Komplikationen nach Hornhautquervernetzung

Zusammenfassung

Ziel: Die Einführung der Hornhautquervernetzung wurde mit großen Hoffnungen sowohl von Patienten als auch von Augenärzten verbunden. Bisherige Ergebnisse deuten darauf hin, dass die Hornhautquervernetzung den Verlauf einer Hornhautektasie sowohl bei Patienten mit Keratokonus als auch bei Patienten mit Ektasie nach Laserablationen verlangsamen, stabilisieren oder sogar umkehren kann. In dieser Arbeit wollen wir unsere eigenen Erfahrungen mit verschiedenen Protokollen zur Hornhautquervernetzung beschreiben und in den Kontext einer Literaturübersicht zu ihren Komplikationen stellen. Methode: Retrospektive Auswertung aller unserer Hornhautquervernetzungen von Januar 2007 bis Juli 2014 unter Anwendung verschiedener Behandlungsprotokolle. Außerdem Literaturübersicht zu den Komplikationen der Hornhautquervernetzung. Ergebnisse: In unserem Patientengut wurden sterile Infiltrate, transiente hauchige Trübungsbildungen, diffuse lamelläre Keratitis und eine mykotische Infektion mit Narbenbildung beobachtet. Des Weiteren traten auch nach transepithelialer Quervernetzung in verschiedenen Varianten Schmerzen und Epitheldisruptionen auf. Aktuell sind in der Literatur nur wenige Infektionen bzw. Endothelschäden beschrieben, allerdings ist zusätzlich die Induktion einer Neoplasie dargestellt. Die Inzidenz von Komplikationen scheint gering. Schlussfolgerung: Die Hornhautquervernetzung scheint eine hohe Erfolgs- und niedrige Komplikationsrate zu haben. So scheinen Endothelschäden ein deutlich kleineres Problem zu sein als ursprünglich befürchtet. Indessen fehlen prospektive Studien mit langer Nachbeobachtungsdauer und es bleibt abzuwarten, ob weitere Neoplasien nach Hornhautquervernetzungen beschrieben werden. In unserer Literaturrecherche fanden wir keine Berichte von Rebehandlungen. Ebenso fanden wir keine über Fallberichte hinausgehende Studie, die eine Keratoplastik nach Quervernetzung untersucht hätte. Angesichts sich rapide ändernder Behandlungsprotokolle erscheinen weitere begleitende Studien zwingend notwendig, um den Erfolg und die Komplikationen dieser Modifikationen zu kontrollieren.

Abstract

Purpose: The introduction of corneal cross-linking was associated with great expectations from patients as well as ophthalmologists. Previous results indicate that corneal cross-linking can slow down, stabilise or even reverse the progression of corneal ectasia in patients with keratoconus as well as in patients with ectasia after excimer laser ablations. We now describe our own experience with different protocols for corneal cross-linking and put these into perspective with the existing literature. Methods: We undertook a retrospective analysis of all of our corneal cross-linking treatments from January 2007 to July 2014 using different protocols. In addition, we provide an overview of the literature regarding complications of corneal cross-linking. Results: In our patient cohort we observed sterile infiltrates, transient cloudy opacifications, diffuse lamellar keratitis and a mycotic infection leading to corneal scarring. Moreover, even after transepithelial corneal cross-linking with different protocols, we have observed pain perception and epithelial disruption. At present there are few reports about infections or endothelial damage in the literature, however, induction of neoplasia is described. The incidence of complications appears to be low. Conclusion: Corneal cross-linking appears to have a high success rate and a low complication rate. Endothelial damage seems to be a far smaller problem than initially suspected. However, prospective studies with long-term follow-up are still lacking and it remains to be seen whether more cases of neoplasia following cross-linking will be reported. In our literature research we found no reports on re-treatments. Similarly, we found no study other than some case reports on keratoplasty after cross-linking. In view of rapidly changing treatment protocols further trials are warranted to monitor the benefits and complications of these modifications.

Schlüsselwörter

Kornea - kollagene Quervernetzung - Keratokonus - Komplikation

Key words

cornea - collagen cross-linking - keratoconus - complications

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