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DOI: 10.1055/s-2005-858728
© Georg Thieme Verlag KG Stuttgart · New York
Frühe postoperative Augeninnendruckspitzen nach Phakoemulsifikation bei terminalen Glaukomen
Early Postoperative Spikes of the Intraocular Pressure (IOP) following Phacoemulsification in Late-Stage GlaucomaPublikationsverlauf
Eingegangen: 23.5.2005
Angenommen: 1.9.2005
Publikationsdatum:
21. März 2006 (online)
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Zusammenfassung
Hintergrund: Die moderne Kataraktchirurgie unter Verwendung von Viskoelastika kann bei Glaukompatienten zu frühen postoperativen Anstiegen des intraokularen Drucks (IOD) führen. Patienten und Methode: Ziel einer prospektiven Untersuchung war die Analyse von Risikokonstellationen, die bei Augen mit terminalem glaukomatösen Papillenschaden hinweisend für einen frühen Augeninnendruckanstieg sind. Die Clear-Cornea-Phakoemulsifikation mit Implantation einer Acryl-Faltlinse wurde entweder in Tropfanästhesie oder in Intubationsnarkose von einem Operateur bei 25 Augen ohne Voroperationen durchgeführt. Alle Augen wiesen eine subtotale glaukomatöse Papillenexkavation (C/D-Quotient 0,9) wegen eines primären Offenwinkel- (inkl. Normaldruckglaukoms) oder Pseudoexfoliationsglaukoms (PEX) auf. Bei PEX wurde der Eingriff durch eine Trabekelaspiration ergänzt. Applanatorische IOD-Messungen wurden präoperativ, 4 h postoperativ sowie am 1. postoperativen Tag durchgeführt. Ergebnisse: Der mittlere Augeninnendruck präoperativ betrug 18,5 ± 4,2 mm Hg unter 2,1 ± 1,0 topischen Antiglaukomatosa. 4 h postoperativ lag der mittlere IOD bei 31,3 ± 11,9 mm Hg. Der frühe postoperative Augendruck korrelierte signifikant mit dem vom Patienten in der Anamnese angegebenen höchsten IOD (p = 0,014). Nach zusätzlicher Trabekelaspiration lag der postoperative Augendruck der PEX-Augen mit 28,5 ± 12,0 mm Hg (n = 12) etwas niedriger - allerdings ohne signifikanten Unterschied zu den restlichen Augen (n = 13). Schlussfolgerungen: Bei Patienten mit terminalem glaukomatösen Papillenschaden und anamnestisch hohen IOD-Werten ist mit deutlichen Augendruckspitzen in der frühen postoperativen Phase zu rechnen, auch wenn präoperativ der Augendruck unter Lokalmedikation reguliert ist. Ein postoperatives Augendruckmonitoring am Tag der Operation ist daher ratsam.
Abstract
Background: Modern cataract surgery with use of viscoelastics can induce remarkable early spikes of the intraocular pressure (IOP) in patients with glaucoma. Patients and Methods: The purpose of this prospective study was to investigate risk factors for an early increase of the IOP following cataract surgery in eyes with end-stage glaucoma. Clear cornea phacoemulsification with implantation of a foldable acrylic lens was performed in 25 eyes with end-stage glaucoma (primary open-angle glaucoma including normal tension glaucoma or exfoliative glaucoma) either under topical anesthesia or under general anesthesia. In eyes with exfoliative glaucoma, trabecular aspiration was performed additionally. IOP measurements were conducted at the day before surgery, 4 hours following surgery and on the first morning following surgery. Results: Cataract surgery was performed without complications. The mean IOP was 18.5 ± 4.2 mm Hg with 2.1 ± 1.0 topical medications. 4 hours postoperatively, mean IOP was 31.3 ± 11.9 mm Hg. In eyes with exfoliative glaucoma (n = 12) the early postoperative IOP was 28.5 ± 12.0 mm Hg, but without significant difference compared to eyes with POAG (n = 13). The early postoperative IOP showed significant correlation with the maximum IOP in patient’s history (p = 0.014). Conclusions: Patients with late-stage glaucoma can experience considerable early IOP spikes following uneventful cataract surgery, although preoperatively IOP is controlled by topical medications. Postoperative IOP monitoring is recommended at the day of surgery, especially if high IOP values are reported in patient’s history.
Schlüsselwörter
Glaukom - Augeninnendruck - Sehnervschaden - Trabekelaspiration - Phakoemulsifikation - Kataraktchirurgie
Key words
Glaucoma - intraocular pressure - optic nerve damage - trabecular aspiration - phacoemulsification - cataract surgery
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PD Dr. Thomas S. Dietlein
Zentrum für Augenheilkunde, Universität Köln
Joseph-Stelzmann-Straße 9
50931 Köln
Telefon: ++ 49/2 21/4 78 50 46
Fax: ++ 49/2 21/4 78 31 00
eMail: Thomas.Dietlein@uk-koeln.de