Análise da variação da espessura corneana transoperatória durante o crosslinking corneano em pacientes com ceratocone, utilizando a riboflavina com veículo hidroxipropilmetilcelulose
Data
2023-08-15
Autores
Matsumoto, Fábio Kenji 
Orientadores
Sousa, Luciene Barbosa de
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar a variação da espessura corneana transoperatória de pacientes com ceratocone que foram submetidos ao crosslinking (CXL) corneano. Métodos: Série de casos prospectivos comparativos. Todas as cirurgias foram realizadas no Departamento de Oftalmologia e Ciências Visuais da Escola Paulista de Medicina (Universidade Federal de São Paulo), por um único cirurgião e pelo Protocolo de Dresden modificado: irradiância 3mW/cm2, energia total de 5,4 J/cm2, tempo de embebição de 30 minutos instilando solução de riboflavina 0,1% com veículo de hidroxipropilmetilcelulose (HPMC) a cada 5 minutos e tempo de radiação com luz ultravioleta tipo A (UVA) por 30 minutos instilando a mesma solução de riboflavina na frequência similar da fase da anterior. Os pacientes foram divididos em três grupos: (A) córnea < 400µm após desepitelização e utilização da solução de riboflavina de 200 miliosmóis (mOsm) com veículo de HPMC, (B) córnea <400µm após desepitelização e utilização da riboflavina de 300mOsm com veículo de HPMC e grupo (C) córnea ≥ 400µm após desepitelização e utilização da riboflavina de 300mOsm com veículo de HPMC (grupo controle). A espessura corneana transoperatória foi medida antes e após a desepitelização, 30 minutos, 45 minutos e 60 minutos. Resultados: No grupo A, foram incluídos 30 pacientes (30 olhos), no grupo B, 19 pacientes (19 olhos) e, no grupo C, 21 pacientes (21 olhos). Utilizou-se STATA 14.0 software (StataCorp LP, College Station, TX, USA) para analisar os dados e equações de estimativas generalizadas para análise estatística. Não houve diferença significante após a remoção do epitélio, porém, em outras fases, como na embebição e na irradiação com UVA, detectou-se diferença estatística do Grupo A em relação ao B e C. Entre os grupos B e C, não houve diferença significativa em nenhuma das etapas do procedimento. O estudo não encontrou correlação da variação da espessura corneana com sexo, idade, paquimetria e Kmáx pré-operatórios. Conclusões: A espessura corneana transoperatória durante o crosslinking varia de acordo com a osmolaridade da riboflavina, não tendo sido encontrado outro fator correlacionado.
Objective: To evaluate the intraoperative corneal thickness variation in patients with keratoconus who underwent corneal crosslinking (CXL). Methods: Comparative Prospective Case Series. All surgeries were performed at the Ophthalmology and Visual Sciences Department of Escola Paulista de Medicina (Federal University of São Paulo), by a single surgeon and by the modified Dresden Protocol: irradiance 3mW/cm2, total energy of 5.4 J/cm2, soaking time of 30 minutes instilling 0.1% riboflavin solution with hydroxypropylmethylcellulose (HPMC) vehicle 1% every 05 minutes and radiation with type A ultraviolet light (UVA) for 30 minutes, instilling the same riboflavin solution at a similar phase frequency as the previous one. The patients were divided into 03 groups: (A) cornea < 400μm after epithelium removal and used 0,1% riboflavin solution with HPMC vehicle 200 milliosmol (mOsm), (B) cornea < 400μm after epithelium removal and used 0,1% riboflavin solution with HPMC vehicle 300 milliosmol (mOsm); and group (C) cornea ³ 400μm after epithelium removal and used 0,1% riboflavin solution HPMC vehicle 300 milliosmol (mOsm) (group control). Transoperative corneal thickness was measured before and after de-epithelialization, 30 minutes, 45 minutes and 60 minutes. Results: Group A included 30 patients (30 eyes), group B 19 patients (19 eyes) and group C 21 patients (21 eyes). STATA 14.0 software (StataCorp LP, College Station, TX, USA) was used to analyze the data and Generalized Estimating Equations for statistical analysis. There was no statistically significant difference after epithelium removal, but in other phases, like soaking and UVA irradiation, a statistical difference was detected in Group A in relation to B and C. Between groups B and C there was no significant difference in any of the steps of the procedure. Furthermore, the study found no correlation between corneal thickness variation and sex, age, pachymetry and Kmax preoperative. Conclusions: Transoperative corneal thickness during crosslinking varies according to riboflavin osmolarity, with no other correlated factor being found.
Objective: To evaluate the intraoperative corneal thickness variation in patients with keratoconus who underwent corneal crosslinking (CXL). Methods: Comparative Prospective Case Series. All surgeries were performed at the Ophthalmology and Visual Sciences Department of Escola Paulista de Medicina (Federal University of São Paulo), by a single surgeon and by the modified Dresden Protocol: irradiance 3mW/cm2, total energy of 5.4 J/cm2, soaking time of 30 minutes instilling 0.1% riboflavin solution with hydroxypropylmethylcellulose (HPMC) vehicle 1% every 05 minutes and radiation with type A ultraviolet light (UVA) for 30 minutes, instilling the same riboflavin solution at a similar phase frequency as the previous one. The patients were divided into 03 groups: (A) cornea < 400μm after epithelium removal and used 0,1% riboflavin solution with HPMC vehicle 200 milliosmol (mOsm), (B) cornea < 400μm after epithelium removal and used 0,1% riboflavin solution with HPMC vehicle 300 milliosmol (mOsm); and group (C) cornea ³ 400μm after epithelium removal and used 0,1% riboflavin solution HPMC vehicle 300 milliosmol (mOsm) (group control). Transoperative corneal thickness was measured before and after de-epithelialization, 30 minutes, 45 minutes and 60 minutes. Results: Group A included 30 patients (30 eyes), group B 19 patients (19 eyes) and group C 21 patients (21 eyes). STATA 14.0 software (StataCorp LP, College Station, TX, USA) was used to analyze the data and Generalized Estimating Equations for statistical analysis. There was no statistically significant difference after epithelium removal, but in other phases, like soaking and UVA irradiation, a statistical difference was detected in Group A in relation to B and C. Between groups B and C there was no significant difference in any of the steps of the procedure. Furthermore, the study found no correlation between corneal thickness variation and sex, age, pachymetry and Kmax preoperative. Conclusions: Transoperative corneal thickness during crosslinking varies according to riboflavin osmolarity, with no other correlated factor being found.