Transplantacija rožnice kod pacijenta s keratokonusom

master's thesis

• Title (english): Corneal transplantation in patients with keratoconus
• Author: Matija Bašić
• Mentor: Miro Kalauz (mentor)
• Committee member: Tomislav Jukić (predsjednik povjerenstva)
• Committee member: Nenad Vukojević (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: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Keratokonus je najčešća primarna ektazija. Obično se javlja u drugom i napreduje do četvrtog
desetljeća života i zahvaća oba spola i sve nacionalnosti. Procijenjena prevalencija u općoj
populaciji iznosi 54 na 100 000.
Okularni simptomi i znakovi variraju ovisno o težini bolesti. Karakteriziran je bilateralnom i
asimetričnom degeneracijom rožnice te posljedičnom protruzijom, visikom miopijom i
nepravilnim astigmatizmom. Iako specifičan uzrok keratokonusa još uvijek nije poznat,
pretpostavlja se da su u podlozi genetski, biomehanički i biokemijski mehanizmi, s naglaskom na
promjene u stromi rožnice.
Liječenje keratokonusa se razlikuje ovisno o težini bolesti. Početni slučajevi se liječe
naočalama, blagi do umjereni slučajevi kontaktnim lećama te tehnikama kao što su cross-linking
ili ugradnja intrastromalnih kornealnih prstenova.
Transplantacija rožnice tj. keratoplastika, tradicionalna je metoda za liječenje uznapredovalog
keratokonusa. Moderna keratoplastika započinje u kasnim 1950-ima u obliku penetrirajuće
keratoplastike (PK) koja označava zamjenu svih slojeva roţnice sa transplantatom pune debljine.
Kroz vrijeme, razvijene su nove, lamelarne tehnike keratoplastike koje koriste transplantate
parcijalne debljine i predstavljaju odrţivu alternativu. Kod keratokonusa, to se odnosi na duboku
prednju lamelarnu keratoplastiku (DALK) koja selektivno zamjenjue stromu rožnice, ostavljajući
netaknutu Descemetovu membranu i endotelne stanice. Ovako izvedena tehnika znatno smanjuje
rizika od odbacivanja transplantata, za razliku od penetrirajuće keratoplastike. Također, uz
smanjeni rizik od odbacivanja endotela, DALK pokazuje smanjenu učestalost ostalih
komplikacija transplantacije rožnice te zauzima svoje mjesto kao superiorna tehnika u modernoj
keratoplastici.

Abstract (english)

Keratoconus is the most common primary ectasia. It usually occurs in the second and progresses
to the fourth decade of life and affects both sexes and all nationalities. The estimated prevalence
in the general population is 54 per 100 000.
Ocular symptoms and signs vary depending on the severity of the disease. It is characterized by
bilateral and asymmetric corneal degeneration and consequent protrusion, high myopia and
irregular astigmatism. Although the specific cause of keratoconus is still unknown, genetic,
biomechanical, and biochemical mechanisms are thought to underlie, with emphasis on changes
in corneal stroma.
Treatment of keratoconus varies depending on the severity of the disease. Initial cases are treated
with spectacles, mild to moderate cases with contact lenses, and techniques such as cross-linking
or implantation of intrastromal corneal rings.
Corneal transplantation, ie keratoplasty, is a traditional method for the treatment of advanced
keratoconus. Modern keratoplasty began in the late 1950s in the form of penetrating keratoplasty
(PK), which replaces all layers of the cornea with a full-thickness graft. Over time, new, lamellar
keratoplasty techniques have been developed that use partial-thickness transplants and represent
a viable alternative. In keratoconus, this refers to deep anterior lamellar keratoplasty (DALK)
that selectively replaces the stroma of the cornea, leaving the Descemet’s membrane and
endothelial cells intact. This technique significantly reduces the risk of graft rejection, in contrast
to penetrating keratoplasty. Also, with a reduced risk of endothelial rejection, DALK shows a
reduced incidence of other complications of corneal transplantation and takes its place as a
superior technique in modern keratoplasty.

• Keywords: keratokonus; penetrirajuća keratoplastika; duboka prednja lamelarna keratoplastika
• Keywords (english): keratoconus; penetrating keratoplasty; deep anterior lamellar keratoplasty
• Language: croatian
• URN:NBN: urn:nbn:hr:105:836096
• 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: 2023-01-02 11:09:49