Makulaforamenchirurgie heute - ein Überblick

Zusammenfassung

Makulaforamina werden nach der Größe des Defektes und der Interaktion des Glaskörpers mit der Netzhautoberfläche eingeteilt. Seit der Erstbeschreibung eines erfolgreichen Verschlusses eines Makulaforamens im Jahr 1991 wurden die chirurgischen Techniken verfeinert. Dadurch konnten die anatomischen und funktionellen Ergebnisse der Makluaforamenchirurgie deutlich verbessert werden. Die moderne Makulaforamenchirurgie umfasst heute eine Vitrektomie, ILM peeling besonders bei großen Foramina (mit oder ohne Anwendung von Farbstoffen wie Indocyaningrün, Trypanblau oder seit Kurzem Brillantblau), Gastamponade und Kopf-Tief-Lagerung für einige Tage. Besonders die Anwendung von ICG wird kontrovers diskutiert, da der Farbstoff aufgrund seiner phototoxischen Eigenschaften das funktionelle Ergebnis negativ beeinflussen kann. Mithilfe moderner bildgebender Verfahren wie der OCT können nicht nur prognostische Faktoren für die zu erwartende funktionelle Entwicklung nach der Operation ermittelt, sondern auch Erklärungen für einen ausbleibenden Visusanstieg trotz erfolgreichen Lochverschlusses gefunden werden. Unter Berücksichtigung der bisher publizierten Studien kann die Chirurgie eines Makulaforamens unabhängig von der präoperativen Sehschärfe und der Dauer der Symptome empfohlen werden, da in fast allen Fällen eine deutliche Verbesserung der Sehschärfe erreicht wird.

Abstract

Macular holes are staged according to the size of the hole and the presence or absence of a posterior vitreous detachment. Since the first report on successful macular hole surgery in 1991, surgical techniques have been refined and have helped to increase anatomic and functional success rates. Macular hole surgery today consists of vitrectomy, ILM peeling (especially in larger macular holes) with or without using vital dyes such as indocyanine green, trypan blue or as very recently suggested, brilliant blue, followed by endotamponade and prone position for a few days. Especially ICG staining has become a subject of controversial discussion as functional success might be diminished due to the phototoxic properties of the dye. Imaging techniques such as OCT may not only serve as prognostic factors for visual recovery, but may also help to explain unsatisfactory visual recovery despite anatomic hole closure. According to the current literature, macular hole surgery can be recommended independently from the preoperative visual acuity and duration of symptoms, as a significant visual improvement can be achieved in almost all cases.

Makulaforamen - Vitrektomie

Macular hole - vitrectomy

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