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Färbetechniken in der Makulachirurgie

Staining techniques in macula surgery

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Zusammenfassung

In den vergangenen Jahren haben sich die funktionellen und anatomischen Ergebnisse der Chirurgie des Makulaforamens, der epiretinalen Gliose und vieler anderer vitreoretinaler Erkrankungen durch wachsende chirurgische Erfahrung, aber auch durch die Verfeinerung operativer Techniken und des chirurgischen Instrumentariums deutlich verbessert. Es herrscht heute weitgehend Einigkeit darüber, dass die Beseitigung der inneren Grenzmembran der Netzhaut (ILM) eine effektive und v. a. sichere Maßnahme zur Therapie verschiedener Erkrankungen der vitreoretinalen Grenzfläche darstellt.

Die ILM ist eine sehr zarte, kaum sichtbare Struktur, und ihre komplikationslose Präparation ist eine mikrochirurgische Herausforderung. Mit Vitalfarbstoffen gelingt eine deutlich bessere Visualisierung der ILM und auch epiretinaler Membranen. Durch die Anfärbung der Netzhautoberfläche wird die Präparation der ILM v. a. für den weniger erfahrenen Chirurgen erheblich erleichtert, kontrollierbarer und vermeintlich sicherer. Die Anwendung von Trypanblau oder Triamzinolon bei chirurgischen Eingriffen an der Makula kann nach dem gegenwärtigen Kenntnisstand als unbedenklich gelten. Im Gegensatz dazu gibt es Hinweise auf toxische Effekte nach Anfärbung der ILM mit Indozyaningün (ICG), die Pathomechanismen sind jedoch bis heute nicht ausreichend bekannt. Weitere Untersuchungen sind nötig, um zu verstehen, unter welchen Bedingungen ICG als sicheres chirurgisches Hilfsmittel angewandt werden kann und welche Farbstoffe bei ähnlich guten Färbeeigenschaften evtl. ein besseres Sicherheitsprofil bieten.

Abstract

Over recent years, evolving surgical experience and the development of techniques in surgery for macular hole, macular pucker and other vitreoretinal diseases have improved anatomic and functional success rates. Today, there is common agreement by many surgeons that removal of the internal limiting membrane (ILM) is an effective and safe treatment option for conditions that involve the vitreoretinal interface.

However, the ILM is a delicate and barely visible structure and its removal represents a challenge to the vitreoretinal surgeon. The introduction of vital dyes for ILM staining has led to better visibility of the ILM and epiretinal membranes, potentially making ILM peeling more controllable, easier and safer. It has opened the door, especially for the less experienced surgeon, to follow the principle of ILM removal in macular surgery. While the use of trypan blue and triamcinolone during such surgery seems to be safe, questions of the potential toxicity of indocyanine green (ICG) are currently being discussed. However, the underlying pathomechansims are not yet completely understood. Whether the observations made on ICG-related toxicity will be sufficient to call ICG a “toxic adjunct” is currently under investigation. Further studies are required to better understand the safety margins of ICG and to investigate other vital dyes offering equal staining characteristics and a better safety profile.

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

    C. Haritoglou & A. Kampik

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  1. C. Haritoglou
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Haritoglou, C., Kampik, A. Färbetechniken in der Makulachirurgie. Ophthalmologe 103, 927–934 (2006). https://doi.org/10.1007/s00347-006-1393-9

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