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Klin Monbl Augenheilkd 2017; 234(01): 26-32
DOI: 10.1055/s-0042-121806
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Okuloplastische Chirurgie bei Expositionskeratopathie auf der Intensivstation

Ophthalmic Plastic Surgery of Exposure Keratopathy in the Intensive Care Unit
C. Siebert
Augenklinik der Universitätsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald
,
A. Menges
Augenklinik der Universitätsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald
,
F. H. Tost
Augenklinik der Universitätsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald
› Author Affiliations
Further Information

Publication History

eingereicht 14 September 2016

akzeptiert 08 November 2016

Publication Date:
30 January 2017 (online)

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Zusammenfassung

Kritisch Kranke auf der Intensivstation (ITS) sind durch beeinträchtigte okuläre Schutzmechanismen oder eine drohende Mitbeteiligung des Sehorgans bei schweren Allgemeinleiden gefährdet. Werden Augeninfektionen oder Augenoberflächenstörungen, auf deren Grundlage sich Endophthalmitis oder Ulcus corneae entwickeln können, nicht rechtzeitig identifiziert, drohen dauerhafte Funktionseinschränkungen des Sehorgans. In einer retrospektiven Datenanalyse wurden 283 komplette intensivmedizinische Behandlungsverläufe unter Einbeziehung ophthalmologischer Konsiliarärzte nach dominierenden Leitsymptomen ausgewertet. Die häufigsten objektiven Symptome waren Lagophthalmus (Exposionskeratopathie), Chemosis, Rötung und Monokel-/Brillenhämatom. Als prädisponierende Risikofaktoren für die Manifestation von Augenkomplikationen während der Schwerstintensivpflege wurden detektiert: Chemosis (p < 0,000), Rötung (p = 0,007), Lagophthalmus, Beatmung, Einsatz von Muskelrelaxanzien, kardiovaskuläre und neurologische Erkrankungen (alle p < 0,001). Bei 71,7 % der ITS-Patienten wurden während des Augenkonsils zusätzliche Behandlungsmaßnahmen angeordnet. Hierzu gehörten die speziellen Augenpflegemaßnahmen (6,0 %) und/oder medikamentöse Lokaltherapien (64,0 %) sowie operative Maßnahmen der okuloplastischen Chirurgie bei 4,3 % der kritisch Kranken. Die häufigste okuloplastisch-chirurgische Maßnahme auf der Intensivstation war die Lidadhäsion zur Herbeiführung eines ausreichenden Schutzes der Hornhautoberfläche bei Expositionskeratopathie. Okuloplastisch-chirurgische Operationsverfahren sind die Methoden der Wahl zum Schutz der Kornea bei kritisch Kranken, wenn die verschiedenen konservativen Möglichkeiten wie Uhrglasverband, hypoallergenes Klebeband usw. keinen ausreichenden Schutz der Augenoberfläche gewährleisten. Es ist auf die rechtzeitige Indikationsstellung und Anwendung zu achten, um dauerhafte Funktionseinbußen durch Transparenzminderung oder irregulären Astigmatismus beim wieder Genesenen sicher zu vermeiden.

Abstract

Critically ill patients in the intensive care unit (ICU) may develop eye problems, due to impaired ocular protective mechanisms or direct involvement of the eye in severe systemic diseases. If eye infections or ocular surface disorders are not identified in time, endophthalmitis or corneal ulcer may develop and can cause permanent functional injuries of the eye. A retrospective analysis was performed and a total of 283 complete intensive care courses of treatment were evaluated, taking into account ophthalmic medical consultations for frequent cardinal symptoms. The most common cardinal symptoms were lagophthalmus (exposure keratopathy), chemosis, redness and periorbital haematoma. The following predisposing risk factors for the onset of ocular complications during intensive care treatment were detected: chemosis (p < 0.001), redness (p = 0.007), lagophthalmus (p = 0.001), ventilation (p < 0.001), use of muscle relaxants (p < 0.001), cardiovascular (p < 0.001), and neurological diseases (p < 0.001). In 71.7 % of ICU patients, additional treatment was prescribed during the eye consultation. This includes special eye care treatment (6.0 %) and/or drug therapy (64.0 %), as well as oculoplastic surgery in 4,3 % of critically ill patients. The most common oculoplastic-surgical procedure in the ICU was lid adhesion to achieve adequate protection of the corneal surface in patients with severe exposure keratopathy. Oculoplastic surgery is the method of choice for protecting the cornea in critically ill patients, when conservative options such as hypoallergenic adhesive tape or a moisture chamber are not sufficient to protect the ocular surface. The main challenges are to pay attention to the indication and performance in due time, and to avoid permanent loss of function through transparency reduction or irregular astigmatism in post-recovery patients.

Schlüsselwörter

Intensivstation - Auge - Exposionskeratopathie - Hornhautulkus - Beatmung - Risikofaktoren - Konsil - Bindehaut - Kornea - Infektiologie - plastische Chirurgie - Trauma - Lider

Key words

intensive care - eye - exposure keratopathy - corneal ulcer - ventilation - risk factors - consult - ocular complication - conjunctiva - cornea - infectious diseases - lids - plastic surgery - trauma
 

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