Einfluss chirurgischer Faktoren auf die Kapsulotomierate   dreistückiger Silikon-Intraokularlinsen - Analyse 457 pseudophaker   Autopsieaugen

Josef M. Schmidbauer; Luis G. Vargas; David J. Apple; Qun Peng; Stella N. Arthur; Marcela Escobar-Gomez; Andrea Izak

doi:10.1055/s-2001-17133

Klinische Monatsblätter für Augenheilkunde, Table of Contents

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. Schmidbauer^{1, 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)

Abstract

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

Full Text

References

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.

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