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Glaukomdrainageimplantate

Glaucoma drainage devices

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Zusammenfassung

Glaukomdrainageimplantate (GDI) haben eine feste Position in der operativen Behandlung komplizierter, refraktärer Glaukome. Nach der Implantation besteht im Grunde genommen eine permanente Sklerostomie, deren Lumen durch den in der Regel in die Vorderkammer eingelegten Silikonschlauch über lange Zeit offen gehalten wird. Es gibt zwei prinzipiell unterschiedliche GDI: kammerwinkelgestützte und episkleral fixierte. Die kammerwinkelgestützten Systeme drainieren das Kammerwasser entweder in den Schlemm-Kanal, unter die Bindehaut oder in den Zwischenraum zwischen Sklera und Chorioidea. Das Grundprinzip der episkleralen GDI besteht in der Verbindung der Vorderkammer (oder Pars plana) mit einem episkleralen Implantat über einen Silikonschlauch, der mit einer Basisplatte aus Silikon oder Polypropylen verbunden ist. Dadurch wird das Kammerwasser in die Äquatornähe des Bulbus geleitet. Um die Basisplatte von definierter Größe bildet sich nach der Implantation eine Zyste. Diese bewirkt einen Flusswiderstand, der letztendlich den Augeninnendruck bestimmt. GDI (insbesondere die episkleralen Modelle) sind bisher Patienten mit komplizierten, anderweitig erfolglos operierten Glaukomen vorbehalten. Neueren Studien zufolge scheint die Implantation der GDI in früheren Erkrankungsstadien gerechtfertigt.

Der Artikel gibt Auskunft über Prinzipien, Indikationen und Implantationsmethoden sowie Komplikationen von kammerwinkelgestützten und episkleralen GDI.

Abstract

Glaucoma drainage devices (GDDs) have a fixed place in the treatment of complicated refractory glaucoma. By implantation of an episcleral GDD, a permanent open sclerostomy is formed, through which a silicone tube is placed into the anterior chamber (or pars plana). Thus, aqueous humor is drained out of the eye under the Tenon and conjunctiva, leading the fluid to a base plate made from silicone or polypropylene. Placed near the equator of the eye, this base plate leads to the formation of a cyst that renders resistance to fluid transport, ultimately leading to a final drop in intraocular pressure. GDDs have been mainly used in complicated glaucoma cases that had previous unsatisfactory results from conventional glaucoma surgery. Recent studies suggest that the implants can also be used satisfactorily in early stages of glaucoma. Other devices are positioned and fixed in the chamber angle. Here they either drain aqueous humor into the Schlemm’s canal or into the subconjunctival or subchoroidal space. This article gives an overview of the current principles, indications, methods, and possible complications of implantation.

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  1. Augenklinik und Augenpoliklinik, Johannes Gutenberg-Universitätsmedizin, Langenbeckstr. 1, 55101, Mainz, Deutschland

    H. Thieme

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Thieme, H. Glaukomdrainageimplantate. Ophthalmologe 106, 1135–1146 (2009). https://doi.org/10.1007/s00347-009-2090-2

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