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Klin Monbl Augenheilkd 2018; 235(10): 1148-1158
DOI: 10.1055/s-0043-111797
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Keratokonus: heutige Therapieoptionen

Therapeutic Options in Keratoconus
Frederik Raiskup
1   Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
,
Janine Lenk
1   Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
,
Robert Herber
1   Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
,
Zisis Gatzioufas
2   Corneo-Plastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom of Great Britain and Northern Ireland
,
Eberhard Spörl
1   Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
› Author Affiliations
Further Information

Publication History

eingereicht 11 March 2017

akzeptiert 24 April 2017

Publication Date:
06 July 2017 (online)

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Zusammenfassung

Die Inzidenz des Keratokonus wird in aktuellen Studien deutlich höher geschätzt als bisher angenommen, somit wird diese Hornhautektasie nicht mehr zu den seltenen Erkrankungen gezählt. Als einer der bedeutendsten Risikofaktoren für die Entstehung des Keratokonus wurde neben Atopie und Down-Syndrom das chronische Augenreiben definiert. Dies ist der durch Verhaltenstraining und konsequente Aufklärung einzig wirklich modifizierbare Risikofaktor. Weitere Therapieoptionen beinhalten Maßnahmen zur Visusverbesserung wie die Anpassung von Brillen und formstabilen Kontaktlinsen, die Implantation kornealer Ringsegmente oder phaker intraokularer Linsen. Im Falle einer Krankheitsprogression bietet das korneale Crosslinking ein effektives und sicheres Verfahren, sodass das Erfordernis einer Hornhauttransplantation in dieser Indikation immer seltener wird. Neuere Studien sehen auch einen positiven Effekt einer Kombination der bisher bei Keratokonus kontraindizierten photorefraktiven Keratektomie und dem Crosslinking. Die perforierende Keratoplastik stellt allerdings weiterhin den Goldstandard der chirurgischen Behandlung des Keratokonus im fortgeschrittenen Stadium dar, wobei in den letzten Jahren auch die lamellären Verfahren immer mehr in den Vordergrund rücken.

Abstract

A recent epidemiology study revealed that prevalence of keratoconus was much higher than previously assumed. Therefore, it is no longer deemed an “orphan disease”, as it has a relevant socioeconomic impact on the healthcare system. One of the most important risk factors for developing keratoconus is chronic eye rubbing which, apart from other known risk factors such as atopy or Downʼs syndrome, is the only modifiable factor. Informing the patient and offering behavior modifying therapies seems to be essential. Further therapeutic options regarding improvement of visual function include the wearing of glasses and the fitting of rigid gas permeable contact lenses and implantation of intrastromal corneal ring segments or phakic intraocular lenses. Corneal crosslinking (CXL) has been proven to be a highly effective and safe procedure in keratoconus cases showing disease progression. Significantly fewer corneal transplants were performed in this indication following the introduction of CXL. Recent studies reevaluated a combination of photorefractive keratectomy, which has been contraindicated until recently for patients with primary corneal ectasia with CXL, reporting a positive visual refractive outcome and stability of keratoconus. Still, penetrating keratoplasty is the gold standard of surgical treatment for end-stage keratoconus, whereas recently lamellar procedures have gained higher importance.

Schlüsselwörter

Kornea - Keratokonus - Ektasie - Therapie

Key words

cornea - keratoconus - ectasia - therapy
 

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