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Klin Monbl Augenheilkd 2013; 230(6): 595-603
DOI: 10.1055/s-0032-1328507
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Therapeutische Excimerlaserchirurgie der Hornhaut

Therapeutic Excimer Laser Treatment of the Cornea
S. J. Linke
1   Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
2   Care-Vision Germany GmbH, Hamburg
,
J. Steinberg
1   Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
,
T. Katz
1   Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
2   Care-Vision Germany GmbH, Hamburg
› Author Affiliations
Further Information

Publication History

eingereicht 04 February 2013

akzeptiert 22 February 2013

Publication Date:
21 June 2013 (online)

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Zusammenfassung

Parallel zu kontinuierlichen Innovationen im Bereich der refraktiven Excimerchirurgie findet auch die phototherapeutische Keratektomie (PTK) eine zunehmende Verbreitung und neue Einsatzmöglichkeiten wie die topografiegeführte Laserbehandlung. Die PTK ist heutzutage eine effektive Behandlungsmethode von Erkrankungen der Hornhautoberfläche. Hauptindikationen sind epitheliale Anhaftungsprobleme, oberflächliche Trübungen und Irregularitäten. Entscheidend für den Therapieerfolg der PTK sind das Wissen um die Tiefen- und Flächenausdehnung der Läsionen, die Natur der Grunderkrankung (Rezidivwahrscheinlichkeit) sowie der refraktive Status des Patienten. Ergänzend zur Spaltlampenmikroskopie dienen die Topografie, die konfokale Mikroskopie und besonders das Vorderabschnitts-OCT zur Objektivierung und Planung des Eingriffs. Dem Operateur steht bei der Durchführung der PTK ein breites Spektrum zur Verfügung: Der Gewebsabtrag kann je nach Pathologie mit einem manuell-chirurgischen Gewebeabtrag kombiniert werden oder komplett mittels Excimerlaser durchgeführt werden. Bei unregelmäßiger Oberfläche können je nach zugrunde liegender Pathologie maskierende Substanzen die Effektivität der PTK verbessern oder topografiegeführte Ablationsprofile zu einer deutlichen Regularisierung der Hornhautoberfläche führen. Zur Vermeidung von Haze und Rezidivprophylaxe hat sich in den letzten Jahren Mitomycin C in einer Konzentration von 0,02 % und einer Applikationsdauer von 20–60 s als sicheres und effektives Verfahren herausgestellt. Berücksichtigt man alle patientenbezogenen Faktoren und gelingt es dem Operateur, die Möglichkeiten der PTK effektiv einzusetzen, stellt sie in vielen Fällen eine höchst individualisierte und minimalinvasive Alternative zur lamellären oder perforierenden Hornhauttransplantation dar. Im Gegensatz zur refraktiven Chirurgie ist die phototherapeutische Keratektomie und die topografiegeführte Laserbehandlung keine automatisierte und keine standardisierte OP-Technik, sondern vielmehr eine „customized procedure“, um im refraktiven Sprachgebrauch zu verbleiben.

Abstract

Concomitant with new innovations in the field of refractive surgery, therapeutic excimer laser applications like phototherapeutic keratectomy (PTK) and topography-guided customised ablation treatment are gaining high importance and undergoing rapid evolution. Nowadays, PTK is an effective treatment modality for superficial corneal pathologies. Primary indications are decreased epithelial adherence, superficial opacifications and an irregular corneal surface. For the right indication and successful treatment of corneal pathologies with PTK, a knowledge of the size, depth and nature of the pathology, as well as the refractive status of both eyes is important. Next to slit-lamp examination, objective measuring systems like the topography, confocal microscopy and the anterior segment OCT facilitate presurgical planning. Regarding the treatment procedure the surgeon can choose between a variety of methods. PTK can be combined with manual epithelial debridement or done by only using the excimer laser. In the case of an irregular corneal surface, depending on the pathology, masking fluids or topography-guided custom ablation protocols can increase the visual outcome. To avoid recurrence of the underlying pathology (e.g., corneal dystrophy, haze), the topical application of 0.02 % mitomycin C for 20–60 seconds has proved to be a safe and effective procedure. If the surgeon considers all the patient-related factors carefully and manages to combine the available treatment options correctly, PTK embodies an effective and minimally invasive alternative to lamellar or penetrating keratoplasty.

Schlüsselwörter

PTK - Laserbehandlung - Hornhautdystrophie - Narbe

Key words

PTK - laser surgery - corneal dystrophy - corneal scars
 

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