Chirurgische Möglichkeiten der Glaukomtherapie

Zusammenfassung

Die Glaukomchirurgie erfährt einen Innovationsschub insbesondere durch neue Mikroimplantate. Auch lange bestehende glaukomchirurgische Verfahren, wie die Trabekulektomie oder die Drainageimplantatchirurgie, erleben eine Aufwertung durch eine Verbesserung ihres Risiko-Nutzen-Profils. Dieser Beitrag gibt einen Überblick über die aktuellen chirurgischen Optionen der Glaukombehandlung.

Abstract

During the last few years, there has been a considerable capacity of innovations in glaucoma surgery owing to new micro-stents increasing the aqueous outflow via transscleral routes, via the trabecular meshwork or the suprachoroidal space. These interventions can be easily performed in combination with small-incision cataract surgery. Even the well-known filtering procedures, trabeculectomy and drainage device surgery, formerly perceived as being outdated, re-achieve better reputation owing to refinements in surgical technique and improved surgical experience. Although enthusiasm is understandable, considering the technical advances, we must wait for clinical long-term results and compare the new procedures with the established ones.

Kernaussagen

• In der chirurgischen Behandlung des Offenwinkelglaukoms besitzt die Trabekulektomie mit Mitomycin C weiter einen überragenden Platz in der primären Behandlung.

• Allerdings wird ihr dieser Platz in der kombinierten Glaukom-Katarakt-Chirurgie mehr und mehr streitig gemacht von den kammerwinkelchirurgischen Verfahren.

• Letztere können mit wenig Zeitaufwand und Risiko in die Kleinschnittkataraktchirurgie integriert werden.

• Bei den komplizierten Glaukomen setzt sich auch in Deutschland zunehmend die Drainageimplantatchirurgie durch, während die Zyklodestruktion eher abnimmt.

• Bei aller Euphorie über die chirurgischen Innovationen muss mit kritischem Abstand abgewartet werden, welches der neueren chirurgischen Verfahren langfristig dem klinischen Vergleich mit den etablierten Verfahren standhält.

Schlüsselwörter

Augendruck - Glaukomchirurgie - Glaukomimplantat - Trabekulektomie

Key words

intraocular pressure - glaucoma surgery - glaucoma drainage device - trabeculectomy

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