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Therapie von Hornhautendothelerkrankungen mittels DMEK und UT-DSAEK

Indikationen, Komplikationen, Ergebnisse und Nachsorge

Treatment of corneal endothelial disorders by DMEK and UT-DSAEK

Indications, complications, results and follow-up

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Zusammenfassung

Die Techniken für die posteriore lamelläre Keratoplastik haben in den letzten 15 Jahren eine stetige Verbesserung erfahren, sodass eine äußerst schnelle Visuserholung dank sehr dünner Transplantate möglich ist. Die „Descemet membrane endothelial keratoplasty“ (DMEK) findet international und besonders in Deutschland zunehmend Verbreitung und kann mittlerweile auch bei schwierigen Verhältnissen des vorderen Augenabschnitts zum Einsatz kommen. Allerdings ist die DMEK mit einer längeren Lernkurve für den Ophthalmochirurgen verbunden, und das Komplikationsrisiko ist im Vergleich zur „Descemet’s stripping automated keratoplasty“ (DSAEK), bei der das Transplantat im Gegensatz zur DMEK noch einen verhältnismäßig dicken Anteil an Spenderstroma enthält, in schwierigen Ausgangssituationen erhöht. Die Vorteile der DMEK gegenüber der DSAEK liegen in besseren Visusergebnissen und deutlich weniger immunologischen Transplantatreaktionen. Die neueste Technik der posterioren lamellären Keratoplastik, die Ultrathin-DSAEK (UT-DSAEK), ist durch ein besonders dünnes Transplantat gekennzeichnet, das aber im Vergleich mit der DMEK immer noch um das 5- bis 8-Fache dicker ist. Vergleichende Studien zwischen DMEK und UT-DSAEK stehen noch aus. Bisherige Untersuchungen legen nahe, dass die Visusergebnisse nach UT-DSAEK ähnlich gut ausfallen. Inwieweit dies auch auf die Endothelzelldichte oder die Abstoßungsrate im langfristigen Verlauf zutrifft, ist noch nicht geklärt.

Abstract

Various techniques for posterior lamellar keratoplasty have been established for the clinical routine and continuously improved during the last 15 years so that an extremely rapid recovery of vision is possible due to very thin transplants. Descemet membrane endothelial keratoplasty (DMEK) is the method of choice for simple corneal endothelial diseases and has already been applied in complex conditions of the anterior segment. The learning curve for DMEK is comparatively long and the risk of complications in complex anterior segment pathologies is higher than in Descemet’s stripping automated endothelial keratoplasty (DSAEK); however, DMEK results in better visual outcome and less graft rejections than DSAEK. The latest evolution in posterior lamellar transplant surgery is ultrathin DSAEK (UT-DSAEK), where the grafted lamella is much thinner than in conventional DSAEK. Currently available data suggest that the resulting visual acuity after UT-DSAEK is close to the visual acuity seen after DMEK; however, studies comparing the results after DMEK and UT-DSAEK are so far lacking. Whether the transplantation of these very thin DSAEK grafts also results in endothelial cell densities and graft rejection rates comparable to DMEK has to be proven.

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COST BM 1302 (www.biocornea.eu).

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Authors and Affiliations

  1. Zentrum für Augenheilkunde, Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland

    B. Bachmann,  F. Schaub &  C. Cursiefen

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  1. B. Bachmann
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  2. F. Schaub
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  3. C. Cursiefen
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Correspondence to B. Bachmann.

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B. Bachmann, F. Schaub und C. Cursiefen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Bachmann, B., Schaub, F. & Cursiefen, C. Therapie von Hornhautendothelerkrankungen mittels DMEK und UT-DSAEK. Ophthalmologe 113, 196–203 (2016). https://doi.org/10.1007/s00347-016-0221-0

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