Immunreaktionen nach DMEK, DSAEK und DALK

Zusammenfassung

Hintergrund: Das Auftreten von Immunreaktionen nach hinterer (DMEK und DSAEK) und vorderer (DALK) lamellärer Keratoplastik sowie deren Prävention und Therapie werden dargestellt.

Methoden: Literaturübersicht aus PubMed sowie eigene klinische und experimentelle Daten.

Ergebnisse: Während das Risiko einer endothelialen Immunreaktion nach hinterer lamellärer Keratoplastik mittels DSAEK nur leicht geringer zu sein scheint als nach perforierender Normalrisiko-Keratoplastik, ist bei isoliertem Austausch der Descemet-Membran (DMEK) das Immunreaktionsrisiko signifikant verringert. Nach DALK tritt keine endotheliale Immunreaktion mehr auf.

Schlussfolgerungen: Die isolierte Transplantation der Descemet-Membran mit Endothelzellen führt zu einem fast völligen Verschwinden von endothelialen Immunreaktionen nach Keratoplastik. Um das Risiko so minimal wie möglich zu halten, sollte dennoch eine postoperative topische Steroidprophylaxe durchgeführt werden. Nach DALK treten überhaupt keine endothelialen Immunreaktionen mehr auf.

Abstract

Purpose: The aim of this study is to describe incidence, diagnosis and therapy for endothelial immune reactions after modern lamellar corneal transplantat surgery (DMEK, DSAEK, DALK).

Methods: A PubMed-based literature review and our own clinical and experimental data are evaluated.

Results: There is no longer an endothelial immune reaction after DALK for keratoconus. DMEK significantly reduces the risk for endothelial immune reactions after surgery for Fuchs dystrophy.

Conclusions: Modern lamellar corneal transplant techniques such as DALK and DMEK have nearly abolished the risk for endothelial immune reactions in the avascular recipient bed.

Schlüsselwörter

Kornea - Pharmakologie - Pathologie - DMEK - DSAEK - DALK - Immunreaktion

Key words

cornea - pharmacology - pathology - DMEK - DSAEK - DALK - immune reactions

• Literatur

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