Zusammenfassung
Die Zyklophotokoagulation mittels Dioden- oder Neodym-YAG-Laser gilt bei der Behandlung therapierefraktärer Glaukome als Standardverfahren der Zyklodestruktion. Neben der transskleralen Zyklophotokoagulation steht seit Beginn der 1990er Jahre die endoskopische Zyklophotokoagulation zur Verfügung, deren technische Grundlagen und Durchführung in diesem Artikel dargestellt werden. Durch die direkte Visualisierung der koagulierten Ziliarkörperzotten und des somit scheinbar besser titrierbaren Effekts soll der endoskopische Zugangsweg dem transskleralen Verfahren überlegen sein. In der Literatur wird die Endozyklophotokoagulation als effektive Methode mit einer niedrigen Komplikationsrate beschrieben. Eigene retrospektive Daten zur endoskopischen Zyklophotokoagulation zeigen hingegen keine suffiziente Drucksenkung. Die Indikation zur endoskpischen und damit invasiven und bulbuseröffnenden Durchführung der Zyklophotokoagulation kann somit kontrovers diskutiert werden.
Abstract
Cyclophotocoagulation is the standard cyclodestructive procedure for treating patients with refractory glaucoma. In addition to transscleral cyclophotocoagulation, endoscopically controlled cyclophotocoagulation (ECPC) is a relatively new method, introduced in the 1990s. Its clinical and technical background is outlined in this article. ECPC allows direct visualization of the ciliary body and better control of the applied laser energy. Therefore, ECPC has been described as being more effective and safer than the transscleral approach. Our own retrospective ECPC data, however, do not indicate that this method can sufficiently decrease intraocular pressure. The indication for the invasive procedure of endoscopic cyclophotocoagulation is therefore questionable.
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Neuburger, M., Böhringer, D. & Jordan, J. Endozyklophotokoagulation bei der Behandlung des Glaukoms. Ophthalmologe 107, 68–74 (2010). https://doi.org/10.1007/s00347-009-2089-8
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DOI: https://doi.org/10.1007/s00347-009-2089-8