Doenças endoteliais corneanas: rumo a novas modalidades terapêuticas

• Autor(a) principal: Vianna, Lucas Monferrari Monteiro [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• dARK ID: ark:/48912/001300000wwm6
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3935592; https://repositorio.unifesp.br/handle/11600/47465
• topic: Ophthalmology; Cornea; Corneal endothelium; Corneal transplantation; Oftalmologia; Córnea; Endotélio da córnea; Transplante de córnea

This PhD thesis focuses on aspects of surgical treatments for corneal endothelial diseases. Its structure includes 3 main publications ? one clinical study (3.1) and two laboratory studies (3.2) and (3.3), one case report, and an ophthalmic image. Clinical Study (3.1). Purpose: to identify possible risk factors for failures during Descemet membrane endothelial keratoplasty (DMEK) graft preparation, currently considered the gold standard technique. Methods: comparision of the rate of failures among donors with or without several ocular and systemic risk factors. Results: it was observed that diabetes and its duration, hypertension and obesity and/or hyperlipidemia were associated with higher failure rates. Conclusion: if tissues from donors with these risk factors were used for other kinds of transplants, the failure rate for DMEK preparation can be considerably reduced. Laboratory studies (3.2) (3.3). Purpose: to relate, for the first time in the literature, the possibility of culturing and cryopreserving corneal endothelial cells using human serum replacing the standard supplement described in the literature (fetal bovine serum). Methods: the comparison of morphology, growth curves, immunohistochemistry and polymerase chain reaction in real time (RT-PCR) for phenotypic and functional markers of corneal endothelial cells. Results: both media behaved similarly before and after cryopreservation. Conclusion: corneal endothelial cells can be cultured and cryopreserved using human serum as a media supplement. The case report (3.4) describes an attempted deep anterior lamellar keratoplasty (DALK) which became complicated with a large rupture in Descemet membrane during dissection. Taking into consideration recent reports of Descemet membrane endothelial transfer (DMET), it was chosen to leave the host DM in the anterior chamber as a potential source of host endothelial cells rather than removing the ruptured host Descemet membrane as part of the conversion to penetrating keratoplasty. The ophthalmic image (3.5) is an illustrative publication of how Fuchs endotheliopathy can influence quality of vision in affected patients.