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Ist alles Neue immer besser?

Is everything new always better?

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Zusammenfassung

Zunehmend werden mehrere „neuere“ Operationsmethoden oder Modifikationen bestehender Operationen, wie selektive Lasertrabekuloplastik, nicht-penetrierende Operationen, Wundheilungsmodulatoren etc. beim Glaukom angewendet. Es wird diskutiert, ob neuere Methoden auch besser sind, d. h., ob eine größere Anzahl von Patientinnen erfolgreich ohne weitere Medikation über einen längeren Zeitraum keine Progression des Krankheitsbildes zeigen. Messlatte bleibt nach wie vor die fistulierende Operation. Sie hat nach wie vor nicht ausgedient, im Gegenteil, durch exakte Technik lassen sich hervorragende Ergebnisse mit relativ dauerhafter tiefer Druckregulierung und reduziertem Risikoprofil erzielen. Nicht-penetrierende Operationen wie tiefe Sklerektomie oder Viskokanalostomie haben zwar ein deutlich niedrigeres frühpostoperatives Nebenwirkungsprofil, erreichen aber längerfristige Drucksenkungen zwischen 15 und 20 mm Hg meist nur mittels Zuhilfenahme augmentativer Maßnahmen. Die Argonlasertrabekuloplastik liefert ähnliche Ergebnisse wie die selektive Trabekuloplastik. Zyklodestruktive Eingriffe sollten auf Grund der ausgeprägten Nebenwirkungen nicht mehr mit Kryosonden, sondern mittels Laser durchgeführt werden. Implantate können den Augendruck bei therapierefraktären Glaukomen senken, man kämpft jedoch mit Hypotonien oder Abkapselungen der Platten. Einige innovative Techniken konnten sich zumindest in Zentren etablieren. Nach wie vor gibt es (noch) keine ideale Glaukomoperation.

Summary

More and more of “new” operations or modifications of operations are used in glaucoma surgery, e. g. the selective lasertrabeculoplasty, non-penetrating procedures or modulations of wound healing. The question is so far, if new procedures are better than the established ones, that means, if they are more successful in regulation of the intraocular pressure without medications over a longer period of time and will stop the progression of the disease. The benchmark is still the fistulating operation (trabeculectomy). A proper technique will lead to excellent results and will reduce the risk profile of side effects. Non-penetrating procedures like deep sclerectomy and viscocanalostomy do have indeed a lower short-time postoperative side effect profile, but a sufficient success can in most of the cases only be reached by additional measures like goniopuncture and implants. The argonlasertrabeculoplasty still has similar results in comparison to the selective trabeculoplasty. In cyclodestructive procedures a method with cryo should be avoided due to severe side effects like a high amount of phthisis. Laser assisted techniques are much more safer. Implants may reduce the intraocular pressure effectively, nevertheless one has to struggle with hypotony and scarring around the plates. Some innovative techniques like goniocurettage or aspiration of the trabeculum could be established at certain centers. The ideal glaucoma operation has still to be found.

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  1. Universitäts-Augenklinik, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich

    C. Faschinger

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Faschinger, C. Ist alles Neue immer besser?. Spektrum Augenheilkd 18, 254–260 (2004). https://doi.org/10.1007/BF03163181

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