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Klin Monbl Augenheilkd 2019; 236(01): 63-68
DOI: 10.1055/s-0043-105271
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Zyklodestruktive Verfahren zur Senkung des Augeninnendrucks – eine Übersicht

Cyclodestructive Procedures to Lower Intraocular Pressure – A Review
Drazen Jurjevic
Augenklinik, UniversitätsSpital Zürich, Schweiz
,
Jens Funk
Augenklinik, UniversitätsSpital Zürich, Schweiz
,
Marc Töteberg-Harms
Augenklinik, UniversitätsSpital Zürich, Schweiz
› Author Affiliations
Further Information

Publication History

eingereicht 12 December 2016

akzeptiert 23 January 2017

Publication Date:
09 June 2017 (online)

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Zusammenfassung

Die einzige Therapie des Glaukoms, für die es eine ausreichende Evidenz gibt, ist die Senkung des Augendrucks. Die Augendrucksenkung kann durch eine Verbesserung des Abflusses oder eine Verringerung der Kammerwasserproduktion erzielt werden. Chirurgisch kann eine Verringerung der Kammerwasserproduktion durch zyklodestruktive Verfahren erreicht werden. Dieser Artikel soll eine kurze Zusammenfassung über die verschiedenen zyklodestruktiven Verfahren geben. Die Effektivität der Zyklophotokoagulation ist hinreichend belegt. Durch Anpassung der Laserprotokolle hat sich das Risikoprofil reduzieren lassen. Die in frühen Studien beschriebenen gravierenden Komplikationen bis hin zu Visusverlust sind selten geworden. Das Indikationsspektrum der Zyklophotokoagulation hat sich von End-Stage-Glaukomen bis zu Glaukomen mit gutem Visus erweitert. Selbst der Einsatz zyklodestruktiver Verfahren bei pädiatrischen Glaukomen hat an Akzeptanz gewonnen. Eine vielversprechende nächste Generation mikrogepulster Diodenlaser könnte bei gleicher Wirksamkeit das Risikoprofil noch weiter reduzieren. Die Nichtunterlegenheit der Mikropulszyklophotokoagulation gegenüber den etablierten Verfahren wurde in ersten Studien unter Beweis gestellt. Zum gegenwärtigen Zeitpunkt fehlen noch Langzeitstudien bezüglich Effektivität und Nebenwirkungsprofil sowie ein standardisiertes Laserprotokoll.

Abstract

The only therapy for glaucoma, for which there is sufficient evidence, is the lowering of intraocular pressure. Intraocular pressure reduction can be achieved by an improvement in outflow or a reduction of aqueous humor production. Surgically, a reduction of aqueous humor production can be achieved by cyclodestructive procedures. This article provides a brief summary of the different cyclodestructive procedures. The efficacy of cyclophotocoagulation is well documented. The risk profile has been reduced by changes in the laser protocols. Serious complications described in early studies (e.g., visual loss) rarely occur nowadays. The indication spectrum of cyclophotocoagulation has expanded from end-stage glaucoma to glaucoma with good visual acuity. Even the use of cyclodestructive procedures in pediatric glaucoma has gained acceptance. A promising next generation of micropulsed diode lasers could further reduce the risk profile with the same effectiveness. The non-inferiority of micropulse cyclophotocoagulation versus the established procedures has been proven in early studies. However, studies with long-term follow-up and on side-effects are still lacking. Furthermore, a standardized laser protocol must be established.

Schlüsselwörter

Glaukom - Kryokoagulation - Mikropuls - Photokoagulation - Zyklodestruktion

Key words

glaucoma - cryocoagulation - micropulse - photocoagulation - cyclodestruction
 

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