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Klin Monbl Augenheilkd 2012; 229(6): 594-602
DOI: 10.1055/s-0031-1299545
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Endotheliale Hornhautdystrophien (HD) – Diagnose und Therapie

Endothelial Corneal Dystrophies (CD) – Diagnosis and Therapy
W. Lisch
1   Johannes Gutenberg Universität Mainz, Augenklinik, Mainz
,
B. Seitz
2   Universitätsklinikum des Saarlandes, Augenklinik, Homburg/Saar
› Author Affiliations
Further Information

Publication History

05 March 2012

03 April 2012

Publication Date:
16 May 2012 (online)

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Zusammenfassung

Die 4 endothelialen Hornhautdystrophien (HD) werden hinsichtlich Klinik, Histologie und Genetik präzisiert. Von diesen ist die Fuchs-endotheliale HD in Europa und Nord-Amerika ein häufig zu beobachtendes Krankheitsbild. Neben der bullösen Keratopathie stellt die Fuchs HD heute die häufigste Indikation zur posterioren lamellären Keratoplastik dar, die aktuell auch unter der Bezeichnung „Descemet Stripping Endothelial Keratoplasty“ oder abgekürzt als „DSEK“ fungiert. Die Vor- und Nachteile der „DSEK“ gegenüber der ausgereiften Excimerlaser-assistierten perforierenden Keratoplastik werden gegenübergestellt. Eine oft bei Fuchs HD gleichzeitig bestehende Katarakt sollte möglichst vor der Keratoplastik mittels Phakoemulsifikation und Hinterkammerlinsen-Implantation behandelt werden. Zahlreiche, vergleichende Untersuchungen der einzelnen Operationstechniken sind hinsichtlich ihrer intra-und postoperativen Vorteile und Resultate im vollen Gange und benötigen noch Jahre für eine endgültige Bewertung.

Abstract

Clinical, histological, and genetic definitions of the four endothelial corneal dystrophies (CD) are presented. Of these, Fuchs endothelial CD is one of the most common corneal dystrophies in Europe and North America. Beside bullous keratopathy, Fuchs CD represents the most frequent indication for posterior lamellar keratoplasty that is currently termed „Descemet stripping endothelial keratoplasty” or abbreviated, „DSEK”. A comparison of the advantages and disadvantages of DSEK against the established Excimer laser-assisted penetrating keratoplasty is given. The often simultaneous occurrence of Fuchs CD and cataract should be treated by phacoemulsification and implantation of a posterior chamber lens before the keratoplasty. There are many comparative studies concerning the different surgical techniques to evaluate their intra- and postoperative advantages and results. Many years will be necessary before we can get a scientific and definitive assessment.

Schlüsselwörter

Cornea guttata – Fuchs HD - „Eisenbahnschiene” - „Mondkrater“ - DD des Buphthalmus - perforierende Excimerlaser-Keratoplastik - Descemet-“stripping“

Key words

cornea guttata – Fuchs CD - „railroad track” - „moon craters” - DD of congenital glaucoma - Excimer laser-assisted penetrating keratoplasty - Descemet stripping
 

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