Therapieoptionen bei Endotheldekompensation nach Glaukomchirurgie

Zusammenfassung

Seit einigen Jahren hat sich die Descemet Membrane endothelial Keratoplasty (DMEK) in Deutschland als Methode der ersten Wahl bei Patienten mit Fuchs-Endotheldystrophie und pseudophaker bullöser Keratopathie durchgesetzt. Bei dieser Operationsmethode, bei der die erkrankte Descemet-Membran durch eine Spenderlamelle aus Descemet-Membran und Endothel ersetzt wird, kann es jedoch nach Glaukomoperationen wie der Trabekulektomie oder der Implantation von Drainageimplantaten zu spezifischen intra- und postoperativen Komplikationen kommen. Hierzu zählen die erschwerte Entfaltung der Transplantate durch das Vorhandensein eines Drainageimplantates mit einem entsprechend erhöhten Endothelzellverlust ebenso wie die Gefahr des Verlustes der Luft-/Gastamponade in der Vorderkammer über die Trabekulektomie bzw. das Drainageimplantat mit entsprechend erhöhtem Dislokationsrisiko für das Transplantat. In der folgenden Übersicht soll zunächst auf das Risiko des Endothelzellverlustes nach verschiedenen Glaukomoperationen eingegangen werden und anschließend die Vor- und Nachteile der verschiedenen Transplantationstechniken erörtert sowie mögliche Hilfestellungen zur Verbesserung der Operationstechnik gegeben werden.

Abstract

During the last few years, Descemet membrane endothelial keratoplasty (DMEK) has become first line surgical treatment for patients with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. However, in eyes with previous trabeculectomy or implantation of a glaucoma drainage device, this surgical technique, where the diseased Descemetʼs membrane and endothelium are replaced by a lamella of donor Descemetʼs membrane and endothelium, may have some limitations. These include complications during surgery such as difficult unfolding of the graft in the presence of a glaucoma tube with a risk of an increased endothelial cell loss and problems after surgery like the loss of the air/gas tamponade in the anterior chamber through the opening of the trabeculectomy or the tube, with an increased risk of graft dislocation. The following review contains information on endothelial cell loss following different glaucoma operations, discusses the advantages and disadvantages of various keratoplasty techniques and gives some technical advice for improving the surgical technique.

Schlüsselwörter

Kornea - DMEK - Glaukom - Keratoplastik

Key words

cornea - DMEK - glaucoma - keratoplasty

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