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Behandlung retinaler Arterienastverschlüsse mittels transluminaler Nd:YAG-Laser-Embolektomie

Treatment of retinal arterial branch occlusion with transluminal Nd:YAG laser embolectomy

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Zusammenfassung

Hintergrund

Bei retinalen Arterienastverschlüssen steht keine ausreichend wirksame Therapie zur Verfügung. Die transluminale Nd:YAG-Laser-Embolektomie (TYE) ist ein kontrovers diskutierter Therapieansatz. Mit dem Nd:YAG-Laser wird die Gefäßwand rupturiert und der Embolus in den Glaskörperraum geschleudert.

Methoden

Wir untersuchten retrospektiv die Ergebnisse von 5 mit dieser Methode behandelten Patienten.

Ergebnisse

Das Alter der Patienten lag zwischen 26 und 75 Jahren (Mittelwert 58, Median 68). Der Ausgangsvisus betrug Handbewegungen bis 1,0. Alle Patienten hatten Gesichtsfeldausfälle. Die Behandlung erfolgte zwischen 4 und 30 h nach Einsetzen der Symptome. In 2 Fällen kam es zu einem deutlichen Visusanstieg am Folgetag (Handbewegungen zu 0,8; 0,4 zu 1,0). Der Endvisus lag zwischen 0,8 und 1,25. In allen Fällen entstand eine Glaskörperblutung, die nur in einem Fall behandelt werden musste. Die Nachbeobachtungszeit betrug 4 bis 42 Monate.

Schlussfolgerung

Die Ergebnisse entsprechen den bisher veröffentlichten Fällen. Die TYE ist eine schnelle, einfache und jederzeit verfügbare Methode, die insbesondere bei schlechtem Ausgangsvisus in Erwägung gezogen werden sollte.

Abstract

Background

There is currently no effective therapy for retinal artery branch occlusion (RABO). Transluminal Nd:YAG embolectomy (TYE) was developed to achieve rapid reperfusion; however, it is still a subject of controversy. A Nd:YAG laser is focused on the occluded vessel, the vessel wall is ruptured and the embolism dislocates to the vitreous humor through the opening in the artery.

Method

We retrospectively examined the results of five patients treated with TYE.

Results

The age of the patients was 26–75 years (mean age 58 years, median 68 years). Initial visual acuity was hand movements to 1.0 and all patients had visual field defects. Treatment was performed between 4 and 30 h from the onset of symptoms. Visual acuity improved markedly in two cases the next day (hand movements to 0.8 and 0.4 to 1.0) and final visual acuity was between 0.8 and 1.25. All treatments led to vitreous hemorrhage but only one patient required surgical treatment. The range of follow-up was 4–42 months.

Conclusions

The results are in accordance with those published in the literature. It can be concluded that TYE is a fast, easy and readily available method that should be taken into account especially in cases with low initial visual acuity.

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Authors and Affiliations

  1. Augenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    M.M. Much

  2. Augenklinik der SLK Kliniken, Klinikum am Gesundbrunnen, Heilbronn, Deutschland

    M.M. Much & L. Hesse

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  1. M.M. Much
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  2. L. Hesse
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Correspondence to M.M. Much.

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Dieser Beitrag basiert auf einem Poster, vorgestellt auf dem DOG-Kongress 2012.

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Much, M., Hesse, L. Behandlung retinaler Arterienastverschlüsse mittels transluminaler Nd:YAG-Laser-Embolektomie. Ophthalmologe 111, 144–150 (2014). https://doi.org/10.1007/s00347-013-2803-4

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