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Klin Monbl Augenheilkd 2012; 229(4): 365-368
DOI: 10.1055/s-0031-1299236
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Mechanische Pupillenerweiterung zur Kataraktoperation: erste Erfahrungen mit dem 6,25 mm Malyugin-Ring

Mechanical Dilatation of the Pupil in Phacoemulsification Surgery: First experiences with the 6.25 mm Malyugin-Ring
J. Stürmer
1   Augenklinik Kantonsspital Winterthur, Schweiz (Direktor: Prof. Dr. med. Jörg Stürmer)
,
M. Scherrer
1   Augenklinik Kantonsspital Winterthur, Schweiz (Direktor: Prof. Dr. med. Jörg Stürmer)
,
N. Lansel
2   Augenärzte Parkside, Zentrum für Augenheilkunde Limmattal, Schlieren, Schweiz
› Author Affiliations
Further Information

Publication History

16 September 2011

16 October 2011

Publication Date:
11 April 2012 (online)

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Zusammenfassung

Fragestellung: Eine ungenügende Mydriase bedeutet bei einer Phakoemulsifikation eine wesentliche Schwierigkeit. Normalerweise werden 4 Irisretraktoren zur Pupillenerweiterung verwendet. Eine Alternative stellt der Malyugin-Ring dar, der eine Pupillenerweiterung auf 6,25 mm ermöglicht.

Patienten und Methode: Ein Malyugin Ring wurde bei der Operation von 46 Augen von 39 Patienten (80,1 ± 6,2 Jahre alt) verwendet. Der Ring wird mit einem Shooter durch den Kataraktschnitt eingebracht und wird genauso wieder entfernt. Indikationen waren eine ungenügende Mydriase wegen PEX (n = 27), ein intraoperatives Floppy-Iris-Syndrom (n = 5), die Kombination von PEX und IFIS (n = 11), ausgeprägte hintere Synechien (n = 2) sowie langjährige Miotikatherapie (n = 1).

Ergebnisse: Bei 44/46 Augen konnten die Phakoemulsifikation und HKL-Implantation problemlos durchgeführt werden. Bei 2 Augen mit starker Phakodonesis musste wegen totaler Zonulolyse nach einer vorderen Vitrektomie eine Artisan-Linse implantiert werden. Für die immer problemlose Im- und Explantation des Malyugin-Ringes wurden mit zunehmender Erfahrung nur insgesamt 2 – 4,5 min (Median 2:51 min) benötigt.

Schlussfolgerungen: Wenn bei einer Phakoemulsifikation eine ungenügende Mydriase besteht, stellt die Implantation eines Malyugin-Rings eine einfache, sichere und schnelle Alternative zu den Irisretraktoren dar; man erreicht eine bessere Pupillenweite ohne zusätzliche Parazentesen.

Abstract

Purpose: Inadequate mydriasis may cause major problems in phacoemulsification surgery. Usually 4 iris retractors are used to allow adequate pupillary dilatation. Implantation of a Malyugin ring to maintain a 6.25 mm pupil is a new alternative.

Patients and Methods: A Malyugin ring was used in 46 eyes of 39 patients (aged 80.1 ± 6.2 years). The ring is im- and explanted with a disposable shooter through the main incision. Indications for the use of the ring were inadequate mydriasis due to pseudoexfoliation (n = 27), intraoperative floppy iris syndrome (n = 5), the combination of PEX and IFIS (n = 11), extensive posterior synechiae (n = 2) or inadquate mydriasis after long-term pilocarpine treatment (n = 1).

Results: In 44/46 eyes phacoemulsification with implantation of foldable posterior chamber lens was performed without complications. In 2 eyes with massive phakodonesis an Artisan anterior chamber lens had to be implanted after anterior vitrectomy because of total zonulolysis. There where no complications associated to the use of the device and with increasing experience duration of implantation as well as explantation was reduced to 2 – 4.5 min (median 2:51 min).

Conclusions: In cases of phacoemulsification surgery with inadequate mydriasis implantation of a Malyugin ring is a simple, safe and fast alternative to iris-retractors; it allows better pupil-size without additional stab incisions.

Schlüsselwörter

Kataraktoperation - enge Pupille - mechanische Pupillenerweiterung - Pseudoexfoliation - intraoperatives Floppy-Iris-Syndrom

Key words

cataract surgery - small pupil - mechanical dilatation - pseudoexfoliation - intraoperative floppy iris syndrome
 

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