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Wundheilung der Hornhaut

Teil II: Therapie von Wundheilungsstörungen

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Zusammenfassung

Zur Therapie kornealer Wundheilungsstörungen steht eine Vielzahl medikamentöser und chirurgischer Maßnahmen zur Verfügung. Eine Indikation zur Applikation von Tränenersatzmitteln besteht beim Sicca-Syndrom und hiermit vergesellschafteten Epithelheilungsstörungen sowie nach refraktiver Chirurgie. Neuere Konzepte der pharmakologischen Stimulierung der epithelialen Wundheilung beinhalten die topische Anwendung von autologem Serum und Kollagenlinsen, deren Anwendung durch die BSE-Problematik zurzeit nicht möglich ist. Topisch applizierte Kortikosteroide weisen Wirkungen auf, die bei der Modulation der stromalen Wundheilung genutzt werden. Die pharmakologische Beeinflussung der Endothelheilung ist bisher noch limitiert. Bei nicht ausreichender Wirkung der pharmakologischen Therapie kommen operative Verfahren zum Einsatz. Die Transplantation von Amnionmembran hat einen festen Platz bei der Behandlung konservativ therapierefraktärer epithelialer und stromaler Defekte eingenommen. Die homologe bzw. autologe Limbusstammzelltransplantation wird in verschiedenen operationstechnischen Varianten durchgeführt. Die bisherigen Ergebnisse dieser Operation sind viel versprechend, eine weitere Optimierung der Methodik ist jedoch erforderlich.

Abstract

A multitude of medical and surgical measures are available to treat disorders of corneal wound healing. Artificial tear replacement is indicated for sicca syndrome and the associated disorders of epithelial wound healing as well as after refractive surgery. Newer pharmacological concepts to stimulate epithelial wound healing include topical application of autologous serum and collagen lenses, which presently cannot be employed because of the BSE problems. Topically applied corticosteroids exhibit properties that are used to modulate stromal wound healing. Transplantation of amniotic membrane has assumed a firm role in the treatment of epithelial and stromal defects refractory to conservative therapy. Homologous or autologous limbal stem cell transplantation is performed by various surgical techniques. The findings up to now for this operation are promising, but the method still requires optimization.

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  1. Augenklinik Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin

    P. W. Rieck & U. Pleyer

  2. Augenklinik Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 , Berlin

    P. W. Rieck

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Rieck, P.W., Pleyer, U. Wundheilung der Hornhaut. Ophthalmologe 100, 1109–1130 (2003). https://doi.org/10.1007/s00347-003-0950-8

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