Stražnja slojevita transplantacija rožnice

master's thesis

• Title (english): Posterior lamellar keratoplasty
• Author: Miroslav Perić
• Mentor: Tomislav Kuzman (mentor)
• Committee member: Tomislav Jukić (predsjednik povjerenstva)
• Committee member: Miro Kalauz (član povjerenstva)
• Committee member: Tomislav Kuzman (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2016-09-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Penetrantna keratoplastika ili transplantacija rožnice pune debljine je sve do nedavno bila zlatni standard za liječenje bolesti rožnice bez obzira na to koji je sloj rožnice uistinu patološki promijenjen. Transplantacijska kirugija rožnice se intenzivno razvija zadnjih petnaestak godina, tako da je danas moguće transplantirati samo unutarnji ili vanjski sloj rožnice. Takve mikrokirurške zahvate nazivamo prednja odnosno stražnja lamelarna keratoplastika. Prednja lamelarna keratoplastika je zahvat kojim se transplantira samo vanjski sloj rožnice, točnije epitel i stroma, a da pri tome unutarnji sloj, tj. Descemetova membrana i endotel ostaju očuvani. Metodom stražnje lamelarne keratoplastike, transplantira se unutarnji sloj rožnice, što uključuje endotel, Descemetovu membranu i tanki sloj strome, a da pri tome epitel i stroma ostaju netaknuti. Temelji moderne stražnje lamelarne keratoplastike postavljeni su 1998. godine. Tada je prvi put uspješno izvedena stražnja lamelarna keratoplastika kod koje se za fiksaciju donorske lamele koristio zrak u prednjoj očnoj sobici umjesto šivanja rožnice. Daljnjim modifikacijama stražnje lamelarne keratoplastike nastale su danas dvije glavne varijante: endotelna keratoplastika (automatizirana) uz odljuštenje Descemetove membrane (DS(A)EK) i endotelna keratoplastika Descemetove membrane (DMEK). DS(A)EK je mikrokirurški zahvat kojim se transplantira Descemetova membrana i endotel s tankim slojem strome. Nasuprot tome DMEK je procedura kojom se transplantira samo Descemetova membrana s pripadajućim endotelom. Glavne indikacije za stražnju lamelarnu keratoplastiku su bolesti i stanja kod kojih unutarnji endotelni sloj ne funkcionira. U praksi su to prvenstveno bulozna keratopatija i Fuchsova endotelna distrofija. Kako bi uopće mogli izvesti stražnju lamelarnu keratoplastiku potrebno je pripremiti donorsku rožničnu lamelu. Priprema se može napraviti u očnoj banci ili je radi sam kirurg tijekom operacije. Za isjecanje donorske lamele odgovarajuće debljine, potreban je automatski mikrokeratom. Stražnja lamelarna keratoplastika ima brojne prednosti u usporedbi s penetrantnom keratoplastikom. Prednosti nad penetrantnom keratoplastikom su kraće trajanje operacije, brži oporavak vida, manji intraoperacijski rizik od komplikacija i manji poslijeoperacijski astigmatizam. Glavni problemi koji se mogu javiti nakon izvođenja stražnje lamelarne keratoplastike su dislokacija i propadanje presatka.

Abstract (english)

Penetrating keratoplasty or full-thickness corneal transplantation has been,until recently, the gold standard for treatment of corneal diseases regardless of which layer of the cornea is truly pathologically changed. Corneal transplantation surgery has been intensely developing for the last fifteen years resulting in the ability to transplant only the inner or outer layer of the cornea. Such microsurgical procedures are called anterior or posterior lamellar keratoplasty. Anterior lamellar keratoplasty is a procedure by which only the outer layer of the cornea, namely the epithelium and stroma, is transplanted, while the remaining inner layer consisting of Descemet’s membrane and the endothelium is preserved. Posterior lamellar keratoplasty consists of transplanting the inner layer of the cornea including the endothelium, Descemet’s membrane and a thin layer of the stroma. By using this procedure epithelium and stroma remain intact. The foundations of the modern posterior lamellar keratoplasty were established in 1998. This was the first time that the posterior lamellar keratoplasty was successfully performed in which air was used for the fixation of the donor lamella in the anterior chamber instead of stitching of the cornea. Further modifications to the posterior lamellar keratoplasty resulted in the two main variants which are in use today: Descemet’s stripping (automated) endothelial keratoplasty (DS(A)EK) and Descemet membrane endothelial keratoplasty (DMEK). DS(A)EK is a microsurgical procedure in which the Descemet’s membrane and endothelium are transplanted with a thin layer of the stroma. In contrast, DMEK is a procedure by which only the Descemet’s membrane with associated endothelium is transplanted. The main indications for the posterior lamellar keratoplasty are diseases and conditions in which the inner endothelial layer does not function. In practice, these are primarily bullous keratopathy and Fuchs' corneal endothelial dystrophy. It is necessary to prepare a donor corneal lamella to be able to carry out the posterior lamellar keratoplasty. The preparation can be done in the eye bank or by a surgeon during surgery. Automatic microkeratome is required to crop the donor lamella of appropriate thickness. Posterior lamellar keratoplasty has many advantages compared with penetrative keratoplasty. The advantages of posterior lamellar keratoplasty are shorter time of operation, faster recovery of vision, lower risk of intraoperative complications and lower postoperative astigmatism. The main problems that can occur after performing posterior lamellar keratoplasty are dislocation and graft failure.

• Keywords: slojevita transplantacija rožnice; stražnja slojevita transplantacija rožnice; endotelna transplantacija (automatizirana) uz odljuštenje Descemetove membrane; endotelna transplantacija Descemetove membrane
• Keywords (english): lamellar keratoplasty; posterior lamellar keratoplasty; Descemet’s stripping (automated) endothelial keratoplasty; Descemet’s membrane endothelial keratoplasty
• Language: croatian
• URN:NBN: urn:nbn:hr:105:377320
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-08-09 08:05:54