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Klin Monbl Augenheilkd 2015; 232(5): 669-675
DOI: 10.1055/s-0034-1383068
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Operative Möglichkeiten bei Ablatio retinae

Surgical Managment of Retinal Detachment
C. Haritoglou
1   Augenklinik Herzog Carl Theodor, München
,
A. Wolf
2   Augenklinik, Klinikum der Universität München
› Author Affiliations
Further Information

Publication History

eingereicht 07 July 2014

akzeptiert 11 August 2014

Publication Date:
13 November 2014 (online)

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Zusammenfassung

Die Ablösung der neurosensorischen Netzhaut vom retinalen Pigmentepithel kann als Folge von Lochbildungen in der Netzhaut, bei exsudativen Prozessen in der Aderhaut wie Tumoren oder entzündlichen Erkrankungen oder als Folge ausgeprägter traktiver Interaktionen des Glaskörpers mit der Netzhaut entstehen. Während bei der traktiven Ablatio die Vitrektomie und bei der exsudativen Ablatio mehr die Behandlung der auslösenden Grunderkrankung im Vordergrund stehen, verfügen wir zur Behandlung der rhegmatogenen Netzhautablösung mit der Buckelchirurgie und Vitrektomie über effektive Operationsmethoden zur anatomischen und funktionellen Rehabilitation unserer Patienten. Die Entscheidung, welches Operationsverfahren im individuellen Fall dabei gewählt wird, ist u. a. abhängig von der persönlichen Erfahrung des Operateurs und anderen okulären Faktoren, wie dem Linsenstatus, der Ausdehnung der Netzhautablösung, der Anzahl der Löcher oder dem Grad einer womöglich schon bestehenden PVR-Reaktion. Mit beiden Verfahren, die teilweise auch kombiniert eingesetzt werden können, lassen sich heute anatomische Erfolgsraten von über 90 % erreichen. Die Buckelchirurgie bietet bei jungen phaken Patienten mit einfacher Ausgangssituation (1 Loch, geringe Ausdehnung) den entscheidenden Vorteil, dass häufige Komplikationen der Vitrektomie, wie die Bildung einer myopisierenden Kernsklerose und der Verlust der Akkommodation als Folge einer sekundären (oder bereits primären) Kataraktoperation, vermieden werden können. Die Buckelchirurgie sollte daher in besonderen Ausgangssituationen einen Stellenwert als effektive Operationsmethode zur Behandlung der rhegmatogenen Ablatio retinae trotz bedeutender Fortschritte im Bereich der modernen Vitrektomietechniken behalten.

Abstract

The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques.

Schlüsselwörter

Retina - Glaskörper - Anatomie

Key words

retina - vitreous - anatomy
 

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