Voruntersuchung bei Kataraktoperation

Zusammenfassung

Die Kataraktoperation stellt mit etwa 800 000 Operationen pro Jahr eine der häufigsten Operationen in Deutschland dar; aufgrund des demografischen Wandels ist von einem Anstieg in den nächsten Jahrzehnten auszugehen. Daneben erweitern sich die diagnostischen und operativen Möglichkeiten. Ziel dieses Beitrags ist, eine strukturierte, ziel- und patientenorientierte Voruntersuchung zu planen und individuelle Besonderheiten aufzuzeigen.

Abstract

To plan and execute a successful and safe cataract surgery one must conduct a structured, goal- and patient-oriented examination. The medical history provides crucial information regarding the planning of the anesthetic procedure, lens selection and possible intraoperative complications. Visual acuity and refraction measurements are essential for both documentation and discussion of the selected target refraction. Multifocal lenses have various contraindications to which attention must be paid during slit lamp examination and other imaging diagnostics. These include epithelial basement membrane dystrophy, Fuchsʼ endothelial dystrophy, zonular weakness, and progressive retinal diseases such as progressive AMD. Tomography reveals corneal irregularities as well as possible refractive laser treatments that have been performed previously. Lens calculation is complicated in these cases. Additionally, an endothelial cell count, aberrometry to rule out higher order aberrations, pupillometry and an analysis of the tear film can provide further information. The patient must be informed verbally about the severity of the procedure and the risks relevant for him with sufficient distance to the surgery.

Kernaussagen

• Die Anamnese gibt entscheidende Hinweise bezüglich der Planung des Anästhesieverfahrens, der Linsenauswahl und der möglichen intraoperativen Komplikationen.

• Die Visus- und Refraktionsmessung ist sowohl zur Dokumentation als auch zur Besprechung der gewählten Zielrefraktion essenziell.

• Multifokale Linsen haben einige Kontraindikationen, auf denen bei der Spaltlampen- und weiteren bildgebenden Diagnostik geachtet werden muss. Hierzu zählen u. a. die epitheliale Basalmembrandystrophie, die Fuchsʼsche Endotheldystrophie, eine Zonulaschwäche und progrediente Netzhauterkrankungen wie eine voranschreitende AMD.

• Die Tomografie deckt neben Hornhautirregularitäten auch mögliche erfolgte refraktive Laserbehandlungen auf. Die Linsenkalkulation ist in diesen Fällen erschwert.

• Der Patient muss mündlich mit ausreichendem Abstand zur Operation über die Schwere des Eingriffs und die für ihn relevanten Risiken aufgeklärt werden.

Schlüsselwörter

Kataraktchirurgie - Voruntersuchung - Operationsplanung

Key words

cataract surgery - preliminary examination - surgery planning

Publication History

Article published online:
15 August 2022

• Literatur

• 1 Peterson SR, Silva PA, Murtha TJ. et al. Cataract Surgery in Patients with Diabetes: Management Strategies. Semin Ophthalmol 2018; 33: 75-82
• 2 EASA. Easy Access Rules for Aircrew (Regulation (EU) No 1178/2011). Im Internet (Stand: 11.07.2022): https://www.easa.europa.eu/easy-access-rules-aircrew-regulation-eu-no-11782011-pdf
• 3 Wesemann W, Schiefer U, Bach M. [New DIN norms for determination of visual acuity]. Ophthalmologe 2010; 107: 821-826
• 4 Radner W. [Ophthalmologic reading charts : Part 2: Current logarithmically scaled reading charts]. Ophthalmologe 2016; 113: 1029-1035
• 5 Bach M, Kellner U. [Electrophysiological diagnosis in ophthalmology]. Ophthalmologe 2000; 97: 898-920
• 6 Bach M, Hoffmann MB, Jägle H. et al. [Contrast vision-definitions, conversions, and equivalence tables]. Ophthalmologe 2017; 114: 341-347
• 7 Kashkouli MB, Abdolalizadeh P, Esʼhaghi A. et al. Postoperative Blepharoptosis After Modern Phacoemulsification Procedure. Am J Ophthalmol 2020; 213: 17-23
• 8 Goerlitz-Jessen MF, Gupta PK, Kim T. Impact of epithelial basement membrane dystrophy and Salzmann nodular degeneration on biometry measurements. J Cataract Refract Surg 2019; 45: 1119-1123
• 9 Miyoshi T, Fujie S, Yoshida H. et al. Effects of capsular tension ring on surgical outcomes of premium intraocular lens in patients with suspected zonular weakness. PLoS One 2020; 15: e0228999
• 10 Wilkinson CP. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev 2014; (2014) CD003170
• 11 Browning AC, Alwitry A, Hamilton R. et al. Role of intraocular pressure measurement on the day of phacoemulsification cataract surgery. J Cataract Refract Surg 2002; 28: 1601-1606
• 12 Chen PP, Lin SC, Junk AK. et al. The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients: A Report by the American Academy of Ophthalmology. Ophthalmology 2015; 122: 1294-1307
• 13 Samuelson TW, Sarkisian SRJ, Lubeck DM. et al. Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results. Ophthalmology 2019; 126: 811-821
• 14 Reitsamer H, Sng C, Vera V. et al. Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2019; 257: 983-996
• 15 Hoffer KJ, Shammas HJ, Savini G. Comparison of 2 laser instruments for measuring axial length. J Cataract Refract Surg 2010; 36: 644-648
• 16 Hirnschall N, Varsits R, Doeller B. et al. Enhanced Penetration for Axial Length Measurement of Eyes with Dense Cataracts Using Swept Source Optical Coherence Tomography: A Consecutive Observational Study. Ophthalmol Ther 2018; 7: 119-124
• 17 Koch DD, Hill W, Abulafia A. et al. Pursuing perfection in intraocular lens calculations: I. Logical approach for classifying IOL calculation formulas. J Cataract Refract Surg 2017; 43: 717-718
• 18 Hayashi K, Manabe SI, Yoshida M. et al. Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens. J Cataract Refract Surg 2010; 36: 1323-1329
• 19 Delrivo M, Ruiseñor Vázquez PR, Galletti JD. et al. Agreement between placido topography and Scheimpflug tomography for corneal astigmatism assessment. J Refract Surg 2014; 30: 49-53
• 20 Herber R, Lenk J, Pillunat LE. et al. Agreement and repeatability of corneal tomography in healthy eyes using a new swept-source OCT, a rotating Scheimpflug camera, and a dual Scheimpflug-Placido system. J Cataract Refract Surg 2022; 48: 190-198
• 21 Schuster AK, Tesarz J, Vossmerbaeumer U. The impact on vision of aspheric to spherical monofocal intraocular lenses in cataract surgery: a systematic review with meta-analysis. Ophthalmology 2013; 120: 2166-2175
• 22 Fu Y, Kou J, Chen D. et al. Influence of angle kappa and angle alpha on visual quality after implantation of multifocal intraocular lenses. J Cataract Refract Surg 2019; 45: 1258-1264
• 23 Chaurasia S, Price FWJ, Gunderson L. et al. Descemetʼs membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery). Ophthalmology 2014; 121: 454-458
• 24 Shajari M, Kolb CM, Mayer WJ. et al. Characteristics of preoperative and postoperative astigmatism in patients having Descemet membrane endothelial keratoplasty. J Cataract Refract Surg 2019; 45: 1001-1006
• 25 Fritz M, Grewing V, Böhringer D. et al. Avoiding Hyperopic Surprises After Descemet Membrane Endothelial Keratoplasty in Fuchs Dystrophy Eyes by Assessing Corneal Shape. Am J Ophthalmol 2019; 197: 1-6
• 26 Epitropoulos AT, Matossian C, Berdy GJ. et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg 2015; 41: 1672-1677
• 27 Bron AJ, Tomlinson A, Foulks GN. et al. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf 2014; 12: S1-31
• 28 Schargus M, Schargus V, Rath S. Anästhesieformen in der Augenheilkunde. Ophthalmologe 2021; 118: 413-428
• 29 OLG Frankfurt. Urteil vom 19.09.2016 (8 U 52/15). Im Internet (Stand: 11.07.2022): https://dejure.org/dienste/vernetzung/rechtsprechung?Gericht=OLG%2520Frankfurt&Datum=19.09.2016&Aktenzeichen=8%2520U%252052/15