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Update: Tiefe anteriore lamelläre Keratoplastik (DALK) bei Keratokonus

Wann, Wie und Warum

Update: Deep anterior lamellar keratoplasty (DALK) for keratoconus

When, how and why

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Zusammenfassung

Hintergrund

Die Therapie des Keratokonus hat sich in den letzten Jahren deutlich erweitert. Neben den bisherigen Optionen der Brillenkorrektur und der Anpassung von harten formstabilen Kontaktlinsen sowie der perforierenden Keratoplastik (pKPL) sind das korneale Crosslinking und die lamellären Transplantationstechniken hinzugekommen.

Ziel der Arbeit

Ziel dieser Übersichtsarbeit ist es, aktuelle Möglichkeiten zur Komplikationsminimierung und zur Standardisierung der tiefen anterioren lamellären Keratoplastik (DALK) bei Keratokonus aufzuzeigen.

Material und Methoden

Zusammengefasst wurden eigene Daten und eine Literaturübersicht in PubMed.

Ergebnisse

Mittels DALK kann Patienten mit Keratokonus eine wesentlich längere Transplantatlebensdauer bei reduziertem Komplikationsrisiko angeboten werden.

Diskussion

Die DALK bietet zahlreiche Vorteile gegenüber der perforierenden Keratoplastik, v. a. die geringere intraoperative Eröffnung des Auges, das damit reduzierte Risiko von schweren intraoperativen Komplikationen sowie das völlige Fehlen von endothelialen Immunreaktionen, da das Endothel des Patienten erhalten bleibt. Das Fehlen endothelialer Immunreaktionen ist gerade bei jungen Patienten mit Keratokonus und Patienten mit erhöhtem Abstoßungsrisiko wie z. B. bei der Neurodermitis ein wichtiges Argument. Daneben gibt es typische Komplikationen der DALK, die so bei der perforierenden Keratoplastik nicht auftreten. Die hier geschilderten Strategien zur Standardisierung und zu intraoperativen und postoperativen Komplikationsvermeidungen sollten dazu führen, die DALK noch sicherer und reproduzierbarer durchführen und diese als primäres Standardverfahren beim Keratokonus etablieren zu können.

Abstract

Background

The treatment of keratoconus has been significantly expanded in recent years. In addition to the previous options for correction by fitting hard contact lenses and penetrating keratoplasty (PK), corneal cross-linking and lamellar transplantation techniques have been added.

Objective

The aim of this review article is to highlight currently available options for minimization of complications and standardization of deep anterior lamellar keratoplasty (DALK) for keratoconus.

Material and methods

This article summarizes our own data and gives a review of the literature in PubMed.

Results

Performing DALK can provide keratoconus patients with corneal grafts with considerably longer graft survival and a reduced risk of complications.

Conclusion

The DALK procedure provides numerous advantages over PK, especially the reduced intraoperative opening of the eye, which thus reduces the risk of serious intraoperative complications. A further benefit is the complete absence of postoperative endothelial immune reactions as the recipient’s endothelium remains untouched. The absence of endothelial immune reactions is especially advantageous for young patients with keratoconus and patients with an increased risk of graft rejection, e.g. in atopic dermatitis; however, there are also typical complications of DALK that do not occur during PK. The outlined strategies for standardization of DALK and avoidance of intraoperative and postoperative complications should make DALK safer and more reproducible and lead to possible establishment as a standard procedure in keratokonus.

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Finanzielle Unterstützung

COST BM 1302 (www.biocornea.de); DFG Forschergruppe FOR2240 (www.for2240.de).

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Authors and Affiliations

  1. Zentrum für Augenheilkunde, Universität zu Köln, Universitätsklinikum Köln, Kerpener Straße 62, 50924, Köln, Deutschland

    C. Cursiefen,  F. Schaub &  B. Bachmann

Authors
  1. C. Cursiefen
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  2. F. Schaub
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  3. B. Bachmann
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Corresponding author

Correspondence to F. Schaub.

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Interessenkonflikt

C. Cursiefen, F. Schaub und B. Bachmann geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen wurden im Einklang mit nationalem Recht sowie der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Es handelt sich um eine Übersichtsarbeit, die auf eigenen Erfahrungen basiert sowie eine Literaturübersicht aus PubMed umfasst. Eine Genehmigung durch das lokale Ethikkomitee war somit nicht erforderlich.

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Cursiefen, C., Schaub, F. & Bachmann, B. Update: Tiefe anteriore lamelläre Keratoplastik (DALK) bei Keratokonus. Ophthalmologe 113, 204–212 (2016). https://doi.org/10.1007/s00347-015-0204-6

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