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Klin Monbl Augenheilkd 2002; 219(12): 883-888
DOI: 10.1055/s-2002-36949
Klinische Studie
© Georg Thieme Verlag Stuttgart · New York

Chirurgie des idiopathischen Makulaforamens: Erfahrungen mit autologem Thrombozytenkonzentrat und Indocyaningrünapplikation

Macular Hole Surgery: Experience with Autologous Platelet Concentrate and Indocyanine Green-Assisted Internal Limiting Membrane PeelingThomas  Kube1, 2 , Martin  Hermel2 , Claudia  Dahlke2 , Gabriele  Hutschenreuter3 , Norbert  Schrage2 , Bernd  Kirchhof1, 4
  • 1Augenklinik der Albert-Ludwigs-Universität Freiburg, Freiburg (komm. Direktor: Prof. Dr. med. Dr. rer. nat. J. Funk)
  • 2Augenklinik der RWTH Aachen, Aachen (Komm. Direktor: PD Dr. med. N. Schrage)
  • 3Institut für Transfusionsmedizin der RWTH Aachen, Aachen (Direktor: Dr. med. G. Hutschenreuter)
  • 4Zentrum für Augenheilkunde der Universität zu Köln, Abteilung für Netzhaut- und Glaskörper-Chirurgie, Köln (Direktor: Prof. Dr. med. B. Kirchhof)
Herrn Professor Dr. med. Heinrich Witschel zum 65. Geburtstag gewidmet
Further Information

Publication History

Eingegangen: 7. März 2002

Angenommen: 6. Dezember 2002

Publication Date:
27 January 2003 (online)

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Zusammenfassung

Hintergrund: Wir berichten über unsere klinischen Erfahrungen bei der Therapie des idiopathischen Makulaforamens unter Verwendung von autologem Thrombozytenkonzentrat mit und ohne Indocyaningrün (ICG)-gestütztem Peeling der Lamina limitans interna. Patienten und Methoden: Bei 107 Augen von 101 Patienten (m : w = 27 : 74; Durchschnittsalter 60 ± 9, Range 30 - 80 Jahre) mit idiopathischem Makulaforamen der Stadien II - IV nach Gass wurde eine Pars-plana-Vitrektomie, Flüssigkeits-Luft-Austausch und eine Applikation von autologem Thrombozytenkonzentrat durchgeführt. Dabei wurden durchschnittlich 1,9 ± 0,1 × 108 Thrombozyten appliziert. Bei 34 Augen wurde ein Peeling der Lamina limitans interna unternommen, dem in 19 Fällen eine Anfärbung mit ICG vorausgegangen war. Ergebnisse: Die anatomische Erfolgsrate nach Ersteingriff lag im Stadium II (n = 68 Augen) bei 85 %, im Stadium III (n = 27 Augen) bei 75 %, und im Stadium IV (n = 3 Augen) bei 100 %. Über alle Stadien betrug die initiale Verschlussrate 82 %, und der Visus stieg um 1 Zeile an. Nach Reoperation stieg die Verschlussrate auf 96 % an. Die Augen, die ICG-unterstützt operiert worden waren, zeigten keine signifikant verbesserte Verschlussrate (94 %), aber einen signifikant höheren Visusanstieg um durchschnittlich zwei Zeilen. Schlussfolgerungen: Die Applikation von autologem Thrombozytenkonzentrat ist sicher und führt zu einer hohen Lochverschlussrate. Durch ICG-gestütztes Peeling der Lamina limitans interna kann das funktionelle Ergebnis zusätzlich verbessert werden.

Abstract

Backgound: To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. Patients and methods: Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 ± 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 ± 0,1 × 108 thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. Results: After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. Conclusion: Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling

Schlüsselwörter

Makulaforamen - autologes Thrombozytenkonzentrat - Indocyaningrün - Lamina limitans interna-Peeling

Key words

Macular hole - autologous platelet concentrate - indocyanine green - internal limiting membrane (ILM) peeling

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Dr. med. Thomas Kube

Augenklinik der Albert-Ludwigs-Universität Freiburg

Killianstraße 5

79106 Freiburg

Email: kube@aug.ukl.uni-freiburg.de

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