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.

Publication History

Article published online:
24 May 2024

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