Descemet-Membran-Endothelkeratoplastik (DMEK)

Zusammenfassung

Die Descemet-Membran-Endothelkeratoplastik (DMEK) stellt den Goldstandard in der Therapie von isolierten Erkrankungen des Hornhautendothels dar, allen voran der Fuchs-Endotheldystrophie. Durch ihre überlegenen Visusergebnisse und aufgrund der niedrigeren und weiter sinkenden Komplikationsrate macht sie der weltweit etablierten Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) den Rang streitig. Die Etablierung einer standardisierten und reproduzierbaren DMEK-Methode und Fortschritte im Bereich der Spendergewebspräparation ebnen den Weg für viele Chirurgen, sich diese spannende und zugleich fordernde Operationstechnik anzueignen. Ein umfassender Blick in die Literatur zeigt, dass es gewisse verbleibende Herausforderungen der Methode zu adressieren gilt. Beispielsweise stellt die Transplantatablösung die häufigste Komplikation der DMEK dar. Es bedarf zukünftig großer prospektiv-randomisierter Studien, um die Vorteile der DMEK-Methode gegenüber alternativen lamellären Keratoplastiktechniken zu untermauern und verbleibende Problembereiche zu beleuchten.

Abstract

Descemet membrane endothelial keratoplasty (DMEK) is the gold standard for the treatment of corneal endothelial disease, first and foremost Fuchsʼ endothelial dystrophy. Superior visual rehabilitation as well as lower and decreasing complication rates can be obtained with DMEK than with Descemet stripping automated endothelial keratoplasty (DSAEK) – still the most commonly performed type of posterior lamellar keratoplasty. Recent advancements in the DMEK method include the establishment of a standardised and reproducible surgical “no touch” technique and the emerging role of eye banks, which are able to prepare convenient pre-cut DMEK grafts. These developments pave the way for increasing numbers of corneal surgeons to add DMEK to their armamentarium, despite the more challenging nature of this procedure. However, a review of the current literature shows that this fascinating technique still offers certain challenges, which need to be further addressed. For example, graft detachment remains the most commonly encountered complication after DMEK. A plethora of prospective-randomised studies is required to further endorse the evident superiority of DMEK over alternative types of lamellar keratoplasty and to help propagate the practice of this fascinating technique.

Schlüsselwörter

DMEK - Descemet-Membran-Endothelkeratoplastik - Hornhaut - Transplantation

Key words

DMEK - Descemet membrane endothelial keratoplasty - cornea - lamellar keratoplasty - transplantation

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