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Klin Monbl Augenheilkd 2012; 229(6): 621-623
DOI: 10.1055/s-0031-1299522
Klinische Studie
© Georg Thieme Verlag KG Stuttgart · New York

Precut Verfahren für Descemet-Membran-Endothelzelltransplantation, Präparation und Aufbewahrung in Kultur

Precut Technique for Descemet's Membrane Endothelial Keratoplasty, Preparation and Storage in Organ Culture
T. Bayyoud
,
D. Röck
,
J. Hofmann
,
K.-U. Bartz-Schmidt
,
E. Yoeruek
Further Information

Publication History

08 February 2012

26 March 2012

Publication Date:
29 June 2012 (online)

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Zusammenfassung

Hintergrund: Prinzipiell kann die Präparation der Descemet-Membran (DM) mit der Endothelzellschicht unmittelbar vor der eigentlichen Operation oder als sogenanntes Precut Verfahren sequenziell erfolgen. Ziel dieser Untersuchung war die Evaluierung der Präparationstechnik der DM und dessen isolierte Aufbewahrung in Kulturmedium über 10 Tage, um eventuell vorhandene Zellverluste in der Precut Technik zu erfassen.

Material und Methoden: Bei zehn Spenderhornhäuten mit einem mittleren Alter von 64,3 wurde die DM mit der Endothelzellschicht präpariert, der zentrale Bereich der Größe 8,5 mm ausgestanzt und über 10 Tage unter Kulturbedingungen aufbewahrt. Während der Aufbewahrungsphase ist am 1., 4., 7. und 10. Tag die Endothelzelldichte (EZD) bestimmt worden. Die Präparationsdauer sowie die morphologische Qualität der Transplantate wurden festgehalten.

Ergebnisse: Bei allen Spenderhornhäuten konnten wir die DM mit der Endothelzellschicht erfolgreich präparieren. Die mittlere Präparationsdauer betrug 8,3 min. Die mittlere EZD betrug 2183 Zellen/mm2 ± 77 vor der Präparation, 2094 ± 110 Zellen/mm2 am 1. Tag, 2078 ± 134 Zellen/mm2 am 4. Tag, 1977 ± 107 Zellen/mm2 am 7. Tag und 1898 ± 170 Zellen/mm2 am 10. Tag jeweils nach der Präparation. Die Endothelzellzahlverluste beliefen sich auf 4,1 %, 4,8 %, 9,4 %, und 13,1 % entsprechend der Kontrollintervalle. Größere zentrale Zellverlustareale traten in keinem der Transplantate auf.

Schlussfolgerung: Eine isolierte Aufbewahrung der DM mit der Endothelzellschicht ohne stromale Anteile der Hornhaut ist unter Kulturbedingungen mit einem moderaten Zellverlust verbunden. Prinzipiell ist daher die Durchführung einer Precut DMEK denkbar.

Abstract

Background: The preparation of the Descemet’s membrane (DM) with the endothelial cell layer may be performed directly prior to surgery or as a precut tissue procedure. The purpose of the current study was the evaluation of the preparation technique and the tissue culture of 10 days regarding potential endothelial cell loss.

Materials and Methods: Ten corneoscleral rims with an average age of 64.3 years were dissected to obtain 8.5 mm in diameter endothelial-DM complexes, which subsequently were organ cultured for 10 days. The endothelial cell density (ECD) was assessed during the cell culture period at days 1., 4., 7. and 10. In addition, time of preparation and transplant morphology were evaluated.

Results: The DM with the endothelial cell layer could successfully be dissected from all corneoscleral rims. The average preparation time was 8.3 min. The average ECD count was 2183 ± 77 cells/mm2 prior to, 2094 ± 110 cells/ mm2 at day 1, 2078 ± 134 cells/mm2 at day 4, 1977 ± 107 cells/mm2 at day 7 and 1898 ± 170 cells/mm2 at day 10 after preparation, respectively. Endothelial cell loss was 4.1 %, 4.8 %, 9.4 % and 13.1 % after preparation, respectively. None of the transplants exhibited large, centrally-located cell deficits.

Conclusion: The isolated storage of DM with the endothelial layer, without any stromal remnants, showed gratifying results under storage conditions in organ culture with a moderate ECD decrease. Hence, the implementation of a precut DMEK is conceivable.

Schlüsselwörter

Descemet-Membran-Endotheliale-Keratoplastik - Posteriore lamelläre Keratoplastik - Precut Gewebe - Descemet-Membran

Key words

Descemet membrane endothelial keratoplasty - Posterior lamellar keratoplasty - Precut tissue - Descemet membrane
 

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