Duncker Gernot I W, Krumeich Jörg, Wilhelm Frank, Bredehorn Timm
Universitätsklinik und Poliklinik für Augenheilkunde der Martin-Luther-Universität Halle-Wittenberg.
Klin Monbl Augenheilkd. 2004 Jan;221(1):14-23. doi: 10.1055/s-2003-812632.
New concepts of lamellar keratoplasty techniques mainly deal with the refinement of the so-called deep lamellar endothelial keratoplasty (DLEK). The aim of the deep lamellar technique is to expose bare Descemet's membrane of the recipient and to suture in a full thickness graft. Graft rejections are not known with DLEK. We describe the preparation techniques of Anwar, Melles, and Krumeich and discuss the advantages and disadvantages. The femtosecond laser enables the surgeon to cut the cornea non-mechanically with a cutting accuracy of +/- 10 microns. Fuchs endothelial dystrophy can be treated by posterior lamellar keratoplasty (POLK). In this technique only a sheet of Descemet's and endothelium are replaced. In severe alkali burn with limbal stem cell deficiency a lamellar corneo-scleral disc can be grafted in order to restore the limbus. Routine central penetrating keratoplasty should follow at least half a year later.
板层角膜移植技术的新概念主要涉及对所谓的深板层内皮角膜移植术（DLEK）的改进。深板层技术的目的是暴露受体的裸露后弹力层，并缝合全层移植物。DLEK不存在移植物排斥反应。我们描述了安瓦尔、梅尔斯和克鲁梅希的制备技术，并讨论其优缺点。飞秒激光使外科医生能够以±10微米的切割精度非机械地切割角膜。富克斯内皮营养不良可通过后板层角膜移植术（POLK）治疗。在该技术中，仅替换一片后弹力层和内皮。在伴有角膜缘干细胞缺乏的严重碱烧伤中，可移植板层角膜巩膜盘以恢复角膜缘。常规的中央穿透性角膜移植术应至少在半年后进行。
