Zusammenfassung
Hintergrund: Die neurotrophe Keratopathie ist eine durch eine Störung der Hornhautsensibilität
verursachte degenerative Hornhauterkrankung, die für den Augenarzt eine Herausforderung
darstellt. Im folgenden Beitrag wird auf Ätiologie, Pathogenese, Diagnosestellung,
therapeutische Aspekte und künftige Entwicklungen eingegangen sowie ein Fallbeispiel
dieser Erkrankung dargestellt: Es sollte insbesondere die Wirkung autologer Serumaugentropfen
bei bilateraler LASIK-induzierter neurotropher Keratopathie mit Epitheldefekten und
positiver Fluoreszein-/Bengalrosa-Färbung sowie reduzierter Tränenfilmaufrisszeit
untersucht werden. Material und Methoden: Therapie einer 42-jährigen Patientin mit LASIK-induzierter neurotropher Keratopathie
und Tränenfilminstabilität mit autologen Serumaugentropfen (5-mal täglich) sowie lipidhaltigen
Augentropfen (Refresh Endura, Allergan, Irvine, CA, USA) nach Einsetzen von Punctum
Plugs. Ergebnisse: Deutliche Stabilisierung des Visus, Heilung des Epithels sowie Verminderung der Symptome
wie Rötung, Kratzen und Brennen innerhalb von sechs Wochen. 10 Monate nach Therapiebeginn
klagte die Patientin noch über leichte Schmerzen beim Lidschlag. Schlussfolgerung: Schwere Denervierung nach LASIK beeinträchtigt die Tränenfilmdynamik und verursacht
Schmerzen im Bereich der okulären Oberfläche. Autologe Serumaugentropfen können eine
effektive Therapie schwerer Epitheldefekte darstellen sowie bei der Wiederherstellung
einer gestörten Integrität der Augenoberfläche wirksam sein. Autologe Serumaugentropfen
sind deshalb ein wesentlicher Bestandteil der Therapie bei LASIK-induzierter Sicca-Symptomatik
und assoziierten Schmerzen.
Abstract
Background: Neurotrophic keratopathy is a degenerative affection of the cornea caused by impairment
of corneal sensitivity and represents a therapeutic challenge for ophthalmologists.
The present article concentrates on the etiology, pathogenesis, diagnosis, therapeutic
aspects and future therapeutic models for treating neurotrophic keratopathy and will
present a case report: Also we evaluate the effects of autologous serum eye drops
in bilateral LASIK-induced neurotrophic keratopathy with epithelial breakdown revealed
by positive fluorescence and rose bengal staining and reduced tear film break-up time.
Methods: We treated a 42-year-old patient with post-LASIK neurotrophic keratopathy and tear
film instability with autologous serum eye drops (5 × daily) and emulsion eye drops
(Refresh Endura, Allergan, Irvine, CA, USA) after insertion of punctal plugs. Results: Stabilization of vision, healing of the epithelium and reduction of the previously
experienced symptoms like redness, itching and burning were achieved within 6 weeks.
10 months after changing therapy, the patient only complained about slight pain during
lid movement. Conclusions: Severe denervation after bilateral LASIK disrupts ocular tear film dynamics and causes
irritation symptoms of the ocular surface. Autologous serum eye drops may be an effective
treatment of severe epithelial breakdown and be helpful to reestablish the disturbed
ocular surface integrity, as shown by negative vital staining. Therefore, autologous
serum eye drops represent a significant approach in the therapy of LASIK-induced severe
dry eye and associated pain.
Schlüsselwörter
Neurotrophe Keratopathie - LASIK - trockenes Auge - Tränenfilm - Serumaugentropfen
- okuläre Oberfläche
Key words
Neurotrophic keratopathy - LASIK - dry eye - tear film - serum eye drops - ocular
surface
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Dr. med. Thomas A. Fuchsluger
Hufelandstraße 55
45144 Essen
Email: thomas@fuchsluger.net
