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Kann die implantierbare Collamer-Linse mit Aquaport eine Winkelblockproblematik sicher verhindern?

Erste Erfahrungen aus dem Homburger Zentrum für refraktive Chirurgie

Can the implantable collamer lens with AquaPORT technology safely prevent an angle block?

Early experiences in the Homburg/Saar refractive surgery center

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Zusammenfassung

Fragestellung

Die Implantation von phaken Intraokularlinsen (pIOL) stellt seit Langem eine Alternative bei höheren Ametropien in der refraktiven Chirurgie dar. Unser Ziel war die Darstellung der intraoperativen und frühpostoperativen Ergebnisse unserer Patienten mit Myopia magna bei Implantation der hinterkammergestützten implantierbaren Collamer-Linsen (ICL). Insbesondere sollte geklärt werden, ob der Aquaport einen Winkelblock sicher verhindern kann.

Patienten und Methodik

Im Zeitraum von März 2012 bis November 2013 wurden im Homburger Zentrum für refraktive Chirurgie insgesamt 24 ICL-Implantationen mit Aquaport bei 12 Patienten mit Myopia magna (− 8,75 ± 4,37, max. − 22,75 dpt) durchgeführt. Die implantierte ICL besteht aus Collamer, einem Kollagen-Copolymer (Staar surgical-V4b/c).

Ergebnisse

Das durchschnittliche Alter der Patienten betrug 35,5 ± 1,35 Jahre. In der 12-Monats-Kontrolle zeigten sich ein Anstieg des mittleren unkorrigierten Visus von 0,013 ± 0,04 auf 0,8 ± 0,45, des mittleren bestkorrigierten Visus von 0,8 ± 0,16 auf 0,8 ± 0,3 und eine Reduktion des sphärischen Äquivalents von − 9,00 ± 4,68 auf 0,12 ± 1,94 dpt. Der Abstand zwischen der Hinterfläche der ICL und der Vorderfläche der eigenen Linse (sog. Vault) betrug 0,45 ± 0,49 (min. 0,064, max. 3,706) mm. Bei einer 28-jährigen Patientin kam es trotz Aquaport zu einem postoperativen Tensionsanstieg auf 42 mmHg beidseits, und die ICL mit Durchmesser 13,2 mm wurde komplikationslos durch eine ICL mit Durchmesser 12,6 mm ersetzt.

Schlussfolgerung

Die Implantation einer ICL mit Aquaport als pIOL, die individuell auf Patientendaten (Größe und Stärke) abgestimmt wird, bietet sich für die Korrektur der Myopia magna als zuverlässige Alternative an. Allerdings sind engmaschige postoperative Kontrollen trotz intraoperativen komplikationslosen Verlaufs nötig, um Tensionsanstiege bei Winkelblockproblematik frühzeitig zu erkennen und zu therapieren.

Abstract

Introduction

The spectrum of surgical correction of high myopia has been broadened through surgical implantation of phakic intraocular lenses (pIOL) as a possible alternative to corneal refractive surgery. The purpose of the present study was to evaluate the intraoperative and early postoperative results of patients after the implantation of a posterior chamber implantable collamer (ICL) pIOL to correct high myopia. In particular the study tried to answer the question whether the AquaPORT technology can safely prevent angle closure glaucoma.

Patients and methods

From March 2012 to November 2013, 24 eyes from 12 patients suffering from a high myopia (− 8.75 ± 4.37 D, maximum − 22.75 D) underwent implantation of a posterior chamber implantable phakic collamer intraocular lens (ICL) with AquaPORT technology in the Homburg/Saar refractive surgery center. The implantable ICL consists of collamer, a collagen copolymer (Staar surgical-V4b/c).

Results

The mean age of the patients was 35.5 ± 1.35 years. At 12 months follow-up mean uncorrected distance visual acuity improved among the patients from 0.013 ± 0.04 preoperatively to 0.8 ± 0.45 postoperatively and the best corrected visual acuity from 0.8 ± 0.16 to 0.8 ± 0.3. Mean spherical equivalent decreased from − 9.00 ± 4.68 D preoperatively to 0.12 ± 1.94 D postoperatively. A statistically significant difference in the intraocular pressure (IOP) was not observed (p = 0.3). The central distance between the posterior surface of the lens and the anterior surface of the pIOL (vault) was 0.45 ± 0.49 mm (minimum 0.064 mm, maximum 3.706 mm). Despite the AquaPORT a 28-year-old white woman suffered from a high postoperative IOP of 42 mmHg in both eyes and an ICL with diameter of 12.6 mm was substituted by an ICL with diameter 13.2 mm without complications.

Conclusion

The implantation of an ICL with AquaPORT technology provides a reliable alternative with good postoperative visual quality to all patients with high myopia when corneal refractive surgery is not possible. In order to enable early detection and treatment of increases in IOP due to angle block, regular postoperative IOP measurements are recommended.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Tsintarakis, T. Eppig, A. Langenbucher, B. Seitz und M. El-Husseiny geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, UKS, Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland

    T. Tsintarakis, B. Seitz & M. El-Husseiny

  2. Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland

    T. Eppig & A. Langenbucher

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  1. T. Tsintarakis
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  2. T. Eppig
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  5. M. El-Husseiny
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Correspondence to T. Tsintarakis.

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Tsintarakis, T., Eppig, T., Langenbucher, A. et al. Kann die implantierbare Collamer-Linse mit Aquaport eine Winkelblockproblematik sicher verhindern?. Ophthalmologe 112, 418–423 (2015). https://doi.org/10.1007/s00347-015-3237-y

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