Crosslinking bei Keratokonus

Zusammenfassung

Bei Keratokonus handelt es sich um eine fortschreitende Verdünnung und Vorwölbung der Hornhaut. Das höchste Risiko für eine starke Progredienz weisen junge Patienten auf. 1998 wurde die Methode des kornealen Crosslinkings beschrieben. Es soll dadurch ein Fortschreiten der Erkrankung verhindert werden. Aktuell existieren nur wenige prospektive Studien mit einem hohen Evidenzgrad. In der Literatur existieren 6 randomisierte prospektive Studien. In allen Studien konnte in den keratometrischen Daten eine Wirkung des Crosslinkings belegt werden. In 2 Studien wurde auch in der Behandlungsgruppe eine Progression beschrieben. In 4 Studien zeigte die Kontrollgruppe nur bei wenigen Patienten eine Progredienz. Nicht jeder Patient mit Keratokonus profitiert zwangsläufig von einem Crosslinking. Risiken des Crosslinkings sind u. a. Narbenbildung und Haze, Endothelzellschäden sowie Entzündungen der Hornhaut und des Auges. Um solche Risiken und eine Übertherapie von eigentlich stabilen Patienten zu vermeiden, sollte vor der Durchführung eines Crosslinkings die Progression des Keratokonus sicher nachgewiesen sein.

Abstract

Keratoconus leads to progressive thinning and protrusion of the cornea. Young patients exhibit the highest risk for progression. Corneal crosslinking was introduced in 1998 and is intended to prevent progression of keratoconus. Only a few prospective controlled trials have been published. Six randomised controlled trials have been published. All these trials confirmed the efficacy of crosslinking through keratometric data. In two trials, progression was reported in some patients of the treatment group. This indicates that not all patients benefit from corneal crosslinking. The risks of the procedure include corneal scarring, haze, endothelial cell damage and infections of the cornea. In order to avoid these risks, patients without progression should not be treated with crosslinking.

Schlüsselwörter

Kornea - Keratokonus - Crosslinking

Key words

cornea - keratoconus - crosslinking

• Literatur

• 1 Krachmer JH, Feder RS, Belin MW. Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol 1984; 28: 293-322
• 2 McMahon TT, Edrington TB, Szczotka-Flynn L et al. Longitudinal changes in corneal curvature in keratoconus. Cornea 2006; 25: 296-305
• 3 Shetty R, Nuijts RM, Nanaiah SG et al. Two novel missense substitutions in the VSX1 gene: clinical and genetic analysis of families with Keratoconus from India. BMC Med Genet 2015; 16: 33
• 4 Wang Y, Rabinowitz YS, Rotter JI et al. Genetic epidemiological study of keratoconus: evidence for major gene determination. Am J Med Genet 2000; 93: 403-409
• 5 Tuft SJ, Hassan H, George S et al. Keratoconus in 18 pairs of twins. Acta Ophthalmol 2012; 90: e482-e486
• 6 Shapiro MB, France TD. The ocular features of Down’s syndrome. Am J Ophthalmol 1985; 99: 659-663
• 7 Bawazeer A, Hodge W, Lorimer B. Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol 2000; 84: 834-836
• 8 McMonnies CW. Mechanisms of rubbing-related corneal trauma in keratoconus. Cornea 2009; 28: 607-615
• 9 Spoerl E, Huhle M, Seiler T. Induction of cross-links in corneal tissue. Exp Eye Res 1998; 66: 97-103
• 10 Wollensak G, Wilsch M, Spoerl E et al. Collagen fiber diameter in the rabbit cornea after collagen crosslinking by riboflavin/UVA. Cornea 2004; 23: 503-507
• 11 Spoerl E, Wollensak G, Seiler T. Increased resistance of crosslinked cornea against enzymatic digestion. Curr Eye Res 2004; 29: 35-40
• 12 Messmer EM, Meyer P, Herwig MC et al. Morphological and immunohistochemical changes after corneal cross-linking. Cornea 2012; 32: 111-117
• 13 Wittig-Silva C, Chan E, Islam FM et al. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Ophthalmology 2014; 121: 812-821
• 14 O’Brart DP, Chan E, Samaras K et al. A randomised, prospective study to investigate the efficacy of riboflavin/ultraviolet A (370 nm) corneal collagen cross-linkage to halt the progression of keratoconus. Br J Ophthalmol 2011; 95: 1519-1524
• 15 Hersh PS, Greenstein SA, Fry KL. Corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 2011; 37: 149-160
• 16 Sykakis E, Karim R, Evans JR et al. Corneal collagen cross-linking for treating keratoconus. Cochrane Database Syst Rev 2015; (3) CD010621
• 17 Sharma N, Suri K, Sehra SV et al. Collagen cross-linking in keratoconus in Asian eyes: visual, refractive and confocal microscopy outcomes in a prospective randomized controlled trial. Int Ophthalmol 2015; 35: 827-832
• 18 Seyedian MA, Aliakbari S, Miraftab M et al. Corneal collagen cross-linking in the treatment of progressive keratoconus: a randomized controlled contralateral eye study. Middle East Afr J Ophthalmol 2015; 22: 340-345
• 19 Lang SJ, Messmer EM, Geerling G et al. Prospective, randomized, double-blind trial to investigate the efficacy and safety of corneal cross-linking to halt the progression of keratoconus. BMC Ophthalmol 2015; 15: 78
• 20 Cagil N, Sarac O, Cakmak HB et al. Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: short-term complications. J Cataract Refract Surg 2015; 41: 1730-1737
• 21 Arora R, Jain P, Gupta D et al. Sterile keratitis after corneal collagen crosslinking in a child. Cont Lens Anterior Eye 2012; 35: 233-235
• 22 Pollhammer M, Cursiefen C. Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet-A. J Cataract Refract Surg 2009; 35: 588-589
• 23 Eberwein P, Auw-Hädrich C, Birnbaum F et al. [Corneal melting after cross-linking and deep lamellar keratoplasty in a keratoconus patient]. Klin Monatsbl Augenheilkd 2008; 225: 96-98
• 24 Wollensak G, Spörl E, Reber F et al. Corneal endothelial cytotoxicity of riboflavin/UVA treatment in vitro. Ophthalmic Res 2003; 35: 324-328
• 25 Lange C, Böhringer D, Reinhard T. Corneal endothelial loss after crosslinking with riboflavin and ultraviolet-A. Graefes Arch Clin Exp Ophthalmol 2012; 250: 1689-1691
• 26 Gokhale NS. Corneal endothelial damage after collagen cross-linking treatment. Cornea 2011; 30: 1495-1498