Praxis der nichtfiltrierenden minimalinvasiven Glaukomchirurgie

Ein erhöhter intraokulärer Druck kann zu Schäden am Sehnerv führen und das Sehvermögen beeinträchtigen. Wenn der Augeninnendruck durch Augentropfen oder Laserbehandlungen nicht ausreichend gesenkt werden kann, muss eine chirurgische Behandlung in Betracht gezogen werden, um den Druck zu verringern. Neben der klassischen Glaukomchirurgie etablieren sich auch minimalinvasive glaukomchirurgische Verfahren, die in diesem Beitrag vorgestellt werden.

Abstract

Minimally invasive glaucoma surgeries (MIGS) offer an alternative approach, aiming to be both safe and effective. Defined by their ab interno technique, which avoids creating a bleb, MIGS procedures seek to reduce intraocular pressure (IOP) by enhancing the outflow pathways of aqueous humor. Techniques include stenting, incisions, and excisions of the trabecular meshwork, canaloplasty of Schlemm’s canal, and drainage implants that enhance uveoscleral outflow to the subchoroidal space. Many of these methods show promise in reducing intraocular pressure and decreasing the need for medication. Nevertheless, with the increasing number of these procedures and devices on the market, it is difficult to keep track of the evidence supporting these methods. Although randomized controlled trials exist for many of the new MIGS procedures, the sample sizes are often small, and follow-up periods are limited. Additionally, there are no randomized controlled trials comparing different MIGS techniques or MIGS with traditional glaucoma surgery. These factors continue to make it challenging to select the most appropriate method for each patient. Therefore, it is essential to persist in conducting randomized controlled long-term studies to gain a deeper understanding of the applications of MIGS.

Kernaussagen

• Minimalinvasive Glaukomoperationen (MIGS) zielen darauf ab, den Augeninnendruck (IOD) zu senken, indem die natürlichen Abflusswege des Kammerwassers verbessert werden, und zeichnen sich durch ihre Ab-interno-Technik ohne Sickerkissenanlage aus.

• Zum Einsatz kommen Stents, Inzisionen und Exzisionen des Trabekelwerks, Kanaloplastik des Schlemm-Kanals und Drainageimplantate, die den uveoskleralen Abfluss in den subchoroidalen Raum verbessern.

• Einige dieser Methoden sind vielversprechend, um den Augeninnendruck zu senken und den Bedarf an Medikamenten zu verringern, wobei es ob der Vielzahl schwierig ist, den Überblick über die Belege für diese Methoden zu behalten.

• Zwar gibt es für viele der neuen MIGS-Verfahren randomisierte kontrollierte Studien, doch sind die Stichprobengrößen oft klein und der Nachbeobachtungszeitraum begrenzt. Außerdem gibt es keine randomisierten kontrollierten Studien, in denen verschiedene MIGS-Techniken oder MIGS mit der herkömmlichen Glaukomchirurgie verglichen werden.

• Diese Faktoren machen es nach wie vor schwierig, für jeden Patienten die am besten geeignete Methode auszuwählen.

• Daher ist es unerlässlich, weiterhin randomisierte, kontrollierte Langzeitstudien durchzuführen, um ein tieferes Verständnis für die Anwendungen der MIGS zu erlangen.

Schlüsselwörter

Glaukom - Glaukomchirurgie - minimalinvasive Glaukomchirurgie - Augeninnendruck

Keywords

glaucoma - glaucoma surgery - minimally invasive glaucoma surgery - intraocular pressure

Publication History

Article published online:
14 January 2025

• Literatur

• 1 Abegao Pinto L, Sunaric Mégevand G, Stalmans I. et al. European Glaucoma Society -A guide on surgical innovation for glaucoma. Br J Ophthalmol 2023; 107 (Suppl. 1) 1-114
• 2 Samuelson TW, Katz LJ, Wells JM. et al. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology 2011; 118: 459-467
• 3 Pillunat LE, Erb C, Jünemann AGM. et al. Micro-invasive glaucoma surgery (MIGS): A review of surgical procedures using stents. Clin Ophthalmol 2017; 11: 1583-1600
• 4 Samuelson TW, Sarkisian SR, Lubeck DM. et al. Prospective, randomized, controlled pivotal trial of an ab interno implanted trabecular micro-bypass in primary open-angle glaucoma and cataract: two-year results. Ophthalmology 2019; 126: 811-821
• 5 Shalaby WS, Jia J, Katz LJ. et al. IStent inject: Comprehensive review. J Cataract Refract Surg 2021; 47: 385-399
• 6 Samuelson TW, Chang DF, Marquis R. et al. A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: The HORIZON Study. Ophthalmology 2019; 126: 29-37
• 7 Ahmed IIK, Fea A, Au L. et al. A prospective randomized trial comparing hydrus and istent microinvasive glaucoma surgery implants for standalone treatment of open-angle glaucoma: The COMPARE Study. Ophthalmology 2020; 127: 52-61
• 8 Dorairaj S, Radcliffe NM, Grover DS. et al. A review of excisional goniotomy performed with the kahook dual blade for glaucoma management. J Curr Glaucoma Pract 2022; 16: 59-64
• 9 Francis BA, Minckler D, Dustin L. et al. Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: Initial results. J Cataract Refract Surg 2008; 34: 1096-1103
• 10 Chow JTY, Hutnik CML, Solo K. et al. When Is Evidence enough evidence? a systematic review and meta-analysis of the trabectome as a solo procedure in patients with primary open-angle glaucoma. J Ophthalmol 2017; 2017: 2965725
• 11 Berlin MS, Shakibkhou J, Tilakaratna N. et al. Eight-year follow-up of excimer laser trabeculostomy alone and combined with phacoemulsification in patients with open-Angle glaucoma. J Cataract Refract Surg 2022; 48: 838-843
• 12 Durr GM, Töteberg-Harms M, Lewis R. et al. Current review of Excimer laser trabeculostomy. Eye Vis (Lond) 2020; 7: 24
• 13 Grover DS, Godfrey DG, Smith O. et al. Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy: Technique report and preliminary results. Ophthalmology 2014; 121: 855-861
• 14 Grover DS, Smith O, Fellman RL. et al. Gonioscopy assisted transluminal trabeculotomy: An ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Brit J Ophthalmol 2015; 99: 1092-1096
• 15 Klabe K, Kaymak H. Standalone trabeculotomy and viscodilation of schlemm’s canal and collector channels in open-angle glaucoma using the OMNI surgical system: 24-month outcomes. Clin Ophthalmol 2021; 15: 3121-3129
• 16 Gallardo MJ, Supnet RA. et al. Viscodilation of Schlemm’s canal for the reduction of IOP via an ab-interno approach. Clin Ophthalmol 2018; 12: 2149-2155
• 17 Lazcano-Gomez G, Antzoulatos GL, Kahook MY. Combined phacoemulsification and streamline surgical system canal of schlemm transluminal dilation in eyes of hispanic patients with mild to moderate glaucoma. Clin Ophthalmol 2023; 17: 1911-1918
• 18 Vold S, Ahmed IIK, Craven ER. et al. Two-Year COMPASS Trial results: supraciliary microstenting with phacoemulsification in patients with open-angle glaucoma and cataracts. Ophthalmology 2016; 123: 2103-2112
• 19 Reiss G, Clifford B, Vold S. et al. Safety and effectiveness of cypass supraciliary micro-stent in primary open-angle glaucoma: 5-year results from the COMPASS XT Study. Am J Ophthalmol 2019; 208: 219-225
• 20 Dick HB, Mackert MJ, Ahmed IIK. et al. Two-Year Performance and Safety Results of the MINIject Supraciliary Implant in Patients with Primary Open-Angle Glaucoma: Meta-Analysis of the STAR-I, II, III Trials. Am J Ophthalmol 2024; 260: 172-181