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Narbenbildung nach Hornhautvernetzung beim Keratokonus

Corneal scar development after cross-linking in keratoconus

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Zusammenfassung

Hintergrund

Retrospektiv wurde die Entwicklung stromaler Narben nach Hornhautvernetzung (CXL) beim Keratokonus beurteilt.

Patienten und Methoden

Ausgewertet und für 1 Jahr nachbeobachtet wurden 163 mit CXL behandelte Augen von 127 Patienten mit Stadium 1–3 eines Keratokonus nach Krumeich-Klassifikation. Zur ersten und allen folgenden Untersuchungen wurden unkorrigierter und bestkorrigierter Visus, Spaltlampenuntersuchung, Hornhauttopographie und Hornhautdicke erfasst.

Ergebnisse

Ein Jahr nach CXL gab es bei 149 Augen (91,4%) von 114 Patienten klare Hornhautbefunde ohne stromale Narbe (Kontrollgruppe) und bei 13 Patienten klinisch signifikante stromale Narben (Narbengruppe). Präoperativ lagen die mittleren K-Werte am Apex in der Kontrollgruppe bei 62,1±13,8 dpt und in der Narbengruppe bei 71,1±13,2 dpt (p=0,02). Der Mittelwert der Hornhautdicke betrug präoperativ 478,1±52,4 μm in der Kontrollgruppe und 420,0±33,9 μm in der Narbengruppe (p<0,001). Unkorrigierter und bestkorrigierter Visus waren präoperativ in beiden Gruppen ähnlich (p=0,59 bzw. p=0,75), verbesserten sich postoperativ in der Kontrollgruppe (p=0,023 bzw. p=0,001), verminderten sich jedoch in der Narbengruppe (p=0,012 bzw. p=0,004).

Schlussfolgerung

K-Werte und Hornhautdicke können u. a. als Risikofaktoren für die Bildung stromaler Narben nach CXL angesehen werden. Ein fortgeschrittener Keratokonus scheint mit einem höheren Risiko der Entwicklung stromaler Hornhautnarben aufgrund verminderter Hornhautdicke, hoher Hornhautkrümmung und intrinsischer Gewebeeigenschaften assoziiert zu sein.

Abstract

Background

Corneal scar development after riboflavin-UVA-induced corneal collagen cross-linking (CXL) was retrospectively evaluated.

Patients and methods

A total of 163 CXL-treated eyes in 127 patients with stage 1–3 keratoconus according to Krumeich’s classification were included in this retrospective analysis. The follow-up period was 1 year. At the first and at all follow-up examinations uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), biomicroscopic findings, corneal topography and corneal thickness were recorded.

Results

At 1 year following CXL, 149 eyes (91.4%) of 114 patients had a clear cornea without corneal scar (control group), while 14 eyes (8.6%) of 13 patients developed clinically significant corneal scar (scar group). Preoperatively, the mean K value of the apex was 62.1 ± 13.8 D in the control group and 71.1 ± 13.2 D in the scar group (P=.02). The mean value of corneal thickness before the procedure was 478.1 ± 52.4 μm in the control group and 420.0 ± 33.9 μm in the scar group (P=.001). The UCVA and BCVA, which were preoperatively similar between groups (P=.59, P=.75 respectively), were postoperatively improved in the control group (P=.023, P=.001 respectively), but reduced in the scar group (P=.012, P=.004 respectively).

Conclusion

K-values and corneal thickness could be considered as predictive factors for the possible development of corneal scarring after riboflavin-UVA-induced CXL. Advanced keratoconus appears to be associated with a higher risk of corneal scar development due to lower corneal thickness, greater curvature and intrinsic tissue characteristics.

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Authors and Affiliations

  1. Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland

    F. Raiskup, A. Kißner, A. Hoyer, E. Spörl & L.E. Pillunat

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  1. F. Raiskup
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  2. A. Kißner
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  3. A. Hoyer
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  4. E. Spörl
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  5. L.E. Pillunat
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Correspondence to F. Raiskup.

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Raiskup, F., Kißner, A., Hoyer, A. et al. Narbenbildung nach Hornhautvernetzung beim Keratokonus. Ophthalmologe 107, 837–842 (2010). https://doi.org/10.1007/s00347-009-2114-y

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