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Visusminderung und Silikonöltamponade

Visual acuity reduction and silicone oil tamponade

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Zusammenfassung

Silikonöl ist ein etabliertes und bis heute durch keine Alternative zu ersetzendes intraokular chirurgisches Hilfsmittel, das die Versorgung von komplexesten Ausgangssituationen ermöglicht. Verfügbare Daten weisen jedoch darauf hin, dass eine unklare Visusminderung während oder nach einer intraokularen Silikonöltamponade möglicherweise häufiger auftritt, als dies der klinische Alltag vermuten lässt. Unterschiedliche Pathomechanismen werden hierfür ursächlich diskutiert, tatsächlich sind die genauen Ursachen aber unklar. Neben atrophischen Veränderungen in der OCT(optische Kohärenztomographie)-Untersuchung finden sich ein deutlich reduzierter Visus sowie meist ein Zentralskotom bei sonst unauffälligen Befunden. Unklare Visusminderungen können auch nach einer Silikonölentfernung auftreten. Ob hier die gleichen Pathomechanismen ursächlich sind, ist unklar. Ferner gibt es keine reproduzierbaren Risikofaktoren, die eine unklare Visusminderung unter Silikonöl a priori wahrscheinlich erscheinen lassen, jedoch werden möglichst frühzeitige Ölentfernung und gute Einstellung des intraokularen Druckes von den Autoren empfohlen. Insgesamt sollte eine Silikonöltamponade auch unter Verwendung von modernen hoch-aufgereinigten Silikonölen sorgfältig abgewogen werden und damit weiterhin v. a. ungünstigen Ausgangssituationen oder komplizierten Verläufen mit Notwendigkeit einer Silikonöltamponade vorbehalten bleiben. Vor diesem Hintergrund scheint eine Studie zur systematischen Erfassung und Aufarbeitung der Fälle von unklarer Visusminderung nach Silikonöltamponade sinnvoll.

Abstract

Silicone oil is an established intraocular surgical aid, which enables the treatment of the most complex starting situations but no other alternative has been found; however, the available data indicate that an unclear loss of visual acuity during or after an intraocular silicone oil tamponade possibly occurs more frequently than assumed from the clinical routine. Various pathological mechanisms are under discussion as causes, but the exact causes are actually unclear. In addition to atrophic alterations in the optical coherence tomography (OCT) examination, there are a clear reduction in visual acuity and mostly a central scotoma with otherwise inconspicuous findings. Unclear loss of visual acuity can also occur after removal of the silicone oil. Whether this is caused by the same pathological mechanism is unclear. Furthermore, there are no reproducible risk factors that appear a priori to possibly cause an unclear loss of vision under silicone oil; however, oil removal as soon as possible and a good adjustment of the intraocular pressure are recommended by the authors. Overall, a silicone oil tamponade should be carefully weighed up even when using modern highly purified silicone oils and it should therefore continue to be reserved particularly for unfavorable initial situations or complicated courses with the necessity for a silicone oil tamponade. Against this background, a study for systematic recording and processing of cases of unclear loss of visual acuity after silicone oil tamponade seems to be meaningful.

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Authors and Affiliations

  1. Augenklinik, Universität Ulm, Prittwitzstr. 43, 89075, Ulm, Deutschland

    Armin Wolf

  2. Humanitas University, Via Montalcini 4 20090 Pieve Emanuele, Mailand, Italien

    Mario R. Romano

  3. Augenklinik Herzog Carl Theodor, Nymphenburger Str. 43, 80335, München, Deutschland

    Christos Haritoglou

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  1. Armin Wolf
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  2. Mario R. Romano
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  3. Christos Haritoglou
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Correspondence to Armin Wolf.

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A. Wolf, M.R. Romano und C. Haritoglou geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wolf, A., Romano, M.R. & Haritoglou, C. Visusminderung und Silikonöltamponade. Ophthalmologie 119, 781–788 (2022). https://doi.org/10.1007/s00347-022-01702-7

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  • DOI: https://doi.org/10.1007/s00347-022-01702-7

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