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DOI: 10.1055/s-0029-1245594
© Georg Thieme Verlag KG Stuttgart · New York
IOL-Kalkulation nach refraktiver Chirurgie
IOL Power Calculation after Refractive SurgeryPublication History
Eingegangen: 31.3.2010
Angenommen: 23.6.2010
Publication Date:
12 August 2010 (online)

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
Literatur
- 1
Hoffmann P C, Hutz W W, Eckhardt H B.
Significance of optic formula selection for postoperative refraction after cataract
operation.
Klin Monatsbl Augenheilkd.
1997;
211
168-177
MissingFormLabel
- 2
Preussner P R, Wahl J, Lahdo H et al.
Ray tracing for intraocular lens calculation.
J Cataract Refract Surg.
2002;
28
1412-1419
MissingFormLabel
- 3
Koch D D, Liu J F, Hyde L L et al.
Refractive complications of cataract surgery after radial keratotomy.
Am J Ophthalmol.
1989;
108
676-682
MissingFormLabel
- 4
Hoffer K J.
Intraocular lens power calculation for eyes after refractive keratotomy.
J Refract Surg.
1995;
11
490-493
MissingFormLabel
- 5
Hoffer K J.
Intraocular lens power calculation after previous laser refractive surgery.
J Cataract Refract Surg.
2009;
35
759-765
MissingFormLabel
- 6
Holladay J T.
Consultations in refractive surgery.
Refract Corneal Surg.
1989;
5
203
MissingFormLabel
- 7
Langenbucher A, Haigis W, Seitz B.
Difficult lens power calculations.
Curr Opin Ophthalmol.
2004;
15
1-9
MissingFormLabel
- 8
Naseri A, McLeod S D.
Cataract surgery after refractive surgery.
Curr Opin Ophthalmol.
2010;
21
35-38
MissingFormLabel
- 9
Seitz B, Langenbucher A.
Intraocular lens power calculation in eyes after corneal refractive surgery.
J Refract Surg.
2000;
16
349-361
MissingFormLabel
- 10
Holladay J T.
Consultations in refractive surgery.
Refract Corneal Surg.
1989;
5
203
MissingFormLabel
- 11
Argento C, Cosentino M J, Badoza D.
Intraocular lens power calculation after refractive surgery.
J Cataract Refract Surg.
2003;
29
1346-1351
MissingFormLabel
- 12
Sun R, Gimbel H, Penno E E.
Intraocular lens power calculation after corneal refractive surgery remains challenging.
Ophthalmology.
2000;
107
226-228
MissingFormLabel
- 13
Ladas J G, Boxer Wachler B S et al.
Intraocular lens power calculations using corneal topography after photorefractive
keratectomy.
Am J Ophthalmol.
2001;
132
254-255
MissingFormLabel
- 14
Latkany R A, Chokshi A R, Speaker M G et al.
Intraocular lens calculations after refractive surgery.
J Cataract Refract Surg.
2005;
31
562-570
MissingFormLabel
- 15
Odenthal M T, Eggink C A, Melles G et al.
Clinical and theoretical results of intraocular lens power calculation for cataract
surgery after photorefractive keratectomy for myopia.
Archives of ophthalmology.
2002;
120
431-438
MissingFormLabel
- 16
Randleman J B, Loupe D N, Song C D et al.
Intraocular lens power calculations after laser in situ keratomileusis.
Cornea.
2002;
21
751-755
MissingFormLabel
- 17
Seitz B, Langenbucher A, Nguyen N X et al.
Underestimation of intraocular lens power for cataract surgery after myopic photorefractive
keratectomy.
Ophthalmology.
1999;
106
693-702
MissingFormLabel
- 18
Feiz V, Mannis M J, Garcia-Ferrer F et al.
Intraocular lens power calculation after laser in situ keratomileusis for myopia and
hyperopia: a standardized approach.
Cornea.
2001;
20
792-797
MissingFormLabel
- 19
Wang L, Booth M A, Koch D D.
Comparison of intraocular lens power calculation methods in eyes that have undergone
LASIK.
Ophthalmology.
2004;
111
1825-1831
MissingFormLabel
- 20
Feiz V, Moshirfar M, Mannis M J et al.
Nomogram-based intraocular lens power adjustment after myopic photorefractive keratectomy
and LASIK: a new approach.
Ophthalmology.
2005;
112
1381-1387
MissingFormLabel
- 21
Aramberri J.
Intraocular lens power calculation after corneal refractive surgery: double-K method.
J Cataract Refract Surg.
2003;
29
2063-2068
MissingFormLabel
- 22
Hamed A M, Wang L, Misra M et al.
A comparative analysis of five methods of determining corneal refractive power in
eyes that have undergone myopic laser in situ keratomileusis.
Ophthalmology.
2002;
109
651-658
MissingFormLabel
- 23
Wang L, Jackson D W, Koch D D.
Methods of estimating corneal refractive power after hyperopic laser in situ keratomileusis.
J Cataract Refract Surg.
2002;
28
954-961
MissingFormLabel
- 24
Walter K A, Gagnon M R, Hoopes P C et al.
Accurate intraocular lens power calculation after myopic laser in situ keratomileusis,
bypassing corneal power.
J Cataract Refract Surg.
2006;
32
425-429
MissingFormLabel
- 25
Masket Jr S, Masket S E.
Simple regression formula for intraocular lens power adjustment in eyes requiring
cataract surgery after excimer laser photoablation.
J Cataract Refract Surg.
2006;
32
430-434
MissingFormLabel
- 26
Jarade E F, Tabbara K F.
New formula for calculating intraocular lens power after laser in situ keratomileusis.
J Cataract Refract Surg.
2004;
30
1711-1715
MissingFormLabel
- 27
Savini G, Barboni P, Zanini M.
Intraocular lens power calculation after myopic refractive surgery: theoretical comparison
of different methods.
Ophthalmology.
2006;
113
1271-1282
MissingFormLabel
- 28
Camellin M, Calossi A.
A new formula for intraocular lens power calculation after refractive corneal surgery.
J Refract Surg.
2006;
22
187-199
MissingFormLabel
- 29
Haigis W.
Corneal power after refractive surgery for myopia: contact lens method.
J Cataract Refract Surg.
2003;
29
1397-1411
MissingFormLabel
- 30
Zeh W G, Koch D D.
Comparison of contact lens overrefraction and standard keratometry for measuring corneal
curvature in eyes with lenticular opacity.
J Cataract Refract Surg.
1999;
25
898-903
MissingFormLabel
- 31
Sonego-Krone S, Lopez-Moreno G, Beaujon-Balbi O V et al.
A direct method to measure the power of the central cornea after myopic laser in situ
keratomileusis.
Archives of ophthalmology.
2004;
122
159-166
MissingFormLabel
- 32
Smith R J, Chan W K, Maloney R K.
The prediction of surgically induced refractive change from corneal topography.
Am J Ophthalmol.
1998;
125
44-53
MissingFormLabel
- 33
Koch D D, Wang L.
Calculating IOL power in eyes that have had refractive surgery.
J Cataract Refract Surg.
2003;
29
2039-2042
MissingFormLabel
- 34
Savini G, Barboni P, Zanini M.
Correlation between attempted correction and keratometric refractive index of the
cornea after myopic excimer laser surgery.
J Refract Surg.
2007;
23
461-466
MissingFormLabel
- 35
Preussner P R, Wahl J, Weitzel D.
Topography-based intraocular lens power selection.
J Cataract Refract Surg.
2005;
31
525-533
MissingFormLabel
- 36
Rabsilber T M, Reuland A J, Holzer M P et al.
Intraocular lens power calculation using ray tracing following excimer laser surgery.
Eye.
2007;
21
697-701
MissingFormLabel
- 37
Mackool R J, Ko W, Mackool R.
Intraocular lens power calculation after laser in situ keratomileusis: Aphakic refraction
technique.
J Cataract Refract Surg.
2006;
32
435-437
MissingFormLabel
- 38
Mackool R J.
The cataract extraction-refraction-implantation technique for IOL power calculation
in difficult cases.
J Cataract Refract Surg.
1998;
24
434-435
MissingFormLabel
- 39
Ianchulev T, Salz J, Hoffer K et al.
Intraoperative optical refractive biometry for intraocular lens power estimation without
axial length and keratometry measurements.
J Cataract Refract Surg.
2005;
31
1530-1536
MissingFormLabel
- 40
Rosa N, Capasso L, Romano A.
A new method of calculating intraocular lens power after photorefractive keratectomy.
J Refract Surg.
2002;
18
720-724
MissingFormLabel
- 41
Rosa N, Capasso L, Lanza M et al.
Reliability of a new correcting factor in calculating intraocular lens power after
refractive corneal surgery.
J Cataract Refract Surg.
2005;
31
1020-1024
MissingFormLabel
- 42
Shammas H J, Shammas M C, Garabet A et al.
Correcting the corneal power measurements for intraocular lens power calculations
after myopic laser in situ keratomileusis.
Am J Ophthalmol.
2003;
136
426-432
MissingFormLabel
- 43
Ferrara G, Cennamo G, Marotta G et al.
New formula to calculate corneal power after refractive surgery.
J Refract Surg.
2004;
20
465-471
MissingFormLabel
- 44
Jin G J, Crandall A S, Jin Y.
Analysis of intraocular lens power calculation for eyes with previous myopic LASIK.
J Refract Surg.
2006;
22
387-395
MissingFormLabel
- 45
Haigis W.
Intraocular lens calculation after refractive surgery for myopia: Haigis-L formula.
J Cataract Refract Surg.
2008;
34
1658-1663
MissingFormLabel
- 46
Borasio E, Stevens J, Smith G T.
Estimation of true corneal power after keratorefractive surgery in eyes requiring
cataract surgery: BESSt formula.
J Cataract Refract Surg.
2006;
32
2004-2014
MissingFormLabel
- 47
Geggel H S.
Pachymetric ratio no-history method for intraocular lens power adjustment after excimer
laser refractive surgery.
Ophthalmology.
2009;
116
1057-1066
MissingFormLabel
- 48
Koch D D.
Cataract surgery following refractive surgery.
Focal Points (American Academy of Ophthalmology).
2001;
19
1-13
MissingFormLabel
- 49
Awwad S T, Kelley P S, Bowman R W et al.
Corneal refractive power estimation and intraocular lens calculation after hyperopic
LASIK.
Ophthalmology.
2009;
116
393-400
MissingFormLabel
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