Die Wirkung von autologen Serumaugentropfen bei therapieresistenten Erosiones und Ulcera der Kornea bei eigenem im Vergleich zu transplantiertem Gewebe

Zusammenfassung

Hintergrund Ziel dieser Arbeit war es, die Wirkung von 100% autologen Serumaugentropfen bei therapieresistenten Erosiones und Ulcera corneae auf der eigenen Hornhaut vs. transplantierter Hornhaut zu vergleichen.

Patienten und Methoden In einer retrospektiven Studie über 7 Jahre wurden 263 Behandlungen mit autologen Serumaugentropfen bei therapieresistenten Epitheldefekten untersucht, die zwischen 2007 und 2014 auftraten. Unterschieden wurde, ob der Epitheldefekt (Erosio [88%] vs. Ulcus corneae [12%]) sich auf dem Hornhauttransplantat (48,1%) oder auf der eigenen Hornhaut (51,9%) befand. Zielgröße war der komplette Epithelschluss innerhalb von 28 Tagen Therapie. Die Rezidivrate im Verlauf wurde ebenfalls untersucht.

Ergebnisse Bei 88,2% der behandelten Defekte kam es innerhalb von 28 Behandlungstagen zu einem kompletten Epithelschluss. Bei 5,1% der erfolgreich geschlossenen Defekte kam es nach Abschluss der 1-monatigen Therapie zu einem Rezidiv. Es zeigte sich kein signifikanter Unterschied zwischen der Erfolgsrate von transplantiertem Hornhautgewebe (88,6%) oder eigenem Hornhautgewebe (87,8%; p = 0,137). Die Rezidivrate lag bei transplantierter Hornhaut bei 6,4%, bei der eigenen Hornhaut bei 1,7%. Bei Ulcera (74,2%) zeigte sich eine signifikant reduzierte Erfolgsrate im Vergleich zu den Erosiones (90,3%; p < 0,001). 4,4% der Erosiones und 4,3% der Ulcera rezidivierten im Verlauf.

Schlussfolgerungen Die autologen Serumaugentropfen stellen eine gute, nicht invasive und sichere Therapiealternative bei therapieresistenten Epitheldefekten dar, ohne signifikanten Unterschied der Wirkung bei Epitheldefekten auf der eigenen Hornhaut und transplantierter Hornhaut. Die Erfolgsrate, aber nicht die Rezidivrate ist bei Hornhautulcera signifikant geringer als bei Erosiones corneae.

Abstract

Purpose The aim of this study is to compare the healing of corneal epithelial defects or ulcers on the corneal graft in comparison with the patientʼs own cornea after treatment with 100%, undiluted autologous serum eye drops.

Methods In a retrospective study over 7 years, we analysed 263 treatments with autologous serum eye drops of persistent corneal epithelial defects (erosions [88%] vs. ulcers [12%]). We compared the epithelial healing tendency of patients with defects on their own cornea (51.9%) vs. patients who had previously undergone penetrating keratoplasty (48.1%). Complete epithelial healing during the 28 days of treatment was considered as therapeutic success. In addition, the recurrence rate of the epithelial defects after finishing the therapy was analysed.

Results 88.2% of the epithelial defects healed during 28 days of therapy. The recurrence rate during follow-up was 5.1%. There was no significant difference with respect to success rate between corneal defects on the patientʼs own cornea (87.8%) and on the graft (88.6%; p = 0.137). There was a significantly lower success rate for corneal ulcers (74.2%) than for erosions (90.3%; p < 0.001). The recurrence rate of erosions was 4.4%, vs. 4.3% in ulcers during follow-up.

Conclusion The results of our study suggest that autologous serum eye drops are a non-invasive and safe alternative treatment for persistent corneal epithelial defects – with no significant difference in patients with a defect on their own cornea vs. defects on the corneal graft. The success rate, but not the recurrence rate, is significantly worse in ulcers than in erosions.

Schlüsselwörter

Kornea - autologe Serumaugentropfen - therapieresistente Epitheldefekte - Erosio - Ulcus - Keratoplastik

Key words

cornea - autologous serum eye drops - therapy resistant epithelial defects - erosion - ulcus - keratoplasty

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