Iatrogene Keratektasie nach refraktiver Chirurgie – Ursachen, Prophylaxe, Therapie

Felix Mathias Wagner; Walter Sekundo

doi:10.1055/a-2073-8478

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2023; 240(06): 783-794
DOI: 10.1055/a-2073-8478

Übersicht/Review

Iatrogene Keratektasie nach refraktiver Chirurgie – Ursachen, Prophylaxe, Therapie

Article in several languages: deutsch | English

Felix Mathias Wagner

¹Universitätsaugenklinik Mainz, Mainz, Deutschland

²Universitätsaugenklinik Marburg, Marburg, Deutschland

,

Walter Sekundo

²Universitätsaugenklinik Marburg, Marburg, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Bei der iatrogenen Keratektasie kommt es bei initial gutem Visus nach refraktivchirurgischen Lasereingriffen zu einer progressiven Myopisierung mit irregulärem Astigmatismus infolge einer zunehmenden Vorwölbung der Hornhaut. Bekannte Risikofaktoren sind u. a. ein zu dünnes postoperativ verbleibendes Stromabett, ein dickerer Flap oder präoperativ unerkannte Anzeichen für einen bereits bestehenden subklinischen Keratokonus. Die Rate postrefraktiver Ektasien bei Augen ohne erkennbare präoperative Risikofaktoren beträgt 20 pro 100 000 Augen bei PRK, 90 pro 100 000 Augen bei LASIK und 11 pro 100 000 Augen bei SMILE. Die klassischen Screening-Tools auf präoperative Risiken beinhalten das „Ectasia Risk Score System“ (ERSS) und „Percentage of Tissue Alteration“ (PTA). Modernere Methoden umfassen neben KI-Methoden für die Datenanalyse auch Einzelschichttomografie mit Epithelkartierung. Die Therapie erfolgt mit Kontaktlinsen, Crosslinking, der Implantation intrakornealer Ringsegmente, perforierenden oder lamellären Keratoplastiken und in ersten Studien durch die Implantation von Hornhautlentikeln.

Schlüsselwörter

Kornea - refraktive Chirurgie - Ektasie

Full Text

References

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