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Perforierende Keratoplastik vs. „Descemet stripping automated endothelial keratoplasty“ im Partnerauge

Funktionelle Ergebnisse und Patientenzufriedenheit

Perforating keratoplasty versus Descemet stripping automated endothelial keratoplasty in the partner eye

Functional results and patient satisfaction

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Zusammenfassung

Hintergrund

Für den Vergleich der postoperativen Ergebnisse und der Zufriedenheit zwischen perforierender Keratoplastik (PK) und „Descemet stripping automated endothelial keratoplasty“ (DSAEK) bieten sich die Patienten an, bei denen an einem Auge eine PK und am Partnerauge eine DSAEK durchgeführt wurde.

Methoden

Wir identifizierten 15 derartige Patienten in unserem Hornhautbankregister. Wir arbeiteten die Krankengeschichten systematisch bezüglich bestkorrigierter Sehschärfe, keratometrischem Astigmatismus, Endothelzelldichte und postoperativen Komplikationen auf. Die Patientenzufriedenheit wurde mittels standardisierten Interviews erhoben.

Ergebnisse

Die mediane Nachbeobachtungsdauer lag nach PK bei 55 Monaten und nach DSAEK bei 18 Monaten (p < 0,01). Die bestkorrigierte Sehschärfe am Ende der Nachbeobachtungszeit betrug nach PK im Median 0,8 und 0,5 nach DSAEK (p = 0,01). Der keratometrische Astigmatismus nach PK betrug im Median 3,1 dpt und 1,9 dpt nach DSAEK (p = 0,2). Die mediane Endothelzelldichte am Ende der Nachbeobachtungszeit betrug in den PK-Augen 831 vs. 860 Zellen/mm2 in den DSAEK-Augen (p = 0,63). Die PK bevorzugten 57 % der Befragten, 36 % präferierten die DSAEK, und 7 % waren unentschlossen. Die subjektiv als besser empfundene Sehleistung wurde bei 64 % im PK-Auge und bei 29 % im DSAEK-Auge lokalisiert; 7 % gaben an, mit beiden Augen gleich gut zu sehen.

Diskussion

Die Ergebnisse lassen an der Überlegenheit der DSAEK gegenüber der PK bei Fuchs-Endotheldystrophie zweifeln. Allerdings sind die ungewöhnlich guten refraktiven Ergebnisse der hier betrachteten 15 PK-Augen und die signifikant längere Nachbeobachtungszeit in diesen Augen möglicherweise für die unerwartet hohe Patientenpräferenz zur PK mit verantwortlich.

Abstract

Background

This study compared the postoperative results and patient satisfaction between penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in patients who underwent PK in one eye and DSAEK in the other eye.

Methods

A total of 15 patients were identified from the corneal database register and the medical charts were analyzed for best corrected visual acuity (BCVA), keratometric astigmatism, endothelial cell density and postoperative complications. Patient satisfaction was evaluated by a standardized interview.

Results

Median follow-up time for PK was 55 months and 18 months for DSAEK (p < 0.01). Median BCVA in PK was 0.8 and 0.5 in DSAEK (p = 0.01) at the end of follow-up. Median keratometric astigmatism was 3.1 diopters after PK and 1.9 diopters after DSAEK (p = 0.2). Median endothelial cell density was 831 cells/mm2 after PK and 860 cells/mm2 after DSAEK (p = 0.63). For the interventions 57 % of the patients preferred PK, 36 % preferred DSAEK and 7 % were undecided. Patients assigned the better performing eye to the PK side in 64 % and in 29 % to the DSAEK side and 7 % perceived equal visual performance in both eyes.

Conclusion

The results leave doubt about the superiority of DSAEK compared to PK; however, exceptionally good refractive results of the 15 PK eyes analyzed and significantly longer follow-up times after PK could be the reason for the unexpectedly high patient preference for PK.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum Freiburg, 79106, Freiburg im Breisgau, Deutschland

    N. J. Gross, D. Böhringer, P. Maier & T. Reinhard

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  1. N. J. Gross
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  2. D. Böhringer
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  3. P. Maier
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  4. T. Reinhard
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Correspondence to N. J. Gross.

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Interessenkonflikt

N.J. Gross, D. Böhringer, P. Maier und T. Reinhard geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Gross, N., Böhringer, D., Maier, P. et al. Perforierende Keratoplastik vs. „Descemet stripping automated endothelial keratoplasty“ im Partnerauge. Ophthalmologe 112, 848–853 (2015). https://doi.org/10.1007/s00347-015-0010-1

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