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Photorefraktive Keratektomie in Kombination mit Hornhautquervernetzung – eine Alternative zur Keratoplastik bei Keratokonus?

Photorefractive keratectomy in combination with corneal cross linking – an alternative treatment for keratoconus?

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An Erratum to this article was published on 13 April 2017

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Zusammenfassung

Hintergrund

Die perforierende Keratoplastik ist, nach wie vor, der am häufigsten durchgeführte Eingriff in der Therapie des progredienten visuslimitierenden Keratokonus. Bei den überwiegend jungen Patienten ist es allerdings schwierig eine altersentsprechende Spenderhornhaut zu finden. Bei jungen Patienten sind häufig auch mehrere Hornhauttransplantationen im Laufe des Lebens wahrscheinlich. Bei jeder Keratoplastik besteht das Risiko eines Transplantatversagens oder einer Abstoßung. Eine photorefraktive Keratektomie (PRK) in Kombination mit Hornhautquervernetzung kann bei vielen Patienten als überbrückende Lösung bis eine geeignete Spenderhornhaut verfügbar ist, oder sogar als endgültige visusverbessernde Maßnahme durchgeführt werden.

Material und Methoden

In dieser retrospektiven Studie wurden die Ergebnisse sechs und zwölf Monate nach einer kombinierten PRK mit Hornhautquervernetzung bei 21 Keratokonuspatienten (25 Augen) vorgestellt.

Resultate

Bei 90 % der Augen zeigte sich im Verlauf ein deutlicher Anstieg des unkorrigierten (UDVA) und bei 68 % ein Anstieg des korrigierten Visus (CDVA). Bei keinem der Patienten wurde eine schwere oder visuslimitierende Komplikation dokumentiert. Unsere bisherige Erfahrung zeigte kein erhöhtes Ektasierisiko verglichen mit der alleinigen Hornhautquervernetzung.

Schlussfolgerung

Die kombinierte Behandlung mit PRK und Hornhautquervernetzung bei Keratokonuspatienten erwies sich, innerhalb des Beobachtungszeitraums, als effiziente und sichere Alternative zur perforierenden Keratoplastik.

Summary

Background

Perforating keratoplasty is still the most frequently performed operation in the definitive treatment of progressive keratoconus. It is however difficult to find a suitable donor cornea for the predominantly young patients, many of whom may need more than one donor cornea during their lifetime. Every perforating keratoplasty carries the risk of tissue rejection or transplant failure. A photorefractive keratectomy (PRK) in combination with a corneal cross linking (CXL) may play a role as a “bridge to transplant” or even definitive treatment for patients for whom a donor cornea is currently unavailable.

Material and methods

This retrospective study looks at a 12 month follow up after combined CXL/PRK of 21 patients (25 eyes).

Results

90% of treated eyes demonstrated a marked increase in uncorrected visual acuity (UDVA) and 68% of treated eyes improved their best corrected visual acuity. There were no serious or vision limiting complications.

Conclusion

The combined PRK and CXL appears to be a safe and effective alternative to keratoplasty for selected patients with keratoconus.

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Change history

  • 13 April 2017

    An erratum to this article has been published.

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Authors and Affiliations

  1. Universitätsaugenklinik Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    Filip Filev FEBO & Robert Kromer

  2. St. Petka Eye Clinic, Varna, Bulgarien

    Jeny Boriskova & Daniela Mitova

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  1. Filip Filev FEBO
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  2. Jeny Boriskova
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Correspondence to Filip Filev FEBO.

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F. Filev, J. Boriskova, R. Kromer und D. Mitova geben an, dass kein Interessenkonflikt besteht.

Additional information

Ein Erratum zu diesem Beitrag ist unter https://doi.org/10.1007/s00717-017-0338-9 zu finden.

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Filev, F., Boriskova, J., Kromer, R. et al. Photorefraktive Keratektomie in Kombination mit Hornhautquervernetzung – eine Alternative zur Keratoplastik bei Keratokonus?. Spektrum Augenheilkd. 31, 173–178 (2017). https://doi.org/10.1007/s00717-017-0336-y

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