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„Zuwarten“ als therapeutisches Prinzip bei Erkrankungen der vitreoretinalen Grenzfläche

Watchful waiting as a therapeutic principle for diseases of the vitreoretinal interface

  • Das therapeutische Prinzip
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Zusammenfassung

Unter den Operationen des hinteren Augenabschnitts sind mittlerweile die elektiven Eingriffe der vitreoretinalen Grenzfläche die häufigste Indikation. Im Rahmen dieser Eingriffe werden OCT (optische Kohärenztomographie)-Befunde sehr unterschiedlich interpretiert. Dieser Beitrag soll einige wichtige Aspekte und Diskrepanzen der Befundinterpretation im Zusammenhang mit der Indikationsstellung und der Nachsorge nach Vitrektomie bei vitreoretinalen Grenzflächenerkrankungen aufgreifen und anhand von Fallbeispielen diskutieren, dass auch Zuwarten eine therapeutische Option sein kann. Entscheidend ist dabei die sorgfältige Indikationsstellung, basierend auf der Symptomatik und dem Leidensdruck des Patienten und der Einordnung postoperativer bildgebender Befunde wie Netzhautverdickung und irreguläre Netzhautoberfläche nach Peelingoperation. Thematisiert wird ferner die Schwierigkeit der Differenzierung zwischen zystoidem Makulaödem nach Kataraktoperation bei gleichzeitig vorhandener epiretinaler Gliose und Gliose als Ursache des Makulaödems.

Abstract

Elective surgery of the vitreoretinal interface is currently the most common reason for vitrectomy in Germany. The evaluation and correct interpretation of spectral domain optical coherence tomography (SD-OCT) images is of great importance but the indications for vitrectomy in macular surgery should be based more on patient symptoms and not only the OCT findings. Watchful waiting is highlighted as an alternative therapeutic option in individual patients. This article addresses a number of aspects and discrepancies between findings and patients’ level of suffering based on binocular symptoms. Postoperative retinal thickening and irregular surface of the macula after peeling operations may still allow excellent function and often require no therapeutic measures. The difficulties in differentiating between cystoid macular edema after cataract operations with simultaneous epiretinal gliosis and gliosis as the cause of macular edema are highlighted.

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Authors and Affiliations

  1. Augenklinik der Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    H. Hoerauf

  2. Abteilung für Netzhaut- und Glaskörperchirurgie, Zentrum für Augenheilkunde, Universität zu Köln, Köln, Deutschland

    B. Kirchhof

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Correspondence to H. Hoerauf.

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Interessenkonflikt

H. Hoerauf und B. Kirchhof geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Hoerauf, H., Kirchhof, B. „Zuwarten“ als therapeutisches Prinzip bei Erkrankungen der vitreoretinalen Grenzfläche. Ophthalmologe 114, 1042–1049 (2017). https://doi.org/10.1007/s00347-017-0549-0

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