Skip to main content
SpringerLink
Log in

Komplikationen der lamellären refraktiven Hornhautchirurgie

Complications of corneal lamellar refractive surgery

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Als lamelläre refraktive Hornhautverfahren stehen die Laser-in-situ-Keratomileusis (LASIK) mittels Mikrokeratom oder Femtosekundenlaser-Schnitt, gefolgt von der Excimerlaserhornhautablation, sowie die rein femtosekundenlasergesteuerte refraktive Lentikelextraktion (ReLEx) zur Verfügung. Diese Operationen gelten heute als sicheres und effektives Standardverfahren der chirurgischen Korrektur von geringen bis mittleren Ametropien. Zu den Komplikationen gehören u. a. optisch wirksame Fehler, intraoperative Schnittfehler und postoperative Entzündungsreaktionen (diffuse lamelläre Keratitis, DLK), Epithel- oder Flapfalten, Epitheleinwachsungen oder die iatrogene Keratektasie. Die Einhaltung entsprechender – auf dem aktuellen wissenschaftlichen Kenntnisstand basierender – Indikations- und Behandlungsstandards kann das Auftreten dieser Komplikationen erheblich vermindern.

Abstract

Techniques available for corneal lamellar refractive surgery are laser-assisted in situ keratomileusis (LASIK) using a microkeratome or femtosecond laser incision followed by excimer laser corneal ablation, and femtosecond laser-assisted refractive lenticule extraction (ReLEx). These treatments are nowadays considered to be safe and effective standard procedures for surgical correction of mild to moderate ametropia. Possible complications include too small or decentered optical zones, intraoperative flap cutting errors and postoperative inflammation (e.g. diffuse lamellar keratitis, DLK), epithelial or flap folds, epithelial ingrowths or iatrogenic ectasia. The occurrence of complications may be significantly reduced by compliance to corresponding standards of indication and treatment that are based on current scientific knowledge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Alio JL, Ortiz D, Muftuoglu O et al (2009) Ten years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for moderate to high myopia (control-matched study). Br J Ophthalmol 93:1313–1318

    Article  CAS  PubMed  Google Scholar 

  2. Ambrosio R Jr, Caiado AL, Guerra FP et al (2011) Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus. J Refract Surg 27:753–758

    Article  PubMed  Google Scholar 

  3. Bühren J, Baumeister M, Cichocki M et al (2002) Confocal microscopic characteristics of stage 1 to 4 diffuse lamellar keratitis after laser in situ keratomileusis. J Cataract Refract Surg 28:1390–1399

    Article  PubMed  Google Scholar 

  4. Bühren J, Bischoff G, Kohnen T (2011) [Keratoconus: clinical aspects, diagnosis, therapeutic possibilities]. Klin Monbl Augenheilkd 228:923–940 (quiz 941–942)

    Article  PubMed  Google Scholar 

  5. Bühren J, Kook D, Kohnen T (2012) Eignung unterschiedlicher korneal topographischer Masszahlen zur Diagnose des fruhen Keratokonus. Ophthalmologe 109:37–44

    Article  PubMed  Google Scholar 

  6. Bühren J, Kook D, Kohnen T (2012) [Suitability of various topographic corneal parameters for diagnosis of early keratoconus]. Ophthalmologe 109:37–44

    Article  PubMed  Google Scholar 

  7. Bühren J, Kook D, Yoon G et al (2010) Detection of subclinical keratoconus by using corneal anterior and posterior surface aberrations and thickness spatial profiles. Invest Ophthalmol Vis Sci 51:3424–3432

    Article  PubMed  Google Scholar 

  8. Bühren J, Martin T, Kuhne A et al (2009) Correlation of aberrometry, contrast sensitivity, and subjective symptoms with quality of vision after LASIK. J Refract Surg 25:559–568

    PubMed  Google Scholar 

  9. Bühren J, Nagy L, Yoon G et al (2010) The effect of the asphericity of myopic laser ablation profiles on the induction of wavefront aberrations. Invest Ophthalmol Vis Sci 51:2805–2812

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bühren J, Pesudovs K, Martin T et al (2009) Comparison of optical quality metrics to predict subjective quality of vision after laser in situ keratomileusis. J Cataract Refract Surg 35:846–855

    Article  PubMed  Google Scholar 

  11. Bühren J, Strenger A, Martin T et al (2007) Wellenfrontaberrationen und subjektive optische Qualitat nach wellenfrontgefuhrter LASIK: Erste Ergebnisse. Ophthalmologe 104:688–692, 694–686

    Article  PubMed  Google Scholar 

  12. Carrillo C, Chayet AS, Dougherty PJ et al (2005) Incidence of complications during flap creation in LASIK using the NIDEK MK-2000 microkeratome in 26,600 cases. J Refract Surg 21:S655–S657

    PubMed  Google Scholar 

  13. Chen S, Feng Y, Stojanovic A et al (2012) IntraLase femtosecond laser vs mechanical microkeratomes in LASIK for myopia: a systematic review and meta-analysis. J Refract Surg 28:15–24

    Article  PubMed  Google Scholar 

  14. El-Naggar MT (2015) Bilateral ectasia after femtosecond laser-assisted small-incision lenticule extraction. J Cataract Refract Surg 41:884–8

    Article  PubMed  Google Scholar 

  15. Farjo AA, Sugar A, Schallhorn SC et al (2013) Femtosecond lasers for LASIK flap creation: a report by the American Academy of ophthalmology. Ophthalmology 120(3):e5–e20

    Article  PubMed  Google Scholar 

  16. Gritz DC (2011) LASIK interface keratitis: epidemiology, diagnosis and care. Curr Opin Ophthalmol 22:251–255

    Article  PubMed  Google Scholar 

  17. Ivarsen A, Asp S, Hjortdal J (2014) Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology 121:822–828

    Article  PubMed  Google Scholar 

  18. Kiraly L, Skarupinski P, Duncker G (2011) LASIK – Neulandbehandlung oder medizinischer Standard. Klin Monbl Augenheilkd 228:995–998

    Article  PubMed  Google Scholar 

  19. Knorz M (2011) Komplikationen der Excimerchirurgie. In: Kohnen T (Hrsg) Refraktive Chirurgie. Springer, Heidelberg

    Google Scholar 

  20. Kohnen T, Klaproth O (2013) Komplikationsvermeidung und –management bei Laser-in-situ-Keratomileusis [Avoidance and management of complications in laser in situ keratomileusis]. Ophthalmologe 110:629–638

    Article  CAS  PubMed  Google Scholar 

  21. Kohnen T, Buhren J, Baumeister M (2001) Confocal microscopic imaging of reticular folds in a laser in situ keratomileusis flap. J Refract Surg 17:689–691

    CAS  PubMed  Google Scholar 

  22. Kohnen T, Klaproth OK, Derhartunian V et al (2009) Ergebnisse von 308 konsekutiven Femtosekundenlaserschnitten fur die LASIK. Ophthalmologe 107:439–445

    Article  Google Scholar 

  23. Kohnen T, Knorz MC, Neuhann T (2007) [Evaluation and quality assurance of refractive surgery procedures by the German Ophthalmological Society and the Professional Association of German Ophthalmologists]. Ophthalmologe 104:719–726

    Article  CAS  PubMed  Google Scholar 

  24. Kohnen T, Neuhann T, Knorz M (2014) Bewertung und Qualitatssicherung refraktiv-chirurgischer Eingriffe durch die DOG und den BVA: Stand Jan 2014. Ophthalmologe 111:320–329

    Article  CAS  PubMed  Google Scholar 

  25. Kohnen T, Terzi E, Kasper T, Kohnen EM, Bühren J (2004) Correlation of infrared pupillometers and CCD-camera imaging from aberrometry and videokeratography for determining scotopic pupil size. J Cataract Refract Surg 30:2116–2123

    Article  PubMed  Google Scholar 

  26. Kymionis GD, Kankariya VP, Plaka AD et al (2012) Femtosecond laser technology in corneal refractive surgery: a review. J Refract Surg 28:912–920

    Article  PubMed  Google Scholar 

  27. Lee JK, Nkyekyer EW, Chuck RS (2009) Microkeratome complications. Curr Opin Ophthalmol 20:260–263

    Article  PubMed  Google Scholar 

  28. Liu M et al (2015) Decentration of optical zone center and its impact on visual outcomes following SMILE. Cornea 34:392–397

    Article  PubMed  Google Scholar 

  29. Moshirfar M, Gardiner JP, Schliesser JA et al (2010) Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison. J Cataract Refract Surg 36:1925–1933

    Article  PubMed  Google Scholar 

  30. Moshirfar M et al (2015) Small-incision lenticule extraction. J Cataract Refract Surg 41:652–65

    Article  PubMed  Google Scholar 

  31. Neuhann T (2011) Zentrierung bei Refraktionskorrekturen mit dem Excimerlaser. In: Kohnen T (Hrsg) Refrative Chirurgie. Springer, Heidelberg

    Google Scholar 

  32. Padmanabhan P, Mrochen M, Viswanathan D et al (2009) Wavefront aberrations in eyes with decentered ablations. J Cataract Refract Surg 35:695–702

    Article  PubMed  Google Scholar 

  33. Pallikaris IG, Papatzanaki ME, Stathi EZ et al (1990) Laser in situ keratomileusis. Lasers Surg Med 10:463–468

    Article  CAS  PubMed  Google Scholar 

  34. Ramirez-Miranda A et al (2015) Refractive lenticule extraction complications. Cornea 34(Suppl 10):S65–S67

    Article  PubMed  Google Scholar 

  35. Randleman JB, Shah RD (2012) LASIK interface complications: etiology, management, and outcomes. J Refract Surg 28:575–586

    Article  PubMed Central  PubMed  Google Scholar 

  36. Randleman JB, Russell B, Ward MA et al (2003) Risk factors and prognosis for corneal ectasia after LASIK. Ophthalmology 110:267–275

    Article  PubMed  Google Scholar 

  37. Randleman JB, Trattler WB, Stulting RD (2008) Validation of the Ectasia Risk Score System for preoperative laser in situ keratomileusis screening. Am J Ophthalmol 145:813–818

    Article  PubMed Central  PubMed  Google Scholar 

  38. Randleman JB, Woodward M, Lynn MJ et al (2008) Risk assessment for ectasia after corneal refractive surgery. Ophthalmology 115:37–50

    Article  PubMed  Google Scholar 

  39. Sakimoto T, Rosenblatt MI, Azar DT (2006) Laser eye surgery for refractive errors. Lancet 367:1432–1447

    Article  PubMed  Google Scholar 

  40. Schnitzler EM, Baumeister M, Kohnen T (2000) Scotopic measurement of normal pupils: Colvard versus Video Vision Analyzer infrared pupillometer. J Cataract Refract Surg 26:859–866

    Article  CAS  PubMed  Google Scholar 

  41. Wang Y et al (2015) Corneal ectasia 6.5 months after small-incision lenticule extraction. J Cataract Refract Surg 41:1100–1106

    Article  PubMed  Google Scholar 

  42. Winkler Von Mohrenfels C, Salgado JP, Khoramnia R (2010) Keratektasie nach refraktiver Chirurgie. Klin Monbl Augenheilkd 228:704–711

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    T. Kohnen FEBO &  M. Remy FEBO

Authors
  1. T. Kohnen FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Remy FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Kohnen FEBO.

Ethics declarations

Interessenkonflikt

T. Kohnen: Alcon, Abbott, B+L, Carl Zeiss, Diomed, Geuder, Hoya, Rayner, Oculus, Rayner, Schwind, Ziemer. M. Remy: Avedro, Schwind.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

Dieser Beitrag ist eine Aktualisierung des Artikels: Kohnen T, Klaproth OK (2013) Komplikationsvermeidung und -management bei Laser-in-situ-Keratomileusis. Ophthalmologe 110: 629–638. Doi: 10.1007/s00347-012-2680-2

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kohnen, T., Remy, M. Komplikationen der lamellären refraktiven Hornhautchirurgie. Ophthalmologe 112, 982–989 (2015). https://doi.org/10.1007/s00347-015-0172-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-015-0172-x

Schlüsselwörter

Keywords

Search

Navigation