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Vitrektomie mit oder ohne Cerclage in der Behandlung von Netzhautablösungen

Vitrectomy with and without encircling element in retinal detachment surgery

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Zusammenfassung

Die Pars-plana-Vitrektomie wurde in der Versorgung von komplizierten Netzhautablösungen häufig mit der Anlage einer Cerclage kombiniert. Hintergrund waren die damals schlechte visuelle Kontrolle der Glaskörperbasis und der Wunsch nach einer effektiven Prophylaxe vor einer Reablatio.

Aufgrund der verbesserten operativen Möglichkeiten ist heute die zusätzliche Cerclage wegen des erheblichen Komplikationsspektrums nur für konkrete Indikationen, wie z. B. eine anteriore PVR, eine Verkürzung der Netzhaut oder durchgreifende Verletzungen mit Beteiligung der Aderhaut gerechtfertigt. Die primäre Vitrektomie kann zur Verbesserung der funktionellen und anatomischen Ergebnisse beitragen, wenn der Operateur auch die diagnostischen Kenntnisse und technischen Anforderungen der extraokularen Netzhautchirurgie beherrscht.

Abstract

In the beginning, pars plana vitrectomy was often combined with encircling elements in the treatment of complicated retinal detachments. Initial considerations were the limited control of the vitreous base due to the restricted view of the fundus periphery and the prevention of redetachment by anterior tears or traction.

Today, additional encircling is justified in specified conditions of retinal surgery, e.g., retinal shortening by long-lasting detachments, anterior PVR, or choroidal injuries. Despite several synergistic effects in surgical management, severe complications have to be taken into account for scleral buckling in vitreoretinal surgery.

Nevertheless, primary vitrectomy in combination with scleral buckling has led to a marked decrease of primary failure rate and improvement of functional results in retinal detachment surgery.

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Wir danken Frau Regina Hofer für die Umsetzung und technische Beratung bei der Erstellung der Abbildungen.

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  1. Abteilung I, Universitätsaugenklinik, Tübingen

    F. Ziemssen & K. U. Bartz-Schmidt

  2. Abteilung I, Universitätsaugenklinik, Schleichstraße 12–16, 72076 , Tübingen

    F. Ziemssen

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Ziemssen, F., Bartz-Schmidt, K.U. Vitrektomie mit oder ohne Cerclage in der Behandlung von Netzhautablösungen. Ophthalmologe 101, 554–562 (2004). https://doi.org/10.1007/s00347-004-1041-1

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