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Technik der „Descemet membrane endothelial keratoplasty“ (DMEK)

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Technique of Descemet membrane endothelial keratoplasty (DMEK)

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Zusammenfassung

Hintergrund

Bei der „Descemet membrane endothelial keratoplasty“ (DMEK) werden selektiv erkranktes Hornhautendothel und Descemet-Membran entfernt und durch gesundes Spendergewebe ersetzt. Die DMEK stellt heute den Goldstandard zur Therapie der kornealen endothelialen Dysfunktion dar.

Methoden

Im vorliegenden Beitrag wird die Operationstechnik der DMEK anhand eines Videos dargestellt, und darüber hinaus werden Operationsindikationen, Patientenaufklärung, Anästhesie und Lagerung, postoperative Behandlung sowie mögliche Komplikationen und deren Management erläutert.

Ergebnis

Die DMEK kann im breiten Spektrum zur Therapie der kornealen endothelialen Dysfunktion angewendet werden. Die Grundlage für die hervorragenden Ergebnisse des Operationsverfahrens sind neben der operativen Umsetzung auch sorgfältige Spender-Patienten-Allokation, gründliche Voruntersuchung und Nachsorge der Patienten und Erfahrung des Operateurs.

Schlussfolgerung

Die DMEK ist ein sicheres und effektives Verfahren zur Therapie der kornealen endothelialen Dysfunktion. Ein standardisiertes und individualisiertes Vorgehen ermöglicht im Vergleich mit allen bisherigen Transplantationsverfahren optimalste Ergebnisse.

Abstract

Background

Descemet membrane endothelial keratoplasty (DMEK) selectively removes diseased corneal endothelium and Descemet membrane and replaces them with healthy donor tissue. The DMEK technique represents the current gold standard for the treatment of corneal endothelial dysfunction.

Methods

In this article the surgical technique for DMEK is presented by means of a video. The indications for surgery, patient education, anesthesia and patient positioning, postoperative treatment as well as possible complications and their management are described.

Results

The DMEK can be applied for the treatment of a wide range of corneal endothelial disorders. In addition to the operative implementation, the basis for the outstanding results of the surgical procedure are careful donor-patient allocation, thorough examination and follow-up of all patients and experience of the surgeon.

Conclusion

The use of DMEK is a safe and effective procedure for the treatment of corneal endothelial dysfunction. A standardized and individualized procedure provides the basis for optimal results compared to all previous transplantation procedures.

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Förderung

German Research Foundation (FOR2240 to CC; MA 5110/5-1 to MM; CU 47/6-1, CU 47/9-1, CU 47/12-1 to CC), FORTUNE Program University of Cologne (to MM); GEROK Program University of Cologne (to MM); Zentrum für Molekulare Medizin Köln (ZMMK; to CC, MM); EU COST BM1302 „Joining Forces in Corneal Regeneration“ (to CC, SS), EU Arrest Blindness (to CC), EU EFRE NRW (to SS).

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Authors and Affiliations

  1. Zentrum für Augenheilkunde, Universitätsklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland

    M. Matthaei FEBO, B. Bachmann, S. Siebelmann & C. Cursiefen

Authors
  1. M. Matthaei FEBO
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  2. B. Bachmann
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  3. S. Siebelmann
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  4. C. Cursiefen
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Corresponding author

Correspondence to M. Matthaei FEBO.

Ethics declarations

Interessenkonflikt

M. Matthaei, B. Bachmann, S. Siebelmann und C. Cursiefen geben an, dass kein Interessenkonflikt besteht.

Alle 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. Es handelt sich um eine Übersichtsarbeit, die auf eigenen Erfahrungen basiert sowie eine Literaturübersicht aus PubMed umfasst.

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Video: „Descemet membrane endothelial keratoplasty“ (DMEK); Copyright: PD Dr. Mario Matthaei, Köln

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Matthaei, M., Bachmann, B., Siebelmann, S. et al. Technik der „Descemet membrane endothelial keratoplasty“ (DMEK). Ophthalmologe 115, 778–784 (2018). https://doi.org/10.1007/s00347-018-0743-8

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