Refraktive Gesichtspunkte moderner Katarakt- Chirurgie

Zusammenfassung

Hintergrund: Moderne Katarakt-Chirurgie ist heute eine refraktive Operation mit dem Ziel, ein gewünschtes postoperatives Refraktionsergebnis möglichst exakt zu erreichen. Methode: Festlegung der Zielrefraktion (genaue Ermittlung des Patientenwunsches), Biometrie, mathematische Kalkulation der Intraokularlinsenstärke und Astigmatismusmanagement sind hierfür von Bedeutung. Zum anderen tragen hierzu auch die vielfältigen Fortentwicklungen der Intraokularlinsentechnologie bei. Ergebnisse: Individuelle Inzisionswahl (Schnittführung im steileren Meridian, Länge, Form und Lokalisation des Schnittes in Bezug zur Cornea bzw. Sklera) reduziert den präoperativ bestehenden Astigmatismus. Die Biometrie mit individueller Personalisierung der A-Konstante zur Ergebnisverbesserung und die Verwendung von Formeln der 3. Generation ist eine weitere Komponente zum Erreichen der Zielrefraktion. Zudem hat in den letzten Jahren die Entwicklung unterschiedlicher Linsendesigns zur Verbesserung der Intraokularlinseneigenschaften in den verschiedensten Bereichen Fortschritte gemacht, wie beispielsweise durch den Einsatz abbildungsoptimierter Kunstlinsen zum Ausgleich der kornealen Aberration, die Implantation torischer Intraokularlinsen zur Korrektur höherer vorbestehender kornealer Astigmatismen oder phaker Intraokularlinsen zur Korrektur höherer Fehlsichtigkeiten. Schlussfolgerungen: Die Zufriedenheit des Patienten hängt vom präzisen Erreichen der gewünschten Zielrefraktion ab. Mit unseren heutigen operativen und technischen Möglichkeiten sind wir in der Lage, dies mit hoher Wahrscheinlichkeit und Sicherheit zu erreichen.

Abstract

Objective: Modern cataract surgery is a refractive procedure whereby one basically can achieve the targeted postoperative refraction. Methods: To achieve this goal, according to the patient’s wishes, biometry, mathematical calculation of IOL power and astigmatism management are important factors. On the other hand, multifarious developments in intraocular lens technology also contribute to this target. Results: The individual choice of incision (on axis surgery: incision in the steeper meridian, length, shape and location concerning cornea or sclera) reduces the preoperatively existing astigmatism. Biometry with personalised data and formulas of the third generation are important factors to achieve the targeted refraction. In addition to this, the development of manifold lens designs in the last years to improve intraocular lens quality has enabled progress within various domains, for example, the use of optimised intraocular lenses to compensate corneal aberration, the implantation of toric lenses for corrections of higher pre-existing corneal astigmatism or the use of phacic intraocular lenses to correct higher ametropia. Conclusion: Patient satisfaction postoperatively depends on the precise refractive result as desired. With our current operative and technical possibilities we are able to achieve this with high probability and safety.

Schlüsselwörter

Katarakt-Chirurgie - refraktiv - Astigmatismus - Intraokularlinse - torisch - multifokal - akkommodativ

Key words

cataract surgery - refractive - astigmatism - intraocular lens - toric - multifocal - accommodative

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