{"id":50617,"date":"2025-07-11T14:30:54","date_gmt":"2025-07-11T14:30:54","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=50617"},"modified":"2025-11-10T11:05:36","modified_gmt":"2025-11-10T11:05:36","slug":"elza-sub400-protocols-endothelial-cell-safety-proven","status":"publish","type":"post","link":"https:\/\/www.elza-institute.com\/pt\/elza-sub400-protocols-endothelial-cell-safety-proven\/","title":{"rendered":"A seguran\u00e7a das c\u00e9lulas endoteliais do protocolo ELZA-sub400 - comprovada"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"50617\" class=\"elementor elementor-50617\" data-elementor-post-type=\"post\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ebb057f e-flex e-con-boxed e-con e-parent\" data-id=\"ebb057f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8a4e4de elementor-widget elementor-widget-text-editor\" data-id=\"8a4e4de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p data-start=\"1037\" data-end=\"1457\">A reticula\u00e7\u00e3o da c\u00f3rnea (CXL), para al\u00e9m de saturar a camada estrutural da c\u00f3rnea - o estroma - com riboflavina, envolve tamb\u00e9m a irradia\u00e7\u00e3o desta regi\u00e3o com luz ultravioleta (UV). Isto faz com que ocorra uma rea\u00e7\u00e3o fotoqu\u00edmica no estroma, que liga as mol\u00e9culas do estroma, tornando-o mais r\u00edgido e forte. Embora o estroma seja essencialmente constitu\u00eddo apenas por colag\u00e9nio e proteoglicanos (quase sem c\u00e9lulas vivas), existem tamb\u00e9m camadas densas de c\u00e9lulas acima e abaixo, que podem ser danificadas pela luz UV.<\/p>\n\n<h4>Porque \u00e9 que o CXL padr\u00e3o apresenta riscos em c\u00f3rneas finas<\/h4>\n<h4><span style=\"color: #7a7a7a; font-size: 17px; font-weight: 400;\">A camada de c\u00e9lulas epiteliais acima do estroma actua como uma barreira para proteger a c\u00f3rnea do ambiente. As c\u00e9lulas epiteliais s\u00e3o normalmente utilizadas durante os protocolos tradicionais de CXL para permitir que a riboflavina penetre no estroma. No entanto, estas c\u00e9lulas crescem rapidamente e repovoam a c\u00f3rnea nos dias ap\u00f3s o procedimento.\u00a0<\/span><\/h4>\n<p data-start=\"1037\" data-end=\"1457\">Seguiram-se v\u00e1rias modifica\u00e7\u00f5es ao protocolo de Dresden: inchar a c\u00f3rnea com riboflavina hipoosmolar para a engrossar artificialmente; adicionar uma lente de contacto embebida em riboflavina e tamb\u00e9m deixar algumas c\u00e9lulas epiteliais intactas nas partes mais finas da c\u00f3rnea. Todos tinham inconvenientes. Estes eram, respetivamente: efeitos de incha\u00e7o imprevis\u00edveis; baixa efic\u00e1cia de endurecimento e problemas com a dispers\u00e3o da luz UV na interface entre as regi\u00f5es com e sem c\u00e9lulas epiteliais.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-18866e6 elementor-widget elementor-widget-text-editor\" data-id=\"18866e6\" data-element_type=\"widget\" data-e-type=\"widget\" data-no-translation=\"\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style>.elementor-element-18866e6{display:none !important}<\/style>\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<div class=\"elementor-element elementor-element-5e9f667 e-flex e-con-boxed e-con e-parent\" data-id=\"5e9f667\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f89dc61 elementor-widget elementor-widget-image\" data-id=\"f89dc61\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-caption\">\n\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"472\" src=\"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/EN-Figure-1024x604.jpg\" class=\"attachment-large size-large wp-image-50627\" alt=\"Protocolo ELZA-sub400 comparado com outros protocolos de CXL para c\u00f3rnea fina\" srcset=\"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/EN-Figure-1024x604.jpg 1024w, https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/EN-Figure-300x177.jpg 300w, https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/EN-Figure-768x453.jpg 768w, https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/EN-Figure-1536x905.jpg 1536w, https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/EN-Figure-18x12.jpg 18w, https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/EN-Figure.jpg 1600w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t<figcaption class=\"widget-image-caption wp-caption-text\">Protocolo ELZA-sub400 comparado com outros protocolos de CXL para c\u00f3rnea fina<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0dc7e5f elementor-widget elementor-widget-image\" data-id=\"0dc7e5f\" data-element_type=\"widget\" data-e-type=\"widget\" data-no-translation=\"\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style>.elementor-element-0dc7e5f{display:none !important}<\/style>\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<div class=\"elementor-element elementor-element-272661a e-flex e-con-boxed e-con e-parent\" data-id=\"272661a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8f161aa elementor-widget elementor-widget-text-editor\" data-id=\"8f161aa\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>ELZA-sub400: Uma abordagem adaptada \u00e0 flu\u00eancia<\/h4><p>A ELZA desenvolveu o\u00a0<a href=\"https:\/\/www.elza-institute.com\/pt\/cross-linking\/cross-linking-cxl-thin-cornea\/\">Protocolo ELZA-sub400<\/a>que adoptou uma abordagem diferente. Em vez de modificar a c\u00f3rnea para se adaptar \u00e0 t\u00e9cnica, o que todas as abordagens anteriores tentaram fazer, adapt\u00e1mos a t\u00e9cnica \u00e0 c\u00f3rnea com um conceito extremamente simples: basta reticular o estroma at\u00e9 ao limite de seguran\u00e7a de 70 \u00b5m. Na realidade, isto envolveu anos de trabalho para construir um modelo matem\u00e1tico de como a luz UV, a riboflavina, o tecido do estroma e o oxig\u00e9nio interagem, e depois trabalho pr\u00e9-cl\u00ednico para o validar antes de os primeiros doentes poderem receber o ELZA-sub400 CXL. E para sermos justos, o ELZA-sub400 CXL funciona. No entanto, havia uma quest\u00e3o a ser respondida: tem algum efeito no endot\u00e9lio da c\u00f3rnea?<\/p><div>\u00a0<\/div><h4>Avalia\u00e7\u00e3o do efeito no endot\u00e9lio<\/h4><p>Um estudo cl\u00ednico recentemente publicado no\u00a0<em data-start=\"1221\" data-end=\"1252\"><a href=\"https:\/\/journals.healio.com\/doi\/10.3928\/1081597X-20250515-06\">Revista de Cirurgia Refractiva<\/a><\/em>\u00a0confirma agora a longa dura\u00e7\u00e3o\u00a0<span data-start=\"1280\" data-end=\"1302\">sub400<\/span>\u00a0<span data-start=\"1280\" data-end=\"1302\">endotelial<\/span>\u00a0seguran\u00e7a do protocolo ELZA-sub400, uma abordagem CXL adaptada \u00e0 flu\u00eancia e guiada por paquimetria, desenvolvida especificamente para c\u00f3rneas ultrafinas.<\/p><p data-start=\"1459\" data-end=\"1880\">Este estudo de centro \u00fanico, iniciado por um investigador, foi realizado no\u00a0<a href=\"https:\/\/www.usz.ch\/fachbereich\/augenklinik\/\">Hospital Universit\u00e1rio de Zurique<\/a>\u00a0em colabora\u00e7\u00e3o com o\u00a0<a href=\"https:\/\/www.elza-institute.com\/pt\/\">Instituto ELZA<\/a>. Dezassete olhos com progress\u00e3o documentada e espessuras m\u00ednimas do estroma t\u00e3o baixas como 210 \u00b5m foram submetidos a CXL utilizando o\u00a0<span data-start=\"1714\" data-end=\"1729\">ELZA-sub400<\/span>\u00a0protocolo. A flu\u00eancia foi ajustada com base na paquimetria intra-operat\u00f3ria, assegurando uma zona tamp\u00e3o m\u00ednima entre o estroma reticulado e o endot\u00e9lio.<\/p><h4>Seguran\u00e7a endotelial confirmada ao longo de 24 meses<\/h4><div>A equipa avaliou a densidade das c\u00e9lulas endoteliais da c\u00f3rnea (ECD) utilizando microscopia confocal na consulta inicial e nas visitas de acompanhamento que se estenderam at\u00e9 aos 24 meses. O estudo n\u00e3o encontrou sinais cl\u00ednicos de descompensa\u00e7\u00e3o endotelial. A altera\u00e7\u00e3o m\u00e9dia da ECD (56,4 c\u00e9lulas\/mm\u00b2, IC 95%: -9,6 a 122,4; P = 0,09) n\u00e3o foi estatisticamente significativa, apoiando diretamente a hip\u00f3tese de que o tratamento n\u00e3o \u00e9 uma solu\u00e7\u00e3o.\u00a0<span data-start=\"2211\" data-end=\"2233\">sub400 endotelial<\/span>\u00a0perfil de seguran\u00e7a do ELZA-sub400. As imagens da linha de demarca\u00e7\u00e3o (DL) com OCT do segmento anterior confirmaram que a profundidade de reticula\u00e7\u00e3o respeitava a margem de seguran\u00e7a, com uma dist\u00e2ncia mediana DL-endot\u00e9lio de 80 \u00b5m.<\/div><p data-start=\"2434\" data-end=\"2834\">A\u00a0<span data-start=\"2438\" data-end=\"2453\">ELZA-sub400<\/span>\u00a0baseia-se em princ\u00edpios f\u00edsicos - nomeadamente a lei de Lambert-Beer da atenua\u00e7\u00e3o dos raios UV e a difus\u00e3o Fickian da riboflavina e do oxig\u00e9nio. Em vez de tentar inchar artificialmente a c\u00f3rnea ou aumentar a complexidade do procedimento, o ELZA-sub400 ajusta o tempo de exposi\u00e7\u00e3o aos raios UV-A de acordo com a espessura real do estroma do paciente, preservando a efic\u00e1cia biomec\u00e2nica e salvaguardando as c\u00e9lulas endoteliais.<\/p><h4>Uma solu\u00e7\u00e3o normalizada para c\u00f3rneas de alto risco?<\/h4><div>Historicamente, as op\u00e7\u00f5es para os pacientes com c\u00f3rneas finas inclu\u00edam t\u00e9cnicas assistidas por lentes de contacto ou dilata\u00e7\u00e3o hipo-osmolar de riboflavina, o que resultava em efeitos de refor\u00e7o de reticula\u00e7\u00e3o sub-\u00f3ptimos ou imprevisibilidade em termos da dilata\u00e7\u00e3o conseguida. O ELZA-sub400 oferece uma alternativa padronizada e baseada em evid\u00eancias. O seu protocolo aplica 3 mW\/cm\u00b2 de UV-A cont\u00ednua e personaliza a dura\u00e7\u00e3o do tratamento, mantendo a flu\u00eancia total dentro de limites biomecanicamente eficazes mas seguros para o endot\u00e9lio.<\/div><p data-start=\"3284\" data-end=\"3620\">Estes dados cl\u00ednicos v\u00eam no seguimento de estudos ex vivo e de modeliza\u00e7\u00e3o anteriores e marcam a primeira confirma\u00e7\u00e3o a longo prazo do ELZA-<span data-start=\"3394\" data-end=\"3416\">endotelial de sub400<\/span>\u00a0seguran\u00e7a numa popula\u00e7\u00e3o do mundo real. Nomeadamente, n\u00e3o foram registadas complica\u00e7\u00f5es intra ou p\u00f3s-operat\u00f3rias e a integridade estrutural do endot\u00e9lio da c\u00f3rnea permaneceu intacta em todos os intervalos de seguimento.<\/p><h4>O que isto significa para a pr\u00e1tica cl\u00ednica<\/h4><div>Embora ainda sejam necess\u00e1rios estudos maiores com an\u00e1lises morfom\u00e9tricas mais extensas, os resultados representam um marco para o CXL em c\u00f3rneas de alto risco. O ELZA-sub400 alarga a elegibilidade do tratamento sem comprometer a seguran\u00e7a, oferecendo aos doentes com c\u00f3rneas ultrafinas uma op\u00e7\u00e3o estruturalmente conservadora e apoiada por dados.<\/div><div>\u00a0<\/div><p data-start=\"3929\" data-end=\"4030\">Refer\u00eancia<\/p><p>Blaser F, Torres-Netto EA, Gatzioufas Z, Perschak P, Hafezi F, Said S. Avalia\u00e7\u00e3o da integridade endotelial em pacientes com ceratocone progressivo e c\u00f3rneas finas tratados com o protocolo de cross-linking corneano sub400.\u00a0<i>J Refract Surg<\/i>. 2025;41(7):e682-e689.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40626429\/\" target=\"_new\" rel=\"noopener\" data-start=\"3970\" data-end=\"4029\">PMID: 40626429<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a1c7a6f elementor-widget elementor-widget-text-editor\" data-id=\"a1c7a6f\" data-element_type=\"widget\" data-e-type=\"widget\" data-no-translation=\"\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style>.elementor-element-a1c7a6f{display:none !important}<\/style>\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":"<p>Uma nova publica\u00e7\u00e3o no JRS relata a seguran\u00e7a endotelial a longo prazo do protocolo ELZA-sub400 para o tratamento do ceratocone progressivo em c\u00f3rneas mais finas do que 400 \u00b5m.<\/p>","protected":false},"author":4,"featured_media":50659,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1,95],"tags":[352,1467,679,1463,1466,1464,1470,1468,1472,1469,1471,1473,1465,1309],"class_list":["post-50617","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general-news","category-scientific-article","tag-corneal-cross-linking","tag-demarcation-line-to-endothelium","tag-elza-institute","tag-elza-sub400-protocol","tag-endothelial-cell-density-ecd","tag-endothelial-cell-safety","tag-fick-diffusion","tag-fluence-adapted-cxl","tag-investigator-initiated-study","tag-lambert-beer-law","tag-no-endothelial-decompensation","tag-single-centre-university-hospital-zurich","tag-stromal-thickness-400-m","tag-ultrathin-corneas"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The endothelial cell safety of the ELZA-sub400 protocol - proven - The ELZA Institute<\/title>\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\/elza-sub400-protocols-endothelial-cell-safety-proven\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The endothelial cell safety of the ELZA-sub400 protocol - proven - The ELZA Institute\" \/>\n<meta property=\"og:description\" content=\"A new publication in JRS reports the long-term endothelial safety of the ELZA-sub400 protocol for treating progressive keratoconus in corneas thinner than 400 \u00b5m.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.elza-institute.com\/pt\/elza-sub400-protocols-endothelial-cell-safety-proven\/\" \/>\n<meta property=\"og:site_name\" content=\"The ELZA Institute\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ELZA.Institute\/\" \/>\n<meta property=\"article:published_time\" content=\"2025-07-11T14:30:54+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-10T11:05:36+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/elza-sub400-endothelial-cells-featured-image.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"600\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Mark Hillen\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Mark Hillen\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tempo estimado de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/\"},\"author\":{\"name\":\"Mark Hillen\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#\\\/schema\\\/person\\\/e3929262886a5a60dd6965a6bc721d15\"},\"headline\":\"The endothelial cell safety of the ELZA-sub400 protocol &#8211; proven\",\"datePublished\":\"2025-07-11T14:30:54+00:00\",\"dateModified\":\"2025-11-10T11:05:36+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/\"},\"wordCount\":1552,\"publisher\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.elza-institute.com\\\/wp-content\\\/uploads\\\/2025\\\/07\\\/elza-sub400-endothelial-cells-featured-image.jpg\",\"keywords\":[\"corneal cross-linking\",\"demarcation line to endothelium\",\"ELZA Institute\",\"ELZA-sub400 protocol\",\"endothelial cell density (ECD)\",\"endothelial cell safety\",\"Fick diffusion\",\"fluence-adapted CXL\",\"investigator-initiated study\",\"Lambert-Beer law\",\"no endothelial decompensation\",\"single-centre University Hospital Zurich.\",\"stromal thickness &lt; 400 \u00b5m\",\"ultrathin corneas\"],\"articleSection\":[\"News\",\"Scientific article\"],\"inLanguage\":\"pt-PT\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/\",\"url\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/\",\"name\":\"The endothelial cell safety of the ELZA-sub400 protocol - proven - The ELZA Institute\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.elza-institute.com\\\/wp-content\\\/uploads\\\/2025\\\/07\\\/elza-sub400-endothelial-cells-featured-image.jpg\",\"datePublished\":\"2025-07-11T14:30:54+00:00\",\"dateModified\":\"2025-11-10T11:05:36+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/#breadcrumb\"},\"inLanguage\":\"pt-PT\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-PT\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/#primaryimage\",\"url\":\"https:\\\/\\\/www.elza-institute.com\\\/wp-content\\\/uploads\\\/2025\\\/07\\\/elza-sub400-endothelial-cells-featured-image.jpg\",\"contentUrl\":\"https:\\\/\\\/www.elza-institute.com\\\/wp-content\\\/uploads\\\/2025\\\/07\\\/elza-sub400-endothelial-cells-featured-image.jpg\",\"width\":1200,\"height\":600,\"caption\":\"ELZA-sub400 endothelial cells study - featured image\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/elza-sub400-protocols-endothelial-cell-safety-proven\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.elza-institute.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"News\",\"item\":\"https:\\\/\\\/www.elza-institute.com\\\/general-news\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"The endothelial cell safety of the ELZA-sub400 protocol &#8211; proven\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#website\",\"url\":\"https:\\\/\\\/www.elza-institute.com\\\/\",\"name\":\"The ELZA Institute\",\"description\":\"Swiss EyeCare at its finest\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.elza-institute.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"pt-PT\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#organization\",\"name\":\"The ELZA Institute\",\"url\":\"https:\\\/\\\/www.elza-institute.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-PT\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/www.elza-institute.com\\\/wp-content\\\/uploads\\\/2016\\\/04\\\/ELZA-logo-V4.jpg\",\"contentUrl\":\"https:\\\/\\\/www.elza-institute.com\\\/wp-content\\\/uploads\\\/2016\\\/04\\\/ELZA-logo-V4.jpg\",\"width\":1181,\"height\":453,\"caption\":\"The ELZA Institute\"},\"image\":{\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/ELZA.Institute\\\/\",\"https:\\\/\\\/x.com\\\/ELZA_Institute\",\"https:\\\/\\\/www.linkedin.com\\\/company\\\/elza-institute?trk=top_nav_home\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/www.elza-institute.com\\\/#\\\/schema\\\/person\\\/e3929262886a5a60dd6965a6bc721d15\",\"name\":\"Mark Hillen\",\"url\":\"https:\\\/\\\/www.elza-institute.com\\\/pt\\\/author\\\/markhillen\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"A seguran\u00e7a das c\u00e9lulas endoteliais do protocolo ELZA-sub400 - comprovada - Instituto ELZA","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.elza-institute.com\/pt\/elza-sub400-protocols-endothelial-cell-safety-proven\/","og_locale":"pt_PT","og_type":"article","og_title":"The endothelial cell safety of the ELZA-sub400 protocol - proven - The ELZA Institute","og_description":"A new publication in JRS reports the long-term endothelial safety of the ELZA-sub400 protocol for treating progressive keratoconus in corneas thinner than 400 \u00b5m.","og_url":"https:\/\/www.elza-institute.com\/pt\/elza-sub400-protocols-endothelial-cell-safety-proven\/","og_site_name":"The ELZA Institute","article_publisher":"https:\/\/www.facebook.com\/ELZA.Institute\/","article_published_time":"2025-07-11T14:30:54+00:00","article_modified_time":"2025-11-10T11:05:36+00:00","og_image":[{"width":1200,"height":600,"url":"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/elza-sub400-endothelial-cells-featured-image.jpg","type":"image\/jpeg"}],"author":"Mark Hillen","twitter_misc":{"Escrito por":"Mark Hillen","Tempo estimado de leitura":"8 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/#article","isPartOf":{"@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/"},"author":{"name":"Mark Hillen","@id":"https:\/\/www.elza-institute.com\/#\/schema\/person\/e3929262886a5a60dd6965a6bc721d15"},"headline":"The endothelial cell safety of the ELZA-sub400 protocol &#8211; proven","datePublished":"2025-07-11T14:30:54+00:00","dateModified":"2025-11-10T11:05:36+00:00","mainEntityOfPage":{"@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/"},"wordCount":1552,"publisher":{"@id":"https:\/\/www.elza-institute.com\/#organization"},"image":{"@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/#primaryimage"},"thumbnailUrl":"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/elza-sub400-endothelial-cells-featured-image.jpg","keywords":["corneal cross-linking","demarcation line to endothelium","ELZA Institute","ELZA-sub400 protocol","endothelial cell density (ECD)","endothelial cell safety","Fick diffusion","fluence-adapted CXL","investigator-initiated study","Lambert-Beer law","no endothelial decompensation","single-centre University Hospital Zurich.","stromal thickness &lt; 400 \u00b5m","ultrathin corneas"],"articleSection":["News","Scientific article"],"inLanguage":"pt-PT"},{"@type":"WebPage","@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/","url":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/","name":"A seguran\u00e7a das c\u00e9lulas endoteliais do protocolo ELZA-sub400 - comprovada - Instituto ELZA","isPartOf":{"@id":"https:\/\/www.elza-institute.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/#primaryimage"},"image":{"@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/#primaryimage"},"thumbnailUrl":"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/elza-sub400-endothelial-cells-featured-image.jpg","datePublished":"2025-07-11T14:30:54+00:00","dateModified":"2025-11-10T11:05:36+00:00","breadcrumb":{"@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/#breadcrumb"},"inLanguage":"pt-PT","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/"]}]},{"@type":"ImageObject","inLanguage":"pt-PT","@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/#primaryimage","url":"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/elza-sub400-endothelial-cells-featured-image.jpg","contentUrl":"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2025\/07\/elza-sub400-endothelial-cells-featured-image.jpg","width":1200,"height":600,"caption":"ELZA-sub400 endothelial cells study - featured image"},{"@type":"BreadcrumbList","@id":"https:\/\/www.elza-institute.com\/elza-sub400-protocols-endothelial-cell-safety-proven\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.elza-institute.com\/"},{"@type":"ListItem","position":2,"name":"News","item":"https:\/\/www.elza-institute.com\/general-news\/"},{"@type":"ListItem","position":3,"name":"The endothelial cell safety of the ELZA-sub400 protocol &#8211; proven"}]},{"@type":"WebSite","@id":"https:\/\/www.elza-institute.com\/#website","url":"https:\/\/www.elza-institute.com\/","name":"O Instituto ELZA","description":"Swiss EyeCare no seu melhor","publisher":{"@id":"https:\/\/www.elza-institute.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.elza-institute.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"pt-PT"},{"@type":"Organization","@id":"https:\/\/www.elza-institute.com\/#organization","name":"O Instituto ELZA","url":"https:\/\/www.elza-institute.com\/","logo":{"@type":"ImageObject","inLanguage":"pt-PT","@id":"https:\/\/www.elza-institute.com\/#\/schema\/logo\/image\/","url":"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2016\/04\/ELZA-logo-V4.jpg","contentUrl":"https:\/\/www.elza-institute.com\/wp-content\/uploads\/2016\/04\/ELZA-logo-V4.jpg","width":1181,"height":453,"caption":"The ELZA Institute"},"image":{"@id":"https:\/\/www.elza-institute.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/ELZA.Institute\/","https:\/\/x.com\/ELZA_Institute","https:\/\/www.linkedin.com\/company\/elza-institute?trk=top_nav_home"]},{"@type":"Person","@id":"https:\/\/www.elza-institute.com\/#\/schema\/person\/e3929262886a5a60dd6965a6bc721d15","name":"Mark Hillen","url":"https:\/\/www.elza-institute.com\/pt\/author\/markhillen\/"}]}},"_links":{"self":[{"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/posts\/50617","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/comments?post=50617"}],"version-history":[{"count":0,"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/posts\/50617\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/media\/50659"}],"wp:attachment":[{"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/media?parent=50617"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/categories?post=50617"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.elza-institute.com\/pt\/wp-json\/wp\/v2\/tags?post=50617"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}