HLA B27 - Rheumatologie

[Donauwelle]

Gibt es Erfahrungswerte für Personen mit positivem HLA B27 Wert (Rheumawert) ?

Besteht nach Lasik/Lasek/PRK ein erhöhtes Risiko zum Problempatienten zu werden?

Besteht ein ev. erhöhtes Risiko auch dann, wenn zum (bzw. bis zum ) Zeitpunkt der OP keinerlei rheumat. Anzeichen erkennbar sind?

Wie äußern sich Probleme, die durch einen HLA B27-positiv-Wert entstehen können?

Würden derartige Probleme unmittelbar nach der OP auftreten, oder könnten diese auch zu einem wesentlich späteren Zeitpunkt auftreten?

[Dr. med. Ron Lehnert]

Hallo Donauwelle,

nach den vorliegenden Daten besteht für HLA-B27 positive Patienten nach LASIK/PRK/LASEK kein erhöhtres Risiko für eine Uveitis des vorderen Augenabschnitts (Anteriore Uveitis). [1-2] Allerdings ist HLA-B27 mit vermehrten Herpes Simplex Infektionen assoziiert [3] und könnte damit für eine suboptimale Wundheilung verantwortlich sein, falls sie in den ersten 6 Monaten nach der Augenlaser-OP eine Herpes Simplex Infektion des Auges hatten.

1. J Cataract Refract Surg. 2002 Oct;28(10):1793-8.

Anterior uveitis after laser in situ keratomileusis.

Suarez E, Torres F, Vieira JC, Ramirez E, Arevalo JF.

Centro Medico Docente La Trinidad, Caracas, Venezuela.

PURPOSE: To report a case series of anterior uveitis after laser in situ
keratomileusis (LASIK) and the incidence of anterior uveitis at a mean of 3
years. SETTING: Centro Medico Docente La Trinidad and Clinica Oftalmologica
Centro Caracas, Caracas, Venezuela. METHODS: Five refractive surgeons and 18488
eyes that had surgical correction of a mean ametropia of -2.23 diopters (D)
(range -10.25 to +4.25 D) participated in the study; 74.3% of the eyes were
myopic. Laser in situ keratomileusis was performed in all eyes. Patients were
followed for a mean of 36 months (range 6 to 48 months) after LASIK. The clinical
charts of patients who developed uveitis after LASIK were reviewed. The mean
preoperative intraocular pressure (IOP) was 15.2 mm Hg (range 12 to 19 mm Hg).
The mean corneal ablation depth was 37.47 micro m (range 12 to 98 micro m). In
the immediate postoperative period, all patients received a combination of
topical dexamethasone and tobramycin. RESULTS: Thirty-five eyes (18 patients)
developed anterior uveitis after LASIK. Signs and symptoms appeared a mean of
20.7 days (range 17 to 28 days) postoperatively and 5.08 days (range 2 to 8 days)
after withdrawal of topical steroid and antibiotic agents. Eyes that developed
LASIK-related uveitis had a mean preoperative spherical equivalent of -2.32 D
(range -7.00 to +4.25 D). Intraocular pressure dropped to a mean of 8.0 mm Hg
(range 4 to 12 mm Hg) at the onset of uveitis (P <.0001). The LASIK-related
anterior uveitis resolved and IOP returned to baseline after a mean of 3 days on
topical steroid and cycloplegic agents. Laboratory and immunology (including
human leukocyte antigen-B27) tests were negative in 15 of 18 patients (83.33%).
The incidence of uveitis after LASIK was 0.18%. CONCLUSIONS: Anterior uveitis
after LASIK is infrequent. It may be due to uveal trauma during surgery with
disruption of normal anterior-chamber-associated immune deviation, decreased
antiinflammatory cytokines, and increased proinflammatory cytokines. Further
studies are needed to investigate the mechanisms of this association.


PMID: 12388030 [PubMed - indexed for MEDLINE]


2. J Cataract Refract Surg. 2008 Jul;34(7):1110-3.

Risk for uveitis after laser in situ keratomileusis in patients positive for
human leukocyte antigen-B27.

Moshirfar M, Siddharthan KS, Meyer JJ, Espandar L, Wolsey DH, Vitale AT.

Department of Ophthalmology and Visual Sciences, University of Utah Health
Sciences Center, Salt Lake City, Utah 84132, USA. majid.moshirfar@hsc.utah.edu

PURPOSE: To assess the incidence of, risk for, and visual outcomes of acute
anterior uveitis (AAU) in human leukocyte antigen (HLA)-B27 positive patients who
had laser in situ keratomileusis (LASIK). SETTING: University-based center.
METHODS: This study comprised 46 eyes of 23 HLA-B27 positive patients with a
5-year follow-up. Data on episodes of uveitis were reviewed retrospectively and
the incidence rates calculated for LASIK and non-LASIK eyes. Kaplan-Meier
survival probabilities were calculated for uveitis occurring during the final 36
to 60 months of the study. Survival probabilities between LASIK and non-LASIK
eyes were compared. RESULTS: Twenty eyes (10 patients) had LASIK a mean of 36
months+/-2 (SD) after the diagnosis of HLA-B27. In the HLA-B27 positive patients,
the incidence rates of uveitis between eyes that had and eyes that did not have
LASIK were not significantly different. The incidence rates of uveitis after
LASIK did not differ significantly between eyes with and eyes without episodes of
uveitis before LASIK (P=.135). The probability of an eye having no episode of
uveitis in the fourth and fifth year of follow-up was not significantly different
between eyes that had LASIK and those that did not (P=.668). CONCLUSIONS: The
occurrence rate of post-LASIK AAU in the HLA-B27 positive population was not
higher than the general incidence in a similar HLA-B27 population without
previous LASIK. A previous episode of uveitis did not appear to increase the risk
for uveitis after LASIK in HLA-B27 positive patients.


PMID: 18571077 [PubMed - indexed for MEDLINE]


3. Ophthalmologe. 2007 Aug;104(8):705-8.

[HLA B27 seems to promote graft failure following penetrating keratoplasties for
herpetic corneal scars]

[Article in German]

Böhringer D, Sundmacher R, Reinhard T.

Augenklinik,Abt. Allgemeine Augenheilkunde mit Poliklinik,
Albert-Ludwigs-Universität Freiburg, Killianstrasse 5, 79106, Freiburg,
Deutschland. daniel.boehringer@uniklinik-freiburg.de

BACKGROUND: Herpes simplex virus (HSV) is the leading cause of infectious corneal
blindness in the developed world. Eighty percent of the general population
develop asymptomatic viral latency in the trigeminal ganglion following orofacial
inoculation, but only 0.2% of all such orofacial inoculations are followed by
recurrent corneal reactivation. Recurrences still threaten graft survival
following penetrating keratoplasty, so that advance identification of patients at
increased risk would be helpful in aftercare following penetrating keratoplasty.
The HLA B27 phenotype is associated with increased susceptibility to genital HSV.
However, no such association has been reported for herpetic eye disease. METHODS:
The HLA phenotypes of 129 patients who underwent penetrating keratoplasties for
herpetic corneal scars were available for retrospective analysis. Four of these
patients were positive for HLA-B27. The 125 HLA-B27-negative patients served as
controls. The mean follow-up was 2.2 years. We compared the frequencies of
herpetic recurrence and graft failure in the two groups using the Kaplan-Meier
method and applied log-rank statistics. RESULTS: After the average period of
follow-up, 75% (three patients) of the HLA B27-positive patients experienced
either graft failure or at least one reversible recurrence of the herpetic eye
disease, as against only 25% of controls. This difference was highly
statistically significant (p<0.01). CONCLUSION: This retrospective analysis
suggests that the HLA B27 phenotype promotes recurrence of herpetic eye disease
following penetrating keratoplasty. HLA B27-positive patients should be closely
monitored, and the indications for prophylactic antiviral therapy should be
viewed liberally in this group.

PMID: 17609950 [PubMed - indexed for MEDLINE]

Außerdem verweise ich auf den Thread: http://augenlaser.operationauge.de/rheu ... t5978.html Anm: Im Zweifelsfall würde ich auf die Studiendaten zählen und nicht auf den Thread.