{"id":9004,"date":"2026-09-13T17:00:00","date_gmt":"2026-09-13T17:00:00","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=9004"},"modified":"2026-09-10T14:06:36","modified_gmt":"2026-09-10T14:06:36","slug":"ten-year-cross-linking-outcomes-escrs-2026","status":"publish","type":"post","link":"http:\/\/www.elza-institute.com\/pt\/ten-year-cross-linking-outcomes-escrs-2026\/","title":{"rendered":"ELZA no ESCRS 2026, domingo em Londres"},"content":{"rendered":"
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O cross-linking tem travado o ceratocone desde o in\u00edcio dos anos 2000. A \u00e1rea \u00e9, portanto, antiga o suficiente para enfrentar uma quest\u00e3o inc\u00f3moda: o efeito mant\u00e9m-se? Os resultados do cross-linking aos dez anos abriram o sess\u00e3o de comunica\u00e7\u00f5es livres sobre *cross-linking* avan\u00e7ado no queratocone<\/a> no domingo, 13 de setembro. Tr\u00eas dos dezoito artigos dessa sess\u00e3o vieram da ELZA.<\/p>

Resultados a dez anos do \"cross-linking\" do protocolo original<\/h3>

Dr. Michalina Furrer<\/a> apresentado primeiro, \u00e0s 08:30<\/a>. O seu tema eram os olhos tratados com o protocolo original de Dresden, durante os primeiros anos do cross-linking em Zurique. O cross-linking corneal (CXL) enrijece uma c\u00f3rnea enfraquecida utilizando riboflavina \u2013 gotas de vitamina B2 \u2013 e luz ultravioleta. O protocolo de Dresden \u00e9 a vers\u00e3o pela qual tudo o resto \u00e9 medido. O epit\u00e9lio \u00e9 removido e a c\u00f3rnea recebe ent\u00e3o 3 mW\/cm\u00b2 durante 30 minutos, num total de 5,4 J\/cm\u00b2.<\/p>

Dos 418 olhos tratados, 51 apresentavam dados completos relativos a dez anos. Ap\u00f3s a exclus\u00e3o dos olhos que foram submetidos a procedimentos adicionais, foram analisados 38. O tempo m\u00e9dio de acompanhamento foi de 10,9 anos. A queratometria m\u00e1xima, ou Kmax, \u00e9 uma medida do grau de curvatura da c\u00f3rnea. Esta diminuiu 1,30 D. A acuidade visual corrigida \u00e0 dist\u00e2ncia melhorou 0,15 logMAR. Pouco mais de metade dos olhos apresentou um achatamento superior a 1 D, 39% mantiveram-se dentro de 1 D em rela\u00e7\u00e3o ao valor basal e 8% apresentaram progress\u00e3o. A estabiliza\u00e7\u00e3o global a longo prazo foi de 90%. Um olho necessitou de um novo procedimento de cross-linking e dois foram submetidos a ceratoplastia. N\u00e3o se observaram infe\u00e7\u00f5es tardias, problemas com as c\u00e9lulas estaminais limbares nem cicatrizes visualmente significativas.<\/p>

A ressalva honesta reside nos pr\u00f3prios n\u00fameros. Apenas 51 de 418 olhos retornaram com dados completos de dez anos. Esse \u00e9 um problema familiar no seguimento corneano a longo prazo, e significa que o grupo analisado pode n\u00e3o representar a coorte inteira. Ainda assim, estes resultados do *cross-linking* a dez anos contam-se entre os mais longos publicados para o protocolo de Dresden.<\/p>

Quando a interliga\u00e7\u00e3o de dados corre mal<\/h3>

\u00c0s 08:50, L\u00e9onard Kollros<\/a> apresentado uma s\u00e9rie de casos<\/a> quinze olhos de onze doentes desenvolveram ceratite t\u00f3xica central ap\u00f3s cross-linking epitelial isolado. Todos foram tratados num centro externo e, posteriormente, recorreram a uma avalia\u00e7\u00e3o no ELZA de forma independente. A ceratite t\u00f3xica central \u00e9 uma opacifica\u00e7\u00e3o e adelga\u00e7amento n\u00e3o inflamat\u00f3rios da c\u00f3rnea central.<\/p>

Dez olhos apresentavam cicatrizes estromais centrais densas, enquanto cinco apresentavam turva\u00e7\u00e3o central. A acuidade corrigida variou de 20\/20 a 20\/200. A imagiologia mostrou um afinamento central marcado, abaixo de 300 \u00b5m em casos graves. A hiperrefletividade estendeu-se por toda a espessura do estroma. V\u00e1rios casos envolveram protocolos acelerados, ou um afinamento substancial durante a cirurgia ap\u00f3s a utiliza\u00e7\u00e3o de riboflavina contendo dextrano.<\/p>

Os autores apontam tr\u00eas fatores contribuintes: exposi\u00e7\u00e3o excessiva \u00e0 radia\u00e7\u00e3o ultravioleta, desbaste intraoperat\u00f3rio e formula\u00e7\u00f5es de riboflavina n\u00e3o regulamentadas. Defendem uma calibra\u00e7\u00e3o rigorosa do ultravioleta, paquimetria intraoperat\u00f3ria e uma escolha cuidadosa da riboflavina. Como os casos foram tratados noutros locais e referenciados, a s\u00e9rie n\u00e3o pode fornecer uma taxa de incid\u00eancia. Documenta o aspeto da complica\u00e7\u00e3o, o que constitui algo diferente e ainda assim \u00fatil.<\/p>

Segmentos de anel que mant\u00eam a sua forma<\/h3>

\u00c0s 09:20 Kollros regressou com trabalho de laborat\u00f3rio<\/a> sobre os segmentos de anel estromal corneano alog\u00e9nico, ou CAIRS. Estes s\u00e3o arcos de tecido corneano de dador, implantados no estroma para aplanar um cone. Foram utilizadas quarenta e oito c\u00f3rneas porcinas para preparar os segmentos. Os segmentos foram randomizados para nenhum tratamento ultravioleta, para 30 J\/cm\u00b2 ou para 60 J\/cm\u00b2 de liga\u00e7\u00f5es cruzadas extracorporais. Todos passaram depois por um ciclo normalizado de desidrata\u00e7\u00e3o e reidrata\u00e7\u00e3o.<\/p>

Ambos os grupos reticulados desidrataram significativamente mais do que os controlos e, al\u00e9m disso, reidrataram significativamente menos. N\u00e3o houve diferen\u00e7a entre 30 J\/cm\u00b2 e 60 J\/cm\u00b2. Em termos pr\u00e1ticos, os segmentos acabam por ficar mais finos e demoram mais tempo a reexpandir. Isso dever\u00e1 torn\u00e1-los mais f\u00e1ceis de manusear e alargar a janela temporal de que um cirurgi\u00e3o disp\u00f5e para os implantar. Trata-se de um trabalho *ex vivo* em tecido su\u00edno, e os autores afirmam claramente que s\u00e3o necess\u00e1rios estudos *in vivo*.<\/p>

Presid\u00eancia e um protocolo personalizado no espa\u00e7o dos p\u00f3steres<\/h3>

Prof. Farhad Hafezi<\/a> presidiu a duas sess\u00f5es de pain\u00e9is apresentados durante o dia. A primeira abordou corre\u00e7\u00e3o da vis\u00e3o por laser<\/a> \u00e0s 09:15, o segundo reticula\u00e7\u00e3o da c\u00f3rnea<\/a> \u00e0s 16:00. Ambas as sess\u00f5es decorreram na zona de exposi\u00e7\u00e3o. Na segunda, \u00e0s 16:35, apresentou resultados a um e dois anos do ELZA-PACE<\/a> em 135 olhos com ceratocone.<\/p>

O ELZA-PACE remove o epit\u00e9lio seletivamente sobre o \u00e1pice do cone. Isso cria uma pequena zona epi-off dentro de uma c\u00f3rnea que, de outro modo, seria epi-on. A energia ultravioleta \u00e9 ent\u00e3o aplicada de forma desigual, com a maior flu\u00eancia sobre a regi\u00e3o ect\u00e1sica. O aplanamento reportado atingiu at\u00e9 12 D de ceratometria m\u00e1xima em casos selecionados, sem descompensa\u00e7\u00e3o endotelial ou *haze* clinicamente relevante. A forma do cone, a idade e a atividade da doen\u00e7a influenciaram a extens\u00e3o do aplanamento verificado. Por outras palavras, os resultados variam consoante o olho, e os casos selecionados n\u00e3o representam a m\u00e9dia.<\/p>

O Instituto ELZA realiza reticula\u00e7\u00e3o da c\u00f3rnea<\/a> para queratocone<\/a> nas suas cl\u00ednicas em Dietikon e Zurique, incluindo ELZA-PACE<\/a>. Os detalhes da sess\u00e3o s\u00e3o publicados pela Sociedade Europeia de Cirurgi\u00f5es de Catarata e Refrativos<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Dez anos de dados de *cross-linking*, uma s\u00e9rie de casos de ceratopatia t\u00f3xica central e trabalho laboratorial sobre segmentos anulares fizeram de domingo o dia mais ocupado para o ELZA no ESCRS 2026 em Londres.<\/p>","protected":false},"author":4,"featured_media":553435,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"page_builder":"","footnotes":""},"categories":[243,770,214,548,1,97,215],"tags":[713,130,100,278,361,123,101685,101696],"class_list":["post-9004","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emilio-torres","category-enes-aydemir","category-farhad-hafezi","category-leonard-kollros","category-general-news","category-podium-power","category-sabine-kling","tag-congress","tag-cross-linking","tag-cxl","tag-escrs","tag-farhad-hafezi","tag-keratoconus","tag-london","tag-long-term-outcomes"],"acf":[],"yoast_head":"\nTen year cross linking 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