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Komplikationen der Vernetzung der Hornhaut

Complications of corneal cross-linking

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Zusammenfassung

Hintergrund

Vor mehr als 10 Jahren wurde die Vernetzung der Hornhaut klinisch eingeführt, und mittlerweile wurden Zehntausende von Augen damit behandelt. Noch steht eine Indikationsliste aus, deren Grundlage unter anderem die Häufigkeit und Art von Komplikationen ist.

Methoden

Mittels einer Pubmed-Recherche wurden die bis März 2013 publizierten Komplikationen von „crosslinking cornea“ gesucht.

Ergebnisse

Die publizierten Beiträge deuten auf eine Komplikationsrate zwischen 1 und 10 % hin, abhängig vom Stadium des behandelten Keratokonus. Bei den frühpostoperativen Komplikationen sind transiente Stromatrübung, sterile Infiltrate, Endotheldekompensation, verzögerte Epithelheilung und Hornhautinfektion zu nennen. Spätpostoperativ können stromale Narben entstehen.

Zusammenfassung

Die Vernetzung der Hornhaut zur Behandlung des Keratokonus darf als komplikationsarmes aber nicht als komplikationsfreies Verfahren angesehen werden.

Abstract

Background

More than 10 years after the clinical introduction of corneal cross-linking (CXL) the indications and contraindications are still not yet defined. Fundamental for such a list is the incidence of complications.

Methods

A PubMed search for complications of corneal crosslinking published up to March 2013 was carried out.

Results

The published complication rates ranged from 1 % to 10 % depending on the stage of keratoconus. Early postoperative complications were transient stromal haze, sterile infiltrates, endothelium decompensation, delayed epithelial healing and infectious keratitis. Stromal opacity can be a delayed postoperative event.

Conclusions

Complications after corneal cross-linking treatment for keratoconus are rare but the management of these complications may need keratoplasty.

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Literatur

  1. Wollensak G, Spörl E, Seiler T (2003) Behandlung von Keratokonus durch Kollagenvernetzung. Ophthalmologe 100:44–49

    Article  PubMed  CAS  Google Scholar 

  2. Hayes S, Kamma-Lorger CS, Boote C et al (2013) The effect of riboflavin/UVA collagen cross-linking therapy on the structure and hydrodynamic behaviour of the ungulate and rabbit corneal stroma. PLoS One 8(1):e52860

    Article  PubMed  CAS  Google Scholar 

  3. Wollensak G, Spörl E, Seiler T (2003) Stress-strain measurements of human and porcine corneas after riboflavin-ultraviolet-A-induced cross-linking. J Cataract Refract Surg 29:1780–1785

    Article  PubMed  Google Scholar 

  4. Wollensak G, Spörl E, Wilsch M, Seiler T (2004) Keratocyte apoptosis after corneal collagen cross-linking using riboflavin/UVA treatment. Cornea 23:43–49

    Article  PubMed  Google Scholar 

  5. Messmer EM, Meyer P, Herwig MC et al (2013) Morphological and immunohistochemical changes after corneal cross-linking. Cornea 32:111–117

    Article  PubMed  Google Scholar 

  6. Zhang Y, Mao X, Schwend T et al (2013) Resistance of corneal RFUVA – cross-linked collagens and small leucine-rich proteoglycans to degradation by matrix metalloproteinases. Invest Ophthalmol Vis Sci 54:1014–1025

    Article  PubMed  CAS  Google Scholar 

  7. Spoerl E, Wollensak G, Seiler T (2004) Increased resistance of crosslinked cornea against enzymatic digestion. Curr Eye Res 29:35–40

    Article  PubMed  CAS  Google Scholar 

  8. Koller T, Mrochen M, Seiler T (2009) Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 35:1358–1362

    Article  PubMed  Google Scholar 

  9. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T (2010) Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena eye cross study. Am J Ophthalmol 149:585–593

    Article  PubMed  CAS  Google Scholar 

  10. Vinciguerra P, Albè E, Trazza S et al (2009) Intraoperative and postoperative effects of corneal collagen cross-linking on progressive keratoconus. Arch Ophthalmol 127:1258–1265

    Article  PubMed  Google Scholar 

  11. Kohlhaas M, Spoerl E, Speck A et al (2005) Eine neue Behandlung der Keratektasie nach LASIK durch Kollagenvernetzung mit Riboflavin/UVA-Licht. Klin Monatsbl Augenheilkd 222:430–436

    Article  PubMed  CAS  Google Scholar 

  12. Hafezi F, Kanellopoulos J, Wiltfang R, Seiler T (2007) Corneal collagen cross-linking with riboflavin/UVA for the treatment of induced keratectasia after LASIK. J Cataract Refract Surg 33:2035–2040

    Article  PubMed  Google Scholar 

  13. Iseli HP, Thiel M, Hafezi F et al (2008) UVA/riboflavin corneal cross-linking (CXL) for infectious keratitis associated with corneal melts. Cornea 27:590–594

    Article  PubMed  Google Scholar 

  14. Makdoumi K, Mortensen J, Sorkhabi O et al (2012) UVA-riboflavin photochemical therapy of bacterial keratitis: a pilot study. Graefes Arch Clin Exp Ophthalmol 250:95–102

    Article  PubMed  CAS  Google Scholar 

  15. Schnitzler E, Spoerl E, Seiler T (2000) Bestrahlung der Hornhaut mit UV-Licht und Riboflavingabe als neuer Behandlungsversuch bei einschmelzenden Hornhautprozessen. Klin Monatsbl Augenheilkd 217:190–193

    Article  PubMed  CAS  Google Scholar 

  16. Ehlers N, Hjortdal J (2008) Riboflavin-ultraviolet light induced cross-linking in endothelial decompensation. Acta Ophthalmol 86:549–551

    Article  PubMed  Google Scholar 

  17. Schumacher S, Oeftiger L, Mrochen M (2011) Equivalence of biomechanical changes induced by rapid and standard corneal cross-linking, using riboflavin and ultraviolet radiation. Invest Ophthalmol Vis Sci 52:9048–9052

    Article  PubMed  Google Scholar 

  18. http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance

  19. Asri D, Touboul D, Fournié P et al (2011) Corneal collagen crosslinking in progressive keratoconus: multicenter results from the French National Reference Center for Keratoconus. J Cataract Refract Surg 37:2137–2143

    Article  PubMed  Google Scholar 

  20. Kampik D, Koch M, Kampik K, Geerling G (2011) Kollagenvernetzung mittels Riboflavin und UV-A-Strahlung (CXL) bei Keratokonus: Zwei-Jahres-Ergebnisse. Klin Monatsbl Augenheilkd 228:525–530

    Article  PubMed  CAS  Google Scholar 

  21. Hersh PS, Greenstein SA, Fry KL (2011) Corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 37:149–160

    Article  PubMed  Google Scholar 

  22. Ivarsen A, Hjortdal J (2013) Collagen cross-linking for advanced progressive keratoconus. Cornea 32 (im Druck)

  23. Pecorella I, Appolloni R, Tiezzi A et al (2013) Histological findings in a failed corneal riboflavin-UVA collagen cross-linking performed for progressive keratoconus. Cornea 32:191–195

    Article  PubMed  Google Scholar 

  24. Seiler T, Hafezi F (2006) Corneal cross-linking-induced stromal demarcation line. Cornea 25:1057–1059

    Article  PubMed  Google Scholar 

  25. Doors M, Tahzib NG, Eggink FA et al (2009) Use of anterior segment optical coherence tomography to study corneal changes after collagen cross-linking. Am J Ophthalmol 148:844–851

    Article  PubMed  Google Scholar 

  26. Greenstein SA, Fry KL, Bhatt J, Hersh PS (2010) Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: Scheimpflug and biomicroscopic analysis. J Cataract Refract Surg 36:2105–2114

    Article  PubMed  Google Scholar 

  27. Knappe S, Stachs O, Zhivov A et al (2011) Results of confocal microscopy examinations after collagen cross-linking with riboflavin and UVA light in patients with progressive keratoconus. Ophthalmologica 225:95–104

    Article  PubMed  CAS  Google Scholar 

  28. Salomão MQ, Chaurasia SS, Sinha-Roy A et al (2011) Corneal wound healing after ultraviolet-A/riboflavin collagen cross-linking: a rabbit study. J Refract Surg 27:401–407

    Article  PubMed  Google Scholar 

  29. Koppen C, Vryghem JC, Gobin L, Tassignon MJ (2009) Keratitis and corneal scarring after UVA/riboflavin cross-linking for keratoconus. J Refract Surg 25:S819–S823

    Article  PubMed  Google Scholar 

  30. Mangioris GF, Papadopoulou DN, Balidis MO et al (2010) Corneal infiltrates after corneal collagen cross-linking. J Refract Surg 26:609–611

    Article  PubMed  Google Scholar 

  31. Arora R, Jain P, Gupta D, Goyal JL (2012) Sterile keratitis after corneal collagen crosslinking in a child. Cont Lens Anterior Eye 35:233–235

    Article  PubMed  Google Scholar 

  32. Ghanem RC, Netto MV, Ghanem VC et al (2012) Peripheral sterile corneal ring infiltrate after riboflavin-UVA collagen cross-linking in keratoconus. Cornea 31:702–705

    Article  PubMed  Google Scholar 

  33. Camesasca FI, Vinciguerra P, Seiler T (2011) Bilateral ring-shaped intrastromal opacities after corneal cross-linking for keratoconus. J Refract Surg 27:913–915

    Article  PubMed  Google Scholar 

  34. Rodríguez-Ausín P, Gutiérrez-Ortega R, Arance-Gil A et al (2011) Keratopathy after cross-linking for keratoconus. Cornea 30:1051–1053

    Article  PubMed  Google Scholar 

  35. Lahners WJ, Hardten DR, Lindstrom RL (2003) Peripheral keratitis following laser in situ keratomileusis. J Refract Surg 19:671–675

    PubMed  Google Scholar 

  36. Wollensak G, Mazzotta C, Kalinski T, Sel S (2011) Limbal and conjunctival epithelium after corneal cross-linking using riboflavin and UVA. Cornea 30:1448–1454

    Article  PubMed  Google Scholar 

  37. Vimalin J, Gupta N, Jambulingam M et al (2012) The effect of riboflavin-UV-A treatment on corneal limbal epithelial cells – a study on human cadaver eyes. Cornea 31:1052–1059

    Article  PubMed  Google Scholar 

  38. Matalia H, Shetty R, Dhamodaran K et al (2012) Potential apoptotic effect of ultraviolet-A irradiation during cross-linking: a study on ex vivo cultivated limbal epithelial cells. Br J Ophthalmol 96:1339–1345

    Article  PubMed  Google Scholar 

  39. Thorsrud A, Nicolaissen B, Drolsum L (2012) Corneal collagen crosslinking in vitro: inhibited regeneration of human limbal epithelial cells after riboflavin-ultraviolet-A exposure. J Cataract Refract Surg 38:1072–1076

    Article  PubMed  Google Scholar 

  40. Pollhammer M, Cursiefen C (2009) Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet-A. J Cataract Refract Surg 35:588–589

    Article  PubMed  Google Scholar 

  41. Garcia-Delpech S, Díaz-Llopis M, Udaondo P, Salom D (2010) Fusarium keratitis 3 weeks after healed corneal cross-linking. J Refract Surg 26:994–995

    Article  PubMed  Google Scholar 

  42. Zamora KV, Males JJ (2009) Polymicrobial keratitis after a collagen cross-linking procedure with postoperative use of a contact lens: a case report. Cornea 28:474–476

    Article  PubMed  Google Scholar 

  43. Goldich Y, Marcovich AL, Barkana Y et al (2010) Safety of corneal collagen cross-linking with UV-A and riboflavin in progressive keratoconus. Cornea 29:409–411

    Article  PubMed  Google Scholar 

  44. Poli M, Cornut PL, Balmitgere T et al (2013) Prospective study of corneal collagen cross-linking efficacy and tolerance in the treatment of keratoconus and corneal ectasia: 3-year results. Cornea 32:583–590

    Article  PubMed  Google Scholar 

  45. Bagga B, Pahuja S, Murthy S, Sangwan VS (2012) Endothelial failure after collagen cross-linking with riboflavin and UV-A: case report with literature review. Cornea 31:1197–1200

    Article  PubMed  Google Scholar 

  46. Sharma A, Nottage JM, Mirchia K et al (2012) Persistent corneal edema after collagen cross-linking for keratoconus. Am J Ophthalmol 154:922–926

    Article  PubMed  Google Scholar 

  47. Vetter JM, Brueckner S, Tubic-Grozdanis M et al (2012) Modulation of central corneal thickness by various riboflavin eyedrop compositions in porcine corneas. J Cataract Refract Surg 38:525–532

    Article  PubMed  Google Scholar 

  48. Faschinger C, Kleinert R, Wedrich A (2010) Beidseitiges Einschmelzen der Hornhaut nach beidseitigem simultanen Kollagen-Crosslinking bei Keratokonus und Down-Syndrom. Ophthalmologe 107:951–955

    Article  PubMed  CAS  Google Scholar 

  49. Eberwein P, Auw-Hädrich C, Birnbaum F et al (2008) Hornhauteinschmelzung nach Cross-Linking und tiefer lamellärer Keratoplastik („DALK“) bei Keratokonus. Klin Monatsbl Augenheilkd 225:96–98

    Article  PubMed  CAS  Google Scholar 

  50. Reinstein DZ, Archer TJ, Gobbe M (2009) Corneal epithelial thickness profile in the diagnosis of keratoconus. J Refract Surg 25:604–610

    PubMed  Google Scholar 

  51. Raiskup F, Hoyer A, Spoerl E (2009) Permanent corneal haze after riboflavin-UVA-induced cross-linking in keratoconus. J Refract Surg 25:S824–S828

    Article  PubMed  Google Scholar 

  52. Kato N, Konomi K, Saiki M et al (2013) Deep stromal opacity after corneal cross-linking. Cornea (im Druck)

  53. Pecorella I, Appolloni R, Tiezzi A et al (2013) Histological findings in a failed corneal riboflavin-UVA collagen cross-linking performed for progressive keratoconus. Cornea 32:191–195

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Frühere Kooperation mit Innocross AG, Zug, Schweiz.

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Correspondence to T.G. Seiler M.D..

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Seiler, T., Schmidinger, G., Fischinger, I. et al. Komplikationen der Vernetzung der Hornhaut. Ophthalmologe 110, 639–644 (2013). https://doi.org/10.1007/s00347-012-2682-0

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