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Riboflavin-UVA-Crosslinking beim Keratokonus

Riboflavin UVA cross-linking for keratoconus

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Zusammenfassung

Beim Keratokonus handelt es sich um eine progressive, ektatische Erkrankung der Hornhaut. Bis vor wenigen Jahren konnte durch Brillen- bzw. Kontaktlinsenanpassung nur symptomatisch behandelt werden, und auch eine Keratoplastik oder intrakorneale Ringsegmente können nicht zu einer Heilung führen. Das Riboflavin-UVA-Crosslinking (CXL) kann zwar ebenfalls keine Heilung bewirken, soll aber die Progression stoppen. Das Wirkprinzip besteht in einer photochemischen Reaktion von Riboflavin und UVA-Licht, wodurch im Stroma freie Sauerstoffradikale entstehen, die zu kovalenten Verbindungen der Kollagenfibrillen führen. Diese Versteifung der Kornea soll die Progression des Keratokonus stoppen. Nach ersten Berichten Ende der 1990er-Jahre kam es in den vergangenen Jahren zu einer zunehmenden Verbreitung dieser Therapie. Zahlreiche Fallserien weisen darauf hin, dass die Progression bei manchen Patienten aufgehalten werden kann. Allerdings gibt es bisher kaum randomisierte, kontrollierte Multicenterstudien, die eine hohe Evidenz nachweisen. In diesem Beitrag soll auf die aktuelle Studienlage zur Effektivität des CXL, auf die Indikationsstellung sowie auf neue Entwicklungen eingegangen werden.

Abstract

Keratoconus is a progressive, ectatic disease of the cornea leading to thinning and highly irregular astigmatism. Until recently all treatment options, such as prescription of glasses or contact lenses were symptomatic and neither keratoplasty nor the implantation of intracorneal rings can heal the disease. Riboflavin ultraviolet A (UVA) collagen cross-linking (CXL) cannot heal keratoconus either but promises to halt the progression. The therapeutic principle is a photochemical reaction of riboflavin and UVA light leading to free oxygen radicals in the corneal stroma that induce covalent linking of the collagen fibrils. This stiffening effect should stop the progression. After the first reports at the end of the 1990s the treatment was widely used and many case series show that CXL can be effective in stopping disease progression in some patients. However, randomized, controlled multicenter trials showing high evidence of the treatment effectiveness are rare. This report includes a review of the literature regarding treatment effectiveness, indications and new developments.

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  1. Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland

    P. Maier & T. Reinhard

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  1. P. Maier
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  2. T. Reinhard
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Correspondence to P. Maier.

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Maier, P., Reinhard, T. Riboflavin-UVA-Crosslinking beim Keratokonus. Ophthalmologe 110, 818–822 (2013). https://doi.org/10.1007/s00347-013-2820-3

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