Suvremeni pristup transplantaciji rožnice

master's thesis

• Title (english): Modern approach to corneal transplantation
• Author: Katarina Oroz
• Mentor: Sanja Masnec (mentor)
• Committee member: Miro Kalauz (predsjednik povjerenstva)
• Committee member: Lovorka Batelja-Vuletić (član povjerenstva)
• Committee member: Sanja Masnec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Transplantacija rožnice najuspješnija je i najizvođenija transplantacija na svijetu. Rožnična patologija kao uzrok gubitka vida u današnje se vrijeme nastoji otkloniti suvremenim metodama pripreme presadaka i uznapredovalim operacijskim tehnikama.
Dugo najizvođenija penetrantna keratoplastika zamijenjena je različitim vrstama lamelarne (slojevite) keratoplastike ovisno o indikaciji. Metode daju bolje postoperativne ishode u vidu bržeg oporavka, kraće primjene kortikosteroida, manjeg postotka odbacivanja presatka te bolje vidne oštrine.

Za patologiju prednjeg dijela rožnice uz očuvani endotel, metoda izbora danas je duboka prednja lamelarna keratoplastika (DALK).

Za patologiju endotela i Descemetove membrane koriste se automatizirana endotelna keratoplastika s uklanjanjem Descemetove membrane (DSAEK), ultra tanki DSAEK (UT-DSAEK) i endotelna keratoplastika Descemetove membrane (DMEK). Svaka od metoda ima svoje prednosti i nedostatke pa je tako DSAEK uvelike zastupljena metoda endotelne keratoplastike zbog tehnički manje zahtjevne procedure dok DMEK dokazano daje bolje ishode po pitanju vidne oštrine.

S obzirom na prednosti svih metoda lamelarne keratoplastike, krivulju učenja operacijskih metoda nastoji se smanjiti pripremom presadaka u očnoj banci i primjenom novih tehnologija poput femtosekundnog lasera i intraoperativne optičke koherentne tomografije (iOCT-a). Laserom pripremljeni visoko kompatibilni presaci te nadgledanje operacije iOCT-om olakšavaju proceduru transplantacije i uspješno smanjuju intraoperativne i postoperativne komplikacije.

Pomanjkanju donorskog tkiva nastoji doskočiti bioinženjering rožnice koji se bavi izradom kvalitetnih i estetski prihvatljivih keratoproteza te razvojem zamjenskih tkiva koja bi imitirala biomehaničku funkciju rožnice. Brzi razvoj tehnologija i materijala obećava skori razvoj mogućeg terapijskog rješenja budućnosti: biointegrirane i funkcionalne umjetne rožnice.

Abstract (english)

Corneal transplantation is the most successful and commonly performed transplant surgery in the world. Corneal pathologies, as a cause of vision loss, are now being addressed with modern methods of graft preparation and advanced surgical techniques.

Traditional penetrating keratoplasty (PKP) has been replaced by various types of lamellar keratoplasty depending on the indication. These methods offer better postoperative outcomes, including faster recovery, shorter corticosteroid use, decreased percentage of graft rejection, and improved visual outcomes.

Today’s method of choice for anterior corneal pathologies with preserved endothelium is Descemet's stripping automated endothelial keratoplasty (DALK).

For pathologies involving the endothelium and Descemet's membrane, procedures such as Descemet's stripping automated endothelial keratoplasty (DSAEK), ultra-thin DSAEK (UT-DSAEK), and Descemet membrane endothelial keratoplasty (DMEK) are utilized. Each method has its advantages and disadvantages, with DSAEK being widely adopted due to its less technically demanding procedure, while DMEK has demonstrated better outcomes in terms of visual outcomes.

Considering the benefits of all lamellar keratoplasty methods, the learning curve of surgical techniques is reduced through graft preparation in eye banks and new technologies such as femtosecond laser and iOCT (intraoperative optical coherence tomography). Laser-prepared highly compatible grafts and intraoperative monitoring with iOCT facilitate the transplantation procedure and successfully reduce intraoperative and postoperative complications.

To overcome the lack of donor tissue, corneal bioengineering focuses on developing high-quality and aesthetically acceptable keratoprostheses and substitute tissues that mimic the biomechanical function of the cornea. Rapid technological and material advancement leads to future therapeutic solutions: bio-integrated and functional artificial corneas.

• Keywords: keratoplastika; suvremeni pristup; rožnica
• Keywords (english): keratoplasty; modern approach; cornea
• Language: croatian
• URN:NBN: urn:nbn:hr:105:036766
• 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: 2023-10-27 10:28:35