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Klin Monbl Augenheilkd 2015; 232(6): 765-772
DOI: 10.1055/s-0035-1545737
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Iatrogene Keratektasie – eine Übersicht

Iatrogenic Keratectasia: A Review
M. Kohlhaas
Klinik für Augenheilkunde, St.-Johannes-Hospital, Dortmund
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Publication History

eingereicht 19 November 2014

akzeptiert 29 January 2015

Publication Date:
08 April 2015 (online)

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Zusammenfassung

Die iatrogene Keratektasie ist eine der schwerwiegendsten postoperativen Komplikationen nach komplikationsloser refraktiver Hornhautlaserchirurgie. Die ektatischen Veränderungen können sich bereits 1 Woche oder auch erst viele Jahre nach der Operation entwickeln. Die tatsächliche aktuelle Inzidenz ist unklar, soll zwischen 0,04 und 2,8 % liegen. Die Keratektasie geht einher mit einer zunehmenden astigmatischen Myopisierung, einer Sehverschlechterung und Bildverzerrungen. Risikofaktoren sind neben einer dünnen Hornhaut < 500 µm eine pathologische Hornhauttopografie, eine geringe residuelle Stromadicke < 300 µm, eine hohe Myopie > 8 dpt, ein junges Lebensalter < 25 J., Neurodermitis, Familienanamnese bez. Keratokonus und Bindegewebserkrankungen sowie auch LASIK-Nachkorrekturen. Bei Erkennen und Diagnosesicherung durch Topografiekontrollen ist ein Crosslinking mittels Riboflavin/UVA-Licht mit späterer Kontaktlinsenanpassung indiziert. In seltenen Fällen ist heutzutage noch eine perforierende, besser eine tiefe lamelläre Keratoplastik erforderlich.

Abstract

Iatrogenic corneal ectasia is a rare complication but also one of the most feared situations that can occur after uneventful corneal laser surgery. Ectatic changes can occur as early as 1 week or can be delayed up to several years after LASIK. The actual incidence of ectasia is undetermined, an incidence rate of 0.04 to almost 2.8 % has been reported. Ectasia is most common following LASIK; however, cases have been reported following PRK and other corneal refractive procedures. Keratectasia shows progressive myopia, irregular astigmatism, ghosting, fluctuating vision and problems with scotopic vision. The progression leads to severe loss of corrected visual acuity. Risk factors are thin corneas < 500 µm, a pathological corneal topography, a residual stromal bed < 300 µm, high myopia > 8 D, young (female) age < 25 years, atopic dermatitis, allergies, family history for keratokonus and collagen diseases and retreatments. Treatment of choice is a cross-linking with riboflavin/UVA light with contact lenses. In severe cases a penetrating or a deep anterior lamellar graft is necessary.

Schlüsselwörter

Kornea - refraktive Chirurgie - LASIK - iatrogene Keratektasie - Crosslinking

Key words

cornea - refractive surgery - LASIK - iatrogenic keratectasia - cross-linking
 

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