Presbyopiekorrektur mittels Laserchirurgie

Zusammenfassung

Trotz verschiedener Behandlungsansätze der Presbyopiebehandlung bleibt dieser Teil der refraktiven Chirurgie eine Herausforderung. Die multifokale Intraokularlinse zeigt befriedigende physikalische Eigenschaften, allerdings bleibt die postoperative Zielrefraktion komplex im Sinne einer nicht immer ganz präzisen postoperativen Zielrefraktion mit Rest- oder induziertem Astigmatismus, unkorrigierter Asphärizität und Aberration. Als weitere Presbyopieverfahren werden heute die Monovision, korneale Inlays und die PresbyLASIK angewendet.

Abstract

Today there are different options for correcting presbyopia by corneal laser procedure, but all of them have their benefits and compromises. The Monovision is a pseudoaccommodation procedure which works with an anisometropy of up to 2 D. The smaller the anisometropy is the faster a neuroadaptation will be achieved. There could be a decrease of binocularity. The monovision is not well supported by all patients, thus it is important to simulate this correction by contact lenses before surgery. The PresbyLASIK is a corneal multifocal solution for presbyopia correction for emmetropic, myopic and hyperopic eyes. It is a true presbyopia procedure where both eyes will be treated for far, intermediate and near. The disadvantage and compromise is that in some cases there could be a loss of uncorrected visual acuity. The corneal inlay is a solution for emmetropic, presbyopic patients who have a strong intention to read without glasses. The disadvantages could be some side effects as halo, glare, decrease of contrast and far vision. All procedures are potentially reversible in case the patient does not support the correction. An enhancement is possible for Monovision and PresbyLASIK.

Kernaussagen

• Heutzutage gibt es verschiedene operative Korrekturmethoden der Presbyopie mittels Laserbehandlung der Hornhaut.

• Jede dieser Methoden hat Vor- und Nachteile bzw. erfordert Kompromisse.

• Der Vorteil einer Monovisionskorrektur liegt in der Einfachheit der Durchführung. Allerdings vertragen nicht alle Patienten eine Anisometropie bis 2 dpt, bzw. die reduzierte Binokularität wird manchmal als störend angegeben. Aus diesem Grund muss vor einer Behandlung eine Simulation mittels Kontaktlinsen durchgeführt werden.

• Bei der PresbyLASIK wird eine korneale multifokale Zone gebildet. Der Vorteil dieser Methode liegt darin, dass beide Augen eine Korrektur für fern, intermediär und nah haben. Allerdings muss die objektive Indikationsstellung der LASIK-Kriterien erweitert werden. Details der topografischen als auch der Wellenfrontanalyse, insbesondere die Zernicke-Polynom-Analyse der Hornhaut, sind sehr wichtig.

• Korneale Inlays sind für emmetrope, presbyope Patienten geeignet, die den großen Wunsch haben, ohne Korrektur lesen zu können. Das Hornhautimplantat wird jeweils im nicht dominanten Auge implantiert. Nebenwirkungen wie Blendungsgefühle, Halos oder Verminderung des Kontrastsehens können auftreten.

• Alle aufgeführten Methoden sind potenziell reversibel.

Schlüsselwörter

korneale Presbyopiebehandlung – Laserbehandlung – Monovision – PresbyLASIK – korneales Inlay

Key words

corneal PresbyLASIK treatment - excimer laser correction - monovision - PresbyLASIK - corneal inlays

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