Chirurgische Therapie der okulären Hypotonie mit autologem Sklerapatch und Bindehautplastik

Abstract

The incidence of ocular hypotony after filtering procedures has increased due to the widespread use of antimetabolites. In cases of persistent hypotony with leaking filtering bleb and/or hypotony-maculopathy surgical repair should be discussed. Between 2001 and 2007 twelve patients (age between 35 and 88 years) underwent surgical repair of an avascular bleb with autologous scleral patch and conjunctival advancement. Indication for surgery was in 9 / 12 patients ocular hypotony, in 2 patients inadvertent filtering blebs after cataract extraction and in one patient a leaking bleb with blebitis. Intraocular pressure was normalized in all cases by the end of the follow-up period (4 - 66 months) (preop: 5.7 +/- 4.1 mmHg; postop 14.8 +/- 3.1 mmHg). Eight out of twelve patients required IOP-lowering medications (1 - 3) to maintain the target IOP. Best-corrected visual acuity increased from 0.4 +/- 0.1 to 0.67 +/- 0.2 (Snellen), 3 / 8 phakic patients required cataract surgery. Revision of avascular filtering blebs with autologous scleral patch and conjunctival advancement is a successful surgical approach to eliminate ocular hypotony. However, the majority of patients need IOP-lowering drugs after surgery.