Kontraindikation Chronische Polyarthritis?

[arabär]

Kann mir bitte jemand erklären, warum man mit dieser Autoimmunerkrankung nicht gelasert werden kann. Steht bei vielen Kliniken auf der Homepage, dass es nicht geht bei Rheuma
Danke!

[Dr. med. Ron Lehnert]

Hallo arabär,

zusammenfassend lässt sich aus der aktuellen Studienlage (Quelle www.pubmed.com) schließen, dass eine "gut eingestellte" Autoimmunkrankheit aus dem rheumatoiden Formenkreis keine Kontraindikation für eine LASIK darstellt.
Oberflächenverfahren wie PRK, LASEK, Epi-LASEK sollten in solchen Fällen besser vermieden werden.

1: Ophthalmology. 2006 Jul;113(7):1118.e1-8. Epub 2006 Apr 27.

Comment in:
Ophthalmology. 2007 May;114(5):1032-3; author reply 1033-4.

LASIK outcomes in patients with underlying systemic contraindications: a
preliminary study.

Cobo-Soriano R, Beltrán J, Baviera J.

Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain.
rosario@fcobo.e.telefonica.net

OBJECTIVES: To determine the anatomic and functional outcomes of photorefractive
surgery in patients with underlying systemic diseases that are traditionally
listed as relative or absolute contraindications. DESIGN: Observational
retrospective case-control study. PARTICIPANTS: The case groups were composed of
275 eyes of 141 consecutive patients who underwent a LASIK procedure with any of
the following underlying conditions: autoimmune connective-tissue disorders (n =
62), psoriasis (n = 91), intestinal inflammatory diseases (n = 67) diabetes
mellitus (n = 44), and history of keloid formation (n = 18). Twenty-nine patients
(56 eyes) were receiving systemic immunosuppressive therapy. The control group
comprised 358 eyes of 181 patients without the above-mentioned conditions who
underwent LASIK. METHODS: The study had 2 parts, relating to the anatomic and
functional (visual and refractive) outcomes. For anatomic outcome, we compared
the entire sample of both groups. For functional outcome, only myopic eyes of
each group were compared. Independent comparisons were performed between each
disease group and the control group. MAIN OUTCOME MEASURES: Anatomic outcomes
included perioperative and postoperative epithelial, flap, and interface
complications. Functional outcomes were evaluated using visual and refractive
indicators, percentage of eyes undergoing enhancement, and number of
postoperative visits. RESULTS: Mild anatomic complications were observed in the
case and control groups with similar percentages, and there were no statistical
differences between groups. Regarding functional outcome, the only significant
finding was a worse refractive outcome in the collagen vascular diseases group
compared with controls. There were no other statistical differences detected in
the other systemic disease groups. CONCLUSIONS: In our experience, LASIK can be
performed effectively and safely in selected patients with stable and controlled
systemic diseases with favorable postoperative anatomic and visual outcomes. The
absolute exclusion of certain systemic contraindications should be reconsidered.


PMID: 16647130 [PubMed - indexed for MEDLINE]


1: J Cataract Refract Surg. 2006 Aug;32(8) 1292-5.

Comment in:
J Cataract Refract Surg. 2006 Aug;32(8) 1241. J Cataract Refract Surg. 2007 Feb;33(2):175; author reply 175-6.

Laser in situ keratomileusis in patients with autoimmune diseases.

Smith RJ, Maloney RK.

Maloney Vision Institute, Los Angeles, California 90024, USA.

PURPOSE: To evaluate the safety of laser in situ keratomileusis (LASIK) in
patients with autoimmune diseases. SETTING: Private clinical practice. METHODS:
In this retrospective case series, the records of patients who had LASIK at the
Maloney Vision Institute between June 1, 1998, and October 1, 2004, were reviewed
for a history of autoimmune disease including systemic lupus erythematosus,
rheumatoid arthritis, psoriatic arthritis, scleroderma, inflammatory bowel
disease, Graves' disease, Reiter's syndrome, and Hashimoto's disease. The records
were reviewed for corneal and scleral complications of autoimmune disease after
LASIK. RESULTS: Forty-nine eyes of 26 patients with inactive or stable autoimmune
disease were identified. No eye developed corneal thinning, melting, persistent
epithelial defect, persistent keratitis, scleral thinning, scleritis, or
scleromalacia. CONCLUSION: Laser in situ keratomileusis may be a reasonable
option in patients with well-controlled or inactive autoimmune disease.


PMID: 16863964 [PubMed - indexed for MEDLINE]

1: Ophthalmology. 2005 Nov;112(11):1948-54. Epub 2005 Sep 15.

LASIK in patients with rheumatic diseases: a pilot study.

Alió JL, Artola A, Belda JI, Perez-Santonja JJ, Muñoz G, Javaloy J,
Rodríguez-Prats JL, Galal A.

Refractive Surgery and Cornea Department, Instituto Oftalmológico de Alicante
Vissum Corporation, and Medical School, Miguel Hernández University, Alicante,
Spain. jlalio@vissum.com

PURPOSE: To investigate the safety of LASIK in patients with a known history of
controlled rheumatic diseases. DESIGN: Retrospective consecutive observational
clinical study. PARTICIPANTS: Forty-two eyes (22 patients) known to have had a
history of rheumatic diseases underwent LASIK. All patients had a history of
controlled rheumatic diseases, including rheumatoid arthritis, systemic lupus
erythematosus, dermatomyositis, scleroderma, ankylosing spondylitis, psoriatic
arthritis, inflammatory bowel disease, arthritis, or Behçet's disease. METHODS:
Assessments were made preoperatively and at 1, 3, and 6 months postoperatively
and included visual acuity (VA), refraction, keratometric readings, slit-lamp
biomicroscopy, and corneal topography. All the patients underwent LASIK.
Postoperative treatment included a topical steroid-antibiotic combination. MAIN
OUTCOME MEASURES: Visual acuity, refraction, keratometric readings, and slit-lamp
biomicroscopy findings at 1, 3, and 6 months postoperatively. RESULTS: LASIK was
performed uneventfully on all patients. The mean pre-LASIK spherical equivalent
(SE) was -5.39+/-2.25, and the sixth month postoperative SE was -0.15+/-0.38
diopters (D) (P<0.001). Uncorrected VA 6 months after the LASIK procedure was
20/25. Enhancement procedures were performed in 6 of 42 eyes (14.3%) at variable
times after the primary procedure. Postoperative follow-up showed development of
a moderate degree of dry eye syndrome in 4 eyes (9.5%). Corneal haze, melting,
flap, or interface complications were not observed in any of the study eyes.
CONCLUSIONS: In this small series, we found good outcomes when correcting
refractive errors using LASIK in selected patients with controlled rheumatic
diseases. In this series, a favorable postoperative visual outcome was obtained
with no operative or postoperative vision-threatening complications.


PMID: 16168484 [PubMed - indexed for MEDLINE]