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Klin Monbl Augenheilkd 2018; 235(03): 309-314
DOI: 10.1055/s-0042-123193
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Bildgebung der intraskleralen Kammerwasserabflusswege – neue Einblicke für die Trabekelwerkschirurgie

Imaging of the Intrascleral Aqueous Drainage System – New Insights for Glaucoma Surgery Targeting the Trabecular Meshwork
C. van Oterendorp
Klinik für Augenheilkunde, Universitätsmedizin Göttingen
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Publication History

eingereicht 09 October 2016

akzeptiert 04 November 2016

Publication Date:
10 February 2017 (online)

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Zusammenfassung

Die Kammerwasserabflusswege distal des Trabekelmaschenwerks (TMW) sind in den letzten Jahren zunehmend in den Fokus der Forschung geraten. Sie umfassen den Schlemm-Kanal, die Kollektorkanäle sowie den intraskleralen Venenplexus. Ihr Beitrag zum gesamten Abflusswiderstand des Kammerwassers wird auf 25–50 % geschätzt. Mit der zunehmenden Anwendung (minimalinvasiver) Trabekelwerkschirurgie kommt den distalen Abflusswegen eine besondere Bedeutung zu. Sie beeinflussen maßgeblich den nach chirurgischer Eröffnung des TMW erreichbaren intraokularen Druck. Die morphologische und funktionelle Darstellung der distalen Abflusswege ist wegen ihrer teils tief intraskleralen Lage und des geringen Gefäßdurchmessers eine besondere Herausforderung. In diesem Artikel werden Fortschritte in der OCT-Bildgebung, der Fluoreszenzkanalografie sowie neue Ansätze, wie OCT-Kontrastmittel und MRT-Flussmessungen, vorgestellt. Zusammen mit klinischen Daten unterstützen sie das Paradigma eines sektoriell unterschiedlichen Abflusses. Die verbesserten Bildgebungsmodalitäten bieten zudem die Perspektive einer prä- oder intraoperativen Diagnostik, um mit der Trabekelwerkschirurgie gezielt an Bereichen, die eine Abflusssteigerung versprechen, anzusetzen.

Abstract

Numerous new techniques in glaucoma surgery target the trabecular meshwork, which is considered to be the main site of aqueous outflow resistance. These approaches rely on a functioning aqueous drainage system distal to the site of surgery. Thus, the intrascleral aqueous outflow tract comprises Schlemmʼs canal, collector channels and aqueous veins and has become an object of increasing research interest. The intrascleral outflow tract contributes approximately 25–50 % to the total aqueous outflow resistance, but the outflow capacity differs greatly over the segments of the eye. Morphological and functional assessment of the intrascleral outflow tract is challenging, due to its deep scleral location and the complex nature of its small diameter vessel network. In this review, we present novel insights into its morphology and function, based on advances in a variety of imaging modalities, including optical coherence tomography, fluorescence imaging and electron microscopy. Together with clinical data, they support the paradigm of significant sectorial differences in aqueous outflow, which has a direct impact on glaucoma surgery targeting sectors of the trabecular meshwork, such as trabeculectomy ab interno or trabecular meshwork bypass stents. Possible future applications of intrascleral outflow tract imaging are discussed.

Schlüsselwörter

Glaukom - optische Kohärenztomografie - Bildgebung - Kammerwasser

Key words

glaucoma - imaging - aqueous humour - optical coherence tomography
 

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