Skip to main content
SpringerLink
Log in

Die Chirurgie des Makulaödems

Surgery for macular edema

  • Das therapeutische Prinzip
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Das Makulaödem wurde bereits Ende des 19. Jahrhunderts als Krankheitsbild beschrieben. Ursächlich kommen überwiegend vaskuläre, entzündliche, degenerative und kongenitale Erkrankungen oder Traumata in Frage. Mit zunehmender Kenntnis über die Pathogenese des Makulaödems haben sich auch die Therapieansätze im Laufe der Zeit gewandelt. Sie umfassen neben der Laserbehandlung oder der medikamentösen Therapie auch die chirurgische Intervention. Die Pars-plana-Vitrektomie (evtl. mit ILM-Peeling) scheint vor allem bei bestimmten Formen des Makulaödems, die mit Pathologien des Glaskörpers bzw. der vitreoretinalen Grenzfläche einhergehen, erfolgversprechend. Zur Behandlung therapieresistenter Formen des Makulaödems gewinnt auch die intravitreale Medikamentenapplikation, z. B. von Triamcinolon, an Bedeutung.

Abstract

At the end of the nineteenth century, “macular edema” had already been recognized as a pathological condition. The main causes for macular edema are vascular, inflammatory, degenerative, and congenital diseases or trauma. The therapeutic approaches have changed along with the increasing knowledge on the underlying causes of action during the last few years and include laser treatment as well as surgical interventions. Pars plana vitrectomy (including ILM peeling) seems beneficial in cases of macular edema that are associated with alterations of the vitreous or the vitreoretinal interface. For the treatment of chronic macular edema, intravitreal application of agents such as triamcinolone has become an option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Aiello LP, Bursell SE, Clermont A et al. (1997) Diabetes 46:1473–1480

    CAS  PubMed  Google Scholar 

  2. Antonetti DA, Barber AJ, Khin S et al. (1998) Vascular permeability in experimental diabetes associated with reduced endothelial occludin content. Diabetes 47:1953–1959

    Google Scholar 

  3. Bangerter A (1945) Zur Diagnose, Differentialdiagnose und Therapie des cystoiden Makulaödems (Maculacysten). Ophthalmologica 109:102–122

    Google Scholar 

  4. Benhamou N, Massin P, Haouchine B et al. (2003) Intravitreal triamcinolone for refractory pseudophakic macular edema. Am J Ophthalmol 135:246–249

    Article  PubMed  Google Scholar 

  5. Boniuk M (1968) Cystic macular edema secondary to vitreoretinal traction. Surv Ophthalmol 13:118–121

    PubMed  Google Scholar 

  6. Bresnik GH (1983) Diabetic maculopathy. A clinical review highlighting diffuse macular edema. Ophthalmology 90:1301–1317

    Google Scholar 

  7. Brooks HL (2000) Macular hole surgery with and without internal limiting membrane peeling. Ophthalmology 107:139–149

    Article  Google Scholar 

  8. Capone A, Panozzo G (2000) Vitrectomy for refractory diabetic macular edema. Semin Ophthalmol 15:78–80

    PubMed  Google Scholar 

  9. De Bustros S, Rice TA, Michels RG et al. (1988) Vitrectomy for macular pucker after treatment of retinal tears or retinal detachment. Arch Ophthalmol 106:758–750

    PubMed  Google Scholar 

  10. Dugel PU, Rao NA, Ozler S, Ligget PE, Smith RE (1992) Pars plana vitrectomy for intraocular inflammation-related cystoid macular edema unresponsive to corticosteroids. A preliminary study. Ophthalmology 99:1535–1541

    CAS  PubMed  Google Scholar 

  11. Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema. Eearly Treatment diabetic Retinopathy Study Report No. 1. Arch Ophthalmol 103:1796–1806

    PubMed  Google Scholar 

  12. Ferrari TM, Cardascia N, Durante G (1999) Pars plana vitrectomy in diabetic macular edema. Doc Ophthalmol 97:267–270

    Article  Google Scholar 

  13. Gandorfer A, Haritoglou C, Kampik A (2003) Retinal damage from indocyanine green in experimental macular surgery. Invest Ophthalmol Vis Sci 44:316–323

    Article  PubMed  Google Scholar 

  14. Gandorfer A, Haritoglou C, Gass CA, Ulbig MW, Kampik A (2001) Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage. Am J Ophthalmol 132:431–433

    Article  CAS  PubMed  Google Scholar 

  15. Gandorfer A, Messmer EM, Ulbig MW, Kampik A (2001) Indocyanine Green Selectively Stains the Internal Limiting Membrane. Am J Ophthalmol 131:387–388

    CAS  PubMed  Google Scholar 

  16. Gandorfer A, Messmer EM, Ulbig MW, Kampik A (2000) Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina 20:126–133

    CAS  PubMed  Google Scholar 

  17. Gaudric A, Cohen D (1992) Chirurgie des membranes epimaculaires idiopathiques. Facteurs prognostiques. J Fr Ophtalmol 15:657–668

    PubMed  Google Scholar 

  18. Graefe von A (1858) Ueber die mit Diabetes mellitus vorkommenden Sehstörungen. Dies Arch IV 2:230–234

    Google Scholar 

  19. Harbour JW, Smiddy WE, Flynn HW, Rubsamen PE (1996) Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol 121:405–413

    CAS  PubMed  Google Scholar 

  20. Haritoglou C, Ehrt O, Gass CA, Kristin N, Kampik A (2001) Paracentral scotomata: A new finding after vitrectomy for idiopathic macular hole. Br J Ophthalmol 85:231–233

    Article  PubMed  Google Scholar 

  21. Haritoglou C, Gandorfer A, Gass CA et al. (2002) Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: A clinicopathologic correlation. Am J Ophthalmol 134:836–841

    Article  Google Scholar 

  22. Haritoglou C, Gandorfer A, Gass CA (2003) The effect of Indocyanine-green on functional outcome of macular pucker surgery. Am J Ophthalmol 135:328–337

    Article  CAS  PubMed  Google Scholar 

  23. Haritoglou C, Gass CA, Gandorfer A, Kampik A (2002) ICG-assited peeling of the retinal ILM. Ophthalmology 106:1039

    Article  Google Scholar 

  24. Haritoglou C, Gass CA, Schaumberger M (2001) Macular changes after peeling of the internal limiting membrane in macular hole surgery. Am J Ophthalmol 132:363–369

    Article  CAS  PubMed  Google Scholar 

  25. Heiligenhaus A, Bornfeld N, Wessing A (1996) Long-term results of pars plana vitrectomy in the management of intermediate uveitis. Curr Opin Ophthalmol 7:77–79

    Google Scholar 

  26. Hikichi T, Fujio N, Akiba Y, Takahashi M, Yoshida A (1997) Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus. Ophthalmology 104:473–478

    CAS  PubMed  Google Scholar 

  27. Hikichi T, Trempe CL (1993) Role of the vitreous in the prognosis of peripheral uveitis. Am J Ophthalmol 116:401–405

    PubMed  Google Scholar 

  28. Irvine SR (1953) A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol 36:599–619

    Google Scholar 

  29. Jaeger E (1856) Beiträge zur Pathologie des Auges. Wien, S 33

  30. Jonas JB, Kreissig I, Degenring RF (2002) Intravitreal triamcinolone acetonide as treatment of macular edema in central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 240:782–783

    Google Scholar 

  31. Jonas JB, Kreissig I, Sofker A, Degenring RF (2003) Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol 121:57–61

    CAS  PubMed  Google Scholar 

  32. Jonas JB, Sofker A (2001) Intraocular injection of cristalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol 132:425–427

    CAS  PubMed  Google Scholar 

  33. Kadonosono K, Itoh N, Uchio E, Nakamura S, Ohno S (2000) Staining of the internal limiting membrane in macular hole surgery. Arch Ophthalmol 118:1116–1118

    CAS  PubMed  Google Scholar 

  34. Kaiser PK, Riemann CD, Sears JE, Lewis H (2001) Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction. Am J Ophthalmol 131:44–49

    CAS  PubMed  Google Scholar 

  35. Kampik A, Green WR, Michels RG, Nase PK (1980) Ultrastructural features of progressive epiretinal membranes removed by vitreous surgery. Am J Ophthalmol 90:797–809

    PubMed  Google Scholar 

  36. Kampik A, Kenyon KR, Michels RG, Green WR, de la Cruz ZC (1981) Epiretinal and vitreous membranes. Comparative study of 56 cases. Arch Ophthalmol 99:1445–1454

    CAS  PubMed  Google Scholar 

  37. Kiryu J, Kita M, Tanabe T (2001) Pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis. Ophthalmology108:1140–1144

  38. Koerner F, Garweg J (1999) Vitrectomy for macular pucker and vitreomacular traction syndrome. Doc Ophthalmol 97:245–254

    Article  Google Scholar 

  39. La Heij EC, Hebdrikse F, Kessels AGH, Derhaag PJFM (2001) Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefes Arch Clin Exp Ophthalmol 239:264–270

    PubMed  Google Scholar 

  40. Lewis H, Abrams GW, Blumenkranz MS, Campo R (1992) Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology 99:753–759

    CAS  PubMed  Google Scholar 

  41. Lewis H (2001) The role of vitrectomy in the treatment of diabetic macular edema. Am J Ophthalmol 131:123–125

    Article  PubMed  Google Scholar 

  42. Machemer R (1978) Die chirurgische Entfernung von epiretinalen Makula-Membranen (macular pucker). Klin Monatsbl Augenheilkd 172:36–42

    Google Scholar 

  43. Martidis A, Duker JS, Greenberg PB et al. (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109:920–927

    Google Scholar 

  44. McDonald HR, Johnson RN, Schatz H (1994) Surgical results in the vitreomacular traction syndrome. Ophthalmology 101:1397–1402

    PubMed  Google Scholar 

  45. Messmer EM, Heidenkummer HP, Kampik A (1998) Ultrastructure of epiretinal membranes associated with macular holes. Graefes Arch Clin Exp Ophthalmol 236:248–254

    Article  CAS  PubMed  Google Scholar 

  46. Michels RG (1981) Vitreous surgery for macular pucker. Am J Ophthalmol 92:628–639

    PubMed  Google Scholar 

  47. Mitchell P, Smith W, Chey T, Wang JJ, Chang A (1997) Prevalence and associations of epiretinal membranes. The Blue Mountains Eye Study, Australia. Ophthalmology 104:1033–1040

    Google Scholar 

  48. Nasrallah FP, Jalkh AE, VanCoppenrolle F et al. (1988) The role of the vitreous in diabetic macular edema. Ophthalmology 95:1335–1339

    CAS  PubMed  Google Scholar 

  49. Nettleship E (1872) On oedema or cystic disease of the retina. Ophth Hosp Rep 7:343–351

    Google Scholar 

  50. Noyes HD (1869) Retinitis in glycosuria. Trans Am Ophthalmol Soc 4:71–75

    Google Scholar 

  51. Pendergast SD, Hassan TS, Williams GA et al. (2000) Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol 130:178–186

    Article  PubMed  Google Scholar 

  52. Pournaras CJ, Kapetanios AD, Donati G (1999) Vitrectomy for traction macular edema. Doc Ophthalmol 97:235–243

    Article  Google Scholar 

  53. Rice TA, de Bustros S, Michels RG (1986) Prognostic factors in vitrectomy for epiretinal membranes of the macula. Ophthalmology 93:602–610

    PubMed  Google Scholar 

  54. Sander B, Larsen M, Maldow B, Lund-Andersen H (2001) Diabetic macular edema : passive and active transport of fluorescein through the blood-retinal barrier. Invest Ophthalmol Vis Sci 42:433–438

    PubMed  Google Scholar 

  55. Sato Y, Lee Z, Shimada H (2001) Vitrectomy for diabetic cystoid macular edema. Nippon Ganka Gakkai Zasshi 105:251–256

    PubMed  Google Scholar 

  56. Smiddy EW, Green WR, Michels GR, de la Cruz Z (1989) Ultrastructural studies of vitreomacular syndrome. Am J Ophthalmol 107:177–185

    CAS  PubMed  Google Scholar 

  57. Stefansson E, Novack RL, Hatchell DL (1990) Vitrectomy prevents retinal hypoxia in branch retinal vein occlusion. Invest Ophthalmol Vis Sci 31:284–289

    CAS  PubMed  Google Scholar 

  58. Tachi N, Ogina N (1996) Vitrectomy for diffuse macular edema in cases of diabetic retinopathy. Am J Ophthalmol 122:258–260

    CAS  PubMed  Google Scholar 

  59. Verbraeken H (1996) Therapeutic pars plana vitrectomy for chronic uveitis: a retrospective study of the long-term results. Graefes Arch Clin Exp Ophthalmol 234:288–293

    PubMed  Google Scholar 

  60. Vogt A (1918) Weitere Ophthalmoskopische Beobachtungen im rotfreien Licht: Cystische Degeneration der Makula lutea. Klin Monatsbl Augenheilkd 61:379–392

    Google Scholar 

  61. Weinberger D, Fink-Cohen S, Gaton et al. (1995) Non-retinovascular leakage in diabetic retinaopathy. Br J Ophthalmol 79:728–731

    PubMed  Google Scholar 

  62. Wiechens B, Nolle B, Reichelt JA (2001) Pars-plane vitrectomy in cystoid macular edema associated with intermediate uveitis. Graefes Arch Clin Exp Ophthalmol 239:474–481

    Google Scholar 

  63. Yamamoto T, Naoko A, Takeuchi S (2001) Vitrectomy for diabetic macular edema: The role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol 132:369–377

    Article  CAS  PubMed  Google Scholar 

  64. Yang CM (2000) Surgical treatment for severe macular edema with massive hard exsudates. Retina 20:121–125

    CAS  PubMed  Google Scholar 

  65. Young S, Larkin G, Branley M, Lightman S (2001) Safety and efficacy of intravitreal triamcinolon for cystoid macular edema in uveitis. Clin Experiment Ophthalmol 29:2–6

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Augenklinik, Ludwig-Maximilians-Universität, München

    C. Haritoglou & A. Kampik

  2. Augenklinik, Ludwig-Maximilians-Universität, Mathildenstraße 8, 80336 , München

    C. Haritoglou

Authors
  1. C. Haritoglou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Kampik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Haritoglou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haritoglou, C., Kampik, A. Die Chirurgie des Makulaödems. Ophthalmologe 101, 618–625 (2004). https://doi.org/10.1007/s00347-004-1027-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-004-1027-z

Schlüsselwörter

Keywords

Search

Navigation