Hipermetropia após ceratotomia radial: flutuação da refração e da acuida<strong>de</strong> visual entre manhã e tar<strong>de</strong> e correlações ...171pressão compensada da córnea (IOPcc). Tal observaçãocorrobora com o conceito <strong>de</strong> que a instabilida<strong>de</strong> dacórnea após RK esteja relacionada com variações dapressão ocular. (17) É importante notar que não houvecorrelações com a IOPg. Tais achados suportam nossahipótese <strong>de</strong> que a inconsistência nas associações entreas variações da hipermetropia e da pressão ocular, observadaem alguns estudos, (15) está relacionada com alteraçõesdas medidas <strong>de</strong> tonometria <strong>de</strong> aplanação <strong>de</strong>Goldmann (TAG) após RK. A IOPcc é uma medidaque consi<strong>de</strong>ra a resposta viscoelástica da córnea paragerar um valor pressórico menos influenciado pela estruturacorneana, (24) o que reduz o impacto das alteraçõesda córnea após cirurgias nesta medida da pressão.(41) Nas medidas da tar<strong>de</strong>, não houve correlaçõessignificantes entre os parâmetros refracionais e ospressóricos, o que po<strong>de</strong> ser explicada pela redução significativaencontrada da pressão ocular ao longo dodia, o que reduz a influência da pressão no estadorefracional.Não se observou correlação entre a flutuação(diferenças entre manhã e tar<strong>de</strong>) no grau esférico eno equivalente esférico e CH e CRF. Entretanto, houveassociação entre a variação do equivalente<strong>de</strong>sfoco e o CRF medido pela manhã. Esta tendência<strong>de</strong> haver maior flutuação relacionada com córneasmais fracas biomecanicamente, merece novos estudosenvolvendo parâmetros biomecânicos mais avançados,como os <strong>de</strong>rivados do sinal do ORA. Existem38 novas variáveis <strong>de</strong>rivadas do sinal <strong>de</strong> reflexo dacórnea durante o exame do ORA*, além dosparâmetros CH e CRF, que são <strong>de</strong>rivados das pressões<strong>de</strong> aplanamento do ORA. Adicionalmente, variáveistopográficas, tomográficas da córnea e <strong>de</strong>aberrometria total <strong>de</strong>vem ser estudadas.A flutuação refracional juntamente com o estadobiomecânico da córnea e a pressão ocular <strong>de</strong>vem serconsi<strong>de</strong>rados individualmente em pacientes submetidosà RK, com interesse em retratamento refrativo. Tais variáveissão também importantes no caso <strong>de</strong> se consi<strong>de</strong>rarcirurgia <strong>de</strong> catarata. (42-44) O aplanamento da córneapo<strong>de</strong> ser acentuado no pós-operatório imediato, levandoa uma relativa surpresa hipermetrópica transitória. Talfenômeno ocorre <strong>de</strong>vido ao e<strong>de</strong>ma corneano juntamentecom a possível hipertensão ocular. O maior conhecimentosobre as variáveis biomecânicas e do impacto dapressão ocular sobre a flutuação da córnea abre <strong>de</strong>finitivamenteum novo horizonte para enten<strong>de</strong>r os achadosclínicos e personalizar tratamentos neste complexo grupo<strong>de</strong> pacientes.REFERÊNCIAS1. Radial keratotomy for myopia. American Aca<strong>de</strong>my of Ophthalmology.Ophthalmology. 1993;100(7):1103-15.2. Rowsey JJ, Morley WA. Surgical correction of mo<strong>de</strong>rate myopia:which method should you choose? I. Radial keratotomy willalways have a place. Surv Ophthalmol. 1998;43(2):147-56.3. Leaming DV. Practice styles and preferences of ASCRS members—1993survey. 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J Cataract Refract Surg. 200521(3).Autor para Correspondência:Dr. Renato Ambrósio JrRua Con<strong>de</strong> <strong>de</strong> Bonfim, 211/712CEP 20520-050 - Tijuca – Rio <strong>de</strong> Janeiro (RJ), BrasilTelefone: (21) 2234-4233; (21) 2274- 5694;(21) 7892-2131e-mail: renatoambrosiojr@terra.com.brRev Bras Oftalmol. 2012; 71 (3): 164-72
- Page 1 and 2: vol. 71 - nº 3 - Maio/Junho 2012RB
- Page 3 and 4: 144Revista Brasileira de Oftalmolog
- Page 5 and 6: 146173 Características e deficiên
- Page 7 and 8: 148Rezende F, Bisol RAR, Tiago Biso
- Page 9 and 10: 150Ventura BV, Ventura M, Lira W, V
- Page 11 and 12: 152Ventura BV, Ventura M, Lira W, V
- Page 13 and 14: 154Ventura BV, Ventura M, Lira W, V
- Page 15 and 16: 156Moura EM, Volpini M, Moura GAGIN
- Page 17 and 18: 158Moura EM, Volpini M, Moura GAGco
- Page 19 and 20: 160ARTIGO ORIGINALEficácia da comb
- Page 21 and 22: 162Almodin J, Buhler Junior C, Almo
- Page 23 and 24: 164ARTIGO ORIGINALHipermetropia ap
- Page 25 and 26: 166Ambrósio Jr R, Silva RS; Lopes
- Page 27 and 28: 168Ambrósio Jr R, Silva RS; Lopes
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- Page 33 and 34: 174Ventura CVOC, Gomes MLS, Ventura
- Page 35 and 36: 176Ventura CVOC, Gomes MLS, Ventura
- Page 37 and 38: 178Ventura CVOC, Gomes MLS, Ventura
- Page 39 and 40: 180ARTIGO ORIGINALPeriocular basal
- Page 41 and 42: 182Macedo EMS, Carneiro RC, Carrico
- Page 43 and 44: 184RELATO DE CASODiplopia após inj
- Page 45 and 46: 186Rassi MMO, Santos LHBTABELA 1Per
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- Page 49 and 50: 190Lorena SHTachados de blefarite e
- Page 51 and 52: 192Passos AF, Borges DFINTRODUÇÃO
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- Page 65 and 66: 206Instruções aos autoresA Revist
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