{"id":115384,"date":"2018-03-11T10:43:53","date_gmt":"2018-03-11T10:43:53","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/analisis-de-la-evolucion-del-queratocono-tratrado-con-crosslinking\/"},"modified":"2018-03-11T10:43:53","modified_gmt":"2018-03-11T10:43:53","slug":"analisis-de-la-evolucion-del-queratocono-tratrado-con-crosslinking","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/oftalmologia\/analisis-de-la-evolucion-del-queratocono-tratrado-con-crosslinking\/","title":{"rendered":"An\u00e1lisis de la evoluci\u00f3n del queratocono tratrado con crosslinking"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Inmaculada Lopez Izquierdo <\/strong><\/h2>\n<p>El queratocono es una patolog\u00eda no inflamatoria de la c\u00f3rnea en la que se produce un adelgazamiento corneal, que causa un aumento progresivo de la curvatura de la c\u00f3rnea, con miop\u00eda y astigmatismo irregular (defectos \u00f3pticos que causan una importante p\u00e9rdida de visi\u00f3n). Es una enfermedad que evoluciona aumentando progresivamente y llegando en la fase avanzada a un adelgazamiento y una ectasia (deformidad) grave, que explicar\u00eda la acusada distorsi\u00f3n de las im\u00e1genes y la p\u00e9rdida de agudeza visual.  \tlas opciones terap\u00e9uticas dependen del mayor o menor adelgazamiento y la deformidad corneal y van desde el uso de gafas \u00f3 lentillas, aplicaci\u00f3n de crosslinking, la implantaci\u00f3n de anillos intracorneales, hasta la queratoplastia. \ten el caso que nos ocupa nos centraremos en el crosslinking, que es un tratamiento que consiste en la activaci\u00f3n, mediante luz ultravioleta, de una sustancia llamada riboflavina que produce una especie de polimerizaci\u00f3n entre las l\u00e1minas de col\u00e1geno corneales, cuyas uniones moleculares se encuentran debilitadas o ausentes, para reforzar la rigidez de la c\u00f3rnea.  \tpor lo tanto, el prop\u00f3sito de este estudio es determinar los cambios inducidos por el crosslinking en ojos con queratocono tratados mediante esta t\u00e9cnica, durante un periodo de tiempo de dos a\u00f1os tras la intervenci\u00f3n.  \tpara ello, se han analizado 22 ojos de 18 pacientes, todos ellos diagnosticados de queratocono en progresi\u00f3n y tratados con  crosslinking. Se han realizado ex\u00e1menes de agudeza visual, refracci\u00f3n subjetiva, presi\u00f3n intraocular, biomicroscop\u00eda, exploraci\u00f3n de fondo de ojo y an\u00e1lisis de scheimpflug con el pentacam. Este protocolo de ex\u00e1menes se  realiz\u00f3 tanto preoperatoriamente como al mes, tres meses, seis meses, un a\u00f1o y dos a\u00f1os tras la intervenci\u00f3n.  \tlos resultados obtenidos muestran como la m\u00e1xima agudeza visual corregida aument\u00f3 1,33 l\u00edneas a los dos a\u00f1os del crosslinking, la esfera de la mejor correcci\u00f3n \u00f3ptica se mantuvo estable a lo largo del tiempo de seguimiento, al igual que el cilindro y la presi\u00f3n intraocular. En la superficie anterior de la c\u00f3rnea, tanto la k media como el astigmatismo, la asfericidad, el grado del queratocono, todos los \u00edndices corneales analizados, incluido el radio m\u00ednimo anterior, y la elevaci\u00f3n en esta cara se mantuvieron estables sin diferencias con respecto al valor preoperatorio. En la superficie posterior corneal la k media, el astigmatismo, la asfericidad y la curvatura m\u00ednima no sufrieron cambios durante este periodo de tiempo. Sin embargo, los valores de la elevaci\u00f3n si que se encontraron por encima de los valores preoperatorios. Los valores de la paquimetr\u00eda en el \u00e1pex y en el punto m\u00e1s delgado a los dos a\u00f1os del crosslinking se encontraron por debajo de los valores preoperatorios, por el contrario, la paquimetr\u00eda en el centro pupilar mantuvo su valor tras el periodo de seguimiento. Tampoco se han encontrado diferencias en la posici\u00f3n de ninguno de los puntos analizados. La densitometr\u00eda corneal, el volumen corneal y el poder refractivo real de la c\u00f3rnea, mantuvieron su valor transcurridos dos a\u00f1os de la intervenci\u00f3n. En la c\u00e1mara anterior, ni el \u00e1ngulo, ni la profundidad cambiaron tras el crosslinking pero el volumen de la c\u00e1mara anterior fue menor. En la densitometr\u00eda del cristalino, no se registr\u00f3 cambio alguno durante el periodo de seguimiento.  \tla impresi\u00f3n general que se obtiene, a la vista de los resultados obtenidos, es que el crosslinking parece ser eficaz para detener la progresi\u00f3n del queratocono, ya que casi todos los par\u00e1metros estudiados se mantienen estables transcurridos dos a\u00f1os de la intervenci\u00f3n.  keratoconus is a non-inflammatory disorder of the cornea that produces corneal thinning, which causes a progressive increase in the curvature of the cornea, with myopia and irregular astigmatism (optical defects that cause an important loss of vision). It is a condition that becomes progressively worse and leads to the advanced phase of thinning and serious ectasia (deformity), which would explain the attributed distortion of images and the loss of visual acuity. the therapeutic options depend on the greater or lesser extent of the thinning and corneal deformation and can range from the use of glasses or contact lenses, implementation of crosslinking, implantation of intracorneal rings, and corneal transplantation.  in the case that interests us we will focus on crosslinking, which is a treatment that consists of the activation, by means of ultraviolet light, of a substance called riboflavin that produces a sort of polymerization among the corneal collagen layers, whose molecular bonds are found weakened or absent, in order to strengthen the rigidity of the cornea.  \t therefore, the intention of this study is to determine the changes provoked by crosslinking in eyes with keratoconus treated with this technique, during a two-year period of time after the procedure.   to do this, 22 eyes from 18 patients have been analyzed, all of them diagnosed with progressing keratoconus and treated with crosslinking. Examinations were performed for visual acuity, subjective refraction, intraocular pressure, biomicroscopy, fundus photography and a scheimpflug analysis with a pentacam. This protocol of examinations was performed pre-operatively as well as within one month, three months, six months, one year and two years after the procedure.   the results obtained show how the maximum visual acuity corrected increased 1.33 lines two years after the crosslinking procedure, the sphere of the best optical correction remained constant throughout the monitoring time, the same was seen in the cylinder and intraocular pressure. On the anterior surface of the cornea, the mean k value, astigmatism, asphericity, the degree of keatoconus, all of the analyzed corneal indices, including the minimum anterior radius, and the elevation in this surface remained stable without differences in respect to the pre-operatory values. In the posterior surface of the cornea the mean k value, astigmatism, asphericity and the minimum curvature did not experience any changes during this period of time. However, the elevation values were found to be higher than those of the pre-operatory values. The pachymetry values of the apex and finest point two years after crosslinking surgery were found to be below pre-operatory values, on the contrary, the pachymetry of pupil center maintains its values after the monitoring period. No differences have been found in the position of any of the analyzed points. Corneal densitometry, corneal volume and actual refractive power of the cornea maintained their values two years after the procedure. In the anterior chamber, neither the angle, nor the depth changed after crosslinking but the volume of the anterior chamber was less. Lens densitometry did not register any change during the treatment period.   the general impression, in light of the obtained results, is that crosslinking seems to be effective in halting the progression of keratoconus, due to the fact that almost all of the studied factors remain stable two years after the operation.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>An\u00e1lisis de la evoluci\u00f3n del queratocono tratrado con crosslinking<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 An\u00e1lisis de la evoluci\u00f3n del queratocono tratrado con crosslinking <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Inmaculada Lopez Izquierdo <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 14\/03\/2014<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Ramon Gutierrez Ortega<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: pablo Artal soriano <\/li>\n<li>Jaime Javaloy esta\u00f1a (vocal)<\/li>\n<li>c\u00e9sar Villa collar (vocal)<\/li>\n<li>Miguel Teus guezala (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Inmaculada Lopez Izquierdo El queratocono es una patolog\u00eda no inflamatoria de la c\u00f3rnea en la que se [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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