Klinische Ergebnisse epiretinaler Sehprothesen

 

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Zusammenfassung

Epiretinale Sehprothesen sind bereits bei blinden Retinitis-pigmentosa-Patienten implantiert worden. Es werden die klinischen Erfahrungen mit dem Argus®-II-System und dem EPIRET-3-System basierend auf Daten der in Deutschland operierten Patienten zusammengefasst. Mit dem Argus-II-System liegen Daten von 28 Patienten mit einer Nachbeobachtung von bis zu 3 Jahren vor. Das EPIRET-3-System ist bei 6 Patienten für 4 Wochen eingesetzt worden. Mit dem Argus II erreicht man bei der Mehrzahl der Patienten eine Verbesserung der visuellen Funktion, messbar an einer besseren Lokalisation von Lichtreizen und an einer besseren Beurteilung der Richtung bewegter Reize. Auch Mobilität und Eigenständigkeit verbessern sich mit dem System. Die Komplikationen bestehen vor allem in Dehiszenzen der Bindehaut aufgrund des kombinierten intra- und extraokularen Konzepts des Implantats. Von den 28 implantierten Systemen mussten 2 Implantate aufgrund von Komplikationen entfernt werden. EPIRET 3 ist dagegen eine vollständig intraokulare Prothese. In der 4-wöchigen Implantationszeit konnten Stimulationsschwellen bestimmt werden, die individuell stark schwanken. Die Patienten waren in der Lage, auch einfache Muster zu erkennen. Insgesamt stellen die epiretinalen Implantate eine Möglichkeit dar, selbst bei weit fortgeschrittener Rezeptordegeneration rudimentäre Sehfunktionen bei akzeptablem Risikoprofil wiederherzustellen.

Abstract

Epiretinal visual prostheses have already been implanted in blind retinitis pigmentosa (RP) patients. Here we report on clinical experience with the Argus® II device and the EPIRET 3 device, on the basis of data from patients operated in Germany. Twenty-eight patients were implanted with the Argus II device and followed for up to three years. EPIRET 3 was implanted in six patients for a period of four weeks. With Argus II, an improvement in visual performance was achieved in the majority of cases, as demonstrated by improved localisation of a light spot and a better perception of moving targets. Mobility and self-confidence improved. The main complications were conjunctival erosion due to the combined extra- and intraocular concept of the device. Among the 28 implanted systems, two needed to be removed because complications refractive to treatment. In contrast, EPIRET 3 is a fully intraocular epiretinal system. During a four week implantation, period thresholds were recorded and exhibited high variability between subjects. However, patients were able to recognise simple patterns. Epiretinal implants for electrical stimulation of the retina should be considered to treat advanced photoreceptor degeneration, and thus to restore basic visual functions at an acceptable rate of complications.

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