Christoph Holtmann

Descemet-membrane endothelial keratoplasty in patients with retinal comorbidity-a prospective cohort study

AIM To investigate indications, surgical challenges, and outcome of Descemet-membrane endothelial keratoplasty (DMEK) in patients with retinal comorbidities (RC). METHODS In a prospective cohort study, 8 eyes of 8 DMEK-patients with known RC were compared to 38 eyes of 38 DMEK-patients without RC. The duration of surgery, the degree of difficulty graded by the surgeon, and the complications through DMEK-surgery were analyzed for each patient. The best-corrected visual acuity (BCVA), the endothelial cell count, the intraocular pressure, and the subjective satisfaction was evaluated after a 6-month follow-up. Data were compared applying the non-parametric Wilcoxon-, Chi-square- and Fisheŕs-exact-test with P≤0. 05 as level of significance. RESULTS RC-patients had dry age-related macular degeneration (n=4) or history of pars-plana vitrectomy (n=4). The main indication for DMEK was pain due to bullous keratopathy for the RC-patients (n=7, 88%) and visual impairment due to Fuchs endothelial keratoplasty for the non-RC-patients (n=33, 87%). The BCVA increased for both groups (P=0.01, P<0.001) and all corneas cleared. For the RC-patients, the subjective satisfaction improved significantly (P=0.02). Oil-filling and missing support of the vitreous body complicated surgery in vitrectomized eyes. CONCLUSION DMEK is a favorable technique to treat endothelial disorders even if patients suffer from a retinal comorbidity. By enhancing the corneal clarity, it enables retinal examination or intraocular surgery and increases the patientś satisfaction. However, in vitrectomized or silicone-oil filled eyes, the duration of surgery and degree of complexity are increased. An experienced surgeon should perform DMEK in these patients. CLINICAL TRIAL REGISTRATION NUMBER DRKS00007566.

Basiskapitel Diagnostik – Augenlider, Orbita, Tränenwege

Die Diagnostik von Krankheiten der Augenlider, Orbita und Tränenwege gehören zum Alltag der ophthalmologischen Versorgung. Die Krankheitsbilder sind vielfältig und ihre Diagnose erfordert meist mehrere diagnostische Schritte. Hierbei sind die klinische Untersuchung und die Erhebung eines sog. „Adnexen-Status“ besonders wichtig. Die folgenden Seiten sollen eine systematische Übersicht und strukturierte Herangehensweise bieten.