Skip to main content

Standardisierte Descemet-Membran-Endothelkeratoplastik (DMEK)

Technik und aktuelle Ergebnisse

Standardized Descemet membrane endothelial keratoplasty (DMEK)

Technique and latest results

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.

This is a preview of subscription content, access via your institution.

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Bahar I, Kaiserman I, McAllum P et al (2008) Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. Ophthalmology 115:1525–1533

    PubMed  Article  Google Scholar 

  2. Chen ES, Terry MA, Shamie N et al (2008) Descemet-stripping automated endothelial keratoplasty: six month results in a prospective study of 100 eyes. Cornea 27:514–520

    PubMed  Article  Google Scholar 

  3. Cursiefen C, Kruse FE (2010) DMEK: Descemet membrane endothelial keratoplasty. Ophthalmologe 107:370–376

    CAS  PubMed  Article  Google Scholar 

  4. Cursiefen C, Steven P, Roters S, Heindl LM (2013) Komplikationsvermeidung und -management bei „Descemet membrane endothelial keratoplasty“ (DMEK) und „Descemet stripping automated endothelial keratoplasty“ (DSAEK). Ophthalmologe 110:614–621

    CAS  PubMed  Article  Google Scholar 

  5. Dapena I, Ham L, Melles GRJ (2009) Endothelial keratoplasty: DSEK/DSAEK or DMEK – the thinner the better? Curr Opin Ophthalmol 20:299–307

    PubMed  Article  Google Scholar 

  6. Dapena I, Ham L, Moutsouris K, Melles GR (2010) Incidence of recipient Descemet membrane remnants at the donor-to-stromal interface after descemetorhexis in endothelial keratoplasty. Br J Ophthalmol 94:1689–1690

    PubMed  Article  Google Scholar 

  7. Dapena I, Ham L, Droutsas K et al (2011) Learning curve in Descemet’s membrane endothelial keratoplasty: first series of 135 consecutive cases. Ophthalmology 118:2147–2154

    PubMed  Article  Google Scholar 

  8. Dapena I, Moutsouris K, Droutsas K et al (2011) Standardized „no-touch“ technique for Descemet membrane endothelial keratoplasty (DMEK). Arch Ophthalmol 129:88–94

    PubMed  Article  Google Scholar 

  9. Dirisamer M, Ham L, Dapena I et al (2011) Efficacy of Descemet membrane endothelial keratoplasty (DMEK): clinical outcome of 200 consecutive cases after a „learning curve“ of 25 cases. Arch Ophthalmol 129:1435–1443

    PubMed  Article  Google Scholar 

  10. Dirisamer M, Dijk K van, Dapena I et al (2012) Prevention and management of graft detachment in Descemet membrane endothelial keratoplasty. Arch Ophthalmol 130:280–291

    PubMed  Article  Google Scholar 

  11. Droutsas K, Ham L, Dapena I et al (2010) Visus nach Descemet-Membran Endothelkeratoplastik (DMEK): Ergebnisse der ersten 100 Eingriffe bei Fuchs’scher Endotheldystrophie. Klin Monatsbl Augenheilkd 227:1–11

    Article  Google Scholar 

  12. Gorovoy MS (2006) Descemet-stripping automated endothelial keratoplasty. Cornea 25:886–889

    PubMed  Article  Google Scholar 

  13. Groeneveld-van Beek EA, Lie JT, Wees J van der et al (2013) Standardized „no-touch“ donor tissue preparation for DALK and DMEK: harvesting undamaged anterior and posterior transplants from the same donor cornea. Acta Ophthalmol 91:145–150

    Article  Google Scholar 

  14. Guerra FP, Anshu A, Price MO, Price FW (2011) Endothelial keratoplasty: fellow eyes comparison of Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Cornea 30:1382–1386

    PubMed  Article  Google Scholar 

  15. Guerra FP, Anshu A, Price MO et al (2011) Descemet’s membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss. Ophthalmology 118:2368–2373

    PubMed  Article  Google Scholar 

  16. Heindl LM, Riss S, Adler W et al (2013) Split cornea transplantation: relationship between storage time of split donor tissue and outcome. Ophthalmology 120:899–907

    PubMed  Article  Google Scholar 

  17. Heinzelmann S, Maier P, Reinhard T (2011) Perspektiven der hinteren lamellären Keratoplastik. Ophthalmologe 108:825–832

    CAS  PubMed  Article  Google Scholar 

  18. Kruse FE, Laaser K, Cursiefen C et al (2011) A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea 30:580–587

    PubMed  Google Scholar 

  19. Lee WB, Jacobs DS, Musch DC et al (2009) Descemet’s stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology (Ophthalmic Technology Assessment). Ophthalmology 116:1818–1830

    PubMed  Article  Google Scholar 

  20. Lie JT, Birbal R, Ham L et al (2008) Donor tissue preparation for Descemet membrane endothelial keratoplasty. J Cataract Refract Surg 34:1578–1583

    PubMed  Article  Google Scholar 

  21. Maier P, Reinhard T, Cursiefen C (2013) Descemet stripping endothelial keratoplasty-rapid recovery of visual acuity. Dtsch Arztebl Int 110:365–371

    PubMed Central  PubMed  Google Scholar 

  22. Mearza AA, Qureshi MA, Rostron CK (2007) Experience and 12-month results of Descemet-stripping endothelial keratoplasty (DSEK) with a small-incision technique. Cornea 26:279–283

    PubMed  Article  Google Scholar 

  23. Melles GRJ, Eggink FAGJ, Lander F et al (1999) A surgical technique for posterior lamellar keratoplasty. Cornea 17:618–626

    Article  Google Scholar 

  24. Melles GR, Lander F, Beekhuis WH et al (1999) Posterior lamellar keratoplasty for a case of pseudophakic bullous keratopathy. Am J Ophthalmol 127:340–341

    CAS  PubMed  Article  Google Scholar 

  25. Melles GR, Lander F, Rietveld FJ (2002) Transplantation of Descemet’s membrane carrying viable endothelium through a small scleral incision. Cornea 21:415–418

    PubMed  Article  Google Scholar 

  26. Melles GR, Wijdh RH, Nieuwendaal CP (2004) A technique to excise the Descemet membrane from a recipient cornea (descemetorhexis). Cornea 23:286–288

    PubMed  Article  Google Scholar 

  27. Melles GR, Ong TS, Ververs B, Wees J van der (2006) Descemet membrane endothelial keratoplasty (DMEK). Cornea 25:987–990

    PubMed  Article  Google Scholar 

  28. Ousley PJ, Terry MA (2005) Stability of vision, topography, and endothelial cell density from 1 year to 2 years after deep lamellar endothelial keratoplasty surgery. Ophthalmology 112:50–57

    PubMed  Article  Google Scholar 

  29. Quilendrino R, Höhn H, Tse WH et al (2013) Do we overestimate the endothelial cell „loss“ after descemet membrane endothelial keratoplasty? Curr Eye Res 38:260–265

    PubMed  Article  Google Scholar 

  30. Price FW Jr, Price MO (2005) Descemet’s stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg 21:339–345

    PubMed  Google Scholar 

  31. Price MO, Giebel AW, Fairchild KM, Price FW Jr (2009) Descemet’s membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology 116:2361–2368

    PubMed  Article  Google Scholar 

  32. Terry MA, Ousley PJ (2001) Deep lamellar endothelial keratoplasty in the first United States patients: early clinical results. Cornea 20:239–243

    CAS  PubMed  Article  Google Scholar 

  33. Terry MA, Shamie N, Chen ES et al (2009) Precut tissue for Descemet’s stripping automated endothelial keratoplasty: vision, astigmatism, and endothelial survival. Ophthalmology 116:248–256

    PubMed  Article  Google Scholar 

  34. Tourtas T, Laaser K, Bachman BO et al (2012) Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 153:1082–1090

    PubMed  Article  Google Scholar 

  35. Williams KA, Muehlberg SM, Lewis RF, Coster DJ (1995) How successful is corneal transplantation? A report from the Australian corneal graft register. Eye (Lond) 9:219–227

  36. Yoeruek E, Bayyoud T, Röck D et al (2012) Clinical results after Descemet membrane endothelial keratoplasty. Klin Monatsbl Augenheilkd 229:615–620

    CAS  PubMed  Article  Google Scholar 

  37. Zhu Z, Rife L, Yiu S et al (2006) Technique for preparation of the corneal endothelium-Descemet membrane complex for transplantation. Cornea 25:705–708

    PubMed  Article  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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

Schlüsselwörter

  • Kornea
  • Posteriore lamelläre Keratoplastik
  • Descemet-Membran
  • Fuchs-Endotheldystrophie
  • Visusrehabilitation

Keywords

  • Cornea
  • Posterior lamellar keratoplasty
  • Descemet membrane
  • Fuchs endothelial dystrophy
  • Visual rehabilitation