Postoperative Trübung von Hinterkammerlinsen - eine   Übersicht

Josef M. Schmidbauer; Liliana Werner; David J. Apple; Suresh K. Pandey; Andrea M. Izak; Rupal H. Trivedi; Tamer A. Macky; Gerd U. Auffarth; Qun Peng; Stella N. Arthur; Marcela Escobar-Gomez; Liwei Ma; Luis G. Vargas

doi:10.1055/s-2001-17635

Klinische Monatsblätter für Augenheilkunde, Inhaltsverzeichnis

Klin Monbl Augenheilkd 2001; 218(9): 586-594
DOI: 10.1055/s-2001-17635

ÜBERSICHT

Georg Thieme Verlag Stuttgart · New York

Postoperative Trübung von Hinterkammerlinsen - eine Übersicht[1] [2] [3]

Postoperative opacification of posterior chamber intraocular lenses - a reviewJosef M. Schmidbauer^1,2 , Liliana Werner¹ , David J. Apple¹ , Suresh K. Pandey¹ , Andrea M. Izak¹ , Rupal H. Trivedi¹ , Tamer A. Macky¹ , Gerd U. Auffarth³ , Qun Peng¹ , Stella N. Arthur¹ , Marcela Escobar-Gomez¹ , Liwei Ma¹ , Luis G. Vargas¹

¹ Center for Research on Ocular Therapeutic and Biodevices; Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, P.O. Box 250676 Charleston SC 29425-2236, South Carolina, USA (Director: David J. Apple, MD), E-mail: appledj@musc.edu
² Universitätsaugenklinik mit Poliklinik, Kirrbergerstr. 1, 66424 Homburg (Saar) (Direktor: Prof. Dr. K. W. Ruprecht)
³ Universitätsaugenklinik mit Poliklinik, Im Neuenheimer Feld 400, 69120 Heidelberg (Direktor: Prof. Dr. H. E. Völcker)

Abstract

Zusammenfassung

Postoperative Trübungen der implantierten Hinterkammerlinse können zu signifikanten visuellen Beeinträchtigungen führen. Einige Kunstlinsentypen, insbesondere zwei Faltlinsentypen zeigten in den letzten Jahren Trübungen der Optik, die eine Explantation nötig machten.1. „Snowflake”-Degeneration bei Poly (methyl methacrylat) (PMMA)-Linsen: Bei der „Snowflake”-Degeneration von PMMA-Linsen handelt es sich um eine unerwartete Spätkomplikation ca. 8 bis 15 Jahre postoperativ. Ursächlich ist nicht das PMMA-Biomaterial selbst, sondern ein Herstellungsproblem einzelner Linsentypen, die in großer Zahl um 1985 produziert worden waren.2. Kalzifikation und Degeneration des UV-Absorbers bei hydrophilen Acryllinsen von Medical Developmental Research Inc. (MDR): Durchschnittlich 2 Jahre postoperativ können milchige Trübungen im Inneren der Optik hydrophiler Acryllinsen SC60B-OUV von MDR auftreten. Es wird vermutet, dass die Einlagerungen auf Monomere ungebundenen, vorzeitig alternden UV-Absorbers und/oder Kalziumpräzipitate zurückzuführen sind.3. Oberflächen-Kalzifikation bei Bausch & Lomb Hydroview™-Linsen: Zwölf bis 15 Monate postoperativ treten granuläre Oberflächen-Kalzifikationen bei Hydroview™-Linsen auf. Der Mechanismus der Trübungen ist nicht vollständig geklärt. Der Hersteller sieht einen Zusammenhang mit Silikonanteilen im Verpackungsmaterial, die ggf. als Katalysator der Kalzifikationen wirkten. Dem Hersteller nach, ist das Problem nun gelöst. Längerfristige klinische Beobachtungen sind erforderlich um dies zu verifizieren.4. „Glistening” hydrophober Acryllinsen: Die Zeitspanne des Auftretens der „Glistenings” in AcrySof™-Linsen ist sehr variabel. Es wird vermutet, dass sich durch Temperaturschwankungen der Linse direkt vor oder bei Linsenimplantation Mikrovakuolen im Acryl-Polymer formen. „Glistenings” bilden sich dann durch Einströmen von Kammerwasser in diese Vakuolen. Meist führen die Veränderungen nicht zu einer Visusreduktion, die Kontrastsensitivität kann beeinträchtigt sein.

Postoperative opacification of intraocular lenses (IOLs) is a very unpleasant complication for the ophthalmic surgeon and the patient. We report on our experiences with opacification of different foldable IOL designs and rigid poly (methyl methacrylate) (PMMA) posterior chamber lenses.1. Snowflake degeneration of PMMA IOLs: This condition is an unanticipated and surprising late postoperative finding 8 to 15 years after implantation. In our opinion, this complication is probably not related to the PMMA biomaterial itself, but rather it appears to represent a manufacturing problem that has affected a selected, albeit large number of lenses manufactured in the 1980s-mid 1990s.2. Degeneration of UV absorber material and calcium deposits within the optic of hydrophilic IOLs: Two years postoperatively degenerations of UV absorber material and calcium deposits within the optic of single piece hydrophilic acrylic lenses SC60B-OUV manufactured by MDR (Medical developmental research Inc. Clearwater FL, USA) can occur. Although the precise mechanism is not fully known, it was assumed that these opacifications are due to premature aging of the UV blocking agent incorporated in the lens biomaterial and calcification.3. Calcification on the surface of the Bausch & Lomb Hydroview™ IOLs: Twelve to 15 months postoperatively granular surface calcifications in Hydroview™ IOLs occured. The mechanism is not fully understood. According to Bausch and Lomb studies, part of the components of the packaging contained silicone, which may have come off the packaging onto the lens optic, where it then appears to be a catalyst for calcium precipitation. The manufacturer has correlated a change in packaging with the appearance of the opacification. The manufacturer now believes that this problem has been solved. However, final verification will require a careful 1 - 2 years clinical study.4. Glistenings in the hydrophobic acrylic AcrySof™ IOLs: The time frame of glistenings in the AcrySof™ IOLs is highly variable. It has been suggested that the occurrence of glistenings may be related to variations in the temperature of the lens just prior to and or during insertion into the eye. Formation of vacuoles may occur within the submersed acrylic polymer when there is a transient increase and then decrease in temperature during the surgical procedure. “Glistenings” may then subsequently form by ingress of anterior chamber fluid. Contrast sensitivity can been decreased in some patients, but clinically significant decrease of visual acuity has been rare.

Schlüsselwörter

Hinterkammerlinse - Material - Degeneration - Biokompatibilität

Key words

intraocular lens - material - degeneration - biocompatibility - opacification

Volltext

Referenzen

Literatur

1 Manuskript erstmalig eingereicht am 28. 6. 01 und in der vorliegenden Form angenommen.

2 Gewidmet Sir Nicholas Harold Lloyd Ridley, Knight Bachelor, M.A., M.D., Cantab. (Cambridge); F.R.C.S., England; D.H.L. Medical University of South Carolina, Charleston; D.S. City University of London, Fellow of the Royal Society.

3 Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY, and a Max Kade postdoctoral research grant (Schmidbauer), Max Kade Foundation, New York, NY.

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