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Klin Monbl Augenheilkd 2022; 239(06): 752-759
DOI: 10.1055/a-1759-3834
Übersicht

Corneal Oedema: Aetiology, Diagnostic Testing, and Treatment

Hornhautödem: Pathogenese, Diagnostik und Behandlung
Daniel Bernhard Zander 
Eye Center, Medical Center – University of Freiburg, Freiburg, Germany
,
Jana Jiang
Eye Center, Medical Center – University of Freiburg, Freiburg, Germany
,
Thomas Reinhard
Eye Center, Medical Center – University of Freiburg, Freiburg, Germany
,
Katrin Wacker
Eye Center, Medical Center – University of Freiburg, Freiburg, Germany
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Abstract

Corneal oedema results from an underlying pathology, which can be diverse in origin, and may be mechanical, dystrophic, or inflammatory, and affect any layer of the cornea. Diagnostic tools such as Scheimpflug imaging and anterior segment optical coherence tomography have standardised quantification of corneal oedema and have become important aids in clinical practice. Timely diagnosis and treatment are key to preventing irreversible damage to the corneal ultrastructure, such as anterior corneal fibrosis or endothelial cell damage. The oedema usually resolves quickly when the underlying cause has been addressed. Symptomatic treatment using hyperosmolar agents has failed to show any benefits in oedema resolution or improvement in visual acuity compared to placebo. In contrast, rho-associated protein kinase (ROCK) inhibitors offer a promising option for medical treatment in cases of endothelial dysfunction, but their safety and efficacy must be further validated in large scale clinical trials. Until then, endothelial or penetrating keratoplasties remain the mainstay treatment where structural changes to the cornea have occurred.

Zusammenfassung

Hornhautödeme entwickeln sich als Folge einer mechanischen, dystrophischen oder inflammatorischen Erkrankung der Hornhaut, die alle Schichten der Hornhaut betreffen kann. Diagnostische Instrumente, wie die Scheimpflug-Tomografie und die optische Kohärenztomografie des Vorderabschnitts, erlauben eine standardisierte Quantifizierung des Hornhautödems und sind so zu wichtigen Hilfsmitteln in der klinischen Praxis geworden. Die frühzeitige Diagnose und Behandlung kornealer Ödeme ist wichtig, um dauerhafte Schäden wie Endothelzellverlust oder Fibrosierung im Bereich der anterioren Hornhaut zu vermeiden. Meist bildet sich das Hornhautödem schnell zurück, wenn die ursächliche Erkrankung behandelt wird. Die symptomatische Behandlung des Hornhautödems mit hyperosmolaren Augentropfen zeigte im Vergleich zu Placebo keinen Mehrwert in Bezug auf die Abnahme des Ödems oder eine Verbesserung der Sehfunktion. Im Gegensatz dazu scheinen Rho-kinase-(ROCK-)Inhibitoren eine vielversprechende nicht chirurgische Therapieoption bei endothelialer Dysfunktion zu sein, deren Sicherheit und Wirksamkeit in klinischen Studien überprüft werden muss. Bis dahin bleiben die endotheliale oder penetrierende Keratoplastik die Therapie der Wahl bei strukturellen Veränderungen der Hornhaut.

Key words

corneal oedema resolution - Descemet membrane endothelial keratoplasty - corneal dystrophy - pathophysiology - endothelial cell function

Schlüsselwörter

Reduktion des Hornhautödems - Pathophysiologie - Endotheltransplantation - Hornhautdystrophie - Endothelzellfunktion


Publication History

Received: 29 November 2021

Accepted: 01 February 2022

Article published online:
14 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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