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Augenheilkunde up2date 2017; 7(03): 219-234
DOI: 10.1055/s-0043-106747
Katarakt und refraktive Chirurgie
Georg Thieme Verlag KG Stuttgart · New York

Refraktiver Linsenaustausch

Refractive Lens Exchange
Fritz H. Hengerer
,
Ina Conrad-Hengerer
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Publication History

Publication Date:
05 September 2017 (online)

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Zusammenfassung

Die operative Entfernung der eigenen Linse mit anschließender Implantation einer Kunstlinse ist ein etabliertes Verfahren in der refraktiven Chirurgie. Der Artikel beschreibt die unterschiedlichen Verfahren und Intraokularlinsensysteme unter Berücksichtigung der aktuellen Empfehlungen der Kommission für Refraktive Chirurgie. Auf die Komplikationsmöglichkeiten der einzelnen Techniken und Intraokularlinsen wird in den Unterabschnitten hingewiesen.

Abstract

In refractive surgery the removal of the natural lens followed by implantation of an artificial intraocular lens has been an established method to treat refractive errors. The term “clear lens exchange” separates this approach from cataract surgery, where a cloudy lens has to be removed. With regard to currently available intraocular lens technologies, there is a wide range to correct myopia, hyperopia as well as astigmatism. Trifocal or extended depth-of-focus lenses (EDOF) even with a toric component offer the patients a potential benefit to further address presbyopia, respectively. Furthermore, the surgery in combination with Femtosecond laser-assistance offers more precision to this highly elective approach.

This article provides an overview about currently available procedures and implants to correct presbyopia and refractive errors. A thorough evaluation of risk and benefit for each patient group is given with regard to recent guidelines of the German Commission for Refractive Surgery (KRC).

Kernaussagen

  • CLE führt zum Verlust der natürlichen Akkommodation. Für den refraktiven Linsenaustausch eignen sich daher Patienten mit hoher Myopie oder hoher Hyperopie bei gleichzeitig bestehender Presbyopie.

  • Die Beratung und Therapieentscheidung sollte sich stets an den aktuellen KRC-Richtlinien orientieren.

  • Nicht nur mögliche intra- und postoperative Komplikationen, sondern auch postoperative refraktive Überraschungen, die neuronale Adaptation und ein möglicherweise erforderlicher Linsenaustausch müssen im Aufklärungsgespräch ausführlich diskutiert und schriftlich fixiert werden.

  • Ein refraktiver Linsenaustausch bei Emmetropie und Presbyopie ohne weitere Refraktionsfehler ist derzeit evidenzbasiert nicht indiziert.

  • IOL mit erweiterter Tiefenschärfe ermöglichen durch den elongierten Fokusbereich bei guter Emmetropisierung einen fast natürlichen Übergangsbereich von der Ferne zur Nähe ohne wesentlichen Lichtverlust oder Einbußen im Kontrastsehen.

  • Die postoperative Nachsorge erfolgt mit topischen nicht steroidalen oder steroidalen Antiphlogistika und Antibiotika.

  • Bei Abweichungen von der Zielrefraktion kann ein Enhancement durch keratorefraktive Chirurgie notwendig sein oder in extrem seltenen Fällen der Austausch der IOL.

Key words

clear lens exchange - refractive surgery - high myopia - high hyperopia - astigmatism - presbyopia

Schlüsselwörter

Clear Lens Exchange - refraktive Chirurgie - hohe Myopie - hohe Hyperopie - Astigmatismus - Presbyopie
 

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