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Phake Intraokularlinsen

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Zusammenfassung

Die optische Qualität nach Korrektur höherer Fehlsichtigkeiten mittels phaker Intraokularlinsen (PIOL) ist im Vergleich zu korneal-ablativen Verfahren potenziell besser, da die normale prolate korneale Asphärizität bei akzeptabler effektiver optischer Zone erhalten bleibt. Verbesserungen des Materials und Designs phaker IOL, der Implantationsinstrumente sowie eine bessere Kenntnis der Interaktion der PIOL mit den umliegenden anatomischen Strukturen führten in den letzten Jahren zu einer gestiegenen Sicherheit und Akzeptanz. Klinische Studien zu PIOL zeigten eine gute Vorhersagbarkeit, Stabilität und Effektivität. Die Sicherheit dieser Implantate über einen längeren Zeitraum (>5 Jahre) hingegen wurde bislang nicht belegt, auch wenn die Implantation PIOL bereits jetzt von vielen Ophthalmochirurgen unter diversen Umständen als das refraktiv-chirurgische Verfahren der Wahl angesehen wird. In dieser Übersicht wird auf die Vor- und Nachteile der verschiedenen aktuellen PIOL-Typen sowie deren Komplikationen eingegangen. Es ist davon auszugehen, dass Verfeinerungen der Bildgebung zu einer genaueren PIOL-Größenbestimmung (besonders in Hinblick auf die ICL) führen werden. Eine recht präzise Vorhersage der effektiven postoperativen Linsenposition mit geringer Abweichung von der Zielrefraktion wäre somit möglich. Die Patienten sollten wissen, dass die Implantation einer phaken Intraokularlinse die Fehlsichtigkeit weitestgehend ausgleicht, aber sowohl die zugrunde liegende Pathologie als auch die Änderungen durch die Operation zu ernsten Komplikationen führen können.

Abstract

Phakic intraocular lenses (PIOLs), which are located closer to the eye’s nodal points than the anterior corneal surface, can provide superior optical quality for higher corrections because of retention of normal prolate corneal asphericity and larger effective optical zones. Improvements in the material and design of phakic intraocular lenses and their insertion devices combined with advances in the understanding of the anatomical and physiological interactions of the PIOLs with intraocular structures, have increased safety and efficacy. Safety of these implants over the long term remains a concern, but in several situations PIOLs are the refractive correction of choice. The purpose of this review is to compare the different types of PIOLs regarding outcome and complications. Improvements in imaging technologies should improve the accuracy of ICL sizing and allow more precise prediction of effective lens position with more accurate power calculation. It is important to inform patients that phakic lens surgery only corrects the refractive aspect, and that the refractive error itself as well as the changes by surgery still has the potential for serious complications.

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  1. Johannes Gutenberg-Universität, Mainz

    H. B. Dick & M. Tehrani

  2. Johannes Gutenberg-Universität, Langenbeckstraße 1, 55131 , Mainz

    H. B. Dick

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  1. H. B. Dick
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Dick, H.B., Tehrani, M. Phake Intraokularlinsen. Ophthalmologe 101, 232–245 (2004). https://doi.org/10.1007/s00347-004-0990-8

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