Augenheilkunde up2date 2017; 7(03): 259-272
DOI: 10.1055/s-0042-122987
Katarakt und refraktive Chirurgie
Georg Thieme Verlag KG Stuttgart · New York

Presbyopiekorrektur mittels Laserchirurgie

Presbyopia treatment solution by Laser Surgery
Bojan Pajic
,
Horace Massa
,
Erika N. Eskina
Further Information

Publication History

Publication Date:
05 September 2017 (online)

Zusammenfassung

Trotz verschiedener Behandlungsansätze der Presbyopiebehandlung bleibt dieser Teil der refraktiven Chirurgie eine Herausforderung. Die multifokale Intraokularlinse zeigt befriedigende physikalische Eigenschaften, allerdings bleibt die postoperative Zielrefraktion komplex im Sinne einer nicht immer ganz präzisen postoperativen Zielrefraktion mit Rest- oder induziertem Astigmatismus, unkorrigierter Asphärizität und Aberration. Als weitere Presbyopieverfahren werden heute die Monovision, korneale Inlays und die PresbyLASIK angewendet.

Abstract

Today there are different options for correcting presbyopia by corneal laser procedure, but all of them have their benefits and compromises. The Monovision is a pseudoaccommodation procedure which works with an anisometropy of up to 2 D. The smaller the anisometropy is the faster a neuroadaptation will be achieved. There could be a decrease of binocularity. The monovision is not well supported by all patients, thus it is important to simulate this correction by contact lenses before surgery. The PresbyLASIK is a corneal multifocal solution for presbyopia correction for emmetropic, myopic and hyperopic eyes. It is a true presbyopia procedure where both eyes will be treated for far, intermediate and near. The disadvantage and compromise is that in some cases there could be a loss of uncorrected visual acuity. The corneal inlay is a solution for emmetropic, presbyopic patients who have a strong intention to read without glasses. The disadvantages could be some side effects as halo, glare, decrease of contrast and far vision. All procedures are potentially reversible in case the patient does not support the correction. An enhancement is possible for Monovision and PresbyLASIK.

Kernaussagen
  • Heutzutage gibt es verschiedene operative Korrekturmethoden der Presbyopie mittels Laserbehandlung der Hornhaut.

  • Jede dieser Methoden hat Vor- und Nachteile bzw. erfordert Kompromisse.

  • Der Vorteil einer Monovisionskorrektur liegt in der Einfachheit der Durchführung. Allerdings vertragen nicht alle Patienten eine Anisometropie bis 2 dpt, bzw. die reduzierte Binokularität wird manchmal als störend angegeben. Aus diesem Grund muss vor einer Behandlung eine Simulation mittels Kontaktlinsen durchgeführt werden.

  • Bei der PresbyLASIK wird eine korneale multifokale Zone gebildet. Der Vorteil dieser Methode liegt darin, dass beide Augen eine Korrektur für fern, intermediär und nah haben. Allerdings muss die objektive Indikationsstellung der LASIK-Kriterien erweitert werden. Details der topografischen als auch der Wellenfrontanalyse, insbesondere die Zernicke-Polynom-Analyse der Hornhaut, sind sehr wichtig.

  • Korneale Inlays sind für emmetrope, presbyope Patienten geeignet, die den großen Wunsch haben, ohne Korrektur lesen zu können. Das Hornhautimplantat wird jeweils im nicht dominanten Auge implantiert. Nebenwirkungen wie Blendungsgefühle, Halos oder Verminderung des Kontrastsehens können auftreten.

  • Alle aufgeführten Methoden sind potenziell reversibel.

 
  • Literatur

  • 1 Chang JS, Ng JC, Lau SY. Visual outcomes and patient satisfaction after presbyopic lens exchange with a diffractive multifocal intraocular lens. J Refract Surg 2012; 28: 468-474
  • 2 Tsaousis KT, Plainis S, Dimitrakos SA. et al. Binocularity enhances visual acuity of eyes implanted with multifocal intraocular lenses. J Refract Surg 2013; 29: 246-250
  • 3 Braun EH, Lee J, Steinert RF. Monovision in LASIK. Ophthalmology 2008; 115: 1196-1202
  • 4 Jain S, Ou R, Azar DT. Monovision outcomes in presbyopic individuals after refractive surgery. Ophthalmology 2001; 108: 1430-1433
  • 5 Bouzoukis DI, Kymionis GD, Panagopoulos SI. et al. Visual outcomes and safety of small diameter intrastromal refractive inlay for the corneal compensation of presbyopia. J Refract Surg 2012; 28: 168-173
  • 6 Yilmaz OF, Alagoz N, Pekel G. et al. Intracorneal inlay to correct presbyopia: long-term results. J Cataract Refract Surg 2011; 37: 1275-1281
  • 7 Saib N, Abrieu-Lacaille M, Berguiga M. et al. Central PresbyLASIK for Hyperopia and Presbyopia Using Micro-monovision With the Technolas 217P Platform and SUPRACOR Algorithm. J Refract Surg 2015; 31: 540-546
  • 8 Vastardis I, Pajic-Eggspuehler B, Mueller J. et al. Femtosecond laser-assisted in situ keratomileusis multifocal ablation profile using a mini-monovision approach for presbyopic patients with hyperopia. Clin Ophthalmol 2016; 10: 1245-1256
  • 9 Fonda G. Presbyopia corrected with single vision spectacles or contact lenses in preference to bifocal corneal lenses. Trans Ophthalmol Soc Aust 1966; 25: 78-80
  • 10 Hom MM. Monovision and LASIK. J Am Optom Accoc 1999; 70: 117-120
  • 11 Saragoussi J. Chirurgie de la presbytie: principes et orientation des indications. J Fr Ophtalmol 2007; 30: 552-558
  • 12 Jain S, Arora I, Azar DT. Success of monovision in presbyopes: review of the literature and potential applications to refractive surgery. Survery Ophthalmol 1996; 40: 491-499
  • 13 Jain S, Ou R, Azar DT. Monovion outcomes in presbyopia individuals after refractive surgery. Ophthalmology 2001; 108: 1430-1433
  • 14 Farid M, Steinert RF. Patient selection for monovision laser refractive surgery. Curr Opin Ophthalmol 2009; 20: 251-254
  • 15 Goldberg DB. Comparison of myopes and hyperopes after laser in situ keratomileusis monovision. J Cataract Refract Surg 2003; 29: 1695-1701
  • 16 Miranda D, Krueger RR. Monovision laser in situ keratomileusis for pre-presbyopic and presbyopic patients. J Refract Surg 2004; 20: 325-328
  • 17 Braun EH, Lee J, Steinert RF. Monovision in LASIK. Ophthalmology 2008; 115: 1196-1202
  • 18 Garcia-Gonzales M, Teus MA, Hernandes-Verdejom JL. Visual outcomes of LASIK-induced monovision in myopic patients with presbyopia. Am J Ophthalmol 2010; 150: 381-386
  • 19 Reinstein DZ, Couch DG, Archer TJ. LASIK for hyperopic astigmatism and presbyopia using micromonovision with the Carl Zeiss Meditec MEL80 platform. J Refract Surg 2009; 25: 37-58
  • 20 Alarcón A, Anera RG, Villa C. et al. Visual quality after monovision correction by laser in situ keratomileusis in presbyopic patients. J Cataract Refract Surg 2011; 37: 1629-1635
  • 21 Uthoff D, Pölzl M, Hepper D. et al. A new method of cornea modulation with excimer laser for simultaneous correction of presbyopia and ametropia. Graefes Arch Clin Exp Ophthalmol 2012; 250: 1649-1661
  • 22 Baudu P, Penin F, Arba Mosquera S. Uncorrected binocular performance after biaspheric ablation profile for presbyopic corneal treatment using AMARIS with the PresbyMAX module. Am J Ophthalmol 2013; 155: 636-647
  • 23 Jackson WB, Tuan KM, Mintsioulis G. Aspheric wavefront-guided LASIK to treat hyperopic presbyopia: 12-month results with the VISX platform. J Refract Surg 2011; 27: 519-529
  • 24 Jung SW, Kim MJ, Park SH. et al. Multifocal corneal ablation for hyperopic presbyopes. J Refract Surg 2008; 24: 903-910
  • 25 Luger MH, Ewering T, Arba-Mosquera S. One-year experience in presbyopia correction with biaspheric multifocal central presbyopia laser in situ keratomileusis. Cornea 2013; 32: 644-652
  • 26 Saib N, Abrieu-Lacaille M, Berguiga M. et al. Central PresbyLASIK for Hyperopia and Presbyopia Using Micro-monovision With the Technolas 217P Platform and SUPRACOR Algorithm. J Refract Surg 2015; 31: 540-546
  • 27 Vastardis I, Pajic-Eggspuehler B, Mueller J. et al. Femtosecond laser-assisted in situ keratomileusis multifocal ablation profile using a mini-monovision approach for presbyopic patients with hyperopia. Clin Ophthalmol 2016; 10: 1245-1256
  • 28 Pajic B, Pajic-Eggspuehler B, Mueller J. et al. A novel laser refractive surgical treatment for presbyopia: optics based customization for improved clinical outcome. Basel: Sensors 2017; 17: 1367
  • 29 Waring 4th GO, Klyce SD. Corneal inlays for the treatment of presbyopia. Int Ophthalmol Clin 2011; 51: 51-62
  • 30 Bouzoukis DI, Kymionis GD, Limnopoulou AN. et al. Femtosecond laser-assisted corneal pocket creation using a mask for inlay implantation. J Refract Surg 2011; 27: 818-820
  • 31 Yilmaz OF, Bayraktar S, Agca A. et al. Intracorneal inlay for the surgical correction of presbyopia. J Cataract Refract Surg 2008; 34: 1921-1927
  • 32 Seyeddain O, Riha W, Hohensinn M. et al. Refractive surgical correction of presbyopia with the AcuFocus small aperture corneal inlay: two-year follow-up. J Refract Surg 2010; 26: 707-715
  • 33 Dexl AK, Seyeddain O, Riha W. et al. Reading performance after implantation of a small-aperture corneal inlay for the surgical correction of presbyopia: Two-year follow-up. J Cataract Refract Surg 2011; 37: 525-531
  • 34 Dexl AK, Seyeddain O, Riha W. et al. Reading performance after implantation of a modified corneal inlay design for the surgical correction of presbyopia: 1-year follow-up. Am J Ophthalmol 2012; 153: 994-1001
  • 35 Dexl AK, Seyeddain O, Riha W. et al. One-year visual outcomes and patient satisfaction after surgical correction of presbyopia with an intracorneal inlay of a new design. J Cataract Refract Surg 2012; 38: 262-269
  • 36 Yılmaz OF, Alagöz N, Pekel G. et al. Intracorneal inlay to correct presbyopia: long-term results. J Cataract Refract Surg 2011; 37: 1275-1281
  • 37 Seyeddain O, Hohensinn M, Riha W. et al. Small-aperture corneal inlay for the correction of presbyopia: 3-year follow-up. J Cataract Refract Surg 2012; 38: 35-45
  • 38 Naroo SA, Bilkhu PS. Clinical utility of the KAMRA corneal inlay. Clin Ophthalmol 2016; 10: 913-919
  • 39 Vilupuru S, Lin L, Pepose JS. Comparison of contrast sensitivity and through focus in small-aperture inlay, accommodating intraocular lens, or multifocal intraocular lens subjects. Am J Ophthalmol 2015; 160: 150-162