Cirugía de catarata en el paciente con fragilidad endotelial. Revisión de la literatura y aproximación para evaluación del riesgo

Juan Guillermo Gaviria C. SCO, Juan Pablo Handal, Luis J. Escaf, Luz M. Melo, Juanita Londoño, Nohora Gomez, Lupe Van Heyl

Resumen


Propósito: Revisar los factores de riesgo preoperatorios y quirúrgicos más importantes de daño corneal en pacientes que requieren cirugía de catarata y arrojar una herramienta para estratificar el riesgo y personalizar el abordaje quirúrgico.

Diseño: Revisión de la literatura.

Métodos: Se realizó una revisión de la literatura utilizando los siguientes términos DeCS: “fragilidad endotelial”, “patología corneal” y “riesgo endotelial en cirugía de catarata” en los buscadores PubMed, Scopus, SciELO, Cochrane Library y Google Scholar. Además se utilizaron palabras clave como “endotelio corneal”, “Distrofia endotelial de Fuchs”, “Queratopatia bulosa pseudofaquica” y “descompensación corneal”.

Resultados: Un total de 39 artículos de 1978-2017 fueron revisados. Los mayores factores de riesgo de daño endotelial fueron identificados con énfasis en la distrofia endotelial de Fuchs. Con base en parámetros cuantitativos y cualitativos de la función endotelial, la dureza de la catarata y la profundidad de la cámara anterior, se diseñó la Matriz de Evaluación de Riesgo Endotelial para evaluar y asignar un puntaje a cada caso. Dependiendo del puntaje, el cirujano puede elegir entre opciones quirúrgicas como: procedimiento triple, técnicas libres de ultrasonido o facoemulsificación con protección endotelial.

Conclusiones: La intersección entre fragilidad endotelial, dureza de la catarata y trauma endotelial en cirugía determina el riesgo de descompensación corneal. La valoración preoperatoria del riesgo usando la Matriz de Evaluación de Riesgo Endotelial tiene el potencial de ayudar en la selección del paciente y de la técnica quirúrgica.


Palabras clave


Endotelio corneal, Distrofia endotelial de Fuchs, Queratopatia bulosa pseudofaquica, descompensación corneal

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Referencias


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Copyright (c) 2017 Juan Guillermo Gaviria C. SCO, Juan Pablo Handal, Luis J. Escaf, Luz M. Melo, Juanita Londoño, Nohora Gomez, Lupe Van Heyl

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