Augenprothetische Rehabilitation in Deutschland heute – Versorgungsmöglichkeiten, Handhabung, Komplikationen und psychologische Aspekte

Zusammenfassung

Hintergrund Eine adäquate Versorgung mit einer optisch ansprechenden Augenprothese nach dem Verlust eines Auges ist nicht nur aus rein kosmetischen Gründen essenziell, sondern erleichtert vor allem eine gute soziale und psychische Rehabilitation.

Fragestellung Es soll eine Übersicht über den aktuellen Stand der augenprothetischen Versorgung in Deutschland erstellt werden. Dabei wird auf die neuesten klinischen Erkenntnisse, die Handhabung der Augenprothesen sowie auf typische Komplikationen und psychologische Fragestellungen, mit denen Augenärzte im Alltag konfrontiert werden, eingegangen.

Methoden Der Beitrag bietet eigene klinische Ergebnisse und eine aktuelle Literaturübersicht aus PubMed.

Ergebnisse Enukleierte Patienten werden in Deutschland meist mit doppelwandigen, hohlen Prothesen aus Kryolithglas versorgt, Patienten mit einem Mikrophthalmus oder einem phthitischen Auge dagegen mit einer einwandigen, dünnen Bulbusschale. Patienten, die Augenprothesen aus Kryolithglas tragen, scheinen sowohl mit ihrem Aussehen als auch mit der Optik der Prothese zufriedener zu sein als PMMA-Augenprothesenträger (PMMA: Polymethylmethacrylat). Glasprothesen müssen mindestens jährlich erneuert, Kunststoffprothesen einmal pro Jahr poliert und alle 5 Jahre ersetzt werden. Bei Kindern, insbesondere in Wachstumsphasen, sollte mindestens halbjährlich die Passform der Prothese kontrolliert werden. Eine leicht höhere Bruchgefahr der Augenprothesen aus Kryolithglas stellt im Alltag für die meisten Patienten keinen größeren Nachteil dar. Okularisten und Ophthalmologen sollten zusammen mit dem Patienten ein individuelles Reinigungsprozedere festlegen, das sowohl vom Prothesenmaterial als auch von äußeren Faktoren abhängt. Komplikationen wie die allergische, die gigantopapilläre, die virale und die bakterielle Konjunktivitis oder auch die Blepharoconjunctivitis sicca müssen frühzeitig erkannt und therapiert werden, um die Prothesenfähigkeit zu erhalten. Bei entzündungsbedingtem Schrumpfungen des Bindehautsackes oder beim Post-Enukleations-Socket-Syndrom muss die Prothesenfähigkeit chirurgisch wiederhergestellt werden. Da die Gesundheit des verbliebenen, sehenden Auges die größte psychologische Belastung von Augenprothesenträgern darstellt, ist eine gute augenärztliche Betreuung, Für- und Vorsorge nach der Exstirpation eines Auges essenziell.

Schlussfolgerungen Eine reibungslose augenprothetische Versorgung, eine adäquate und frühzeitige Therapie möglicher Komplikationen sowie die Berücksichtigung psychologischer Aspekte sind maßgeblich, um Patienten nach dem Verlust eines Auges dauerhaft erfolgreich zu rehabilitieren.

Abstract

Background A smooth supply with a visually appealing prosthetic eye after enucleation is not just a cosmetic solution, it is also a key factor in successful social and psychological rehabilitation.

Objectives This article provides an overview of the current state of medical and ocular care regarding prosthetic eyes in Germany. It focuses mainly on the newest clinical results, daily care, complications, and psychological aspects of wearing prosthetic eyes.

Methods The study is comprised of the newest clinical results and a current PubMed literature review.

Results In Germany, enucleated patients normally get a double-walled, hollow prosthetic eye made of cryolite glass, and patients with a microphthalmic or phthisic eye receive a thin single-walled prosthesis. Anophthalmic patients wearing cryolite glass prosthetic eyes seem to be more satisfied with their appearance and the look of their prostheses than polymethylmethacrylate (PMMA) prosthetic eye wearers. Cryolite glass prosthetic eyes must be renewed at least each year, while PMMA prostheses need to be polished once a year and renewed after five years of wearing. Among children, the fit of the prosthetic eye must be checked, based on growth, semi-annually. A slightly higher risk of breakage of cryolite glass prostheses is, for most patients, not a great disadvantage in everyday life. Ocularists and ophthalmologists should determine an individual cleaning regime, together with the patient, that is dependent on the material of the ocular prosthesis and other external factors. Complications, such as allergic, giant papillary, viral and bacterial conjunctivitis and blepharoconjunctivitis sicca must be treated at an early stage to allow for a prosthetic eye. In the case of inflammation-caused socket shrinkage or post-enucleation socket syndrome, surgical interventions are needed to re-enable the use of a prosthetic eye. Since the health of the remaining eye is the major psychological burden of prosthetic eye wearers, good ophthalmological care and medical screenings are essential elements.

Conclusions A smooth supply with a prosthetic eye, adequate and early treatment of possible complications and attention to psychological aspects is essential for successful long-term rehabilitation of enucleated patients.

Schlüsselwörter

Enukleation - Anophthalmie - Kunstauge - Augenprothese - Kryolithglas

Key words

enucleation - anophthalmia - prosthetic eye - ocular prosthesis - cryolite glass

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