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Klin Monbl Augenheilkd 2010; 227(8): 624-629
DOI: 10.1055/s-0029-1245594
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

IOL-Kalkulation nach refraktiver Chirurgie

IOL Power Calculation after Refractive SurgeryT. M. Rabsilber1 , G. U. Auffarth1
  • 1International Vision Correction Research Centre (IVCRC), Univ.-Augenklinik Heidelberg
Further Information

Publication History

Eingegangen: 31.3.2010

Angenommen: 23.6.2010

Publication Date:
12 August 2010 (online)

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Zusammenfassung

Die Kataraktoperation entwickelt sich immer mehr zu einem refraktiven Verfahren mit hohen Erwartungen an eine optimale visuelle Rehabilitation. Insbesondere Patienten, die bereits eine Refraktionskorrektur mittels Excimer-Laserbehandlung der Hornhaut hatten, sind an eine Brillenunabhängigkeit gewöhnt. Bei diesen Patienten kam es jedoch in der Vergangenheit zu unerwünschten, häufig hyperopen Refraktionsabweichungen im Vergleich zur geplanten Zielrefraktion. Die Änderung der Hornhautradien und des Keratometerindex sowie die fehlerhafte Vorhersage der postoperativen Intraokularlinsenposition durch bestimmte Berechnungsformeln wurden als Fehlerquellen ermittelt, wodurch die Intraokularlinsenstärke unpräzise bestimmt wird. Um dieses Problem zu überwinden, wurden verschiedene Methoden entwickelt, welche man prinzipiell in 2 Gruppen einteilen kann: Solche, welche auf ursprüngliche Refraktions- und Biometriedaten zurückgreifen (z. B. Refraktionsanamnese [Clinical history method], Feiz-Mannis-, „Double-K”-, „adjusted effective refractive power [EffRadj]”-, „Cornea Bypass” bzw. „Wake Forest”-Methode sowie Korrekturfaktoren zur K-Wert Anpassung) und solche, welche auf aktuellen Messwerten basieren und somit unabhängig von anderen Daten sind (z. B. Kontaktlinsenmethode, Verwendung von Hornhauttopografiesystemen, Ray tracing, Aphake Refraktionstechnik, Korrekturfaktoren der Hornhautradien, neue Formeln [Haigis-L, BESSt] sowie die kürzlich vorgestellte Pachymetrie-Methode). Diese Übersichtsarbeit stellt die einzelnen Verfahren vor und analysiert Stärken sowie Schwächen. An der Anzahl der hier vorgestellten Methoden lässt sich schon erahnen, dass bisher jedoch keine perfekte Lösung, welche für alle Augen anwendbar wäre, gefunden wurde. Einige der Methoden zeigen im Mittel eine sehr gute Vorhersagegenauigkeit, wobei mit individuellen Abweichungen gerechnet werden muss. Generell ist es daher empfehlenswert, die Patienten darüber aufzuklären, dass ein höheres Risiko einer ungenauen Intraokularlinsenberechnung vorliegt. Empfehlenswert ist es, wenn verschiedene Methoden miteinander verglichen werden können. Voraussetzung hierfür ist, dass bereits der Chirurg, der initial die Excimer-Laserbehandlung durchführt, darauf achtet, dem Patienten seine individuellen prä- und postoperativen Werte mitzuteilen mit dem Hinweis, diese langfristig aufzubewahren, damit diese Daten gegebenenfalls für eine spätere Intraokularlinsenberechnung herangezogen werden können.

Abstract

Cataract surgery is evolving more and more into a refractive procedure with high expectations in terms of visual rehabilitation. Especially patients presenting after previous Excimer laser corneal surgery are used to being independent from glasses. Unfortunately, some of these patients showed unexpected hyperopic surprises after cataract surgery in the past. The changes of corneal radii and keratometer index as well as the inaccurate prediction of the postoperative intraocular lens (IOL) position using different formulas were determined as error sources which led to a reduced IOL power calculation in dioptres. Several methods have been proposed to solve this problem which can be divided in two groups. On the one hand, there are methods that depend on refraction and biometry values before the initial treatment (e. g., clinical history, Feiz-Mannis, double-K, adjusted effective refractive power [EffRadj]-, cornea bypass/Wake Forest methods as well as correction factors to adjust K-values) and on the other hand procedures that only need current pre-cataract surgery measurements (e. g., contact lens method, corneal topography systems, ray tracing, aphakic refraction technique, correction factors to adjust K-values and new formulas including Haigis-L or BESSt and recently a novel pachymetry method). This review describes these procedures and analyses their strengths and weaknesses. The number of presented methods emphasises already that no perfect solution has been determined so far that would be valid for every patient. Some methods do provide a good predictability; however, individual deviations can occur. In general, it is advisable to inform the patient about the higher risk for an inaccurate IOL power calculation. It can be helpful to compare the results of different methods indicating the importance to provide all required individual data by the refractive surgeon already.

Schlüsselwörter

refraktive Chirurgie - Kornea - Katarakt

Key words

refractive surgery - cornea - cataract

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Dr. Tanja M. Rabsilber

International Vision Correction Research Centre (IVCRC), Univ.-Augenklinik Heidelberg

INF 400

69120 Heidelberg

Phone: ++ 49/62 21/5 63 66 18

Fax: ++ 49/62 21/56 82 29

Email: tanja.rabsilber@med.uni-heidelberg.de

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