Split-Cornea-Transplantation – ein neues Konzept gegen Spendermangel

 

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Zusammenfassung

Hintergrund: Die perforierende Keratoplastik ist bisher das Standardverfahren der Hornhauttransplantation. In den letzten Jahren haben sich jedoch die lamellären Techniken, wie die tiefe anteriore lamelläre Keratoplastik (DALK) mittels „big bubble“ und die posteriore lamelläre Keratoplastik mittels „Descemet Membrane Endothelial Keratoplasty“ (DMEK) revolutioniert. Ziel dieser Arbeit ist es, die Split-Cornea-Transplantation mit der Kombination von DALK und DMEK als ein neues Konzept gegen den Hornhautspendermangel darzustellen.

Methoden: Der Beitrag bietet eine Literaturübersicht aus PUBMED und eigene klinische Ergebnisse.

Ergebnisse: Durch Teilung einer Spenderhornhaut in eine anteriore Lamelle (bestehend aus Epithel, Basalmembran, Bowman’scher Lamelle und Stroma) für eine DALK-Operation bei einem Patienten mit anterior-stromaler Hornhauterkrankung (z. B. Keratokonus) einerseits und eine posteriore Spenderlamelle (bestehend aus Descemet’scher Membran und Endothel) für eine DMEK-Operation bei einem Patienten mit endothelialer Hornhauterkrankung (z. B. Fuchs’sche Hornhautendotheldystrophie) andererseits kann der Bedarf an Hornhautspendergewebe um etwa 50 % reduziert werden. Im 6-Monats-Follow-up zeigten sich gute visuelle und refraktive Ergebnisse bei niedrigen Komplikationsraten und akzeptablen Endothelzellverlusten.

Schlussfolgerung: Die Split-Cornea-Transplantation mit Kombination von DALK und DMEK ist ein vielversprechendes, zukunftsträchtiges Konzept, dem Spendermangel im Bereich der Hornhauttransplantation zu begegnen.

Abstract

Background: Penetrating keratoplasty is at present the gold standard for corneal transplantation, but tremendous progress has been made in recent years in improving lamellar keratoplasty techniques, such as deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK). The purpose of this report is to describe split-cornea transplantation by combining DALK and DMEK as a novel concept to reduce donor shortage.

Methods: The study consists of a PUBMED literature review and our own clinical results.

Results: Splitting of a single donor cornea into an anterior part (including epithelium, its basement membrane, Bowman layer, and stroma) for use in a DALK procedure in a patient with anterior-stromal disease (e. g., keratoconus) and into a posterior part (endothelium-Descemet membrane layer) for use in a DMEK procedure in a patient with endothelial disease (e. g., Fuchs endothelial dystrophy) can reduce the need for corneal donor tissue by around 50 %. A short-term 6-months follow-up has revealed good visual and refractive outcomes with low complication rates and acceptable endothelial cell loss.

Conclusion: Split-cornea transplantation by combining DALK and DMEK surgeries is a promising concept to reduce donor shortage in corneal transplantation surgery in the future.

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