Periphere Netzhautdefekte — wann behandeln? Behandlungsrichtlinien der American Academy of Ophthalmology

Augenabteilung KH Hietzing Wien Österreich
Spektrum der Augenheilkunde (Impact Factor: 0.18). 12/2006; 20(6):272-274. DOI: 10.1007/BF03163642

ABSTRACT Preferred Practice Pattern (PPP) der American Academy of Ophthalmology (AAO) sind Richtlinien, die Charakteristiken und Komponenten
hochqualitativer Augenbehandlung definieren. Sie basieren auf aktuellsten wissenschaftlichen Daten, interpretiert durch anerkannte
Spezialisten und werden regelmäßig aktualisiert (mindestens jährlich).

Die Prinzipien der PPP im Allgemeinen sind Empfehlungen, die klinisch relevant sein und sinnvolle Informationen für den Praktizierenden
liefern sollen. Die Empfehlungen sollen die Wichtigkeit für den Behandlungsprozess widerspiegeln und die Aussagekraft des
wissenschaftlichen Nachweises im Sinne einer evidence based medicine für die entsprechende Behandlung reflektieren.

Ziel der Behandlungsrichtlinien der AAO für Patienten mit peripheren Netzhautdefekten ist es, Patienten mit hohem Risiko für
Netzhautabhebung zu erkennen, zu managen, über Symptome einer hinteren Glaskörperabhebung (HGKAH), eines Netzhautdefektes
oder einer Netzhautabhebung und den Bedarf von weiteren Kontrollen aufzuklären. Weiters ist es wichtig, Patienten mit Symptomen
einer akuten HGKAH zu untersuchen und relevante Netzhautdefekte zu behandeln. Ziel der Behandlung ist die Erzeugung einer
festen chorioretinalen Adhäsion in der anliegenden Netzhaut unmittelbar um den Netzhautdefekt, soweit wie möglich in die Vitreusbasis

Die Richtlinien beruhen auf einer Medlinesuche über HGKAH, Netzhautdefekt und Lattice Degeneration für die Jahre 1997–2002.

Evidence-based-Empfehlungen existieren ausschließlich für akute symptomatische Lappenrisse. Bei anderen Läsionen muss immer
daran gedacht werden, dass die Behandlung unnötig, ineffektiv oder sogar schädlich sein kann.

Durch Identifizierung von Risikopatienten und Befolgen der Behandlungsrichtlinien können akuter Visusverlust und bleibende
Sehbeeinträchtigung vermieden werden und so die Lebensqualität erhalten bleiben.

Preferred Practice Pattern (PPP) of the American Academy of Ophthalmology (AAO) are guidelines that identify characteristics
and components of quality eye care. They are based on the best available scientific data, interpreted by panels of knowledgeable
health professional and are reviewed annually and updated accordingly.

Each PPP should be clinically relevant and specific enough to provide useful information to practitioners. Each recommendation
should also be given an explicit rating that shows the strength of evidence that supports the recommendation and reflects
the best evidence available.

The aim of the guidelines for patients with peripheral retinal breaks is to identify and manage patients at risk for rhegmatogenous
retinal detachment, and to educate high-risk patients about symptoms of posterior vitreous detachment, retinal breaks, and
retinal detachment and about the need for periodic follow up. A further goal is to examine patients with symptoms of acute
posterior vitreous detachment to detect and treat significant retinal breaks. The purpose of treatment is to create a firm
chorioretinal adhesion in the attached retina immediately adjacent to the retinal tear extending well into the vitreous base.

The guidelines are based on a detailed literature search of articles on the subject of posterior vitreous detachment, retinal
breaks, and lattice degeneration for the years 1997 to 2002.

Sufficient information for evidence-based recommendation exists only for acute, symptomatic horseshoe tears. Treating other
vitreoretinal abnormalities might be unnecessary, ineffective or harmful.

Identification of patients at risk for retinal detachment and following the guidelines for diagnosing and management prevents
visual loss and functional impairment and maintains quality of life.

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    ABSTRACT: To identify symptoms in patients with isolated posterior vitreous detachment predictive for the later development of retinal breaks. Two hundred eighty consecutive patients seen with symptoms of posterior vitreous detachment were prospectively asked to complete a questionnaire detailing their symptoms. At the time of presentation and follow-up, all patients had a full ophthalmologic examination including slitlamp biomicroscopy with Goldmann 3-mirror contact lens after maximal pupil dilatation. Two hundred fifty patients with an isolated posterior vitreous detachment were included and reexamined 6 weeks after the onset of symptoms. If small retinal or vitreous hemorrhages were detected, patients were reexamined after 2 weeks. In 13 patients (5.2%) a retinal break was detected at reexamination. Logistic regression analysis with backward elimination revealed that symptoms of flashes in combination with clouds or multiple (>10) small dots at the time of the initial examination or an increase of floaters after the initial examination were statistically significantly (P<.001) related to the development of new breaks. These symptoms had a predictive value for the presence or absence of a new retinal break of 75.0% and 99.6%, respectively. Specific symptoms can identify patients at risk for the development of new retinal breaks after an initial examination in which no abnormalities were found and may obviate the need for follow-up appointments of patients not at risk.
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