Aderhautdicke nach Buckelchirurgie versus Pars-plana-Vitrektomie bei Makula-off-rhegmatogener Ablatio retinae

 

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Zusammenfassung

Hintergrund: Spectral-Domain-optische Kohärenztomografie und Tiefendarstellung („enhanced depth imaging“, EDI) haben zur Darstellung von retinalen/choroidalen Pathologien an Bedeutung erlangt. Es liegen wenig Informationen über choroidale Veränderungen nach Buckelchirurgie und Pars-plana-Vitrektomie (PPV) nach Macula-off Ablatio retinae vor. Material und Methoden: 44 Patienten, die wegen rhegmatogener Macula-off-Ablatio mit Buckelchirurgie versus PPV versorgt worden waren, wurden retrospektiv untersucht. Die Aderhaut (AH)-Dickenmessung erfolgte in 2 Gruppen (Gruppe 1: Cerclage + Kryopexie + Ablassung subretinaler Flüssigkeit [SRF]) + Luft oder SF₆ (n = 28 Augen); Gruppe 2: PPV + Laserphotokoagulation + C₃F₈ (n = 16 Augen) mittels EDI-OCT 1 Woche, 1 und 6 Monate postoperativ. Die Gruppen wurden miteinander, die operierten Augen mit dem Partnerauge verglichen. Ergebnisse: Die subfoveale AH-Dicke der operierten Augen war in Gruppe 1 und Gruppe 2 eine Woche postoperativ dicker als 4 Wochen postoperativ. Es zeigte sich nach der Buckelchirurgie versus PPV 1 und 6 Monate postoperativ zwischen operiertem Auge und gesundem Partnerauge kein signifikanter Unterschied der AH-Dicke. Schlussfolgerung: Es zeigte sich in der subfovealen AH-Dicke der Augen mit Macula-off-Ablatio 1 Woche postoperativ sowohl nach Buckelchirurgie als auch PPV eine AH-Dickenzunahme. Die dickere AH in der frühen postoperativen Phase scheint in Gruppe 1 am ehesten durch Kryopexie- und Cerclage-Wirkung und in Gruppe 2 eher durch die vorübergehende inflammatorische Wirkung der ausgedehnten retinalen Laserphotokoagulation bedingt zu sein. Bezüglich der mechanischen Wirkung von intravitrealer Gabe von SF6 bzw. C3F8 auf AH sind klinische und experimentelle prospektiv randomisierte Studien erforderlich.

Abstract

Purpose: Enhanced depth imaging (EDI) optical coherence tomography (OCT) provides high-definition cross-sectional images of the choroid. Information on alterations in choroidal thickness (CT) after scleral buckling surgery (SBS) and pars plana vitretomy (PPV) are rare. Methods: The medical charts of 44 patients (44 eyes) who underwent SBS versus PPV for macula-off rhegmatogenous retinal detachment (RRD) were retrospectively analysed. Patients with a follow-up ≥ 6 months were included. Postoperative EDI-OCT images concerning CT were evaluated 1 week, 1 month and 6 months postoperatively in 2 groups: group 1: cerclage + cryopexy + subretinal fluid drainage (SRD) + SF₆ or air (n = 28 eyes), group 2: PPV + laser photocoagulation + C₃F₈. Subfoveal CT was compared between the groups and with the non-operated fellow eye. Results: Subfoveal CT in groups 1 and 2 was thicker 1 week postoperatively. There were no significant differences between the groups 2 or when comparing the operated eye with the fellow eye 1 and 6 months postoperatively. Conclusion: There were no differences in subfoveal CT 1 and 6 months after SBS between the eye with macula-off RRD and the fellow eye. Thicker CT 1 week postoperatively after SBS may most likely be induced by scleral buckle reduced blood flow and increased haemostasis in the choroidal circulation and by scleral and choroidal inflammation after cryopexy versus laser photocoagulation after SBS versus PPV.

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