PDF herunterladen
Klin Monbl Augenheilkd 2001; 218(8): 523-527
DOI: 10.1055/s-2001-17133
KLINISCHE STUDIE

Georg Thieme Verlag Stuttgart · New York

Einfluss chirurgischer Faktoren auf die Kapsulotomierate dreistückiger Silikon-Intraokularlinsen - Analyse 457 pseudophaker Autopsieaugen[1] [2]

Influence of surgery-related factors on the Nd:YAG laser capsulotomy rates of 3-piece silicone IOLs - analysis of 457 pseudophakic human globes obtained post mortemJosef  M. Schmidbauer1, 2 , Luis  G. Vargas1 , David  J. Apple1 , Qun Peng1 , Stella  N. Arthur1 , Marcela Escobar-Gomez1 , Andrea Izak1
  • 1 Center for Research on Ocular Therapeutic and Biodevices; Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston 29425, South Carolina, USA (Direktor: David J. Apple, MD), E-mail: appledj@musc.edu
  • 2 Augenklinik mit Poliklinik, Universitätskliniken des Saarlandes, 66421 Homburg (Saar) (Direktor: Prof. Dr. K. W. Ruprecht)
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
13. September 2001 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Hintergrund Die Genese der Nachstarbildung ist multifaktoriell. Drei chirurgische Faktoren haben sich als besondere Einflussgrößen auf die Nachstarrate erwiesen. Zweck dieser Analyse war, Kapsulotomieaugen mit Augen ohne Kapsulotomie zu vergleichen, bezüglich 1) Qualität der Rindenrestentfernung, 2) Haptikfixation und 3) Kapsulorhexis-Größe und -Konfiguration.Material und Methode Autopsieaugen mit 3-stückigen Silikon-Optik-PMMA-Haptik-Designs und Silikon-Optik-Prolene-Haptik-Designs, zugeleitet zwischen Januar 1993 und Dezember 2000 wurden mittels der posterioren Miyake-Apple-Technik untersucht. 457 Augen wurden bezüglich Areal und Intensität der Soemmerring-Ring-Bildung und Fixationstyp evaluiert. Durchmesser und Konfiguration der Rhexis wurden bei 221 Augen analysiert.Ergebnisse 1) Das Ausmaß der Soemmerring-Ring-Bildung war statistisch signifikant höher bei Kapsulotomieaugen in beiden Linsendesigns. 2) Der Anteil nicht kapselsackfixierter Linsen war bei Kapsulotomieaugen offensichtlich größer. Der Unterschied zeigte sich jedoch statistisch nicht signifikant. 3) Die Augen mit Kapsulotomie zeigten in beiden Linsendesigns statistisch hoch signifikant größere Areale der Rhexis, die den Optikrand nicht bedeckten.Schlussfolgerungen 1) Die Studie bestätigt den klinischen Eindruck, dass die Nachstarrate abhängig von sorgfältiger Rindenrestentfernung und der Entfernung äquatorialer Linsenepithelien ist. 2) Haptikfixation außerhalb des Kapselsacks scheint das Nachstarrisiko zu erhöhen. 3) Die Daten bestätigen den Zusammenhang zwischen Rhexiskonfiguration und Nachstar. Eine Kapsulorhexis, die den kompletten Optikrand bedeckt, ist optimal zur Nachstarprävention.

Background The purpose of this study was to analyze any possible surgical reasons which may have had caused posterior capsule opacification in 3-piece silicone IOLs that had required Nd:YAG laser treatment. Special attention was given to 1) quality of cortical clean up, 2) type of haptic fixation, and 3) continuous curvilinear capsulorhexis (CCC) size and shape.Materials and Methods Human eyes obtained post-mortem implanted with 3-piece silicone optic - PMMA haptic (SI 40 NB) and 3-piece silicone optic - Prolene haptic (SI 30 NB) designs IOLs, accessioned between January 1993 and December 2000 were evaluated by gross examination from behind under an operating microscope using the Miyake-Apple posterior photographic technique. The area and intensity of Soemmerring's ring and type of fixation was studied in 457 eyes. The mean diameter of the CCC and relation of the CCC edge to the optic rim were analyzed in 221 eyes.Results 1) The amount of Soemmerring's ring formation was significantly larger in the group of IOLs requiring Nd:YAG capsulotomy in both the SI 40 NB and SI 30 NB design than in the IOLs without capsulotomies. 2) The percentage of not in-the-bag fixated IOLs in both the SI 40 NB and SI 30 NB design was larger in the “Nd:YAG groups”, without being statistically significant. 3) The “Nd:YAG groups” showed a significant higher amount of non overlapping clock hours of the CCC edge in relation to the optic rim.Conclusion 1) The data confirm the clinical assumption that the incidence of PCO is correlated with the cortical clean up. 2) Our findings also support the clinical assumption, that poor IOL fixation increases the risk of PCO. 3) This study also verifies the relation of the CCC to PCO, namely a relatively small CCC covering the entire optic rim is best to reduce the Nd:YAG laser rate.

Schlüsselwörter

Laser-Kapsulotomie - Intraokularlinse - Nachstar - Kataraktchirurgie

Key words

Nd:YAG laser capsulotomy - intraocular lens - posterior capsule opacification - cataract surgery

1 Manuskript erstmalig eingereicht am 27. 5. 01 und in der vorliegenden Form angenommen.

2 Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY and a Max Kade postdoctoral research grant (Schmidbauer), Max Kade Foundation, New York, NY.

Literatur

1 Manuskript erstmalig eingereicht am 27. 5. 01 und in der vorliegenden Form angenommen.

2 Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY and a Max Kade postdoctoral research grant (Schmidbauer), Max Kade Foundation, New York, NY.

  • 01 Apple  D J, Assia  E I, Wasserman  D. Evidence in support of the continuous tear anterior capsulectomy capsulorhexis technique. In: Cangelosi GC (ed): Advances in Cataract Surgery, New Orleans Academy of Ophthalmology. Slack Inc., Thorofare, New Jersey; 1991;: p. 21-47.
    Suche in Google Scholar
  • 02 Apple  D J, Auffarth  G U, Peng  Q, Visessook  N. Foldable intraocular lenses, evolution, clinicopathologic correlation and complications.  (Chapter 7). Slack Inc., Thorofare, New Jersey; 2000.:
    Suche in Google Scholar
  • 03 Apple  D J, Ram  J, Foster  A, Peng  Q. Elimination of Cataract Blindness: A Global Perspective Entering the New Century. Chapter 1: Introduction.  Surv Ophthalmol. 2000;;  45: 1-20.
    Suche in Google Scholar
  • 04 Apple  D J, Ram  J, Foster  A, Peng  Q. Elimination of Cataract Blindness: A Global Perspective Entering the New Century. Chapter 6: Cataract surgery with rigid and foldable posterior chamber IOLs, ECCE and phacoemulsification.  Surv Ophthalmol. 2000;;  45: 70-99.
    Suche in Google Scholar
  • 05 Apple  D J, Ram  J, Foster  A, Peng  Q. Elimination of Cataract Blindness: A Global Perspective Entering the New Century. Chapter 7: Posterior capsule opacification (secondary cataract).  Surv Ophthalmol. 2000;;  45: 100-130.
    Suche in Google Scholar
  • 06 Apple  D J, Peng  Q, Vitessook  N, Werner  L et al. Eradication of posterior capsule opacification. Documentation of a marked decrease in Neodymium: Yttrium-Aluminium-Garnet laser posterior capsulotomy rates noted in an analysis of 5416 pseudophakic human eyes obtained postmortem.  Ophthalmology. 2001;;  108: 505-518.
    Suche in Google Scholar
  • 07 Auffarth  G U, Beischel  C J, Wesendahl  T A, Apple  D J. Soemmerrings Ring Bildung nach Kataraktoperation und HKL Implantation: Eine Studie von 827 Autopsiaugen. In: Rochels R, Duncker G, Hartmann C (eds.): Transactions of the 9th Congress of the German Intraocular Lens Implant Society, Kiel. Springer, Heidelberg; 1995.:
    Suche in Google Scholar
  • 08 Fine  I H. Cortical cleaving hydrodissection.  J Cataract Refract Surg. 1992;;  18: 508-512.
    Suche in Google Scholar
  • 09 Gimbel  H V, Neuhann  T. Developments, advantages, and methods of the continuous curvilinear capsulorhexis technique.  J Cataract Refract Surg. 1990;;  16: 31-37.
    Suche in Google Scholar
  • 10 Hollick  E J, Spalton  D J, Meacock  W R. The effect of capsulorhexis size on posterior capsule opacification: one year results of a randomized prospective trial.  Am J Ophthalmol. 1999;;  128: 271-279.
    CrossrefPubMedSuche in Google Scholar
  • 11 Lyle  W A, Jin  G JC. Prospective evaluation of early visual and refractive effects with small clear corneal incision for cataract surgery.  J Cataract Refract Surg. 1996;;  22: 1456-1460.
    PubMedSuche in Google Scholar
  • 12 Mamalis  N, Phillips  B, Kopp  C H et al. Neodymium: YAG capsulotomy rates after phacoemulsification with silicone posterior chamber intraocular lenses.  J Cataract Refract Surg. 1996;;  22 (Suppl): 1296-1302.
    PubMedSuche in Google Scholar
  • 13 Nishi  O. Incidence of posterior capsule opacification in eyes with and without posterior chamber intraocular lenses.  J Cataract Refract Surg. 1986;;  12: 519-522.
    PubMedSuche in Google Scholar
  • 14 Peng  Q, Visessook  N, Apple  D J et al. Surgical prevention of posterior capsule opacification. Part 3. The intraocular lens barrier effect as a second line of defense.  J Cataract Refract Surg. 2000;;  26: 198-213.
    CrossrefPubMedSuche in Google Scholar
  • 15 Ram  J, Apple  D J, Peng  Q et al. Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part I. Elimination of fixation-induced decentration to achieve precise optical correction and visual rehabilitation.  Ophthalmology. 1999;;  106: 883-890.
    CrossrefPubMedSuche in Google Scholar
  • 16 Ram  J, Apple  D J, Peng  Q et al. Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part II. Choosing the correct haptic fixation and intraocular lens design to help eradicate posterior capsule opacification.  Ophthalmology. 1999;;  106: 891-900.
    CrossrefPubMedSuche in Google Scholar
  • 17 Ravalico  G, Tognetto  D, Palomba  M et al. Capsulorhexis size and posterior capsule opacification.  J Cataract Refract Surg. 1996;;  22: 98-103.
    PubMedSuche in Google Scholar
  • 18 Schaumberg  D A, Dana  M, Christen  W G, Glynn  R J. A systematic overview of the incidence of posterior capsule opacification.  Ophthalmology. 1998;;  105: 1213-1221.
    CrossrefPubMedSuche in Google Scholar
  • 19 Schmidbauer  J, Vargas  L, Apple  D J et al. Complications of Aphakic and Refractive Foldable Intraocular Lenses (IOLs), Chapter 6 Behind (posterior). Posterior Capsule Opacification.  Int Ophth Clin,. in press.; 
    PubMedSuche in Google Scholar
  • 20 Sterling  S, Wood  T. Effect of intraocular lens convexity on posterior capsule opacification.  J Cataract Refract Surg. 1986;;  12: 655-657.
    PubMedSuche in Google Scholar
  • 21 Tetz  M, O'Morchoe  D, Gwin  T et al. Posterior capsular Opacification and intraocular lens decentration. Part II. Experimental findings on a prototype circular intraocular lens design.  J Cataract Refract Surg. 1988;;  14: 614-623.
    PubMedSuche in Google Scholar
  • 22 Tetz  M R, Nimsgern  C. Posterior capsule opacification. Part II. Clinical findings.  J Cataract Refract Surg. 1999;;  25: 1662-1674.
    CrossrefPubMedSuche in Google Scholar
  • 23 Wilhelmus  K R, Emery  J M. Posterior capsule opacification following phacoemulsification.  Ophthalmic Surg. 1980;;  11: 264-267.
    PubMedSuche in Google Scholar