5 opções de tratamento para ceratocone
A escolha do melhor tratamento para ceratocone vai depender do estágio em que o paciente se encontra e das características observadas pelo oftalmologista.
Ainda que seja possível se detectar já pelo exame clínico oftalmológico, o ceratocone só será devidamente classificado depois da realização de exames adicionais, como a topografia corneana computadorizada.
Podemos classificar os tratamentos para ceratocone da seguinte forma:
- Casos leves a moderados: óculos e lentes de grau.
- Casos moderados a graves: crosslinking e anel intracorneano (anel de Ferrara).
- Casos severos: transplante de córnea.
Conheça abaixo um pouco mais sobre cada um dos tipos de tratamento:
- Óculos
Indicados apenas para o tratamento de casos mais leves de ceratocone, os óculos são capazes de auxiliar na melhora temporária da acuidade visual do paciente.
Isso, porque apesar de não influenciarem ou impedirem a progressão do ceratocone, os óculos conseguem corrigir parte dos erros de refração da luz, ocasionados pelo formato anormal da córnea, provocado pela doença.
2. Lentes de contato
Apesar de também serem consideradas tratamentos para casos mais leves, as lentes de contato são mais eficientes que os óculos, por atuarem diretamente na córnea, corrigindo irregularidades nessa estrutura e melhorando a acuidade visual do paciente.
Para atingir esse efeito, no entanto, não é qualquer lente que basta. Na verdade, as principais lentes associadas ao tratamento de ceratocone são as chamadas RGP (lentes rígidas) e a lente escleral.
É importante salientar, contudo, que as lentes de contato não são capazes de interromper a progressão do ceratocone.
3. Anéis intracorneanos (anéis de Ferrara)
Os anéis intracorneanos são indicados em casos moderados de ceratocone e, assim como algumas lentes de contato, buscam corrigir o formato da córnea. Todavia, sua atuação é interna e realizada pela introdução de anéis de acrílico no globo ocular.
O procedimento é simples e seguro, dura cerca de poucos minutos e é feito com uso de anestesia tópica, ou seja, com colírios. Além de auxiliar na deformidade anatômica da córnea, melhorando a acuidade visual, o anel intracorneano é capaz de frear e até mesmo impedir a progressão do ceratocone.
O procedimento de implante dos anéis de Ferrara pode ser feito por meio do SUS, mas apenas em poucos lugares do Brasil (no Distrito Federal não está disponível). É também coberto por grande parte dos planos de saúde, a se observar as condições da ANS.
4. Crosslinking
O procedimento de crosslinking é uma das técnicas mais modernas e menos invasivas para o tratamento do ceratocone. Ainda assim, ele é considerado um procedimento cirúrgico e só é indicado para pacientes que apresentam casos moderados a graves da doença.
Com o paciente sentado e mediante a aplicação de anestesia local, é feita a “raspagem” da córnea e a aplicação de algumas gotas de colírio de riboflavina (vitamina B2). Em seguida, o oftalmologista realiza a exposição do olho a um feixe de luz ultravioleta A (UVA).
A interação entre a riboflavina e o raio ultravioleta estimula a união e o fortalecimento das fibras de colágeno da córnea, tornando-a menos propensa a se deformar.
Ao final do procedimento, o paciente deverá utilizar uma lente gelatinosa e terapêutica por cerca de 24 horas visando auxiliar na proteção e cicatrização da área.
O crosslinking é um procedimento muito simples, que não exige internação hospitalar e que leva no máximo 30 minutos. A aplicação de colírio e luz ultravioleta também é cuidadosamente controlada e o paciente não sente dor em momento algum.
Esse procedimento costuma gerar uma melhora significativa, não apenas na acuidade, como também no desaceleramento de progressão da doença, que é essencial em casos mais graves.
O Crosslinking gera uma redução significativa na velocidade de progressão da doença, sendo essencial nos casos de pacientes mais jovens, que têm maior risco e tempo para que isso ocorra.
O procedimento também pode ser realizado pelo SUS e também é coberto pela maior parte dos planos de saúde, seguindo as diretrizes da ANS. Porém, assim como o Anel Intracorneano, também não está disponível no Distrito Federal.
- Transplante de córnea
É realizado apenas em último caso, quando outras opções de tratamento para ceratocone não surtiram efeito ou não estão indicadas, e o paciente já apresenta significativa perda de acuidade visual e grandes danos ao tecido corneano.
A cirurgia de transplante pode ser feita de duas maneiras:
- Penetrante: promove a remoção de toda a espessura da córnea.
- Lamelar: que envolve a remoção apenas de parte (algumas camadas) da córnea, preservando outras estruturas do globo ocular do paciente e reduzindo as chances de rejeição.
A realização do procedimento, contudo, na maioria das vezes não é imediata, precisando obedecer à fila de transplantes de órgãos gerida pelo SUS. Essa fila é organizada por ordem de chegada. Porém, pacientes em estado mais grave podem receber lugares mais à frente.
Onde fazer o tratamento para ceratocone?
Grande parte dos transplantes de córnea no mundo são feitos devido ao ceratocone; fato que poderia ser revertido com diagnóstico precoce e tratamento adequado da doença.
O ceratocone – e diversas outras doenças oculares – tende a responder bem a tratamentos mais simples e rápidos, quando é diagnosticado mais cedo. Por isso, fique atento caso você perceba:
- Visão desfocada.
- Fotofobia (sensibilidade aumentada à luz).
- Dificuldade para enxergar durante à noite.
- Dificuldade de enxergar com nitidez e para realizar atividades cotidianas.
- Visão duplicada ou múltipla.
É importante lembrar que o ceratocone costuma se manifestar ainda na infância, adolescência ou idade adulta jovem.
Por isso, se você tem filhos ou convive com crianças, fique atento a sinais como dificuldade de enxergar, baixo desempenho escolar, dores frequentes na cabeça e nos olhos e, em especial, se a criança coça os olhos! Todos esses sinais podem indicar a presença de algum problema visual, inclusive o ceratocone. 
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