Zusammenfassung
Gelegentlich kommt es trotz aller Sorgfalt und präziser Operationstechnik in der
Katarakt- und Refraktivchirurgie zu unbefriedigenden refraktiven und visuellen
Ergebnissen. In diesen Fällen ist eine nachträgliche Korrektur erforderlich, um
das beste endgültige visuelle Ergebnis zu erzielen. Dieser Beitrag zeigt die
Möglichkeiten zur Behandlung residualer Refraktionsfehler nach Linsen- und
refraktiver Hornhautchirurgie auf.
Abstract
Background Modern preoperative diagnostics as well as current surgical
techniques allow cataract and refractive surgery to deliver precise refractive
results.
Occasionally, unsatisfactory refractive and visual results occur despite all the
care taken. In these cases, subsequent improvement is required to achieve the
best final visual outcome. This article shows the therapeutic options for the
treatment of residual refractive errors after lens and corneal refractive
surgery.
Key messages The causes of postoperative refractive errors after
refractive laser- or lens-based procedures are very diverse and require
extensive workup of the cause as well as an individual solution to achieve the
desired result. Before any further surgical intervention, specific complications
of the primary procedure as well as concomitant ocular diseases must be excluded
or treated. The appropriate enhancement after keratorefractive surgery depends
primarily on the type of primary surgery, residual stromal thickness, possible
complications from the initial surgery, and the patientʼs personal preference.
For enhancements using surface treatments, such as PRK, the use of mitomycin C
is recommended for prophylaxis of haze formation. After lens surgery, for
low-grade postoperative refractive errors (spherical and astigmatic),
keratorefractive enhancements provide the most accurate results. For higher
refractive errors, lens-based procedures can be used, with add-on IOLs being
safer and more precise compared with one IOL exchange. Low astigmatisms can be
successfully treated with LRI or keratorefractive surgery, but higher
astigmatisms should be corrected with an IOL exchange in the early postoperative
period and with an add-on IOL in the later postoperative period. IOL
explantations should be performed very cautiously, especially in cases of
pronounced capsular fibrosis, previous posterior capsulotomy, and existing
weakness of the zonular apparatus.
Schlüsselwörter
Enhancement - Bioptics - refraktiver residualer Fehler - refraktive Überraschung -
Kataraktchirurgie
Key words
cornea-based enhancement - lens-based enhancement - refractive surprise - residual
refractive error - cataract surgery
