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Aphakie- und Pseudophakieglaukom nach Kataraktoperation im Kindesalter

Aphakic and pseudophakic glaucoma following pediatric cataract surgery

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Zusammenfassung

Durch moderne Techniken ist die kongenitale Katarakt heute chirurgisch sehr erfolgreich behandelbar. Die am meisten gefürchtete postoperative Komplikation ist die Ausbildung eines Sekundärglaukoms (etwa ein Drittel aller kindlichen Sekundärglaukome). Angaben zur Prävalenz sind aufgrund der limitierten Aussagekraft der Literatur schwierig. Angegeben wird eine Inzidenz von 10−25% über 10 Jahre postoperativ, die Wahrscheinlichkeit steigt mit zunehmender Nachbeobachtungsdauer. Ein entscheidender Risikofaktor für die Glaukomentstehung ist offensichtlich das Alter bei Operation: je geringer das Lebensalter zum Operationszeitpunkt, desto höher das Risiko für ein Sekundärglaukom. Eine Mikrokornea ist nach multivariater Analyse ein weiterer Risikofaktor. Folgende postoperative Veränderungen könnten pathogenetisch relevant sein: periphere anteriore Synechien, hohe Irisinsertion und Membranen über dem Trabekelwerk, ferner die postoperative Entzündung, die Reaktion auf Linsenepithelzellen, das perioperative Barotrauma und die Veränderung der Architektur im Vorderabschnitt nach Kataraktoperation. Zur Evaluation des optimalen Zeitfensters für die Operation einer kongenitalen Katarakt und der Risikofaktoren für die Ausbildung eines Sekundärglaukoms ist eine prospektive Longitudinalstudie erforderlich.

Abstract

Modern surgical techniques allow congenital cataract surgery to be performed much more successfully. The development of a secondary glaucoma is the most dreaded postoperative complication (one third of all pediatric secondary glaucomas). Due to the limited value of the available literature, data on prevalence are unreliable. A 10-year postoperative incidence of 10-25% is given in the literature for developing secondary glaucoma and the frequency increases with the duration of follow-up. A major risk factor seems to be the age at the time of surgery. The younger the patient is at the time of surgery the higher the risk of secondary glaucoma. A microcornea seems to be another risk factor in multivariate analysis. The following postoperative changes might be involved in the pathogenesis: peripheral anterior synechia, high iris insertion and membranous material over the trabecular meshwork. Additionally postoperative inflammation, reaction to lens epithelial cells, perioperative barotrauma and loss of anterior segment architecture might also be responsible. In order to evaluate the optimal age window for congenital cataract surgery and risk factors for the development of secondary glaucoma, a prospective longitudinal study is mandatory.

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Authors and Affiliations

  1. Institute of Child Health UCL, 30 Guildford Street, WC1N 1EH, London, England

    A.L. Solebo & J. Rahi

  2. Universitäts-Augenklinik der Julius-Maximilians-Universität, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    F. Grehn

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  1. A.L. Solebo
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Solebo, A., Rahi, J. & Grehn, F. Aphakie- und Pseudophakieglaukom nach Kataraktoperation im Kindesalter. Ophthalmologe 109, 83–92 (2012). https://doi.org/10.1007/s00347-011-2516-5

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