Die senile Katarakt

Zusammenfassung

Die Vorstellung der alten Griechen war, dass eine trübe Flüssigkeit über das Auge herabrinne – daher die vom Verb καταρρηγνυναι = herabfließen hergeleitete Bezeichnung. Diese Auffassung zur Pathophysiologie der Katarakt hat sich heute grundlegend geändert.

Abstract

The purpose of this article is a condensed overview of contemporaneous „state of art and knowledge“ of age-related cataract. As an introduction, some aspects of terminology, epidemiology, lens anatomy and pathophysiology of age-related cataract, selected for clinical interest and relevance, are outlined. Clinical aspects include signs and symptoms: Objective criteria for cortical, nuclear and posterior subcapsular cataract are described, followed by typical symptoms such as decreased visual acuity, contrast sensitivity and foggy vision, altered colour perception, decreased mesopic and scotopic vision, glare, myopization and monocular diplopia. Diagnostic evaluation consists of a general ophthalmic examination, including history, refraction and vision testing, tonometry and morphologic examination of anterior and posterior segment, and is supplemented by special tests and examinations, such as interference vision (retinometer), keratometry including corneal topo-/tomography, biometry (ultrasound and optical), specular microscopy of the corneal endothelium and OCT of the central retina. Treatment is exclusively surgical: Evaluating the indication for surgery individually, weighing chances and risks, determining individual decisions such as anesthesia, surgical technical options, target refraction and intraocular lens options is discussed in detail. Finally, some perioperative considerations for medical treatment and infection prophylaxis are outlined. The last section deals with short- and long-term complications and their management – including early pressure rises, corneal edema, inflammatory response and endophthalmitis, and, in the longer term, secondary cataract, refractive problems, cystoid macular edema and retinal detachment.

Kernaussagen

• Die Alterskatarakt ist keine Krankheit im eigentlichen Sinne – sie ist eine natürliche Alterungsfolge und betrifft jeden Menschen, wenn auch in einer weiten zeitlichen Bandbreite des Auftretens mit relevanten funktionellen Konsequenzen.

• Ihre einzig sinnvolle Behandlung ist die operative Entfernung der getrübten Linse und der Ersatz durch eine Kunstlinse. Dies ist eine der häufigsten Operationen am Menschen, wenn nicht die häufigste.

• Das Erfolgs-/Risikoprofil von Kataraktoperationen ist unter derzeitigen Bedingungen extrem günstig.

• Die Möglichkeiten der funktionellen Rehabilitation sind heute sehr vielfältig – eine sehr differenzierte individuelle Beratung ist deshalb unerlässlich.

Schlüsselwörter

Alterskatarakt - grauer Star - Linsentrübung - Kunstlinse

Keywords

age-related cataract - basic and clinical aspects - evaluation - treatment - complications

Publication History

Article published online:
04 March 2022

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