Nachbehandlung nach nicht penetrierender Glaukomchirurgie: die Goniopunktion
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Nachbehandlung nach nicht penetrierender Glaukomchirurgie: die Goniopunktion. / Gesser-Wendt, Caroline; Klemm, M.
In: KLIN MONATSBL AUGENH, 10.12.2013.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Nachbehandlung nach nicht penetrierender Glaukomchirurgie: die Goniopunktion
AU - Gesser-Wendt, Caroline
AU - Klemm, M
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2013/12/10
Y1 - 2013/12/10
N2 - Non-penetrating glaucoma surgery was primarily developed as an alternative to the widely applied trabeculectomy. Since the anterior chamber in non-penetrating surgery is not directly opened, common postoperative complications such as hypotony are rare. The most frequently applied technique in this group is the deep sclerectomy. After having prepared a superficial scleral flap a deeper scleral flap is performed and excised unroofing Schlemm's canal. The trabecular meshwork is then peeled leaving a residual trabeculodescemet membrane. As a consequence aqueous humour diffuses via the trabeculodescemet membrane under the scleral flap and subsequently under the conjunctiva. One of the reasons for a postoperatively high IOP is seen in the resistance of the residual trabculodescemet membrane. A solution to this problem lies in its puncture, the so-called goniopuncture. Goniopunctures are done in approximately 50 % of cases after deep sclerectomy and are also applied in cases of canaloplasty and viscocanaloplasty. Usually a 1064 nm Nd : YAG laser is used. A potential risk of iris incarceration is described. Two studies have shown that an equally IOP lowering effect can be achieved by treating the trabeculodescemet membrane with a frequency-doubled 532 nm Nd : YAG laser (SLT). No complications were detected in those cases. In conclusion, goniopuncture should be considered as the first line treatment for postoperative IOP increase in cases of non-penetrating glaucoma surgery. It should therefore be preferred to a (re)start of topical treatment.
AB - Non-penetrating glaucoma surgery was primarily developed as an alternative to the widely applied trabeculectomy. Since the anterior chamber in non-penetrating surgery is not directly opened, common postoperative complications such as hypotony are rare. The most frequently applied technique in this group is the deep sclerectomy. After having prepared a superficial scleral flap a deeper scleral flap is performed and excised unroofing Schlemm's canal. The trabecular meshwork is then peeled leaving a residual trabeculodescemet membrane. As a consequence aqueous humour diffuses via the trabeculodescemet membrane under the scleral flap and subsequently under the conjunctiva. One of the reasons for a postoperatively high IOP is seen in the resistance of the residual trabculodescemet membrane. A solution to this problem lies in its puncture, the so-called goniopuncture. Goniopunctures are done in approximately 50 % of cases after deep sclerectomy and are also applied in cases of canaloplasty and viscocanaloplasty. Usually a 1064 nm Nd : YAG laser is used. A potential risk of iris incarceration is described. Two studies have shown that an equally IOP lowering effect can be achieved by treating the trabeculodescemet membrane with a frequency-doubled 532 nm Nd : YAG laser (SLT). No complications were detected in those cases. In conclusion, goniopuncture should be considered as the first line treatment for postoperative IOP increase in cases of non-penetrating glaucoma surgery. It should therefore be preferred to a (re)start of topical treatment.
U2 - 10.1055/s-0033-1351060
DO - 10.1055/s-0033-1351060
M3 - SCORING: Zeitschriftenaufsatz
C2 - 24327300
JO - KLIN MONATSBL AUGENH
JF - KLIN MONATSBL AUGENH
SN - 0023-2165
ER -