Podcast zu neuen Therapiemöglichkeiten des Glaukoms (Grüner Star), Prof. Dr. Peter Szurman

medical cousin Specialists Specialist talk Podcast with Susanne am Rhein Medicine for the ears Today's episode is about glaucoma, officially called glaucoma, and behind it lies an eye disease that unfortunately those affected only notice very late: the questions The most important questions about the Turkish disease are answered by Professor Peter Schurmann, specialist in eye surgery and chief physician at the Sulzbach eye clinic at the Knappschaftsklinikum Saar. Professor Schurmann, what exactly is glaucoma? Yes, I welcome you too. Rhein glaucoma, or commonly known as glaucoma, is the second most common cause of blindness and the most common cause of blindness among people under 60 years of age in Germany;

More than half a million people are affected and glaucoma is a Jewish disease that results from it. due to relatively high eye pressure This relatively high eye pressure leads to slow and gradual damage to the optic nerve and the more optic nerve fibers are lost, the closer the time of possible blindness is and what symptoms does glaucoma cause that those affected can have. Do you feel yourself? He is talking about something important: glaucoma is a very typical disease because the patient does not even notice it and if he notices it then it is too late because the fibers of the optic nerve are slowly destroyed and the visual field.

The losses that arise from this always

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t on the outside, which means that the patient does not see it at all and it is a bit comparable to when you walk into an abyss, but you still have stability. The ground still has to be two meters before. the abyss, you can already hear the screams in the background, be careful and you don't even know what is happening because I have solid ground under my feet and once you are in free fall then it is too late and that is the reason why visiting a ophthalmologist and getting regular early screening by an ophthalmologist is incredibly important because only the practicing ophthalmologist can use his special methods to determine if glaucoma is already present, even if the patient still has 100% vision in both eyes at the same time. time. , so in principle yes, although in many patients there is a difference between the sides, but the other eye usually appears a few years later, so you always have to monitor both eyes.

There are individual colors where it is. Instead, it is only used on one eye. This is quite rare, so the ophthalmologist always has to examine both eyes and every specialist does this. What is the explanation why these diseases are popularly known as green

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? It is a medieval word and actually comes from staring. The blind look forward. Nowadays, of course, with our modern diagnostic and therapeutic options, we almost always manage to avoid blindness as long as patients are under ophthalmological control, but if we go back to the Middle Ages and people went blind hundreds of thousands of times per that and in each of the towns there was someone who stared in front of him and that was the star and in an absolute final stage, which rarely happens today, the eye acquires a bluish green color and that's where the expression comes from glaucoma, but for them, of course, it is more important historically.

Affected patients, how can glaucoma be treated? I have already noted the value of early detection. and I also think it can be used in treatment. The most important thing in treatment is, first of all, detection: there are infinite ways to treat glaucoma and the standard is, if the eye pressure is relatively too high, to lower the eye pressure. pressure with eye drops - that is the goal of the therapy, that is, to reduce eye pressure by 25 to 30 percent, so that you are almost always safe and this is usually achieved with eye drops. This is done by colleagues in private practice. and they do it very conscientiously and then they call you every three months, for example, for therapeutic checks, but there are also some patients where, even with maximum eye pressure therapy, the eye pressure still has not increased, it is a safe area and then you have to do something invasive.

There are various procedures from lasers to small foot operations to actual glaucoma operations if you can put it that way and as always in life a lot helps a little bit helps a little of course laser is gentler . and in very mild cases it can also have a minimal effect on eye pressure, but in our clinic in our specialized glaucoma center it is mainly patients who have eye pressure that is simply no longer controllable and where nerve damage continues to progress. Although the ophthalmologist in practice does everything that works and in such cases the pressure must be lowered with an operation.

You've already mentioned the various procedures and treatment methods that have been established for these more difficult cases, so the important word is difficult cases because, of course. We also treat mild cases with eye drops and moderately severe cases with laser or stent procedures also have their value, but we are mainly known for being able to treat these severe and desperate cases where nothing works anymore and this is done by reducing really constant pressure with an operation. Two procedures must be differentiated: the old classic procedure is the so-called trabicolectomy, which is a fistulizing operation drilled so that it drains to the outside, it works well, otherwise it would not have lasted so many years, but it also has many side effects and this hole can close again like a scar and that is why we have been looking for alternative, much gentler procedures for many years and in the last ten years we have significantly developed the so-called canaloplasty with a variety of modifications and by For the first time in four years we have undergone a canaloplasty, a procedure that is as effective as this important mallet operation but without these dangerous side effects that have made this trabicolectomy so special and that is why so many patients from all over Germany now They come to Sulzbach because we are the main treatment center for this canadoplasty.

What exactly is a canaloplasty and is the mechanism really one? It is completely different if your eye pressure is too high. and you want to relieve it and the natural drainage pathways no longer work. That is the mechanism of glaucoma. Eye water is constantly produced in the eye and flows through natural drainage pathways, just as rainwater overflows the drainage system and drainage channels. they are transported again and when that closes there are two options: either abandon the natural drainage paths and make an artificial drainage hole in the eye or say that the drainage paths are now maybe 40, 50 or 60 years old.

They have done it successfully. They fulfill their function and have a little dust, but they would have to be rinsed again so that the natural drainage pathways can work sufficiently again and that is the principle of canaloplasty, so we do not make a hole in the eye, strengthen the Natural drainage paths, so to speak, are cleaned like you clean a pipe and then it works again and then you don't have an artificial drainage but a natural one and that explains why this procedure is incredibly gentler than these old techniques. Patients obtain with this procedure. This operation is actually more painful for you than the old techniques.

The operation lasts about 20 minutes. It can only be performed under local or general anesthesia. Patients can choose very freely and the hospital stay is. Then only two days because the healing phase is very short and, unlike the old Trabi colectomy, intensive preparation for weeks and intensive follow-up for months with readjustments is not necessary, but with the operation it is already done and then deliver the further treatment to the doctor Ophthalmologist the patient feels a very slight sensation of grain of sand for about one or two weeks, but there are ointments that relieve everything, but it is not painful and what about the success of this surgical method?

Therefore, glaucoma operations have always been feared in ophthalmology, in general, they have very high success rates, if you take cataracts, for example, they have incredibly high success rates and glaucoma surgeries, the old ones, only They had a success rate of around 50 percent. and then there were also many complications and side effects and that was it. The reason why many office ophthalmologists only recommended surgery to their patients very late and sometimes even advised against it and only sent them to the clinic when it was five to twelve and that has changed dramatically in the last ten years.

Ophthalmologists have become accustomed to the fact that the success rate has increased from 50 to 85 percent and that there are no complications or almost no complications or side effects and that is why they send their patients much earlier and that is very important because A central aspect is understanding that we cannot recover anything with surgery, so once there is damage, we can very reliably stop the progression with an unprecedented success rate, but of course we can. The link cannot be restored and that is why it is important to diagnose patients early and then send people for surgery as soon as possible, before the damage has caused a reduction in quality of life.

It still happens that at some point, perhaps years later, vision deteriorates again, but each year there is a small percentage of patients in whom the glaucoma operation loses its effect. The long-term results are still good, but that can be seen every year. completely successful patients simply become a little less and that explains why there is also a successfully operated patient who is not cured in the sense that he never has to go to the ophthalmologist again, but all successfully operated glaucoma patients remain glaucoma for life that are well adjusted but always need to be reviewed by the ophthalmologist to check if we are still in the safe range.

And could the procedure be repeated if necessary? Do they really speak more from the heart, that is, canaloplasty, which is so popular because it has so many? Advantages: Higher success rate, lower complication rate, significantly less burden on patients, no weeks of preparation, no extensive aftercare, but canaloplasty still has one important advantage and that is that we have a wild card. With canaloplasty we have the possibility. If it gradually loses its effectiveness after years, we can reinforce this effect again with a small measure of two minutes so that the thread comes out and the door of the natural drainage path essentially opens from the width of the space to the total width and The vast majority of patients then reach the same good pressure level that they had shortly after the actual operation.

We only have this wild card once, but unlike all other procedures, in glaucoma surgery we have this wild card with the old trabicolectomy. has disappeared, then you have to wait three months and then do the same operation again and more than two times it is almost impossible, maybe a third time and then there is. Of course, there are special procedures for particularly difficult patients and with the Canon plastic you simply have the option of pulling the wild card and you are usually back to the successful pressure level. You were talking about your wild card, a thread.

Can you please explain to me again what is stretched in canaloplasty? Yes, you can still see the natural drainage channels afterwards. After treatment, they are five times larger than the old half-rotted drainage path, so this is very impressive and explains why the drainage is restored so smoothly, but this effect also has a long-term effect. What remains is that a tension thread is placed. inserted into the main drainage channel, which keeps this channel open through its tension and you can even use the tension of the thread to regulate the pressure level. The tighter you tighten the thread, the better the drainage will work.

Don't overdo it, it's just medical art, experience is perhaps the best word and this tension thread, which can also lose its effect over time, loses tension and then you can take it out completely and it doesn't come out of it. place but, to put it bluntly, it is torn off and with it the canal is completely opened, so it is not the same situation as without surgery, but basically it is like that. The maximum possible reduction in pressure is really an effective trick and Everyone who has listened to us so far is probably thinking: I don't want to get glaucoma.

Is there anything each individual can do to prevent this disease? Are there preventive eye drops? or something like that. In reality there is no such thing. It is a so-called multifactorial disease, which means that many factors influence it, especially genetic makeup, so if glaucoma is known in the family, the risk is also significantly higher. of contracting it yourself, even those who are nearsighted are at higher risk of contracting it and there are more. There are a number of other risk factors, but you cannot diagnose glaucoma or influence eye pressure through lifestyle habits and that is why ophthalmologists promote this early detection through the nationalearly detection of glaucoma.

Hundreds of thousands of people have been saved from blindness and this is truly an initiative worth supporting. They have to go to the ophthalmologist periodically to make sure their eye pressure is not too much. high They do not have to do it every month if it can be proven that they do not have risk factors and if the early detection program goes completely unnoticed, it is enough to do it once a year, but people over 50 years of age should do it. I also discussed this early detection with the ophthalmologist at least once. Thank you, Professor Schurmann, yes, thank you, that was the first doctor-specialist talk, thank you for that.

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