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Eine neue Operationstechnik für die Behandlung von sekundären refraktären posttraumatischen Glaucomen nach Trabekulektomie mit PRECLUDE® Pericardial Membrane – eine Fallbeschreibung

A new surgical technique for the treatment of secondary refractory post-traumatic glaucoma after trabeculectomy using PRECLUDE® Pericardial Membrane—A case report

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Zusammenfassung

Hintergrund

Die häufigste Ursache für ein Misslingen der filtrierenden Glaukomoperation ist eine durch das Einwachsen von Fibrosegewebe verursachte Fistelblockade oder eine Adhäsion der Skleralamelle auf das Sklerabett. Ziel dieses Beitrags ist es, eine neue Operationstechnik mit PRECLUDE® Pericardial Membrane zur Behandlung des sekundären refraktären posttraumatischen Glaukoms vorzustellen, nachdem zuvor eine Trabekulektomie vorgenommen wurde.

Methode

Ein 40-jähriger Mann wurde auf unsere Station wegen eines schweren stumpfen Bulbustraumas aufgenommen. Obwohl eine maximale lokale und systemische Glaukomtherapie durchgeführt wurde, konnte der Augeninnendruck nicht reguliert werden. Zwei Wochen nach der Verletzung wurde eine Trabekulektomie durchgeführt. Zwei Wochen nach dem Eingriff kam es zu einem stark erhöhten Augeninnendruck. Es wurde ein Revisionseingriff an der Skleralamelle vorgenommen. Eine 7 mm lange und 2 mm breite PRECLUDE® Pericardial Membrane wurde mit einer feiner Pinzette unter die Skleralamelle implantiert. Dabei wurde an beiden Seiten ein Rand von 1 bis 2 mm gelassen, ohne die Membran an die Sklera anzunähen.

Resultate

Bei den Verlaufskontrollen, die noch drei Jahre nach dem Eingriff erfolgten, wurden keine Anzeichen für Infektionen, Entzündungen oder Beschwerden jeglicher Art beobachtet. Der Augeninnendruck war normal, ohne lokale Glaukomtherapie.

Schlussfolgerung

Bei dieser neuen Methode handelt es sich um einen einfachen und sicheren Eingriff, der auch als filtrationsmodulierende Methode bei allen posttraumatischen refraktären Glaukomen verwendet werden kann; insbesondere bei Patienten, bei denen man das antimetabolitenbezogene Risiko vermeiden muss, zur Zeit oder nach der Trabekulektomie. Weitere Studien sind erforderlich, um diese Operationsmethode als einfach und sicher für alle refraktären Glaukom-Arten zu bestätigen.

Summary

Background

The most common causes for failure after filtration surgery are the blockage of fistula by fibrous tissue ingrowth or adhesion of scleral flap to scleral bed. The aim of this presentation is to present a new surgical technique for management of secondary refractory post-traumatic glaucoma after previous performed trabeculectomy using PRECLUDE® Pericardial Membrane.

Methods

A 40-year old man was admitted to our department because of severe blunt ocular trauma. Despite maximal local and systemic antiglaucoma therapy, intraocular pressure was not regulated. Two weeks after injury, trabeculectomy was performed, following with severe elevation of intraocular pressure two weeks after surgery. Revision of the flap was performed. A 7 mm long and 2 mm width PRECLUDE® Pericardial Membrane was implanted beneath the scleral flap with a fine forceps left 1 bis 2 mm of the patch left over both sides without sutering the membrane to the sclera.

Results

No signs of infections, inflammations or any kind of discomfort were detected on follow-up examinations during 3 years. Intraocular pressure was normal without any antiglaucoma therapy.

Conclusions

Our new surgical treatment is simple and safe procedure and can be used as filtration-modulating device in all post-traumatic refractory glaucoma, especially in cases where antimetabolite-related risk must be avoided at the same time or after trabeculectomy. Further studies are necessary to confirm this surgical technique as a simple and safe procedure for all kinds of refractory glaucoma.

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Authors and Affiliations

  1. Augenabteilung, Universitätskrankenhaus Maribor, Ljubljanska 5, 2000, Maribor, Slowenien

    Dušica Pahor & Tomaž Gračner

  2. Medizinische Fakultät, Universität Maribor, Maribor, Slowenien

    Dušica Pahor & Tomaž Gračner

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  1. Dušica Pahor
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Correspondence to Dušica Pahor.

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Pahor, D., Gračner, T. Eine neue Operationstechnik für die Behandlung von sekundären refraktären posttraumatischen Glaucomen nach Trabekulektomie mit PRECLUDE® Pericardial Membrane – eine Fallbeschreibung. Spektrum Augenheilkd. 33, 74–80 (2019). https://doi.org/10.1007/s00717-019-0428-y

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