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Tiefe Sklerektomie

Eine Alternative zur Trabekulektomie

Deep sclerectomy

An alternative to trabeculectomy

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Zusammenfassung

Hintergrund

Um ernsthafte intra- und postoperative Komplikationen zu vermeiden, wurde die tiefe Sklerektomie als Alternative zur chirurgisch ähnlichen Trabekulektomie entwickelt.

Methoden

Im Unterschied zur Trabekulektomie findet intraoperativ jedoch keine Eröffnung der Vorderkammer statt. Zusätzlich zu dem oberflächlichen Skleradeckel wird ein tiefer Skleradeckel präpariert. Nach Entdachung des Schlemm-Kanals bleibt ein Descemet-Fenster als Abgrenzung zur Vorderkammer bestehen. Verschiedene Implantate dienen zur Verzögerung oder Verhinderung der Narbenbildung. Bei unzureichender Drucksenkung kann durch eine Goniopunktion das Descemet-Fenster fein perforiert werden, um einen stärkeren Abfluss des Kammerwassers zu gewährleisten.

Schlussfolgerung

Die drucksenkende Wirkung der tiefen Sklerektomie im Vergleich zur Trabekulektomie wird in der Literatur kontrovers diskutiert. Einige Studien belegen eine ähnlich lange Wirksamkeit beider Verfahren, andere Studien sehen die Trabekulektomie im Vorteil. Die Komplikationsrate konnte, wie erwartet, deutlich gesenkt werden. Abschließend stellt somit die tiefe Sklerektomie eine sichere Alternative zur Trabekulektomie dar.

Abstract

Background

Deep sclerectomy was developed to avoid the intraoperative and postoperative complications seen with trabeculectomy.

Methods

Compared to trabeculectomy, the anterior chamber is not opened in deep sclerectomy. In addition to a superficial scleral flap as performed in trabeculectomy, a second deep scleral flap is created directly beneath the first flap so that the external part of Schlemm’s canal is opened and corneal tissue removed leaving only Descemet’s membrane separating the anterior chamber. Various implants serve to delay or avoid formation of scar tissue. In cases of insufficient reduction of intraocular pressure (IOP) Descemet’s membrane can be finely perforated by an additional goniopuncture leading to better drainage of the aqueous humor.

Conclusions

There is a controversial discussion about the pressure lowering effect of deep sclerectomy in comparison to trabeculectomy. Some studies have shown a similar long-term efficacy for both procedures but others showed an advantage for trabeculectomy. As expected, the complication rate could be clearly reduced with deep sclerectomy. Deep sclerectomy therefore represents a safe alternative to trabeculectomy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Klemm gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    M. Klemm

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Klemm, M. Tiefe Sklerektomie. Ophthalmologe 112, 313–318 (2015). https://doi.org/10.1007/s00347-014-3161-6

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  • DOI: https://doi.org/10.1007/s00347-014-3161-6

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