Universität zu Köln

Hos, Deniz, Matthaei, Mario, Bock, Felix, Maruyama, Kazuichi, Notara, Maria, Clahsen, Thomas, Hou, Yanhong, Salabarria, Ann-Charlott ORCID: 0000-0001-6829-2001, Horstmann, Jens, Bachmann, Bjoern O. and Cursiefen, Claus (2019). Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation. Prog. Retin. Eye Res., 73. OXFORD: PERGAMON-ELSEVIER SCIENCE LTD. ISSN 1873-1635

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Abstract

In the past decade, novel lamellar keratoplasty techniques such as Deep Anterior Lamellar Keratoplasty (DALK) for anterior keratoplasty and Descemet stripping automated endothelial keratoplasty (DSAEK)/Descemet membrane endothelial keratoplasty (DMEK) for posterior keratoplasty have been developed. DALK eliminates the possibility of endothelial allograft rejection, which is the main reason for graft failure after penetrating keratoplasty (PK). Compared to PK, the risk of endothelial graft rejection is significantly reduced after DSAEK/ DMEK. Thus, with modern lamellar techniques, the clinical problem of endothelial graft rejection seems to be nearly solved in the low-risk situation. However, even with lamellar grafts there are epithelial, subepithelial and stromal immune reactions in DALK and endothelial immune reactions in DSAEK/DMEK, and not all keratoplasties can be performed in a lamellar fashion. Therefore, endothelial graft rejection in PK is still highly relevant, especially in the high-risk setting, where the cornea's (lymph)angiogenic and immune privilege is lost due to severe inflammation and pathological neovascularization. For these eyes, currently available treatment options are still unsatisfactory. In this review, we will describe currently used keratoplasty techniques, namely PK, DALK, DSAEK, and DMEK. We will summarize their indications, provide surgical descriptions, and comment on their complications and outcomes. Furthermore, we will give an overview on corneal transplant immunology. A specific focus will be placed on endothelial graft rejection and we will report on its incidence, clinical presentation, and current/future treatment and prevention options. Finally, we will speculate how the field of keratoplasty and prevention of corneal allograft rejection will develop in the future.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hos, Deniz UNSPECIFIED UNSPECIFIED UNSPECIFIED Matthaei, Mario UNSPECIFIED UNSPECIFIED UNSPECIFIED Bock, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Maruyama, Kazuichi UNSPECIFIED UNSPECIFIED UNSPECIFIED Notara, Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Clahsen, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Hou, Yanhong UNSPECIFIED UNSPECIFIED UNSPECIFIED Salabarria, Ann-Charlott UNSPECIFIED orcid.org/0000-0001-6829-2001 UNSPECIFIED Horstmann, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Bachmann, Bjoern O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cursiefen, Claus UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-128735
DOI:	10.1016/j.preteyeres.2019.07.001
Journal or Publication Title:	Prog. Retin. Eye Res.
Volume:	73
Date:	2019
Publisher:	PERGAMON-ELSEVIER SCIENCE LTD
Place of Publication:	OXFORD
ISSN:	1873-1635
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MEMBRANE ENDOTHELIAL KERATOPLASTY; DEEP ANTERIOR LAMELLAR; HIGH-RISK CORNEAL; FINE-NEEDLE DIATHERMY; GROWTH-FACTOR RECEPTOR-3; AQUEOUS CYTOKINE LEVELS; COLLAGEN CROSS-LINKING; IMMUNOLOGICAL-REJECTION-EPISODES; PREDNISOLONE ACETATE 1-PERCENT; CELL SHEET TRANSPLANTATION Multiple languages Ophthalmology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12873