Acessibilidade / Reportar erro

Brasil

Arquivos Brasileiros de Oftalmologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW ARTICLE • Arq. Bras. Oftalmol. 83 (1) • Jan-Feb 2020 • https://doi.org/10.5935/0004-2749.20200014 copiar

Centralização em cirurgia refrativa

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

O ponto de centralização da cirurgia refrativa é tema de grande importância e gera muita discussão entre especialistas e cirurgiões da área. Afinal, qualquer alteração na luz pode alterar o tamanho da pupila, além disso, o eixo visual da linha de fixação para a fóvea é particular em cada paciente. Existem opções para centralização em cirurgia refrativa com resultados diferentes na literatura. Ainda não há consenso sobre a melhor técnica em cirurgia refrativa que avalie cada caso específico visando um resultado cirúrgico final satisfatório.

Descritores:
Procedimentos cirúrgicos refrativos/métodos; Córnea/patologia; Pupila/fisiologia; Fixação ocular; Córnea/cirurgia; Lasers de excimer

	Preoperative SE	Ablation center	Excimer used	Results
Chan et al.⁽¹⁴⁾14 Chan CC, Boxer Wachler BS. Centration analysis of ablation over the coaxial corneal light reflex for hyperopic LASIK. J Refract Surg. 2006;22(5):467-71. Comment in: J Refract Surg. 2007;23(1):11; author reply 11.	+1.875	Purkinje	VISX 52	UCVA, better refractive results when compared with the contralateral eye, PC-centered
Nepomuceno et al.⁽²⁰⁾20 Nepomuceno RL, Boxer Wachler BS, Kim JM, Scruggs R, Sato M. Laser in situ keratomileusis for hyperopia with the LADARVision 4000 with centration on the coaxially sighted corneal light reflex. J Cataract Refract Surg. 2004;30(6):1281-6.	+2.73±1.41	Purkinje	LadarVision 4000	MRSE: 0.25±0.82 (D)/UCVA: 44.4% 20/20 and 81.5% 20/30 or better
Chang et al.⁽⁴⁾4 Chang JS, Law AK, Ng JC, Chan VK. Comparison of refractive and visual outcomes with centration points 80% and 100% from pupil center toward the coaxially sighted corneal light reflex. J Cataract Refract Surg. 2016;42(3):412-9.	+2.17±0.93	Purkinje	LadarVision 4000	UCVA (logMAR): 0.22±0.17
Kermani et al.⁽²⁴⁾24 Kermani O, Oberheide U, Schmiedt K, Gerten G, Bains HS. Outcomes of hyperopic LASIK with the NIDEK NAVEX platform centered of the visual axis or line of sight. J Refract Surg. 2009;25 (1 Suppl):S98-103.	+2.57±1.56 (VA)	VA and PC	NIDEK MK 2000	MRSE: +0.29±0.70 D (VA) vs. +0.19±0.57 D (PC). 81% of eyes (VA) with less than ±0.50 D vs. 64% (PC). Less coma induction in the VA group
	+2.46±1.32 (PC)	VA and PC	NIDEK MK 2000
De Ortueta et al.⁽²⁾2 De Ortueta D, Schreyger FD. Centration on the cornea vertex normal during hyperopic refractive photoablation using videokeratoscopy. J Refract. 2007;23(2):198-200.	+2.76±0.90	CV	Esiris	MRSE: +0.09±0.32 D. 94% eyes with less than ±0.50 D
Soler et al.⁽⁸⁾8 Soler V, Benito A, Soler P, Triozon C, Arné JL, Madariaga V, et al. A randomized comparison of pupil-centered versus vertex-centered ablation in LASIK correction of hyperopia. Am J Ophthalmol. 2011; 152(4):591-599.e2.	+2.69±0.91 (VC)	CV and PC	Allegretto 200 Hz	Similar refractive results. In terms of coma in eyes with SAK: 0.60±0.24 µm (PC) vs. 0.34±0.30 µm (CV). In eyes with LAK: 0.34±0.30 µm (PC) vs. 0.62±0.67 µm (CV)
	+2.26±0.62 (PC)	CV and PC	Allegretto 200 Hz
Reinstein et al.⁽¹⁰⁾10 Reinstein DZ, Archer TJ, Gobbe M. Refractive and topographic errors in topography-guided ablation produced by epithelial compensation predicted by 3D Arternis VHF digital ultrasound stromal and epithelial thlckness mapping. J Refract Surg. 2012;28(9):657-53.	+3.85±0.98 (SAK)	Purkinje	MEL 80	Similar refractive results, nearly equal contrast sensitivity, increase in total ocular aberrations in patients with LAK, mainly coma
	+3.87±0.90 (LAK)	Purkinje	MEL 80

	CV group	PC group
Defocus (D)	-0.26 ± 0.49	-0.29 ± 0.40
Astigmatism (D)	0.15 ± 0.18	0.19 ± 0.21
BSCVA	1.24 ± 0.47	1.20 ± 0.45
Coma (µm)	0.23 ± 0.11	0.27 ± 0.17
Trefoil (µm)	0.15 ± 0.09	0.15 ± 0.08
Spherical aberration (µm)	0.09 ± 0.29	0.14 ± 0.30
High-order RMS (µm)	0.48 ± 0.12	0.51 ± 0.17
Pupillary offset (mm) (considering 6-mm pupil)	0.28 ± 0.11	0.31 ± 0.19

	Device	Technique	Applied	Type
WaveLight	Allegretto Allegretto-Eye-Q EX500 Concept 1000	Manually based CLR (but not truly CS), for large offsets or angles (alpha, kappa, lambda) "in between"	Under the laser	Overall ablation is shifted
SCHWIND	AMARIS AMARIS 500E AMARIS 750S AMARIS 1050RS	Manually based on corneal vertex (numerically taken from diagnosis)	During treatment planning	The optical axis is shifted (even for customized treatments), but the overall ablation remains concentric to the pupil boundaries
ZEISS Meditec	MEL80 MEL90	Manually based CLR (but not truly CS), considering contralateral viewing eye to reduce parallax	Under the laser	Overall ablation is shifted
Nidek	Quest	Manually based CLR (but not truly CS)	Under the laser	Overall ablation is shifted
Bausch & Lomb 217 Zyoptix	217 Zyoptix	Manually based CLR (but not truly CS)	Under the laser	Overall ablation is shifted
Novatec	LightBlade	Manually based CLR (but not truly CS)	Under the laser	Overall ablation is shifted

Conselho Brasileiro de Oftalmologia Rua Casa do Ator, 1117 - cj.21, 04546-004 São Paulo SP Brazil, Tel: 55 11 - 3266-4000, Fax: 55 11- 3171-0953 - São Paulo - SP - Brazil
E-mail: abo@cbo.com.br

Acompanhe os números deste periódico no seu leitor de RSS