Avaliação das aberrações de alta ordem em córneas regulares e do remodelamento epitelial em pacientes de pacientes submetidos a femtolasik topoguiado (contoura) em um olho e customizado pela asfericidade (custom-q) em olhos contra-laterais: estudo prospectivo, randomizado e duplo-cego
Data
2024-06-14
Autores
Lyra, Adriana Falcão 
Orientadores
Nose, Walton
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar os resultados refrativos, as aberrações corneais de alta ordem (HOA’s RMS), o mapeamento epitelial (SD-OCT Avanti®) e o consumo tecidual no pré e pós-operatório de córneas regulares submetidas a cirurgia refrativa com a técnica FEMTOLASIK. Em um olho foi realizada a técnica customizada pela asfericidade (Custom-Q®, WaveLight®; Alcon®) e Topoguiada (Contoura®, WaveLight®; Alcon®) no olho contralateral, em pacientes míopes com ou sem astigmatismo. Métodos: Realizado um estudo prospectivo, randomizado e duplo-cego, que avaliou 96 olhos de 48 pacientes. Foram incluídos pacientes de ambos os sexos, entre 20 e 35 anos, com equivalente esférico estável e máximo de -8.00 DE. Todos os pacientes realizaram exame oftalmológico completo durante o acompanhamento pré e pós- operatório, sendo mapeamento epitelial e tomografia de córnea realizada no pré e pós-operatório de 3 meses. Resultados: A acuidade visual sem correção de 20/20 foi obtida em 97% em ambas as técnicas. A acuidade visual sem correção de 20/16 foi obtida em 64% dos olhos submetidos ao Custom-Q® e em 56% dos olhos submetidos ao Contoura®. Ambas as técnicas apresentaram ganhos na acuidade visual corrigida e foram efetivas na correção do astigmatismo refracional. Avaliamos 17 setores do mapa epitelial e não encontramos diferença estatística entre os grupos no pré e pós- operatório (P>.05). HOA’s RMS, Coma Z3±1, Trefoil Z3-3 e o consumo tecidual exibiram diferenças estatísticas entre as técnicas (P<.05). Conclusão: Não houve diferença estatística entre as técnicas nos resultados refrativos e no remodelamento epitelial, nos 17 quadrantes avaliados. Na técnica Contoura® foi encontrado um menor valor pós-operatório de HOA’s RMS, Coma Z3±1 e Trefoil Z33 (P<.05), mas sem diferença estatística na correção da aberração esférica e no componente do astigmatismo corneal no mapa de Wavefront de Zernike (P>.05). O grupo Contoura® apresentou um maior consumo tecidual em relação ao Custom Q® (P<.05).
Purpose: To evaluate refractive results, cornea high order aberrations (HOA’s), epithelial mapping (SD-OCT Avanti®) and tissue consumption in the pre and postoperative period of regular corneas undergoing refractive surgery with FEMTOLASIK. In one eye the customized by asphericity technique (Custom-Q®, WaveLight® Alcon®) and Topography-guided (Contoura®, WaveLight® Alcon®) in the contralateral eye, in myopic patients with or without astigmatism. Methods: A prospective, randomized and double-blind study was carried out, which evaluated 96 eyes of 48 patients. Patients of both genders, between 20 and 35 years old, with a maximum and stable spherical equivalent of -8.00 DE were included in the study. All patients underwent a complete ophthalmological examination during pre and postoperative follow-up, with epithelial mapping and corneal tomography performed pre and 3 months postoperatively. Results: Uncorrected visual acuity of 20/20 was obtained in 97% in both techniques. Uncorrected visual acuity of 20/16 was achieved in 64% of eyes submitted to Contoura®. Both techniques presented gains in corrected visual acuity and effectiveness in correcting refractive astigmatism. We evaluated 17 sectors of the epithelial map and found no statistical difference between the groups in pre and postoperatively (P>.05). HOA’s RMS, Coma Z3±1e Trefoil Z3-3and tissue consumption exhibited statistical differences between the techniques (P<.05). Conclusions: There was no statistical difference between the techniques in refractive results and epithelial remodeling in the 17 quadrants evaluated (P>.05). In tne Contoura® technique a lower postoperative value of RMS HOA’s, Coma Z3±1e Trefoil Z3-3 was found (P<.05), but without statistical difference in the correction of spherical aberration and the corneal astigmatism component in the Zernike wavefront map. The Contoura® group showed greater tissue consumption compared to the Custom- Q®(P<.05).
Purpose: To evaluate refractive results, cornea high order aberrations (HOA’s), epithelial mapping (SD-OCT Avanti®) and tissue consumption in the pre and postoperative period of regular corneas undergoing refractive surgery with FEMTOLASIK. In one eye the customized by asphericity technique (Custom-Q®, WaveLight® Alcon®) and Topography-guided (Contoura®, WaveLight® Alcon®) in the contralateral eye, in myopic patients with or without astigmatism. Methods: A prospective, randomized and double-blind study was carried out, which evaluated 96 eyes of 48 patients. Patients of both genders, between 20 and 35 years old, with a maximum and stable spherical equivalent of -8.00 DE were included in the study. All patients underwent a complete ophthalmological examination during pre and postoperative follow-up, with epithelial mapping and corneal tomography performed pre and 3 months postoperatively. Results: Uncorrected visual acuity of 20/20 was obtained in 97% in both techniques. Uncorrected visual acuity of 20/16 was achieved in 64% of eyes submitted to Contoura®. Both techniques presented gains in corrected visual acuity and effectiveness in correcting refractive astigmatism. We evaluated 17 sectors of the epithelial map and found no statistical difference between the groups in pre and postoperatively (P>.05). HOA’s RMS, Coma Z3±1e Trefoil Z3-3and tissue consumption exhibited statistical differences between the techniques (P<.05). Conclusions: There was no statistical difference between the techniques in refractive results and epithelial remodeling in the 17 quadrants evaluated (P>.05). In tne Contoura® technique a lower postoperative value of RMS HOA’s, Coma Z3±1e Trefoil Z3-3 was found (P<.05), but without statistical difference in the correction of spherical aberration and the corneal astigmatism component in the Zernike wavefront map. The Contoura® group showed greater tissue consumption compared to the Custom- Q®(P<.05).
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Citação
LYRA, Adriana Falcão Veloso. Avaliação das aberrações de alta ordem em córneas regulares e sua relação com o remodelamento epitelial em pacientes submetidos a FEMTOLASIK Topoguiado (Contoura®) em um olho e customizado pela asfericidade (Custom-Q®) em olhos contra-laterais: estudo prospectivo, randomizado e duplo cego. 2024. 122 f. (Doutorado em Oftalmologia e Ciências Visuais) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.