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Keratoplastik: Lamellieren oder perforieren?

Teil 2: Lamelläre Keratoplastik

verfasst von: Dr. P. Maier, T. Reinhard

Erschienen in: Die Ophthalmologie | Ausgabe 7/2009

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Zusammenfassung

Zahlreiche Hornhauterkrankungen führen früher oder später zu der Entscheidung, ob eine Hornhauttransplantation notwendig wird. Im Gegensatz zum bisherigen Goldstandard, der perforierenden Keratoplastik (PKP), lagen die Nachteile ursprünglicher lamellärer Transplantationstechniken in schlechten visuellen Ergebnissen durch Interfaceprobleme. Zahlreiche technische Neuerungen haben in jüngster Vergangenheit zu einer Wiederentdeckung verschiedener lamellärer Operationsverfahren geführt. Bei der Deep Anterior Lamellar Keratoplasty (DALK) wird die Gefahr endothelialer Abstoßungsreaktionen vermieden. Bei unvollständiger Deszemetfreilegung sind die visuellen Ergebnisse jedoch mit denen nach einer PKP nicht vergleichbar. Bei einer Variante der posterioren lamellären Keratoplastik, der sog. Descemet Stripping (Automated) Endothelial Keratoplasty [DS(A)EK], wird am Empfänger ausschließlich das erkrankte Endothel mit Descemet-Membran (Descemetorhexis) entfernt. Anschließend kann das lamelläre, endotheltragende Transplantat über einen korneoskleralen/kornealen Tunnel implantiert werden, wobei kaum Astigmatismus induziert wird. Der Hauptvorteil der DS(A)EK im Vergleich zur PKP liegt in einer rascheren visuellen Rehabilitation bei nahezu unveränderter Refraktion, wobei die Visuswerte häufig etwas schlechter ausfallen. Für diese neu entwickelten Operationstechniken fehlen jedoch noch valide Studienergebnisse, die einen nachhaltigen Vergleich der neuen Verfahren gegen die konventionelle perforierende Keratoplastik erlauben.

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Titel: Keratoplastik: Lamellieren oder perforieren?
Teil 2: Lamelläre Keratoplastik
verfasst von: Dr. P. Maier
T. Reinhard
Publikationsdatum: 01.07.2009
Verlag: Springer-Verlag
Erschienen in: Die Ophthalmologie / Ausgabe 7/2009
Print ISSN: 2731-720X
Elektronische ISSN: 2731-7218
DOI: https://doi.org/10.1007/s00347-009-1943-z

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