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Einfluss der kornealen Biomechanik auf die Myopieregression nach Laser-in-situ-Keratomileusis

Influence of corneal biomechanical properties on myopic regression after laser in situ keratomileusis

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Zusammenfassung

Hintergrund

Eine Laser-in-situ-Keratomileusis (LASIK) gilt als sicheres und anerkanntes Verfahren zur Korrektur von Kurzsichtigkeiten. Postoperative Ergebnisse zeigen jedoch bei einzelnen Patientengruppen Probleme in der Langzeitstabilität. Vermutet wird u. a., dass der präoperative Zustand der Hornhaut einen Einfluss auf postoperative Probleme haben könnte.

Methode

Die Studie schloss 46 Augen von 25 Patienten ein. Bei 15 Patienten (19 Augen) handelte es sich um LASIK-Patienten, die 3 Monate postoperativ ein Refraktionsdefizit von − 0,50 dpt oder mehr aufwiesen. Innerhalb dieser Gruppe entwickelten 11 Patienten (15 Augen) innerhalb der ersten 3 postoperativen Monate eine Regression (Regressionsgruppe). Der Rest der Gesamtgruppe zeigte dagegen keine Regression (Stabilitätsgruppe). Neben der Prüfung der Hornhautdicke wurden Refraktionsfehler, Visus und Augeninnendruck gemessen. Bestimmt wurden außerdem die korneale Hysterese und der korneale Resistenzfaktor.

Ergebnisse

Die mittlere präoperative Myopie lag in der Stabilitätsgruppe bei − 3,14± 1,41 dpt (SE) und in der Regressionsgruppe bei − 6,47± 1,40 dpt. Auch die postoperativen, sphärischen Äquivalente sind statistisch signifikant unterschiedlich. Im Gegensatz dazu zeigt die mittlere, präoperative Hornhautdicke in beiden Gruppen keinen Unterschied.

Schlussfolgerung

Das Ziel der Studie, einen möglichen kausalen Zusammenhang zwischen einer Myopieregression nach LASIK und den biomechanischen Eigenschaften der Hornhaut und der Hornhautdicke festzustellen, lässt sich nicht eindeutig ableiten. In der Regressionsgruppe blieb ein erwarteter Zusammenhang zwischen der präoperativen kornealen Hysterese sowie dem Resistenzfaktor und einer postoperativen Regression aus.

Abstract

Background

Laser in situ keratomileusis is a safe and accepted method for correcting myopia. The operational results in terms of accuracy as well as the subjective acceptance of patients for corrections to – 8 D are now considered to be promising (Seiler, Refraktive Chirurgie der Hornhaut, 2000); however, postoperative results show individual patient problems in long-term stability. It is believed that the preoperative condition of the cornea (e.g. thickness, biomechanical properties) could have an influence on postoperative problems such as myopic regression.

Method

This study included a total of 46 eyes from 25 patients. At 3 months postoperatively, 15 patients (19 eyes) showed a SEQ of − 0.50 D or more. Within this group, 11 patients (15 eyes) developed a regression (regression group) within the first 3 postoperative months. The remainder of the total group did not show any regression (stability group). The subjects of this study were on average 33 ± 8 years (stability group) and 31 ± 7 years old (regression group). The corneal thickness was tested and refractive error, visual acuity (BCVA/UCVA) and intraocular pressure was measured. In addition, the corneal hysteresis (CH) and corneal resistance factor (CRF) were determined.

Results

The mean preoperative spherical equivalent refraction was − 3.14 D ± 1.41 D (SE) in the stability group and − 6.47 D ± 1.40 D (p = 0.001)in the regression group. Also, the postoperative spherical equivalents were statistically significant different (p < 0.05). In contrast, the mean preoperative corneal thickness showed no differences in both groups (p = 0.96) (stability group 563 ± 36 µm and regression group 563 ± 28 µm).

Conclusions

The aim of the study to detect a possible causal relationship between myopia regression after LASIK and the biomechanical properties of the cornea and corneal thickness could not be clearly identified.

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Authors and Affiliations

  1. Augenklinik Bellevue, Lindenallee 21, 24105, Kiel, Deutschland

    D. Uthoff MD, FSES, FABI

  2. Augen-Laserzentrum Halle GmbH (Eye-Lasercenter Halle), Halle, Deutschland

    K. Hebestedt

  3. Universitätsklinikum, Martin-Luther-Universität Halle-Wittenberg, Wittenberg, Deutschland

    G.I.W. Duncker

  4. Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland

    E. Spörl

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  1. D. Uthoff MD, FSES, FABI
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  2. K. Hebestedt
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  3. G.I.W. Duncker
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  4. E. Spörl
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Correspondence to D. Uthoff MD, FSES, FABI.

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Uthoff, D., Hebestedt, K., Duncker, G. et al. Einfluss der kornealen Biomechanik auf die Myopieregression nach Laser-in-situ-Keratomileusis. Ophthalmologe 110, 41–47 (2013). https://doi.org/10.1007/s00347-012-2633-9

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  • DOI: https://doi.org/10.1007/s00347-012-2633-9

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