Die Transplantation des kornealen Endothels – Möglichkeiten und Grenzen

Zusammenfassung

Hintergrund: Die Endothel-Keratoplastik ist ein vielversprechendes Verfahren, welches den Vorteil bietet, z. B. bei Erkrankungen, die ausschließlich das korneale Endothel betreffen, lediglich den posterioren Anteil der Hornhaut zu ersetzen. Dieses Verfahren kann postoperative Astigmatismen und möglicherweise auch Abstoßungen vermeiden helfen. Methoden und Ergebnisse: Das chirurgische Verfahren konnte klinisch an einzelnen Zentren bereits gut etabliert werden. Allerdings zeigen die Publikationen zu dem Thema, dass das Problem des postoperativen Endothelzellverlusts ähnlich gravierend oder z. T. noch problematischer als bei der perforierenden Keratoplastik ist. Während die Verbesserung der chirurgischen Verfahren zur Endothel-Keratoplastik zu einer Reduzierung des Endothelzellverlusts führten, gibt es kaum zellbiologische oder gentechnische Ansätze, um den Endothelverlust von Spenderhornhäuten oder Endothellamellen ganz zu verhindern oder die Endothelzelldichte sogar zu erhöhen. Diskussion: Der Übersichtsartikel beschreibt den klinischen Stand der Endothel-Keratoplastik und beschreibt eigene und weltweite Forschungsansätze, die zukünftig helfen können, den Endothelzellverlust zu vermeiden, wie die Entwicklung geeigneter Gewebekulturbedingungen oder die genetische Manipulation des Hornhautendothels. Weiterhin werden Ansätze aus dem Bereich des Tissue Engineerings beschrieben, welche auf die Entwicklung eines transplantierbaren Endothelzell-Sheets zielen. Schlussfolgerung: Vor dem Hintergrund der begrenzten Verfügbarkeit von Spenderhornhäuten müssen zellbiologische Grundlagen des kornealen Endothels und Ansätze des Tissue Engineerings deutlich mehr in den Fokus der Forschung rücken. Methoden zur Vermeidung von Endothelzellverlusten, aber auch zur Erhöhung der Endothelzelldichte sind notwendig und erfordern interdisziplinäre Forschungsansätze.

Abstract

Background: Endothelial keratoplasty is a promising surgical procedure which may replace penetrating keratoplasty in cases of endothelial cell diseases of the cornea. This method may thereby help to prevent postoperative astigmatism and transplant rejection. Methods and Results: A survey of publications reporting about results after endothelial keratoplasty shows that the main problem of this transplantation technique is a postoperative endothelial cell loss which is comparable to or even higher than that observed in penetrating keratoplasty. Improving surgical techniques led to a reduction of the endothelial cell loss, however, cell-based strategies to prevent postoperative cell loss or to enhance the cell densities of donor corneas or endothelial lamellae are rare. Discussion: This review presents an overview of clinical results after endothelial keratoplasty. Current strategies in the field of cell biology and tissue cultivation of corneal endothelial cells, genetic manipulation of the corneal endothelium and tissue engineering strategies aiming at the production of transplantable endothelial cell sheets are described. Conclusion: The limited availability of donor corneas makes it mandatory to develop methods in the field of tissue engineering in order to improve corneal endothelial cell survival or to increase corneal endothelial cell density, using interdisciplinary approaches.

Schlüsselwörter

Endothel-Keratoplastik - perforierende Keratoplastik - Spenderhornhaut - serumfreie Organkultivierung - genetische Manipulation - Tissue Engineering

Key words

endothelial keratoplasty - penetrating keratoplasty - donor cornea - serum-free organ cultivation - genetic manipulation - tissue engineering

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