Zusammenfassung
Hintergrund: Trotz aller technischer Entwicklungen, welche die Vitrektomie in den 35 Jahren seit ihrer Erfindung zu einem hoch effektiven und sicheren Routineverfahren der intraokularen Chirurgie werden ließen, stößt die mechanische Glaskörperentfernung und Manipulation der Netzhaut an ihre Grenzen. Material und Methoden: Durch die Zusammenschau klinischer und pathologischer, meist ultrastruktureller Befunde werden die Grenzen der Vitrektomie aufgezeigt und Lösungsansätze aktueller und zukünftiger Forschungsaktivitäten vorgestellt. Ergebnisse: Die Grenzen der Vitrektomie sind: 1. Inkomplette Glaskörperentfernung. 2. Therapie von Spätstadien. 3. Fehlende Neuroprotektion. 4. Ungenügend sicher definierte Dissektionsebenen. Diese Grenzen lassen sich nur in Kombination der Chirurgie mit der Pharmakologie überwinden. Schlussfolgerungen: Folgende Forschungs- und Lösungsansätze werden vorgestellt: Ad 1. Pharmakologische Vitreolyse. Ad 2. Frühere, weniger traumatische Intervention. Ad 3. Neuroprotektion und antiproliferative Substanzen. Ad 4. Selektive Anfärbung von Glaskörperrinde und ILM.
Abstract
Background: While the limits of mechanical vitrectomy are being approached, scientists and vitreoretinal surgeons are looking for a combination of pharmacology and vitrectomy, i. e., pharmacology-assisted vitrectomy. Methods: This review shows the limits of conventional vitreoretinal surgery by presenting clinical and ultrastructural data related to vitreoretinal surgical techniques and outcomes. Results: The limits of conventional vitreoretinal surgery include: 1. Incomplete vitreous cortex removal. 2. Surgery of advanced stages of the disease. 3. The lack of neuroprotection and antiproliferative agents. 4. Ill-defined cleavage planes when removing tissue from the retina. Conclusions: Pharmacology-assisted vitrectomy helps to overcome the limits of conventional vitreoretinal surgery by addressing: Item 1. Pharmacological vitreolysis. Item 2. Earlier, less traumatic intervention. Item 3. Neuroprotection and antiproliferative agents. Item 4. Selective staining of distinct structures of the vitreoretinal interface, such as cortical vitreous, cellular proliferation, and internal limiting membrane.
Schlüsselwörter
Glaskörper - Pathologie - Retina
Key words
pathology - retina - vitreous
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Priv.-Doz. Dr. A. Gandorfer
Vitreoretinal and Pathology Unit, Universitäts-Augenklinik München
Mathildenstr. 8
80336 München
Phone: ++ 49/89/51 60 38 56
Fax: ++ 49/89/51 60 47 78
Email: arnd.gandorfer@med.uni-muenchen.de
