Zusammenfassung
Unter den filtrierenden Eingriffen wird als chirurgisches Verfahren zur Therapie der Offenwinkelglaukome die Trabekulektomie am häufigsten angewandt. Hierbei müssen intra- und postoperative Komplikationen erkannt und adäquat behandelt werden. Viele dieser Komplikationen treten innerhalb der ersten Wochen auf, wie beginnende Sickerkissenvernarbung, verminderter Abfluss unter dem Skleradeckel, Überfiltration ggf. mit Aderhautamotio sowie Vorderkammerabflachung. Weniger häufig sind Fibrinreaktion, Hornhautdellen, Irisprolaps, äußere Fistulation und Ziliarkörperabhebung. Wundinfektionen sind selten, das Risiko der Entwicklung einer Endophthalmitis in Folge einer Trabekulektomie ist bei guter Infektionsprophylaxe durch prä- und perioperativ applizierte Antibiotika gering. Die sorgfältige Operationsvorbereitung erfordert eine besondere Berücksichtigung der Bindehautsituation und ist neben der intensiven Nachbehandlung eine Grundvoraussetzung für den Langzeiterfolg nach einer fistulierenden Operation. Der Erfolg der Trabekulektomie ist zudem abhängig von der präoperativen Ausgangssituation, dem intraoperativen sowie dem postoperativen Verlauf, insbesondere der Sickerkissenentwicklung. Rechtzeitiges Erkennen postoperativer Komplikationen, vor allem bei beginnender Sickerkissenvernarbung, ermöglicht rechtzeitige Therapieentscheidungen wie Nadelung des Filterkissens oder frühzeitige Revision. Durch engmaschige postoperative Betreuung lässt sich langfristig eine wesentlich höhere Erfolgsquote erreichen.
Abstract
Of the filtering procedures employed, trabeculectomy is the one most frequently used for surgical therapy in primary open angle glaucoma patients. Intra- and postoperative complications must be detected promptly and treated adequately. Many complications arise within the first weeks, such as bleb scaring, decreased flow beneath the scleral flap, extensive filtration with choroidal detachment and anterior chamber narrowing. Fibrin reaction, corneal dellen, iris prolapse, conjunctival leakage and ciliary body detachment are seen more rarely. With prophylactic pre- and perioperative application of antibiotics, wound infections are rare and the risk of endophthalmitis following trabeculectomy remains small. Careful surgical planning requires special consideration of the conjunctiva and provides the basis for long-term success as long as intensive follow-up treatment is ensured. The success of trabeculectomy depends on the preoperative, intraoperative as well as postoperative condition and in particular on bleb development. Early detection of postoperative complications, especially in terms of early scaring in the bleb area, enables implementation of adequate therapeutic measures, such as needling procedures and early bleb revision. Close patient monitoring substantially increases long-term success rates.
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Jonescu-Cuypers, C., Seitz, B. Postoperative Komplikationen und Management der Filtrationschirurgie. Ophthalmologe 106, 1029–1039 (2009). https://doi.org/10.1007/s00347-009-2071-5
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DOI: https://doi.org/10.1007/s00347-009-2071-5