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Glaukomchirurgie im Kindesalter

Glaucoma surgery in childhood

Der Ophthalmologe volume 108, pages 618–623 (2011)Cite this article

Zusammenfassung

Neben den technischen Besonderheiten der kindlichen Glaukomchirurgie ist die langfristige Therapieplanung aufgrund der hohen Lebenserwartung von entscheidender Bedeutung. Die etablierte Kammerwinkelchirurgie (Goniotomie und Trabekulotomie) erzielt bei den primären kindlichen Glaukomen gute Erfolgsraten (70–90%). Die Trabekulektomie scheint bei der Gruppe der primären kindlichen Glaukome als Zweiteingriff langsam von den Glaukomdrainageimplantaten (GDI) verdrängt zu werden, da die Ergebnisse v. a. in der Gruppe der unter 3-jährigen Kinder für die Trabekulektomie reduziert sind. Die Ergebnisse der GDI sind auch für die sekundären kindlichen Glaukome, insbesondere das sehr therapierefraktäre Aphakieglaukom, ausgesprochen günstig. Die Erfolgsraten der GDI für alle kindlichen Glaukome liegen um 80% in den ersten 2 Jahren. Die Ergebnisse scheinen unabhängig von der Glaukomform und vom Implantattyp zu sein. Das Komplikationsspektrum der GDI wird durch die schnellere IOD-Regulation in der Phase der Visusentwicklung aufgewogen. Die zyklodestruktiven Verfahren können adjuvant nach Ersteingriffen erwogen werden, erhöhen jedoch das Hypotonie- und Vernarbungsrisiko für Folgeeingriffe.

Abstract

Technical characteristics and a long-term therapeutic strategy due to a long life expectancy play a key role in pediatric glaucoma surgery. The well-established angle surgery (goniotomy and trabeculotomy) achieves successful results in primary childhood glaucoma. Trabeculectomy seems to have been displaced as a secondary approach by glaucoma drainage devices (GDD) in primary childhood glaucoma due to inferior results, especially for children under 3 years of age. Even for secondary childhood glaucoma the results of GDD are encouraging, especially for therapy refractory aphakic glaucoma. In the first 2 years after GDD surgery success rates are about 80% for pediatric glaucoma and the results appear to be independent of the type of glaucoma and implant used. The complications of GDD are balanced to the faster intraocular pressure (IOP) control during the phase of visual acuity development. Cyclodestructive procedures may be applied as a secondary adjuvant approach but they increase the risk of conjunctival scarring and hypotony for subsequent procedures.

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  1. Julius-Maximilians-Universität Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    T. Klink & F. Grehn

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  1. T. Klink
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  2. F. Grehn
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Correspondence to T. Klink.

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Klink, T., Grehn, F. Glaukomchirurgie im Kindesalter. Ophthalmologe 108, 618–623 (2011). https://doi.org/10.1007/s00347-010-2292-7

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  • DOI: https://doi.org/10.1007/s00347-010-2292-7

Schlüsselwörter

  • Kindliches Glaukom
  • Glaukomchirurgie
  • Trabekulotomie
  • Glaukomdrainageimplantate
  • Trabekulektomie

Keywords

  • Pediatric glaucoma
  • Glaucoma surgery
  • Trabeculotomy
  • Glaucoma drainage devices
  • Trabeculectomy