{"id":552509,"date":"2026-03-20T00:58:14","date_gmt":"2026-03-20T00:58:14","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=552509"},"modified":"2026-03-20T14:48:46","modified_gmt":"2026-03-20T14:48:46","slug":"high-dose-riboflavin-and-sunlight-cxl","status":"publish","type":"post","link":"https:\/\/www.elza-institute.com\/pt\/high-dose-riboflavin-and-sunlight-cxl\/","title":{"rendered":"Dose elevada de riboflavina e luz solar CXL?"},"content":{"rendered":"
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A luz solar e a riboflavina (vitamina B2) podem tratar o ceratocone? ELZA faz perguntas\u2026<\/h2>\n

A publica\u00e7\u00e3o recente<\/a> no Revista Brasileira de Oftalmologia<\/em> aborda uma quest\u00e3o que circula cada vez mais online e entre os doentes: se o ceratocone pode ser tratado atrav\u00e9s de riboflavina oral em alta dose (vitamina B2) combinada com exposi\u00e7\u00e3o \u00e0 luz solar<\/span>.<\/p>\n

O artigo \u00e9 uma Carta ao Editor em resposta a um estudo publicado anteriormente que sugeria que tal abordagem \u201cparece ser eficaz na estabiliza\u00e7\u00e3o da progress\u00e3o do ceratocone\u201d.\u201d<\/p>\n

Foi redigido por uma equipa do Instituto ELZA, em Zurique, incluindo Dr. Emilio A. Torres-Netto, MD, PhD, FEBO<\/a>, FWCRS e Farhad Hafezi, MD, PhD, FARVO<\/a> e Dr. Mark Hillen, PhD<\/a>, que questionou algumas das premissas na artigo original<\/a> a carta pergunta sobre.<\/p>\n

O artigo original pode ser acedido aqui<\/a>:<\/p>\n

O que estava a ser afirmado<\/h2>\n

O estudo original prop\u00f4s que a combina\u00e7\u00e3o de riboflavina oral com exposi\u00e7\u00e3o \u00e0 luz solar pode estabilizar o ceratocone, efetuando, na pr\u00e1tica, reticula\u00e7\u00e3o da c\u00f3rnea<\/a>. Esta ideia tem ganho aten\u00e7\u00e3o porque parece simples e acess\u00edvel, particularmente quando comparada a procedimentos cl\u00ednicos de reticula\u00e7\u00e3o.<\/p>\n

Limita\u00e7\u00f5es do desenho do estudo<\/h2>\n

A resposta real\u00e7a que o estudo foi retrospetivo, n\u00e3o controlado e envolveu um n\u00famero relativamente pequeno de pacientes, com desist\u00eancias num curto per\u00edodo de acompanhamento. Crucialmente, n\u00e3o existia a exig\u00eancia de que o ceratocone estivesse ativamente a progredir na linha de base.<\/p>\n

Neste contexto, a estabilidade observada n\u00e3o pode ser interpretada como um efeito do tratamento. Como afirmam os autores, \u201cestas n\u00e3o s\u00e3o limita\u00e7\u00f5es menores, mas barreiras fundamentais para estabelecer a efic\u00e1cia causal\u201d.\u201d<\/p>\n

Fatores de confus\u00e3o<\/h2>\n

A interpreta\u00e7\u00e3o \u00e9 ainda mais complicada por medidas adicionais aplicadas durante o estudo. Os pacientes foram instru\u00eddos a evitar esfregar os olhos e receberam terapia antial\u00e9rgica. Ambos s\u00e3o conhecidos por reduzir a progress\u00e3o do ceratocone de forma independente.<\/p>\n

Estes efeitos n\u00e3o foram separados da influ\u00eancia proposta da riboflavina e da luz solar, tornando dif\u00edcil atribuir quaisquer altera\u00e7\u00f5es observadas \u00e0 interven\u00e7\u00e3o em si.<\/p>\n

Plausibilidade biol\u00f3gica do tratamento do ceratocone com riboflavina e luz solar<\/h2>\n

Reticula\u00e7\u00e3o da c\u00f3rnea<\/a> depende de se atingir uma concentra\u00e7\u00e3o de riboflavina suficiente na c\u00f3rnea e de se administrar uma quantidade definida de energia ultravioleta.<\/p>\n

Os autores relatam que a riboflavina sist\u00e9mica produz concentra\u00e7\u00f5es estromais \u201cmais de 400 vezes inferiores \u00e0 concentra\u00e7\u00e3o tipicamente alcan\u00e7ada com instila\u00e7\u00e3o t\u00f3pica na CXL cl\u00ednica\u201d.\u201d<\/p>\n

Ao mesmo tempo, a exposi\u00e7\u00e3o ultravioleta da luz solar \u00e9 muito menor do que a utilizada em protocolos cl\u00ednicos, com energia absorvida \u201ctr\u00eas ordens de magnitude abaixo da fornecida no protocolo de Dresden\u201d.\u201d<\/p>\n

Sob estas condi\u00e7\u00f5es, os requisitos para uma reticula\u00e7\u00e3o eficaz n\u00e3o s\u00e3o cumpridos.<\/p>\n

Evid\u00eancia experimental<\/h2>\n

A publica\u00e7\u00e3o refere dados experimentais controlados nos quais a riboflavina oral e a exposi\u00e7\u00e3o solar n\u00e3o aumentaram a rigidez da c\u00f3rnea. Testes biomec\u00e2nicos n\u00e3o demonstraram efeito de fortalecimento, e algumas descobertas foram consistentes com a redu\u00e7\u00e3o da rigidez.<\/p>\n

Estes resultados contradizem diretamente o resultado esperado de reticula\u00e7\u00e3o bem-sucedida.<\/p>\n

Variabilidade da exposi\u00e7\u00e3o solar<\/h2>\n

A luz solar natural \u00e9 intrinsecamente vari\u00e1vel. A exposi\u00e7\u00e3o depende da localiza\u00e7\u00e3o geogr\u00e1fica, hora do dia, esta\u00e7\u00e3o do ano, condi\u00e7\u00f5es meteorol\u00f3gicas e comportamento individual.<\/p>\n

Sem uma medi\u00e7\u00e3o precisa da dose de ultravioleta, n\u00e3o \u00e9 poss\u00edvel normalizar o tratamento ou atribuir de forma fi\u00e1vel quaisquer efeitos observados a um processo fotoqu\u00edmico. Os autores descrevem tal atribui\u00e7\u00e3o como especulativa.<\/p>\n

Implica\u00e7\u00f5es cl\u00ednicas<\/h2>\n

Os autores manifestam a preocupa\u00e7\u00e3o de que a promo\u00e7\u00e3o desta abordagem possa atrasar o acesso a tratamentos comprovados. O cross-linking da c\u00f3rnea realizado em ambiente cl\u00ednico continua a ser a \u00fanica interven\u00e7\u00e3o com efic\u00e1cia estabelecida na interrup\u00e7\u00e3o da progress\u00e3o do ceratocone.<\/p>\n

Como assinalado na publica\u00e7\u00e3o, \u201co potencial de dano \u00e9 consider\u00e1vel se os pacientes renunciarem ao CXL atempado com base em alega\u00e7\u00f5es sem fundamento.\u201d<\/p>\n

Conclus\u00e3o<\/h2>\n

Esta publica\u00e7\u00e3o n\u00e3o apoia o conceito de reticula\u00e7\u00e3o ativada pela luz solar usando riboflavina oral. Em vez disso, fornece uma cr\u00edtica estruturada da evid\u00eancia dispon\u00edvel e explica por que \u00e9 improv\u00e1vel que o mecanismo proposto produza um efeito clinicamente significativo.<\/p>\n

Para os pacientes, a mensagem principal \u00e9 que o cross-linking da c\u00f3rnea realizado em condi\u00e7\u00f5es cl\u00ednicas controladas continua a ser o padr\u00e3o de tratamento para deter a progress\u00e3o do ceratocono.<\/p>\n

Refer\u00eancias<\/span><\/strong>

Almodin EM, Almodin F, Almodin J. Reticula\u00e7\u00e3o do colag\u00e9nio da c\u00f3rnea por exposi\u00e7\u00e3o solar e riboflavina oral em alta dose: um estudo observacional longitudinal multic\u00eantrico. Revista Brasileira de Oftalmologia. 2025;84:e0036.<\/span><\/p>\n

Torres EA, Aydemir ME, Lu NJ, et al. Carta para: Cross-linking do col\u00e1geno da c\u00f3rnea por exposi\u00e7\u00e3o solar e riboflavina oral em altas doses: um estudo observacional longitudinal multic\u00eantrico. Revista Brasileira de Oftalmologia. 2026;85:e0020.<\/span><\/p>\n

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Carta de Torres-Netto et al. ao Editor<\/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>\n\t\t
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A luz solar e a riboflavina (vitamina B2) podem tratar o ceratocone? Uma nova publica\u00e7\u00e3o explica por que raz\u00e3o as provas actuais n\u00e3o o apoiam.<\/p>","protected":false},"author":4,"featured_media":552519,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[243,214,1109,1],"tags":[130,354,100,101613,454,101616,101615,101614,292,654,1067],"class_list":["post-552509","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emilio-torres","category-farhad-hafezi","category-mark-hillen","category-general-news","tag-cross-linking","tag-crosslinking","tag-cxl","tag-high-dose-riboflavin","tag-letter","tag-letter-to-the-editor","tag-light","tag-oral-riboflavin","tag-riboflavin","tag-sunlight","tag-uv-light"],"acf":[],"yoast_head":"\nHigh-dose riboflavin and sunlight CXL? - 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\/high-dose-riboflavin-and-sunlight-cxl\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"High-dose riboflavin and sunlight CXL? - The ELZA Institute\" \/>\n<meta property=\"og:description\" content=\"Can sunlight and riboflavin (vitamin B2) treat keratoconus? 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