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Klin Monbl Augenheilkd 2000; 216(5): 272-277
DOI: 10.1055/s-2000-10559
KLINISCHE STUDIE

Georg Thieme Verlag Stuttgart · New York

Prognostische Faktoren und Resultate nach operativer Behandlung idiopathischer Macula foramina Stadium 2 und 3

Vitreous surgery for idiopathic macular holes stage 2 and 3. Results and prognostic factorsIrène  Ch. Gander, Peter Senn, Magdalena Lüthi, Isaak Schipper
  • Augenklinik Kantonsspital Luzern, 6000 Luzern 16, Schweiz (Chefarzt: PD Dr. med. I. Schipper)
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Publikationsdatum:
31. Dezember 2000 (online)

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Zusammenfassung

Fragestellung Prognostische Faktoren, subjektive Bewertung und funktionelle Resultate nach Chirurgie von Macula foramina Stadium 2 und 3.

Patienten und Methode 53 Augen von 49 Patienen nach Makulalochchirurgie (46 % Stadium 2, 54 % Stadium 3) wurden untersucht. Die durchschnittliche Nachbeobachtungszeit war 114 Wochen (32 - 204, Std.Abw. ± 48), das Alter 68,9 Jahre (48 - 89, Std.Abw. ± 6,8). 72 % waren Frauen. 11 % waren pseudophak, 19 % phak, bei 70 % wurde kombiniert eine Vitrektomie, Phakoemulsifikation und Kunstlinsenimplantation durchgeführt. Die Technik bestand in einer Pars-plana-Vitrektomie, Peeling epiretinaler Membranen und der M. limitans interna, Lochtamponade (98 % SF6, 2 % Si-Öl) und postoperativer Lagerung (6 × 20 Minuten täglich Gesicht tief).

Resultate Ein vollständiger Lochverschluss gelang in 90,6 %. Versager mitgerechnet verbesserte sich der Visus in 86 %, bei 41 % = 5 Zeilen (Schlussvisus Median 0,6, max. 1,0). Nach 6 Monaten verbesserte sich retinal die Sehschärfe nicht mehr. Der Visusanstieg korrelierte nicht mit der Anamnesedauer. 84 % waren mit dem Resultat zufrieden, 94 % würden den Eingriff wiederholen. Die Zufriedenheit korrelierte nicht mit dem Visusergebnis. 19 % zeigten typische periphere Gesichtsfeldausfälle, es bestand kein Zusammenhang zu perioperativen Intraokulardrucksteigerungen.

Schlussfolgerung Die Makulalochchirurgie hat eine hohe anatomische und funktionelle Erfolgsrate. Die typischen peripheren Gesichtsfeldausfälle sind bis dato das größte Problem.

Purpose To determine prognostic factors, functional outcome and subjective rating after surgery for macular holes stage 2 and 3.

Methods We studied 53 eyes of 49 patients undergoing vitreous surgery for macular holes stage 2 (46 %) and 3 (54 %). Mean follow-op was 114 weeks (32 - 204, std.dev. ± 48), mean age 68,9 years (44 - 89, std.dev. ± 6,8). 72 % were female. 11 % were pseudophakic, 19 % phakic, 70 % had a combined procedure (pars plana vitrectomy, phakoemulsification and IOL). Surgery consisted in a pars plana vitrectomy, peeling of epiretinal membranes and ILM, internal tamponade with SF6 (98 %) resp. Si-oil in one case. Patients had to keep face-down postion 6 × 20 minutes per day.

Results The hole was completely closed in 90,6 %. Anatomical failures included, 86 % had an increase of VA, 41 % = 5 lines (Final VA median 20/30, max. 20/20). No further increase of the retinal function occurred after 6 months. The visual result did not correlate with the duration of symptoms. 84 % were satisfied with the outcome, subjective rating was not correlated with final VA or change of VA. 19 % showed postoperative typical peripheral visual field defects. Visual field loss was not correlated with perioperative IOP elevation.

Conclusion Macular hole surgery has a high functional success rate. Postoperative visual field defects are an important problem.

Schlüsselwörter

Makulaloch - Vitrektomie - Gesichtsfeldausfall

Key words

Macula hole - vitreous surgery - visual field

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