Zusammenfassung
Intrastromale korneale Ringsegmente (ICRS®, Intacs®) sind Hornhautimplantate aus PMMA mit einer Bogenlänge von 150° zur Korrektur einer niedrigen Myopie bis etwa - 4 D. Dieses additive und damit potenziell reversible chirurgische Verfahren wurde in den letzten Jahren zur klinischen Reife geführt. Neben der Entwicklung der Methodik und den Ergebnissen der amerikanischen (US-FDA-)Studien wird vor allem über die europäischen Erfahrungen mit dieser Technik berichtet. Erstmals werden Langzeitergebnisse (aus der Landesaugenklinik Salzburg) mit einer Nachbeobachtung bis zu 5 Jahren präsentiert. Die biomikroskopisch sichtbaren Veränderungen der Hornhaut nach Intacs®-Implantation wurden an einer Serie von Patienten mittels konfokaler Mikroskopie untersucht. Einige Wochen und Monate nach der Implantation der PMMA-Segmente kommt es zum Auftreten von morphologischen Veränderungen in Form so genannter „Lamellar Channel Deposits” um die Implantate. Neue histologische Untersuchungen an Versuchstieren ergaben, dass es sich bei diesem Material um intrazelluläre Fette (Cholesterol-Estern, Triglyzeriden und unverestertes Cholesterol) handelt. Zu den neuesten Entwicklungen dieser Technik zählen kürzere Segmente zur Korrektur von myopem Astigmatismus sowie stabförmige, kurze radiäre Implantate (intrastromale korneale Segmente, ICS®) zur Hyperopiekorrektur. In den letzten Jahren wurde ebenfalls versucht, Intacs® bei Keratokonus und Keratektasie nach LASIK einzusetzen. Diese noch sehr frühen Resultate geben Hoffnung, dass diese Technik in ausgewählten Fällen von Keratokonus zu einer Verbesserung der Hornhautgeometrie führen kann. Auch der Einsatz von Intacs® zur Korrektur einer Restmyopie nach Regression oder unterkorrigierter LASIK (mit zu dünner Hornhaut für eine weitere Laserbehandlung) erscheint viel versprechend. Obwohl die klinischen Daten der Intacs®-Implantation sowohl hinsichtlich der Sicherheit als auch der Effektivität jenen von PRK und LASIK entsprechen, hat sich die Intacs®-Technologie bei refraktiven Chirurgen und Patienten bisher noch nicht in großem Ausmaß durchsetzen können. Ob Intacs® - trotz ihrer unbestreitbaren Vorzüge - ihre Stellung in der refraktiven Routinepraxis halten und ausbauen werden können oder als „Nischenprodukt” für Keratokonus, Keratektasien oder Regressionen nach LASIK übrig bleiben, wird erst die Zukunft zeigen.
Abstract
Intrastromal corneal ring segments (ICRS®, Intacs®) are corneal inlays made of PMMA with an arc length of 150° for the correction of low to moderate myopia. This additive and potentially reversible method has recently been developed to clinical usefulness during the last few years. Besides the historical development und the results of the US FDA studies, we focus on the results of the European experience with this technique. For the first time, long-time follow-up results (5 years from a single surgical center) are presented. Morphological changes after implantation of Intacs® were investigated in a series of patients by confocal microscopy. Weeks and months after implantation „lamellar channel deposits” regularly appear around the segments. This material consists of intracellular lipids (cholesterol ester, triglyceride and unesterified cholesterol), as we could show in new histological studies on rabbit eyes. New developments of this technique include short arc length segments (130°) for the correction of myopia concurrent with astigmatism and radially placed corneal inlays (Intrastromal Corneal Segments, ICS®) for the correction of hyperopia. In recent years, Intacs® have also been implanted in eyes with keratoconus and keratectasia after LASIK. These early results seem to indicate that in certain cases of early keratoconus, these implants can indeed improve corneal geometry and vision. Even in cases of regression or undercorrection after LASIK (with thin corneas), Intacs® seem to give promising results in selected cases. Although Intacs® do give comparable results regarding both safety and efficacy when compared with PRK and LASIK, this technology has not yet been widely accepted among refractive surgeons. Whether Intacs® will play a greater role in routine refractive surgery in the future or will just remain a special device for the correction of keratectasia, keratoconus or regression after LASIK cannot yet be decided with certainty.
Schlüsselwörter
Intacs® - ICRS® - ICR® - Hornhautimplantate - additive Methoden - Myopiekorrektur - Astigmatismus - Langzeitresultate - Deposits - Keratokonus
Key words
Intacs® - ICRS® - ICR® - corneal inlays - additive methods - correction of myopia - astigmatism - long-term results - deposits - keratoconus
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Dr. Josef Ruckhofer
Landesklinik für Augenheilkunde und Optometrie · St. Johanns Spital · Landeskliniken Salzburg
Müllner Hauptstraße 48
5020 Salzburg · Österreich
Email: j.ruckhofer@lks.at
