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Suprachoroidale minimalinvasive Glaukomchirurgie

Verfahren und klinische Ergebnisse

Suprachoroidal minimally invasive glaucoma surgery

Procedures and clinical outcome

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Zusammenfassung

Der uveosklerale Abflussweg erfolgt über den Ziliarmuskel zu den suprachoroidalen Räumen hin zu dem orbitalen Blut- und Lymphsystem. Die treibende Kraft für den uveoskleralen Abfluss ist der onkotische Druck in der Aderhaut. Der CyPass (Alcon Pharma GmbH, Freiburg) ist derzeit der einzige verfügbare Stent für die ab interno suprachoroidale minimalinvasive Glaukomchirurgie. Der CyPass erreicht eine maximale Drucksenkung auf 16–17 mm Hg im 1‑ bis 2‑Jahres-Verlauf und ist für frühe bis moderate Glaukomstadien beim primären Offenwinkelglaukom zugelassen. Es ist eine einfach anzuwendende minimalinvasive glaukomchirurgische Stentoperation und hat wenig intraoperative sowie Kurzzeit- und Langzeitkomplikationen. Das postoperative Management ist unkompliziert, und die postoperativen Belastungen für die Patienten sind gering, was zu einer beschleunigten Rekonvaleszenz führt. Für eine gute Erfolgsquote ist allerdings die richtige Auswahl der Patienten entscheidend. Langzeitstudien müssen noch zeigen, wie lange die drucksenkende Wirkung anhält.

Abstract

The uveoscleral outflow route is via the ciliary muscles into the suprachoroidal spaces and then to the orbital blood and lymph systems. The main driving force behind this uveoscleral outflow is the high oncotic pressure in the choroidal vessels. Currently, the CyPass microstent is the only available suprachoroidal device for ab interno minimally invasive glaucoma surgery. The CyPass achieves a maximum reduction of intraocular pressure (IOP) to 16–17 mm Hg over 12–24 months and is approved for mild to moderate primary open-angle glaucoma. The CyPass is an easy to use minimally invasive glaucoma surgery stent operation and has few intraoperative as well as short and long-term complications. Postoperative management is unproblematic and the postoperative burden for patients is low, which leads to rapid recovery of patients; however, the correct selection of glaucoma patients is crucial for maintaining a sustainable success rate. Long-term studies are necessary to demonstrate the persistence of the IOP lowering effect.

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  1. Augenklinik am Wittenbergplatz, Kleiststr. 23–26, 10787, Berlin, Deutschland

    C. Erb

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C. Erb ist Berater für Alcon, Allergan, Thea, Santen, Glaukos, Zeiss, Haag-Streit.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Erb, C. Suprachoroidale minimalinvasive Glaukomchirurgie. Ophthalmologe 115, 370–380 (2018). https://doi.org/10.1007/s00347-017-0594-8

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