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Descemet-Membran-Endothelkeratoplastik (DMEK) – Klinische Ergebnisse der ersten 120 Fälle

Descemet Membrane Endothelial Keratoplasty (DMEK): clinical outcome of our first 120 consecutive cases

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Zusammenfassung

Hintergrund

Ziel dieser Studie war es, unsere ersten 120 konsekutiven Descemet-Membran-Endothelkeratoplastik (DMEK) Fälle bezüglich klinischer Ergebnisse, Komplikationen und der Durchführbarkeit dieser neuen Operationsmethode zu evaluieren. Zudem sollte untersucht werden, ob DMEK auch für ein breiteres Indikationsspektrum, beispielsweise als Sekundärtransplantation nach primärer lamellierender Keratoplastik, geeignet ist.

Material und Methode

Alle DMEK Operationen wurden gemäß einer standardisierten, berührungsfreien Technik von 2 Operateuren durchgeführt. Bei allen Augen wurde präoperativ und 3, 6 und 12 Monate postoperativ eine Spaltlampenuntersuchung durchgeführt sowie die bestkorrigierte Sehstärke bestimmt. Weiters wurden Scheimpflug-Tomographie und Spektral-Domain Optische Kohärenz Tomographie Aufnahmen angefertigt sowie alle aufgetretenen Komplikationen aufgezeichnet.

Resultate

Drei Monate postoperativ erreichten Augen mit einem funktionellen Transplantat und ohne Visus-kompromittierende Begleiterkrankungen (n = 58) eine bestkorrigierte Sehstärke von ≥ 0,5 in 91 %, von ≥ 0,8 in 63 %, von ≥ 1,0 in 39 % und von ≥ 1,2 in 7 % der Fälle. Ein Jahr postoperativ erhöhte sich diese Verteilung auf ≥ 0,5 in 98 %, ≥ 0,8 in 88 %, ≥ 1,0 in 64 % und ≥ 1,2 in 10 %. Intraoperative Komplikationen wurden in 12 Fällen (10 %) verzeichnet. Die häufigsten postoperativen Komplikationen waren eine klinisch signifikante Transplantatablösung (14 %) bzw. das primäre Transplantatversagen (18 %).

Schlussfolgerung

Die vorliegende Studie ist die größte Studie konsekutiver DMEK Operationen in Österreich. Sie bestätigt auf Grund exzellenter Visusergebnisse, rascher Restitution des Visus, sowie niedriger Komplikationsrate die Vorrangstellung der DMEK bei endothelialen Erkrankungen gegenüber alternativen Keratoplastik Methoden. Auch bei der Sekundärtransplantation nach primärer lamellierender oder perforierender Keratoplastik erscheint die DMEK als die geeignete Methode.

Summary

Background

In the last decade Descemet membrane endothelial keratoplasty (DMEK) has emerged as the treatment of choice for various diseases of the corneal endothelium, first and foremost Fuchs endothelial dystrophy (FED). Aim of this study was to assess the first 120 DMEK cases performed at our institution with regards to clinical outcomes and complications. Furthermore, this study intended to explore further indications for this technique.

Material and methods

All procedures were performed by two surgeons following the previously described standardized no-touch DMEK technique. A comprehensive slit lamp examination, best corrected visual acuity (BCVA) testing, Scheimpflug tomography and spectral-domain optical coherence tomography were performed preoperatively as well as 3 months, 6 months and 1 year postoperatively. Furthermore, all intraoperative and postoperative complications were noted.

Results

In eyes with functional DMEK grafts and good visual prognosis (n = 58), 3 months postoperatively the BCVA was ≥ 0.5 (≥ 20/40) in 91 %, ≥ 0.8 (≥ 20/25) in 63 %, ≥ 1.0 (≥ 20/20) in 39 % and ≥ 1.2 (≥ 20/17) in 7 % of eyes, respectively. One year postoperatively, the distribution of BCVA was ≥ 0.5 (≥ 20/40) in 98 %, ≥ 0.8 (≥ 20/25) in 88 %, ≥ 1.0 (≥ 20/20) in 64 % and ≥ 1.2 (≥ 20/17) in 10 % of eyes, respectively. Intraoperative complications occurred in 10 % of cases. Main postoperative complications were clinically significant graft detachment (14 %) and primary graft failure (18 %).

Conclusions

We present the largest study of consecutive DMEK cases in Austria reported to date. DMEK provides relatively quick and nearly complete visual rehabilitation in a vast majority of patients operated on for endothelial diseases. Complications were generally rare and manageable when they occurred. Our results suggest that the scope of indications for DMEK might be widened, for example for managing lamellar or penetrating keratoplasty cases with poor visual outcome.

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Authors and Affiliations

  1. Ars Ophthalmica Study Center, Augenabteilung AKH Linz, Krankenhausstraße 9, 4020, Linz, Österreich

    Nikolaus Luft,  Siegfried G. Priglinger FEBO, Josef Pretzl, Eva Wimmer, Klaus Wiesinger, Matthias Bolz & Martin Dirisamer

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  1. Nikolaus Luft
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  2. Siegfried G. Priglinger FEBO
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  3. Josef Pretzl
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  4. Eva Wimmer
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  6. Matthias Bolz
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  7. Martin Dirisamer
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Correspondence to Siegfried G. Priglinger FEBO.

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Luft, N., Priglinger, S.G., Pretzl, J. et al. Descemet-Membran-Endothelkeratoplastik (DMEK) – Klinische Ergebnisse der ersten 120 Fälle. Spektrum Augenheilkd. 29, 10–18 (2015). https://doi.org/10.1007/s00717-015-0258-5

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