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Präoperative Therapieumstellung vor filtrierender Glaukomchirurgie

Einfluss der systemischen augendrucksenkenden sowie der lokalen antiphlogistischen Therapie auf den Augendruck

Preoperative therapy switch before glaucoma filtration surgery

Influence of the systemic antiglaucomatous and local antiphlogistic therapy on the intraocular pressure

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Zusammenfassung

Hintergrund

Die präoperative Umstellung einer lokalen auf eine systemische antiglaukomatöse Therapie sowie die additive Applikation von lokalen Antiphlogistika stellen einen wichtigen Teil der perioperativen Wundheilungsmodulation im Rahmen einer filtrierenden Glaukomchirurgie dar.

Ziel der Arbeit

Ziel der vorliegenden Studie ist es, die Augendruckwerte vor und nach dieser Therapieumstellung zu vergleichen und evtl. kritische Tensioanstiege zu evaluieren.

Methoden

Einhunderteinundzwanzig konsekutive Patienten, die sich 2013 einer primären geplanten Trabekulektomie an unserer Klinik unterzogen und sich mindestens 3 Wochen präoperativ vorstellten, wurden in die retrospektive klinische Analyse eingeschlossen. Bei den Patienten wurde entweder die augendrucksenkende Lokaltherapie unverändert fortgeführt (mit oder ohne additiv lokal Dexamethason 1 mg/ml 3‑mal/Tag) oder auf Azetazolamid (250 mg 3‑mal/Tag) mit oder ohne additiv Dexamethason 1 mg/ml 3‑mal/Tag umgestellt. Verglichen wurde der Augendruck vor sowie 3 Wochen nach der Therapieumstellung.

Ergebnisse

Die Umstellung der lokalen auf die systemische drucksenkende Therapie führte zu einem mittleren Augendruckanstieg von 3,14 mmHg (p = 0,052). Die Verabreichung lokaler Steroide allein betrachtet veränderte den Augendruck ebenfalls nicht statistisch signifikant (p = 0,218). Einige derjenigen Patienten, die oral Azetazolamid und zusätzlich lokale Steroide erhielten, entwickelten sehr ausgeprägte Augendruckanstiege (bis zu 30 mmHg Differenz zum Ausgangsdruck) unter dieser Therapie.

Diskussion

Der mittlere Augendruckanstieg von 3,14 mmHg unter systemischer antiglaukomatöser Therapie erscheint klinisch in Anbetracht der relativ kurzen Zeitspanne der präoperativen Therapieumstellung vernachlässigbar. Einzelne sehr ausgeprägte Augendruckanstiege unter Azetazolamid oral und lokalen Steroiden sollten berücksichtigt werden.

Abstract

Background

The preoperative switch from local to systemic antiglaucomatous therapy and the additional application of local antiphlogistic drugs represents an important component of perioperative wound healing modulation within the framework of glaucoma filtration surgery.

Objective

The aim of the present study was to compare the intraocular pressure (IOP) under a maximum local and oral antiglaucomatous therapy with or without additional application of local steroids.

Methods

A retrospective clinical analysis of 121 consecutive patients who underwent primary trabeculectomy for open-angle glaucoma in 2013 and who attended the outpatient clinic at least 3 weeks before surgery was carried out. The patients were set on preoperative therapy as follows: continuation of the maximum local antiglaucomatous therapy (with or without local dexamethasone 1 mg/ml 3 times daily) or administration of 750 mg acetazolamide orally per day (with or without local steroids).

Results

The switch to oral antiglaucomatous therapy led to a mean IOP rise of 3.14 mm Hg which was short of statistical significance (p = 0.052). The additional administration of local steroids did not significantly influence the IOP (p = 0.218). Some patients with oral acetazolamide therapy and local steroid application showed large increases in IOP up to 30 mm Hg.

Conclusion

The mean IOP rise of 3.14 mm Hg 3 weeks after replacement of antiglaucomatous eye drops by acetazolamide was short of missing statistical significance and seems to be clinically negligible for this relatively short period. The advantages of a lower postoperative fibrotic activity have to be weighed up against this change in IOP. Surprisingly, the effect of administration of local steroids for 3 weeks was minor compared to the effect of the switch from local to oral antiglaucomatous medication. Individual major IOP increases under the preoperative therapy change should be taken into consideration.

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Authors and Affiliations

  1. Klinik und Poliklinik für Augenheilkunde, Klinikum der Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    I. Oberacher-Velten FEBO, F. Lehmann, T. Barth, P. Peters, H. Helbig & R. Greslechner

  2. Zentrum für klinische Studien, Klinikum der Universität Regensburg, Regensburg, Deutschland

    F. Zeman

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  1. I. Oberacher-Velten FEBO
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  2. F. Zeman
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  6. H. Helbig
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Correspondence to I. Oberacher-Velten FEBO.

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Interessenkonflikt

I. Oberacher-Velten, F. Zeman, F. Lehmann, T. Barth, P. Peters, H. Helbig und R. Greslechner geben an, dass kein Interessenkonflikt besteht.

Bei der vorliegenden Studie handelt es sich um eine klinische, restrospektive, anonymisierte Analyse, die den Richtlinien der Ethikkommissionen entspricht.

Additional information

Die Ergebnisse wurden als Vortrag auf dem DOG-Kongress 2013 in Berlin präsentiert.

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Oberacher-Velten, I., Zeman, F., Lehmann, F. et al. Präoperative Therapieumstellung vor filtrierender Glaukomchirurgie. Ophthalmologe 114, 632–638 (2017). https://doi.org/10.1007/s00347-016-0396-4

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  • DOI: https://doi.org/10.1007/s00347-016-0396-4

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