Filtrierende Glaukomchirurgie – Verfahren mit Bildung eines Filterkissens

Die Filtrationschirurgie zählt zu den ältesten Prinzipien der Glaukomchirurgie. Ergänzend zur Trabekulektomie wurden neuere Stent-basierte Verfahren wie der Preserflo-Microshunt und der XEN-Stent entwickelt. Dieser Artikel stellt diese drei filtrierenden Operationstechniken vor. Er fasst die Operationstechnik, Daten zur Effektivität sowie Art und Häufigkeit von Komplikationen zusammen und versucht, sie soweit möglich miteinander zu vergleichen.

Abstract

Glaucoma filtration surgery has been a standard surgical therapy for decades. An increasing knowledge about wound healing processes in the eye, the introduction of antimetabolite treatment and continuous improvements of the surgical technique helped making trabeculectomy – the prototype filtration surgery – a very effective therapeutic tool. However, best results will only be regularly achieved with a high level of experience and time dedicated to postoperative follow-up. Furthermore, the potential for severe early and late complications still remains high. Thus, novel stent-based filtration surgery approaches, such as the Preserflo and the XEN shunt have been introduced. This review presents these three bleb-forming filtration procedures, covering the basic principles of surgical technique, data on effectivity as well as complications.

Kernaussagen

• Die Trabekulektomie ist ein sehr effektiver Therapieansatz mit hohem Drucksenkungspotenzial, der aber ein hohes Maß an Erfahrung und eine intensive Nachsorge erfordert.

• Die Antimetaboliten leisten einen entscheidenden Beitrag zur hohen Effektivität, bergen aber aufgrund ihrer geringen therapeutischen Breite ein hohes Nebenwirkungspotenzial.

• Der Preserflo-Microshunt ist als Ab-externo-Verfahren hinsichtlich der Behandlung des Filtrationsbereichs und in seiner Effektivität sehr nah an der Trabekulektomie, vereinfacht aber durch den Stent den intraoperativen Ablauf und meist auch die postoperative Nachsorge.

• Beim XEN-Gel-Stent liegt mit dem Ab-interno-Ansatz der Fokus auf noch schnellerer und weniger invasiver Operation. Hier geht die fehlende chirurgische Öffnung des Filtrationsraums aber auch mit einer hohen Revisionsrate und einer wahrscheinlich geringeren Drucksenkung im Vergleich zur Trabekulektomie einher. Der Mangel aussagekräftiger prospektiver vergleichender Studien erschwert allerdings den direkten Vergleich.

• Ein Vorteil beider Stent-basierter Verfahren ist der im Revisionsfall in der Regel noch durchgängige Stent.

• Als Nachteile sind die hohen Kosten, implantat-spezifische Komplikationen wie Dislokation sowie Extrusion und das Risiko für bislang noch unbekannte Spätfolgen wie ein möglicher Endothelzellverlust zu nennen.

Schlüsselwörter

Glaukom - Trabekulektomie - Filterkissen - Wundheilung

Key words

Glaucoma - trabeculectomy - filtering bleb - wound healing

Publikationsverlauf

Artikel online veröffentlicht:
24. Mai 2024

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