Skip to main content
SpringerLink
Log in

Zehn Jahre „Descemet membrane endothelial keratoplasty“ bei Fuchs-Dystrophie

Was haben wir gelernt?

10 years of Descemet membrane endothelial keratoplasty in Fuchs endothelial corneal dystrophy

What have we learned?

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund und Ziel der Arbeit

Die „Descemet membrane endothelial keratoplasty“ (DMEK) erfreut sich seit ihrer Einführung vor über 10 Jahren weltweit zunehmender Beliebtheit in der Therapie der Fuchs-Dystrophie. Im vorliegenden Beitrag sollen am Zentrum für Augenheilkunde der Universität zu Köln gesammelte Erfahrungen der vergangenen Jahre in einer Übersicht dargestellt werden.

Methoden

Es erfolgte eine Literaturübersicht von Studien zur DMEK primär aus dem Zentrum für Augenheilkunde der Universität zu Köln. Es werden eigene Erfahrungen in den Bereichen der Spenderauswahl und Transplantatpräparation, der DMEK-Chirurgie, des Komplikationsmanagements und der postoperative Therapie zusammengefasst.

Ergebnis

Seit Einführung der DMEK haben Erfahrungszuwachs und fortwährende Verbesserungen von der Spender-Empfänger-Allokation bis hin zur postoperativen Nachsorge stattgefunden. Diese führen zur besseren Reproduzierbarkeit des Eingriffs für den Chirurgen, zum besseren postoperativen Ergebnis und zur Reduktion der Komplikationsrate am Patienten.

Diskussion

Die DMEK stellt ein sicheres und individualisiertes Verfahren zur Endotheltransplantation bei kornealer endothelialer Dysfunktion dar. Kontinuierliche Weiterentwicklungen des Verfahrens führen zu optimaleren Ergebnissen.

Abstract

Background and objective

Descemet membrane endothelial keratoplasty (DMEK) has increased in popularity since its introduction over 10 years ago. This article presents a summary of the experiences of the past years collected at the Department of Ophthalmology at the University of Cologne.

Methods

A literature review of DMEK studies primarily from the Department of Ophthalmology at the University of Cologne, Germany was carried out. Own experiences in the fields of donor selection and graft preparation, DMEK surgery, complication management and postoperative treatment are summarized.

Results

Since the introduction of DMEK experience has been gained and ongoing improvements have occurred ranging from donor-recipient allocation to postoperative follow-up. These led to a better reproducibility of the intervention for the surgeon, to a better postoperative result and to a reduction of the complication rate.

Discussion

The DMEK represents a safe and individualized procedure for endothelial transplantation for corneal endothelial dysfunction. Continuing development of the method leads to optimization and safer results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Bachmann B, Cursiefen C (2017) Intra- and postoperative complications and their management in DMEK (including re-DMEK). In: Cursiefen C, Jun AS (Hrsg) Current treatment options for Fuchs endothelial dystrophy. Springer, Cham, S 153–164

    Chapter  Google Scholar 

  2. Bachmann B, Schrittenlocher S, Matthaei M et al (2019) DMEK in komplexen Augen. Ophthalmologe (im Druck)

  3. Bachmann BO, Laaser K, Cursiefen C et al (2010) A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. Am J Ophthalmol 149:922–925

    Article  Google Scholar 

  4. Bachmann BO, Pogorelov P, Kruse FE et al (2008) Patientenzufriedenheit nach posteriorer lamellärer Keratoplastik (DSAEK). Klin Monatsbl Augenheilkd 225:577–581

    Article  CAS  Google Scholar 

  5. Bachmann BO, Schrittenlocher SA, Schaub F et al (2017) DMEK: Probleme vermeiden, erkennen, lösen. Klin Monatsbl Augenheilkd 234:1354–1361

    Article  Google Scholar 

  6. Baydoun L, Dapena I, Melles G (2016) Evolution of posterior lamellar keratoplasty: PK – DLEK – DSEK/DSAEK – DMEK – DMET. In: Cursiefen C, Jun AS (Hrsg) Current treatment options for Fuchs endothelial dystrophy. Springer, Cham, S 73–85

    Google Scholar 

  7. Bucher F, Hos D, Muller-Schwefe S et al (2015) Spontaneous long-term course of persistent peripheral graft detachments after descemet’s membrane endothelial keratoplasty. Br J Ophthalmol 99:768–772

    Article  Google Scholar 

  8. Cursiefen C, Kruse FE (2010) DMEK: posteriore lamelläre Keratoplastiktechnik. Ophthalmologe 107:370–376

    Article  CAS  Google Scholar 

  9. Cursiefen C, Steven P, Roters S et al (2013) Komplikationsvermeidung und -management bei „Descemet membrane endothelial keratoplasty“ (DMEK) und „Descemet stripping automated endothelial keratoplasty“ (DSAEK). Ophthalmologe 110:614–621

    Article  CAS  Google Scholar 

  10. Flockerzi E, Maier P, Böhringer D et al (2018) Trends in corneal transplantation from 2001 to 2016 in Germany: a report of the DOG-section cornea and its keratoplasty registry. Am J Ophthalmol 188:91–98

    Article  Google Scholar 

  11. Heindl LM, Koch KR, Bucher F et al (2013) Descemet membrane endothelial keratoplasty in eyes with glaucoma implants. Optom Vis Sci 90:e241–244 (discussion 1029)

    Article  Google Scholar 

  12. Heindl LM, Riss S, Adler W et al (2013) Split cornea transplantation: relationship between storage time of split donor tissue and outcome. Ophthalmology 120:899–907

    Article  Google Scholar 

  13. Heindl LM, Riss S, Bachmann BO et al (2011) Split cornea transplantation for 2 recipients: a new strategy to reduce corneal tissue cost and shortage. Ophthalmology 118:294–301

    Article  Google Scholar 

  14. Heindl LM, Riss S, Laaser K et al (2011) Split cornea transplantation for 2 recipients—review of the first 100 consecutive patients. Am J Ophthalmol 152:523–532.e2

    Article  Google Scholar 

  15. Heinzelmann S, Huther S, Bohringer D et al (2014) Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea 33:644–648

    Article  Google Scholar 

  16. Heinzelmann S, Maier P, Bohringer D et al (2015) Cystoid macular oedema following descemet membrane endothelial keratoplasty. Br J Ophthalmol 99:98–102

    Article  Google Scholar 

  17. Hoerster R, Stanzel TP, Bachmann BO et al (2016) Intensified early postoperative topical steroids do not influence endothelial cell density after descemet membrane endothelial keratoplasty combined with cataract surgery (triple-DMEK). Cornea 35:1396–1400

    Article  Google Scholar 

  18. Hoerster R, Stanzel TP, Bachmann BO et al (2016) Intensified topical steroids as prophylaxis for macular edema after posterior lamellar keratoplasty combined with cataract surgery. Am J Ophthalmol 163:174–179.e172

    Article  CAS  Google Scholar 

  19. Hos D, Heindl LM, Bucher F et al (2014) Evidence of donor corneal endothelial cell migration from immune reactions occurring after descemet membrane endothelial keratoplasty. Cornea 33:331–334

    Article  Google Scholar 

  20. Hos D, Tuac O, Schaub F et al (2017) Incidence and clinical course of immune reactions after descemet membrane endothelial keratoplasty: retrospective analysis of 1000 consecutive eyes. Ophthalmology 124:512–518

    Article  Google Scholar 

  21. Iovieno A, Neri A, Soldani AM et al (2017) Descemetorhexis without graft placement for the treatment of Fuchs endothelial dystrophy: preliminary results and review of the literature. Cornea 36:637–641

    Article  Google Scholar 

  22. Kinoshita S, Koizumi N, Ueno M et al (2018) Injection of cultured cells with a ROCK inhibitor for bullous keratopathy. N Engl J Med 378:995–1003

    Article  CAS  Google Scholar 

  23. Kruse FE, Laaser K, Cursiefen C et al (2011) A stepwise approach to donor preparation and insertion increases safety and outcome of descemet membrane endothelial keratoplasty. Cornea 30:580–587

    Article  Google Scholar 

  24. Kruse FE, Schrehardt US, Tourtas T (2014) Optimizing outcomes with Descemet’s membrane endothelial keratoplasty. Curr Opin Ophthalmol 25:325–334

    Article  Google Scholar 

  25. Lang SJ, Bischoff M, Bohringer D et al (2014) Analysis of the changes in keratoplasty indications and preferred techniques. PLoS ONE 9:e112696

    Article  Google Scholar 

  26. Lapp T, Heinzelmann S, Bohringer D et al (2018) Use of donor corneas from pseudophakic eyes for descemet membrane endothelial keratoplasty. Cornea 37:859–862

    Article  Google Scholar 

  27. Maier AK, Gundlach E, Schroeter J et al (2015) Influence of the difficulty of graft unfolding and attachment on the outcome in descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 253:895–900

    Article  Google Scholar 

  28. Matthaei M, Bachmann B, Siebelmann S et al (2018) Technik der „Descemet membrane endothelial keratoplasty“ (DMEK): Videobeitrag. Ophthalmologe 115:778–784

    Article  CAS  Google Scholar 

  29. Melles GRJ, Ong TS, Ververs B et al (2006) Descemet membrane endothelial keratoplasty (DMEK). Cornea 25:987–990

    Article  Google Scholar 

  30. Price MO, Gupta P, Lass J et al (2017) EK (DLEK, DSEK, DMEK): new frontier in cornea surgery. Annu Rev Vis Sci 3:69–90

    Article  Google Scholar 

  31. Price MO, Lisek M, Feng MT et al (2017) Effect of donor and recipient diabetes status on descemet membrane endothelial keratoplasty adherence and survival. Cornea 36:1184–1188

    PubMed  Google Scholar 

  32. Price MO, Scanameo A, Feng MT et al (2016) Descemet’s membrane endothelial keratoplasty: risk of immunologic rejection episodes after discontinuing topical corticosteroids. Ophthalmology 123:1232–1236

    Article  Google Scholar 

  33. Schaub F, Cursiefen C, Heindl LM (2015) Retrospective appraisal of split-cornea transplantation: an audit of 1141 donor corneas. JAMA Ophthalmol 133:1086–1087

    Article  Google Scholar 

  34. Schaub F, Enders P, Bluhm C et al (2017) Two-year course of corneal densitometry after Descemet membrane endothelial keratoplasty. Am J Ophthalmol 175:60–67

    Article  Google Scholar 

  35. Schaub F, Enders P, Snijders K et al (2017) One-year outcome after descemet membrane endothelial keratoplasty (DMEK) comparing sulfur hexafluoride (SF6) 20 % versus 100 % air for anterior chamber tamponade. Br J Ophthalmol 101:902–908

    Article  Google Scholar 

  36. Schaub F, Enders P, Zachewicz J et al (2016) Impact of donor age on descemet membrane endothelial keratoplasty outcome: evaluation of donors aged 17–55 years. Am J Ophthalmol 170:119–127

    Article  Google Scholar 

  37. Schaub F, Pohl L, Enders P et al (2017) Impact of corneal donor lens status on two-year course and outcome of Descemet membrane endothelial keratoplasty (DMEK). Graefes Arch Clin Exp Ophthalmol 255:2407–2414

    Article  Google Scholar 

  38. Schaub F, Simons HG, Roters S et al (2016) Einfluss von 20 % Schwefelhexafluorid (SF6) auf humane korneale Endothelzellen: eine In-vitro-Studie. Ophthalmologe 113:52–57

    Article  CAS  Google Scholar 

  39. Schrittenlocher S, Penier M, Schaub F et al (2017) Intraocular lens calcifications after (triple‑)descemet membrane endothelial keratoplasty. Am J Ophthalmol 179:129–136

    Article  Google Scholar 

  40. Schrittenlocher S, Schaub F, Hos D et al (2018) Evolution of consecutive descemet membrane endothelial keratoplasty outcomes throughout a 5-Year period performed by two experienced surgeons. Am J Ophthalmol 190:171–178

    Article  Google Scholar 

  41. Siebelmann S, Bachmann B, Lappas A et al (2016) Intraoperative optische Koharenztomographie bei hornhaut- und glaukomchirurgischen Eingriffen. Ophthalmologe 113:646–650

    Article  CAS  Google Scholar 

  42. Siebelmann S, Gehlsen U, Le Blanc C et al (2016) Detection of graft detachments immediately following descemet membrane endothelial keratoplasty (DMEK) comparing time domain and spectral domain OCT. Graefes Arch Clin Exp Ophthalmol 254:2431–2437

    Article  Google Scholar 

  43. Siebelmann S, Lopez Ramos S, Scholz P et al (2018) Graft detachment pattern after descemet membrane endothelial keratoplasty comparing air versus 20 % SF6 tamponade. Cornea 37:834–839

    Article  Google Scholar 

  44. Siebelmann S, Matthaei M, Horster R et al (2017) Lutein and Brilliant Blue-based dye for donor preparation and transplantation in descemet membrane endothelial keratoplasty. Cornea 36:440–444

    Article  Google Scholar 

  45. Siebelmann S, Ramos SL, Matthaei M et al (2018) Factors associated with early graft detachment in primary descemet membrane endothelial keratoplasty. Am J Ophthalmol 192:249–250

    Article  Google Scholar 

  46. Siebelmann S, Scholz P, Sonnenschein S et al (2017) Anterior segment optical coherence tomography for the diagnosis of corneal dystrophies according to the IC3D classification. Surv Ophthalmol 63:365–380

    Article  Google Scholar 

  47. Siggel R, Heindl LM, Cursiefen C (2015) Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes with shallow anterior chamber. Graefes Arch Clin Exp Ophthalmol 253:817–819

    Article  Google Scholar 

  48. Stanzel TP, Ersoy L, Sansanayudh W et al (2016) Immediate postoperative intraocular pressure changes after anterior chamber air fill in descemet membrane endothelial keratoplasty. Cornea 35:14–19

    Article  Google Scholar 

  49. Steven P, Hos D, Heindl LM et al (2013) Immunreaktionen nach DMEK, DSAEK und DALK. Klin Monatsbl Augenheilkd 230:494–499

    Article  CAS  Google Scholar 

  50. Steven P, Le Blanc C, Velten K et al (2013) Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography. JAMA Ophthalmol 131:1135–1142

    Article  Google Scholar 

  51. Tourtas T, Heindl LM, Kopsachilis N et al (2013) Use of accidentally torn descemet membrane to successfully complete descemet membrane endothelial keratoplasty. Cornea 32:1418–1422

    Article  Google Scholar 

  52. Tourtas T, Schlomberg J, Wessel JM et al (2014) Graft adhesion in descemet membrane endothelial keratoplasty dependent on size of removal of host’s Descemet membrane. JAMA Ophthalmol 132:155–161

    Article  Google Scholar 

  53. Weller JM, Schlotzer-Schrehardt U, Tourtas T et al (2016) Influence of ultrastructural corneal graft abnormalities on the outcome of descemet membrane endothelial keratoplasty. Am J Ophthalmol 169:58–67

    Article  Google Scholar 

Download references

Danksagung

Wir danken den Mitarbeitern der Hornhautbank am Zentrum für Augenheilkunde der Uniklinik zu Köln für die Bereitstellung der Daten für Abb. 1.

Author information

Authors and Affiliations

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

    M. Matthaei FEBO, S. Schrittenlocher, D. Hos, S. Siebelmann, F. Bucher, F. Schaub, R. Siggel, S. Roters, L. M. Heindl, B. Bachmann & C. Cursiefen

  2. UCL Institute of Ophthalmology, University College London, London, Großbritannien

    F. Bucher

  3. Moorfields Eye Hospital, London, Großbritannien

    F. Bucher

  4. MVZ ADTC Mönchengladbach/Erkelenz, Erkelenz, Deutschland

    R. Hoerster

Authors
  1. M. Matthaei FEBO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Schrittenlocher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Hos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Siebelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Bucher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Schaub
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Hoerster
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. Siggel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Roters
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. L. M. Heindl
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. B. Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C. Cursiefen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Matthaei FEBO.

Ethics declarations

Interessenkonflikt

M. Matthaei, S. Schrittenlocher, D. Hos, S. Siebelmann, F. Bucher, F. Schaub, R. Hoerster, R. Siggel, S. Roters, L.M. Heindl, B. Bachmann und C. Cursiefen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matthaei, M., Schrittenlocher, S., Hos, D. et al. Zehn Jahre „Descemet membrane endothelial keratoplasty“ bei Fuchs-Dystrophie. Ophthalmologe 116, 236–242 (2019). https://doi.org/10.1007/s00347-018-0800-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-018-0800-3

Schlüsselwörter

Keywords

Search

Navigation