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Komplikationen der Descemetmembran-Endothel-Keratoplastik

Complications of Descemet’s membrane endothelial keratoplasty

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Zusammenfassung

Die Descemetmembran-Endothel-Keratoplastik (DMEK) ist ein noch relativ neues, aber in Deutschland mittlerweile etabliertes Verfahren zur Therapie kornealer endothelialer Dysfunktionen. Allerdings gibt es auf Spender- und Empfängerseite Quellen für Komplikationen, die teilweise schon präoperativ identifiziert und bedacht werden können oder eventuell zu intra- oder postoperativen Problemen führen. Präoperativ sollten Risiken für ein limitiertes postoperatives Visusergebnis (okuläre Begleiterkrankung, Z. n. Voroperation, stromale/subepitheliale Narben) und die individuelle Indikation zur DMEK mit dem Patienten diskutiert werden. Intraoperativ kann ein junges Spenderalter mit einer elastischen, schwer zu entfaltenden Transplantatrolle assoziiert sein. Diese Transplantate sind ungeeignet für „schwierige“ Empfängeraugen (sehr trübe Empfängerhornhaut, Z. n. Vitrektomie). Postoperativ ist die Transplantatdehiszenz die häufigste Komplikation, die in vielen Fällen erfolgreich mit einer Wiedereingabe von Luft (oder einem Gemisch aus SF6-Gas und Luft) in die Vorderkammer behoben werden kann. Augeninnendruckanstiege nach DMEK sind oft durch eine Steroidreaktion bedingt. Trotz eines geringeren Abstoßungsrisikos nach DMEK im Vergleich zur DSAEK („Descemet stripping automated endothelial keratoplasty“) und perforierenden Keratoplastik ist eine suffiziente lokale Steroidtherapie empfehlenswert. Diese Arbeit gibt eine Übersicht zu den häufigen und einigen selteneren Komplikationen des Verfahrens.

Abstract

Descemet’s membrane endothelial keratoplasty (DMEK) is a relatively new, but now established surgical procedure to cure corneal endothelial disorders. However, there are donor- and recipient-associated sources of potential complications, some of which can be identified and addressed prior to the procedure and others that may lead to intra- or postoperative problems. Preoperatively, risk factors for a limited visual outcome (ocular comorbidities, previous ocular surgery, subepithelial/stromal scars) and the specific indication for DMEK should be discussed with the patient. Intraoperatively, young donor age can be associated with a particularly elastic graft, which may be difficult to unfold. Such transplants are not appropriate for particularly difficult recipient situations (very opaque cornea, history of vitreoretinal surgery). Postoperatively, transplant dehiscence is the most common complication, which in many cases can be managed by reinjection of air (or a 20 % SF6 gas/air mix) into the anterior chamber. An elevation of the intraocular pressure after DMEK is often caused by a reaction to topical steroid therapy. Although immune rejections after DMEK are less likely than after Descemet’s stripping automated endothelial keratoplasty (DSAEK) and perforating keratoplasty, adequate treatment with topical steroidal drugs is recommended. These common and several rare complications are discussed in this review.

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Authors and Affiliations

  1. Universitätsaugenklinik Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    K. Spaniol, M. Borrelli, C. Holtmann, S. Schrader & G. Geerling

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  1. K. Spaniol
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  2. M. Borrelli
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  3. C. Holtmann
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  4. S. Schrader
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Correspondence to K. Spaniol.

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Interessenkonflikt

K. Spaniol, M. Borrelli, C. Holtmann, S. Schrader und G. Geerling geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript 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. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Spaniol, K., Borrelli, M., Holtmann, C. et al. Komplikationen der Descemetmembran-Endothel-Keratoplastik. Ophthalmologe 112, 974–981 (2015). https://doi.org/10.1007/s00347-015-0170-z

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