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

Publikationsverlauf

Artikel online veröffentlicht:
15. August 2022

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