Zusammenfassung
Das Trabektom bietet eine neue Möglichkeit der minimal-invasiven Kammerwinkelchirurgie bei Offenwinkelglaukomen. Über einen 1,7-mm-clear-Cornea-Zugang wird unter gonioskopischer Kontrolle das juxtakanalikuläre Trabekelmaschenwerk über mehrere Uhrzeiten gezielt elektroabladiert. Es werden somit die Kollektorkanäle der skleralen Wand des Schlemm-Kanals freigelegt und der Abflusswiderstand Trabekelwerk wird entfernt. Die zu erreichende Augeninnendrucksenkung liegt nach eigenen Erfahrungen und in der Literatur bei 30–35% – dies bei einer simultanen Reduktion der erforderlichen Lokalmedikation um die Hälfte. Das Trabektom kann gut mit der Operation der Katarakt kombiniert werden. Ernste Komplikationen wurden bislang nicht berichtet. Da die Bindehaut völlig unberührt bleibt, ist eine spätere Trabekulektomie, sofern erforderlich, ohne prognostische Einschränkung möglich. Bei realistisch erreichbaren Zielaugeninnendruckwerten um 16 mmHg ist das Trabektom bei moderatem Sehnervenschaden indiziert.
Abstract
The Trabectome provides a new perspective in angle surgery for open angle glaucoma. Through a 1.7 mm clear cornea tunnel, the juxtacanalicular meshwork is electroablated under gonioscopic control. Thereby, the collector channels in the outer wall of Schlemm’s canal are uncovered and resistance to trabecular outflow is removed. From the literature and from our own experience, a pressure reduction by 30–35% can be achieved with a simultaneous reduction of eye drops by 50%. The Trabectome can conveniently be combined with phako-emulsification. Serious complications have not yet been reported. As the conjunctiva remains completely untouched, trabeculectomy, if necessary, could be performed without prognostic restrictions. With a realistic target pressure of approximately 16 mmHg, Trabectome surgery is indicated in patients with moderate optic nerve damage.
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Jordan, J., Neuburger, M. & Reinhard, T. Minimal-invasive Kammerwinkelchirurgie. Ophthalmologe 107, 855–860 (2010). https://doi.org/10.1007/s00347-010-2235-3
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DOI: https://doi.org/10.1007/s00347-010-2235-3