Download PDF
Klin Monbl Augenheilkd 2011; 228(8): 704-711
DOI: 10.1055/s-0029-1245754
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Keratektasie nach refraktiver Chirurgie

Keratectasia after Refractive SurgeryC. Winkler von Mohrenfels1 , J. P. Salgado1 , R. Khoramnia1
  • 1Klinik und Poliklinik für Augenheilkunde der TUM, Klinikum rechts der Isar
Further Information

Publication History

Eingegangen: 10.2.2010

Angenommen: 10.9.2010

Publication Date:
24 November 2010 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: Die refraktive Chirurgie ist in den letzten Jahren immer populärer geworden. Eine der schwerwiegendsten Komplikationen ist die iatrogene Keratektasie. In dieser Arbeit soll der gegenwärtige Stand des Wissens dargestellt werden. Methoden: Es wurde eine Literaturrecherche (Medline) nach den Begriffen Keratektasie, Komplikation nach refraktiver Chirurgie und Cross-Linking durchgeführt. Daneben wurden eigene Daten aus zum Teil unveröffentlichten Studien verwendet. Ergebnisse: Seit der ersten Publikation einer Keratektasie im Jahr 1998 wird immer häufiger über iatrogene Keratektasien berichtet. Ein gehäuftes Auftreten war Ende der 90er-Jahre festzustellen. Hauptrisikofaktor ist eine Irregularität der präoperativen Topografie. Risikofaktoren für eine Keratektasie nach refraktiver Chirurgie sind jedoch auch eine dünne Hornhaut, tiefe Abtragungen, ein dünnes Restroma und ein junges Patientenalter. Diskussion: Obwohl immer genauere Voruntersuchungen durchgeführt werden und die Indikationsbereiche für eine refraktive Chirurgie immer stärker eingeschränkt worden sind, kommt es immer noch zu iatrogenen Keratektasien. Daher muss Patienten eine längere Nachbeobachtungszeit empfohlen werden, um eine Keratektasie frühzeitig zu erkennen und gegebenenfalls zu therapieren.

Abstract

Background: Refractive surgery has become more and more popular in the past years. One of the most severe complications is iatrogenic keratectasia. The purpose of this article is to review the current knowledge about iatrogenic keratectasia. Method. A literature research (Medline) using the key words keratectasia, complication after refractive surgery and cross-linking was carried out. Apart from this, our own data from partially unpublished studies have been used. Results: Since the first publication of keratectasia in 1998 more and more cases of keratectasia have been published. The main risk factor is a preoperative irregular topography. But also thin corneas, deep ablations, thin residual stromal beds and young patients age at the time of the laser surgery are further risk factors. Discussion: Although preoperative examinations before refractive surgery are becoming more and more accurate and the inclusion criteria for laser ablation have become stricter, iatrogenic keratectasia still occurs. Therefore longer follow-up visits should be performed over a longer period to diagnose keratectasia in an early stage and to provide therapy.

Schlüsselwörter

Keratektasie - LASIK - PRK - Cross-Linking

Key words

keratectasia - LASIK - PRK - cross-linking

Literatur

  • 1 Trokel S L, Srinivasan R, Braren B. Excimer laser surgery of the cornea.  Am J Ophthalmol. 1983;  96 710-715
    Google Scholar
  • 2 Ambrosio Jr R, Wilson S. LASIK vs. LASEK vs. PRK: advantages and indications.  SeminOphthalmol. 2003;  18 2-10
    Google Scholar
  • 3 Durrie D S, Slade S G, Marshall J. Wavefront-guided excimer laser ablation using photorefractive keratectomy and sub-Bowman’s keratomileusis: a contralateral eye study.  J Refract Surg. 2008;  24 S77-S84
    Google Scholar
  • 4 Argento C, Cosentino M J, Ganly M. Comparison of laser epithelial keratomileusis with and without the use of mitomycin C.  J Refract Surg. 2006;  22 782-786
    Google Scholar
  • 5 O’Brart D P, Lohmann C P, Klonos G et al. The effects of topical corticosteroids and plasmin inhibitors on refractive outcome, haze, and visual performance after photorefractive keratectomy. A prospective, randomized, observer-masked study.  Ophthalmology. 1994;  101 1565-1574
    Google Scholar
  • 6 Knorz M C. Flap and interface complications in LASIK.  Curr Opin Ophthalmol. 2002;  13 242-245
    Google Scholar
  • 7 Seiler T, Koufala K, Richter G. Iatrogenic keratectasia after laser in situ keratomileusis.  J Refract Surg. 1998;  14 312-317
    Google Scholar
  • 8 Bansal A S, Randleman J B. Corneal ectasia after LASIK in a patient with superior pellucid marginal degeneration.  J Refract Surg. 2009;  25 172-174
    Google Scholar
  • 9 Ou R J, Shaw E L, Glasgow B J. Keratectasia after laser in situ keratomileusis (LASIK): evaluation of the calculated residual stromal bed thickness.  Am J Ophthalmol. 2002;  134 771-773
    Google Scholar
  • 10 Randleman J B, Banning C S, Stulting R D. Corneal ectasia after hyperopic LASIK.  J Refract Surg. 2007;  23 98-102
    Google Scholar
  • 11 Randleman J B, Russell B, Ward M A et al. Risk factors and prognosis for corneal ectasia after LASIK.  Ophthalmology. 2003;  110 267-275
    Google Scholar
  • 12 Randleman J B, Stulting R D. Ectasia after photorefractive keratectomy.  Ophthalmology. 2007;  114 396 ; author reply 396 – 397
    Google Scholar
  • 13 Pallikaris I G, Kymionis G D, Astyrakakis N I. Corneal ectasia induced by laser in situ keratomileusis.  J Cataract Refract Surg. 2001;  27 1796-1802
    Google Scholar
  • 14 Rad A S, Jabbarvand M, Saifi N. Progressive keratectasia after laser in situ keratomileusis.  J Refract Surg. 2004;  20 S718-S722
    Google Scholar
  • 15 Jaycock P D, Lobo L, Ibrahim J et al. Interferometric technique to measure biomechanical changes in the cornea induced by refractive surgery.  J Cataract Refract Surg. 2005;  31 175-184
    Google Scholar
  • 16 Müller L J, Pels E, Vrensen G F. The specific architecture of the anterior stroma accounts for maintenance of corneal curvature.  Br J Ophthalmol. 2001;  85 437-443
    Google Scholar
  • 17 Kerautret J, Colin J, Touboul D et al. Biomechanical characteristics of the ectatic cornea.  J Cataract Refract Surg. 2008;  34 510-513
    Google Scholar
  • 18 Hamilton D R, Johnson R D, Lee N et al. Differences in the corneal biomechanical effects of surface ablation compared with laser in situ keratomileusis using a microkeratome or femtosecond laser.  J Cataract Refract Surg. 2008;  34 2049-2056
    Google Scholar
  • 19 Chen M C, Lee N, Bourla N et al. Corneal biomechanical measurements before and after laser in situ keratomileusis.  J Cataract Refract Surg. 2008;  34 1886-1891
    Google Scholar
  • 20 Qazi M A, Sanderson J P, Mahmoud A M et al. Postoperative changes in intraocular pressure and corneal biomechanical metrics Laser in situ keratomileusis versus laser-assisted subepithelial keratectomy.  J Cataract Refract Surg. 2009;  35 1774-1788
    Google Scholar
  • 21 Dawson D G, Randleman J B, Grossniklaus H E et al. Corneal ectasia after excimer laser keratorefractive surgery: histopathology, ultrastructure, and pathophysiology.  Ophthalmology. 2008;  115 2181-2191 e2181
    Google Scholar
  • 22 Randleman J B, Woodward M, Lynn M J et al. Risk assessment for ectasia after corneal refractive surgery.  Ophthalmology. 2008;  115 37-50
    Google Scholar
  • 23 Mihaltz K, Kovacs I, Takacs A et al. Evaluation of keratometric, pachymetric, and elevation parameters of keratoconic corneas with pentacam.  Cornea. 2009;  28 976-980
    Google Scholar
  • 24 Sanctis de U, Loiacono C, Richiardi L et al. Sensitivity and specificity of posterior corneal elevation measured by Pentacam in discriminating keratoconus/subclinical keratoconus.  Ophthalmology. 2008;  115 1534-1539
    Google Scholar
  • 25 Solomon K D, Donnenfeld E, Sandoval H P et al. Flap thickness accuracy: comparison of 6 microkeratome models.  J Cataract Refract Surg. 2004;  30 964-977
    Google Scholar
  • 26 Pfaeffl W A, Kunze M, Zenk U et al. Predictive factors of femtosecond laser flap thickness measured by online optical coherence pachymetry subtraction in sub-Bowman keratomileusis.  J Cataract Refract Surg. 2008;  34 1872-1880
    Google Scholar
  • 27 Sporl E, Huhle M, Kasper M et al. Increased rigidity of the cornea caused by intrastromal cross-linking.  Ophthalmologe. 1997;  94 902-906
    Google Scholar
  • 28 Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus.  Am J Ophthalmol. 2003;  135 620-627
    Google Scholar
  • 29 Wittig-Silva C, Whiting M, Lamoureux E et al. A randomized controlled trial of corneal collagen cross-linking in progressive keratoconus: preliminary results.  J Refract Surg. 2008;  24 S720-S725
    Google Scholar
  • 30 Raiskup-Wolf F, Hoyer A, Spoerl E et al. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results.  J Cataract Refract Surg. 2008;  34 796-801
    Google Scholar
  • 31 Kohlhaas M. Collagen crosslinking with riboflavin and UVA-light in keratoconus.  Ophthalmologe. 2008;  105 785-793 ; quiz 794
    Google Scholar
  • 32 Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking.  J Cataract Refract Surg. 2009;  35 1358-1362
    Google Scholar
  • 33 Kohlhaas M, Spoerl E, Speck A et al. [A new treatment of keratectasia after LASIK by using collagen with riboflavin/UVA light cross-linking].  Klin Monatsbl Augenheilkd. 2005;  222 430-436
    Google Scholar
  • 34 Hafezi F, Kanellopoulos J, Wiltfang R et al. Corneal collagen crosslinking with riboflavin and ultraviolet A to treat induced keratectasia after laser in situ keratomileusis.  J Cataract Refract Surg. 2007;  33 2035-2040
    Google Scholar
  • 35 Colin J. European clinical evaluation: use of Intacs for the treatment of keratoconus.  J Cataract Refract Surg. 2006;  32 747-755
    Google Scholar
  • 36 Colin J, Malet F J. Intacs for the correction of keratoconus: two-year follow-up.  J Cataract Refract Surg. 2007;  33 69-74
    Google Scholar
  • 37 Pinero D P, Alio J L, Uceda-Montanes A et al. Intracorneal ring segment implantation in corneas with post-laser in situ keratomileusis keratectasia.  Ophthalmology. 2009;  116 1665-1674
    Google Scholar
  • 38 Kamburoglu G, Ertan A. Intacs implantation with sequential collagen cross-linking treatment in postoperative LASIK ectasia.  J Refract Surg. 2008;  24 S726-S729
    Google Scholar

PD Dr. Christoph Winkler von Mohrenfels

Augenklinik der TUM, Klinikum rechts der Isar

Ismaningerstr. 22

81675 München

Phone: ++ 49/89/41 40 23 20

Fax: ++ 49/89/41 40 48 58

Email: christoph.wvm@gmail.com

      >