Keratoplasti Endikasyonları ve Teknikleri
Özet
Kornea hastalıkları dünyada körlüğün önde gelen nedenlerinden olup, kornea saydamlığının ve yapısının bozulduğu durumlarda sağlıklı bir donör korneası ile değiştirilmesi işlemi keratoplasti olarak adlandırılmaktadır. Tarihsel süreçte tam kat doku nakli sağlayan penetran keratoplasti (PK) temel yöntemken, günümüzde gelişen teknolojiyle birlikte korneanın yalnızca hastalıklı tabakalarının değiştirilmesine imkan tanıyan lameller keratoplasti teknikleri ön plana çıkmıştır. Görme aksının kapandığı durumlarda optik amaçlı yapılan bu ameliyatlar, glob bütünlüğünün bozulduğu durumlarda tektonik, inatçı enfeksiyonlarda teropötik ve estetik amaçla kozmetik olarak uygulanabilmektedir. Donör seçiminde viral enfeksiyon ve malignite geçişini önlemek amacıyla ölüm nedeni ile serolojik testler titizlikle incelenmektedir. Modern cerrahide, endotel ve desme membranının sağlıklı olduğu durumlarda derin ön lamellar keratoplasti (DALK) altın standart haline gelerek endotelyal greft reddi riskini ortadan kaldırmıştır. Endotel yetmezliği durumlarında ise daha iyi görsel iyileşme ve düşük red oranları sunan Desme membran endotelyal keratoplasti (DMEK) ile Desme soymalı otomatize endotelyal keratoplasti (DSAEK) teknikleri tercih edilmektedir. Cerrahi sonrası erken dönemde enfeksiyon, göz içi basıncı artışı ve greft reddi gibi komplikasyonlar görülebilirken; lameller teknikler öğrenme eğrisi yüksek olmasına rağmen daha kısa iyileşme süresi sağlamaktadır.
Corneal diseases are among the leading causes of blindness worldwide, and the transplantation procedure in which a healthy donor cornea replaces a cornea that has lost its transparency and structural integrity is called keratoplasty. While penetrating keratoplasty (PK), which provides full-thickness tissue transplantation, was the primary method historically, lamellar keratoplasty techniques that allow for the replacement of only the diseased layers of the cornea have come to the fore today with advancing technology. These surgeries, performed for optical purposes when the visual axis is obscured, can also be applied for tectonic purposes in cases of compromised globe integrity, therapeutically in persistent infections, and cosmetically for aesthetic appearances. In donor selection, the cause of death and serological test results are meticulously evaluated to prevent the transmission of viral infections and malignancies. In modern surgery, deep anterior lamellar keratoplasty (DALK) has become the gold standard when the endothelium and Descemet's membrane are healthy, eliminating the risk of endothelial graft rejection. For endothelial failures, Descemet's membrane endothelial keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) techniques are preferred, offering better visual recovery and lower rejection rates. While complications such as infection, increased intraocular pressure, and graft rejection may occur in the early postoperative period, lamellar techniques provide shorter recovery times despite having a high learning curve.
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