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Papers by Patrick Tzelikis

Open Journal of Ophthalmology

Arquivos Brasileiros de Oftalmologia, 2022

To describe the clinical outcomes of manual scraping of epithelial ingrowth followed by compresse... more To describe the clinical outcomes of manual scraping of epithelial ingrowth followed by compressed heating air flow after laser in situ keratomileusis (LASIK). Methods: We underwent a retrospective, noncomparative, and interventional case series. Twenty eyes of 17 patients were included in this study. Each patient with a history of LASIK underwent epithelial removal with mechanical debridement followed by compressed heating air flow. Our primary outcome was the recurrence of epithelial ingrowth after 3 months of follow-up, while our secondary outcomes were uncorrected distance visual acuity, corrected distance visual acuity, and complications after surgery. Results: Ten patients (58.8%) were male, and eight eyes of seven (41.2%) patients underwent primary LASIK surgery, while12 eyes of 10 patients had flap-lift retreatment LASIK; sixteen eyes (80.0%) underwent mechanical microkeratome LASIK and four (20.0%) underwent femtosecond laser-assisted LASIK. Mean age at surgical removal of epithelial ingrowth was 37.0 years ± 9.3 years (range 24 to 55 years). There was recurrence of ingrowth in two eyes (10%) after 3 months of follow-up. The mean corrected distance visual acuity of patients before surgery was 0.07 ± 0.09 logMAR, and after the last follow-up was 0.02 ± 0.04 logMAR (p=0.06). The odds ratio of presenting with epithelial ingrowth after LASIK enhancement compared to primary LASIK was 29.41. Conclusion: Manual scraping followed by compressed heating air flow is a safe and effective treatment of clinically significant epithelial ingrowth after LASIK. At the last follow-up, no eye lost any line in corrected distance visual acuity.

European Journal of Ophthalmology, 2021

Purpose: To compare VA outcomes in patients with advanced keratoconus wearing SCL or after ICRS o... more Purpose: To compare VA outcomes in patients with advanced keratoconus wearing SCL or after ICRS or DALK. In addition, determine the percentage of complimentary treatments after ICRS and DALK, and which of these was fitting a SCL, and final visual acuity (f-VA) results. Methods: Retrospective case series analyzed 55 eyes with advanced keratoconus fitted with SCL, or after ICRS or a DALK between 2010 and 2018. The variables analyzed were sex, age, UDVA, CDVA, SEQ, K-readings, and f-VA after complimentary treatments. Results: Twenty-eight eyes underwent a DALK, 14 were fitted with a SCL, and other 13 underwent ICRS insertion. Patients after DALK and after ICRS showed statistically significant improvement in UDVA and CDVA after surgery, with no difference between these groups. Patients fitted with SCL showed statistically higher CDVA improvement when compared to ICRS. After DALK and ICRS, respectively, nine eyes (32.14%) and seven eyes (53.85%) were fitted with SCL. Comparison between f...

Clinical Ophthalmology, 2019

Journal of cataract and refractive surgery, 2018

To compare the antiinflammatory efficacy of topical nepafenac 0.3% for prophylaxis of macular ede... more To compare the antiinflammatory efficacy of topical nepafenac 0.3% for prophylaxis of macular edema after cataract extraction. São Paulo University, São Paulo, Brazil. Prospective randomized clinical trial. Patients with bilateral cataract were included in this study. Each patient was assigned randomly to receive nepafenac 0.3% drops in 1 eye and a placebo in the fellow eye. The primary outcome measure was the change in the mean spectral-domain optical coherence tomography central subfield thickness 5 weeks postoperatively. The secondary outcome measures were the total macular volume 1, 5, and 12 weeks postoperatively; the percentage of patients in both groups who developed macular edema, and the corrected distance visual acuity within 5 weeks and 12 weeks after cataract surgery. The study comprised 224 eyes of 112 patients. For all retinal thickness measurements, a significant increase in both groups was detected starting from the first postoperative week until 12 weeks. At 5 weeks...

Journal of cataract and refractive surgery, 2017

To compare the accuracy of intraoperative wavefront aberrometry (ORA) and the Hill-radial basis f... more To compare the accuracy of intraoperative wavefront aberrometry (ORA) and the Hill-radial basis function (RBF) formula with other formulas based on preoperative biometry in predicting residual refractive error after cataract surgery in eyes with axial myopia. Private practice, Harrisburg, Pennsylvania, USA. Retrospective consecutive case series. Eyes with an axial length (AL) greater than 25.0 mm had cataract extraction with intraocular lens implantation. For each eye, the 1-center Wang-Koch AL-optimized Holladay 1 formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using the SRK/T, Holladay 1 and 2, Barrett Universal II, and Hill-RBF formulas and intraoperatively using wavefront aberrometry. The postoperative refraction was compared with the preoperative and intraoperative predictions. The study comprised 37 patients (51 eyes). The mean numerical errors ± standard error associated with using the SRK/T, Holladay 1, AL-optimi...

Revista Brasileira de Oftalmologia, 2016

A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolo... more A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolones Um caso atípico de esclero-uveíte por Nocardia Asteroides resistente a fluorquinolona de quarta-geração

$Research paper thumbnail of Visual outcomes after implantation of a novel refractive toric multifocal intraocular lens$

Arquivos Brasileiros de Oftalmologia, 2014

The goal of modern cataract surgery is to gain spectacle independence for distance, intermediate,... more The goal of modern cataract surgery is to gain spectacle independence for distance, intermediate, and near vision, which can be achieved with the implantation of multifocal intraocular lenses (IOLs). However, approximately 15%-29% cataract patients have more than 1.50 diopters (D) of corneal or refractive astigmatism (1-3). A residual astigmatism error of 1.50 to 3.0 D after cataract surgery may decrease uncorrected visual acuity (UCVA) to 20/70 or 20/100 and may interfere with spectacle independence after multifocal IOL implantation (4). To overcome this problem, various surgical options to control astigmatism during cataract surgery are available (4,5). Patients with a considerable amount of corneal astigmatism who wish to undergo multifocal IOL implantation have several options, including a clear corneal cataract incision along the steep meridian (5) , astigmatic keratotomy (AK) (6,7) , opposite clear corneal incisions (8) , limbal relaxing ABSTRACT Purpose: To assess the postoperative outcomes of a novel toric multifocal intraocular lens (IOL) in patients with cataract and corneal astigmatism. Methods: This prospective nonrandomized study included patients with cataract, corneal astigmatism, and a motivation for spectacle independence. In all patients, a Rayner M-flex ® T toric IOL was implanted in the capsular bag. Three months after surgery, the distance, intermediate, and near visual acuities; spherical equivalent; residual refractive astigmatism; defocus curve; and contrast sensitivity were evaluated. A patient satisfaction and visual phenomena questionnaire was administered to all patients. Results: Thirty-four eyes of 18 patients were included in this study. Three months after surgery, the mean corrected distance visual acuity (logMAR) was 0.00 ± 0.08 at 6 m, 0.20 ± 0.09 at 70 cm, and 0.08 ± 0.11 at 40 cm. Uncorrected distance vision acuity was 20/40 or better in 100% eyes. The preoperative mean refractive cylinder (RC) was-2.19 (SD: ± 0.53). After a 3-month follow-up, the average RC was-0.44 D (SD: ± 0.27; p<0.001). Contrast sensitivity levels were high. At the last follow-up, 87.5% patients were spectacle-independent for near, intermediate, and distance vision, and approximately 44% patients reported halos and glare. Conclusion: Toric multifocal IOL implantation in patients with cataract and cor neal astigmatism using the Rayner M-flex ® T toric IOL was a simple, safe, and accurate option. This technology provides surgeons with a feasible option for meeting patient expectations of an enhanced lifestyle resulting from decreased spectacle dependence.

Revista Brasileira de Oftalmologia, 2012

O objetivo é descrever uma nova técnica cirúrgica para fixação iriana de lente intraocular durant... more O objetivo é descrever uma nova técnica cirúrgica para fixação iriana de lente intraocular durante transplante de córnea em pacientes sem suporte capsular. A técnica de fixação iriana Tied Out Open Sky é uma técnica de fácil execução comparado com as técnicas já descritas, dispensando manobras cirúrgicas complexas, minimizando a manipulação e as complicações pós-operatórias.

Global Journal of Cataract Surgery and Research in Ophthalmology

The human eye is an optical system with two lenses in parallel, with complementary functions esse... more The human eye is an optical system with two lenses in parallel, with complementary functions essential to vision: the cornea and the lens. There is an intimate relationship between these two structures, especially during cataract surgery when there is inevitably corneal endothelium injury at different severity levels. Every cataract surgeon should be aware of the functioning of the fragile corneal tissue, especially its noblest layer and responsible for corneal transparency: the endothelium. It is of paramount importance to be able to identify the different endothelial pathologies and local conditions associated with greater tissue damage before cataract surgery, as well as to proceed individually in the pre-operative evaluation, during surgery (choice of supplies, technologies and techniques) and prescription of medications or need for additional procedures in the post-operative period. There are several conditions peculiar to cataract surgery and others to the corneal endothelium ...

Arquivos Brasileiros de Oftalmologia, 2017

Here we describe a rare case of a benign tumor in the lacrimal gland of a healthy 4-year-old girl... more Here we describe a rare case of a benign tumor in the lacrimal gland of a healthy 4-year-old girl. Mild proptosis was the only abnormality observed on clinical examination. Magnetic resonance imaging of the right orbit revealed an oval, solid, well-circumscribed, homogeneous mass extending from the lacrimal gland and measuring 2.5 × 2.3 × 1.7 cm without any evidence of invasion into adjacent bones. The lesion was surgically excised and histological analyses defined the diagnosis of oncocytoma of the lacrimal gland. Although rare, oncocytoma should be included in the differential diagnosis of lacrimal gland tumors.

Arquivos Brasileiros de Oftalmologia, 2016

INTRODUCTION Staphyloma is an abnormal protrusion of the uveal tissue through a weak point of the... more INTRODUCTION Staphyloma is an abnormal protrusion of the uveal tissue through a weak point of the eye. Acquired anterior staphyloma occurs subse quent to corneal perforation, usually following untreated or non-responding infective keratitis (1) .Anterior staphylomas are rarely observed in patients with Peters anomaly (2). Various ocular complications that are associated with crack cocaine have been reported, including epitheliopathy, microbial keratitis, and corneal perforation (3-5). Such manifestations result from many factors, ranging from direct drug effects to the social environment of the patient. Treatment options in cases of anterior staphyloma include penetrating keratoplasty, mushroom grafts, sclerokeratoplasty, and du ral patch (6-8). We report a case of acquired anterior staphyloma following perforation of a corneal ulcer in a patient who used crack cocaine daily for 6 months prior to the second presentation and its management. CASE REPORT A 30-year-old black man presented with a 4-week history of a foreign body sensation, redness, and pain in his right eye. His left eye was stable. The patient had a history of crack cocaine and injected heroin abuse. He was homeless and admitted to using crack cocaine daily over the past 4 months. He denied any previous contact lens use, trauma, or ocular surgery. He was otherwise quite well with no systemic symptoms, and his general medical history was unremarkable. On examination at our hospital, uncorrected visual acuity was found to be light perception (LP) in the right eye and 20/25 in the

Arquivos Brasileiros de Oftalmologia, 2012

$Research paper thumbnail of doi:10.1155/2010/717591 Clinical Study Visual Performance of Tecnis ZM900 Diffractive Multifocal IOL$

Copyright © 2010 Leonardo Akaishi et al. This is an open access article distributed under the Cre... more Copyright © 2010 Leonardo Akaishi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To evaluate visual performance for near, intermediate, and distant vision; complaints of photic phenomena, and patient satisfaction with the new diffractive multifocal IOL used in eyes which underwent phacoemulsification. Methods. Twothousand and five hundred consecutive eyes undergoing Tecnis ZM900 multifocal IOL implantation were included in this retrospective analysis. The minimum followup of 3 months was required after the surgery. Patients were assessed for uncorrected near visual acuity (UNVA) at a fixed distance (33 cm), uncorrected intermediate visual acuity (UIVA) at 60 cm, and uncorrected distance visual acuity (UDVA). Using a subjective questionnaire, patients satisfaction, their independence from using glasses,...

PURPOSE: To compare the accuracy of Optiwave Refractive Analysis (ORA) intraoperative aberrometry... more PURPOSE: To compare the accuracy of Optiwave Refractive Analysis (ORA) intraoperative aberrometry (Alcon Laboratories, Inc., Fort Worth, TX) with preoperative biometry in predicting residual refractive error after cataract surgery in eyes that underwent radial keratotomy.
METHODS: This was a prospective consecutive case series of patients with cataract and prior radial keratotomy. Each patient underwent a preoperative intraocular lens (IOL) power calculation using partial coherence interferometry (IOLMaster version 5; Carl Zeiss Meditec, Jena, Germany). For each eye, the Barrett True-K formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using the SRK/T, Hoffer Q, Haigis, and Holladay formulas 1 and 2, and the ORA intraoperatively. Between 8 and 12 weeks after cataract extraction with IOL implantation, the postoperative refraction was compared with the preoperative and intraoperative predictions.
RESULTS: The study comprised 52 eyes of 34 patients. The median absolute errors associated with each method were as follows: Barrett True-K formula (0.34), ORA aberrometer (0.53), and SRK/T (0.54), Hoffer Q (0.51), Haigis (0.54), SRK/T (0.57), and Holladay formulas 1 and 2 (0.44) (P = .08). The pro- portion of patients within ±0.50 diopters of the predicted error was 63.5%, 48.1%, 44.2%, 48.1%, 53.8%, 36.5%, and 57.7%, respectively (P = .03). No statistically significant difference was observed in the number of eyes with hyperopic outcomes (P = .68).
CONCLUSIONS: In eyes with prior radial keratotomy surgery, the ORA aberrometer performance was similar to the Bar- rett True-K formula and all of the other established formulas, with no significant difference between median absolute error and mean absolute error. The Barrett True-K formula pro- duced significantly more eyes within ±0.50 diopters than the SRK/T, Hoffer Q, and Holladay 1 formulas.

Purpose: To assess the stability and reliability of femtosecond laser-assisted cataract surgery (... more Purpose: To assess the stability and reliability of femtosecond laser-assisted cataract surgery (FLACS) incisions design and dimensions using anterior segment optical coherence tomography (AS-OCT) imaging. Setting: Renato Ambrósio Ophthalmologic Study Center from Hospital Oftalmológico de Brasília, Brasília, Brazil. Design: Prospective nonrandomized controlled case series. Methods: Eyes undergoing FLACS with triplanar main temporal clear corneal incision (CCI) were evaluated at the end of the case. Eyes that required any incision hydration, surgical complications or lacked follow-up were excluded. The AS-OCT was performed after femtosecond delivery; at the end of the case; at 1 day and at 30 days after surgery. Data of pachymetry, endothelial and epithelial gaps, Descemet detachment and CCI architecture were compared. Results: Eleven eyes from 11 patients completed follow-up. Corneal thickness was statistically different between after femtosecond delivery and the end of the case (P-value ,0.05), but without difference compared to 30 days evaluation. There was an increase of Descemet detachments (P-value ,0.05) and endothelial gaps (P-value =0.0133) at the end of the case compared to post-femtosecond delivery. As for the architecture of the CCI, significant difference was found between the parameters of entry angle and exit angle measured with AS-OCT and the programmed. Conclusion: The AS-OCT was capable of visualizing changes in the cornea at the CCI. Despite the stress caused by manipulation, results indicated good stability of incision and reproducibility of tunnel length. Synopsis: Difference of corneal thickness at the CCI between after femtosecond and after phacoemulsification measurements (P-value ,0.05), with increase of endothelial gaps (P-value =0.0133) and Descemet detachments (P-value ,0.05).

Purpose: To compare the antiinflammatory efficacy of topical nepafenac 0.3% for prophylaxis of ma... more Purpose: To compare the antiinflammatory efficacy of topical nepafenac 0.3% for prophylaxis of macular edema after cataract extraction.
Setting: Sao Paulo University, Sao Paulo, Brazil.
Design: Prospective randomized clinical trial.
Methods: Patients with bilateral cataract were included in this study. Each patient was assigned randomly to receive nepafenac 0.3% drops in 1 eye and a placebo in the fellow eye. The primary outcome measure was the change in the mean spectral-domain optical coherence tomography central subfield thickness 5 weeks postoperatively. The secondary outcome measures were the total macular volume 1, 5, and 12 weeks postoperatively; the percentage of patients in both groups who developed macular edema, and the corrected distance visual acuity within 5 weeks and 12 weeks after cataract surgery.
Results: The study comprised 224 eyes of 112 patients. For all retinal thickness measurements, a significant increase in
both groups was detected starting from the first postoperative week until 12 weeks. At 5 weeks, there was a statistically significant difference in central subfield thickness and total macular volume between the nepafenac group and control group (P Z .01 and P < .001, respectively). At the fifth postoperative week, no eye in the nepafenac group and 4 eyes (3.57%) in the control group had macula edema, highlighting a trend toward a greater incidence in the control group. The between-group differences in visual outcomes were not statistically significant.
Conclusion: Used prophylactically after cataract surgery, nepafenac 0.3% was efficacious in reducing macular thickness compared with a placebo 5 weeks postoperatively, without a difference in final visual acuity.

Clinical Ophthalmology

The purpose of this study was to compare intraoperative parameters between femtosecond laser-assi... more The purpose of this study was to compare intraoperative parameters between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification using Centurion ® Vision System with Active Fluidics. Setting: This study was performed at Brasília Ophthalmologic Hospital, Brasília, Federal District, Brazil. Patients and methods: This was a prospective randomized comparative study. Patients with the diagnosis of cataract and surgical extraction programmed were divided into two groups: conventional phacoemulsification and FLACS. Intraoperative data were collected and submitted for statistical analysis. Results: A total of 400 eyes were enrolled, 200 in each group. There were no surgical complications. Groups were statistically equivalent in age and nucleus density. Cumulative dissipated energy and torsional time were significantly reduced in the FLACS group. Conventional surgery had less fluid usage, total case time and aspiration (ASP) time. Conclusion: FLACS with Active Fluidics System can reduce the ultrasound energy use during cataract surgery, in spite of increasing case time, fluid usage and ASP time.