Lamelarna keratoplastika kao metoda izbora u liječenju bolesti rožnice

master's thesis

• Title (english): Lamellar keratoplasty as a treatment of choice for corneal disease
• Author: Marko Mladić
• Mentor: Miro Kalauz (mentor)
• Committee member: Damir Katušić (predsjednik povjerenstva)
• Committee member: Tomislav Jukić (član povjerenstva)
• Committee member: Miro Kalauz (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2015-09-25, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Tradicionalno, penetrantna keratoplastika, kojom se transplantira cijela debljina rožnice, smatrala se metodom izbora za liječenje bolest rožnice. No, iako uspješna u liječenju brojnih poremećaja rožnice, penetrantna keratoplastika obilježena je brojnim komplikacijama, poput razvoja odbacivanja donorskog tkiva, i dugim periodom rehabilitacije. Unazad desetak godina, razvojem novih kirurških tehnika, dolazi do ponovnog interesa za lamelarnu keratoplastiku. Lamelarna keratoplastika karakterizirana je selektivnošću, transplantiraju se samo oni dijelovi rožnice koji su patološki promijenjeni, dok zdravi dijelovi ostaju netaknutim. Ovisno o dijelovima rožnice koji se presađuju, razlikuju se prednja, ako se transplantiraju prednji slojevi rožnice, i stražnja lamelarna keratoplastika ili endotelna keratoplastika, ako se presađuju Descemetova membrana i endotel rožnice. Daljnjim razvojem kirurških tehnika, obje su metode doživjele brojne varijacije. Duboka prednja lamelarna keratoplastika metoda je kojom se presađuju prednji slojevi rožnice do maksimalne dubine strome rožnice, gotovo do Descemetove membrane. Tom se metodom dobivaju dobri vizualni ishodi, dok je broj komplikacija manji, a period rehabilitacije kraći. Zbog toga što čuva imunološki integritet oka, ta metoda gotovo u potpunosti isključuje razvoj endotelnog odbacivanja, jedan od najvažnijih razloga odbacivanja
donorskog tkiva kod penetrantne keratoplastike. Endotelna keratoplastika s odljuštenjem Descemetove membrane i endotelna keratoplastika Descemetove membrane dvije su novije metode stražnje lamelarne keratoplastike, koje omogućuju selektivno liječenje bolesti endotela rožnice. Ishodi tih metoda bolji su od penetrantne keratoplastike, a komplikacije poput gubitka endotelnih stanica rijeđe. Upravo zbog brojnih prednosti nad penetrantnom keratoplastikom te daljnjim unaprijeđenjima tehnike i tehnologije u svrhu olakšanja izvođenja zahvata i dodatnog smanjenja komplikacija, lamelarna keratoplastika nameće se kao metoda izbora u liječenju bolesti rožnice.

Abstract (english)

Traditionally, penetrating keratoplasty, a procedure consisting of full-thickness replacment of the cornea, has been the treatment of choice for numerous corneal disease. Altough successefully used for treatment of most corneal disease,
penetrating keratoplasty can have many complications, such as transplant rejection, and long rehabilitation period is required for good visual outcome. However, improvements in surgical instruments and adoption of newer surgical techniques have resulted in a reintroduction of lamellar keratoplasty as an acceptable alternative to penetrating keratoplasty. Lamellar keratoplasty involves selective removal and replacment of diseased corneal layers, while leaving healty layers intact. Anterior lamellar keratoplasty is a procedure in which the anterior parts of recipient cornea are
removed, while preserving healty recipient endothelium. Posterior lamellar keratoplasty selectively replaces the corenal endothelium in patients with endothelial disease. Variations on both methods do exist. Deep anterior lamellar keratoplasty is
surgical procedure for removing the corneal stroma down to Descemet membrane. DALK avoids most compliactions associated with an open eye system surgery. Immunological integrity of the eye is kept intact, which lowers the risk of endothelial graft rejection, one of the major factors for transplant rejection. Newer forms of endothelial keratoplasty, such as Descemet stripping endothelial keratoplasty and Descemet membrane endothelial keratoplasty, selectively replace recipient corneal endothelium, resulting in more rapid and predictable visual outcomes. The advantages of lamellar keratoplasty are numerous and if disadvantages of such surgeries can be overcome, lamellar keratoplasty can be considerd as an acceptable alternative to traditional penetrating keratoplasty.

• Keywords: Lamelarna keratoplastika; prednja lamelarnja keratoplastika; endotelna keratoplasika; duboka prednja lamelarna keratoplastika; endotelna keratoplastika s odljuštenjem Descemetove membrane; endotelna keratoplastika Descemetove membrane
• Keywords (english): Lamellar keratoplasty; anterior lamellar keratoplasty; posterior lamellar keratoplasty; endothelial keratoplasty; deep anterior lamellar keratoplasty; Descemet stripping endothelial keratoplasty; Descemet membrane endothelial keratoplasty
• Language: croatian
• URN:NBN: urn:nbn:hr:105:730307
• 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: 2016-11-24 09:07:28