Ceratocone
O ceratocone é uma doença da córnea, caracterizada pela alteração do colágeno corneano gerando um aumento progressivo e irreversível de sua curvatura e a diminuição progressiva de sua espessura. Assim ela adquire um formato atípico extremamente curvo (pontudo) semelhante a um cone. A causa do ceratocone ainda permanece desconhecida, porém sabe-se que alguns genes podem estar envolvidos no aparecimento do ceratocone, a ocorrência pode ser mais comum em membros de uma mesma família, mas sabe-se também que alguns fatores externos atuam diretamente acelerando a progressão do ceratocone, como traumas repetitivos devido ao hábito de coçar os olhos cronicamente.
O ceratocone começa a se desenvolver geralmente na adolescência, entretanto, existem alguns casos de aparecimento e evolução precoces ou tardia. Os sintomas inicialmente estão relacionados a baixa da visão (principalmente noturna e mesmo com a correção de óculos adequada) e aumento progressivo da miopia e principalmente do astigmatismo. Nesse estágio inicial, o uso de óculos ou lentes de contato gelatinosas é capaz de oferecer uma visão relativamente boa ao paciente. Felizmente, alguns pacientes estabilizam nesse estágio inicial e não chegam a necessitar lentes rígidas, porém, com a evolução do ceratocone, é esperado um aumento progressivo da miopia e do astigmatismo e a correção com óculos perde a eficiência. Nesse estágio, somente as lentes de contato duras (rígidas) serão capazes de melhorar a visão.
Atualmente uma boa evolução das lentes chamadas esclerais pode oferecer bons resultados visuais. A evolução pode ou não ocorrer e a adaptação com lentes de contato rígidas vai se tornando cada vez mais limitada, pois aumenta a dificuldade de estabilização das lentes de contato, bem como diminui a visão do paciente. No estágio final do ceratocone, o transplante de córnea passa a ser a única alternativa terapêutica capaz de restabelecer a visão. Felizmente temos duas boas alternativas terapêuticas para tratar o paciente portador do ceratocone, que são os anéis intraestromais corneanos e o crosslinking da córnea. Ambos são recursos mais novos com excelentes resultados e a época correta e a seleção dos candidatos a estas técnicas só podem ser determinados por um especialista habilitado e exames específicos. Porém, o ceratocone ainda é a principal causa de transplantes no Brasil.
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