Zusammenfassung
Fragestellung: Wertigkeit von Vorderkammerblutungen nach Kanaloplastie. Methodik: Von November 2008 – Oktober 2009 sind in unserem Haus 21 Augen von 17 Patienten bei
einem primären Offenwinkelglaukom mit einer Kanaloplastie versorgt worden. Am Ende
der OP wurden alle Augen mit tiefer Vorderkammer ohne Blutung vom OP-Tisch entlassen.
Ergebnisse: Der intraokulare Druck (IOD) am 1. Post-OP-Tag betrug im Mittel 9,6 mmHg, wobei 15
der 21 Augen ein Hyphaema von 0,5 – 2 mm zeigten. Augen ohne Blutung wiesen zum gleichen
Zeitpunkt einen IOD von über 15 mmHg auf. In keinem der 15 Augen mit Hyphaema kam
es zu weiteren Nachblutungen, das Blut resorbierte sich komplett innerhalb von 1 Woche.
Schlussfolgerung: Im Gegensatz zur Trabekulektomie legt man bei der Kanaloplastie eine Dilatation des
Schlemm’schen Kanals sowie der Kollektorkanäle an, um den physiologischen Weg des
Kammerwasserabflusses wiederherzustellen. Fällt der Druck in der Vorderkammer temporär
unter das Niveau des venösen Kapillardrucks, muss es bei einem durchgängigen Leitungssystem
so lange zu einer Strömungsumkehr mit Blutreflux in die Vorderkammer kommen, bis ein
minimaler Druckgradient von der Vorderkammer in Richtung Schlemm’schen Kanal wiederhergestellt
ist.
Abstract
Objective: An attempt has been made to evaluate transient anterior chamber haemorrhage after
canaloplasty. Method: In the period from November 2008 to October 2009 a total of 21 eyes in 17 patients
underwent canaloplasty for primary open angle glaucoma in our clinic. At the end of
surgery all eyes left the surgical table with an intraocular pressure (IOP) of 5 –
10 mmHg and a deep anterior chamber without any bleeding. Results: The IOP on day 1 after surgery was 9.6 mmHg in average. By that time 15 of 21 eyes
showed anterior chamber haemorrhage with a hyphaema between 0.5 – 2 mm in height.
Eyes without hyphaema showed an IOP of > 15 mmHg at the same time. In no case was
there further haemorrhage, the blood was absorbed in all cases within a maximum of
1 week without further complications. Conclusion: In contrast to trabeculectomy, where the natural anterior chamber water outflow is
by-passed via an artificial fistula, canaloplasty attempts to re-establish the physiological
anterior chamber water draining system by means of a 360 degree viscocanalostomy and
a thread mediated dilation of Schlemm’s canal and its collector channels. If the anterior
chamber pressure temporarily lowers the level of the venous capillary pressure, it
is consistent with a patent piping system when a reverse flow with blood reflux into
the anterior chamber can be observed as long as a minimal physiological pressure gradient
from the anterior chamber in the direction of channel Schlemm’s canal has been restored.
Thus, in the authors opinion, anterior chamber haemorrhage shows the desired consistency
of the water draining system and should therefore logically be expected after each
successful operation in all cases where hypotony in the postoperative period occurs.
Schlüsselwörter
Glaukom - Kanaloplastie - Hyhaema
Key words
primary open angle glaucoma - canaloplasty - hyphaema
Literatur
- 1
Jones E, Clarke J, Khaw P T.
Recent advances in trabeculectomy technique.
Curr Opin Ophthalmol.
2005;
16
107-113
- 2
Borisuth N SC, Phillips B, Krupin T.
The risk profile of glaucoma filtration surgery.
Curr Opin Ophthalmol.
1999;
10
112-116
- 3
Gedde S J, Herndon L W, Brandt J D et al.
Surgical complications in the tube versus trabeculectomy studyduring the first year
of follow up.
Am J Ophthalmol.
2007;
143
23-31
- 4
Edmunds B, Thompson J R, Salmon J F et al.
The national survey of trabeculectomy III. Early and late complications.
Eye.
2002;
16
297-303
- 5
Lewis R A, v Wolf K, Tetz M et al.
Canaloplasty: Circumferential viscodilation and tensioning of Schlemm’s canal using
a flexible microcatheter for the treatment of open-angle glaucoma in adults.
J Cataract Refract Surg.
2007;
33
1217-1226
- 6
Shingleton B, Tetz M, Korber N.
Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with
temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma
and visually significant cataract: one-year results.
J Cataract Refract Surg.
2008;
34
433-440
- 7
Minckler D S, Hill R A.
Use of novel devices for control of intraocular pressure.
Exp Eye Res.
2009;
88
792-798
- 8
Godfrey D G, Fellman R L, Neelakantan A.
Canal surgery in adult glaucomas.
Curr Opin Ophthalmol.
2009;
20
116-121
- 9
Körber N.
Kanaloplastik.
Ophthalmo-Chirurgie.
2008;
20
24-30
- 10
Peckar C O, Körber N.
Canaloplasty for open angle glaucoma: a three year critical evaluation and comparison
with viscocanalostomy.
Spectrum Augenheilkd.
2008;
22
1-7
- 11
Stegmann R, Pienaar A, Miller D.
Viscocanalostomy for open angle glaucoma in black African patients.
J Cataract Refract Surg.
1999;
25
316-322
Dr. Jörg M. Koch
Augenabteilung, St. Franziskus Hospital
Hohenzollernring 74
48145 Münster
Telefon: ++ 49/2 51/9 35 27 11
Fax: ++ 49/2 51/9 35 27 19
eMail: joerg.koch@augen-franziskus.de
