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DOI: 10.1055/a-2505-4983
Praxis der nichtfiltrierenden minimalinvasiven Glaukomchirurgie
Insights into the practice of minimally invasive glaucoma surgery
Ein erhöhter intraokulärer Druck kann zu Schäden am Sehnerv führen und das Sehvermögen beeinträchtigen. Wenn der Augeninnendruck durch Augentropfen oder Laserbehandlungen nicht ausreichend gesenkt werden kann, muss eine chirurgische Behandlung in Betracht gezogen werden, um den Druck zu verringern. Neben der klassischen Glaukomchirurgie etablieren sich auch minimalinvasive glaukomchirurgische Verfahren, die in diesem Beitrag vorgestellt werden.
Abstract
Minimally invasive glaucoma surgeries (MIGS) offer an alternative approach, aiming to be both safe and effective. Defined by their ab interno technique, which avoids creating a bleb, MIGS procedures seek to reduce intraocular pressure (IOP) by enhancing the outflow pathways of aqueous humor. Techniques include stenting, incisions, and excisions of the trabecular meshwork, canaloplasty of Schlemm’s canal, and drainage implants that enhance uveoscleral outflow to the subchoroidal space. Many of these methods show promise in reducing intraocular pressure and decreasing the need for medication. Nevertheless, with the increasing number of these procedures and devices on the market, it is difficult to keep track of the evidence supporting these methods. Although randomized controlled trials exist for many of the new MIGS procedures, the sample sizes are often small, and follow-up periods are limited. Additionally, there are no randomized controlled trials comparing different MIGS techniques or MIGS with traditional glaucoma surgery. These factors continue to make it challenging to select the most appropriate method for each patient. Therefore, it is essential to persist in conducting randomized controlled long-term studies to gain a deeper understanding of the applications of MIGS.
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Minimalinvasive Glaukomoperationen (MIGS) zielen darauf ab, den Augeninnendruck (IOD) zu senken, indem die natürlichen Abflusswege des Kammerwassers verbessert werden, und zeichnen sich durch ihre Ab-interno-Technik ohne Sickerkissenanlage aus.
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Zum Einsatz kommen Stents, Inzisionen und Exzisionen des Trabekelwerks, Kanaloplastik des Schlemm-Kanals und Drainageimplantate, die den uveoskleralen Abfluss in den subchoroidalen Raum verbessern.
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Einige dieser Methoden sind vielversprechend, um den Augeninnendruck zu senken und den Bedarf an Medikamenten zu verringern, wobei es ob der Vielzahl schwierig ist, den Überblick über die Belege für diese Methoden zu behalten.
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Zwar gibt es für viele der neuen MIGS-Verfahren randomisierte kontrollierte Studien, doch sind die Stichprobengrößen oft klein und der Nachbeobachtungszeitraum begrenzt. Außerdem gibt es keine randomisierten kontrollierten Studien, in denen verschiedene MIGS-Techniken oder MIGS mit der herkömmlichen Glaukomchirurgie verglichen werden.
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Diese Faktoren machen es nach wie vor schwierig, für jeden Patienten die am besten geeignete Methode auszuwählen.
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Daher ist es unerlässlich, weiterhin randomisierte, kontrollierte Langzeitstudien durchzuführen, um ein tieferes Verständnis für die Anwendungen der MIGS zu erlangen.
Publication History
Article published online:
19 February 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
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