Descemet-Stripping ohne Transplantat bei Fuchsʼscher endothelialer Hornhautdystrophie?

Zusammenfassung

Traditionell wird das Hornhautendothel als postmitotisch angesehen, sodass von einer spontanen Regeneration nach Verlust von Endothelzellen (z. B. im Rahmen der Fuchsʼschen endothelialen Hornhautdystrophie) nicht ausgegangen wird. Dennoch konnte in mehreren Fällen beobachtet werden, dass eine ödematöse Hornhaut nach Entfernung eines kleineren Areals der Descemet-Membran aufklart. Der posteriore Aspekt dieses Bereichs wurde von Hornhautendothelzellen wieder bedeckt. Hieraus entstand ein operatives Therapiekonzept ohne posteriores lamelläres Transplantat: „Descemet stripping only“. Zugleich legen Daten aus In-vitro-Versuchen nahe, dass Rho-Kinase-Inhibitoren (ROCK-Inhibitoren) pharmakologische Wirkstoffe sind, die eine Proliferation und Migration des Hornhautendothels fördern und somit den Heilungsverlauf nach Descemet-Stripping positiv beeinflussen. Mittlerweile liegen erste Daten aus kleineren prospektiven, kontrollierten klinischen Studien vor, die durchweg gute Ergebnisse nach Descemet-Stripping und ROCK-Inhibitor-Augentropfen berichten. Offene Fragen bestehen jedoch derzeit noch hinsichtlich der Charakteristika der Patientengruppe, die von diesem Therapieansatz besonders profitiert und hinsichtlich der Nachhaltigkeit eines Therapieerfolgs.

Schlüsselwörter

Kornea - ROCK-Inhibitor - Keratoplastik - Fuchsʼsche endotheliale Hornhautdystrophie - Descemet-Stripping

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