{"id":49271,"date":"2025-02-11T15:08:02","date_gmt":"2025-02-11T15:08:02","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=45339"},"modified":"2025-02-11T15:08:02","modified_gmt":"2025-02-11T15:08:02","slug":"dual-chromophore-pack-cxl-treatment-for-acanthamoeba-keratitis","status":"publish","type":"post","link":"https:\/\/www.elza-institute.com\/pt\/dual-chromophore-pack-cxl-treatment-for-acanthamoeba-keratitis\/","title":{"rendered":"PACK-CXL com duplo crom\u00f3foro: Uma nova abordagem para o tratamento da ceratite por Acanthamoeba"},"content":{"rendered":"
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A ceratite por Acanthamoeba (AK) \u00e9 uma infe\u00e7\u00e3o grave e muitas vezes refract\u00e1ria da c\u00f3rnea, frequentemente associada ao uso de lentes de contacto durante a nata\u00e7\u00e3o ou \u00e0 lavagem das lentes com \u00e1gua da torneira. Apesar da terapia m\u00e9dica intensiva, muitos casos n\u00e3o se resolvem devido \u00e0 forma c\u00edstica altamente resistente do parasita, que pode persistir no estroma da c\u00f3rnea. Um relato de caso publicado recentemente em Olho e vis\u00e3o<\/em><\/a> por Hafezi<\/a> et al. explora uma nova abordagem de tratamento: crom\u00f3foro duplo fotoactivado para reticula\u00e7\u00e3o ceratite-c\u00f3rnea (PACK-CXL) na mesma sess\u00e3o, utilizando riboflavina\/UV-A e rosa bengala\/luz verde.<\/p>

Superar os desafios do tratamento das QA<\/h2>

O PACK-CXL convencional com riboflavina e UV-A provou ser eficaz na queratite bacteriana e f\u00fangica, mas n\u00e3o demonstrou um sucesso consistente no tratamento da QA. Da mesma forma, o PACK-CXL de rosa bengala\/luz verde mostrou-se promissor em infec\u00e7\u00f5es f\u00fangicas, mas n\u00e3o foi suficiente contra a Acanthamoeba. Reconhecendo esta limita\u00e7\u00e3o, o Instituto ELZA investigou uma abordagem combinada utilizando ambos os crom\u00f3foros num \u00fanico procedimento.<\/p>

As QA apresentam desafios \u00fanicos devido \u00e0 capacidade do parasita de existir numa forma c\u00edstica, que \u00e9 altamente resistente \u00e0 terapia antimicrobiana padr\u00e3o. A necessidade de tratamento prolongado com m\u00faltiplos agentes antimicrobianos aumenta o risco de cicatriza\u00e7\u00e3o da c\u00f3rnea e de defici\u00eancia visual. Por conseguinte, o desenvolvimento de estrat\u00e9gias terap\u00eauticas mais eficazes, como o PACK-CXL com duplo crom\u00f3foro, \u00e9 fundamental para melhorar os resultados dos doentes com infec\u00e7\u00f5es recalcitrantes.<\/p>

Estudo de caso: Uma abordagem sequencial na mesma sess\u00e3o<\/h2>

No caso relatado, um doente de 44 anos com QA que n\u00e3o respondeu a 10 meses de terapia padr\u00e3o foi submetido a tr\u00eas procedimentos PACK-CXL na mesma sess\u00e3o no Instituto ELZA. O protocolo envolveu a aplica\u00e7\u00e3o sequencial de riboflavina\/UV-A (365 nm, 10 J\/cm2) seguida de irradia\u00e7\u00e3o de rosa bengala\/luz verde (522 nm, 5,4 J\/cm2). Ap\u00f3s tr\u00eas tratamentos, a infe\u00e7\u00e3o foi erradicada e a c\u00f3rnea estabilizada, embora tenha sido necess\u00e1ria uma ceratoplastia penetrante para a reabilita\u00e7\u00e3o visual.<\/span><\/p>

Ao longo do tratamento, o doente registou uma melhoria cl\u00ednica progressiva. Ap\u00f3s a segunda sess\u00e3o de PACK-CXL, os sinais de infe\u00e7\u00e3o ativa diminu\u00edram significativamente, com redu\u00e7\u00e3o da dor ocular, fotofobia e ep\u00edfora. A microscopia confocal confirmou a aus\u00eancia de quistos de Acanthamoeba vi\u00e1veis ap\u00f3s a \u00faltima sess\u00e3o de tratamento, apoiando a efic\u00e1cia da abordagem de crom\u00f3foro duplo na elimina\u00e7\u00e3o da infe\u00e7\u00e3o.<\/span><\/p>

Um novo paradigma de tratamento?<\/h2>

Este caso sugere que a combina\u00e7\u00e3o de dois crom\u00f3foros com propriedades fotoqu\u00edmicas distintas pode aumentar a efic\u00e1cia do PACK-CXL no tratamento das QA. A aplica\u00e7\u00e3o sequencial permite que cada crom\u00f3foro exer\u00e7a o seu efeito sem interfer\u00eancia, conduzindo potencialmente a uma melhor erradica\u00e7\u00e3o dos agentes patog\u00e9nicos e ao fortalecimento do estroma. Os espectros de absor\u00e7\u00e3o \u00fanicos da riboflavina e da rosa de bengala garantem que os crom\u00f3foros n\u00e3o competem pela energia, maximizando a resposta fotoqu\u00edmica no tecido da c\u00f3rnea.<\/p>

Al\u00e9m disso, esta nova abordagem poder\u00e1 ter implica\u00e7\u00f5es mais alargadas no tratamento da queratite infecciosa grave e resistente ao tratamento. Ao refor\u00e7ar o estroma da c\u00f3rnea e, simultaneamente, exercer efeitos antimicrobianos, o PACK-CXL com crom\u00f3foro duplo pode constituir um complemento valioso \u00e0 terapia antimicrobiana convencional. Estudos futuros devem estabelecer protocolos de tratamento padronizados e avaliar os resultados a longo prazo em grupos de pacientes maiores.<\/p>

Embora seja necess\u00e1ria mais investiga\u00e7\u00e3o cl\u00ednica, esta abordagem inovadora pode oferecer uma op\u00e7\u00e3o vi\u00e1vel para casos de QA refract\u00e1rios. A erradica\u00e7\u00e3o bem sucedida da infe\u00e7\u00e3o neste doente real\u00e7a o potencial do PACK-CXL com duplo crom\u00f3foro como uma modalidade terap\u00eautica emergente para infec\u00e7\u00f5es da c\u00f3rnea dif\u00edceis.<\/p>

\"Crom\u00f3foro<\/a><\/p>

Refer\u00eancia:<\/strong> Hafezi F, Messerli J, Torres-Netto EA, et al. Crom\u00f3foro duplo riboflavina\/UV-A e rosa bengala\/luz verde PACK-CXL na mesma sess\u00e3o na queratite por Acanthamoeba: relato de um caso. Olho e Vis.<\/em> 2025;12(1):2. Liga\u00e7\u00e3o PubMed<\/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\t\t<\/div>","protected":false},"excerpt":{"rendered":"

O tratamento PACK-CXL com crom\u00f3foros duplos, utilizando riboflavina\/UV-A e rosa bengala\/luz verde, pode oferecer uma solu\u00e7\u00e3o eficaz para a ceratite por Acanthamoeba refract\u00e1ria.<\/p>","protected":false},"author":4,"featured_media":49201,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[214,95],"tags":[924,352,105,679,690,289,688,104,292,669,692],"class_list":["post-49271","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-farhad-hafezi","category-scientific-article","tag-acanthamoeba-keratitis","tag-corneal-cross-linking","tag-corneal-infection","tag-elza-institute","tag-green-light","tag-infection","tag-keratitis-treatment","tag-pack-cxl","tag-riboflavin","tag-rose-bengal","tag-uv-a"],"acf":[],"yoast_head":"\nDual Chromophore PACK-CXL: A New Approach to Treating Acanthamoeba Keratitis - The ELZA Institute<\/title>\n<meta name=\"description\" content=\"A novel dual chromophore PACK-CXL treatment using riboflavin\/UV-A and rose bengal\/green light treated a Acanthamoeba keratitis case.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.elza-institute.com\/pt\/dual-chromophore-pack-cxl-treatment-for-acanthamoeba-keratitis\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dual Chromophore PACK-CXL: A New Approach to Treating Acanthamoeba Keratitis - 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