Enhancement-Optionen nach Linsen- und refraktiver Hornhautchirurgie

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.

Kernaussagen

• Die Ursachen postoperativer Refraktionsfehler nach refraktiven Laser- oder Linsen-basierten Verfahren sind sehr vielfältig und benötigen eine umfange Aufarbeitung der Ursache sowie eine individuelle Lösung, um das gewünschte Ergebnis zu erreichen.

• Vor jedem weiteren chirurgischen Eingriff müssen spezifische Komplikationen des primären Eingriffs sowie okuläre Begleiterkrankungen ausgeschlossen bzw. behandelt werden.

• Das geeignete Enhancement nach keratorefraktivem Eingriff richtet sich vor allem nach der Art des primären Eingriffs, der residualen Stromadicke, möglicher Komplikationen durch den initialen Eingriff sowie der persönlichen Präferenz des Patienten.

• Bei Enhancements durch Oberflächenbehandlungen wie der PRK wird der Einsatz von Mitomycin C zur Prophylaxe einer Haze-Bildung empfohlen.

• Nach Linsenchirurgie liefern bei geringgradigen postoperativen Refraktionsfehlern (sphärisch und astigmatisch) keratorefraktive Enhancements die präzisesten Ergebnisse.

• Bei höheren Refraktionsfehlern können Linsen-basierte Verfahren zum Einsatz kommen, wobei Add-on-IOLs im Vergleich zu einem IOL-Austausch sicherer und präziser sind.

• Geringe Astigmatismen können mit einer LRI oder keratorefraktiven Eingriffen erfolgreich behandelt werden, höhere Astigmatismen hingegen sollten in der frühen postoperativen Phase durch einen IOL-Austausch und in der späteren postoperativen Phase durch eine Add-on-IOL behoben werden.

• IOL-Explantationen sollten insbesondere in Fällen von ausgeprägter Kapselfibrose, stattgehabter posteriorer Kapsulotomie sowie vorhandener Schwäche des Zonula-Apparates sehr zurückhaltend durchgeführt werden.

Schlüsselwörter

Enhancement - Bioptics - refraktiver residualer Fehler - refraktive Überraschung - Kataraktchirurgie

Key words

cornea-based enhancement - lens-based enhancement - refractive surprise - residual refractive error - cataract surgery

Publication History

Article published online:
22 February 2023

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