{"id":51854,"date":"2024-09-29T15:29:40","date_gmt":"2024-09-29T15:29:40","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=51854"},"modified":"2026-02-02T15:31:04","modified_gmt":"2026-02-02T15:31:04","slug":"recent-advances-in-the-treatment-of-keratoconus","status":"publish","type":"post","link":"https:\/\/www.elza-institute.com\/pt\/recent-advances-in-the-treatment-of-keratoconus\/","title":{"rendered":"Avan\u00e7os recentes no tratamento do ceratocone"},"content":{"rendered":"
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Na \u00faltima d\u00e9cada, o papel do cross-linking corneano (CXL) no tratamento do ceratocone evoluiu substancialmente. O que come\u00e7ou como um m\u00e9todo para interromper a progress\u00e3o da doen\u00e7a evoluiu para uma fam\u00edlia de estrat\u00e9gias de tratamento cada vez mais refinadas e individualizadas. Em uma revis\u00e3o de 2024, Farhad Hafezi, MD, PhD, FARVO<\/a> resume os avan\u00e7os mais relevantes que moldam a pr\u00e1tica moderna do CXL num artigo publicado na ZPA<\/a>.<\/p>\n\n

Avan\u00e7os no cross-linking da c\u00f3rnea<\/h3>\n\n

O \u201cprotocolo de Dresden\u201d de remo\u00e7\u00e3o do epit\u00e9lio continua a ser a base hist\u00f3rica do CXL. Ao remover o epit\u00e9lio, saturar o estroma com riboflavina e aplicar irradia\u00e7\u00e3o UV-A a 3 mW\/cm\u00b2 durante 30 minutos, este protocolo aumenta de forma fi\u00e1vel a estabilidade biomec\u00e2nica da c\u00f3rnea. No entanto, a sua dura\u00e7\u00e3o e morbilidade p\u00f3s-operat\u00f3ria t\u00eam motivado esfor\u00e7os para otimizar a efici\u00eancia do tratamento sem comprometer a efic\u00e1cia.<\/p>\n\n

Os protocolos de CXL acelerado surgiram com a introdu\u00e7\u00e3o das modernas fontes de luz LED UV-A, com o objetivo de fornecer uma flu\u00eancia equivalente em tempos de tratamento mais curtos. As primeiras tentativas revelaram uma limita\u00e7\u00e3o importante: a deple\u00e7\u00e3o de oxig\u00e9nio pode reduzir a rigidez biomec\u00e2nica quando a flu\u00eancia \u00e9 fornecida demasiado rapidamente. Com base neste conhecimento, a investiga\u00e7\u00e3o de Zurique demonstrou que os protocolos de flu\u00eancia total mais elevada - como 10 J\/cm\u00b2 fornecidos em pouco mais de nove minutos - podem obter efeitos biomec\u00e2nicos compar\u00e1veis aos do protocolo de Dresden, reduzindo substancialmente o tempo de tratamento. Estas abordagens podem ser particularmente relevantes em casos pedi\u00e1tricos ou avan\u00e7ados em que se pretende um efeito mais forte.<\/p>\n\n

A gest\u00e3o de c\u00f3rneas finas e ultrafinas continua a ser um desafio central no tratamento do ceratocone. O CXL tradicional sem epit\u00e9lio \u00e9 contraindicado abaixo de uma espessura do estroma de 400 \u00b5m devido a preocupa\u00e7\u00f5es com a seguran\u00e7a endotelial. A t\u00e9cnica individualizada ELZA-sub400<\/a> aborda esta limita\u00e7\u00e3o ajustando a flu\u00eancia UV de acordo com a espessura do estroma medida, permitindo uma CXL segura em c\u00f3rneas t\u00e3o finas como 180 \u00b5m. A valida\u00e7\u00e3o cl\u00ednica forneceu uma estrutura padronizada para o tratamento de olhos que anteriormente eram considerados inadequados para o cross-linking.<\/p>\n\n

Esfor\u00e7os paralelos t\u00eam-se concentrado no CXL transepitelial (epi-on) para reduzir a dor e o risco de infe\u00e7\u00e3o associados \u00e0 remo\u00e7\u00e3o do epit\u00e9lio. Os avan\u00e7os nas formula\u00e7\u00f5es de riboflavina e nas estrat\u00e9gias de irradia\u00e7\u00e3o tornaram poss\u00edvel obter um refor\u00e7o clinicamente significativo sem suplementa\u00e7\u00e3o adicional de oxig\u00e9nio ou iontoforese.<\/p>\n\n

Um passo adicional em dire\u00e7\u00e3o \u00e0 personaliza\u00e7\u00e3o \u00e9 o CXL personalizado de segunda gera\u00e7\u00e3o. O ELZA-PACE combina a queratectomia fototerap\u00eautica guiada por mapeamento epitelial sobre o \u00e1pice do cone com o CXL epi-on personalizado, criando gradientes controlados de concentra\u00e7\u00e3o de riboflavina, disponibilidade de oxig\u00e9nio e flu\u00eancia UV. Esta abordagem demonstrou um maior achatamento dos cones do que os protocolos personalizados anteriores, sem a necessidade de sistemas complexos de seguimento ocular.<\/p>\n\n

Juntos, esses desenvolvimentos refletem uma mudan\u00e7a mais ampla no tratamento do ceratocone: da estabiliza\u00e7\u00e3o uniforme para a otimiza\u00e7\u00e3o biomec\u00e2nica e refrativa espec\u00edfica do paciente, orientada pela espessura da c\u00f3rnea, topografia e est\u00e1gio da doen\u00e7a.<\/p>\n\n

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Os recentes avan\u00e7os do cross-linking corneano v\u00e3o para al\u00e9m da estabiliza\u00e7\u00e3o da doen\u00e7a, introduzindo abordagens de tratamento individualizadas e personalizadas de segunda gera\u00e7\u00e3o para o ceratocone.<\/p>","protected":false},"author":4,"featured_media":51863,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[214,1,95],"tags":[352,100,945,637,1531,123,1490],"class_list":["post-51854","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-farhad-hafezi","category-general-news","category-scientific-article","tag-corneal-cross-linking","tag-cxl","tag-elza-pace","tag-epi-on-cxl","tag-individualized-treatment","tag-keratoconus","tag-sub400-protocol"],"acf":[],"yoast_head":"\nRecent Advances in the Treatment of Keratoconus - 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\/recent-advances-in-the-treatment-of-keratoconus\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Recent Advances in the Treatment of Keratoconus - 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