Klin Monbl Augenheilkd 2010; 227(6): 478-482
DOI: 10.1055/s-0029-1245447
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Komplikationen nach posteriorer lamellärer Keratoplastik (DSAEK): Vermeiden, Erkennen und Behandeln

Complications after Posterior Lamellar Keratoplasty (DSAEK): Prevention, Detection and TreatmentL. M. Heindl1 , F. E. Kruse1 , C. Cursiefen1
  • 1Augenklinik des Universitätsklinikums Erlangen
Further Information

Publication History

Eingegangen: 19.1.2010

Angenommen: 26.4.2010

Publication Date:
17 June 2010 (online)

Zusammenfassung

Hintergrund: Posteriore lamelläre Keratoplastiktechniken, wie die Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), nehmen zunehmend Einzug in die klinische Routine. Ziel der Arbeit ist es, typische Komplikationen nach DSAEK, deren Management sowie Strategien zur Vermeidung darzustellen. Methoden: Literaturübersicht aus PUBMED und eigene klinische Ergebnisse. Ergebnisse: Die postoperative Flapdislokation, die mit erneuter Luftfüllung der Vorderkammer behandelt werden kann, ist die häufigste und typischste Komplikation nach DSAEK (10 – 30 % der Patienten). Schlussfolgerung: Eine sorgfältige Indikationsstellung, Operationstechnik und Nachsorge können die DSAEK zu einem relativ sicheren und effektiven Therapieverfahren bei endothelialen Hornhauterkrankungen machen.

Abstract

Purpose: The aim of this study was to outline typical complications after Descemet’s stripping automated endothelial keratoplasty (DSAEK) and to discuss their prevention and management. Methods: Our own clinical results and PUBMED literature search were evaluated. Results: Postoperative flap dislocation, which can be effectively treated by re-bubbling the graft, is the most common and typical complication after DSAEK. Conclusions: Careful preoperative indication, surgery and postoperative care make DSAEK a safe and effective new therapeutic option for patients with endothelial corneal disease.

Literatur

  • 1 Cursiefen C, Küchle M, Naumann G OH. Changing indications for penetrating keratoplasty: histopathology of 1250 corneal buttons.  Cornea. 1998;  17 468-470
  • 2 Price F W, Price M O. Does endothelial cell survival differ between DSEK and standard PK?.  Ophthalmology. 2009;  116 367-368
  • 3 Das Jr S, Langenbucher A, Jacobi C et al. Long-term refractive and visual outcome after penetrating keratoplasty only versus the triple procedure in Fuchs’ dystrophy.  Graefes Arch Clin Exp Ophthalmol. 2006;  244 1089-1095
  • 4 Bachmann B O, Pogorelov P, Kruse F E et al. Patientenzufriedenheit nach posteriorer lamellärer Keratoplastik (DSAEK).  Klin Monbl Augenheilkd. 2008;  225 577-581
  • 5 Bahar I, Kaiserman I, Levinger E et al. Retrospective contralateral study comparing descemet stripping automated endothelial keratoplasty with penetrating keratoplasty.  Cornea. 2009;  28 485-488
  • 6 Gorovoy M S. Descemet-stripping automated endothelial keratoplasty.  Cornea. 2006;  25 886-889
  • 7 Heindl L M, Hofmann-Rummelt C, Schlötzer-Schrehardt U et al. Histologic analysis of descemet stripping in posterior lamellar keratoplasty.  Arch Ophthalmol. 2008;  126 461-464
  • 8 Melles G R, Eggink F A, Lander F et al. A surgical technique for posterior lamellar keratoplasty.  Cornea. 1998;  17 618-626
  • 9 Busin M, Arffa R C, Sebastiani A. Endokeratoplasty as an alternative to penetrating keratoplasty for the surgical treatment of diseased endothelium: initial results.  Ophthalmology. 2000;  107 2077-2082
  • 10 Cursiefen C, Kruse F E. Posteriore lamelläre Keratoplastik (DSAEK).  Ophthalmologe. 2009;  106 939-952
  • 11 Terry M A, Shamie N, Chen E S et al. Endothelial keratoplasty for Fuchs’ dystrophy with cataract: complications and clinical results with the new triple procedure.  Ophthalmology. 2009;  116 631-639
  • 12 Ousley P J, Terry M A. Stability of vision, topography, and endothelial cell density from 1 year to 2 years after deep lamellar endothelial keratoplasty surgery.  Ophthalmology. 2005;  112 50-57
  • 13 Pogorelov P, Cursiefen C, Bachmann B O et al. Changes in donor corneal lenticule thickness after Descemet’s stripping automated endothelial keratoplasty (DSAEK) with organ-cultured corneas.  Br J Ophthalmol. 2009;  93 825-829
  • 14 Price M O, Price F W. Descemet’s stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue.  Ophthalmology. 2006;  113 1936-1942
  • 15 Price M O, Jordan C S, Moore Jr G et al. Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part two: the statistical analysis of probability and risk factors.  Br J Ophthalmol. 2009;  93 391-395
  • 16 Terry M A. Endothelial keratoplasty: clinical outcomes in the two years following deep lamellar endothelial keratoplasty (an American Ophthalmological Society thesis).  Trans Am Ophthalmol Soc. 2007;  105 530-563
  • 17 Terry M A, Ousley P J. Deep lamellar endothelial keratoplasty: visual acuity, astigmatism, and endothelial survival in a large prospective series.  Ophthalmology. 2005;  112 1541-1548
  • 18 Cursiefen C, Kruse F E. Posteriore lamelläre Keratoplastik (DSAEK).  Ophthalmologe. 2008;  105 183-190
  • 19 Anshu A, Chee S P, Mehta J S et al. Cytomegalovirus endotheliitis in Descemet’s stripping endothelial keratoplasty.  Ophthalmology. 2009;  116 624-630
  • 20 Jordan C S, Price M O, Trespalacios R et al. Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms.  Br J Ophthalmol. 2009;  93 387-390
  • 21 Nguyen N X, Seitz B, Martus P et al. Long-term topical steroid treatment improves graft survival following normal-risk penetrating keratoplasty.  Am J Ophthalmol. 2007;  144 318-319
  • 22 Melles G R, Ong T S, Ververs B et al. Descemet membrane endothelial keratoplasty (DMEK).  Cornea. 2006;  25 987-990
  • 23 Ham L, Balachandran C, Verschoor C A et al. Visual rehabilitation rate after isolated descemet membrane transplantation: descemet membrane endothelial keratoplasty.  Arch Ophthalmol. 2009;  127 252-255
  • 24 Bachmann B, Laaser K, Cursiefen C et al. A new method for correct orientation of Descemet membrane during DMEK.  Am J Ophthalmol. (in press)
  • 25 Lam V M, Nguyen N X, Martus P et al. Surgery-related factors influencing corneal neovascularization after low-risk keratoplasty.  Am J Ophthalmol. 2006;  141 260-266
  • 26 Ide T, Yoo S H, Kymionis G D et al. Descemet-stripping automated endothelial keratoplasty (DSAEK): effect of nontoxic gentian violet marking pen on DSAEK donor tissue viability by using vital dye assay.  Cornea. 2008;  27 562-564

PD Dr. Claus Cursiefen

Augenklinik des Universitätsklinikums Erlangen

91054 Erlangen

Phone: ++ 49/91 31/8 53 30 01

Fax: ++ 49/91 31/8 53 64 01

Email: ccursiefen@yahoo.com