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Management der Bulbusruptur

Management of a ruptured globe

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Zusammenfassung

Die Bulbusruptur ist eine der schwersten offenen Augenverletzungen, beeinträchtigt das Sehvermögen dauerhaft oder führt zur Erblindung. Risikofaktoren für eine Bulbusruptur sind vorherige Augenoperationen (27-fach erhöhtes Risiko), Myopie, fortgeschrittenes Alter, weibliches Geschlecht und Stürze. Die Abgrenzung der gedeckten Bulbusruptur von der Kontusion kann bei ausgeprägtem Hyposphagma mit Chemosis der Bindehaut erschwert sein. Im Zweifelsfall muss nach einer schweren stumpfen Augenverletzung eine Bulbusruptur ausgeschlossen werden. Die 360°-Peritomie dient zur Limbus- und Skleraexploration und sichert die Diagnose. Die Wunde muss zeitnah wasserdicht verschlossen werden, um eine expulsive Blutung, persistierende Bulbushypotonie oder Epitheleinwachsung zu verhindern. Ein verzögerter Wundverschluss potenziert das Risiko einer posttraumatischen Endophthalmitis. Mit einer Frühvitrektomie bei hohem Risiko einer Netzhautbeteiligung mit Glaskörperblutung kann der traktiven Netzhautablösung vorgebeugt werden. Die Silikonölinstillation bei offenem Bulbustrauma stabilisiert die zentrale Netzhaut, die prophylaktische Cerclage ist noch umstritten.

Abstract

Globe rupture is one of the most severe open globe injuries, permanently impairing visual acuity or leading to blindness. The risk of globe rupture is increased after previous intraocular surgery (27-fold), in myopia, older age, females, and after sudden falls. The differentiation between an occult globe rupture and severe ocular contusion may be complicated by pronounced subconjunctival hemorrhage with conjunctival swelling. In case of doubt, a rupture of the eyeball should be ruled out after a severe blunt ocular trauma. Limbal and scleral exploration after 360° peritomy leads to the correct diagnosis. Immediate and watertight wound closure is essential to avoid expulsive choroidal hemorrhage, persisting ocular hypotony or epithelial ingrowth. Delayed wound closure raises the risk of posttraumatic endophthalmitis. Early vitrectomy may prevent tractional retinal detachment in case of retinal injury with vitreal bleeding. Silicone oil instillation stabilizes the central retina after open globe injury; scleral buckling is controversial.

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  1. Augenklinik mit Poliklinik der Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Deutschland

    A. Viestenz, S. Walter & W. Behrens-Baumann

  2. Augenpraxisklinik Erlangen-Mitte, Erlangen, Deutschland

    M. Küchle

  3. Universitätsaugenklinik Würzburg & Maximilians-Augenklinik, Würzburg, Deutschland

    W. Schrader

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  1. A. Viestenz
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Viestenz, A., Schrader, W., Küchle, M. et al. Management der Bulbusruptur. Ophthalmologe 105, 1163–1175 (2008). https://doi.org/10.1007/s00347-008-1815-y

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