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Standardisierte Descemet-Membran-Endothelkeratoplastik (DMEK)

Technik und aktuelle Ergebnisse

Standardized Descemet membrane endothelial keratoplasty (DMEK)

Technique and latest results

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Zusammenfassung

Hintergrund

Zur Behandlung endothelialer Hornhauterkrankungen haben sich die Verfahren der posterioren lamellären Keratoplastiken inzwischen als Therapie der Wahl durchgesetzt. Die „Descemet membrane endothelial keratoplasty“ (DMEK) stellt das jüngste Verfahren dar. Mit dieser Studie wurden 400 konsekutive Fälle nach der standardisierten No-touch-DMEK evaluiert.

Methoden

Es handelt sich um eine nicht randomisierte, retrospektive klinische Studie. Von 400 konsekutiven DMEK-Augen (321 Patienten) wurden der bestkorrigierte Visus, die Endothelzelldichte (EZD) und Hornhautpachymetrie sowie Komplikationen innerhalb der ersten 6 Monate nach DMEK evaluiert. Zusätzlich wurden 2 Subgruppen (I: Fälle 1 bis 200; II: Fälle 201 bis 400) getrennt voneinander ausgewertet.

Ergebnisse

Nach 6 Monaten erreichten 80 % aller Augen einen bestkorrigierten Visus von ≥ 0,8, 44 % von ≥ 1,0 und 14 % von ≥ 1,2. Zwischen den Subgruppen bestand kein signifikanter Unterschied. Die Endothelzelldichte nahm durchschnittlich von präoperativ 2542 (± 217) Zellen/mm2 auf 1622 (± 500) Zellen/mm2 nach 6 Monaten ab (− 36 %). Die Anzahl der Folgeeingriffe lag bei 5 %, wobei drei Viertel davon in der ersten Subgruppe durchgeführt wurden.

Schlussfolgerung

Die nun standardisierte No-touch-DMEK-Technik ermöglicht bei der Mehrzahl der operierten Augen eine rasche und fast vollständige Visusrehabilitation. Sie ist eine sichere Operationsmethode, die sich zum Standardverfahren der posterioren lamellären Keratoplastiken entwickelt.

Abstract

Background

The procedure of posterior lamellar keratoplasty has now become established as first choice therapy for the treatment of corneal endothelial diseases, with Descemet membrane endothelial keratoplasty (DMEK) as the most recent refinement of endothelial keratoplasty techniques. In this study the outcome of 400 consecutive cases after standardized no-touch DMEK was evaluated.

Methods

This was a non-randomized retrospective clinical study of 400 consecutive eyes in 321 patients who underwent standard DMEK. Outcome measures included best corrected visual acuity (BCVA) preoperatively and postoperatively at 1, 3 and 6 months, endothelial cell density (ECD), pachymetry and complications within the first 6 months. In addition two subgroups were analyzed (subgroup I cases 1–200 and subgroup II cases 201–400).

Results

At 6 months postoperatively 80 % of all eyes had a BCVA of ≥ 20/25 (≥ 0.8), 44 % of ≥ 20/20 (≥ 1.0) and 14 % of ≥ 20/18 (≥ 1.2). There were no significant differences between the two subgroups. The mean ECD preoperatively was 2,542 (± 217) cells/mm2 and 6 months postoperatively 1,622 (± 500) cells/mm2. The mean ECD decrease was 36 % 6 months after DMEK. No difference between the subgroups was noted. In 5 % a re-operation was needed of which 75 % were performed in subgroup I.

Conclusion

With the standardized no-touch DMEK technique a rapid and nearly complete visual rehabilitation as well as ECD values similar to earlier endothelial keratoplasty techniques can be achieved. Therefore DMEK may become the preferred treatment for corneal endothelial disorders.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G.R.J. Melles fungiert als Berater für DORC International BV/Dutch Ophthalmic USA. P.P. Ciechanowski, K. Droutsas, L. Baydoun, M. Dirisamer und S. Oellerich geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071 AA, Rotterdam, Niederlande

    P.P. Ciechanowski, K. Droutsas, L. Baydoun, M. Dirisamer, S. Oellerich &  G.R.J. Melles M.D., Ph.D.

  2. Melles Cornea Clinic Rotterdam, Rotterdam, Niederlande

    P.P. Ciechanowski, K. Droutsas, L. Baydoun, M. Dirisamer &  G.R.J. Melles M.D., Ph.D.

  3. Klinik für Augenheilkunde, Universitätsklinikum Marburg, Marburg, Deutschland

    K. Droutsas

  4. AKH Linz, Linz, Österreich

    M. Dirisamer

  5. Amnitrans EyeBank Rotterdam, Rotterdam, Niederlande

    G.R.J. Melles M.D., Ph.D.

  6. Stadtspital Triemli Zürich, Zürich, Schweiz

    P.P. Ciechanowski

Authors
  1. P.P. Ciechanowski
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  2. K. Droutsas
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  3. L. Baydoun
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  4. M. Dirisamer
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  5. S. Oellerich
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  6. G.R.J. Melles M.D., Ph.D.
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Correspondence to G.R.J. Melles M.D., Ph.D..

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Ciechanowski, P., Droutsas, K., Baydoun, L. et al. Standardisierte Descemet-Membran-Endothelkeratoplastik (DMEK). Ophthalmologe 111, 1041–1049 (2014). https://doi.org/10.1007/s00347-013-3014-8

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  • DOI: https://doi.org/10.1007/s00347-013-3014-8

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