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Endothelkritische Prozeduren während der Herstellung und Transplantation posteriorer lamellärer Hornhauttransplantate

Critical endothelial procedures during posterior lamellar graft preparation and transplantation

  • Leitthema
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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.

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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
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  2. F. E. Kruse
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  3. G. Geerling
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Corresponding author

Correspondence to T. A. Fuchsluger FEBO MSc.

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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.

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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

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

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