Skip to main content
SpringerLink
Log in

Konservierungsmittel aus Sicht der Glaukomchirurgie

Preservatives from the perspective of glaucoma surgery

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Die fistulierende Trabekulektomie stellt bei der chirurgischen Versorgung von Glaukompatienten nach wie vor den Goldstandard dar. Die Entstehung eines Sickerkissens ist bei dieser Operation erklärtes Ziel, wofür der Bindehautstatus vor der Operation entscheidend ist. Eine langfristige Drucksenkung ist nur dann erfolgreich, wenn die Konfiguration des Sickerkissens erhalten bleibt. Vernarbungen in diesem Bereich führen zu einem Wiederansteigen des Augeninnendruckes und sind trotz des standardmäßigen Einsatzes von Proliferationshemmern wie Mitomycin C und 5 Fluoruracil keine Seltenheit. Die individuelle Wundheilung bestimmt also den Erfolg der Operation, wobei der langjährige Einsatz von konservierungsmittelhaltigen Antiglaukomatosa den Erfolg der Trabekulektomie negativ beeinflusst. Aus diesem Grund sollte der Einsatz von konservierungsmittelhaltigen Antiglaukomatosa vor der Operation reduziert werden. In vielen Fällen wird vor einer Trabekulektomie zu einer völligen Karenz von 4 bis 6 Wochen vor der Operation geraten. Sinnvoller wäre jedoch ein kompletter Verzicht von konservierungsmittelhaltigen Tropfen bei der langfristigen Behandlung von Glaukompatienten. Hierdurch würde eine höhere Erfolgsrate für eine möglicherweise später notwendige Trabekulektomie gesichert.

Abstract

Trabeculectomy is still the gold standard in the surgical treatment of glaucoma patients. Development of a bleb is the primary goal of this procedure and the conjunctival status is therefore decisive. Only a good functioning bleb renders good intraocular pressure (IOP) control. Scar tissue formation leads to bleb failure which is quite common despite the use of antiproliferative agents, such as mitomycin C and 5 fluoruracil. Wound healing is important and is influenced and impaired by the chronic use of topical antiglaucoma drugs. Therefore, complete abstinence is recommended from 4–6 weeks prior to a planned trabeculectomy; however, it seems mandatory to completely abolish preservatives such as drops containing benzalkonium chloride to enhance trabeculectomy success rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Batterbury M, Wishart PK (1993) Is high initial aqueous outflow of benefit in trabeculectomy? Eye (Lond) 7(Pt1:109–112)

    Google Scholar 

  2. Baudouin C, Garcher C, Haouat N et al (1994) Expression of inflammatory membrane markers by conjunctival cells in chronically treated patients with glaucoma. Ophthalmology 101:454–460

    PubMed  CAS  Google Scholar 

  3. Baudouin C, Pisella PJ, Fillacier K et al (1999) Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. Ophthalmology 106:556–563

    Article  PubMed  CAS  Google Scholar 

  4. Baudouin C, Nordmann JP, Denis P et al (2002) Efficacy of indomethacin 0.1% and fluorometholone 0.1% on conjunctival inflammation following chronic application of antiglaucomatous drugs. Graefes Arch Clin Exp Ophthalmol 240(11):929–935

    Article  PubMed  CAS  Google Scholar 

  5. Baudouin C, Hamard P, Liang H et al (2004) Conjunctival epithelial cell expression of interleukins and inflammatory markers in glaucoma patients treated over a long term. Opthalmology 111(2):2186–2192

    Article  Google Scholar 

  6. Baudouin C, Labbe A, Liang H et al (2010) Preservatives in eye drops: the good, the bad and the ugly. Progr Ret Eye Res 29:313–331

    Article  Google Scholar 

  7. Broadway DC, Grierson I, O‘Brien, Hitchings RA (1994) Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile. Arch Ophthalmol 112:1437–1445

    Article  PubMed  CAS  Google Scholar 

  8. Broadway DC, Grierson I, O‚Brien C, Hitchings RA (1994) Adverse effects of topical antiglaucoma medication. II. The outcome on filtration surgery. Arch Ophthalmol 112:1446–1454

    Article  PubMed  CAS  Google Scholar 

  9. Broadway DC, Grierson I, Hitchings RA (1995) The influence of age on the cell profile of the conjunctiva and the results of trabeculectomy. Invest Ophthalmol Vis Sci 36:S 344

    Google Scholar 

  10. Broadway DC, Grierson I, Stürmer J, Hitchings RA (1996) Reversal of topical antiglaucoma medication effects on the conjunctiva. Arch Opthalmol 114:262–268

    Article  CAS  Google Scholar 

  11. Broadway DC, Chang LP (2001) Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma 10:237–249

    Article  PubMed  CAS  Google Scholar 

  12. Campagna P, Macri A, Rolando M, Calabria G (1997) Chronic topical eye preservative-free beat blocker therapy effect on the ocular surface in glaucomatous patients. Acta Opthalmol Scand Suppl 224:53

    Google Scholar 

  13. Debbasch C, Bringole F, Pisella PJ et al (2001) Quaternary ammoniums and other preservatives‘ contribution in oxidative stress and apoptosis on Chang conjuntival cells. Invest Ophtalmol Vis Sci 42(3):642–652

    CAS  Google Scholar 

  14. Flach AJ (2004) Does medical treatment influence the success of trabeculectomy? Trans Am Ophthalmol Soc 102:219–224

    PubMed  Google Scholar 

  15. Hong S, Lee CS, Seo KY et al (2006) Effects of topical antiglaucoma application on conjunctival impression cytology specimens. Am J Ophthalmol 142(1):185–186

    Article  PubMed  CAS  Google Scholar 

  16. Ito T, Ohguro H, Mamiya K et al (2006) Effects of antiglaucoma drops an MMP and TIMP balance in conjunctival and subconjunctival tissue. Invest Opthalmol Vis Sci 47(3):823–830

    Article  Google Scholar 

  17. Khaw PT, Chang L, Wong TT et al (2001) Modulation of wound helaing after glaucoma surgery. Curr Opin Ophthalmol 12(2):143–148

    Article  PubMed  CAS  Google Scholar 

  18. Lawin MJ, Wormald RP, Migdal CS, Hitchings RA (1990) The influence of prior therapy on the success of trabeculectomy. Arch Ophthalmol 108:1543–1548

    Article  Google Scholar 

  19. Lichter PR, Musch DC, Gillespie BW et al (2001) Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment to medication or surgery. Ophthalmology 108(11):1943–1953

    Article  PubMed  CAS  Google Scholar 

  20. Nuzzi R, Vercelli A, Finazzo C, Cracco C (1995) Conjunctival and subconjunctival tissue in primary open angle glaucoma after long term topical treatment: an immunohistochemical and ultrastructural study. Graefes Arch Clin Exp Ophthalmol 233(3):154–162

    Article  PubMed  CAS  Google Scholar 

  21. Pisella PJ, Pouliquen P, Boudouin C (2002) Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication. Br J Ophthalmol 86(4):418–423

    Article  PubMed  CAS  Google Scholar 

  22. Pisella PJ (2006) Conjunctival markers as predictable markers for preoperative glaucoma assessment. Br J Ophthalmol 90(11):1335–1336

    Article  PubMed  Google Scholar 

  23. Renieri G, Führer K, Scheithe K et al (2010) Efficacy and tolerability of preservative free eye drops containing a fixed combination of dorzolamide and timolol in glaucoma patient. J Ocul Phar Ther 26(6):597–603

    Article  CAS  Google Scholar 

  24. Sherwood MB, Grierson I, Millar L et al (1989) Long term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon’s capsule in glaucomatous patients. Ophthalmology 96(3):327–335

    PubMed  CAS  Google Scholar 

  25. European Glaucoma Society (EGS) (2008) Terminology and guidelines for glaucoma. Dogma, Savona

  26. Wolfram C, Pfeiffer N (2012) Blindness and low vision in Germany 1993–2009. Ophthalmic Epidemiol 19(1):3–7

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: Beide Autoren erhalten Honorare der Firma MSD und fungieren als Berater.

Author information

Authors and Affiliations

  1. Universitätsaugenklinik, Otto von Guericke Universität, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    H. Thieme & K.K. van der Velden

Authors
  1. H. Thieme
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K.K. van der Velden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Thieme.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thieme, H., van der Velden, K. Konservierungsmittel aus Sicht der Glaukomchirurgie. Ophthalmologe 109, 1073–1076 (2012). https://doi.org/10.1007/s00347-012-2642-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-012-2642-8

Schlüsselwörter

Keywords

Search

Navigation