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Klin Monbl Augenheilkd 2005; 222(6): 471-479
DOI: 10.1055/s-2005-858114
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Elektronische Sehprothesen

Electronic Visual ProsthesesP. Walter1
  • 1Augenklinik (Direktor: Univ.-Prof. Dr. Peter Walter), Universitätsklinikum Aachen
Further Information

Publication History

Eingegangen: 3.2.2005

Angenommen: 3.3.2005

Publication Date:
23 June 2005 (online)

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Zusammenfassung

Hintergrund: Derzeit gibt es keine Therapie für progressive Netzhautdystrophien. Durch Fortschritte in der Herstellung extrem kleiner komplexer Mikrosysteme und durch ihre Integration in biokompatible Strukturen erscheint die Fertigung einer implantierbaren Sehprothese heute möglich. Material und Methoden: Die derzeitige Entwicklung elektronischer implantierbarer Sehprothesen beruht auf der Herstellung von Stimulationselektrodenarrays, die in die jeweilige Zielregion des visuellen Systems implantiert werden. Funktionsmuster und Prototypen solcher Systeme wurden tierexperimentell erprobt und in Einzelfällen bereits bei Menschen eingesetzt. Ergebnisse: Derzeit werden vier Konzepte verfolgt: 1. Epiretinales Implantat - Befestigung auf der Netzhautoberfläche, 2. Subretinales Implantat - Implantation im subretinalen Raum, 3. Sehnervprothese - Cuffelektrode um den Sehnerven, 4. Cortexprothese - Implantation von Oberflächenelektroden über dem visuellen Cortex. Alle Verfahren wurden bisher in Pilotversuchen am Menschen eingesetzt. Die Ergebnisse bezüglich der Sehwahrnehmung zeigen bisher hoffnungsvolle Ergebnisse. Schlussfolgerungen: Die Entwicklung implantierbarer elektronischer Sehprothesen stellt eine mögliche Option in der Behandlung weit fortgeschrittener Netzhautdystrophien dar. Weitere Grundlagenuntersuchungen zur funktionellen Stimulation des visuellen Systems sind ebenso erforderlich wie Pilotstudien zur Stimulation beim Menschen zur genauen Charakterisierung der Stimulationsparameter und Optimierung vorhandener Systeme.

Abstract

Background: Currently, no treatment is available for progressive retinal dystrophies. The fabrication of an implantable visual prosthesis seems to be possible now as a result of advances in the fabrication of extremely small micro-systems and their encapsulation in biocompatible materials. Materials and Methods: The development of implantable visual prostheses is based on the fabrication of remotely controlled microelectrode arrays which have to be implanted in different target regions of the visual system. Prototypes of such systems have already been implanted in animal experiments and also in pilot trials in humans. Results: Four concepts are pursued: 1. epiretinal implant - fixation onto the inner retinal surface; 2. subretinal implant - implantation within the subretinal space; 3. optic nerve stimulator - cuff electrode placed around the optic nerve; 4. cortical prosthesis - implantation of surface electrodes in the region of the visual cortex. All these concepts have already been applied in pilot trials in humans. The results show some promising visual perception. Conclusions: The use of implantable electronic visual prostheses will become a possible option in the treatment of currently untreatable retinal dystrophies. Further basic research initiatives are necessary as well as further human trials to characterize the stimulation parameters and to improve the currently available devices.

Schlüsselwörter

Aktive Implantate - Cortexprothesen - elektrische Stimulation - Erblindung - Retina Implant - Retinitis pigmentosa - Sehnervprothesen - Sehprothesen

Key words

Active implants - blindness - cortical prosthesis - electrical stimulation - optic nerve prosthesis - retina implant - retinitis pigmentosa - visual prosthesis

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Prof. Dr. Peter Walter

Universitätsklinikum Aachen, Augenklinik

Pauwelsstr. 30

52074 Aachen

Phone: 02 41/8 08 81 91

Fax: 02 41/8 08 24 08

Email: pwalter@ukaachen.de

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