Resultados a Longo Prazo de Crosslinking Transepitelial Acelerado em Doentes com Queratocone Progressivo
DOI:
https://doi.org/10.48560/rspo.33250Palavras-chave:
Crosslinking Corneano, Progressão da Doença, Queratocone, Reagentes de Crosslinking, Topografia da CórneaResumo
INTRODUÇÃO: Avaliação sistematizada da efetividade a longo prazo do crosslinking transepitelial acelerado (TE-ACXL) no tratamento de olhos com queratocone (KC) progressivo, ao longo de um período de 4 anos.
MÉTODOS: Foram incluídos olhos com KC progressivo submetidos a TE-ACXL (6 mW/cm2 durante 15 minutos), com seguimento de 48 meses. Foram avaliados os seguintes parâmetros: melhor acuidade visual para longe corrigida (CDVA), parâmetros queratométricos (queratometria máxima (Kmax), queratometria media (Kmean) e astigmatismo corneano (Astg)), espessura corneana mínima (PachyMin), índices topográficos e tomográficos (nomeadamente o raio de curvatura posterior dos 3 mm centrados no ponto mais fino da córnea (PRC) e o índice D). Estes parâmetros foram analisados pré-operatoriamente e a cada 12 meses após o TE-ACXL, até 48 meses após a cirurgia.
RESULTADOS: Foram incluídos 41 olhos de 30 doentes. A idade média pré-operatória foi 20,90±4,69 anos. Foram excluídos 11 olhos da comparação entre os resultados aos 48 meses e os resultados pré-TE-ACXL, visto que estes olhos foram submetidos a outros procedimentos 36 meses após a cirurgia inicial (nomeadamente, crosslinking com remoção do epitélio (n=6), segmentos de anel intracorneanos (n=4) ou queratoplastia penetrante (n=1). Registou-se um aumento significativo da Kmean (+0,64±1,04 D, p<0,001; +0,98 ± 1,49 D, p<0,001; +1,27±2,01 D, p<0,001; +1,13±2,00 D, p=0,006) e do índice D (+0,51±1,03 unidades, p=0,007; +0,69±1,25 unidades, p=0,002; +1,02±1,72 unidades, p=0,002; +1,15±1,64 unidades, p<0,001) ao longo do seguimento. O PRC diminuiu significativamente ao longo dos 48 meses (-0,12±0,22 mm, p=0,002; -0,15±0,24 mm, p<0,001; -0,17±0,43 mm, p=0,021; -0,16±0,43 mm, p=0,027). A PachyMin diminuiu significativamente aos 36 e aos 48 meses (-8,50±15,93 μm, p=0,004; -7,82±18,37, p=0,033). A CDVA melhorou significativamente aos 12 e aos 48 meses (-0,10±0,29 unidades logMAR, p=0,045; -0,17±0,33 unidades logMAR, p=0,013), mas não aos 24 meses ou aos 36 meses. A cirurgia e o seguimento dos doentes decorreram sem intercorrências em todos os doentes incluídos.
CONCLUSÃO: O TE-ACXL é um tratamento seguro para o KC progressivo. Contudo, pode ocorrer uma variação significativa dos parâmetros topográficos, tomográficos e paquimétricos nestes olhos, num período de 4 anos após o procedimento. Assim, podem ser necessários outros procedimentos para abrandar a progressão da doença.
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