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Tiefe Sklerektomie mit Hyaluronatimplantat vs. Trabekulektomie

Zwei Glaukomoperationen unter Verwendung von Mitomycin C

Deep sclerectomy using a hyaluronate implant versus trabeculectomy

A comparison of two glaucoma operations using mitomycin C

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Zusammenfassung

Hintergrund

Untersucht wurde, ob durch Modifikationen der tiefen Sklerektomie ein niedriger Zieldruck erreichbar ist, ohne die Vorzüge der nicht penetrierenden im Vergleich zu konventioneller Filtrationschirurgie preiszugeben.

Patienten und Methode

Es wurden 22 Augen von 22 Patienten mit Glaucoma chronicum simplex 2 operativen Verfahren zugeordnet. Bei allen Augen wurde subkonjunktival Mitomycin C appliziert. Gruppe 1 erhielt eine tiefe Sklerektomie mit Entfernung juxtakanalikulären Trabekelmaschenwerks. Ein trockenes quer vernetztes Hyaluronat wurde als Implantat verwendet. Gruppe 2 erhielt eine Trabekulektomie.

Ergebnisse

Der Median des intraokularen Drucks (IOD) betrug 12 Monate postoperativ in der Gruppe mit tiefer Sklerektomie 11,5 mmHg, in der Trabekulektomiegruppe 11 mmHg; die mediane relative IOD-Senkung in der Gruppe mit tiefer Sklerektomie −47%, in der Trabekulektomiegruppe −57%. Der Visus 12 Monate postoperativ war in beiden Gruppen unverändert.

Schlussfolgerung

Ein aggressives chirurgisches Konzept mit intendierter Filtration und Anwendung von Antimetaboliten bei Durchführung einer tiefen Sklerektomie ermöglicht eine genauso starke IOD-Senkung wie bei einer Trabekulektomie. Vorteile des operativ aufwändigeren Verfahrens in Bezug auf Visus, Komplikationen und postoperative Interventionen im Vergleich zur Trabekulektomie sind dann allerdings nicht mehr vorhanden.

Abstract

Background

It was investigated whether a very low target pressure could be achieved by modification of deep sclerectomy without losing the advantages of non penetrating surgery in comparison to conventional filtration surgery.

Patients and methods

A total of 22 eyes from 22 patients with advanced open angle glaucoma were randomly assigned to receive a deep sclerectomy or a trabeculectomy. Both groups received 0.02% mitomycin C under the conjunctiva prior to preparation of the scleral flap. In the deep sclerectomy group at least parts of the outer trabecular meshwork were removed until an apparent filtration was achieved. A dry cross-linked hyaluronate served as an implant. In the other group a classical trabeculectomy was performed.

Results

The median intraocular pressure 12 months post-operation was 11.5 mm Hg in the deep sclerectomy group compared to 11 mm Hg in the trabeculectomy group; the median of the relative IOP reduction was −47% in the deep sclerectomy group, and −57% in the trabeculectomy group. The best corrected visual acuity was unchanged 12 months postoperatively in both groups.

Discussion

As a more aggressive IOP-lowering procedure (intended filtration, use of antimetabolites) deep sclerectomy proved to be as effective as trabeculectomy. Nevertheless, the advantages of the more difficult surgical procedure concerning visual acuity, complications and surgical interventions were lost postoperatively.

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Authors and Affiliations

  1. Augenklinik der Johannes Gutenberg-Universität, Mainz

    O. Schwenn, C. Springer, A. Troost, S. H. Yun & N. Pfeiffer

  2. Augenklinik des Bürgerhospitals, Nibelungenallee 37–41, 60318, Frankfurt am Main

    O. Schwenn

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  1. O. Schwenn
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Correspondence to O. Schwenn.

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Schwenn, O., Springer, C., Troost, A. et al. Tiefe Sklerektomie mit Hyaluronatimplantat vs. Trabekulektomie. Ophthalmologe 101, 696–704 (2004). https://doi.org/10.1007/s00347-003-0940-x

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  • DOI: https://doi.org/10.1007/s00347-003-0940-x

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