{"id":27358,"date":"2024-09-11T17:18:48","date_gmt":"2024-09-11T15:18:48","guid":{"rendered":"https:\/\/eyelaser.at\/crosslinking-pentru-degenerarea-marginala-pellucida-pmd\/"},"modified":"2025-08-07T23:06:27","modified_gmt":"2025-08-07T21:06:27","slug":"crosslinking-pentru-degenerarea-marginala-pellucida-pmd","status":"publish","type":"post","link":"https:\/\/eyelaser.at\/ro\/crosslinking-pentru-degenerarea-marginala-pellucida-pmd\/","title":{"rendered":"Crosslinking pentru degenerarea marginal\u0103 pellucid\u0103 (PMD)"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Degenerescen\u021ba marginal\u0103 pellucid\u0103 (PMD) este o boal\u0103 degenerativ\u0103 rar\u0103 a corneei care duce la sub\u021bierea \u0219i deformarea corneei inferioare. Ea prezint\u0103 unele asem\u0103n\u0103ri cu keratoconusul, dar difer\u0103 \u00een mai multe aspecte importante. <\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Caracteristici ale PMD<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Sub\u021bierea corneei:<\/b><span style=\"font-weight: 400;\"> \u00cen cazul PMD, sub\u021bierea corneei apare de obicei \u00een zona inferioar\u0103 (inferioar\u0103), adesea aproape de marginea corneei.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Modificarea formei:<\/b><span style=\"font-weight: 400;\"> Aceast\u0103 sub\u021biere duce la o aplatizare a corneei superioare \u0219i la o \u00eenclinare a corneei inferioare, rezult\u00e2nd o form\u0103 caracteristic\u0103 de &#8222;arip\u0103 a corbului&#8221; atunci c\u00e2nd se observ\u0103 topografia corneei.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Afectarea vederii:<\/b><span style=\"font-weight: 400;\"> Forma neregulat\u0103 a corneei provoac\u0103 distorsiuni semnificative \u0219i pierderea vederii, similar cu keratoconusul, dar modelul de distorsiune este diferit.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Diferen\u021be \u00eentre PMD \u0219i keratoconus<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Localizarea dilu\u021biei:<\/b>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>PMD:<\/b><span style=\"font-weight: 400;\"> Sub\u021bierea apare \u00een principal \u00een partea inferioar\u0103 a corneei, aproape de margine.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Keratoconus:<\/b><span style=\"font-weight: 400;\"> Sub\u021bierea este mai central\u0103 sau paracentral\u0103 \u0219i formeaz\u0103 adesea o proeminen\u021b\u0103 \u00een form\u0103 de con.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Forma de deformare:<\/b>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>PMD:<\/b><span style=\"font-weight: 400;\"> Duce la o aplatizarea corneei superioare \u0219i la o \u00eenclinare a corneei inferioare.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Keratoconus:<\/b><span style=\"font-weight: 400;\"> Duce la o proeminen\u021b\u0103 generalizat\u0103 \u00een form\u0103 de con a corneei.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Debutul \u0219i evolu\u021bia:<\/b>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>PMD:<\/b><span style=\"font-weight: 400;\"> Se dezvolt\u0103 adesea mai t\u00e2rziu \u00een via\u021b\u0103 \u0219i progreseaz\u0103 mai lent.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Keratoconus:<\/b><span style=\"font-weight: 400;\"> \u00cen mod tipic \u00eencepe \u00een adolescen\u021b\u0103 sau la v\u00e2rsta adult\u0103 t\u00e2n\u0103r\u0103 \u0219i poate progresa mai rapid.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Diagnosticul:<\/b>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>PMD:<\/b><span style=\"font-weight: 400;\"> Diagnosticat\u0103 prin topografie cornean\u0103 \u0219i modele caracteristice de deformare a corneei care arat\u0103 sub\u021bierea periferic\u0103 inferioar\u0103.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><b>Keratoconus:<\/b><span style=\"font-weight: 400;\"> Diagnosticat, de asemenea, prin topografie cornean\u0103, dar prezint\u0103 o proeminen\u021b\u0103 central\u0103 sau paracentral\u0103 \u00een form\u0103 de con.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Tratamentul PMD<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Crosslinking-ul (CXL) este o metod\u0103 dovedit\u0103 pentru tratamentul keratoconusului \u0219i poate fi utilizat\u0103 \u0219i \u00een PMD pentru a stabiliza corneea \u0219i a \u00eencetini evolu\u021bia bolii.  <\/span><\/p>\n<h3><b>Preg\u0103tirea \u0219i punerea \u00een aplicare a reticul\u0103rii cu PMD<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Examinare preliminar\u0103:<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Este necesar\u0103 o examinare am\u0103nun\u021bit\u0103 a corneei prin topografie cornean\u0103 \u0219i pahimetrie (m\u0103surarea grosimii corneei) pentru a determina amploarea \u0219i localizarea exact\u0103 a sub\u021biririi.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Anestezie:<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Se utilizeaz\u0103 pic\u0103turi de anestezic local pentru a amor\u021bi ochiul \u00een timpul procedurii.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Managementul epitelial:<\/b><\/li>\n<\/ul>\n<p><b>Epi-off crosslinking:<\/b><span style=\"font-weight: 400;\"> Epiteliul (stratul superior al corneei) este \u00eendep\u0103rtat pentru a permite o penetrare mai bun\u0103 a riboflavinei.<\/span><\/p>\n<p><b>Epi-on Crosslinking:<\/b><span style=\"font-weight: 400;\">  Epiteliul r\u0103m\u00e2ne intact. Cu toate acestea, aceast\u0103 metod\u0103 este utilizat\u0103 mai rar pentru PMD, deoarece penetrarea riboflavinei poate fi mai pu\u021bin eficient\u0103. <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Aplicarea riboflavinei:<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Riboflavina (vitamina B2) este picurat\u0103 pe cornee \u0219i trebuie l\u0103sat\u0103 s\u0103 ac\u021bioneze pentru o perioad\u0103 suficient de lung\u0103 de timp, astfel \u00eenc\u00e2t s\u0103 poat\u0103 p\u0103trunde ad\u00e2nc \u00een cornee. Acest lucru dureaz\u0103 de obicei 20-30 de minute. <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Iradiere UV:<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Corneea este iradiat\u0103 cu lumin\u0103 UV-A. Aceast\u0103 iradiere activeaz\u0103 riboflavina, ceea ce duce la o \u00eent\u0103rire a fibrelor de colagen din cornee. Iradierea dureaz\u0103 aproximativ 30 de minute.  <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Concluzie:<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Dup\u0103 radioterapie, se utilizeaz\u0103 o lentil\u0103 de contact terapeutic\u0103 pentru a proteja ochiul \u0219i a promova vindecarea. De asemenea, se prescriu pic\u0103turi oculare antibiotice \u0219i antiinflamatoare. <\/span><\/p>\n<h3><b>Considera\u021bii speciale \u00een tratamentul PMD<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Localizarea sub\u021bierii:<\/b><span style=\"font-weight: 400;\"> Deoarece PMD afecteaz\u0103 de obicei corneea inferioar\u0103, este important s\u0103 se asigure c\u0103 riboflavina p\u0103trunde uniform \u00een aceast\u0103 zon\u0103 \u0219i c\u0103 iradierea UV este suficient de puternic\u0103 pentru a trata \u00eentreaga regiune afectat\u0103.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Grosimea corneei:<\/b><span style=\"font-weight: 400;\">  \u00cen cazul corneelor foarte sub\u021biri, grosimea trebuie monitorizat\u0103 cu aten\u021bie, deoarece o cornee prea sub\u021bire cre\u0219te riscul de complica\u021bii \u00een timpul iradierii UV. \u00cen astfel de cazuri, pot fi utilizate tehnici speciale pentru a \u00eengro\u0219a temporar corneea. <\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Monitorizarea pe termen lung:<\/b><span style=\"font-weight: 400;\"> Dup\u0103 crosslinking, sunt necesare controale regulate pentru a monitoriza stabilitatea corneei \u0219i pentru a recunoa\u0219te eventualele complica\u021bii \u00eentr-un stadiu incipient.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Metode alternative de tratament pentru PMD  <\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Lentile de contact speciale:<\/b><\/li>\n<\/ul>\n<p><b>Lentile sclerale:<\/b><span style=\"font-weight: 400;\"> Aceste lentile de contact mari acoper\u0103 corneea neregulat\u0103 \u0219i ofer\u0103 o suprafa\u021b\u0103 uniform\u0103, neted\u0103.<\/span><\/p>\n<p><b>Lentile hibride:<\/b><span style=\"font-weight: 400;\"> Combin\u0103 o zon\u0103 central\u0103 ferm\u0103, permeabil\u0103 la gaze, cu o zon\u0103 exterioar\u0103 moale pentru un confort sporit.<\/span><\/p>\n<p><b>Lentile RGP (Rigid Gas Permeable):<\/b><span style=\"font-weight: 400;\"> Lentile dure, permeabile la gaz, care pot oferi o corec\u021bie mai bun\u0103 a vederii.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Inele corneene intrastromale (intacs):<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Inele mici, semicirculare, care sunt implantate \u00een cornee pentru a-i schimba forma \u0219i a o stabiliza.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Transplant cornean:<\/b><\/li>\n<\/ul>\n<p><b>Keratoplastie lamelar\u0103:<\/b><span style=\"font-weight: 400;\"> Un transplant cornean par\u021bial \u00een care sunt \u00eenlocuite doar straturile afectate ale corneei.<\/span><\/p>\n<p><b>Keratoplastie penetrant\u0103:<\/b><span style=\"font-weight: 400;\"> Un transplant cornean complet \u00een care \u00eentreaga cornee este \u00eenlocuit\u0103.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Lentile intraoculare fazice (PIOL):<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Implanturi de lentile care sunt inserate \u00een ochi \u00een plus fa\u021b\u0103 de lentila natural\u0103 pentru a \u00eembun\u0103t\u0103\u021bi acuitatea vizual\u0103.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Injec\u021bii oculare terapeutice:<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Injec\u021bii de medicamente pentru a reduce inflama\u021bia \u0219i a \u00eembun\u0103t\u0103\u021bi stabilitatea corneei.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Keratectomie fotorefractiv\u0103 ghidat\u0103 de topografia corneei (PRK):<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Un tratament cu laser pentru a corecta deformarea corneei \u0219i a \u00eembun\u0103t\u0103\u021bi calitatea vederii.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Aceste metode alternative pot fi utilizate \u00een func\u021bie de gravitatea PMD \u0219i de nevoile individuale ale pacientului.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ce este keratoconusul? Dr. Victor Derhartunian explic\u0103 ce este keratoconusul \u0219i ce op\u021biuni de tratament sunt disponibile. Cite\u0219te mai mult&#8230;&#8230;<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[147],"tags":[148],"class_list":["post-27358","post","type-post","status-publish","format-standard","hentry","category-intrebari-frecvente","tag-glosar-crosslinking"],"acf":[],"_links":{"self":[{"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/posts\/27358","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/comments?post=27358"}],"version-history":[{"count":0,"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/posts\/27358\/revisions"}],"wp:attachment":[{"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/media?parent=27358"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/categories?post=27358"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/eyelaser.at\/ro\/wp-json\/wp\/v2\/tags?post=27358"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}