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Inzisionen für die biaxiale und koaxiale mikroinzisionale Kataraktchirurgie

Incisions for biaxial and coaxial microincision cataract surgery

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Zusammenfassung

Die mikroinzisionale Kataraktchirurgie (MICS) stellt eine neue Stufe in der Entwicklung der Kataraktchirurgie dar. Durch Inzisionen von ≤2 mm kann koaxial in herkömmlicher Weise, aber mit kleinerem Durchmesser (C-MICS), oder biaxial, mittels Separation von Phakotip und Irrigation (B-MICS), eine Phakoemulsifikation einschließlich IOL-Implantation durchgeführt werden. Die Vorteile der MICS im Vergleich zur Standardkleinschnittkataraktchirurgie sind ein geringerer Astigmatismus und weniger korneale Oberflächenveränderungen mit günstigen Auswirkungen auf die optische Qualität und frühe Rehabilitation. In dem Bestreben nach kleineren Schnitten sollte der Wundintegrität, auch im Hinblick auf das Endophthalmitisrisiko, besondere Beachtung zukommen. Bei limitierter kornealer Elastizitätskapazität können eher irreversible Inzisionsdehnungen mit Gewebeverletzungen auftreten. Kleinere Schnitte können nur dann als überlegen angesehen werden, wenn diese tatsächlich ein geringeres Trauma verursachen. Hierzu ist ein optimiertes Verhältnis von Inzisionsgröße und IOL-Implantationsmanipulation bei ausreichender Sicherheit erforderlich. Die MICS bietet eine Plattform neuer Größenmaßstäbe in der Phakoemulsifikation.

Abstract

Microincision cataract surgery (MICS) represents a new level in the development of cataract surgery. Phacoemulsification with intraocular lens (IOL) implantation via incisions of ≤2 mm may be performed by the coaxial approach, such as conventional phacoemulsification but with a smaller diameter of the phaco tip (C-MICS), or by the biaxial approach, with separation of the phaco tip and irrigation (B-MICS). Compared with standard small-incision cataract surgery, the advantages of MICS are less corneal astigmatism and fewer corneal surface irregularities, with favorable implications for visual quality and early rehabilitation. In the effort toward smaller incisions, special interest should be given to wound integrity, especially regarding the risk of endophthalmitis. With limited corneal elastic capacity, irreversible expansion of the incision with tissue laceration may occur. Smaller incisions are superior only if they cause less trauma. This requires an optimized relationship between incision size and manipulation during IOL implantation as well as attention to safety issues. MICS offers a platform for new benchmarks in phacoemulsification.

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  1. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Müller

  2. Klinik für Augenheilkunde und Cullen Eye Institute, Baylor College of Medicine, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland

    T. Kohnen

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Müller, M., Kohnen, T. Inzisionen für die biaxiale und koaxiale mikroinzisionale Kataraktchirurgie. Ophthalmologe 107, 108–115 (2010). https://doi.org/10.1007/s00347-009-1980-7

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  • DOI: https://doi.org/10.1007/s00347-009-1980-7

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