Update minimalinvasive lamelläre Keratoplastik: DMEK, DSAEK und DALK

Zusammenfassung

Hintergrund: Das Spektrum an operativen Möglichkeiten bei kornealen Pathologien, die eine Keratoplastik erfordern, hat sich in den letzten Jahren deutlich erweitert. Zu dem bisher gängigen durchgreifenden Hornhautersatz (perforierende Keratoplastik) sind die lamellären Transplantationstechniken hinzugekommen, bei welchen selektiv und minimalinvasiv nur die erkrankte Schicht ersetzt werden kann. Ziel dieser Übersichtsarbeit ist es, aktuelle Möglichkeiten, Indikationen, typische Komplikationen und Strategien zur Standardisierung der lamellären Keratoplastiken aufzuzeigen. Material und Methoden: Eine Literaturübersicht aus PubMed und eigene Daten und Erfahrungen werden zusammengefasst. Ergebnisse: Mittels der „Descemet Membrane Endothelial Keratoplasty“ (DMEK), der „Descemt Stripping Automated Endothelial Keratoplasty“ (DSAEK) und der „Deep Anterior Lamellar Keratoplasty“ (DALK) kann bei Patienten mit Erkrankungen des Hornhautendothels oder des anterioren Stromas ein minimalinvasiver Hornhautersatz mit reduziertem Komplikationsrisiko angeboten werden. Schlussfolgerung: DMEK und DSAEK gelten inzwischen international als Operationstechnik der Wahl bei Endothelerkrankungen wie der Fuchs-Endotheldystrophie. Die DALK bei Pathologien des anterioren Stromas wie dem Keratokonus benötigt noch weitere Standardisierungen, um jenseits spezialisierter Zentren in größerer Zahl durchgeführt zu werden. Die Vorteile der lamellären Keratoplastiken liegen insbesondere in den guten Visusergebnissen und deutlich weniger auftretenden immunologischen Transplantatreaktionen. Auch intraoperative Komplikationen sind seltener. Langfristig ist eine weitere Standardisierung der Verfahren sowie deren Etablierung als primäre Standardverfahren wünschenswert.

Abstract

Background: The spectrum of operative interventions in corneal disorders requiring keratoplasty has been expanded considerably in recent years. In addition to the standard technique with full-thickness replacement of the cornea (perforating keratoplasty), lamellar techniques have been introduced. The aim of this review is to highlight current opportunities, indications and complications, as well as possible strategies to standardise lamellar keratoplasties. Materials and Methods: Our own data and a review of the literature in PubMed are summarised. Results: Performing “Descemet Membrane Endothelial Keratoplasty” (DMEK), “Descemt Stripping Automated Endothelial Keratoplasty” (DSAEK) and “Deep Anterior Lamellar Keratoplasty” (DALK) can provide patients with disorders of the corneal endothelium or the anterior corneal stroma with minimally invasive corneal grafts at a reduced risk of complications. Conclusion: DMEK and DSAEK are now internationally the surgical methods of choice in patients with endothelial corneal pathologies, i.e. in Fuchsʼ Endothelial Dystrophy. The DALK technique for lamellar replacement of the anterior stroma, i.e. in keratoconus, needs further standardisation, so that DALK can in future be performed more often even in less specialised departments. Major advantages of lamellar keratoplasties are the very good results in visual outcome and fewer immune reactions or graft rejections. Even intraoperative complications are rare. In the long term, further strategies are desirable for the standardisation of lamellar keratoplasties and its establishment as the primary standard procedure.

Schlüsselwörter

DMEK - DSAEK - DALK - lamelläre Keratoplastik - Endothel - Keratokonus

Key words

DMEK - DSAEK - DALK - lamellar keratoplasty - endothelial - keratoconus

^* Prof. Dr. C. Cursiefen und Dr. F. Schaub haben die gemeinsame Erstautorenschaft.

• Literatur

• 1 Cursiefen C, Kruse FE. [DMEK: Descemet membrane endothelial keratoplasty]. Ophthalmologe 2010; 107: 370-376
• 2 Melles GR, Eggink FA, Lander F et al. A surgical technique for posterior lamellar keratoplasty. Cornea 1998; 17: 618-626
• 3 Melles GR. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea 2006; 25: 879-881
• 4 Al-Torbak AA, Al-Motowa S, Al-Assiri A et al. Deep anterior lamellar keratoplasty for keratoconus. Cornea 2006; 25: 408-412
• 5 Alio JL, Shah S, Barraquer C et al. New techniques in lamellar keratoplasty. Curr Opin Ophthalmol 2002; 13: 224-229
• 6 Cursiefen C, Kruse FE. [Descemetʼs stripping automated endothelial keratoplasty (DSAEK)]. Ophthalmologe 2009; 106: 939-952
• 7 Cursiefen C, Heindl LM. [Perspectives of deep anterior lamellar keratoplasty]. Ophthalmologe 2011; 108: 833-839
• 8 Price MO, Giebel AW, Fairchild KM et al. Descemetʼs membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology 2009; 116: 2361-2368
• 9 Maier P, Reinhard T, Cursiefen C. Descemet stripping endothelial keratoplasty–rapid recovery of visual acuity. Dtsch Arztebl Int 2013; 110: 365-371
• 10 Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea 2006; 25: 886-889
• 11 Ashar JN, Madhavi LK, Vaddavalli PK. Descemetʼs stripping endothelial keratoplasty (DSEK) for children with congenital hereditary endothelial dystrophy: surgical challenges and 1-year outcomes. Graefes Arch Clin Exp Ophthalmol 2012; 250: 1341-1345
• 12 Ashar JN, Ramappa M, Chaurasia S. Endothelial keratoplasty without Descemetʼs stripping in congenital hereditary endothelial dystrophy. J AAPOS 2013; 17: 22-24
• 13 Ashar JN, Ramappa M, Vaddavalli PK. Paired-eye comparison of Descemetʼs stripping endothelial keratoplasty and penetrating keratoplasty in children with congenital hereditary endothelial dystrophy. Br J Ophthalmol 2013; 97: 1247-1249
• 14 Fernandez MM, Buckley EG, Afshari NA. Descemet stripping automated endothelial keratoplasty in a child. J AAPOS 2008; 12: 314-316
• 15 Jeng BH, Marcotty A, Traboulsi EI. Descemet stripping automated endothelial keratoplasty in a 2-year-old child. J AAPOS 2008; 12: 317-318
• 16 Esquenazi S, Rand W. Safety of DSAEK in patients with previous glaucoma filtering surgery. J Glaucoma 2010; 19: 219-220
• 17 Schoenberg ED, Levin KH, Savetsky MJ et al. Surgical outcomes of DSAEK in patients with prior Ahmed glaucoma drainage device placement. Eur J Ophthalmol 2013; 23: 807-813
• 18 Bachmann B, Avgitidou G, Siebelmann S et al. [Pediatric corneal surgery and corneal transplantation]. Ophthalmologe 2015; 112: 110-117
• 19 Anshu A, Price MO, Price jr. FW. Risk of corneal transplant rejection significantly reduced with Descemetʼs membrane endothelial keratoplasty. Ophthalmology 2012; 119: 536-540
• 20 Gonnermann J, Klamann MK, Maier AK et al. Descemet membrane endothelial keratoplasty in a child with corneal endothelial dysfunction in Kearns-Sayre syndrome. Cornea 2014; 33: 1232-1234
• 21 Steven P, Hos D, Heindl LM et al. [Immune reactions after DMEK, DSAEK and DALK]. Klin Monatsbl Augenheilkd 2013; 230: 494-499
• 22 Dapena I, Ham L, Melles GR. Endothelial keratoplasty: DSEK/DSAEK or DMEK – the thinner the better?. Curr Opin Ophthalmol 2009; 20: 299-307
• 23 Schaub F, Cursiefen C, Heindl LM. Retrospective appraisal of split-cornea transplantation: an audit of 1141 donor corneas. JAMA Ophthalmol 2015; 133: 1086-1087
• 24 Melles GR, Ong TS, Ververs B et al. Descemet membrane endothelial keratoplasty (DMEK). Cornea 2006; 25: 987-990
• 25 Nanavaty MA, Wang X, Shortt AJ. Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy. Cochrane Database Syst Rev 2014; (2) CD008420
• 26 Parker J, Dirisamer M, Naveiras M et al. Outcomes of Descemet membrane endothelial keratoplasty in phakic eyes. J Cataract Refract Surg 2012; 38: 871-877
• 27 Bersudsky V, Trevino A, Rumelt S. Management of endothelial decompensation because of glaucoma shunt tube touch by Descemet membrane endothelial keratoplasty and tube revision. Cornea 2011; 30: 709-711
• 28 Busin M. [DSAEK for the treatment of endothelial disease: results in the initial 100 cases]. Klin Monatsbl Augenheilkd 2009; 226: 757-760
• 29 Siggel R, Heindl LM, Cursiefen C. Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes with shallow anterior chamber. Graefes Arch Clin Exp Ophthalmol 2015; 253: 817-819
• 30 Feng MT, Price MO, Price jr. FW. Update on Descemet membrane endothelial keratoplasty (DMEK). Int Ophthalmol Clin 2013; 53: 31-45
• 31 Bachmann BO, Schaub F, Cursiefen C. [Treatment of corneal endothelial disorders by DMEK and UT-DSAEK: indications, complications, results and follow-up]. Ophthalmologe 2016; [Epub ahead of print]
• 32 Cursiefen C. Descemet membrane endothelial keratoplasty: the taming of the shrew. JAMA Ophthalmol 2013; 131: 88-89
• 33 Dapena I, Ham L, Droutsas K et al. Learning curve in Descemetʼs membrane endothelial keratoplasty: first series of 135 consecutive cases. Ophthalmology 2011; 118: 2147-2154
• 34 Gorovoy MS. DMEK complications. Cornea 2014; 33: 101-104
• 35 Krabcova I, Studeny P, Jirsova K. Endothelial quality of pre-cut posterior corneal lamellae for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S): two-year outcome of manual preparation in an ocular tissue bank. Cell Tissue Bank 2013; 14: 325-331
• 36 Cursiefen C, Steven P, Roters S et al. [Prevention and management of complications in Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK)]. Ophthalmologe 2013; 110: 614-621
• 37 Schaub F, Enders P, Roters S et al. High accuracy single-pass Ultrathin DSAEK (UT-DSAEK) with the SLc Expert Microkeratome®. Acta Ophthalmol 2015; submitted
• 38 Dapena I, Moutsouris K, Droutsas K et al. Standardized “no-touch” technique for Descemet membrane endothelial keratoplasty. Arch Ophthalmol 2011; 129: 88-94
• 39 Kruse FE, Laaser K, Cursiefen C et al. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea 2011; 30: 580-587
• 40 Hlinomazova Z, Horackova M, Pirnerova L. [DMEK (Descemet membrane endothelial keratoplasty) – early and late postoperative complications]. Cesk Slov Oftalmol 2011; 67: 75-79
• 41 Bachmann BO, Laaser K, Cursiefen C et al. A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. Am J Ophthalmol 2010; 149: 922-925
• 42 Chaurasia S, Price jr. FW, Gunderson L et al. Descemetʼs membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery). Ophthalmology 2014; 121: 454-458
• 43 Droutsas K, Giallouros E, Melles GR et al. Descemet membrane endothelial keratoplasty: learning curve of a single surgeon. Cornea 2013; 32: 1075-1079
• 44 Nguyen NX, Seitz B, Martus P et al. Long-term topical steroid treatment improves graft survival following normal-risk penetrating keratoplasty. Am J Ophthalmol 2007; 144: 318-319
• 45 Price MO, Feng MT, Scanameo A et al. Loteprednol etabonate 0.5 % gel vs. prednisolone acetate 1 % solution after Descemet membrane endothelial keratoplasty: prospective randomized trial. Cornea 2015; 34: 853-858
• 46 Stanzel T, Ersoy L, Sansanayudh W et al. Immediate postoperative intraocular pressure changes after anterior chamber air fill in Descemet membrane endothelial keratoplasty (DMEK). Cornea 2016; 35: 14-19
• 47 Jordan CS, Price MO, Trespalacios R et al. Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms. Br J Ophthalmol 2009; 93: 387-390
• 48 Cursiefen C, Heiligenhaus A. [Endothelial immune reactions in times of lamellar corneal transplant surgery: mission completed?]. Klin Monatsbl Augenheilkd 2013; 230: 484-485
• 49 Price MO, Price jr. FW, Kruse FE et al. Randomized comparison of topical prednisolone acetate 1 % versus fluorometholone 0.1 % in the first year after descemet membrane endothelial keratoplasty. Cornea 2014; 33: 880-886
• 50 Heinzelmann S, Maier P, Böhringer D et al. Cystoid macular oedema following Descemet membrane endothelial keratoplasty. Br J Ophthalmol 2015; 99: 98-102
• 51 Hoerster R, Stanzel T, Bachmann B et al. Intensified topical steroids as prophylaxis for macular edema after posterior lamellar keratoplasty combined with cataract surgery. Am J Ophthalmol 2016; 163: 174-179.e2
• 52 Maier PC, Heinzelmann S, Böhringer D et al. [Intraocular lens opacification following posterior lamellar keratoplasty]. Klin Monatsbl Augenheilkd 2015; 232: 976-981
• 53 Bachmann BO, Pogorelov P, Kruse FE et al. [Patient satisfaction after posterior lamellar keratoplasty (DSAEK)]. Klin Monatsbl Augenheilkd 2008; 225: 577-581
• 54 Tourtas T, Laaser K, Bachmann BO et al. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 2012; 153: 1082-1090
• 55 Laaser K, Bachmann BO, Horn FK et al. Descemet membrane endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation: advanced triple procedure. Am J Ophthalmol 2012; 154: 47-55
• 56 Feng MT, Price MO, Miller JM et al. Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: five-year follow-up. J Cataract Refract Surg 2014; 40: 1116-1121
• 57 Patel SV, Hodge DO, Bourne WM. Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Am J Ophthalmol 2005; 139: 311-319
• 58 Steven P, Le Blanc C, Velten K et al. Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography. JAMA Ophthalmol 2013; 131: 1135-1142
• 59 Guell JL, Morral M, Gris O et al. Comparison of sulfur hexafluoride 20 % versus air tamponade in Descemet membrane endothelial keratoplasty. Ophthalmology 2015; 122: 1757-1764
• 60 Schaub F, Simons HG, Roters S et al. [Influence of 20 % sulfur hexafluoride (SF6) on human corneal endothelial cells: an in vitro study]. Ophthalmologe 2016; 113: 52-57
• 61 Busin M, Patel AK, Scorcia V et al. Microkeratome-assisted preparation of ultrathin grafts for descemet stripping automated endothelial keratoplasty. Invest Ophthalmol Vis Sci 2012; 53: 521-524
• 62 Busin M, Albe E. Does thickness matter: ultrathin Descemet stripping automated endothelial keratoplasty. Curr Opin Ophthalmol 2014; 25: 312-318
• 63 Neff KD, Biber JM, Holland EJ. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea 2011; 30: 388-391
• 64 Reinhart WJ, Musch DC, Jacobs DS et al. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by the American academy of ophthalmology. Ophthalmology 2011; 118: 209-218
• 65 Seitz B, Cursiefen C, El Husseiny M et al. [DALK and penetrating laser keratoplasty for advanced keratoconus]. Ophthalmologe 2013; 110: 839-848
• 66 Dua HS, Mastropasqua L, Faraj L et al. Big bubble deep anterior lamellar keratoplasty: the collagen layer in the wall of the big bubble is unique. Acta Ophthalmol 2015; 93: 427-430
• 67 Anwar M, Teichmann KD. Big-bubble technique to bare Descemetʼs membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 2002; 28: 398-403
• 68 Riss S, Heindl LM, Bachmann BO et al. Pentacam-based big bubble deep anterior lamellar keratoplasty in patients with keratoconus. Cornea 2012; 31: 627-632
• 69 Cursiefen C, Schaub F, Bachmann BO. [Update DALK in keratoconus: when, how and why]. Ophthalmologe 2016; [in press]
• 70 Riss S, Heindl LM, Bachmann BO et al. Microbubble incision as a new rescue technique for big-bubble deep anterior lamellar keratoplasty with failed bubble formation. Cornea 2013; 32: 125-129
• 71 Feizi S, Javadi MA, Daryabari SH. Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus. Br J Ophthalmol 2015; [Epub ahead of print]
• 72 Ghanem RC, Bogoni A, Ghanem VC. Pachymetry-guided intrastromal air injection (“pachy-bubble”) for deep anterior lamellar keratoplasty: results of the first 110 cases. Cornea 2015; 34: 625-631
• 73 Kubaloglu A, Sari ES, Unal M et al. Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus. Am J Ophthalmol 2011; 151: 760-767
• 74 Unal M, Bilgin B, Yucel I et al. Conversion to deep anterior lamellar keratoplasty (DALK): learning curve with big-bubble technique. Ophthalmic Surg Lasers Imaging 2010; 41: 642-650
• 75 Koenig Y, Bock F, Kruse FE et al. Angioregressive pretreatment of mature corneal blood vessels before keratoplasty: fine-needle vessel coagulation combined with anti-VEGFs. Cornea 2012; 31: 887-892
• 76 Noble BA, Agrawal A, Collins C et al. Deep Anterior Lamellar Keratoplasty (DALK): visual outcome and complications for a heterogeneous group of corneal pathologies. Cornea 2007; 26: 59-64
• 77 Dietrich T, Weisbach V, Seitz B et al. [Manufacture of autologous serum eye drops for out-patient therapy: cooperation between ophthalmic clinic and transfusion medicine department]. Ophthalmologe 2008; 105: 1036-1038 1040–1042
• 78 Watson SL, Ramsay A, Dart JK et al. Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus. Ophthalmology 2004; 111: 1676-1682
• 79 Han DC, Mehta JS, Por YM et al. Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus. Am J Ophthalmol 2009; 148: 744-751
• 80 Krumeich JH, Knülle A, Krumeich BM. [Deep anterior lamellar (DALK) vs. penetrating keratoplasty (PKP): a clinical and statistical analysis]. Klin Monatsbl Augenheilkd 2008; 225: 637-648
• 81 Cheng YY, Visser N, Schouten JS et al. Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology 2011; 118: 302-309
• 82 Buzzonetti L, Laborante A, Petrocelli G. Standardized big-bubble technique in deep anterior lamellar keratoplasty assisted by the femtosecond laser. J Cataract Refract Surg 2010; 36: 1631-1636
• 83 Au J, Goshe J, Dupps jr. WJ et al. Intraoperative optical coherence tomography for enhanced depth visualization in deep anterior lamellar keratoplasty from the PIONEER Study. Cornea 2015; 34: 1039-1043
• 84 Benito-Llopis L, Mehta JS, Angunawela RI et al. Intraoperative anterior segment optical coherence tomography: a novel assessment tool during deep anterior lamellar keratoplasty. Am J Ophthalmol 2014; 157: 334-341
• 85 Siebelmann S, Steven P, Cursiefen C. Intraoperative optical coherence tomography: ocular surgery on a higher level or just nice pictures?. JAMA Ophthalmol 2015; 133: 1133-1134