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Klin Monbl Augenheilkd 2019; 236(01): 74-87
DOI: 10.1055/s-0043-106301
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Netzhautablösung im Kindesalter

Pediatric Retinal Detachment
Petra Meier
Klinik und Poliklinik für Augenheilkunde, Universität Leipzig
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Further Information

Publication History

eingereicht 12 December 2016

akzeptiert 02 February 2017

Publication Date:
09 June 2017 (online)

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Zusammenfassung

Eine Ablatio retinae tritt im Kindesalter im Vergleich zum Erwachsenenalter relativ selten auf, nur 3 bis 7% aller Netzhautablösungen werden bei Kindern und Jugendlichen im Alter bis zu 18 Jahren diagnostiziert. Risikofaktoren für das Auftreten einer Ablatio retinae im Kindesalter sind ein Trauma, eine Myopie, hereditäre Vitreoretinopathien, Malformationen und Morbus Coats. Am häufigsten treten in dieser Altersgruppe traumaassoziierte Netzhautablösungen auf, Vitreoretinopathien sind die häufigste Ursache für eine erblich bedingte kindliche Ablatio. Es werden die krankheitsspezifischen chirurgischen Behandlungskonzepte diskutiert. Bei klarer Linse sollte immer geprüft werden, inwieweit eine episklerale Buckelchirurgie durchgeführt werden kann, insbesondere bei einer Oradialyse und bei genau definierter Lochsituation in der Netzhautperipherie. Eine primäre Vitrektomie ist vorrangig bei Vitreoretinopathien erforderlich. Der Einsatz von Anti-VEGF-Inhibitoren ist zur Behandlung vasoproliferativer Erkrankungen geeignet, allerdings benötigen wir noch weitere Informationen über mögliche Nebenwirkungen bei Kindern. Insgesamt sind die funktionellen und anatomischen Behandlungsergebnisse bei Kindern oftmals schlechter als vergleichbare Resultate bei Erwachsenen. Weitere chirurgische Innovationen und ätiologiespezifische Therapiekonzepte sind erforderlich, um die Ergebnisse in dieser Patientengruppe zu verbessern.

Abstract

The number of retinal detachments in children is rarely compared to the number of retinal detachments in adults; only 3 – 7% occur in children. The main predisposing factors are trauma, myopia, hereditary vitreoretinopathies, retinopathy of prematurity, malformations and Coatsʼ disease. The most frequent paediatric retinal detachments are trauma-associated and vitreoretinopathies are the most common cause of inherited retinal detachment. Disease-specific surgical treatments are discussed. Episcleral buckling surgery should be the preferred method in any case of clear lens, especially for treatment of oradialysis and well-defined localization of peripherally retinal tears. In those suffering from vitreoretinopathy, primary vitrectomy is necessary. The intravitreal use of VEGF-inhibitors to treat vasoproliferative retinopathy in children is a new and effective tool, but we need further results about safety and side-effects in young patients. The functional and anatomical outcomes of retinal detachment in children are less successful than in adults. Further surgical innovations and etiology-specific treatment strategies are required to improve the outcome in this group.

Schlüsselwörter

Kinderophthalmologie - vitreoretinale Chirurgie - kindliche Netzhautablösung

Key words

paediatric retinal detachment - vitreoretinal surgery - paediatric ophthalmology
 

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