Lameller Keratoplastide Güncel Yaklaşımlar
Özet
Kornea, gözün ön kısmında yer alan altı tabakalı, saydam ve damarsız bir dokudur. Hasta kornea dokusunun sağlam olanla değiştirilmesi işlemi keratoplasti olarak adlandırılır. Cerrahinin tam kat yapıldığı penetran keratoplastiye alternatif olarak, günümüzde sadece hastalıklı tabakanın değiştirildiği kısmi kalınlıktaki lameller keratoplasti yaklaşımları öne çıkmaktadır. Bu cerrahiler temel olarak korneanın ön tabakalarını etkileyen hastalıklar için anterior lameller keratoplasti (ALK) ve endotel disfonksiyonu için posterior lameller keratoplasti (PLK) olarak ikiye ayrılır. Günümüzde ALK teknikleri arasında en sık tercih edileni, endoteli sağlıklı stromal patolojilerde uygulanan derin anterior lameller keratoplastidir (DALK). DALK, penetran cerrahiye kıyasla endotel reddi riskini ortadan kaldırma ve daha az steroid kullanımı gibi önemli avantajlara sahiptir. Endotel hastalıklarında ise Descemet Membran Endotelyal Keratoplasti (DMEK) ve Descemet Soymalı Otomatize Endotelyal Keratoplasti (DSAEK) gibi teknikleri içeren endotelyal keratoplasti (EK) tercih edilmektedir. Küresel ölçekte yaşanan donör kornea dokusu sıkıntısını aşabilmek amacıyla hemi-DMEK, çeyrek-DMEK ve tek bir donör korneadan iki farklı alıcı için greft hazırlığına olanak tanıyan bölünmüş (split) kornea nakli gibi yenilikçi teknikler geliştirilmiştir. Ayrıca Pre-Descemet Endotelyal Keratoplasti (PDEK), Descemet Membran Endotel Transferi (DMET) ve greft nakli yapılmadan uygulanan Descemet soyma yöntemi (DWEK) gibi güncel tıbbi ve cerrahi yaklaşımlar, lameller keratoplastide görsel kazanımı hızlandırmayı ve doku verimliliğini optimize etmeyi hedeflemektedir.
The cornea is a six-layered, transparent, and avascular tissue located in the anterior part of the eye, where keratoplasty refers to the replacement of diseased corneal tissue with healthy donor tissue. As an alternative to full-thickness penetran keratoplasty, partial-thickness lamellar keratoplasty, which replaces only the diseased layers, is categorized into anterior lamellar keratoplasty (ALK) for superficial diseases and posterior lamellar keratoplasty (PLK) for endothelial dysfunction. Deep anterior lamellar keratoplasty (DALK) is the most preferred ALK technique for patients with healthy endothelium, providing advantages such as eliminating endothelial rejection and requiring shorter topical steroid therapy compared to penetran surgery. For endothelial diseases, endothelial keratoplasty (EK) techniques like Descemet Membrane Endothelial Keratoplasti (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) are utilized. To address the global donor shortage, innovative methods have been developed, including hemi-DMEK, quarter-DMEK, and split cornea transplantation, which allows two recipients to benefit from a single donor cornea. Furthermore, advanced approaches such as Pre-Descemet Endothelial Keratoplasty (PDEK), Descemet Membrane Endothelial Transfer (DMET), Descemetorhexis Without Endothelial Keratoplasty (DWEK), and Rho-kinase inhibitors aim to accelerate visual recovery and optimize tissue efficiency.
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