Tratamento de triquíase menor e maior com laser de diodo
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Data
2018-07-17
Autores
Bezerra, Raquel Galvão
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Universidade Estadual Paulista (Unesp)
Resumo
Objetivo: estabelecer valores-padrão para a aplicação do laser de diodo verde para o tratamento da triquíase menor e maior, assim como avaliar a taxa de sucesso com o tratamento realizado. Método: estudo prospectivo, com intervenção, realizado nos anos de 2016 e 2017, envolvendo portadores de triquíase com até 10 cílios alterados por pálpebra e que foram submetidos ao tratamento de termoablação dos cílios utilizando o laser de diodo Zeiss Visulas 532s com emissão de luz verde com comprimento de onda de 532nm. Os parâmetros utilizados foram definidos empiricamente, com tempo de aplicação de 200 ms, mira de 50 μm, intervalo de 150 a 200 ms, potência de 600 a 750 mW. O número de tiros aplicados foi definido pela a profundidade de ablação de 2,5 mm para cílios na pálpebra superior e 1,5 mm para os da pálpebra inferior. Os pacientes foram seguidos por até 15 meses, com reavaliações a cada 3 ou 4 meses. Dados demográficos, características da triquíase, bem como a taxa de sucesso no tratamento foram analisados estatisticamente. Resultados: Noventa e oito pacientes, 130 olhos, 135 pálpebras acometidas e 337 cílios triquiáticos foram estudados. A média de idade dos pacientes foi de 72,1 ± 12,3 anos, a maioria do sexo masculino (54,1%), da raça branca (98%), com triquíase menor (91,8%), unilateral (67,3%), sendo o olho direito (54,6%) e a pálpebra inferior (85,9%) os mais acometidos. A causa mais comum da triquíase foi a blefarite (64,3%), seguida de causas idiopáticas (15,3%). Não houve significância estatística na comparação das variáveis idade, sexo, raça, olho acometido e etiologia com a presença ou quantidade de cílios triquiáticos (p>0,05). Houve perda de seguimento em 11,2% dos pacientes. Utilizando os parâmetros citados, do total que permaneceu até o final do estudo, 69% obtiveram cura com 1 sessão, 13,8% com 2 e 1,1% com 3 ou 4 sessões. Considerando apenas os indivíduos que concluíram o tratamento e excluindo os que perderam seguimento, a taxa de cura foi de 85%. Houve redução de 2,5 para 0,7 cílios triquiáticos por pálpebra com apenas 1 sessão (p<0,001) e o número médio de tiros por cílio foi de 60,7. Pacientes submetidos a tratamentos prévios e com etiologia idiopática tiveram as maiores taxas de cura, 98,1% e 91,7% respectivamente. Conclusão: a termoablação com laser de diodo, usando os parâmetros observados neste estudo, é efetiva, apresentando altas taxas de cura no tratamento da triquíase.
Purpose: to establish standard parameters for laser application as well as to evaluate the success rate of treatment of minor and major trichiasis using green diode laser. Method: a prospective study with intervention, was carried out in the years 2016 and 2017, involving trichiasis carriers with up to 10 misdirected lashes per eyelid that were submitted to the thermoablation treatment of the misdirected lashes using Zeiss Visulas 532s diode laser with green light emission with wavelength of 532nm. The parameters used were empirically defined, with an application time of 200 ms, 50 μm size, range of 150 to 200 ms and power of 600 to 750 mW. The number of shots applied was defined by the depth of ablation of 2.5 mm for upper eyelid lashes and 1.5 mm for lower eyelid lashes. The patients were followed for up 15 months, with revaluations every 3 or 4 months. Demographic data, trichiasis characteristics, as well as the success rate with treatment were statistically analyzed. Results: ninety eight patients, 130 eyes, 135 affected eyelids and 337 trichiatic eyelashes were studied. The mean age was 72.1 ± 12.3 years old, the majority male (54.1%), Caucasian (98%), with minor trichiasis (91,8%) unilateral (67,3%), being the right eye (54,6%) and the lower eyelid (85,9%) the most affected. The most common etiology was blepharitis (64.3%), followed by idiopathic causes (15.3%). There was no statistical significance in the comparison of age, gender, race, affected eye, and etiology with the presence or quantity of the trichiatic eyelashes (p>0,05). Around 11.2% of patients lost follow-up. Using the mentioned parameters, of the total remaining until the end of study, 69% of patients achieving cure with 1 session, 13.8% with 2 and 1.1% with 3 or 4 sessions. Considering only the individuals who completed the treatment and excluding those who lost follow-up, the cure rate was 85%. There was a reduction of 2.5 to 0.7 trichiatic eyelashes per eyelid with only 1 session (p<0,001) e the average number of shots per eyelash was 60.7. Patients submitted to previous treatments and with idiopathic etiology had the highest cure rates, 98.1% and 91.7%, respectively. Conclusion: thermoablation with diode laser, using the parameters observed in this study, is effective, with high cure rates in the treatment of trichiasis.
Purpose: to establish standard parameters for laser application as well as to evaluate the success rate of treatment of minor and major trichiasis using green diode laser. Method: a prospective study with intervention, was carried out in the years 2016 and 2017, involving trichiasis carriers with up to 10 misdirected lashes per eyelid that were submitted to the thermoablation treatment of the misdirected lashes using Zeiss Visulas 532s diode laser with green light emission with wavelength of 532nm. The parameters used were empirically defined, with an application time of 200 ms, 50 μm size, range of 150 to 200 ms and power of 600 to 750 mW. The number of shots applied was defined by the depth of ablation of 2.5 mm for upper eyelid lashes and 1.5 mm for lower eyelid lashes. The patients were followed for up 15 months, with revaluations every 3 or 4 months. Demographic data, trichiasis characteristics, as well as the success rate with treatment were statistically analyzed. Results: ninety eight patients, 130 eyes, 135 affected eyelids and 337 trichiatic eyelashes were studied. The mean age was 72.1 ± 12.3 years old, the majority male (54.1%), Caucasian (98%), with minor trichiasis (91,8%) unilateral (67,3%), being the right eye (54,6%) and the lower eyelid (85,9%) the most affected. The most common etiology was blepharitis (64.3%), followed by idiopathic causes (15.3%). There was no statistical significance in the comparison of age, gender, race, affected eye, and etiology with the presence or quantity of the trichiatic eyelashes (p>0,05). Around 11.2% of patients lost follow-up. Using the mentioned parameters, of the total remaining until the end of study, 69% of patients achieving cure with 1 session, 13.8% with 2 and 1.1% with 3 or 4 sessions. Considering only the individuals who completed the treatment and excluding those who lost follow-up, the cure rate was 85%. There was a reduction of 2.5 to 0.7 trichiatic eyelashes per eyelid with only 1 session (p<0,001) e the average number of shots per eyelash was 60.7. Patients submitted to previous treatments and with idiopathic etiology had the highest cure rates, 98.1% and 91.7%, respectively. Conclusion: thermoablation with diode laser, using the parameters observed in this study, is effective, with high cure rates in the treatment of trichiasis.
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Palavras-chave
Triquíase, Termoablação, Laser, Diodo, Trichiasis, Thermoablation, Diode