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Radiäre Optiko-Neurotomie (RON) bei Zentralvenenthrombosen

Radial optico-neurotomy (RON) in Central retinal vein occlusion (CRVO)

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Zusammenfassung

Hintergrund

Als Ursache des Zentralvenenverschlusses (ZVV) wird eine Kompression der retinalen Zentralvene im Bereich der Durchtrittsstelle durch die Skiera diskutiert. Die bisherigen Therapieoptionen sind auf rheologische Maßnahmen und Laserphotokoagulation beschränkt und haben meist schlechte funktioneile Ergebnisse.

Methode

Bei 5 Patienten im Alter von 75–86 Jahren mit einem hämorrhagischen ZVV und einem Visusverlust auf < 0,1 führten wir eine Pars-plana-Vitrektomie mit Entfernung der Membrana limitans interna und Durchtrennung der Sklerascheide am nasalen Optikusrand durch. Prä- und postoperativ wurden Visus, Angiographie und optische Kohärenz-Tomographie (OCT) durchgeführt.

Ergebnisse

Bei allen Patienten ließ sich die sklerale Optikusscheide mit einer Lanzette ohne größere Blutung durchtrennen. In der postoperativen Beobachtungszeit von 8 bis 18 Monaten stieg der Visus auf 0,05–0,4 an. Klinisch konnte bei allen Patienten ein deutlicher Rückgang der intraretinalen Blutungen nachgewiesen werden, wenngleich das retinale Ödem im OCT persistierte. Im OCT vermindert sich die Nervenfaserschichtdicke durch die Neurotomie nicht. Bei keinem Patienten trat eine Rubeosis iridis oder retinale Proliferation auf und erforderte bisher keine Laserphotokoagulation.

Diskussion

Bei Augen mit ZVV scheint eine Vitrektomie und Durchtrennung der skleralen Optikusscheide gefürchtete Komplikationen wie Proliferationen zu vermeiden. Intraoperativ traten keine besonderen Komplikationen auf. Im OCT waren postoperativ keine Nervenfaserdefekte nachweisbar. Ob die zusätzliche intravitreale Gabe von Triamcinolon das Makulaödem reduzieren und dadurch zu einem Visus fuhren kann, müssen weitere Studien zeigen.

Summary

Background

Central retinal vein occlusion (CRVO) are caused by a compression of the retinal vein the lamina cribrosa. Current therapy options are limited to rheologic treatment and laser photocoagulation and have a bad functional outcome.

Methods and patients

In 5 patients at the age of 75–86 years with a haemorhagic CRVO and a visual acuity of < 0.1 we performed a pars-plana vitrectomy with peeling of the inner limiting membrane and a surgical delamination of the scierai sheath at the nasal edge of the optic nerve. Visual acuity, angiography and optical coherence tomography (OCT) were perfomed pre- and postoperatively.

Results

The scierai sheath of the optic disc was separated by an MVR-blade without severe bleedings in all patients. Vision improved to 0.05 to 0.4 during the follow-up periode of 8 to 18 months. A significant regression of the retinal bleedings became apparent in all patients, although a macular edema persisted on OCT. The retinal nerve fiber layer at the optic nerve head was not reduced on OCT after RON. No patient developed a proliferation at the retinal or iris and no laser photocoagulation was required during the follow-up periode.

Discussion

A vitrectomy and separation of the scleral sheath of the optic nerve seams to prevent complications such as proliferations. Intraoperatively occured no severe complications. On OCT there were no defects of the RNFL visible. Further studies are needed to demonstrate if an additional intravitreal administration of Triamcinolone may reduce the macular edema and achieve a better visual outcome.

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Authors and Affiliations

  1. Zentrum für Augenheilkunde, Philipps-Universität Marburg, Robert-Koch-Straße 4, D-35037, Marburg, Deutschland

    C. H. Meyer, S. Mennel, S. Kunze & J. C. Schmidt

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  1. C. H. Meyer
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  2. S. Mennel
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  3. S. Kunze
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  4. J. C. Schmidt
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Correspondence to C. H. Meyer.

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Meyer, C.H., Mennel, S., Kunze, S. et al. Radiäre Optiko-Neurotomie (RON) bei Zentralvenenthrombosen. Spektrum Augeheilkd 18, 55–60 (2004). https://doi.org/10.1007/BF03163277

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