanais, 80,6% praticam exercícios físicos e 73,6% ganham acima de 2.490 reais mensais. A maior parte possui outra atividade laboral (75%) e 43,6% possuem titulação de especialista. Em relação a ter filhos, um número expressamente grande de 84,7% não possui filhos e 66,7% são solteiros. 62,5% acreditam que o trabalho interfere na vida pessoal e 86,1% não pensam em mudar de profissão. Dos fisioterapeutas avaliados, 33 (46%) apresentaram estresse, 2 (6%) estavam na fase de alerta, 26 (79%) na fase de resistência e 5 fisioterapeutas estavam na fase de exaustão. O local de trabalho foi a única variável que teve significância (p = 0,024) na associação com o estresse. Dentre os locais de trabalho, as clínicas foram os locais mais propícios para o surgimento do estresse nos fisioterapeutas, onde foram avaliados 28 fisioterapeutas e dentre eles 17 (24%) tinham estresse. A associação entre clínica e consultório também gerou estresse nos fisioterapeutas avaliados. Conclusão: o estresse está presente em grande parte dos profissionais da Resumo xv saúde, incluindo os fisioterapeutas devido às características da profissão. A grande maioria dos fisioterapeutas avaliados são jovens, solteiros, não possuem filhos e praticam atividades físicas. Normalmente trabalham em clínicas, fato que influenciou no surgimento do estresse. Atendem muitos pacientes e não são contratados por CLT. Costumam trabalhar pelo menos 30 horas semanais, ganham na maioria, acima de R$ 2.490 reais mensais e costumam possui mais de um emprego. A maioria possui titulação mínima de especialista e não pensam em mudar de profissão. É necessário realizar mais estudos com maior número de fisioterapeutas para verificar o papel de outros estressores, porque o estresse pode influenciar a qualidade de vida do profissional e o serviço prestado ao paciente. Introduction: Stress first described in 1936 by Hans Selye, it occurs due to stimuli that trigger the aggression physiological changes in the body. The answers can be positive (eustress) or negative (distress), this subdivided into three stages of alarm, resistance and exhaustion. Physiotherapists working in orthopedic rehabilitation coexist with stressors that can lead to job stress. Objectives: Develop an integrative review on stress in health professionals, with an emphasis on physical therapists. Define the socio demographic profile and professional characteristics of physiotherapists working in orthopedic rehabilitation in the cities of Goiânia and Aparecida de Goiânia. Determine the incidence and the association between stress and factors in the work activity of these physiotherapists. Methodology: This study was divided into two studies. The first integrative review on stress in the work activities of the physiotherapist. Initially descriptors were defined both in MeSH, as in MeSH, after used for data collection through databases SciELO, LILACS, Cochrane and PubMed, for the period August 2013 to July 2014. 8357 articles were found 17 were included in the study after primary selection by date of publication (1994-2014) and the language used (English, Portuguese and Spanish). The secondary selection occurred by reading the titles and abstracts later. Selected articles were tabulated according to the methodological format (literature review, qualitative and quantitative studies). The second study consisted of a quantitative survey, observational, cross-sectional, of which 72 physiotherapists participated, 34 females and 39 males, between 22 and 42 years who work in orthopedic rehabilitation in the cities of Goiânia and Aparecida de Goiânia. All participants completed a demographic questionnaire and professional characteristics developed by the authors and the Inventory of Stress Symptoms for Adults Lipp (ISSL). The results were quantified and tabulated in frequency and percentage using Microsoft Office Excel 2007. The software relationship between the presence of stress and sociodemographic variables were evaluated by chi-square test with the Statistical Package for the Social Sciences, version 20 (SPSS, Chicago, IL). Abstract xvii Results: The first study found 17 articles, four of literature review, two qualitative and 11 quantitative methodology. The selected articles, 12 were published in English, one in Spanish and four articles in Portuguese. Few studies are found about the presence of stress on physical therapists, however it is present in some workplaces. The factors generating stress were: inadequate work, insufficient human resources, relations between unsatisfactory professional, high-volume activities, limited time, excessive bureaucracy, conflicts of function and autocratic management environment. The second study shows that the proportion of men and women physiotherapists found in this study was similar. The Profile of professionals working with the orthopedic rehabilitation in the city of Goiânia and Aparecida de Goiânia is on average 22.7 years old with 4.5 years of graduation on average, predominantly working in clinics (38.9%), where 69.4% of all physical therapists have not evaluated CLT contract. The smaller number of patients seen per week was 3 and the highest 200, with an average of 56.3 patients per week, 43.1% worked 30 hours per week, 80.6% practice physical exercises and 73.6% earn above 2,490 actual monthly. Most have other labor activity (75%) and 43.6% have specialist titration. About having children, a large number of explicitly 84.7% do not have children, and 66.7% are single. 62.5% believe that work interferes with personal life and 86.1% did not think of changing professions. Physiotherapists evaluated, 33 (46%) had stress, 2 (6%) was in the alert phase, 26 (79%) in the resistance stage and five physiotherapists were at the stage of exhaustion. The workplace was the only variable that was significant (p = 0.024) in association with stress. Among workplaces, clinics were the most favorable sites for the emergence of stress on physical therapists, physiotherapists where 28 were evaluated and 17 of them (24%) had stress. The association between clinical practice and also generated a lot of stress on physical therapists evaluated. Conclusion: The stress is present in the majority of health professionals, including physiotherapists due to the characteristics of the profession. The vast majority of physiotherapists evaluated are young, single, have no children and do physical activities. Usually work in clinics, a fact that influenced the emergence of stress. Serve many patients and have no contract CLT. Usually work at least 30 hours per week, earning mostly above Abstract xviii 2,490 reais a month and usually has more than one job. Most have minimal titration expert and not think about changing professions. It is necessary to conduct further studies with larger numbers of physiotherapists to verify the role of other stressors, because stress can influence the quality of life of the professional and the service provided to the patient.

Relatamos o caso de uma mulher de 19 anos apresentando perda auditiva neurossensorial bilateral, anormalidades mentais e perda de campo visual no olho esquerdo. A acuidade visual era 20/20 em OD e 20/25 em OE. Paciente foi sistematicamente investigada, audiometria mostrou perda auditiva neurossensorial nos dois ouvidos e ressonância magnética nuclear (RNM) cerebral mostrou múltiplas pequenas lesões na substância branca em ambos os hemisférios cerebrais e no corpo caloso. A fundoscopia mostrou disco óptico normal bilateral, e embainhamento das arteríolas na média periferia do olho direito. Edema de retina e exsudatos algodonosos foram vistos. Angiofluoresceinografia mostrou vasculopatia arterial obstrutiva periférica bilateral. A paciente foi diagnosticada com síndrome Susac e tratada com fumarato de quetiapina, flunitrazepam e prednisona resultando em estabilização do quadro. Este caso mostra que um alto índice de suspeita levando ao reconhecimento precoce e tratamento é importante para evitar o diagnóstico tardio.

Francisco R Stefanini,1–3 Maurício Maia,1 Paulo Falabella,1–3 Marcel Pfister,2,3 Moritz Niemeyer,2 Amir H Kashani,3 Mark S Humayun,3 Michael J Koss2,3,41Retina Division, Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil; 2Doheny Eye Institute, Los Angeles, CA, USA; 3Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; 4Department of Ophthalmology, Goethe University, Frankfurt/Main, GermanyAbstract: The recent approval by the US Food and Drug Administration of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA), often associated with vitreomacular traction (VMT) and macular hole (MH), has brought new attention to the field of pharmacologic vitreolysis. The need for an enzyme to split the vitreomacular interface, which is formed by a strong adhesive interaction between the posterior vitreous cortex and the internal limiting membrane, historically stems from pediatric eye surgery. This review summarizes the different anatomic classifications of posterior vitreous detachment or anomalous posterior vitreous detachment and puts these in the context of clinical pathologies commonly observed in clinical practice of the vitreoretinal specialist, such as MH, VMT, age-related macular degeneration, and diabetic macular edema. We revisit the outcome of the Phase II studies that indicated ocriplasmin was a safe and effective treatment for selected cases of symptomatic VMA and MH. Release of VMA at day 28 was achieved by 26.5% of patients in the ocriplasmin group versus 10.1% in the placebo group (P

This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy.

O presente trabalho tem como objetivo identificar e propor ações para o desenvolvimento de líderes à motivação no uso do gerenciamento da rotina a partir das diretrizes nas empresas, partindo da premissa de que o gerenciamento da rotina só é alcançado, por líderes competentes e motivados, dispostos a receber reforços, comprometidos e disciplinados no cumprimento das atividades do PDCA no seu cotidiano. Através de uma análise entre diversos modelos de liderança e motivação nas empresas, propõe metodologia para o desenvolvimento de líderes que utilizam o gerenciamento da rotina a partir das diretrizes, utilizando como fundamento os preceitos da Liderança Situacional. O trabalho considera a idéia de que o desenvolvimento dos líderes para o gerenciamento da rotina está diretamente alinhado às ações ligadas ao comportamento de liderança acompanhado e avaliado pelo RH, orientado pelo superior imediato e apoiadas pela alta administração, dentro de um enfoque corporativo, levando em consideração as necessidades e maturidade de cada líder. Assim, partindo do diagnóstico do nível de maturidade de cada profissional, o líder imediato conduz um processo de amadurecimento do seu liderado, direcionado ao perfil do profissional desejado, que tem como objetivo desenvolver líderes no modelo de gestão direcionado para a estratégia da empresa. Os resultados obtidos no estudo de caso permitem concluir que a motivação para o gerenciamento da rotina a partir das diretrizes possui relação direta com desenvolvimento da maturidade do líder, e que é válida a proposta de aplicação da Liderança Situacional como fundamento para seu desenvolvimento

Acesso restrito: Texto completo. p. 362-368. Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2012-04-13T14:13:09Z No. of bitstreams: 1 __ac.els-cdn.com_S001448...151faa97dd61d7d13eb4203ea5c2d.pdf: 299560 bytes, checksum: 2c52cee077921206d93395e46104effc (MD5) Made available in DSpace on 2012-04-13T14:13:09Z (GMT). No. of bitstreams: 1 __ac.els-cdn.com_S001448...151faa97dd61d7d13eb4203ea5c2d.pdf: 299560 bytes, checksum: 2c52cee077921206d93395e46104effc (MD5) Previous issue date: 2010 We developed a diagnostic tool to differentiate between endophthalmitis and uveitis using Raman spectroscopy. Twenty-two New Zealand rabbits with endophthalmitis induced by Staphylococcus aureus (10 animals), noninfectious uveitis induced by lipopolysaccharide from Escherichia coli (10 animals) and controls (two animals) were analyzed. Twenty-four hours after the eyes were inoculated, iris tissue was dissected and subjected to dispersive Raman spectroscopy using an excitation source at 830 nm and a spectrograph/CCD camera to detect a Raman signal with an integration time of 50 s. With the collected spectra of endophthalmitis and uveitis, we developed a routine to classify spectra in each specimen using principal components analysis, using a leave-one-out cross-validation procedure. The mean Raman spectra of tissues with uveitis and endophthalmitis showed several bands in the region of 800e1800 cm 1, which have been attributed to nucleic acids, amino acids, proteins, and lipids. The bands at 1004, 1339, and 1555 cm 1 differed significantly (t-test, p < 0.05) between diseases. The principal components PC3 and PC4 differed significantly (ANOVA, p < 0.05) for the two tissue types, indicating that these PCs can be used to discriminate between the two diseases using Mahalanobis distance as a discriminator. This technique is useful for differentiating the spectral bands of uveitis and endophthalmitis, and the diagnostic model showed sensitivity of 89%, specificity of 100%, and accuracy of 92% using the leave-one-out cross-validation procedure. These results may be clinically relevant for differentiating endophthalmitis from uveitis, and this approach may become a noninvasive method to optimize the diagnosis of inflammatory and infectious vitreoretinal diseases.

Purpose: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (IVB) (Avastin; Genentech Inc., San Francisco, CA) (1.25 or 2.5 mg) in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Design: Retrospective, multicenter, interventional, comparative case series. Participants: We reviewed the clinical records of 180 consecutive patients (207 eyes) with subfoveal CNV secondary to AMD at 9 centers from 8 countries. Methods: Patients were treated with at least 1 injection of IVB 1.25 mg (124 eyes [59.9%]) or 2.5 mg (83 eyes [40.1%]). Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and 1-, 3-, 6-, 12-, and 24-month visits. Main Outcome Measures: Changes in BCVA and OCT. Results: The mean age of our patients was 74.3±7.5 years. The mean number of IVB injections per eye was 5.1 (range, 124 injections). In the 1.25 mg group, baseline BCVA improved from 20/235 (logarithm of the minimum angle of resolution [logMAR] 1.07) to 20/172 (logMAR 0.92) at 24 months (P less than 0.0001). Similar BCVA changes were observed in the 2.5 mg group. At baseline, the mean central macular thickness (CMT) by OCT in the 1.25 mg group was 308.4±127.52 ?m, which was reduced to 269.35±97.92 ?m, 262.1±94.81 ?m, 264.03±97.06 ?m, 245.91±89.52 ?m, and 249.27±89.14 ?m at 1, 3, 6, 12, and 24 months, respectively (P less than 0.0001). Similar changes were observed in the 2.5 mg group. In the 2.5 mg group, systemic complications included 2 new cases (2.6%) of arterial hypertension, 1 case (1.3%) of stroke, and 1 case (1.3%) of death. Conclusions: Primary IVB at a dose of 1.25 or 2.5 mg seems to provide stability or improvement in BCVA, OCT, and FA in subfoveal CNV secondary to AMD at 24 months. Our results show no significant difference regarding BCVA with IVB at doses of 1.25 or 2.5 mg. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2010 American Academy of Ophthalmology.

Purpose: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin; Genentech, Inc., San Francisco, CA; 1.25 or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the 2 different doses of intravitreal bevacizumab (IVB) used is presented. Design: Retrospective, multicenter, interventional, comparative case series. Participants: The clinical records of 115 consecutive patients (139 eyes) with DDME at 11 centers from 8 countries were reviewed. Methods: Patients were treated with at least 1 intravitreal injection of 1.25 or 2.5 mg of bevacizumab. All patients were followed up for 24 months. Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at the baseline, 1-, 3-, 6-, 12-, and 24-month visits. Main Outcome Measures: Changes in BCVA and OCT results. Results: The mean age of the patients was 59.4±11.1 years. The mean number of IVB injections per eye was 5.8 (range, 1-15 injections). In the 1.25-mg group at 1 month, BCVA improved from 20/150 (0.88 logarithm of the minimum angle of resolution [logMAR] units) to 20/107, 0.76 logMAR units (P less than 0.0001). The mean BCVA at 24 months was 20/75 (0.57 logMAR units; P less than 0.0001). Similar BCVA changes were observed in the 2.5-mg group: at 1 month, BCVA improved from 20/168 (0.92 logMAR units) to 20/118 (0.78 logMAR units; P = 0.02). The mean BCVA at 24 months was 20/114 (0.76 logMAR units; P less than 0.0001). In the 1.25-mg group, the mean central macular thickness (CMT) decreased from 466.5±145.2 ?m at baseline to 332.2±129.6 ?m at 1 month and 286.6±81.5 ?m at 24 months (P less than 0.0001). Similar results were obtained in the 2.5-mg group. Conclusions: Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 24 months. The results show no evident difference between IVB at doses of 1.25 or 2.5 mg. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2009 American Academy of Ophthalmology.

Purpose: To report the 6-month anatomic and best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) in patients with diabetic macular edema (DME).Design: Interventional retrospective multicenter study at 6 centers from 6 countries of patients with DME.Participants: We reviewed the clinical records of 88 consecutive patients (110 eyes) with DME. Seventy-eight eyes of 64 consecutive patients with a minimum follow-up of 6 months and mean age of 59.7--9.3 years were included in this analysis.Intervention: Patients were treated with at least one intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab and underwent Early Treatment Diabetic Retinopathy Study (ETDRS) BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. Repeated- measures analysis of variance was used to compare mean values.Main Outcome Measures: Changes in BCVA, OCT, and FA.Results: Mean follow-up was 6.31 +/- 0.81 months (range, 6-9). Sixteen (20.5%) eyes needed a second injection at a mean of 13.8 weeks (range, 4-28), and 6 eyes needed a third injection (7.7%) at a mean of 11.5 weeks (range, 5-20). the mean baseline BCVA was 0.87 (logarithm of the minimum angle of resolution), and the final mean BCVA was 0.6, a difference that was statistically significant (P < 0.0001). Final BCVA analysis by subgroups demonstrated that 32 (41.1%) eyes remained stable, 43 (55.1 %) improved >= 2 ETDRS lines of BCVA, and 3 (3.8%) decreased :2 ETDRS lines of BCVA. Mean central macular thickness at baseline by OCT was 387.0 +/- 182.8 mu m and decreased to a mean of 275.7 +/- 108.3 at end of follow-up (P < 0.0001). No ocular or systemic adverse events were observed.Conclusions: Primary intravitreal bevacizumab at doses of 1.25 to 2.5 mg seem to provide stability or improvement in VA, OCT, and FA in DME at 6 months. Follow-up is still short to make any specific treatment recommendations; however, the results appear promising. Evaluation in a multicenter randomized controlled clinical trial with longer follow-up is needed. Clin Oftalmol Ctr Caracas, Retina & Vitreous Serv, Caracas 1010A, Venezuela Hosp Dr Luis Sanchez Bulnes, Asociac Evitar Ceguera Mexico, Mexico City, DF, Mexico Inst Cirugia Ocular, San Jose, Costa Rica Universidade Federal de São Paulo, Dept Oftalmol, Inst Visao, São Paulo, Brazil Univ Puerto Rico, San Juan, PR 00936 USA Universidade Federal de São Paulo, Dept Oftalmol, Inst Visao, São Paulo, Brazil Web of Science

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Objetivos: 1- Avaliar as alterações de cor do corante natural de antocianina de açaí (Euterpe oleracea) nos diferentes valores de pH e osmolaridades; 2- classificar e quantificar as antocianinas presentes no corante natural de açaí (Euterpe oleracea); e 3- analisar a toxicidade do corante natural de açaí (Euterpe oleracea) em modelo de coelhos. Métodos: O produto foi obtido a partir do extrato natural que contém 0,5% de antocianina, pH de 5,5 (Grupo Centroflora, Botucatu São Paulo, Brasil), liofilizado e envasado em frasco âmbar previamente esterilizado em autoclave. A osmolaridade foi ajustada em 300 mOsm e o pH ajustado para 7,00, usando uma solução diluída de corante de antocianina em solução de tampão fosfato PBS (Ophthalmos, São Paulo, Brasil), e os valores de pH foram ajustados para uma solução tamponada com hidróxido de sódio e após as modificações químicas necessárias, foram obtidos solução de concentração de 0,5%, com coloração roxa, pH 7,06 e osmolaridade 304 mOsm, demonstrando grande afinidade pela MLI em 12 olhos cadavéricos testados. Cinco padrões primários de moléculas de antocianina de açaí (Euterpe oleracea) adquiridas da empresa ChromaDex® foram utilizadas como comparativo para a solução manipulada: taxifolina 25mg, orientina 25mg, isovitexina 25mg, homo-orientina 25mg e cianidina-3-0-glucosídeo 25mg. As concentrações de antocianinas na amostra foram quantificadas e qualificadas por cromatografia líquida de alta eficiência (HPLC) e espectrometria de massas (EM). Injeções intravítreas em coelhos nas concentrações de 10%, 25% e 35% do corante natural de açaí (Euterpe oleracea) foram realizadas, e os olhos controle receberam solução salina balanceada (SSB). Exames de eletrorretinografia (ERG), retinografia, angiofluoresceinografia (AFG), tomografia de coerência óptica (OCT), microscopia óptica (LM) e microscopia eletrônica de transmissão (MET) foram executados: antes das injeções intravítreas, bem como em 24 horas e 7 dias. Resultados: O corante ajustado à osmolaridade de 300 mOsm e o pH ajustado de 7,00 resultaram em coloração roxa. As cinco principais antocianinas descritas em literatura estão presentes no corante natural de açaí (Euterpe oleracea), sendo a cianidina-3-0-glucosídeo a mais prevalente. O uso do corante foi seguro nas concentrações de 10% e 25% no estudo em coelhos por não apresentar alteração morfológica de toxicidade significante; já na concentração de 35%, anormalidades compatíveis com toxicidade incipiente foram observadas. Conclusões: O corante extraído do fruto do açaí resultou em coloração roxa e após ajustes físico-químicos de osmolaridade (304 mOsm) e pH (7,06) adequados para uso na cromovitrectomia, apresentou boa afinidade pela MLI em olhos cadavéricos e, portanto, pode ser útil para cirurgia vitreorretiniana A cianidina-3-0-glucosídeo foi a antocianina mais encontrada. A concentração das antocianinas a 10% e 25% foram seguras em olhos de coelhos. Objectives: 1- to evaluate the acai fruit (Euterpe oleracea) at different pH-values and osmolarities; 2- to classify and quantify the anthocyanins at the natural acai (Euterpe oleracea) dye; and 3- to analyse the safety profile of the acai (Euterpe oleracea) dye in rabbit model. Methods: The product was obtained from the natural extract that contains 0.5% of anthocyanins, pH = 5.5 and was lyophilized and packaged in ambar flasks previously sterilized in the autoclave (Etno Brasil, São Paulo, Brazil). The osmolarity was adjusted in 300 mOsm and pH = 7.00 using a diluted solution of the anthoacyanin dye and phosphate buffer (PSB Ophthalmos, São Paulo, Brazil); pH-values were adjusted with sodium hydroxide and after the necessary chemical modifications, a solution with a concentration of 0.5% was obtained, with a purple color, pH 7.06 and osmolarity 304 mOsm, demonstrating great affinity for ILM in 12 cadaveric eyes tested. Five samples of anthocyanins molecules from acai fruit (Euterpe oleracea) acquired from ChromaDex® company (São Paulo, Brazil) were used as pattern at 25mg: taxifolin, orientin, isovitexin, homoorientin and cyanidin-3-0-glucoside. The concentrations of anthocyanins were quantified and qualified by high performance liquid chromatography (HPLC) and mass spectrophotometry (MS). Intravitreal injections in rabbits at 10%, 25% and 35% of the natural acai dye (Euterpe oleracea) were performed and control-eyes were submitted to balanced saline solution (BSS). Electroretinography (ERG), fundus photographs, fluorescein angiogram (AF), optical choherence tomography (OCT), light microscopy (LM) and transmission electron microscopy (MET) were performed at baseline as well as 24 hours and 7 days. Results: The dye that had the osmolarity adjusted to 300 mOsm and pH = 7.00 resulted in purple color. The five main anthocyanins described at the literature were also present at the natural acai dye (Euterpe oleracea), and the cyanidine-3-0-glucoside was the most prevalent one. The use of the dye was safe at concentrations of 10% and 25% at the rabbit study; however, at 35%, abnormalities suggestive of toxicity were observed. Conclusions: The dye extracted from the acai fruit resulted in purple color. The cyanidine-3-0-glucoside was the most prevalent anthocyanin. The anthocyanins concentrations of 10% and 25% were safe in rabbit eyes. 402718/2013-5

Objetivo: avaliar o desempenho de duas plataformas de vitrectomia em relacao ao fluxo experimental de vitreo e agua, analisando-se a influencia do diametro do vitreotomo (cutter), os niveis de vacuo e a velocidade de corte, bem como os efeitos da variacao do ciclo de trabalho (duty cycle - DC). Metodos: analise com video de alta velocidade foi realizada para se determinar o DC padrao dos vitreofagos utilizados - Constellation Vision System (Alcon Labs, Fort Worth, EUA) e Stellaris PC (Bausch & Lomb, St. Louis, EUA). Para a plataforma Alcon, tambem, foi determinado, atraves de video, o DC real nos modos: o50-50o, oshaveo e ocoreo. A quantidade de agua ou vitreo removida a partir de um recipiente foi calculada em funcao do tempo (ml/seg), utilizando-se tres vitreotomos de cada um dos tres diferentes diametros analisados (20, 23 e 25-gauge), diferentes cortes por minuto (CPM) (0,1000, 2000, 3000, 4000 e 5000) e niveis de vacuo (100, 200, 300, 400, 500 e 600mmHg). Para a plataforma Alcon, tres vitreotomos de 23-ga tambem foram testados nos diferentes DCs ja referidos. As taxas de fluxo de agua e vitreo foram calculadas para cada nivel de aspiracao e velocidade de corte. Regressao multipla foi utilizada para estimar este fluxo para cada aumento em 100mmHg no vacuo, 1000 CPM na taxa de corte e tambem para se comparar o desempenho entre os dois aparelhos. Para todas as analises estatisticas foi utilizado o software estatistico SAS v9.2, adotando-se um nivel de significancia de 5%. Resultados: nos dois sistemas estudados, para todos os tres diametros de vitreotomos (20, 23 e 25-ga), o DC padrao atingiu um pico aos 1000 CPM e diminuiu proporcionalmente de acordo com o aumento da taxa de corte. As taxas de fluxo de agua aumentaram proporcionalmente aos niveis de vacuo (a cada aumento de 100mmHg) e diminuiram de acordo com o aumento da taxa de corte (a cada aumento de 1000 CPM). As taxas de fluxo vitreo aumentaram proporcionalmente ao acrescimo do vacuo e das taxas de corte e nao foram diferentes ao compararem-se os dois sistemas estudados. O DC do vitreotomo da plataforma Alcon aumentou com o aumento da taxa de corte ao utilizar-se a opcao shave, ficou relativamente estavel no modo 50-50 e diminuiu no modo core - com convergencia dos 3 modos em 50% aos 5000 CPM. As curvas de fluxo de agua acompanharam a variacao aumento do vacuo e taxa de corte. Conclusao: as taxas de fluxo foram previsiveis para todos os diametros de vitreotomos e nao foram diferentes para as duas plataformas estudadas. Maiores diametros e niveis de vacuo e de corte produziram taxas de fluxo vitreo aumentadas. O controle do ciclo de trabalho tambem tem um efeito importante sobre o fluxo vitreo, mas este efeito foi reduzido nos niveis de corte elevados devido a convergencia dos modos do ciclo de trabalho Purpose: To compare the performance between two ultra-high-speed vitrectomy systems: spring controlled versus dual cycle pneumatic. We evaluated the influence of gauge size, cut rate, vacuum and duty cycle on the flow rate in an experimental model. Methods: Analysis of a high-speed video was used to determine the standard duty cycle of studied vitrectomy systems (Constellation Vision System, Alcon and Stellaris PC, Bausch & Lomb). For the Alcon system, the duty cycle was also determined for the 50-50 and Shave modes. Flow rates from 20-, 23- and 25-gauge cutters were calculated (ml/s) in predetermined conditions of vacuum levels (100, 200, 300, 400, 500 e 600mmHg) and cut rates (0,1000, 2000, 3000, 4000 e 5000 CPM); water and fresh porcine vitreous samples were studied. Mixed models with repeated measures were used to obtain regression equations for predicting mean vitreous and water flow rates and also to compare the performance between the systems. SAS V9.2 programming language (SAS Institute, Cary, NC) was used for all analyses. Accepted level of significance for all tests was P < 0.05. Results: Using both vitrectomy systems, for all three gauges of cutters, the duty cycle and water flow showed an inverse correlation with increasing cut rates and a direct correlation with increasing aspiration levels. Vitreous flow rates from all gauges increased with increasing aspiration and cut rates and were similar when both systems were compared. For the dual-pneumatic system, the DC increased with increasing cut rate in the shave mode was relatively stable in the 50–50 mode and decreased for the core mode. The DC converged at 5,000 cycles per minute for the 3 different modes. Water flow curves followed the DC variation. Vitreous flow rates for all the DC modes increased with increasing cut rates and peaked at 5,000 cycles per minute. Conclusion: Both ultra high-speed vitreous cutters produce consistent and similar vitreous and water flow rates across the tested range of cuts per minute and vacuum levels. Larger gauges of the cutters as well as higher aspiration and cut rate levels resulted in improvement of the vitreous flow rates. The DC control also has an important effect on the vitreous flow, but this effect was reduced at high cut rates because of convergence of the DC modes. BV UNIFESP: Teses e dissertações

Resumo: Objetivos: Desenvolver um modelo animal de neovascularização retiniana através de uma ou duas injeções do fator de crescimento do endotélio vascular (VEGF) 165 na cavidade vítrea de coelhos. Avaliar esse modelo com angiografia fluorescente (AF), tomografia de coerência óptica (OCT) e análise histopatológica. Materais e métodos: Doze coelhos foram divididos em três grupos. Grupo I (n=3) recebeu injeção intra-vítrea de 0.1 mL de solução salina balanceada (grupo controle). Grupo II (n=6) recebeu 10 ?g de VEGF no dia 0; grupo III foi aplicado 10 ?g de VEGF no dia 0 e 7. O acompanhamento (dia 0,3,7,14,21,28) incluiu fotografia colorida do fundo de olho, AF, OCT e exame histopatológico. Os olhos foram removidos e corados com hematoxilina e eosina (HE). Resultados: Os animais do grupo I (controle) não apresentaram alterações no globo ocular durante os 28 dias de acompanhamento. Por outro lado os olhos do grupo II (uma injeção de VEGF) demonstraram após 72 horas da aplicação dilatação e tortuosidade dos capliares retinianos, já a neovascularização foi detectada no dia 7 e regrediu na segunda semana. No grupo III (duas injeções de VEGF) o vazamento dos capilares retinianos e a neovascularização se acentuaram até o dia 14 e ao final do acompanhamento tanto a histologia como o OCT evidenciaram o descolamento de retina tracional. O estudo histopatológico demonstrou um aumento no tamanho do calibre dos vasos tanto do grupo II e III ao se comparar com o controle. Conclusão: Os resultados demonstram um modelo animal eficiente e confiável de neovascularização de retina pela AF, OCT e histopatologia. Uma injeção de angiogênico desenvolve a neovascularização de retina que regride após sete dias, já duas aplicações desenvolvem uma neovascularização mais intensa, que após quatro semanas evolui para o descolamento de retina.