{"id":3532,"date":"2022-12-23T14:28:18","date_gmt":"2022-12-23T14:28:18","guid":{"rendered":"https:\/\/profmunteanu.ro\/?p=3532"},"modified":"2023-09-05T10:00:54","modified_gmt":"2023-09-05T09:00:54","slug":"ciclofotocoagularea-laser-transclerala-micropulsata","status":"publish","type":"post","link":"https:\/\/profmunteanu.ro\/en\/ciclofotocoagularea-laser-transclerala-micropulsata\/","title":{"rendered":"Ciclofotocoagularea laser transclerala micropulsata"},"content":{"rendered":"
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Ciclofotocoagularea laser transclerala micropulsata<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Ciclofotocoagularea laser transclerala micropulsata este o procedur\u0103 oftalmologic\u0103 inovatoare utilizat\u0103 pentru tratarea glaucomului refractar. Aceasta implic\u0103 utilizarea unui laser cu impulsuri scurte \u0219i energie redus\u0103 pentru a coagula \u021besutul ocular \u00een zona de produc\u021bie a fluidului intraocular. Beneficiile ciclofotocoagul\u0103rii laser transclerale micropulsate includ reducerea presiunii intraoculare, sc\u0103derea necesit\u0103\u021bii de medicamente \u0219i ameliorarea simptomelor nepl\u0103cute asociate cu glaucomul. Indica\u021biile pentru ciclofotocoagularea laser transcleral\u0103 micropulsat\u0103 includ glaucomul necontrolat prin alte metode terapeutice, intoleran\u021ba la medicamente sau contraindica\u021biile acestora. Procedura se efectueaz\u0103 \u00een mod sigur \u0219i eficient, oferind pacien\u021bilor o op\u021biune terapeutic\u0103 viabil\u0103 pentru gestionarea glaucomului refractar.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Introducere<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Conform Societ\u0103\u021bii Rom\u00e2ne de Glaucom, boala numit\u0103 glaucom<\/a> se define\u0219te a fi un grup de afec\u021biuni caracterizatee printr-o distrugere progresiv\u0103 a fibrelor nervului optic. Nervul optic este cel care asigur\u0103 transmiterea informa\u021biilor de la ochi la creier. Odat\u0103 cu distrugerea progresiv\u0103 a fibrelor nervului optic are loc \u0219i o restrangere concentric\u0103 a c\u00e2mpului vizual, ajung\u00e2ndu-se \u00een cazurile netratate p\u00e2n\u0103 la orbire. Modific\u0103rile nervului optic \u015fi ale c\u00e2mpului vizual se datoreaz\u0103 raportului dintre presiunea intraocular\u0103 \u015fi \u201esensibilitatea\u201d papilei nervului optic la stresul mecanic<\/p>

Tratamentul glaucomului se incepe prin administrarea de picaturi care au ca scop reducerea presiunii intraoculare. Desi exista mai multe clase de medicamente antiglaucomatoase care pot fi folosite pentru normalizarea presiunii intraoculare, exista situatii in care acestea nu pot controla nivelul presional intraocular si pacientul necesita alte solutii terapeutice pentru stabilizarea presiunii intraoculare.<\/p>

Tratamentele laser<\/a> sunt non-invazive, rapide, se efectueza fara incizii sau \u201cperforari\u201dale globului ocular, nu influenteaza acuitate vizuala, nu pot genera complicatii legate de tehnica si pot fi repetate in cazul in care nu se atinge tinta presionala dorita sau daca glaucomul se decompenseaza in timp.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Ciclofotocoagularea\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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1. Cum actioneaza ciclofotocoagularea laser transclerala micropulsata?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Distruc\u021bia corpului ciliar ca metod\u0103 de tratament a glaucomului, a fost folosit\u0103 \u00eenc\u0103 din 1930. Sc\u0103derea presiunii intraoculare, ob\u021binut\u0103 \u00een urma procedurilor ciclodistructive, rezult\u0103 din distrugerea epiteliului secretor al corpului ciliar. Datorit\u0103 capacit\u0103\u021bii de regenerare a corpului ciliar, este posibil sa fie nevoie de multiple \u0219edin\u021be de ciclofotocoagulare laser pentru a atinge presiunea intraocular\u0103 dorit\u0103 \u0219i men\u021binerea valorii ei de-a lungul timpului.<\/p>

Exist\u0103 multiple op\u021biuni pentru realizarea ciclodistruc\u021biei: diatermia, crioterapia , excizia chirurgical\u0103, ecografic \u0219i prin intermediul undei laser. Ciclofotocoagularea este cea mai folosit\u0103 tehnic\u0103 de realizare a ciclodistruc\u021biei \u0219i poate folosi diferite lungimi de und\u0103. Beckman \u0219i colaboratorii au efectuat prima interven\u021bie de ciclofotocoagulare laser folosind laserul rubin ( lungime de und\u0103 693 nm). Laserul Neodimium:yttrium-aluminiu-granat (Nd:YAG), cu lungime de und\u0103 1064 nm, este de asemenea folosit pentru realizarea ciclodistruc\u021biei, at\u00e2t prin tehnici contact c\u00e2t \u0219i non-contact. Tehnicile moderne de ciclofotocoagulare laser, folosesc laserul diod\u0103 (lungime de und\u0103 810 nm), deoarece melanina din epiteliul corpului ciliar absoarbe cel mai bine lungimea de und\u0103 de 810 nm, realiz\u00e2nd astfel o distruc\u021bie \u021bintit\u0103 \u0219i reac\u021bii inflamatorii reduse. Laserul diod\u0103 poate fi aplicat transscleral sau endoscopic. Unda laser poate fi livrat\u0103 \u00een modul continuu sau micropulsat.<\/p>

Tehnica este realizat\u0103 printr-un sistem semi-conductor, laser diod\u0103 \u00een stare solid\u0103 cu o lungime de und\u0103 de 810 nm (Oculight SLx, Iridex Corporation, Mountain View, CA). Pentru livarea undei laser se folose\u0219te un instrument manual, numit sonda P3, de micropuls (G probe, Iridex, Mountain View, CA), \u00eentr-un mod discontinuu, impulsuri scurte repetitive, permit tesuturilor s\u0103 se r\u0103ceasc\u0103 \u00eentre aplic\u0103ri, diminu\u00e2nd efectele secundare produse de emisia continu\u0103. Parametrii laser sunt: lungime de und\u0103 \u2013 810 nm, putere \u2013 2000 mW, timp de aplicare \u00eentre 160 \u0219i 260 s. Ciclul de func\u021bionare este de 31,3%, care semnific\u0103 0.5 ms de transmitere \u0219i 1.1 ms de pauz\u0103.\u00a0 Se practic\u0103 anestezie retrobulbar\u0103 sau peribulbar\u0103. Sonda se aplic\u0103 printr-o mi\u0219care de alunecare, de-a lungul limbului scero-cornean, \u00een dreptul corpului ciliar, evit\u00e2nd meridianele orelor 3 \u0219i 9, datorit\u0103 traseului nervilor ciliari<\/p>

Metoda micropulsat\u0103 de livrarea a laserului permite controlul efectului de \u00eenc\u0103lzire a \u021besuturilor, prin fragmentarea undei continue de laser \u00een pulsuri scurte, repetitive. Tratamentul laser se efectueaza in sala de operatii, in conditii aseptice, si dureaza intre 3-5 minute.<\/p>

P\u00e2n\u0103 de cur\u00e2nd s-a considerat c\u0103 ciclofotocoagularea laser micropulsat\u0103 determin\u0103 sc\u0103derea presiunii intraoculare, prin cre\u0219terea outflow ului uveoscleral, datele recente din literatura arat\u0103 c\u0103 stimuleaz\u0103 \u0219i outflow ul conven\u021bional prin mi\u0219carea de contrac\u021bie pe care o imprim\u0103 mu\u0219chiului ciliar, care trage de re\u021beaua trabecular\u0103 \u0219i de canalul Schlem, astfel \u00eembun\u0103t\u0103\u021bind outflowul conven\u021bional.<\/p>

\u00a0<\/p>

Ciclofotocoagularea laser micropulsata transscleral\u0103 \u0219i endociclofotocoagularea laser reprezint\u0103, \u00een deosebi, indica\u021bii de tratament pentru formele de glaucom refractar la tratament \u0219i la pacien\u021bii cu acuitate vizual\u0103 \u0219i poten\u021bial vizual sc\u0103zute.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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2. In ce cazuri se poate folosi acest tratament laser?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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