{"id":553888,"date":"2026-10-05T15:09:00","date_gmt":"2026-10-05T15:09:00","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=553888"},"modified":"2026-10-05T15:09:01","modified_gmt":"2026-10-05T15:09:01","slug":"stepwise-visual-rehabilitation-keratoconus","status":"publish","type":"post","link":"https:\/\/www.elza-institute.com\/pt\/stepwise-visual-rehabilitation-keratoconus\/","title":{"rendered":"Reabilita\u00e7\u00e3o visual por etapas no queratocono, Prof. Hafezi no Der Augenspiegel"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"553888\" class=\"elementor elementor-553888\" data-elementor-post-type=\"post\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1fed301f e-flex e-con-boxed e-con e-parent\" data-id=\"1fed301f\" 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-27375513 elementor-widget elementor-widget-text-editor\" data-id=\"27375513\" 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>Muitas pessoas com queratocone ainda conseguem ler a tabela de vis\u00e3o com bastante clareza. No entanto, elas descrevem uma sensa\u00e7\u00e3o de v\u00e9u sobre a vis\u00e3o, contornos duplos, halos e brilho noturno. A tabela mede a nitidez; n\u00e3o captura a \u00f3tica distorcida por tr\u00e1s dessas queixas. Na edi\u00e7\u00e3o de setembro de 2026 da revista Cornea, <a href=\"https:\/\/www.augenspiegel.com\/stufenweise-visuelle-rehabilitation-bei-keratokonus\/\"><em>O espelho do olho<\/em><\/a>, <a href=\"https:\/\/www.elza-institute.com\/pt\/sobre\/farhad-hafezi\/\">Prof. Farhad Hafezi<\/a> exibe a resposta da ELZA: uma reabilita\u00e7\u00e3o visual progressiva, que passa pela estabiliza\u00e7\u00e3o da c\u00f3rnea, pelo remodelamento dela e, finalmente, pelo ajuste final da sua \u00f3ptica.<\/p>\n<h3>Por que os \u00f3culos muitas vezes n\u00e3o s\u00e3o suficientes<\/h3>\n<p><a href=\"https:\/\/www.elza-institute.com\/pt\/ceratocone\/\">Ceratocone<\/a> \u00c9 uma perda progressiva e enfraquecimento da c\u00f3rnea que geralmente come\u00e7a na segunda d\u00e9cada de vida. \u00c0 medida que as superf\u00edcies anterior e posterior da c\u00f3rnea se tornam irregulares, elas criam aberra\u00e7\u00f5es de ordem superior. Essas erros \u00f3ticos, principalmente a coma vertical, n\u00e3o podem ser corrigidos com \u00f3culos ou lentes de contato macias. As lentes de contato escleral ou r\u00edgidas podem frequentemente mascarar esses erros. No entanto, nem todos os toleram a longo prazo e elas n\u00e3o fazem nada para a fraqueza biomec\u00e2nica subjacente.<\/p>\n<p>As medidas conservadoras t\u00eam prioridade: melhor corre\u00e7\u00e3o \u00f3ptica, tratamento das alergias oculares e evitar o esfregamento ocular. Quando estas n\u00e3o forem suficientes, existem agora v\u00e1rias op\u00e7\u00f5es cir\u00fargicas dispon\u00edveis. O professor Hafezi observa que uma quest\u00e3o surge repetidamente na cl\u00ednica: qual \u00e9 o padr\u00e3o de tratamento atual? \u201cA resposta honesta \u00e9: depende.\u201d<\/p>\n<h3>Reabilita\u00e7\u00e3o visual por etapas, a pir\u00e2mide ELZA<\/h3>\n<p>A ELZA organiza essas op\u00e7\u00f5es em uma pir\u00e2mide de tr\u00eas etapas, que podem ser usadas separadamente ou em combina\u00e7\u00e3o:<\/p>\n<ul>\n<li>Etapa 1, estabiliza\u00e7\u00e3o: parada do avan\u00e7o da doen\u00e7a com a cross-linking corneana (CXL).<\/li>\n<li>Passo 2, primeira melhoria visual: regulariza\u00e7\u00e3o da forma da c\u00f3rnea com segmentos de anel intrastromal de origem aut\u00f3loga (CAIRS ou ECO-CAIRS) ou com ELZA-PACE.<\/li>\n<li>Etapa 3, ajuste final: redu\u00e7\u00e3o das aberra\u00e7\u00f5es de ordem superior restantes com a PRK trans-epit\u00e9lia guiada pelo perfil de ondas ou pela topografia.<\/li>\n<\/ul>\n<p>Qual o procedimento adequado para cada olho depende da topografia, tomografia, espessura da c\u00f3rnea, imagem biomec\u00e2nica e os desejos do pr\u00f3prio paciente. Um princ\u00edpio fundamental \u00e9 remover o m\u00ednimo poss\u00edvel de tecido da c\u00f3rnea. Os segmentos de tecido doador podem ser removidos ou trocados, enquanto a reticula\u00e7\u00e3o e a abla\u00e7\u00e3o com laser alteram permanentemente a c\u00f3rnea. Desta forma, a c\u00f3rnea permanece \u201cdispon\u00edvel\u201d para os procedimentos subsequentes.<\/p>\n<h3>Passo 1: estabiliza\u00e7\u00e3o da c\u00f3rnea<\/h3>\n<p><a href=\"https:\/\/www.elza-institute.com\/pt\/cross-linking\/\">Reticula\u00e7\u00e3o<\/a> a t\u00e9cnica utiliza gotas de riboflavina (vitamina B2) e luz ultravioleta para alongar a c\u00f3rnea. Desde que o protocolo de Dresden foi descrito pela primeira vez em 2003, tornou-se o tratamento padr\u00e3o para o keratoconus progressivo. Ao longo de duas d\u00e9cadas, ele passou de um m\u00e9todo fixo para uma abordagem personalizada. O artigo destaca tr\u00eas dire\u00e7\u00f5es atuais: <a href=\"https:\/\/www.elza-institute.com\/pt\/cross-linking\/cross-linking-cxl-thin-cornea\/\">Protocolo ELZA-sub400<\/a> Trata c\u00f3rneas com espessura inferior a 400 \u00b5m. Moderno <a href=\"https:\/\/www.elza-institute.com\/pt\/cross-linking\/epi-on-or-epi-off-cross-linking-cxl\/\">protocolos do epi-on<\/a> deixar a camada superficial intacta. Finalmente, a reticula\u00e7\u00e3o de alta intensidade proporciona 10 J\/cm\u00b2. Em estudos laboratoriais, a reticula\u00e7\u00e3o epi-on com um reforcedor de penetra\u00e7\u00e3o modificado endureceu a c\u00f3rnea tanto quanto acelerou a reticula\u00e7\u00e3o epi-off. Ainda \u00e9 necess\u00e1rio estudar se isso se traduz em um mesmo efeito cl\u00ednico a longo prazo. A ELZA j\u00e1 informou <a href=\"https:\/\/www.elza-institute.com\/pt\/elza-epi-on-protocol-escrs-2026\/\">Resultados cl\u00ednicos de 1 ano para o seu protocolo epi-on<\/a>.<\/p>\n<h3>Passo 2: remodelagem da c\u00f3rnea<\/h3>\n<p><a href=\"https:\/\/www.elza-institute.com\/pt\/ceratocone\/pace-customized-cross-linking-cxl\/\">ELZA-PACE<\/a> (CXL personalizado com assist\u00eancia da PTK) visa regularizar a c\u00f3rnea e estabiliz\u00e1-la, sem remover o tecido estromal. Combina quatro gradientes. Primeiro, um laser remove uma fina camada de epit\u00e9lio, cerca de 8\u201310 \u00b5m, na parte mais \u00edngreme do cone. Como resultado, a riboflavina e o oxig\u00eanio chegam mais facilmente ao estrato. Finalmente, a luz UV pulsada de alta intensidade com um impulso central concentra a reticula\u00e7\u00e3o onde a c\u00f3rnea \u00e9 mais fraca. Os resultados cl\u00ednicos da coorte de pacientes do ELZA est\u00e3o atualmente em fase de revis\u00e3o por pares. De acordo com os palavras do Prof. Hafezi, o PACE move a reticula\u00e7\u00e3o de um procedimento puramente estabilizante para \u201cum primeiro elemento da reabilita\u00e7\u00e3o visual\u201d.<\/p>\n<p>Quando a PACE n\u00e3o regulariza a c\u00f3rnea o suficiente, os segmentos anulares entram em a\u00e7\u00e3o. <a href=\"https:\/\/www.elza-institute.com\/pt\/understanding-icrs-and-femto-cairs-a-simple-guide\/\">Segmentos de anel de pl\u00e1stico (PMMA)<\/a> Est\u00e3o em uso h\u00e1 mais de 20 anos. No entanto, eles v\u00eam em comprimentos fixos e podem ocasionalmente migrar ou se expandir. O CAIRS, desenvolvido por Soosan Jacob em 2018, utiliza segmentos cortados a partir de c\u00f3rneas doadoras. Devido \u00e0 sua composi\u00e7\u00e3o de col\u00e1geno, eles se integram biologicamente e podem se fixar em camadas mais profundas para proporcionar um efeito de remodelagem mais eficaz. <a href=\"https:\/\/www.elza-institute.com\/pt\/ceratocone\/femto-cairs-keratoconus\/\">ECO-CAIRS<\/a> vai um passo adiante: os segmentos doador s\u00e3o <a href=\"https:\/\/www.elza-institute.com\/pt\/elza-researchers-publish-jcrs-study-on-cross-linked-allogenic-corneal-ring-segments\/\">reticulado com uma flu\u00eancia ultra-elevada<\/a> fora do olho antes da implanta\u00e7\u00e3o. Os segmentos endurecidos mant\u00eam a sua forma durante a implanta\u00e7\u00e3o e se encaixam na c\u00f3rnea de forma mais f\u00e1cil, com menos incha\u00e7o. Se isso proporciona resultados mais previs\u00edveis a longo prazo do que o tratamento n\u00e3o realizado com CAIRS, ainda \u00e9 necess\u00e1rio realizar estudos comparativos mais amplos. Na experi\u00eancia da ELZA at\u00e9 agora, o ECO-CAIRS pode ser considerado particularmente eficaz no queratocone moderado a avan\u00e7ado. Regularizar a c\u00f3rnea antes da implanta\u00e7\u00e3o <a href=\"https:\/\/www.elza-institute.com\/pt\/cirurgia-de-catarata\/\">cirurgia de catarata<\/a> tamb\u00e9m pode tornar os c\u00e1lculos de pot\u00eancia das lentes mais confi\u00e1veis.<\/p>\n<h3>Passo 3: ajuste fino da \u00f3ptica<\/h3>\n<p>Em uma c\u00f3rnea est\u00e1vel e, idealmente, j\u00e1 regularizada, <a href=\"https:\/\/www.elza-institute.com\/pt\/cirurgia-ocular-laser\/\">PRK trans-epitelial guiado pelo feixe de ondas<\/a> Em seguida, \u00e9 poss\u00edvel refinar os erros visuais remanescentes. O objetivo n\u00e3o \u00e9 corrigir a corre\u00e7\u00e3o total, mas reduzir as aberra\u00e7\u00f5es de ordem mais elevada, especialmente a coma vertical. Os pr\u00e9-requisitos incluem estabilidade documentada, espessura corneana suficiente, remo\u00e7\u00e3o limitada do tecido planejada e uma forma de cone adequada. No Instituto ELZA, esta etapa utiliza um laser exc\u00edmer SCHWIND AMARIS com um algoritmo integrado de orienta\u00e7\u00e3o pelo plano de frente da c\u00f3rnea. Algoritmos mais recentes tamb\u00e9m utilizam <a href=\"https:\/\/www.elza-institute.com\/pt\/total-corneal-wavefront-analysis-excimer-laser-surgery\/\">superf\u00edcie posterior da c\u00f3rnea<\/a> Esses procedimentos devem ser considerados e podem ajudar a evitar a remo\u00e7\u00e3o desnecess\u00e1ria de tecidos. Seu benef\u00edcio adicional ainda precisa ser confirmado em estudos prospectivos.<\/p>\n<h3>Op\u00e7\u00f5es al\u00e9m do transplante de c\u00f3rnea<\/h3>\n<p>O professor Hafezi resume a reabilita\u00e7\u00e3o visual por etapas como uma \u201cambos-e-ou-n\u00e3o\u201d gradativa, em vez de uma \u201cou-sim-ou-n\u00e3o\u201d: estabilizar com a cross-linking, remodelar com o ECO-CAIRS ou o ELZA-PACE e ajustar com o PRK guiado pelo feixe de ondas, mantendo cada etapa o mais poupadora de tecido poss\u00edvel. Sua mensagem aos colegas \u00e9 que at\u00e9 mesmo o queratocono avan\u00e7ado agora possui op\u00e7\u00f5es realistas al\u00e9m de um transplante completo da c\u00f3rnea. Al\u00e9m disso, a encaminhamento precoce para um centro especializado preserva essas op\u00e7\u00f5es tanto para o olho quanto para o paciente.<\/p>\n<p>O artigo completo sobre a reabilita\u00e7\u00e3o visual por etapas pode ser lido em <a href=\"https:\/\/www.augenspiegel.com\/stufenweise-visuelle-rehabilitation-bei-keratokonus\/\"><em>O espelho do olho<\/em>, setembro de 2026, p\u00e1ginas 30\u201333<\/a>. Mais informa\u00e7\u00f5es sobre a abordagem da ELZA podem ser encontradas na sua p\u00e1gina sobre <a href=\"https:\/\/www.elza-institute.com\/pt\/ceratocone\/improving-vision-keratoconus\/\">Melhorando a vis\u00e3o no caso de keratoconus<\/a> e em uma vis\u00e3o geral anterior <a href=\"https:\/\/www.elza-institute.com\/pt\/the-elza-approach-to-rehabilitating-keratoconus-corneas\/\">A abordagem ELZA para a reabilita\u00e7\u00e3o das c\u00f3rneas com queratocono<\/a>. Os pacientes que querem saber qual etapa pode ser a mais indicada podem <a href=\"https:\/\/www.elza-institute.com\/pt\/appointment\/\">reserve uma consulta<\/a> no Instituto ELZA.<\/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<div class=\"elementor-element elementor-element-99cb104 e-flex e-con-boxed e-con e-parent\" data-id=\"99cb104\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-46d51ca2 e-con-full e-flex e-con e-child\" data-id=\"46d51ca2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5ff3e02 e-con-full e-flex e-con e-child\" data-id=\"5ff3e02\" data-element_type=\"container\" data-e-type=\"container\">\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>No artigo \u201cDer Augenspiegel\u201d, o professor Farhad Hafezi apresenta a reabilita\u00e7\u00e3o visual escalonada da ELZA para o queratocono: estabiliza\u00e7\u00e3o com cross-linking, remodelagem com ECO-CAIRS ou ELZA-PACE e ajuste final com PRK guiado pelo perfil de ondas.<\/p>","protected":false},"author":4,"featured_media":553889,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"page_builder":"","footnotes":""},"categories":[214,1126,96],"tags":[778,1519,130,993,945,578,171,123,128,759],"class_list":["post-553888","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-farhad-hafezi","category-intrastromal-rings","category-popular-press","tag-cairs","tag-corneal-regularization","tag-cross-linking","tag-eco-cairs","tag-elza-pace","tag-icrs","tag-irregular-astigmatism","tag-keratoconus","tag-trans-prk","tag-visual-rehabilitation"],"acf":[],"yoast_head":"<!-- This site is optimized 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