Pseudophakie-Ablatio

Zusammenfassung

Die Operation der Katarakt ist mit modernen Techniken ein sicherer und dankbarer Eingriff geworden. Spät auftretende Komplikationen werden sowohl von Operateur als auch Patienten nicht unbedingt mit der Linsenoperation kausal in Verbindung gebracht. In den letzten Jahren haben mehrere Untersuchungen allerdings gezeigt, dass ein solcher Zusammenhang für lange Zeit nach Linsenoperation bestehen bleibt und dass das Risiko in den postoperativen Jahren um ein Mehrfaches im Vergleich zu phaken Patienten erhöht ist. Der Zeitabstand zwischen Kataraktoperation und Pseudophakie-Ablatio beträgt im Mittel zwischen 3 und 4 Jahren. Die Operation des grauen Stares verändert die Physiologie des Auges und führt über Jahre postoperativ zu verstärkten Destruktionen des Glaskörpers. Daher bleibt das Risiko für Netzhautablösungen auch nach komplikationsloser Kataraktoperation für mindestens 10 Jahre um ein Mehrfaches erhöht. Epidemiologische Risikofaktoren sind Myopie, junges Patientenalter und männliches Geschlecht. Bei Kombination dieser Faktoren ergibt sich ein 10-Jahres-Ablatiorisiko nach Kataraktoperation von beachtlichen 20 %. Intraoperative Komplikationen wie Kapselruptur und Kernverlust erhöhen das Ablatio-Risiko erheblich. Klinisch sind Patienten mit Pseudophakie-Ablatio älter als solche mit phaker Ablatio, die Anamnese ist kürzer und es finden sich häufig kleine, weit anterior gelegene, aber weniger Foramina, die oft erst intraoperativ entdeckt werden. Die anatomischen Ergebnisse der Chirurgie sind durch die Vitrektomie wesentlich besser geworden. Dennoch erreicht fast die Hälfte der Patienten postoperativ keinen Lesevisus. Das langfristig erhöhte Ablatio-Risiko sollte besonders bei jungen und kurzsichtigen Patienten in die Entscheidungsfindung und Aufklärung zur Linsenoperation mit einbezogen werden.

Abstract

Modern phacoemulsification has established itself as a safe and very rewarding surgical procedure. Patients and surgeons may not associate late complications with the initial surgery. However, recent studies have demonstrated that such a causal relationship may persist for many years after the cataract procedure and that there is a significant increase in the risk for developing a retinal detachment during the postoperative years. The mean time period between cataract surgery and pseudophakic retinal detachment is between 3 and 4 years. Even uncomplicated cataract surgery alters the physiological processes within the eye and can lead to progressive destruction of the vitreous for many years after the surgery. Therefore, the risk for a retinal detachment is increased for at least 10 years after the initial procedure. In recent epidemiological studies, the most important risk factors for pseudophakic retinal detachment were myopia, younger age and male gender. If all factors are combined, the cumulative risk for developing a retinal detachment after cataract surgery may rise to 20 %. Additional factors that may increase this risk are additional intraoperative complications, for example, rupture of the posterior capsule, vitreous loss or dropped nucleus. Compared to phakic retinal detachments, pseudophakic patients on average present with a shorter history of visual symptoms, are older, more commonly male and display fewer, smaller and more anteriorly located retinal breaks that frequently are only detected during surgery. The anatomic success rates have improved significantly over the past years, in particular through the advances and increasing popularity of primary vitrectomy. However, functional results are still disappointing. Only about half of the patients will achieve reading ability without low vision aids. The increased and long-term risk for pseudophakic retinal detachment should be part of the preoperative consent process of any cataract surgery, in particular, in young myopic males.

Schlüsselwörter

Katarakt - Retina - Glaskörper

Key words

cataract - retina - vitreous

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