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Operative Zielvorgabe in der Makulaforamenchirurgie

Neue Aspekte zur Feinstruktur der vitreomakulären Grenzfläche

The primary objective in macular hole surgery

Ultrastructural features of the vitreomacular interface

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Zusammenfassung

Wir führten bei 77 Augen mit Makulaforamen (MF) °III und bei 19 Augen mit MF °IV eine Vitrektomie mit Peeling der Membrana limitans interna (ILM) und epiretinalem Gewebe erfolgreich durch. Bei 16 anderen Augen mit primär nicht geschlossenem MF wurde durch eine zweite Vitrektomie der Bereich des ILM-Peelings erweitert. Die chirurgischen Präparate wurden hinsichtlich ihrer Ultrastruktur verglichen. Fibrozelluläre Proliferationen an der vitrealen Seite der ILM fanden sich in 57% der durch eine Operation geschlossenen MF sowie in 100% der primär nicht geschlossenen MF. Ein- und mehrschichtige zelluläre Membranen sowie natives Glaskörperkollagen an der ILM waren in MF °IV signifikant häufiger als in MF °III. In nicht geschlossenen MF fanden sich irreguläre Zellhaufen und massive Ansammlungen von neu geformtem Kollagen. Verbleibende ILM und Kollagen stellen einen Stimulus für die zeitige Ausbildung tangentialer Traktionen dar, die den erfolgreichen Verschluss des MF verhindern. Demnach ergibt sich als operatives Ziel die komplette Separation der Glaskörperrinde von der ILM und die ausgedehnte Entfernung der ILM im Bereich der Makula.

Abstract

We compared the ultrastructure of the inner limiting membrane (ILM) and epiretinal tissue in closed and non-closed, idiopathic macular holes (MH). Peeling of ILM and epimacular tissue during vitrectomy was successfully performed on 77 eyes with stage III MH and on 19 eyes with stage IV MH. In 16 additional eyes with non-closed MH, we performed a second vitrectomy with extended ILM removal. The specimens were processed for transmission electron microscopy. Fibrocellular proliferation at the vitreal side of the ILM was found in 57% of MH that were closed by one operation, and in 100% of non-closed MH. Mono- and multilayered cellular membranes as well as native vitreous collagen at the ILM were significantly more frequent in eyes with stage IV MH than in eyes with stage III MH. In non-closed MH, cellular proliferation was mostly seen as irregular cell accumulation, and masses of newly formed collagen were found. Since ILM remnants and collagen represent a stimulus for the early formation of tangential traction preventing successful MH closure, it appears mandatory to create a complete vitreoretinal separation and to remove the ILM and collagen thoroughly during MH surgery.

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  1. Augenklinik der Universität, Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Mathildenstraße 8, 80336, München, Deutschland

    R.G. Schumann, M.M. Schaumberger, M. Rohleder, C. Haritoglou, A. Kampik & A. Gandorfer

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  1. R.G. Schumann
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  2. M.M. Schaumberger
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  3. M. Rohleder
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  4. C. Haritoglou
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  5. A. Kampik
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  6. A. Gandorfer
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Correspondence to R.G. Schumann.

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Schumann, R., Schaumberger, M., Rohleder, M. et al. Operative Zielvorgabe in der Makulaforamenchirurgie. Ophthalmologe 104, 783–789 (2007). https://doi.org/10.1007/s00347-007-1553-6

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  • DOI: https://doi.org/10.1007/s00347-007-1553-6

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