Zusammenfassung
Eine Vielzahl an Hornhauterkrankungen geht mit einem hohen Versagensrisiko von
Hornhauttransplantaten einher. Häufig handelt es sich um Patienten mit
beidseitig hornhautbedingter Blindheit ohne Aussicht auf Besserung. In diesen,
eigentlich aussichtslosen Situationen können Keratoprothesen häufig sehr
schnelle und erstaunliche Sehverbesserungen erzielen, die aber mit einem hohen
Risiko für schwerwiegende Komplikationen erkauft werden.
Abstract
Corneal blindness affects over 8 million adults and 1.5 million children
worldwide, making it one of the top 5 causes of blindness. Depending on the
recipientʼs corneal condition corneal transplantation may not be a viable
treatment option. In such seemingly no-alternative situations, keratoprosthesis
implantation can be an option in some patients. In terms of numbers, two types
of keratoprostheses are currently used: 1. Keratoprostheses with biological
haptics made of tooth or tibia bone. 2. The Boston type I-keratoprosthesis. Both
types have optics made of PMMA. The most common complication is the formation of
an optically disturbing retroprosthetic membrane behind the optic, which can
usually be removed with YAG laser. Causes of blindness after keratoprosthesis
implantation are glaucoma, endophthalmitis and retinal detachment. The extrusion
rate of the Boston type I-keratoprosthesis seems to be higher than after
keratoprosthesis implantation with biological haptic. Autoimmunological corneal
diseases have increased extrusion rates and higher rates of endophthalmitis when
compared to non-autoimmunological diseases. Visual outcomes after
keratoprosthesis implantation are potentially very good and usually limited by
extracorneal concomitant diseases. Advances in glaucoma diagnostic (OCT,
implantation of intraocular pressure sensors), standard glaucoma prophylaxis by
medication or surgery, modern retinal surgery and better treatment options in
case of extrusion improve the prognosis of keratoprosthesis surgery. Still, the
ideal technique for permanent anchoring of artifical optics in biological tissue
has yet to be developed.
Schlüsselwörter
Keratoprothese - OOKP - BI-KPro - Extrusion - retroprothetische Membran
Key words
Keratoprosthesis - OOKP - BI-KPro - corneal blindness - extrusion - retroprosthetic
membrane
