O transplante de córnea é indicado para pacientes com ceratocone em estágio avançado, quando já houve uma perda significativa da visão e uma grande deterioração do tecido corneano.
Nesse estágio, há um aumento no grau de miopia ou astigmatismo, tornando o uso de óculos de grau ou de lentes de contato insuficiente para a qualidade visual do paciente.
Acompanhe o artigo para entender como é realizado o transplante de córnea, e quais são as alternativas desse procedimento cirúrgico para tratar o ceratocone.
Como é feita a cirurgia de transplante de córnea?
O transplante da córnea pode ser realizado por meio de duas técnicas cirúrgicas: a penetrante e a lamelar — esta última corresponde a um avanço no campo das cirurgias oftalmológicas, tornando o procedimento menos invasivo, mais seguro e com tempo de recuperação reduzido. Acompanhe com mais detalhes a seguir!
Fase do Pré-Operatório
Após o diagnóstico do defeito na córnea causado pelo ceratocone avançado, o paciente é encaminhado para uma lista de espera única para receber uma córnea doada. A lista de espera segue uma ordem cronológica (isto é, quem entrou antes, é atendido primeiro), e inclui tanto particulares, quanto SUS e convênios.
Apenas pacientes que apresentem um quadro mais severo de saúde possuem prioridade na lista de espera. Alguns exemplos são: olho perfurado, úlcera de córnea, opacidade de córnea bilateral, retransplante após falência primária do enxerto, descemetocele, pacientes com menos de sete anos.
Assim que houver a disponibilidade de uma córnea no seu Estado, o paciente é chamado pelo seu médico responsável para agendar a cirurgia.
Realização da cirurgia de transplante de córnea
Existem duas técnicas utilizadas para o transplante da córnea:
- Transplante Penetrante — na técnica penetrante, toda a espessura da córnea é substituída. Com o auxílio de uma lâmina (trépano), é feito um corte circular de cerca de 8 a 9 milímetros de diâmetro para remover o tecido. Em seguida, pinças posicionam cuidadosamente a nova córnea doada, fixando-a por meio de pontos de náilon, menores do que um fio de cabelo. O procedimento é indolor e é aplicado anestesia no local.
- Transplante Lamelar — na técnica lamelar, apenas uma parte da córnea é removida, preservando outros componentes do tecido corneano. Para cirurgias de ceratocone, é indicado o chamado transplante lamelar anterior, no qual é removida apenas a camada mais externa da córnea (estroma), mantendo o endotélio do paciente. O procedimento é menos invasivo, e diminui as taxas de rejeição da córnea doada.
Vale ressaltar que é o médico quem irá indicar o melhor tratamento, a depender da doença ou irregularidade que afetou a córnea, tudo bem?
Fase do Pós-Operatório
Após o procedimento cirúrgico, pode haver pouca ou nenhuma dor, variando de paciente para paciente. Caso ocorra algum incômodo, o emprego de colírios ou de medicamentos anti-inflamatórios e de antibióticos podem aliviar os sintomas.
O tempo de recuperação vai variar de acordo com a técnica cirúrgica utilizada, e dos hábitos do paciente que ajudam a preservar o olho operado. A recomendação básica é não esfregar os olhos, usar rigorosamente a medicação passada pelo médico, e realizar consultas regulares para fazer o acompanhamento adequado.
De modo geral, se o paciente passou pelo transplante penetrante, a recuperação completa se dá em torno de 12 meses. Já o tempo de recuperação para o transplante lamelar anterior tende a ser menor — em torno de seis meses.
O que é Ceratocone?
O ceratocone é uma doença ocular que não tem cura e que causa a curvatura da córnea, deixando-a semelhante a um cone. Nos casos mais avançados da doença, pode ser indicado o transplante de córnea como forma de tratamento. O procedimento evoluiu ao longo do tempo, sendo minimamente invasivo e com raros casos de rejeição pelo doador.
Quando se faz transplante de córnea?
Como dito anteriormente, o transplante da córnea é indicado apenas nos casos mais graves, em que demais alternativas para tratar o ceratocone não apresentaram os resultados esperados.
Se o ceratocone for descoberto ainda cedo, o uso de óculos ou lentes de contato devolvem a acuidade visual ao paciente, e podem impedir a evolução da doença.
Caso o ceratocone avance mesmo com o tratamento, o médico oftalmologista avaliará a possibilidade de realizar cirurgias de estabilização da doença — Anel de Ferrara e Crosslinking Corneano.
Ambos os procedimentos são rápidos, seguros e indolores. Eles têm o intuito de frear o avanço do ceratocone e de devolver a visão ao paciente, evitando que ele tenha que recorrer ao transplante de córnea.
227 comentários em “Transplante de córnea: cirurgia e recuperação”
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