Klinische Untersuchung zur Veränderung der kornealen Biomechanik bei Patienten mit systemischer Sklerodermie

Zusammenfassung

Einleitung Die Studie vergleicht die biomechanischen Eigenschaften der Hornhaut bei Patienten mit einer seit mindestens 10 Jahren bestehenden systemischen Sklerodermie (SSc) mit einer gesunden Kontrollkohorte.

Material und Methoden Untersucht wurden 14 SSc-Patienten und 38 Kontrollprobanden. Ein randomisiertes Studienauge wurde auf die kornealen biomechanischen Eigenschaften zentrale Hornhautdicke (CCT), korneale Hysterese (CH) und kornealer Resistenzfaktor (CRF) untersucht. Die Bestimmung des Augeninnendrucks (IOP) erfolgte anhand der Goldmann-Applanationstonometrie (GAT) und der dynamischen Konturtonometrie (DCT) sowie mittels Non-Contact-Tonometrie (NCT) mit dem Ocular Response Analyzer^® (ORA) als Goldmann-Applanationstonometrie-korreliertem IOP (IOPgat) und hornhautdickenkompensiertem IOP (IOPcc).

Ergebnisse Der IOP war mittels DCT- und ORA-basierter NCT-Messung bei SSc-Patienten signifikant geringer als bei der Kontrollgruppe (DCT IOP: p = 0,048, NCT IOPgat: p = 0,002, NCT IOPcc: p = 0,000). Die CCT war ebenfalls bei SSc-Patienten signifikant dünner (p = 0,001). Bezüglich der CH und des CRF ergaben sich keine statistisch signifikanten Unterschiede. Die Differenz der korrigierten Parameter (CH_korr – CRF_korr) zeigte in beiden Gruppen eine negative Differenz, die im Gegensatz zur Kontrollgruppe (− 0,66) bei den Sklerodermiepatienten (− 0,83) leicht erniedrigt war. Es bestanden deutliche signifikante negative Korrelationen der CH- und CRF-Werte bzw. CH_korr- und CRF_korr-Werte bei SSc-Patienten. Dagegen zeigte sich in der Kontrollgruppe eine nicht signifikante positive Korrelation von Lebensalter und den biomechanischen Parametern.

Schlussfolgerung Zwischen den untersuchten Gruppen konnte keine Veränderung der biomechanischen Parameter (CH, CRF) festgestellt werden. Eine deutlich vorhandene signifikante negative Korrelation von Lebensalter und CH bzw. CRF bei SSc könnte durch eine leichte Degression der viskösen Komponente und Verringerung der kornealen Dämpfungskapazität bedingt sein. Die dünnere CCT und der erniedrigte Differenzwert lassen auf veränderliche Prozesse in der Zusammensetzung der kornealen Extrazellulärmatrix bei SSc-Patienten schließen.

Abstract

Introduction Our study compares the biomechanical properties of the cornea in patients with long-term pre-existing (for at least 10 years) systemic sclerosis (SSc) with those of healthy suspects.

Material/Methods The examination was performed in 14 systemic SSc patients and 38 healthy volunteers. Non-invasive assessment of corneal biomechanical parameters, including central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF), was performed in one randomised study eye in accordance with a standardised protocol. Intraocular pressure (IOP) values were analysed using different measuring techniques, including Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT) and Ocular Response Analyzer^® (ORA)-based non-contact tonometry (NCT), GAT-correlated IOP (IOPgat) and CCT-compensated-IOP (IOPcc).

Results When measured with DCT and ORA-based NCT, IOP levels were significantly lower in SSc patients than in the control group (DCT IOP: p = 0.048, NCT IOPgat: p = 0.002, NCT IOPcc: p < 0.001). CCT was also significantly reduced in the SSc (p = 0.001). There were no statistically significant differences between the groups in CH and CRF. The difference between the corrected values (CHcorr – CRFcorr) was negative in the two groups. This was slightly lower for the SSc patients (delta = − 0.83) than for the control group (delta = − 0.66). For SSc patients, there were highly significant negative correlations between CH and CRF and between CHcorr and CRFcorr. In contrast, in the control group there was a non-significant positive correlation between age and biomechanical properties.

Conclusion In the course of the disease SSc leads to various alterations in connective tissue, which can also involve corneal tissue. CCT becomes significantly thinner and simultaneously partially loses elastic properties and gains viscosity. This accounts for reduced IOP values with dynamic contour tonometry as well as with ORA-tonometry (Goldmann-correlated IOP, CCT-compensated IOP). This distinct pre-existing significant negative correlation between age and CH and CRF values in patients with SSc could be due to slight regression of the viscous components and diminution of corneal damping capacity.

Schlüsselwörter

korneale Biomechanik - korneale Hysterese - kornealer Resistenzfaktor - Ocular Response Analyzer - systemische Sklerodermie

Key words

corneal hysteresis - corneal resistance factor - ocular response analyzer - corneal biochemical features - systemic sclerosis

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