Estudo do processo de adaptação de lentes de contato esclerais em pacientes com córneas irregulares e análise clínica e bioquímica da superfície ocular antes e após seu uso para o tratamento do olho seco moderado e grave

• Autor(a) principal: Weber, Sarah La Porta [UNIFESP]
• Data de Publicação: 2017
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5273919; http://repositorio.unifesp.br/handle/11600/50585
• topic: Scleral contact lens; Scleral lens fitting; Contact lens; Scheimpflug camera; Dry eye disease; Irregular cornea; Impression citology; Olho seco; Lentes esclerais; Adaptacao de lentes de contato; Camera de Scheimpflug; Citologia de impressao

Purpose: Paper 1: To study the scleral contact lens (SCL) fitting process and to verify the possibility of tomographic variables derived from the Scheimpflug system to assist in this process. Paper 2: To evaluate the efficacy of the Esclera SCL treatment and its impact on clinical testing for moderate to severe dry eye disease (DED). Paper 3: To evaluate conjunctival impression cytology and HLA-DR expression changes after wearing SCL for moderate to severe DED. Methods: Paper 1: Forty-seven patients (63 eyes) were indicated for the use of Esclera SCL. All patients underwent Scheimpflug imaging before the initial SCL evaluation. The following parameters were measured by Pentacam: corneal elevations, thickness, density, and anterior chamber depth (ACD). Correlations between the SCL parameters and the Pentacam measurements were analysed with Pearson's correlation coefficients. A simple linear regression model was created for each lens parameter using the most-correlated Pentacam variable. Paper 2: A total of 41 eyes from 25 patients with moderate to severe DED were evaluated for the SCL treatment. Best-corrected visual acuity (BCVA), tear osmolarity, the Schirmer I test, tear film breakup time (TBUT), corneal and conjunctival staining, meibomian grading and Ocular Surface Disease Index and SF-36v2 questionnaires were assessed before and after the SCL treatment. These values were compared to assess the real benefit of using SCL as a treatment for DED. Paper 3: Forty-one eyes of 25 patients with moderate to severe DED were treated with SCL. Conjunctival impression cytology were collected before and after 12 months of SCL use. Samples were analyzed using the morphological score and HLA-DR antigen expression. The values obtained were compared to evaluate the changes in the impression cytology after the SCL wear. Results: Paper 1: Regarding the tomographic variables derived from the Scheimpflug camera and the SCL variables, the results show correlations between the SCL parameters and the corneal astigmatism, ACD and pentacam-measured corneal height (Hm) in the total group with (p<.001). In addition, an inverse correlation between the lens sagittal depth (LSD) and the anterior radii minimum was shown (p<.001). In the keratoconus group, the results show correlations between the SCL parameters and ACD and Hm (p<.001, each). An inverse correlation between the LSD and the total thickness corneal density average was also observed (p=.003). Paper 2: Regarding the analysis of the treatment with SCL in patients with moderate to severe DED, the underlying diseases were: Stevens-Johnson syndrome (22 eyes), Sjogren syndrome (11 eyes), graft-vs-host disease (2 eyes), dry eye after keratomileusis in situ (2 eyes) and undifferentiated ocular surface disease (4 eyes). BCVA improved from 0.703 ± 0.55 logMAR with habitual correction to 0.406 ± 0.43 logMAR with SCL (p < .001). There was a significant decrease in tear osmolarity values (338.1 ± 27.1 to 314.25 ± 38.8 mOsm/L, p < .001) and van Bijsterveld scores (3.63 ± 2.33 to 2.63 ± 2.46 grade, p= .015) between the baseline and 12 months after SCL wear. There were also significant improvements in dry eye symptoms and quality of life as assessed by the OSDI and SF-36v2 questionnaires (both with p<.001). Paper 3: The HE-PAS impression cytology score did not differ significantly before and after wearing SCL for 12 months in DED patients (p>.05). The percentage of eyes expressing the HLA-DR antigen in the temporal conjunctiva after wearing SCL for 12 months significantly increased in patients with Sjogren syndrome (11.11% to 66.66%; p=.498). In groups with Stevens Johnson syndrome and other ocular surface disorders, we did not observe statistically significant differences (p>.05). Conclusions: Paper 1: There was a positive correlation between SCL and Pentacam variables, such as LSD and ACD, as well as LD and ACD in the keratoconus group. Thus, these results suggest that certain measurements of Pentacam may be good predictors for the most appropriate SCL to be fitted in patients with keratoconus. Paper 2: In addition, we concluded that the adjuvant treatment for DED with SCL had a positive impact, with improvement of the BCVA, tear osmolarity, van Bijsterveld score, dry eye symptoms and quality of life. Paper 3: The SCL did not change the parameters used to evaluate inflammatory processes, which were measured using conjunctival impression cytology and HLA-DR expression, except in Sjogren syndrome, in which there was an unexpected increase in HLA expression.