Keratoplastik – Übersicht der Verfahren mit ihrem perioperativen Management

Die Hornhauttransplantation (Keratoplastik) dient dem Ersatz von erkranktem Hornhautgewebe mit einer intakten gesunden Spenderhornhaut. Sie ist die älteste Gewebetransplantation der Medizin und wurde erstmals 1905 durch Dr. Eduard Zirm erfolgreich durchgeführt [1]. Heutzutage ist sie die häufigste und erfolgreichste Form der Transplantation am Menschen weltweit.

Abstract

Corneal transplantation can be divided into two groups: penetrating and lamellar keratoplasty. Newer minimally invasive procedures have emerged over the years, to improve the visual outcome and reduce complications. This article summarizes the different procedures, their indications and complications, and outlines the pre-, peri- and postoperative management in a clinical setting.

Corneal transplantation is the most commonly performed transplantation of donor tissue in modern medicine. In the last years a shift away from penetrating keratoplasty (PK) towards minimally invasive lamellar operative techniques, associated with less complications, can be observed. The Descemet membrane endothelial keratoplasty (DMEK) is used to treat endothelial corneal pathologies and has overtaken the PK to become the most commonly performed form of keratoplasty. Preparation and identification of possible risk-factors are essential preoperative steps to reduce peri- and postoperative complications of keratoplasties. If corneal graft rejection occurs, early and maximum therapy is crucial for graft survival. Laser-assisted techniques offer different advantages in lamellar and penetrating keratoplasty but are not very cost-efficient.

Kernaussagen

• Die Keratoplastik ist die weltweit häufigste Transplantation von Spendergewebe in der Medizin.

• In den letzten Jahren findet ein deutlicher Wandel weg von der perforierenden Keratoplastik hin zu minimalinvasiveren und komplikationsärmeren lamellären Verfahren statt.

• Die DMEK (Descemet Membrane Endothelial Keratoplasty) ist die am häufigsten durchgeführte Form der Keratoplastik und kommt bei endothelialen Hornhautpathologien zum Einsatz.

• Die Vorbereitung und Erkennung von möglichen Risikofaktoren sind essenzielle Schritte vor einer Keratoplastik, um Komplikationen vorzubeugen.

• Beim Auftreten einer Abstoßungsreaktion ist eine frühzeitige und intensive Therapie entscheidend.

• Die laserassistierten Techniken bieten bei der lamellären und perforierenden Keratoplastik verschiedene Vorteile, sind jedoch wenig kosteneffizient.

Publikationsverlauf

Artikel online veröffentlicht:
24. Mai 2024

• Literatur

• 1 Zirm EK. Eine erfolgreiche totale Keratoplastik (A successful total keratoplasty). 1906. Refract Corneal Surg 1989; 5: 258-261
• 2 Seitz B. Deutsches Keratoplastikregister 2021. Deutsche Ophthalmologische Gesellschaft; 2021. Zugriff am 06. April 2024 unter: https://www.dog.org/wp-content/uploads/2022/11/Deutsches-Keratoplastik-Register-2021.pdf
• 3 Arbeitskreis „Augenhornhautbanken“ des Wissenschaftlichen Beirats der Bundesärztekammer. Richtlinie zur Gewinnung von Spernderhornhäuten und zum Führen einer Augenhornhautbank, erste Fortschreibung. Paul-Ehrlich-Institut; 2018. Zugriff am 06. April 2024 unter: https://www.pei.de/SharedDocs/Downloads/DE/newsroom/bundesanzeiger/veroeffentlichungen/2018/banz-at-26-03-2018-b5-anlage.pdf?__blob=publicationFile&v=2
• 4 Pollmann AS, Vianna JR, George SP. et al. Graft dislocation following descemet stripping automated endothelial keratoplasty: a comparative cohort analysis of optisol GS and organ culture preserved corneas. Cell Tissue Bank 2023; 24: 503-514 DOI: 10.1007/s10561-022-10050-4.
• 5 Spierer O, Lazar M. Urrets-Zavalia syndrome (fixed and dilated pupil following penetrating keratoplasty for keratoconus) and its variants. Surv Ophthalmol 2014; 59: 304-310 DOI: 10.1016/j.survophthal.2013.12.002.
• 6 Seitz B, El-Husseiny M, Langenbucher A. et al. Prophylaxe und Management von Komplikationen bei perforierender Keratoplastik. Ophthalmologe 2013; 110: 605-613 DOI: 10.1007/s00347-012-2678-9.
• 7 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 DOI: 10.1097/ICO.0b013e31823f8f7a.
• 8 Seitz B, Langenbucher A, Hager T. et al. Penetrating keratoplasty for keratoconus – excimer versus femtosecond laser trephination. Open Ophthalmol J 2017; 11: 225-240 DOI: 10.2174/1874364101711010225.
• 9 Birnbaum F, Maier P, Reinhard T. Perspektiven der Femtosekundenlaser-assistierten Keratoplastik. Ophthalmologe 2011; 108: 807-816 DOI: 10.1007/s00347-011-2334-9.
• 10 Solano JM, Hodge DO, Bourne WM. Keratometric astigmatism after suture removal in penetrating keratoplasty: double running versus single running suture techniques. Cornea 2003; 22: 716-720 DOI: 10.1097/00003226-200311000-00002.
• 11 Jonas JB, Budde WM. Loosening of single versus double running sutures in penetrating keratoplasty for keratoconus. Graefes Arch Clin Exp Ophthalmol 1999; 237: 522-523 DOI: 10.1007/s004170050273.
• 12 [Anonym] Peri- und postoperative Behandlungsempfehlungen bei perforierender Keratoplastik der Sektion Kornea der DOG: Deutsche Ophthalmologische Gesellschaft (DOG). Zugriff am 06. April 2024 unter: https://www.dog.org/wp-content/uploads/2010/02/Behandlungsempfehlungen-Keratoplastik.pdf
• 13 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 DOI: 10.1016/j.ajo.2007.03.028.
• 14 Kersten A, Sundmacher R, Reinhard T. Postoperative complications of penetrating keratoplasty in herpes infected eyes. Differential diagnosis, therapy and prognostic significance. Ophthalmologe 1997; 94: 889-896 DOI: 10.1007/s003470050217.
• 15 Zhou Y, Wang T, Tuli SS. et al. Overview of corneal transplantation for the nonophthalmologist. Transplant Direct 2023; 9: e1434 DOI: 10.1097/TXD.0000000000001434.
• 16 Abu Dail Y, Suffo S, Flockerzi FA. et al. Fibröse retrokorneale und perilentale Membran nach perforierender Keratoplastik. Ophthalmologie 2022; 119: 1054-1058 DOI: 10.1007/s00347-021-01540-z.
• 17 Gurnani B, Czyz CN, Mahabadi N. et al. Corneal graft rejection. StatPearls: Treasure Island (FL); 2023
• 18 Qazi Y, Hamrah P. Corneal allograft rejection: immunopathogenesis to therapeutics. J Clin Cell Immunol 2013; 2013: 006 DOI: 10.4172/2155-9899.S9-006.
• 19 van Essen TH, Roelen DL, Williams KA. et al. Matching for human leukocyte antigens (HLA) in corneal transplantation – to do or not to do. Prog Retin Eye Res 2015; 46: 84-110 DOI: 10.1016/j.preteyeres.2015.01.001.
• 20 Di Zazzo A, Kheirkhah A, Abud TB. et al. Management of high-risk corneal transplantation. Surv Ophthalmol 2017; 62: 816-827 DOI: 10.1016/j.survophthal.2016.12.010.
• 21 Keane M, Coster D, Ziaei M. et al. Deep anterior lamellar keratoplasty versus penetrating keratoplasty for treating keratoconus. Cochrane Database Syst Rev 2014; (2014) CD009700 DOI: 10.1002/14651858.CD009700.pub2.
• 22 Sarnicola V, Toro P, Sarnicola C. et al. Long-term graft survival in deep anterior lamellar keratoplasty. Cornea 2012; 31: 621-626 DOI: 10.1097/ICO.0b013e31823d0412.
• 23 Anwar M, Teichmann KD. Big-bubble technique to bare Descemetʼs membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 2002; 28: 398-403 DOI: 10.1016/s0886-3350(01)01181-6.
• 24 Liu S, Wong YL, Walkden A. Current perspectives on corneal transplantation. Clin Ophthalmol 2022; 16: 631-646 DOI: 10.2147/OPTH.S289359.
• 25 Terry MA, Ousley PJ. Deep lamellar endothelial keratoplasty in the first United States patients: early clinical results. Cornea 2001; 20: 239-243 DOI: 10.1097/00003226-200104000-00001.
• 26 Melles GR, Wijdh RH, Nieuwendaal CP. A technique to excise the descemet membrane from a recipient cornea (descemetorhexis). Cornea 2004; 23: 286-288 DOI: 10.1097/00003226-200404000-00011.
• 27 Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea 2006; 25: 886-889 DOI: 10.1097/01.ico.0000214224.90743.01.
• 28 Madi S, Leon P, Nahum Y. et al. Five-year outcomes of ultrathin descemet stripping automated endothelial keratoplasty. Cornea 2019; 38: 1192-1197 DOI: 10.1097/ICO.0000000000001999.
• 29 Melles GR, Ong TS, Ververs B. et al. Descemet membrane endothelial keratoplasty (DMEK). Cornea 2006; 25: 987-990 DOI: 10.1097/01.ico.0000248385.16896.34.
• 30 Melles GR, Ong TS, Ververs B. et al. Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol 2008; 145: 222-227 DOI: 10.1016/j.ajo.2007.09.021.
• 31 Deng SX, Lee WB, Hammersmith KM. et al. Descemet membrane endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology 2018; 125: 295-310 DOI: 10.1016/j.ophtha.2017.08.015.
• 32 Szurman P, Januschowski K, Rickmann A. et al. Novel liquid bubble dissection technique for DMEK lenticule preparation. Graefes Arch Clin Exp Ophthalmol 2016; 254: 1819-1823 DOI: 10.1007/s00417-016-3377-z.
• 33 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 DOI: 10.1016/j.ophtha.2015.05.013.
• 34 Gundlach E, Pilger D, Dietrich-Ntoukas T. et al. Impact of re-bubbling after Descemet membrane endothelial keratoplasty on long-term results. Curr Eye Res 2021; 46: 784-788 DOI: 10.1080/02713683.2020.1842459.
• 35 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 DOI: 10.1016/j.jcrs.2014.04.023.
• 36 Price MO, Scanameo A, Feng MT. et al. Descemetʼs membrane endothelial keratoplasty: risk of immunologic rejection episodes after discontinuing topical corticosteroids. Ophthalmology 2016; 123: 1232-1236 DOI: 10.1016/j.ophtha.2016.02.001.
• 37 Quilendrino R, Rodriguez-Calvo de Mora M, Baydoun L. et al. Prevention and management of Descemet membrane endothelial keratoplasty complications. Cornea 2017; 36: 1089-1095 DOI: 10.1097/ICO.0000000000001262.
• 38 Sun SY, Wacker K, Baratz KH. et al. Determining subclinical edema in fuchs endothelial corneal dystrophy: revised classification using scheimpflug tomography for preoperative assessment. Ophthalmology 2019; 126: 195-204 DOI: 10.1016/j.ophtha.2018.07.005.
• 39 De Clerck EEB, Bravetti GE, Kropp M. et al. Bowman layer transplantation for treating keratoconus-preliminary findings. J Clin Med 2023; 12: 2402 DOI: 10.3390/jcm12062402.
• 40 Garcia de Oteyza G, Gonzalez Dibildox LA, Vazquez-Romo KA. et al. Bowman layer transplantation using a femtosecond laser. J Cataract Refract Surg 2019; 45: 261-266 DOI: 10.1016/j.jcrs.2018.10.034.
• 41 van Dijk K, Parker JS, Baydoun L. et al. Bowman layer transplantation: 5-year results. Graefes Arch Clin Exp Ophthalmol 2018; 256: 1151-1158 DOI: 10.1007/s00417-018-3927-7.
• 42 Jacob S, Patel SR, Agarwal A. et al. Corneal allogenic intrastromal ring segments (CAIRS) combined with corneal cross-linking for keratoconus. J Refract Surg 2018; 34: 296-303 DOI: 10.3928/1081597X-20180223-01.
• 43 Spadea L, Giammaria D, Fiasca A. et al. Excimer laser-assisted lamellar keratoplasty for the surgical treatment of keratoconus. J Cataract Refract Surg 2009; 35: 105-112 DOI: 10.1016/j.jcrs.2008.10.013.
• 44 Deshmukh R, Stevenson LJ, Vajpayee RB. Laser-assisted corneal transplantation surgery. Surv Ophthalmol 2021; 66: 826-837 DOI: 10.1016/j.survophthal.2021.01.009.
• 45 Behrens A, Seitz B, Kuchle M. et al. “Orientation teeth” in non-mechanical laser corneal trephination for penetrating keratoplasty: 2.94 microm Er : YAG v 193 nm ArF excimer laser. Br J Ophthalmol 1999; 83: 1008-1012 DOI: 10.1136/bjo.83.9.1008.
• 46 Serdarevic ON, Hanna K, Gribomont AC. et al. Excimer laser trephination in penetrating keratoplasty. Morphologic features and wound healing. Ophthalmology 1988; 95: 493-505 DOI: 10.1016/s0161-6420(88)33160-x.
• 47 Mian SI, Shtein RM. Femtosecond laser-assisted corneal surgery. Curr Opin Ophthalmol 2007; 18: 295-299 DOI: 10.1097/ICU.0b013e3281a4776c.
• 48 Einan-Lifshitz A, Sorkin N, Boutin T. et al. Comparison of femtosecond laser-enabled descemetorhexis and manual descemetorhexis in Descemet membrane endothelial keratoplasty. Cornea 2017; 36: 767-770 DOI: 10.1097/ICO.0000000000001217.
• 49 Chamberlain WD, Rush SW, Mathers WD. et al. Comparison of femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty. Ophthalmology 2011; 118: 486-491 DOI: 10.1016/j.ophtha.2010.08.002.