Die Visusminderung in Zusammenhang mit Silikonöltamponaden

Zusammenfassung

ein dauerhafter Visusverlust beobachtet. Bei den meisten dieser Patienten liegt dieser Visusminderung eine Ausdünnung der inneren Netzhautschichten zugrunde. Die hierfür ursächliche Pathologie ist nach wie vor unklar. Ein direkter Zusammenhang der Visusminderung mit dem Silikonöl ist wahrscheinlich, aber nicht belegt. Bei Patienten, die eine Gas- oder keine Tamponade erhalten haben, gibt es diese Beobachtung nicht. Die Visusminderung während oder nach Entfernung einer Silikonöltamponade ist ein unterschätztes Phänomen. Die Sicherheit von Silikonöl als vitreoretinale Tamponade sollte erneut und systematisch untersucht werden. Es scheint lohnenswert, nach neuen dauerhaften intraokularen Tamponaden zu suchen. Eine Verwendung von Silikonöl sollte in jedem Einzelfall genauestens abgewogen werden.

Abstract

Silicone oil tamponades have been a key feature of vitreoretinal surgery for more than 40 years. The use of these durable vitreous substitutes has not only been limited to tractive retinal detachments, inflammatory chorioretinopathies or other complicated vitreoretinal diseases, but also to macular holes and rhegmatogenous retinal detachment. During the last 12 years, an increasing number of cases of vision loss during or after the removal of silicone oil have been reported in the literature. In up to one third of patients with uncomplicated macula-attached retinal detachment with good preoperative vision, continuing vision loss is seen. In most of these cases, thinning of the inner retinal layers can be found. The underlying pathological mechanism is unknown. A direct connection to silicone oil is likely, but has not been proven. However, the increasing number of reports raises evidence that silicone oil itself might be the reason for this phenomenon, which is not observed in gas tamponades. Vision loss during or after the removal of silicone oil is an underestimated problem. The safety and toxicity of silicone oil should be reexamined systematically. The search for novel vitreous replacements is indispensable. The use of silicone oil should be strictly evaluated and balanced against other possible tamponades in every individual case.

Schlüsselwörter

Silikonöl - Vitrektomie - Visusminderung - vitreoretinale Chirurgie

Key words

silicone oil - vitrectomy - vision loss - vitreoretinal surgery

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