{"id":115385,"date":"2018-03-11T10:43:53","date_gmt":"2018-03-11T10:43:53","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/control-de-la-aberracion-esferica-en-la-ciruga%c2%ada-de-la-miopa%c2%ada-con-laser-excimer\/"},"modified":"2018-03-11T10:43:53","modified_gmt":"2018-03-11T10:43:53","slug":"control-de-la-aberracion-esferica-en-la-ciruga%c2%ada-de-la-miopa%c2%ada-con-laser-excimer","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/oftalmologia\/control-de-la-aberracion-esferica-en-la-ciruga%c2%ada-de-la-miopa%c2%ada-con-laser-excimer\/","title":{"rendered":"Control de la aberraci\u00f3n esf\u00e9rica en la cirugia de la miop\u00edacon l\u00e1ser excimer"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Alejandro Higueras Esteban <\/strong><\/h2>\n<p>La correcci\u00f3n de la miop\u00eda mediante queratomileusis in situ asistida por l\u00e1ser (lasik) modifica las aberraciones y en especial la aberraci\u00f3n esf\u00e9rica. Esto se manifiesta en condiciones de baja iluminaci\u00f3n como una p\u00e9rdida de calidad visual en forma de halos y condiciona la satisfacci\u00f3n de los pacientes intervenidos. Este deterioro en la calidad de visi\u00f3n nocturna es proporcional al n\u00famero de dioptr\u00edas (d) que son corregidas.  el incremento de aberraci\u00f3n esf\u00e9rica tras la t\u00e9cnica lasik se debe a la modificaci\u00f3n de la asfericidad (q) de la cara anterior de la c\u00f3rnea. Sin embargo factores como la cicatrizaci\u00f3n, la zona \u00f3ptica eficaz y el perfil de ablaci\u00f3n utilizado tambi\u00e9n han demostrado su influencia. El perfil de ablaci\u00f3n custom q de allegretto permite programar asfericidades personalizables que pueden ayudar a mejorar los resultados de este tipo de cirug\u00eda.  material y m\u00e9todos  en el an\u00e1lisis retrospectivo, estudiamos 106 pacientes intervenidos de miop\u00eda con distintos perfiles de ablaci\u00f3n. Cuantificamos como influyen las variables en la aberraci\u00f3n esf\u00e9rica ocular inducida a 5mm de di\u00e1metro.   en el an\u00e1lisis prospectivo comparamos dos grupos de pacientes con miop\u00eda elevada (n=71). A un primer grupo le programamos una asfericidad fija de -0,5 y al segundo le programamos una asfericidad personalizada a partir de sus datos topogr\u00e1ficos y de aberrometr\u00eda. Analizamos los resultados refractivos, la aberraci\u00f3n esf\u00e9rica inducida, la asfericidad y par\u00e1metros de calidad visual.  por \u00faltimo, estudiamos la precisi\u00f3n del top\u00f3grafo pentacam en la medida de la asfericidad postoperatoria.  resultados  el perfil de ablaci\u00f3n esf\u00e9rica (tipo munnerlyn) para un defecto refractivo medio de -4,60 d mostr\u00f3 un incremento de aberraci\u00f3n esf\u00e9rica de 0,362 \u00c2\u00b1 0,247 \u00c2\u00b5m.  en el perfil de ablaci\u00f3n est\u00e1ndar de allegretto, encontramos un incremento de 0,006 \u00c2\u00b5m en miopes &lt;-3,00 d; 0,105 \u00c2\u00b5m en miopes medios y 0,243 \u00c2\u00b5m en &gt;-5,00 d.   el perfil de ablaci\u00f3n asf\u00e9rico custom q demostr\u00f3 un mayor control de la aberraci\u00f3n esf\u00e9rica en todos los grupos de dioptr\u00edas. En miopes &lt;-3,00 d el incremento de aberraci\u00f3n esf\u00e9rica fue de -0,002 \u00c2\u00b5m; en miopes medios 0,054 \u00c2\u00b5m y en &gt;-5,00 d fue de 0,045 \u00c2\u00b5m.  al programar una asfericidad personalizada obtuvimos un  menor incremento de aberraci\u00f3n esf\u00e9rica comparado con una q fija de -0,5. El incremento de aberraci\u00f3n esf\u00e9rica en el grupo con asfericidad personalizada fue de 0,019 \u00c2\u00b5m y en el grupo con q fija fue de 0,039 \u00c2\u00b5m; esta diferencia no fue estad\u00edsticamente significativa. En el grupo de q personalizada obtuvimos una asfericidad postoperatoria de -0,12 mientras que en el grupo con q fija fue de 0,012; esta diferencia fue estad\u00edsticamente significativa.   la asfericidad postoperatoria medida con pentacam y la asfericidad final calculada mostraron diferencias estad\u00edsticamente significativas (p&lt;0,001). El error cometido por pentacam se correlacion\u00f3 con el tratamiento de miop\u00edas altas (p&lt;0,001) y con corneas planas (p&lt;0,016).  conclusiones     el perfil de ablaci\u00f3n esf\u00e9rica (tipo munnerlyn) produce incrementos muy notables de aberraci\u00f3n esf\u00e9rica. El perfil de ablaci\u00f3n est\u00e1ndar de allegretto es eficaz en el control de la aberraci\u00f3n esf\u00e9rica cuando se intervienen miop\u00edas bajas. La utilizaci\u00f3n de una asfericidad personalizada en el tratamiento de miopes &gt;-3,00 d ha demostrado ser un m\u00e9todo eficaz en el control de la aberraci\u00f3n esf\u00e9rica. El top\u00f3grafo pentacam no mide con precisi\u00f3n la asfericidad postoperatoria especialmente en c\u00f3rneas operadas de miop\u00edas elevadas y en sujetos con queratometr\u00edas bajas.   summary  refractive surgery for myopia correction with in situ laser keratomileusis (lasik) induces a shift in ocular aberrations and specifically in spherical aberration wich affects in low luminosity environments, creating halos around the lights that can be frustrating postoperative phenomena. Vision quality deterioration is proportional to the amount of corrected diopters (d)  lasik refractive surgery tends to increase spherical aberration due to changes in asphericity (q) of the anterior corneal surface. However a correlation has also been found between high rates of spherical aberrations and high myopic corrections, cornea wound healing, biomechanical tissue changes and lasik ablation profile may contribute. Custom q ablation profile (allegretto) can be used for customized aspheric treatments achieving better outcomes when performing this surgery.  methods  a retrospective review of 106 patients who underwent successful lasik with different ablation profiles was firstly studied. Statistical analysis was made to quantify how spherical aberration is influenced by the amount of refractive correction, keratometric and ashpericity changes.  a second prospective phase of the study was performed with two consecutive groups of patients with moderate and high myopia (n=71). One group would have a fixed programmed asphericity of -0,5 and the second group would have a customized asphericity based on topographic data and aberrometry. We would analyze refractive results, induced spherical aberration, asphericity and visual quality parameters.   finally we study the precision of pentacam topographic measure of the postoperative asphericity.      results  conventional ablation profile with a mean -4,60 d of preoperative sphere correction registered an increase in spherical aberration of 0,362 \u00c2\u00b1 0,247 \u00c2\u00b5m.  wavefront optimized algorithm demostrated inconsiderable induction of spherical aberration (0,006 \u00c2\u00b5m) when &lt;-3,00 d were treated. Significant induction was detected in moderate (0,105 \u00c2\u00b5m) and &gt;-5,00 d (0,243 \u00c2\u00b5m).  custom q algorithm did not induced clinically significant aberrations in any group. Spherical induction in &lt;-3,00 d was 0,002 \u00c2\u00b5m; 0,054 \u00c2\u00b5m in moderate myopia and 0,045 \u00c2\u00b5m in &gt;-5,00 d.  customization of an ideal and individualized asphericity demonstrated lower rates of spherical aberration in comparison with a fixed -0,5 target. Increase in spherical aberration for customized asphericity group was 0,019 \u00c2\u00b5m and 0,039 \u00c2\u00b5m in fixed q group, this difference was not statistically significant.    customization of asphericity maintained postoperative asphericity at negative values, while fixed programming resulted in positive values wich was a significant statistical difference. Statistically significant differences (p&lt;0,001) were found between postoperative asphericity measured using pentacam and calculated final asphericity. Pentacam deviation was correlated to the treatment of high myopia (p&lt;0,001) and flat postoperative corneas (p&lt;0,016)  conclusions  conventional ablation (munnerlyn profile) induces high rates of spherical aberration. Wavefront-optimized algorithm is effective for spherical aberration control when treating low myopia errors. Customized q profile achieved excellent postoperative spherical aberration outcomes when high myopia was treated. Customized q profile maintains postoperative asphericity at negative rates. Pentacam does not provide a precise measurement of postoperative asphericity specially in cases with high myopia treated or flat corneas.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Control de la aberraci\u00f3n esf\u00e9rica en la cirugia de la miop\u00edacon l\u00e1ser excimer<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Control de la aberraci\u00f3n esf\u00e9rica en la cirugia de la miop\u00edacon l\u00e1ser excimer <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Alejandro Higueras Esteban <\/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>C\u00e9sar Villa Collar<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Manuel anton Vidal sanz <\/li>\n<li>pablo Artal soriano (vocal)<\/li>\n<li>Jaime Javaloy esta\u00f1a (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 Alejandro Higueras Esteban La correcci\u00f3n de la miop\u00eda mediante queratomileusis in situ asistida por l\u00e1ser (lasik) modifica [&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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