Hornhautvernetzung beim Keratokonus: „Epi-off“ oder „Epi-on“?

 

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Zusammenfassung

Eine Hornhautquervernetzung kann die Progression des Keratokonus stoppen, doch welche ist die beste Behandlungsmethode? Es gibt verschiedene Korrektur- und Behandlungsmöglichkeiten beim Keratokonus, doch nur die Hornhautquervernetzung (CXL) scheint die Progression der Krankheit aufzuhalten. Um eine effektive Hornhautquervernetzung zu garantieren, wird bei der CXL-Behandlung das Hornhautepithel vor der Applikation von Riboflavin und der Bestrahlung mit ultraviolettem Licht entfernt – „Epi-off“-CXL. Einige Methoden der „Epi-on“-CXL (transepithelial) wurden vorgeschlagen, da eine Instandhaltung des Hornhautepithels weniger schmerzhaft sein sollte und dabei hilft, andere Nebenwirkungen im Zusammenhang mit CXL zu minimieren. Bisherige Befunde zeigen, dass die Epi-off-CXL die effektivste Methode zur Stabilisierung der Hornhaut und zur Verlangsamung der Keratokonusprogression ist – doch transepitheliale Methoden gewinnen an Boden.

Abstract

Corneal cross-linking can halt the progression of keratoconus, but what is the best approach for treatment? There are a number of treatment options for keratoconus, but only corneal cross-linking (CXL) appears to halt the progression of the disease. To guarantee effective cross-linking, CXL treatment involves removal of the corneal epithelium prior to riboflavin application and ultraviolet light illumination – “epi-off” CXL. Several methods of “epi-on” (transepithelial) CXL have been proposed, such as keeping the corneal epithelium intact which should be less painful and help avoid other CXL-associated adverse events. The evidence so far is that epi-off CXL remains the most effective method of strengthening the cornea and slowing keratoconus progression – but transepithelial methods are gaining ground.

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