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Nachsorge nach filtrierenden Glaukomoperationen

Postoperative care after glaucoma filtration surgery

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Zusammenfassung

Die Sickerkissenvernarbung ist die Hauptkomplikation nach filtrierender Glaukomchirurgie. Die postoperative Nachsorge entscheidet daher über Erfolg oder Misserfolg der Operation. Bereits vor der Operation kann durch eine antiinflammatorische Vorbehandlung und Absetzen oder zumindest Reduktion der Lokalmedikation ein günstiger Effekt auf die Vernarbungsreaktion der Bindehaut erzielt werden. Mit konventioneller Nachsorge nach Trabekulektomie lässt sich nur bei etwa 40% der Patienten langfristig der Zieldruckbereich ohne Medikation erreichen. Durch das Konzept der intensivierten postoperativen Nachsorge kann die Erfolgsrate in 5 Jahren um etwa 25% gesteigert werden. Kern des Konzepts ist eine den Stadien der Wundheilung des Sickerkissens angepasste wundmodulierende Therapie. Die genaue Beachtung der Sickerkissenmorphologie ist Grundlage für den Einsatz von topischen Steroiden und 5-Fluorouracil. Eine ausführliche Aufklärung des Patienten und engmaschige Kontrollen sind Teil des Behandlungskonzepts. Um Nebenwirkungen der Antimetabolitentherapie zu vermeiden und die Erfolgsrate der filtrierenden Glaukomchirurgie weiter zu steigern, sind ein tieferes Verständnis der Wundheilungsstadien und eine spezifische vernarbungshemmende Therapie notwendig.

Abstract

Scarring of the filtering bleb is the main complication after glaucoma filtration surgery. Postoperative care most importantly determines success or failure of the operation. Both, preoperative antiinflammatory treatment and reduction or discontinuation of topical medication have a positive effect on postoperative conjunctival wound healing. After conventional postoperative care only about 40% of patients reach target pressures in the long-term without topical medication. Intensified postoperative care (IPC) increases the success rate by 25% after 5 years. Central to the concept of IPC is a wound modulating therapy which is adapted to the phases of wound healing of the filtering bleb. Evaluation of filtering bleb morphology is a prerequisite for the application of topical steroids and 5-fluorouracil. In addition, dedicated counseling of the patient and close follow-up are mandatory. In order to further increase the success rate of penetrating glaucoma surgery and decrease the side effects of the current antimetabolite therapy more research on wound healing as well as specific therapy to prevent scarring are necessary.

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  1. Universitäts-Augenklinik Würzburg, Julius-Maximilians-Universität Würzburg, Josef-Schneider-Straße 11, 97080 , Würzburg

    T. Klink, R. Guthoff, F. Grehn & G. Schlunck

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  1. T. Klink
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  2. R. Guthoff
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  3. F. Grehn
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  4. G. Schlunck
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Correspondence to T. Klink.

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Klink, T., Guthoff, R., Grehn, F. et al. Nachsorge nach filtrierenden Glaukomoperationen. Ophthalmologe 103, 815–826 (2006). https://doi.org/10.1007/s00347-006-1404-x

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