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Einfluss der Spenderlamellendicke auf die Sehschärfe nach „Descemet’s stripping automated endothelial keratoplasty“ (DSAEK)

Influence of donor lamella thickness on visual acuity after Descemet’s stripping automated endothelial keratoplasty (DSAEK)

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Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es, den Einfluss der Spenderlamellendicke auf die Sehschärfenentwicklung nach hinterer lamellärer Keratoplastik („Descemet’s stripping automated endothelial keratoplasty“, DSAEK) zu untersuchen.

Material und Methoden

Es wurden 65 Augen von 61 Patienten in diese retrospektive Studie eingeschlossen. Bei allen Patienten erfolgte eine DSAEK-Operation bei Fuchs-Endotheldystrophie oder bullöser Hornhautdekompensation über einen Zeitraum von Mitte 2008 bis Ende 2011. Die Messung der kornealen Lamellendicke wurde intraoperativ mit der Ultraschallpachymetrie und mindestens 6 Monate postoperativ mit dem Vorderabschnittsegment der optischen Kohärenztomographie (Stratus OCT, Carl Zeiss Meditec Inc., Dublin, CA) bestimmt. Zusätzlich erfolgte die Messung der Endothelzellzahl und der bestkorrigierten Sehschärfe.

Ergebnisse

Die Messwerte der intraoperativ und postoperativ gemessenen Spenderlamellendicke korrelieren signifikant miteinander (r = 0,874, p < 0,001). Eine signifikant positive Korrelation zwischen Sehschärfe und der postoperativ mit dem Stratus-OCT gemessenen zentralen Spenderlamellendicke konnte gezeigt werden (r = 0,273, p = 0,028), jedoch keine zwischen Sehschärfe und intraoperativ gemessener Spenderlamellendicke (r = 0,241, p = 0,103). Eine Abhängigkeit zwischen postoperativer Endothelzellzahl und intraoperativer sowie postoperativer kornealer Lamellendicke konnte nicht nachgewiesen werden (r = −0,059, p = 0,731, r = 0,024 p = 0,869).

Schlussfolgerung

Bei einer zentralen Spenderlamellendicke < 120 µm werden bessere postoperative, funktionelle Ergebnisse erreicht als bei einer Hornhautdicke > 120 µm. Ein größerer Endothelzellverlust trotz schwierigerer Präparationstechnik der dünneren Lamelle ist nicht nachweisbar. Die DSAEK mit einer Spenderlamellendicke < 120 µm ist daher als Alternative zur DMEK von großem Interesse.

Abstract

Background

The aim of this study was to evaluate the effect of donor lamella thickness on postoperative visual acuity after Descemet’s stripping automated endothelial keratoplasty (DSAEK).

Materials and methods

A retrospective analysis of 65 eyes from 61 patients who underwent DSAEK surgery in cases of Fuchs’ corneal dystrophy or bullous keratopathy between 2008 and 2011 was performed. The thickness of donor lamella was measured intraoperatively by ultrasonic pachymetry and postoperatively by anterior segment optical coherence tomography (OCT) and correlated to the visual acuity and number of endothelial cells.

Results

The donor lamella thickness measured intraoperatively and postoperatively correlated significantly with each other (r = 0.874, p < 0.001). A significant correlation was found between postoperative corneal lamella thickness measured by anterior segment OCT and visual acuity (r = 0.273, p = 0.028) but not between intraoperative donor lamella thickness measured by ultrasonic pachymetry and visual acuity (r = 0.241, p = 0.103). The postoperative endothelial cell number did not show a correlation with either the intraoperatively or the postoperatively measured donor lamella thickness (r = − 0.059, p = 0.731, r = 0.024, p = 0.869, respectively).

Conclusions

Corneal lamella thickness < 120 µm was found to be correlated with a better visual outcome than in cases of thicker corneas > 120 µm. Despite greater difficulty in corneal transplant technique in cases of thinner lamella no increased damage of corneal endothelium was shown. Therefore, DSAEK with corneal lamella thickness < 120 µm is an interesting therapeutic alternative to DMEK.

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Interessenkonflikt

Die korrespondierende Autorin gibt für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.

Anna-Karina B. Maier: „Friedrich C. Luft“ Clinical Scientist-Pilotprogramm, gefördert von der Volkswagen Stiftung und der Stiftung Charité.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    A.-K.B. Maier, E. Gundlach, M.K.J. Klamann, J. Gonnermann, E. Bertelmann, A.M. Joussen & N. Torun

  2. Augenklinik Berlin-Marzahn, Berlin, Deutschland

    P.W. Rieck

Authors
  1. A.-K.B. Maier
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  2. E. Gundlach
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  3. M.K.J. Klamann
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  4. J. Gonnermann
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  5. E. Bertelmann
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  6. A.M. Joussen
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  7. N. Torun
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  8. P.W. Rieck
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Correspondence to A.-K.B. Maier.

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Maier, AK., Gundlach, E., Klamann, M. et al. Einfluss der Spenderlamellendicke auf die Sehschärfe nach „Descemet’s stripping automated endothelial keratoplasty“ (DSAEK). Ophthalmologe 111, 128–134 (2014). https://doi.org/10.1007/s00347-013-2795-0

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  • DOI: https://doi.org/10.1007/s00347-013-2795-0

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