Skip to main content
SpringerLink
Log in

Descemet Membran Endothelkeratoplastik (DMEK) und/oder Phakoemulsifikation in phaken Augen mit Hornhautendotheldystrophie

Descemet membrane endothelial keratoplasty (DMEK) and/or phacoemulsification in phakic eyes with corneal endothelial dystrophy

  • themenschwerpunkt
  • Published:
Spektrum der Augenheilkunde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Phake Patienten mit gleichzeitiger Fuchs Endotheldystrophie (FED) stellen eine Herausforderung hinsichtlich der Entscheidung über Zeitpunkt und Reihenfolge einer Descemet Membran Endothelkeratoplastik (DMEK) und/oder Katarakt-Operation dar.

Material und Methode

Klinischer Erfahrungsbericht basierend auf mehr als 500 konsekutiven DMEK-Operationen, die in unserer Klinik durchgeführt wurden.

Resultate

Patienten mit signifikanter Katarakt profitieren primär von einer Katarakt-Operation im ersten Schritt und bei unzureichender Visusverbesserung infolge einer signifikanten Hornhautdekompensation von einer DMEK im zweiten Schritt. Bei Patienten mit inzipienter Katarakt ist eine Identifikation der Hauptursache der Sehverschlechterung (Hornhaut oder Linse) unter Berücksichtigung der subjektiven Beschwerden und der objektiven Diagnostik hilfreich. Auf der anderen Seite profitieren insbesondere junge emmetrope Patienten mit signifikanter FED aber noch relativ klarer Linse von einer alleinigen DMEK, wobei das Risiko postoperativ eine signifikante Katarakt zu entwickeln, relativ gering ist.

Schlussfolgerung

Bei phaken Patienten ist, abhängig vom Ausmaßβ der Linsentrübung und der gleichzeitigen endothelialen Hornhautdystrophie individuell zu entscheiden, ob und in welcher Reihenfolge eine Katarakt-Operation und/oder DMEK zur signifikanten und zufriedenstellenden Visusbesserung am wahrscheinlichsten beitragen wird.

Summary

Background

For phakic patients with Fuchs endothelial dystrophy (FED) undergoing Descemet membrane endothelial keratoplasty (DMEK) there are no clear guidelines whether the crystalline lens should or should not be removed before, during or after DMEK.

Material and Methods

Report of clinical experience based on our consecutive series of more than 500 DMEK surgeries.

Results

Patients with a significant cataract may profit from cataract surgery primary to DMEK, and if still required, DMEK can be performed as a secondary procedure. For patients with an incipient cataract, the primary cause of the reduced visual acuity or visual complaints (cornea or lens) may first be identified to judge which procedure will contribute to the highest visual improvement. On the other hand, especially young phakic patients with a “clear lens” and significant FED may profit from DMEK first leaving the crystalline lens in situ, while the risk to develop a significant cataract after DMEK is relatively small.

Conclusions

Depending on the degree of lens opacification in eyes with endothelial dystrophy, an individual decision may be taken whether or not and in which order cataract surgery and/or DMEK are indicated.

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. Hayashi K, Hayashi H. Simultaneous versus sequential penetrating keratoplasty and cataract surgery. Cornea. 2006;25:1020–5.

    Article  PubMed  Google Scholar 

  2. Covert DJ, Koenig SB. New triple procedure: Descemet’s stripping and automated endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation. Ophthalmology. 2007;114:1272–7.

    Article  PubMed  Google Scholar 

  3. Price MO, Price DA, Fairchild KM, Price FW Jr. Rate and risk factors for cataract formation and extraction after Descemet stripping endothelial keratoplasty. Br J Ophthalmol. 2010;94:1468–71.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Tsui JYM, Goins KM, Sutphin JE, Wagoner MD. Phakic descemet stripping automated endothelial keratoplasty: prevalence and prognostic impact of postoperative cataracts. Cornea. 2011;30:291–5.

    Article  PubMed  Google Scholar 

  5. Parker J, Dirisamer M, Naveiras M, et al. Outcome of Descemet membrane endothelial keratoplasty in phakic eyes. J Cataract Refract Surg. 2012;37:871–7.

    Article  Google Scholar 

  6. Payant JA, Gordon LW, Van der Zwaag R, Wood TO. Cataract formation following corneal transplantation in eyes with Fuchs’ endothelial dystrophy. Cornea. 1990;9:286–9.

    Article  CAS  PubMed  Google Scholar 

  7. Price MO, Price FW Jr. Cataract progression and treatment following posterior lamellar keratoplasty. J Cataract Refract Surg. 2004;30:1310–5.

    Article  PubMed  Google Scholar 

  8. Price FW Jr., Price DA, Ngakeng V, Price MO. Survey of steroid usage patterns during and after low-risk penetrating keratoplasty. Cornea. 2009;28:865–7.

    Article  PubMed  Google Scholar 

  9. Melles GRJ, Dapena I. How to get started with standardized ‚no-touch‘ Descemet membrane endothelial keratoplasty (DMEK). 1st ed. Rotterdam: Netherlands Institute for Innovative Ocular Surgery; 2014. Chapter 10, DMEK and Lens Disease. S. 131–40.

  10. Taylor DM. Keratoplasty and intraocular lenses. Ophthalmic Surg. 1976;7:31–42.

    CAS  PubMed  Google Scholar 

  11. Laaser K, Bachmann BO, Horn FK, Cursiefen CC, Kruse FE. Descemet membrane endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation: advanced triple procedure. Am J Ophthalmol. 2012;154:47–55.

    Article  CAS  PubMed  Google Scholar 

  12. Binder PS. Intraocular lens powers used in the triple procedure: effect on visual acuity and refractive error. Ophthalmology. 1985;92:1561–6.

    Article  CAS  PubMed  Google Scholar 

  13. Binder PS. The triple procedure. Refractive results. 1985 update. Ophthalmology. 1986;93:1482–8.

    Article  PubMed  Google Scholar 

  14. Anshu A, Planchard B, Price MO, da R Pereira C, Price FW Jr. A cause of reticular interface haze and its management after Descemet stripping endothelial keratoplasty. Cornea. 2012;31:1365–8.

    Article  PubMed  Google Scholar 

  15. Dapena I, Moutsouris K, Droutsas K, Ham L, van Dijk K, Melles GRJ. Standardized ‚no touch‘ technique for Descemet’s membrane endothelial keratoplasty. Arch Ophthalmol. 2011;129:88–94.

    Article  PubMed  Google Scholar 

  16. Van Dijk K, Ham L, Tse WHW, et al. Near complete visual recovery and refractive stability in modern corneal transplantation: Descemet membrane endothelial keratoplasty (DMEK). Contact Lens Anterior Eye. 2013;36:13–21.

    Article  PubMed  Google Scholar 

  17. Price M, Price FW Jr. Endothelial keratoplasty – a review. Clin Exp Ophthalmol. 2010;38:128–40.

    Article  Google Scholar 

  18. Tourtas T, Laaser K, Bachmann BO, Cursiefen C, Kruse FE. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2012;153:1082–90.

    Article  PubMed  Google Scholar 

  19. Ham L, Dapena I, Moutsouris K, et al. Refractive change and stability after Descemet membrane endothelial keratoplasty. Effect of corneal dehydration-induced hyperopic shift on intraocular lens power calculation. J Cataract Refract Surg. 2011;37:1455–64.

    Article  PubMed  Google Scholar 

  20. Naveiras M, Dirisamer M, Parker J, et al. Causes of glaucoma after Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2012;153:958–66.

    Article  PubMed  Google Scholar 

  21. Dapena I, Ham L, Tabak S, Balachandran C, Melles GRJ. Phacoemulsification after descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2009;35:1314–5.

    Article  PubMed  Google Scholar 

  22. Dapena I, Yeh R-Y, Quilendrino R, Melles GRJ. Surgical step to facilitate phacoemulsification after Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2012;38:1106–7.

    Article  PubMed  Google Scholar 

  23. Baydoun L, Van Dijk K, Dapena I, Liarakos V, Ham L, Melles GRJ. Repeat Descemet membrane endothelial keratoplasty after complicated primary DMEK. Ophthalmology. 2014. doi:10.1016/j.ophtha.2014.07.024.

  24. Musa FU, Cabrerizo J, Quilendrino R, Dapena I, Ham L, Melles GR. Outcomes of phacoemulsification after Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2013;39:836–40.

    Article  PubMed  Google Scholar 

  25. Dapena I, Ham L, Moutsouris K, Melles GRJ. Incidence of recipient Descemet membrane remnants at the donor-to-stromal interface after descemetorhexis in endothelial keratoplasty. Br J Ophthalmol. 2010;94:1689–90.

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Gerrit Melles fungiert als Berater für DORC International/Dutch Ophthalmic USA und SurgiCube International. Ricarda Konder, Lamis Baydoun, Martin Dirisamer, Peter Ciechanowski und Silke Oellerich geben an, dass kein Interessenkonflikt in Zusammenhang mit diesem Artikel besteht.

Author information

Authors and Affiliations

  1. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande

    Ricarda Konder, Lamis Baydoun MD, FEBO, Martin Dirisamer MD, FEBO, Peter Ciechanowski MD, FEBO, Silke Oellerich PhD & Gerrit Melles MD, PhD

  2. Melles Cornea Clinic Rotterdam, Rotterdam, Niederlande

    Lamis Baydoun MD, FEBO & Gerrit Melles MD, PhD

  3. Amnitrans Eye Bank, Rotterdam, Niederlande

    Lamis Baydoun MD, FEBO & Gerrit Melles MD, PhD

  4. AHK Linz, Linz, Österreich

    Martin Dirisamer MD, FEBO

  5. Stadtspital Triemli, Zürich, Schweiz

    Peter Ciechanowski MD, FEBO

Authors
  1. Ricarda Konder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lamis Baydoun MD, FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Dirisamer MD, FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Ciechanowski MD, FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silke Oellerich PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerrit Melles MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerrit Melles MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Konder, R., Baydoun, L., Dirisamer, M. et al. Descemet Membran Endothelkeratoplastik (DMEK) und/oder Phakoemulsifikation in phaken Augen mit Hornhautendotheldystrophie. Spektrum Augenheilkd. 29, 19–24 (2015). https://doi.org/10.1007/s00717-015-0253-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00717-015-0253-x

Schlüsselwörter

Keywords

Search

Navigation