Perioperative antientzündliche Therapie im Rahmen der Glaukomchirurgie

Zusammenfassung

Viele klinische Studien belegen, dass der funktionelle Ausgang der Glaukomchirurgie, insbesondere der Filtrationschirurgie, durch eine topische antientzündliche Vor- und Nachbehandlung signifikant beeinflusst werden kann. Die topischen Steroide erweisen sich sowohl in der Vor- als auch in der Nachbehandlung nach Trabekulektomie als günstig, wobei die Dauer der postoperativen Behandlung vom individuellen Befund abhängig gemacht werden soll. Eine systemische Steroidtherapie oder Immunmodulation ist beim uveitischen Sekundärglaukom für den Erfolg der Glaukomchirurgie signifikant von Bedeutung, bei anderen Glaukomformen ist ein Nutzen der systemischen Therapie nicht belegt. Eine zusätzliche topische Therapie mit nicht steroidalen Antiphlogistika ist bei einer kombinierten Katarakt-Glaukom-Chirurgie zu erwägen. Eine topische antientzündliche Therapie nach selektiver Lasertrabekuloplastik ist nicht notwendig, bei Argonlasertrabekuloplastik und Zyklophotokoagulation wirkt diese sich schmerzlindernd aus. Die intravitreale Gabe von Steroiden im Rahmen der Glaukomchirurgie muss aufgrund der Induktion von Augendruckspitzen immer kritisch abgewogen werden.

Abstract

Many clinical studies have demonstrated the benefit of topical anti-inflammatory medication before and after glaucoma surgery, especially for trabeculectomy, and that they improve the long term outcome. Pre- and postoperative topical steroids improve the outcome of trabeculectomy, but duration and intensity of treatment should be adapted individually. Systemic steroid or oral immunomodulation have significant impact on the outcome in uveitic glaucoma, but not in other glaucoma subtypes. Additional topical treatment with non-steroidal anti-inflammatories is an option in combined cataract-glaucoma surgery. Anti-inflammatory treatment after selective laser trabeculoplasty is not necessary, but relieves pain after argon laser trabeculoplasty and laser cyclophotocoagulation. Intravitreal application of steroids in glaucoma surgery must be critically evaluated and must consider the risk of a rise in secondary intraocular pressure.

Schlüsselwörter

Glaukomchirurgie - Steroide - postoperative Therapie - Trabekulektomie

Key words

glaucoma surgery - steroids - postoperative therapy - trabeculectomy

• Literatur

• 1 Broadway DC, Grierson I, OʼBrian C. et al. Adverse effects of topical antiglaucoma medication. II The outcome of filtration surgery. Arch Ophthalmol 1994; 112: 1446-1454
• 2 Broadway DC, Grierson I, Stürmer J. et al. Reversal of topical antiglaucoma medication effects on the conjunctiva. Arch Ophthalmol 1996; 114: 262-267
• 3 Oberacher-Velten I, Zeman F, Lehmann F. et al. Präoperative Therapieumstellung vor filtrierender Glaukomchirurgie. Einfluss der systemischen augendrucksenkenden sowie der lokalen antiphlogistischen Therapie auf den Augendruck. Ophthalmologe 2017; 114: 632-638
• 4 Thygesen J. Glaucoma therapy: preservative-free for all?. Clin Ophthalmol 2018; 12: 707-717
• 5 Rodríguez-Uña I, Martínez-de-la-Casa JM, Pablo Júlvez L. et al. Perioperative pharmacological management in patients with glaucoma. Arch Soc Esp Oftalmol 2015; 90: 274-284
• 6 Breusegem C, Spielberg L, Van Ginderdeuren R. et al. Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial. Ophthalmology 2010; 117: 1324-1330
• 7 Baudouin C, Nordmann JP, Denis P. et al. Efficacy of indomethacin 0.1 % and fluorometholone 0.1 % on conjunctival inflammation following chronic application of antiglaucomatous drugs. Graefes Arch Clin Exp Ophthalmol 2002; 240: 929-935
• 8 Petrov SY, Antonov AA, Makarova AS. et al. Options for prolonging the hypotensive effect of trabeculectomy. Vestn Oftalmol 2015; 131: 75-81
• 9 Aptel F, Colin C, Kaderli S. et al. Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey. Br J Ophthalmol 2017; 101: 1-10
• 10 Araujo SV, Spaeth GL, Roth SM. et al. A ten-year follow-up on a prospective, randomized trial of postoperative corticosteroids after trabeculectomy. Ophthalmology 1995; 102: 1753-1759
• 11 Kent AR, Dubiner HB, Whitaker R. et al. The efficacy and safety of diclofenac 0.1 % versus prednisolone acetate 1 % following trabeculectomy with adjunctive mitomycin-C. Ophthalmic Surg Lasers 1998; 29: 562-569
• 12 Levkovitch-Verbin H, Katz G, Kalev-Landoi M. et al. Postoperative treatment with topical diclofenac versus topical dexamethasone after combined phacotrabeculectomy with mitomycin C. J Glaucoma 2013; 22: 177-182
• 13 Vote B, Fuller JR, Bevin TH. et al. Systemic anti-inflammatory fibrosis suppression in threatened trabeculectomy failure. Clin Exp Ophthalmol 2004; 32: 81-86
• 14 Almatlouh A, Bach-Holm D, Kessel L. . Acta Ophthalmol 2018; DOI: 10.1111/aos.13919.
• 15 Yuki K, Shiba D, Kimura I. et al. Trabeculectomy with or without intraoperative sub-tenon injection of triamcinolone acetonide in treating secondary glaucoma. Am J Ophthalmol 2009; 147: 1055-1060
• 16 Sagara H, Yamamoto T, Imaizumi K. et al. Impact of topically administered steroids, antibiotics, and sodium hyaluronate on bleb-related infection onset: The Japan Glaucoma Society survey of bleb-related infection Report 4. J Ophthalmol 2017; DOI: 10.1155/2017/7062565.
• 17 Jampel HD, Quigley HA, Kerrigan-Baumrind LA. et al. Risk factors for late-onset infection following glaucoma filtration surgery. Arch Ophthalmol 2001; 119: 1001-1008
• 18 Islamaj E, Wubbels RJ, de Waard PWT. Primary Baerveldt versus trabeculectomy study after one-year follow-up. Acta Ophthalmol 2018; 96: e740-e746
• 19 Khairy HA, Elsawy MF, Said-Ahmed K. Sutureless scleral tunnel trabeculectomy: evaluation of feasibility and effectiveness versus conventional trabeculectomy for management of primary open angle glaucoma. Semin Ophthalmol 2018; 33: 345-350
• 20 Vahedian Z, Mafi M, Fakhraie G. et al. Short-term results of trabeculectomy using adjunctive intracameral bevacizumab versus mitomycin C: a randomized controlled trial. J Glaucoma 2017; 26: 829-834
• 21 Pakravan M, Esfandiari H, Yazdani S. et al. Mitomycin C-augmented trabeculectomy: subtenon injection versus soaked sponges: a randomised clinical trial. Br J Ophthalmol 2017; 101: 1275-1280
• 22 De Mata A, Burk SE, Netland PA. et al. Management of uveitic glaucoma with Ahmed glaucoma valve implantation. Ophthalmology 1999; 106: 2168-2172
• 23 Wiese C, Heiligenhaus A, Heinz C. Changes in inflammatory activity after glaucoma filtration surgery in children with chronic anterior uveitis. Ocul Immunol Inflamm 2016; 24: 397-401
• 24 Yuen D, Buys Y, Jin YP. et al. Corticosteroids versus NSAIDs on intraocular pressure and the hypertensive phase after Ahmed glaucoma valve surgery. J Glaucoma 2011; 20: 439-444
• 25 Scott GR, Weizer JS, Moroi SE. et al. Can topical ketorolac 0.5 % improve the function of Ahmed glaucoma drainage devices?. Ophthalmic Surg Lasers Imaging 2011; 42: 190-195
• 26 Välimäki J, Airaksinen PJ, Tuulonen A. et al. Postoperative systemic corticosteroid treatment and Molteno implant surgery: a randomized clinical trial. Acta Ophthalmol Scand 1999; 77: 50-56
• 27 Wang B, Dong N, Xu B. et al. Efficacy and safety of intracameral triamcinolone acetonide to control postoperative inflammation after phacotrabeculectomy. J Cataract Refract Surg 2013; 39: 1691-1697
• 28 Koval MS, Moster MR, Freidl KB. et al. Intracameral triamcinolone acetonide in glaucoma surgery: a prospective randomized controlled trial. Am J Ophthalmol 2014; 158: 395-401
• 29 Kiddee W, Trope GE, Sheng L. et al. Intraocular pressure monitoring post intravitreal steroids: a systematic review. Surv Ophthalmol 2013; 58: 291-310
• 30 Jain S, Thompson JR, Foot B. et al. Severe intraocular pressure rise following intravitreal triamcinolone: a national survey to estimate incidence and describe case profiles. Eye (Lond) 2014; 28: 399-401
• 31 Kinoshita-Nakano E, Nakanishi H, Ohashi-Ikeda H. et al. Comparative outcomes of trabeculotomy ab externo versus trabecular ablation ab interno for open angle glaucoma. Jpn J Ophthalmol 2018; 62: 201-208
• 32 Shakrawal J, Bali S, Sidhu T. et al. Randomized trial on illuminated-microcatheter circumferential trabeculotomy versus conventional trabeculotomy in congenital glaucoma. Am J Ophthalmol 2017; 180: 158-164
• 33 Kim YY, Glover BK, Shin DH. et al. Effect of topical anti-inflammatory treatment on the long-term outcome of laser trabeculoplasty. Fluorometholone-Laser Trabeculoplasty Study Group. Am J Ophthalmol 1998; 126: 721-723
• 34 Champagne S, Anctil JL, Goyette A. et al. Influence on intraocular pressure of anti-inflammatory treatments after selective laser trabeculoplasty. J Fr Ophthalmol 2015; 38: 588-594
• 35 Jinapriya D, DʼSouza M, Hollands H. et al. Anti-inflammatory therapy after selective laser trabeculoplasty: a randomized, double-masked, placebo-controlled clinical trial. Ophthalmology 2014; 121: 2356-2361
• 36 DeKeyser M, De Belder M, De Groot V. Randomized prospective study on the use of anti-inflammatory drops after selective laser trabeculoplasty. J Glaucoma 2017; 26: e22-e29
• 37 Birt CM. The use of topical ketorolac 0.5 % for pain relief following cyclophotocoagulation. Ophthalmic Surg Lasers Imaging 2003; 34: 381-385
• 38 Klink T, Guthoff R, Grehn F. et al. Nachsorge nach filtrierenden Glaukomoperationen. Ophthalmologe 2006; 103: 815-826