{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T12:29:31Z","timestamp":1790944171379,"version":"4.1.0"},"reference-count":57,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Monbl Augenheilkd"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Die Hornhauttransplantation ist das weltweit am h\u00e4ufigsten durchgef\u00fchrte Verfahren zur Transplantation von menschlichem Gewebe. Aufgrund der gro\u00dfen Anzahl von Transplantationen hat sich das\n\t\t\t\t\tVersagen von Hornhauttransplantaten aus immunologischen und nicht immunologischen Gr\u00fcnden (z.\u200aB. Rezidiv der Grunderkrankung, hoher Augendruck, transplantierte Guttae, \u00fcbertragene HSV- oder\n\t\t\t\t\tCMV-Infektion) zu einer der h\u00e4ufigsten Indikationen f\u00fcr Hornhauttransplantationen entwickelt. Die relativ neuen lamell\u00e4ren Transplantationstechniken haben bestimmte potenzielle\n\t\t\t\t\tKomplikationen mit sich gebracht, die zu einem Transplantatversagen f\u00fchren und andere Ans\u00e4tze als die perforierende Keratoplastik f\u00fcr eine erneute Transplantation erforderlich machen k\u00f6nnen.\n\t\t\t\t\tAndererseits bieten diese neuen lamell\u00e4ren Techniken auch neue M\u00f6glichkeiten zur Rettung fehlgeschlagener perforierender Transplantate, mit potenziellen Vorteilen gegen\u00fcber\n\t\t\t\t\taufeinanderfolgenden perforierenden Keratoplastiken, wie z.\u200aB. geringere intraoperative Risiken, schnellere visuelle Rehabilitation und reduziertes Absto\u00dfungsrisiko. Heute stellt bei gutem\n\t\t\t\t\tHeilungsverlauf der mit seinem Transplantat vor der endothelialen Dekompensation zufriedene Patient mit geringem Astigmatismus und ohne stromale Narben die optimale Voraussetzung f\u00fcr die\n\t\t\t\t\tDMEK nach PKP dar. Diese kann auch mit einer Phakoemulsifikation kombiniert werden (sog. Triple-DMEK). Anderenfalls erfolgt eine perforierende Re-Keratoplastik mit einem gr\u00f6\u00dferen\n\t\t\t\t\tTransplantat (typischerweise Excimerlaser-Re-PKP 8,5\/8,6\u2009mm), um gleichzeitig \u00d6dem, Narben und Verkr\u00fcmmung zu therapieren. Die Anamnese hat bei dieser Entscheidung Gewicht! Eine Re-DMEK bei\n\t\t\t\t\tTransplantatversagen nach DMEK und DSAEK bedarf keiner Modifikation der Standardtechnik und f\u00fchrt bei raschem Vorgehen zu guten Visusergebnissen. Bei eindeutiger stromaler Vernarbung nach\n\t\t\t\t\tmultiplen (externen) DMEKs kann auch eine PKP zur Bereinigung der Situation erwogen werden. Bei ansonsten grundlos rezidivierenden Transplantatversagen muss man an eine herpetische oder\n\t\t\t\t\tCMV-Endotheliitis denken und nach PCR-Analyse des Kammerwasseraspirats entsprechend medikament\u00f6s therapieren.<\/jats:p>","DOI":"10.1055\/a-1774-4862","type":"journal-article","created":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T03:09:25Z","timestamp":1651288165000},"page":"775-785","source":"Crossref","is-referenced-by-count":13,"title":["Transplantatversagen nach PKP und DMEK: Was ist die beste Option?"],"prefix":"10.1055","volume":"239","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9701-8204","authenticated-orcid":false,"given":"Berthold","family":"Seitz","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Augenheilkunde, Universit\u00e4tsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loay","family":"Daas","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr 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