Glaukom-Drainage-Implantate: Indikationen, OP-Management und Nachsorge

Glaukom-Drainage-Implantate (GDI) setzt man bei Patienten mit Sekundärglaukom ein, z. B. bei uveitischem oder neovaskulärem Glaukom, die unter lokaler Therapie unkontrolliert sind. Ebenso bei Fällen von Bindehautvernarbung, etwa nach vorausgegangener Vitrektomie oder erfolgloser Glaukomoperation (z. B. Trabekulektomie). Außerdem sind sie eine Therapieoption für kongenitale Glaukome, Aphakieglaukome oder bei iridokorneoendothelialen Syndromen.

Abstract

Glaucoma drainage devices (GDD) are used for patients with secondary glaucoma, such as uveitic or neovascular glaucoma, which is uncontrolled under local therapy. They are also used in patients with conjunctival scarring, for example after a previous vitrectomy or after unsuccessful previous glaucoma surgery, such as trabeculectomy. They are also a treatment option for congenital glaucoma, aphakic glaucoma or for the treatment of iridocorneoendothelial syndromes. The conventional GDD were the Baerveldt, Molteno or Ahmed glaucoma implant, whereby the first two were valveless and the latter had a valve. Newer GDD include the PAUL glaucoma implant, the Ahmed Clear Path and the EyeWatch system. Hypotony is a feared complication after GDD surgery, and there are various options for avoiding it: external ligation of the tube or intraluminal suture obstruction. However, low IOP may still occur postoperatively. If early postoperative hypotension occurs in combination with a shallow anterior chamber, the injection of a viscoelastic can be helpful. Late hypotension is usually treated with permanent occlusion or removal of the tube. Furthermore, GDD erosion and migration can occur postoperatively, in such cases a surgical revision is required. Corneal decompensation can also occur after GDD; Descemet’s membrane endothelial keratoplasty (DMEK) is the treatment of choice in many centers and is performed more frequently than a penetrating keratoplasty. Finally, double vision is a possible complication after GDI. Most patients have short-term, self-limited diplopia or can be adequately treated with prism glasses; a few require strabologic surgery.

Kernaussagen

• GDI stellen eine effektive chirurgische Therapie zur IOD-Senkung dar, insbesondere bei Augen mit hoher Vernarbungstendenz oder kompromittierter Konjunktiva, da die äquatoriale Drainage sowie die Basisplatte eine Vernarbung in diesem Bereich verhindern.

• GDI haben spezielle Komplikationen, die sich von den anderen filtrierenden Verfahren unterscheiden können.

• Zur Vermeidung einer Hypotonie gibt es unterschiedliche Optionen: externe Ligatur des Drainage-Röhrchens oder eine intraluminale Fadenobstruktion (Ripcord).

• Bei einer frühen postoperativen Hypotonie in Kombination mit einer flachen Vorderkammer ist die Eingabe eines Viskoelastikums hilfreich.

• Eine spät auftretende Hypotonie wird in der Regel mit permanenter Okklusion oder Entfernung des Drainageröhrchens behandelt.

• Weitere Komplikationen sind eine GDI-Erosion und Migration, eine korneale Dekompensation und Doppelbilder.

• Die Nachsorge ist im Gegensatz zu filtrierenden Verfahren, wie der TE, weniger aufwendig und weniger von der Patientenadhärenz abhängig.

• Für Sekundärglaukome stellen GDI eine First-Line-Therapie dar, beim PCOWG werden diese eher sekundär eingesetzt, nachdem eine vorherige Glaukomoperation zu keinem Erfolg geführt hat.

Schlüsselwörter

Glaukomchirurgie - Glaukom-Drainage-Implantate - Sekundärglaukom - Komplikationen

Keywords

glaucoma surgery - glaucoma drainage devices - secondary glaucoma - complications

Publication History

Article published online:
06 December 2024

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