Chirurgische Astigmatismuskorrektur bei der Kataraktoperation

Zusammenfassung

Hintergrund: Um die optische Qualität des Patienten nach der heute sehr sicheren Kataraktoperation zu verbessern, können unter anderem verschiedene Verfahren zur Korrektur kornealer Astigmatismen herangezogen werden. Material und Methoden: Übersichtsarbeit zu Verfahren der Astigmatismuskorrektur während der Kataraktoperation mittels selektiver Literaturrecherche und Einbeziehung eigener Erfahrungen. Dargestellt werden inzisionale Techniken zur Änderung der kornealen Kurvatur sowie die Implantation torischer Hinterkammer-Intraokularlinsen (IOL) nach Phakoemulsifikation. Außerdem werden die Patientenselektion und die Indikationen der verschiedenen Methoden aufgezeigt. Ergebnisse: Unter Einbeziehung allgemeiner und individueller Nomogramme der Operateure stellen vor allem die limbalen relaxierenden Inzisionen eine zufriedenstellende Möglichkeit zur Korrektur von Astigmatismen bis 2 dpt dar. Höhere Astigmatismen bis ca. 30 dpt können mit torischen IOL korrigiert werden. Diese zeigen im Vergleich mit den inzisionalen Techniken auch die bessere Vorhersagbarkeit, höhere Präzision sowie die geringere Regression. Schlussfolgerung: Stand früher lediglich die Korrektion der Aphakie nach der Kataraktoperation im Vordergrund, so bieten heutige Methoden und Implantate dem Chirurgen zusätzlich die Möglichkeit, den postoperativen Astigmatismus und damit die Sehleistung des Patienten besser auf die individuellen Ansprüche abzustimmen.

Abstract

Background: To enhance patients’ postoperative optical quality after cataract surgery, among others, different procedures to correct corneal astigmatism are used. Material and Methods: An overview is presented on procedures to correct astigmatism during cataract surgery, based on a seletive literature review and the authors" own experience. Described are incisional techniques to change the corneal curvature as well as the implantation of toric posterior chamber intraocular lenses (IOL) after phacoemulsification. Further on patient selection and indications of the different methods are illustrated. Results: In particular, limbal relaxing incisions provide satisfying results in astigmatism correction of up to 2 diopters, if published and surgeons individual nomograms are used. Larger astigmatism of up to about 30 diopters may be corrected with toric IOL. Compared to incisional techniques, those toric implants provide better predictability and precision and suffer less from regression.Conclusion: Usually the focus of cataract surgery is the correction of aphakia. Today’s techniques and implants, however, offer surgeons the chance to individualise patients postoperative astigmatism and thus increase overall patient satisfaction.

Schlüsselwörter

Katarakt - Astigmatismus - IOL - LRI - PCRI

Key words

cataract - astigmatism - IOL - LRI - PCRI

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