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Klin Monbl Augenheilkd 2018; 235(05): 568-575
DOI: 10.1055/a-0586-3974
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Katarakt bei Uveitis

Cataracts in Uveitis
Arnd Heiligenhaus
1   Augenzentrum und Ophtha-Lab, St. Franziskus Hospital, Münster
2   Universität Duisburg-Essen
,
Karoline Walscheid
1   Augenzentrum und Ophtha-Lab, St. Franziskus Hospital, Münster
,
Uwe Pleyer
3   Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
› Author Affiliations
Further Information

Publication History

eingereicht 11 January 2018

akzeptiert 26 February 2018

Publication Date:
08 May 2018 (online)

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Zusammenfassung

Eine häufige Komplikation bei Uveitis ist die Katarakt, deren Management anspruchsvoll sein kann. Die Operationsplanung setzt eine Kenntnis von Ursache (z. B. infektiös versus nichtinfektiös) und Verlauf der Uveitis voraus, einschließlich aller intraokularen Komorbiditäten (z. B. Makulaödem). Die präoperative Patientenselektion ist bei Uveitispatienten zum Erzielen guter Operationsergebnisse bei Uveitis besonders bedeutsam. Mit steroidsparenden krankheitsmodifizierenden antirheumatischen Medikamenten (DMARDs) kann die Rate postoperativer Komplikationen reduziert und das Visusergebnis verbessert werden. Vor der Operation muss eine stabile Entzündungskontrolle erzielt werden. Die Operation sollte minimalinvasiv erfolgen. Eine IOL-Implantation sollte nicht bei Patienten mit unvorhersehbarem Entzündungsverlauf erfolgen. Durch die Verwendung von intraokularen Kortikosteroiden (z. B. Dexamethason-Azetonid-Implantat, Triamcinolon-Azetonid) kann die Komplikationsrate reduziert werden. Postoperativ sollte die entzündungshemmende Medikation intensiviert und diese bis zu 3 Monate lang fortgesetzt werden. Bei sorgsamer Patientenauswahl, Planung und Durchführung der Kataraktoperation sowie postoperativer Nachsorge können bei Uveitispatienten zufriedenstellende anatomische und visuelle Operationsergebnisse erzielt werden.

Abstract

Cataracts are a frequent complication of uveitis, and their management can be challenging. Operation planning requires knowledge of the cause (e.g., infectious versus noninfectious) and course of uveitis, including any intraocular comorbidities (e.g., macular edema). Preoperative patient selection is particularly important in uveitis patients to achieve good surgical results. Steroid-sparing disease-modifying antirheumatic drugs (DMARDs) can reduce the rate of postoperative complications and can improve visual acuity. Before the operation, a stable inactivity of intraocular inflammation must be achieved. The surgical approach should be minimally invasive. Intraocular lens implantation should only be performed under stable inflammatory control. By using intraocular corticosteroids (e.g., dexamethasone acetonide implant, triamcinolone acetonide) the complication rate can be reduced. Postoperatively, the additional anti-inflammatory medication should be intensified and continued for up to 3 months. With careful patient selection, planning and execution of cataract surgery and postoperative care, satisfactory anatomical and functional outcomes can be achieved in uveitis patients.

Schlüsselwörter

Katarakt - Komplikationen - Therapie - Uveitis

Key words

cataract - complications - therapy - uveitis
 

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