{"id":51899,"date":"2025-11-03T08:32:28","date_gmt":"2025-11-03T08:32:28","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=51899"},"modified":"2026-02-03T08:33:05","modified_gmt":"2026-02-03T08:33:05","slug":"cataract-surgery-in-keratoconus","status":"publish","type":"post","link":"https:\/\/www.elza-institute.com\/pt\/cataract-surgery-in-keratoconus\/","title":{"rendered":"Cirurgia de catarata em olhos com ceratocone - Considera\u00e7\u00f5es pr\u00e1ticas"},"content":{"rendered":"
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A cirurgia da catarata em doentes com ceratocone apresenta desafios que v\u00e3o muito para al\u00e9m dos casos de rotina. Uma revis\u00e3o cl\u00ednica recente em ophta<\/a><\/em> por Dr. Emilio Torres-Netto<\/a> MD, PhD, FEBO, FWCRS, examina a forma como a irregularidade da c\u00f3rnea, a biometria ocular alterada e o est\u00e1dio da doen\u00e7a afectam o c\u00e1lculo da lente intraocular (LIO), o planeamento cir\u00fargico e os resultados p\u00f3s-operat\u00f3rios. O artigo enfatiza que uma cirurgia de catarata bem sucedida em olhos queratoc\u00f3nicos requer uma abordagem individualizada e gerida de acordo com as expectativas, em vez de depender de fluxos de trabalho padr\u00e3o.<\/p>\n\n

O c\u00e1lculo exato da pot\u00eancia da LIO \u00e9 uma dificuldade central. No ceratocone, o poder refrativo da c\u00f3rnea \u00e9 altamente vari\u00e1vel e frequentemente descentrado, enquanto o comprimento axial tende a ser maior do que nos olhos normais. O astigmatismo irregular, as aberra\u00e7\u00f5es de ordem superior, a instabilidade da pel\u00edcula lacrimal e a m\u00e1 fixa\u00e7\u00e3o podem comprometer ainda mais a fiabilidade da biometria. Al\u00e9m disso, a inclina\u00e7\u00e3o posterior da c\u00f3rnea altera o r\u00e1cio de curvatura anterior-posterior, levando a uma sobrestima\u00e7\u00e3o do poder da c\u00f3rnea e a uma tend\u00eancia para o erro hiper\u00f3pico p\u00f3s-operat\u00f3rio.<\/p>\n\n

Nenhuma f\u00f3rmula \u00fanica de c\u00e1lculo de LIO funciona de forma fi\u00e1vel em todas as fases do ceratocone. Embora a doen\u00e7a precoce possa permitir uma precis\u00e3o aceit\u00e1vel com as f\u00f3rmulas modernas de quarta gera\u00e7\u00e3o, a previsibilidade diminui acentuadamente nos casos moderados e avan\u00e7ados. A revis\u00e3o recomenda a compara\u00e7\u00e3o de v\u00e1rias f\u00f3rmulas, utilizando diferentes dados ceratom\u00e9tricos, e reconhecendo a imprecis\u00e3o inerente a todos os m\u00e9todos actuais. As f\u00f3rmulas espec\u00edficas para o ceratocone podem ajudar em casos selecionados, mas permanecem limitadas em valores ceratom\u00e9tricos mais elevados.<\/p>\n\n

A sele\u00e7\u00e3o das lentes deve ser conservadora. As LIOs monofocais s\u00e3o geralmente preferidas, sendo as lentes t\u00f3ricas monofocais consideradas apenas em olhos cuidadosamente selecionados com astigmatismo central relativamente regular e sem inten\u00e7\u00e3o de retomar o uso de lentes de contacto r\u00edgidas. As lentes multifocais, EDOF, ou outros desenhos complexos de LIO s\u00e3o desencorajados devido \u00e0 instabilidade \u00f3tica das c\u00f3rneas queratoc\u00f3nicas. A refra\u00e7\u00e3o alvo \u00e9 tipicamente uma miopia ligeira para compensar a frequente mudan\u00e7a hiper\u00f3pica observada no p\u00f3s-operat\u00f3rio, particularmente na doen\u00e7a mais avan\u00e7ada.<\/p>\n\n

Do ponto de vista cir\u00fargico, a extra\u00e7\u00e3o da catarata no ceratocone assemelha-se frequentemente \u00e0 facoemulsifica\u00e7\u00e3o padr\u00e3o, mas requer aten\u00e7\u00e3o ao adelga\u00e7amento perif\u00e9rico da c\u00f3rnea, \u00e0 coloca\u00e7\u00e3o da incis\u00e3o e ao controlo da press\u00e3o intra-operat\u00f3ria. A cirurgia de catarata assistida por laser de femtosegundo pode facilitar a capsulorrexis e a fragmenta\u00e7\u00e3o do cristalino em olhos com distor\u00e7\u00e3o ou opacidade da c\u00f3rnea.<\/p>\n\n

O artigo destaca a import\u00e2ncia das estrat\u00e9gias de otimiza\u00e7\u00e3o da c\u00f3rnea. Em pacientes selecionados, a regulariza\u00e7\u00e3o da c\u00f3rnea - utilizando procedimentos como a abla\u00e7\u00e3o da superf\u00edcie guiada pela frente de onda, segmentos de anel alog\u00e9nico intra-estromal ou cross-linking corneano personalizado - pode ser realizada antes da cirurgia de catarata para melhorar a precis\u00e3o da biometria e os resultados visuais. A calendariza\u00e7\u00e3o depende da estabilidade da c\u00f3rnea, da gravidade da doen\u00e7a e dos objectivos visuais espec\u00edficos do doente.<\/p>\n\n

No Instituto ELZA, a cirurgia de catarata no ceratocone \u00e9 abordada como parte de uma estrat\u00e9gia em etapas, com a c\u00f3rnea em primeiro lugar, quando indicada. A evid\u00eancia revista sublinha que o planeamento cuidadoso, o aconselhamento realista e a sequencia\u00e7\u00e3o individualizada dos procedimentos corneanos e lenticulares s\u00e3o essenciais para alcan\u00e7ar resultados clinicamente significativos neste grupo complexo de doentes.<\/p>\n\n

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A cirurgia da catarata no ceratocone requer uma biometria individualizada, uma escolha conservadora da LIO e um planeamento cuidadoso da c\u00f3rnea.<\/p>","protected":false},"author":4,"featured_media":51906,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[243,1,96],"tags":[166,1429,1519,1546,1542,1543,123,1544,1547,1545],"class_list":["post-51899","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emilio-torres","category-general-news","category-popular-press","tag-cataract-surgery","tag-corneal-irregularity","tag-corneal-regularization","tag-femtosecond-cataract-surgery","tag-intraocular-lens-calculation","tag-iol-power","tag-keratoconus","tag-monofocal-iol","tag-ophta","tag-toric-iol"],"acf":[],"yoast_head":"\nCataract Surgery in Eyes with Keratoconus - Practical Considerations - 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\/cataract-surgery-in-keratoconus\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cataract Surgery in Eyes with Keratoconus - 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