Hornhautvernetzung mit Riboflavin und UV-A-Licht bei Keratokonus

Zusammenfassung

Beim Keratokonus handelt es sich um eine degenerative ektatische Erkrankung des Auges, bei der die Hornhaut zunehmend ihre Stabilität verliert. Infolgedessen kommt es zu einer Vorwölbung derselben mit zunehmender Stromaausdünnung. Es resultieren ein irregulärer Hornhautastigmatismus sowie eine hohe Myopie, die zu einer progredienten Sehverschlechterung führen. Es sind beide Augen betroffen, allerdings in asymmetrischer Ausprägung. Aufgrund des jungen Alters bei Erstmanifestation übt die Erkrankung einen erheblichen Einfluss auf die weitere Lebensqualität und -planung der Patienten aus. Der Krankheitsverlauf bei dieser primären Hornhautektasie ist sehr variabel und beeinflusst die Entscheidung in Bezug auf die richtige Behandlungsstrategie. Ein international anerkanntes Therapieregime in der Behandlung des progressiv verlaufenden Keratokonus ist die Hornhautkollagenvernetzung, auch „corneal collagen cross-linking“ (CXL) genannt. Dieses Verfahren wird eingesetzt, um ein Fortschreiten dieser Ektasie zu verzögern oder sogar zum Stillstand zu bringen. Die Notwendigkeit einer Hornhautverpflanzung kann damit reduziert werden.

Abstract

Changes in the biomechanical properties of the human cornea play an important role in the pathogenesis of corneal ectatic diseases. Many different pathological conditions in the cornea may reduce its biomechanical resistance. Corneal collagen cross-linking (CXL) has emerged as a promising technique to slow or even to stop the progression of ectasia. In this procedure, riboflavin (vitamin B₂) is administered in conjunction with ultraviolet A light (UVA, 365 nm). This interaction causes the formation of reactive oxygen species, leading to additional covalent bonds between collagen molecules, with consequent biomechanical stiffening of the cornea. Although this method is not yet accepted as an evidence-based treatment of corneal ectasia, the results of prospective, randomised studies of CXL used in the treatment of this pathological entity show significant changes in the properties of corneal tissue. This procedure is currently the only aetiopathogenetic treatment of ectatic eyes that can delay or stop the process of cornea destabilisation, reducing the necessity for keratoplasty. Despite promising results, CXL is associated with issues that include long-term safety and duration of the stabilising effect.

Schlüsselwörter

Kornea - Ektasie - Keratokonus - Cross-Linking - Vernetzung

Key words

cornea - ectasia - keratoconus - cross-linking - collagen

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