Skip to main content
SpringerLink
Log in

Endothelkritische Prozeduren während der Herstellung und Transplantation posteriorer lamellärer Hornhauttransplantate

Critical endothelial procedures during posterior lamellar graft preparation and transplantation

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Angesichts der sehr niedrigen Proliferationsrate und der funktionellen Bedeutung des Hornhautendothels bei der Aufrechterhaltung der Hornhauttransparenz spielt die Wahrung der Unversehrtheit dieses Monolayers bei hinteren lamellären Hornhauttransplantationen eine zentrale Rolle. Zur Durchführung einer solchen Transplantation sind mehrere endothelkritische Arbeitsschritte notwendig.

Ziel der Arbeit

Diese Arbeit legt verschiedene präparatorische und operative Vorgehensweisen zur Durchführung der notwendigen und kritischen Schritte im Rahmen einer posterioren lamellären Hornhauttransplantation dar und widmet sich zudem der Frage ihrer Optimierung.

Methoden

Übersicht über eigene Studien sowie Arbeiten anderer Gruppen.

Ergebnisse

Zur Durchführung endothelkritischer Arbeitsschritte bestehen unterschiedliche Vorgehensweisen. Diese erstrecken sich von der Herstellung und der Insertion des Transplantates über dessen Manipulation während der Zentrierung bis hin zu den Effekten der postoperativen Luft- oder Gasblasentamponade.

Schlussfolgerung

Da Endothelschädigungen die Güte des lamellären Transplantates dauerhaft beeinträchtigen können, ist in allen kritischen Prozeduren ein „minimal handling“/„no touch“ anzustreben. Langzeitverlaufsdaten werden aufzeigen, welche von verschiedenen Autoren favorisierten Prozeduren zu den besten postoperativen Ergebnissen führen.

Abstract

Background

In view of the very low proliferation rate and functional importance of the corneal endothelium in maintaining corneal transparency, safeguarding the integrity of this monolayer plays a central role in posterior lamellar corneal transplantation. Several critical endothelial procedural stages are necessary to carry out such a transplantation.

Objective

This article presents various preparatory and operative approaches for carrying out the necessary and critical stages within the framework of posterior lamellar corneal transplantation and concentrates on the question of optimization.

Methods

A review of our own studies and studies of other groups is presented.

Results

For the performance of critical endothelial procedural steps, a variety of approaches are available. These range from preparation and insertion of the transplant, through the manipulation during centralization up to the effects of postoperative air or gas bubble tamponade.

Conclusion

Because endothelial damage can permanently impair the integrity of lamellar transplants, a minimal handling and no touch policy should be strived for in all critical procedures. Long-term data on the follow-up course will show which of the procedures favored by various authors lead to the best postoperative results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. 2016 Annual Report, European Eye Bank Association

  2. 2016 Annual Statistics, Eye Bank Association of America

  3. Busin M, Scorcia V, Patel AK et al (2010) Pneumatic dissection and storage of donor endothelial tissue for Descemet’s membrane endothelial keratoplasty. Ophthalmology 117:1517–1520

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. Czugala M, Mykhaylyk O, Böhler P et al (2016) Efficient and safe gene delivery to human corneal endothelium using magnetic nanoparticles. Nanomedicine 11:1787–1800

    Article  CAS  PubMed  Google Scholar 

  6. Feizi S, Javadi MA (2016) DMEK lenticule preparation using an air dissection technique: central versus peripheral injection. Eur J Ophthalmol 26:6–11

    Article  PubMed  Google Scholar 

  7. Fuchsluger T, Lisch W, Geerling G et al (2015) Cornea: endothelial dystrophies and degenerations. Klin Monbl Augenheilkd 232:85–96

    CAS  PubMed  Google Scholar 

  8. Fuchsluger TA, Jurkunas U, Kazlauskas A et al (2011) Anti-apoptotic gene therapy prolongs survival of corneal endothelial cells during storage. Gene Ther 18:778–787

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Fuchsluger TA, Jurkunas U, Kazlauskas A et al (2011) Corneal endothelial cells are protected from apoptosis by gene therapy. Hum Gene Ther 22:549–558

    Article  CAS  PubMed  Google Scholar 

  10. Fuchsluger TA (2016) Protection of corneal endothelium from apoptosis by gene and cell therapy. Ophthalmologe 113:524–528

    Article  CAS  PubMed  Google Scholar 

  11. Gain P, Thuret G, Chiquet C et al (2002) Value of two mortality assessment techniques for organ cultured corneal endothelium: trypan blue versus TUNEL technique. Br J Ophthalmol 86:306–310

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Güell JL, Morral M, Gris O et al (2013) Bimanual technique for insertion and positioning of endothelium-Descemet membrane graft in Descemet membrane endothelial keratoplasty. Cornea 32:1521–1526

    Article  PubMed  Google Scholar 

  13. Güell JL, Morral M, Gris O et al (2015) Comparison of sulfur hexafluoride 20 % versus air tamponade in Descemet membrane endothelial keratoplasty. Ophthalmology 122:1757–1764

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Hong A, Caldwell MC, Kuo AN et al (2009) Air bubble-associated endothelial trauma in Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 148:256–259

    Article  PubMed  Google Scholar 

  16. Jahresbericht 2016 der Sektion Kornea der Deutschen Ophthalmologischen Gesellschaft

  17. Kaiserman I, Bahar I, Mcallum P et al (2008) Suture-assisted vs forceps-assisted insertion of the donor lenticula during Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 145:986–990

    Article  PubMed  Google Scholar 

  18. Kim BZ, Meyer JJ, Brookes NH et al (2016) New Zealand trends in corneal transplantation over the 25 years 1991–2015. Br J Ophthalmol. doi:10.1136/bjophthalmol-2016-309021

    PubMed Central  Google Scholar 

  19. Kovtun A, Epple M, Steuhl KP et al (2012) Gene therapy in ophthalmology: state of the art. Klin Monbl Augenheilkd 229:603–607

    Article  CAS  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. Kuo AN, Harvey TH, Afshari NA (2008) Novel delivery method to reduce endothelial injury in Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 145:91–96

    Article  PubMed  Google Scholar 

  22. Okumura N, Fujii K, Kagami T et al (2016) Activation of the rho/rho kinase signaling pathway is involved in cell death of corneal endothelium. Invest Ophthalmol Vis Sci 57:6843–6851

    Article  PubMed  Google Scholar 

  23. Rudolph M, Laaser K, Bachmann BO et al (2012) Corneal higher-order aberrations after Descemet’s membrane endothelial keratoplasty. Ophthalmology 119:528–535

    Article  PubMed  Google Scholar 

  24. Salvalaio G, Parekh M, Ruzza A et al (2014) DMEK lenticule preparation from donor corneas using a novel ‚SubHyS‘ technique followed by anterior corneal dissection. Br J Ophthalmol 98:1120–1125

    Article  PubMed  Google Scholar 

  25. Schaub F, Cursiefen C, Heindl LM (2015) Retrospective appraisal of split-cornea transplantation: an audit of 1141 donor corneas. JAMA Ophthalmol 133:1086–1087

    Article  PubMed  Google Scholar 

  26. Schaub F, Enders P, Snijders K et al (2016) One-year outcome after Descemet membrane endothelial keratoplasty (DMEK) comparing sulfurhexafluoride (SF6) 20 % versus 100 % air for anterior chamber tamponade. Br J Ophthalmol. doi:10.1136/bjophthalmol-2016-309653

    Google Scholar 

  27. Schaub F, Simons HG, Roters S et al (2016) Influence of 20 % sulfur hexafluoride (SF6) on human corneal endothelial cells: an in vitro study. Ophthalmologe 113:52–57

    Article  CAS  PubMed  Google Scholar 

  28. Schlögl A, Tourtas T, Kruse FE et al (2016) Long-term clinical outcome after Descemet membrane endothelial keratoplasty. Am J Ophthalmol 169:218–226

    Article  PubMed  Google Scholar 

  29. Schlötzer-Schrehardt U, Bachmann BO, Laaser K et al (2011) Characterization of the cleavage plane in Descemet’s membrane endothelial keratoplasty. Ophthalmology 118:1950–1957

    Article  PubMed  Google Scholar 

  30. Spaniol K, Holtmann C, Schwinde JH et al (2016) Descemet-membrane endothelial keratoplasty in patients with retinal comorbidity – a prospective cohort study. Int J Ophthalmol 18:390–394

    Google Scholar 

  31. Szurman P, Januschowski K, Rickmann A et al (2016) Novel liquid bubble dissection technique for DMEK lenticule preparation. Graefes Arch Clin Exp Ophthalmol 254:1819

    Article  CAS  PubMed  Google Scholar 

  32. Terry MA, Saad HA, Shamie N et al (2009) Endothelial keratoplasty: the influence of insertion techniques and incision size on donor endothelial survival. Cornea 28:24–31

    Article  PubMed  Google Scholar 

  33. Venzano D, Pagani P, Randazzo N et al (2010) Descemet membrane air-bubble separation in donor corneas. J Cataract Refract Surg 36:2022–2027

    Article  PubMed  Google Scholar 

  34. Weller JM, Tourtas T, Kruse FE (2015) Feasibility and outcome of Descemet membrane endothelial keratoplasty in complex anterior segment and vitreous disease. Cornea 34:1351–1357

    Article  PubMed  Google Scholar 

  35. Zhu C, Joyce NC (2004) Proliferative response of corneal endothelial cells from young and older donors. Invest Ophthalmol Vis Sci 45:1743–1751

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinik Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland

    T. A. Fuchsluger FEBO MSc & F. E. Kruse

  2. Klinik für Augenheilkunde, Universitätsklinik Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    G. Geerling

Authors
  1. T. A. Fuchsluger FEBO MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. E. Kruse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Geerling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. A. Fuchsluger FEBO MSc.

Ethics declarations

Interessenkonflikt

T.A. Fuchsluger, F.E. Kruse und G. Geerling geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fuchsluger, T.A., Kruse, F.E. & Geerling, G. Endothelkritische Prozeduren während der Herstellung und Transplantation posteriorer lamellärer Hornhauttransplantate. Ophthalmologe 114, 688–692 (2017). https://doi.org/10.1007/s00347-017-0524-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-017-0524-9

Schlüsselwörter

Keywords

Search

Navigation