Subscribe to RSS
DOI: 10.1055/a-1017-0134
Das Management von Glaskörpertrübungen
The Management of Vitreous OpacitiesZusammenfassung
Das Management von symptomatischen Glaskörpertrübungen stellt sich in der täglichen Praxis oft als kompliziert dar. Die Nd:YAG-Laser-Vitreolyse rückt als weitere therapeutische Option immer mehr in den Fokus. Vergleichende randomisierte Studien zur Vitrektomie, Nd:YAG-Laser-Vitreolyse und einer abwartenden Vorgehensweise zum Spontanverlauf gibt es leider nicht. Dieser Beitrag versucht, zu dieser Problematik einen Überblick zu geben.
Abstract
The management of symptomatic vitreous opacities is often complicated in daily practice. The technically significantly improved surgical possibilities lead to an increased number of surgical interventions. The Nd:YAG laser vitreolysis is increasingly becoming a therapeutic option. Unfortunately, there are no comparative randomized studies on vitrectomy, Nd:YAG laser vitreolysis and a wait-and-see approach to spontaneous progress. This article gives an overview of this problem.
-
Die Hauptursache für strukturelle Veränderungen im Glaskörper und am vitreoretinalen Interface ist das Alter.
-
Grundsätzlich werden primäre Glaskörpertrübungen von sekundären unterschieden.
-
Die Indikation zur Therapie von Glaskörpertrübungen sollte streng vom Leidensdruck des Patienten abhängig gemacht werden.
-
Vor einer interventionellen Behandlung sollte der Spontanverlauf nach sorgfältiger Aufklärung des Patienten abgewartet werden.
-
Die Therapie ist die nahtlose trokargeführte Pars-plana-Vitrektomie und die Nd:YAG-Laser-Vitreolyse.
-
Der Effekt und die Sicherheit einer Nd:YAG-Laser-Therapie muss in weiteren kontrollierten Studien noch nachgewiesen werden.
Schlüsselwörter
primäre und sekundäre Glaskörpertrübungen - Floater - Nd:YAG-Laser - Pars-plana-Vitrektomie - Masquerade-SyndromKey words
symptomatic vitreous opacities - floater - Nd:YAG laser vitreolysis - vitrectomy - Masquerade-SyndromePublication History
Article published online:
10 August 2020
Georg Thieme Verlag KG
Stuttgart · New York
-
Literatur
- 1 Bishop PN. Structural macromolecules and supramolecular organisation of the vitreous gel. Prog Retin Eye Res 2000; 19: 323-344
- 2 Reardon AJ, Le Goff M, Briggs MD. et al. Identification in vitreous and molecular cloning of opticin, a novel member of the family of leucine-rich repeat proteins of the extracellular matrix. J Biol Chem 2000; 275: 2123-2129 doi:10.1074/jbc.275.3.2123
- 3 Milston R, Madigan MC, Sebag J. Vitreous floaters: Etiology, diagnostics, and management. Surv Ophthalmol 2016; 61: 211-227 doi:10.1016/j.survophthal.2015.11.008
- 4 Sebag J. Anatomy and pathology of the vitreo-retinal interface. Eye (Lond) 1992; 6: 541-552 doi:10.1038/eye.1992.119
- 5 Johnson MW. Posterior vitreous detachment: evolution and complications of its early stages. Am J Ophthalmol 2010; 149: 371-382.e1 doi:10.1016/j.ajo.2009.11.022
- 6 Saxena S, Jalali S, Verma L. et al. Management of vitreous haemorrhage. Indian J Ophthalmol 2003; 51: 189-196
- 7 Coupland SE. The pathologistʼs perspective on vitreous opacities. Eye (Lond) 2008; 22: 1318-1329 doi:10.1038/eye.2008.31
- 8 Kador PF, Wyman M. Asteroid hyalosis: pathogenesis and prospects for prevention. Eye (Lond) 2008; 22: 1278-1285 doi:10.1038/eye.2008.35
- 9 Theodore FH. Conjunctival carcinoma masquerading as chronic conjunctivitis. Eye Ear Nose Throat Mon 1967; 46: 1419-1420
- 10 Grange LK, Kouchouk A, Dalal MD. et al. Neoplastic masquerade syndromes in patients with uveitis. Am J Ophthalmol 2014; 157: 526-531 doi:10.1016/j.ajo.2013.11.002
- 11 Kubicka-Trzaska A, Romanowska-Dixon B. Non-malignant uveitis masquerade syndromes. Klin Oczna 2008; 110: 203-206
- 12 Schuler A, Coupland SE, Krause L. et al. [Malignant and non-malignant uveitis-masquerade syndromes in childhood]. Klin Monbl Augenheilkd 2007; 224: 477-482 doi:10.1055/s-2007-963274
- 13 Balasubramanya R, Pushker N, Bajaj MS. et al. Atypical presentations of retinoblastoma. J Pediatr Ophthalmol Strabismus 2004; 41: 18-24
- 14 Webb BF, Webb JR, Schroeder MC. et al. Prevalence of vitreous floaters in a community sample of smartphone users. Int J Ophthalmol 2013; 6: 402-405 doi:10.3980/j.issn.2222-3959.2013.03.27
- 15 Nussenblatt RB, Palestine AG, Chan CC. et al. Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology 1985; 92: 467-471 doi:10.1016/s0161-6420(85)34001-0
- 16 de Nie KF, Crama N, Tilanus MA. et al. Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction. Graefes Arch Clin Exp Ophthalmol 2013; 251: 1373-1382 doi:10.1007/s00417-012-2205-3
- 17 Hahn U, Krummenauer F, Ludwig K. 23G pars plana vitrectomy for vitreal floaters: prospective assessment of subjective self-reported visual impairment and surgery-related risks during the course of treatment. Graefes Arch Clin Exp Ophthalmol 2018; 256: 1089-1099 doi:10.1007/s00417-018-3979-8
- 18 Henry CR, Smiddy WE, Flynn HW. Pars plana vitrectomy for vitreous floaters: is there such a thing as minimally invasive vitreoretinal surgery?. Retina 2014; 34: 1043-1045 doi:10.1097/IAE.0000000000000124
- 19 Lin Z, Zhang R, Liang QH. et al. Surgical Outcomes of 27-Gauge Pars Plana Vitrectomy for Symptomatic Vitreous Floaters. J Ophthalmol 2017; 2017: 5496298 doi:10.1155/2017/5496298
- 20 Tan HS, Mura M, Lesnik Oberstein SY. et al. Safety of vitrectomy for floaters. Am J Ophthalmol 2011; 151: 995-998 doi:10.1016/j.ajo.2011.01.005
- 21 Sebag J, Yee KM, Wa CA. et al. Vitrectomy for floaters: prospective efficacy analyses and retrospective safety profile. Retina 2014; 34: 1062-1068 doi:10.1097/IAE.0000000000000065
- 22 Mason JO, Neimkin MG, Mason JO. et al. Safety, efficacy, and quality of life following sutureless vitrectomy for symptomatic vitreous floaters. Retina 2014; 34: 1055-1061 doi:10.1097/IAE.0000000000000063
- 23 Park JC, Ramasamy B, Shaw S. et al. A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy: clinical presentation, microbiology, management and outcome. Br J Ophthalmol 2014; 98: 1080-1086 doi:10.1136/bjophthalmol-2013-304486
- 24 Patel KC, Rahman R. Incidence of post-operative endophthalmitis following 23-gauge transconjunctival sutureless vitrectomy in the United Kingdom: a survey. Eye (Lond) 2011; 25: 956 doi:10.1038/eye.2011.46
- 25 Sun X, Tian J, Wang J. et al. Nd:YAG Laser Vitreolysis for Symptomatic Vitreous Floaters: Application of Infrared Fundus Photography in Assessing the Treatment Efficacy. J Ophthalmol 2019; 2019: 8956952 doi:10.1155/2019/8956952
- 26 Vogel A, Schweiger P, Frieser A. et al. [Mechanism of action, scope of the damage and reduction of side effects in intraocular Nd:YAG laser surgery]. Fortschr Ophthalmol 1990; 87: 675-687
- 27 Delaney YM, Oyinloye A, Benjamin L. Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters. Eye (Lond) 2002; 16: 21-26 doi:10.1038/sj.eye.6700026
- 28 Kokavec J, Wu Z, Sherwin JC. et al. Nd:YAG laser vitreolysis versus pars plana vitrectomy for vitreous floaters. Cochrane Database Syst Rev 2017; (06) CD011676
- 29 Brasse K, Schmitz-Valckenberg S, Junemann A. et al. [YAG laser vitreolysis for treatment of symptomatic vitreous opacities]. Ophthalmologe 2019; 116: 73-84 doi:10.1007/s00347-018-0782-1