Reabilitação visual em pacientes com ceratocone submetidos a transplante de córnea
Data
2017-09-28
Autores
Prazeres, Tatiana Moura Bastos 
Orientadores
Sousa, Luciene Barbosa de
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: 1) Avaliar a efetividade do implante de anel intracorneano na reabilitação visual de pacientes com ceratocone submetidos a transplante de córnea; 2) Avaliar resultados visuais de pacientes com ceratocone submetidos a transplante lamelar anterior, utilizando córneas doadas com a presença da membrana de Descemet e endotélio; 3) Comparar os resultados visuais em pacientes com ceratocone submetidos a transplante de córnea lamelar anterior, utilizando córneas doadas com e sem a presença da membrana de Descemet e endotélio; e 4) Descrever qualitativamente as características do exame de microscopia confocal em pacientes com ceratocone submetidos a transplante lamelar anterior, utilizando córneas doadas com e sem a presença da membrana de Descemet e endotélio. Métodos: o primeiro estudo analisou retrospectivamente 14 olhos com alto astigmatismo após transplante penetrante e que foram submetidos a implante de anel intracorneano. Foram avaliados acuidade visual com e sem correção, astigmatismo e curvatura corneana máxima. No segundo estudo, foram revisados 90 prontuários e avaliados os resultados visuais em pacientes com ceratocone submetidos a transplante lamelar anterior sem retirada da membrana de Descemet e endotélio do tecido doado. O terceiro estudo, prospectivo, comparou acuidade visual corrigida e sensibilidade ao contraste com uso de lente de contato rígida em pacientes com ceratocone submetidos a transplante lamelar anterior com e sem a presença da membrana de Descemet e endotélio. O último trabalho foi uma análise descritiva do exame confocal de 11 pacientes com ceratocone submetidos a transplante lamelar anterior com e sem a presença da membrana de Descemet e endotélio no tecido doado. Resultado: A acuidade visual corrigida em pacientes transplantados que apresentavam elevado astigmatismo melhorou após o implante de anel intraestromal comparada com acuidade visual no pré-operatório. A acuidade visual corrigida desses pacientes com 3 meses foi similar à de 6 meses assim como a acuidade visual não corrigida. Astigmatismo e curvatura máxima foram maiores no pré-operatório do que no pós-operatório. No grupo de pacientes analisados retrospectivamente submetidos a transplante lamelar anterior preservando a membrana de Descemet e endotélio do tecido doado, houve melhora significativa no pós-operatório da acuidade visual com e sem correção em relação ao pré-operatório. Em pacientes com ceratocone submetidos a transplante lamelar anterior por meio da técnica de big-bubble não houve diferença estatisticamente significante entre os grupos com e sem membrana de Descemet em relação à acuidade visual corrigida e à sensibilidade ao contraste com uso de lente de contato rígida, assim como em relação à contagem endotelial. Na análise da microscopia confocal um aumento da refletividade da matriz acelular e ceratócitos ativados foi observado nos 2 grupos; entretanto esses achados foram mais evidentes no grupo sem membrana de Descemet. Conclusão: O implante de anel intraestromal usando laser de femtosegundo para correção de astigmatismo residual após transplante penetrante de córnea é seguro e apresenta resultados visuais satisfatórios. Em pacientes com ceratocone submetidos a transplante lamelar anterior através da técnica de big-bubble não houve diferença nos resultados visuais em relação à preparação do botão doado com ou sem a membrana de Descemet e endotélio.
Purpose: 1) To evaluate the safety and efficacy of intracorneal ring segments for the correction of residual astigmatism after penetrating keratoplasty; 2) To evaluate visual outcomes of keratoconus patients submitted to deep anterior lamellar utilizing donor corneas with Descemet membrane and endothelium attached; 3) To compare the visual outcomes of Descemet membrane on and off after deep anterior lamellar keratoplasty in keratoconus patients; and 4) To compare confocal microscopic features in patients with keratoconus submitted to anterior lamellar keratoplasty using donor corneal tissue with DM-on and off. Methods: the first cited retrospective study comprised 14 eyes presenting high astigmatism post penetrating keratoplasty who had intracorneal rings implantation. The study evaluated uncorrected distance visual acuity, corrected distance visual acuity, refractive astigmatism, and corneal maximum curvature. In the second study visual outcomes of 90 patients who underwent anterior lamellar keratoplasty without the removal of donor graft endothelium were retrospectively analyzed. In the third study, a prospective trial, keratoconic eyes undergoing anterior lamellar keratoplasty were randomized in two groups: Descemet on and off and compared with respect to best-corrected visual acuity and contrast sensitivity while wearing gas permeable contact lenses and also endothelial cell counts. The last study was a descriptive confocal microscopic analysis comparing 11 keratoconus patients submitted to anterior lamellar keratoplasty with Descemet membrane on and off in the donor graft. Results: Corrected distance visual acuity postoperatively improved after ring segment implantation in 3 and 6 months compared with corrected distance visual acuity preoperatively. The corrected distance visual acuity at 3 months was similar to that at 6 months as well as the uncorrected distance visual acuity. The preoperative astigmatism and maximum curvature were higher than post-operative findings. In the retrospective analysis of keratoconus patients submitted to anterior lamellar keratoplasty without removal of donor graft endothelium it was observed significant improvement in visual outcomes in the post-operative. There were no statistically significant differences between the Descemet on and off groups concerning to best-corrected visual acuity and contrast sensitivity using gas permeable contact lenses as well as endothelial cell count. And the microscopic confocal evaluation showed an increased reflectivity of the acellular matrix and activated keratocytes in both groups, however these findings were more evident in the DM-off group. Conclusion: The implantation of corneal ring segments for residual astigmatism post-penetrating keratoplasty was safe and showed satisfactory results. Anterior lamellar keratoplasty procedures using the big-bubble technique for keratoconus with and without the Descemet membrane in the donor graft presented no significant differences regarding the visual outcomes or endothelial cell counts.
Purpose: 1) To evaluate the safety and efficacy of intracorneal ring segments for the correction of residual astigmatism after penetrating keratoplasty; 2) To evaluate visual outcomes of keratoconus patients submitted to deep anterior lamellar utilizing donor corneas with Descemet membrane and endothelium attached; 3) To compare the visual outcomes of Descemet membrane on and off after deep anterior lamellar keratoplasty in keratoconus patients; and 4) To compare confocal microscopic features in patients with keratoconus submitted to anterior lamellar keratoplasty using donor corneal tissue with DM-on and off. Methods: the first cited retrospective study comprised 14 eyes presenting high astigmatism post penetrating keratoplasty who had intracorneal rings implantation. The study evaluated uncorrected distance visual acuity, corrected distance visual acuity, refractive astigmatism, and corneal maximum curvature. In the second study visual outcomes of 90 patients who underwent anterior lamellar keratoplasty without the removal of donor graft endothelium were retrospectively analyzed. In the third study, a prospective trial, keratoconic eyes undergoing anterior lamellar keratoplasty were randomized in two groups: Descemet on and off and compared with respect to best-corrected visual acuity and contrast sensitivity while wearing gas permeable contact lenses and also endothelial cell counts. The last study was a descriptive confocal microscopic analysis comparing 11 keratoconus patients submitted to anterior lamellar keratoplasty with Descemet membrane on and off in the donor graft. Results: Corrected distance visual acuity postoperatively improved after ring segment implantation in 3 and 6 months compared with corrected distance visual acuity preoperatively. The corrected distance visual acuity at 3 months was similar to that at 6 months as well as the uncorrected distance visual acuity. The preoperative astigmatism and maximum curvature were higher than post-operative findings. In the retrospective analysis of keratoconus patients submitted to anterior lamellar keratoplasty without removal of donor graft endothelium it was observed significant improvement in visual outcomes in the post-operative. There were no statistically significant differences between the Descemet on and off groups concerning to best-corrected visual acuity and contrast sensitivity using gas permeable contact lenses as well as endothelial cell count. And the microscopic confocal evaluation showed an increased reflectivity of the acellular matrix and activated keratocytes in both groups, however these findings were more evident in the DM-off group. Conclusion: The implantation of corneal ring segments for residual astigmatism post-penetrating keratoplasty was safe and showed satisfactory results. Anterior lamellar keratoplasty procedures using the big-bubble technique for keratoconus with and without the Descemet membrane in the donor graft presented no significant differences regarding the visual outcomes or endothelial cell counts.