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Makulaforamen

Überblick und aktuelle chirurgische Konzepte

Macular hole

Survey and relevant surgical concepts

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Zusammenfassung

Die bislang auf biomikroskopischen Beobachtungen beruhenden Vorstellungen zur Pathogenese des Makulaforamens haben sich durch die Weiterentwicklung der optischen Kohärenztomographie deutlich geändert. Die exakte Darstellung der vitreofovealen Pathologie zeigt, dass bei den verschiedenen Stadien der Erkrankung unterschiedliche Kraftvektoren wirken. Diese Erkenntnisse machen eine stadienangepasste operative Behandlung des Makulaforamens prinzipiell möglich. Einzelne chirurgische Schritte werden in der Literatur nach wie vor kontrovers diskutiert, es gibt noch keinen goldenen Standard für die operative Behandlung. Insbesondere besteht noch keine Einigkeit über den Nutzen einer chirurgischen Entfernung der Membrana limitans interna (ILM-Peeling) und der hierzu ggf. durchgeführten Indozyaningrünanfärbung. Auch die Art der Endotamponade und die ggf. postoperative Lagerung sind umstritten, sodass die operative Therapie der Erkrankung abhängig vom Operateur sehr variabel sein kann. In dieser Übersicht wird anhand der umfangreichen Literatur der aktuelle Kenntnisstand zu diesem Thema aufgezeigt.

Abstract

The theory of macular hole pathogenesis, which had so far been based on biomicroscopy, has been considerably altered by optical coherence tomography. The precise presentation of vitreofoveal pathology shows that forces acting in different directions are associated with different stages of the disease, making surgical treatment adapted to the different stages possible. Some surgical procedures are still controversial, and there is still no gold standard in macular hole surgery. Especially no agreement exists on the benefit of internal limiting membrane peeling, possibly assisted by staining with indocyanine green. Also details of endotamponade and postoperative positioning are controversial. Therefore, the method of surgical treatment depends a lot on the individual surgeon. This review summarizes the broad spectrum of the literature and the present knowledge in this field.

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    S. Dithmar

  2. Universitätsaugenklinik Heidelberg, Im Neuenheimer Feld 400, 69120 , Heidelberg

    S. Dithmar

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Dithmar, S. Makulaforamen. Ophthalmologe 102, 191–207 (2005). https://doi.org/10.1007/s00347-004-1155-5

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