Traktive myope Makulopathie – vitreoretinales Traktionssyndrom bei hoher Myopie und hinterem Staphylom

Zusammenfassung

Die pathologischen Veränderungen des hinteren Pols bei hoher Myopie sind charakterisiert durch eine sklerale Verdünnung mit posteriorem Staphylom sowie strukturellen Veränderungen der Retina. Epiretinale Membranen und epiretinale Traktion in Verbindung mit einer Separation der ILM können zu einer fovealen Retinoschisis führen mit konsekutiver Entwicklung einer traktiven Amotio des hinteren Pols und der Entstehung von myopen Makulaforamina. Die foveale Abhebung und Retinoschisis in hochmyopen Augen kann nach Vitrektomie mit ILM-Peeling entlastet werden. Es besteht jedoch die Gefahr der Entwicklung eines konsekutiven Makulaforamens. Die sklerale Buckelchirurgie des hinteren Pols wird derzeit wiederentdeckt. Sie erlaubt in selektierten Fällen, die traktiven Kräfte zu entlasten. Da insbesondere bei Patienten mit einem lang bestehenden myopen Makulaforamen in der Regel keine Verbesserung des Lesevisus möglich ist, muss eine prophylaktische Behandlung des Partnerauges überlegt werden. Die Glaskörperchirurgie mit Entfernung epiretinaler Membranen könnte hier das Risiko der Entstehung eines Makulaforamens am zweiten Auge vermindern und sollte in ausgewählten Fällen diskutiert werden, muss jedoch gegen die möglichen chirurgischen Komplikationen abgewägt werden.

Abstract

The pathology of the posterior pole in high myopic eyes is characterised by scleral thinning and staphyloma associated with structural changes of the retina. Epiretinal membranes and epiretinal traction together with partial separation of the ILM result in myopic foveoschisis and posterior tractional detachment with myopic macular holes. Foveal detachment and retinoschisis in highly myopic eyes may resolve after vitrectomy with ILM peeling: however, there is a considerable risk for the development of macular hole formation. Skleral buckling surgery is currently regaining interest and allows one to reduce the tractional forces in selected cases. While reading visual acuity is usually not regained after macular hole development, prophylactic measures should be considered for the fellow eye. Vitreous surgery might have a rationale as prophylactic treatment for highly myopic eyes at high risk of macular hole development; however, this needs to be weighed against possible surgical complications.

Schlüsselwörter

pathologische Myopie - myope Traktions-Makulopathie - foveale Retinoschisis

Key words

pathological myopia - myopic traction maculopathy - foveal retinoschisis

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